bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Lidocaine Cream for Pain Management During Immunizations of Infants at an Urban Health Clinic
Authors: Lepa Trisha , Valentine Menogh , Alshehry Abdullah O. , Morgan Eva Paige , Sessa Kelly , Fischetti Briann
Published: May 2021

Background:

Immunizations are a common source of pain and anxiety within the pediatric population. Implementation of lidocaine 4% cream, which has a short onset of action, as a standard of care for immunization practices may be feasible.

Objective:

The objective of this study was to assess the efficacy of lidocaine 4% cream as pain management during immunizations and to evaluate satisfaction of caregivers and nursing staff.

Methods:

This study was a prospective, randomized, placebo-controlled trial in an urban clinic, which included patients who were ≤ 14 months old accompanied by a caregiver who witnessed the patient receiving an immunization within the previous 7 months. Patients were randomized to receive either lidocaine 4% cream or placebo cream prior to vaccination. Time to cry and duration of cry were recorded. Caregivers completed surveys evaluating attitudes toward pain associated with immunizations as well as their satisfaction with the immunization process through Likert Scale ratings. Nurses completed a questionnaire assessing efficacy and feasibility of lidocaine 4% cream for pain management.

Results:

A total of 44 patients were included in the analysis in order to achieve 80% power with a p-value < 0.05. Mean duration of cry in patients receiving lidocaine 4% cream was 48.6 seconds in comparison to 65.9 seconds in patients receiving placebo (95%CI, −33.97 seconds to −0.48 seconds; p < 0.05).

Conclusions:

Lidocaine 4% cream decreased total duration of cry following vaccinations in comparison to placebo with both caregivers and nurses willing to utilize lidocaine 4% cream in a clinic setting if available
Residents’ Perceptions of a Community-Led Intervention on Health, Well-Being, and Community Inclusion Through Photovoice
Authors: Jackson Clare , Ronzi Sara
Published: May 2021

Community-centered approaches can be effective ways to engage communities and improve their health and well-being. The Grange is a community-led, multifaceted, and dynamic intervention incorporating a community hub and garden, that took place in a small area of the North-West of England, characterized by high levels of deprivation and poor health. Activities have been defined, developed, and supported by residents to meet locally defined needs. This study used photovoice methods to explore residents’ perceptions and experiences of this community-led intervention and any perceived impact on health, well-being, and community inclusion. Through photographs, semistructured interviews, a focus group discussion, and an exhibition, this study engaged intensively and creatively with a group of six residents. They identified positive and negative aspects related to The Grange and suggested recommendations that were directly communicated to policy makers during the photo-exhibition event. Participants reflected on various activities such as the community garden and the community shop. They also reflected on contextual factors and suggested that the culture of inclusivity and friendships associated with The Grange were more important to them than specific activities. This study demonstrated the value of using photovoice to (a) explore residents’ perceptions of community led interventions; and (b) meaningfully engage residents living in areas with high levels of deprivation. Public health practitioners should consider the use of photovoice (a) in the evaluation of health interventions that take place in a complex and changing context, and (b) as a powerful tool to engage with members of the community, especially traditionally disadvantaged groups, to ensure that engagement about health, well-being, and social inclusion is meaningful.
Guy Talk: A Gender-Specific Sexual Education Program to Reduce Sexual Risk Behaviors With High School Males
Authors: LeCroy Craig Winston , Milligan-LeCroy Skyler , Lopez Darlene
Published: May 2021

Purpose

The purpose of this study was to investigate the feasibility and effectiveness of a gender-specific intervention targeted to adolescent males to reduce sexual risks.

Method

This study used a randomized clinical trial comparing a broad-based male empowerment curriculum with a no-treatment control group. The sample ( N = 580) was recruited from schools and was implemented in community-based settings mostly in an after-school context. Assessments were conducted at baseline, postintervention, and 3 months follow-up time periods.

Results

There were significant differences between the two groups favoring the intervention group on several of the outcome indicators, including condom technical skills, attitudes toward women, social skills, peer assertiveness, and attitudes toward consent. Quality of implementation was rated high, and qualitative data suggest themes that reflect key lessons emphasized in the curriculum.

Conclusions

Gender-specific programs for adolescent males can help reduce indicators that are related to sexual risk reduction. More long-term follow-up is needed to assess impact on sexual behaviors. Efforts directed at male populations should continue to be researched for potential in reducing sexual risks.
Moraxella nonliquefaciens superinfecting herpes simplex keratitis
Authors: Porcar Plana Carmen Alejandra , Matarredona Muñoz Jaime , Moya Roca Jaime , Campos Mollo Ezequiel
Published: May 2021

Introduction:

Moraxella nonliquefaciens ( M. nonliquefaciens) is a low pathogenicity microorganism, which rarely causes ocular infections, unless there is a predisposing factor. The main clinical manifestation of M. nonliquefaciens ocular infections is endophthalmitis and only five cases of corneal infection have been reported. This work shows an update in M. nonliquefaciens corneal infections, and the first reported case of keratitis due to M. nonliquefaciens superinfecting herpes simplex infection.

