bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of a Pediatric Admission Booklet Significantly Improves the Comprehensiveness of Admission Documentation: A Quality Improvement Project
Authors: Beverstock Andrew , Lewis Carianne , Bruce David , Barnes James , Kelly Alison
Published: March 2021

Introduction:

At present, doctors in some tertiary pediatric hospitals across the United Kingdom record admission on blank continuation sheets rather than using a specific admission document. Previous evidence from adult medicine shows that using admission booklets to prompt the admitting doctor improves the thoroughness of admission documentation, but no work has evaluated this in pediatrics.

Methods:

Documentation standards for pediatric admissions were created using national standards. We performed a baseline audit of admissions documented on blank continuation sheets. We included 120 patient admissions across pediatric medicine, pediatric surgery, and pediatric orthopedics (40 from each specialty). We introduced an admission booklet for each specialty, which contained prompts for documenting each aspect of the medical history. We then repeated the audit of 120 additional admissions documented on these booklets.

Results:

On average, across all 3 specialties, there was a 33% increase in the inclusion of items in the documented history after the introduction of an admission booklet. In particular, documentation of medication history improved from 46% to 99%, and documentation of allergies improved from 47% to 93%. These improvements were statistically significant.

Conclusion:

We recommend the use of a pediatric admission booklet as a simple and effective way to improve medical record documentation. The use of these booklets was associated with an increase in the thoroughness of the documentation. As NHS hospitals transition to electronic medical records, they should make use of admission templates that retain the advantages of these paper booklets.
Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative
Authors: Herbsman Jodi M. , D’Agati Michael , Klein Daniella , O’Donnell Siobhan , Corcoran John R. , Folks Tiffany D. , Al-Qaqaa Yasir M.
Published: March 2021

Introduction:

Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients.

Methods:

We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing.

Results:

All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05).

Conclusions:

This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.
Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed
Authors: Anderson Kim , Kalk Emma , Madlala Hlengiwe P. , Nyemba Dorothy C. , Jacob Nisha , Slogrove Amy , Smith Mariette , Kroon Max , Harrison Michael C. , Eley Brian S. , Boulle Andrew , Myer Landon , Davies Mary-Ann
Published: March 2021

Objectives:

Infants who are HIV exposed but uninfected (HEU) compared with HIV unexposed uninfected (HUU) have an increased risk of adverse birth outcomes, morbidity and hospitalization. In the era of universal maternal antiretroviral treatment, there are few insights into patterns of neonatal morbidity specifically.

Design:

A prospective cohort study.

Methods:

We compared neonatal hospitalizations among infants who were HEU (n = 463) vs. HUU (n = 466) born between 2017 and 2019 to a cohort of pregnant women from a large antenatal clinic in South Africa. We examined maternal and infant factors associated with hospitalization using logistic regression.

Results:

Hospitalization rates were similar between neonates who were HEU and HUU (13 vs. 16%; P = 0.25). Overall, most hospitalizations occurred directly after birth (87%); infection-related causes were identified in 34%. The most common reason for hospitalization unrelated to infection was respiratory distress (25%). Very preterm birth (<32 weeks) (29 vs. 11%; P = 0.01) as well as very low birthweight (<1500 g) (34 vs. 16%; P = 0.02) occurred more frequently among hospitalized neonates who were HEU. Of those hospitalized, risk of intensive care unit (ICU) admission was higher in neonates who were HEU (53%) than HUU (27%) [risk ratio = 2.1; 95% confidence interval (95% CI) 1.3–3.3]. Adjusted for very preterm birth, the risk of ICU admission remained higher among neonates who were HEU (aRR = 1.8; 95% CI 1.1–2.9).

Conclusion:

Neonates who were HEU (vs. HUU) did not have increased all-cause or infection-related hospitalization. However, very preterm birth, very low birthweight and ICU admission were more likely in hospitalized neonates who were HEU, indicating increased severity of neonatal morbidity.
Viral suppression is associated with HIV-antibody level and HIV-1 DNA detectability in early treated children at 2 years of age
Authors: Veldsman Kirsten A. , Laughton Barbara , Janse van Rensburg Anita , Zuidewind Peter , Dobbels Els , Barnabas Shaun , Fry Samantha , Cotton Mark F. , van Zyl Gert U.
Published: March 2021

Objectives:

Early infant HIV diagnosis and antiretroviral therapy (ART) initiation are now implemented shortly after birth. Maintaining and monitoring ART adherence is difficult and requires frequent visits. We, therefore, investigated whether HIV antibodies and HIV-1 DNA levels are markers of cumulative viremia.

Design:

We conducted a cross sectional investigation at 2 years of age of HIV antibodies and HIV-1 DNA levels in a well characterized cohort of 31 children who started ART shortly after birth.

Methods:

HIV antibodies were measured by a combination of the Abbott ARCHITECT HIV Ag/Ab Combo and Geenius HIV 1/2 supplemental assays; and total HIV-1 DNA quantified using a sensitive quantitative PCR (qPCR) assay targeting the HIV-1 integrase gene.

