bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood in Biafra: Re‐evaluating politics and ethnocultural conflict in the Nigerian‐Biafran War
Authors: Otiono Kikachukwu (Kika)
Published: May 2021

In 1967, just ​seven years after declaring independence from British colonization, a civil war erupted in Nigeria that left millions of civilians dead and the country known as the “Giant of Africa” fractured and reeling. In the decades since the conflict, historians delineated the causes and consequences of what became known as the Nigerian‐Biafran War. The aim of this paper is to examine historical and academic sources about the years leading up to the war in 1967, towards a nuanced understanding of a watershed moment in Nigerian history. The article contends that for Nigeria to progress towards political stability and economic prosperity in the twenty‐first century, the Nigerian‐Biafran War must be re‐imagined as a predictable aftermath of hegemonic colonialism and ethnicism. As such, this paper contributes to the emerging literature on the impact of the civil war on collective grief, ethnocultural relations, economics, and post‐colonial history.
Prediction of future cardiovascular events by Framingham, SCORE and asCVD risk scores is less accurate in HIV‐positive individuals from the HIV‐HEART Study compared with the general population
Authors: Schulz C‐A , Mavarani L , Reinsch N , Albayrak‐Rena S , Potthoff A , Brockmeyer N , Hower M , Erbel R , Jöckel K‐H , Schmidt B , Esser S ,   HIV HEART Aging Study Group and Heinz Nixdorf Recall Investigative Group
Published: May 2021

Objectives

Cardiovascular diseases (CVDs) occur more often in people living with HIV (PLWH) than in the general population. It has been reported that CVD risk scores developed for the general population underestimate the CVD risk in PLWH. Performances of the Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation (SCORE) and the atherosclerotic cardiovascular disease (asCVD) risk score in PLWH were compared with the general population to quantify score‐specific differences in risk prediction.

Methods

HIV‐positive outpatients from the HIV‐HEART (HIVH) study (n = 567) were compared with participants from the population‐based Heinz Nixdorf Recall (HNR) study (n ~ 4440) both recruited from the German Ruhr area. During a follow‐up time of around 5 years, the associations between the FRS and incident CVD and peripheral artery disease (CVD_pAD), SCORE and coronary heart disease (CHD), and asCVD and incident CVD were examined using logistic regression. Score performances were assessed by comparing the areas under the curve (AUCs).

Results

The mean ages were 52.9 ± 6.7 and 59.1 ± 7.7 years in the HIVH and HNR studies, respectively. There were fewer incident CVD events in the HNR study than in the HIVH study (CVD_pAD: 3.9% vs. 12.1%; CHD: 2.1% vs. 7.8%; CVD: 3.5% vs. 9.9%). Age‐ and sex‐adjusted CVD risk was greater with increasing FRS, SCORE and asCVD in both cohorts, but the scores performed more accurately in the HNR than in HIVH study (AUCs FRS: 0.71 vs. 0.65; SCORE: 0.70 vs. 0.62; asCVD: 0.74 vs. 0.62).

Conclusions

Associations between risk scores and future CVD were observed in both cohorts, but the score performances were less reliable in PLWH than in the general population.
Comparison of pembrolizumab with conventional chemotherapy after first‐line platinum‐based chemotherapy for advanced urothelial carcinoma in real‐world practice: A multicenter retrospective study
Authors: Narita Takuma , Hatakeyama Shingo , Numakura Kazuyuki , Kobayashi Mizuki , Muto Yumina , Saito Mitsuru , Narita Shintaro , Tanaka Toshikazu , Noro Daisuke , Tokui Noriko , Yoneyama Takahiro , Hashimoto Yasuhiro , Habuchi Tomonori , Ohyama Chikara
Published: May 2021

Objectives

To assess the clinical benefit of pembrolizumab as second‐line therapy for advanced urothelial carcinoma.

Methods

We retrospectively compared the effects of pembrolizumab with those of conventional chemotherapy on the prognosis of patients with advanced urothelial carcinoma at six hospitals between January 2004 and August 2020. We compared the oncological outcomes between the patients treated with pembrolizumab and those treated with conventional chemotherapy using Kaplan–Meier curve analysis and multivariate Cox regression analysis with the inverse probability of treatment weighting method.

Results

The numbers of patients in the pembrolizumab and chemotherapy groups were 121 and 67, respectively. Patients in the pembrolizumab group were significantly older (median 72 vs 66 years, P = 0.001), and had poor Eastern Cooperative Oncology Group performance status (median 1 vs 0, P = 0.001). The unadjusted Kaplan–Meier curve analysis showed no significant differences in the median overall survival from the first‐line chemotherapy (24.7 months vs 16.3 months, P = 0.159). Inverse probability of treatment weighting‐adjusted multivariate Cox proportional hazards analyses showed a significant difference between the pembrolizumab and chemotherapy groups in overall survival (P = 0.003, hazard ratio 0.63).

