bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of thurincin H, ChiA74 and Cry proteins at the sporulation phase in Bacillus thuringiensis HD1
Authors: Gaona-Mendoza America S. , Bravo-Rivas Martha C. , Barboza-Corona José E. , Massange-Sánchez Julio A. , Casados-Vázquez Luz E.
Published: December 2021

Aims

The objective of this study was to produce thurincin H, ChiA74 and Cry proteins together using Bacillus thuringiensis subsp. kurstaki HD1 as a heterologous host.

Methods and Results

pSTAB-ThurH and pSTAB-ChiA74 constructs were designed to produce thurincin H and chitinase, respectively, at the sporulation phase. They were transformed into Bt HD1 generating the recombinant strains HD1/pSTAB-ThurH and HD1/pSTAB-ThurH/pSTAB-ChiA74. Antimicrobial and chitinolytic activity tests were performed with recombinant strains. Both strains were able to produce thurincin H up to 72 h with antibacterial activity of ~4000 U mg−1. The HD1/pSTAB-ThurH/pSTAB-ChiA74 strain also showed chitinolytic activity of ~23 mU mg−1 at 72 h. All B. thuringiensis strains exhibited crystal formation at 72, and 96 h. In addition, the application of thurincin H in corn seeds increased the germination percentage and root length by 7% and 10%, respectively.

Conclusions

We showed that is possible to produce three proteins of biotechnological interest at the sporulation stage in B. thuringiensis, which two of them (thurincin H, and ChiA74) are naturally expressed in the vegetative stage.

Significance and Impact of the Study

These results form the basis for developing of a biocontrol and biostimulator product that can be used as an alternative for chemical application.
Self and other reported workplace traits: A communal gap of men across occupations
Authors: Gartzia Leire
Published: December 2021

There is general agreement in organizational research about the relevance of the big two set of traits in social psychology: communion or consideration of other people and agency or pursuit of the self. I argue that, whereas both dimensions play critical functions at work, men are still overwhelmingly limited in communion. Results of five studies with male and female employees and managers across settings ranging from social work to the bank industry support this prediction in relation to both self‐ratings and judgment of others and reveal that men are characterized with less communal traits by themselves and others. In contrast, women and men are perceived and perceive themselves as similar in agency, suggesting closing gender gaps in agentic traits. An analysis across occupational levels showed that sex differences in communion favoring women only disappeared at top managerial levels. Exploratory analyses of prescriptive traits (ideal characterizations) revealed more demanding expectations of communion for women than men, despite female employees' and managers' generally greater endorsement of these traits. Implications for organizations are discussed, underscoring the need to implement gender action focused on reducing male stereotyping and the communal gap, rather than increasing women's agency.
Understanding the role of endotoxin tolerance in chronic inflammatory conditions and periodontal disease
Authors: Larsson Lena , Garaicoa‐Pazmino Carlos , Asa'ad Farah , Castilho Rogerio Moraes
Published: December 2021

Objective

This review aims to present the current understanding of endotoxin tolerance (ET) in chronic inflammatory diseases and explores the potential connection with periodontitis.

Subsequent exposure to lipopolysaccharides (LPS) triggers ET, a phenomenon regulated by different mechanisms and pathways, including toll‐like receptors (TLRs), nuclear factor kappa‐light‐chain enhancer of activated B‐cells (NFκB), apoptosis of immune cells, epigenetics, and microRNAs (miRNAs). These mechanisms interconnect ET with chronic inflammatory diseases including periodontitis. While the direct correlation between ET and periodontal destruction has not been fully elucidated, emerging reports point towards the potential tolerization of human periodontal ligament cells (hPDLCs) and gingival tissues with a significant reduction of TLR levels.

Conclusions

There is a potential link between ET and periodontal diseases. Future studies should explore the crucial role of ET in the pathogenesis of periodontal diseases, as evidence of a tolerized oral mucosa may represent an intrinsic mechanism capable of regulating the oral immune response. A clear understanding of this host immune regulatory mechanism might lead to effective and more predictable therapeutic strategies to treat chronic inflammatory diseases and periodontitis.
Mathematical models in GnRH research
Authors: Voliotis Margaritis , Plain Zoe , Li Xiao Feng , McArdle Craig A. , O’Byrne Kevin T. , Tsaneva‐Atanasova Krasimira
Published: December 2021

