bluuebunny/crossref_metadata_2025 huggingface dataset:
Redescription of Apobaetis lakota McCafferty, 2000 (Ephemeroptera: Baetidae) and description of two new species from Brazil
Authors: CRUZ PAULO VILELA , BOLDRINI RAFAEL , HAMADA NEUSA
Published: November 2020

The genus Apobaetis Day is known by its small size and larval shifting-sand habitat preference (psammophilous). Three species of this genus are recorded in North America, from these, only Apobaetis lakota McCafferty needs to be redescribed because its original description is incomplete, turning difficult to distinguish it from species with similar morphology. Therefore, one of the objectives of this study is to redescribe A. lakota. Based on this redescription, two new species from Brazil, with similar morphology could be identified and are described (Apobaetis biancae sp. nov. and Apobaetis jacobusi sp. nov.). Apobaetis lakota can be differentiated by the labrum rectangular, distal margin without medial emargination, medial area of distal margin with three sockets of setae on dorsal surface; maxillary palp long, more than 2.0× the length of galea-lacinia, segment I with the same length as galea-lacinia; lingua subcircular with one medial lobe; glossa distally rounded; inner projection of labial palp segment II rounded and distally directed, segment III triangular; tarsal claws 1.3× the length of tarsus, without row of denticles. Apobaetis jacobusi sp. nov. can be differentiated from other species by fore tarsal claw I with the same length of tarsus, labrum medially with two protuberances and glossa with pointed apex. Apobaetis biancae sp. nov. can be differentiated by the absence of a ventral row of long thin setae near distolateral margin of labrum, four marginal spines on the paraproct, a subrectangular hypopharynx, and by the absence of robust setae on inner margin of the glossa.
The Initiation of Dry Patches in Cloud-Resolving Convective Self-Aggregation Simulations: Boundary Layer Dry-Subsidence Feedback
Authors: Yang Bolei , Tan Zhe-Min
Published: November 2020

Self-aggregation of convection can be considered as the simultaneous occurrence of dry patch initiation/amplification and wet patch contraction/intensification from initially uniform moisture and temperature fields. As the twin of wet patches, dry patches play an important role in moisture and energy balance during convective self-aggregation. In this study, the WRF Model is used to study the initiation of dry patches in convective self-aggregation, especially the continuous drying in their boundary layer (BL). In the dry patch BL, increased air density leads to an enhanced high pressure anomaly, which drives an amplifying BL divergent flow and induces an amplifying BL subsidence. The virtual effect of drying by subsidence counteracts warming by subsidence and the BL process, further increasing BL air density. Our analysis indicates the existence of a dry-subsidence feedback, which leads to the initiation of dry patches in convective self-aggregation. This feedback is shown to be important even in very large-scale (3000 km × 9000 km) cloud-resolving convective self-aggregation simulations.
Sea Surface Salinity Change since 1950: Internal Variability versus Anthropogenic Forcing
Authors: Sun Qiwei , Du Yan , Xie Shang-Ping , Zhang Yuhong , Wang Minyang , Kosaka Yu
Published: November 2020

Using an eastern tropical Pacific pacemaker experiment called the Pacific Ocean–Global Atmosphere (POGA) run, this study investigated the internal variability in sea surface salinity (SSS) and its impacts on the assessment of long-term trends. By constraining the eastern tropical Pacific sea surface temperature variability with observations, the POGA experiment successfully simulated the observed variability of SSS. The long-term trend in POGA SSS shows a general pattern of salty regions becoming saltier (e.g., the northern Atlantic) and fresh regions becoming fresher, which agrees with previous studies. The 1950–2012 long-term trend in SSS is modulated by the internal variability associated with the interdecadal Pacific oscillation (IPO). Due to this variability, there are some regional discrepancies in the SSS 1950–2012 long-term change between POGA and the free-running simulation forced with historical radiative forcing, especially for the western tropical Pacific and southeastern Indian Ocean. Our analysis shows that the tropical Pacific cooling and intensified Walker circulation caused the SSS to increase in the western tropical Pacific and decrease in the southeastern Indian Ocean during the 20-yr period of 1993–2012. This decadal variability has led to large uncertainties in the estimation of radiative-forced trends on a regional scale. For the 63-yr period of 1950–2012, the IPO caused an offset of ~40% in the radiative-forced SSS trend in the western tropical Pacific and ~170% enhancement in the trend in the southeastern Indian Ocean. Understanding and quantifying the contribution of internal variability to SSS trends helps improve the skill for estimates and prediction of salinity/water cycle changes.
An Investigation of Large Cross-Track Errors in North Atlantic Tropical Cyclones in the GEFS and ECMWF Ensembles
Authors: Leonardo Nicholas M. , Colle Brian A.
Published: November 2020

