bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic progress of upland rice (Oryza sativa L.) lines for disease resistance
Authors: Alves Natália Botega , Balestre Marcio , Pennacchi João Paulo , Nunes Fernandes Monique Caroline , Goulart Castro Douglas , Barbosa Silva Botelho Flávia
Published: May 2020

The rice crop is affected by diseases throughout its cycle, impacting negatively on grain yield and quality. The control of the disease impact can be accomplished via crop breeding, using highly multiple resistant genotypes. This study aimed to evaluate the efficiency of multiple‐character and specific selection of multiple resistance to major culture‐associated diseases (neck blast, leaf scald and grain discoloration) in rice lines of the Upland Rice Genetic Breeding Program. The experiments were conducted in 35 sites during 12 agricultural years, where 124 lines were evaluated for the severity of fungal diseases, under natural field conditions. Multiple parameters were calculated based on the diseases´ scores: genetic, phenotypic and environmental variances, heritability, selection gain, renewal rate, and genetic and renewal progress. Genetic variance for the disease resistance was identified in the population, and the selection gain for multiple‐character selection was of 3.16 year−1 throughout the breeding process with a renewal rate of over 35%. The programme has showed efficiency in selecting multiple resistant genotypes to the mentioned diseases, highlighting genotypes with high potential for market release.
Mutagenic treatment of microspore‐derived embryos of turnip rape (Brassica rapa) to increase oleic acid content
Authors: Daurova Ainash , Daurov Dias , Volkov Dmitryi , Karimov Aibek , Abai Zhandos , Raimbek Daniyar , Zhapar Kuanish , Zhambakin Kabyl , Shamekova Malika
Published: May 2020

The article presents the results of a study on obtaining mutant doubled haploids of turnip rape. The culture medium for producing embryos in isolated microspore culture was optimized. The optimal medium formula was NLN + 13% S + 0.05 mg/L NAA + 0.05 mg/L BA. Embryos derived from isolated microspore culture were treated with EMS mutagen in three concentrations (4 mM, 8 mM, and 12 mM). Mutant doubled haploid plants and their seeds were obtained. Agronomic evaluation and analysis of fatty acid composition in mutant lines seeds showed that they had valuable traits in terms of seed oil quality and yield. Analysis of the fatty acid composition of the seeds of the obtained mutant doubled haploids showed an increase in the percentage of oleic acid (~11%–12%) in comparison with donor cultivars. Our results showed that mutagenesis of embryos from a culture of isolated microspores has potential for improving the qualitative traits of turnip rape.
Hydraulic and photosynthetic limitations prevail over root non‐structural carbohydrate reserves as drivers of resprouting in two Mediterranean oaks
Authors: Resco de Dios Víctor , Arteaga Carles , Peguero‐Pina José Javier , Sancho‐Knapik Domingo , Qin Haiyan , Zveushe Obey K. , Sun Wei , Williams David G. , Boer Matthias M. , Voltas Jordi , Moreno José M. , Tissue David T. , Gil‐Pelegrín Eustaquio
Published: May 2020

Resprouting is an ancestral trait in angiosperms that confers resilience after perturbations. As climate change increases stress, resprouting vigor is declining in many forest regions, but the underlying mechanism is poorly understood. Resprouting in woody plants is thought to be primarily limited by the availability of non‐structural carbohydrate reserves (NSC), but hydraulic limitations could also be important. We conducted a multifactorial experiment with two levels of light (ambient, 2–3% of ambient) and three levels of water stress (0, 50 and 80 percent losses of hydraulic conductivity, PLC) on two Mediterranean oaks (Quercus ilex and Q. faginea) under a rain‐out shelter (n = 360). The proportion of resprouting individuals after canopy clipping declined markedly as PLC increased for both species. NSC concentrations affected the response of Q. ilex, the species with higher leaf construction costs, and its effect depended on the PLC. The growth of resprouting individuals was largely dependent on photosynthetic rates for both species, while stored NSC availability and hydraulic limitations played minor and non‐significant roles, respectively. Contrary to conventional wisdom, our results indicate that resprouting in oaks may be primarily driven by complex interactions between hydraulics and carbon sources, whereas stored NSC play a significant but secondary role.
“We've Cared for the Dead since We Started Caring”: COVID‐19 and Our Relationship to Public and Private Deathcare
Authors: Zavattaro Staci M.
Published: May 2020

The COVID‐19 pandemic has highlighted public organizations’ challenges related to deathcare. Within the emergency management literature, and specifically within public administration, there is a gap when it comes to planning past death. Using data from interviews with 35 municipal cemetery managers throughout the United States, I show how our unwillingness to talk about or plan for death, coupled with cemetery managers who are underfunded and often left out of emergency management planning processes, needs increased attention. While many deathcare best practices were deployed to respond to the virus, cemetery managers often are not part of the planning process.
Seed planning, sourcing, and procurement
Authors: Erickson Vicky J. , Halford Anne
Published: May 2020

