bluuebunny/crossref_metadata_2025 huggingface dataset:
A mixing microfluidic chip for real-time NMR monitoring of macromolecular reactions
Authors: Yamasaki Kazuhiko , Yamasaki Tomoko , Takahashi Masaharu , Suematsu Hiroto
Published: April 2021

NMR spectroscopy permits real-time monitoring of reactions that involve changes in the spectra of reactants. MICCS (MIcro Channelled Cell for Synthesis monitoring) is a microfluidic chip for such purposes, which is used to rapidly activate reactions by mixing the reactant solutions in the chip inserted into the typical NMR tube. Although it allows monitoring of chemical reactions of small compounds, its simple mixing system dependent on diffusion in the microchannel was not suitable for macromolecules such as proteins with low diffusion rates. Here, we developed a new microfluidic chip based on MICCS by incorporating a mixer of split-and-recombination type within the microchannel. We applied it to monitoring of the protein-folding reaction in a stopped-flow mode. A solution of denaturant-unfolded RNase A was injected from a syringe pump into the microchip set inside the NMR magnet and mixed with a buffer for dilution to reach the folding condition. Immediately after dilution, the reaction was initiated and detected by a series of NMR measurements that were synchronized with activation and inactivation of the pump. The process was repeated for accumulation of the data. By analysing the change of the spectra by factor analysis, a kinetic constant of 0.57 min−1 was obtained.
The Pollination and Fruit Quality of Two Kiwifruit Cultivars (Actinidia chinensis var. chinensis ‘AU Golden Sunshine’ and ‘AU Gulf Coast Gold’) (Ericales: Actinidiaceae) Grown in the Southeastern United States
Authors: Abbate Anthony P , Campbell Joshua W , Vinson Edgar L , Williams Geoffrey R
Published: April 2021

Kiwifruit is a new emerging crop for the southeastern United States that requires cross-pollination to set fruit. However, the pollination requirements for varieties grown in the southeastern United States are unknown. Through insect surveys and a bagging experiment, we assessed the pollination requirements of two female kiwifruit cultivars (Actinidia chinensis var. chinensis ‘AU Golden Sunshine’ and A. chinensis var. chinensis ‘AU Gulf Coast Gold’). For each, fruit quantity (fruit set) and fruit quality (weight, size, seed count, firmness, soluble solid content, and dry matter) were compared among three pollination treatments (wind, insect, and artificial pollination). Low abundances of insects were observed visiting female flowers of both kiwifruit cultivars, and therefore likely minimally influenced kiwifruit pollination. Artificial pollination resulted in the greatest percentages of fruit set and marketable fruits, followed by insect and wind pollination. Artificial pollination resulted in fruits that were greater in weight, size, and contained more seeds, than insect- and wind-pollinated fruits. Firmness and soluble solid content did not vary greatly between pollination treatments, yet were greater in ‘AU Golden Sunshine’. Dry matter content did not vary greatly between pollination treatments or between each cultivar. To maximize yields and optimize fruit quality, these results suggest that kiwifruit producers should place more effort into artificial pollination compared to wind and insect pollination. Future research should explore the use of managed bees (e.g., honey bees and bumble bees) within kiwifruit orchards to determine ways to utilize them as a secondary source for pollination needs.
Rival guests or defiant hosts? The local economic impact of hosting refugees
Authors: Batut Cyprien , Schneider-Strawczynski Sarah
Published: April 2021

This article investigates the local economic cost of hosting refugees. Using administrative data in France, we show that the opening of small housing centers for refugees decreases the economic activity in hosting municipalities. We demonstrate that this downturn is related to a decline in the population by around 2% due to fewer people moving to hosting municipalities. We show that this avoidance behavior of natives results from prejudices, and is unlikely to be driven by a labor market supply shock from the arrival of refugees. We also estimate the aggregate cost of hosting refugees.
Assessing the Impact of the Habitats Directive: A Case Study of Europe’s Plants
Authors: Amos Rob
Published: April 2021

The Habitats Directive will remain central to the EU’s continuing efforts to halt and ultimately reverse biodiversity loss under its 2030 Strategy for Biodiversity. Understanding the role this Directive plays in protecting European species is, therefore, critical if the EU is to deliver on its ambitious nature conservation agenda. This article presents a new study that furthers our understanding of EU law’s ability to deliver meaningful changes to a species’ conservation status by comparing the status of European plants that are protected under the Habitats Directive with those that are not, using the International Union for Conservation of Nature’s (IUCN)  Red List. Its findings suggest that the Directive has had only a limited impact on European flora. The article concludes by proposing reforms that could address the shortcomings in the EU’s approach to conservation which are highlighted by the study.
Biology and Management of the Rice Stink Bug (Hemiptera: Pentatomidae) in Rice, Oryza sativa (Poales: Poaceae)
Authors: Bhavanam Santhi , Wilson Blake , Blackman Bryce , Stout Michael
Published: April 2021