Case report:

A 84-year old woman with worsening of her herpes simplex keratitis, diagnosed, and treated 2 days before. The slit lamp showed deep paracentral infiltrate and hypopyon. A corneal sample was collected for culture prior to initiation of empiric antibiotic therapy with vancomycin and ceftazidime fortified, oral acyclovir, and cyclopentolate. The strain was identified as M. nonliquefaciens and topical antibiotic therapy was adjusted to ciprofloxacin and ceftazidime. After 2 weeks, the epithelial defect and the infiltrate were resolved and prednisolone was added to the regimen. As the corneal oedema and neovascularization decreased, acyclovir, and prednisolone were slowly tapered. About 4 months later, the visual outcome was 20/50 and the ophthalmic examination showed a clear cornea with a paracentral leucoma.

Conclusion:

Keratitis due to M. nonliquefaciens is rare and should be suspected in patients with local predisposing factors such as corneal damage or previous corneal infection. Prompt and appropriate combined treatment for the predisposing lesions and the keratitis may improve the prognosis and avoid a more aggressive approach.
Impact of Public Health Insurance on Out-of-Pocket Health Expenditures of the Near-Poor in Vietnam
Authors: Duc Thanh Nguyen , Anh Bui Thi My , Thanh Hung Phung , Quynh Anh Pham , Huyen Xiem Chu
Published: May 2021

Out-of-pocket payment is one of the indicators measuring the achievement of Universal Health Coverage. According to the World Health Organization, for countries from the Asia Pacific Region, out-of-pocket payments should not exceed 30%-40% of total health expenditure. This study aimed to identify factors influencing out-of-pocket payment for the near-poor for outpatient healthcare services as well as across health facilities at different levels. The data of 1143 individuals using outpatient care were used for analysis. Healthcare payments were analyzed for those who sought outpatient care in the past 6 months. The Heckman selection model was used to control any bias resulting from self-selection of the insurance scheme. The finding revealed that health insurance reduces average out-of-pocket payments by about 21% ( P < .001). Using private health facilities incurred more out-of-pocket payments than public health facilities ( P < .001). The study suggested that health insurance for the near-poor should be modified to promote universal health coverage in Vietnam.
Vascular Endothelial Repair and the Influence of Circulating Antiplatelet Drugs in a Carotid Coil Model
Authors: Fukawa Norihito , Ueda Takahiro , Ogoshi Tomofumi , Kitazawa Yasuhide , Takahashi Jun
Published: May 2021

Background:

Clinicians may choose to administer antiplatelet medications to patients with cerebral aneurysms following endovascular coiling to prevent thrombus formation and vascular occlusion, if they fear a thrombus will form on the platinum wire where it diverges into the vessel from the aneurysm sac. However, the mechanism by which vascular endothelial cells repair a vessel in the living body in the event of a coil deviation and the effects of antiplatelet drugs on these cells have not been fully elucidated. We aimed to investigate the association between endothelial progenitor cells (EPCs) and endothelium formation at the surface of the platinum coils deployed in the carotid artery of rats, and to determine the effects of different antiplatelet drugs on this process.

Subjects and Methods:

We established an experimental model using normal and diabetic rats at 12 months of age. The diabetic rats were assigned to 4 different diet groups, distinguished by whether they were fed plain rat feed, or the same feed supplemented by 1 of 3 antiplatelet drugs (cilostazol, aspirin, or clopidogrel: all 0.1%) for 2 weeks, and the carotid artery was perforated by an embolization coil (“carotid coil model”). We monitored the process by which vascular endothelial cells formed the new endothelium on the surface of the coil by sampling and evaluating the region at 1, 2, and 4 weeks after placement. This repair process was also compared among 3 groups treated with different antiplatelet drugs (i.e. aspirin, clopidogrel, and cilostazol). One-way analysis of variance tests were performed to evaluate the differences in vascular thickness between groups, and P < .05 was considered statistically significant.

Results:

The diabetic rats showed delayed neoendothelialization and marked intimal hyperplasia. Cilostazol and clopidogrel effectively counteracted this delayed endothelial repair process. Flk1 immunostaining revealed greater expression in the diabetic rats administered cilostazol, second only to normal rats, suggesting that this agent acted to recruit EPCs.