Results:

Infant post-exposure prophylaxis consisted of zidovudine (AZT) and nevirapine (NPV) (or NVP only, in one child) within 1 day of birth, transitioning, after positive diagnosis, to three-drug ART, at a median [interquartile range (IQR)] of 7 (4–9.5) days. Twelve of 31 children had well suppressed HIV plasma viral loads (HIVVL) and the remainder periods of viremia (HIVVL > 100 copies/ml after 3 months of ART), classified as non-suppressed. At 24 months of age: 11 of 12 (92%) of well suppressed children had undetectable HIV-1 antibodies versus 3 of 19 (16%) non-suppressed children (P < 0.001) and 7 of 12 (58%) well suppressed children had undetectable HIV-1 DNA versus 3 of 19 (16%) non-suppressed children (P = 0.02).

Conclusion:

Considering low assay costs and the high proportion of well suppressed children with undetected antibody levels at 2 years, HIV antibody levels may be a valuable marker of cumulative adherence in children who start treatment shortly after birth and could prompt adherence and viral load investigation.
Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa
Authors: Cluver Lucie , Shenderovich Yulia , Toska Elona , Rudgard William E. , Zhou Siyanai , Orkin Mark , Haghighat Roxanna , Chetty Angelique N. , Kuo Caroline , Armstrong Alice , Sherr Lorraine
Published: March 2021

Objective:

Adolescent antiretroviral treatment (ART) adherence remains critically low. We lack research testing protective factors across both clinic and care environments.

Design:

A prospective cohort of adolescents living with HIV (sample n = 969, 55% girls, baseline mean age 13.6) in the Eastern Cape Province in South Africa were interviewed at baseline and 18-month follow-up (2014–2015, 2015–2016). We traced all adolescents ever initiated on treatment in 52 government health facilities (90% uptake, 93% 18-month retention, 1.2% mortality).

Methods:

Clinical records were collected; standardized questionnaires were administered by trained data collectors in adolescents’ language of choice. Probit within-between regressions and average adjusted probability calculations were used to examine associations of caregiving and clinic factors with adherence, controlling for household structure, socioeconomic and HIV factors.

Results:

Past-week ART adherence was 66% (baseline), 65% (follow-up), validated against viral load in subsample. Within-individual changes in three factors were associated with improved adherence: no physical and emotional violence (12.1 percentage points increase in adjusted probability of adherence, P < 0.001), improvement in perceived healthcare confidentiality (7.1 percentage points, P < 0.04) and shorter travel time to the clinic (13.7 percentage points, P < 0.02). In combination, improvement in violence prevention, travel time and confidentiality were associated with 81% probability of ART adherence, compared with 47% with a worsening in all three.

Conclusion:

Adolescents living with HIV need to be safe at home and feel safe from stigma in an accessible clinic. This will require active collaboration between health and child protection systems, and utilization of effective violence prevention interventions.
Perinatally acquired HIV infection is associated with abnormal blood mitochondrial function during childhood/adolescence
Authors: Jao Jennifer , Jacobson Denise L. , Russell Jonathan S. , Wang Jiajia , Yu Wendy , Gojanovich Greg S. , Siminski Sue , Hyzy Laurie , Geffner Mitchell E. , Gerschenson Mariana
Published: March 2021

Objective:

We assessed differences in mitochondrial function between youth living with perinatal HIV (YPHIV) and youth perinatally HIV-exposed but uninfected (YPHEU).

Design:

Cross-sectional analysis.

Methods:

We measured lactate and pyruvate values, as well as mitochondrial Complex I and Complex IV activity in peripheral blood mononuclear cells. Logistic or linear regression models were fit, as appropriate, to assess the association between PHIV status and each mitochondrial parameter, adjusted for confounders. We introduced interaction terms to assess effect modification of PHIV status on the relationship between anthropometric factors and each mitochondrial parameter. Among YPHIV, similar regression models were fit to assess the relationship between HIV-associated factors and each mitochondrial outcome.

Results:

A total of 243 YPHIV and 118 YPHEU were compared. On average, YPHIV had higher lactate/pyruvate ratio (β: 7.511, 95% confidence interval [95% CI]: 0.402, 14.620) and Complex IV activity (β: 0.037, 95% CI: 0.002, 0.072) compared to YPHEU, adjusted for confounders. Among YPHIV, body mass index Z score (BMIZ) and Complex I activity were inversely associated, whereas, among YPHEU, there was a positive association (β for interaction: −0.048, P = 0.003). Among YPHIV, current (β: −0.789, 95% CI: −1.174, −0.404) and nadir CD4+% (β: −0.605, 95% CI: −1.086, −0.125) were inversely associated with lactate/pyruvate ratio; higher current (4.491, 95% CI: 0.754, 8.229) and peak (7.978, 95% CI: 1.499, 14.457) HIV RNA levels were positively associated with lactate/pyruvate ratio in adjusted models.