The rice stink bug, Oebalus pugnax (Fabricius), is the most important late-season insect pest of rice in the southern United States. Nymphs and adults feed on rice grains, resulting in losses in yield and grain quality. Aspects of the biology, ecology, life history, and chemical ecology have been investigated in southern rice producing states but several outstanding questions remain. Standard economic threshold levels (ETLs) based on sweep net sampling for rice stink bug have been established depending on grain development stage and geographic location. However, recent studies on the relationship between rice stink bug densities, feeding damage, and its economic impacts suggests that changes to ETLs for rice stink bug may be needed. The primary management tactic for controlling rice stink bug infestations is the application of chemical insecticides, but alternative management tactics are needed because of the potential for development of insecticide resistance and impacts on non-target organisms. Biological control appears to be a promising strategy, even though it has remained largely untapped. Future research should focus on the biology, behavior, host plant preference, and chemical ecology of the rice stink bug, knowledge of which will aid in the development of integrated pest management strategies. This review article covers the biology, feeding behavior, sampling techniques, ETLs, management, knowledge gaps, and potential management tactics of rice stink bug.
Agaveflower visitation by pallid bats,Antrozous pallidus, in the Chihuahuan Desert
Authors: Jaquish Virginia G , Ammerman Loren K
Published: April 2021

Pallid bats, Antrozous pallidus, despite being primarily insectivorous gleaning predators, consume nectar of the cardón cactus, Pachycereus pringlei, in the Sonoran Desert. It is unknown whether nectar feeding occurs in the Chihuahuan Desert of Texas, where pallid bats covered in pollen have been captured. We collected pollen samples from 67 pallid bats in Brewster County, Texas, United States, between April and August 2018. Pollen-covered pallid bats were captured in every month sampled. Pollen densities were three times higher on wings than on the head or ventral body. In all samples collected, the pollen was homogeneous and identified as Agave pollen. Although two species of Agave, A. havardiana and A. lechuguilla, occur in this region of Texas, linear discriminant analysis classified 701 of 723 (97%) of pollen grains analyzed as A. lechuguilla. Additional evidence from infrared video footage collected in August 2018 indicated that pallid bats became covered in A. lechuguilla pollen while consuming nectar. Pallid bats might be engaging in facultative nectarivory across their range and could be important nocturnal pollinators.
Resveratrol protects intestinal epithelial cells against radiation-induced damage by promoting autophagy and inhibiting apoptosis through SIRT1 activation
Authors: Qin Haoren , Zhang Heng , Zhang Xipeng , Zhang Shiwu , Zhu Siwei , Wang Hui
Published: April 2021

Intrinsic autophagy is important for the maintenance of intestinal homeostasis and intestinal regeneration. Ionizing radiation suppresses intrinsic autophagy and reduces damage-induced regeneration in the intestine, resulting in intestinal injury. Resveratrol, a sirtuin 1 (SIRT1) agonist, promotes autophagy and exerts radioprotective effect. In this study, the protective effect of resveratrol against radiation-induced intestinal injury and its potential mechanism were investigated. Intestinal epithelial cells (IEC-6) were exposed to 10 Gy ionizing radiation and resveratrol (0.1–40.0 μM). Cell viability was investigated using Cell Counting Kit 8 (CCK8), apoptosis was observed by Annexin V-fluorescein isothiocyanate/propidium iodide (PI) staining and flow cytometry, and the expression of apoptotic and autophagic proteins was determined by western blotting. Resveratrol exerted a high toxicity against IEC-6 cells, but at low concentrations, it inhibited ionizing radiation-induced apoptosis. Resveratrol increased SIRT1 expression after irradiation and inhibited ionizing radiation-induced p53 acetylation and pro-apoptotic protein, Bax, expression. Furthermore, resveratrol promoted autophagy via the phosphoinositide 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway, thereby protecting IEC-6 cells against radiation-induced damage. These results suggest that resveratrol reduces radiation-induced IEC-6 cell damage by inhibiting apoptosis and promoting autophagy via the activation of SIRT1, and that the PI3K/AKT/mTOR signaling pathway is involved in the induction of autophagy.
Strategies of Divergence: Local Authorities, Law, and Discretionary Spaces in Migration Governance
Authors: Oomen Barbara , Baumgärtel Moritz , Miellet Sara , Durmus Elif , Sabchev Tihomir
Published: April 2021

This article classifies and theorizes the strategies of divergence that local authorities employ when confronting the discretionary spaces offered by domestic migration law. We propose a distinction between strategies that are either within or outside the perceived boundaries of the law and those that adopt an explicit or an implicit approach to positioning, thus harnessing or downplaying the communicative potential of the law. Based thereon, we introduce a fourfold typology of strategies of divergences that include defiance, dodging, deviation, and dilution. This typology was developed and refined based on field research in local authorities in Greece, Turkey, Italy, and The Netherlands. The case material also leads us into a preliminary exploration of which types of cities and conditions may lead to the adoption of one strategy over another. As such, this article draws attention to the relevance of law within multi-level migration governance and to the meaning of legal ambiguity and discretion as shaped by law and legal interpretation. The strategies of divergence that mould discretionary spaces, in turn, either mitigate or exacerbate legal uncertainty and should be considered a significant factor to account for change in migration governance.
Incidence of human granulocytic anaplasmosis in returning travellers with fever
Authors: Camprubí-Ferrer Daniel , Portillo Aránzazu , Santibáñez Sonia , Almuedo-Riera Alejandro , Rodriguez-Valero Natalia , Subirà Carme , Martinez Miguel J , Navero-Castillejos Jessica , Fernandez-Pardos Marc , Genton Blaise , Cobuccio Ludovico , Van Den Broucke Steven , Bottieau Emmanuel , Muñoz Jose , Oteo José Antonio
Published: April 2021

Background

Although tick-borne pathogens have been reported as an important cause of imported fever, the incidence of Anaplasma phagocytophilum, the causative agent of human granulocytic anaplasmosis (HGA), in travellers is unknown.

