bluuebunny/crossref_metadata_2025 huggingface dataset:
Marked Reduction of Socioeconomic and Racial Disparities in Invasive Pneumococcal Disease Associated With Conjugate Pneumococcal Vaccines
Authors: Raman Rameela , Brennan Julia , Ndi Danielle , Sloan Chantel , Markus Tiffanie M , Schaffner William , Talbot H Keipp
Published: August 2020

Background

It is not known whether reductions in socioeconomic and racial disparities in incidence of invasive pneumococcal disease (defined as the isolation of Streptococcus pneumoniae from a normally sterile body site) noted after pneumococcal conjugate vaccine (PCV) introduction have been sustained.

Methods

Individual-level data collected from 20 Tennessee counties participating in Active Bacterial Core surveillance over 19 years were linked to neighborhood-level socioeconomic factors. Incidence rates were analyzed across 3 periods—pre–7-valent PCV (pre-PCV7; 1998–1999), pre–13-valent PCV (pre-PCV13; 2001–2009), and post-PCV13 (2011–2016)—by socioeconomic factors.

Results

A total of 8491 cases of invasive pneumococcal disease were identified. Incidence for invasive pneumococcal disease decreased from 22.9 (1998–1999) to 17.9 (2001–2009) to 12.7 (2011–2016) cases per 100 000 person-years. Post-PCV13 incidence (95% confidence interval [CI]) of PCV13-serotype disease in high- and low-poverty neighborhoods was 3.1 (2.7–3.5) and 1.4 (1.0–1.8), respectively, compared with pre-PCV7 incidence of 17.8 (15.7–19.9) and 6.4 (4.9–7.9). Before PCV introduction, incidence (95% CI) of PCV13-serotype disease was higher in blacks than whites (17.3 [15.1–19.5] vs 11.8 [10.6–13.0], respectively); after introduction, PCV13-type disease incidence was greatly reduced in both groups (white: 2.7 [2.4–3.0]; black: 2.2 [1.8–2.6]).

Conclusions

Introduction of PCV13 was associated with substantial reductions in overall incidence and socioeconomic and racial disparities in PCV13-serotype incidence.
Emergence of tigecycline- and eravacycline-resistant Tet(X4)-producing Enterobacteriaceae in the gut microbiota of healthy Singaporeans
Authors: Ding Yichen , Saw Woei-Yuh , Tan Linda Wei Lin , Moong Don Kyin Nwe , Nagarajan Niranjan , Teo Yik Ying , Seedorf Henning
Published: August 2020

Objectives

The recently discovered tigecycline-inactivating enzyme Tet(X4) can confer high-level tigecycline resistance on its hosts, which makes it a public health concern. This study focused on isolation and screening of Tet(X4)-positive Enterobacteriaceae from the gut microbiota of a cohort of healthy individuals in Singapore.

Methods

MinION and Illumina sequencing was performed to obtain the complete genome sequences of Escherichia coli 2EC1-1 and 94EC. Subsequently, 109 human faecal samples were screened retrospectively for eravacycline-resistant Enterobacteriaceae strains, which were further tested for tet(X4) by PCR. The taxonomy of the isolated strains was determined by 16S rRNA gene PCR and Sanger sequencing.

Results

Comparative genomic analysis of E. coli 2EC1-1 and 94EC revealed that both carry tet(X4), which is encoded by IncI1-type plasmids p2EC1-1 and p94EC-2, respectively. Retrospective screening of faecal samples collected from 109 healthy individuals showed that the faecal carriage rate of Tet(X4)-producing Enterobacteriaceae is 10.1% (95% CI = 5.1%–17.3%), suggesting that tet(X4) is widely distributed in the gut microbiota of healthy individuals in Singapore.

Conclusions

To the best of our knowledge, this is the first report on the prevalence of tet(X4) in the gut microbiota of a healthy human cohort, as well as the first description of this resistance mechanism outside of China. Our findings suggest that surveillance of tet(X4) in community settings is vital to monitor the spread of this resistance mechanism.
Technical Note: Assessment of two methods for estimating bone ash in pigs
Authors: Wensley Madie R , Vier Carine M , Gebhardt Jordan T , Tokach Mike D , Woodworth Jason C , Goodband Robert D , DeRouchey Joel M
Published: August 2020

Data from three experiments conducted to evaluate the effects of increasing available P in swine diets were used to compare two different bone processing methods. Our objective was to determine if the procedures influenced treatment differences and the ability to detect changes in the percentage bone ash. In each experiment, pigs (nursery pigs in experiments 1 and 2, and finishing pigs in experiment 3) were fed a wide range of available phosphorus levels provided from either increasing monocalcium P or added phytase. At the completion of each experiment, a subset of pigs was euthanized, and either fibulas (experiments 1 and 2) or metacarpals (experiment 3) were collected to determine the percentage bone ash. Bones were processed by cleaning away all soft tissues followed by ether extraction for 7 d (defatted), or no lipid extraction (non-defatted), and then ashed. In nursery and finishing pigs, defatted bones had increased (P < 0.001) percentage bone ash compared with non-defatted bones. No evidence of a method × treatment interaction or linear and quadratic interactions were observed in bone ash weight and percentage bone ash (P > 0.10) for nursery pigs; however, a linear interaction was detected (P < 0.05) in percentage bone ash for grow-finish pigs. This response was minimal and likely due to increased variation observed in grow-finish pigs when bones were not defatted. The processing method did not affect the ability to detect differences among treatments as a result of changing dietary P concentrations in the nursery or grow-finish pigs. In summary, either non-defatted or defatted bone processing methods can be used to determine bone ash weight and percentage bone ash as a way to assess bone mineralization and dietary treatment differences in nursery pigs; however, the increased variation observed in mature pigs suggests that defatted bone processing is the preferred method for grow-finish pigs.
‘The Indispensable Agent’: Coal and Its Displacements in Victorian Britain
Authors: Fanning Colin
Published: August 2020