Mathematical modelling is an indispensable tool in modern biosciences, enabling quantitative analysis and integration of biological data, transparent formulation of our understanding of complex biological systems, and efficient experimental design based on model predictions. This review article provides an overview of the impact that mathematical models had on GnRH research. Indeed, over the last 20 years mathematical modelling has been used to describe and explore the physiology of the GnRH neuron, the mechanisms underlying GnRH pulsatile secretion, and GnRH signalling to the pituitary. Importantly, these models have contributed to GnRH research via novel hypotheses and predictions regarding the bursting behaviour of the GnRH neuron, the role of kisspeptin neurons in the emergence of pulsatile GnRH dynamics, and the decoding of GnRH signals by biochemical signalling networks. We envisage that with the advent of novel experimental technologies, mathematical modelling will have an even greater role to play in our endeavour to understand the complex spatiotemporal dynamics underlying the reproductive neuroendocrine system.
Effectiveness of nurse‐led clinics on healthcare delivery: An umbrella review
Authors: Connolly Carmel , Cotter Patrick
Published: December 2021

Background

Healthcare provision remains challenging leading to a focus on health service redesign including the development of nurse‐led clinics. While there is a belief that nurse‐led services positively impact on healthcare delivery, it is necessary to inform development through examination of the evidence.

Methods

A search was conducted of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, EMBASE, Scopus and the Cochrane Library for systematic reviews evaluating the effectiveness of nurse‐led clinics when compared with usual care published between 2015 and 2020. Outcomes of interest were clinical outcomes, patient satisfaction and patient access to health care. Study quality was appraised using the AMSTAR 2 tool (A MeaSurement tool to Assess Systematic Reviews). A narrative analysis was conducted.

Results

From 681 identified studies, nine were included, with reporting quality rated from very low to high quality. Patient clinical outcomes were reported as equal to or better than usual care across all studies included. There was evidence of high levels of patient satisfaction with nurse‐led clinics across the included systematic reviews. While access to health care was the least reported variable, there were reports that access to health care increased or patient reliance on other healthcare providers reduced due to nurse‐led clinics.

Conclusions

Despite the heterogeneous nature of the systematic reviews, along with some quality issues in reporting, there was evidence that nurse‐led services provided comparable or superior care to usual care with high levels of patient satisfaction. There was a lack of reporting on the impact of nurse‐led clinics on patient access to health care; further research is required on this area. Health service managers should consider nurse‐led clinics an effective innovation in health service provision.
Parechovirus infection in infants: Evidence‐based parental counselling for paediatricians
Authors: Silcock Robyn A , Doyle Rebecca , Clark Julia E , Kynaston J Anne , Thomas Marion , May Meryta L
Published: December 2021

Aim

Human parechovirus (HPeV) is an increasingly recognised cause of severe illness and central nervous system infection in infants. Medium‐ to long‐term neurodevelopmental outcomes post‐HPeV infection remain unknown. This study aims to assess neurodevelopmental outcomes for children hospitalised as infants with HPeV infection in their second and third years of life.

Methods

This prospective cohort study followed children hospitalised with HPeV in Brisbane, Queensland during the 2017/2018 outbreak. Serial application of Ages and Stages Questionnaire (ASQ) was used to assess developmental progress in the second and third years of life. Data from clinical follow‐up, audiology and neuroradiology were included.

Results

In the second year of life, 63% (n = 29) of children showed some or significant concerns for developmental delay. This had largely been ameliorated by the third year of life when only 30% (n = 14) reported developmental concerns. Prematurity and apnoeas were associated with developmental concerns at 27–36 months of age. Communication was the most common domain of concern.

Conclusions

The majority of infants hospitalised with HPeV infection in 2017–2018 showed normalisation of developmental progress by 27–36 months of age. Further investigation into more subtle neurological impairments in later childhood is required. These results can help guide clinicians in counselling parents during the acute illness and in planning appropriate follow‐up.
Impact of seed-applied fungicide and insecticide on Azospirillum brasilense survival and wheat growth-promoting ability
Authors: Takahashi W.Y. , Galvão C.W. , Urrea-Valencia S. , Gonçalves D.R.P. , Hyeda D. , Caires E.F. , Etto R.M.
Published: December 2021

The use of Azospirillum brasilense as a crop inoculant has increased in recent years. Thus, the compatibility of the inoculation technology with seed treatments using pesticides needs to be evaluated. In this study, we evaluated the effect of an insecticide and fungicide formulation on A. brasilense strain FP2 population by culturing and culture-independent approaches. In addition, we evaluated the impact of these pesticides on the ability of A. brasilense to promote plant growth by monitoring biometric traits (root and shoot dry mass and length) of wheat grown in Greenhouse conditions. Seed pesticide dressings, mainly fungicide, led to a significant mortality of A. brasilense over time. The ability of A. brasilense to promote wheat growth also decreased due to pesticide treatments combined with sowing delay. Considering that pesticides confer fitness advantages to the wheat in field condition, our results suggest that sowing within the first 4 h after inoculation maintain the beneficial effects of A. brasilense on wheat growth promotion. Furthermore, we conclude that inoculation and treatment of seeds with pesticides may be compatible techniques when carried out immediately before sowing.
Nanoscale mineralogy and organic structure in Orgueil (CI) and EET 92042 (CR) carbonaceous chondrites studied with AFM‐IR spectroscopy
Authors: Phan Van T. H. , Rebois Rolando , Beck Pierre , Quirico Eric , Bonal Lydie , Noguchi Takaaki
Published: December 2021

