bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent Herpes Gladiatorum: Should we be Screening Our Service Members Prior to Close Combat Training?
Authors: Field Robert D , Taylor Bradley M
Published: December 2019

A 19-year-old active duty Marine presented to clinic with a history of a reoccurring vesicular rash on left side of his forehead. The lesion was cultured and identified as herpes simplex virus 1 (HSV-1). Herpes gladiatorum is a recurrent cutaneous infection caused by HSV-1 and spread by skin-to-skin contact. Serious complications have been reported, including blindness from acute retinal necrosis. Outbreaks of herpes gladiatorum have been observed in the high school and collegiate wrestling community for years and to prevent the spread, screening, and treatment guidelines have been implemented by governing bodies of these organizations. Active duty members who participate in the Marine Corps Martial Arts Program and the Army and US Air Force Combatives programs are exposed to similar conditions; however, no uniform screening or treatment protocol exists. To minimize the spread of skin infections, we propose adopting a uniform screening procedure and implementing a standardized form to assist primary care providers in the evaluation and treatment of herpes gladiatorum and other communicable skin diseases commonly seen in close combat training.
A Supersaturated Oxygen Emulsion for the Topical Treatment of Ocular Trauma
Authors: Pate Kathryn M , Goswami Dinesh G , Lake Mark , Lake Sharon , Kant Rama , Ammar David , Tewari-Singh Neera
Published: December 2019

Introduction

Roughly 13% of all battlefield injuries include some form of ocular trauma. Ocular tissue preservation is critical for wound healing for warfighters with ocular injuries. Our team hypothesized that oxygen plays a vital role in ocular tissue preservation and wound healing and has developed a supersaturated oxygen emulsion (SOE) for the topical treatment of ocular trauma.

Materials and Methods

The partial pressure of oxygen (PO2) was measured in the SOE. Safety and efficacy studies were carried out in primary human corneal epithelial (HCE) cells, as the outermost layer is the first barrier to chemical and mechanical injury. Western blot, scratch assay, and MTT assays were conducted to determine the effect of the SOE on various molecular markers, the rate of scratch closure, and cellular viability, respectively.

Results

Data indicate that the SOE releases oxygen in a time-dependent manner, reaching a partial pressure within the emulsion over four times atmospheric levels. Studies in HCE cells indicate that application of the SOE does not lead to DNA damage, promote cell death, or hinder the rate of scratch closure and enhances cellular viability. Preliminary studies were carried out with chloropicrin (CP; developed as a chemical warfare agent and now a commonly used pesticide) as a chemical agent to induce ocular injury in HCE cells. CP exposures showed that SOE treatment reverses CP-induced DNA damage, apoptotic cell death, and oxidative stress markers.

Conclusions

Maintaining adequate tissue oxygenation is critical for tissue preservation and wound repair, especially in avascular tissues like the cornea. Further studies examining the application of the SOE in corneal injury models are warranted.
Outcomes of Casualties Without Airway Trauma Undergoing Prehospital Airway Interventions: A Department of Defense Trauma Registry Study
Authors: Schauer Steven G , Naylor Jason F , Maddry Joseph K , Kobylarz Fred C , April Michael D
Published: December 2019

Introduction

Airway obstruction is the second leading cause of preventable death on the battlefield. Most airway obstruction occurs secondary to traumatic disruptions of the airway anatomical structures. However, casualties may require airway interventions for other indications (e.g., depressed mental status). We describe casualties undergoing airway intervention in the prehospital, combat setting without apparent upper airway trauma.

Materials and Methods

We used a series of emergency department procedure codes to identify patients within the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016. This is a subgroup analysis of those patients with a documented prehospital airway intervention and no apparent airway trauma as defined by abbreviated injury scale of 0 for body regions 1 (head/neck) and 2 (face).

Results

Our predefined search codes captured 28222 DODTR subjects of whom 409 (1.4%) met criteria for study inclusion. Subjects included members of host nation forces (34%) and civilians (30%). Most subjects sustained injuries in Afghanistan (82%). Explosive (57%) and gunshot wounds (36%) were the most frequent mechanisms of injury. Median injury severity scores were 17. The most common anatomical locations of injuries for included subjects included extremities (53%) and thorax (29%). A majority of subjects underwent intubation (89%); comparatively few casualties underwent placement of a nasopharyngeal airway (2%) or supraglottic airway (2%). The proportion of subjects surviving to hospital discharge was 80% and was highest among subjects undergoing intubation (82%).

