bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic tuberculosis caused by Mycobacterium bovis in a domestic donkey in Central Europe
Authors: Siwinska Natalia , Zak Agnieszka , Slowikowska Malwina , Niedzwiedz Artur , Ciaputa Rafal , Janus Izabela , Lipiec Marek , Radulski Lukasz , Szymerowski Adam , Nowak Marcin
Published: February 2022

Bovine tuberculosis is a contagious and zoonotic disease of animals and humans. In Europe, the number of reported cases of tuberculosis has decreased. Equidae are relatively rarely infected even in endemic areas. The presented report describes a case of chronic Mycobacterium bovis tuberculosis in a 30‐year‐old female donkey. The donkey initially presented with persistent lymphadenopathy; however, as the disease progressed, weight loss became apparent. To the authors' knowledge, this is the second confirmed case of tuberculosis in a donkey in Europe.
A legitimacy theory perspective on Scope 3 freight transportation emissions
Authors: Ellram Lisa M. , Tate Wendy L. , Saunders Lance W.
Published: February 2022

Freight transportation emissions reduction is on the environmental sustainability agenda for the logistics and transportation function in many organizations. Transportation is the fastest growing form of emissions in developing countries and is second only to electricity emissions generation globally. However, freight transportation is not a priority on the overall organizational sustainability agenda for many companies. This research uses in‐depth interviews with 12 organizations to provide insight into the Transportation functional and the organizational level action and commitment to freight transportation emissions reduction as part of the overall corporate sustainability agenda. The context of this research takes the perspective of shippers to understand the benefits perceived by shippers in joining a green network/partnership focused on the reduction of freight emissions, fuel consumption, and the associated costs. In most organizations, reducing freight emissions is managed within the Transportation function and there is a lack of organizational focus on outsourced freight transportation emissions reduction. Given the increasing saliency of emissions reductions in many organizations, this represents a gap that needs to be addressed. The research suggests methods for creating more concern and visibility of freight transportation emissions.
Estimated blood pressure trajectories and hypertension patterns among pregnant women living with HIV, Haiti, 2007–2017
Authors: Tymejczyk Olga , Deschamps Marie Marcelle , Rouzier Vanessa , McNairy Margaret L. , Peck Robert N. , Malha Line , Macius Youry , Fitzgerald Daniel W. , Pape Jean W. , Nash Denis
Published: February 2022

Hypertension in pregnancy is a key driver of mortality and morbidity among Haitian women. HIV infection and treatment may worsen hypertension and increase cardiovascular disease risk. The authors examined blood pressure and hypertension patterns among 1965 women (2306 pregnancies ending in live births) in a prevention of maternal‐to‐child transmission (PMTCT) program in Port‐au‐Prince, Haiti, between 2007 and 2017. Hypertension was defined as blood pressure ≥140/90 mm Hg on two consecutive visits. Latent class analysis assessed trajectories of mean arterial pressure (MAP) and multinomial ordinal logistic regression examined factors associated with higher trajectories. Between 2007–2009 and 2013–2016, hypertension at PMTCT entry increased from 1.3% to 3.8% (p = .005), while incidence at any time during PMTCT follow‐up increased from 5.0 to 16.1 per 100 person‐years (p < .001). Hypertension detected ≤20 weeks and > 20 weeks of gestation (possible gestational hypertension) increased from 1.1% to 3.5% (p = .003) and from 2.3% to 6.9% (p < .001), respectively. Five MAP trajectories ranged from low‐stable to high‐increasing. In multivariable analysis controlling for history of antiretroviral therapy, age, parity, and weight, program entry in more recent years was associated with greater odds of higher MAP trajectory (adjusted odds ratio for 2013–2016 vs. 2007–2009 = 3.1, 95% confidence interval: 1.7–5.6). The increasing prevalence and incidence of hypertension highlight a need for screening and management prior to PMTCT entry and during follow‐up. In a population with limited access to chronic disease care, and where many deliveries occur outside of a clinical setting, the period of PMTCT follow‐up represents an opportunity to diagnose and initiate management of preexisting and pregnancy‐related hypertension.
Powerful CEOs and Corporate Governance
Authors: Humphery‐Jenner Mark , Islam Emdad , Rahman Lubna , Suchard Jo‐Ann
Published: February 2022

Excessive CEO power is often regarded as value‐destroying. We use a quasi‐exogenous regulatory shock to analyze whether improved governance helps to channel firms with powerful CEOs toward more value‐enhancing corporate policies. We use the Sarbanes‐Oxley Act and NYSE/NASDAQ listing rules and focus on firms that were required to improve governance. We find that postregulation firms led by powerful CEOs increase innovation inputs (Research and Development expenditures) and produce more innovation outputs (patents) that are scientifically more important (citations) and economically more valuable (market value of patents). Investment quality also improves, manifesting in better takeover performance and improvements in firm performance and corporate value. Our results suggest that improved governance can mitigate value destruction in powerful CEO‐managed firms. We take steps to mitigate econometric concerns and ensure our results are robust to various combinations of fixed effects and control variables.
Pandemics and consumer well‐being from the Global South
Authors: Das Arindam , Chaudhuri Himadri Roy
Published: February 2022

