bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a care home data platform in Scotland: a mixed methods study of data routinely collected in care homes
Authors: Shenkin Susan D , Johnston Lucy , Hockley Jo , Henderson David A G
Published: December 2022

Background

care homes collect extensive data about their residents, and their care, in multiple ways, for multiple purposes. We aimed to (i) identify what data are routinely collected and (ii) collate care home managers’ views and experiences of collecting, using and sharing data.

Methods

we examined data collected in six care homes across Lothian, Scotland. We extracted the meta-data, cross-referenced definitions and assessed the degree of harmonisation between care homes and with data sets currently in use in Scotland and internationally. We interviewed care home managers about their views and experiences of collecting, using and sharing data.

Results

we identified 15 core data items used routinely, with significant heterogeneity in tools and assessments used, and very limited harmonisation. Two overarching themes were identified of importance to the development of a care home data platform: (i) the rationale for collecting data, including to (a) support person-centred care, (b) share information, (c) manage workforce and budget and (d) provide evidence to statutory bodies and (ii) the reality of collecting data, including data accuracy, and understanding data in context.

Discussion

considerable information is collected by care home staff, in varied formats, with heterogeneity of scope and definition, for range of reasons. We discuss the issues that should be considered to ensure that individual resident-level form the strong foundations for any data platform for care homes, which must also include, robust infrastructure and clear interoperability, with appropriate governance. It must be co-produced by academics, policy makers and sector representatives, with residents, their families and care staff.
Enablers and barriers to nurse-facilitated geriatric teleconsultations in nursing homes: a qualitative descriptive multi-site study
Authors: Qi Tan Apphia Jia , Chua Wei Ling , McKenna Lisa , Chin Tan Laurence Lean , Lim Yu Jun , Liaw Sok Ying
Published: December 2022

Background

Nurses play a major role in facilitating teleconsultations in nursing homes with remote physicians. Currently, evidence explicating their role in teleconsultations is lacking. As telemedicine usage grows, understanding the factors that enable or impede nurses’ role in teleconsultations allows for more support in the provision of patient care through this modality.

Objective

This study sought to explore enablers and barriers nurses faced in facilitating geriatric teleconsultations in nursing homes.

Methods

A qualitative descriptive study using semi-structured interviews was conducted in Singapore, from July to November 2021. Purposive sampling of nursing home nurses was undertaken. Data were inductively analysed using Braun and Clarke’s thematic analysis approach.

Results

Twenty-two nursing home nurses participated in the study. Six key themes were identified as enablers and barriers in nurse-facilitated geriatrics teleconsultations. Enablers included nurses’ acknowledgement of teleconsultations as needs-orientated service, close partnership with the hospital-based geriatric service for training and workflow support and nurses’ sense of empowerment in teleconsultation involvement. Barriers that existed were the nurses’ lack of confidence in physical assessment and communication competencies, role conflict due to nurses’ perceived inability to meet physicians’ expectations and limited scope of practice in performing teleconsultation-related tasks and the presence of technology-related challenges.

Conclusion

The identification of enablers and barriers in teleconsultations for nursing home residents provides insights for future research and development in telemedicine-related implementation and educational interventions in long-term care. Developing strong partnerships between telemedicine providers and nursing homes, further enhancement of nurses’ telemedicine competencies and optimising digital infrastructure are warranted.
Factors associated with informal caregivers’ ability to continue care: a subgroup analysis
Authors: Wang Shanshan , de Almeida Mello Johanna , Declercq Anja
Published: December 2022

Background/objective

maintaining informal caregiver’s ability to continue care can prevent early institutionalisation and decrease health care costs, contributing to sustainable health care. This study aims to identify factors associated with informal caregiver’s ability to continue care across several degrees of cognitive decline and risk of burden.

Methods

this is a cross-sectional study that collected nationwide data on frail older people and their informal caregivers living in the community. Instruments used were InterRAI Home Care, Zarit Burden Interview and questionnaire for the informal caregiver. Multivariate logistic regression analyses and a stratification of the population were performed.