Conclusions

In this subgroup analysis of casualties without apparent upper airway trauma, survival rates were lower when compared to our previous report. Higher quality data are necessary to better understand the resuscitation needs of this critically ill subset of combat casualties.
A Mixed Methods Analysis of Acute Upper Extremity Pain as Measured by the Patient Reported Outcomes Measurement Information System
Authors: Tennekoon Robin L , Smith-Forbes Enrique V , Woods Yvette
Published: December 2019

Introduction

Chronic pain affects U.S. service member’s (SMs) more disproportionately than individuals in the general public. SMs have unique cultural pressures to ignore or deny acute pain; therefore, the beliefs and behaviors of this group may cause them to self-report their acute pain in a specific manner. This study evaluated the strength of the relationship of the patient reported outcomes measurement information system (PROMIS) upper extremity computer adaptive test (CAT) and assessed U.S. active duty SMs experience of acute pain and function compared to the quick disabilities of the arm, shoulder, and hand (QuickDASH). In addition, the PROMIS pain interference CAT, PROMIS pain behavior CAT, and PROMIS anxiety CAT were correlated to the PROMIS upper extremity CAT and QuickDASH questionnaires.

Materials and Methods

This mixed methods, sequential, explanatory study included a convenience sample of 26 participants from two occupational therapy clinics. Participants were administered five self-report questionnaires at initial evaluation and at follow up (30–90 day). At follow up, 12 participants completed a semi-structured interview. Categorical variables were summarized using percentages and analyzed using a chi-square goodness of fit test. A Pearson correlation coefficient was used to analyze the linear relationship between the QuickDASH and specified PROMIS questionnaires. This study was approved by the Institutional Review Board at Brooke Army Medical Center, reference number C.2017.173d.

Results

The initial and follow up scores from the self-report questionnaires demonstrated a good to excellent correlation between the PROMIS upper extremity CAT and the QuickDASH (r = –0.65; r = –0.81; p < 0.001). Qualitative data were gathered during a semi-structured interview of 12 participants after the follow up and were analyzed using thematic analysis. Three themes emerged from qualitative analysis of data: (1) impact of military culture, (2) psychosocial effects of acute pain, and (3) therapist contributions to disability awareness.

Conclusions

This study demonstrates several cultural and psychosocial influences concerning the experience of SMs with acute UE disability and pain, which were not previously reported for this population.
Towards machine-assisted meta-studies: the Hubble constant
Authors: Crossland Tom , Stenetorp Pontus , Riedel Sebastian , Kawata Daisuke , Kitching Thomas D , Croft Rupert A C
Published: December 2019

We present an approach for automatic extraction of measured values from the astrophysical literature, using the Hubble constant for our pilot study. Our rules-based model – a classical technique in natural language processing – has successfully extracted 298 measurements of the Hubble constant, with uncertainties, from the 208 541 available arXiv astrophysics papers. We have also created an artificial neural network classifier to identify papers in arXiv which report novel measurements. From the analysis of our results we find that reporting measurements with uncertainties and the correct units is critical information when distinguishing novel measurements in free text. Our results correctly highlight the current tension for measurements of the Hubble constant and recover the 3.5σ discrepancy – demonstrating that the tool presented in this paper is useful for meta-studies of astrophysical measurements from a large number of publications.
UN SCINDAGE DU MORPHISME DE FROBENIUS SUR L’ALGÈBRE DES DISTRIBUTIONS D’UN GROUPE RÉDUCTIF
Authors: Gros Michel , Masaharu Kaneda
Published: December 2019

Pour un groupe algébrique semi-simple simplement connexe sur un corps algébriquement clos de caractéristique positive, nous avons précédemment construit un scindage de l’endomorphisme de Frobenius sur son algèbre des distributions. Nous généralisons la construction au cas de des groupes réductifs connexes et en dégageons les corollaires correspondants.

For a simply connected semisimple algebraic group over an algebraically closed field of positive characteristic we have already constructed a splitting of the Frobenius endomorphism on its algebra of distributions. We generalize the construction to the case of general connected reductive groups and derive the corresponding corollaries.
Amplified prevalence and incidence of cardiovascular disease in patients with inflammatory arthritis and coexistent autoimmune disorders
Authors: Heslinga Maaike , Nielen Mark M J , Smulders Yvo , Simsek Suat , Nurmohamed Mike T
Published: December 2019

Objective

This study aims to assess the prevalence proportion and incidence rate of cardiovascular morbidity in patients with inflammatory arthritis compared with that in controls, and to determine whether the co-existence of multiple autoimmune disorders is associated with an amplified risk of cardiovascular disease.

Methods

Data from the Nivel Primary Care Database were used to assess prevalence proportion and incidence rate of cardiovascular disease in patients with inflammatory arthritis only, patients with inflammatory arthritis coexistent with another autoimmune disorder, and controls. Hazard ratios were calculated using Cox regression models.

Results

The prevalence proportions in inflammatory arthritis patients were increased for type 1 diabetes [odds ratio (OR) 1.80, 95% CI: 1.27, 2.55], hypothyroidism (OR 1.49, 95% CI: 1.37, 1.61), psoriasis (OR 2.72, 95% CI: 2.49, 2.97) and IBD (OR 2.64, 95% CI: 2.28, 3.07) compared with that in controls. Cardiovascular disease prevalence (OR 1.34, 95% CI: 1.28, 1.41) and incidence rates (incidence rate ratio 1.3, 95% CI: 1.23, 1.41) were higher in inflammatory arthritis patients compared with that in controls, and were further increased in the presence of a second autoimmune disorder. The hazard ratio for cardiovascular disease was 1.32 (95% CI: 1.23, 1.41) for patients with inflammatory arthritis only, and 1.49 (95% CI: 1.31, 1.68) for patients with inflammatory arthritis co-existent with another autoimmune disorder.