Conclusion:

Neoendothelialization is delayed when vascular endothelial cells fail to function normally, which consequently leads to the formation of hyperplastic tissue. Cilostazol may remedy this dysfunction by recruiting EPCs to the site of injury.
Returns to Educational Attainment in Urban Ghana: The Role of Job-to-Job Transition
Authors: Otchia Christian S.
Published: May 2021

It is well established that additional educational attainment above lower secondary yields higher returns. We find that these returns are mediated by the job transitions, especially for individuals with vocational education. We then study whether the job-to-job transition explains the differences in the returns to educational attainment and find evidence of positive returns of the movement from employee to self-employed. We show that successful employee voluntary move to self-employment to maximize their earnings, while early spell of self-employment tends to have a lasting negative effect on earnings. Our analysis partially explains why self-employment is the top final destination for many workers in developing countries.
Rethinking Communal Land Governance in the Great Lakes Region of Central Africa
Authors: Claessens Klara , Bisoka Aymar Nyenyezi , Ansoms An
Published: May 2021

In the Great Lakes region of Central Africa, land-use rights underwent profound changes following processes of colonization, commodification and conflict, leading to an increased individualization and privatization of tenure. Despite these evolutions, customary tenure continues to be described as a common-property system managed through a strong hierarchical and tribute-based land allocation mechanism. This central place of the commons in policy discourses either stems from a romantic, often Western, notion on communal land governance or from a neoliberal privatization discourse that frames communal land governance as chaotic and non-productive. In this article, we will use cases from Eastern DRC, Burundi and Rwanda to demonstrate how communal land governance has always existed in the region, but in modalities that do not correspond to the notions found in policy discourses. These cases demonstrate how the memory and the actual practice of communal land governance continues to play a role in contemporary land access negotiations. Through a process of institutional bricolage, the discourse of the, often imaginary, commons is used by different actors to legitimize the restructuring of land claims in their favour. Hence, the commons do not correspond to an idealized or normative situation, but they are rather a starting point to rethink land governance in a contextualized socio-historical perspective.
Field Experiments for Testing Revenue Strategies in the Hospitality Industry
Authors: Lopez Mateos David , Cohen Maxime C. , Pyron Nancy
Published: May 2021

Field experimentation has been widely adopted as an optimization technique in product design and marketing in several industries. Companies have successfully used field experimentation to reduce costs, increase revenues, and maintain an edge in their customer experience in highly competitive environments. However, in certain quantitative applications, such as revenue management in hospitality, to the authors’ knowledge, there is little publicly documented work on experimentation, and its use remains the privilege of big corporate brands with a small market share. This article discusses the likely causes of the sparse adoption of field experimentation for revenue management in hospitality. It also outlines opportunities that field experimentation can bring to accommodation managers and describes specific types of experimental designs that can help exploit those opportunities. By explicitly addressing the complexities of revenue management, this article aims to start a conversation about experimentation in hospitality that should benefit the industry as a whole.
Challenging Bourdieu’s Theory: Dialogic Interaction as a Means to Provide Access to Highbrow Culture for All
Authors: Torras-Gómez Elisabeth , Ruiz-Eugenio Laura , Sordé-Martí Teresa , Duque Elena
Published: May 2021

According to Bourdieu, class position is related to cultural capital, taste, and preferences. Accordingly, the author states that, because of their “habitus,” those from high social classes have higher cultural capital and preferences for highbrow culture, which gives them more chances to succeed in life. On the contrary, those from low social classes have lower cultural capital because of their lowbrow cultural preferences, which makes it more difficult for them to achieve in a system that favors the dominant classes. Through the review of articles on Dialogic Literary Gatherings published in peer-reviewed journals, this article aims to provide more insights on how the principles of dialogic learning occur. The results of the review challenge Bourdieu’s concept of “habitus,” providing evidence of how socioeconomic status (SES) is not determinant to cultural capital.
The Impact of Rising Housing Rent on Residents’ Consumption and Its Underlying Mechanism: Empirical Evidence from China
Authors: Liu Guangping , Chang Xiayuan
Published: May 2021

Based on 465 panel data from 31 provinces, autonomous regions, and municipalities in China from 2001 to 2015 (data come from “China Statistical Yearbook”), static and dynamic panel models were established by Stata16.0 software to analyze the impact of housing rent on household consumption. In order to explore the specific impact of rising housing rents on residents’ consumption, and then adjust housing policies to stimulate consumer demand, this article analyses three research topics: (a) the impact of rising housing rent on the overall consumption level of residents and whether there are regional differences; (b) the internal mechanism underlying the effect of rising housing rent on residents’ consumption; and (c) the different impacts of rising housing rent on different types of residents’ consumption by establishing fixed-effects and random-effects models. The results show that a rise in housing rent causes a wealth effect on residents’ consumption at the national level in all regions. The upgrading of the industrial structure plays a positive role in the relationship between the fluctuation in housing rent and residents’ consumption, that is, the more rational the industrial structure, the stronger the wealth effect of rising housing rent on residents’ consumption. The rise in housing rent positively affects residents’ daily necessities and services consumption; transportation and telecommunication consumption; education, culture, and entertainment consumption; and habitation consumption; while negatively affects food, tobacco, and alcohol consumption; clothing consumption; and other supplies and services consumption. However, the impact on health care consumption is not significant. Accordingly, the government should start by improving the housing rental market and reasonably promote the further development of the housing rental market, thereby further stimulating Chinese consumption level.
Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome
Authors: Correia P , Machado S , Meyer I , Amiguet M , Eskandari A , Michel P
Published: May 2021

Introduction

Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users.

