bluuebunny/crossref_metadata_2025 huggingface dataset:
How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units
Authors: Johansen Lars T. , Braut Geir Sverre , Acharya Ganesh , Andresen Jan Fredrik , Øian Pål
Published: July 2020

Introduction

The Norwegian Board of Health Supervision inspects healthcare institutions to ensure safety and quality of health and welfare services. A planned inspection of 12 maternity units aimed to investigate the practice of obstetric care in the case of birth asphyxia, shoulder dystocia and severe postpartum hemorrhage.

Material and methods

The inspection was carried out at two large, four medium and six small maternity units in Norway in 2016 to investigate adverse events that occurred between 1 January and 31 December 2014. Six of them were selected as control units. The Norwegian Board of Health Supervision searched the Medical Birth Registry of Norway to identify adverse events in each of the categories and then requested access to the medical records for all patients identified. Information about guidelines, formal teaching and simulation training at each unit was obtained by sending a questionnaire to the obstetrician in charge of each maternity unit.

Results

The obstetric units inspected had 553 serious adverse events of birth asphyxia, shoulder dystocia or severe postpartum hemorrhage among 17 323 deliveries. Twenty‐nine events were excluded from further analysis due to erroneous coding or missing data in the patients’ medical records. We included 524 cases (3.0% of all deliveries) of adverse events in the final analysis. Medical errors caused by substandard care were present in 295 (56.2%) cases. There was no difference in the prevalence of substandard care among the maternity units according to their size. Surprisingly, we found significantly fewer cases with substandard care in the units which the supervisory authorities considered particularly risky before the inspection, compared with the control units. Seven of the 12 units had regular formal teaching and training arrangements for obstetric healthcare personnel as outlined in the national guidelines.

Conclusions

Prevalence of adverse events was 3% and similar in all maternity units irrespective of their size. A breach in the standard of care was observed in 56.2% of cases and almost half of the maternity units did not follow national recommendations regarding teaching and practical training of obstetric personnel, suggesting that they should focus on implementing guidelines and training their staff.
How to evaluate the outflow tract of LVAD after minimally invasive implantation by 3D CT‐scan
Authors: Gallo Michele , Spigolon Luca , Bejko Jonida , Gerosa Gino , Bottio Tomaso
Published: July 2020

During a minimally invasive implantation technique, the outflow graft of left ventricular assist device (LVAD) is tunnelled blindly through the pericardium or left pleura, with an inability to assess for twisting or malposition. Three‐dimensional computed tomography scan (CT‐scan) has a role in qualitative evaluation of the different outflow tract configurations. The different surgical minimally invasive approaches include: (a) mini‐sternotomy and left mini‐thoracotomy, (b) right mini‐thoracotomy and left mini‐thoracotomy, (c) subclavian artery access and left mini‐thoracotomy. The outflow graft could be anastomosed to the left axillary artery or the ascending aorta. CT‐scan reconstruction using syngo InSpace4D (Siemens, Muenchen, Germany) was used to provide fast segmentation and high‐resolution images. The 3D reconstructions permit an evaluation of different anastomosis configurations and to assess the route of outflow graft.
Impact of EU regulatory label changes for diclofenac in people with cardiovascular disease in four countries: Interrupted time series regression analysis
Authors: Morales Daniel R. , Morant Steven V. , MacDonald Thomas M. , Hallas Jesper , Ernst Martin Thomsen , Pottegard Anton , Herings Ron M.C. , Smits Elisabeth , Overbeek Jetty A. , Mackenzie Isla S. , Doney Alexander S.F. , Mitchell Lyn , Bennie Marion , Robertson Chris , Wei Li , Nicholson Lizzie , Morris Carole , Flynn Robert W.V.
Published: July 2020

Objective

Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations.

Method

Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland.

Results

The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark −0.08%, 95%CI −0.13, −0.03; England −0.09%, 95%CI −0.13 to −0.06%; the Netherlands −1.84%, 95%CI −2.51 to −1.17%; Scotland −0.34%, 95%CI −0.38 to −0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post‐intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (−0.12%, 95%CI −0.19 to −0.04), PAD (−0.13%, 95%CI −0.22 to −0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (−0.01%, 95%CI −0.02 to −0.007%), IHD (−0.017, 95%CI −0.02, −0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action.

Conclusion

Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings.
Human disturbance has contrasting effects on niche partitioning within carnivore communities
Authors: Sévêque Anthony , Gentle Louise K. , López‐Bao José V. , Yarnell Richard W. , Uzal Antonio
Published: July 2020