Conclusions

Despite the non‐negligible age difference between the trial and our clinical practice, our study supports the benefit of second‐line pembrolizumab over chemotherapy in real‐world practice.
Nunca Más
Authors: Mong Ambrose
Published: May 2021

This article highlights efforts to promote peace and reconciliation in Guatemala. One of the reconcilers has been Rigoberta Menchú, receiver of the Nobel Peace Prize in 1992. The clergy and laity of the Roman Catholic Church have worked to ensure that the atrocities and violence the people suffered in the past would not happen again – nunca más (never again). The murder of Bishop Juan José Gerardi reveals not only the crimes of the military, but also the resolute commitment of the church in the process toward peace, reconciliation, and the healing of the nation.
Admission respiratory status predicts mortality in COVID‐19
Authors: Chatterjee Neal A. , Jensen Paul N. , Harris Andrew W. , Nguyen Daniel D. , Huang Henry D. , Cheng Richard K. , Savla Jainy J. , Larsen Timothy R. , Gomez Joanne Michelle D. , Du‐Fay‐de‐Lavallaz Jeanne M. , Lemaitre Rozenn N. , McKnight Barbara , Gharib Sina A. , Sotoodehnia Nona
Published: May 2021

COVID‐19 has significant case fatality. Glucocorticoids are the only treatment shown to improve survival, but only among patients requiring supplemental oxygen. WHO advises patients to seek medical care for “trouble breathing,” but hypoxemic patients frequently have no respiratory symptoms. Our cohort study of hospitalized COVID‐19 patients shows that respiratory symptoms are uncommon and not associated with mortality. By contrast, objective signs of respiratory compromise—oxygen saturation and respiratory rate—are associated with markedly elevated mortality. Our findings support expanding guidelines to include at‐home assessment of oxygen saturation and respiratory rate in order to expedite life‐saving treatments patients to high‐risk COVID‐19 patients.
Study of the formation of acid‐based geopolymer networks and their resistance to water by time/temperature treatments
Authors: Jouin Jenny , Celerier Helene , Ouamara Lila , Tessier‐Doyen Nicolas , Rossignol Sylvie
Published: May 2021

Acid‐based geopolymers are known for their high temperature resistance and good mechanical performances. Some compositions also exhibit water resistance, which make them suitable for outdoor applications. This work aims to understand accurately the steps occurring during the geopolymerization process and focuses on the type of networks forming at early stages of the reaction. The sample, prepared from metakaolin and phosphoric acid, has been analyzed at different durations and temperatures during its solidification, in order to identify which compounds would crystallize. The structural characterizations have been performed using Fourier transform infrared spectroscopy and X‐ray diffraction. Several Al–O–P compounds and especially AlPO4 polymorphs crystallize in these conditions. They belong to three families of aluminophosphates and are a reliable indication of the amorphous organization of the original sample. The first one is similar to the phases that appear in the phase transition sequences of silica, the second one is composed of AlPO4‐based zeolites, and the last one is characterized by the presence of aluminum in an octahedral network. The transitions between the different phases are also discussed. Finally, the water resistance of the calcined samples is improved, and the release of acidic species in the water is limited even after a calcination at low temperature.
(BaTiO3)1‐x + (Co0.5Ni0.5Nb0.06Fe1.94O4)x nanocomposites: Structure, morphology, magnetic and dielectric properties
Authors: Slimani Yassine , Shirsath Sagar E. , Hannachi Essia , Almessiere Munirah A. , Aouna Moustafa M. , Aldossary Nouf E. , Yasin Ghulam , Baykal Abdulhadi , Ozçelik Bekir , Ercan Ismail
Published: May 2021

Two phase‐based nanocomposites consisting of dielectric barium titanate (BaTiO3 or BTO) and magnetic spinel ferrite Co0.5Ni0.5Nb0.06Fe1.94O4 (CNNFO) have been synthesized through solid state route. Series of (BaTiO3)1‐x + (Co0.5Ni0.5Nb0.06Fe1.94O4)x nanocomposites with x content of 0.00, 0.25, 0.50, 0.75, and 1.00 were considered. The structure has been examined via X‐rays diffraction (XRD) and indicated the occurrence of both perovskite BTO and spinel CNNFO phases in various nanocomposites. A phase transition from tetragonal BTO structure to cubic structure occurs with inclusion of CNNFO phase. The average crystallites size of BTO phase decreases, whereas that for the CNNFO phase increases with increasing x in various nanocomposites. The morphological observations revealed that the porosity is highly reduced, and the connectivity between grains is enhanced with increasing x content. The optical properties have been investigated by UV−vis diffuse reflectance spectroscopy. The deduced band gap energy (Eg) value is found to reduce with increasing the content of spinel ferrite phase. The magnetic as well as the dielectric properties were also investigated. The analysis showed that CNNFO ferrite phase greatly affects the magnetic properties and dielectric response of BTO material. The obtained findings can be useful to enhance the performances of magneto‐dielectric composite‐based systems.
Unplanned readmission for older persons: A concept analysis
Authors: Coatsworth‐Puspoky Robin , Duggleby Wendy , Dahlke Sherry , Hunter Kathleen
Published: May 2021

Aim

The purpose of this concept analysis is to define and analyse the concept of unplanned readmission to hospital for older persons.

Design

Review the literature and analyse the concept of unplanned readmission.

Method

Guided by Walker and Avant's eight‐stage method of concept analysis, four databases (Ovid MEDLINE, Scopus, CINAHL, and Embase) were searched between 1946 and 2020 for empirical studies focused on older persons with multiple chronic conditions, experiences or perspectives and unplanned readmission. A total of 34 articles (10 quantitative, 17 qualitative, three mixed methods), one concept analysis and three historical articles were included.