Ensuring the availability of adequate seed supplies of species and sources appropriate for restoration projects and programs necessitates extensive science‐based planning. The selection of target species requires a review of disturbance conditions and reference areas, development of a reference model, and consideration of specific objectives, timeframes, available resources, and budgets as well as the performance of prospective species in past restoration efforts. Identification of seed sources adapted to site conditions is critical to provide for short‐term establishment and long‐term sustainability. Seed zones and plant movement guidelines provide tools for sourcing plant materials with reduced risk of maladaptation. A seed zone framework also facilitates seed use planning and contributes to stability and predictability of the commercial market, thereby reducing costs and improving the availability of adapted seed supplies. Calculating the amount of seed required for each species is based on seed quality (viability, purity), seed weight, expected seedling establishment, and desired composition of the seeding. If adequate collections from wildland stands are not feasible, then seed increase in seed fields or use of nursery stock may be warranted. Adherence to seed collection and seed production protocols for conserving genetic diversity is critical to protect genetic resources and buffer new seedings and plantings against environmental stressors. Maintenance of genetic diversity becomes even more critical considering current or expected climate change impacts. Collaboration and partnerships can benefit seed selection and procurement programs through sharing of information, coordination in project planning, and increasing the availability of native seed.
Robust Testing in Generalized Linear Models by Sign Flipping Score Contributions
Authors: Hemerik Jesse , Goeman Jelle J. , Finos Livio
Published: May 2020

Generalized linear models are often misspecified because of overdispersion, heteroscedasticity and ignored nuisance variables. Existing quasi-likelihood methods for testing in misspecified models often do not provide satisfactory type I error rate control. We provide a novel semiparametric test, based on sign flipping individual score contributions. The parameter tested is allowed to be multi-dimensional and even high dimensional. Our test is often robust against the mentioned forms of misspecification and provides better type I error control than its competitors. When nuisance parameters are estimated, our basic test becomes conservative. We show how to take nuisance estimation into account to obtain an asymptotically exact test. Our proposed test is asymptotically equivalent to its parametric counterpart.
Who succeeds in STEM? Elementary girls' attitudes and beliefs about self and STEM
Authors: Wieselmann Jeanna R. , Roehrig Gillian H. , Kim Justine N.
Published: May 2020

With ongoing underrepresentation of women in STEM fields, it is necessary to explore ways to maintain girls' STEM interest throughout elementary and middle school. This study is situated within the context of Designs in STEM (pseudonym), an out‐of‐school program that engages urban youth in authentic STEM experiences. Participants were 30 girls attending Designs in STEM in grades four and five. Participants were interviewed about their STEM interest, out‐of‐school versus in‐school STEM learning experiences, and how gender relates to STEM success. Several key findings emerged. First, although students' prior school experiences with mathematics resulted in less positive dispositions toward mathematics than other STEM disciplines, their experiences at Designs in STEM revealed that mathematics could be fun and valuable when used for real‐world purposes. Second, students found Designs in STEM to be more engaging and inspiring due to the context and pedagogies employed by Designs in STEM instructors. Third, despite observing girls' behavior that was more aligned with academic success, participants still identified STEM advantages for boys. Finally, participants defined success and intelligence in STEM based on speed and tracking. Discussion focuses on the need to consider how school‐based mathematics instruction may serve as a barrier to girls' STEM interest and involvement.
PBL as a pedagogical approach for integrated STEM: Evidence from prospective teachers
Authors: Navy Shannon L. , Kaya Fatma
Published: May 2020

Problem‐based learning (PBL) and science, technology, engineering, and mathematics (STEM) are two acronyms widely visible in education literature today. However, few studies have explored these in connection with one another, specifically with regard to teacher preparation. This study investigated how 47 prospective elementary teachers developed PBL units and how they integrated STEM and other disciplines into those units. It also addressed the affordances and constraints of integrated STEM as perceived by the prospective elementary teachers. Data sources in this multimethod study included PBL units and interviews. Findings revealed that all of the units integrated at least two of the STEM disciplines, as well as literacy, in a variety of ways. The prospective teachers articulated perceived benefits of integrated STEM, such as: making connections across content areas, preparing students for the real world, teaching students that failure is not a bad thing, and providing future opportunities. They also addressed perceived barriers of integrated STEM, such as: having limited experience with the content, diminishing the effect of individual content areas, and needing better curriculum alignment. Overall, this study provides evidence that PBL can be a pedagogical approach to integrate STEM. Implications for teachers, teacher educators, and curriculum specialists are discussed.
Stored RBC metabolism as a function of caffeine levels
Authors: D'Alessandro Angelo , Fu Xiaoyun , Reisz Julie A. , Kanias Tamir , Page Grier P. , Stone Mars , Kleinman Steve , Zimring James C. , Busch Michael ,   for the Recipient Epidemiology and Donor Evaluation Study‐III (REDS III)
Published: May 2020

BACKGROUND

Coffee consumption is extremely common in the United States. Coffee is rich with caffeine, a psychoactive, purinergic antagonist of adenosine receptors, which regulate red blood cell energy and redox metabolism. Since red blood cell (purine) metabolism is a critical component to the red cell storage lesion, here we set out to investigate whether caffeine levels correlated with alterations of energy and redox metabolism in stored red blood cells.

STUDY DESIGN AND METHODS

We measured the levels of caffeine and its main metabolites in 599 samples from the REDS‐III RBC‐Omics (Recipient Epidemiology Donor Evaluation Study III Red Blood Cell‐Omics) study via ultra‐high‐pressure‐liquid chromatography coupled to high‐resolution mass spectrometry and correlated them to global metabolomic and lipidomic analyses of RBCs stored for 10, 23, and 42 days.

