bluuebunny/crossref_metadata_2025 huggingface dataset:
Toward a potential association between eosinophilic esophagitis and Klinefelter syndrome: a case series and review of the literature
Authors: Ghisa Matteo , Savarino Vincenzo , Buda Andrea , Katzka David A. , Savarino Edoardo
Published: February 2022

Klinefelter syndrome (KS) is a sex aneuploidy abnormality comprised by one additional X chromosome. It occurs in 1:500–1000 male births. As with women, an increased susceptibility to autoimmune diseases is present. We report three cases of coexisting EoE and KS for a prevalence of 2% in our EoE clinic. Possible changes in gene expression in KS are reviewed, some of which may be related to activation of genes located on the X chromosome. We postulate that these X-activated genes in patients with KS yield a greater likelihood of developing EoE because of their genetic predisposition to autoimmune diseases.
Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients
Authors: Frödin Maria , Ahlstrom Linda , Gillespie Brigid M. , Rogmark Cecilia , Nellgård Bengt , Wikström Ewa , Erichsen Andersson Annette
Published: February 2022

Background

Urinary catheter (UC)–associated infections are one of the most common preventable healthcare-associated infections (HAIs) and they frequently occur in older, frail populations.

Aim

The study aim was to describe the incidence of UC-associated infection in elderly patients undergoing hip fracture surgery after implementing a preventive care bundle.

Methods

A longitudinal prospective study using a before-and-after design. The bundle was theory driven and involved the co-creation of a standard operational procedure, education and practical training sessions. Prospectively collected registry data were analysed. Univariable statistics and multivariable logistic regressions were used for analyses.

Results

2,408 patients with an acute hip fracture were included into the study. There was an overall reduction in UC catheter associated-associated urinary tract infections, from 18.5% ( n = 75/406) over time to 4.2% ( n = 27/647). When adjusting for all identified confounders, patients in phase 4 were 74% less likely to contract an UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p < 0.0001).

Discussion

Bundled interventions can reduce UC-associated infections substantially, even in elderly frail patients. Partnership and co-creation as implementation strategies appear to be promising in the fight against HAI.
Chemical Composition and Antioxidant Activity of Thymus ciliatus (Desf.) Benth. Essential Oils of Algeria
Authors: Souadia Ahmed
Published: February 2022

The aim of this work was to study the chemical composition and antioxidant activity of essential oils of Thymus ciliatus (Desf.) Benth from middle Algeria obtained from the aerial parts by hydrodistillation using a Clevenger-type apparatus. The oil was analyzed by gas chromatography (GC) and gas chromatography coupled with mass spectrometry (GC-MS). The antioxidant capacity values of T ciliatus extracts were determined using 2 different and complementary assays: free radical scavenging ( 2,2-diphenyl- 1-picrylhydrazyl [DPPH]) and ferric reducing antioxidant power (FRAP) assays. Six samples of T ciliatus collected in 2019 were used in the study. GC and GC-MS were used to determine the chemical composition of the essential oils. Twenty-five compounds were identified with a percentage of 89.3%–97.7%. The essential oils of T ciliatus were characterized by the presence of myrcene (9.6%-26.9%), p-cymene (7.6%-17.0%), and borneol (13.4%-30.2%) as principal components.
Smoothing the Way Into School Nursing Practice
Authors: Tsai Stacey , McClanahan Rachel
Published: February 2022

Role transition can be a struggle for new or seasoned nurses moving into the specialty of school. School nursing, a specialized field that entails a scope of practice and competencies very different from other settings, is not taught in many primary nursing education programs. New nurses may find themselves unprepared for their role without a proper orientation, causing them to feel anxious and not ready to care for students properly, leading to attrition. This article describes the barriers and facilitators to smooth role transition and provides evidence-based orientation strategies for new school nurses.
Social Media and Adolescent Mental Health: Sounding the Alarm
Authors: Flynn Hannah C. , Mote Sandra L. , Morse Brenna L.
Published: February 2022

Adolescence is a period of emotional and developmental vulnerability in which mental illness can be first detected. This is also a time in which adolescents are introduced to social media and may experience the direct and indirect criticism that accompanies it. School nurses are providers that may be the first to detect signs and symptoms of adolescent mental illness inside and outside of the classroom. In order to decrease the risk of social media’s harmful effects, school nurses should consider providing adequate education to school and community members on the signs and symptoms of adolescent mental illness and self-harm. Providing timely health guidance to teenagers by assisting in dealing with negative emotions in positive ways may also decrease the risk of this harmful effect. As technology expands, social media is becoming more easily accessible for younger individuals, creating a heightened need for the role of a school nurse. The purpose of this article is to review current knowledge regarding social media and mental health and provide practical suggestions for school nurses to ameliorate the negative impact of social media on student well-being.
Durable outcomes of double cord blood transplantation in adults with acute lymphoblastic leukemia: high-risk features for early and long-term mortality
Authors: Yoon Jae-Ho , Min Gi June , Park Sung-Soo , Park Silvia , Lee Sung-Eun , Cho Byung-Sik , Eom Ki-Seong , Kim Yoo-Jin , Kim Hee-Je , Min Chang-Ki , Cho Seok-Goo , Lee Jong Wook , Lee Seok
Published: February 2022

Background:

Cord blood transplantation (CBT) has been reported as an acceptable option with comparable outcomes to conventional donors in adults with acute lymphoblastic leukemia (ALL). We aimed to analyze the long-term CBT outcomes and risk factors for early and long-term mortalities.