Methods

We conducted a prospective cohort study to investigate the aetiologies of fever in returning travellers (November 2017—July 2019). Polymerase chain reaction for msp2 gene amplification and indirect immunofluorescence assay for A. phagocitophilum were performed in all returning travellers with undifferentiated non-malarial fever.

Results

Among 141 travellers included, 8 patients were diagnosed with probable or confirmed HGA. The overall incidence rate of HGA was 19.9 cases/1000 person—week of travel. The main destination of travel was Asia, accounting for 62.5% patients with HGA. Co-infections were found in 37.5% of patients with HGA.

Conclusions

Diagnosis of HGA and empirical treatment with doxycycline should be considered in travellers with fever.
Postoperative Opioid Pain Medication Usage Following Adult Tonsillectomy
Authors: Winters Jessica R , Hill Christopher J , Frasier Samuel D , Riddick Jeanelle D , Schlocker Caroline M
Published: April 2021

Introduction

The purpose of this study was to determine if short-term, high-quantity opioid use following adult tonsillectomy in active duty military members results in opioid misuse, using a proxy measure of referrals to substance abuse rehabilitation programs.

Materials and Methods

An Institutional Review Board-approved retrospective chart review was performed of 741 active duty patients who underwent tonsillectomy between 2012 and 2017. Data collection included preoperative medications within 60 days of surgery, all postoperative opioid prescriptions up to 12 months following surgery, and referrals to substance abuse rehabilitation within a year of surgery.

Results

Out of 741 patients, 658 met inclusion criteria. Fifty-one percent were women and the average age was 26 years. Fifty-nine percent of patients received 5 mg/325 mg oxycodone/acetaminophen as their initial postoperative pain medication. The average number of opioid tablets prescribed was 70 ± 18. Ninety three percent of patients received at least 60 tabs. The refill rate within 30 days of tonsillectomy was 38.6%. In the year following surgery, 25.4% of patients received additional doses of outpatient opioids for other indications. Nineteen patients (2.9%) were referred for substance abuse treatment within 1 year of tonsillectomy: seventeen for alcohol abuse, one for marijuana, and one for alcohol/marijuana. There were no referrals for opiate misuse or abuse.

Conclusion

Short-term, high-quantity opioid treatment of post-tonsillectomy pain in active duty adults does not result in long-term opioid misuse, as measured by substance abuse treatment program referrals within a year after surgery. This finding supports the appropriateness of adequate short-term narcotic medication treatment. The long-term readiness of these patients appears unaffected by long-term opioid misuse or abuse. Even with this finding, there is an institutional shift to multi-modality pain management and appropriate opioid reduction to further mitigate the risk of opioid misuse. Extrapolation of these findings to all adult tonsillectomy patients should be done with caution, as there are several protective factors in the active duty population such as stable full-time employment with mandatory random drug screening.
Accelerated Progression of Disseminated Coccidioidomycosis Following SARS-CoV-2 Infection: A Case Report
Authors: Krauth Daniel S , Jamros Christina M , Rivard Shayna C , Olson Niels H , Maves Ryan C
Published: April 2021

We describe a patient with subclinical coccidioidomycosis who experienced rapid disease dissemination shortly after SARS-CoV-2 infection, suggesting host immune response dysregulation to coccidioidomycosis by SARS-CoV-2. We hypothesize that disrupted cell-mediated signaling may result after SARS-CoV-2 infection leading to functional exhaustion and CD8+ T-cell senescence with impairment in host cellular response to Coccidioides infection.
Proselytism as Epistemic Violence: A Jewish Approach to the Ethics of Religious Persuasion
Authors: Lebens Samuel
Published: April 2021

The purpose of this paper is two-fold: (1) to provide a philosophical justification for the counterintuitive attitude that Judaism seems to have towards proselytism; and (2) to extend the case so as to create a general argument, applicable to all religions, against many forms of proselytism.
Crystal structure and functional implication of a bacterial cyclic AMP–AMP–GMP synthetase
Authors: Ko Tzu-Ping , Wang Yu-Chuan , Tsai Chia-Ling , Yang Chia-Shin , Hou Mei-Hui , Chen Yeh
Published: April 2021

Mammalian cyclic GMP-AMP synthase (cGAS) and its homologue dinucleotide cyclase in Vibrio cholerae (VcDncV) produce cyclic dinucleotides (CDNs) that participate in the defense against viral infection. Recently, scores of new cGAS/DncV-like nucleotidyltransferases (CD-NTases) were discovered, which produce various CDNs and cyclic trinucleotides (CTNs) as second messengers. Here, we present the crystal structures of EcCdnD, a CD-NTase from Enterobacter cloacae that produces cyclic AMP-AMP-GMP, in its apo-form and in complex with ATP, ADP and AMPcPP, an ATP analogue. Despite the similar overall architecture, the protein shows significant structural variations from other CD-NTases. Adjacent to the donor substrate, another nucleotide is bound to the acceptor binding site by a non-productive mode. Isothermal titration calorimetry results also suggest the presence of two ATP binding sites. GTP alone does not bind to EcCdnD, which however binds to pppApG, a possible intermediate. The enzyme is active on ATP or a mixture of ATP and GTP, and the best metal cofactor is Mg2+. The conserved residues Asp69 and Asp71 are essential for catalysis, as indicated by the loss of activity in the mutants. Based on structural analysis and comparison with VcDncV and RNA polymerase, a tentative catalytic pathway for the CTN-producing EcCdnD is proposed.
Untangling the contributions of meteorological conditions and human mobility to tropospheric NO2 in Chinese mainland during the COVID-19 pandemic in early 2020
Authors: Zhang Yuxiang , Bo Haixu , Jiang Zhe , Wang Yu , Fu Yunfei , Cao Bingwei , Wang Xuewen , Chen Jiaqi , Li Rui
Published: April 2021

