bluuebunny/crossref_metadata_2025 huggingface dataset:
The fungal NADPH oxidase is an essential element for the molecular dialog between Trichoderma and Arabidopsis
Authors: Villalobos‐Escobedo José M. , Esparza‐Reynoso Saraí , Pelagio‐Flores Ramón , López‐Ramírez Fabiola , Ruiz‐Herrera León F. , López‐Bucio José , Herrera‐Estrella Alfredo
Published: June 2020

Members of the fungal genus Trichoderma stimulate growth and reinforce plant immunity. Nevertheless, how fungal signaling elements mediate the establishment of a successful Trichoderma−plant interaction is largely unknown. In this work, we analyzed growth, root architecture and defense in an Arabidopsis−Trichoderma co‐cultivation system, including the wild‐type (WT) strain of the fungus and mutants affected in NADPH oxidase. Global gene expression profiles were assessed in both the plant and the fungus during the establishment of the interaction. Trichoderma atroviride WT improved root branching and growth of seedling as previously reported. This effect diminished in co‐cultivation with the ∆nox1, ∆nox2 and ∆noxR null mutants. The data gathered of the Arabidopsis interaction with the ∆noxR strain showed that the seedlings had a heightened immune response linked to jasmonic acid in roots and shoots. In the fungus, we observed repression of genes involved in complex carbohydrate degradation in the presence of the plant before contact. However, in the absence of NoxR, such repression was lost, apparently due to a poor ability to adequately utilize simple carbon sources such as sucrose, a typical plant exudate. Our results unveiled the critical role played by the Trichoderma NoxR in the establishment of a fine‐tuned communication between the plant and the fungus even before physical contact. In this dialog, the fungus appears to respond to the plant by adjusting its metabolism, while in the plant, fungal perception determines a delicate growth−defense balance.
Blood use for transvenous lead extractions at a high‐volume center
Authors: Cho Brian C. , Nyhan Sinead , Merkel Kevin R. , Hensley Nadia B. , Gehrie Eric A. , Choi Chun W. , Love Charles J. , Frank Steven M.
Published: June 2020

BACKGROUND

Transvenous lead extractions (TLEs) have increased in number due to an increased prevalence of cardiac implantable devices. Bleeding complications associated with TLEs can be catastrophic, and many institutions order blood components to be available in the procedure room. There are few studies supporting or refuting this practice. We evaluated transfusion rates for TLEs at a single, high‐volume center to assess the need for having blood in the procedure room.

STUDY DESIGN AND METHODS

Patients undergoing TLEs from April 2010 to February 2019 were identified from our institutional database. The percentage of patients transfused intraoperatively, the number of units transfused, and the reasons for transfusion were determined from the database and by manual chart review.

RESULTS

A total of 473 patients underwent a TLE during this time frame. Of these, only 17 patients (3.6%) received a red blood cell (RBC) transfusion. Ten of the 17 patients received RBCs secondary to preoperative anemia. Of the remaining seven patients, only four patients received more than 2 RBC units, and only one received more than 10 RBC units. No patient received more than 2 RBC units or any plasma or platelets in the past 4 years.

CONCLUSION

Due to improvements in procedural techniques, advent of accessible remote blood allocation systems, and changes in transfusion practice (e.g., electronic crossmatch), routinely having blood components in the procedure room for every TLE may be an outdated practice for high‐volume centers.
Intraosseous transfusion of hemoglobin vesicles in the treatment of hemorrhagic shock with collapsed vessels in a rabbit model
Authors: Hagisawa Kohsuke , Kinoshita Manabu , Saitoh Daizoh , Morimoto Yuji , Sakai Hiromi
Published: June 2020

BACKGROUNDS

Intravenous transfusion sometimes encounters difficulty under prehospital conditions when peripheral vessels are collapsed and inaccessible. We investigated whether the cellular type hemoglobin‐based oxygen carriers (Hemoglobin Vesicles: HbVs) allow intraosseous administration into blood circulation for the resuscitation of rabbits with severe hemorrhagic shock.

STUDY DESIGN AND METHODS

New Zealand white rabbits (2.5 kg average) were set in severe hemorrhagic shock [mean arterial pressure (MAP): 21 ± 2 mm Hg, Hb 5.1 ± 0.8 g/dL]. Immediately thereafter, 12 mL/kg of HbVs, 5% human serum albumin (HSA), autologous whole blood (WB), stored red blood cells (RBCs) or 36 mL/kg of Lactated Ringer's (LR) were intraosseously transfused, followed by an additional intraosseous transfusion with 8 mL/kg of HSA (following HbV, HSA or stored RBC transfusion), or WB or 24 mL/kg of LR (following LR transfusion), respectively.