Conclusion

The amplification of cardiovascular disease risk in inflammatory arthritis patients with multiple autoimmune disorders warrants greater awareness, and since autoimmune disorders often co-exist, the need for cardiovascular risk management in these patients is once again emphasized.
STAT3 localizes in mitochondria-associated ER membranes instead of in mitochondria
Authors: Su Yixun , Huang Xiaomin , Huang Zhangsen , Huang Taida , Xu Yunsheng , Yi Chenju
Published: December 2019

Signal Transducer and Activator of Transcription 3 (STAT3) is a transcription factor (TF) that regulates a variety of biological processes, including a key role in mediating mitochondrial metabolism. It has been shown that STAT3 performs this function by translocating in minute amounts into mitochondria and interacting with mitochondrial proteins and genome. However, whether STAT3 localizes in mitochondria is still up for debate.

To decipher the role of mitochondrial STAT3 requires a detailed understanding of its cellular localization. Using Percoll density gradient centrifugation, we surprisingly found that STAT3 is not located in the mitochondrial fraction, but instead, in the mitochondria-associated endoplasmic reticulum membrane (MAM) fraction. This was confirmed by sub-diffraction image analysis of labeled mitochondria in embryonic astrocytes. Also, we find that other TFs that have been previously found to localize in mitochondria are also found instead in the MAM fraction. Our results suggest that STAT3 and other transcriptional factors are, contrary to prior studies, consolidated specifically at MAMs, and further efforts to understand mitochondrial STAT3 function must take into consideration this localization, as the associated functional consequences offer a different interpretation to the questions of STAT3 trafficking and signaling in the mitochondria.
Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults
Authors: Gilson Aaron M. , Stone Jamie A. , Morris Ashley O. , Brown Roger L. , Xiong Ka Z , Jacobson Nora , Holden Richard J. , Albert Steven M. , Phelan Cynthia H. , Pigarelli Denise L. Walbrandt , Breslow Robert M. , Welch Lauren , Chui Michelle A.
Published: December 2019

Objectives

This pilot study examines effectiveness of an innovative pharmacy design change on over-the-counter (OTC) medication misuse in older adults (ages ≥65). Few interventions have attempted to decrease older adult OTC misuse, and none have addressed system barriers. A structural redesign of the pharmacy (the Senior Section™) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications (for pain, cough/cold, allergy, sleep) and is close to the prescription department to facilitate pharmacy staff/patient engagement to reduce misuse.

Methods

A pre-/post-implementation design was used to recruit 87 older adults from three pharmacies. Using a hypothetical scenario, participants selected an OTC medication, which was compared to their medication list and health conditions, and their reported use was compared against the product labeling. Four misuse outcomes were determined: (1) Drug/Drug, (2) Drug/Disease, (3) Drug/Age, and (4) Drug/Label with five sub-types. Patient characteristics were collected and compiled into a propensity-score matching logistic regression model to estimate their effects on the Senior Section’s association with misuse outcomes at pre-/post-implementation.

Results

Patient characteristic were uniform between pre-/post-implementation and, once entered into a propensity-score matching model, Drug/Disease Misuse significantly lessened over time (z=-2.09, p=0.037). The Senior Section reduced Drug/Drug Misuse, but not significantly. Drug/Label Misuse varied according to the sub-type, with reduced Daily-Dosage (z=-2.42, p=0.016) and Single-Dosage misuse (z=-5.82, p=0.001); however, Timing/Frequency misuse increased (z=2.16, p=0.031).

Conclusions

These nascent outcomes support a well-conceived pharmacy-based OTC aisles redesign as valuable for reducing older adult OTC medication misuse. The Senior Section, when broadly implemented, would create new permanent structures and processes to assist older adults in accessing risk information for confidently selecting safer OTC medications.
Accounting for variability in ion current recordings using a mathematical model of artefacts in voltage-clamp experiments
Authors: Lei Chon Lok , Clerx Michael , Whittaker Dominic G. , Gavaghan David J. , de Boer Teun P. , Mirams Gary R.
Published: December 2019