Results

An unplanned readmission is an experience, process and event. The proposed definition of unplanned readmission is an older person's need for acute care treatment for an urgent or emergent health crisis that has occurred after a previous hospitalization(s). Unplanned readmission is characterized by the attributes of older persons’ previous hospitalization(s), the urgent or emergent nature of the older persons’ health and the older persons’ need for acute care hospital services to resolve their health crisis.

Conclusion

Unplanned readmission is a complex concept that is different from planned and emergency visits/admissions and readiness for discharge. These findings provide a link for understanding unplanned readmission as a consequence of discharge readiness. Analysing this concept supports the need for older persons to seek unplanned readmission for acute care treatment of urgent and emergent health crisis, reduces the blame that older persons may feel from questions related to preventability, and stresses the need to include older persons’ experiences in the development and expansion of nursing theory, interventions and current understandings of unplanned readmission.
Association of urinary vanin‐1 with kidney function decline in hypertensive patients
Authors: Hosohata Keiko , Matsuoka Hiroyuki , Kumagai Etsuko
Published: May 2021

Previously, the authors reported the utility of urinary vanin‐1 as an early biomarker of kidney injury in spontaneously hypertensive rats and in humans. However, little is known about whether urinary vanin‐1 can be used to predict the clinical outcome. This study aimed to evaluate the predictive power of urinary vanin‐1 based on kidney function decline in hypertensive patients. The authors measured urinary vanin‐1 in 147 patients at the baseline and examined its association with the incidence of ≥20% decline in the estimated glomerular filtration rate (eGFR) using the Cox regression analysis. The mean age of the patients averaged 72.9 ± 8.2 years, and 39% were women. Median (interquartile range) urinary vanin‐1 was 0.33 (0–2.6) ng/mg Cr During a median follow‐up of 12 months, 14 patients showed kidney function decline. A higher urinary vanin‐1 level was associated with an increased risk of kidney function decline (hazard ratio, 9.87; 95% CI, 1.11–87.5) (p = .04) in the fully adjusted model. In conclusion, urinary vanin‐1 is an independent risk factor for kidney function decline in hypertensive patients and it could be useful in clinical settings. The underlying pathophysiologic mechanisms warrant additional investigation.
Cigarette smoking status alters dysbiotic gut microbes in hypertensive patients
Authors: Wang Pan , Dong Ying , Jiao Jie , Zuo Kun , Han Chunming , Zhao Lei , Ding Shu , Yang Xinchun , Chen Mulei , Li Jing
Published: May 2021

Smoking not only is one of the most important risk factors of hypertension (HTN), but also alters the composition of gut microbiota (GM) in previous studies. Although dysbiosis of GM has been implicated in HTN, how GM alters in patients with HTN under smoking status is still not clear. This study aimed to explore the difference in intestinal microflora among smokers with HTN (S‐HTN), nonsmokers with HTN (NS‐HTN), and smokers without HTN (S‐CTR) and identify whether cigarette smoking led to disordered intestinal microbiota in patients with HTN. Metagenomic sequencing analysis of fecal specimens was conducted in nonsmokers without HTN (NS‐CTR, n = 9), S‐CTR (n = 9), NS‐HTN (n = 18), and S‐HTN (n = 23). Compared with S‐CTR or NS‐HTN, the GM in S‐HTN was disordered, with lower microbial α‐diversity and significant difference of β‐diversity on axes as compared to S‐CTR at genus and species level. The microbial enterotype in S‐HTN was inclined to Prevotella‐dominant type. Dramatic changes in the intestinal genera and species composition were observed in S‐HTN, including reduced enrichment of Phycisphaera and Clostridium asparagiforme. Moreover, the intestinal function altered in S‐HTN. Therefore, the findings of the present study revealed GM disorders in S‐HTN and clarified the role of smoking in impairing the intestinal microbiome in HTN. Tobacco control is particularly important for improving GM in patients with HTN, and might be beneficial in preventing future cardiovascular events.
Williams syndrome transcription factor promotes proliferation and invasion of cervical cancer cells by regulating PI3K/Akt signaling pathway
Authors: Jiang Dongyuan , Ren Chenchen , Yang Li , Li Feiyan , Yang Xin , Zheng Yating , Ji Xiaoying , Tian Yue
Published: May 2021

Objective

This study aimed to investigate the expression of Williams Syndrome transcription factor (WSTF) in cervical cancer (CC) tissues and cells, the effect on the proliferation, migration, invasion, and the molecular mechanism of WSTF in CC cells to find a new biomarker.

Materials and Methods

The expression of WSTF in tissues was detected by real‐time quantitative polymerase chain reaction (RT‐qPCR) and/or immunohistochemistry. Human CC cell lines and human normal cervical epithelial cell lines were detected by RT‐qPCR. Lentivirus‐mediated gene transfected in Siha/CaSki cells. The transfection efficiency of lentivirus was observed by a fluorescence microscope, RT‐qPCR, and western blot. After transfection, the proliferation of Siha/CaSki cells was detected by CCK‐8 assay and colony formation assay. The migration and invasion of Siha/CaSki cells were detected by transwell assay and wound healing assay. Western blot assay were used to detect the expression of WSTF and PI3K/Akt‐related proteins in Siha/CaSki cells.

Results

The expression of WSTF in CC tissues was higher than that in adjacent tissues (p < 0.05). The expression of WSTF in CC cells was higher than that in normal cervical epithelial cells (p < 0.01). Downregulation of WSTF expression could inhibit the proliferation, migration, and invasion of CC cells (p < 0.01). WSTF overexpression activates PI3K/Akt signaling pathway (p < 0.01).

