bluuebunny/crossref_metadata_2025 huggingface dataset:
Nuclear genome of a pedinophyte pinpoints genomic innovation and streamlining in the green algae
Authors: Repetti Sonja I. , Iha Cintia , Uthanumallian Kavitha , Jackson Christopher J. , Chen Yibi , Chan Cheong Xin , Verbruggen Heroen
Published: December 2021

The genomic diversity underpinning high ecological and species diversity in the green algae (Chlorophyta) remains little known. Here, we aimed to track genome evolution in the Chlorophyta, focusing on loss and gain of homologous genes, and lineage‐specific innovations of the core Chlorophyta.

We generated a high‐quality nuclear genome for pedinophyte YPF701, a sister lineage to others in the core Chlorophyta and incorporated this genome in a comparative analysis with 25 other genomes from diverse Viridiplantae taxa.

The nuclear genome of pedinophyte YPF701 has an intermediate size and gene number between those of most prasinophytes and the remainder of the core Chlorophyta. Our results suggest positive selection for genome streamlining in the Pedinophyceae, independent from genome minimisation observed among prasinophyte lineages. Genome expansion was predicted along the branch leading to the UTC clade (classes Ulvophyceae, Trebouxiophyceae and Chlorophyceae) after divergence from their last common ancestor with pedinophytes, with genomic novelty implicated in a range of basic biological functions.

Results emphasise multiple independent signals of genome minimisation within the Chlorophyta, as well as the genomic novelty arising before diversification in the UTC clade, which may underpin the success of this species‐rich clade in a diversity of habitats.
Blue‐light receptor phototropin 1 suppresses immunity to promote Phytophthora infestans infection
Authors: Naqvi Shaista , He Qin , Trusch Franziska , Qiu Huishan , Pham Jasmine , Sun Qingguo , Christie John M. , Gilroy Eleanor M. , Birch Paul R. J.
Published: December 2021

Blue‐light (BL) phototropin receptors (phot1 and phot2) regulate plant growth by activating NPH3/RPT2‐like (NRL) family members. Little is known about roles for BL and phots in regulating plant immunity. We showed previously that Phytophthora infestans RXLR effector Pi02860 targets potato (St)NRL1, promoting its ability to enhance susceptibility by facilitating proteasome‐mediated degradation of the immune regulator StSWAP70. This raises the question: do BL and phots negatively regulate immunity?

We employed coimmunoprecipitation, virus‐induced gene silencing, transient overexpression and targeted mutation to investigate contributions of phots to regulating immunity.

Whereas transient overexpression of Stphot1 and Stphot2 enhances P. infestans colonization of Nicotiana benthamiana, silencing endogenous Nbphot1 or Nbphot2 reduces infection. Stphot1, but not Stphot2, suppressed the INF1‐triggered cell death (ICD) immune response in a BL‐ and NRL1‐dependent manner. Stphot1, when coexpressed with StNRL1, promotes degradation of StSWAP70, whereas Stphot2 does not. Kinase‐dead Stphot1 fails to suppress ICD, enhance P. infestans colonization or promote StSWAP70 degradation. Critically, BL enhances P. infestans infection, which probably involves phots but not other BL receptors such as cryptochromes and F‐box proteins ZTL1 and FKF1.

We demonstrate that Stphot1 and Stphot2 play different roles in promoting susceptibility, and Stphot1 kinase activity is required for BL‐ and StNRL1‐mediated immune suppression.
Genetic models and approaches to study orofacial clefts
Authors: Leslie Elizabeth J.
Published: December 2021

Introduction

Orofacial clefts (OFCs) are common craniofacial birth defects with heterogeneous phenotype and etiology. Geneticists have applied nearly every available method and technology for further understanding of the genetic architectures of OFCs.

Objective

This review describes the evidence for a genetic etiology in OFCs, statistical genetic approaches employed to identify genetic causes, and how the results have shaped our current understanding of the genetic architectures of syndromic and nonsyndromic OFCs.

Conclusion

There has been rapid progress toward elucidating the genetic architectures of OFCs due to the availability of large collections of DNA samples from cases, controls, and families with OFCs and the consistent adoption of new methodologies and novel statistical approaches as they are developed. Genetic studies have identified rare and common variants influencing risk of OFCs in both Mendelian and complex forms of OFCs, blurring the distinction traditional categories used in genetic studies and clinical medicine.
Possessed by property: Inheritance in Samuel Richardson’s Clarissa (1747–1748)
Authors: Cortese Beth
Published: December 2021