The largest medium-range (72–120 h) cross-track errors (CTE) of tropical cyclone (TC) forecasts from the Global Ensemble Forecast System (GEFS) over the northern Atlantic Ocean are examined for the 2008–16 seasons. The 38 unique forecasts within the upper quartile of most negative CTEs (i.e., left-of-track bias larger than 250 km by 72 h) do not have a clear common source of steering error, although 12 of the forecasts involve the underprediction of a weak upper-level trough to the west of the TC by 36 h. Meanwhile, at least 18 of the 36 most positive CTEs (right-of-track bias) are associated with TCs embedded in the southwest extent of a subtropical ridge, the strength of which is increasingly underpredicted during the first 24 h of the forecast. Excessive height falls north of the TC are driven by overpredicted divergence aloft, which corresponds to overpredicted TC outer-core convection. The convection is triggered by a 5%–20% overprediction of near-TC moisture and instability in the initial conditions. Weather Research and Forecasting (WRF) Model simulations are run at 36-, 12-, and 4-km grid spacing for select right-of-track cases, using the GEFS for initial and lateral boundary conditions. The 36-km WRF reproduces the same growth of errors as the GEFS because of, in part, sharing the same stability and moisture errors in the initial conditions. Changes in the convective parameterization affect how quickly these errors grow by affecting how much convection spins up. The addition of a 4-km nest with no convective parameterization causes the errors to grow ~20% faster, resulting in an even larger right-of-track error.
Subseasonal Prediction of Wintertime Northern Hemisphere Extratropical Cyclone Activity by SubX and S2S Models
Authors: Zheng Cheng , Kar-Man Chang Edmund , Kim Hyemi , Zhang Minghua , Wang Wanqiu
Published: November 2020

The prediction of wintertime extratropical cyclone activity (ECA) on subseasonal time scales by models participating in the Subseasonal Experiment (SubX) and the Seasonal to Subseasonal Prediction (S2S) is assessed. Consistent with a previous study that investigated the S2S models, the SubX models have skillful predictions of ECA over regions from central North Pacific across North America to western North Atlantic, as well as East Asia and northern and southern part of eastern North Atlantic at 3–4 weeks lead time. SubX provides daily mean data, while S2S provides instantaneous data at 0000 UTC each day. This leads to different variance of ECA. Different S2S and SubX models have different reforecast initialization times and reforecast time periods. These factors can all lead to differences in prediction skill. To fairly compare the prediction skill between different models, we develop a novel way to evaluate the prediction of individual model across the two ensembles by comparing every model to the Climate Forecast System, version 2 (CFSv2), as CFSv2 has 6-hourly output and forecasts initialized every day. Among the S2S and SubX models, the European Centre for Medium-Range Weather Forecasts model exhibits the best prediction skill, followed by CFSv2. Our results also suggest that while the prediction skill is sensitive to forecast lead time, including forecasts up to 4 days old into the ensemble may still be useful for weeks 3–4 predictions of ECA.
Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain
Authors: Blanco-Molina Mauricio , Pinazo-Hernandis Sacramento , Montoro-Rodriguez Julian , Tomas Jose M.
Published: November 2020

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults’ life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.
A Community Pediatric Camp Escape Room: An Interactive Approach to Applying Real-Life Critical Thinking Skills
Authors: Spears Syretta , Díaz Gabriel M. , Diaz Desiree A.
Published: November 2020

Background.

Escape rooms have been utilized to incorporate teamwork, communication, policy, and procedures reinforcement, as well as clinical care. Often themed, escape rooms challenge a team of players to discover clues and sequentially solve puzzles with the ultimate task of accomplishing a specific goal in a limited time frame, fostering critical thinking.

Method.

This learning activity incorporates legal implications for prelicensure nursing students in a pediatric community summer camp/after school care environment. Care and legal implications for a minor experiencing respiratory distress was the premise of this escape room.

Outcomes.

While this was not a research study, surveys were distributed for quality improvement and a deeper needs assessment related to the content and delivery of an escape room. Learners discussed the positive aspects of this activity through journal entries and a survey, noting the need for increased content related to legal implications for the medical team. This room engaged the learner in the forward-thinking that is needed related to emergency care, Good Samaritan Act, liability for cost, and permission to treat in a time-pressured environment.

Future Plans.