Conclusion

WSTF is highly expressed in CC tissues and cells, and downregulation of WSTF can inhibit the proliferation, invasion, and migration of CC cells by activating the PI3K/Akt signaling pathway. WSTF is a very promising new biomarker for CC.
Trueness of Intaglio Surface of Milled Digital Dentures Designed from Intraoral Scans
Authors: Lo Russo Lucio , Troiano Giuseppe , Santarelli Andrea , Salamini Angelo , Gallo Crescenzio , Guida Laura
Published: May 2021

Purpose

To asses trueness of the intaglio surface of milled dentures fabricated according to a fully digital protocol starting from intraoral scans in a clinical study by means of 3‐dimensional (3D) digital analysis.

Materials and Methods

Ten maxillary and 10 mandibular dentures, designed from intraoral scans and milled in‐house, were studied. Intraoral scans were compared with the scans of intaglio surface of milled dentures. To this end, they were aligned, trimmed and used in a metrology software to measure their mean 3D distance, absolute mean deviation, and other parameters. Measured differences for all parameters were statistically investigated. Subgroup analysis for the maxillary and mandibular dentures was performed using independent samples t‐test or, in case of non‐normal distribution, by means of Mann‐Whitney test.

Results

Using a mean of 24.9 ±2.8 measurement points/mm2, a mean 3D distance of 0.0006 ±0.007 mm between intraoral scans and the scans of the intaglio surface of milled dentures was measured. The corresponding absolute mean deviation was 0.055 ±0.032 for maxillary dentures and 0.061 ±0.016 for mandibular dentures; such a difference between arches was statistically significant (p = 0.035).

Conclusions

Milled dentures fabricated using a fully digital protocol and intraoral scans have accurate intaglio surfaces. It is reasonable to assume that they may achieve an adequate fit.
Evaluating the Effect of Listeners' Response on Speakers' Later Recollection and Impression of the Story
Authors: Salus Sanae , Kita Tomoya , Aoyama Yuki , Sugimori Eriko
Published: May 2021

The purpose of this study was to investigate a listener's role in a speaker's later recollection and impression of the story through a story‐retelling method. Two experiments were conducted, and listener responses were manipulated in each experiment in different ways. Experiment 1 examined the effect of a listener's attitude toward story retelling, and Experiment 2 studied the effect of a listener's subtle nonverbal reaction to a specific part of the story's retelling on a speaker's later recollection and impression of that story. Results showed that the listener's verbal empathetic attitude encouraged more word utterances from the speaker, changed the narrative content more positively, and reinforced the speaker's recollection, especially with positive ideas. It also amplified the speaker's emotions more than the non‐empathetic attitude (Experiment 1). However, the listener's nonverbal reaction to the specific part of the speaker's story did not appear to have a direct effect upon later recollection nor on the impression of the story (Experiment 2).
Access and returns to unpaid graduate work experience
Authors: Holford Angus
Published: May 2021

We use longitudinal data on graduates from UK universities to evaluate whether unpaid work experience is a stepping stone into paid or stable employment. We document the characteristics and occupations of recent graduates taking unpaid work experience and then use propensity score matching to estimate the treatment effect of unpaid work experience on outcomes 3.5 years after graduation. We find negative treatment effects compared with initially being in paid work, on annual salary (£2900), job security and attainment of a professional occupation (both 9% pts). We find no evidence of a benefit to salary or job attributes compared with initially being out of the labour force.
Magnetic resonance imaging markers for multiple sclerosis and neuromyelitis optica spectrum disorders
Authors: Cao Guanmei , Xu Siyao , Xu Xiaolu , Zhuo Zhizheng , Duan Yunyun , Liu Yaou
Published: May 2021

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are two common inflammatory, demyelinating and neurodegenerative diseases of the CNS. It is clinically crucial to differentiate these two diseases since they have distinct treatment strategy and prognosis. MRI has an increasingly important role in the differential diagnosis of NMOSD from MS. Conventional MRI is sensitive and its objective is to demonstrate the lesion characteristics, including lesion number, size, and distribution, while the advanced MRI can offer the structural, functional, and other microscopic information. We herein review the current advances in the understanding of MRI study of the brain, spinal cord, and optic nerve in MS and NMOSD.
The disassembly of lipid droplets in Chlamydomonas
Authors: Li‐Beisson Yonghua , Kong Fantao , Wang Pengfei , Lee Youngsook , Kang Byung‐Ho
Published: May 2021

Lipid droplets (LDs) are ubiquitous and specialized organelles in eukaryotic cells. Consisting of a triacylglycerol core surrounded by a monolayer of membrane lipids, LDs are decorated with proteins and have myriad functions, from carbon/energy storage to membrane lipid remodeling and signal transduction. The biogenesis and turnover of LDs are therefore tightly coordinated with cellular metabolic needs in a fluctuating environment. Lipid droplet turnover requires remodeling of the protein coat, lipolysis, autophagy and fatty acid β‐oxidation. Several key components of these processes have been identified in Chlamydomonas (Chlamydomonas reinhardtii), including the major lipid droplet protein, a CXC‐domain containing regulatory protein, the phosphatidylethanolamine‐binding DTH1 (DELAYED IN TAG HYDROLYSIS1), two lipases and two enzymes involved in fatty acid β‐oxidation. Here, we review LD turnover and discuss its physiological significance in Chlamydomonas, a major model green microalga in research on algal oil.
Comparisons draw us close: The influence of leader‐member exchange dyadic comparison on coworker exchange
Authors: Tang Yipeng , Lam Catherine K. , Ouyang Kan , Huang Xu , Tse Herman H. M.
Published: May 2021