Methods:

Between 2006 and 2020, 112 patients (median age: 35 years; 62 Ph-negative ALL and 50 Ph-positive ALL) were treated with double CBT. Conditioning regimen consisted of total body irradiation (12 Gy) plus cytarabine (9.0 g/m2) plus fludarabine (150 mg/ m2), and graft-versus-host disease (GVHD) prophylaxis was attempted by administering tacrolimus plus mycophenolate mofetil.

Results:

The median time for neutrophil and platelet recovery was 25 days (range: 5–59 days) and 34 days (range: 7–185 days), respectively. The cumulative incidence of acute GVHD at 1 year was 43.8%, and the incidence of acute GVHD with grades III–IV was 8.9%. The overall cumulative incidence of chronic GVHD was 22.0%, and the incidence of moderate to severe chronic GVHD was 8.5%. After a median follow-up of 60.1 months (range: 5.7–181.3 months), the 5-year cumulative incidence of relapse (CIR) and nonrelapse mortality (NRM) were 15.9% and 28.5% (9.7% and 27.2% for CR1), respectively, and the 5-year overall survival (OS) was 57.9% (66.5% for CR1). In multivariate analysis of 88 patients receiving double CBT in CR1, delayed CR1 was related to high CIR, and age older than 40 years was associated with high NRM and early mortality. Unexpectedly, Ph-positive ALL with MRD had a higher NRM and early mortality than Ph-negative ALL and Ph-positive ALL without MRD subgroups, possibly due to delayed neutrophil and platelet recovery.

Conclusion:

Our data suggest that double CBT for adult ALL in CR1 has a greater benefit in younger patients and in patients with Ph-positive ALL without MRD or Ph-negative ALL.
A thrombopoietin receptor agonist to rescue an unusual platelet transfusion-induced reaction in a p.V1316M-associated von Willebrand disease type 2B patient
Authors: Casari Caterina , Favier Remi , Legendre Paulette , Kauskot Alexandre , Adam Frederic , Picard Veronique , Lenting Peter J. , Denis Cecile V. , Proulle Valerie
Published: February 2022

This report describes the first case of splenic injury in a patient with p.V1316M-associated von Willebrand disease type 2B (VWD2B) with chronic thrombocytopenia, successfully treated with nonoperative management including von Willebrand factor (VWF) replacement therapy, and platelet transfusions relayed by a thrombopoietin receptor agonist (TPO-RA, Eltrombopag). Eltrombopag was initially introduced to rescue an unusual post-platelet-transfusion reaction exacerbating the thrombocytopenia. In-depth analysis of the dramatic platelet count drop and VWF measurements timeline ruled out an allo-immune reaction and supported an alternative hypothesis of a sudden platelet clearance as a consequence of stress-induced release of abnormal VWF. One year later, a second life-threatening bleeding episode required urgent surgery successfully managed with VWF replacement therapy and platelet transfusions. Eltrombopag was further introduced in the post-surgery period to allow bleeding-free and platelet-transfusion-free successful recovery. Treatment decisions are particularly challenging in patients with VWD2B, and this case highlights how such decisions can benefit from understanding the molecular origin of platelet count fluctuations observed in these patients. Here, we successfully used a new therapeutic approach combining VWF-replacement therapy and initial platelet-transfusion relayed by TPO-RA to optimize patient management.

Plain language summary

A combination of von Willebrand factor replacement and thrombopoietin receptor agonist in thrombocytopenic patients with von Willebrand disease type 2B: a new therapy approach to optimize patient management? Therapeutic management of patients with von Willebrand disease type 2B are particularly challenging in case of severe thrombocytopenia. Treatment includes von Willebrands factor replacement therapy and iterative platelet transfusions. We describe the first case of splenic injury in a patient with p.V1316M-associated von Willebrand disease type 2B successfully treated with nonoperative management including von Willebrand factor replacement therapy and platelet transfusions relayed by a thrombopoietin receptor agonist. We showed that the unusual post-platelet-transfusion reaction associated with a dramatic platelet count drop was a consequence of stress-induced release of abnormal von Willebrand factor. The combination of von Willebrand factor replacement therapy and thrombopoietin receptor agonist may offer a new therapeutic approach to optimize patient management.
Children living with HIV: a narrative review of recent advances in pediatric HIV research and their implications for clinical practice
Authors: Nalwanga Damalie , Musiime Victor
Published: February 2022