Results

a total of 8,309 people had at least one primary caregiver, and a majority of them were able to continue care (68.2%). Cognitive impairment was a risk factor for being able to continue care, even the borderline (odds ratios (ORs): 0.72; 95% CI: 0.61–0.85) or mild condition (OR: 0.52; 95% CI: 0.43–0.61). Protective factors like social participation of older people, strong family support and availability of a secondary caregiver showed the highest association in subgroups with mild cognitive impairment (ORs: 2.20, 2.08, 1.64) and in subgroups at low risk of burden (ORs: 1.91, 2.77, 1.64).

Conclusion

factors associated with informal caregiver’s ability to continue care vary across several degrees of cognitive decline and risk of burden. Interventions related to family and social support resources are recommended, and informal caregivers at a lower level of risk may benefit most. Supportive counselling should be proactively provided to informal caregivers, considering the changes of associated factors with the ongoing caregiving situation.
Ultrasound-derived muscle assessment system for older adults: a promising muscle mass estimation tool
Authors: Tang Xinyi , Huang Songya , Huang Li , Feng Ziyan , Wang Ziyao , Yue Jirong , Qiu Li
Published: December 2022

Background

Quantitative assessment of muscle mass is a critical step in sarcopenia disease management. Expanding upon the use of ultrasound in foetal growth assessment, we established and validated an ultrasound-derived muscle assessment system for older adults at a risk of sarcopenia.

Methods

A total of 669 older adults were recruited in three cohorts in this cross-sectional study. In cohort 1(n = 103), the most valuable sites for skeletal muscle mass index (SMI) estimation were located among 11 ultrasound scanning sites. An ultrasound-derived SMI estimating algorithm based on muscle thickness (MT) was obtained in the modelling group composed of cohorts 1 and 2 (n = 309). The reliability of the muscle mass estimation equation and the validity of the obtained cut-off values were verified in cohort 3 (n = 257), which was selected as the verification group.

Results

In the modelling group, the cut-off values of ultrasound-derived e-SMI for low SMI were 7.13 kg/m2 for men and 5.81 kg/m2 for women. In the verification group, the intraclass correlation between e-SMI and SMI was 0.885. The sensitivity of the e-SMI in detecting low SMI was 93.6% for men and 89.7% for women, and the negative predictive value was 94.9% for men and 94.7% for women. Combined with the handgrip strength and gait speed, the e-SMI had an overall diagnostic sensitivity of 92.7% and a specificity of 91.0% for sarcopenia.

Conclusion

The ultrasound-derived muscle assessment system can be a promising muscle mass estimation tool and a potential disease classification tool.
Injurious falls before, during and after dementia diagnosis: a population-based study
Authors: Zhang Lulu , Wang Jiao , Dove Abigail , Yang Wenzhe , Qi Xiuying , Xu Weili
Published: December 2022

Background

the timing of incident injurious falls at different stages of dementia diagnosis is unclear.

Objectives

to identify when the occurrence of injurious falls begins to increase among individuals who are going to develop dementia, to explore the time point at which people living with dementia are at highest risk of injurious falls and to ascertain differences in fall-related factors pre- and post-dementia diagnosis.

Design

this study included 2,707 participants with incident dementia and 2,707 1:1 matched (i.e. same birth year and sex) controls without dementia.

Methods

dementia diagnosis and date of onset were identified from the National Patient Registry (NPR) and the Swedish Cause of Death Register following international criteria. Information on injurious falls and history of chronic disease was obtained from the NPR. Data were analysed using conditional Poisson regression and generalized estimating equation models.

Results

compared with controls, the incidence of injurious falls among participants with dementia started to increase beginning 4 years pre-diagnosis (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI] 1.30–2.22), reaching a peak (IRR 3.73, 95% CI 3.16–4.41) in the year of dementia diagnosis. Heavy drinking, physically active and cardiometabolic diseases (CMDs) were associated with incident falls among those with dementia.

Conclusion

people with dementia have a higher incidence of injurious falls beginning 4 years leading up to diagnosis and peaking during the year of diagnosis. Older age, female, heavy drinking, physically active and CMDs may predict injurious falls among people with dementia.
Understanding Pathways into Care homes using Data (UnPiCD study): a retrospective cohort study using national linked health and social care data
Authors: Burton Jennifer Kirsty , Ciminata Giorgio , Lynch Ellen , Shenkin Susan D , Geue Claudia , Quinn Terence J
Published: December 2022

Background

Pathways into care are poorly understood but important life events for individuals and their families. UK policy is to avoid moving-in to care homes from acute hospital settings. This assumes that moves from secondary care represent a system failure. However, those moving to care homes from community and hospital settings may be fundamentally different groups, each requiring differing care approaches.