Despite the prominent role of fossil fuels in the technological and social shifts of nineteenth-century Britain, coal—as a tangible thing that touched many aspects of Victorian life—has often been left out of histories of design. A topic of keen political and cultural interest in the period, coal was both an object of displacement (extracted, circulated, consumed) and its agent, reworking Britain’s economic and geological landscapes. This article argues that the ‘coal fetishism’ of Victorian Britain was not an inevitable outgrowth of the material’s proliferation, but was produced in part through the activity of designers, civil servants and manufacturers. Examining coal through the paired notions of display and concealment, I first consider how the substance was elevated in cultural terms at spectacles like the Great Exhibition of 1851, where conjoined strategies of pageantry and didacticism reinforced its centrality to national prosperity. I then turn to explore the coal-burning devices shown in these same spectacular events, showing how the fuel forced designers and manufacturers to contain, conceal or otherwise displace its negative effects and by-products. Attempting to re-place the messy materiality of coal into the history of Victorian design, I argue, thus illuminates the larger tensions and ambiguities of industrial modernity.
OLIG2 Immunolabeling of Mesenchymal Chondrosarcoma: Report of 14 Cases
Authors: Yao Kun , Duan Zejun , Yang Shaomin , Du Zunguo , Wang Yin , Qi Xueling
Published: August 2020

Mesenchymal chondrosarcoma (MC) is a rare aggressive mesenchymal sarcoma. Specific markers for the differential diagnosis of MCs remain to be developed. OLIG2 expression has been reported only in neuroepithelial tumors. Recently, OLIG2 expression was found to be involved in the development of NCOA2 fusion-positive alveolar rhabdomyosarcomas. Therefore, we investigated whether OLIG2 expression could be used as a diagnostic marker for MC. We report the clinical pathological and immunohistochemical features of 14 MCs. All tumors showed typical pathological features including biphasic patterns with sheets of primitive round mesenchymal cells and interspersed islands of cartilage. These tumors expressed BCL2, SOX9, and CD99. OLIG2 was robustly expressed in 12/14 of MCs. NCOA2 rearrangement was found in 12 cases. OLIG2 expression was not found in the NCOA2 rearrangement-negative MCs. Notably, OLIG2 expression was not detected in 52 neoplasms (8 Ewing sarcomas, 23 hemangiopericytomas, and 21 chondrosarcomas) that are frequently misdiagnosed as MC. Our findings provide convincing evidence that OLIG2 can serve as a reliable marker in the differential diagnosis of MC and may be a unique neurodevelopmental gene expression signature for the NCOA2 rearranged MCs.
Spectropolarimetric observations of the CIZA J2242.8+5301 northern radio relic: no evidence of high-frequency steepening
Authors: Loi F , Murgia M , Vacca V , Govoni F , Melis A , Wittor D , Beck R , Kierdorf M , Bonafede A , Boschin W , Brienza M , Carretti E , Concu R , Feretti L , Gastaldello F , Paladino R , Rajpurohit K , Serra P , Vazza F
Published: August 2020

Observations of radio relics at very high frequency (>10 GHz) can help to understand how particles age and are (re-)accelerated in galaxy cluster outskirts and how magnetic fields are amplified in these environments. In this work, we present new single-dish 18.6 GHz Sardinia Radio Telescope and 14.25 GHz Effelsberg observations of the well-known northern radio relic of CIZA J2242.8+5301. We detected the relic which shows a length of ∼1.8 Mpc and a flux density equal to $S_{14.25\, \mathrm{ GHz}}=(9.5\pm 3.9)\, \mathrm{ mJy}$ and $S_{18.6\, \mathrm{ GHz}}=(7.67\pm 0.90)\, \mathrm{ mJy}$ at 14.25 and 18.6 GHz, respectively. The resulting best-fitting model of the relic spectrum from 145 MHz to 18.6 GHz is a power-law spectrum with spectral index α = 1.12 ± 0.03: no evidence of steepening has been found in the new data presented in this work. For the first time, polarization properties have been derived at 18.6 GHz, revealing an averaged polarization fraction of $\sim\! 40{{\ \rm per\ cent}}$ and a magnetic field aligned with the ’filaments’ or ’sheets’ of the relic.
Low-redshift tests of Newtonian cosmologies with a time-varying gravitational constant
Authors: Hanımeli Ekim Taylan , Tutusaus Isaac , Lamine Brahim , Blanchard Alain
Published: August 2020