Among species, coexistence is driven partly by the partitioning of available resources. The mechanisms of coexistence and competition among species have been a central topic within community ecology, with particular focus on mammalian carnivore community research. However, despite growing concern regarding the impact of humans on the behaviour of species, very little is known about the effect of humans on species interactions. The aim of this review is to establish a comprehensive framework for the impacts of human disturbance on three dimensions (spatial, temporal and trophic) of niche partitioning within carnivore communities and subsequent effects on both intraguild competition and community structure. We conducted a systematic review of the literature on carnivore niche partitioning (246 studies) and extracted 46 reported effects of human disturbance. We found evidence that human disturbance impacts resource partitioning, either positively or negatively, in all three niche dimensions. The repercussions of such variations are highly heterogeneous and differ according to both the type of human disturbance and how the landscape and/or availability of resources are affected. We propose a theoretical framework of the three main outcomes for the impacts of human disturbance on intraguild competition and carnivore community structure: (i) human disturbance impedes niche partitioning, increasing intraguild competition and reducing the richness and diversity of the community; (ii) human disturbance unbalances niche partitioning and intraguild competition, affecting community stability; and (iii) human disturbance facilitates niche partitioning, decreasing intraguild competition and enriching the community. We call for better integration of the impact of humans on carnivore communities in future research on interspecific competition.
Hypercapnia promotes microglial pyroptosis via inhibiting mitophagy in hypoxemic adult rats
Authors: Ding Hong‐guang , Li Ya , Li Xu‐sheng , Liu Xin‐qiang , Wang Kang‐rong , Wen Miao‐yun , Jiang Wen‐qiang , Zeng Hong‐ke
Published: July 2020

Background

Hypoxemia is a typical symptom of acute respiratory distress syndrome. To avoid pulmonary morbidity, low tidal volume ventilation is often applied. The ventilation strategy will certainly cause hypercapnia. This study aimed to explore whether hypercapnia would promote microglial pyroptosis via inhibiting mitophagy in adult rats with hypoxemia.

Methods

The cerebral oxygen extraction ratio (CERO2) and partial pressure of brain tissue oxygen (PbtO2) in a rat model of hypercapnia/hypoxemia were assessed. The reactive oxygen species (ROS) production and the expression of LC3‐II/I, p62, caspase‐1, gasdermin D‐N domains (GSDMD‐N), IL‐1β, and IL‐18 in microglial cells were detected.

Results

Hypercapnia decreased the PbtO2 levels of the hypoxic rats, which was further evidenced by the increased levels of CERO2. Expression levels of LC3‐II were reduced, while p62 expression was increased by hypercapnia in hypoxic microglia. Hypercapnia increased the production of ROS and the expression of caspase‐1, GSDMD‐N, IL‐1β, and IL‐18 in hypoxia‐activated microglia. Scavenging ROS inhibited microglial pyroptosis and expression of IL‐1β and IL‐18.

Conclusions

These results suggest that hypercapnia‐induced mitophagy inhibition may promote pyroptosis and enhance IL‐1β and IL‐18 release in hypoxia‐activated microglia.
B3GNT5 is a novel marker correlated with stem‐like phenotype and poor clinical outcome in human gliomas
Authors: Jeong Hang Yeon , Park Seo‐Young , Kim Hyun‐Jin , Moon Seungju , Lee Seongsoo , Lee Seung Ho , Kim Sung‐Hak
Published: July 2020

Aims

Glioblastoma multiforme (GBM) is the most lethal tumor with a median patient survival of 14 to 15 months. Glioma stem cells (GSCs) play a critical role in tumor initiation and therapeutic resistance in GBM. B3GNT5 has been suggested as the key glycosyltransferase in the biosynthesis of the (neo‐) lacto series of glycosphingolipid. In this study, we evaluated the B3GNT5 expression in GSCs as well as the correlation with clinical data in GBM.

Methods

The mRNA levels of B3GNT5 in normal astrocytes, four glioma cell lines, and four GSCs were evaluated using real‐time PCR. Small interference RNAs (siRNAs) were used to inhibit B3GNT5 expression and analyze its ability to form neurospheres. Statistical analyses were conducted to determine the association with B3GNT5 expression and tumor grade and GBM subtypes as well as patient survival using public datasets.

Results

B3GNT5 expression was significantly elevated in GSCs compared with normal astrocytes, glioma cell lines, and their matched differentiated tumor cells. Knockdown of B3GNT5 in GSCs decreased the neurosphere formation. Patients with high B3GNT5 expression had a short overall survival. B3GNT5 is correlated with classical and mesenchymal GBM subtypes.

Conclusion

The findings suggest the central role of B3GNT5 in regulating malignancy of GBM.
Modern therapies in atopic dermatitis: biologics and small molecule drugs
Authors: Worm Margitta , Francuzik Wojciech , Kraft Magdalena , Alexiou Aikaterina
Published: July 2020

Atopic dermatitis (AD) is a frequent, chronic remittent skin disease. The pathophysiology of AD has been increasingly understood within the last years, which may help to identify different endotypes suitable for defined therapies in the future. A patient‐oriented therapy considers phenotypical features in addition to genetic and biological markers. The most recent developments in biologics and small‐molecule drugs for AD treatment are presented in this article. These molecules, if approved, could change the perspectives for future therapies.