Conclusions:

Mitochondrial function and substrate utilization appear perturbed in YPHIV compared to YPHEU. Increasing immunosuppression and viremia are associated with mitochondrial dysfunction among YPHIV.
Short telomeres drive pessimistic judgement bias in zebrafish
Authors: Espigares F. , Abad-Tortosa D. , Varela S. A. M. , Ferreira M. G. , Oliveira R. F.
Published: March 2021

The role of telomerase reverse transcriptase has been widely investigated in the contexts of ageing and age-related diseases. Interestingly, decreased telomerase activities (and accelerated telomere shortening) have also been reported in patients with emotion-related disorders, opening the possibility for subjective appraisal of stressful stimuli playing a key role in stress-driven telomere shortening. In fact, patients showing a pessimistic judgement bias have shorter telomeres. However, in humans the evidence for this is correlational and the causal directionality between pessimism and telomere shortening has not been established experimentally yet. We have developed and validated a judgement bias experimental paradigm to measure subjective evaluations of ambiguous stimuli in zebrafish. This behavioural assay allows classification of individuals in an optimistic–pessimistic dimension (i.e. from individuals that consistently evaluate ambiguous stimuli as negative to others that perceive them as positive). Using this behavioural paradigm we found that telomerase-deficient zebrafish (

tert

−

/

−

) were more pessimistic in response to ambiguous stimuli than wild-type zebrafish. The fact that individuals with constitutive shorter telomeres have pessimistic behaviours demonstrates for the first time in a vertebrate model a genetic basis of judgement bias.
Systematic variation in food web body-size structure linked to external subsidies
Authors: Perkins Daniel M. , Durance Isabelle , Jackson Michelle , Jones J. Iwan , Lauridsen Rasmus B. , Layer-Dobra Katrin , Reiss Julia , Thompson Murray S. A. , Woodward Guy
Published: March 2021

The relationship between body mass (M) and size class abundance (N) depicts patterns of community structure and energy flow through food webs. While the general assumption is that M and N scale linearly (on log–log axes), nonlinearity is regularly observed in natural systems, and is theorized to be driven by nonlinear scaling of trophic level (TL) with M resulting in the rapid transfer of energy to consumers in certain size classes. We tested this hypothesis with data from 31 stream food webs. We predicted that allochthonous subsidies higher in the web results in nonlinear M–TL relationships and systematic abundance peaks in macroinvertebrate and fish size classes (latter containing salmonids), that exploit terrestrial plant material and terrestrial invertebrates, respectively. Indeed, both M–N and M–TL significantly deviated from linear relationships and the observed curvature in M–TL scaling was inversely related to that observed in M–N relationships. Systemic peaks in M–N, and troughs in M–TL occurred in size classes dominated by generalist invertebrates, and brown trout. Our study reveals how allochthonous resources entering high in the web systematically shape community size structure and demonstrates the relevance of a generalized metabolic scaling model for understanding patterns of energy transfer in energetically ‘open’ food webs.
Adaptation of sperm whales to open-boat whalers: rapid social learning on a large scale?
Authors: Whitehead Hal , Smith Tim D. , Rendell Luke
Published: March 2021

Animals can mitigate human threats, but how do they do this, and how fast can they adapt? Hunting sperm whales was a major nineteenth century industry. Analysis of data from digitized logbooks of American whalers in the North Pacific found that the rate at which whalers succeeded in harpooning (‘striking’) sighted whales fell by about 58% over the first few years of exploitation in a region. This decline cannot be explained by the earliest whalers being more competent, as their strike rates outside the North Pacific, where whaling had a longer history, were not elevated. The initial killing of particularly vulnerable individuals would not have produced the observed rapid decline in strike rate. It appears that whales swiftly learned effective defensive behaviour. Sperm whales live in kin-based social units. Our models show that social learning, in which naive social units, when confronted by whalers, learned defensive measures from grouped social units with experience, could lead to the documented rapid decline in strike rate. This rapid, large-scale adoption of new behaviour enlarges our concept of the spatio-temporal dynamics of non-human culture.
How the geometry of cities determines urban scaling laws
Authors: Molinero Carlos , Thurner Stefan
Published: March 2021

Urban scaling laws relate socio-economic, behavioural and physical variables to the population size of cities. They allow for a new paradigm of city planning and for an understanding of urban resilience and economics. The emergence of these power-law relations is still unclear. Improving our understanding of their origin will help us to better apply them in practical applications and further research their properties. In this work, we derive the basic exponents for spatially distributed variables from fundamental fractal geometric relations in cities. Sub-linear scaling arises as the ratio of the fractal dimension of the road network and of the distribution of the population embedded in three dimensions. Super-linear scaling emerges from human interactions that are constrained by the geometry of a city. We demonstrate the validity of the framework with data from 4750 European cities. We make several testable predictions, including the relation of average height of cities and population size, and the existence of a critical density above which growth changes from horizontal densification to three-dimensional growth.
Curcumin improves adipocytes browning and mitochondrial function in 3T3-L1 cells and obese rodent model
Authors: Zhao Dandan , Pan Yanyun , Yu Na , Bai Ying , Ma Rufeng , Mo Fangfang , Zuo Jiacheng , Chen Beibei , Jia Qiangqiang , Zhang Dongwei , Liu Jiaxian , Jiang Guanjian , Gao Sihua
Published: March 2021