Mathematical models of ion channels, which constitute indispensable components of action potential models, are commonly constructed by fitting to whole-cell patch-clamp data. In a previous study we fitted cell-specific models to hERG1a (Kv11.1) recordings simultaneously measured using an automated high-throughput system, and studied cell-cell variability by inspecting the resulting model parameters. However, the origin of the observed variability was not identified. Here we study the source of variability by constructing a model that describes not just ion current dynamics, but the entire voltage-clamp experiment. The experimental artefact components of the model include: series resistance, membrane and pipette capacitance, voltage offsets, imperfect compensations made by the amplifier for these phenomena, and leak current. In this model, variability in the observations can be explained by either cell properties, measurement artefacts, or both. Remarkably, by assuming that variability arises exclusively from measurement artefacts, it is possible to explain a larger amount of the observed variability than when assuming cell-specific ion current kinetics. This assumption also leads to a smaller number of model parameters. This result suggests that most of the observed variability in patch-clamp data measured under the same conditions is caused by experimental artefacts, and hence can be compensated for in post-processing by using our model for the patch-clamp experiment. This study has implications for the question of the extent to which cell-cell variability in ion channel kinetics exists, and opens up routes for better correction of artefacts in patch-clamp data.
RNA-seq transcriptome analysis reveals LTR-retrotransposons modulation in Human Peripheral Blood Mononuclear Cells (PBMCs) afterin vivoLipopolysaccharides (LPS) injection
Authors: Pisano Maria Paola , Tabone Olivier , Bodinier Maxime , Grandi Nicole , Textoris Julien , Mallet François , Tramontano Enzo
Published: December 2019

Human Endogenous Retroviruses (HERVs) and Mammalian apparent LTR-retrotransposons (MaLRs) are retroviral sequences that integrated into the germline cells millions year ago. Transcripts of these LTR-retrotransposons are present in several tissues, and their expression is modulated in pathological conditions, although their function remains often far from being understood. In this work, we focused on the HERVs/MaLRs expression and modulation in a scenario of immune system activation. We used a public dataset of Human Peripheral Blood Mononuclear Cells (PBMCs) RNA-seq from 15 healthy participants to a clinical trial before and after the exposure to Lipopolysaccharide (LPS), for which we established an RNA-seq workflow for the identification of expressed and modulated cellular genes and LTR-retrotransposon elements.

Importance

We described the HERV and MaLR transcriptome in PBMCs, finding that about 8.4 % of the LTR-retrotransposons loci were expressed, and identifying the betaretrovirus-like HERVs as those with the highest percentage of expressed loci. We found 4,607 HERVs and MaLRs loci that were modulated as a result ofin vivostimulation with LPS. The HERV-H group showed the highest number of differentially expressed most intact proviruses. We characterized the HERV and MaLR loci differentially expressed checking their genomic context of insertion and, interestingly, we found a general co-localization with genes that are involved and modulated in the immune response, as consequence of LPS stimulation. The analyses of HERVs and MaLRs expression and modulation show that this LTR-retrotransposons are expressed in PBMCs and regulated in inflammatory settings. The similar regulation of HERVs/MaLRs and genes after LPS stimulation suggests possible interactions of LTR-retrotransposons and the immune host response.
Optimized breeding strategies to harness Genetic Resources with different performance levels
Authors: Allier Antoine , Teyssèdre Simon , Lehermeier Christina , Moreau Laurence , Charcosset Alain
Published: December 2019

The narrow genetic base of elite germplasm compromises long-term genetic gain and increases the vulnerability to biotic and abiotic stresses in unpredictable environmental conditions. Therefore, an efficient strategy is required to broaden the genetic base of commercial breeding programs while not compromising short-term variety release. Optimal cross selection aims at identifying the optimal set of crosses that balances the expected genetic value and diversity. We propose to consider genomic selection and optimal cross selection to recurrently improve genetic resources (i.e. pre-breeding), to bridge the improved genetic resources with elites (i.e. bridging), and to manage introductions into the elite breeding population. Optimal cross selection is particularly adapted to jointly identify bridging, introduction and elite crosses to ensure an overall consistency of the genetic base broadening strategy. We compared simulated breeding programs introducing donors with different performance levels, directly or indirectly after bridging. We also evaluated the effect of the training set composition on the success of introductions. We observed that with recurrent introductions of improved donors, it is possible to maintain the genetic diversity and increase mid- and long-term performances with only limited penalty at short-term. Considering a bridging step yielded significantly higher mid- and long-term genetic gain when introducing low performing donors. The results also suggested to consider marker effects estimated with a broad training population including donor by elite and elite by elite progeny to identify bridging, introduction and elite crosses.
Reduced responsiveness of the reward system is associated with tolerance to cannabis impairment in chronic users
Authors: Mason Natasha L. , Theunissen Eef L. , Hutten Nadia R.P.W. , Tse Desmond H.Y. , Toennes Stefan W. , Jansen Jacobus F.A. , Stiers Peter , Ramaekers Johannes G.
Published: December 2019

