bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic burden and health related quality of life of ultra-rare Gaucher disease in China
Authors: Qi Xinye , Xu Jiao , Shan Linghan , Li Ye , Cui Yu , Liu Huan , Wang Kexin , Gao Lijun , Kang Zheng , Wu Qunhong
Published: August 2021

Background

The diagnosis and health care of patients with rare diseases present a tremendous challenge worldwide. This study described the health care service utilization through participants’ perspective and estimated the cost of illness (COI), and patients with Gaucher disease (GD)’s/caregivers’ health-related quality of life in China.

Method

An online retrospective survey of patients with GD and their caregivers was conducted during May–June 2018. Socio-demographic, health service utilization, disease-related expenses, social support, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the Short Form Health Survey (SF-36) were investigated. Using self-reported information, we estimated the annual COI, including direct healthcare, direct non-healthcare, and indirect costs.

Results

Forty patients and their 49 caregivers were surveyed. The patients’ onset age of GD was 9.3 ± 10.9; their disease course was 3.5 ± 3.1 years. 21 (42.9%) patients had ≥ 2 caregivers, but 35 (71.4%) caregivers reported have no experience as a caregiver. 79.6% caregivers have stopped working, and 87.8% changed weekly working schedule. Before final diagnosis, patients visited 3.9 ± 3.1 (max = 20) hospitals and took 1.2 ± 1.7 (max = 6.6) years for confirmed diagnosis. On average, 5.0 ± 9.6 misdiagnoses occurred, and the per-patient diagnoses cost was USD ($) 7576. After GD confirmation, 8 (16.3%) patients received no treatment, 40 (81.6%) received pharmacotherapy, 10 (20.4%) received surgery, 38 (77.6%) received outpatient service (8.8 ± 9.1 times/annually), and 37 (77.5%) received inpatient service (4.0 ± 3.5 times/annually). Annual per-patient COI was USD ($) 49,925 (95% confidence interval: 29,178, 70,672). Average direct healthcare cost was $41,816, including pharmaceutical ($29,908), inpatient ($7,451), and outpatient ($1,838). Productivity loss per-caregiver was $1,980, and their Zarit Burden Inventory score was moderate-severe (48.6 ± 19.6). Both patients/caregivers reported lower social support (32.4 ± 7.4, 34.9 ± 7.6), two times higher PSQI (7.9 ± 2.9, 8.7 ± 3.6), and half lower SF-36 (41.3 ± 18.6, 46.5 ± 19.3) than those reported for healthy Chinese individuals.

Conclusions

The high misdiagnosis rate, together with delayed diagnosis, substantial costs, and deteriorated health-related quality of life of GD patients as well as their heavy care burden, calls for extreme attention from policymakers in China. Further efforts of government and society are urgently demanded, including pharmaceutical reimbursement, screening newborns, developing precise diagnostic tools, and training doctors.
Microglial inclusions and neurofilament light chain release follow neuronal α-synuclein lesions in long-term brain slice cultures
Authors: Barth Melanie , Bacioglu Mehtap , Schwarz Niklas , Novotny Renata , Brandes Janine , Welzer Marc , Mazzitelli Sonia , Häsler Lisa M. , Schweighauser Manuel , Wuttke Thomas V. , Kronenberg-Versteeg Deborah , Fog Karina , Ambjørn Malene , Alik Ania , Melki Ronald , Kahle Philipp J. , Shimshek Derya R. , Koch Henner , Jucker Mathias , Tanriöver Gaye
Published: August 2021

Background

Proteopathic brain lesions are a hallmark of many age-related neurodegenerative diseases including synucleinopathies and develop at least a decade before the onset of clinical symptoms. Thus, understanding of the initiation and propagation of such lesions is key for developing therapeutics to delay or halt disease progression.

Methods

Alpha-synuclein (αS) inclusions were induced in long-term murine and human slice cultures by seeded aggregation. An αS seed-recognizing human antibody was tested for blocking seeding and/or spreading of the αS lesions. Release of neurofilament light chain (NfL) into the culture medium was assessed.

Results

To study initial stages of α-synucleinopathies, we induced αS inclusions in murine hippocampal slice cultures by seeded aggregation. Induction of αS inclusions in neurons was apparent as early as 1week post-seeding, followed by the occurrence of microglial inclusions in vicinity of the neuronal lesions at 2–3 weeks. The amount of αS inclusions was dependent on the type of αS seed and on the culture’s genetic background (wildtype vs A53T-αS genotype). Formation of αS inclusions could be monitored by neurofilament light chain protein release into the culture medium, a fluid biomarker of neurodegeneration commonly used in clinical settings. Local microinjection of αS seeds resulted in spreading of αS inclusions to neuronally connected hippocampal subregions, and seeding and spreading could be inhibited by an αS seed-recognizing human antibody. We then applied parameters of the murine cultures to surgical resection-derived adult human long-term neocortical slice cultures from 22 to 61-year-old donors. Similarly, in these human slice cultures, proof-of-principle induction of αS lesions was achieved at 1week post-seeding in combination with viral A53T-αS expressions.