Accumulating evidence suggests that mitochondrial dysfunction and adipocyte differentiation promote lipid accumulation in the development of obesity and diabetes. Curcumin is an active ingredient extracted from
Curcuma longa
that has been shown to exhibit antioxidant and anti-inflammatory potency in metabolic disorders. However, the underlying mechanisms of curcumin in adipocytes remain largely unexplored. We studied the effects of curcumin on adipogenic differentiation and mitochondrial oxygen consumption and analysed the possible mechanisms. 3T3-L1 preadipocytes were used to assess the effect of curcumin on differentiation of adipocytes. The Mito Stress Test measured by Seahorse XF Analyzer was applied to investigate the effect of curcumin on mitochondrial oxygen consumption in 3T3-L1 adipocytes. The effect of curcumin on the morphology of both white and brown adipose tissue (WAT and BAT) was evaluated in a high-fat diet-induced obese mice model. We found that curcumin dose-dependently (10, 20 and 35 µM) induced adipogenic differentiation and the intracellular fat droplet accumulation. Additionally, 10 µM curcumin remarkably enhanced mature adipocyte mitochondrial respiratory function, specifically, accelerating basic mitochondrial respiration, ATP production and uncoupling capacity via the regulation of peroxisome proliferator-activated receptor γ (PPARγ) (
p
< 0.01). Curcumin administration also attenuated the morphological changes in adipose tissues in high-fat diet-induced obese mice. Moreover, curcumin markedly increased the mRNA and protein expressions of mitochondrial uncoupling protein 1 (UCP1), PPARγ, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) and PR domain protein 16 (PRDM16)
in vivo
and
in vitro
. Collectively, the results demonstrate that curcumin promotes the adipogenic differentiation of preadipocytes and mitochondrial oxygen consumption in 3T3-L1 mature adipocytes by regulating UCP1, PRDM16, PPARγ and PGC-1α expression.
Phosphate bound to calcareous sediments hampers skeletal development of juvenile coral
Authors: Iijima Mariko , Yasumoto Jun , Iguchi Akira , Koiso Kiyomi , Ushigome Sayaka , Nakajima Natsuki , Kunieda Yuko , Nakamura Takashi , Sakai Kazuhiko , Yasumoto-Hirose Mina , Mori-Yasumoto Kanami , Mizusawa Nanami , Amano Haruna , Suzuki Atsushi , Jimbo Mitsuru , Watabe Shugo , Yasumoto Ko
Published: March 2021

To test the hypothesis that terrestrial runoff affects the functions of calcareous sediments in coral reefs and hampers the development of corals, we analysed calcareous sediments with different levels of bound phosphate, collected from reef areas of Okinawajima, Japan. We confirmed that phosphate bound to calcareous sediments was readily released into ambient seawater, resulting in much higher concentrations of phosphorous in seawater from heavily polluted areas (4.3–19.0 µM as compared with less than 0.096 µM in natural ambient seawater). Additionally, we examined the effect of phosphate released from calcareous sediments on the development of
Acropora digitifera
coral juveniles. We found that high phosphate concentrations in seawater clearly inhibit the skeletal formation of coral juveniles. Our results demonstrate that calcareous sediments in reef areas play a crucial role in mediating the impact of terrestrial runoff on corals by storing and releasing phosphate in seawater.
Graph-structured populations and the Hill–Robertson effect
Authors: Whigham Peter A. , Spencer Hamish G.
Published: March 2021

The Hill–Robertson effect describes how, in a finite panmictic diploid population, selection at one diallelic locus reduces the fixation probability of a selectively favoured allele at a second, linked diallelic locus. Here we investigate the influence of population structure on the Hill–Robertson effect in a population of sizeN. We model population structure as a network by assuming that individuals occupy nodes on a graph connected by edges that link members who can reproduce with each other. Three regular networks (fully connected, ring and torus), two forms of scale-free network and a star are examined. We find that (i) the effect of population structure on the probability of fixation of the favourable allele is invariant for regular structures, but on some scale-free networks and a star, this probability is greatly reduced; (ii) compared to a panmictic population, the mean time to fixation of the favoured allele is much greater on a ring, torus and linear scale-free network, but much less on power-2 scale-free and star networks; (iii) the likelihood with which each of the four possible haplotypes eventually fix is similar across regular networks, but scale-free populations and the star are consistently less likely and much faster to fix the optimal haplotype; (iv) increasing recombination increases the likelihood of fixing the favoured haplotype across all structures, whereas the time to fixation of that haplotype usually increased, and (v) star-like structures were overwhelmingly likely to fix the least fit haplotype and did so significantly more rapidly than other populations. Last, we find that small (N< 64) panmictic populations do not exhibit the scaling property expected from Hill & Robertson (1966Genet. Res.8, 269–294. (doi:10.1017/S0016672300010156)).
Political architectures in the municipality of Varre-Sai (Brazil): forsustainabilitiesin ‘specialty coffees' production management
Authors: Morais Marcelo Orozco , César Pinheiro da Silva Augusto
Published: March 2021