In early 2020, unprecedented lockdowns and travel bans were implemented in Chinese mainland to fight COVID-19, which led to a large reduction in anthropogenic emissions. This provided a unique opportunity to isolate the effects from emission and meteorology on tropospheric nitrogen dioxide (NO2). Comparing the atmospheric NO2 in 2020 with that in 2017, we found the changes of emission have led to a 49.3 ± 23.5% reduction, which was ∼12% more than satellite-observed reduction of 37.8 ± 16.3%. The discrepancy was mainly a result of changes of meteorology, which have contributed to an 8.1 ± 14.2% increase of NO2. We also revealed that the emission-induced reduction of NO2 has significantly negative correlations to human mobility, particularly that inside the city. The intra-city migration index derived from Baidu Location-Based-Service can explain 40.4% ± 17.7% variance of the emission-induced reduction of NO2 in 29 megacities, each of which has a population of over 8 million in Chinese mainland.
Rate-Amplifying Demand and the Excess Sensitivity of Long-Term Rates
Authors: Hanson Samuel G , Lucca David O , Wright Jonathan H
Published: April 2021

Long-term nominal interest rates are surprisingly sensitive to high-frequency (daily or monthly) movements in short-term rates. Since 2000, this high-frequency sensitivity has grown even stronger in U.S. data. By contrast, the association between low-frequency changes (at 6- or 12-month horizons) in long- and short-term rates, which was also strong before 2000, has weakened substantially. This puzzling post-2000 pattern arises because increases in short rates temporarily raise the term premium component of long-term yields, leading long rates to temporarily overreact to changes in short rates. The frequency-dependent excess sensitivity of long-term rates that we observe in recent years is best understood using a model in which (i) declines in short rates trigger “rate-amplifying” shifts in investor demand for long-term bonds, and (ii) the arbitrage response to these demand shifts is both limited and slow. We study, theoretically and empirically, how such rate-amplifying demand can be traced to mortgage-refinancing activity, investors who extrapolate recent changes in short rates, and investors who “reach for yield” when short rates fall. We discuss the implications of our findings for the validity of event study methodologies and the transmission of monetary policy.
X-RAY AND MOLECULAR IMAGING DURING PREGNANCY AND BREASTFEEDING—WHEN SHOULD WE BE WORRIED?
Authors: Mattsson Sören , Leide-Svegborn Sigrid , Andersson Martin
Published: April 2021

Some of the ethically most sensitive issues in radiation protection arise at imaging of pregnant—and potentially pregnant—patients and of newborn.

This article reviews the current literature and recommendations on imaging during pregnancy and breastfeeding. Risks related to alternative non-ionizing radiation methods are also considered.

With few exceptions, exposure of the fetus through radiography, computed tomography (CT) and nuclear medicine imaging can be limited to safe levels, although studies such as abdominal-pelvic CT cannot avoid significant exposure to fetuses. Eight to 10 weeks post-conception, the fetus has a thyroid which starts to concentrate iodide having crossed the placenta barrier resulting in unacceptably high doses to the fetal thyroid after administration of 131I- and even 123I-iodide and other radiopharmaceuticals with a high content of free radioiodine.

Many radiopharmaceuticals are excreted through breast milk. Breastfeeding interruption recommendations should be followed to keep the effective dose to the infant below 1 mSv.
Universal Toxicity Gene Signatures for Early Identification of Drug-Induced Tissue Injuries in Rats
Authors: Glaab Warren E , Holder Daniel , He Yudong D , Bailey Wendy J , Gerhold David L , Beare Carolann , Erdos Zoltan , Lane Pamela , Michna Laura , Muniappa Nagaraja , Lawrence Jeffrey W , Tanis Keith Q , Sina Joseph F , Skopek Thomas R , Sistare Frank D
Published: April 2021

A new safety testing paradigm that relies on gene expression biomarker panels was developed to easily and quickly identify drug-induced injuries across tissues in rats prior to drug candidate selection. Here, we describe the development, qualification, and implementation of gene expression signatures that diagnose tissue degeneration/necrosis for use in early rat safety studies. Approximately 400 differentially expressed genes were first identified that were consistently regulated across 4 prioritized tissues (liver, kidney, heart, and skeletal muscle), following injuries induced by known toxicants. Hundred of these “universal” genes were chosen for quantitative PCR, and the most consistent and robustly responding transcripts selected, resulting in a final 22-gene set from which unique sets of 12 genes were chosen as optimal for each tissue. The approach was extended across 4 additional tissues (pancreas, gastrointestinal tract, bladder, and testes) where toxicities are less common. Mathematical algorithms were generated to convert each tissue’s 12-gene expression values to a single metric, scaled between 0 and 1, and a positive threshold set. For liver, kidney, heart, and skeletal muscle, this was established using a training set of 22 compounds and performance determined by testing a set of approximately 100 additional compounds, resulting in 74%–94% sensitivity and 94%–100% specificity for liver, kidney, and skeletal muscle, and 54%–62% sensitivity and 95%–98% specificity for heart. Similar performance was observed across a set of 15 studies for pancreas, gastrointestinal tract, bladder, and testes. Bundled together, we have incorporated these tissue signatures into a 4-day rat study, providing a rapid assessment of commonly seen compound liabilities to guide selection of lead candidates without the necessity to perform time-consuming histopathologic analyses.
OPDAT1, a plastid envelope protein involved in 12-oxo-phytodienoic acid export for jasmonic acid biosynthesis in Populus
Authors: Zhao Xin , Li Nannan , Song Qin , Li Xiaohong , Meng Hongjun , Luo Keming
Published: April 2021