Members compare their differential leader‐member exchanges (LMXs) to understand the triadic relationship (Member A, Member B, and their common leader); this will affect how members interact. Prior research based on balance theory assumes that the two members have a consensus on the structure of the triadic relationship, to argue that when Member A perceives their LMX to be lower than that of Member B, such an LMX imbalance would drive Member A to interact negatively with Member B. Comparison of LMX, however, reflects one's subjective perception, which may not be shared by the other. Therefore, we draw on social comparison theory to examine both members’ comparisons of LMX simultaneously and suggest that when they both perceive the other's LMX as better than their own, they may engage more in affiliative behaviors and develop a higher‐quality coworker exchange (CWX). The results of two studies consistently supported these hypotheses. This research extends our understanding of LMX in triadic relations and demonstrates that mismatched perceptions of LMX dyadic comparison between two members (i.e., both perceive an LMX imbalance) could motivate members to develop a positive relationship.
GWAS with a PCA uncovers candidate genes for accumulations of microelements in maize seedlings
Authors: Ma Langlang , Qing Chunyan , Zhang Minyan , Zou Chaoying , Pan Guangtang , Shen Yaou
Published: May 2021

Microelements are necessary for plant growth and development, they control key processes of physiological metabolism. Herein, we evaluated three accumulation‐related performances for each of the four microelements (Fe, Zn, Cu, and Mn) among 305 inbred maize lines. Quantification of these microelements in maize roots and shoots revealed abundant phenotypic variations in the association panel, with the variation coefficients ranging from 0.31 to 0.76. Principal component analysis (PCA) of the three related traits (concentration in root, concentration in shoot, and transport coefficient) showed that PC1 and PC2 explained >95% of phenotypic variations for each element. The scores of PC1 and PC2 were thereby used for a genome‐wide association study by combining 44,134 SNPs of this panel. A total of 27, 1, 5, and 3 SNPs were significantly (P < .05) associated with Zn‐PC1, Zn‐PC2, Cu‐PC1, and Mn‐PC2, respectively, with 11 genes closely linked (r2 > 0.8) to these SNPs. Of them, GRMZM2G142870, GRMZM2G045531, and GRMZM2G143512 were individually annotated as ABC transporter C family member 14, zinc transporter 3, and heavy metal ATPase10. A candidate gene association analysis further verified that GRMZM2G142870 and GRMZM2G045531 affect Zn and Mn accumulations, respectively. Evaluation of contrasting allele ratios in elite lines indicated that the majority of the alleles correlating with higher Zn or Cu had not been utilized in maize breeding. Integration of more “higher‐accumulation” alleles in the elite lines will be practical for improving Zn and Cu accumulations in maize. Our findings contribute to genetic revelation and molecular marker‐assisted selection of microelement accumulations in maize.
Machine learning for predicting preoperative red blood cell demand
Authors: Feng Yannan , Xu Zhenhua , Sun Xiaolin , Wang Deqing , Yu Yang
Published: May 2021

Background

The paucity of accurate quantitative standards for determining the quantity of red blood cells (RBCs) needed for perioperative patients and the predominant application of the “preoperative hemoglobin + surgery type” empirical decision‐making model have led to widespread RBC application problems.

Objective

The mathematical model of preoperative variables constructed by machine learning (ML) methods can help doctors decide preoperative RBC applications.

Methods

We retrospectively analysed 130 996 records of patients who received surgery in our hospital from January 2011 to June 2017. Through the analysis of multiple preoperative parameters that may affect the RBC transfusion volume, we used ML algorithms to build up the artificial intelligence (AI) model to predict the accurate RBC demand quantity and compared each result with those predicted by clinicians.

Results

Among the seven ML algorithms, the light gradient boosting machine (Lightgbm) algorithm was the best. The AI model predicted whether the patients needed RBC transfusion, and the area under curve (AUC) was 0.908 (95% CI 0.907–0.913). The AI model was more accurate than doctors in predicting RBC of 0, 2, and 4 units (85% data), with RMSEs of 1.61 vs. 2.15, 1.06 vs. 1.21, and 1.46 vs. 1.68, respectively. However, the AI model was not better than doctors in 1, 3, 5–6, 7–8, and 9–10 units (15% data), with RMSEs of 0.92 vs. 0.89, 0.92 vs. 0.89, 2.73 vs. 1.94, 4.53 vs. 3.92, and 6.26 vs. 5.08, respectively.