This introductory article makes a critical estimation of the impact of pandemics on the Global South consumer's well‐being. Our paper moves beyond the concerns of the other papers of this Special Issue. Instead, we focus on the issues of the vulnerable, marginal, and subaltern consumers of the Global South—experiences and anxieties, distinct from those of more “modern,” capitalized, industrialized, democratized, and economically liberated Global North consumers. We offer the North–South comparisons across national lines or from block to block that bring in a series of promising directions and new currents in the critical, interdisciplinary studies of consumer affairs. Primary perspectives and associated topics for future agenda impacting TCR highlighted are (i) socio‐economic inequalities and injustices, (ii) environmental injustice and sustainable future. We finally suggest an innovative research paradigm, “altruistic‐activist consumer research,” to address the concerns and impact the well‐being of marginal consumers from the Global South.
Does industry self‐regulation work to protect consumers? An evaluation of the children's food and beverage advertising initiative
Authors: Avery Rosemary J. , Brown Aerin , Mathios Alan
Published: February 2022

The study evaluates the success of an industry self‐regulatory initiative, the Children's Food and Beverage Advertising Initiative (CFBAI), designed to limit advertising of less nutritious foods to children that began in 2006 and implemented by pledging firms by 2013. We estimate the nutritional profile (calories, sugar, sodium, and fiber) of cereals that were advertised on national/local television (approximately 170 million ads) and measure children's exposure (over 21,000 children) to these ads for years 2001–2013. We also examine how firms responded to the voluntary agreement in terms of their advertising and product line decisions. Results reveal improvements in the nutritional quality of cereal children are exposed to through advertising, indicating the success of this self‐regulatory initiative in this product category. Results also reveal the ways in which manufacturers adapted their product line offerings and ad airings in response to their CFBAI pledges.
Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis
Authors: Brown Nicholas , Bhatt Heli , Salunke Amrita , Chinnakotla Srinath , Qureshi Athar M. , Aggarwal Varun
Published: February 2022

Portal hypertension because of liver cirrhosis is a significant cause of morbidity and mortality. Treatment options in these patients include liver transplant, symptomatic treatment of oesophageal varices via endoscopic treatment and symptomatic management of ascites. Portosystemic shunt creation can be challenging in newborns and infants. We present a newborn with Trisomy 21, severe portal hypertension secondary to neonatal cirrhosis, oesophageal varices and upper GI bleeding, severe ascites refractory to medical management who underwent ductus venosus stenting as a palliative procedure. He demonstrated remarkable clinical improvement with no subsequent upper GI bleed and resolution of ascites till his last follow‐up at 12 months of age. To the best of our knowledge, stenting of the patent ductus venosus to create a portosystemic shunt to relieve portal hypertension has not been reported in English literature.
Feasibility and effectiveness of HCV viraemia testing at harm reduction sites in Georgia: A prospective three‐arm study
Authors: Shilton Sonjelle , Markby Jessica , Japaridze Maia , Chihota Violet , Shadaker Shaun , Gvinjilia Lia , Tsereteli Maia , Alkhazashvili Maia , Butsashvili Maia , Stvilia Ketevan , Ruiz Ryan Jose , Asatiani Alexander , Adamia Ekaterine , Easterbrook Philippa , Khonelidze Irma , Gamkrelidze Amiran
Published: February 2022

Background and Aims

In 2015, Georgia began a hepatitis C virus (HCV) elimination programme. Although screening programmes have been decentralized for high‐risk groups, viraemic testing remains a bottleneck for people who inject drugs. Here, we describe two models of viraemic testing that aimed to address this gap.

Methods

We assigned eight harm reduction sites (HRS) to one of three arms (2,1:1): Xpert HCV viral load testing on‐site, blood draw on‐site with centralized HCV core antigen testing (HCVcAg), or standard‐of‐care (SOC) referral with viremia testing performed at treatment centres.

Results

1671 HCV‐seropositive participants were enrolled (Xpert, 37.1%; HCVcAg, 29.1%; referral, 33.8%). Participants were predominantly male (95.4%), mean age (IQR) 43 (37, 50) years and 1290 (77.2%) were currently injecting drugs. Significantly higher proportions of participants in the Xpert (100%) and HCVcAg (99.8%) arms received viraemia testing compared with the referral arm (91.3%) (Xpert vs referral, p < 0.0001; HCVcAg vs referral, p < 0.0001). Among viraemic participants, treatment uptake was similar (Xpert, 84.0%; HCVcAg, 79.5%; referral, 88.4%). The time between screening and sample collection for viraemia testing was significantly longer in the referral arm compared with both Xpert and HCVcAg arms (median 1 day compared with 0 days respectively), and the overall time between screening to treatment initiation was longer for the referral arm (median 67 days) compared with both Xpert and HCVcAg arms (median 57 and 50 days respectively).

Conclusions

Point‐of‐care viraemia testing and blood drawn on‐site for HCVcAg testing yielded more HCV‐seropositive patients receiving viraemic testing within a shorter timeframe compared with referrals.
A novel serum metabolomic panel distinguishes IgG4‐related sclerosing cholangitis from primary sclerosing cholangitis
Authors: Radford‐Smith Daniel E. , Selvaraj Emmanuel A. , Peters Rory , Orrell Michael , Bolon Jonathan , Anthony Daniel C. , Pavlides Michael , Lynch Kate , Geremia Alessandra , Bailey Adam , Culver Emma L. , Probert Fay
Published: February 2022

Background & Aims

Primary sclerosing cholangitis (PSC) and IgG4‐related sclerosing cholangitis (IgG4‐SC) are chronic fibro‐inflammatory immune‐mediated hepatobiliary conditions that are challenging to distinguish in a clinical setting. Accurate non‐invasive biomarkers for discriminating PSC and IgG4‐SC are important to ensure a correct diagnosis, prompt therapy and adequate cancer surveillance.