Dupilumab is the first approved biologic for the treatment of moderate to severe atopic dermatitis in adolescence and adulthood and has led to a significant improvement in the treatment of this chronic disease. In the present article we present real‐life data on the efficacy of dupilumab in adult dermatitis patients. We also discuss other data relevant to the use of dupilumab, and address open questions important for the standard care of atopic dermatitis patients.
Entrepreneurial ecosystems as a bridging concept? A conceptual contribution to the debate on entrepreneurship and regional development
Authors: Lange Bastian , Schmidt Suntje
Published: July 2020

This paper explores the potential of considering entrepreneurial ecosystems as a bridging concept that enables a trans‐disciplinary exchange. We aim to contribute to the debate by offering a perspective that takes entrepreneurial ecosystems out of their systemic—often geographically fixed—notion of administrative and territorial boundaries by offering a novel conceptual understanding of it. So far, entrepreneurial ecosystems are appreciated for first exhibiting conceptual strengths in terms of integrating entrepreneurs as economic actors (rather than firms as the smallest unit of analysis), and, second, considering entrepreneurship as a process that focuses on the co‐evolution of entrepreneurial activities and their institutional environment. Criticism of this concept arises on its simplification by translating social elements into entrepreneurial ecosystem terminologies and on focusing on quantifiable indicators for measuring and comparing regional ecosystems rather than appreciating the complexity and interrelatedness of qualitative dimensions and their temporal dynamics. Against this background, we first argue for expanding the debate on entrepreneurial ecosystems by paying particular attention to the spatial as well as to temporal dynamics of entrepreneurship and its environment. Second, we regard entrepreneurial ecosystems as a communicative bridge that enables a fruitful exchange between academic disciplines and practitioners rather than approaching the concept as a mono‐disciplinary theoretical framework.
Imprinting, immunodominance, and other impediments to generating broad influenza immunity
Authors: Knight Matthew , Changrob Siriruk , Li Lei , Wilson Patrick C.
Published: July 2020

Natural influenza virus infections and seasonal vaccinations often do not confer broadly neutralizing immunity across diverse influenza strains. In addition, the virus is capable of rapid antigenic drift in order to evade pre‐existing immunity. The surface glycoproteins, hemagglutinin, and neuraminidase can easily mutate their immunodominant epitopes without impacting fitness. Skewing human antibody repertoires to target more conserved epitopes is thus an expanding area of research: Many groups are attempting to produce universal influenza vaccines that can protect across a wide variety of strains. Achieving this goal will require a detailed understanding of how infection history impacts humoral responses. It will also require the ability to manipulate or enhance B cell selection in order to expand clones that can recognize subdominant but protective epitopes. In this review, we will discuss what immune imprinting means to immunologists and describe efforts to overcome or silence imprinting in order to improve vaccination efficiency.
Augmented reality and competition in robotics education: Effects on 21st century competencies, group collaboration and learning motivation
Authors: Chen Ching‐Huei , Yang Chin‐Kun , Huang Kun , Yao Kai‐Chao
Published: July 2020

Robotics education has received an increasing attention in recent years as a means to build students' motivation, team collaboration skills, and other valuable 21st century competencies. Yet there is a lack of experimental studies to investigate and identify strategies to facilitate robotics education. This study adopted a 2 × 2 quasi‐experimental design to investigate two strategies: the incorporation of augmented reality (AR) and the introduction of competition in robotics activities. Students' robotics task performance, team collaboration processes, 21st century learning competencies and learning motivation were measured as dependent variables. The results indicated that AR significantly improved students' motivation, team processes, and 21st century competencies. Moreover, the effects of AR were more pronounced with the competition groups. Implications are drawn to provide guidelines on the use of AR and competition in robotics education.
Novel gene signatures for prognosis prediction in ovarian cancer
Authors: Bao Mingyang , Zhang Lihua , Hu Yueqing
Published: July 2020

Ovarian cancer (OV) is one of the leading causes of cancer deaths in women worldwide. Late diagnosis and heterogeneous treatment result to poor survival outcomes for patients with OV. Therefore, we aimed to develop novel biomarkers for prognosis prediction from the potential molecular mechanism of tumorigenesis. Eight eligible data sets related to OV in GEO database were integrated to identify differential expression genes (DEGs) between tumour tissues and normal. Enrichment analyses discovered DEGs were most significantly enriched in G2/M checkpoint signalling pathway. Subsequently, we constructed a multi‐gene signature based on the LASSO Cox regression model in the TCGA database and time‐dependent ROC curves showed good predictive accuracy for 1‐, 3‐ and 5‐year overall survival. Utility in various types of OV was validated through subgroup survival analysis. Risk scores formulated by the multi‐gene signature stratified patients into high‐risk and low‐risk, and the former inclined worse overall survival than the latter. By incorporating this signature with age and pathological tumour stage, a visual predictive nomogram was established, which was useful for clinicians to predict survival outcome of patients. Furthermore, SNRPD1 and EFNA5 were selected from the multi‐gene signature as simplified prognostic indicators. Higher EFNA5 expression or lower SNRPD1 indicated poorer outcome. The correlation between signature gene expression and clinical characteristics was observed through WGCNA. Drug‐gene interaction was used to identify 16 potentially targeted drugs for OV treatment. In conclusion, we established novel gene signatures as independent prognostic factors to stratify the risk of OV patients and facilitate the implementation of personalized therapies.
Effect of botulinum toxin type A for treating hypertrophic scars: A split‐scar, double‐blind randomized controlled trial
Authors: Elshahed Ahmad R. , Elmanzalawy Khaled S. , Shehata Hany , ElSaie Mohamed L.
Published: July 2020

Background

Hypertrophic scars (HS) are a challenging disorder that mostly develops during wound‐healing process following skin injuries.