Objective

To characterise individuals who move-in to a care home from hospital and compare with those moving-in from the community.

Design and setting

A retrospective cohort study using cross-sectoral data linkage of care home data.

Methods

We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Care home data were linked to general and psychiatric hospital admissions, community prescribing and mortality records to ascertain comorbidities, significant diagnoses, hospital resource use, polypharmacy and frailty. Multivariate logistic regression identified predictors of moving-in from hospital compared to from community.

Results

We included 23,892 individuals moving-in to a care home, 13,564 (56.8%) from hospital and 10,328 (43.2%) from the community. High frailty risk adjusted Odds Ratio (aOR) 5.11 (95% Confidence Interval (CI): 4.60–5.68), hospital discharge with diagnosis of fracture aOR 3.91 (95%CI: 3.41–4.47) or stroke aOR 8.42 (95%CI: 6.90–10.29) were associated with moving-in from hospital. Discharge from in-patient psychiatry was also a highly significant predictor aOR 19.12 (95%CI: 16.26–22.48).

Conclusions

Individuals moving-in to care homes directly from hospital are clinically distinct from those from the community. Linkage of cross-sectoral data can allow exploration of pathways into care at scale.
A negative association between nectar standing crop and pollen transfer suggests nectar functions as a manipulator of pollinating bats
Authors: Domingos-Melo Arthur , Cocucci Andrea A , Tschapka Marco , Machado Isabel C
Published: December 2022

Background and Aims

Nectar standing crop has a fundamental role in controlling pollinator movements between flowers and individuals within a population. In bat pollination systems, plants take advantage of the cognitive abilities of nectarivorous bats, which integrate complex perceptions of the quality and spatial distribution of resources. Here, we propose that associations between standing crop and pollen transfer help to reveal the role of nectar as a manipulator of pollinator behaviour.

Methods

We used Harpochilus neesianus Ness (Acanthaceae), a bat-pollinated shrub from the Brazilian Caatinga, as a model system to assess nectar removal effects and standing crop, respectively, over the night and to test associations between the amount of nectar available to pollinators, and pollen import and export.

Key Results

Harpochilus neesianus showed continuous nectar secretion throughout the flower lifespan. Flowers subjected to successive nectar removals produced less nectar than flowers sampled just once, and showed, despite a higher sugar concentration, a lower absolute amount of sugar. Under these conditions, bats may realize that nectar production is decreasing after repeated visits to the same flower and could be manipulated to avoid such already pollinated flowers with little nectar, thus increasing the probability of visits to flowers with a high amount of nectar, and a still high pollen availability on anthers and low pollen deposition on stigmas. We found that during most of the period of anthesis, nectar standing crop volume was positively correlated with the number of pollen grains remaining in the anthers, and negatively with the number of pollen grains deposited on the stigma.

Conclusions

Nectar secretion patterns can function as a manipulator of pollinating bats in H. neesianus. We propose that the assessment of variability in nectar secretion in response to removal, and the correlation between nectar standing crop and relative pollen transfer throughout anthesis should be considered in order to understand the role of nectar in the manipulation of pollinators.
To each their own! Nectar plasticity within a flower mediates distinct ecological interactions
Authors: Balduino Hannelise de Kassia , Tunes Priscila , Giordano Emanuele , Guarnieri Massimo , Machado Silvia Rodrigues , Nepi Massimo , Guimarães Elza
Published: December 2022