Methods

We performed nuclear magnetic resonance (NMR)‐based metabolomic profiling using serum samples collected prospectively from patients with PSC (n = 100), IgG4‐SC (n = 23) and healthy controls (HC; n = 16).

Results

Multivariate analysis of the serum metabolome discriminated PSC from IgG4‐SC with greater accuracy (AUC 0.95 [95%CI 0.90–0.98]) than IgG4 titre (AUC 0.87 [95%CI 0.79–0.94]). When inflammatory bowel disease (IBD) was excluded as a comorbid condition (IgG4‐SC n = 20, PSC n = 22), the diagnostic AUC increased to 1.0, suggesting that the metabolome differences identified are not a result of the increased prevalence of IBD in PSC relative to IgG4‐SC patients. Serum lactate (p < .0001), glucose (p < .01) and glutamine (p < .01) metabolites were increased in IgG4‐related disease (IgG4‐RD) and IgG4‐SC individuals compared to PSC, whereas mobile choline (p < .05), 3‐hydroxybutyric acid (p < .01) and ‐CH3 lipoprotein resonances (p < .01) were decreased.

Conclusions

Taken together, serum metabolomic profiling has the potential to be incorporated as a diagnostic criterion, independent of IgG4 titre, to improve the diagnosis of IgG4‐RD and help distinguish IgG4‐SC from PSC.
From Quantitative Fact to Discursive Practice: Techniques for Asserting the Reliability of Anthropological Knowledge in Expert Testimony
Authors: Rodriguez Leila
Published: February 2022

Unlike other expert witnesses, cultural anthropologists must not only provide expert evidence on the case but also convince judges of its validity for meeting the Daubert standard. In this article, I juxtapose two expert testimony reports I have written in criminal and asylum cases. For the first, I conducted cultural consensus analysis, a formal quantitative technique, to gather data on beliefs about co‐sleeping behavior among Mexican migrants. For the second, I relied on discursive practice to signal the facts as meeting the standard of evidence. I argue that despite anthropology not being an “exact science,” our locus at the intersection of the sciences, social sciences, and humanities provides us with a range of tools to assert the reliability and validity of our testimony.
The 14‐3‐3 protein GF14c positively regulates immunity by modulating the protein homoeostasis of the GRAS protein OsSCL7 in rice
Authors: Lu Ling , Diao Zhijuan , Yang Dewei , Wang Xun , Zheng Xingxing , Xiang Xinquan , Xiao Yueping , Chen Zhiwei , Wang Wei , Wu Yunkun , Tang Dingzhong , Li Shengping
Published: February 2022

Various types of transcription factors have been reported to be involved in plant‐pathogen interactions by regulating defence‐related genes. GRAS proteins, plant‐ specific transcription factors, have been shown to play essential roles in plant growth, development and stress responses. By performing a transcriptome study on rice early defence responses to Magnaporthe oryzae, we identified a GRAS protein, OsSCL7, which was induced by M. oryzae infection. We characterized the function of OsSCL7 in rice disease resistance. OsSCL7 was upregulated upon exposure to M. oryzae and pathogen‐associated molecular pattern treatments, and knocking out OsSCL7 resulted in decreased disease resistance of rice to M. oryzae. In contrast, overexpression of OsSCL7 could improve rice disease resistance to M. oryzae. OsSCL7 was mainly localized in the nucleus and showed transcriptional activity. OsSCL7 can interact with GF14c, a 14‐3‐3 protein, and loss‐of‐function GF14c leads to enhanced susceptibility to M. oryzae. Additionally, OsSCL7 protein levels were reduced in the gf14c mutant and knocking out OsSCL7 affected the expression of a series of defence‐related genes. Taken together, these findings uncover the important roles of OsSCL7 and GF14c in plant immunity and a potential mechanism by which plants fine‐tune immunity by regulating the protein stability of a GRAS protein via a 14‐3‐3 protein.
Age‐related differences in the error‐related negativity and error positivity in children and adolescents are moderated by sample and methodological characteristics: A meta‐analysis
Authors: Boen Rune , Quintana Daniel S. , Ladouceur Cecile D. , Tamnes Christian K.
Published: February 2022