Methods

A split‐scar, double‐blind randomized controlled trial was held to assess the safety and efficacy of botulinum toxin type A (BTA) injection in hypertrophic scars (HS). Thirty patients with old scars (range: 1‐15 years) were treated, with sides randomized to receive treatment with either BTA or 0.9% normal saline once monthly for three consecutive months. Scars were assessed using the Vancouver scar scale (VSS) along with digital photograph standardization.

Results

Twenty‐one subjects completed the study. The mean VSS score for the BTA‐treated half of the scars decreased from 7.29 ± 2.327 before injection to 5.33 ± 2.41 following injection which was highly significant (P = .01). For the control half, the mean VSS decreased insignificantly from 7.29 ± 2.327 before injection to 7.10 ± 2.234 following injection (P = .104).

Conclusion

Clinical and cosmetic improvement was demonstrated significantly among the BTA‐treated group. BTA can be an additional and useful tool for improving scar outcomes.
A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards
Authors: Guzman‐Parra Jose , Aguilera‐Serrano Carlos , Huizing Evelyn , Bono del Trigo Aguila , Villagrán José María , García‐Sánchez Juan Antonio , Mayoral‐Cleries Fermín
Published: July 2020

Accessible summary

What is known on the subject?

A relevant number of restraint prevention programmes have been developed internationally.

In Spain, there is no harmonized policy to prevent the use of restraint.

More studies are necessary to establish which programmes and components are necessary to prevent restraint.

What does the paper add to existing knowledge?

There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention.

There was no significant decreasing trend in the number of mechanical restraint episodes.

What are the implications for practice?

Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context.

All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint.

Introduction

Mechanical restraint (MR) is used in many countries, including Spain, where non‐harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use.

Aim

To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR.

Method

Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression.

Results

There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (−1.79%, p < .001), but not in the number of restraint episodes (−0.45%; p = .149).

Discussion

The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention.

Implications for Practice

Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.
Harry Johnson's “Case for flexible exchange rates”—50 years later
Authors: Obstfeld Maurice
Published: July 2020

Fifty years ago, Harry G. Johnson published “The Case for Flexible Exchange Rates, 1969”, its title echoing Milton Friedman's classic essay of the early 1950s. Though somewhat overlooked today, Johnson's reprise was an important element in the late 1960s debate over the future of the international monetary system. The present paper has three objectives. The first is to lay out the historical context in which Johnson's “Case” was written and read. The second is to examine Johnson's main points and see how they stand up to nearly five decades of experience with floating exchange rates since the end of the Bretton Woods system. The third is to review the most recent academic critiques of exchange‐rate flexibility and ask how fatal they are to Johnson's basic argument. I conclude that the essential case for exchange‐rate flexibility still stands strong.
Role of TaALMT1 malate‐GABA transporter in alkaline pH tolerance of wheat
Authors: Kamran Muhammad , Ramesh Sunita A. , Gilliham Matthew , Tyerman Stephen D. , Bose Jayakumar
Published: July 2020

Malate exudation through wheat (Triticum aestivum L) aluminium‐activated malate transporter 1 (TaALMT1) confers Al3+ tolerance at low pH, but is also activated by alkaline pH, and is regulated by and facilitates significant transport of gamma‐aminobutyric acid (GABA, a zwitterionic buffer). Therefore, TaALMT1 may facilitate acidification of an alkaline rhizosphere by promoting exudation of both malate and GABA. Here, the performance of wheat near isogenic lines ET8 (Al+3‐tolerant, high TaALMT1 expression) and ES8 (Al+3‐sensitive, low TaALMT1 expression) are compared. Root growth (at 5 weeks) was higher for ET8 than ES8 at pH 9. ET8 roots exuded more malate and GABA at high pH and acidified the rhizosphere more rapidly. GABA and malate exudation was enhanced at high pH by the addition of aluminate in both ET8 and transgenic barley expressing TaALMT1. Xenopus laevis oocytes expressing TaALMT1 acidified an alkaline media more rapidly than controls corresponding to higher GABA efflux. TaALMT1 expression did not change under alkaline conditions but key genes involved in GABA turnover changed in accordance with a high rate of GABA synthesis. We propose that TaALMT1 plays a role in alkaline tolerance by exuding malate and GABA, possibly coupled to proton efflux.
Forgetting memory skepticism
Authors: Frise Matthew , McCain Kevin
Published: July 2020