In this work, we investigate Newtonian cosmologies with a time-varying gravitational constant, G(t). We examine whether such models can reproduce the low-redshift cosmological observations without a cosmological constant, or any other sort of explicit dark energy fluid. Starting with a modified Newton’s second law, where G is taken as a function of time, we derive the first Friedmann–Lemaître equation, where a second parameter, G*, appears as the gravitational constant. This parameter is related to the original G from the second law, which remains in the acceleration equation. We use this approach to reproduce various cosmological scenarios that are studied in the literature, and we test these models with low-redshift probes: type-Ia supernovae (SNIa), baryon acoustic oscillations, and cosmic chronometers, taking also into account a possible change in the supernovae intrinsic luminosity with redshift. As a result, we obtain several models with similar χ2 values as the standard ΛCDM cosmology. When we allow for a redshift-dependence of the SNIa intrinsic luminosity, a model with a G exponentially decreasing to zero while remaining positive (model 4) can explain the observations without acceleration. When we assume no redshift-dependence of SNIa, the observations favour a negative G at large scales, while G* remains positive for most of these models. We conclude that these models offer interesting interpretations to the low-redshift cosmological observations, without needing a dark energy term.
Chandra and XMM–Newton observations of A2256: cold fronts, merger shocks, and constraint on the IC emission
Authors: Ge Chong , Liu Ruo-Yu , Sun Ming , Yu Heng , Rudnick Lawrence , Eilek Jean , Owen Frazer , Dasadia Sarthak , Rossetti Mariachiara , Markevitch Maxim , Clarke Tracy E , Jones Thomas W , Ghizzardi Simona , Venturi Tiziana , Finoguenov Alexis , Eckert Dominique
Published: August 2020

We present the results of deep Chandra and XMM–Newton observations of a complex merging galaxy cluster Abell 2256 (A2256) that hosts a spectacular radio relic (RR). The temperature and metallicity maps show clear evidence of a merger between the western subcluster (SC) and the primary cluster (PC). We detect five X-ray surface brightness edges. Three of them near the cluster centre are cold fronts (CFs): CF1 is associated with the infalling SC; CF2 is located in the east of the PC; and CF3 is located to the west of the PC core. The other two edges at cluster outskirts are shock fronts (SFs): SF1 near the RR in the NW has Mach numbers derived from the temperature and the density jumps, respectively, of MT = 1.62 ± 0.12 and Mρ = 1.23 ± 0.06; SF2 in the SE has MT = 1.54 ± 0.05 and Mρ = 1.16 ± 0.13. In the region of the RR, there is no evidence for the correlation between X-ray and radio substructures, from which we estimate an upper limit for the inverse-Compton emission, and therefore set a lower limit on the magnetic field (∼ 450 kpc from PC centre) of B > 1.0 μG for a single power-law electron spectrum or B > 0.4 μG for a broken power-law electron spectrum. We propose a merger scenario including a PC, an SC, and a group. Our merger scenario accounts for the X-ray edges, diffuse radio features, and galaxy kinematics, as well as projection effects.
Detecting the inner regions of discs around sources of microlensing with Roman Space Telescope
Authors: Sajadian Sedighe , Salehi Ali
Published: August 2020

The inner region of circumstellar discs makes an extra near-infrared emission (NIR bump). Detecting and studying these NIR bumps from nearby stars have been done mostly through infrared interferometry. In this work, we study the feasibility of detecting NIR bumps for Galactic bulge stars through microlensing from observations by The Nancy Grace Roman Space Telescope (RST) survey. We first simulate microlensing light curves from source stars with discs in NIR. Four main conclusions can be extracted from the simulations. (i) If the lens is crossing the disc inner radius, two extra and wide peaks appear and the main peak of microlensing light curve is flattened. (ii) In microlensing events with the lens impact parameters larger than the disc inner radius, the disc can break the symmetry of light curves with respect to the time of closest approach. (iii) In caustic-crossing binary microlensing, the discs produce wide peaks right before entering and immediately after exiting from the caustic curves. (iv) The disc-induced perturbations are larger in the W149 filter than in the Z087 filter, unless the lens crosses the disc condensation radius. By performing a Monte Carlo simulation, the probabilities of detecting the disc perturbations by RST are estimated ∼3 and 20 per cent in single and binary microlensing, respectively. We anticipate that RST detects around 109 disc-induced perturbations during its microlensing survey if 5 per cent of its source stars have discs.
First in situ detection of the CN radical in comets and evidence for a distributed source
Authors: Hänni Nora , Altwegg Kathrin , Pestoni Boris , Rubin Martin , Schroeder Isaac , Schuhmann Markus , Wampfler Susanne
Published: August 2020

Although the debate regarding the origin of the cyano (CN) radical in comets has been ongoing for many decades, it has yielded no definitive answer to date. CN could previously only be studied remotely, strongly hampering efforts to constrain its origin because of very limited spatial information. Thanks to the European Space Agency's Rosetta spacecraft, which orbited comet 67P/Churyumov–Gerasimenko for 2 yr, we can investigate, for the first time, CN around a comet at high spatial and temporal resolution. On board Rosetta's orbiter module, the high-resolution double-focusing mass spectrometer DFMS, part of the ROSINA instrument suite, analysed the neutral volatiles (including HCN and the CN radical) in the inner coma of the comet throughout that whole 2-yr phase and at variable cometocentric distances. From a thorough analysis of the full-mission data, the abundance of CN radicals in the cometary coma has been derived. Data from a close flyby event in 2015 February indicate a distributed origin for the CN radical in comet 67P/Churyumov–Gerasimenko.
Subpulse drifting and periodic nulling in single pulse emission of PSR B2000+40
Authors: Basu Rahul , Lewandowski Wojciech , Kijak Jarosław
Published: August 2020