Conclusion

The successful translation of these brain cultures from mouse to human with the first reported induction of human αS lesions in a true adult human brain environment underlines the potential of this model to study proteopathic lesions in intact mouse and now even aged human brain environments.
Cerebrospinal fluid cell count variability is a major confounding factor in external ventricular drain-associated infection surveillance diagnostics: a prospective observational study
Authors: Bådholm Marcus , Blixt Jonas , Glimåker Martin , Ternhag Anders , Hedlund Jonas , Nelson David W.
Published: August 2021

Background

External ventricular drain (EVD)-related infections (EVDIs) are feared complications that are difficult to rapidly and correctly diagnose, which can lead to unnecessary treatment with broad-spectrum antibiotics. No readily available diagnostic parameters have been identified to reliably predict or identify EVDIs. Moreover, intraventricular hemorrhage is common and affect cerebrospinal fluid (CSF) cellularity. The relationship between leukocytes and erythrocytes is often used to identify suspected infection and triggers the use of antibiotics pending results of cultures, which may take days. Cell count based surveillance diagnostics assumes a homogeneous distribution of cells in the CSF. Given the intraventricular sedimentation of erythrocytes on computed tomography scans this assumption may be erroneous and could affect diagnostics.

Aims

To evaluate the consistency of cell counts in serially sampled CSF from EVDs, with and without patient repositioning, to assess the effect on infection diagnostics.

Methods

We performed a prospective single-center study where routine CSF sampling was followed by a second sample after 10 min, allocated around a standard patient repositioning, or not. Changes in absolute and pairwise cell counts and ratios were analyzed, including mixed regression models.

Results

Data from 51 patients and 162 paired samples were analyzed. We observed substantial changes in CSF cellularity as the result of both resampling and repositioning, with repositioning found to be an independent predictor of bidirectional cellular change. Glucose and lactate levels were affected, however clinically non-significant. No positive CSF cultures were seen during the study. Thirty percent (30%) of patients changed suspected EVDI status, as defined by the cell component of local and national guidelines, when resampling after repositioning.

Conclusions

CSF cell counts are not consistent and are affected by patient movement suggesting a heterogeneity in the intraventricular space. The relationship between leukocytes and erythrocytes was less affected than absolute changes. Importantly, cell changes are found to increase with increased cellularity, often leading to changes in suspected EVDI status. Faster and more precise diagnostics are needed, and methods such as emerging next generation sequencing techniques my provide tools to more timely and accurately guide antibiotic treatment.

Trial RegistrationNCT04736407, Clinicaltrials.gov, retrospectively registered 2nd February 2021.
Comparison of iguratimod and conventional cyclophosphamide with sequential azathioprine as treatment of active lupus nephritis: study protocol for a multi-center, randomized, controlled clinical trial (iGeLU study)
Authors: Yan Qingran , Du Fang , Kang Yuening , Ye Ping , Wang Xiaodong , Xu Jianhua , Tang Jianping , Wang Niansong , Jiang Gengru , Li Zhijun , Wang Xuan , Xue Qin , Huang Xinfang , Zhang Xiaoyan , Zhou Ying , Dai Min , Bao Chunde
Published: August 2021

Background

Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve multiple organs or systems. Lupus nephritis (LN) is associated with high mortality and morbidity. However, plenty of patients do not respond to present treatment or relapse. Iguratimod (IGU) is a new small molecular, anti-rheumatic drug and has shown the potential for drug repurposing from rheumatoid arthritis (RA) to LN treatment. It has been approved for treating RA in northeast Asia. Beyond expectation in a recent observational study, over 90% of thirteen refractory LN patients responded to iguratimod monotherapy in 24 weeks, with no steroids dose increasing or any other medication add-on during the entire follow-up.

Methods/design

This study is a multi-center, randomized, 52-week parallel positive drug-controlled study. The study was designed as a head-to-head comparison between the iguratimod and present first-line therapy on LN patients. A total of 120 patients (60 patients each group) is in the enrolling plan. All enrolled patients are assigned randomly into trial and control groups. The patients will be selected from six study sites in China and will all have biopsy-proven active lupus nephritis. In the first 24 weeks of the trial, IGU is compared with cyclophosphamide as an induction therapy, and in the second 24 weeks, IGU is compared with azathioprine as a maintenance therapy. The primary outcome is renal remission rate including both complete remission and partial remission at week 52, which will be analyzed using a non-inferiority hypothesis test.

Discussion

Most patients diagnosed with SLE will develop LN within 5 years and LN remains a major cause of morbidity and death for SLE patients. Although some medications are proven effective for the treatment of this condition, at least 20–35% LN patients have to suffer from relapse or ineffective treatment and medication intolerance is also frequent. This trial is designed to demonstrate whether iguratimod can be used as an alternative induction or maintenance therapy in subjects who have lupus nephritis. Data from this study will provide an evidence on whether or not iguratimod should be recommended to active LN patients.