The coffee cultivation has historically had great importance in Rio de Janeiro's social-spatial organization, and it is once again in the spotlight of the state's economic scenario. The novelty is that the local production has been renewed, and, now, the state surpasses the old status of ‘low-quality coffee producer' and achieves the ‘specialty coffee' market which, in addition to quality, also values environmental, social and economicsustainabilities1. This change has caused a series of transformations in the social-spatial and economic realities of some municipalities in the state of Rio de Janeiro. This article analyses the possiblesustainabilitiesexisting in the production process of this new coffee profile, based on the reality of the municipality of Varre-Sai, located in the northwest of Rio de Janeiro state. The objective is to find out the main actors and to elucidate the political network involved in this process.
Female putty-nosed monkeys (
Cercopithecus nictitans
) vocally recruit males for predator defence
Authors: Mehon Frederic Gnepa , Stephan Claudia
Published: March 2021

Alarm calls can trigger very different behavioural changes in receivers and signallers might apply different alarm call strategies based on their individual cost-benefit ratio. These cost-benefit ratios can also vary as a function of sex. For instance, male but not female forest guenons possess loud alarms that serve warning and predator deterrence functions, but also intergroup spacing and male–male competition. In some forest guenons, the context specificity and alarm call repertoire size additionally differs between females and males but it remains unclear if this corresponds to similar sexual dimorphisms in alarm calling strategies. We here experimentally investigated whether general female and more context-specific male alarm calls in putty-nosed monkeys (
Cercopithecus nictitans
) had different effects on the opposite sex's behaviour and whether they might serve different female and male alarm calling strategies. We presented a leopard model separately to the females or to the male of several groups while ensuring that the opposite sex only heard alarm calls of target individuals. While female alarms led to the recruitment of males in the majority of cases, male alarms did not have a similar effect on female behaviour. Males further seem to vocally advertise their engagement in group defence with more unspecific alarms while approaching their group. Males switched alarm call types once they spotted the leopard model and started mobbing behaviour. Females only ceased to alarm call when males produced calls typically associated with anti-predator defence, but not when males produced unspecific alarm calls. Our results suggest that sexual dimorphisms in the context specificity of alarms most likely correspond to different alarm calling strategies in female and male putty-nosed monkeys.
Estimating the state of the COVID-19 epidemic in France using a model with memory
Authors: Forien Raphaël , Pang Guodong , Pardoux Étienne
Published: March 2021

In this paper, we use a deterministic epidemic model with memory to estimate the state of the COVID-19 epidemic in France, from early March until mid-December 2020. Our model is in the SEIR class, which means that when a susceptible individual (S) becomes infected, he/she is first exposed (E), i.e. not yet contagious. Then he/she becomes infectious (I) for a certain length of time, during which he/she may infect susceptible individuals around him/her, and finally becomes removed (R), that is, either immune or dead. The specificity of our model is that it assumes a very general probability distribution for the pair of exposed and infectious periods. The law of large numbers limit of such a model is a model with memory (the future evolution of the model depends not only upon its present state, but also upon its past). We present theoretical results linking the (unobserved) parameters of the model to various quantities which are more easily measured during the early stages of an epidemic. We then apply these results to estimate the state of the COVID-19 epidemic in France, using available information on the infection fatality ratio and on the distribution of the exposed and infectious periods. Using the hospital data published daily by Santé Publique France, we gather some information on the delay between infection and hospital admission, intensive care unit (ICU) admission and hospital deaths, and on the proportion of people who have been infected up to the end of 2020.
Ecdysone coordinates plastic growth with robust pattern in the developing wing
Authors: Alves André Nogueira , Oliveira Marisa Mateus , Koyama Takashi , Shingleton Alexander , Mirth Christen
Published: March 2021