RESULTS

Caffeine levels positively correlated with increased levels of the main red cell antioxidant, glutathione, and its metabolic intermediates in glutathione‐dependent detoxification pathways of oxidized lipids and sugar aldehydes. Caffeine levels were positively correlated with transamination products and substrates, tryptophan, and indole metabolites. Expectedly, since caffeine and its metabolites belong to the family of xanthine purines, all xanthine metabolites were significantly increased in the subjects with the highest levels of caffeine. However, high‐energy phosphate compounds ATP and DPG were not affected by caffeine levels, despite decreases in glucose oxidation products—both via glycolysis and the pentose phosphate pathway.

CONCLUSION

Though preliminary, this study is suggestive of a beneficial correlation between the caffeine levels and improved antioxidant capacity of stored red cells.
Directionally resolved measurements of momentum transport in sputter plumes as a critical test for simulations
Authors: Klette Mathis , Maas Manuel , Trottenberg Thomas , Kersten Holger
Published: May 2020

A 50×50mm2 copper target is sputtered by an ion beam at angles of incidence from 0° to 90°. The resulting sputter plumes are characterized directionally resolved using a compact and maneuverable force probe. It measures the momentum flux of particles released due to sputtering or reflection inside the sputter plume. Argon ions at energies from 320 to 1220 eV are studied. As expected, the directional distributions are sensitive to the angle of incidence. The ion energy has significant influence only on the magnitude of forces and not their directional distribution. The experimental results are compared with simulations based on the “stopping and range of ions in matter” code (SRIM). The general trends of the directional distributions of forces match reasonably with simulations. However, the simulations overestimate the forces at normal incidence and shallow angles of incidence.
Assessing auditory masking for management of underwater anthropogenic noise
Authors: Pine Matthew K. , Nikolich Katrina , Martin Bruce , Morris Corey , Juanes Francis
Published: May 2020

Masking is often assessed by quantifying changes, due to increasing noise, to an animal's communication or listening range. While the methods used to measure communication or listening ranges are functionally similar if used for vocalizations, they differ in their approaches: communication range is focused on the sender's call, while the listening range is centered on the listener's ability to perceive any signal. How these two methods differ in their use and output is important for management recommendations. Therefore it was investigated how these two methods may alter the conclusions of masking assessments based on Atlantic cod calls in the presence of a commercial air gun array. The two methods diverged with increasing distance from the masking noise source with maximum effects lasting longer between air gun pulses in terms of communication range than listening range. Reductions in the cod's communication ranges were sensitive to fluctuations in the call's source level. That instability was not observed for the listening range. Overall, changes to the cod's communication range were more conservative but very sensitive to the call source level. A high level of confidence in the call is therefore required, while confidence in the receiver's audiogram and soundscape is required for the listening range method.
Bandwidth extension of intensity-based sound power estimates
Authors: Mortenson Michael C. , Gilbert Suzanna , Neilsen Tracianne B. , Gee Kent L. , Sommerfeldt Scott D.
Published: May 2020

The traditional method for intensity-based sound power estimates often used in engineering applications is limited in bandwidth by microphone phase mismatch at low frequencies and by microphone spacing at high frequencies. To overcome these limitations, the Phase and Amplitude Gradient Estimator (PAGE) method [Gee, Neilsen, Sommerfeldt, Akamine, and Okamoto, J. Acoust. Soc. Am. 141(4), EL357–EL362 (2017)] is applied to sound power for a reference sound source, a blender, and a vacuum cleaner. Sound power measurements taken according to ISO 3741:2010 (2010) are compared against traditional- and PAGE-processed intensity-based sound power estimates measured according to ANSI S12.12-1992 (R2017). While the traditional method underestimates the sound power at the spatial Nyquist frequency by 7–10 dB, the PAGE-based sound power is accurate up to the spatial Nyquist frequency, and above when phase unwrapping is successful.
The Man Behind the Teaching Personal and Social Responsibility Model: A Life History of Don Hellison
Authors: Jacobs Jenn M. , Templin Thomas
Published: May 2020

Don Hellison was a legend in the field of physical education and youth development and the impact he made throughout his life is immeasurable. This contribution to the monograph cannot begin to illustrate the totality of Don’s achievements throughout his life and academic career. It provides a life history of Hellison across three phases: the lone ranger, trailblazer, and icon phases that aligned with various periods and events in his life and in the United States and the world. It concludes with a statement of gratitude to Hellison for the many gifts he gave to urban youth, his students, colleagues, and importantly to his family and friends. His legacy will live on for a very long time.
Host-Directed Antiviral Therapy
Authors: Kumar Naveen , Sharma Shalini , Kumar Ram , Tripathi Bhupendra N. , Barua Sanjay , Ly Hinh , Rouse Barry T.
Published: May 2020

Antiviral drugs have traditionally been developed by directly targeting essential viral components. However, this strategy often fails due to the rapid generation of drug-resistant viruses. Recent genome-wide approaches, such as those employing small interfering RNA (siRNA) or clustered regularly interspaced short palindromic repeats (CRISPR) or those using small molecule chemical inhibitors targeting the cellular “kinome,” have been used successfully to identify cellular factors that can support virus replication.
Conserved Herpesvirus Kinase ORF36 Activates B2 Retrotransposons during Murine Gammaherpesvirus Infection
Authors: Schaller Aaron M. , Tucker Jessica , Willis Ian , Glaunsinger Britt A.
Published: May 2020