Conclusion

Through the comparison of seven ML methods, the Lightgbm algorithm‐based model is more accurate than clinician experience‐based in predicting preoperative RBC transfusion, which reduces the risk of untimely blood supply caused by insufficient preoperative blood preparation, and reduces the unnecessary cost of blood compatibility testing caused by excessive preoperative blood preparation.
Sin Nombre virus prevalence from 2014–2017 in wild deer mice,Peromyscus maniculatus, on five of the California Channel Islands
Authors: Orrock John L. , Connolly Brian M. , Guiden Peter W. , Chandler Jennifer L. , Bron Gebbiena M. , Drost Charles A. , Garcelon David K.
Published: May 2021

Sin Nombre virus (SNV) is a zoonotic virus that is highly pathogenic to humans. The deer mouse,Peromyscus maniculatus, is the primary host of SNV, and SNV prevalence inP. maniculatusis an important indicator of human disease risk. Because the California Channel Islands contain permanent human settlements, receive hundreds of thousands of visitors each year, and can have extremely high densities ofP. maniculatus, surveillance for SNV in islandP. maniculatusis important for understanding the human risk of zoonotic disease. Despite the importance of surveillance on these heavily utilized islands, SNV prevalence (i.e. the proportion ofP. maniculatusthat test positive to antibodies to SNV) has not been examined in the last 13–27 years. We present data on 1,610 mice sampled for four consecutive years (2014–2017) on five of the California Channel Islands: East Anacapa, Santa Barbara, Santa Catalina, San Nicolas, and San Clemente. Despite historical data indicating SNV‐positive mice on San Clemente and Santa Catalina, we detected no SNV‐positive mice on these islands, suggesting very low prevalence or possible loss of SNV. Islands historically free of SNV (East Anacapa, Santa Barbara, and San Nicolas) remained free of SNV, suggesting that rates of pathogen introduction from other islands and/or the mainland are low. Although continued surveillance is warranted to determine whether SNV establishes on these islands, our work helps inform current human disease risk in these locations and suggests that SNV prevalence on these islands is currently very low.
Molecular dynamics simulation of associative polymers: Understanding linear viscoelasticity from the sticky Rouse model
Authors: Jiang Nuofei , Zhang Hongdong , Yang Yuliang , Tang Ping
Published: May 2021

Polymers bearing associative groups (APs) are characterized by their fantastic viscoelastic behaviors. In a work recently published by our group [Jiang et al., Macromolecules 53, 3438–3451 (2020)], a single chain sticky Rouse model (SRM) is proposed to describe the linear viscoelasticity of APs without the entanglement effect. In this work, equilibrium molecular dynamics simulation of an unentangled melt of an AP with uniformly distributed stickers is carried out, and the dynamic properties are simultaneously analyzed from the SRM. A chain model with capped stickers is proposed so that a well-defined association chemistry is promised in the simulation system. The relative effective frictional coefficient of stickers, which is the key parameter in the SRM, is extracted from the chain center-of-mass diffusion, and it is found to be consistent with the dynamics of associative reaction in the fully gelated network. Based on this, a linear relaxation modulus and segmental diffusion functions are predicted from the SRM without fitting parameters, and these are found to quantitatively agree with the simulation results, showing the effectiveness of the SRM in connecting the dynamic properties at different molecular levels. The change in relaxation modes and the definition of the effective chain center are found to be crucial in the scenario of the SRM. Finally, the above analysis from the SRM is successfully extended to the simulation system with asymmetric chains. All these simulation results strongly support the SRM as a molecular model for the linear rheology of AP.
Mix-and-Match System for the Enzymatic Synthesis of Enantiopure Glycerol-3-Phosphate-Containing Capsule Polymer Backbones from
Actinobacillus pleuropneumoniae
,
Neisseria meningitidis
, and
Bibersteinia trehalosi
Authors: Litschko Christa , Budde Insa , Berger Monika , Bethe Andrea , Schulze Julia , Alcala Orozco E. Alberto , Mahour Reza , Goettig Peter , Führing Jana Indra , Rexer Thomas , Gerardy-Schahn Rita , Schubert Mario , Fiebig Timm
Published: May 2021

Economic synthesis platforms for the production of animal vaccines could help reduce the overuse and misuse of antibiotics in animal husbandry, which contributes greatly to the increase of antibiotic resistance. Here, we describe a highly versatile, easy-to-use mix-and-match toolbox for the generation of glycerol-phosphate-containing capsule polymers that can serve as antigens in glycoconjugate vaccines against
Actinobacillus pleuropneumoniae
and
Bibersteinia trehalosi
, two pathogens causing considerable economic loss in the swine, sheep, and cattle industries.
Microbial Science Research in the Post-COVID Environment
Authors: Nguyen Nguyen K. , Burnham Carey-Ann D. , Casadevall Arturo , Estes Mary K. , Ferrell Rebecca V. , Fleiszig Suzanne M. J.
Published: May 2021

Since early 2020, the world has witnessed the unprecedented accomplishments of the scientific community in the fight against the coronavirus disease 2019 (COVID-19) pandemic. In the meantime, we also learned valuable lessons and recognized the challenges that hindered our successes.
MetFish: a Metabolomics Pipeline for Studying Microbial Communities in Chemically Extreme Environments
Authors: Xu Chengdong , Couvillion Sneha P. , Sontag Ryan L. , Isern Nancy G. , Maezato Yukari , Lindemann Stephen R. , Roy Chowdhury Taniya , Zhao Rui , Morton Beau R. , Chu Rosalie K. , Moore Ronald J. , Jansson Janet K. , Bailey Vanessa L. , Mouser Paula J. , Romine Margaret F. , Fredrickson James F. , Metz Thomas O.
Published: May 2021

The identification and accurate quantification of metabolites using electrospray ionization-mass spectrometry (ESI-MS) in hypersaline samples is a challenge due to matrix effects. Clean-up and desalting strategies that typically work well for samples with lower salt concentrations are often ineffective in hypersaline samples.
Infliximab-induced autoimmune hepatitis
Authors: Jenkins Alexander , Austin Amy , Hughes Kathryn , Sadowski Brett , Torres Dawn
Published: May 2021