Animals develop in unpredictable, variable environments. In response to environmental change some aspects of development adjust to generate plastic phenotypes. Other aspects of development, however, are buffered against environmental change to produce robust phenotypes. How organ development is coordinated to accommodate both plastic and robust developmental responses is poorly understood. Here, we demonstrate that the steroid hormone ecdysone coordinates both plasticity of organ size and robustness of organ pattern in the developing wings of the fruit flyDrosophila melanogaster. Using fed and starved larvae that lack prothoracic glands, which synthesise ecdysone, we show that nutrition regulates growth both via ecdysone and via an ecdysone-independent mechanism, while nutrition regulates patterning only via ecdysone. We then demonstrate that growth shows a graded response to ecdysone concentration, while patterning shows a threshold response. Collectively, these data support a model where nutritionally-regulated ecdysone fluctuations confer plasticity by regulating disc growth in response to basal ecdysone levels, and confers robustness by initiating patterning only once ecdysone peaks exceeds a threshold concentration. This could represent a generalizable mechanism through which hormones coordinate plastic growth with robust patterning in the face of environmental change.
The Effects of Pericapsular nerve group (PENG) block on Postoperative Recovery in Elderly Patients with Hip fracture: a study protocol for randomized, parallel controlled, double-blind trial
Authors: Luo Wei , Luo Quehua , Wu Jieting , Liang Jianhui , Wu Huiyi , Ou Yanhua , Li Yuhui , Ma Wuhua
Published: March 2021

Introduction

Hip fracture is a common and serious emergency in the elderly, it is associated with severe pain, significant postoperative morbidity and mortality. Featuring peripheral nerve block in Enhanced recovery after surgery (ERAS) pathway may have significantly effect on shortening length of hospital stay, decreasing complications and costs, particular in improvement in dynamic pain and reducing the use of opioid. Pericapsular Nerve Group Block(PENG), suggested by Arangoet al, may provide a effective blockade to the articular branches of the anterior hip joint,which innervate the most section of the hip capsule richly, with a potential motor-sparing effect.The purpose of this trail is to investigate whether PENG is effective to enhanced recovery in elderly patients with hip fracture.

Methods and analysis

This study will be a single centre,randomized, parallel controlled, double-blind trail. 92 elderly patients scheduled for hip fracture surgery will be divided into two groups randomly to receive ultrasound-guided PENG block or ultrasound-guided femoral nerve(FN) block. The primary outcome will be compare the quality of recovery-15(QoR-15) score at 24h postoperatively between two groups.The secondary outcomes include the strength of quadriceps, the visual analogue scale(VAS) at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilization, the complications.

Ethics and dissemination

This study has been approved by the Medical Science Research Ethics Committees of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (Reference K2020-110). The results of this study will be published in peer-reviewed international journals.

Trial registration number

ChiCTR2100042341.
Show us the Data: Global COVID-19 Wastewater Monitoring Efforts, Equity, and Gaps
Authors: Naughton Colleen C. , Roman Fernando A. , Alvarado Ana Grace F. , Tariqi Arianna Q. , Deeming Matthew A. , Bibby Kyle , Bivins Aaron , Rose Joan B. , Medema Gertjan , Ahmed Warish , Katsivelis Panagis , Allan Vajra , Sinclair Ryan , Zhang Yihan , Kinyua Maureen N.
Published: March 2021

A year since the declaration of the global coronavirus disease 2019 (COVID-19) pandemic there were over 110 million cases and 2.5 million deaths. Learning from methods to track community spread of other viruses such as poliovirus, environmental virologists and those in the wastewater based epidemiology (WBE) field quickly adapted their existing methods to detect SARS-CoV-2 RNA in wastewater. Unlike COVID-19 case and mortality data, there was not a global dashboard to track wastewater monitoring of SARS-CoV-2 RNA worldwide. This study provides a one year review of the “COVIDPoops19” global dashboard of universities, sites, and countries monitoring SARS-CoV-2 RNA in wastewater. Methods to assemble the dashboard combined standard literature review, direct submissions, and daily, social media keyword searches. Over 200 universities, 1,000 sites, and 55 countries with 59 dashboards monitor wastewater for SARS-CoV-2 RNA. However, monitoring is primarily in high-income countries (65%) with less access to this valuable tool in low and middle income countries (35%). Data are not widely shared publicly or accessible to researchers to further inform public health actions, perform meta-analysis, better coordinate, and determine equitable distribution of monitoring sites. For WBE to be used to its full potential during COVID-19 and beyond, show us the data.
Lessons learned from the resilience of Chinese hospitals to the COVID-19 pandemic: a scoping review
Authors: Stennett Jack , Hou Renyou , Traverson Lola , Ridde Valéry , Zinszer Kate , Chabrol Fanny
Published: March 2021

As the SARS-CoV-2 pandemic has brought huge strain on hospitals worldwide, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic. This paper aims to determine the key findings, recommendations and lessons learned in terms of hospital resilience during the pandemic, as well as the quality and limitations of research in this field at present.

We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the CNKI and WHO databases) were used to identify papers meeting the eligibility criteria, from which we selected 59 publications (English: n= 26; Chinese: n= 33). After extracting the data, we present an information synthesis using a resilience framework.

We found that much research was rapidly produced in the first half of 2020, describing certain strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene and planning. Our search revealed that considerable attention was focused on interventions related to training, healthcare worker well-being, e-health/ telemedicine, and work organization, while other areas, such as hospital financing, information systems and healthcare infrastructure, were less well represented in the literature.