Viral infection dramatically changes the levels of many types of RNA in a cell. In particular, certain oncogenic viruses activate expression of repetitive genes called retrotransposons, which are normally silenced due to their ability to copy and spread throughout the genome. Here, we established that infection with the gammaherpesvirus MHV68 leads to a dramatic induction of a class of noncoding retrotransposons called B2 SINEs in multiple cell types. We then explored how MHV68 activates B2 SINEs, revealing a role for the conserved herpesviral protein kinase ORF36. Both ORF36 kinase-dependent and kinase-independent functions contribute to B2 induction, perhaps through ORF36 targeting of proteins involved in controlling the accessibility of chromatin surrounding SINE loci. Understanding the features underlying induction of these elements following MHV68 infection should provide insight into core elements of SINE regulation, as well as disregulation of SINE elements associated with disease.
Automated Cell-Free Multiprotein Synthesis Facilitates the Identification of a Secretory, Oligopeptide Elicitor-Like, Immunoreactive Protein of the Oomycete Pythium insidiosum
Authors: Sae-Chew Pattarana , Rujirawat Thidarat , Kumsang Yothin , Payattikul Penpan , Lohnoo Tassanee , Yingyong Wanta , Jaturapaktrarak Chalisa , Rotchanapreeda Tiwa , Reamtong Onrapak , Srisuk Tanawut , Kittichotirat Weerayuth , Krajaejun Theerapong
Published: May 2020

Technical limitations of conventional biotechnological methods (i.e., genetic engineering and protein synthesis) prevent extensive functional studies of the massive amounts of genetic information available today. We employed a cell-free protein synthesis system to rapidly and simultaneously generate multiple proteins from genetic codes of the oomycete
Pythium insidiosum
, which causes the life-threatening disease called pythiosis, in humans and animals worldwide. We aimed to screen for potential diagnostic and therapeutic protein targets of this pathogen. Eighteen proteins were synthesized. Of the 18 proteins, one was a secreted immunoreactive protein, called I06, that triggered host immunity and was recognized explicitly by all tested sera from pythiosis patients. It is one of the OPEL proteins; these proteins are present only in the unique group of microorganisms called oomycetes. Here, we demonstrated that cell-free protein synthesis was useful for the production of multiple proteins to facilitate functional studies and identify a potential target for diagnosis and treatment of pythiosis.
Experimental Evolution
In Vivo
To Identify Selective Pressures during Pneumococcal Colonization
Authors: Cooper Vaughn S. , Honsa Erin , Rowe Hannah , Deitrick Christopher , Iverson Amy R. , Whittall Jonathan J. , Neville Stephanie L. , McDevitt Christopher A. , Kietzman Colin , Rosch Jason W.
Published: May 2020

Evolution is a powerful force that can be experimentally harnessed to gain insight into how populations evolve in response to selective pressures. Herein we tested the applicability of experimental evolutionary approaches to gain insight into how the major human pathogen
Streptococcus pneumoniae
responds to repeated colonization events using a murine model. These studies revealed the population dynamics of repeated colonization events and demonstrated that
in vivo
experimental evolution resulted in highly reproducible trajectories that reflect the environmental niche encountered during nasal colonization. Mutations impacting the surface charge of the bacteria were repeatedly selected during colonization and provided a fitness benefit in this niche that was counterbalanced by a corresponding fitness defect during lung infection. These data indicate that experimental evolution can be applied to models of pathogenesis to gain insight into organism-specific tissue tropisms.
Late Quaternary slip rates on the Sierra Madre fault zone and paleoseismic evidence on the size and frequency of past ruptures
Authors: Burgette* R. , Scharer* K. , Lindvall* S.
Published: May 2020

The Sierra Madre fault zone is a south-vergent, active reverse fault that accommodates shortening between basins on the northern margin of the Los Angeles region and the San Gabriel Mountains. The preservation of late Quaternary alluvial fill and fan surfaces in the hanging wall of the fault provides evidence of long-term uplift. Surface rupture from the 1971 Mw 6.6 San Fernando earthquake and evidence of large prehistoric displacements from trenching investigations emphasize the ongoing hazard posed by the fault system to the region. This one-day field trip visits some of the key locations near Pasadena and San Fernando, California, where slip rates have been determined from cosmogenic and luminescence dating of abandoned surfaces dating to 50–70, ca. 30, and ca. 12 ka and surface offsets measured from lidar and pre-development topographic maps. Another stop is the site of a paleoseismic trench, which provided key evidence on the timing and displacement of past ruptures on the fault. In combination, results from these field investigations converge on a slip rate for the eastern ~100 km of the fault zone of 1–2 mm/yr, which matches or exceeds the rates for other reverse faults in southern California. This rate, in combination with trenching data that show no evidence of post–mid Holocene ruptures along the central and eastern portions of the fault, indicate the fault zone poses a significant seismic hazard to the region.
Evidence for glacial geological controls on the hydrology of Maine (USA) peatlands
Authors: Chen Xi , Comas Xavier , Reeve Andrew , Slater Lee
Published: May 2020