Patients and methods

Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis.

Results

Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all.

Conclusion

Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.
Stroke in women: Is it different?
Authors: Corbière Sydney , Tettenborn Barbara
Published: May 2021

In the last decades, there has been great progress in the field of stroke. With the introduction of acute therapies (intravenous thrombolysis and intra-arterial treatment), the outcome after stroke has improved significantly. Better prevention, improved acute therapy, and acute rehabilitation improved the morbidity and mortality rate after stroke. Gender differences in risk factors and epidemiology have been known for a long time, but lately attention to gender differences in stroke has increased. The aim of this mini-review is to demonstrate gender disparities in stroke with a focus on epidemiology, specific risk factors (gender-specific and unspecific), and outcomes. The influence of some risk factors for stroke is stronger in women (atrial fibrillation and hypertension) and there are risk factors exclusive to women such as pregnancy, pregnancy-associated hypertensive disorders, oral contraceptives, and hormonal replacement treatment. Data on the impact of other risk factors are inconsistent. The worse outcome after a stroke is mainly caused by demographic characteristics in women. Specific gender research is needed to better understand gender disparities in stroke to improve prevention strategies and treatment for women.
Nonhuman glycans can regulate anti–factor VIII antibody formation in mice
Authors: Arthur Connie M. , Zerra Patricia E. , Shin Sooncheon , Wang Jianmei , Song Xeuzheng , Doering Christopher B. , Lollar Pete , Meeks Shannon , Stowell Sean R.
Published: May 2021

Recombinant factor VIII (FVIII) products represent a life-saving intervention for patients with hemophilia A. However, patients can develop antibodies against FVIII that prevent its function and directly increase morbidity and mortality. The development of anti-FVIII antibodies varies depending on the type of recombinant product used, with previous studies suggesting that second-generation baby hamster kidney (BHK)-derived FVIII products display greater immunogenicity than do third-generation Chinese hamster ovary (CHO)-derived FVIII products. However, the underlying mechanisms responsible for these differences remain incompletely understood. Our results demonstrate that BHK cells express higher levels of the nonhuman carbohydrate α1-3 galactose (αGal) than do CHO cells, suggesting that αGal incorporation onto FVIII may result in anti-αGal antibody recognition that could positively influence the development of anti-FVIII antibodies. Consistent with this, BHK-derived FVIII exhibits increased levels of αGal, which corresponds to increased reactivity with anti-αGal antibodies. Infusion of BHK-derived, but not CHO-derived, FVIII into αGal–knockout mice, which spontaneously generate anti-αGal antibodies, results in significantly higher anti-FVIII antibody formation, suggesting that the increased levels of αGal on BHK-derived FVIII can influence immunogenicity. These results suggest that posttranslational modifications of recombinant FVIII products with nonhuman carbohydrates may influence the development of anti-FVIII antibodies.
The clinical and functional effects of TERT variants in myelodysplastic syndrome
Authors: Reilly Christopher R. , Myllymäki Mikko , Redd Robert , Padmanaban Shilpa , Karunakaran Druha , Tesmer Valerie , Tsai Frederick D. , Gibson Christopher J. , Rana Huma Q. , Zhong Liang , Saber Wael , Spellman Stephen R. , Hu Zhen-Huan , Orr Esther H. , Chen Maxine M. , De Vivo Immaculata , DeAngelo Daniel J. , Cutler Corey , Antin Joseph H. , Neuberg Donna , Garber Judy E. , Nandakumar Jayakrishnan , Agarwal Suneet , Lindsley R. Coleman
Published: May 2021