The inheritance conflict in Samuel Richardson´s novel Clarissa (1747–1748) has been read as staging the clash between two different class ideologies and as an expression of the dead’s posthumous agency exerted on the living. I argue that the novel’s two wills ultimately serve to make a broader point about inheritance. I contend that Richardson´s complex treatment of the effects of each will on each member of the Harlowe family underscores the problematic nature of inheritance as a gift. I compare the novel’s two wills in light of Marcel Mauss’s work on gift‐exchange to discuss how Richardson engages with inheritance as a gift that confirms or reorganises familial hierarchies and imposes an obligation on the heir. Reading the novel in terms of the way in which inheritance places the heir in the position of caretaker that they cannot be released from until their death, offers a different reading of Clarissa’s reluctance to refer to herself as the possessor of the estate in the novel. My reading of the novel moves beyond the novel’s inheritance dispute to provide insight into the circular and problematic nature of inheritance as gift. While attention has been paid to the power that the testator or donor possesses in bequeathing their inheritance, less attention has been paid to what it means to receive such a gift.
Surgical treatment of multiple impacted supernumerary teeth in a cleidocranial dysplasia patient
Authors: Wu Ye , Shaohai He
Published: December 2021

To report a case of cleidocranial dysplasia (CCD) with 15 supernumerary teeth and review the relevant literature. Diagnose and treat a CCD patient with 15 impacted supernumerary teeth in the maxilla and mandible. When CCD is accompanied by supernumerary teeth ambushed in the jaw and does not affect the health of the body, it can be regarded as a part of normal bone tissue. If X‐ray or computed tomography examination shows that supernumerary teeth affect permanent tooth eruption, the replacement process of adjacent teeth and permanent tooth eruption should be closely observed, and supernumerary teeth should be extracted in time if necessary.
Pediatric lower respiratory tract infection: Considerations for the anesthesiologist
Authors: Rai Ekta , Alaraimi Rashid , AL Aamri Is'haq
Published: December 2021

Neonatal and childhood infectious diseases continue to be a global health problem. Acute respiratory tract infections are typically classified as upper respiratory tract infection and lower respiratory tract infections. The most common lower respiratory infections in childhood are pneumonia and bronchiolitis. Vaccination against measles, diphtheria, pertussis, Haemophilus influenzae, pneumococcus, and influenza resulted in a significant reduction in the incidence of acute respiratory tract infection globally. Though the global burden of the disease has decreased, the mortality rates still are higher in developing countries. Patients with severe lower respiratory tract infections and their complications are often evaluated for elective or emergency procedures. In this review article, the authors aim to discuss the etiology, pathogenesis, preoperative evaluation of lower respiratory tract infections, and the anesthesia implications pertinent to the practice of anesthesia.
Genome‐wide association study reveals molecular markers and genes potentially associated with soybean (Glycine max) resistance to Xanthomonas citri pv. glycines
Authors: Capobiango da Fonseca Pollyanna , Maria Barbosa Rosângela , de Oliveira Ferreira Dalton , Badel Jorge Luis , Schuster Ivan , Vieira Rogerio Faria , Lopes da Silva Felipe
Published: December 2021

Soybean bacterial pustule is caused by the gram‐negative bacterium Xanthonomas citri pv. glycines. The identification of sources of resistance for use in molecular breeding is a challenge due to the existence of complex interactions between pathogenic strains and soybean cultivars. This study aimed to evaluate the reaction of 118 soybean cultivars to inoculation with strains 2440P and 2447 of X. citri pv. glycines and to identify molecular markers associated with the resistance. The genome‐wide association study approach was used to identify association between the phenotype and the single nucleotide polymorphisms (SNP) markers. The positions of significant SNPs were mapped to the soybean Williams 82 genome, and protein‐coding genes near them were identified. One and 116 cultivars were resistant to strains 2440P and 2447, respectively. Eleven SNPs were significantly associated with resistance to strain 2440P and five to 2447. Two significant SNPs are predicted to result in amino acid changes in benzyl alcohol O‐benzoyltransferase‐like and MAIN‐LIKE 1‐like proteins, which after confirmation, could be used in marker‐assisted selection in order to increase the frequency of resistant alleles in new cultivars.
Immune mechanisms in humanSarcoptes scabiei(Acari: Sarcoptidae) infestations
Authors: Gazi Umut , Taylan ‐ Ozkan Aysegul , Mumcuoglu Kosta Y.
Published: December 2021

Scabies is a parasitic infestation of human and animal skin caused by different strains of the itch mite,Sarcoptes scabiei. The World Health Organization (WHO) has declared scabies in human as a neglected tropical disease, and today over 200 million people worldwide are affected. The two most commonly reported clinical manifestation of the condition are ordinary (OS) and crusted scabies (CS). CS, which can lead to fatal consequences due to secondary bacterial infections, is mostly observed in immunocompromised subjects but can also, although rarely, be detected in immunocompetent individuals. Innate and adaptive immune system components are involved in protection and pathogenesis of scabies, although with some differences between OS and CS. While the cutaneous immune response is dominated by CD4+T‐cells in OS, it is mainly mediated by CD8+T‐cells in CS. The two clinical conditions also differ in CD4+T‐cell‐mediated immune responses with mixed TH1/TH2 (protective) and TH2/TH17 (non‐protective) immunoprofiles in OS and CS, respectively. Moreover, the development of CS is associated with early immunosuppression that is followed by deleterious immune response to uncontrolled mite proliferation. However, the immune response to scabies still needs further attention due to inconsistent results in the literature. The aim of this study is to attract more attention to this area by summarizing the current literature on innate and adaptive immune responses triggered againstS.scabieimites.
Field sampling methods on seismic lines: a comparison between circular plots and belt transects
Authors: Jones Caren , Van Dongen Angeline , Harvey Jill , Degenhardt Dani
Published: December 2021