Testing the knowledge pre-post survey related to legal implications with implied care will be explored.
Macitentan in infants and children with pulmonary hypertensive vascular disease. Feasibility, tolerability and practical issues – a single‐centre experience
Authors: Albinni Sulaima , Pavo Imre , Kitzmueller Erwin , Michel‐Behnke Ina
Published: November 2020

Macitentan is a safe and effective substance for treatment of adults with pulmonary arterial hypertension. Data on its use in paediatric patients are limited. In this single‐centre prospective study, we report on our experience with macitentan in children focusing on applicability and practical aspects. Between December 2014 and July 2018, macitentan was introduced to paediatric patients according to a dosing protocol adjusted to body weight. Blood pressure, heart rate, saturation and clinical symptoms were recorded daily during introduction. Liver function parameters and haemoglobin levels were measured at baseline, four weeks and three months after initiation and after one year of treatment. Twenty‐four patients (14 male, 10 female) were enrolled for treatment with macitentan. The mean age was 10.7 ± 7.6 years (range: 0.1 year–23 years). Fifteen out of 24 patients were World Health Organization functional class (FC) II, 7 patients in FC III and 2 patients in FC IV. Twenty out of 24 patients (83%) received additional advanced therapy with sildenafil and/or prostacyclines. We had two early discontinuations because of clinical relevant oedema. In the remaining 22 patients, macitentan was well tolerated. Liver function parameters and blood count levels remained stable during the observational time. The introduction of macitentan was feasible and mostly well tolerated in paediatric patients. Special attention should be paid to oedema during introduction of the drug. To the best of our knowledge, this is the first study to report on its applicability in infants and children. However, larger prospective trials are warranted to verify these preliminary findings.
Transformational Leadership and Follower’s Perceived Group Cohesiveness: Mediating Role of Follower’s Karma-yoga
Authors: Muppidathi Ponmythili , Krishnan Venkat R.
Published: November 2020

This article looks at the relationship between five sub-dimensions of transformational leadership (idealised influence attributed, idealised influence behaviour, inspirational motivation, intellectual stimulation and individualised consideration), follower’s karma-yoga and follower’s perceived group cohesiveness. Data were collected in a research and development organisation in India, from 771 employees (561 male and 210 female) with minimum 5 years of work experience in that organisation. Partial least squares structural equation modelling PLS-SEM analysis shows that four sub-dimensions of transformational leadership—idealised influence attributed, idealised influence behaviour, inspirational motivation, and intellectual stimulation—are positively related to follower’s perceived group cohesiveness. In addition, this relationship is partially mediated by the follower’s karma-yoga. Focusing on increasing the frequency of idealised influence attributed, idealised influence behaviour, inspirational motivation and intellectual stimulation of managers will result in making the employees more karma-yoga oriented; both these will result in increasing the follower’s perceived group cohesiveness in the organisation, making the work environment more harmonious and productive.
Adaptive T-cell immunity controls senescence-prone MyD88- or CARD11-mutant B-cell lymphomas
Authors: Reimann Maurice , Schrezenmeier Jens , Richter-Pechanska Paulina , Dolnik Anna , Hick Timon Pablo , Schleich Kolja , Cai Xiurong , Fan Dorothy N. Y. , Lohneis Philipp , Maßwig Sven , Denker Sophy , Busse Antonia , Knittel Gero , Flümann Ruth , Childs Dorothee , Childs Liam , Gätjens-Sanchez Ana-Maria , Bullinger Lars , Rosenwald Andreas , Reinhardt Hans Christian , Schmitt Clemens A.
Published: November 2020

Aberrant B-cell receptor/NF-κB signaling is a hallmark feature of B-cell non-Hodgkin lymphomas, especially in diffuse large B-cell lymphoma (DLBCL). Recurrent mutations in this cascade, for example, in CD79B, CARD11, or NFKBIZ, and also in the Toll-like receptor pathway transducer MyD88, all deregulate NF-κB, but their differential impact on lymphoma development and biology remains to be determined. Here, we functionally investigate primary mouse lymphomas that formed in recipient mice of Eµ-myc transgenic hematopoietic stem cells stably transduced with naturally occurring NF-κB mutants. Although most mutants supported Myc-driven lymphoma formation through repressed apoptosis, CARD11- or MyD88-mutant lymphoma cells selectively presented with a macrophage-activating secretion profile, which, in turn, strongly enforced transforming growth factor β (TGF-β)-mediated senescence in the lymphoma cell compartment. However, MyD88- or CARD11-mutant Eµ-myc lymphomas exhibited high-level expression of the immune-checkpoint mediator programmed cell death ligand 1 (PD-L1), thus preventing their efficient clearance by adaptive host immunity. Conversely, these mutant-specific dependencies were therapeutically exploitable by anti–programmed cell death 1 checkpoint blockade, leading to direct T-cell–mediated lysis of predominantly but not exclusively senescent lymphoma cells. Importantly, mouse-based mutant MyD88- and CARD11-derived signatures marked DLBCL subgroups exhibiting mirroring phenotypes with respect to the triad of senescence induction, macrophage attraction, and evasion of cytotoxic T-cell immunity. Complementing genomic subclassification approaches, our functional, cross-species investigation unveils pathogenic principles and therapeutic vulnerabilities applicable to and testable in human DLBCL subsets that may inform future personalized treatment strategies.
How to manage CML patients with comorbidities
Authors: Cortes Jorge
Published: November 2020