The error‐related negativity (ERN) and the error positivity (Pe) are electrophysiological components associated with error processing that are thought to exhibit distinctive developmental trajectories from childhood to adulthood. To investigate the age and age moderation effects on the ERN and the Pe strength during development, we conducted a preregistered three‐level meta‐analysis synthesizing 120 and 41 effect sizes across 18 group comparison studies and 19 correlational studies, respectively. The meta‐analysis included studies with mean age between 3.6 and 28.7 (min‐max age range: 3.5 and 49.8) years for age‐group comparisons and 6.1 to 18.7 (min‐max age range: 4.0–35.7) years for age correlations. Results showed that age was associated with a more negative ERN (SMD = −.433, r = −.230). No statistically significant association between age and the Pe was found (SMD = .059, r = −.091), except for in a group comparison between younger and older adolescents. The age effects were not significantly moderated by whether a Flanker or a Go/No‐Go task was used, whereas a probabilistic learning task moderated the age effect on the Pe. Moreover, the Fz and Cz electrode sites yielded stronger negative associations between age and the ERN and the Pe, respectively. The results confirm that the ERN and the Pe show differential development courses and suggest that sample and methodological characteristics influence the age effects, and lay the foundation for investigations of developmental patterns of the ERN and the Pe in relation to psychopathology and early genetic and environmental risk factors.
Group differences in agency modulate error monitoring
Authors: Bauer Elizabeth A. , MacNamara Annmarie
Published: February 2022

Mistakes can lead to aversive outcomes. Error monitoring may help prevent mistakes, but it might be maladaptive for individuals who lack control over aversive outcomes, as it consumes cognitive processing resources that could be allocated elsewhere. Here, we examined the effect of agency (i.e., control over punishment) on error monitoring using the error‐related negativity (ERN), an event‐related potential measure of error monitoring and error rate. Ninety unselected participants performed a flanker task in which they were shocked according to their own errors (controllable punishment, n = 47) or were shocked in accordance with another participant's errors (uncontrollable punishment, n = 43). Participants without agency over punishment showed smaller ERNs and higher error rates compared with participants with agency. Furthermore, punishment only reduced error rates for participants with agency. Together, these results provide the first experimental evidence that agency modulates error monitoring and suggest an adaptive process in which error monitoring is increased/decreased depending on its utility.
Snakes and ladders and loaded dice: Poverty dynamics and inequality in South Africa between 2008 and 2017
Authors: Schotte Simone , Zizzamia Rocco , Leibbrandt Murray
Published: February 2022

Longitudinal surveys allow us to understand how markers of (dis)advantage determine present material welfare and economic upward or downward mobility over time. In this paper, we use five waves of panel data to empirically assess the extent and dynamics of poverty in South Africa between 2008 and 2017. Investigating the correlates of poverty entries and exits, we analyse how multidimensional inequalities in terms of household‐ and individual‐level characteristics relate to these dynamics and identify markers of vulnerability. We utilise these markers to classify the South African population into five strata characterised by their present and future risk to poverty.
Do political relations affect exports to China? Evidence from the ‘Quad’
Authors: Agarwal Vishesh , Golley Jane
Published: February 2022

This paper quantifies the effects of shocks in political relations on merchandise goods exports to China for the’Quad’ countries, namely Australia, India, Japan and the USA, between 1998 and 2018. Using a vector auto‐regression approach, our estimates suggest that deteriorating political relations only have short‐ and long‐run effects on India's aggregate export growth to China over this period; for Australia, Japan and the USA, there are none. A time‐disaggregated analysis of 5‐year sub‐periods shows that long‐term effects (lasting for up to 2 years) are significant for India and Japan for the sub‐period 1998–2002, while in all other sub‐periods there are no significant effects for any of the four countries. A product‐disaggregated analysis of the top five exports for each of the Quad countries to China reveals that, while the effects of political relations on trade do vary by product type and country in the short term, there are no long‐run effects of deteriorating political relations on any of these countries’ major exports to China.
Chronic wounds: Treatment consensus
Authors: Eriksson Elof , Liu Paul Y. , Schultz Gregory S. , Martins‐Green Manuela M. , Tanaka Rica , Weir Dot , Gould Lisa J. , Armstrong David G. , Gibbons Gary W. , Wolcott Randy , Olutoye Oluyinka O. , Kirsner Robert S. , Gurtner Geoffrey C.
Published: February 2022

The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub‐sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID‐19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care.
Evaluation of Synergy Between Lignite and Carbonized Biomass During Co-Combustion
Authors: Aydemir Sinem Ozsoy , Haykiri-Acma Hanzade , Yaman Serdar
Published: February 2022

Synergy often occurs between coal and biomass during co-utilization, and the combustion reactivity and combustion properties of coal are affected mainly due to high volatile matter in biomass. However, it is not clear that a synergistic interaction will be encountered if coal is processed with biochar that contains a limited amount of volatiles due to charring process. In this article, the existence of synergy was questioned based on the thermal analysis data obtained from the co-combustion of several biochars and lignite. The biochars produced at 400 °C from lignocellulosic biomasses such as Fraxinus (FR—ash tree), Populus hybrids (PO—hybrid poplar), and Rhododendron (RH) were blended with Turkish lignite (Adıyaman-Golbasi) to form blends that contain 5–15% biochars. These blends were burned in a thermogravimetric analyzer, and the combustion characteristics of the blends were evaluated, considering the criteria that include the reactivity and combustion performance indices including ignition index, comprehensive combustion index, burnout performance index, combustion stability indices, and rate and intensity index. Also, synergy indices such as synergy indicator, synergy factor, and interaction coefficient were calculated to identify the presence and intensity of synergy. It was concluded that depending on the type of biochar and the addition rate, changes occurred in the combustion properties of the coal, which can sometimes be considered as additive behavior and sometimes as a synergistic interaction. The presence of 5% or 10% PO biochar in the blends resulted in very obvious synergies in combustion characteristics according to all eight criteria considered.
New Procedure for Optimal Integration of Steam Power Plant With Process Site Utility to Produce Power, Steam, and Freshwater
Authors: Ghiasi Mahdi , Khosgoftar Manesh Mohammad Hasan , Lari Kamran , Salehi Gholam Reza , Torabi Azad Masoud
Published: February 2022