Seismic lines are linear clearings created for oil and gas exploration. Regeneration on seismic lines in Alberta's boreal forest is limited by slow natural recovery, making them persistent features on the landscape and prompting interest in line restoration through vegetation reestablishment. The goal of this study was to establish an effective woody vegetation sampling method for monitoring seismic line regeneration in boreal mixedwood forests. Data collected in belt transects and circular plots were similar, and doubling the area sampled did not impact the results. Based on ease of implementation, a 30 m × 2 m belt transect in the center of a seismic line is the recommended sampling method. However, if woody understory vegetation is also being measured, dividing the belt transect into smaller areas is recommended as a single belt transect yielded less accurate height data than circular plots. Plots were also measured along seismic lines' edge and inner areas to determine if vegetation recovery differs across the width of the line. While all tree responses did not differ between the plot locations, woody understory vegetation was more abundant when measured along the inner seismic line locations. Therefore, if woody understory recovery is the focus of the sampling program, using plots placed across the seismic line width is recommended to prevent overestimation. These recommendations are intended for measuring woody vegetation recovery on 5 m wide seismic lines in upland mixedwood forests in the boreal forest; implementation in other environments or for other response variables requires additional testing.
Red blood cell transfusion in myelodysplastic syndromes: A systematic review
Authors: Kaka Shaima , Jahangirnia Ashkan , Beauregard Nickolas , Davis Alexandra , Tinmouth Alan , Chin‐Yee Nicolas
Published: December 2021

Patients with myelodysplastic syndrome (MDS) frequently receive red blood cell (RBC) transfusions for anaemia resulting from ineffective erythropoiesis. While RBC transfusions may rapidly increase haemoglobin values, their impact on clinical and health services outcomes in MDS patients has not previously been summarized. We conducted a systematic review of the literature to evaluate risks and benefits of RBC transfusions in MDS patients. We searched electronic databases (MEDLINE, Embase, CENTRAL, CINAHL) from inception through June 4, 2021 to identify studies reporting data on RBC transfusions in MDS patients. Full text publications that assessed RBC transfusions as an intervention and reported at least one clinical, laboratory, or healthcare outcome associated with transfusion were included. Study characteristics, transfusion information and transfusion‐related outcomes were extracted and reported. We identified 1243 original studies, of which 38 met eligibility requirements and were included. Fourteen reported on survival following diagnosis of MDS, with the majority reporting poorer survival among patients receiving or requiring more frequent transfusions. Nine reported on transfusion‐related iron overload and its complications. Other outcomes included rates of allo/autoimmunization and adverse transfusion reactions, and healthcare costs incurred by patients with a greater transfusion burden. Only two studies reported on symptom relief following transfusion. This review underscores transfusion dependence as a negative prognostic factor for MDS patients and highlights the paucity of evidence surrounding quality of life and symptom‐related outcomes following RBC transfusions in this population. Further study of patient‐important outcomes associated with transfusion in MDS patients is warranted to improve therapeutic recommendations and inform resource allocation.
Ex situ Spectroscopic Characterization of Residual Effects of Thermomechanical Loading on Polyurea
Authors: Huynh Nha Uyen , Youssef George
Published: December 2021

The residual effect of thermally and mechanically loaded polyurea samples was investigated in this study using terahertz time-domain spectroscopy (THz-TDS). Samples of different thicknesses were submerged in liquid nitrogen and allowed to reach cryogenic isothermal conditions while another set of samples were extracted from quasi-statically loaded strips. All samples were interrogated using THz-TDS since terahertz waves exhibit non-ionizing, nondestructive interactions with polymers. The time-domain terahertz signals were used to extract the optical and electrical properties as a function of sample thickness and loading conditions. The residual effect was prominent in the mechanically loaded samples compared to a nearly negligible presence in thermally loaded polyurea. On average, the results of the thermally loaded samples were subtle when compared to the virgin samples, whereas samples that were mechanically stretched showed a considerable difference in the characteristics of the time-domain signals. For example, the peak amplitude in the time-domain signal of the stretched thick sample showed a 9% difference from that of the virgin sample, whereas the thermally loaded sample saw only a 4.9% difference. Spectral analysis reported the frequency-dependent, complex refractive index of virgin and loaded polyurea as a function of thickness and spectral peaks associated with fundamental vibrational modes of the polyurea structure. The disappearance of three spectral peaks, 0.56 THz, 0.76 THz, and 0.95 THz, elucidated the residual effect of the mechanically loaded samples. In general, terahertz spectroscopy was shown to be a promising tool for future in situ and in operando investigations of field-dependent polymer responses.
TiO2–SiO2 Nanoparticle-Stabilized Soybean Oil-in-Water Emulsions: Dispersion Stability, Rolling Lubrication Performance, and Surface Self-Cleaning Effects
Authors: Taheri Reza , Kosasih Buyung , Zhu Hongtao
Published: December 2021