Despite the great strides that have been made in prevention of mother to child transmission (PMTCT), children continue to acquire HIV. The reduction in transmission is variable, for example in Africa, great gains have been made in Eastern and Southern Africa, but critical gaps remain in West and Central Africa. These gaps are also observed in the treatment of children living with HIV. Although there is increased access to lifesaving antiretroviral therapy (ART), management of pediatric HIV infection continues to be a challenge to clinicians in low-income countries where the disease burden is disproportionately high. On the contrary, recent advances in ART drug types and formulations provide great hope. In this narrative review, we present key updates in HIV care and promising ART research among children and adolescents living with HIV. We particularly highlight the dolutegravir (DTG) research which informed the change of the World Health Organization (WHO) ART guidelines in this age group. Significant gaps remain around management of children presenting with advanced disease to minimize mortality and in the long-term care and treatment of adolescents living with HIV. Research to address these sensitive areas is crucial for the realization of global, regional, and national pediatric HIV targets.
Psychometric properties of Alcohol Use Disorder Identification Test screening tool among medical outpatients in Dilla University Referral Hospital, southern Ethiopia, 2020
Authors: Habtamu Endashaw , Madoro Derebe
Published: February 2022

Objective:

A quick, efficient, and flexible screening tool is essential for identifying alcohol use disorder in a busy clinical context. The Alcohol Use Disorders Identification Test is the most widely used and validated screening tool in the outpatient context. The psychometric features of the Alcohol Use Disorders Identification Test have yet to be confirmed for Ethiopians. As a result, the purpose of this study was to evaluate the Alcohol Use Disorders Identification Test screening tool’s reliability and validity among medically ill patients in Ethiopia.

Method:

A total of 325 patients who visited the internal medicine outpatient department were included in this study. To diagnose alcohol use disorder based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the psychometric features of the Alcohol Use Disorders Identification Test were compared to the gold standard of Mini International Neuropsychiatry Interview. The reliability was determined by examining internal consistency. The receiver operating characteristic curve was established to calculate sensitivity and specificity of the screening tool. Construct validity was determined using confirmatory factor analysis.

Result:

The translated version of Alcohol Use Disorders Identification Test showed language clarity. Internal consistency was excellent (Cronbach’s α = 0.9). The Alcohol Use Disorders Identification Test provides an excellent receiver operating curve with cut-off point ⩾8 for females (sensitivity = 0.92, specificity = 0.87, positive predictive value = 70.2, negative predictive value = 96.9, likelihood ratio+ = 7.16, and likelihood ratio− = 0.1) and ⩾10 for males (sensitivity = 0.91, specificity = 0.84, positive predictive value = 72.6%, negative predictive value = 95.3%, likelihood ratio+ = 5.57, and likelihood ratio− = 0.10). Confirmatory factor analysis yielded good model fit indices for the two- and three-factor models, with the two-factor model outperforming the others.

Conclusion:

The Alcohol Use Disorders Identification Test has been proven to be a reliable tool for detecting alcohol use in gedofa-speaking medical outpatients.
Multimodal conservative treatment of migrating bone marrow edema associated with early osteonecrosis of the hip
Authors: Sconza Cristiano , Coletta Francesco , Magarelli Nicola , D’Agostino Maria Cristina , Egan Colin Gerard , Di Matteo Berardo , Respizzi Stefano , Mazziotti Gherardo
Published: February 2022

Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment and related to pathogenetic mechanisms not yet clearly recognized. We report the case of a 59-year-old post-menopausal woman, affected by bone marrow edema associated with early osteonecrosis of the femoral head with secondary appearance of a rare migrant bone edema of the hip acetabulum. Clinical evaluation and magnetic resonance imaging were used to monitor the outcome of the patient. Pre-treatment clinical evaluation revealed pain upon stepping with the left limb, reduced range of motion of spine and hip, and hip pain during passive rotation. Magnetic resonance imaging showed diffuse signal alteration of the head and neck of the left femur in relation to bone edema, associated with an unclear small cephalic area of the femoral head suggestive of initial osteonecrosis. A further computed tomography scan was performed that did not reveal any alterations in bone profile, interruption of the cortex, or trabecular bone collapse. We immediately started a multimodal conservative treatment administering neridronate (100 mg, intravenously) combined with calcium and vitamin D supplementation and biophysical therapies (magnetotherapy and extracorporeal shockwave therapy). We also instructed the patient not to bear the load on the affected lower limb during standing and walking, using crutches. After 2 months, a notable regression of pain with improvement in mobility was observed. Magnetic resonance imaging revealed complete regression of edema at the head and neck of the femur; however, the new appearance of acetabular bone edema of the ipsilateral acetabular roof was detected. After 4 months, a third magnetic resonance imaging showed the disappearance of the femoral head and acetabular roof defects as well as the complete clinical recovery of the patient. An early diagnosis and intervention are essential to conservatively treat cases of bone marrow edema syndrome.
The impact of COVID-19 pandemic on acute urology admissions in a busy district general hospital in the United Kingdom
Authors: Bheenick Divya , Young Matthew J , Elmussareh Muhammad , Ali Ased
Published: February 2022

Objective:

Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the United Kingdom. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the United Kingdom.