Meteorite matrices from primitive chondrites are an interplay of ingredients at the sub‐µm scale, which requires analytical techniques with the nanometer spatial resolution to decipher the composition of individual components in their petrographic context. Infrared spectroscopy is an effective method that enables the probing of vibrations at the molecule atomic scale of organic and inorganic compounds but is often limited to a few micrometers in spatial resolution. To efficiently distinguish spectral signatures of the different constituents, we apply here nano‐infrared spectroscopy (AFM‐IR), based on the combination of infrared and atomic force microscopy, having a spatial resolution beyond the diffraction limits. Our study aims to characterize two chosen meteorite samples to investigate primitive material in terms of bulk chemistry (the CI chondrite Orgueil) and organic composition (the CR chondrite EET 92042). We confirm that this technique allows unmixing the IR signatures of organics and minerals to assess the variability of organic structure within these samples. We report an investigation of the impact of the widely used chemical HF/HCl (hydrogen fluoride/hydrochloric acid) extraction on the nature of refractory organics (insoluble organic matter [IOM]) and provide insights on the mineralogy of meteorite matrices from these two samples by comparing to reference (extra)terrestrial materials. These findings are discussed with a perspective toward understanding the impact of post‐accretional aqueous alteration and thermal metamorphism on the composition of chondrites. Last, we highlight that the heterogeneity of organic matter within meteoritic materials extends down to the nanoscale, and by comparison with IOMs, oxygenated chemical groups are not affected by acid extractions.
Age and sickness absence: Testing physical health issues and work engagement as countervailing mechanisms in a cross‐national context
Authors: Shao Yiduo , Goštautaitė Bernadeta , Wang Mo , Ng Thomas W. H.
Published: December 2021

Workforces are aging rapidly and older workers are typically assumed to take more sickness absence. However, the relationship between age and sickness absence is not well understood, as research has yielded mixed findings and has neglected broader societal factors that cascade to shape the age‐sickness absence relationship. To advance the literature, we adopted a resource‐based perspective and investigated the relationship between employee age and sickness absence as mediated by two countervailing mechanisms: physical health issues and work engagement. We also highlighted two country‐level boundary conditions (health expenditure per capita and labor force participation rate) for these mechanisms. We tested our hypotheses with two archival datasets. In Study 1, using a sample of 28,553 employees from 35 European countries, we tested a multilevel model and found that age was positively related to the number of physical health issues, which in turn was positively associated with sickness absence. Country‐level health expenditure per capita was found to mitigate this relationship. We also found that age was positively related to work engagement, which was negatively related to sickness absence, and country‐level labor force participation rate strengthened this relationship. In Study 2, using a multi‐wave dataset (N = 304) from the Health and Retirement Study (HRS) in the United States, we found further support for the two hypothesized mechanisms (physical health issues and work engagement) between age and sickness absence. Our findings have cross‐national implications for understanding and managing sickness absence by helping workers stay healthier and be more engaged in the context of population aging.
Outcomes of granulocyte colony‐stimulating factor use in pediatric kidney transplant recipients: A Pediatric Nephrology Research Consortium study
Authors: Engen Rachel M. , Weng Patricia L. , Shih Weiwen , Patel Hiren P. , Richardson Kelsey , Dowdrick Shauna L. , Ashoor Isa F. , Misurac Jason , Traum Avram Z. , Semanik Michael G. , Jain Namarata G. , Mansuri Asifhusen , Sreedharan Rajasree
Published: December 2021

Background

Neutropenia is common in the first year after pediatric kidney transplant and is associated with an increased risk of infection, allograft loss, and death. Granulocyte colony‐stimulating factor (G‐CSF) increases neutrophil production, but its use in pediatric solid organ transplant recipients remains largely undescribed.

Methods

We performed a multicenter retrospective cohort study of children with neutropenia within the first 180 days after kidney transplant. Multivariable linear regression and Poisson regression were used to assess duration of neutropenia and incidence of hospitalization, infection, and rejection.

Results

Of 341 neutropenic patients, 83 received G‐CSF during their first episode of neutropenia. Median dose of G‐CSF was 5 mcg/kg for 3 (IQR 2–7) doses. G‐CSF use was associated with transplant center, induction immunosuppression, steroid‐free maintenance immunosuppression, hospitalization, and decreases in mycophenolate mofetil, valganciclovir, and trimethoprim–sulfamethoxazole dosing. Absolute neutrophil count nadir was also significantly lower among those treated with G‐CSF. G‐CSF use was not associated with a shorter duration of neutropenia (p = .313) and was associated with a higher rate of neutropenia relapse (p = .002) in adjusted analysis. G‐CSF use was associated with a decreased risk of hospitalization (aIRR 0.25 (95%CI 0.12–0.53) p < .001) but there was no association with incidence of bacterial infection or rejection within 90 days of neutropenic episode.