Freshwater pools commonly form eccentric crescent patterns in peatlands, an important atmospheric methane (CH4) source, and show an apparent spatial association with eskers in some deglaciated regions. However, the role of underlying permeable glacial deposits such as eskers in regulating hydrogeology, and perhaps even carbon cycling, in peatlands is rarely considered. In this study, ground-penetrating radar imaging and direct coring confirmed that clustered pools coincide with buried esker crests in contact with peat soil in Caribou Bog and Kanokolus Bog in Maine (USA). Hydraulic head and geochemical data combined with lidar indicate vertical water flow from shallow peat toward the permeable esker crests, suggesting enhanced downward transport of labile organic carbon that presumably accelerates rates of methanogenesis in deep peat. Eskers might therefore serve as proxies for enhanced CH4 production in deep peat, as supported by differences in dissolved CH4 profiles depending on proximity to pools. Geographic data compiled from multiple sources suggest that many peatlands with eccentric pools appear to be located proximal to esker systems in Maine and Fennoscandia. These geological factors may be important, previously unrecognized controls on water and the carbon cycle in peatlands.
A 1000-yr-old tsunami in the Indian Ocean points to greater risk for East Africa
Authors: Maselli Vittorio , Oppo Davide , Moore Andrew L. , Gusman Aditya Riadi , Mtelela Cassy , Iacopini David , Taviani Marco , Mjema Elinaza , Mulaya Ernest , Che Melody , Tomioka Ai Lena , Mshiu Elisante , Ortiz Joseph D.
Published: May 2020

The December 2004 Sumatra-Andaman tsunami prompted an unprecedented research effort to find ancient precursors and quantify the recurrence time of such a deadly natural disaster. This effort, however, has focused primarily along the northern and eastern Indian Ocean coastlines, in proximal areas hardest hit by the tsunami. No studies have been made to quantify the recurrence of tsunamis along the coastlines of the western Indian Ocean, leading to an underestimation of the tsunami risk in East Africa. Here, we document a 1000-yr-old sand layer hosting archaeological remains of an ancient coastal Swahili settlement in Tanzania. The sedimentary facies, grain-size distribution, and faunal assemblages indicate a tsunami wave as the most likely cause for the deposition of this sand layer. The tsunami in Tanzania is coeval with analogous deposits discovered at eastern Indian Ocean coastal sites. Numerical simulations of tsunami wave propagation indicate a megathrust earthquake generated by a large rupture of the Sumatra-Andaman subduction zone as the likely tsunami source. Our findings provide evidence that teletsunamis represent a serious threat to coastal societies along the western Indian Ocean, with implications for future tsunami hazard and risk assessments in East Africa.
Late Miocene sediment delivery from the axial drainage system of the East Carpathian foreland basin to the Black Sea
Authors: de Leeuw Arjan , Vincent Stephen J. , Matoshko Anton , Matoshko Andrei , Stoica Marius , Nicoara Igor
Published: May 2020

We describe a late Miocene to early Pliocene axial drainage system in the East Carpathian foreland, which was an important sediment supplier to the Black Sea and the Dacian Basin. Its existence explains the striking progradation of the northwest Black Sea shelf prior to the onset of sediment supply from the continental-scale Danube River in the late Pliocene to Pleistocene. This axial drainage system evolved due to the diachronous along-strike evolution of the Carpathians and their foreland; continental collision, overfilling, slab breakoff, and subsequent exhumation of the foreland occurred earlier in the West Carpathians than in the East Carpathians. After overfilling of the western foreland, excess sediment was transferred along the basin axis, giving rise to a 300-km-wide by 800-km-long, southeast-prograding river-shelf-slope system with a sediment flux of ∼12 × 103 km3/m.y. Such late-stage axial sediment systems often develop in foreland basins, in particular, where orogenesis is diachronous along strike. Substantial lateral sediment transport thus needs to be taken into account, even though evidence of these axial systems is often eroded following slab breakoff and inversion of their foreland basins.
Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis
Authors: Alexander Karen M , Chan Sherwin S , Opfer Erin , Cuna Alain , Fraser Jason D , Sharif Shazia , Khashu Minesh
Published: May 2020

Necrotising enterocolitis (NEC) is a serious inflammatory bowel disease of prematurity with potentially devastating complications and remains a leading cause of morbidity and mortality among premature infants. In recent years, there has been accumulating data regarding benefits of using bowel ultrasound (BUS) in the diagnosis and management of NEC. Despite this, adoption of robust BUS programmes into clinical practice has been slow. As BUS is a relatively new technique, many barriers to implementation exist, namely lack of education and training for sonographers and radiologists, low case volume and unfamiliarity by clinicians regarding how to use the information provided. The aim of this manuscript is to provide a framework and a roadmap for units to implement BUS in day-to-day practice for NEC diagnosis and management.
Association of glucose variability at the last day of hospitalization with 30-day readmission in adults with diabetes
Authors: Spanakis Elias K , Singh Lakshmi G , Siddiqui Tariq , Sorkin John D , Notas George , Magee Michelle F , Fink Jeffrey C , Zhan Min , Umpierrez Guillermo E
Published: May 2020

Objective

To evaluate whether increased glucose variability (GV) during the last day of inpatient stay is associated with increased risk of 30-day readmission in patients with diabetes.

