bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous pneumothorax and subpleural bullae in a patient with COVID-19: a 92-day observation
Authors: Fan Qianqian , Pan Feng , Yang Lian
Published: July 2020

This report describes a patient with COVID-19 who developed spontaneous pneumothorax and subpleural bullae during the course of the infection. Consecutive chest computed tomography images indicated that COVID-19-associated pneumonia had damaged the subpleural alveoli and distal bronchus. Coughing might have induced a sudden increase in intra-alveolar pressure, leading to the rupture of the subpleural alveoli and distal bronchus and resulting in spontaneous pneumothorax and subpleural bullae. At the 92-day follow-up, the pneumothorax and subpleural bullae had completely resolved, which indicated that these complications had self-limiting features.
Perioperative outcomes of segmentectomies versus lobectomies in high-risk patients: an ESTS database analysis
Authors: Brunelli Alessandro , Decaluwe Herbert , Gossot Dominique , Guerrera Francesco , Szanto Zalan , Falcoz Pierre Emmanuel
Published: July 2020

OBJECTIVES

We queried the European Society of Thoracic Surgeons (ESTS) database with the aim to assess cardiopulmonary morbidity and 30-day mortality of segmentectomies and lobectomies in patients with a Eurolung-predicted mortality above the upper interquartile and classified as high risk.

METHODS

A total of 61 492 patients registered in the ESTS database (2007–2018) and submitted to lobectomy (55 353) or segmentectomy (6139) were divided into high risk or low risk according to a Eurolung-predicted mortality cut-off of 2.5% (corresponding in our population to the upper interquartile). Predicted versus observed mortalities were compared within each type of operation by using binomial test of proportion. Observed morbidity and mortality rates were compared between the 2 procedures using the χ2 test.

RESULTS

A total of 14 007 lobectomies and 1251 segmentectomies were classified as high risk. In the high-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 12% vs 17%, P < 0.0001; mortality: 2.4% vs 3.7%, P = 0.018). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (2.4% vs 3.8%, P = 0.009), while in the lobectomy patients, there was no difference between observed and predicted mortality (3.7% vs 3.8%, P = 0.9). In the low-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 4.5% vs 7.8%, P < 0.0001; mortality: 0.6% vs 1.0%, P = 0.01). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (0.6% vs 1.0%, P = 0.0003), while in the lobectomy patients, there was no difference between observed and predicted mortality (1.0% vs 1.1%, P = 0.06).

CONCLUSIONS

Segmentectomy was found associated with a 0.65 relative risk of mortality rate compared to lobectomy in patients deemed at higher surgical risk.
Characterization of the β-glucuronidase Pn3Pase as the founding member of glycoside hydrolase family GH169
Authors: Wantuch Paeton L , Jella Satya , Duke Jeremy A , Mousa Jarrod J , Henrissat Bernard , Glushka John , Avci Fikri Y
Published: July 2020

Paenibacillus sp. 32352 is a soil-dwelling bacterium capable of producing an enzyme, Pn3Pase that degrades the capsular polysaccharide of Streptococcus pneumoniae serotype 3 (Pn3P). Recent reports on Pn3Pase have demonstrated its initial characterization and potential for protection against highly virulent S. pneumoniae serotype 3 infections. Initial experiments revealed this enzyme functions as an exo-β1,4-glucuronidase cleaving the β(1,4) linkage between glucuronic acid and glucose. However, the catalytic mechanism of this enzyme is still unknown. Here, we report the detailed biochemical analysis of Pn3Pase. Pn3Pase shows no significant sequence similarity to known glycoside hydrolase (GH) families, thus this novel enzyme establishes a new carbohydrate-active enzyme (CAZy) GH family. Site-directed mutagenesis studies revealed two catalytic residues along with truncation mutants defining essential domains for function. Pn3Pase and its mutants were screened for activity, substrate binding and kinetics. Additionally, nuclear magnetic resonance spectroscopy analysis revealed that Pn3Pase acts through a retaining mechanism. This study exhibits Pn3Pase activity at the structural and mechanistic level to establish the new CAZy GH family GH169 belonging to the large GH-A clan. This study will also serve toward generating Pn3Pase derivatives with optimal activity and pharmacokinetics aiding in the use of Pn3Pase as a novel therapeutic approach against type 3 S. pneumoniae infections.
Disruption of foxc1 genes in zebrafish results in dosage-dependent phenotypes overlapping Axenfeld-Rieger syndrome
Authors: Ferre-Fernández Jesús-José , Sorokina Elena A , Thompson Samuel , Collery Ross F , Nordquist Emily , Lincoln Joy , Semina Elena V
Published: July 2020