RESULTS

Intraosseous transfusion of HbVs increased MAP (48 ± 9 mm Hg) and improved hypohemoglobinemia (7.1 ± 0.6 g/dL) as well as WB or RBC transfusion. In contrast, neither HSA nor LR improved hemodynamics or Hb levels. Seven out of 10 rabbits receiving HbVs survived for 24 hours, while only one out of 10 rabbits receiving LR survived (WB and RBC; 100% survivals, HSA; 30% survival).

CONCLUSIONS

Intraosseous infusion of HbVs might be an effective initial treatment to maintain hemodynamics during acute hemorrhagic shock. This approach could be used in emergency situations in which access to peripheral vessels is difficult.
The impact of blood product ratio and procoagulant therapy on the development of thromboembolic events in severely injured hemorrhaging trauma patients
Authors: Wirtz Mathijs R. , Schalkers Daisy V. , Goslings J. Carel , Juffermans Nicole P.
Published: June 2020

INTRODUCTION

Transfusion therapy in hemorrhaging trauma patients is associated with the development of thromboembolic events. It is unknown whether current resuscitation strategies, including large volumes of plasma and early administration of procoagulant therapy, increases this risk.

METHODS

A systematic search was conducted in MEDLINE, PubMed, and Embase. Studies were screened by two independent reviewers and included if they reported on thromboembolic events in patients with severe trauma (injury severity score ≥16) who received transfusion of at least 1 unit of red blood cells. The ratio by which blood products were transfused, as well as use of procoagulant or antifibrinolytic medication, was recorded.

RESULTS

A total of 40 studies with 11.074 bleeding trauma patients were included, in which 1.145 thromboembolic events were reported, yielding an incidence of 10% thromboembolic events. In studies performing routine screening for thromboembolic complications, the incidence ranged from 12% to 23%. The risk of thromboembolic events was increased after administration of tranexamic acid (TXA; odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7‐4.1; p < 0.001) and fibrinogen concentrate (OR, 2.1; 95% CI, 1.0‐4.2; p = 0.04). Blood product ratio, the use of prothrombin complex concentrate or recombinant factor VIIa were not associated with thromboembolic events.

CONCLUSION

This systematic review identified an incidence of thromboembolic events of 10% in severely injured bleeding trauma patients. The use of TXA and fibrinogen concentrate was associated with the development of thromboembolic complications.
Agricultural Productions and Its Implications on Economic Growth in Ivory Coast: The Use of the Econometric Approach
Authors: Paul-Alfred Kouakou Kouakou
Published: June 2020

The objective of this article is to assess the effect of the agricultural sector on the economic growth in Ivory Coast.The data used are those of the World Bank and cover the period from 1985 to 2015. The analysis of the data required the use of the AutoRegressive Distributed Lag (ARDL). It emerges from this study that there is a positive and significant relationship between manufacturing agriculture and economic growth in the short and long term. On the other hand, the food-crop production has a negative effect on GDP, even if it is significant. The variable of interest such as agricultural investment has a positive and significant effect on economic development, while cash crop production have a positive but not significant effect on long-term economic growth. Therefore, in view of these results, the State must promote the processing of agricultural products in order to create more value added.
Experimental determination of electron attenuation lengths in complex materials by means of epitaxial film growth: Advantages and challenges
Authors: Chambers Scott A. , Du Yingge
Published: June 2020

Accurate electron attenuation lengths are of critical importance in using electron spectroscopic methods to quantitatively characterize complex materials. Here, the authors show that analysis of core-level and valence-band x-ray photoelectron spectra excited with monochromatic AlKα x-rays from the substrate and measured as a function of film thickness can be used to determine electron attenuation lengths in epitaxial SrTiO3 films on Ge(001). Closely lattice-matched epitaxial heterojunctions are ideal systems for determining attenuation lengths provided the films grow in a layer-by-layer fashion, leading to atomically flat surfaces, and the buried interfaces are atomically abrupt. In principle, either the rate of attenuation of substrate peak intensities or the rate of increase of film peak intensities can be used for this purpose. However, the authors find that structural nonuniformities in the films reduce the accuracy of electron attenuation lengths determined from photoelectrons that originate within the films. A more reliable source of information is found in photoelectrons from the substrate which traverse the film. By using the energy dependence of calculated electron attenuation lengths from the NIST database in combination with Ge 3d core and Ge-derived valence-band intensities, the authors determine electron attenuation length as a function of kinetic energy for SrTiO3.
Increasing piezoelectric effect in radially polarized soft piezoelectric cylinders by pressure treating and its practical applications
Authors: Aronov Boris S. , Aikins Eric K. , Brown David A.
Published: June 2020