Nuptial and extranuptial nectaries are involved in interactions with different animal functional groups. Nectar traits involved in pollination mutualisms are well known. However, we know little about those traits involved in other mutualisms, such as ant–plant interactions, especially when both types of nectaries are in the same plant organ, the flower. Here we investigated if when two types of nectaries are exploited by distinct functional groups of floral visitors, even being within the same plant organ, the nectar secreted presents distinct features that fit animal requirements. We compared nectar secretion dynamics, floral visitors and nectar chemical composition of both nuptial and extranuptial nectaries in natural populations of the liana Amphilophium mansoanum (Bignoniaceae). For that we characterized nectar sugar, amino acid and specialized metabolite composition by high-performance liquid chromatography. Nuptial nectaries were visited by three medium- and large-sized bee species and extranuptial nectaries were visited mainly by ants, but also by cockroaches, wasps and flies. Nuptial and extranuptial nectar differed regarding volume, concentration, milligrams of sugars per flower and secretion dynamics. Nuptial nectar was sucrose-dominated, with high amounts of γ-aminobutyric acid and β-aminobutyric acid and with theophylline-like alkaloid, which were all exclusive of nuptial nectar. Whereas extranuptial nectar was hexose-rich, had a richer and less variable amino acid chemical profile, with high amounts of serine and alanine amino acids and with higher amounts of the specialized metabolite tyramine. The nectar traits from nuptial and extranuptial nectaries differ in energy amount and nutritional value, as well as in neuroactive specialized metabolites. These differences seem to match floral visitors’ requirements, since they exclusively consume one of the two nectar types and may be exerting selective pressures on the composition of the respective resources of interest.
KMCP: accurate metagenomic profiling of both prokaryotic and viral populations by pseudo-mapping
Authors: Shen Wei , Xiang Hongyan , Huang Tianquan , Tang Hui , Peng Mingli , Cai Dachuan , Hu Peng , Ren Hong
Published: December 2022

Motivation

The growing number of microbial reference genomes enables the improvement of metagenomic profiling accuracy but also imposes greater requirements on the indexing efficiency, database size and runtime of taxonomic profilers. Additionally, most profilers focus mainly on bacterial, archaeal and fungal populations, while less attention is paid to viral communities.

Results

We present KMCP (K-mer-based Metagenomic Classification and Profiling), a novel k-mer-based metagenomic profiling tool that utilizes genome coverage information by splitting the reference genomes into chunks and stores k-mers in a modified and optimized Compact Bit-Sliced Signature Index for fast alignment-free sequence searching. KMCP combines k-mer similarity and genome coverage information to reduce the false positive rate of k-mer-based taxonomic classification and profiling methods. Benchmarking results based on simulated and real data demonstrate that KMCP, despite a longer running time than all other methods, not only allows the accurate taxonomic profiling of prokaryotic and viral populations but also provides more confident pathogen detection in clinical samples of low depth.

Availability and implementation

The software is open-source under the MIT license and available at https://github.com/shenwei356/kmcp.

Supplementary information

Supplementary data are available at Bioinformatics online.
Psychosocial Professionals in Chilean Justice Institutions. Reflections Based on the Experiences and Practice of Psychologists and Social Workers
Authors: Miranda-Pérez Fabiola , Andrade Guzmán Carlos
Published: December 2022

This study seeks to answer what is understood by the psychosocial and how this is implemented based on the experiences of those who apply it in Chilean justice institutions—specifically social workers and psychologists. A qualitative study was conducted in two regions of Chile with a high number of intervened cases in justice institutions. Results show that the psychosocial approach is a way to understand and address a complex social problem beyond the limits of psychological and social methods. However, even when this framework is theoretically considered throughout a professional’s formation, it may not be evident when applied in practice. Overall, the effort to incorporate this knowledge in justice needs to be expanded to achieve better interventions.
Morphological and environmental variability ofDianthus sylvestris(Caryophyllaceae) in the Balkan Peninsula
Authors: Terlević Ana , Temunović Martina , Bogdanović Sandro , Grgurev Marin , Ljubičić Ivica , Rešetnik Ivana
Published: December 2022