The Forkhead Box C1 (FOXC1) gene encodes a forkhead/winged helix transcription factor involved in embryonic development. Mutations in this gene cause dysgenesis of the anterior segment of the eye, most commonly Axenfeld-Rieger syndrome (ARS), often with other systemic features. The developmental mechanisms and pathways regulated by FOXC1 remain largely unknown. There are two conserved orthologs of FOXC1 in zebrafish, foxc1a and foxc1b. To further examine the role of FOXC1 in vertebrates, we generated foxc1a and foxc1b single knockout zebrafish lines and bred them to obtain various allelic combinations. Three genotypes demonstrated visible phenotypes: foxc1a−/− single homozygous and foxc1−/− double knockout homozygous embryos presented with similar characteristics comprised of severe global vascular defects and early lethality, as well as microphthalmia, periocular edema and absence of the anterior chamber of the eye; additionally, fish with heterozygous loss of foxc1a combined with homozygosity for foxc1b (foxc1a+/−;foxc1b−/−) demonstrated craniofacial defects, heart anomalies and scoliosis. All other single and combined genotypes appeared normal. Analysis of foxc1 expression detected a significant increase in foxc1a levels in homozygous and heterozygous mutant eyes, suggesting a mechanism for foxc1a upregulation when its function is compromised; interestingly, the expression of another ARS-associated gene, pitx2, was responsive to the estimated level of wild-type Foxc1a, indicating a possible role for this protein in the regulation of pitx2 expression. Altogether, our results support a conserved role for foxc1 in the formation of many organs, consistent with the features observed in human patients, and highlight the importance of correct FOXC1/foxc1 dosage for vertebrate development.
The Human Right to Land, for Peasants and for All: Tracing the Social Function of Property to 1948
Authors: Heri Corina
Published: July 2020

In 1948, Article 17 of the Universal Declaration of Human Rights (UDHR) pioneered a right to (individual and collective) ownership of property. Today, the right to property—specifically the social function of property, which was a mainstay of the discussions—can be linked to the idea of a human right to land, which has been particularly prevalent in the discourse concerning the creation of human rights protections specific to peasants. The peasant rights process highlights a number of normative and implementation gaps in international human rights law, including relating to land use and tenure. The present contribution will argue that the claims made in this context are neither new nor niche but relate to universal human rights entitlements and have existed at least since the drafting of the UDHR. They are not only an iteration of an age-old class struggle but are at the forefront of a contemporary critique of the existing international legal system as a whole. While existing human rights, including the right to property, can be part of a response to these critiques, however, neither peasant rights nor the activists who promote them can be expected to resolve them alone.
Error-based output tracking for a one-dimensional wave equation with harmonic type disturbance
Authors: Tian Ziqing , Wu Xiao-Hui
Published: July 2020

In this paper, we consider output tracking for a one-dimensional wave equation, where the boundary disturbances are either collocated or non-collocated with control. The regulated output and the control are supposed to be non-collocated with control, which represents a difficult case for output tracking of PDEs. We apply the trajectory planning approach to design an observer, in terms of tracking error only, to estimate both states of the system and the exosystem from which the disturbances are produced. An error-based feedback control is proposed by solving a standard regulator equation. It is shown that (a) the closed-loop system is uniformly bounded whenever the exosystem is bounded; (b) when the disturbance is zero, the closed-loop is asymptotically stable; and (c) the tracking error converges to zero asymptotically as time goes to infinity. Numerical simulations are performed to validate the effectiveness of the proposed control.
Broad Antibody and Cellular Immune Response From a Phase 2 Clinical Trial With a Novel Multivalent Poxvirus-Based Respiratory Syncytial Virus Vaccine
Authors: Jordan Elke , Lawrence Steven J , Meyer Thomas P H , Schmidt Darja , Schultz Stephanie , Mueller Jutta , Stroukova Daria , Koenen Brigitte , Gruenert Robert , Silbernagl Guenter , Vidojkovic Sanja , Chen Liddy M , Weidenthaler Heinz , Samy Nathaly , Chaplin Paul
Published: July 2020

Background

Respiratory syncytial virus (RSV) is a major cause of severe respiratory disease in young children and the elderly. Protective immunity is not generated after repeated infections, but vaccination may hopefully prove effective.

Methods

This phase 2 clinical study investigated a multivalent RSV vaccine (MVA-BN-RSV) designed to induce broad antibody and cellular immune responses by encoding RSV surface proteins F, G (for both A and B subtypes), and internal antigens (M2, N). This study evaluated the immune response in adults aged ≥55 years to identify the optimal MVA-BN-RSV dose and vaccination schedule.

Results

A single dose increased the levels of neutralizing (plaque reduction neutralization test to RSV A and B) and total (IgG and IgA ELISA) antibodies (1.6 to 3.4-fold increase from baseline) and induced a broad Th1-biased cellular immune response (interferon-γ ELISPOT) to all 5 vaccine inserts (5.4 to 9.7-fold increases). Antibody responses remained above baseline for 6 months. A 12-month booster dose elicited a booster effect in antibody and T-cell responses (up to 2.8-fold from preboost levels). No drug-related serious adverse events were reported.

Conclusions

MVA-BN-RSV induces a broad immune response that persists at least 6 months and can be boosted at 12 months, without significant safety findings.