Steam power plants are usually used for producing electricity and can simultaneously work as a multigeneration plant to produce steam, freshwater, and power. This study performed the optimal combination of a steam power station as the source and a site utility system as the sink of power and steam. Approximating the potential of the cogeneration before designing a central utility system for site utility systems is vital to set goals for onsite fuel demand along with power, freshwater, and steam production. For this purpose, a precise and efficient cogeneration targeting strategy was utilized to couple a site utility of a process and a steam power plant. This study proposed a novel strategy for optimal designing integrated steam power plants and site utility consisting of process station industries. Accordingly, exergy, exergoenvironmental, and exergoeconomic analyses were conducted. The environmental impacts of life cycle assessment (LCA) in exergoenvironmental analysis were apportioned to the exergy streams, pointing out the key factors of the system with the most significant impact on the environment and possible improvements related to them. Besides, the water cycle algorithm (WCA) was employed to optimize the integrated plant. The capabilities of the proposed procedure were implemented to the petrochemical complex site utility and steam power plant. The results showed that an optimum solution was achieved using the new procedure with significantly reduced computation time.
Representation of 3-h Offshore Short-Crested Wave Field in the Fully Nonlinear Potential Flow Model REEF3D::FNPF
Authors: Wang Weizhi , Pakozdi Csaba , Kamath Arun , Bihs Hans
Published: February 2022

Stochastic wave properties are crucial for the design of offshore structures. Short-crested seas are commonly seen at the sites of offshore structures, especially during storm events. A long time duration is required in order to obtain the statistical properties, which is challenging for numerical simulations. In this scenario, a potential flow solver is ideal due to its computational efficiency. A procedure of reproducing accurate short-crested sea states using the open-source fully nonlinear potential flow model REEF3D::FNPF is presented in the paper. The procedure examines the sensitivity of the resolutions in space and time as well as the arrangements of wave gauge arrays. A narrow band power spectrum and a mildly spreading directional spreading function are simulated, and an equal energy method is used to generate input waves and avoid phase-locking. REEF3D::FNPF solves the Laplace equation together with the boundary conditions using a finite difference method. A sigma grid is used in the vertical direction and the vertical grid clustering follows the principle of constant truncation error. High-order discretization methods are implemented in space and time. Message passing interface is used for high performance computation using multiple processors. Three-hour simulations are performed in full-scale at a hypothetic offshore site with constant water depth. The significant wave height, peak period, kurtosis, skewness and ergodicity are examined in the numerically generated wave field. The stochastic wave properties in the numerical wave tank (NWT) using REEF3D::FNPF match the input wave conditions with high fidelity.
Borrelia burgdorferi Is a Poor Inducer of Gamma Interferon: Amplification Induced by Interleukin-12
Authors: van de Schoor Frederik R. , Vrijmoeth Hedwig D. , Brouwer Michelle A. E. , ter Hofstede Hadewych J. M. , Lemmers Heidi L. M. , Dijkstra Helga , Boahen Collins K. , Oosting Marije , Kullberg Bart-Jan , Hovius Joppe W. , van den Wijngaard Cees C. , van de Veerdonk Frank L. , Netea Mihai G. , Joosten Leo A. B.
Published: February 2022

Laboratory diagnosis of Lyme borreliosis (LB) is mainly based on serology, which has limitations, particularly in the early stages of the disease. In recent years there have been conflicting reports concerning a new diagnostic tool using the cytokine interferon-gamma (IFN-γ).
Adenomyosis in a uterine horn of a patient with Mayer-Rokitansky-Kuster-Hauser syndrome
Authors: Pinto Ana Marta , Santos Ana Cláudia , Oliveira Nuno , Oliveira Mário
Published: February 2022

A 37-year-old woman with a previous diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome at 18 years of age was referred from a primary healthcare physician to a gynaecology appointment in our centre. She presented with a 2-year worsening pelvic pain and dyspareunia, symptoms that were previously absent and, at the time, with inadequate relief with oral analgesia. Physical examination showed absent uterine cervix and hypoplastic superior vagina. Transvaginal ultrasound and MRI suggested the presence of an hypoplasic uterus in left rotation. Laparoscopically, two asymmetric rudimentary horns were found, united by a fibrous central band, with an enlarged and congestive left horn. The three structures were removed as a whole. Histopathological examination reported the presence of multiple adenomyotic foci along the full thickness of the left rudimentary horn. The patient had an uneventful postoperative recovery and full remission of her symptoms.
Uveitis associated with tattoo granulomas
Authors: Abdel-Aty Ahmad , Apostolopoulos Nicholas , Kombo Ninani
Published: February 2022