Twelve-oxo-phytodienoic acid (OPDA), the cyclopentenone precursor of jasmonic acid (JA), is required for the wounding response of plants. OPDA is derived from plastid-localized α-linolenic acid (α-LeA; 18:3) via the octadecanoid pathway, and is further exported from plastids to the cytosol for JA biosynthesis. However, the mechanism of OPDA transport from plastids has yet to be elucidated. In the current study, a plastid inner envelope-localized protein, designated 12-oxo-Phtyodienoic Acid Transporter 1 (OPDAT1), was identified and shown to potentially be involved in OPDA export from plastids, in Populus trichocarpa. Torr. OPDAT1 is expressed predominantly in young leaves of P. trichocarpa. Functional expression of OPDAT1 in yeast cells revealed that OPDAT1 is involved in OPDA transport. Loss-of-function of OPDAT1 in poplar resulted in increased accumulation of OPDA in the extracted plastids and a reduction in JA concentration, whereas an OPDAT1-overexpressing line showed a reverse tendency in OPDA accumulation and JA biosynthesis. OPDAT1 transcripts were rapidly induced by mechanical wounding of leaves, and an opdat1 mutant transgenic plant displayed increased susceptibility to spider mite (Tetranychus urticae) infestation. Collectively, these data suggest that OPDAT1 is an inner envelope transporter for OPDA, and this has potential implications for JA biosynthesis in poplar under environmental stresses.
Development of LAMP Assays Using a Novel Target Gene for Specific Detection of Pythium terrestris, Pythium spinosum, and ‘Candidatus Pythium huanghuaiense’
Authors: Feng Hui , Ye Wenwu , Liu Zhuoyuan , Wang Yang , Chen Jiajia , Wang Yuanchao , Zheng Xiaobo
Published: April 2021

Pythium terrestris, Pythium spinosum, and ‘Candidatus Pythium huanghuaiense’ are closely related species and important pathogens of soybean that cause root rot. However, the sequences of commonly used molecular markers, such as rDNA internal transcribed spacer 2 and cytochrome oxidase 1 gene, are similar among these species, making it difficult to design species-specific primers for loop-mediated isothermal amplification (LAMP) assays. The genome sequences of these species are also currently unavailable. Based on a comparative genomic analysis and de novo RNA-sequencing transcript assemblies, we identified and cloned the sequences of the M90 gene, a conserved but highly polymorphic single-copy gene encoding a Puf family RNA-binding protein among oomycetes. After primer design and screening, three LAMP assays were developed that specifically amplified the targeted DNA sequences in P. terrestris and P. spinosum at 62°C for 70 min and in ‘Ca. Pythium huanghuaiense’ at 62°C for 60 min. After adding SYBR Green I, a positive yellow-green color (under natural light) or intense green fluorescence (under ultraviolet light) was observed by the naked eye only in the presence of the target species. The minimum concentration of target DNA detected in all three LAMP assays was 100 pg·μl−1. The assays also successfully detected the target Pythium spp. with high accuracy and sensitivity from inoculated soybean seedlings and soils collected from soybean fields. This study provides a method for identification and cloning of candidate detection targets without a reference genome sequence and identified M90 as a novel specific target for molecular detection of three Pythium species causing soybean root rot.
The Relationship Between Patient Satisfaction and Healthcare Expenditures in Adults with Spine Related Disorders
Authors: Gliedt Jordan A. , Walker Rebekah J. , Lu Kaiwei , Dawson Aprill Z. , Egede Leonard E.
Published: April 2021

Study Design.

Cross-sectional study.

Objective.

The aim of this study was to investigate the relationship between patient satisfaction (PS) and healthcare expenditures (HCE) in adults with spine related disorders (SRDs).

Summary of Background Data.

SRDs are widespread and pose a high cost to society. PS and HCE have yet to be studied in this population.

Methods.

Fifteen thousand eight hundred fifty adults with SRDs from the Medical Expenditures Panel Survey (MEPS) (2008–2015) were analyzed. The MEPS medical conditions files were used to identify SRDs based on International Classification of Diseases-9 codes. Frequencies and percentages of sample demographics were calculated. HCE was measured as total direct payments for care provided during the survey year. A composite PS score was constructed using a 0 to 10 rating of their healthcare providers combined with the frequency in which patients felt they were listened to, were given understandable explanations, were respected, and were given enough time. Mean unadjusted HCE were calculated for each year and by quartile of PS. A two-part model consisting of a probit model and subsequent generalized linear model with gamma distribution was performed, adjusting for relevant covariates. Margins command was used to calculate incremental estimates of HCE.