Clinical Trials Registration

NCT02873286
Human Respiratory Syncytial Virus-Induced Immune Signature of Infection Revealed by Transcriptome Analysis of Clinical Pediatric Nasopharyngeal Swab Samples
Authors: Nicolas De Lamballerie Claire , Pizzorno Andrés , Dubois Julia , Padey Blandine , Julien Thomas , Traversier Aurélien , Carbonneau Julie , Orcel Elody , Lina Bruno , Hamelin Marie-Eve , Roche Magali , Textoris Julien , Boivin Guy , Legras-Lachuer Catherine , Terrier Olivier , Rosa-Calatrava Manuel
Published: July 2020

Human respiratory syncytial virus (HRSV) constitutes one the main causes of respiratory infection in neonates and infants worldwide. Transcriptome analysis of clinical samples using high-throughput technologies remains an important tool to better understand virus-host complex interactions in the real-life setting but also to identify new diagnosis/prognosis markers or therapeutics targets. A major challenge when exploiting clinical samples such as nasal swabs, washes, or bronchoalveolar lavages is the poor quantity and integrity of nucleic acids. In this study, we applied a tailored transcriptomics workflow to exploit nasal wash samples from children who tested positive for HRSV. Our analysis revealed a characteristic immune signature as a direct reflection of HRSV pathogenesis and highlighted putative biomarkers of interest such as IP-10, TMEM190, MCEMP1, and TIMM23.
Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Meister Toni Luise , Brüggemann Yannick , Todt Daniel , Conzelmann Carina , Müller Janis A , Groß Rüdiger , Münch Jan , Krawczyk Adalbert , Steinmann Jörg , Steinmann Jochen , Pfaender Stephanie , Steinmann Eike
Published: July 2020

The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic creates a significant threat to global health. Recent studies suggested the significance of throat and salivary glands as major sites of virus replication and transmission during early coronavirus disease 2019, thus advocating application of oral antiseptics. However, the antiviral efficacy of oral rinsing solutions against SARS-CoV-2 has not been examined. Here, we evaluated the virucidal activity of different available oral rinses against SARS-CoV-2 under conditions mimicking nasopharyngeal secretions. Several formulations with significant SARS-CoV-2 inactivating properties in vitro support the idea that oral rinsing might reduce the viral load of saliva and could thus lower the transmission of SARS-CoV-2.
Mammal Molar Size Ratios and the Inhibitory Cascade at the Intraspecific Scale
Authors: Vitek N S , Roseman C C , Bloch J I
Published: July 2020

Synopsis

Mammalian molar crowns form a module in which measurements of size for individual teeth within a tooth row covary with one another. Molar crown size covariation is proposed to fit the inhibitory cascade model (ICM) or its variant the molar module component (MMC) model, but the inability of the former model to fit across biological scales is a concern in the few cases where it has been tested in Primates. The ICM has thus far failed to explain patterns of intraspecific variation, an intermediate biological scale, even though it explains patterns at both smaller organ-level and larger between-species biological scales. Studies of this topic in a much broader range of taxa are needed, but the properties of a sample appropriate for testing the ICM at the intraspecific level are unclear. Here, we assess intraspecific variation in relative molar sizes of the cotton mouse, Peromyscus gossypinus, to further test the ICM and to develop recommendations for appropriate sampling protocols in future intraspecific studies of molar size variation across Mammalia. To develop these recommendations, we model the sensitivity of estimates of molar ratios to sample size and simulate the use of composite molar rows when complete ones are unavailable. Similar to past studies on primates, our results show that intraspecific variance structure of molar ratios within the rodent P. gossypinus does not meet predictions of the ICM or MMC. When we extend these analyses to include the MMC, one model does not fit observed patterns of variation better than the other. Standing variation in molar size ratios is relatively constant across mammalian samples containing all three molars. In future studies, analyzing average ratio values will require relatively small minimum sample sizes of two or more complete molar rows. Even composite-based estimates from four or more specimens per tooth position can accurately estimate mean molar ratios. Analyzing variance structure will require relatively large sample sizes of at least 40–50 complete specimens, and composite molar rows cannot accurately reconstruct variance structure of ratios in a sample. Based on these results, we propose guidelines for intraspecific studies of molar size covariation. In particular, we note that the suitability of composite specimens for averaging mean molar ratios is promising for the inclusion of isolated molars and incomplete molar rows from the fossil record in future studies of the evolution of molar modules, as long as variance structure is not a key component of such studies.
Ethics and informatics in the age of COVID-19: challenges and recommendations for public health organization and public policy
Authors: Subbian Vignesh , Solomonides Anthony , Clarkson Melissa , Rahimzadeh Vasiliki Nataly , Petersen Carolyn , Schreiber Richard , DeMuro Paul R , Dua Prerna , Goodman Kenneth W , Kaplan Bonnie , Koppel Ross , Lehmann Christoph U , Pan Eric , Senathirajah Yalini
Published: July 2020

The COVID-19 pandemic response in the United States has exposed significant gaps in information systems and processes that prevent timely clinical and public health decision-making. Specifically, the use of informatics to mitigate the spread of SARS-CoV-2, support COVID-19 care delivery, and accelerate knowledge discovery bring to the forefront issues of privacy, surveillance, limits of state powers, and interoperability between public health and clinical information systems. Using a consensus-building process, we critically analyze informatics-related ethical issues in light of the pandemic across 3 themes: (1) public health reporting and data sharing, (2) contact tracing and tracking, and (3) clinical scoring tools for critical care. We provide context and rationale for ethical considerations and recommendations that are actionable during the pandemic and conclude with recommendations calling for longer-term, broader change (beyond the pandemic) for public health organization and policy reform.
Are the Problems and Motives Clear Enough? A Study on the Placement of Unaccompanied Asylum-Seeking Minors at Compulsory Care Institutions in Sweden
Authors: Ghazinour Mehdi , Rostami Arian , Eriksson Malin , Padyab Mojgan , Wimelius Malin
Published: July 2020