Conclusion

G‐CSF use for neutropenia in pediatric kidney transplant recipients did not shorten the overall duration of neutropenia but was associated with lower risk of hospitalization. Prospective studies are needed to determine which patients may benefit from G‐CSF treatment.
Online Misinformation and “Phantom Patterns”: Epistemic Exploitation in the Era of Big Data
Authors: Fritts Megan , Cabrera Frank
Published: December 2021

In this article, we examine how the availability of massive quantities of data, that is, the “Big Data” phenomenon, contributes to the creation, spread, and harms of online misinformation. Specifically, we argue that a factor in the problem of online misinformation is the evolved human instinct to recognize patterns. While the pattern‐recognition instinct is a crucial evolutionary adaptation, we argue that in the age of Big Data, these capacities have, unfortunately, rendered us vulnerable. Given the ways in which online media outlets profit from the spread of misinformation by preying on this pattern‐finding instinct, we conceptualize the problem that we identify as a morally objectionable form of “epistemic exploitation.” As we argue, the consumer of digital misinformation is often exploited by having her pattern‐recognition instinct used against her. This exploitation is morally objectionable because it deprives her of an epistemic good to which she has a right. This epistemic good is the integrity of the pattern‐recognition instinct itself, which, we argue, is a capacity that allows us to participate in uniquely human goods. While our primary goal is to bring attention to this form of epistemic exploitation, we conclude by briefly evaluating some general solutions to the growing problem of online misinformation.
Transfusion practice in the bleeding critically ill: An international online survey—The TRACE‐2 survey
Authors: de Bruin Sanne , Eggermont Dorus , van Bruggen Robin , de Korte Dirk , Scheeren Thomas W. L. , Bakker Jan , Vlaar Alexander P. J. ,   Cardiovascular Dynamics Section and Transfusion Task Force of the ESICM
Published: December 2021

Background

Transfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non‐bleeding critically ill patients practices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients.

Study design and methods

An international online survey was performed among physicians working in the ICU. Transfusion practice in massively and non‐massively bleeding patients was examined, including transfusion ratios, thresholds, and the presence of transfusion guidelines.

Results

Six hundred eleven respondents filled in the survey of which 401 could be analyzed, representing 64 countries. Among the respondents, 52% had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell [RBC] concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratios (p < .001). For RBC transfusion in the general non‐massively bleeding ICU population, a hemoglobin (Hb) threshold of 7.0[7.0–7.3] g/dl was reported. In the general ICU population, a platelet count threshold of 50[26–50] × 109/L was applied.

Discussion

Half of the centers had no massive transfusion protocol available. Transfusion practice in massively bleeding critically ill patients is highly variable and driven by the presence of an MTP. In the general non‐massively bleeding ICU population restrictive transfusion triggers were chosen.
Effect of plasma-species to functionalize isocyanate-groups on multiwalled carbon nanotubes
Authors: Ogawa Daisuke , Abdel-Fattah Essam Mohammed , Nakamura Keiji
Published: December 2021

This article reports our recent investigation of the relationship between the density of the active species in nitrogen-oxygen plasma and the degree of isocyanate (R-NCO) functionalization onto multiwalled carbon nanotubes. We first monitored the plasma active species with optical emission spectroscopy focusing on atomic nitrogen and oxygen species, which are the major components to form NCO groups. The optical emission intensity allowed us to find the density of atomic nitrogen and oxygen in plasma through the plasma optical actinometry method. The actinometry result showed that the density of atomic nitrogen and oxygen becomes as close as the nitrogen content in plasma increased to 90%. We then investigated the functionalization ratio with the fluorescent method and Raman spectroscopy to monitor the degree of NCO functionalization. The results suggested that NCO groups on carbon nanotubes should increase as the content ratio of atomic nitrogen and oxygen becomes equal in the plasma.
Method to create cuprate tunnel junctions with atomically sharp interfaces
Authors: Bollinger Anthony T. , He Xi , Xu Xiaotao , Shi Xiaoyan , Božović Ivan
Published: December 2021

We present a method for producing tunnel junctions from cuprate thin films grown by atomic layer-by-layer molecular beam epitaxy (ALL-MBE). Our approach utilizes microfabrication processing and relies on the atomically precise interfaces provided by the ALL-MBE synthesis technique. The method is suitable for a wide range of junction dimensions and materials and allows for more complex designs such as superconducting quantum interference devices and junction arrays. Fully superconducting electrodes ensure that the contact resistances in the devices created by this method remain very low.
Facile growth of epitaxial vanadium monoxide on SrTiO3 via substrate oxygen scavenging
Authors: Posadas Agham B. , Kwon Sunah , Christensen Adam , Kim Moon J. , Demkov Alexander A.
Published: December 2021