Results.

Mean unadjusted HCE increased annually from $7057 (95% confidence interval [CI], $6516, $7597) in 2008 to $9820 (95% CI, $8811, $10,830) in 2015 for adults with SRDs. Adjusting for predisposing factors, individuals in second, third, and fourth quartiles of PS were significantly different from the first quartile. Adjusting for predisposing and enabling factors, only fourth quartile was significantly different from first quartile. After adjusting for predisposing, enabling and need factors, second, third, and fourth quartiles were no longer significantly different from the first quartile.

Conclusion.

Expenditures have increased over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.

Level of Evidence: 2
Prenatal Education in the Digital Age
Authors: GRASECK ANNA , LEITNER KIRSTIN
Published: April 2021

The millennial pregnant patient expects an innovative approach to prenatal care. Patients are reaching to peer support online communities or engaging in direct-to-consumer mobile applications during their pregnancy. Currently developed solutions show promise, however, the clinical impact and generalizability of these solutions remains unclear. Technology has the potential to decrease health care disparities, improve patient and provider satisfaction as well as clinical outcomes. In this article we discuss traditional models of prenatal education as well and suggest how obstetricians should consider utilizing technology as an approach to provide prenatal education to their patients.
Surgical Management of Stress Incontinence
Authors: COLLINS SARAH A.
Published: April 2021

The aim was to describe contemporary surgical procedures for the treatment of stress urinary incontinence (SUI) in women. The 4 most commonly performed surgical procedures for the treatment of SUI were reviewed using standardized terminology. We addressed the history and evolution of the procedures as well as the mechanisms of action by which they work. Efficacy and safety data were also presented. Midurethral Sling, Pubovaginal Sling, Retropubic Colposuspension, and Urethral Bulking are safe and effective procedures. Midurethral Sling, Pubovaginal Sling, Retropubic Colposuspension, and Urethral Bulking are contemporary procedures for the treatment of SUI in women.
Early coronary healing in ST segment elevation myocardial infarction: sirolimus-eluting stents vs. drug-coated balloons after bare-metal stents. The PEBSI-2 optical coherence tomography randomized study
Authors: García-Touchard Arturo , Gonzalo Nieves , Goicolea Javier , Gomez-Lara Josep , Martín-Yuste Victoria , Peral Vicente , Martínez-Romero Pedro , Vaquerizo Beatriz , Sánchez-Recalde Ángel , Sarnago Fernando , Oteo Juan Francisco , Alfonso Fernando
Published: April 2021

Objectives

Drug-coated balloons (DCBs) have theoretical advantages over drug-eluting stents (DESs) to facilitate stent healing. We studied whether, in patients undergoing primary coronary interventions (pPCIs), a strategy of DCB after bare-metal stent improves early healing as determined by optical coherence tomography (OCT) compared with new-generation DES.

Methods

pPCI patients were randomized (1:1) to treatment with new-generation sirolimus-eluting stents (DES group) or DCB-strategy. Vessel healing was assessed by OCT at 90 days.

Results

Fifty-three patients were randomized (26 DES vs. 27 DCB). At 90 days, both strategies showed a low rate of uncovered struts (3.2 vs. 3.2%, P = 0.64) and a very high and similar rate of covered and apposed struts (96.6 vs. 96.1%, respectively; P = 0.58). However, DCB group had a significantly lower rate of major coronary evaginations (68 vs. 37%, P = 0.026), and more frequently developed a thin homogeneous neointimal layer (20 vs. 70.4%, P = 0.001) suggesting distinct superior healing at 3 months compared to DES.

Conclusions

In pPCI both, sirolimus-DES and DCB-strategy, provide excellent strut coverage at 3 months. However, DCB ensures more advanced and optimal stent healing compared to sirolimus-DES. Further research is needed to determine whether, in patients undergoing pPCI, DCB offers superior long-term clinical and angiographic outcomes than new-generation DES (NCT03610347).
Social Identities of Persons With Schizophrenia and Social Functioning
Authors: Pérez Vanesa , Melo Luisa Elena Hernández , del Carmen Lara-Muñoz María , Kopelowicz Alex , Ullman Jodie , López Steven Regeser
Published: April 2021

We apply social identity theory and self-categorization theory to examine the role of social identities in relation to the recovery of persons with schizophrenia. We assess whether illness-based and non–illness-based identities held by both those with schizophrenia and their caregivers explain additional variance in social functioning in persons with schizophrenia beyond the previously established predictors of negative symptoms and theory of mind. Sixty Mexican-origin adults diagnosed with schizophrenia and their family caregivers were obtained through an outpatient mental health clinic located in either Los Angeles, CA, or in Puebla, Mexico. A three-step hierarchical regression indicated that identity endorsements, from both the perspective of the person with schizophrenia and their caregiver, and negative symptomatology are significant independent predictors of social functioning. Specifically, greater endorsement of nonillness identities both for the person with schizophrenia and also their caregiver is associated with higher social functioning. Illness identity plays an important role in the path to recovery.
Panel-reactive Antibody and the Association of Early Steroid Withdrawal With Kidney Transplant Outcomes
Authors: Bae Sunjae , McAdams-DeMarco Mara A. , Massie Allan B. , Garonzik-Wang Jacqueline M. , Coresh Josef , Segev Dorry L.
Published: April 2021

Background.