Trial registration

ClinicalTrials.govNCT 02936375. Registered on October 18, 2016.
Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care
Authors: Nemis-White Joanna M. , Hamilton Laura M. , Shaw Sarah , MacKillop James H. , Parkash Ratika , Choudhri Shurjeel H. , Ciaccia Antonio , Xie Feng , Thabane Lehana , Cox Jafna L. ,   for the IMPACT-AF Investigators
Published: August 2021

Background

Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) was a pragmatic, cluster randomized trial assessing the effectiveness of a clinical decision support (CDS) tool in primary care, Nova Scotia, Canada. We evaluated if CDS software versus Usual Care could help primary care providers (PCPs) deliver individualized guideline-based AF patient care.

Methods

Key study challenges including CDS development and implementation, recruitment, and data integration documented over the trial duration are presented as lessons learned.

Results

Adequate resources must be allocated for software development, updates and feasibility testing. Development took longer than projected. End-user feedback suggested network access and broadband speeds impeded uptake; they felt further that the CDS was not sufficiently user-friendly or efficient in supporting AF care (i.e., repetitive alerts).

Integration across e-platforms is crucial. Intellectual property and other issues prohibited CDS integration within electronic medical records and provincial e-health platforms. Double login and data entry were impediments to participation or reasons for provider withdrawal. Data integration challenges prevented easy and timely data access, analysis, and reporting.

Primary care study recruitment is resource intensive. Altogether, 203 PCPs and 1145 of their patients participated, representing 25% of eligible providers and 12% of AF patients in Nova Scotia, respectively. The most effective provider recruitment strategy was in-office, small group lunch-and-learns. PCPs with past research experience or who led patient consent were top recruiters. The study office played a pivotal role in achieving patient recruitment targets.

Conclusions

A rapid growth in healthcare data is leading to widespread development of CDS. Our experience found practical issues to address for such applications to succeed. Feasibility testing to assess the utility of any healthcare CDS prior to implementation is recommended. Adequate resources are necessary to support successful recruitment for future pragmatic trials. CDS tools that integrate multiple co-morbid guidelines across eHealth platforms should be pursued.

Trial registration

ClinicalTrials.gov NCT01927367. Registered on August 22, 2013
Symptoms in first-degree relatives of patients with rheumatoid arthritis: evaluation of cross-sectional data from the symptoms in persons at risk of rheumatoid arthritis (SPARRA) questionnaire in the PRe-clinical EValuation of Novel Targets in RA (PREVeNT-RA) Cohort
Authors: Costello R. E. , Humphreys J. H. , Sergeant J. C. , Haris M. , Stirling F. , Raza K. , van Schaardenburg D. , Bruce Ian N.
Published: August 2021

Background

First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) have a fourfold increased risk of developing RA. The Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire was developed to document symptoms in persons at risk of RA. The aims of this study were (1) to describe symptoms in a cohort of FDRs of patients with RA overall and stratified by seropositivity and elevated CRP and (2) to determine if patient characteristics were associated with symptoms suggestive of RA.

Methods

A cross-sectional study of FDRs of patients with RA, in the PREVeNT-RA study, who completed a study questionnaire, provided a blood sample measured for rheumatoid factor, anti-CCP and CRP and completed the SPARRA questionnaire. Moderate/severe symptoms and symmetrical, small and large joint pain were identified and described. Symptoms associated with both seropositivity and elevated CRP were considered suggestive of RA. Logistic regression was used to determine if symptoms suggestive of RA were associated with patient characteristics.

Results

Eight hundred seventy participants provided all data, 43 (5%) were seropositive and 122 (14%) had elevated CRP. The most frequently reported symptoms were sleep disturbances (20.3%) and joint pain (17.9%). Symmetrical and small joint pain were 11.3% and 12.8% higher, respectively, in those who were seropositive and 11.5% and 10.7% higher in those with elevated CRP. In the logistic regression model, seropositivity, older age and feeling depressed were associated with increased odds of small and symmetrical joint pain.

Conclusions

This is the first time the SPARRA questionnaire has been applied in FDRs of patients with RA and has demonstrated that the presence of symmetrical and small joint pain in this group may be useful in identifying people at higher risk of developing RA.
Joint optimization of BS-VS association and power control in secure HSR communication systems
Authors: Xu Hao , Yan Lu , Liu Haixiang , Li Ke , Wang Jian
Published: August 2021

In this paper, the secure transmission for high-speed railway (HSR) communication system is studied. The considered HSR wireless communication system consists of a macro base station, B roadside base stations, and K vehicle stations (VSs) on the top of the train, and the eavesdropping user is a mobile unmanned aerial vehicle (UAV). We consider maximizing the sum of the minimum security rate of each time slot as the objective function, and the constraint conditions contain the quality of service (QoS), switch requirements and the total power constraint. The original optimization problem is mixed-integer and non-convex, it is intractable to solve directly. The block coordinate descent (BCD) method is applied, and the original problem can be decoupled into two sub-problems. The one is the joint BS-VS association problem, and the other is the power control problem. The first sub-problem of optimizing BS-VS association can be solved by the successive convex approximation (SCA) algorithm, and the second one of optimizing transmit power can be solved by the lagrangian dual method. Simulation results show that the proposed algorithms have good convergence.
Stability of solutions for generalized fractional differential problems by applying significant inequality estimates
Authors: Kassim Mohammed D. , Abdeljawad Thabet , Ali Saeed M. , Abdo Mohammed S.
Published: August 2021