Patients with chronic myeloid leukemia (CML) often have comorbidities, at an incidence that might be higher than in the general population. Because of the favorable outcome of most patients with CML treated with tyrosine kinase inhibitors (TKIs), a greater number of comorbidities might be the most significant adverse feature for long-term survival. The presence of comorbidities may also affect the risk of developing adverse events with TKIs. This effect is perhaps best exemplified by the risk of developing arterio-occlusive events, which is greatest for patients who have other risk factors for such events, with the risk increasing with higher numbers of comorbidities. The coexistence of comorbidities in patients with CML not only may affect TKI selection but also demands close monitoring of the overall health condition of the patient to optimize safety and provide the opportunity for an optimal outcome to such patients. With optimal, holistic management of leukemia and all other conditions afflicting them, patients with CML and comorbidities may aim for a near-normal life expectancy, just as the more select patients enrolled in clinical trials now enjoy.
Increased B4GALT1 expression is associated with platelet surface galactosylation and thrombopoietin plasma levels in MPNs
Authors: Di Buduo Christian A. , Giannini Silvia , Abbonante Vittorio , Rosti Vittorio , Hoffmeister Karin M. , Balduini Alessandra
Published: November 2020

Aberrant megakaryopoiesis is a hallmark of the myeloproliferative neoplasms (MPNs), a group of clonal hematological malignancies originating from hematopoietic stem cells, leading to an increase in mature blood cells in the peripheral blood. Sialylated derivatives of the glycan structure β4-N-acetyllactosamine (Galβ1,4GlcNAc or type-2 LacNAc, hereafter referred to as LacNAc) regulate platelet life span, hepatic thrombopoietin (TPO) production, and thrombopoiesis. We found increased TPO plasma levels in MPNs with high allele burden of the mutated clones. Remarkably, platelets isolated from MPNs had a significant increase in LacNAc expression that correlated with the high allele burden regardless of the underlying identified mutation. Megakaryocytes derived in vitro from these patients showed an increased expression of the B4GALT1 gene encoding β-1,4-galactosyltransferase 1 (β4GalT1). Consistently, megakaryocytes from MPN showed increased LacNAc expression relative to healthy controls, which was counteracted by the treatment with a Janus kinase 1/2 inhibitor. Altered expression of B4GALT1 in mutant megakaryocytes can lead to the production of platelets with aberrant galactosylation, which in turn promote hepatic TPO synthesis regardless of platelet mass. Our findings provide a new paradigm for understanding aberrant megakaryopoiesis in MPNs and identify β4GalT1 as a potential actionable target for therapy.
Persistent challenges with treating multiple myeloma early
Authors: Goodman Aaron M. , Kim Myung S. , Prasad Vinay
Published: November 2020

Over the past decade, 2 strategies have advanced the treatment of patients with multiple myeloma and its precursor diseases. First, the definition has changed to include patients without end organ damage, who previously would not have been treated. Second, there is widespread enthusiasm for treating high-risk, smoldering multiple myeloma. In this commentary, we explore the evidence supporting these therapeutic expansions. Although early treatment adds cost and therapeutic burden, it remains unknown whether survival and health-related quality of life are improved by early treatment. Herein, we consider the implications of diagnostic expansion in multiple myeloma.
Sulfated vizantin causes detachment of biofilms composed mainly of the genus Streptococcus without affecting bacterial growth and viability
Authors: Hasegawa Taisuke , Takenaka Shoji , Oda Masataka , Domon Hisanori , Hiyoshi Takumi , Sasagawa Karin , Ohsumi Tatsuya , Hayashi Naoki , Okamoto Yasuko , Yamamoto Hirofumi , Ohshima Hayato , Terao Yutaka , Noiri Yuichiro
Published: November 2020

Background

Sulfated vizantin, a recently developed immunostimulant, has also been found to exert antibiofilm properties. It acts not as a bactericide, but as a detachment-promoting agent by reducing the biofilm structural stability. This study aimed to investigate the mechanism underlying this activity and its species specificity using two distinct ex vivo oral biofilm models derived from human saliva.