Ocular symptoms are a common reason for patients to present to the emergency department or to their primary care physician. Though often benign, these symptoms can also be an early manifestation of systemic disease. We report the case of a patient who presented to the emergency department with 1 week of rash followed by 2 days of fever, sore throat, chills, blurry vision and photophobia. His physical examination was notable for a desquamative rash over his tattoos, left-sided tonsillar exudate and pharyngeal oedema without lymphadenopathy. Biopsy of his tattoos revealed subepithelial non-caseating granulomas, confirming the diagnosis of tattoo granulomas with uveitis. The patient was started on corticosteroids and methotrexate and responded well to treatment. This case emphasises the importance of recognising ocular symptoms that are indicative of systemic disease and require further evaluation.
Hyperpigmented patch: an uncommon but early marker of Wilson’s disease
Authors: Tiwari Lokesh , ­Fadila  , Ghorui Arnab
Published: February 2022

Wilson’s disease in childhood could present with features ranging from asymptomatic liver disease to acute liver failure and cirrhosis. Neurological manifestations and psychiatric illness occur more commonly in adults and older children. Skin manifestation with Wilson’s disease is not frequently reported in literature but could be an early diagnostic clincher. We present a child with hepatic Wilson’s disease and skin hyperpigmentation. We aim to highlight the possible importance of skin lesions as an early marker of Wilson’s disease.
Successful living kidney donation from a patient with a Gitelman’s syndrome
Authors: Darrat Milad , Likinyo Hannah , Winata Shin-Howe Ryan , Morgan Sarah , Courtney Aisling E , Lindsay John
Published: February 2022

Living kidney donation from Gitelman’s syndrome (GS) patients remains very rare. Long-term renal prognosis of donor and recipient patients remains unknown. We report a 67-year-old man with GS, harbouring a mutation of theSLC12A3gene, who donated his kidney for transplant. Five years post-transplantation, his clinical condition and biochemical parameters remained stable with close monitoring and follow-up. Patients with non-complicated GS can be considered eligible to donate their kidney for transplant.
Rescue of an asymptomatic arterial occlusion after kidney transplant
Authors: Kadakia Yash , Hwang Christine , MacConmara Malcolm
Published: February 2022

Arterial injury leading to vascular occlusion is a rare complication of kidney transplantation that requires urgent intervention to salvage the kidney and prevent graft loss. Occasionally, the recipient iliac vessels may be injured, resulting in acute ischaemia of the lower extremity in addition to loss of blood flow to the kidney transplant. In the case presented here, a 58-year-old man with chronic kidney disease secondary to IgA nephropathy underwent pre-emptive deceased donor renal transplantation complicated by an external iliac artery (EIA) dissection proximal to the transplant anastomosis. However, as a result of retrograde blood flow from collateral vessels, perfusion of the kidney and right lower extremity was initially preserved and early diagnosis was made after post-transplant ultrasound. This report reviews the aetiology, clinical features and therapeutic options for arterial injuries post-transplant. This case also highlights the importance of post-transplant vigilance and the value of routine postoperative ultrasound imaging.
Inequalities in full vaccination coverage based on maternal education and wealth quintiles among children aged 12–23 months: further analysis of national cross-sectional surveys of six South Asian countries
Authors: Acharya Kiran , Dharel Dinesh , Subedi Raj Kumar , Bhattarai Asmita , Paudel Yuba Raj
Published: February 2022

Objective

This study was conducted to compare full vaccination coverage and its inequalities (by maternal education and household wealth quintile).

Design

This further analysis was based on the data from national-level cross-sectional Demographic and Health Survey (DHS) from six countries in South Asia.

Setting

We used most recent DHS data from six South Asian countries: Nepal, India, Pakistan, Bangladesh, Afghanistan and the Maldives. The sample size of children aged 12–23 months ranged from 6697 in the Maldives to 628 900 in India.

Primary and secondary outcome measures

To measure absolute and relative inequalities of vaccination coverage, we used regression-based inequality measures, slope index of inequality (SII) and the relative index of inequality (RII), respectively, by maternal education and wealth quintile.

Results

Full vaccination coverage was the highest in Bangladesh (84%) and the lowest in Afghanistan (46%), with an average of 61.5% for six countries. Pakistan had the largest inequalities in coverage both by maternal education (SII: −50.0, RII: 0.4) and household wealth quintile (SII: −47.1, RII: 0.5). Absolute inequalities were larger by maternal education compared with wealth quintile in four of the six countries. The relative index of inequality by maternal education was lower in Pakistan (0.5) and Afghanistan (0.5) compared with Nepal (0.7), India (0.7) and Bangladesh (0.7) compared with rest of the countries. By wealth quintiles, RII was lower in Pakistan (0.5) and Afghanistan (0.6) and higher in Nepal (0.9) and Maldives (0.9).

Conclusions

The full vaccination coverage in 12–23 months old children was below 85% in all six countries. Inequalities by maternal education were more profound than household wealth-based inequalities in four of six countries studied, supporting the benefits of maternal education to improve child health outcome.
Anti-SARS-CoV-2 antibodies among indigenous populations of the Brazilian Amazon: a cross-sectional study
Authors: Lima Carlos Neandro Cordeiro , Abreu Isabella Nogueira , Rodrigues Eliene Putira Sacuena , Freitas Vanessa de Oliveira , Botelho Bruno José Sarmento , Souza Sandra Lima , Cayres-Vallinoto Izaura , Guerreiro João Farias , Ishak Ricardo , Vallinoto Antonio C R
Published: February 2022

Objectives

The emergence of SARS-CoV-2 and its pandemic spread generated serious concern about the impact of the infection on vulnerable indigenous populations of the Brazilian Amazon. Thus, this study aimed to perform a seroepidemiological survey of anti-SARS-CoV-2 antibodies in those populations.