In this research paper, we intend to study the stability of solutions of some nonlinear initial value fractional differential problems. These equations are studied within the generalized fractional derivative of various orders. In order to study the solutions’ decay to zero as a power function, we establish sufficient conditions on the nonlinear terms. To this end, some versions of inequalities are combined and generalized via the so-called Bihari inequality. Moreover, we employ some properties of the generalized fractional derivative and appropriate regularization techniques. Finally, the paper involves examples to affirm the validity of the results.
Bacterial colonization dynamics and antibiotic resistance gene dissemination in the hospital environment after first patient occupancy: a longitudinal metagenetic study
Authors: Klassert Tilman E. , Leistner Rasmus , Zubiria-Barrera Cristina , Stock Magdalena , López Mercedes , Neubert Robert , Driesch Dominik , Gastmeier Petra , Slevogt Hortense
Published: August 2021

Background

Humans spend the bulk of their time in indoor environments. This space is shared with an indoor ecosystem of microorganisms, which are in continuous exchange with the human inhabitants. In the particular case of hospitals, the environmental microorganisms may influence patient recovery and outcome. An understanding of the bacterial community structure in the hospital environment is pivotal for the prevention of hospital-acquired infections and the dissemination of antibiotic resistance genes. In this study, we performed a longitudinal metagenetic approach in a newly opened ward at the Charité Hospital (Berlin) to characterize the dynamics of the bacterial colonization process in the hospital environment after first patient occupancy.

Results

The sequencing data showed a site-specific taxonomic succession, which led to stable community structures after only a few weeks. This data was further supported by network analysis and beta-diversity metrics. Furthermore, the fast colonization process was characterized by a significant increase of the bacterial biomass and its alpha-diversity. The compositional dynamics could be linked to the exchange with the patient microbiota. Over a time course of 30 weeks, we did not detect a rise of pathogenic bacteria in the hospital environment, but a significant increase of antibiotic resistance determinants on the hospital floor.

Conclusions

The results presented in this study provide new insights into different aspects of the environmental microbiome in the clinical setting, and will help to adopt infection control strategies in hospitals and health care-related buildings.
Established and candidate transthyretin amyloidosis variants identified in the Saudi population by data mining
Authors: Abouelhoda Mohamed , Mohty Dania , Alayary Islam , Meyer Brian F. , Arold Stefan T. , Fadel Bahaa M. , Monies Dorota
Published: August 2021

Abstract

Background

Familial transthyretin (TTR) amyloidosis (ATTR) is an autosomal dominant disease with significant phenotypic heterogeneity. Its prevalence in Saudi Arabia has not previously been investigated. An existing exome variant database of Saudi individuals, sequenced to globally investigate rare diseases in the population, was mined for TTR variants and filtered for missense mutations resulting in single amino acid changes. A total of 13,906 Saudi exomes from unrelated individuals were analyzed blindly.

Results

Three TTR variants known to be associated with ATTR amyloidosis were identified. Additionally, three novel TTR mutations were identified. Structural analysis of the three novel variants suggests that at least two could be amyloidogenic. The most common variant associated with amyloidosis was p.Val142Ile (allele frequency 0.001). Further investigation of these variants and their translation to clinical practice may help to diagnose, monitor, and manage patients with ATTR amyloidosis.

Conclusion

Multiple TTR variants potentially associated with systemic ATTR amyloidosis were identified in the Saudi population. Early diagnosis and intervention, facilitated by familial genetic testing of patients with ATTR amyloidosis, may benefit in the management of this disease. Early diagnosis could be enhanced through inclusion of ATTR variants in existing population-based screening programs.
A segmental osteotomy with 3D virtual planning to move a malpositioned dental implant
Authors: Bastidas Dario Andrés , Roldan Lina , Ramirez Pamela , Munera Andrés
Published: August 2021

Background

Correct positioning and alignment of dental implants are crucial to successfully meet the aesthetic and functional criteria in implant-prosthetic rehabilitation. When an implant is in the wrong position, especially in the esthetical zone, there are limited options to solve it. Some techniques have been described to reposition implants, such as reverse torque, trephine drills, and segmental osteotomies; current approaches aim to reduce the damage of the periimplant tissues.

Case presentation

A 20-year-old man with good general health was referred to the oral and maxillofacial surgery department of the CES University, Medellin Colombia in 2017, He had undergone a previous camouflage orthodontic therapy for a dental Class III, which finished in 2014, posteriorly a dental implant was placed in 2015 to replace upper right lateral incisor (1.2) before vertical growth of maxilla was complete; therefore, the implant was retained in a coronal position. A segmental osteotomy was suggested to reposition the implant in a more caudal position, a 3D surgical cut guide obtained by virtual planning was used to increase osteotomy accuracy and lower human error, to avoid the risk of damaging the adjacent tissues and to achieve a predictable result.