The deposition of vanadium metal on SrTiO3 results in the spontaneous scavenging of oxygen ions from SrTiO3 to oxidize vanadium to VOx, where x = 0.3–1.1, depending on the deposition temperature. At temperatures above 700 °C, an epitaxial film of the rock salt compound vanadium monoxide is formed on both SrTiO3 (111) and SrTiO3 (100) substrates. Surprisingly, oxygen scavenging and epitaxy persist for thicknesses over 800 Å with no sign of degradation. We describe the growth process and layer-by-layer characterization of the films using in situ reflection high-energy electron diffraction and x-ray photoelectron spectroscopy, as well as ex situ in-plane and out-of-plane x-ray diffraction and cross-sectional scanning transmission electron microscopy. This easy method of growing vanadium monoxide with controlled stoichiometry can provide new opportunities to study this normally hard to synthesize material known for the highly correlated nature of its electronic structure.
Neurodynamics Is an Effective Intervention for Carpal Tunnel Syndrome
Authors: Wise Stephanie , Bettleyon Jordan
Published: December 2021

Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS.
Aqueous misdirection syndrome masking as myopic surprise following phacoemulsification surgery
Authors: Chean Chung Shen , Gabadage Duminda , Mukherji Subhanjan
Published: December 2021

Aqueous misdirection syndrome is a rare but serious condition that can present after routine phacoemulsification surgery. This report examines a case of myopic surprise following an uncomplicated left eye (LE) phacoemulsification surgery. The patient had previous bilateral peripheral iridotomies for narrow anterior chamber angles. Repeat biometry measurement of the pseudophakic LE did not show shallow anterior chamber, and intraocular pressure (IOP) was normal at initial presentation. However, approximately 3 years postoperatively, LE IOP was raised. Surgical management was considered as medical and laser procedures did not stop deterioration. Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Myopic surprise may be the only initial presenting sign. Patients who are at risk of aqueous misdirection syndrome should be followed up closely after cataract surgery with accurate gonioscopic assessments for early diagnosis and treatment to prevent optic nerve damage.
Successful management of a high-output urinary fistula following radical cystectomy and ileal conduit: a conservative approach
Authors: Talwar Harkirat Singh , Panwar Vikas Kumar , Mittal Ankur , Ghorai Rudra Prasad
Published: December 2021

Urinary leak following ileal conduit after a radical cystectomy is a rare yet serious complication which presents early in the postoperative period. We herein present a case of a 38-year-old man diagnosed with recurrent high-grade non-muscle invasive bladder carcinoma. He underwent robot-assisted radical cystectomy and bilateral pelvic lymph node dissection. Postoperatively, the patient developed a high output urinary fistula (800–1000 mL/day) which was confirmed by fluid creatinine levels and a contrast study. He was managed successfully with a conservative approach. The leak subsided in 6 weeks and on follow-up patient is doing well. Most of the literature favours a surgical approach in such cases, however with optimal nutritional support (enteral/parenteral), adequate diversion of urine, percutaneous drainage of undrained collections, adequate intravenous antibiotics and good nursing care, resurgery with its associated morbidity can be avoided resulting in successful outcomes.
CT perfusion: stroke, seizure or both?
Authors: Davis Elizabeth , Elnagi Fathalla , Smith Thomas
Published: December 2021

An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell’s palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan revealed evidence of small vessel disease and arterial calcification. As there were no contraindications, he received thrombolytic treatment. CT angiography and CT perfusion imaging were performed in preparation for possible thrombectomy. There was no evidence of a large vessel thrombus, and changes on CT perfusion were suggestive of seizure activity, with relative hyperperfusion on the cerebral hemisphere of interest. Post thrombolysis, his NIHSS was 5. An MR scan revealed evidence of bilateral thalamic infarcts. After a period of rehabilitation, he was discharged home and independently mobile but with cognitive impairment.

Acute stroke care increasingly uses multimodal imaging to confirm the clinical diagnosis and help optimise initial emergency management. Such imaging is useful in determining whether the presentation is a vascular event or stroke mimic. Moreover, seizures complicate and mimic acute strokes, which can lead to therapeutic uncertainty. This case highlights the increasingly sophisticated investigation of patients presenting with suspected acute stroke, with the attendant need for accurate interpretation by experienced clinicians.
Atypical presentation of giant cell arteritis associated with SIADH: a rare association
Authors: Tariq Sadia , Jonny Sameh , Asalieh Hanadi
Published: December 2021