Results

The biofilm, composed mainly of the genus Streptococcus and containing 50 μM of sulfated vizantin, detached significantly from its basal surface with rotation at 500 rpm for only 15 s, even when 0.2% sucrose was supplied. Expression analyses for genes associated with biofilm formation and bacterial adhesion following identification of the Streptococcus species, revealed that a variety of Streptococcus species in a cariogenic biofilm showed downregulation of genes encoding glucosyltransferases involved in the biosynthesis of water-soluble glucan. The expression of some genes encoding surface proteins was also downregulated. Of the two quorum sensing systems involved in the genus Streptococcus, the expression of luxS in three species, Streptococcus oralis, Streptococcus gordonii, and Streptococcus mutans, was significantly downregulated in the presence of 50 μM sulfated vizantin. Biofilm detachment may be facilitated by the reduced structural stability due to these modulations. As a non-specific reaction, 50 μM sulfated vizantin decreased cell surface hydrophobicity by binding to the cell surface, resulting in reduced bacterial adherence.

Conclusion

Sulfated vizantin may be a candidate for a new antibiofilm strategy targeting the biofilm matrix while preserving the resident microflora.
Poor cardiovascular health status among Chinese women
Authors: Han Tian-Wen , Liu Yu-Qi , Dong Wei , Bai Xiao-Juan , Liu Yu-Yang , Su Xi , Li Yu-Ming , Qian Ju-Ying , Xiang Mei-Xiang , Cai Lin , Lin Qian , Hou Jing-Bo , Yang Jie , Li Dan-Dan , Yang Huan-Wan , Zhou Shan-Shan , Wang Jing , Tian Feng , Zhao Xue-Qiao , Chen Yun-Dai
Published: November 2020

Background

Systematic investigation and analysis of cardiovascular health status (CVHS) of Chinese women is rare. This study aimed to assess CVHS and atherosclerotic cardiovascular disease (ASCVD) burden in the Chinese women physicians (CWP) and community-based non-physician cohort (NPC).

Methods

In this prospective, multicenter, observational study, CVHS using the American Heart Association (AHA) defined 7 metrics (such as smoking and fasting glucose) and ASCVD risk factors including hypertension, hyperlipidemia and type-2 diabetes were evaluated in CWP compared with NPC.

Results

Of 5832 CWP with a mean age of 44 ± 7 years, only 1.2% achieved the ideal CVHS and 90.1% showed at least 1 of the 7 AHA CVHS metrics at a poor level. Total CVHS score was significantly decreased and ASCVD risk burden was increased in postmenopausal subjects in CWP although ideal CVHS was not significantly influenced by menopause. Compared to 2596 NPC, fewer CWP had ≥ 2 risk factors (8% vs. 27%,P < 0.001); CWP scored significantly higher on healthy factors, a composite of total cholesterol, blood pressure, fasting glucose (P < 0.001), but, poorly on healthy behaviors (P < 0.001), specifically in the physical activity component; CWP also showed significantly higher levels of awareness and rates of treatment for hypertension and hyperlipidemia, but, not for type-2 diabetes.

Conclusion

Chinese women’s cardiovascular health is far from ideal and risk intervention is sub-optimal. Women physicians had lower ASCVD burden, scored higher in healthy factors, but, took part in less physical activity than the non-physician cohort. These results call for population-specific early and improved risk intervention.
GERO Cohort Protocol, Chile, 2017–2022: Community-based Cohort of Functional Decline in Subjective Cognitive Complaint elderly
Authors: Slachevsky Andrea , Zitko Pedro , Martínez-Pernía David , Forno Gonzalo , Court Felipe A. , Lillo Patricia , Villagra Roque , Duran-Aniotz Claudia , Parrao Teresa , Assar Rodrigo , Orellana Paulina , Toledo Carolina , Rivera Rodrigo , Ibañez Agustín , Parra Mario A. , González-Billault Christian , Amieva Helena , Thumala Daniela
Published: November 2020

Background

With the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years. Cognitive complaint is considered a predictor for cognitive and functional decline, incident mild cognitive impairment, and incident dementia. The GERO cohort is the Chilean core clinical project of the Geroscience Center for Brain Health and Metabolism (GERO). The objective of the GERO cohort is to analyze the rate of functional decline and progression to clinical dementia and their associated risk factors in a community-dwelling elderly with subjective cognitive complaint, through a population-based study. We also aim to undertake clinical research on brain ageing and dementia disorders, to create data and biobanks with the appropriate infrastructure to conduct other studies and facilitate to the national and international scientific community access to the data and samples for research.

Methods

The GERO cohort aims the recruitment of 300 elderly subjects (> 70 years) from Santiago (Chile), following them up for at least 3 years. Eligible people are adults not diagnosed with dementia with subjective cognitive complaint, which are reported either by the participant, a proxy or both. Participants are identified through a household census. The protocol for evaluation is based on a multidimensional approach including socio-demographic, biomedical, psychosocial, neuropsychological, neuropsychiatric and motor assessments. Neuroimaging, blood and stool samples are also obtained. This multidimensional evaluation is carried out in a baseline and 2 follow-ups assessments, at 18 and 36 months. In addition, in months 6, 12, 24, and 30, a telephone interview is performed in order to keep contact with the participants and to assess general well-being.