We identified a number of lessons learned regarding how China’s hospitals have maintained resilience when confronted with the SARS-CoV-2 pandemic. However, we also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly-focused research on individual interventions and holistic research that attempted to unite the topics within a resilience framework. Research on Chinese hospitals would benefit from a greater range of analysis in order to draw more nuanced and contextualised lessons from the responses to the crisis.
Pneumonia in patients with rheumatoid arthritis: effect of microbial airway colonization
Authors: Ideguchi Shuhei , Yamamoto Kazuko , Tahara Masahiro , Koga Tomohiro , Ide Shotaro , Hirayama Tatsuro , Takazono Takahiro , Imamura Yoshifumi , Miyazaki Taiga , Sakamoto Noriho , Morimoto Shimpei , Izumikawa Koichi , Yanagihara Katsunori , Ashizawa Kazuto , Aoki Takatoshi , Kawakami Atsushi , Yatera Kazuhiro , Mukae Hiroshi
Published: March 2021

Rheumatoid arthritis frequently complicates airway diseases and is associated with high rates of pneumonia and mortality. The relationship between microorganisms colonizing the lower respiratory tract and the subsequent incidence of pneumonia in patients with rheumatoid arthritis is unclear. In this study, we aimed to identify microorganisms colonizing the lower respiratory tract in patients with rheumatoid arthritis related to the risk of developing subsequent pneumonia in these patients.

A retrospective cohort study was designed to include a total of 121 patients with rheumatoid arthritis (median age, 67 years; women, 78.5%) who underwent bronchoscopy at three hospitals from January 2008 to December 2017. The following information was extracted from their electronic medical records: patient characteristics, microorganisms detected by bronchoscopy, and subsequent incidences of pneumonia. The patients were divided into groups based on the microorganisms isolated from the lower respiratory tract and compared with control subjects. The cumulative incidence of pneumonia was assessed using the Kaplan–Meier method and log-rank test. Risk factors for pneumonia were analyzed using the Cox proportional-hazards analysis.

The most frequently isolated microbes from the lower respiratory tract in descending order were Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae. The annual incidence rates of pneumonia per 1000 patients were 100, 62, 132, and 38, in the P. aeruginosa, S. aureus, H. influenzae, and control group, respectively. Patients colonized with P. aeruginosa had a higher frequency of macrolide use and a higher degree of bronchiectasis than patients in the control group. The rate of the subsequent incidence of pneumonia was higher in the P. aeruginosa group (P = 0.038), and P. aeruginosa was an independent risk factor for pneumonia (hazard ratio, 3.504; 95% confidence interval, 1.153–10.330).

The colonization of the lower respiratory tract by P. aeruginosa in patients with rheumatoid arthritis was associated with the subsequent incidence of pneumonia.
Tocilizumab Effect in COVID-19 Hospitalized Patients: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Abdulrahman Basheer , Aletreby Waleed , Mady Ahmed , Noor Alfateh Mohammed , Lhmdi Mohammed , Faqihi Fahad , Alharthy Abdulrahman , Al-Odat Mohammed , Karakitsos Dimitrios , Memish Ziad
Published: March 2021

Since the emergence of the first cases of COVID-19 viral pneumonia late 2019 several studies evaluated the benefits of different treatment modalities. Early in the pandemic, the interleukin 6 (IL-6) receptor antibody Tocilizumab was considered in view of the cytokine release syndrome associated with COVID-19 infection. Several early observational studies showed beneficial effect of treatment with Tocilizumab on mortality, however, results from well-designed randomized clinical trials (RCT) were contradicting.

Objectives

To perform a systematic literature review and meta-analysis of RCTs utilizing Tocilizumab in the treatment of COVID-19 pneumonia, with in-hospital mortality as a primary objective, while secondary objectives included composite outcome of mortality, intubation, or ICU admission, another secondary outcome was super added infection.

Method

This was a random effects model (DerSimonian and Laird) model of relative risk (RR), along with corresponding 95% confidence intervals, p values, and forest plots of both primary and secondary outcomes. A fixed effect sensitivity test was performed for the primary outcome, in addition to subgroup and meta-regression analyses with predefined criteria.

Results

The primary outcome of mortality showed statistically insignificant reduction of mortality with Tocilizumab (RR = 0.9, 95% CI: 0.8 – 1.01; p = 0.09) although with an unmistakable apparent clinical benefit. There was a significant reduction in the RR of the secondary composite outcome (RR = 0.83, 95% CI: 0.76 – 0.9; p < 0.001), and no difference between groups in super-added infection (RR = 0.77, 95% CI: 0.51 – 1.19; p = 0.24). Treatment protocol allowing a second dose was the only significant predictor of improved mortality in the meta-regression analysis. Certainty of evidence was reduced to moderate for the primary outcome and the secondary outcome of clinical deterioration, while it was reduced to low for the secondary outcome of super-added infection.