Research design and methods

A comprehensive list of clinical, pharmacy and utilization files were obtained from the Veterans Affairs (VA) Central Data Warehouse to create a nationwide cohort including 1 042 150 admissions of patients with diabetes over a 14-year study observation period. Point-of-care glucose values during the last 24 hours of hospitalization were extracted to calculate GV (measured as SD and coefficient of variation (CV)). Admissions were divided into 10 categories defined by progressively increasing SD and CV. The primary outcome was 30-day readmission rate, adjusted for multiple covariates including demographics, comorbidities and hypoglycemia.

Results

As GV increased, there was an overall increase in the 30-day readmission rate ratio. In the fully adjusted model, admissions with CV in the 5th–10th CV categories and admissions with SD in the 4th–10th categories had a statistically significant progressive increase in 30-day readmission rates, compared with admissions in the 1st (lowest) CV and SD categories. Admissions with the greatest CV and SD values (10th category) had the highest risk for readmission (rate ratio (RR): 1.08 (95% CI 1.05 to 1.10), p<0.0001 and RR: 1.11 (95% CI 1.09 to 1.14), p<0.0001 for CV and SD, respectively).

Conclusions

Patients with diabetes who exhibited higher degrees of GV on the final day of hospitalization had higher rates of 30-day readmission.

Trial registration number

NCT03508934,NCT03877068.
Acute kidney injury after multiphase imaging for lesions detected on hepatocellular carcinoma surveillance in patients with cirrhosis
Authors: Khan Adnan Aman , Hadi Yousaf Bashir , Thompson Jesse Martin , Kupec Justin Thomas
Published: May 2020

Objective

The risk difference between multiphase multidetector contrast-enhanced CT and MRI for developing acute kidney injury (AKI) has not been previously evaluated in patients with cirrhosis undergoing hepatocellular carcinoma (HCC) surveillance. We aimed to compare the rate of AKI after CT and MRI for evaluation of these lesions.

Design

A retrospective chart review of all patients with cirrhosis who underwent either multiphase multidetector liver protocol CT or MRI for lesions detected on HCC screening was conducted at West Virginia University. The rate of AKI after imaging was compared between the two groups.

Results

A total of 416 patients were included. Hepatitis C was the most common aetiology (34.6%) of cirrhosis. Thirty-six patients had chronic kidney disease at the time of imaging. CT imaging was conducted for 173 (41.5%) patients, while 58.5% underwent MRI. Nineteen (4.6%) patients developed AKI after imaging. The incidence of AKI was 2.89% for CT and 5.76% for MRI (p value = 0.25). Multivariate logistic regression analysis revealed that inpatient status (p value = 0.015) and Model for End-Stage Liver Disease score (p value = 0.02) were independently linked to the development of AKI following imaging, while the type of imaging modality was not.

Conclusions

There is no difference in the risk of AKI after CT or MRI for evaluation of lesions identified on HCC surveillance. The rates of AKI after these imaging studies are low and are attributable to other aetiologies in most cases. We propose that the choice of imaging should be made based on availability, cost, and other patient-related and facility-related factors.
Autologous transplantation of umbilical cord blood-derived cells in extreme preterm infants: protocol for a safety and feasibility study
Authors: Malhotra Atul , Novak Iona , Miller Suzanne Lee , Jenkin Graham
Published: May 2020

Introduction

Preterm brain injury continues to be an important complication of preterm birth, especially in extremely premature infants. Umbilical cord blood-derived cells (UCBCs) are increasingly being evaluated for their neuroprotective and neuroreparative properties in preclinical and clinical studies. There remains a paucity of information on the feasibility and safety of autologous UCBC transplantation in extremely premature infants.

Methods and analysis

A single centre safety and feasibility study in preterm babies born before 28 weeks gestation. Cord blood will be collected after birth and if sufficient blood is obtained, UCB mononuclear cells will be harvested from the cord blood, characterised and stored. After excluding infants who have already suffered severe preterm brain injury, based on cranial ultrasounds in first week of life, preterm infants will be infused with autologous UCBCs via the intravenous route at a dose of 25–50 million UCBCs/kg body weight of live cells, with the cell number being the maximum available up to 50 million cells/kg. A minimum of 20 infants will be administered autologous UCBCs. Primary outcomes will include feasibility and safety. Feasibility will be determined by access to sufficient cord blood at collection and UCBCs following processing. Safety will be determined by lack of adverse events directly related to autologous UCBC administration in the first few days after cell administration. Secondary outcomes studied will include neonatal and neurodevelopmental morbidities till 2 years of life. Additional outcomes will include cell characteristics of all collected cord blood, and cytokine responses to cell administration in transplanted infants till 36 weeks’ corrected age.

Ethics and dissemination

Monash Health Human Research Ethics Committee approved this study in December 2019. Recruitment is to commence in July 2020 and is expected to take around 12 months. The findings of this study will be disseminated via peer-reviewed journals and at conferences.