Germline pathogenic TERT variants are associated with short telomeres and an increased risk of developing myelodysplastic syndrome (MDS) among patients with a telomere biology disorder. We identified TERT rare variants in 41 of 1514 MDS patients (2.7%) without a clinical diagnosis of a telomere biology disorder who underwent allogeneic transplantation. Patients with a TERT rare variant had shorter telomere length (P < .001) and younger age at MDS diagnosis (52 vs 59 years, P = .03) than patients without a TERT rare variant. In multivariable models, TERT rare variants were associated with inferior overall survival (P = .034) driven by an increased incidence of nonrelapse mortality (NRM; P = .015). Death from a noninfectious pulmonary cause was more frequent among patients with a TERT rare variant. Most variants were missense substitutions and classified as variants of unknown significance. Therefore, we cloned all rare missense variants and quantified their impact on telomere elongation in a cell-based assay. We found that 90% of TERT rare variants had severe or intermediate impairment in their capacity to elongate telomeres. Using a homology model of human TERT bound to the shelterin protein TPP1, we inferred that TERT rare variants disrupt domain-specific functions, including catalysis, protein–RNA interactions, and recruitment to telomeres. Our results indicate that the contribution of TERT rare variants to MDS pathogenesis and NRM risk is underrecognized. Routine screening for TERT rare variants in MDS patients regardless of age or clinical suspicion may identify clinically inapparent telomere biology disorders and improve transplant outcomes through risk-adapted approaches.
Genetic mapping of metabolic traits in the blind Mexican cavefish reveals sex-dependent quantitative trait loci associated with cave adaptation
Authors: Riddle Misty R. , Aspiras Ariel , Damen Fleur , McGaugh Suzanne , Tabin Julius A. , Tabin Clifford J.
Published: May 2021

Background

Despite a longstanding interest in understanding how animals adapt to environments with limited nutrients, we have incomplete knowledge of the genetic basis of metabolic evolution. The Mexican tetra,Astyanax mexicanus, is a species of fish that consists of two morphotypes; eyeless cavefish that have adapted to a low-nutrient cave environment, and ancestral river-dwelling surface fish with abundant access to nutrients. Cavefish have evolved altered blood sugar regulation, starvation tolerance, increased fat accumulation, and superior body condition. To investigate the genetic basis of cavefish metabolic evolution we carried out a quantitative trait loci (QTL) analysis in surface/cave F2 hybrids. We genetically mapped seven metabolism-associated traits in hybrids that were challenged with a nutrient restricted diet.

Results

We found that female F2 hybrids are bigger than males and have a longer hindgut, bigger liver, and heavier gonad, even after correcting for fish size. Although there is no difference between male and female blood sugar level, we found that high blood sugar is associated with weight gain in females and lower body weight and fat level in males. We identified a significant QTL associated with 24-h-fasting blood glucose level with the same effect in males and females. Differently, we identified sex-independent and sex-dependent QTL associated with fish length, body condition, liver size, hindgut length, and gonad weight. We found that some of the genes within the metabolism QTL display evidence of non-neutral evolution and are likely to be under selection. Furthermore, we report predicted nonsynonymous changes to the cavefish coding sequence of these genes.

Conclusions

Our study reveals previously unappreciated genomic regions associated with blood glucose regulation, body condition, gonad size, and internal organ morphology. In addition, we find an interaction between sex and metabolism-related traits inA. mexicanus.We reveal coding changes in genes that are likely under selection in the low-nutrient cave environment, leading to a better understanding of the genetic basis of metabolic evolution.
IDA (INFLORESCENCE DEFICIENT IN ABSCISSION)-like peptides and HAE (HAESA)-like receptors regulate corolla abscission in Nicotiana benthamiana flowers
Authors: Ventimilla Daniel , Velázquez Karelia , Ruiz-Ruiz Susana , Terol Javier , Pérez-Amador Miguel A. , Vives Mª. Carmen , Guerri José , Talon Manuel , Tadeo Francisco R.
Published: May 2021

Background

Abscission is an active, organized, and highly coordinated cell separation process enabling the detachment of aerial organs through the modification of cell-to-cell adhesion and breakdown of cell walls at specific sites on the plant body known as abscission zones. In Arabidopsis thaliana, abscission of floral organs and cauline leaves is regulated by the interaction of the hormonal peptide INFLORESCENCE DEFICIENT IN ABSCISSION (IDA), a pair of redundant receptor-like protein kinases, HAESA (HAE) and HAESA-LIKE2 (HSL2), and SOMATIC EMBRYOGENESIS RECEPTOR-LIKE KINASE (SERK) co-receptors. However, the functionality of this abscission signaling module has not yet been demonstrated in other plant species.

Results

The expression of the pair of NbenIDA1 homeologs and the receptor NbenHAE.1 was supressed at the base of the corolla tube by the inoculation of two virus-induced gene silencing (VIGS) constructs in Nicotiana benthamiana. These gene suppression events arrested corolla abscission but did not produce any obvious effect on plant growth. VIGS plants retained a higher number of corollas attached to the flowers than control plants, an observation related to a greater corolla breakstrength. The arrest of corolla abscission was associated with the preservation of the parenchyma tissue at the base of the corolla tube that, in contrast, was virtually collapsed in normal corollas. In contrast, the inoculation of a viral vector construct that increased the expression of NbenIDA1A at the base of the corolla tube negatively affected the growth of the inoculated plants accelerating the timing of both corolla senescence and abscission. However, the heterologous ectopic overexpression of citrus CitIDA3 and Arabidopsis AtIDA in N. benthamiana did not alter the standard plant phenotype suggesting that the proteolytic processing machinery was unable to yield active peptides.