The Swedish National Board of Institutional Care (SNBIC) is an independent governmental agency that provides compulsory care for minors with psychosocial problems, criminal behavior, and substance abuse. During recent years, a noticeable number of the youth placed at compulsory care institutions have been asylum-seeking minors who have arrived in Sweden without parents or guardians. This steady increase in placements has raised questions and concerns among the involved actors regarding the motives and needs underlying these placements. This qualitative study investigates the main motives that lead unaccompanied asylum-seeking minors to be placed at SNBIC residential homes and the problems that are to be solved during their placement, according to social workers and SNBIC staff. The study is based on 28 in-depth interviews with social workers and SNBIC staff. Findings indicate clear disagreement between social workers and SNBIC staff with regard to the motives for placing unaccompanied minors at SNBIC homes. Although the social workers and SNBIC staff explain that most of the unaccompanied youth placed at SNBIC homes have some form of criminal behavior or substance abuse, SNBIC staff believe, in some cases, the problem is not sufficiently serious to warrant compulsory care. As these disagreements and misunderstandings between the actors have an impact on their collaboration and, consequently, the situation of the unaccompanied minors, all attempts to reach a consensus on the leading causes for placement and the problems that need to be solved with SNBIC placement would increase security for both the young people and the relevant staff.
Safety and immunogenicity of a primary yellow fever vaccination under low-dose methotrexate therapy—a prospective multi-centre pilot study1
Authors: Bühler Silja , Jaeger Veronika Katharina , Eperon Gilles , Furrer Hansjakob , Fux Christoph A , Jansen Stephanie , Neumayr Andreas , Rochat Laurence , Schmid Sabine , Schmidt-Chanasit Jonas , Staehelin Cornelia , de Visser Adriëtte W , Visser Leonardus G , Niedrig Matthias , Hatz Christoph
Published: July 2020

Background

More people on immunosuppression live in or wish to travel to yellow fever virus (YFV)-endemic areas. Data on the safety and immunogenicity of yellow fever vaccination (YFVV) during immunosuppression are scarce. The aim of this study was to compare the safety and immunogenicity of a primary YFVV between travellers on methotrexate and controls.

Methods

We conducted a prospective multi-centre controlled observational study from 2015 to 2017 in six Swiss travel clinics. 15 adults (nine with rheumatic diseases, five with dermatologic conditions and one with a gastroenterological disease) on low-dose methotrexate (≤20 mg/week) requiring a primary YFVV and 15 age and sex-matched controls received a YFVV. Solicited/unsolicited adverse reactions were recorded, YFV-RNA was measured in serum samples on Days 3, 7, 10, 14, 28 and neutralizing antibodies on Days 0, 7, 10, 14, 28.

Results

Patients´ and controls’ median ages were 53 and 52 years; 9 patients and 10 controls were female. 43% of patients and 33% of controls showed local side effects (P = 0.71); 86% of patients and 66% of controls reported systemic reactions (P = 0.39). YFV-RNA was detected in patients and controls on Day 3–10 post-vaccination and was never of clinical significance. Slightly more patients developed YFV-RNAaemia (Day 3: n = 5 vs n = 2, Day 7: n = 9 vs n = 7, Day 10: n = 3 vs n = 2, all P > 0.39). No serious reactions occurred. On Day 10, a minority of vaccinees was seroprotected (patients: n = 2, controls: n = 6). On Day 28, all vaccinees were seroprotected.

Conclusions

First-time YFVV was safe and immunogenic in travellers on low-dose methotrexate. Larger studies are needed to confirm these promising results.
Human L1 Transposition Dynamics Unraveled with Functional Data Analysis
Authors: Chen Di , Cremona Marzia A , Qi Zongtai , Mitra Robi D , Chiaromonte Francesca , Makova Kateryna D
Published: July 2020

Long INterspersed Elements-1 (L1s) constitute >17% of the human genome and still actively transpose in it. Characterizing L1 transposition across the genome is critical for understanding genome evolution and somatic mutations. However, to date, L1 insertion and fixation patterns have not been studied comprehensively. To fill this gap, we investigated three genome-wide data sets of L1s that integrated at different evolutionary times: 17,037 de novo L1s (from an L1 insertion cell-line experiment conducted in-house), and 1,212 polymorphic and 1,205 human-specific L1s (from public databases). We characterized 49 genomic features—proxying chromatin accessibility, transcriptional activity, replication, recombination, etc.—in the ±50 kb flanks of these elements. These features were contrasted between the three L1 data sets and L1-free regions using state-of-the-art Functional Data Analysis statistical methods, which treat high-resolution data as mathematical functions. Our results indicate that de novo, polymorphic, and human-specific L1s are surrounded by different genomic features acting at specific locations and scales. This led to an integrative model of L1 transposition, according to which L1s preferentially integrate into open-chromatin regions enriched in non-B DNA motifs, whereas they are fixed in regions largely free of purifying selection—depleted of genes and noncoding most conserved elements. Intriguingly, our results suggest that L1 insertions modify local genomic landscape by extending CpG methylation and increasing mononucleotide microsatellite density. Altogether, our findings substantially facilitate understanding of L1 integration and fixation preferences, pave the way for uncovering their role in aging and cancer, and inform their use as mutagenesis tools in genetic studies.
How Do Consumers Fare When Dealing with Debt Collectors? Evidence from Out-of-Court Settlements
Authors: Cheng Ing-Haw , Severino Felipe , Townsend Richard R
Published: July 2020