Vegetable oil-in-water emulsions are common cold rolling lubricants. However, maintaining the required dispersion for polar oil droplets for consistent lubrication and proper surface self-cleaning after rolling remains a practical challenge. In this study, titanium silicate TiO2–SiO2 nanoparticle (NP)-stabilized soybean oil emulsions are produced and NPs functions as dispersant, lubrication enhancer, and detergent agent to clean up oil residue are explored. Cold rolling of SS316 strips reveals a threshold of NPs wt%, at which stably dispersed oil droplets improve tribology and lower the rolling parameters relative to without or at high wt% of NPs. Cleaner as-rolled strips are also obtained with NPs. Favorable results are attributed to the formation of NP-coating layers on oil droplets which enhances dispersion, optimizes plate-out while keeping adequate wetting, and provides a three-body abrasive rolling as opposed to two-body adhesion without NPs. A model of sliding–rolling lubrication in cold rolling is also discussed.
Active Vibration Control on a Smart Composite Structure Using Modal-Shaped Sliding Mode Control
Authors: Rodriguez Jonathan , Collet Manuel , Chesné Simon
Published: December 2021

This article proposes an active modal vibration control method based on a modal sliding mode controller applied to a smart material composite structure with integrated piezoelectric transducers as actuators and sensors. First, the electromechanical coupled system is identified using a modal reduced-order model. The sliding surface is based on the modal-filtered states and designed using a general formulation allowing the control of multiple vibration modes with multiple piezoelectric sensors and actuators. The performance and stability of the nonlinear controller are addressed and confirmed with the experimental results on a composite smart spoiler-shaped structure. The nonlinear switching control signal based on the modal-shaped sliding surface improves performances of the linear part of the control while maintaining not only stability but also robustness. The attenuation level achieved on the target modes on all piezoelectric sensors starts from −14 dB up to −22 dB, illustrating the strong potential of nonlinear switching control methods in active vibration control.
Steady-State Velocity of a Chain Falling from the Edge of a Table
Authors: Rodriguez Juan , Tang Becky , Martin Marcos H. , Irias Adrin , Adel Amani , Zaldivar Sebastian , Carvajal Abel A. , Gallardo Camila , Walecki Wojciech J.
Published: December 2021

We investigated a very long chain falling from the pile on the edge of a table to the floor both experimentally and theoretically. In this very simple and novel configuration we showed that the velocity of the chain quickly converges to its asymptotic value, and that the steady-state velocity is proportional to the square root of the height of the table. The results are general and do not depend on the type of chain. We explained our measurements using simple dimensional analysis and Newton’s second law. The measurements do not require any special instrumentation other than a stopwatch, a desk, and a chain. This experiment can be performed in any classroom.
Mission to Mars — Concept and Implementation of a Design-Based (Hands-On) Smartphone Experiment Helping Students Understand the Effects Caused by Differences in Air Pressure
Authors: Spicker Sebastian J. , Küpper Alexander , Bresges André
Published: December 2021

Physics is not a very popular subject at German schools, and several studies indicate that girls are less interested than boys in the traditional physics curriculum. To address this problem, physics education should be up to date, context oriented, interesting for girls and boys, and emerge from their everyday life. The ROSE study shows that astronomy, human biology, and space are interesting for boys and girls and therefore a suitable context for physics lessons. In the field of astronomy and space exploration, the research is both highly current and part of the students’ life, as they hear about discoveries and missions in the news. One possible future space mission is the human exploration of Mars. Such a trip is not easy; various factors have to be considered and risks must be minimized. One risk is the vacuum in space while there is higher air pressure in the spaceship itself. This aspect must be taken into account when designing a spaceship, for example, the “Crew Dragon” by Space X.
Gaussian Formula for Ray Tracing in Lenses and Mirrors
Authors: Balta Nuri
Published: December 2021

In introductory texts, some “special” rays are selected to draw the image produced by lenses and mirrors. After teaching special rays, students usually ask how to draw an arbitrary ray. One method for drawing an arbitrary ray is the tilted principal axis. As an example, the tracing of an arbitrary ray in diverging lens is indicated in Fig. 1.
Rapid assessment of SARS-CoV-2–evolved variants using virus-like particles
Authors: Syed Abdullah M. , Taha Taha Y. , Tabata Takako , Chen Irene P. , Ciling Alison , Khalid Mir M. , Sreekumar Bharath , Chen Pei-Yi , Hayashi Jennifer M. , Soczek Katarzyna M. , Ott Melanie , Doudna Jennifer A.
Published: December 2021