Cannabis is the most commonly used illicit drug in the world. However, because of a changing legal landscape and rising interest in therapeutic utility, there is an increasing trend in (long‐term) use and possibly cannabis impairment. Importantly, a growing body of evidence suggests that regular cannabis users develop tolerance to the impairing, as well as the rewarding, effects of the drug. However, the neuroadaptations that may underlie cannabis tolerance remain unclear. Therefore, this double‐blind, randomized, placebo‐controlled, cross‐over study assessed the acute influence of cannabis on the brain and behavioral outcomes in two distinct cannabis user groups. Twelve occasional and 12 chronic cannabis users received acute doses of cannabis (300‐μg/kg delta‐9‐tetrahydrocannabinol) and placebo and underwent ultrahigh field functional magnetic resonance imaging and magnetic resonance spectroscopy. In occasional users, cannabis induced significant neurometabolic alterations in reward circuitry, namely, decrements in functional connectivity and increments in striatal glutamate concentrations, which were associated with increases in subjective high and decreases in performance on a sustained attention task. Such changes were absent in chronic users. The finding that cannabis altered circuitry and distorted behavior in occasional, but not chronic users, suggests reduced responsiveness of the reward circuitry to cannabis intoxication in chronic users. Taken together, the results suggest a pharmacodynamic mechanism for the development of tolerance to cannabis impairment, of which is important to understand in the context of the long‐term therapeutic use of cannabis‐based medications, as well as in the context of public health and safety of cannabis use when performing day‐to‐day operations.
Free and kerogen‐bound biomarkers from late Tonian sedimentary rocks record abundant eukaryotes in mid‐Neoproterozoic marine communities
Authors: Zumberge J. Alex , Rocher Don , Love Gordon D.
Published: December 2019

Lipid biomarker assemblages preserved within the bitumen and kerogen phases of sedimentary rocks from the ca. 780–729 Ma Chuar and Visingsö Groups facilitate paleoenvironmental reconstructions and reveal fundamental aspects of emerging mid‐Neoproterozoic marine communities. The Chuar and Visingsö Groups were deposited offshore of two distinct paleocontinents (Laurentia and Baltica, respectively) during the Tonian Period, and the rock samples used had not undergone excessive metamorphism. The major polycyclic alkane biomarkers detected in the rock bitumens and kerogen hydropyrolysates consist of tricyclic terpanes, hopanes, methylhopanes, and steranes. Major features of the biomarker assemblages include detectable and significant contribution from eukaryotes, encompassing the first robust occurrences of kerogen‐bound regular steranes from Tonian rocks, including 21‐norcholestane, 27‐norcholestane, cholestane, ergostane, and cryostane, along with a novel unidentified C30 sterane series from our least thermally mature Chuar Group samples. Appreciable values for the sterane/hopane (S/H) ratio are found for both the free and kerogen‐bound biomarker pools for both the Chuar Group rocks (S/H between 0.09 and 1.26) and the Visingsö Group samples (S/H between 0.03 and 0.37). The more organic‐rich rock samples generally yield higher S/H ratios than for organic‐lean substrates, which suggests a marine nutrient control on eukaryotic abundance relative to bacteria. A C27 sterane (cholestane) predominance among total C26–C30 steranes is a common feature found for all samples investigated, with lower amounts of C28 steranes (ergostane and crysotane) also present. No traces of known ancient C30 sterane compounds; including 24‐isopropylcholestanes, 24‐n‐propylcholestanes, or 26‐methylstigmastanes, are detectable in any of these pre‐Sturtian rocks. These biomarker characteristics support the view that the Tonian Period was a key interval in the history of life on our planet since it marked the transition from a bacterially dominated marine biosphere to an ocean system which became progressively enriched with eukaryotes. The eukaryotic source organisms likely encompassed photosynthetic primary producers, marking a rise in red algae, and consumers in a revamped trophic structure predating the Sturtian glaciation.
Turkey's Geographical Limitation: The Legal Implications of an Eventual Lifting
Authors: Güler Arzu
Published: December 2019

Being a Contracting Party to the 1951 Convention Relating to the Status of Refugees and its Protocol with geographical limitation, Turkey provides conditional refugee status, not refugee status, to persons feeling persecution as a result of events occurring outside Europe. This study focuses on the rights of conditional refugees under Turkish laws and questions whether these rights comply with or diverge from the rights of refugee under the Convention. It draws conclusions on the significance and challenging character of the identified divergences and on the changes that Turkey needs to make in its laws in case of an eventual lifting.
Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies
Authors: Boman Erika , Duvaland Elisabeth , Gaarde Kim , Leary Alison , Fagerström Lisbeth
Published: December 2019

Aim

To evaluate the implementation of advanced practice nursing in emergency care in Norway for patients with orthopaedic injuries, including hip fractures. The outcomes relate to quality of care and patient trust.

Design

A non‐inferiority study comparing an advanced practice nursing care model with a standard (physician‐led) care model.

Methods

Data will be collected from patient records and through the Patient Trust Questionnaire, completed by patients. The data will be analysed by descriptive and inferential statistics. Funding for the research was granted in 2015 and the regional ethical committee approved the current study in February 2019.

Discussion

In Norway and the other Nordic countries, advanced practice nursing is still in its infancy, especially in the emergency care context. This study will evaluate advanced practice nursing in this new context.