Species with wide ranges often exhibit morphological variability that is mostly shaped by ecological and evolutionary processes, and the resulting diversity is frequently reflected in intraspecific taxonomy. Dianthus sylvestris in the Balkan Peninsula encompasses six subspecies (D. sylvestris subspp. alboroseus, bertisceus, kozjakensis, nodosus, sylvestris and tergestinus), the identification of which is problematic due to a great morphological variability and complex patterns of environmental variation. To explore morphological variation of described subspecies and to investigate how their morphology varies in relation to environmental variations across their geographical distribution, we evaluated 97 populations of D. sylvestris for variability in 25 morphological characters and 20 environmental variables. Number and shape of epicalyx scales, calyx length and petal denticulation captured the greatest extent of morphological variability between populations. Morphometric analyses revealed a continuous variability in quantitative morphological characters and an absence of clear morphological differentiation between the investigated subspecies. However, two main morphologically distinct entities, the north-western Balkan populations and the south-eastern Balkan populations, were identified and they were split approximately along the Neretva River valley. In addition, our results indicate that environment, rather than geography, plays a potentially more important role in shaping the morphological variability of this taxon. Overall, our results do not support the recognition of the described subspecies or the currently accepted taxonomic concept, instead pointing to a continuous morphological variability of D. sylvestris in the Balkan Peninsula.
Characterization of proteogenomic signatures of differentiation of CD4+ T cell subsets
Authors: Kanno Toshio , Konno Ryo , Miyako Keisuke , Nakajima Takahiro , Yokoyama Satoru , Sasamoto Shigemi , Asou Hikari K , Ohzeki Junichiro , Kawashima Yusuke , Hasegawa Yoshinori , Ohara Osamu , Endo Yusuke
Published: December 2022

Functionally distinct CD4+ helper T (Th) cell subsets, including Th1, Th2, Th17, and regulatory T cells (Treg), play a pivotal role in the regulation of acquired immunity. Although the key proteins involved in the regulation of Th cell differentiation have already been identified how the proteogenomic landscape changes during the Th cell activation remains unclear. To address this issue, we characterized proteogenomic signatures of differentiation to each Th cell subsets by RNA sequencing and liquid chromatography-assisted mass spectrometry, which enabled us to simultaneously quantify more than 10,000 protein-coding transcripts and 8,000 proteins in a single-shot. The results indicated that T cell receptor activation affected almost half of the transcript and protein levels in a low correlative and gene-specific manner, and specific cytokine treatments modified the transcript and protein profiles in a manner specific to each Th cell subsets: Th17 and Tregs particularly exhibited unique proteogenomic signatures compared to other Th cell subsets. Interestingly, the in-depth proteome data revealed that mRNA profiles alone were not enough to delineate functional changes during Th cell activation, suggesting that the proteogenomic dataset obtained in this study serves as a unique and indispensable data resource for understanding the comprehensive molecular mechanisms underlying effector Th cell differentiation.
Mean arterial pressure predicts 48 h clinical deterioration in intermediate-high risk patients with acute pulmonary embolism
Authors: Zuin Marco , Rigatelli Gianluca , Bongarzoni Amedeo , Enea Iolanda , Bilato Claudio , Zonzin Pietro , Casazza Franco , Roncon Loris
Published: December 2022

Aims

We assess the prognostic role of mean arterial pressure (MAP) for 48 h clinical deterioration in intermediate-high risk pulmonary embolism (PE) patients after admission.

Methods and results

A post hoc analysis of intermediate-high-risk PE and intermediate-low-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. Clinical deterioration within 48 h was defined as patient worsening from a stable to an unstable haemodynamic condition, need of catecholamine infusion, endotracheal intubation, or cardiopulmonary resuscitation. Of 450 intermediate-high risk PE patients (mean age 71.4 ± 13.8 years, 298 males), 40 (8.8%) experienced clinical deterioration within 48 h from admission. Receiver operating characteristic analysis established the optimal cut-off value for MAP, as a predictor of 48 h clinical deterioration, ≤81.5 mmHg [area under curve (AUC) of 0.77 ± 0.3] with sensitivity, specificity, positive predictive value, and negative predictive value were 77.5, 95.0, 63.2, and 97.7%, respectively. Multivariate Cox regression analysis showed that independent risk factors for 48 h clinical deterioration were age [hazard ratio (HR): 1.26, 95% confidence interval (CI): 1.19–1.28, P < 0.0001], history of heart failure (HR: 1.76, 95% CI: 1.72–1.81, P < 0.0001), simplified Pulmonary Embolism Severity Index (HR: 1.52, 95% CI: 1.49–1.58, P = 0.001), systemic thrombolysis (HR: 0.54, 95% CI: 0.30–0.65, P < 0.0001), and a MAP of ≤81.5 mmHg at admission (HR: 3.25, 95% CI: 1.89–5.21, P < 0.0001). The deteriorating group had a significantly higher risk of 30-day mortality (HR: 2.61, 95% CI: 2.54–2.66, P < 0.0001) compared with the non-deteriorating group.