Early steroid withdrawal (ESW) is a viable maintenance immunosuppression strategy in low-risk kidney transplant recipients. A low panel-reactive antibody (PRA) may indicate low-risk condition amenable to ESW. We aimed to identify the threshold value of PRA above which ESW may pose additional risk and to compare the association of ESW with transplant outcomes across PRA strata.

Methods.

We studied 121 699 deceased-donor kidney-only recipients in 2002–2017 from Scientific Registry of Transplant Recipients. Using natural splines and ESW-PRA interaction terms, we explored how the associations of ESW with transplant outcomes change with increasing PRA values and identified a threshold value for PRA. Then, we assessed whether PRA exceeding the threshold modified the associations of ESW with 1-y acute rejection, death-censored graft failure, and death.

Results.

The association of ESW with acute rejection exacerbated rapidly when PRA exceeded 60. Among PRA ≤60 recipients, ESW was associated with a minor increase in rejection (adjusted odds ratio [aOR], 1.001.051.10) and with a tendency of decreased graft failure (adjusted hazard ratio [aHR], 0.910.971.03). However, among PRA >60 recipients, ESW was associated with a substantial increase in rejection (aOR, 1.191.271.36; interaction P < 0.001) and with a tendency of increased graft failure (aHR, 0.981.081.20; interaction P = 0.028). The association of ESW with death was similar between PRA strata (PRA ≤60, aHR, 0.910.961.01; and PRA >60, aHR, 0.900.991.09; interaction P = 0.5).

Conclusions.

Our findings show that the association of ESW with transplant outcomes is less favorable in recipients with higher PRA, especially those with PRA >60, suggesting a possible role of PRA in the risk assessment for ESW.
The consequences of null model selection for predicting mortality from multiple stressors
Authors: Dey Cody J. , Koops Marten A.
Published: April 2021

Many ecological systems are now exposed to multiple stressors, and ecosystem management increasingly requires consideration of the joint effects of multiple stressors on focal populations, communities and ecosystems. In the absence of empirical data, ecosystem managers could use null models based on the combination of independently acting stressors to estimate the joint effects of multiple stressors. Here, we used a simulation study and a meta-analysis to explore the consequences of null model selection for the prediction of mortality resulting from exposure to two stressors. Comparing five existing null models, we show that some null models systematically predict lower mortality rates than others, with predicted mortality rates up to 67.5% higher or 50% lower than the commonly used Simple Addition model. However, the null model predicting the highest mortality rate differed across parameter sets, and therefore there is no general ‘precautionary null model’ for multiple stressors. Using a multi-model framework, we re-analysed data from two earlier meta-analyses and found that 54% of the observed joint effects fell within the range of predictions from the suite of null models. Furthermore, we found that most null models systematically underestimated the observed joint effects, with only the Stressor Addition model showing a bias for overestimation. Finally, we found that the intensity of individual stressors was the strongest predictor of the magnitude of the joint effect across all null models. As a result, studies characterizing the effects of individuals stressors are still required for accurate prediction of mortality resulting from multiple stressors.
Antimicrobial resistance and multilocus sequence types of Stenotrophomonas maltophilia isolated from dogs and cats in Japan
Authors: Shimizu Takae , Tsuyuki Yuzo , Shimoike Kenta , Iyori Keita , Miyamoto Tadashi , Harada Kazuki
Published: April 2021

As the representative multidrug-resistant pathogen,

Stenotrophomonas maltophilia

has multiple intrinsic and acquired resistances, including carbapenem resistance. In companion animals, the antimicrobial susceptibility and sequence types (STs) of

S. maltophilia

are not well understood due to its limited isolation rate. We investigated the antimicrobial susceptibilities and multilocus sequence types (MLSTs) of 38 

S

.

maltophilia

strains isolated from dogs and cats in Japan. Prevalence of resistance was detected for imipenem (100 %), aztreonam (94.7 %), piperacillin (65.8 %), trimethoprim–sulfamethoxazole (65.8 %), and ceftazidime (60.5 %). Rates of resistances to chloramphenicol, minocycline, and levofloxacin were low (2.6–5.3 %). MLST analysis revealed that all 38 strains were assigned to 34 STs, including 11 previously reported STs and 23 newly identified STs. Phylogenetic analysis of MLSTs enabled categorization of 13 isolates (34.2 %) into genogroup 6, which is a major genogroup of human isolates. Multinational surveillance would be needed to clarify the significance of antimicrobial-resistant

S. maltophilia

isolates from companion animals.
Co-Immune: a case study on open innovation for vaccination hesitancy and access
Authors: Masselot Camille M. , Tzovaras Bastian Greshake , Graham Chris L.B. , Finnegan Gary , Jeyaram Rathin , Vitali Isabelle , Landrain Thomas E. , Santolini Marc
Published: April 2021

Background

The rise of major complex public health problems, such as vaccination hesitancy and access to vaccination, requires innovative, open and transdisciplinary approaches. In spite of this, institutional silos, paywalls and lack of participation of non-academic citizens in the design of solutions hamper efforts to meet these challenges. Against this background, new solutions have been explored, with participatory research, citizen science, hackathon and challenge-based approaches being applied in the context of public health.

Objectives

Our ambition was to develop a framework for creating citizen science and open innovation projects that address the contemporary challenges of vaccination in France and around the globe.