A tool to probe SARS-CoV-2 biology

To develop therapies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerging variants, it is important to understand the viral biology and the effect of mutations. However, this is challenging because live virus can only be studied in a few laboratories that meet stringent safety standards. Syed
et al
. describe a virus-like particle (VLP) that comprises the four SARS-CoV-2 structural proteins, but instead of packaging viral RNA, it packages messenger RNA (mRNA) that expresses a reporter protein (see the Perspective by Johnson and Menachery). The amount of reporter expressed in receiver cells depends on the efficiency of packaging and assembly in the producer cells and the efficiency of entry into receiver cells. Mutations in the nucleocapsid protein that are found in more transmissible variants increase mRNA packaging and expression. The VLPs provide a platform for studying the effect of mutations in the structural proteins and for screening therapeutics. —VV
Molecular basis of immune evasion by the Delta and Kappa SARS-CoV-2 variants
Authors: McCallum Matthew , Walls Alexandra C. , Sprouse Kaitlin R. , Bowen John E. , Rosen Laura E. , Dang Ha V. , De Marco Anna , Franko Nicholas , Tilles Sasha W. , Logue Jennifer , Miranda Marcos C. , Ahlrichs Margaret , Carter Lauren , Snell Gyorgy , Pizzuto Matteo Samuele , Chu Helen Y. , Van Voorhis Wesley C. , Corti Davide , Veesler David
Published: December 2021

How the Delta variant evades defenses

In the course of the COVID-19 epidemic, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, some of which evade immunity or increase transmission. In late 2020, the Delta and Kappa variants were detected, and the Delta variant became globally dominant by June 2021. McCallum
et al
. show that vaccine-elicited serum-neutralizing activity is reduced against these variants. Based on biochemistry and structural studies, the authors show that mutations in the domain that binds the ACE2 receptor abrogate binding to some monoclonal antibodies but do not improve ACE2 binding, suggesting that they emerged to escape immune recognition. Remodeling of the N-terminal domain allows the variants to escape recognition by most neutralizing antibodies that target it. The work could guide the development of next-generation vaccines and antibody therapies. —VV
The spatial association of accessory minerals with biotite in granitic rocks from the South Mountain Batholith, Nova Scotia, Canada
Authors: Clarke D. Barrie , Renno Axel D. , Hamilton David C. , Gilbricht Sabine , Bachmann Kai
Published: December 2021

We use mineral liberation analysis (MLA) to quantify the spatial association of 15,118 grains of accessory apatite, monazite, xenotime, and zircon with essential biotite, and clustered with themselves, in a peraluminous biotite granodiorite from the South Mountain Batholith in Nova Scotia (Canada). A random distribution of accessory minerals demands that the proportion of accessory minerals in contact with biotite is identical to the proportion of biotite in the rock, and the binary touching factor (percentage of accessory mineral touching biotite divided by modal proportion of biotite) would be ~1.00. Instead, the mean binary touching factors for the four accessory minerals in relation to biotite are: apatite (5.06 for 11,168 grains), monazite (4.68 for 857 grains), xenotime (4.36 for 217 grains), and zircon (5.05 for 2876 grains). Shared perimeter factors give similar values. Accessory mineral grains that straddle biotite grain boundaries are larger than completely locked, or completely liberated, accessory grains. Only apatite-monazite clusters are significantly more abundant than expected for random distribution. The high, and statistically significant, binary touching factors and shared perimeter factors suggest a strong physical or chemical control on their spatial association. We evaluate random collisions in magma (synneusis), heterogeneous nucleation processes, induced nucleation in passively enriched boundary layers, and induced nucleation in actively enriched boundary layers to explain the significant touching factors. All processes operate during the crystallization history of the magma, but induced nucleation in passively and actively enriched boundary layers are most likely to explain the strong spatial association of phosphate accessories and zircon with biotite. In addition, at least some of the apatite and zircon may also enter the granitic magma as inclusions in grains of Ostwald-ripened xenocrystic biotite.
Multiple sediment incorporation events in a continental magmatic arc: Insight from the metasedimentary rocks of the northern North Cascades, Washington (USA)
Authors: Hanson Ann E. H. , Gordon Stacia M. , Ashley Kyle T. , Miller Robert B. , Langdon-Lassagne Elizabeth
Published: December 2021