Conclusion

Moderate certainty of evidence suggest no statistically significant improvement of 28-30 day all-cause mortality of hospitalized COVID-19 patients treated with TCZ, although there may be clinically important value. Moderate certainty of evidence suggest lowered relative risk of a composite outcome of death or clinical deterioration, while, low grade evidence indicate no increase in the risk of super-added infection associated with TCZ treatment. A protocol allowing two doses of TCZ shows evidence of improved mortality as compared to a strictly single dose protocol.
Electronic health record enabled track and trace in an urban hospital network: implications for infection prevention and control
Authors: Pi Li , Expert Paul , Clarke Jonathan M , Jauneikaite Elita , Costelloe Céire E
Published: March 2021

Healthcare-associated infections represent one of the most significant challenges for modern medicine as they can significantly impact patients’lives. Carbapenemase-producing Enterobacteriaceae (CPE) pose the greatest clinical threat, given the high levels of resistance to carbapenems, which are considered as agents of ‘last resort’ against life-threatening infections. Understanding patterns of CPE infection spreading in hospitals is paramount to design effective infection control protocols to mitigate the presence of CPE in hospitals. We used patient electronic health records from three urban hospitals to: i) track microbiologically confirmed carbapenemase producingEscherichia coli(CP-Ec) carriers and ii) trace the patients they shared place and time with until their identification. We show that yearly contact networks in each hospital consistently exhibit a core-periphery structure, highlighting the presence of a core set of wards where most carrier-contact interactions occured before being distributed to peripheral wards. We also identified functional communities of wards from the general patient movement network. The contact networks projected onto the general patient movement community structure showed a comprehensive coverage of the hospital. Our findings highlight that infections such as CP-Ec infections can reach virtually all parts of hospitals through first-level contacts.
A bibliometric analysis of COVID-19 research in Africa
Authors: Guleid Fatuma H , Oyando Robinson , Kabia Evelyn , Mumbi Audrey , Akech Samuel , Barasa Edwine
Published: March 2021

Background

The ongoing COVID-19 pandemic has led to an unprecedented global research effort to build a body of knowledge that can inform mitigation strategies. We carried out a bibliometric analysis to describe the COVID-19 research output in Africa.

Methods

We searched for articles published between 1st December 2019 and 3rd January 2021 from various databases including PubMed, African Journals Online, MedRxiv, BioRxiv, Collabovid, the World Health Organisation global research database and Google for grey literature. Editorial type publications and papers reporting original research done in Africa and were included. Data analysis was done using Microsoft Excel.

Results

A total of 1296 articles were retrieved. 46.6% were primary research articles, 48.6% were editorials type articles while 4.6% were secondary research articles. 20.3% articles used the entire continent of Africa as their study setting while South Africa (15.4%) was the most common country focused setting. 90.3% of the articles had at least one African researcher as author, 78.5% had an African researcher as first author, while 63.5% had an African researcher as last author. The University of Cape Town tops the list with the greatest number of first and last authors. Over 13% of the articles were published in MedRxiv and of the studies that declared funding, the Wellcome Trust was the top funding body. The most common research topics include “country preparedness and response” (24.9%) and “the direct and indirect health impacts of the pandemic” (21.6%). However, only 1.0% of articles focus on therapeutics and vaccines.

Conclusions

This study sheds light on the contribution of African researchers to COVID-19 research in Africa and highlights Africa’s existing capacity to carry out research that addresses local problems. However, the uneven distribution of research productivity amongst African countries emphasizes the need for increased investment where needed.
Seroreactivity to SARS-CoV-2 in individuals attending a university campus in Bogotá Colombia
Authors: Gonzalez John M. , Santos-Barbosa Juan Carlos , Jaller Catherine , Otalora German , Hernandez Luis J. , Guevara-Suarez Marcela , Restrepo Silvia
Published: March 2021

Most community-specific serological surveys for SARS-CoV-2 antibodies have been performed in healthcare workers and institutions. In this study, IgG antibodies specific to the virus were evaluated in individuals working at a university campus in Bogotá, Colombia. The aim of this work was to determine previous exposure to SARS-CoV-2 in those attending the campus during city lockdown. A total of 237 individuals, including 93 women and 144 men were evaluated using chemiluminescent detection of IgG anti N-viral protein between November and December 2020. There were 32 positives individuals corresponding to a seroprevalence of 13.5% (10 women and 22 men) and mostly asymptomatic (68.75%) and three cluster of seropositive individuals were identified. Only 13 of the seropositive individuals had previous positive detection of SARS-CoV-2 RNA by RT-qPCR performed in average 91 days before serological test. Seropositive individuals did not come from boroughs having higher percentages of SARS-CoV-2 cases in the city. This survey was carried out after the first peak of SARS-CoV-2 transmission in the city, and before the preparedness to reopening the campus for students in 2021, demonstrating a low seroprevalence in high percentage of asymptomatic. These results will help to evaluate some of the strategies stablished to control virus spread in the campus or other similar communities.