We have carried out a detailed study of single pulse emission from the pulsar B2000+40 (J2002+4050), observed at 1.6-GHz frequencies using the Effelsberg radio telescope. The pulsar has three components, which are not well separated, with the central component resembling core emission. We have investigated modulations in single pulse behaviour using the fluctuation spectral analysis, which showed the presence of two prominent periodicities, around 2.5P and 40P, respectively. The shorter periodicity was associated with the phenomenon of subpulse drifting and was seen to be absent in the central core component. Drifting showed large phase variations in conal components. Additionally, the periodic modulations had significant evolution with time, varying between very sharp and highly diffuse features. In addition to drifting the pulsar also had the presence of nulling in the single pulse sequence. The longer periodic feature in the fluctuation spectra was associated with nulling behaviour. The pulsar joins a select group, which shows the presence of the phase-modulated drifting as well as periodic nulling in the presence of core emission. This provides further evidence for the two phenomena to be distinct from each other with different physical origins.
Atypical structures of GAA/TTC trinucleotide repeats underlying Friedreich’s ataxia: DNA triplexes and RNA/DNA hybrids
Authors: Zhang Jiahui , Fakharzadeh Ashkan , Pan Feng , Roland Christopher , Sagui Celeste
Published: August 2020

Expansion of the GAA/TTC repeats in the first intron of the FXN gene causes Friedreich’s ataxia. Non-canonical structures are linked to this expansion. DNA triplexes and R-loops are believed to arrest transcription, which results in frataxin deficiency and eventual neurodegeneration. We present a systematic in silico characterization of the possible DNA triplexes that could be assembled with GAA and TTC strands; the two hybrid duplexes [r(GAA):d(TTC) and d(GAA):r(UUC)] in an R-loop; and three hybrid triplexes that could form during bidirectional transcription when the non-template DNA strand bonds with the hybrid duplex (collapsed R-loops, where the two DNA strands remain antiparallel). For both Y·R:Y and R·R:Y DNA triplexes, the parallel third strand orientation is more stable; both parallel and antiparallel protonated d(GA+A)·d(GAA):d(TTC) triplexes are stable. Apparent contradictions in the literature about the R·R:Y triplex stability is probably due to lack of molecular resolution, since shifting the third strand by a single nucleotide alters the stability ranking. In the collapsed R-loops, antiparallel d(TTC+)·d(GAA):r(UUC) is unstable, while parallel d(GAA)·r(GAA):d(TTC) and d(GA+A)·r(GAA):d(TTC) are stable. In addition to providing new structural perspectives for specific therapeutic aims, our results contribute to a systematic structural basis for the emerging field of quantitative R-loop biology.
Robust partitioning of microRNA targets from downstream regulatory changes
Authors: Patel Ravi K , West Jessica D , Jiang Ya , Fogarty Elizabeth A , Grimson Andrew
Published: August 2020

The biological impact of microRNAs (miRNAs) is determined by their targets, and robustly identifying direct miRNA targets remains challenging. Existing methods suffer from high false-positive rates and are unable to effectively differentiate direct miRNA targets from downstream regulatory changes. Here, we present an experimental and computational framework to deconvolute post-transcriptional and transcriptional changes using a combination of RNA-seq and PRO-seq. This novel approach allows us to systematically profile the regulatory impact of a miRNA. We refer to this approach as CARP: Combined Analysis of RNA-seq and PRO-seq. We apply CARP to multiple miRNAs and show that it robustly distinguishes direct targets from downstream changes, while greatly reducing false positives. We validate our approach using Argonaute eCLIP-seq and ribosome profiling, demonstrating that CARP defines a comprehensive repertoire of targets. Using this approach, we identify miRNA-specific activity of target sites within the open reading frame. Additionally, we show that CARP facilitates the dissection of complex changes in gene regulatory networks triggered by miRNAs and identification of transcription factors that mediate downstream regulatory changes. Given the robustness of the approach, CARP would be particularly suitable for dissecting miRNA regulatory networks in vivo.
Long-term cognitive deficits in pediatric low-grade glioma (LGG) survivors reflect pretreatment conditions—report from the German LGG studies
Authors: Traunwieser Thomas , Kandels Daniela , Pauls Franz , Pietsch Torsten , Warmuth-Metz Monika , Bison Brigitte , Krauss Juergen , Kortmann Rolf-Dieter , Timmermann Beate , Thomale Ulrich-Wilhelm , Luettich Peggy , Neumann-Holbeck Anne , Tischler Tanja , Hernáiz Driever Pablo , Witt Olaf , Gnekow Astrid K
Published: August 2020

Background

Disease and treatment contribute to cognitive late effects following pediatric low-grade glioma (LGG). We analyzed prospectively collected neuropsychological data of German pediatric LGG survivors and focused on the impact of hydrocephalus at diagnosis, neurofibromatosis type 1 (NF1) status, and extent of surgery.

Methods

We used the Neuropsychological Basic Diagnostic screening tool based on the Cattell–Horn–Carroll model for intelligence and the concept of cross-battery assessment at 2 and 5 years from diagnosis for 316 patients from the German pediatric LGG study and LGG registry (7.1 years median age; 45 NF1; cerebral hemispheres 16%, supratentorial midline 39%, infratentorial 45%). Hydrocephalus was classified radiologically in 137 non-NF1 patients with infratentorial tumors (95/137 complete/subtotal resection).