Patient and methods:

Retrospective data of patients presenting acutely to the urology department were collected between 13 January to 22 March 2020 (pre-lockdown period) and 23 March to 31 May 2020 (lockdown period). The nature of referrals, types of admission encountered and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown.

Results:

Overall, 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age.

Conclusion:

The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.
Fighting Fire With Fire? Relegitimizing Strategies for Media Institutions Faced With Unwarranted “Fake News” Accusations
Authors: Neo Ric
Published: February 2022

Empirical accounts point to the increasing weaponization of the “fake news” label—or unwarranted fake news accusations—by politicians to deflect critical reporting and delegitimize media outlets and achieve political ends. While research has begun unpacking the implications of such attacks, little attention has been paid toward avenues to counter them. Drawing upon the literature on misinformation and crisis management research and through an experimental survey ( n = 1,460), this study explores strategies that media outlets can employ to protect themselves against unwarranted “fake news” accusations—specifically through various denial and attack responses. Results show that denial strategies significantly increase respondents’ belief in the initial critical report, increase support of the media while conversely decreasing support of the politician. While variants of more offensive attack strategies also led to these anticipated effects, simple denials were found to be more effective in protecting the legitimacy of the media outlet. This suggests that such strategies can constitute a simple first-level measure through which institutions can undertake to challenge unfounded fake news accusations.
Automated Platform Governance Through Visibility and Scale: On the Transformational Power of AutoModerator
Authors: Wright Lucas
Published: February 2022

When platforms use algorithms to moderate content, how should researchers understand the impact on moderators and users? Much of the existing literature on this question views moderation as a series of decision-making tasks and evaluates moderation algorithms based on their accuracy. Drawing on literature from the field of platform governance, I argue that content moderation is more than a series of discrete decisions but rather a complex system of rules, mechanism, and procedures. Research must therefore articulate how automated moderation alters the broader regime of governance on a platform. To demonstrate this, I report on the findings of a qualitative study on the Reddit bot AutoModerator, using interviews and trace ethnography. I find that the scale of the bot allows moderators to carefully manage the visibility of content and content moderation on Reddit, fundamentally transforming the basic rules of governance on the platform.
Sex differences in the efficacy of omalizumab in the treatment of chronic spontaneous urticaria
Authors: Sirufo Maria Maddalena , Bassino Enrica Maria , De Pietro Francesca , Ginaldi Lia , De Martinis Massimo
Published: February 2022

Background

Omalizumab is shown to be effective in the treatment of chronic spontaneous urticaria (CSU), a disease with high personal and social impact. Sex differences in CSU are recognized with women more frequently affected. Scarce is the knowledge about response to omalizumab between sex groups. We sought to identify any differences based on the sex of patients receiving omalizumab.

Methods

We evaluated data of patients diagnosed with CSU refractory to high-dose second-generation H1 antihistamines and treated with 300 mg omalizumab every 4 weeks for 6 months and then at relapse.

Results

Discussion: All patients, regardless of sex, age, or any other factor, achieved the clinical remission of the disease after the first 3 doses with a reduction of the disease activity indices and impact on the quality of life. Recurrences predominate in men, two months after the suspension of the drug. Respect to sex and recurrence we did not find any correlation with age, body mass index, peripheral eosinophil counts, total IgE levels, D-dimer, plasma prothrombine level or C-reactive protein. We found no sex differences in tolerability and safety. CSU in girls may persist longer and have worse prognosis, but no one has so far noted sex differences in response to omalizumab.

Conclusions

Although there are no certainties on the mechanism of action of omalizumab in CSU, the noticeable difference in response between males and females lead us to suppose a role of the hormonal balance both on the pathogenesis of the CSU and on the efficacy of OmAb.
Preservation of Antegrade Pulmonary Blood Flow in Kawashima Procedure With Prior Right Ventricular Outflow Tract Stent
Authors: Bhansali Suneet , Bhatla Puneet , Argilla Michael , Saharan Sunil , Mosca Ralph , Kumar TK Susheel
Published: February 2022

Surgical management of single ventricle with interrupted inferior vena cava and azygos continuation typically requires a Kawashima procedure with subsequent completion of Fontan. However, this group is at risk of development of pulmonary arteriovenous malformations. Evidence suggests preservation of hepatic venous flow into the pulmonary circulation can potentially delay this development. We hereby describe a method of preserving antegrade pulmonary blood flow during the Kawashima procedure in the setting of prior right ventricular outflow tract stents.
Policing Gender, Race, and Place: A Multi-Level Assessment of Stop and Frisks
Authors: Farrell Chelsea
Published: February 2022