The rheology and composition of arc crust and the overall evolution of continental magmatic arcs can be affected by sediment incorporation events. The exhumed Cretaceous–Eocene North Cascades arc exposes abundant metasedimentary rocks that were incorporated into the arc during multiple events. This study uses field relationships, detrital zircon geochronology, bulk rock geochemistry, geothermometry, and quartz-in-garnet geobarometry to distinguish approximate contacts and emplacement depths for different metasedimentary units to better understand their protolith incorporation history and impact on the arc. The Skagit Gneiss Complex is one of the main deep crustal units of the North Cascades arc. It includes metasedimentary rocks with distinct detrital zircon signatures: Proterozoic–Cretaceous (Group 1) or Triassic–Cretaceous (Group 2) zircon populations. Both metasedimentary groups achieved near-peak metamorphic conditions of 640–800 °C and 5.5–7.9 kbar; several Group 2 samples reveal the higher pressures. A third group of metasedimentary rocks, which was previously interpreted as metamorphosed equivalents of backarc sediments (Group 3), exhibited unimodal Triassic or bimodal Late Jurassic–Early Cretaceous detrital zircon signatures and achieved near-peak conditions of 570–700 °C and 8.7–10.5 kbar. The combined field and analytical data indicate that protoliths of Group 1 and Group 2 metasedimentary rocks were successively deposited in a forearc basin and underthrusted into the arc as a relatively coherent body. Group 3 backarc sediments were incorporated into the arc along a transpressional step-over zone. The incorporation of both forearc and backarc sediments was likely facilitated by arc magmatism that weakened arc crust in combination with regional transpression.
Very severe aortic stenosis masquerading as acute coronary syndrome
Authors: Ghosh Soumitra , Batta Akash , Sharma Yash Paul , Panda Prashant
Published: December 2021

Severe aortic stenosis (AS) may rarely present like acute coronary syndrome with increased cardiac biomarker despite having normal coronaries. Here we describe a case of very severe AS, who presented with exertional and rest angina and a high level of TnI. Angiography revealed normal coronaries. Echocardiography showed very severe AS with peak velocity of 5.08 m/s and maximum and mean gradient of 103 and 54 mm Hg, respectively. The patient subsequently underwent aortic valve replacement (AVR) successfully. Subendocardial ischaemia may occur in patients with severe AS during haemodynamic stress, even in the setting of normal unobstructed coronaries due to supply-demand mismatch. Subsequent degeneration and death of the cardiac myocytes cause cTnI elevation, which anticipates the start of the clinical downhill course in severe AS. Our case highlights the importance of thorough physical examination and early use of echocardiography in patients with angina to detect the presence of severe AS.
Sclerosing angiomatoid nodular transformation of the spleen: a case report
Authors: Papatheodorou Panayiotis , Taliadoros Athanasios , Thrasyvoulou Christos , Tsironis George
Published: December 2021

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon primary benign condition with specific histopathological characteristics. The majority of the patients are usually asymptomatic and present for treatment after an incidental finding on a routine abdominal imaging. The differential diagnosis includes other benign tumours, as well as primary malignancy or metastases of unknown origin. We report a 55-year-old woman who was presented to the surgical team of our hospital for splenectomy after the investigation of an incidental splenic lesion led to the diagnosis of SANT. The pathology report of the specimen repeated the initial diagnosis. The patient has not yet presented any complication or recurrence of the disease 8 months after the operation. From such infrequent cases, the most valuable conclusion which can be yielded is that the more the number of patients reported, the more the knowledge about the disease is broadened.
Temporal trends in the epidemiology of childhood severe visual impairment and blindness in the UK
Authors: Teoh Lucinda J , Solebo Ameenat Lola , Rahi Jugnoo S
Published: December 2021

Background/aims

Understanding temporal trends in childhood visual disability is necessary for planning and evaluating clinical services and health policies. We investigate the changing epidemiology of severe visual impairment (SVI) and blindness (BL) in children in the UK in the 21st century.

Methods

Comparative analysis of two national population-based epidemiological studies of incident childhood SVI/BL (ICD-10 definition; visual acuity worse than 1.0 LogMAR in the better eye). We carry out comparative analysis of studies conducted in 2000 and 2015 using identical methods.

Results

Overall annual and cumulative incidence rates remained broadly stable in 2015 at 0.38 per 10 000 (95% CI 0.34 to 0.41) for 0–15 years old and 5.65 per 10 000 (5.16 to 6.18) by 16 years, respectively, and with annual incidence in infancy (3.52 per 10 000, 3.13 to 3.97) remaining considerably higher than any other age. Mortality among children diagnosed in infancy declined (from 61.4 to 25.6 per 1000), despite an increase (from 77% to 84%, p=0.037) in the overall proportion with significant non-ophthalmic impairments/disorders. The relative contribution of all the main groups of disorders increased over time, most notably cerebral visual impairment (from 50% to 61%). Aetiological factors operating prenatally continued to predominate, with an increased relative contribution of hereditary conditions in all children (from 35% to 57%, p<0.001). The substantially elevated rates for any ethnic minority group and those born preterm were unchanged, with amplification of increased rates associated with low birth weight.