Subjecting soft piezoelectric ceramics such as lead zirconate titanate (PZT)-5 to uniaxial stress in a direction perpendicular to the principal polarization axis is known to increase its transverse piezoelectric modulus [Krueger, J. Acoust. Soc. Am. 43 (3), 583–559 (1968)], however, practical transducer applications of this effect remain undeveloped. This study explores uniaxial pressure-treatment to develop experimental methods to realize practical pressure treatment, to use dynamic measurements of the electromechanical coupling coefficient k32, piezoelectric modulus, and dielectric constants, and to enhance piezoelectric properties and performance of underwater acoustic cylindrical transducer designs. The results of axial pressure treatment on parameters of the cylinders are shown to increase the coupling coefficient by about 20% and remained stable. The applicability of using pressure treated cylinders in transducer designs is investigated. The performance was analyzed under one-dimensional circumferential static compression and under the hydrostatic compression. When the improved piezoelectric cylinders are used in air-backed transducer designs, the benefit is only useful at shallow depths as it is observed that when subjected to increased hydrostatic pressure, the corresponding induced circumferential stress reduces the piezoelectric properties, namely, the coupling coefficient, to approximately its original pre-treated value. However, when the improved cylinders are used in transducers of the pressure-equalized design, such as liquid filled or free-flooded, the increase in coupling coefficient remains stable with environmental hydrostatic pressure.
The effect of speaker gender on Cantonese tone perception
Authors: Lai Wei , Kuang Jianjing
Published: June 2020

This paper presents three experiments on the integration of speaker gender cues in Cantonese tone perception. Experiment 1 compared tone identification of F0-matched stimuli between different gender voices and showed that listeners tended to hear lower tones for stimuli with female-sounding voices and higher tones for stimuli with male-sounding voices. Experiment 2 investigated whether a similar voice gender normalization effect would occur in pitch perception. The results showed that unlike tone categorization shifting with voice gender systematically, voice gender interfered with pitch perception in listener-specific ways. In particular, musicians who were not affected by voice gender in pitch perception still showed a tone boundary shift induced by voice gender. Experiment 3 evaluated the influence of non-voice gender cues on tone identification with the guises of gendered names. The result shows that gendered names barely induced any shift on their own as guises of an identical set of gender-ambiguous stimuli; however, gendered names enhanced the shift when patterned with gender-prototypical voices of their gender. These findings support an additional phonological normalization process on top of psychoacoustic sensation. They also suggest that speaker normalization involves fine-grained processing of rich social cues conveyed by acoustic signals rather than merely abstract social labels.
Terrifying film music mimics alarming acoustic feature of human screams
Authors: Trevor Caitlyn , Arnal Luc H. , Frühholz Sascha
Published: June 2020

One way music is thought to convey emotion is by mimicking acoustic features of affective human vocalizations [Juslin and Laukka (2003). Psychol. Bull. 129(5), 770–814]. Regarding fear, it has been informally noted that music for scary scenes in films frequently exhibits a “scream-like” character. Here, this proposition is formally tested. This paper reports acoustic analyses for four categories of audio stimuli: screams, non-screaming vocalizations, scream-like music, and non-scream-like music. Valence and arousal ratings were also collected. Results support the hypothesis that a key feature of human screams (roughness) is imitated by scream-like music and could potentially signal danger through both music and the voice.
Effect of Weekly Training Frequency With the Nordic Hamstring Exercise on Muscle-Strain Risk Factors in Football Players: A Randomized Trial
Authors: Medeiros Thales M. , Ribeiro-Alvares João B. , Fritsch Carolina G. , Oliveira Gabriel S. , Severo-Silveira Lucas , Pappas Evangelos , Baroni Bruno M.
Published: June 2020

Purpose: To examine the differences between performing Nordic hamstring exercises once or twice a week on hamstring eccentric strength and other muscle-strain risk factors in high-level football players. Methods: In this randomized trial, 32 football players (18–23 y old) completed an 8-week Nordic hamstring exercise training program in 1 of 2 experimental groups: group 1 (once a week; n = 15) and group 2 (twice a week; n = 17). Knee-flexor/extensor peak torques and biceps femoris long-head muscle architecture were assessed through isokinetic dynamometry and ultrasonography, respectively, before and after the training programs. Analysis of covariance, effect sizes (ESs), and t tests for percentage change were used to assess the effect of the 2 interventions on the outcome measures. Results: Group 2 demonstrated higher hamstring concentric peak torque than group 1 posttraining (155–164 vs 149–158 N·m; P = .043; ES = 0.27), although there was also a statistical trend for higher hamstring eccentric peak torque (212–234 vs 198–221 N·m; P = .098; ES = 0.37), hamstring-to-quadriceps conventional ratio (0.56–0.59 vs 0.54–0.57; P = .089; ES = 0.31), and hamstring-to-quadriceps functional ratio (0.76–0.84 vs 0.71–0.79; P = .076; ES = 0.50). No between-groups differences were found for muscle thickness (P = .864; ES = 0.12), pennation angle (P = .289; ES = 0.18), fascicle length (P = .406; ES = 0.03), and quadriceps concentric peak torque (P = .340; ES = 0.02). Conclusion: Only the Nordic hamstring exercise training program performed twice a week strengthened the hamstrings of high-level football players, while similar changes in muscle architecture occurred with both once- and twice-weekly sessions.
Who Are We Honoring? Extending the Ebony & Ivy Discussion to Include Sport Facilities
Authors: Turick Robert , Weems Anthony , Swim Nicholas , Bopp Trevor , Singer John N.
Published: June 2020