Memory skepticism denies our memory beliefs could have any notable epistemic good. One route to memory skepticism is to challenge memory’s epistemic trustworthiness, that is, its functioning in a way necessary for it to provide epistemic justification. In this paper we develop and respond to this challenge. It could threaten memory in such a way that we altogether lack doxastic attitudes. If it threatens memory in this way, then the challenge is importantly self‐defeating. If it does not threaten memory in this way, then the challenge leaves a foundation for an inference to the best explanation response, one we articulate and support.
Basaloid squamous cell carcinoma with adenoid cystic‐like features of the head and neck region: A report of two cases
Authors: Kusafuka Kimihide , Yagi Haruna , Baba Satoshi , Inagaki Hiroshi , Tsuchiya Chinatsu , Hirata Kazuki , Muramatsu Aya , Suzuki Makoto , Arai Kazumori , Terada Tadashi
Published: July 2020

The histology of basaloid squamous cell carcinoma (BSCC) can resemble that of adenoid cystic carcinoma (AdCC). Herein, we report two cases of BSCC with adenoid cystic‐like features (BSCC‐AdC). We collected cases of AdCC and BSCC of the head and neck region, extracted two cases with unusual histology, and reexamined them histologically and immunohistochemically. Case 1 involved an 81‐year‐old Japanese male, who had an elastic‐hard mass on the left side of his tongue, and a biopsy examination suggested AdCC. Case 2 involved a 63‐year‐old Japanese male, who had a polypoid mass on his right hypopharynx. He was diagnosed with AdCC with high‐grade transformation. Histologically, atypical cells in a myxoid stroma, which exhibited trabecular, nest‐like, and/or cribriform growth patterns, and necrosis were observed in both cases. Case 2 displayed more marked cellular atypia than Case 1. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin 5/6, p63/p40, SRY‐related HMG‐box 10 and Ki‐67, but negative for other myoepithelial markers and p16. Finally, both cases were rediagnosed as BSCC‐AdC. It is known that esophageal BSCC displays adenoid cystic‐like features, and BSCC‐AdC also sometimes occurs in the head and neck region. Clinicians should carefully differentiate BSCC‐AdC from AdCC of the minor salivary glands and human papillomavirus‐related carcinoma.
The 'difficult patient' phenomenon in home nursing and 'self‐inflicted' illness
Authors: Michaelsen Jette Joost
Published: July 2020

Rationale and aim

Home nurses work largely alone, and consequently, 'difficult patients' can be challenging for them. Understanding of this phenomenon can have a major impact on the quality of care. The aim is to explore how nurses characterise, relate to and interact with these patients. Why do nurses perceive some patients as difficult and what are the consequences for the patient? What are these patients´ expectations of the nurses and their perceptions of illness?

Methods

An ethnographic study with 30 participant observations of 12 nurses visiting 146 patients was conducted. A total of 6 interviews were made with 4 'difficult patients' and 11 interviews with 5 nurses.

Findings

In the nurses' view, the 'difficult patients' had little insight into their illnesses, denied they were ill and were noncompliant. Some nurses had negative feelings about a patient, regarded the patient as too demanding or found the patient´s personal characteristics repulsive. The difficulty lies in the relationship between nurse and patient. Important health problems of some patients remained unrecognised. The nurses regarded the patients' illnesses as self‐inflicted. The patients had low expectations of nurses, lacked knowledge about what to expect of them, and their views on their illnesses differed from those of the nurses. Contributing causes of patients becoming difficult for nurses seemed to be different norms and values and the nurses' work situation.

Conclusion

It is important that nurses communicate their knowledge about the connection between illness and pathogenic social conditions and discuss 'self‐inflicted' illness and their role in relation to this. Supervision is suggested. Improved working conditions could lead to fewer 'difficult patients'.

Study limitations

The perspectives of patients should be studied in greater detail.
Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country
Authors: Leon‐Rodriguez Eucario , Rivera‐Franco Monica M. , Terrazas‐Marin Ricardo A. , Virgen‐Cuevas Margarita , Aguirre‐Limon Melissa I. , Saldaña‐González Erika S. , Pacheco‐Arias Maria A. , Gomez‐Vázquez Oscar R.
Published: July 2020

Background

Hematopoietic cell transplantation (HCT) outcomes, including infectious complications, change between centers and countries. Thus, the aim of this study was to report the incidence of infections and isolated pathogens among recipients of HCT and the association with mortality at a tertiary referral center in Mexico.

Methods

Two hundred and eighty‐two patients undergoing autologous or allogeneic HCT between January 2005 and December 2018 at the National Institute of Medical Sciences and Nutricion Salvador Zubiran were included.

Results

In autologous HCT (n = 176), within the preengraftment and the early postengraftment, 130 (74%) and 31 (18%) recipients presented infections, respectively. Within the preengraftment, the early postengraftment, and the late postengraftment, 81 (76%), 34 (33%), and 58 (60%) allogeneic HCT recipients presented infections, respectively. Non‐relapse mortality (NRM) as a result of infections occurred in 1 (0.6%) and 5 (5%) autologous and allogeneic HCT recipients, respectively.