Literature on race and policing as well as place and policing has often neglected the role of gender. With an intersectional and ecological framework in mind, this study uses NYPD Stop, Question, and Frisk data to examine how the intersections of gender, race, and place simultaneously shape stop and frisks. Specifically, this study examines if suspect identity and characteristics of the stop location impact whether an officer pursues further action such as a frisk, search, summons, or arrest. Investigatory stops are not gender-blind, not uniformly experienced by all women, and do no operate identically across place. Evidence indicates that characteristics of place (concentrated disadvantage, racial composition) along with suspect race and gender might shape officers’ evaluations of suspiciousness and dangerousness. Research on policing practices and changes to policing procedures should consider how intersections of gender, race, and place shape officers’ actions.
Extending the Theory of Planned Behavior: Predicting Young Consumer Purchase Behavior of Energy-Efficient Appliances (Evidence From Developing Economy)
Authors: Bhutto Muhammad Yaseen , Soomro Yasir Ali , Yang Hailan
Published: February 2022

Global electricity consumption has increased dramatically in the past few decades, resulting in many countries considering energy efficiency as the only solution to tackle issues related to energy and pursue sustainable development goals. However, there is a shortage of studies at the household level on the propensity to use energy-efficient appliances (EEA), especially for developing countries, which have great potential for EEA adoption and usage. Besides, young consumers form an important part of developing countries’ population as well as the next generation of consumers. Yet studies examining their inclination toward more sustainable products such as EEA remain scarce. This study employs data gathered from a survey questionnaire among 240 young Pakistani consumers to explain EEA adoption by focusing on extended version of the theory of planned behavior (TPB), incorporating additional variables such as self-expressive benefits, utilitarian environmental benefits and moral obligations. The results show that utilitarian environmental benefits significantly influence attitudes, whereas self-expressive has an insignificant influence on attitude. Along with this study found moral obligation also has an insignificant impact on subjective norms. Finally, the study revealed the impact of purchase intention of EEAs on the purchase behavior of EEAs. Therefore, the results of this study present a novel understanding for Pakistani policymakers should pay more attention on shaping consumer attitudes, social values and perceived behavioral control, which will eventually drive energy-efficient appliance purchasing behavior.
Lexical Choice and Crazy-wisdom: A Usage-Based Interpretation of Bᾱhῡ’s Abyᾱt
Authors: Iqbal Hafiz Muhammad Zahid
Published: February 2022

Bᾱhῡ’s Abyᾱt opens the doors of spiritual world for the Seekers of God who have been demoted from their spiritual quest. The objective of the study is to interpret Bᾱhῡ’s poetry from the perspective of semantic field theory by pinpointing the semantic content of the synonyms for Murshid such as rāṅjhā, yᾱr, faqīr and ʿᾱshiq and antonyms to Murshid such as ʿᾱlim and bay- adab, a few examples being mentioned from Abyᾱt. Albeit, these words have different denotative signification, yet revealingly, these have the same connotative purport and seem to be related or un-related, as the case may be, to the concept of Murshid. The significance of the study lies in the fact that Bᾱhῡ’s poetry appears to have never been analyzed from semantic field theory viewpoint. Thus, the present research is an endeavor to unearth the underlying principles working behind such untraditional lexical choice as well as the incorporation of the phenomenon of “crazy-wisdom” in Bᾱhῡ’s poetry.
Balanced Funds in India Amid COVID-19 Crisis: Spreader of Financial Contagion?
Authors: Malhotra Priya , Sinha Pankaj
Published: February 2022

In its latest financial stability report, dated 11 January 2021, the Reserve Bank of India (RBI) emphasised the significance of balanced mutual funds in risk transmission. We investigate the transmission of volatility and contagion effect from Indian balanced funds to representative indices—Bank, PSU Bank, Private Bank, Financial Services, Broader Market, Services Sector and Fixed Income—using three established models: Diagonal BEKK (1995), Dynamic Conditional Correlation (DCC GARCH (2002)) and network model. In analyses of financial time series data, the COVID-19 pandemic has been widely regarded as a structural break. We may better understand the dynamism and scale of spillover before and during a crisis by dividing the study into two periods: pre-COVID-19 (January 2011–29 December 2019) and during COVID-19 (30 December 2019–20 April 2021). The results of all three models support our hypothesis of statistically significant spillover from balanced funds to chosen indices, with strong persistence and a marked increase in long-term volatility spillover, showing the presence of contagion effects. The findings of this paper can assist fund managers in diversifying their portfolios while also benefiting investors educationally.

JEL Classification: C23, G12, G23
Veterans Health Administration Staff Perceptions of Overseeing Care in Community Nursing Homes During COVID-19
Authors: Haverhals Leah M. , Magid Kate H. , Blanchard Kelly N. , Levy Cari R.
Published: February 2022

Introduction

The Veterans Health Administration (VA) contracts with non-VA owned and operated community nursing homes (CNHs) to provide Veterans nursing home care. This study explored VA staffs’ experiences coordinating care with CNH staff during the COVID-19 pandemic.

Methods

Qualitative study interviewing VA staff overseeing and coordinating care for CNH Veterans. Interviews were recorded, transcribed, and analyzed using inductive and deductive thematic analysis.

Results

Three themes influenced care coordination. (1) Pre-established working relationships strengthened trust in CNH staff and remote access to CNH electronic medical records (EMRs). (2) Remote oversight proved challenging as virtual visits did not fully capture Veterans’ needs and Veterans experienced challenges due to cognitive status, hearing impairment, and discomfort with technology. (3) Partnerships strengthened as VA staff provided CNHs personal protective equipment, COVID-19 testing, infection control education, and emotional support.