Do deals with debt collectors alleviate consumer financial distress? Using new data linking court and credit registry records, we examine civil collection lawsuits where consumers can settle out of court. Random assignment of judges with different styles generates exogenous variation in the likelihood of settlement negotiations. We find that settlements increase financial distress relative to going to court, likely by draining consumers of liquidity. The effect is stronger among less financially literate consumers. Survey evidence suggests that consumers generally overestimate how much they would pay through the court system. Perceived nonpecuniary benefits also motivate some consumers to settle.
Leptospira Triggered Anti-N-Methyl-d-Aspartate Receptor Encephalitis
Authors: Panda Prateek Kumar , Sharawat Indar Kumar , Bolia Rishi
Published: July 2020

Primary neuroleptospirosis although rare but has been reported in the literature in the form of case reports and case series. However, there are no reports of autoimmune encephalitis triggered by leptospirosis in the literature, although four cases of acute disseminated encephalomyelitis, which is also considered to have autoimmune etiology have been reported. We are reporting an adolescent girl, who developed anti-N-methyl-d-aspartate receptor encephalitis after the resolution of systemic symptoms of leptospirosis. Her symptoms including neuropsychiatric and extrapyramidal features and sleep disturbances resolved completely after immunotherapy. As recently autoimmune encephalitis triggered by various infections are getting reported more frequently around the world, the clinicians need to consider this clinical possibility, even in patients with leptospirosis, who develop neurological symptoms while systemic clinical features are subsiding. Early recognition and timely administration of immunotherapy have the potential to completely reverse the neurological symptoms.
COVID-19 Global Pandemic: Options for Management of Gynecologic Cancers
Authors: Ramirez Pedro T. , Chiva Luis , Eriksson Ane Gerda Z. , Frumovitz Michael , Fagotti Anna , Martin Antonio Gonzalez , Jhingran Anuja , Pareja Rene
Published: July 2020

(Abstracted from Int J Gynecol Cancer 2020;30:561–563)

In the midst of this devastating pandemic associated with the novel coronavirus 2019 (COVID-19) disease, we must continue to provide high-value care to patients with chronic diseases such as cancer while being mindful of the safety of our patients, their families, and our health care providers. The editorial team of the International Journal of Gynecological Cancer has compiled evidence-based suggestions in this guideline document to both continue high-quality care for our patients and strategically allocate resources to alleviate the burden on our health care system amid the coronavirus pandemic.
Rapid Point of Care Test for Detecting Urogenital Chlamydia Trachomatis Infection in Nonpregnant Women and Men at Reproductive Age
Authors: Grillo-Ardila Carlos F. , Torres Marcela , Gaitán Hernando G.
Published: July 2020

(Abstracted from Cochrane Database Syst Rev 2020;1(1):CD011708)

Chlamydia trachomatis is associated with deleterious effects on the reproductive health of men and women. Its estimated prevalence is 90 million cases worldwide and is highest among the sexually active population 25 years or younger.
Intensive Care Unit-Acquired Weakness
Authors: Harvey Nina R. , Stanton Marietta P.
Published: July 2020

Purpose:

The purpose of this case study is to provide a specific example of the disease trajectory for one patient's experience with intensive care unit-acquired weakness (ICUAW). This case study provides those in case management with an overview of some of the common signs and symptoms of ICUAW, as well as the possible prognosis and recovery from ICUAW.

Primary Practice Setting:

The events in this case study take place in the acute care setting including the intensive care unit of a mid-sized health center, a general medical-surgical (med-surg) unit, and a long-term acute care facility.

Conclusions:

ICUAW affects the clinical, functional, and financial outcomes of patients. If the patient survives, their quality of life and the quality of life of their family members could be severely impacted. Case management practice has a significant role in coordinating care for those diagnosed with ICUAW. Case managers can use knowledge about ICUAW to improve the patient's transition throughout the hospital stay, improve discharge recommendations, and improve the patient's short-term and long-term outcomes. This may reduce unnecessary utilization of health care resources.
Case Management and the Documentation of Avoidable Days
Authors: Shelerud Leah N. , Esden Jana L.
Published: July 2020

Purpose of Study:

Avoidable Days/Delays (ADs) account for a large portion of dollars lost for many health care organizations, and with ongoing changes in health care reimbursement, available funds will become increasingly limited. Avoidable Days cannot be reduced or eliminated without accurate causal documentation. The purpose of this study was to determine whether a system upgrade with a change in documentation layout for AD tracking increased case manager compliance with AD documentation. In addition, staff perceptions and opinions on AD documentation were obtained to determine whether or not these perceptions could affect accurate documentation of ADs.

Primary Practice Setting:

A large academic medical center.

Methodology And Sample:

Quantitative data were gathered through a survey completed by the hospital's case managers, and raw data were obtained from the electronic health record system on the number of documented ADs before and after the system upgrade.

Results:

The results indicated that the system upgrade did improve case manager documentation of ADs. Survey results suggested that more education was needed on ADs, including information on financial impact, importance of accurate documentation, and plans for performance improvement initiatives for frequently documented AD causes.