Trial registration number

ACTRN12619001637134.
Protocol for assessing the determinants of preoperative test-ordering behaviour for low-risk surgical procedures using a theoretically driven, qualitative design
Authors: Pike Andrea , Mahoney Krista , Patey Andrea M , Inwood Samantha , Mortazhejri Sameh , Lawrence Rebecca , Hall Amanda
Published: May 2020

Introduction

Current evidence suggests that preoperative tests such as chest X-rays, electrocardiograms and baseline laboratory studies may not be useful for healthy patients undergoing low-risk surgical procedures. Routine preoperative testing for healthy patients having low-risk surgery is not a scientifically sound practice. In this study, we will interview healthcare providers working at medical facilities where low-risk surgical procedures are carried out. This will allow us to gain insight into the determinants of preoperative testing behaviours for healthy patients undergoing low-risk surgeries and their barriers and enablers to guideline adherence.

Methods and analysis

We will use semistructured interviews with anaesthesiologists, surgeons and preadmission clinic nurses to assess the determinants of preoperative testing behaviours. The interview guide was designed around the Theoretical Domains Framework (TDF), developed specifically to determine the barriers and enablers to implementing evidence-based guidelines. Interviews will be audio-recorded, transcribed verbatim and coded according to the TDF. Key themes will be generated for each of the identified domains.

Ethics and dissemination

We have received ethics approval from the Health Research Ethics Board in Newfoundland and Labrador (HREB #2018.190) for this study. The results of this work will be disseminated through a peer-reviewed publication, presentation at a healthcare forum and plain-language infographic summaries. Additionally, deidentified data collected and analysed for this study will be available for review from the corresponding author on reasonable request.
Effects of introduction of an inflammatory bowel disease nurse position on healthcare use
Authors: Martinez-Vinson Christine , Le Sebastien , Blachier Audrey , Lipari Maud , Hugot Jean-Pierre , Viala Jerome
Published: May 2020

Objective

Inflammatory bowel diseases (IBDs) are chronic relapsing remitting diseases which potentially result in hospitalisation, requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice and support.

The aim of this study was to assess the impact of introduction of an IBD nurse position on healthcare use and costs in a tertiary IBD centre.

Methods

An IBD nurse was instituted in September 2017 in our multidisciplinary IBD team. We compared differences in healthcare use 1 year before and 1 year after the introduction of an IBD nurse position for all the patients with a confirmed diagnosis of IBD attending the Robert Debre Hospital via two information sources: Programme de Médicalisation des Systèmes d’Information and Centre des Maladies Rares.

Results

252 patients (78.5% of patients with IBD followed up in our centre) were included in the patient education programme. After the introduction of an IBD nurse position, fewer patients were hospitalised for a flare, with less hospital stays: 56 before vs 28 after (p=0.002). An estimated saving of €35 070 was achieved through the decrease of hospitalisations for flare.

More patients were also hospitalised for diagnosis: 32 hospitalisations before vs 54 hospitalisations after (p=0.001). All other hospitalisation categories were comparable, and the same reasons for hospitalisation were found before and after.

Conclusion

This study demonstrates that the IBD nurse position reduces hospital admissions. Instead of the traditional model, the IBD nurse provides accessible advice and allows patients to be outpatients.
Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) randomised clinical trial: study protocol
Authors: Daneman Nick , Rishu Asgar H , Pinto Ruxandra L , Arabi Yaseen M , Cook Deborah J , Hall Richard , McGuinness Shay , Muscedere John , Parke Rachael , Reynolds Steven , Rogers Benjamin , Shehabi Yahya , Fowler Robert A
Published: May 2020

Introduction

Bloodstream infections are a leading cause of mortality and morbidity; the duration of treatment for these infections is understudied.

Methods and analysis

We will conduct an international, multicentre randomised clinical trial of shorter (7 days) versus longer (14 days) antibiotic treatment among hospitalised patients with bloodstream infections. The trial will include 3626 patients across 60 hospitals and 6 countries. We will include patients with blood cultures confirming a pathogenic bacterium after hospital admission. Exclusion criteria will include patient factors (severe immunosuppression), infection site factors (endocarditis, osteomyelitis, undrained abscesses, infected prosthetic material) and pathogen factors (Staphylococcus aureus, Staphylococcus lugdunensis, Candida and contaminant organisms). We will leave the selection of specific antibiotics, doses and route of delivery to the discretion of treating physicians; no placebo control will be used given the diversity of pathogens and sources of bacteraemia. The intervention will be assignment of treatment duration to be 7 versus 14 days. We will minimise selection bias via central randomisation with variable block sizes, with concealed allocation until day 7 of adequate antibiotic treatment. The primary outcome is 90-day survival; we will test whether 7 days is non-inferior to 14 days of treatment, with a non-inferiority margin of 4% absolute mortality. Secondary outcomes include hospital and intensive care unit (ICU) mortality, relapse rates of bacteraemia, hospital and ICU length of stay, mechanical ventilation and vasopressor duration, antibiotic-free days, Clostridium difficile infection, antibiotic allergy and adverse events and colonisation/infection with antibiotic-resistant organisms.

Ethics and dissemination

The study has been approved by the ethics review board at each participating site. Sunnybrook Health Sciences Centre is the central ethics committee. We will disseminate study results via the Canadian Critical Care Trials Group and other collaborating networks to set the global paradigm for antibiotic treatment duration for non-staphylococcal Gram-positive, Gram-negative and anaerobic bacteraemia, among patients admitted to hospital.