Conclusion

The changing landscape of healthcare and increased survival of affected children, is reflected in increasing clinical complexity and heterogeneity of all-cause SVI/BL alongside declining mortality.
Effect of music on clinical outcome after hip fracture operations (MCHOPIN): study protocol of a multicentre randomised controlled trial
Authors: Fu Victor X , Jeekel Johannes , Van Lieshout Esther M M , Van der Velde Detlef , Slegers Leonie J P , Haverlag Robert , Haumann Johan , Poley Marten J , Verhofstad Michael H J
Published: December 2021

Background

Patients undergoing proximal femur fracture surgery are at high risk of postoperative complications, with postoperative delirium occurring in 25%–40% of patients. Delirium has profound effects on patient outcome and recovery, the patient’s family, caregivers and medical costs. Perioperative music has a beneficial effect on eliciting modifiable risk factors of delirium. Therefore, the aim of this trial was to evaluate the effect of perioperative recorded music on postoperative delirium in patients with proximal femur fracture undergoing surgery.

Methods and analysis

The Music on Clinical Outcome after Hip Fracture Operations study is an investigator-initiated, multicentre, randomised controlled, open-label, clinical trial. Five hundred and eight patients with proximal femur fracture meeting eligibility criteria will be randomised to the music intervention or control group with concealed allocation in a 1:1 ratio, stratified by hospital site. The perioperative music intervention consists of preselected lists totalling 30 hours of music, allowing participants to choose their preferred music from these lists (classical, jazz and blues, pop and Dutch). The primary outcome measure is postoperative delirium rate. Secondary outcome measures include pain, anxiety, medication requirement, postoperative complications, hospital length of stay and 30-day mortality. A 90-day follow-up will be performed in order to assess nursing home length of stay, readmission rate and functional ability to perform daily living activities. Furthermore, the cost and cost-effectiveness of the music intervention will be assessed. Data will be analysed according to an intention-to-treat principle.

Ethics and dissemination

The study protocol has been approved by the Medical Research Ethics Committee Erasmus MC on 8 October 2018 (MEC-2018–110, NL64721.078.18). The trial will be carried out following the Declaration of Helsinki principles, Good Clinical Practice guidelines and Dutch Medical Research Involving Human Subjects Act. Research data will be reported following Consolidated Standards of Reporting Trials guidelines and study results will be published in a peer-reviewed journal.

Trial registration number

NTR7036.
Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey
Authors: Omer Sumaira , Pan Mengyuan , Ali Salamat , Shukar Sundus , Fang Yu , Yang Caijun
Published: December 2021

Objective

This study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.

Design

Online questionnaire survey.

Setting and participants

Hospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).

Primary and secondary outcome measures

Prevalence and type of shortages were identified along with strategies to reduce its effect on patient care.

Method

A validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.

Results

Out of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.

Conclusion

Drug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.
Exploring data quality and use of the routine health information system in Ethiopia: a mixed-methods study
Authors:   The Operational Research and Coaching for Analysts (ORCA)- participants & team, Adane Abyot , Adege Tewabe M , Ahmed Mesoud M , Anteneh Habtamu A , Ayalew Emiamrew S , Berhanu Della , Berhanu Netsanet , Getnet Misrak , Bishaw Tesfahun , Busza Joanna , Cherinet Eshetu , Dereje Mamo , Desta Tsega H , Dibabe Abera , Firew Heven S , Gebrehiwot Freweini , Gebreyohannes Etenesh , Gella Zenebech , Girma Addis , Halefom Zuriash , Jama Sorsa F , Janson Annika , Kemal Binyam , Kiflom Abiy , Mazengiya Yidnekachew D , Mekete Kalkidan , Mengesha Magdelawit , Nega Meresha W , Otoro Israel A , Schellenberg Joanna , Taddele Tefera , Tefera Gulilat , Teketel Admasu , Tesfaye Miraf , Tsegaye Tsion , Woldesenbet Kidist , Wondarad Yakob , Yusuf Zemzem M , Zealiyas Kidist , Zeweli Mebratom H , Persson Lars Åke , Lemma Seblewengel
Published: December 2021

Objective

A routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data.

Design

This was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework.

Setting

This study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts.

Participants

We visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment.

Outcome measures

We assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions.

Results

There was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting.

Conclusion

We identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia.
Evaluation of the quality of contracted family doctor services based on patient perceptions and expectations: a follow-up analysis from the elderly with chronic diseases in rural Jiangsu, China
Authors: Jin Shengxuan , Wang Zhonghua , Tian Lanlan , Sun Zhenyu , Lin Zhenping , Qian Dongfu
Published: December 2021

Introduction

The policy focus of contracted family doctor services (CFDS) has been shifting to improve quality and efficiency in China. The study’s objective was to establish a quality evaluation scale for CFDS based on the perceived service quality model and to assess the service quality from the perspective of patient perceptions and expectations.

Methods

Data were obtained from a 2-year follow-up survey of CFDS in Jiangsu, China. A total of 1264 elderly people with chronic diseases were tracked. The self-developed scale was designed based on the perceived service quality model. The product scale method was used to assign weighted values, the Wilcoxon signed-rank test was used to compare the differences over the 2 years, and pooled cross-sectional regression was conducted to evaluate the associated factors with the gap scores of service quality.