One prominent, well-debated issue in the American higher education system is whether university officials should remove the names of individuals with racist pasts from campus buildings/structures that bear their namesake. The purpose of this study was to analyze basketball and football facilities at Division I Football Bowl Subdivision institutions to explore the racialized history of the people whom these facilities are named after. Utilizing a collective case study approach, the authors identified 18 facilities that were named after athletic administrators, coaches, and philanthropists who engaged in racist activities or harbored racist views. The authors argue, using critical race theory and systemic racism theory as interpretative lenses, that naming buildings after racist persons legitimizes their legacies, rationalizes systemic racism, and continues to unjustly enrich this particular group.
Chapter 4: Twitter as a Professional Development Platform Among U.S. Physical Education Teachers
Authors: R. Richards K. Andrew , Killian Chad M. , Kinder Christopher J. , Badshah Kaizeen , Cushing Casey
Published: June 2020

Purpose: The purpose of this study was to investigate how U.S. physical educators who actively engage with professional content on Twitter view it as a platform for continuing professional development. Method: Thirty-two U.S.-based physical educators participated in semistructured telephone interviews. Most of these teachers were White (n = 29; 91.00%) and taught in elementary schools (n = 26; 81.25%). The data were coded inductively and deductively, using role socialization theory as the guiding framework. Results: Four themes were generated: (a) socialization into Twitter takes time and is often encouraged by existing members; (b) socialization through Twitter focuses on improving practices via the sharing of resources; (c) everyone has a voice on Twitter, but the content requires critical appraisal; and (d) teachers create a community on Twitter that addresses marginalization and isolation. Discussion/Conclusion: The participants used Twitter to develop a sense of professional community and reduce perceptions of isolation. Twitter has the potential to support the improvement of practice through grassroots continuing professional development.
The Biocontrol Agent and Insect Pathogen Photorhabdus luminescens Interacts with Plant Roots
Authors: Regaiolo Alice , Dominelli Nazzareno , Andresen Karsten , Heermann Ralf
Published: June 2020

Insect-pathogenic
Photorhabdus luminescens
bacteria are widely used in biocontrol strategies against pests. Very little is known about the life of these bacteria in the rhizosphere. Here, we show that
P. luminescens
can specifically react to and interact with plant roots. Understanding the adaptation of
P. luminescens
in the rhizosphere is highly important for the biotechnological application of entomopathogenic bacteria and could improve future sustainable pest management in agriculture.
During Oxidative Stress the Clp Proteins of
Escherichia coli
Ensure that Iron Pools Remain Sufficient To Reactivate Oxidized Metalloenzymes
Authors: Sen Ananya , Zhou Yidan , Imlay James A.
Published: June 2020

Hydrogen peroxide mediates the toxicity of phagocytes, lactic acid bacteria, redox-cycling antibiotics, and photochemistry. The underlying mechanisms all involve its reaction with iron atoms, whether in enzymes or on the surface of DNA. Accordingly, when bacteria perceive toxic H
2
O
2
, they activate defensive tactics that are focused on iron metabolism. In this study, we identify a conundrum: DNA is best protected by the removal of iron from the cytoplasm, but this action impairs the ability of the cell to reactivate its iron-dependent enzymes. The actions of the Clp proteins appear to hedge against the oversequestration of iron by the miniferritin Dps. This buffering effect is important, because
E. coli
seeks not just to survive H
2
O
2
but to grow in its presence.
Draft Genome Sequence of
Geobacter
sp. Strain SVR, Isolated from Antimony Mine Soil
Authors: Warashina Tomoro , Harada Masafumi , Nakajima Nobuyoshi , Yamamura Shigeki , Tomita Masaru , Suzuki Haruo , Amachi Seigo
Published: June 2020

We report here the draft genome sequence of
Geobacter
sp. strain SVR, isolated from antimony mine soil in Hyogo Prefecture, Japan. The genome sequence data in this study will provide useful information for understanding bacterial antimonate reduction.
Draft Genome Sequence of Bifidobacterium pseudocatenulatum Bif4, Isolated from Healthy Infant Feces
Authors: Chander Atul Munish , Singh Shashank , Sharma Shikha , Chaudhry Vasvi , Rajarammohan Sivasubramanian , Mantri Shrikant Subhash , Bishnoi Mahendra , Bhadada Sanjay Kumar , Kondepudi Kanthi Kiran
Published: June 2020