Trial registration number

The BALANCE (Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness) trial was registered at www.clinicaltrials.gov (registration number: NCT03005145).
Norethisterone and its acetate – what’s so special about them?
Authors: Huvinen Emilia , Holopainen Elina , Heikinheimo Oskari
Published: May 2020

Introduction

Progestogens (progestins) are widely used for contraception, in postmenopausal hormone therapy, and in treatment of abnormal uterine bleeding and endometriosis. Norethisterone (NET) and its acetate (NETA) differ from other progestogens by their partial conversion to ethinylestradiol (EE). We review their special characteristics and focus on the clinically relevant risk factors associated with estrogen action, such as migraine with aura and risk of thrombosis.

Methods

Narrative review based on a medical literature (OvidMedline and PubMed) search.

Results

NET converts to significant amounts of EE; 10–20 mg NET corresponds to 20–30 µg EE. The effects of NET on the endometrium are pronounced, making it a good choice for treating abnormal uterine bleeding, endometriosis, and endometrial hyperplasia. NET also has beneficial effects on bone mineral density and positive or neutral effects on cardiovascular health. Conversely, long-term use of NET is associated with a slightly increased breast cancer risk, and the risk of venous thromboembolism is moderately increased. This risk seems to be dose-dependent; contraceptive use carries no risk, but therapeutic doses might be associated with an increased risk. Studies suggest an association between combinations of EE and progestogens and ischaemic stroke, which in particular concerns women with migraine. No studies have, however, assessed this risk related to the therapeutic use of NET.

Conclusions

NET is a potent progestogen, especially when considering the endometrium. Its partial conversion to EE, however, is important to remember. Clinical consideration is required with women at high risk for either breast cancer or thromboembolism, or experiencing migraine with aura.
Lipid parameters and vitamin A modify cardiovascular risk prediction by plasma neopterin
Authors: Dhar Indu , Siddique Sumia , R Pedersen Eva , F T Svingen Gard , Lysne Vegard , Olsen Thomas , Nilsen Dennis W , Nordrehaug Jan Erik , Midttun Øivind , M Ueland Per , S Tell Grethe , K Nygård Ottar
Published: May 2020

Objectives

Oxidised cholesterol metabolites are linked to increased production of the active vitamin A (Vit-A) form and monocyte/macrophage activation, which may be reflected by neopterin, a marker of both interferon-γ–mediated immune activation and coronary artery disease risk. We examined the influence of serum lipid parameters and Vit-A on the risk association between neopterin and incident acute myocardial infarction (AMI).

Methods

We included 4130 patients with suspected stable angina pectoris (SAP), of whom 80% received lipid-lowering treatment with statins. Risk associations between plasma neopterin and AMI are given as HRs per SD increase in log-transformed neopterin.

Results

During a median follow-up of 7.5 years, 530 (12.8%) patients experienced an AMI. In age-adjusted and sex-adjusted analysis, plasma neopterin was positively associated with incident AMI (HR (95% CI) per SD: 1.26 (1.17 to 1.35)). However, the estimates were most pronounced in patients with serum low-density lipoprotein cholesterol (LDL-C) or apolipoprotein (apo) B100 below-median (HR (95% CI) per SD: 1.35 (1.24 to 1.48) and 1.42 (1.27 to 1.58), respectively; both pinteraction≤0.03). We also observed a particularly strong risk association in those with above-median Vit-A (HR (95% CI) per SD: 1.32 (1.21 to 1.44); pinteraction=0.03). The estimates were slightly modified after multivariable adjustment.

Conclusions

In patients with suspected SAP, the majority of whom receiving statin therapy, high plasma neopterin was associated with increased risk of AMI particularly among those with low LDL-C and apoB100 or high Vit-A levels. The particularly strong relationship of plasma neopterin with residual cardiovascular risk in patients with low lipid levels should be further investigated.
Effects of high differential stress and mineral properties on deformation and failure mechanism of hard rocks
Authors: Feng Xia-Ting , Zhao Jun , Wang Zhaofeng , Yang Chengxiang , Han Qiang , Zheng Zhi
Published: May 2020

To study the deformation and failure mechanism of hard rocks, true triaxial compression tests were conducted on four types of hard rocks to obtain the complete stress–strain curves and failure modes. Under true triaxial compression conditions, the shapes of the complete stress–strain curves can be divided into three types: elastic–brittle (EB), elastic–plastic–brittle (EPB), and elastic–plastic–ductile (EPD) types. According to the different post-peak deformation behaviours, the stress–strain curves of EPB type can be subdivided into three sub-categories: post-peak instantaneous brittle (EPB-I), post-peak multi-stage brittle (EPB-M), and post-peak delayed brittle (EPB-D). The stress–strain curves change from EPD to EPB-D, EPB-M, EPB-I, and finally EB with increasing differential stress (σ2– σ3). The deformation characteristics are dependent on intermediate principal stress σ2, minimum principal stress σ3, mineral compositions, and mineral textures of rock samples. An increase in σ3leads to an increased ductility, while an increase in σ2leads to an increased brittleness. Moreover, rocks with regular mineral textures and low mineral hardness are more prone to ductility. When the deformation curve is transformed from EPD to EPB and then to EB, the tensile crack gradually predominates, and the macroscopic failure angle gradually becomes steeper.