Impact

The study will add to knowledge on the quality of care provided for orthopaedic patients with minor orthopaedic injuries or hip fractures as delivered by advanced practice nurses and physicians, respectively. It will also evaluate how well‐advanced practice nursing is accepted by patients in this new context.
Reduction of visual and auditory stimuli to reduce pain during venipuncture in premature infants. Study protocol for a randomized controlled trial
Authors: Bonjorn Juarez Maria , Manrique Pons Meritxell , Grau Alcón Laia , Martinez‐Momblan María Antonia , Alonso‐Fernández Sergio
Published: December 2019

Aim

To evaluate the efficacy of the reduction of visual and auditory stimuli on pain during venipuncture in premature newborns of 32–36 weeks of gestation.

Design

Open, randomized, non‐blind parallel clinical trial.

Method

Study to take place at the neonatal intensive care unit of a University Hospital in 2019–2021. Fifty‐six recently born babies between 32‐36 weeks of gestation will participate. The dependent variable is the level of pain determined using the premature infant pain profile instrument. The intervention will be assigned randomly using the random.org software. Data analysis will be carried out using the IBM SPSS v.25 software assuming a level of significance of 5%.

Discussion

The evidence for the efficacy of reducing sensory stimulation and its effect on pain in minor procedures has not been studied in depth. There are no studies that evaluate the reduction of visual and auditory stimuli in a combined way.

Impact

It is easy to incorporate the reduction of visual and auditory stimuli into nursing practice. The results of this study could have a direct impact on clinical practice.

Trial registered at clinicaltrials.gov: NCT04041635
The impact of a personalised action plan delivered at discharge to patients with COPD on readmissions: a pilot study
Authors: Hegelund Annette , Andersen Ingrid Charlotte , Andersen Marianne N. , Bodtger Uffe
Published: December 2019

Background

Self‐management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory‐related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital.

Aim

This pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3‐month follow‐up.

Methods

The study was carried out in a randomised controlled design with follow‐up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD‐related readmissions was measured as the primary outcome.

Results

Compared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS‐depression, but none in HADS‐anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy.

Conclusions

A personally tailored action plan introduced at or postdischarge combined with follow‐up support is an effective self‐management tool to support recovery and to reduce unnecessary readmissions. In future follow‐up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.
Staff strategies for dealing with care situations at an emergency department
Authors: Frank Catharina , Elmqvist Carina
Published: December 2019

Introduction

Overcrowding is a common international problem at Emergency Departments often due to those patients get recommendations or referrals from other health professionals to seek care at the emergency department. Crowding brings with it an amount of adverse consequences for both patients and staff, and knowledge about staff’s strategies of dealing with this caring situation is limited.

Aim

The aim of the present study was thus to describe staffs’ strategies to deal with the caring situations at an emergency department.

Method

Secondary analysis has been made of 18 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis.

Findings

The results showed that the staff at the ED worked in twofold directions using both proactive and reactive strategies in order to deal with the care situation when caring for patients at ED. The proactive strategy is optimising conditions, controlling patient flow and being boundary. The reactive strategy is about customising the conversation and holding an open approach.

Conclusion

In conclusion, the proactive strategy is to make what you decided for unseen circumstances. The reactive strategy is then about less anticipation of the encounter, waiting for the patient to act and react to it.

Implication

The result can have implications with respect to developing and improving care at crowded Emergency departments. Knowledge about strategies creates a fundament for developing visible sustainable structure for patient flow in making work patient safety for patients, staff and organisation.
A TrAdaBoost Method for Detecting Multiple Subjects’ N200 and P300 Potentials Based on Cross-Validation and an Adaptive Threshold
Authors: Li Mengfan , Lin Fang , Xu Guizhi
Published: December 2019

Traditional training methods need to collect a large amount of data for every subject to train a subject-specific classifier, which causes subjects fatigue and training burden. This study proposes a novel training method, TrAdaBoost based on cross-validation and an adaptive threshold (CV-T-TAB), to reduce the amount of data required for training by selecting and combining multiple subjects’ classifiers that perform well on a new subject to train a classifier. This method adopts cross-validation to extend the amount of the new subject’s training data and sets an adaptive threshold to select the optimal combination of the classifiers. Twenty-five subjects participated in the N200- and P300-based brain–computer interface. The study compares CV-T-TAB to five traditional training methods by testing them on the training of a support vector machine. The accuracy, information transfer rate, area under the curve, recall and precision are used to evaluate the performances under nine conditions with different amounts of data. CV-T-TAB outperforms the other methods and retains a high accuracy even when the amount of data is reduced to one-third of the original amount. The results imply that CV-T-TAB is effective in improving the performance of a subject-specific classifier with a small amount of data by adopting multiple subjects’ classifiers, which reduces the training cost.
Optimization of makespan and resource utilization in the fog computing environment through task scheduling algorithm
Authors: Vijayalakshmi R. , Vasudevan V. , Kadry Seifedine , Lakshmana Kumar R.
Published: December 2019