Discussion

Our work will allow us to determine multidimensional risks factors associated with functional decline and conversion to dementia in elderly with subjective cognitive complain. The aim of our GERO group is to establish the capacity to foster cutting edge and multidisciplinary research on aging in Chile including basic and clinical research.

Trial registration

NCT04265482in ClinicalTrials.gov. Registration Date: February 11, 2020. Retrospectively Registered.
Age and education as factors associated with medication literacy: a community pharmacy perspective
Authors: Plaza-Zamora Javier , Legaz Isabel , Osuna Eduardo , Pérez-Cárceles María D.
Published: November 2020

Background

Aging implies a higher prevalence of chronic pathologies and a corresponding increase in medication. The correct adherence and use of the medication are prerequisites for reducing risks of disease progression, comorbidity, and mortality. Medication literacy (ML) is the specific ability to safely access and understand the information available concerning medication, and to act accordingly. Currently, there are few specific instruments that ascertain the extent of ML in the general population. The aim of this work was to analyse ML in a large cohort of pharmacy customers.

Methods

A total of 400 community pharmacy clients were analyzed to assess the level of ML (documental and numeracy) through the validated MedLitRxSE tool.

Results

The results showed that out of a total of 400 community pharmacy clients only 136 (34%) had an adequate degree of ML, while the rest of the clients (n = 264; 66%) were adjudged not to have this ability. Statistically significant differences were found between the different age groups in terms of ML (P < 0.001; OR = 0.312; 95% CI: 0.195–0.499), the 51–65 and >65-year age groups having a lower frequency of adequate ML (23.5 and 7.1%, respectively) than the rest of the age groups. A statistically significant increase in adequate ML was observed as the academic level of the clients increased (P < 0.001; OR = 15.403; 95% CI: 8.109–29.257). Multivariate logistic regression confirmed the influence of both variables on ML.

Conclusions

An inadequate ML level was found in community pharmacy clients over the age of 51, and also in those with primary or non-formal studies. Our data add to our knowledge about ML, and should pharmacists and other health professionals to adopt new strategies to prevent, or at least reduce, errors in taking medicines, thus avoiding the undesirable effects of any misuse.
No evidence of a synergistic effect of HIV infection and diabetes mellitus type 2 on fat distribution, plasma adiponectin or inflammatory markers
Authors: Hove-Skovsgaard Malene , Abildgaard Julie , Gelpi Marco , Gaardbo Julie Christine , Kolte Lilian , Ullum Henrik , Trøseid Marius , Lindegaard Birgitte , Nielsen Susanne Dam
Published: November 2020

Background

Altered fat distribution and chronic inflammation are found in both persons living with HIV (PLWH) and persons with diabetes mellitus type 2 (DM2) and are known risk factors for cardiovascular diseases (CVD). We aimed to investigate if a synergistic effect of HIV infection and DM2 was found on fat distribution and inflammation.

Methods

A cross-sectional study was performed including PLWH with HIV RNA < 200 copies/mL (18 with DM2 (HIV + DM2+), 18 without DM2 (HIV + DM2-)) and controls (19 with DM2 (controls with DM2) and 25 without DM2 (healthy controls). We measured fat distribution using dual-energy X-ray absorptiometry scan. Plasma concentrations of adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alfa (TNF-α) and soluble CD14 (sCD14) was measured using snap-frozen plasma.

Results

HIV + DM2+ and HIV + DM2- had comparable trunk/limb fat ratio. In contrast, HIV + DM2+ had a higher trunk/ limb fat ratio than controls with DM2 and healthy controls (p = 0.013 andp < 0.001, respectively). However, HIV + DM2+ and controls with DM2 had comparable amount of trunk fat mass (kg) (p = 0.254). A lower concentration of plasma adiponectin and higher concentration of IL-6 was found in HIV + DM2+ than in HIV + DM2-(p = 0.037 andp = 0.039) and in healthy controls (p = 0.001 andp = 0.012). In contrast, plasma adiponectin and IL-6 concentrations were comparable in HIV + DM2+ and controls with DM2 (p = 0.345 andp = 0.825). Concentration of sCD14 was comparable in HIV + DM2+ and HIV + DM2–(p = 0.850), but elevated in HIV + DM2+ compared to controls with DM2 (p < 0.001) and healthy controls (p = 0.007). No statistical interactions were found between HIV infection and DM2 for any of the depending variables.