We present here an interesting case of a 67-year-old man with 3 weeks history of lethargy, loss of appetite, generalised weakness and weight loss. Following thorough investigations, occult malignancy was ruled out. Hyponatraemia was a consistent finding which needed further classification. Additional workup including cerebral imaging and neurophysiological studies excluded cerebral vascular events and myopathies. Vasculitis screening was undertaken, and the diagnostic dilemma was revealed by the temporal arteries Doppler ultrasound which showed classical ‘halo sign’. Diagnosis of temporal arteritis was made and linked with syndrome of inappropriate antidiuretic hormone secretion, which appears to be a rare association with few instances on record. Patient was treated with high dose of prednisolone with marked improvement of clinical features.
Unusual oral presentation of acyclovir-resistant herpes simplex in an allogeneic haematopoietic stem cell transplant recipient
Authors: Saunsbury Thomas , Harte Molly , Ion Daniela
Published: December 2021

The early engraftment phase of allogeneic haematopoietic stem cell transplantation can be associated with a number of oromucosal infective complications. While the routine use of prophylactic acyclovir has reduced the incidence of herpes simplex virus (HSV) reactivation, there is an increasing prevalence of acyclovir resistance within this cohort of patients. The authors present a case of acyclovir-resistant HSV reactivation in a 26-year-old woman 7 days post T-deplete sibling allograft on a background of combined cyclophosphamide and total body irradiation myeloablative conditioning, successfully treated with foscarnet and cidofovir therapy and discuss the differential diagnoses for early/late engraftment oral disease.
Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis
Authors: Chowdhury Mahin , Nevitt Sarah , Eleftheriadou Aikaterini , Kanagala Prathap , Esa Hani , Cuthbertson Daniel J , Tahrani Abd , Alam Uazman
Published: December 2021

We aimed to determine the prognostic association between cardiac autonomic neuropathy (CAN) and cardiovascular disease events (CVE) and mortality in type 1 and type 2 diabetes through a systematic review and meta-analysis. This systematic review and meta-analysis was registered with PROSPERO (CRD42020216305) and was conducted with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodological criteria. CAN was defined on the basis of 1 (early/possible CAN) or ≥2 (definite CAN) positive autonomic function tests as per the Toronto Consensus guidelines. Studies included those with prospective CVE or mortality data. Methodological variables/risk of bias were assessed using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) and RoB-2 (Risk-Of-Bias tool for randomized trials) appraisal tools. Electronic database searches yielded 18 467 articles; 84 articles were screened full-text, 26 articles fulfilled the inclusion criteria for quantitative synthesis. Sixteen studies from patients with (n=2875) and without (n=11 722) CAN demonstrated a pooled relative risk (RR) of 3.16 (95%CI 2.42 to 4.13; p<0.0001) of future CVE in favour of CAN. Nineteen studies provided all-cause mortality data from patients with (n=3679) and without (n=12 420) CAN, with a pooled RR of 3.17 (95%CI 2.11 to 4.78; p<0.0001) in favour of CAN. The risk of both future CVE and mortality was higher in type 1 compared with type 2 diabetes and with a definite CAN (vs possible CAN) diagnosis. Three studies were considered to have risk of serious bias. This study confirms the significant association between CAN and CVE and all-cause mortality. The implementation of population-based CAN screening will identify a subgroup with disproportionately higher cardiovascular and mortality risk that will allow for earlier targeted intervention.
Religion and cancer prevention: study protocol for a systematic review
Authors: Kretzler Benedikt , König Hans-Helmut , Brandt Linéa , Hajek André
Published: December 2021

Introduction

Several studies explored a relationship between religiousness and the utilisation of cancer screenings, as religious people may obtain an increased social network or could have certain personality traits that enhance screening use. To the best of our knowledge, there is no systematic review that sums up the evidence gained from research on that relationship. Thus, our review aims to appraise the findings of observational studies regarding that relationship. Its findings may be useful in addressing specific target groups to increase ineffectively the low cancer screening rates.

Methods and analysis

Employing a predefined search algorithm, three online databases (CINAHL, PsycInfo and PubMed) will be searched. In addition, the bibliographies of the studies included in our review will be searched through manually and independently by two reviewers. We are looking for observational studies (both cross-sectional and longitudinal) which examine the association between religion and cancer screening utilisation. However, studies regarding specific samples (as ethnic minorities or religious sects) will be excluded. We expect that the studies examine various dimensions of religion, such as religious attendance or religious intensity. We will extract data that describe methodology, sample characteristics and the findings concerning our object of investigation. Moreover, a quality assessment will be performed. Two reviewers will independently select the studies, extract the data and assess the studies’ quality. Disagreements will be dissolved by discussion or by inclusion of a third party. The findings will be presented narratively in text and tables. If possible, a meta-analysis will be carried out.

Ethics and dissemination

As no primary data are collected, the approval from an ethics committee is not required. Our review will be published in a peer-reviewed, scientific journal.