Implications for Case Management Practice:

The majority of surveyed case managers felt that they would benefit from increased education on AD documentation. Recommendations for case management practice include (1) incorporating AD education into the orientation curriculum for new case managers, (2) readdressing the importance of AD documentation in case managers' annual review education, and (3) extending AD education to additional hospital staff to make AD tracking an organizational commitment.
Integrated Transitions of Care for Patients With Rare Pulmonary Diseases
Authors: Moreo Kathleen , Lattimer Cheri , Lett James E. , Heggen-Peay Cherilyn L. , Simone Laura
Published: July 2020

Purpose/Objectives:

Many continuing education (CE) resources are available to support case management professionals in developing competencies in transitions of care (TOC) that apply generally across disease areas. However, CE programs and tools are lacking for advanced TOC competencies in specific disease areas. This article describes 2 projects in which leading TOC, case management, and CE organizations collaborated to develop CE-accredited interdisciplinary pathways for promoting safe and effective TOC for patients with rare pulmonary diseases, including pulmonary arterial hypertension (PAH) and idiopathic pulmonary fibrosis (IPF).

Primary Practice Setting(s):

The interdisciplinary pathways apply to PAH and IPF case management practice and TOC across settings that include community-based primary care and specialty care, PAH or IPF centers of expertise, acute care and post-acute settings, long-term care, rehabilitation and skilled nursing facilities, and patients' homes.

Findings/Conclusions:

Both PAH and IPF are chronic, progressive respiratory diseases that are associated with severe morbidity and mortality, along with high health care costs. Because they are relatively rare diseases with nonspecific symptoms and many comorbidities, PAH and IPF are difficult to diagnose. Early diagnosis, referral to centers of expertise, and aggressive treatment initiation are essential for slowing disease progression and maintaining quality of life and function. Both the rarity and complexity of PAH and IPF pose unique challenges to ensuring effective and safe TOC. Expert consensus and evidence-based approaches to meeting these challenges, and thereby improving PAH and IPF patient outcomes, are presented in the 2 interdisciplinary TOC pathways that are described in this article.

Implications for Case Management Practice:

In coordinating care for patients with complex pulmonary diseases such as PAH and IPF, case managers across practice settings can play key roles in improving workflow processes and communication, transition planning, coordinating TOC with centers of expertise, coordinating care and TOC for patients with comorbidities, providing patient and caregiver education, promoting engagement between patients and the team, advancing the care plan, and improving ongoing adherence to treatment in order to maximize the patient's pulmonary function. Details regarding these interprofessional roles and responsibilities are provided in the full interdisciplinary TOC pathways for PAH and IPF.
Case Management Resources: Wounded Warriors, the Music Corp, and Operation We Are Here
Authors: Powell Suzanne K.
Published: July 2020

Case managers have a wealth of resources in their toolbox. We must share ones that others may not know about. One important resource is the MusiCorp, a conservatory-level music rehabilitation program that helps wounded warriors play music and recover in their lives. Operation We Are Here is another hub of resources.
COVID-19 Time Capsule 1: DATE: March 15, 2020
Authors: Powell Suzanne K.
Published: July 2020

This Editorial will be the first of COVID-19 Time Capsule. This one is dated on March 15, 2020, but will not publish until the September–October 2020 issue. Time Capsule 2 will come out in about 2 months. Consider them “historical” documents—snapshots in time.
Building Capacity of Evidence-Based Public Health Practice at King Saud University: Perceived Challenges and Opportunities
Authors: Wahabi Hayfaa , Zakaria Nasriah
Published: July 2020

Background:

Implementation of evidence-based public health (EBPH) is lagging behind in Saudi Arabia and the region. Graduate-level public health curriculum at King Saud University, College of Medicine, Riyadh, is designed to equip students to integrate best available evidence in public health decision making.

Objectives:

The objectives of this study were to explore the viewpoint of the students on the perceived challenges they faced during training and the possible opportunities to improve their learning experience of EBPH.

Methods:

Eighteen graduate students participated in 3 focus groups that were audio-recorded, transcribed, and de-identified before analysis. Social construction and constructivism lens using thematic analysis were adopted. Saturation was reached when similar responses were recorded.

Results:

Two themes (challenges and opportunities) and 9 subthemes emerged. The lack of a national health information system, scarcity of research pertinent to the Saudi community, and deficient communication between the postgraduate programs and the Ministry of Health were the main barriers perceived by participants to affect their EBPH training. However, participants perceived opportunities for change through establishment of partnership and communication channels with the Ministry of Health and the Saudi community. In addition, participants considered building community of practice and using social media as a platform for communication between public health professionals and the community at large as a valid opportunity for professional growth and community service.

Conclusion:

Although systematic training in EBPH through postgraduate programs is effective in providing the future manpower with the needed skill and knowledge to practice EBPH, organizational and cultural barriers remain toward practicing EBPH. Reaching out to those in leadership positions and communicating with other public health professionals may facilitate spreading the culture of EBPH.
Development of a quantum-dot lateral flow immunoassay strip based portable fluorescence smart-phone system for ultrasensitive detection of IgM/IgG to SARS-CoV-2
Authors: Liu Bochao , Li Jinfeng , Tang Xi , Wu Ze , Lu Jinhui , Liang Chaolan , Hou Shuiping , Zhang Ling , Li Tingting , Zhao Wei , Fu Yongshui , Ke Yuebin , Li Chengyao
Published: July 2020

Background

Since December 2019, the outbreak of coronavirus disease (COVID-19) has been occurred by novel coronavirus (SARS-CoV-2). The rapid and sensitive immunoassays are urgently demanded for detecting specific antibodies as assistant diagnosis for primary screening of asymptomatic individuals, close contacts, suspected or recovered patients of COIVD-19 during the pandemic period.