Conclusion

A synergistic effect of HIV and DM2 was not found for any of the outcomes. However, HIV + DM2+ had features related to both HIV infection and DM2 with a high trunk/limb ratio, high trunk fat mass, low concentration of plasma adiponectin and elevated concentrations of IL-6 and sCD14. This could contribute to elevated risk of CVD.
Association between haematological parameters and sickle cell genotypes in children with Plasmodium falciparum malaria resident in Kisumu County in Western Kenya
Authors: Kosiyo Paul , Otieno Walter , Gitaka Jesse , Munde Elly O. , Ouma Collins
Published: November 2020

Background

Sickle cell disease (SCD) is a monogenic disorder due to point mutation in the β-globin gene resulting in substitution of Valine for Glutamic acid. The SCD is prevalent inP. falciparumendemic regions such as western Kenya. Carriage of different sickle cell genotypes may influence haematological parameter during malaria. Children resident in malaria holoendemic regions suffer more from malaria-related complications and this is moderated by the presence of the SCD. In the current study, we determined the association between sickle cell genotypes and haematological parameters in children withP. falciparummalaria resident in Kisumu County in Western Kenya.

Methodology

Children (n = 217, aged 1–192 months) with acute febrile condition were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital. Chi-square (χ2) analysis was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Multivariate logistic regression analysis controlling for infection status was used to determine the association between sickle cell genotypes and haematological parameters.

Results

Using HbAA as the reference group, multivariate logistic regression analysis revealed that carriage of HbSS was associated with reduced haemoglobin [OR = 0.310, 95% CI = 0.101–0.956,P = 0.041], reduced haematocrit [OR = 0.318, 95% CI = 0.128–0.793,P = 0.014], reduced RBC count [OR = 0.124, 95% CI = 0.045–0.337,P = 0.001], reduced MCHC [OR = 0.325, 95% CI = 0.118–0.892,P = 0.029], increased leucocytosis [OR = 9.283, 95% CI = 3.167–27.210,P = 0.001] and reduced monocytosis [OR = 0.319, 95% CI = 0.123–0.830,P = 0.019]. However, carriage of HbAS was only associated with increased micro-platelets [OR = 3.629, 95% CI = 1.291–8.276,P = 0.012].

Conclusion

Results show that carriage of HbSS in children influence the levels of haemoglobin, haematocrit, RBC, MCHC, WBC and Monocytes. Therefore prior knowledge of HbSS should be considered to improve clinical management of haematological alterations during malaria in children.
High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana
Authors: Bediako-Bowan Antoinette A. A. , Kurtzhals Jørgen A. L. , Mølbak Kåre , Labi Appiah-Korang , Owusu Enid , Newman Mercy J.
Published: November 2020

Background

There is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana.

Methods

As part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively.

Results

Of 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus.

Conclusions

The predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.
The impact of hypertension on chronic kidney disease and end-stage renal disease is greater in men than women: a systematic review and meta-analysis
Authors: Weldegiorgis Misghina , Woodward Mark
Published: November 2020

Background

Hypertension (HTN) is an established risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). Whether sex differences in the effect of HTN on CKD and ESRD incidence exist remains unclear. This systematic review and meta-analysis was conducted to evaluate the relative impact of HTN on CKD and ESRD risk in women compared with men.

Methods

We systematically searched Embase and PubMed for cohort studies until 24 July 2020. Studies were selected if they reported a sex-specific association between systolic blood pressure (SBP) and CKD or ESRD. Random effects meta-analyses with inverse variance weighting were used to pool sex-specific relative risks (RRs) and the women-to-men ratio of RRs (the RRR) for incident CKD and ESRD.

Results

Data from six cohorts, including 2,382,712 individuals and 6856 incident CKD events, and 833 ESRD events, were included in the meta-analysis. The RR for incident CKD or ESRD associated with HTN (SBP ≥140 mmHg) versus ideal BP (SBP < 120 mmHg) was 1.56 (95% CI, 1.39–1.75) in women and 2.06 (95% CI, 1.64–2.60) in men. The RR for incident CKD or ESRD was 23% lower in women than in men RRR 0.77 [95% CI, 0.63–0.95] with no significant heterogeneity between studies (p-value for Q test = 0.507,I2 = 17.7%).

Conclusion

HTN confers about a fifth lower excess risk of incident CKD or ESRD in women than men. Sex differences in onset, duration, and severity of some risk factors, such as albuminuria, diabetes, cardiovascular disease, obesity, and socioeconomic status, may explain part of the excess risk in men. Another explanation could be that women might be under-diagnosed and less likely to initiate dialysis. Future studies are needed to demonstrate the mechanisms responsible for the observed sex difference.
CCT: continuous care trial - a randomized controlled trial of the provision of continuous care during labor by maternity care assistants in the Netherlands
Authors: Lettink Adrie , Chaibekava Karina , Smits Luc , Langenveld Josje , van de Laar Rafli , Peeters Babette , Verstappen Marie-Louise , Dirksen Carmen , Nieuwenhuijze Marianne , Scheepers Hubertina
Published: November 2020

Background

In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor.