PROSPERO registration number

CRD42021229222.
Predictive effect of molecular and clinical characteristics for the OS and PFS efficacy of anti-PD-1/PD-L1 immunotherapy in patients with NSCLC: a meta-analysis and systematic review
Authors: An Rui , Zhao Feng , Wang Liqian , Shan Jikang , Wang Xianjun
Published: December 2021

Objective

To evaluate the predictive effect of molecular and clinical characteristics for the efficacy of anti-programmed cell death 1 (PD-1)/programmed cell death ligand-1 (PD-L1) immunotherapy in patients with non-small cell lung cancer (NSCLC).

Design

Systematic review and meta-analysis.

Setting

Twelve randomised controlled trials (RCTs) with 7442 patients were retrieved from all over the world.

Methods

Electronic databases were searched for eligible RCTs. The HRs and 95% CIs for overall survival (OS) and progression‐free survival (PFS) for the whole and subgroup population were extracted for meta-analysis using Review Manager V.5.3 software.

Primary and secondary outcome measure

OS was the primary outcome and PFS was the secondary outcome.

Results

Twelve RCTs with 7442 patients were included. For the trial population, anti-PD-1/PD-L1 immunotherapy significantly improved OS (HR=0.78, 95% CI 0.70 to 0.86, p<0.00001) and objective response rate (ORR) (risk ratio=1.37, 95% CI 1.08 to 1.74, p=0.009). Subgroup analysis results showed an improved OS at PD-L1≥1%, ≥5% and ≥50% levels, and a longer PFS at PD-L1≥5% and ≥50% levels. Moreover, OS and PFS benefits were observed in the non-first line treatment, squamous cell carcinoma histology, male, smoking, non-central nervous system (CNS) metastasis, epidermal growth factor receptor (EGFR) wild-type and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutant subgroups.

Conclusions

Anti-PD-1/PD-L1 immunotherapy significantly improved OS and ORR and reduced the rate of Adverse Events (AEs) compared to chemotherapy. PD-L1 expression, line of therapy, histology, sex, smoking history, CNS metastases, EGFR and KRAS mutational status might be potential predictors for the therapeutic effect of anti-PD-1/PD-L1 immunotherapy in specific patients with NSCLC.
Loneliness, coping, suicidal thoughts and self-harm during the COVID-19 pandemic: a repeat cross-sectional UK population survey
Authors: John Ann , Lee Sze Chim , Solomon Susan , Crepaz-Keay David , McDaid Shari , Morton Alec , Davidson Gavin , Van Bortel Tine , Kousoulis Antonis A.
Published: December 2021

Objectives

There has been speculation on the impact of the COVID-19 pandemic and the associated lockdown on suicidal thoughts and self-harm and the factors associated with any change. We aimed to assess the effects and change in effects of risk factors including loneliness and coping, as well as pre-existing mental health conditions on suicidal thoughts and self-harm during the COVID-19 pandemic.

Design

This study was a repeated cross-sectional online population-based survey.

Participants and measures

Non-probability quota sampling was adopted on the UK adult population and four waves of data were analysed during the pandemic (17 March 2020 to 29 May 2020). Outcomes were suicidal thoughts and self-harm associated with the pandemic while loneliness, coping, pre-existing mental health conditions, employment status and demographics were covariates. We ran binomial regressions to evaluate the adjusted risks of the studied covariates as well as the changes in effects over time.

Results

The proportion of individuals who felt lonely increased sharply from 9.8% to 23.9% after the UK lockdown began. Young people (aged 18–24 years), females, students, those who were unemployed and individuals with pre-existing mental health conditions were more likely to report feeling lonely and not coping well. 7.7%–10.0% and 1.9%–2.2% of respondents reported having suicidal thoughts and self-harm associated with the pandemic respectively throughout the period studied. Results from cross-tabulation and adjusted regression analyses showed young adults, coping poorly and with pre-existing mental health conditions were significantly associated with suicidal thoughts and self-harm. Loneliness was significantly associated with suicidal thoughts but not self-harm.

Conclusions

The association between suicidality, loneliness and coping was evident in young people during the early stages of the pandemic. Developing effective interventions designed and coproduced to address loneliness and promote coping strategies during prolonged social isolation may promote mental health and help mitigate suicidal thoughts and self-harm associated with the pandemic.
Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study
Authors: Kumwenda Moses K , Mavhu Webster , Lora Wezzie S , Chilongosi Richard , Sikwese Simon , Taegtmeyer Miriam , Hatzold Karin , Johnson Cheryl C , Corbett Elizabeth L , Desmond Nicola
Published: December 2021

Objectives

HIV testing is the gateway to HIV prevention and care services. Female sex workers (FSW) may benefit from HIV self-testing (HIVST), which offers greater control and confidentiality than other approaches. However, FSW also have unique vulnerabilities, making it critical to understand their perspective of HIVST to best contextualise HIVST to their needs. This study explored feasibility and acceptability of providing oral fluid-based peer-led HIVST to FSW to inform tailored HIVST delivery approaches.