Conclusion

The mean arterial pressure appears to be a useful, bedside, and non-invasive prognostic tool potentially capable of promptly identifying intermediate-high risk PE patients at higher risk of 48 h clinical deterioration.
Arch vessels’ switch in frozen elephant trunk: a new technique to facilitate the second-stage endovascular thoraco-abdominal aorta repair
Authors: Gatta Emanuele , Berretta Paolo , Vento Vincenzo , Di Eusanio Marco
Published: December 2022

In patients with extensive thoraco-abdominal aortic disease, staged hybrid repair involving open total aortic arch replacement and endovascular thoraco-abdominal aorta repair with branched stent graft has emerged as a valuable treatment option. However, total arch replacement with the available branched vascular grafts often results in acute angulation between the reimplanted vessels and the aortic arch hampering antegrade catheterization of the thoraco-abdominal aorta during the second endovascular stage. Here, we present our ‘switch technique’ for arch vessels’ reimplantation to facilitate antegrade aortic catheterization of the thoraco-abdominal aorta and visceral vessels.
Twenty-year experience of aortic valve reimplantation using the Valsalva graft
Authors: Chirichilli Ilaria , Scaffa Raffaele , Irace Francesco Giosuè , Salica Andrea , Weltert Luca Paolo , D’Aleo Salvatore , Chiariello Luigi , De Paulis Ruggero
Published: December 2022

OBJECTIVES

Over the past 20 years, valve-sparing aortic root replacement has aroused increasing interest because of a progressive attitude towards the preservation of natural tissue. Aortic reimplantation is the most used technique to spare the valve, allowing simultaneously aortic root replacement and aortic annular stabilization. The reimplantation into a graft with sinuses guarantees an optimal anatomic and functional reconstruction with established good results at 15 years. The aim of this study is to report the world longest follow-up (up to 20 years) of aortic valve reimplantation using the Valsalva graft.

METHODS

From February 2000 to December 2021, 265 consecutive patients with aortic root aneurysm received aortic valve reimplantation using the Valsalva graft. From 2018, leaflet plication with the routine use of calliper was performed. For each patient, we performed both intraoperative and post-procedural transoesophageal echocardiography. All patients were followed with clinical assessment and echocardiography. The mean duration of follow-up was 85 ± 63 months.

RESULTS

The study cohort had a median age of 55 ± 18 and 87.2% were male. The aortic root aneurysm was associated to bicuspid aortic valve in 18.9% of patients and to Marfan syndrome in 10.6% of cases. 55.9% had an aortic regurgitation ≥ 2+. Overall survival at 15 was 87.6 ± 3.4. Freedom from cardiac death was stable at 99.6 ± 0.4 at 5, 10 and 15 years. Freedom from recurrent AR ≥3+ and freedom from reoperation remained stable at 10 and 15 years at 92.2 ± 2.1 and 95.9 ± 1.6, respectively. There was a minimal incidence of infective endocarditis (0.8%), thromboembolism (2.2%) and haemorrhage (2.0%). Six out of 7 patients requiring reoperation had surgery in the first period of our experience (last in 2004). Early suboptimal results had a negative effect on residual aortic regurgitation. Moreover, we hypothesized that the routine use of calliper may have contributed to a further improvement of the outcome, even if these data need to be confirmed by a longer follow-up.

CONCLUSIONS

The first long-term follow-up after aortic valve reimplantation using the Valsalva graft demonstrated excellent results. These long-term results gradually improved with learning curve, remaining stable during the second decade of observation. The systematic use of calliper may have contributed to a further improvement of the outcome.
Cardiometabolic multimorbidity and incident dementia: the Swedish twin registry
Authors: Dove Abigail , Guo Jie , Marseglia Anna , Fastbom Johan , Vetrano Davide Liborio , Fratiglioni Laura , Pedersen Nancy L , Xu Weili
Published: December 2022

Aims

Cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke, are established risk factors for dementia, but their combined impact has been investigated only recently. This study aimed to examine the association between mid- and late-life cardiometabolic multimorbidity and dementia and explore the role of genetic background in this association.