Conclusions

The segmental alveolar osteotomy is an effective alternative to reposition an implant; however, it must be carefully planned because human error remains a possibility that may affect the final result. Therefore, 3D planning is a better way to minimize these mistakes during the surgical procedure and the final position of the implant.
Data mining in clinical big data: the frequently used databases, steps, and methodological models
Authors: Wu Wen-Tao , Li Yuan-Jie , Feng Ao-Zi , Li Li , Huang Tao , Xu An-Ding , Lyu Jun
Published: August 2021

Many high quality studies have emerged from public databases, such as Surveillance, Epidemiology, and End Results (SEER), National Health and Nutrition Examination Survey (NHANES), The Cancer Genome Atlas (TCGA), and Medical Information Mart for Intensive Care (MIMIC); however, these data are often characterized by a high degree of dimensional heterogeneity, timeliness, scarcity, irregularity, and other characteristics, resulting in the value of these data not being fully utilized. Data-mining technology has been a frontier field in medical research, as it demonstrates excellent performance in evaluating patient risks and assisting clinical decision-making in building disease-prediction models. Therefore, data mining has unique advantages in clinical big-data research, especially in large-scale medical public databases. This article introduced the main medical public database and described the steps, tasks, and models of data mining in simple language. Additionally, we described data-mining methods along with their practical applications. The goal of this work was to aid clinical researchers in gaining a clear and intuitive understanding of the application of data-mining technology on clinical big-data in order to promote the production of research results that are beneficial to doctors and patients.
Coronary artery aneurysms in children is not always Kawasaki disease: a case report on Takayasu arteritis
Authors: Lee Michelle , Meidan Esra , Son MaryBeth , Dionne Audrey , Newburger Jane W. , Friedman Kevin G.
Published: August 2021

Background

Coronary artery (CA) aneurysms in children are a rare but potentially life-threatening finding and are highly associated with Kawasaki disease (KD).

Case presentation

We describe a four-year-old female with a vasculitis and CA aneurysms. She had a prolonged course with recurrent fever and systemic inflammation several times upon discontinuation of steroid treatment. Due in part to the CA aneurysms, she initially was diagnosed with KD but due to the unusual clinical course, further evaluation was performed. Abdominal and chest MRI/A revealed diffuse aortitis suggestive of a large vessel vasculitis, specifically Takayasu arteritis. With treatment targeted for Takayasu arteritis, there was resolution of fever and inflammation and the CA aneurysms improved.

Conclusions

This case demonstrates the utility in broadening the differential diagnosis in cases of presumed KD with CA involvement in which the clinical course is atypical for KD.
Susceptibility of the fall armyworm, Spodoptera frugiperda (J.E. Smith, 1797) (Lepidoptera: Noctuidae), to four species of entomopathogenic nematodes (Steinernematidae and Heterorhabditidae) from Mizoram, North-Eastern India
Authors: Lalramnghaki Hrang Chal , Lalramliana  , Lalremsanga Hmar Tlawmte , Vanlalhlimpuia  , Lalramchuani Mary , Vanramliana
Published: August 2021

Background

Outbreak of the fall armyworm Spodoptera frugiperda (J.E. Smith, 1797)
(Lepidoptera: Noctuidae) occurred in Mizoram, North-Eastern India. The infestation spread in the entire state covering a total area of around 2840 hectares of maize cultivated land. Entomopathogenic nematodes (EPNs) represent potential candidates for the biological control of S. frugiperda. In the study,
the susceptibility of the pest against 4 locally isolated EPN species Heterorhabditis indica, H. baujardi, Steinernema sangi and S. surkhetense was evaluated.

Results

The results indicated that all the isolated EPN species showed a high rate of larvicidal and pupicidal activities against the pest. Mortality between 43.75–100.00 and 25.00–100.00% of 3rd and 5th larval instars, respectively (at concentrations 10–800 IJs/larva), and 37.50–68.75% mortality of pupae (at concentrations 200–1600 IJs /pupa) were found after exposure to the EPN species. The mortality rate of the pest showed significant variations with life stages of the host insect, nematode concentrations and incubation time. Based on the median lethal concentration (LC50), H. indica was the most pathogenic species, followed by S. sangi, H. baujardi and S. surkhetense. The LC50 values of H. indica at 72 h post-incubation were 20.26 and 62.07 IJs/larva for the 3rd and 5th larval instars, respectively, and 913.34 IJs/pupa. The penetration assay showed that H. indica had the highest penetration rate into the hosts, 27.24, 21.30 and 20.00% in the 3rd, 5th larval instars and pupae, respectively. Furthermore, all the EPN isolates were capable of successful multiplication inside the cadaver of S. frugiperda that showed significant differences with the EPN isolates and life stages of the pest. Among the isolates, H. indica showed the highest multiplication rates, 17,692.25 ± 2103.59, 8345.63 ± 785.34 and 79,146.38 ± 5943.73 IJs per 3rd instar larva, 5th instar larva and pupa, respectively.