The Fog computing is rising as a dominant and modern computing model to deliver Internet of Things (IoT) computations, which is an addition to the cloud computing standard to get it probable to perform the IoT requests in the network of edge. In those above independent and dispersed environment, resource allocation is vital. Therefore, scheduling will be a test to enhance potency and allot resources properly to the tasks. This paper offers a distinct task scheduling algorithm in the fog computing environment that tries to depreciate the makespan and maximize resource utilization. This algorithm catalogues the task based on the mean Suffrage value. The suggested algorithm gives much resource utilization and diminishes makespan. Our offered algorithm is compared with different alive scheduling for performance investigation, and test results confirm that our algorithm has a more significant resource utilization rate and low makespan than other familiar algorithms.
Influence of transition metal ions on multiferroic properties of lead-free NBT–BT ceramics
Authors: Shanmuga Sundari S. , Dhanasekaran R.
Published: December 2019

Using the conventional solid-state reaction method, 0.5[Formula: see text]wt.% of MnO2-, NiO-, Cr2O3-, Fe2O3- and Co2O3-added 0.94[Formula: see text][Formula: see text]TiO3 (NBT)–0.06BaTiO3 (BT) ceramics were prepared. The perovskite nature of the prepared ceramics was analyzed by powder XRD and the surface morphology was studied by means of SEM. The dielectric analysis was carried out from room temperature to [Formula: see text]C at various frequencies and the diffusive transition at the dielectric maxima confirmed the relaxor nature of the ceramics. Creation of oxygen vacancies by the possible substitution of ferromagnetic impurities decreased the dielectric constant and piezoelectric constant ([Formula: see text]. The co-existence of ferromagnetism and the ferroelectricity was observed in the Mn, Ni, Co and Cr-added NBT–BT ceramics. The magnetic force microscopy (MFM) analysis was carried out to study the ferromagnetic domains in the prepared ceramic.
Pregnancy Outcome after Exposure to Migalastat for Fabry Disease: A Clinical Report
Authors: Haninger-Vacariu Natalja , El-Hadi Sarah , Pauler Udo , Foretnik Marina , Kain Renate , Prohászka Zoltán , Schmidt Alice , Skuban Nina , Barth Jay A. , Sunder-Plassmann Gere
Published: December 2019

Our patient was a 37-year-old woman with Fabry disease (GLA p.R112H) with a medical history of recurrent headache, nausea, vomiting, vertigo, and tobacco use (20 cigarettes/day). Fabry disease was diagnosed in 2005 when she experienced proteinuria, preeclampsia, and hypertension (201/130 mm Hg) during pregnancy (delivered 50 cm, 3.4 kg healthy boy; GLA wild type [WT]). Enzyme replacement therapy was initiated in 2009. The patient enrolled in the phase 3 ATTRACT trial (ClinicalTrials.gov; NCT01218659) and started migalastat in May 2012 while taking hormonal contraceptives. Two years after initiating migalastat, the patient had proteinuria (2166 mg/24 h) without hypertension (131/68 mm Hg), which persisted (788 mg/24 h a month later). Kidney biopsy results were consistent with existing Fabry disease. A serum pregnancy test and ultrasound confirmed pregnancy (18 weeks’ gestation). Migalastat and hormonal contraceptives were stopped; the patient continued to smoke. Fetal MRI was normal at ~29 weeks’ gestation. In October 2014, at 37+ weeks’ gestation, the patient delivered a 45-cm, 2.29-kg healthy girl (GLA WT). Excepting low birth weight, which may be related to the patient’s smoking, pregnancy outcome was normal despite exposure to migalastat for 18 weeks. Migalastat therapy during pregnancy is not advised.
Familial Russell–Silver Syndrome like Phenotype in the PCNA Domain of the CDKN1C Gene, a Further Case
Authors: Sabir A. H. , Ryan G. , Mohammed Z. , Kirk J. , Kiely N. , Thyagarajan M. , Cole T.
Published: December 2019

We present two half siblings with significant short stature who proved a diagnostic challenge for several years. Radiological findings included subtle epiphyseal changes. The diagnosis was made through whole genome sequencing via the 100,000 genome project. A maternally inherited pathogenic heterozygous CDKN1C variant was found in the PCNA (proliferating cell nuclear antigen) domain. Mutations of the PCNA domain of the CDKN1C gene are known to be associated with IMAGe syndrome thus with adrenal disease, although neither affected patient in our case had evidence of adrenal dysfunction. This report supports the previously reported findings of Russell–Silver syndrome (RSS) like phenotype caused by this unusual mechanism (CDKN1C mutations in the PCNA domain), highlights subtle radiological features not described previously and the phenotypic variability between two affected siblings. Additionally it reminds clinicians of the importance of considering associated adrenal disease/diabetes mellitus for variants within the PCNA domain. Finally it confirms RSS-like disorders should be considered in patients who have epiphyseal or metaphyseal changes and short stature, since CDKN1C PCNA domain mutations can result in this phenotype.
Myogenic Disease and Metabolic Acidosis: Consider Multiple Acyl-Coenzyme A Dehydrogenase Deficiency
Authors: Dernoncourt A. , Bouchereau J. , Acquaviva-Bourdain C. , Wicker C. , De Lonlay P. , Gourguechon C. , Sevestre H. , Merle P.-E. , Maizel J. , Brault C.
Published: December 2019