Results

Patients with NF1 versus non-NF1 exhibited inferior verbal short-term memory and visual processing (P < .001–.021). In non-NF1 patients, infratentorial tumor site and complete/subtotal resection were associated with sequelae in visual processing, psychomotor speed, and processing speed (P < .001–.008). Non-NF1 patients without surgical tumor reduction and/or nonsurgical treatment experienced similar deficits. Degree of hydrocephalus at diagnosis had no further impact. Psychomotor and processing speed were impaired comparably following chemo-/radiotherapy (P < .001–.021). Pretreatment factors such as NF1 or tumor site were relevant at multivariate analysis.

Conclusions

All pediatric LGG survivors are at risk to experience long-term cognitive impairments in various domains. Even surgical only management of cerebellar LGG or no treatment at all, that is, biopsy only/radiological diagnosis did not protect cognitive function. Since pattern and extent of deficits are crucial to tailor rehabilitation, neuropsychological and quality of survival assessments should be mandatory in future LGG trials.
The MEK inhibitor selumetinib reduces spinal neurofibroma burden in patients with NF1 and plexiform neurofibromas
Authors: Jackson Sadhana , Baker Eva H , Gross Andrea M , Whitcomb Patricia , Baldwin Andrea , Derdak Joanne , Tibery Cecilia , Desanto Jennifer , Carbonell Amanda , Yohay Kaleb , O’Sullivan Geraldine , Chen Alice P , Widemann Brigitte C , Dombi Eva
Published: August 2020

Background

Spinal neurofibromas (SNFs) in neurofibromatosis type 1 (NF1) can cause progressive spinal cord compression and neurological dysfunction. The MEK inhibitor selumetinib shrinks the majority of plexiform neurofibromas (PNs) in patients with NF1. We assessed the effect of selumetinib on SNF.

Methods

Pediatric and adult patients with NF1 and inoperable PN participating in phase 2 studies of selumetinib for PN were included in this analysis if they had SNF and serial spine magnetic resonance imaging (MRI). Selumetinib was administered orally at the recommended dose of 25 mg/m2/dose twice daily (max 50 mg b.i.d.; 1 cycle = 28 days). We qualitatively assessed the effect of selumetinib on SNF-related spinal canal distortion, cerebrospinal fluid distribution, and spinal cord deformity on MRI.

Results

Twenty-four patients (18 male), median age 16.9 years (range, 6.2–60.3), had SNF, 22 of which were associated with the same nerves as the target PN assessed on the clinical trial. Twenty patients had spinal cord deformity. Twenty-three patients completed at least 12 treatment cycles to date. Eighteen patients showed subtle to a marked improvement in SNF burden, 5 remained stable, and no worsening was observed during treatment.

Conclusions

This is the first study describing the effect of selumetinib on SNF. Of 24 patients, 18 exhibited some improvement of SNF burden on imaging. These findings suggest that selumetinib may prevent the worsening of cord compression, potentially reducing the need for surgical interventions in select patients or benefitting patients who do not have a surgical option. Prospective evaluation of the clinical benefit of selumetinib for SNF is warranted.
Credit Default Swaps and Bank Regulatory Capital*
Authors: Shan Chenyu , Tang Dragon Yongjun , Yan Hong , Zhou Xing (Alex)
Published: August 2020

While credit default swaps (CDSs) can be used to hedge credit risk exposures or to speculate, we examine another use of them: banks buy CDS referencing their borrowers to obtain regulatory capital relief. Such capital relief activities have unintended consequences, as banks extend riskier loans when they buy CDS to boost capital ratios. While capital-induced CDS-user banks achieve higher profitability during normal times, they perform worse and request more government support in crisis periods than other banks that use CDS for trading or speculation. Our findings suggest that banks’ CDS trading for capital relief purposes may make these banks riskier.
Missed opportunities for tuberculosis investigation in a municipal hospital in Ghana: evidence from patient exit interviews
Authors: Der Joyce B , Grint Daniel J , Narh Clement T , Bonsu Frank , Grant Alison D
Published: August 2020

Background

We assessed coverage of symptom screening and sputum testing for tuberculosis (TB) in hospital outpatient clinics in Ghana.

Methods

In a cross-sectional study, we enrolled adults (≥18 years) exiting the clinics reporting ≥1 TB symptom (cough, fever, night sweats or weight loss). Participants reporting a cough ≥2 weeks or a cough of any duration plus ≥2 other TB symptoms (per national criteria) and those self-reporting HIV-positive status were asked to give sputum for testing with Xpert MTB/RIF.

Results

We enrolled 581 participants (median age 33 years [IQR: 24–48], 510/581 [87.8%] female). The most common symptoms were fever (348, 59.9%), chest pain (282, 48.5%) and cough (270, 46.5%). 386/581 participants (66.4%) reported symptoms to a healthcare worker, of which 157/386 (40.7%) were eligible for a sputum test per national criteria. Only 31/157 (19.7%) had a sputum test requested. Thirty-two additional participants gave sputum among 41 eligible based on positive HIV status. In multivariable analysis, symptom duration ≥2 weeks (adjusted odds ratio [aOR] 6.99, 95% confidence interval [CI] 2.08–23.51) and previous TB treatment (aOR: 6.25, 95% CI: 2.24–17.48) were the strongest predictors of having a sputum test requested. 6/189 (3.2%) sputum samples had a positive Xpert MTB/RIF result.