Setting

Six indigenous ethnic groups living in the State of Pará (Northern Brazil) were investigated. The villages of Xikrin do Bacajá, Assurini, Araweté, Parakanã, Munduruku and Kararaô were visited from October 2020 to January 2021.

Design and participants

We performed a cross-sectional study to investigate the prevalence of anti-spike (S1) IgG antibodies. Plasma was tested for the presence of anti-SARS-CoV-2 IgM and IgG antibodies using two assays (a lateral flow rapid test and an ELISA). A total of 1185 individuals of both sexes were enrolled in the study.

Results

The prevalences of IgM and IgG antibodies were 6.9% and 68.1%, respectively, ranging from 0% to 79.6%, with significant differences (p<0.001) between age groups in three communities (Araweté, Xikrin and Munduruku) and a virulence rate of 0.86%. The overall IgG prevalence obtained by rapid tests and ELISAs were similar, and the agreement of the results between the two tests was 80%, which was classified as good (kappa=0.4987; p<0.001; sensitivity of 82.1% and specificity of 71.6%). Herd immunity was probably attained, similar to that found in other communities of the Amazon.

Conclusions

SARS-CoV-2 spread rapidly among the indigenous populations investigated, but it had a low mortality rate. It is necessary to expand serological investigations to other communities in the Amazon region of Brazil.
Development, deployment and evaluation of digitally enabled, remote, supported rehabilitation for people with long COVID-19 (Living With COVID-19 Recovery): protocol for a mixed-methods study
Authors: Murray Elizabeth , Goodfellow Henry , Bindman Julia , Blandford Ann , Bradbury Katherine , Chaudhry Tahreem , Fernandez-Reyes Delmiro , Gomes Manuel , Hamilton Fiona L , Heightman Melissa , Henley William , Hurst John R , Hylton Hannah , Linke Stuart , Pfeffer Paul , Ricketts William , Robson Chris , Singh Richa , Stevenson Fiona A , Walker Sarah , Waywell Jonathan
Published: February 2022

Introduction

Long COVID-19 is a distressing, disabling and heterogeneous syndrome often causing severe functional impairment. Predominant symptoms include fatigue, cognitive impairment (‘brain fog’), breathlessness and anxiety or depression. These symptoms are amenable to rehabilitation delivered by skilled healthcare professionals, but COVID-19 has put severe strain on healthcare systems. This study aims to explore whether digitally enabled, remotely supported rehabilitation for people with long COVID-19 can enable healthcare systems to provide high quality care to large numbers of patients within the available resources. Specific objectives are to (1) develop and refine a digital health intervention (DHI) that supports patient assessment, monitoring and remote rehabilitation; (2) develop implementation models that support sustainable deployment at scale; (3) evaluate the impact of the DHI on recovery trajectories and (4) identify and mitigate health inequalities due to the digital divide.

Methods and analysis

Mixed-methods, theoretically informed, single-arm prospective study, combining methods drawn from engineering/computer science with those from biomedicine. There are four work packages (WP), one for each objective. WP1 focuses on identifying user requirements and iteratively developing the intervention to meet them; WP2 combines qualitative data from users with learning from implementation science and normalisation process theory, to promote adoption, scale-up, spread and sustainability of the intervention; WP3 uses quantitative demographic, clinical and resource use data collected by the DHI to determine illness trajectories and how these are affected by use of the DHI; while WP4 focuses on identifying and mitigating health inequalities and overarches the other three WPs.

Ethics and dissemination

Ethical approval obtained from East Midlands – Derby Research Ethics Committee (reference 288199). Our dissemination strategy targets three audiences: (1) Policy makers, Health service managers and clinicians responsible for delivering long COVID-19 services; (2) patients and the public; (3) academics.

Trial registration number

Research Registry number: researchregistry6173.
‘Where is the ECG machine?’: a quality improvement project using WhatsApp to improve the efficiency in locating shared medical devices in an inpatient unit
Authors: Ali Adnan , Khan Haroon , Tully Vicki
Published: February 2022

Access to medical devices are vital to deliver safe patient care. In the context of constrained resources, however, clinical areas often have insufficient basic equipment, which tend to be shared among multiple clinical teams. This can result in delayed patient management and reduced institutional productivity. In our experience, in 2019, while working at Carseview Centre, an inpatient mental health unit in Dundee (National Health Service Tayside), there was only one functioning ECG machine shared between the five wards.

Using the work WhatsApp chat, we aimed to facilitate better sharing of the one machine. Plan, do, study, act (PDSA) 1 intervention introduced the project protocol, which encouraged doctors to post a photo of the device after use, captioned with its location. PDSA 2 involved printing a physical copy of the memorandum and attaching it to the machine to prompt further compliance. In PDSA 3, concise photo-posting guidelines were established and adherence was encouraged to mitigate concerns for potential confidential-data leaks.

A dynamic outcome measure, the overall effectiveness metric (OEM), was conceived to prospectively monitor the effectiveness of our interventions. An OEM ≥1 indicates engagement and thereby improvement, whereby <1 indicates no change compared with baseline.