Conclusions

Our results demonstrated that despite our limited resources, infections were not a significant burden for NRM among HCT recipients. More importantly, the isolation rates were higher than international studies, which could be explained by the existence of a specialized infectious diseases department and laboratory, which we consider key elements for the establishment of an HCT program worldwide.
Liver transplant recipients infected with SARS‐CoV‐2 in the early postoperative period: Lessons from a single center in the epicenter of the pandemic
Authors: Waisberg Daniel Reis , Abdala Edson , Nacif Lucas Souto , Haddad Luciana Bertocco , Ducatti Liliana , Santos Vinicius Rocha , Gouveia Larissa Nunes , Lazari Carolina Santos , Martino Rodrigo Bronze , Pinheiro Rafael Soares , Arantes Rubens Macedo , Terrabuio Debora Raquel , Malbouisson Luiz Marcelo , Galvao Flavio Henrique , Andraus Wellington , Carneiro‐D'Albuquerque Luiz Augusto
Published: July 2020

The impact of coronavirus disease‐19 (COVID‐19) in liver recipients remains largely unknown. Most data derive from small retrospective series of patients transplanted years ago. We aimed to report a single‐center case series of five consecutive patients in the early postoperative period of deceased‐donor liver transplantation who developed nosocomial COVID‐19. Two patients presented important respiratory discomfort and eventually died. One was 69 years old and had severe coronary disease. She rapidly worsened after COVID‐19 diagnosis on 9th postoperative day. The other was 67 years old with non‐alcoholic steatohepatitis, who experienced prolonged postoperative course, complicated with cytomegalovirus infection and kidney failure. He was diagnosed on 36th postoperative day and remained on mechanical ventilation for 20 days, ultimately succumbing of secondary bacterial infection. The third, fourth, and fifth patients were diagnosed on 10th, 11th, and 18th postoperative day, respectively, and presented satisfactory clinical evolution. These last two patients were severely immunosuppressed, since one underwent steroid bolus for acute cellular rejection and another also used anti‐thymocyte globulin for treating steroid‐resistant rejection. Our novel experience highlights that COVID‐19 may negatively impact the postoperative course, especially in elder and obese patients with comorbidities, and draws attention to COVID‐19 nosocomial spread in the early postoperative period.
UK trading patterns within and between regions in the automotive sector—A network analysis
Authors: Smith Matthew , Sarabi Yasaman
Published: July 2020

This study provides an analysis of the UK's role in the automotive sector, focusing on the trading relationship of the UK within and between regions. It additionally provides an examination of the countries that hold equivalent trading positions to the UK in various segments of the automotive sector. The results indicate a high level of integration with Europe & Central Asia; outside the region, there appears to be a trend towards sourcing inputs from East Asia & Pacific, along with the Middle East & North Africa acting as an export destination. The equivalence analysis results provide a set of nations that could reposition themselves to gain from the UK's departure from the European Union. Amongst them are traditional key European players in the sector, along with Eastern European nations, which have been developing key strengths within the sector in recent years.
Impact of acute conjunctivitis on ocular surface homeostasis in dogs
Authors: Sebbag Lionel , Soler Elizabeth A. , Allbaugh Rachel A. , Mochel Jonathan P.
Published: July 2020

Objective

To investigate the effects of acute conjunctivitis on tear film characteristics and corneal sensitivity in dogs.

Animals studied

Eight female spayed Beagle dogs (1.5‐2 years old, 7.5‐10 kg).

Procedures

On two consecutive days, one randomly selected eye in each dog received 1 or 375 mg/mL histamine solution to induce mild or severe conjunctivitis, while the contralateral eye served as control. Diagnostic tests were performed in the following order: fluorescein instillation and repeated tear collection over 20 minutes (to determine tear volume [TV] and turnover rate [TTR] by fluorophotometry), Schirmer tear test‐1 (STT‐1), tear ferning, corneal esthesiometry, and tear film breakup time (TFBUT).

Results

Results are presented as median values for severe conjunctivitis, mild conjunctivitis, and control eyes. Eyes with severe conjunctivitis had significantly higher STT‐1 (24, 19.5, 17.5 mm/min; P = .002) and significantly lower TFBUT (10.5, 13.5, 15.5 s; P = .002), but no changes were noted in corneal tactile sensation (2, 2.5, 2.5 cm) or tear ferning (grades 2, 2, 2.5). Severe conjunctivitis significantly increased TV by nearly 10‐fold (631, 97, 65 µL) initially (reflex tearing), although basal TV returned rapidly (<5 minutes) in all eyes (46, 58, 48 µL). Finally, there was a nonsignificant trend for higher reflex TTR in the conjunctivitis vs control eyes (68, 58, 43%/min).

Conclusions

Experimentally induced conjunctivitis increases tear quantity and decreases tear quality in dogs, but has no impact on corneal sensitivity. Changes in tear film dynamics could affect ocular pharmacology (eg, precorneal retention time), although homeostasis of lacrimal volume and drainage is rapidly restored.
Nonlinear Vibrations of Embedded Nanoplates Under In-Plane Magnetic Field Based on Nonlocal Elasticity Theory
Authors: Mazur Olga , Awrejcewicz Jan
Published: July 2020