Conclusion

Opportunities for early identification of people with TB are being missed in health facilities in Ghana.
Are Nursing Students Learning About Social Determinants of Health?
Authors: Lee Susan K. , Willson Pamela
Published: August 2020

Nurses must be knowledgeable about social determinants of health (SDH) to provide holistic care with improved patient outcomes. When evaluating the Baccalaureate of Science in Nursing curriculum, it is unclear if SDH are adequately identified, assessed, and discussed, or if students grasp their importance. To move to a population health approach, faculty need to be more inclusive of community and public health. For purposes of this study, the factors comprising SDH were identified as childhood experiences, housing, education, social support, family income, employment, communities, and access to health services. These eight factors were used to categorize participants’ qualitative responses to baseline and completion surveys.
Innovation in Health Policy Education: Examples From Jonas Policy Scholars
Authors: Hallowell Sunny G. , Oerther Sarah E. , Dowling-Castronovo Annemarie , Rossiter Alicia Gill , Montalvo Wanda
Published: August 2020

In the decade since the Institute of Medicine published the Future of Nursing report, the development of a pipeline of doctorally prepared nursing leaders proficient in research, leadership, teaching, and practice has been one of great successes. The investment of Jonas Philanthropies, in collaboration with donors and foundation partners, has supported scholarships to more than 1,000 scholars nationwide. Scholars are prepared to lead health care reform in education, practice, and leadership. This article shares four examples of creative approaches to teaching health policy with students and professionals who may inspire similarly creative approaches to prepare future health policy leaders.
Design and Implementation of an Innovative Undergraduate Pediatric Clinical Experience With Teenagers of Mexican Heritage
Authors: D'Alonzo Karen T. , Seaman Kimberly , Rawlins Latoya
Published: August 2020

This article describes an innovative community-based pediatric clinical rotation for undergraduate nursing students. Students were charged with conducting interactive educational sessions on health-related topics of interest to participants in a six-week summer day camp for adolescents of Mexican heritage. At the completion of the experience, students identified social determinants of health that impacted the health of the community and the impact of the experience on their nursing practice. Overall, both the adolescents and the nursing students benefited from the experience. Community-academic partnerships can be used to promote student learning while contributing to the overall health of the community.
Interprofessional Education: TeamSTEPPS® and Simulation With Respiratory Therapy and Nursing Students in Their Final Year
Authors: Russell Kendra , Brown Jasmine , Manella Leanne , Colquitt James , Ingram Donna
Published: August 2020

TeamSTEPPS® is a curriculum designed to improve team communication to reduce medical errors and improve patient safety. This exploratory study used a questionnaire to explore differences in attitudes of 130 nursing and respiratory therapy students using a TeamSTEPPS-based interprofessional education seminar and simulation. Results support that students’ attitudes regarding the principles Team Structure, Leadership, Situation Monitoring, Mutual Support, and Communication improved from Time 1 (preseminar) to Time 2 (postseminar; p < .05). This improvement was sustained at Time 3 (postsimulation) in all principles except for Mutual Support. Participation in a TeamSTEPPS seminar and simulation can influence attitudes among health care professional students.
Sex-specific Associations of Alcohol Withdrawal in Patients Admitted for the Treatment of Alcohol Use Disorder
Authors: Sanvisens Arantza , Zuluaga Paola , Short Antoni , Rubio Gabriel , Gual Antoni , Torrens Marta , Fuster Daniel , Bolao Ferran , Rodríguez de Fonseca Fernando , Muga Roberto
Published: August 2020

Objectives:

There are sex differences in the pattern of alcohol consumption and in the complications of alcohol use disorder (AUD). We aimed to identify sex-specific differences in the factors associated with alcohol withdrawal syndrome (AWS) among patients that requested a first treatment for AUD.

Methods:

We enrolled 313 patients (75% men) with a Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis that started treatment between 2014 and 2016. We collected socio-demographics, the type and amount of alcohol and other substances consumed, and clinical and laboratory parameters. According to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD criteria, AWS occurred when patients experienced 2 or more clinical signs/symptoms and/or consumed alcohol to relieve symptoms. Logistic regression models were used to determine factors associated with AWS according to sex.

Results:

The median age of participants was 50 years (interquartile range [IQR]: 43–54 years). The median age of starting alcohol consumption was 16 years (IQR: 14–18 years). Notably, 69% of participants smoked tobacco, and 61% had a family history of AUD; 18% currently used cannabis, and 7.7% used cocaine. Overall, 73% of patients exhibited AWS criteria, and men (76.5%) were more likely than women (64.6%) to report AWS (P = 0.038). In the adjusted analysis, factors associated with AWS were the age at starting alcohol consumption (odds ratio [OR] for every 5 years = 1.89, 95% confidence interval [CI]: 1.69–2.08), and cannabis use (OR = 2.8, 95% CI: 1.04–7.7) in men, and a family history of AUD in women (OR = 2.85 95% CI: 1.07–7.54).