Methods

The recombinant receptor binding domain of SARS-CoV-2 spike protein (S-RBD) was used as the antigen to detect specific IgM and the mixture of recombinant nucleocapsid phosphoprotein (NP) and S-RBD were used to detect specific IgG by the newly designed quantum-dot lateral flow immunoassay strip (QD-LFIA), respectively.

Results

A rapid and sensitive QD-LFIA based portable fluorescence smart-phone system was developed for detecting specific IgM/IgG to SARS-CoV-2 from 100 serum samples of COVID-19 patients and 450 plasma samples from healthy blood donors. Among 100 COVID-19 patients diagnosed with NAT previously, 3 were severe, 35 mild and 62 recovered cases. By using QD-LFIA, 78 (78%) and 99 (99%) samples from 100 COVID-19 patients’ serum were detected positive for anti-SARS-CoV-2 IgM or IgG, respectively, but only one sample (0.22%) was cross-reactive with S-RBD from 450 healthy blood donor plasmas that were collected from different areas of China.

Conclusion

An ultrasensitive and specific QD-LFIA based portable fluorescence smart-phone system was developed fo r detection of specific IgM and IgG to SARS-CoV-2 infection, which could be used for investigating the prevalence or assistant diagnosis of COVID-19 in humans.
Nitrapyrin has far reaching effects on the soil microbial community structure, composition, diversity and functions
Authors: Schmidt Ruth , Wang Xiao-Bo , Garbeva Paolina , Yergeau Étienne
Published: July 2020

Nitrapyrin is one of the most common nitrification inhibitors that are used to retain N in the ammonia form in soil to improve crop yields and quality. Whereas the inhibitory effect of nitrapyrin is supposedly specific to ammonia oxidizers, in view of the keystone role of this group in soils, nitrapyrin could have far-reaching impacts. Here, we tested the hypothesis that nitrapyrin leads to large shifts in soil microbial community structure, composition, diversity and functions, beyond its effect on ammonia-oxidizers. To test this hypothesis, we set-up a field experiment where wheat (Triticum aestivumcv. AC Walton) was fertilized with ammonium nitrate (NH4NO3) and supplemented or not with nitrapyrin. Rhizosphere and bulk soils were sampled twice, DNA was extracted, the 16S rRNA gene and ITS region were amplified and sequenced to follow shifts in archaeal, bacterial and fungal community structure, composition and diversity. To assess microbial functions, several genes involved in the nitrogen cycle were quantified by real-time qPCR and volatile organic compounds (VOCs) were trapped in the rhizosphere at the moment of sampling. As expected, sampling date and plant compartment had overwhelming effects on the microbial communities. However, within these strong effects, we found statistically significant effects of nitrapyrin on the relative abundance of Thaumarchaeota, Proteobacteria, Nitrospirae and Basidiomycota, and on several genera. Nitrapyrin also significantly affected bacterial and fungal community structure, and the abundance of all the N-cycle gene tested, but always in interaction with sampling date. In contrast, nitrapyrin had no significant effect on the emission of VOCs, where only sampling date significantly influenced the profiles observed. Our results point out far-reaching effects of nitrapyrin on soil and plant associated microbial communities, well beyond its predicted direct effect on ammonia-oxidizers. In the longer term, these shifts might counteract the positive effect of nitrapyrin on crop nutrition and greenhouse gas emissions.
Molecular determinants of vascular transport of dexamethasone in COVID-19 therapy
Authors: Shabalin Ivan G. , Czub Mateusz P. , Majorek Karolina A. , Brzezinski Dariusz , Grabowski Marek , Cooper David R. , Panasiuk Mateusz , Chruszcz Maksymilian , Minor Wladek
Published: July 2020

Dexamethasone, a widely used corticosteroid, has recently been reported as the first drug to increase the survival chances of patients with severe COVID-19. Therapeutic agents, including dexamethasone, are mostly transported through the body by binding to serum albumin. Herein, we report the first structure of serum albumin in complex with dexamethasone. We show that it binds to Drug Site 7, which is also the binding site for commonly used nonsteroidal anti-inflammatory drugs and testosterone, suggesting potentially problematic binding competition. This study bridges structural findings with our analysis of publicly available clinical data from Wuhan and suggests that an adjustment of dexamethasone regimen should be considered for patients affected by two major COVID-19 risk-factors: low albumin levels and diabetes.