Autoimmune hepatitis (AIH) is an inflammatory disorder of the liver with a wide spectrum of disease presentation, from asymptomatic elevations in liver-associated enzymes to acute liver failure. AIH is classically associated with elevated immunoglobulins and autoantibodies, although approximately 20% of patients with features of AIH lack circulating antibodies. Recently, tumour necrosis factor alpha inhibitors have been implicated in several cases of drug-induced AIH which impact treatment regimens for patients with inflammatory bowel disease (IBD). We present a case of infliximab-induced seronegative AIH responding to budesonide therapy with successful alteration of IBD treatment regimen to vedolizumab.
Idiopathic subglottic stenosis in a young female patient
Authors: Pomerantz Benjamin , Pomerantz Michael , Finn Arkadiy
Published: May 2021

A previously healthy 30-year-old woman presented with 3 years of progressive shortness of breath and audible wheezing. One year prior to presentation, she developed a chronic non-productive cough. Pulmonary function testing revealed flattened inspiratory and expiratory peaks, characteristic of an extrathoracic fixed tracheal obstruction. Bronchoscopy confirmed subglottic stenosis (SGS). She had no history of intubation, tracheostomy or evidence of a systemic inflammatory illness. She was diagnosed with idiopathic SGS and referred for rigid bronchoscopy with balloon dilatation resulting in improvement in her symptoms.
Deodorant aerosol spray can in the rectum: a potential fire hazard during surgery
Authors: Kumarasamy Sivaraman , Kaman Lileswar , Ansari Azhar , Hazarika Amarjyoti
Published: May 2021

Rectal foreign bodies are not uncommon and often pose a serious challenge to surgeons. In majority, the objects are inserted by self in children, psychiatric patients and for sexual gratification in adults. Various rectal foreign bodies have been reported. Deodorant aerosol spray can in the rectum has not been reported previously. Danger of aerosol dispenser can is the risk of fire and explosion. Especially during any surgical procedures to remove the foreign body using cautery or any energy devices. We report of a rare foreign body of deodorant aerosol spray can in the rectum in a young male patient, which was removed under general anaesthesia.
Bickerstaff brainstem encephalitis with Guillain-Barré syndrome overlap following chlamydia infection
Authors: Wong Chee Keong , Ng Chen Fei , Tan Hui Jan , Mukari Shahizon Azura Mohamed
Published: May 2021

Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune encephalitis characterised by ataxia, ophthalmoplegia and altered consciousness. An overlap between BBE with Guillain-Barré syndrome (GBS) shows similar clinical and immunological features. We report a case of BBE with GBS overlap secondary toChlamydia pneumoniaeinfection. The triad of altered consciousness, ataxia and ophthalmoplegia were present in the patient. The investigations included cerebrospinal fluid cytoalbuminological dissociation, nerve conduction test that showed prolonged or absent F wave latencies, hyperintensity in the left occipital region on brain MRI and diffuse slow activity on the electroencephalogram. The chlamydia serology was positive indicating a postinfectious cause of BBE syndrome. He required artificial ventilation as his consciousness level deteriorated with tetraparesis, oropharyngeal and respiratory muscle weakness. Immunotherapy with intravenous immunoglobulin and methylprednisolone was commenced. He made good recovery with the treatment. Prompt recognition of this rare condition following chlamydia infection is important to guide the management.
Descending necrotising mediastinitis: how a sore throat can result in purulent peritonitis
Authors: Rice Darragh , Fearon Naomi , Reynolds John V , Ravi Narayanasamy
Published: May 2021

This is a rare case of descending necrotising mediastinitis (DNM) that originated as an oropharyngeal infection, before spreading caudally to include all compartments of the mediastinum and the peritoneum beyond. The mediastinitis was treated early and aggressively with drainage, lavage and debridement in conjunction with broad-spectrum antimicrobial treatment. This case includes a right cervical incision, and a seldom needed surgical laparotomy approach to address the intra-abdominal involvement, and necessity of peritoneal washout. Following a prolonged Intesive Care Unit (ICU) stay and antibiotic course as well as other interventions detailed, the patient made a remarkable recovery and was discharged 101 days post presentation. This report goes on to discuss the rapidly evolving, life-threatening nature of DNM as well as providing an overview of possible management options, outlining how we think such cases should be approached and the clinical suspicion required in a deteriorating patient.
Legionellapulmonary abscess and pleural space infection in an immunocompetent patient
Authors: Flint Kristen L , Lloyd Maxwell R , van den Berg Polly , Kanjee Zahir
Published: May 2021

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. HerLegionellaurinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. CT imaging revealed interval development of a loculated complicated parapneumonic effusion. Successful treatment required chest tube drainage assisted by fibrinolytic therapy. This case highlights the importance of consideringLegionellain patients with pulmonary abscess, demonstrates an approach to a patient with a non-resolving pneumonia and illustrates the management of parapneumonic effusions.
Development and evaluation of a training programme on asset-based community development aimed at general practice trainees: protocol for a mixed-method multilevel and multicentric action research study
Authors: Calderón-Larrañaga Sara , Valls-Pérez Blanca , Cardo-Miota Adrián , Botello Blanca , Lafuente Nieves , Hernán Mariano
Published: May 2021

Introduction

Asset-based community development (ABCD) is a strategy aimed at strengthening communities of interest through the identification and enhancement of those protective resources (also called ‘health assets’) that contribute to improve population health. Although primary care is specially well placed to contribute to ABCD by facilitating patients’ access to community health assets, the implementation of ABCD approaches is limited, in part due to training deficiencies amongst general practitioners. In this study, we will develop a training programme on ABCD aimed at general practice trainees and evaluate its implementation and scale-up in Andalusia, Spain. We will also investigate whether the programme may contribute to strengthen the community orientation of the primary care practices involved in the study.