Discussion

Despite pre-existing relationships and improved partnerships, most VA staff felt uncertain about the quality of oversight provided through remote monitoring and preferred in-person interactions. However, they found benefit in remote access to CNH EMRs and shared optimism with expanding virtual care.

Conclusions

Fostering strong partnerships between VAs and CNHs improve care coordination during crises like the COVID-19 pandemic and for daily care.
Reflections on the Republican Party: (Prompted by Recollections of Encounters at 15 Janpath)
Authors: Duncan Ian
Published: February 2022

Towards the end of the 1960s, the Ambedkarite Republican Party of India was facing a serious crisis. Its plight intensified with the death of the leader Dadasaheb Gaikwad at the end of 1971. This article takes the long view of the predicament of the party and asks why it had suffered such frequent and lasting instability. Drawing on interviews conducted at that time, including those conducted at the party New Delhi headquarters on Janpath, more recent discussions and a close examination of documentary records, the article examines the volatility and factional conflict exhibited by the party. In contrast to approaches that seek to find the roots of factionalism in personal rivalries and individual animosities, the article searches for more structural causes. It concludes that the inability of the party to broker differences about political cooperation and electoral alliances was a major cause of dissent. Particularly intense differences and division were generated by the issue of cooperation with the Congress party. Ultimately, it was the absence of any institutional procedures for settling disputes that caused the party to decline and eventually collapse into rival factional organizations.
Reflections of family caregivers and health professionals on the everyday challenges of caring for persons with amyotrophic lateral sclerosis and cognitive impairments: a qualitative study
Authors: Olesen Lene Klem , Cour Karen la , With Heidi , Handberg Charlotte
Published: February 2022

Aims and objectives:

To explore reflections of family caregivers and health professionals regarding the challenges involved in caring for persons with amyotrophic lateral sclerosis and cognitive and/or behavioral impairments (PALS/CIs).

Background:

Family caregivers of PALS/CIs are highly burdened and at great risk of psychological sequela. Professionals working with these families can be negatively affected on their well-being and are at risk of burnout.

Design:

The design was a qualitative interview study.

Methods:

One focus group and 10 individual semi-structured interviews were conducted with seven family caregivers and nine professionals after the death of a PALS/CIs. The analysis was guided by the interpretive description methodology and the theory of sense of coherence. This study adheres to the COREQ guidelines and the ICMJE recommendations.

Results:

The family caregivers’ challenges regarding coping with everyday needs related to the sick person were associated with ‘Accepting that nothing else matters’, ‘Adjusting to new roles while balancing’, and ‘Realizing different values in relationships’; whereas the professionals’ challenges were related to ‘Collaboration a balancing act’, ‘Working in a home of sorrow’, and ‘Coordinating threads to tie’.

Conclusion:

Family caregivers found coping with the complexity of the diseases a challenge, and their everyday life needed constant adjustment to new roles, coping with inappropriate behavior, and navigating through the progression of the diseases of their sick relatives while collaborating with numerous professionals. The professionals struggled with coordinating and collaborating with the families and with other colleagues due to the severeness and complexity of diseases.

Relevance to clinical practice:

Findings point to the importance of relationships for caregivers and professionals and a need to provide support through an online palliative rehabilitation program that encompass coping strategies in relation to the diseases.

Trial registration details:

Id no. NCT 04638608.
An analytical framework to assess earthquake-induced downtime and model recovery of buildings
Authors: Molina Hutt Carlos , Vahanvaty Taikhum , Kourehpaz Pouria
Published: February 2022

While modern seismic design codes intend to ensure life-safety in extreme earthquakes, policy-makers are moving toward performance objectives stated in terms of acceptable recovery times. This article describes a framework to probabilistically model the post-earthquake recovery of buildings and provide quantitative seismic performance measures, expressed in terms of downtime, that are useful for decision-making. Downtime estimates include the time for mobilizing resources after an earthquake and conduct necessary repairs. The proposed framework advances the well-established Federal Emergency Management Agency (FEMA) P-58 and Resilience-based Earthquake Design initiative (REDi) methodologies by modeling temporal building recovery trajectories to target recovery states, such as stability, shelter-in-place, reoccupancy, and functional recovery. The shelter-in-place recovery state accounts for relaxed post-earthquake habitability standards, in contrast with the reoccupancy recovery state that relates to pre-event habitability criteria. Analogous to safety-based codes, which specify a threshold for the probability of collapse under a given ground motion shaking intensity, this framework permits evaluating the probability of a building not achieving a target recovery state, for example, shelter-in-place, immediately after an earthquake, or, alternatively, the probability of achieving a target recovery state, for example, functional recovery, within a specified time frame. The proposed framework is implemented to evaluate a modern 12-story residential reinforced concrete shear wall building in Seattle, WA. The assessment results indicate that under a functional-level earthquake (roughly equivalent to ground motion shaking with a return period of 475 years), the probability of not achieving shelter-in-place immediately after the earthquake is 22%, and the probability of downtime to functional recovery exceeding 4 months is 88%, which far exceeds acceptable thresholds suggested in the 2015 National Earthquake Hazards Reductions Program (NEHRP) guidelines and FEMA P-2090.
Validating predicted site response in sedimentary basins from 3D ground motion simulations
Authors: Nweke Chukwuebuka C , Stewart Jonathan P , Graves Robert W , Goulet Christine A , Brandenberg Scott J
Published: February 2022