Methods

We designed and implemented Co-Immune, a programme created to tackle the question of vaccination hesitancy and access to vaccination through an online and offline challenge-based open innovation approach. The programme was run on the open science platform Just One Giant Lab.

Results

Over a 6-month period, the Co-Immune programme gathered 234 participants of diverse backgrounds and 13 partners from the public and private sectors and organized 8 events to facilitate the creation of 20 new projects as well as the continuation of 2 existing projects to address the issues of vaccination hesitancy and access, ranging from app development and data mining to analysis and game design. In an open framework, the projects made their data, code, and solutions publicly available.

Conclusion

Co-Immune highlights how open innovation approaches and online platforms can help to gather and coordinate non-institutional communities in a rapid, distributed and global way towards solving public health issues. Through the ideas of hackathons and other contest approaches, such initiatives can lead to the production and transfer of knowledge, creating novel solutions in the public health sector. The example of Co-Immune contributes to paving the way for organisations and individuals to collaboratively tackle future global challenges.
Relative expression of pro-inflammatory molecules in COVID-19 patients manifested disease severities
Authors: Nigar Shireen , Shah SM Tanjil , Setu Md. Ali Ahasan , Dip Sourav Dutta , Ibnat Habiba , Islam M Touhidul , Akter Selina , Jahid Iqbal Kabir , Hossain M Anwar
Published: April 2021

Aggressive immune response, due to over-expressed pro-inflammatory molecules, had been characterized in COVID-19 patients. Some of those mediators have a dual and opposite role on immune-systems to play behind differential disease severities. We investigated the expression of some cytokines and chemokines in COVID-19 patients in Bangladesh. We diagnosed the patients by detecting SARS-CoV-2 RNA in nasal swab samples by the real-time RT-PCR method. Thirty adult patients were preselected based on their disease severities and grouped into mild, moderate, and severe cases. Nine healthy volunteers participated in this study as control. Relative expression of nine cytokines/chemokine in total leukocytes was semi-quantified in SYBRgreen-based qRT-PCR. We performed statistical tests on transformed log data using SPSS 24.0. At the onset of symptoms (day-1), ACE2 (P < 0.05) and IL-6 (P > 0.05) were up-regulated in all COVID-19 groups, although expression levels did not significantly correlate with disease severities. However, expression of IL-6, MCP-1, MIP-1α, TNF-α, RANTES, and ACE2, on day-14, were positively correlated with disease severities. Relative viral load at day-1 showed no significant correlation with cytokine expression but had a significant positive correlation with RANTES and ACE2 expression on day-14 (P < 0.05). Male patients had a higher level of IL-6 than female patients on day-1 (P < 0.05). All COVID-19 patients showed up-regulated cytokines and chemokines on the day-14 compared to day-1 except TNF-α. Female patients had higher expression of ACE2 and IL-12 on day-14. Up-regulated cytokines/chemokines at the convalescent stage, especially IL-6, may target anti-cytokine therapy in post-COVID-19 patients’ management.
Central role of the glutamate metabolism in long-term antiretroviral treated HIV-infected individuals with metabolic syndrome: a cross-sectional cohort study
Authors: Gelpi Marco , Mikaeloff Flora , Dehlbæk Knudsen Andreas , Benfeitas Rui , Krishnan Shuba , Høgh Julie , Murray Daniel D. , Ullum Henrik , Neogi Ujjwal , Dam Nielsen Susanne
Published: April 2021

Background

Metabolic syndrome (MetS) is one of the major factors for cardiometabolic comorbidities in people living with HIV (PLWH). The long-term consequences of HIV-infection and combination antiretroviral therapy (cART) in metabolic reprogramming are unknown. In this study, we aim to investigate metabolic alterations in long-term well-treated PLWH with MetS to identify the potential mechanism behind the MetS phenotype using advanced statistical and machine learning algorithms.

Methods

We included 200 PLWH ≥40 years old from the Copenhagen Comorbidity in HIV-infection (COCOMO) study. PLWH were grouped into PLWH with MetS (n=100) and without MetS (n=100). The clinical data were collected from the COCOMO database and untargeted plasma metabolomics was performed using ultra-high-performance liquid chromatography/mass spectrometry (UHPLC/MS/MS). Both clinical characteristics and plasma samples were collected at study baseline. We applied several conventional approaches, machine learning algorithm and linear classification model to identify the biologically relevant metabolites associated with MetS in PLWH.

Findings

A total of 877 characterized biochemicals were identified. Of these, 9% (76/877) biochemicals differed significantly between PLWH with and without MetS (false discovery rate <0.05). The majority belonged to the amino acid metabolism (n=33, 43%). A consensus identification by combining supervised and unsupervised methods indicates 11 biomarkers of MetS phenotype in PLWH, of which seven (63%) have higher abundance in PLWH with MetS compared to the PLWH without MetS. A weighted co-expression network by Leiden partitioning analysis identified seven communities of positively intercorrelated metabolites, of which a single community contained six of the potential biomarkers mainly related to glutamate metabolism (glutamate, 4-hydroxyglutamate, α-ketoglutamate and γ-glutamylglutamate).

Interpretation

Altered amino acid metabolism is a central characteristic of PLWH with MetS and a potential central role for glutamate metabolism in establishing this phenotype is suggested.

Funding

Rigshospitalet Research Council, Danish National Research Foundation (DNRF126) NovoNordisk Foundation, the Swedish Research Council (2017-01330 and 2018-06156)