Design

Qualitative study.

Setting

Malawi.

Participants

Thirty-nine FSW who had obtained a HIVST kit and eight peer distributors.

Results

Peer distributors’ accounts suggested that peer-led HIVST is feasible. Overall, FSW spoke positively about peer-led HIVST and younger FSW preferred it to facility-based HIV testing. FSW highlighted both greater control of their testing experience and that HIVST could allow them to avoid discriminatory attitudes frequently experienced in public facilities. Some also felt that HIVST kits could enable them to establish the HIV status of their sexual partners, better informing their decisions about condomless sex. Despite overall acceptance of HIVST, a few expressed doubts in the procedure. Some FSW already aware of their HIV-positive status reported using HIVST. A few accounts suggested peer pressure to self-test predominantly from peer distributors.

Conclusions

This study enabled us to explore feasibility and acceptability of peer-led HIVST among FSW, as well as potential shortcomings of the HIV testing modality. Peer distributors are a welcome additional model. However, they should avoid distribution in actual venues. Programmes should ensure a range of testing options are available and expand peer’s representation. Study findings will be used to tailor the HIVST distribution model to ensure its enhanced uptake among key populations in general and FSW, specifically.
Quoted text in the mental healthcare electronic record: an analysis of the distribution and content of single-word quotations
Authors: Jayasinghe Lasantha , Velupillai Sumithra , Stewart Robert
Published: December 2021

Objective

To investigate the distribution and content of quoted text within the electronic health records (EHRs) using a previously developed natural language processing tool to generate a database of quotations.

Design

χ2and logistic regression were used to assess the profile of patients receiving mental healthcare for whom quotations exist. K-means clustering using pre-trained word embeddings developed on general discharge summaries and psychosis specific mental health records were used to group one-word quotations into semantically similar groups and labelled by human subjective judgement.

Setting

EHRs from a large mental healthcare provider serving a geographic catchment area of 1.3 million residents in South London.

Participants

For analysis of distribution, 33 499 individuals receiving mental healthcare on 30 June 2019 in South London and Maudsley. For analysis of content, 1587 unique lemmatised words, appearing a minimum of 20 times on the database of quotations created on 16 January 2020.

Results

The strongest individual indicator of quoted text is inpatient care in the preceding 12 months (OR 9.79, 95% CI 7.84 to 12.23). Next highest indicator is ethnicity with those with a black background more likely to have quoted text in comparison to white background (OR 2.20, 95% CI 2.08 to 2.33). Both are attenuated slightly in the adjusted model. Early psychosis intervention word embeddings subjectively produced categories pertaining to: mental illness, verbs, negative sentiment, people/relationships, mixed sentiment, aggression/violence and negative connotation.

Conclusions

The findings that inpatients and those from a black ethnic background more commonly have quoted text raise important questions around where clinical attention is focused and whether this may point to any systematic bias. Our study also shows that word embeddings trained on early psychosis intervention records are useful in categorising even small subsets of the clinical records represented by one-word quotations.
Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews
Authors: Levack William Mark Magnus , Fadyl Joanna Kirstin
Published: December 2021

Objective

To conduct an overview of systematic reviews to examine the effectiveness of vocational interventions to help adults with long-term health conditions or disability gain and maintain new paid work and to analyse the spread and quality of evidence in this area.

Methods

We pre-published our protocol in PROSPERO (CRD42019132448). We searched Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Proquest Dissertations and Theses database, NICE and Business Source Complete from inception to 21 August 2020. We included any systematic reviews of clinical trials on vocational interventions for adults with long-term health conditions or disability who were not in work or had recently gained work. We excluded reviews of vocational interventions for employed people on sick leave. Two researchers identified, critically appraised,using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2, and extracted data from included reviews. We used Grading of Recommendations Assessment, Development and Evaluation to evaluate strength of evidence underpinning overview findings.

Results

We identified 26 reviews (5 high-quality and 21 critically low to moderate quality) that focused on vocational interventions for acquired brain injury, autism, intellectual disability, multiple sclerosis, mental health conditions, spinal cord injury and general disability populations. We identified moderate quality evidence that people with moderate to severe mental health conditions who participate in supported employment, particularly individual placement and support, are more likely to gain competitive employment compared with people who receive traditional vocational services (risk ratio 2.07; 95% CI 1.82 to 2.35; 27 studies, 6651 participants). We found only very low-quality to low-quality evidence on vocational intervention for people with any other health condition. We found little to no data on employer or employee satisfaction with work outcomes or the cost effectiveness of interventions.

Conclusion

Given the importance placed on work opportunities for people with long-term health conditions or disability, there is urgent need for more high-quality research on vocational interventions for this population.

Prospero registration number

CRD42019132448.