Nonlinear vibrations of the orthotropic nanoplates subjected to an influence of in-plane magnetic field are considered. The model is based on the nonlocal elasticity theory. The governing equations for geometrically nonlinear vibrations use the von Kármán plate theory. Both the stress formulation and the Airy stress function are employed. The influence of the magnetic field is taken into account due to the Lorentz force yielded by Maxwell's equations. The developed approach is based on applying the Bubnov–Galerkin method and reducing partial differential equations to an ordinary differential equation. The effect of the magnetic field, elastic foundation, nonlocal parameter, and plate aspect ratio on the linear frequencies and the nonlinear ratio is illustrated and discussed.
Aerodynamic Optimisation of the Low Pressure Turbine Module: Exploiting Surrogate Models in a High-Dimensional Design Space
Authors: Baert Lieven , Lepot Ingrid , Sainvitu Caroline , Chérière Emmanuel , Nouvellon Arnaud , Leonardon Vincent
Published: July 2020

Further improvement of state-of-the-art Low Pressure (LP) turbines has become progressively more challenging. LP design is more than ever confronted to the need to further integrate complex models and to shift from single component design to the design of the complete LPT module at once. This leads to high-dimensional design spaces and automatically challenges its applicability within an industrial context, where CPU resources are limited and the cycle time crucial.

The aerodynamic design of a multistage LP turbine is discussed for a design space defined by 350 parameters. Using an online surrogate-based optimisation (SBO) approach a significant efficiency gain of almost 0.5pt has been achieved. By discussing the sampling of the design space, the quality of the surrogate models, and the application of adequate data mining capabilities to steer the optimisation, it is shown that despite the high-dimensional nature of the design space the followed approach allows to obtain performance gains beyond target.

The ability to control both global as well as local characteristics of the flow throughout the full LP turbine, in combination with an agile reaction of the search process after dynamically strengthening and/or enforcing new constraints in order to adapt to the review feedback, illustrates not only the feasibility but also the potential of a global design space for the LP module. It is demonstrated that intertwining the capabilities of dynamic SBO and efficient data mining allows to incorporate high-fidelity simulations in design cycle practices of certified engines or novel engine concepts to jointly optimise the multiple stages of the LPT.
The Effects of Caffeine Mouth Rinsing on Exercise Performance: A Systematic Review
Authors: Ehlert Alex M. , Twiddy Hannah M. , Wilson Patrick B.
Published: July 2020

Caffeine ingestion can improve performance across a variety of exercise modalities but can also elicit negative side effects in some individuals. Thus, there is a growing interest in the use of caffeine mouth rinse solutions to improve sport and exercise performance while minimizing caffeine’s potentially adverse effects. Mouth rinse protocols involve swilling a solution within the oral cavity for a short time (e.g., 5–10 s) before expectorating it to avoid systemic absorption. This is believed to improve performance via activation of taste receptors and stimulation of the central nervous system. Although reviews of the literature indicate that carbohydrate mouth rinsing can improve exercise performance in some situations, there has been no attempt to systematically review the available literature on caffeine mouth rinsing and its effects on exercise performance. To fill this gap, a systematic literature search of three databases (PubMed, SPORTDiscus, and Web of Science) was conducted by two independent reviewers. The search resulted in 11 randomized crossover studies that were appraised and reviewed. Three studies found significant positive effects of caffeine mouth rinsing on exercise performance, whereas the remaining eight found no improvements or only suggestive benefits. The mixed results may be due to heterogeneity in the methods across studies, interindividual differences in bitter tasting, and differences in the concentrations of caffeine solutions. Future studies should evaluate how manipulating the concentration of caffeine solutions, habitual caffeine intake, and genetic modifiers of bitter taste influence the efficacy of caffeine mouth rinsing as an ergogenic strategy.
Nutrient ratios in marine particulate organic matter are predicted by the population structure of well-adapted phytoplankton
Authors: Sharoni Shlomit , Halevy Itay
Published: July 2020

Global patterns in organic matter stoichiometry are predicted by the population structure of well-adapted phytoplankton.
The shape of educational inequality
Authors: Quarles Christopher L. , Budak Ceren , Resnick Paul
Published: July 2020

The ability of community college students to be successful is conceptualized, measured, and shown to be exponentially distributed.
Helicity-dependent photocurrents in the chiral Weyl semimetal RhSi
Authors: Rees Dylan , Manna Kaustuv , Lu Baozhu , Morimoto Takahiro , Borrmann Horst , Felser Claudia , Moore J. E. , Torchinsky Darius H. , Orenstein J.
Published: July 2020

The CPGE spectrum and optical conductivity in RhSi are measured and discussed, comparing to theoretical predictions.
A customized belonging intervention improves retention of socially disadvantaged students at a broad-access university
Authors: Murphy Mary C. , Gopalan Maithreyi , Carter Evelyn R. , Emerson Katherine T. U. , Bottoms Bette L. , Walton Gregory M.
Published: July 2020

Bolstering belonging at a broad-access university improves persistence.
An artificial metalloenzyme for catalytic cancer-specific DNA cleavage and operando imaging
Authors: Gao Liang , Zhang Ya , Zhao Lina , Niu Wenchao , Tang Yuhua , Gao Fuping , Cai Pengju , Yuan Qing , Wang Xiayan , Jiang Huaidong , Gao Xueyun
Published: July 2020