The intervention in PDSA 1 was a success with an OEM of 3.5. Although no actual data leaks occurred, a potential for concern was raised by a senior doctor. This limited engagement with the protocol during PDSA 2 and 3, causing the OEM to decline to <1 towards the end of the project. Sixty percent reported that the protocol saved them time in locating the machine.

Individual factors, mainly frustration with the current situation, was a primary driver for the initial engagement among doctors. Although other factors such as senior doctor buy-in, may play a greater role in directing longevity of a technology-based quality improvement solution.
Transesophageal echocardiography and risk of respiratory failure in patients who had ischemic stroke or transient ischemic attack: an IDEAL phase 4 study
Authors: Bruce Samuel S , Navi Babak B , Zhang Cenai , Kim Jiwon , Devereux Richard B , Schenck Edward J , Sedrakyan Art , Díaz Iván , Kamel Hooman
Published: February 2022

Objective

Transesophageal echocardiography (TEE) is sometimes used to search for cardioembolic sources after ischemic stroke or transient ischemic attack (TIA). TEE visualizes some sources better than transthoracic echocardiography, but TEE is invasive and may cause aspiration. Few data exist on the risk of respiratory complications after TEE in patients who had stroke or TIA. Our objective was to determine whether TEE was associated with increased risk of respiratory failure in patients who had ischemic stroke or TIA.

Design

This is a retrospective cohort study using administrative data from inpatient and outpatient insurance claims collected by the US federal government’s Centers for Medicare and Medicaid Services.

Setting

Hospitals and outpatient clinics throughout the USA.

Participants

99 081 patients ≥65 years old hospitalized for out-of-hospital ischemic stroke or TIA, defined by validated International Classification of Disease-9/10 diagnosis codes and present-on-admission codes, using claims data from 2008 to 2018 in a random 5% sample of Medicare beneficiaries.

Main outcome measures

Acute respiratory failure, defined as endotracheal intubation and/or mechanical ventilation, starting on the first day after admission through 28 days afterward.

Results

Of 99 081 patients included in this analysis, 73 733 (74.4%) had an ischemic stroke and 25 348 (25.6%) a TIA. TEE was performed in 4677 (4.7%) patients and intubation and/or mechanical ventilation in 1403 (1.4%) patients. The 28-day cumulative risk of respiratory failure after TEE (1.4%; 95% CI 0.8% to 2.7%) was similar to that seen in those without TEE (1.4%; 95% CI 1.4% to 1.5%) (p=0.84). After adjustment for age, sex, race, Charlson comorbidities, diagnosis of stroke versus TIA, intravenous thrombolysis, and mechanical thrombectomy, TEE was not associated with an increased risk of respiratory failure (HR, 0.9; 95% CI 0.6 to 1.2).

Conclusions

In a cohort of older patients who had ischemic stroke or TIA, TEE was not associated with an increased risk of subsequent respiratory failure.
Anti-CCR4 treatment depletes regulatory T cells and leads to clinical activity in a canine model of advanced prostate cancer
Authors: Maeda Shingo , Motegi Tomoki , Iio Aki , Kaji Kenjiro , Goto-Koshino Yuko , Eto Shotaro , Ikeda Namiko , Nakagawa Takayuki , Nishimura Ryohei , Yonezawa Tomohiro , Momoi Yasuyuki
Published: February 2022

Background

Targeting regulatory T cell (Treg) infiltration is an emerging strategy for cancer immunotherapy. However, its efficacy in advanced prostate cancer remains unclear. Here, we showed the therapeutic efficacy of anti-Treg treatment in a canine model of advanced prostate cancer.

Methods

We used dogs with naturally occurring prostate cancer to study the molecular mechanism underlying Treg infiltration and the effect of anti-Treg treatment. Tumor-infiltrating Tregs was evaluated by immunohistochemistry, and the association with prognosis was examined in dogs with spontaneous prostate cancer. The molecular mechanism of Treg infiltration was explored by RNA sequencing and protein analyses. A non-randomized canine clinical trial was conducted to define the therapeutic potential of anti-Treg treatment for advanced prostate cancer. Human prostate cancer datasets were analyzed to compare gene expression in dogs and humans.

Results

Tumor-infiltrating Tregs were associated with poor prognosis in dogs bearing spontaneous prostate cancer. RNA sequencing and protein analyses showed a possible link between the CCL17–CCR4 pathway and the increase of tumor-infiltrating Tregs. Dogs with advanced prostate cancer responded to mogamulizumab, a monoclonal antibody targeting CCR4, with decreased circulating Tregs, improved survival, and low incidence of clinically relevant adverse events. Urinary CCL17 concentration and BRAFV595E mutation were independently predictive of the response to mogamulizumab. Analysis of a transcriptomic dataset of human prostate cancer showed that the CCL17–CCR4 axis correlated with Foxp3. In silico survival analyses revealed that high expression of CCL17 was associated with poor prognosis. Immunohistochemistry confirmed that tumor-infiltrating Tregs expressed CCR4 in human patients with prostate cancer.

Conclusions

Anti-Treg treatment, through CCR4 blockade, may be a promising therapeutic approach for advanced prostate cancer in dogs and some population of human patients.