We report the 2.24-Mb draft genome sequence of
Bifidobacterium pseudocatenulatum
Bif4, isolated from a fecal sample from a healthy infant. The specific annotations revealed genes predictive of its probiotic attributes.
Draft Genome Sequence of Erysipelothrix rhusiopathiae, Isolated from a Canine Case of Diskospondylitis
Authors: Little Sara V. , Hillhouse Andrew E. , Lawhon Sara D.
Published: June 2020

This is the draft genome of an
Erysipelothrix rhusiopathiae
strain isolated from the blood of a canine. Initial 16S ribosomal DNA amplification identified the isolate as belonging to the
Erysipelothrix
genus but could not elucidate the species due to previous misidentification of
E. rhusiopathiae
and
E. tonsillarum
. The species identification was confirmed by whole-genome sequencing.
Supplemental Material: A test of the efficacy of sand saltation for silt production: Implications for the interpretation of loess
Authors: Adams Steven , Soreghan Gerilyn
Published: June 2020

Table S1 (GPS coordinates of sample locations), Table S2 (grain-size distribution data; https://doi.pangaea.de/10.1594/pangaea.914301), Table S3 (point-counting data), Table S4 (automated surface observing stations [ASOS] GPS and wind data), Table S5 (scaling methods and detailed calculation), Table S6 (law of wall calculation and plot), and Table S7 (control sample mass loss).
Impact of myopia on the association of long-term intraocular pressure
fluctuation with the rate of progression in normal-tension glaucoma
Authors: Lee Jinho , Ahn Eun Jung , Kim Yong Woo , Ha Ahnul , Kim Young Kook , Jeoung Jin Wook , Park Ki Ho
Published: June 2020

Background/Aims

To investigate whether the association of long-term intraocular pressure
(IOP) fluctuation with the rate of progression of normal-tension glaucoma (NTG)
differs between myopia and non-myopia.

Methods

The medical records of 65 myopic NTG (axial length (AL) > 24.0 mm) and
64 non-myopic NTG eyes (AL < 24.0 mm), who had been treated with topical
medications for more than 5 years, were reviewed. Multiple linear regression
models were fitted to analyse the relationships of the slope of mean deviation
(MD) or visual field index (VFI) with the clinical factors, including the
interactions with myopia.

Results

The average follow-up period was 8.3 years. Twenty-two (22) non-myopic
eyes (34.4%) and 27 myopic eyes (41.5%) showed NTG progression (p=0.511). The
interaction of myopia with IOP fluctuation was a significant factor regarding
both MD and VFI slope (p=0.002, 0.024, respectively); stratified analyses
suggested that the risk effect of IOP fluctuation was significant only in
myopic NTG in terms of both MD (β= −1.27, p=0.003) and VFI slope (β=−2.32,
p=0.011).

Conclusion

Long-term IOP fluctuation was significantly related to faster visual field
progression in myopic NTG eyes, compared with non-myopic NTG eyes.
Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study
Authors: Santosh Paramala , Singh Jatinder , Adams Laura , Mastroianni Mathilde , Heaney Natalie , Lievesley Kate , Sagar-Ouriaghli Ilyas , Allibrio Giovanni , Appleton Rebecca , Davidović Nikolina , de Girolamo Giovanni , Dieleman Gwen , Dodig-Ćurković Katarina , Franić Tomislav , Gatherer Charlotte , Gerritsen Suzanne , Gheza Elisa , Madan Jason , Manenti Lidia , Maras Athanasios , Margari Francesco , McNicholas Fiona , Pastore Adriana , Paul Moli , Purper-Ouakil Diane , Rinaldi Francesco , Sakar Vehbi , Schulze Ulrike , Signorini Giulia , Street Cathy , Tah Priya , Tremmery Sabine , Tuffrey Amanda , Tuomainen Helena , Verhulst Frank , Warwick Jane , Wilson Anna , Wolke Dieter , Fiori Federico , Singh Swaran
Published: June 2020

Objective

Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16–18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person’s readiness for transition, and their outcomes at the transfer boundary.

Design

MILESTONE prospective study.

Setting

Eight European Union (EU) countries participating in the EU-funded MILESTONE study.

Participants

The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people.

Results

The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported.

Conclusion

The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person.

Trial registration number

ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.
Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study
Authors: Assefa Endalkachew Mekonnen , Berhane Yemane
Published: June 2020

Objective

To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.

Design

The study was a facility-based, cross-sectional study.

Setting

Two public and tertiary hospitals in Addis Ababa.

Participants

All pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals.

Primary and secondary outcome measures

The primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model.

Results

A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays.