A metal cluster stuck in a protein acts as a synthetic metalloenzyme for cancer-specific catalytic therapy.
Self-healable sticky porous elastomer for gas-solid interacted power generation
Authors: Xiong Jiaqing , Thangavel Gurunathan , Wang Jiangxin , Zhou Xinran , Lee Pooi See
Published: July 2020

Gas-solid electrification enabled by a sticky porous elastomer.
The potential of socially assistive robots during infectious disease outbreaks
Authors: Scassellati Brian , Vázquez Marynel
Published: July 2020

Robots may address the secondary impact of infectious disease outbreaks by supporting social distancing, mental health, and education.
Draft Genome Sequence of Fusarium oxysporum f. sp.
albedinis
Strain Foa 133, the Causal Agent of Bayoud Disease on Date Palm
Authors: Khayi Slimane , Khoulassa Siham , Gaboun Fatima , Abdelwahd Rabha , Diria Ghizlane , Labhilili Mustapha , Iraqi Driss , El Guilli Mohammed , Fokar Mohamed , Mentag Rachid
Published: July 2020

Fusarium oxysporum
f. sp.
albedinis
is the causal agent of vascular wilt of date palm. Here, we report the genome assembly of the Foa 133 strain, which consists of 3,325 contigs with a total length of 56,228,901 bp, a GC content of 47.42%, an
N
50
value of 131,587 bp, and 3,684 predicted genes.
Complete Genome Sequence of Allorhizobium vitis Strain K306, the Causal Agent of Grapevine Crown Gall
Authors: Xi Hangwei , Ryder Maarten , Searle Iain R.
Published: July 2020

Here, we present the annotated complete genome sequence of
Allorhizobium vitis
K306, a phytopathogenic strain causing crown gall of grapevine. The
A. vitis
K306 genome is 5.79 Mb long with 5,199 predicted protein-coding genes and contains 2 circular chromosomes of 3.8 Mb and 1.1 Mb and 2 plasmids, namely, pTiK306 and pTrK306, that are 262 kb and 581 kb, respectively.
Complete Genome Sequence of a
Tomato Brown Rugose Fruit Virus
Isolated in the United States
Authors: Chanda Bidisha , Rivera Yazmín , Nunziata Schyler O. , Galvez Marco E. , Gilliard Andrea , Ling Kai-Shu
Published: July 2020

The complete genome sequence of a U.S. isolate of a
Tomato brown rugose fruit virus
(ToBRFV) (CA18-01) was obtained through Illumina and MinION sequencing. The U.S. ToBRFV isolate shared a high nucleic acid sequence identity (>99%) with known ToBRFV isolates. Phylogenetic analysis revealed a tight cluster for ToBRFV isolates throughout the world, suggesting a short evolutionary history.
Draft Genome Sequence of Psychrobacter okhotskensis Strain 5179-1A, Isolated from a Raw Cured Ham Storage Crate
Authors: Wambui Joseph , Morach Marina , Cernela Nicole , Stevens Marc J. A. , Ghielmetti Giovanni , Stephan Roger
Published: July 2020

We present the draft genome sequence of
Psychrobacter okhotskensis
strain 5179-1A, which was isolated from a raw cured ham storage crate. Its size and GC content are 3.4 Mb and 43.4%, respectively. The 16S rRNA sequences of strain 5179-1A and
P. okhotskensis
MD17
T
are 100% identical.
Burnout in gastroenterology registrars: a feasibility study conducted in the East of England using a 31-item questionnaire
Authors: Ong John , Swift Carla , Ong Sharon , Lim Wan Yen , Al-Naeeb Yasseen , Shankar Arun
Published: July 2020

Objective

The scale of burnout in UK gastroenterology trainees and the feasibility to determine its prevalence using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool are unknown. The primary objective of this region-wide pilot study was to evaluate the response rate to a 31-item questionnaire. The secondary objectives were to estimate the prevalence of burnout in gastroenterology trainees within the East of England deanery (EoE) and identify common stressors that trainees experience.

Design

This was a cross-sectional study involving gastroenterology trainees from 16 hospitals across the EoE using a 31-item questionnaire. The questionnaire consisted of the 22-item MBI-HSS and nine additional free-text questions. All gastroenterology trainees in the EoE were invited to complete the anonymised survey online. Data were analysed quantitatively and qualitatively.

Results

The response rate for the survey was acceptable: 44.0% (40/91). 57.5% (23/40) of gastroenterology trainees reported emotional exhaustion. 23.5% (8/34) had depersonalisation and 63.9% (23/36) experienced low professional accomplishment. Burnout prevalence was 35.3% (12/34). 48.4% (15/31) of gastroenterology trainees were aware of professional support services within EoE. Stressors related to service requirements (eg, workload, staffing levels) and professional relationships with colleagues and patients were commonly reported: 65.6% and 25.0%, respectively.

Conclusions

It is feasible to use a 31-item questionnaire in a national cohort of UK gastroenterology trainees for future burnout studies. Burnout in EoE gastroenterology trainees was high and this may reflect a national prevalence within the specialty. More extensive studies, greater awareness of burnout and improved access to professional support services are required.