Conclusions:

factors associated with AWS differ by sex which may have clinical implications for proactive management of AWS during treatment for AUD.
Calls for Access to Safe Injecting Supplies as a Critical Public Health Measure During the COVID-19 Pandemic
Authors: Chayama Koharu Loulou , Ng Cara , McNeil Ryan
Published: August 2020

More than 3 decades of research has provided compelling evidence regarding the effectiveness, safety, and cost-effectiveness of needle and syringe programs in reducing syringe-sharing and transmission of HIV, HCV, and other bloodborne infections. However, repressive drug policies and drug law enforcement practices around the world continue to undermine their operations and scale-up, as well as access to harm reduction among people who inject drugs. The COVID-19 pandemic has heightened access barriers to needle and syringe programs, raising concerns about unsafe injecting practices due to inadequate access to safe injecting supplies. This commentary discusses the robust public health responses that are needed at this particularly vulnerable and critical juncture to ensure access to safe injecting supplies and minimize the risk for transmission of bloodborne infections among people who inject drugs.
Anxiety, Depression, and Opioid Misuse Among Adults With Chronic Pain
Authors: Rogers Andrew H. , Garey Lorra , Bakhshaie Jafar , Viana Andres G. , Ditre Joseph W. , Zvolensky Michael J.
Published: August 2020

Objectives:

The opioid epidemic is a significant public health problem largely driven by opioid prescriptions for chronic pain. Among those with chronic pain, anxiety and depressive symptoms have been linked to opioid misuse, and individual differences in anxiety and depressive symptoms among adults with chronic pain may be important for better understanding pain. Yet, little work has examined mechanisms that may link anxiety and depressive symptoms to opioid misuse among adults with chronic pain. Anxiety sensitivity (AS), or the fear of anxiety-related physical sensations, may be one candidate construct that has been linked independently to anxiety and depressive symptoms as well as opioid misuse.

Methods:

The current survey-based study examined the indirect association of AS in the relation between anxiety and depressive symptoms and opioid misuse among 429 adults with chronic pain currently using prescription opioid medication (73.9% female, M
age
=38.32 y, SD=11.07).

Results:

Using structural equation modeling, it appears that AS is a potential construct in the interrelation between anxiety and depressive symptoms and opioid misuse. However, an alternative model found equally strong empirical support, as mental health symptoms may serve as an explanatory factor between AS and opioid misuse.

Discussion:

Bi-directional effects are apt to be involved among the studied variables. Prospective research is needed to replicate the study results and isolate the temporal patterning between the studied constructs. Nonetheless, the data overall highlight the importance of both AS and anxiety and depressive symptoms in terms of understanding opioid misuse among adults with chronic pain.
Child- and Environment-Related Factors Influencing Daily Cochlear Implant Use: A Datalog Study
Authors: de Jong Tjeerd , van der Schroeff Marc , Vroegop Jantien
Published: August 2020

Objectives:

To understand the varying levels of daily cochlear implant (CI) use in children, previous studies have investigated factors that may be of influence. The objective of this study was to investigate the degree with which new child-related and environment-related characteristics were associated with consistent CI use.

Design:

The design of this study was retrospective. Data were reviewed of 81 children (51% females, mean age 6.4 years with a range of 1.3 to 17.7 years) who received a CI between 2012 and 2019. Developmental status, quantified burden of comorbidity, hearing experience, and hearing environment were investigated for correlation with consistency in daily CI use. The CIs datalog was used to objectively record the wearing times. Associations were examined using univariate correlation analyses and a linear regression analysis.

Results:

On average, the CI was worn 8.6 hr per day and 59% of the children wore it more than 8 hr daily. The latter children’s hearing performance was significantly higher than that of the others. Consistency in CI use correlated significantly with the child-related characteristics chronological age, nonverbal intelligence quotient (IQ), American Society of Anesthesiologists physical status class, pre CI acoustic experience, CI experience, and one of the environment related characteristics “parental communication mode.” In a multivariate linear regression model, consistency in CI use was significantly dependent on nonverbal IQ and parental communication mode. These together accounted for 47% of the variation in daily CI use.

Conclusions:

The findings indicate that children with lower nonverbal IQ scores and low exposure to oral communication by their parents are at risk of inconsistent CI use.
Rhythmic Abilities of Children With Hearing Loss
Authors: Hidalgo Céline , Zécri Annabelle , Pesnot-Lerousseau Jacques , Truy Eric , Roman Stéphane , Falk Simone , Dalla Bella Simone , Schön Daniele
Published: August 2020

Objectives:

Children with hearing loss (HL), in spite of early cochlear implantation, often struggle considerably with language acquisition. Previous research has shown a benefit of rhythmic training on linguistic skills in children with HL, suggesting that improving rhythmic capacities could help attenuating language difficulties. However, little is known about general rhythmic skills of children with HL and how they relate to speech perception. The aim of this study is twofold: (1) to assess the abilities of children with HL in different rhythmic sensorimotor synchronization tasks compared to a normal-hearing control group and (2) to investigate a possible relation between sensorimotor synchronization abilities and speech perception abilities in children with HL.

Design:

A battery of sensorimotor synchronization tests with stimuli of varying acoustic and temporal complexity was used: a metronome, different musical excerpts, and complex rhythmic patterns. Synchronization abilities were assessed in 32 children (aged from 5 to 10 years) with a severe to profound HL mainly fitted with one or two cochlear implants (n = 28) or with hearing aids (n = 4). Working memory and sentence repetition abilities were also assessed. Performance was compared to an age-matched control group of 24 children with normal hearing. The comparison took into account variability in working memory capacities. For children with HL only, we computed linear regressions on speech, sensorimotor synchronization, and working memory abilities, including device-related variables such as onset of device use, type of device, and duration of use.