Conclusions

The study revealed that the 4 species of EPNs showed a high potency against S. frugiperda, thereby having the potential to be developed as a biological control agent against the pest. Moreover, the isolated EPN species could potentially serve as alternatives for chemical insecticides and could further be incorporated into the Integrated Pest Management (IPM).
Randomized Phase III Trial of Prophylactic Cranial Irradiation With or Without Hippocampal Avoidance for Small-Cell Lung Cancer (PREMER): A GICOR-GOECP-SEOR Study
Authors: Rodríguez de Dios Núria , Couñago Felipe , Murcia-Mejía Mauricio , Rico-Oses Mikel , Calvo-Crespo Patricia , Samper Pilar , Vallejo Carmen , Luna Javier , Trueba Itziar , Sotoca Amalia , Cigarral Cristina , Farré Núria , Manero Rosa M. , Durán Xavier , Gispert Juan Domigo , Sánchez-Benavides Gonzalo , Rognoni Teresa , Torrente Margarita , Capellades Jaume , Jiménez Mar , Cabada Teresa , Blanco Miguel , Alonso Ana , Martínez-San Millán Juan , Escribano José , González Beatriz , López-Guerra José Luis
Published: August 2021

PURPOSE

Radiation dose received by the neural stem cells of the hippocampus during whole-brain radiotherapy has been associated with neurocognitive decline. The key concern using hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) in patients with small-cell lung cancer (SCLC) is the incidence of brain metastasis within the hippocampal avoidance zone.

METHODS

This phase III trial enrolled 150 patients with SCLC (71.3% with limited disease) to standard prophylactic cranial irradiation (PCI; 25 Gy in 10 fractions) or HA-PCI. The primary objective was the delayed free recall (DFR) on the Free and Cued Selective Reminding Test (FCSRT) at 3 months; a decrease of 3 points or greater from baseline was considered a decline. Secondary end points included other FCSRT scores, quality of life (QoL), evaluation of the incidence and location of brain metastases, and overall survival (OS). Data were recorded at baseline, and 3, 6, 12, and 24 months after PCI.

RESULTS

Participants' baseline characteristics were well balanced between the two groups. The median follow-up time for living patients was 40.4 months. Decline on DFR from baseline to 3 months was lower in the HA-PCI arm (5.8%) compared with the PCI arm (23.5%; odds ratio, 5; 95% CI, 1.57 to 15.86; P = .003). Analysis of all FCSRT scores showed a decline on the total recall (TR; 8.7% v 20.6%) at 3 months; DFR (11.1% v 33.3%), TR (20.3% v 38.9%), and total free recall (14.8% v 31.5%) at 6 months, and TR (14.2% v 47.6%) at 24 months. The incidence of brain metastases, OS, and QoL were not significantly different.

CONCLUSION

Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC. No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.
Accounting for Democracy: Excessive Subjects in a State of Consensus
Authors: Delgado L. Elena
Published: August 2021

In the face of the public debates and protests fueled by Spain's persistent economic, social, and institutional crisis (2008–present), the country's politicians and media have consistently identified these debates and protests—in a word, social unrest—with three phenomena: nationalism, populism, and feminism. In my essay, I begin by showing how Spanish public discourse tends to situate all three on a single continuum, identifying their intersections in negative terms as a potentially disruptive excess that must be controlled, if not eliminated, to avoid a crisis of democracy. The second part of my essay moves to a theoretically informed reflection on the nature and function of political elements categorized as “excessive” in consensus democracies. Drawing on C. Lefort, J. Rancière, C. Mouffe, W. Brown. B. Honig, and L. Grattan, among others, I delve into how these perceived forms of excess function as dissonant remainders that account for the paradoxes of popular sovereignty, signaling its limits as well as its conditions of possibility.
The Generative Politics of Presentism in Post-15M Spain
Authors: Evinson Katryn
Published: August 2021

This essay revises post-15M movement political party landscape, emphasizing the intentional yet unusual use of the present within the New Left's organizing grammar. Against sectors of the traditional Left, who see presentism as a product of neoliberalism, I claim that in the post-15M conjuncture, the present constituted a battleground in the struggle for a dignified life. First, I focus on the Catalan left-wing nationalist party CUP's use of anarchist symbols to suggest that references to sabotage were deployed to disrupt parliamentary politics, forcing constant interruption. Second, I analyze Podemos founding member Iñigo Errejón's speech after the party's 2016 national election defeat, where his rhetoric linked the temporality of the present with anti-austerity protestors’ embodied presence. Last, I read the rise of neomunicipalisms as another iteration of presentism, aiming to politicize everyday life. To conclude, I advance that such material practices of “generative presentism” problematize presentism's assumed depoliticizing nature.
Processes of Destitution in Spain: Unavowable Communities between the Regime of ’78 and the Total State
Authors: Gozalo-Salellas Ignasi
Published: August 2021