Methods and analysis

We will undertake a mixed methods, multilevel and multicentric action research study drawing on theoretical frameworks relevant to learning (pedagogy) and community health promotion. The intervention will be implemented and evaluated in eight different study areas over 48 months. It will comprise a classroom-based session and a practical exercise, which will involve general practice trainees producing a map of community health assets relevant to common health conditions. In each study area, we will set up a stakeholder group to guide our study. We will run the intervention sequentially across the eight study areas, and modify and refine it iteratively by incorporating the findings from the evaluation. We will employ qualitative (interviews and focus groups with general practice trainees, primary care workers, members of the teaching units and policymakers) and quantitative methods (self-administered questionnaires with an approximate sample of 157 general practice trainees and 502 primary care workers).

Ethics and dissemination

Ethics approval from the Andalusian Regional Health Council has been granted (6/2020). It is envisaged that this research will provide relevant, evidence-based guidance on how best to incorporate learning on ABCD into the general practice training curriculum. Findings will be disseminated in an ongoing manner and will target the following audiences: (1) general practice trainees, primary care workers and members of the teaching units, (2) policymakers and strategic decision makers and (3) the academic community.
Symptom presentation of SARS-CoV-2-positive and negative patients: a nested case–control study among patients calling the emergency medical service and medical helpline
Authors: Moeller Amalie Lykkemark , Mills Elisabeth Helen Anna , Collatz Christensen Helle , Gnesin Filip , Blomberg Stig Nikolaj Fasmer Nikolaj , Zylyftari Nertila , Jensen Britta , Ringgren Kristian Bundgaard , Broccia Marcella Ditte , Bøggild Henrik , Torp-Pedersen Christian
Published: May 2021

Objective

Currently effective symptom-based screening of patients suspected of COVID-19 is limited. We aimed to investigate age-related differences in symptom presentations of patients tested positive and negative for SARS-CoV-2.

Design

Setting

Calls to the medical helpline (1-8-1-3) and emergency number (1-1-2) in Copenhagen, Denmark. At both medical services all calls are recorded.

Participants

We included calls for patients who called for help/guidance at the medical helpline or emergency number prior to receiving a test for SARS-CoV-2 between April 1stand 20th2020 (8423 patients). Among these calls, we randomly sampled recorded calls from 350 patients who later tested positive and 250 patients tested negative and registered symptoms described in the call.

Outcome

Results

After exclusions, 544 calls (312 SARS-CoV-2 positive and 232 negative) were included in the analysis. Fever and cough remained the two most common of COVID-19 symptoms across all age groups and approximately 42% of SARS-CoV-2 positive and 20% of negative presented with both fever and cough. Symptoms including nasal congestion, irritation/pain in throat, muscle/joint pain, loss of taste and smell, and headache were common symptoms of COVID-19 for patients younger than 60 years; whereas loss of appetite and feeling unwell were more commonly seen among patients over 60 years. Headache and loss of taste and smell were rare symptoms of COVID-19 among patients over 60 years.

Conclusion

Our study identified age-related differences in symptom presentations of SARS-CoV-2-positive patients calling for help or medical advice. The specific symptoms of loss of smell or taste almost exclusively reported by patients younger than 60 years. Differences in symptom presentation across age groups must be considered when screening for COVID-19.
Caesarean sections and health financing: a global analysis
Authors: Hoxha Ilir , Fink Günther
Published: May 2021

Objectives

The objective of this study is to explore the association of health financing indicators with the proportion of births by caesarean section (CS) across countries.

Design

Ecological cross-country study.

Setting

This study examines CS proportions across 172 countries.

Main outcome measures

The primary outcome was the percentage excess of CS proportion, defined as CS proportions above the global target of 19%. We also analysed continuous CS proportions, as well as excess proportion with a more restrictive 9% global target. Multivariable linear regressions were performed to test the association of health financing factors with the percentage excess proportions of CS. The health financing factors considered were total available health system resources (as percentage of gross domestic product), total contributions from private households (out-of-pocket, compulsory and voluntary health insurance contributions) and total national income.

Results

We estimate that in 2018 there were a total of 8.8 million unnecessary CS globally, roughly two-thirds of which occurred in upper middle-income countries. Private health financing was positively associated with percentage excess CS proportion. In models adjusted for income and total health resources as well as human resources, each 10 per cent increase in out-of-pocket expenditure was associated with a 0.7 per cent increase in excess CS proportions. A 10 per cent increase in voluntary health insurance was associated with a 4 per cent increase in excess CS proportions.

Conclusions

We have found that health system finance features are associated with CS use across countries. Further monitoring of these indicators, within countries and between countries will be needed to understand the effect of financial arrangements in the provision of CS.
Abstracts from international emergency medicine journals
Authors: Production EMJ
Published: May 2021

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.