Results

There were significant differences between perceptions and expectations in each dimension in the 2 years (p<0.05), and the service quality gaps existed. Over the 2 years, Accessibility and Horizontal continuity were the first-ranked and second-ranked in expectations; the top three scores in perception were Horizontal continuity, Comprehensive service and Accessibility dimensions. The service quality gap in 2020 was smaller than that in 2019 (p<0.05). There were differences in the perception scores in the Vertical continuity, Technical and Economic dimensions and in the expectation scores in the Horizontal continuity, Vertical continuity and Technical dimensions between the 2 years (p<0.05). The factors that were significantly associated with each dimension score included the Jiangsu region, gender, age and education levels (p<0.05).

Conclusion

The quality evaluation scale of CFDS has good reliability and validity. Policy efforts should be focused on accelerating the development of medical alliances, optimising medical insurance policies and improving the capacity of family doctor services to meet the needs of the elderly with chronic diseases.
Clinical decision-making for spinal manipulation for persistent spinal pain following lumbar surgery: a protocol for a systematic review and meta-analysis of individual participant data
Authors: Trager Robert James , Daniels Clinton J , Meyer Kevin W , Stout Amber C , Dusek Jeffery A
Published: December 2021

Introduction

There are limited available research and guidance regarding the use of spinal manipulative therapy (SMT) in patients with low back-related symptoms following lumbar spine surgery, a condition called persistent spinal pain syndrome type 2 (PSPS-2). This publication outlines a review protocol to identify and synthesise individual participant data (IPD) to examine associations between patient, clinical and surgical variables and SMT application in adults with PSPS-2.

Methods and analysis

PubMed, OVID, Web of Science, Scopus, PEDro, Index to Chiropractic Literature and KoreaMed will be searched from inception to 1 January 2022 without language restrictions. Case reports, series, observational studies and cases from grey literature of adults receiving SMT for PSPS-2 will be included. Two investigators will independently screen citations, abstracts and full-text articles. A risk-of-bias assessment will be performed in duplicate to rate cases according to exposure and outcome ascertainment and data completeness. Data extraction will be performed in duplicate and missing IPD will be requested from corresponding authors. Multiple binary logistic regression will be used to identify independent predictors of the use of lumbar–SMT, lumbar–manual-thrust SMT and SMT within 1-year postsurgery. Patient, clinical and surgical variables will be summarised using descriptive statistics, while SMT-related outcomes (lumbar–SMT, lumbar–manual-thrust SMT and 1-year surgery-to-SMT interval) will be described using adjusted ORs with 95% CIs.

Ethics and dissemination

This study was deemed not human subjects research by the University Hospitals’ institutional review board. The results of this review will be disseminated at conferences and/or published in a peer-reviewed journal.

PROSPERO registration number

CRD42021250039.
Parents’ attitudes as mediators between knowledge and behaviours in unintentional injuries at home of children aged 0–3 in Shanghai, Eastern China: a cross-sectional study
Authors: Ma Xueqi , Zhang Qi , Jiang Ruo , Lu Jun , Wang Huiping , Xia Qinghua , Zheng Jicui , Deng Wei , Chang Fengshui , Li Xiaohong
Published: December 2021

Objective

Parental behaviours are important in preventing unintentional injury at home among young children. Previous research showed an inconsistent relationship between knowledge and behaviours, indicating that the mechanisms may vary for different behaviours. This study aimed to examine the mediating roles of different attitudes in the mechanism of knowledge acting on different behaviours.

Design

Cross-sectional study.

Setting

Eastern China.

Participants

Participants were recruited using stratified community-based sampling. A total of 488 parents of children aged 0–3 years participated in the study and 476 (97.5%) valid questionnaires were recovered.

Primary outcome measures

Parents’ knowledge, attitudes (including injury attribution, preventability and responsibility) and behaviours (including supervision behaviours, risky behaviours and providing a safe home environment).

Results

The results of mediation analysis showed that the mediator variables were different for different behaviours and that all associations were positive. Parents’ knowledge (β 0.19, 95% CI 0.13 to 0.24) and attitude of injury attribution (β 0.37, 95% CI 0.21 to 0.46) were directly associated with risky behaviours. Attitude of preventability was directly associated with parents’ supervision behaviour (β 0.27, 95% CI 0.14 to 0.40). Parents’ attitude of preventability mediated the positive association between knowledge, attitudes of injury attribution and responsibility, and supervision behaviours, as well as providing a safe home environment. In addition, the occurrence of child injuries at home was directly associated with home environment (β −0.41, 95% CI −0.82 to −0.01).

Conclusions

The current findings confirm that attitudes play varying mediating roles between knowledge and different behaviours. An important recommendation is that parents’ attitudes, especially towards preventability and responsibility, need to be considered when health providers develop health education programmes targeted at improving parental supervision behaviours and providing a safe home environment.