Conclusion

Here, we demonstrate that the pair of NbenIDA1 homeologs encoding small peptides of the IDA-like family and the receptor NbenHAE.1 control cellular breakdown at the base of the corolla tube awhere an adventitious AZ should be formed and, therefore, corolla abscission in N. benthamiana flowers. Altogether, our results provide the first evidence supporting the notion that the IDA-HAE/HSL2 signaling module is conserved in angiosperms.
Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial
Authors: Liu Xia , Zhang Peng , Liu Meng Xue , Ma Jun Li , Wei Xin Chuan , Fan Dan
Published: May 2021

Background

The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.

Methods

This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded.

Results

Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml;p < 0.001) and produced significantly less urine output (200 ml [150–300] vs 400 ml [290–500];p < 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h;p = 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h;p = 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients;p = 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p > 0.05).

Conclusions

Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications.

Trial registration

ChiCTR,ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered.
A comparative assessment of two tools designed to support patient safety culture in UK general practice
Authors: Litchfield Ian , Marsden Kate , Doos Lucy , Perryman Katherine , Avery Anthony , Greenfield Sheila
Published: May 2021

Background

The NHS has recognised the importance of a high quality patient safety culture in the delivery of primary health care in the rapidly evolving environment of general practice. Two tools, PC-SafeQuest and MapSaf, were developed with the intention of assessing and improving patient safety culture in this setting. Both have been made widely available through their inclusion in the Royal College of General Practitioners’ Patient Safety Toolkit and our work offerss a timely exploration of the tools to inform practice staff as to how each might be usefully applied and in which circumstances. Here we present a comparative analysis of their content, and describe the perspectives of staff on their design, outputs and the feasibility of their sustained use.

Methods

We have used a content analysis to provide the context for the qualitative study of staff experiences of using the tools at a representative range of practices recruited from across the Midlands (UK). Data was collected through moderated focus groups using an identical topic guide.

Results

A total of nine practices used the PC-SafeQuest tool and four the MapSaf tool. A total of 159 staff completed the PC-SafeQuest tool 52 of whom took part in the subsequent focus group discussions, and 25 staff completed the MapSaf tool all of whom contributed to the focus group discussions. PC-SafeQuest was perceived as quick and easy to use with direct questions pertinent to the work of GP practices providing useful quantitative insight into important areas of safety culture. Though MaPSaF was more logistically challenging, it created a forum for synchronous cross- practice discussions raising awareness of perceptions of safety culture across the practice team.

Conclusions

Both tools were able to promote reflective and reflexive practice either in individual staff members or across the broader practice team and the oversight they granted provided useful direction for senior staff looking to improve patient safety. Because PC SafeQuest can be easily disseminated and independently completed it is logistically suited to larger practice organisations, whereas the MapSaf tool lends itself to smaller practices where assembling staff in a single workshop is more readily achieved.
Genetic diversity analysis of Chinese Leishmania isolates and development of L. donovani complex-specific markers by RAPD
Authors: Yuan Dongmei , Qin Hanxiao , Chen Dali , Chen Jianping
Published: May 2021

Background

Leishmaniasis is one of the most neglected tropical diseases in the world and remains endemic in some underdeveloped regions, including western China. The phylogeny and classification of Chinese Leishmania has not been completely clarified to date, especially within the Leishmania (L.) donovani complex, although phylogenetic analyses based on a series of gene markers have been performed. More analytic methods and data are still needed. Random amplified polymorphic DNA (RAPD) technology can sensitively identify slight intraspecific differences, and it is a powerful tool to seek species-specific markers. This work attempted to identify Chinese Leishmania isolates from diverse geographic regions at the genomic level. Meanwhile, specific markers of the L. donovani complex were also developed by RAPD.

Methods

RAPD was applied to 14 Chinese Leishmania isolates from diverse geographic regions and 3 WHO reference strains. The polymorphic sites of amplification were transformed into a data matrix, based on which genetic similarity was calculated, and a UPGMA dendrogram was constructed to analyse the genetic diversity of these Leishmania isolates. Meanwhile, the specific amplification loci of the L. donovani complex were TA-cloned, sequenced and converted into sequence characterized amplified region (SCAR) markers, which were validated preliminarily in 17 available Leishmania strains in this study and analysed by bioinformatics.