Results:

Compared to the normal-hearing group, children with HL performed poorly in all sensorimotor synchronization tasks, but the effect size was greater for complex as compared to simple stimuli. Group differences in working memory did not explain this result. Linear regression analysis revealed that working memory, synchronization to complex rhythms performances, age, and duration of device use predicted the number of correct syllables produced in a sentence repetition task.

Conclusion:

Despite early cochlear implantation or hearing aid use, hearing impairment affects the quality of temporal processing of acoustic stimuli in congenitally deaf children. This deficit seems to be more severe with stimuli of increasing rhythmic complexity highlighting a difficulty in structuring sounds according to a temporal hierarchy.
Quantitative Analysis for the Change in Lengths of the Radius and Ulna in Missed Bado Type I Monteggia Fracture
Authors: Oka Kunihiro , Tanaka Hiroyuki , Shigi Atsuo , Abe Shingo , Miyamura Satoshi , Shiode Ryoya , Kazui Arisa , Murase Tsuyoshi
Published: August 2020

Background:

In missed Monteggia fracture (MMF) cases, ulnar angulation and lengthening by osteotomy are required to reduce the dislocated radial head. This study aimed to clarify the abnormal discrepancy in length between the radius and ulna in MMF. We tested the hypothesis that the increase in the abnormal discrepancy in length between the radius and ulna relates with the duration of radial head dislocation.

Methods:

In total, 24 patients with MMF were studied and classified into 2 groups, according to the duration of radial head dislocation, including the early group (n=9, within 3 y) and the long-standing group (n=15, older than 3 y). The lengths of the radius (Lr) and ulna (Lu) were measured. The difference in length between the ulna and radius (DL=Lu−Lr) was calculated on both the affected (DLaff) and normal (DLnor) sides. DLnor−DLaff, which represented an abnormal discrepancy in both bones, was analyzed for correlation with the duration of radial head dislocation and the age at initial injury.

Results:

The affected and normal sides had no differences in the Lr of both the groups and in the Lu of the early group. However, in the long-standing group, Lu was significantly smaller in the affected side than in the normal side (P=0.001). In the long-standing group, DLaff was significantly smaller, owing to decreased length of the ulna, than DLnor (P=0.003). The DLnor−DLaff was positively correlated with the duration of radial head dislocation and was negatively correlated with the age at injury.

Conclusions:

In chronic MMF cases, the length of the ulna was shorter in the affected side than in the normal side. Therefore, ulnar lengthening is necessary to resolve this abnormal discrepancy and reduce the radial head. Because excessive ulnar lengthening has risks of postoperative complications, one of the surgical options is gradual ulnar lengthening or shortening osteotomy of the radius.

Level of Evidence:

Level III—Prognosis study.
Proprotein Convertase Subtilisin/Kexin Type 9 Loss-of-Function Is Detrimental to the Juvenile Host With Septic Shock*
Authors: Atreya Mihir R. , Whitacre Brynne E. , Cvijanovich Natalie Z. , Bigham Michael T. , Thomas Neal J. , Schwarz Adam J. , Weiss Scott L. , Fitzgerald Julie C. , Allen Geoffrey L. , Lutfi Riad , Nowak Jeffrey E. , Quasney Michael W. , Shah Amy S. , Wong Hector R.
Published: August 2020

Objectives:

Proprotein convertase subtilisin/kexin type 9 is a central regulator of lipid metabolism and has been implicated in regulating the host response to sepsis. Proprotein convertase subtilisin/kexin type 9 loss-of-function is associated with improved sepsis outcomes in the adult host through increased hepatic bacterial clearance. Thus, there is interest in leveraging proprotein convertase subtilisin/kexin type 9 inhibitors as a therapeutic strategy in adults with sepsis. We sought to validate this association in children with septic shock and in a juvenile murine model of sepsis.

Design:

Prospectively enrolled cohort of children with septic shock; experimental mice.

Setting:

Seventeen participating institutions; research laboratory.

Patients and Subjects:

Five-hundred twenty-two children with septic shock; juvenile (14 d old) and adult (10–14 wk) mice with constitutive proprotein convertase subtilisin/kexin type 9 null and wildtype control mice (C57BL/6).

Interventions:

Proprotein convertase subtilisin/kexin type 9 single-nucleotide polymorphisms, serum proprotein convertase subtilisin/kexin type 9, and lipid profiles in patients. Cecal slurry murine model of sepsis; survival studies in juvenile and adult mice, assessment of lipoprotein fractions, bacterial burden, and inflammation in juvenile mice.

Measurements and Main Results:

PCSK9 loss-of-function genetic variants were independently associated with increased odds of complicated course and mortality in children with septic shock. PCSK9, low-density lipoprotein, and high-density lipoprotein concentrations were lower among patients with complicated course relative to those without. PCSK9 concentrations negatively correlated with proinflammatory cytokine interleukin-8. Proprotein convertase subtilisin/kexin type 9 loss-of-function decreased survival in juvenile mice, but increased survival in adult mice with sepsis. PCSK9 loss-of-function resulted in low lipoproteins and decreased hepatic bacterial burden in juvenile mice.

Conclusions:

In contrast to the adult host, proprotein convertase subtilisin/kexin type 9 loss-of-function is detrimental to the juvenile host with septic shock. PCSK9 loss-of-function, in the context of low lipoproteins, may result in reduced hepatic bacterial clearance in the juvenile host with septic shock. Our data indicate that children should be excluded in sepsis clinical trials involving proprotein convertase subtilisin/kexin type 9 inhibitors.