Conclusion and recommendation

This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals’ set-up and readiness to manage obstetric emergencies.
Ecological study of playground space and physical activity among primary school children
Authors: Grunseit Anne C , O'Hara Blythe Jane , Drayton Bradley , Learnihan Vincent , Hardy Louise L , Clark Eve , Klarenaar Paul , Engelen Lina
Published: June 2020

Objectives

To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students.

Design

Cross-sectional ecological analysis.

Setting

43 primary schools in New South Wales, Australia.

Participants

Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey.

Outcome measures

Self (for age ≥11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness.

Results

Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students’ predicted probability of meeting PA recommendations increased sharply between 15 m2 and 25 m2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30 m2 returned to levels comparable to students in schools with no equipment (0.18, 95% CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15 m2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20 m2 per student. There was no relationship between space and FMS.

Conclusions

School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25 m2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.
Identification of cardiovascular and molecular prognostic factors for the medium-term and long-term outcomes of sepsis (ICROS): protocol for a prospective monocentric cohort study
Authors: Coldewey Sina M , Neu Charles , Baumbach Philipp , Scherag Andre , Goebel Björn , Ludewig Katrin , Bloos Frank , Bauer Michael
Published: June 2020

Introduction

Sepsis is one of the most prevalent life-threatening conditions in the intensive care unit. Patients suffer from impaired organ function, reduced physical functional capacity and decreased quality of life even after surviving sepsis. The identification of prognostic factors for the medium-term and long-term outcomes of this condition is necessary to develop personalised theragnostic approaches. Sepsis can cause cardiac impairment. The impact of this septic cardiomyopathy on patient’s long-term outcome remains unclear. This study aims to evaluate cardiovascular risk factors, particularly the occurrence of septic cardiomyopathy, regarding their suitability as prognostic factors for the short-term and long-term outcomes of septic patients. Additionally, the study seeks to validate preclinical pathophysiological findings of septic cardiomyopathy in the clinical setting.

Methods and analysis

In this prospective monocentric cohort study, patients will be clinically assessed during the acute and postacute phase of sepsis and two follow-ups after 6 and 12 months. To determine the effect of septic cardiomyopathy and concomitant cellular and molecular changes on patient mortality and morbidity, a comprehensive cardiovascular and molecular deep phenotyping of patients will be performed. This includes an echocardiographic and electrocardiographic assessment, and the evaluation of heart rate variability, body composition, mitochondrial oxygen metabolism, macrocirculation and microcirculation, and endothelial barrier function. These analyses are complemented by routine immunological, haematological and biochemical laboratory tests and analyses of the serum metabolome and lipidome, microbiome and epigenetic modifications of immune cells. The reversibility of patients’ organ dysfunction, their quality of life and physical functional capacity will be investigated in the follow-ups. Patients with cardiomyopathy without infection and healthy subjects will serve as control groups.

Ethics and dissemination

Approval was obtained from the Ethics Committee of the Friedrich Schiller University Jena (5276-09/17). The results will be published in peer-reviewed journals and presented at appropriate conferences.

Trial registration numbers

DRKS00013347; NCT03620409.
ILD-specific health-related quality of life in systemic sclerosis-associated ILD compared with IPF
Authors: Durheim Michael T , Hoffmann-Vold Anna-Maria , Eagan Tomas M , Hovden Arnt-Ove , Lund May Brit , Bjerke Gisle , Birring Surinder S , Jonassen Trygve M , Johansen Odd Erik , Sjåheim Tone
Published: June 2020

Introduction

Idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-associated interstitial lung disease (SSc-ILD) are fibrotic ILDs with divergent disease populations. Little is known about health-related quality of life (HRQL) in SSc-ILD relative to IPF.

Methods

We used the Kings Brief Interstitial Lung Disease Questionnaire (K-BILD) to compare HRQL in a cross-sectional study of 57 patients with IPF and 29 patients with SSc-ILD. Analysis of covariance was used to adjust for age, gender and lung function.

Results

The unadjusted mean K-BILD score was 63.1 (95% CI 57.1 to 69.1) among patients with SSc-ILD, as compared with 54.7 (51.8–57.5) among those with IPF (p=0.005). However, this difference in HRQL was attenuated after adjustment for age, gender and lung function. In a multivariable model, only forced vital capacity was associated with K-BILD scores. K-BILD scores were correlated with both forced vital capacity and with other relevant HRQL measures, regardless of ILD diagnosis.

Discussion

Patients with SSc-ILD may have better ILD-specific quality of life than patients with IPF, but this difference appears to be driven primarily by better lung function. These results underscore the impact of lung function on HRQL in fibrotic ILD and the utility of K-BILD to assess HRQL in SSc-ILD.
Multisystem chronic illness prognostication in non-oncologic integrated care
Authors: Bretos-Azcona Pablo E , Ibarrola Guillén Cristina , Sánchez-Iriso Eduardo , Cabasés Hita Juan M , Gorricho Javier , Librero López Julián
Published: June 2020

Objectives

To develop a mortality-predictive model for correct identification of patients with non-cancer multiple chronic conditions who would benefit from palliative care, recognise predictive indicators of death and provide with tools for individual risk score calculation.