We introduce procedures to validate site response in sedimentary basins as predicted using ground motion simulations. These procedures aim to isolate contributions of site response to computed intensity measures relative to those from seismic source and path effects. In one of the validation procedures, simulated motions are analyzed in the same manner as earthquake recordings to derive non-ergodic site terms. This procedure compares the scaling with sediment isosurface depth of simulated versus empirical site terms (the latter having been derived in a separate study). A second validation procedure utilizes two sets of simulations, one that considers three-dimensional (3D) basin structure and a second that utilizes a one-dimensional (1D) representation of the crustal structure. Identical sources are used in both procedures, and after correcting for variable path effects, differences in ground motions are used to estimate site amplification in 3D basins. Such site responses are compared to those derived empirically to validate both the absolute levels and the depth scaling of site response from 3D simulations. We apply both procedures to southern California in a manner that is consistent between the simulated and empirical data (i.e. by using similar event locations and magnitudes). The results show that the 3D simulations overpredict the depth-scaling and absolute levels of site amplification in basins. However, overall patterns of site amplification with depth are similar, suggesting that future calibration may be able to remove observed biases.
Primary plasma cell leukemias displaying t(11;14) have specific genomic, transcriptional, and clinical features
Authors: Cazaubiel Titouan , Leleu Xavier , Perrot Aurore , Manier Salomon , Buisson Laure , Maheo Sabrina , Do Souto Ferreira Laura , Lannes Romain , Pavageau Luka , Hulin Cyrille , Marolleau Jean-Pierre , Voillat Laurent , Belhadj Karim , Divoux Marion , Slama Borhane , Brechignac Sabine , Macro Margaret , Stoppa Anne-Marie , Sanhes Laurence , Orsini-Piocelle Frédérique , Fontan Jean , Chretien Marie-Lorraine , Demarquette Hélène , Mohty Mohamad , Schavgoulidze Anais , Avet-Loiseau Herve , Corre Jill
Published: February 2022

Primary plasma cell leukemia (pPCL) is an aggressive form of multiple myeloma (MM) that has not benefited from recent therapeutic advances in the field. Because it is very rare and heterogeneous, it remains poorly understood at the molecular level. To address this issue, we performed DNA and RNA sequencing of sorted plasma cells from a large cohort of 90 newly diagnosed pPCL and compared with MM. We observed that pPCL presents a specific genomic landscape with a high prevalence of t(11;14) (about half) and high-risk genomic features such as del(17p), gain 1q, and del(1p32). In addition, pPCL displays a specific transcriptome when compared with MM. We then wanted to characterize specifically pPCL with t(11;14). We observed that this subentity displayed significantly fewer adverse cytogenetic abnormalities. This translated into better overall survival when compared with pPCL without t(11;14) (39.2 months vs 17.9 months, P = .002). Finally, pPCL with t(11;14) displayed a specific transcriptome, including differential expression of BCL2 family members. This study is the largest series of patients with pPCL reported so far.
Unfavorable genetic correlations between fecal egg count and milk production traits in the French blond-faced Manech dairy sheep breed
Authors: Aguerre Sophie , Astruc Jean-Michel , Legarra Andrés , Bordes Léa , Prevot Françoise , Grisez Christelle , Vial Novella Corinne , Fidelle Francis , Jacquiet Philippe , Moreno-Romieux Carole
Published: February 2022

Background

Genetic selection has proven to be a successful strategy for the sustainable control of gastrointestinal parasitism in sheep. However, little is known on the relationship between resistance to parasites and production traits in dairy breeds. In this study, we estimated the heritabilities and genetic correlations for resistance to parasites and milk production traits in the blond-faced Manech breed. The resistance to parasites of 951 rams from the selection scheme was measured through fecal egg counts (FEC) at 30 days post-infection under experimental conditions. Six milk production traits [milk yield (MY), fat yield (FY), protein yield (PY), fat content (FC), protein content (PC) and somatic cell score (LSCS)], were used in this study and were collected on 140,127 dairy ewes in first lactation, as part of the official milk recording. These ewes were related to the 951 rams (65% of the ewes were daughters of the rams).