Results

The cluster analyses showed that the three Leishmania sp. isolates SC10H2, SD and GL clustered together and apart from others, the strains of the L. donovani complex clearly divided into two clades, and the three isolates Cy, WenChuan and 801 formed a subclade. Three specific SCAR markers of the L. donovani complex, i.e., 1-AD17, 2-A816 and 3-O13, were successfully obtained and validated on 17 available Leishmania strains in this study. Through bioinformatic analyses, Marker 1-AD17 may have more specificity for PCR detection of VL, and Marker 3-O13 has the potential to encode a protein.

Conclusions

The RAPD results verified that the undescribed Leishmania species causing visceral leishmaniasis (VL) in China was a unique clade distinguished from L. donovani and revealed that there was genetic differentiation among Chinese L. donovani. The identification of L. donovani-specific markers may help to provide a foundation for future research attempting to develop new specific diagnostic markers of VL and identify specific gene functions.
“What do you think about nephrology?” A national survey of internal medicine residents
Authors: Nakhoul Georges N. , Mehdi Ali , Taliercio Jonathan J. , Arrigain Susana , Schold Jesse D. , Spencer Abby , Greenfield Jessica , Diwakar Amit , Snyder Grace , O’Toole John , Nally Joseph V. , Sedor John R. , Kao Patricia F. , Bierer S. Beth
Published: May 2021

Background

Interest in nephrology has been declining among internal medicine residents but the reasons behind this observation are not well characterized. Our objective was to evaluate factors influencing residents’ choice of subspecialty.

Methods

This is a mixed-method QUAL-QUAN design study that used the results of our previously published qualitative analysis on residents’ perception of nephrology to create and pilot a questionnaire of 60 questions. The final questionnaire was distributed to 26 programs across the United States and a total of 1992 residents. We calculated response rates and tabulated participant characteristics and percentage of participant responses. We categorized choice of fellowship into 2 medical categories (Highly Sought After vs. Less Sought After) and fitted a logistic regression model of choosing a highly vs. less sought after fellowship.

Results

Four hundred fifteen out of 1992 (21%) US residents responded to the survey. Of the 268 residents planning to pursue fellowship training, 67 (25%) selected a less sought after fellowship. Female sex was associated with significantly higher odds of selecting a less sought after fellowship (OR = 2.64, 95% CI: 1.47, 4.74). Major factors deterring residents from pursuing nephrology were perception of inadequate financial compensation, broad scope of clinical practice and complexity of patient population. We observed a decline in exposure to nephrology during the clinical years of medical school with only 35.4% of respondents rotating in nephrology versus 76.8% in residency. The quality of nephrology education was rated less positively during clinical medical school years (median of 50 on a 0–100 point scale) compared to the pre-clinical years (median 60) and residency (median 75).

Conclusion

Our study attempts to explain the declining interest in nephrology. Results suggest potential targets for improvement: diversified trainee exposure, sub-specialization of nephrology, and increased involvement of nephrologists in the education of trainees.
Seven-year retrospective study understanding the latent TB infection treatment cascade of care among adults in a low incidence country
Authors: Sullivan K. , Pease C. , Zwerling A. , Mallick R. , Van Dyk D. , Mulpuru S. , Allen C. , Alsdurf H. , Alvarez G. G.
Published: May 2021

Background

Prevention of TB is paramount to achieving elimination targets as recommended by the World Health Organization’s action framework for low incidence countries striving to eliminate TB. Although the rates of TB in Canada are low, understanding the latent TB infection (LTBI) cascade is paramount to identifying gaps in care and treatment barriers, thereby increasing the effectiveness of preventive strategies. The purpose of this study was to examine the LTBI cascade of care and identify barriers to treatment completion in adults referred from primary care to a regional tertiary care TB clinic in Ottawa, Canada.

Methods

Electronic medical records between January 2010 and December 2016 were reviewed retrospectively and an LTBI cascade of care was constructed from The Ottawa Hospital TB clinic and surrounding primary care clinics. A cohort of 2207 patients with untreated LTBI was used to ascertain the associations between demographic and clinical factors for both treatment non-initiation and non-completion using log-binomial univariable and multivariable regression models.

Results

Of 2207 patients with untreated LTBI who were seen in the clinic during the study period, 1771 (80.2%) were offered treatment, 1203 (67.9% of those offered) started treatment, and 795 (66.1% of those started) completed treatment. In multivariable analysis, non-initiation of treatment was associated with older age (adjusted risk ratio [aRR] 1.06 per 5-year increase, 95% CI: 1.03–1.08) and female gender (aRR 1.28, 95% CI: 1.11–1.47). Non completion of treatment was associated with referral from the TB Clinic back to the primary care team following initial consult (aRR 1.62, 95% CI: 1.35–1.94) and treatment with the standard of 9 months of Isoniazid (9H) compared to 4 months of Rifampin (4R) (aRR 1.45, 95% CI:1.20–1.74).