Background. Multiple acyl-coA dehydrogenase deficiency (MADD) is a rare, inherited, autosomal-recessive disorder leading to the accumulation of acylcarnitine of all chain lengths. Acute decompensation with cardiac, respiratory or hepatic failure and metabolic abnormalities may be life-threatening. Case Presentation. A 29-year-old woman presented with severe lactic acidosis associated with intense myalgia and muscle weakness. The clinical examination revealed symmetric upper and lower limb motor impairment (rated at 2 or 3 out of 5 on the Medical Research Council scale) and clear amyotrophy. Laboratory tests had revealed severe rhabdomyolysis, with a serum creatine phosphokinase level of 8,700 IU/L and asymptomatic hypoglycemia in the absence of ketosis. Electromyography revealed myotonic bursts in all four limbs. The absence of myositis-specific autoantibodies ruled out a diagnosis of autoimmune myositis. Finally, Acylcarnitine profile and gas chromatography–mass spectrometry analysis of organic acids led to the diagnosis of MADD. A treatment based on the intravenous infusion of glucose solutes, administration of riboflavin, and supplementation with coenzyme Q10 and carnitine was effective. Lipid consumption was strictly prohibited in the early stages of treatment. The clinical and biochemical parameters rapidly improved and we noticed a complete disappearance of the motor deficit, without sequelae. Conclusion. A diagnosis of MADD must be considered whenever acute or chronic muscle involvement is associated with metabolic disorders. Acute heart, respiratory or hepatic failure and metabolic abnormalities caused by MADD may be life-threatening, and will require intensive care.
Intravitreal Injection of Anti-VEGF Antibody Induces Glomerular Endothelial Cells Injury
Authors: Touzani F. , Geers C. , Pozdzik A.
Published: December 2019

Introduction. Antiangiogenic agents that inhibit vascular endothelial growth factor have emerged as important tools in cancer therapy and ocular diseases. Their systemic use can induce renal limited microangiopathy. Local use of anti-VEGF agent is supposed to be safe. We report here a unique case of early endothelial cells injury induced by intravitreal injection of bevacizumab. Case Presentation. A 72-year-old man was addressed for acute kidney injury with proteinuria. He was under treatment with intravitreal injections of bevacizumab for glaucoma. Kidney biopsy was performed and electron microscopy showed signs of early stages of glomerular microangiopathy. Bevacizumab was discontinued resulting in the improvement of renal function and albuminuria. Discussion. Bevacizumab, a humanized monoclonal antibody to VEGF is an approved therapy for metastatic cancer. Systemic adverse events including thrombotic microangiopathy have been mainly reported after its systemic injection. Podocytes produce VEGF that interacts with endothelial cells VEGF receptor-2 maintaining glomerular basement membrane integrity. Bevacizumab induce the detachment of endothelial cells from glomerular basement membrane leading to the proteinuria and renal function decline. Intravitreal bevacizumab is generally supposed to be safe. However, glomerular injury with microangiopathy features, even after intravitreal injection is possible. Conclusion. We report the electron microscopy evidence that intravitreal injection of anti-VEGF induces glomerular endothelial cells injury. Nephrologists and ophthalmologists should be aware of this complication.
Compliance to Iron-Folic Acid Supplementation and Its Association with the Number of ANC Visits in Ethiopia: Systematic Review and Meta-Analysis
Authors: Workineh Yinager , Semachew Ayele , Ayalew Emiru , Temesgen Worku Animaw
Published: December 2019

Background. The World Health Organization recommended that 80% of communities in all countries should receive the standard dose of iron folic acid. But, in Ethiopia, this target was not yet achieved. The compliance of iron folic acid was also variable across each district. Therefore, the aim of this study was to assess women compliance with iron-folic acid supplementation and its association with a number of antenatal care visits in Ethiopia using systematic review and meta-analysis, 2018. Methods. In the current meta-analysis, the target variables were searched from different electronic database system like PubMed, Google Scholar, Science Direct, and Cochrane Library. To predict the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia, all original studies were considered. All necessary data were extracted by using a standardized data extraction format. The data were analyzed by using STATA 14 statistical software. Heterogeneity between the studies was assessed by Cochrane Q and I2 tests. A random effect model was computed to estimate the pooled compliance with iron-folic acid supplementation. Results. Twelve full-text studies were included in the meta-analysis. The findings of this meta-analysis revealed that the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia was 43.63% (CI: 28.00, 59.25%). The women from the city administration had a high rate of compliance as compared with other regions of Ethiopia. The odds of having four or more antenatal care visit were the independent pooled predictor of compliance with iron-folic acid supplementation. Conclusion. Current compliance with iron-folic supplementation was lower than the World health organization recommendation. Mothers from the city administration who utilized the antenatal care four and above times, had high level compliance with iron-folic acid supplementation. Therefore, we recommended that women should visit the antenatal clinic four times to compliance with the iron folic acid supplementation.