Design

Retrospective observational study with multivariate logistic regression models.

Participants

All patients with high-risk multiple chronic conditions incorporated into an integrated care strategy that fulfil two conditions: (1) they belong to the top 5% of the programme’s risk pyramid according to the adjusted morbidity groups stratification tool and (2) they suffer simultaneously at least three selected chronic non-cancer pathologies (n=591).

Main outcome measure

1 year mortality since patient inclusion in the programme.

Results

Among study participants, 201 (34%) died within the 1 year follow-up. Variables found to be independently associated to 1 year mortality were the Barthel Scale (p<0.001), creatinine value (p=0.032), existence of pressure ulcers (p=0.029) and patient global status (p<0.001). The area under the curve (AUC) for our model was 0.751, which was validated using bootstrapping (AUC=0.751) and k-fold cross-validation (10 folds; AUC=0.744). The Hosmer-Lemeshow test (p=0.761) showed good calibration.

Conclusions

This study develops and validates a mortality prediction model that will guide transitions of care to non-cancer palliative care services. The model determines prognostic indicators of death and provides tools for the estimation of individual death risk scores for each patient. We present a nomogram, a graphical risk calculation instrument, that favours a practical and easy use of the model within clinical practices.
Less social emergency departments: implementation of workplace contact reduction during COVID-19
Authors: Sangal Rohit B , Scofi Jean E , Parwani Vivek , Pickens Andrew T , Ulrich Andrew , Venkatesh Arjun K
Published: June 2020

The COVID-19 pandemic has led to rapid changes in community and healthcare delivery policies creating new and unique challenges to managing ED pandemic response efforts. One example is the practice of social distancing in the workplace as an internationally recommended non-pharmaceutical intervention to reduce transmission. While attention has been focused on public health measures, healthcare workers cannot overlook the transmission risk they present to their colleagues and patients. Our network of three EDs are all high traffic areas for both patients and staff, which makes the limitation of close person-to-person contact particularly difficult to achieve. To design, implement and communicate contact reduction changes in the ED workplace, our COVID-19 task force formalised a set of multidisciplinary recommendations that enumerated concrete ways to reduce healthcare worker transmission to coworkers and to patients from ED patient arrival to discharge. We also addressed staff-to-staff contact reduction strategies when not performing direct patient care. We describe our conceptual approach and successful implementation of workplace distancing.
Inflammatory bowel disease is associated with higher dementia risk: a nationwide longitudinal study
Authors: Zhang Bing , Wang Hohui E , Bai Ya-Mei , Tsai Shih-Jen , Su Tung-Ping , Chen Tzeng-Ji , Wang Yen-Po , Chen Mu-Hong
Published: June 2020

Objective

Increasing evidence supports reciprocal communication between the enteric and the central nervous system in disease, termed the ‘gut–brain axis’. Recent findings suggest a connection between IBD and development of Parkinson’s disease. The role of IBD in dementia, another insidious neurodegenerative disorder, has not been explored.

Design

Using the Taiwanese National Health Insurance Research Database, we performed comparative analysis of 1742 patients with IBD ≥45 years old against 17 420 controls to assess dementia risk following IBD diagnosis. Controls were matched on bases of sex, access to healthcare, income and dementia-related comorbidities. All individuals were followed for dementia diagnosis for up to 16 years. Subanalyses included the relationship between sex, ulcerative colitis (UC) and Crohn’s disease (CD), and dementia risk.

Results

Overall incidence of dementia among patients with IBD was significantly elevated (5.5% vs 1.4% among controls). Patients with IBD were diagnosed with dementia at 76.24 years old on average, compared with 83.45 among controls. The HR of developing dementia among patients with IBD was 2.54 (95% CI 1.91 to 3.37). Among dementia types, the risk of developing Alzheimer’s dementia demonstrated the greatest increase. Dementia risk did not differ between sex differences nor UC versus CD.