One Sentence Summary

Structure of serum albumin with dexamethasone reveals why the drug may not always help COVID-19 patients.
Increased isoDGR motifs in plasma fibronectin are associated with atherosclerosis through facilitation of vascular fibrosis
Authors: Park Jung Eun , Guo Xue , Liou Ken Cheng Kang , Lynn Soe EinSi , Ng Ser Sue , Meng Wei , Lim Su Chi , Leow Melvin Khee-Shing , Richards A Mark , Pennington Daniel J , McCarthy Neil E. , de Kleijn Dominique P.V. , Sorokin Vitaly , Ho Hee Hwa , Sze Siu Kwan
Published: July 2020

Abnormal matrix deposition on vessels and recruitment of inflammatory cells into the arterial wall are critical events in atherosclerotic plaque formation. Fibronectin protein is a key matrix component that exhibits high levels of deamidation in atherosclerotic plaques and blood plasma, but it is unclear how this structural change impacts on endothelial function or modifies interactions with recruited leukocytes. This study aimed to determine how deamidation-induced isoDGR motifs in fibronectin influence extracellular matrix accumulation on endothelial cells, and to investigate possible effects on integrin ‘outside-in’ signalling in matrix-bound monocytes which are key mediators of human atherosclerosis.

Blood plasma fibrinogen and fibronectin displayed marked accumulation of isoDGR motifs in ischemic heart disease (IHD) as determined by ELISA analysis of patients undergoing coronary artery bypass grafting compared with age-matched healthy controls. Biochemical and functional assays confirmed that isoDGR-containing fibronectin promoted activation of integrin β1 in monocytes and facilitated protein deposition and fibrillogenesis on endothelial cell layers. In addition, isoDGR interactions with integrins on the monocyte cell surface triggered an ERK:AP-1 signalling cascade that induced potent secretion of chemotactic mediators (including CCL2, CCL4, IL-8, and TNFα), that promoted further leukocyte recruitment to the assembling plaque.

Fibronectin deamidation forms isoDGR motifs that increase binding to β1 integrins on the surface of endothelial cells and monocytes. Subsequent activation of integrin ‘outside-in’ signalling pathways elicits a range of potent cytokines and chemokines that drive additional leukocyte recruitment to the developing atherosclerotic matrix and likely constitutes a key early event in progression to IHD.
Obstructive Sleep Apnea destabilizes myocardial repolarization homogeneity
Authors: Jarecka-Dobroń Aleksandra , Braksator Wojciech , Chrom Paweł
Published: July 2020

Background

Literature shows that patients with obesity and Obstructive Sleep Apnea (OSA), both occurring independently, are more likely to develop cardiovascular diseases and sudden cardiac death (SCD). Assuming that ventricular depolarization is more stable than repolarization then QT interval parameters may be used for heart muscle repolarization assessment for those groups of patients.

Methods

There were 121 patients included in the study, both – women and men, aging from 35-65 with visceral obesity. Only healthy patients were included – the ones who were not treated for any chronic disease, taking QT elongating drugs, or were not treated with Continuous Positive Airway Pressure (CPAP) therapy at that time.

Results

OSA was diagnosed in 70 patients (including 41 male). A statistically significant difference for QT interval parameters between OSA positive and negative patients was found (p<0.001 for all variables). No difference for QTc max or for QT interval parameters between groups of patients with different OSA severity degrees was found. A correlation between QTVi2 and QTVi3 (p=0.008) and between polygraphy specific parameters and QTc max, QTVi2 and QTVi3 was found.

Conclusions

OSA has a negative influence on heart muscle repolarization processes by increasing QTV and QTVi values, without such an impact on QTc max interval among patients with visceral obesity. A temporary intensification of OSA causes additional increase of QTVi value. OSA severity degree expressed by specific parameters taken from polygraphic examination prolongs QTc max and increases QTV and QTVi values.

What is the key question?

Does Obstructive Sleep Apnea destabilize heart muscle repolarization time heterogeneity expressed by QT interval assessment parameters (QTc, QTV, QTVi)?

What is the bottom line?

Obstructive Sleep Apnea occurrence presents an essential negative influence on heart muscle repolarization time, as heterogeneity by QTV and QTVi values increase, while QTc max interval remains unaffected among patients with visceral obesity.

Why to read on?

Knowing that obesity and Obstructive Sleep Apnea (occurring separately) increase the risk of sudden cardiac death, cardiovascular risk evaluation becomes an important point for obese, OSA positive patient’s care.
Is Kambô psychoactive? Acute and subacute effects of the secretion of the Giant Maki Frog (Phyllomedusa bicolor) on human consciousness
Authors: Schmidt Timo Torsten , Reiche Simon , Hage Caroline L. C. , Bermpohl Felix , Majić Tomislav
Published: July 2020

Kambô is the name for the secretion of the Giant Leaf Frog (Phyllomedusa bicolor) containing a plethora of bioactive peptides. Originally, it is ritually used by different ethnicities from the Amazon basin as a remedy against bad luck in hunting. In the last twenty years, Kambô has spread to Western urban centers, often associated with the use of ayahuasca. Anecdotal reports claim beneficial effects on wellbeing and different medical and mental health conditions. However, to date it has been controversial if Kambô elicits altered states of consciousness. Here we retrospectively investigated acute and subacute psychological effects of Kambô in a sample of n = 22 anonymous users (n = 22, mean age: 39 years, ± 8.5; 45.5% female), administering standardized questionnaires for the assessment of psychoactive effects. Acutely, participants reported psychological effects which remained on a mild to moderate level, but no psychedelic-type distortions of perception or thinking. In contrast, persisting effects were predominantly described as positive and pleasant, revealing surprisingly high measures of personal and spiritual significance. Subacute and long-term effects showed some overlap with the “afterglow” phenomena that follow the use of serotonergic psychedelics.