This essay analyzes what I call processes of destitution as a result of the various social movements that took place in Spain throughout the 2010s. I argue that the exhaustion of the Regime of ’78 meant an epistemological turn away from hegemonic concepts such as consensus, truth, and historical agreement toward those central to a new destituent process: dissent, divergence, and plurality, among others. Over the course of this essay, I carry out a genealogical review of the two intersecting social movements of the period which drove that change: first, the anti-austerity movement—better known as the indignados, or 15M, movement and its political derivatives, such as municipal platforms, the “mareas,” and Podemos—and second, the Catalan pro-independence movement. Finally, based on Carl Schmitt's political theology, I study the Spanish State's reaction beginning in 2017 as the creation of a state of exception based on the intensification of “the political” and on a shift in the “friend/enemy” paradigm, from a relationship between nation-states to an intranational relationship between the Spanish State and the Catalan pro-independence movement.
Timing of increased temperature sensitivity coincides with nervous system development in winter moth embryos
Authors: van Dis Natalie E. , van der Zee Maurijn , Hut Roelof A. , Wertheim Bregje , Visser Marcel E.
Published: August 2021

Climate change is rapidly altering the environment and many species will need to genetically adapt their seasonal timing to keep up with these changes. Insect development rate is largely influenced by temperature, but we know little about the mechanisms underlying the temperature sensitivity of development. Here, we investigate seasonal timing of egg hatching in the winter moth, one of the few species which has been found to genetically adapt to climate change, likely through selection on temperature sensitivity of egg development rate. To study when during development winter moth embryos are most sensitive to changes in ambient temperature, we gave eggs an increase or decrease in temperature at different moments during their development. We measured their developmental progression and time of egg hatching, and used fluorescence microscopy to construct a timeline of embryonic development for the winter moth. We found that egg development rate responded more strongly to temperature once embryos were in the fully extended germband stage. This is the phylotypic stage at which all insect embryos have developed a rudimentary nervous system. Furthermore, at this stage, timing of ecdysone signaling determines developmental progression, which could act as an environment dependent gateway. Intriguingly, this may suggest that, from the phylotypic stage onward, insect embryos can start to integrate internal and environmental stimuli to actively regulate important developmental processes. As we found evidence that there is genetic variation for temperature sensitivity of egg development rate in our study population, such regulation could be a target of selection imposed by climate change.
Cumulative radiation doses due to nuclear medicine examinations: a systematic review
Authors: Brambilla Marco , Kuchcińska Agnieszka , Matheoud Roberta , Muni Alfredo
Published: August 2021

Objectives:

To systematically review the published data regarding the cumulative exposure to radiation in selected cohorts of adults or paediatric patients due to diagnostic nuclear medicine examinations.

Methods:

We conducted PubMed/Medline searches of peer-reviewed papers on cumulated effective dose (CED) from diagnostic nuclear medicine procedures published between 01 January 2010 until 31 January 2021. Studies were considered eligible if the contribution of nuclear medicine examinations to total CED was >10%. Studies reporting cumulative doses in a single episode of care or in a limited time (≤1 year) were excluded. The main outcomes for which data were sought were the CED accrued by patients, the period in which the CED was accrued, the percentage of patients with CED > 100 mSv and the percentage contribution due to nuclear medicine procedures to the overall CED.

Results:

The studies included in the synthesis were 18 which enrolled a total of 1,76,371 patients. Eleven (1,757 patients), three (1,74,079 patients) and four (535 patients) were related to oncological, cardiologic and transplanted patients, respectively. All the studies were retrospective; some of the source materials referred to small number of patients and some of the patients were followed for a short time. Not many studies accurately quantified the contribution of nuclear medicine procedures to the overall radiation exposure due to medical imaging. Finally, most of the studies covered an observation period which extended mainly in the 2000–2010 decade.

Conclusions:

There is a need of prospective, multicentric studies enrolling a greater number of patients, followed for longer period in selected groups of patients to fully capture the cumulative exposure to radiation in these settings

Advances in knowledge:

This systematic review allows to identify selected group of patients with a specific health status in which the cumulated exposure to radiation may be of concern and where the contribution of nuclear medicine procedures to the total CED is significant.
Teaching and learning how to make informed health choices: Protocol for a context analysis in Spanish primary schools
Authors: Martínez García Laura , Samsó Jofra Laura , Alonso-Coello Pablo , Ansuategi Eukane , Asso Mistral Laia , Ballesteros Monica , Canelo-Aybar Carlos , Casino Gonzalo , Gallego Iborra Ana , Niño de Guzmán Quispe Ena Pery , Requeijo Carolina , Roqué i Figuls Marta , Salas Karla , Ubeda Mar , Urreta Iratxe , Rosenbaum Sarah
Published: August 2021

Introduction

The Informed Health Choices (IHC) project developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore the educational context for teaching and learning critical thinking about health in Spanish primary schools.

Methods

During the 2020-2021 school year, we will conduct 1) a systematic assessment of educational documents and resources, and 2) semi-structured interviews with key education and health stakeholders. In the systematic assessment of educational documents and resources, we will include state and autonomous communities’ curriculums, school educational projects, and commonly used textbooks and other health teaching materials. In the semi-structured interviews, we will involve education and health policy makers, developers of learning resources, developers of health promotion and educational interventions, head teachers, teachers, families, and paediatric primary care providers. We will design and pilot a data extraction form and a semi-structured interview guide to collect the data. We will perform a quantitative and a qualitative analysis of the data to explore how critical thinking about health is being taught and learned in Spanish primary schools.