Conclusion

This population-based cohort study demonstrates significant association between IBD and subsequent development of dementia. Dementia was diagnosed at an earlier age among patients with IBD, and disease risk appeared to increase with IBD chronicity. These findings highlight the need for future research to elucidate the relationship between IBD and dementia.
Exome and genome sequencing in adults with undiagnosed disease: a prospective cohort study
Authors: Shickh Salma , Gutierrez Salazar Mariana , Zakoor Kathleen-Rose , Lázaro Conxi , Gu Jessica , Goltz Jamie , Kleinman Dakota , Noor Abdul , Khalouei Sam , Mighton Chloe , Reble Emma , Kodida Rita , Bombard Yvonne , DiTroia Stephanie , Baxter Samantha , Watkins Nicholas , Care Melanie , Adler Arnon , Horsburgh Sheri , Morar Oana , Murphy Jillian , Nevay Dayna-Lynn , Szybowska Marta , Aronson Melyssa , Panchal Seema , Godoy Ruth , Holter Spring , Randall Armel Susan , Semotiuk Kara , Elser Christine , Kim Raymond H , Chitayat David , So Joyce , Faghfoury Hanna , Silver Josh , Morel Chantal F , Lerner-Ellis Jordan
Published: June 2020

Background

Exome and genome sequencing have been demonstrated to increase diagnostic yield in paediatric populations, improving treatment options and providing risk information for relatives. There are limited studies examining the clinical utility of these tests in adults, who currently have limited access to this technology.

Methods

Patients from adult and cancer genetics clinics across Toronto, Ontario, Canada were recruited into a prospective cohort study evaluating the diagnostic utility of exome and genome sequencing in adults. Eligible patients were ≥18 years of age and suspected of having a hereditary disorder but had received previous uninformative genetic test results. In total, we examined the diagnostic utility of exome and genome sequencing in 47 probands and 34 of their relatives who consented to participate and underwent exome or genome sequencing.

Results

Overall, 17% (8/47) of probands had a pathogenic or likely pathogenic variant identified in a gene associated with their primary indication for testing. The diagnostic yield for patients with a cancer history was similar to the yield for patients with a non-cancer history (4/18 (22%) vs 4/29 (14%)). An additional 24 probands (51%) had an inconclusive result. Secondary findings were identified in 10 patients (21%); three had medically actionable results.

Conclusions

This study lends evidence to the diagnostic utility of exome or genome sequencing in an undiagnosed adult population. The significant increase in diagnostic yield warrants the use of this technology. The identification and communication of secondary findings may provide added value when using this testing modality as a first-line test.
‘A higher form of listening’: a commentary on ‘the human bodies of World War II: beyond the battlefield’
Authors: Mayhew Emily
Published: June 2020

This issue’s interdisciplinary range parallels the generative multidisciplinary scope in the developing field of medical humanities. A closely detailed and empathic interdisciplinary analysis of physical and mental injury can offer additional historical and cultural resources to medical practitioners, thus broadening potential patient treatment options beyond institutional and disciplinary boundaries.
Endocrine changes in SARS-CoV-2 patients and lessons from SARS-CoV
Authors: Agarwal Shubham , Agarwal Sanjeev Kumar
Published: June 2020

Coronavirus infection outbreaks have occurred frequently in the last two decades and have led to significant mortality. Despite the focus on reducing mortality by preventing the spread of the virus, patients have died due to several other complications of the illness. The understanding of pathological mechanisms and their implications is continuously evolving. A number of symptoms occur in these patients due to the involvement of various endocrine glands. These clinical presentations went largely unnoticed during the first outbreak of severe acute respiratory syndrome (SARS) in 2002–2003. A few of these derangements continued during the convalescence phase and sometimes occurred after recovery. Similar pathological and biochemical changes are being reported with the novel coronavirus disease outbreak in 2020. In this review, we focus on these endocrine changes that have been reported in both SARS coronavirus and SARS coronavirus-2. As we battle the pandemic, it becomes imperative to address these underlying endocrine disturbances that are contributing towards or predicting mortality of these patients.
Maintaining vascular trauma proficiency for military non-vascular surgeons
Authors: Hall Andrew , Qureshi Iram , Brumagen Kegan , Glaser Jacob
Published: June 2020

Background

Vascular injuries in combat casualty patients are common and remain an ongoing concern. In civilian trauma centers, vascular surgeons are frequently available to treat vascular injuries. Within the military, vascular surgeons are not available at all locations where specialty expertise may be optimal. This study aims to determine if a visiting surgeon model, where a general surgeon can visit a civilian trauma center, would be practical in maintaining proficiency in vascular surgery.

Methods

All vascular trauma relevant cases done by any surgical service were identified during a 2-year period at Saint Louis University Hospital between October 1, 2016 and September 30, 2018. These included cases performed by trauma/general, thoracic, vascular, and orthopedic surgery. Predictions on the number of call days to experience an operative case were then calculated.

Results

A total of 316 vascular cases were performed during the time period. A surgeon on call for five 24-hour shifts would experience 2.1 urgent vascular cases with 95% certainty. To achieve five cases with 95% certainty, a surgeon would have to be on call for 34 24-hour shifts.

Discussion

A visiting surgeon model would be very difficult to maintain to acquire or maintain proficiency in vascular surgery. High-volume trauma centers, or centers with significant open vascular cases in addition to trauma, may have more reasonable time requirements, but would have to be evaluated using these methods.

Level of evidence

Economic and value-based evaluations, level II.