Conclusions

LTBI treatment completion was significantly decreased among patients who were referred back to primary care from the TB clinic. The 4R regimen resulted in more people completing LTBI treatment compared to 9H in keeping with a recently published RCT. Improved education, communication, and collaboration between tertiary care TB clinics and primary care teams may improve treatment completion rates and address the TB burden in low incidence communities in Canada.
Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States
Authors: Liu Xiaoshuang , Xu Xiao , Li Guanqiao , Xu Xian , Sun Yuyao , Wang Fei , Shi Xuanling , Li Xiang , Xie Guotong , Zhang Linqi
Published: May 2021

Background

The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs), such as non-essential business closures and gathering bans, to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is greatly needed to assist in guiding individualized decision making for adjustment of interventions in the US and around the world. However, the impacts of these approaches remain uncertain.

Methods

Based on the reported cases, the effective reproduction number (Rt) of COVID-19 epidemic for 50 states in the US was estimated. Measurements on the effectiveness of nine different NPIs were conducted by assessing risk ratios (RRs) between Rt and NPIs through a generalized linear model (GLM).

Results

Different NPIs were found to have led to different levels of reduction in Rt. Stay-at-home contributed approximately 51% (95% CI 46–57%), wearing (face) masks 29% (15–42%), gathering ban (more than 10 people) 19% (14–24%), non-essential business closure 16% (10–21%), declaration of emergency 13% (8–17%), interstate travel restriction 11% (5–16%), school closure 10% (7–14%), initial business closure 10% (6–14%), and gathering ban (more than 50 people) 7% (2–11%).

Conclusions

This retrospective assessment of NPIs on Rt has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases.
Real time surveillance of COVID-19 space and time clusters during the summer 2020 in Spain
Authors: Rosillo Nicolás , Del-Águila-Mejía Javier , Rojas-Benedicto Ayelén , Guerrero-Vadillo María , Peñuelas Marina , Mazagatos Clara , Segú-Tell Jordi , Ramis Rebeca , Gómez-Barroso Diana
Published: May 2021

Background

On June 21st de-escalation measures and state-of-alarm ended in Spain after the COVID-19 first wave. New surveillance and control strategy was set up to detect emerging outbreaks.

Aim

To detect and describe the evolution of COVID-19 clusters and cases during the 2020 summer in Spain.

Methods

A near-real time surveillance system to detect active clusters of COVID-19 was developed based on Kulldorf’s prospective space-time scan statistic (STSS) to detect daily emerging active clusters.

Results

Analyses were performed daily during the summer 2020 (June 21st – August 31st) in Spain, showing an increase of active clusters and municipalities affected. Spread happened in the study period from a few, low-cases, regional-located clusters in June to a nationwide distribution of bigger clusters encompassing a higher average number of municipalities and total cases by end-August.

Conclusion

STSS-based surveillance of COVID-19 can be of utility in a low-incidence scenario to help tackle emerging outbreaks that could potentially drive a widespread transmission. If that happens, spatial trends and disease distribution can be followed with this method. Finally, cluster aggregation in space and time, as observed in our results, could suggest the occurrence of community transmission.
Selection of the fusion and fixation range in the intervertebral surgery to correct thoracolumbar and lumbar tuberculosis: a retrospective clinical study
Authors: Yang Zongqiang , Liu Changhao , Niu Ningkui , Tang Jing , Shi Jiandang , Wang Zili , Ding Huiqiang
Published: May 2021

Background

To compare the diseased verses the non-diseased intervertebral surgery used in the treatment of thoracolumbar and lumbar spinal tuberculosis and to explore the best choice of fusion of fixation range.

Methods

Two hundred twenty-one patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. One hundred eighteen patients underwent the diseased intervertebral surgery (lesion vertebral pedicle fixation, Group A) and 103 patients underwent the non-diseased intervertebral surgery (1 or 2 vertebral fixation above and below the affected vertebra, group B). Spinal tuberculosis diagnosis was confirmed in both groups of patients before lesion removal, bone graft fusion, and internal fixation. Clinical data and efficacy of the two surgical methods were then evaluated.

Results

The mean follow-up duration for both procedures was 65 months (50–68 months range). There were no significant differences in laboratory examinations, VAS scores, and the Cobb angle correction rate and the angle loss. However, significant differences existed in the operation time, blood loss, serosanguineous drainage volume, and blood transfusion requirement between the two groups. The diseased intervertebral surgery group performed significantly better than the non-diseased intervertebral surgery group in all of these areas. In both cases, the bone graft fused completely with the normal bone by the last follow-up, occuring at 50–86 months post surgery.

Conclusion

The diseased intervertebral surgery is a safe and feasible option for the treatment of thoracolumbar and lumbar tuberculosis. It effectively restores the physiological curvature of the spine and reduces the degeneration of adjacent vertebral bodies in the spinal column.