Methods

A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992).

Discussion

We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a cost-effective intervention.

Trial registration

Trial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.
Women’s experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study
Authors: Pilli Patrick , Sekweyama Peter , Kayira Anthony
Published: November 2020

Background

Emergency peripartum hysterectomy (EPH) is a known remedy for saving women’s lives when faced with the challenging situation of severe post partum hemorrhage not responsive to conservative management. However, EPH by its nature is also a traumatic birth event that causes serious physical, emotional and psychological harm. Unfortunately at St. Francis Hospital Nsambya nothing much is known about these experiences since no study has been undertaken and these women are not routinely followed up. The purpose of this study was to explore these emotional experiences.

Methods

This was a qualitative phenomenological study carried out between August and December 2018. All those women who had undergone EPH between January 2015 and August 2018 were eligible to participate in the study. Purposive sampling was used. 18 women were interviewed before saturation was reached. All interviews were audio-recorded and then transcribed verbatim. Thematic analysis was used to analyze the data.

Results

Three major themes were identified as the main experiences of these women in this study and they were; Loss of Womanhood, Joy for being alive and Loss of marital safety.

Conclusion

Women experience serious emotional consequences following EPH. We recommend routine follow-up to help appreciate these experiences and advise them on appropriate mitigating measures.
Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study
Authors: Shiraishi Mie , Matsuzaki Masayo , Kurihara Shoko , Iwamoto Maki , Shimada Mieko
Published: November 2020

Background

The rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum.

Methods

This prospective cohort study was conducted at a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant’s feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine factors affecting exclusive breastfeeding at 3 months postpartum.

Results

Of the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08–59.59), having a university degree (5.25, 1.04–26.53), no plan to return to work by 6 months postpartum (0.02, 0.00–0.46), and exclusive breastfeeding (42.84, 6.05–303.52), lower cortisol level after breastfeeding (0.00, 0.00–0.02), and higher breastfeeding self-efficacy scale score (1.07, 1.00–1.14) at 1 month postpartum. In parity-specific analyses, exclusive breastfeeding (25.33, 4.75–134.98) and lower cortisol level after breastfeeding (0.00, 0.00–0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00–0.94), higher breastfeeding self-efficacy score (1.18, 1.05–1.32), and absence of breast complications (0.09, 0.01–0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum.

Conclusions

Stress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.
Fertility treatment and oral contraceptive discontinuation for identification of pregnancy planning in routinely collected health data – an application to analgesic and antibiotic utilisation
Authors: Hjorth Sarah , Wood Mollie , Tauqeer Fatima , Nordeng Hedvig
Published: November 2020

Background

Women with unplanned pregnancies use folic acid less frequently, and more often use potentially teratogenic medications in the first trimester. Yet most studies based on routinely collected data lack information on pregnancy planning. Further, only pregnancies proceeding beyond a certain gestational age appear in routinely collected data, creating the possibility for collider-stratification bias. If pregnancy intention could be identified, pregnancies could be ascertained earlier. This study aimed to investigate fertility treatment and discontinuation of oral contraception (OC) as proxies for pregnancy planning by describing variations in patterns of prescription fills for antibiotics and analgesics during the peri-pregnancy period by these proxies of pregnancy intention.

Methods

Fertility treatment with clomiphene and discontinuation of OC were identified in the Norwegian Prescription Database (NorPD) and linked with data from the Medical Birth Registry of Norway for the years 2006 to 2017. Filled prescriptions for antibiotics and analgesics from NorPD were displayed for women on fertility treatment, women who discontinued OC before pregnancy, and women who discontinued during pregnancy.

Results

Of 172,585 included pregnancies, fertility treatment was identified in 19,449, and OC discontinuation before or during pregnancy in 153,136. Women who discontinued OC during pregnancy were less likely to use preconception folic acid (25.4%) than women who discontinued before pregnancy (32.9%), and women on fertility treatment (51.0%). Proportions of first trimester prescription fills were 4.9% (analgesics) and 12.8% (antibiotics) for women who discontinued OC during pregnancy, compared to 4.0 and 11.4% in women who discontinued OC before pregnancy, and 4.7 and 11.0% in women on fertility treatment.

Conclusions

There were no substantial differences in patterns of prescription fills for analgesics and antibiotics before or during pregnancy by fertility treatment and OC discontinuation. This suggests that there were few differences in medication use between women with planned and unplanned pregnancies, or that fertility treatment and timing of OC discontinuation from routinely collected health data cannot stand alone in the identification of unplanned pregnancies. A narrower definition of OC discontinuation during pregnancy seemed to be a better proxy, but this should be confirmed in other studies.