Conclusion

We will identify opportunities for and barriers to teaching and learning critical thinking about health in Spanish primary schools. We will formulate recommendations—for both practice and research purposes—on how to use, adapt (if needed), and implement the IHC resources in this context.
Development of a legume-enriched feed for treatment of severe acute malnutrition
Authors: Walsh Kevin , Delamare de la Villenaise de Chenevarin Gael , McGurk Joe , Maitland Kathryn , Frost Gary
Published: August 2021

Background: Outcomes in children hospitalised with severe acute malnutrition (SAM) remain poor. The current milk-based formulations focus on restoring weight-gain but fail to address modification of the integrity of the gut barrier and may exacerbate malabsorption owing to functional lactase, maltase and sucrase deficiency. We hypothesise that nutritional feeds should be designed to promote bacterial diversity and restore gastrointestinal (GI) barrier function.

Methods: Our major objective was to develop a lactose-free, fermentable carbohydrate-containing alternative to traditional F75 and F100 formulae for the inpatient treatment of SAM. New target nutritional characteristics were developed and relevant food and infant food specific legislation were reviewed. Suitable certified suppliers of ingredients were identified. Processing and manufacture steps were evaluated and optimised for safety (nutritional, chemical and microbiological), and efficacy at meeting target characteristics (lactose-free, containing resistant starch 0.4-0.5% final product weight).

Results: A final validated production process was developed and implemented to produce a novel food product for the inpatient treatment of SAM in children in Africa designed to reduce risk of osmotic diarrhoea and support symbiotic gut microbial populations. The final product matched the macronutrient profile of double-concentrated F100, adhered to all relevant legislation regulating infant foods, was lactose free, and contained 0.6% resistant starch. Chickpeas were selected as the source of resistant starch, since they are widely grown and eaten throughout Africa. Micronutrient content could not be matched in this ready-to-use product, so this was replaced at the point of feeding, as was fluid lost through concentration.

Conclusions: The processes and product described illustrate the development steps for a novel nutritional product. The new feed product was ready for evaluation for safety and efficacy in a phase II clinical trial in Ugandan children admitted to hospital with SAM (Modifying Intestinal MicroBiome with Legume-Based feed 2: MIMBLE feed 2 (ISRCTN10309022)).
The Software Engineering Workbook for Team Projects
Authors: Bryce Renee
Published: August 2021

Software Engineering is a broad field and many textbooks explain general topics that are critical for Software Engineers, but often in an abstract way. There is no substitute for hands-on experience and self reflection.  This workbook contains a collection of exercises that are targeted to early career Software Engineers.
Sustaining Effectiveness in Global Teams: The Coevolution of Knowledge Management Activities and Technology Affordances
Authors: Gibson Cristina B. , Dunlop Patrick D. , Majchrzak Ann , Chia Terence
Published: August 2021

Despite the dynamic nature of knowledge-related activities and the availability of a variety of communication technologies, many global teams habitually use technology in the same way across activities. However, as teams move through cycles of accumulating, integrating, and implementing knowledge, the purposes for communication technologies change. Current theorizing and empirical work on team knowledge management has yet to develop a dynamic theory that incorporates these changes. By conducting a multiwave, mixed method analysis of 48 global teams, we develop a theory of how global teams sustain effectiveness through technology affordance processes. We found that effective teams are those that recognize cues indicating change is necessary and coevolve a symbiosis between new activities, new purposes for interaction, and new uses of communication technologies. This coevolution of purpose with technology use forms new affordances, which enable the team to move on to new knowledge management activities and sustain effectiveness. Our theory more realistically models the dynamics of staying connected while sharing, combining, and implementing knowledge across the globe.
Specyfika opieki pielęgniarskiej nad pacjentem starszym leczonym chirurgicznie
Authors: Ulatowska Agnieszka , Bączyk Grażyna , Włodarczyk Elżbieta , Bosacka Małgorzata
Published: August 2021

The aging of the human body is a continuous and progressive process, leading to dysfunction of organs and systems and disturbing homeostasis. Aging without additional pathology (physiological aging) occurs relatively rarely. In the case of co-morbidities (pathological aging) additional organ damage can be diagnosed, which deteriorate the condition of the elderly patient. Age-related illnesses can create complicated problems for therapeutic teams. The most common diseases include cardiovascular disease and pathology of the respiratory, digestive, nervous and immune systems. The overall deterioration of health (often named the frailty syndrome) can be accompanied by loss of muscle mass, malnutrition, decreased physical activity, decreased exercise tolerance, deterioration of the cognitive function and increased sensitivity to stressors. Due to specificity of the aged physiology and the presence of co-morbidity, elderly patients require an interdisciplinary treatment, which often requires surgery, with special need for specific preparation for the surgery, postoperative care and rehabilitation. The elderly are at particular risk for various complications after surgery from the organ systems: hypoxia, infection, hypoproteinaemia, hyponatremia, hypovolemia. Proper nursing care should include accurate preoperative preparation, including an assessment of the physical and mental status of the patient and proper postoperative management and rehabilitation, thus reducing the risk of serious postoperative complications and improve the well-being of the patient.