Results

Fecal egg counts at the end of the first and second infections were moderately heritable (0.19 and 0.37, respectively) and highly correlated (0.93). Heritabilities were moderate for milk yields (ranging from 0.24 to 0.29 for MY, FY and PY) and high for FC (0.35) and PC (0.48). MY was negatively correlated with FC and PC (− 0.39 and − 0.45, respectively). FEC at the end of the second infection were positively correlated with MY, FY and PY (0.28, 0.29 and 0.24, respectively with standard errors of ~ 0.10). These slightly unfavorable correlations indicate that the animals with a high production potential are genetically more susceptible to gastrointestinal parasite infections. A low negative correlation (− 0.17) was also found between FEC after the second infection and LSCS, which suggests that there is a small genetic antagonism between resistance to gastrointestinal parasites and resistance to mastitis, which is another important health trait in dairy sheep.

Conclusions

Our results indicate an unfavorable but low genetic relationship between resistance to gastrointestinal parasites and milk production traits in the blond-faced Manech breed. These results will help the breeders’ association make decisions about how to include resistance to parasites in the selection objective.
Time-course RNA-seq analysis reveals stage-specific and melatonin-triggered gene expression patterns during the hair follicle growth cycle in Capra hircus
Authors: Li Chun , Feng Cong , Ma Guangyuan , Fu Shaoyin , Chen Ming , Zhang Wenguang , Li Jinquan
Published: February 2022

Background

Cashmere goat is famous for its high-quality fibers. The growth of cashmere in secondary hair follicles exhibits a seasonal pattern arising from circannual changes in the natural photoperiod. Although several studies have compared and analyzed the differences in gene expression between different hair follicle growth stages, the selection of samples in these studies relies on research experience or morphological evidence. Distinguishing hair follicle growth cycle according to gene expression patterns may help to explore the regulation mechanisms related to cashmere growth and the effect of melatonin from a molecular level more accurately.

Results

In this study, we applied RNA-sequencing to the hair follicles of three normal and three melatonin-treated Inner Mongolian cashmere goats sampled every month during a whole hair follicle growth cycle. A total of 3559 and 988 genes were subjected as seasonal changing genes (SCGs) in the control and treated groups, respectively. The SCGs in the normal group were divided into three clusters, and their specific expression patterns help to group the hair follicle growth cycle into anagen, catagen and telogen stages. Some canonical pathways such as Wnt, TGF-beta and Hippo signaling pathways were detected as promoting the hair follicle growth, while Cell adhesion molecules (CAMs), Cytokine-cytokine receptor interaction, Jak-STAT, Fc epsilon RI, NOD-like receptor, Rap1, PI3K-Akt, cAMP, NF-kappa B and many immune-related pathways were detected in the catagen and telogen stages. The PI3K-Akt signaling, ECM-receptor interaction and Focal adhesion were found in the transition stage between telogen to anagen, which may serve as candidate biomarkers for telogen-anagen regeneration. A total of 16 signaling pathways, 145 pathway mRNAs, and 93 lncRNAs were enrolled to construct the pathway-mRNA-lncRNA network, which indicated the function of lncRNAs through interacting with their co-expressed mRNAs. Pairwise comparisons between the control and melatonin-treated groups also indicated 941 monthly differentially expressed genes (monthly DEGs). These monthly DEGs were mainly distributed from April and September, which revealed a potential signal pathway map regulating the anagen stage triggered by melatonin. Enrichment analysis showed that Wnt, Hedgehog, ECM, Chemokines and NF-kappa B signaling pathways may be involved in the regulation of non-quiescence and secondary shedding under the influence of melatonin.

Conclusions

Our study decoded the key regulators of the whole hair follicle growth cycle, laying the foundation for the control of hair follicle growth and improvement of cashmere yield.
Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization
Authors: Abu Tal , Levi Amos , Hasdai David , Kramer Mordechai R. , Bental Tamir , Bdolah-Abram Tali , Shiyovich Arthur , Samara Abed , Vaknin-Assa Hana , Perl Leor , Rosengarten Dror , Shapira Yaron , Kornowski Ran , Skalsky Keren
Published: February 2022

Background

Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary artery systolic pressure (PASP) assessment in lung transplantation (LT) candidates, although this is not mandated by current guidelines. We aimed to explore the performance of echocardiographic PASP as an indicator of pulmonary hypertension in LT candidates, in order to assess the necessity of RHC.

Methods

From a retrospective registry of 393 LT candidates undergoing RHC and echocardiography during 2015–2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg, according to two methods—echocardiography and RHC. The primary outcome was the correlation between the PASP estimated by echocardiography to that measured by RHC. Secondary outcomes were the prediction value of the echocardiographic evaluation and its accuracy.

Results

The mean value of PASP estimated by echocardiography was 49.5 ± 20.0 mmHg, compared to 42.5 ± 18.0 mmHg measured by RHC. The correlation between the two measurements was moderate (Pearson’s correlation: r = 0.609,p < 0.01). Echocardiography PASP measurements were moderately discriminative to diagnose PH, with an area under the curve (AUC) of 0.72 (95% CI 0.66–0.77). Echocardiographic overestimation of PASP of more than 10 mmHg was found in 35.0% of the patients, and underestimation was found in 11.6% of the patients.

Conclusion

In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP had moderate correlation and limited accuracy compared to the PASP measured by RHC. We thus recommend performing routine RHC to all LT candidates, regardless of the echocardiographic estimation of PASP.