Methods and results

Within the Swedish Twin Registry, 17 913 dementia-free individuals aged ≥60 were followed for 18 years. CMDs [including age of onset in mid (60) or late (≥60) life] and dementia were ascertained from medical records. Cardiometabolic multimorbidity was defined as having ≥2 CMDs. Cox regression was used to estimate the CMD–dementia association in (i) a classical cohort study design and (ii) a co-twin study design involving 356 monozygotic and dizygotic pairs. By comparing the strength of the association in the two designs, the contribution of genetic background was estimated. At baseline, 3,312 (18.5%) participants had 1 CMD and 839 (4.7%) had ≥2 CMDs. Over the follow-up period, 3,020 participants developed dementia. In the classic cohort design, the hazard ratio (95% confidence interval) of dementia was 1.42 (1.27–1.58) for 1 CMD and 2.10 (1.73–2.57) for ≥2 CMDs. Dementia risk was stronger with mid-life as opposed to late-life CMDs. In the co-twin design, the CMD–dementia association was attenuated among monozygotic [0.99 (0.50–1.98)] but not dizygotic [1.55 (1.15–2.09)] twins, suggesting that the association was in part due to genetic factors common to both CMDs and dementia.

Conclusion

Cardiometabolic multimorbidity, particularly in mid-life, is associated with an increased risk of dementia. Genetic background may underpin this association.
COVID-19 on the Nile: a cross-sectional investigation of COVID-19 among Nile River cruise travellers returning to the United States, February–March 2020
Authors: Guagliardo Sarah Anne J , Quilter Laura A S , Uehara Anna , White Stefanie B , Talarico Sarah , Tong Suxiang , Paden Clinton R , Zhang Jing , Li Yan , Pray Ian , Novak Ryan T , Fukunaga Rena , Rodriguez Andrea , Medley Alexandra M , Wagner Riley , Weinberg Michelle , Brown Clive M ,   US State and Local Departments of Health, Bandy Utpala , Barter Devra , Bateman Allen , Bhatt Premal , Blankenship Heather M , Blanton Jason , Chan Philip A , Colón Ana , Gumke Megan , Johnson Shannon , Kolsin Jonathan , Salmanson Amelia Prebish , Rakeman Jennifer L , Schmedes Sarah E , Schroeder Betsy , Shockey Abigail , Snyder Robert E , Sockwell Denise C , Villarino Elsa , Friedman Cindy R
Published: December 2022

Background

Early in the pandemic, cruise travel exacerbated the global spread of SARS-CoV-2. We report epidemiologic and molecular findings from an investigation of a cluster of travellers with confirmed COVID-19 returning to the USA from Nile River cruises in Egypt.

Methods

State health departments reported data on real-time reverse transcription-polymerase chain reaction-confirmed COVID-19 cases with a history of Nile River cruise travel during February–March 2020 to the Centers for Disease Control and Prevention (CDC). Demographic and epidemiologic data were collected through routine surveillance channels. Sequences were obtained either from state health departments or from the Global Initiative on Sharing Avian Flu Data (GISAID). We conducted descriptive analyses of epidemiologic data and explored phylogenetic relationships between sequences.

Results

We identified 149 Nile River cruise travellers with confirmed COVID-19 who returned to 67 different US counties in 27 states: among those with complete data, 4.7% (6/128) died and 28.1% (38/135) were hospitalized. These individuals travelled on 20 different Nile River cruise voyages (12 unique vessels). Fifteen community transmission events were identified in four states, with 73.3% (11/15) of these occurring in Wisconsin (as the result of a more detailed contact investigation in that state). Phylogenetic analyses supported the hypothesis that travellers were most likely infected in Egypt, with most sequences in Nextstrain clade 20A 93% (87/94). We observed genetic clustering by Nile River cruise voyage and vessel.

Conclusions

Nile River cruise travellers with COVID-19 introduced SARS-CoV-2 over a very large geographic range, facilitating transmission across the USA early in the pandemic. Travellers who participate in cruises, even on small river vessels as investigated in this study, are at increased risk of SARS-CoV-2 exposure. Therefore, history of river cruise travel should be considered in contact tracing and outbreak investigations.
Impact of cosmic rays on the global 21-cm signal during cosmic dawn
Authors: Bera Ankita , Samui Saumyadip , Datta Kanan K
Published: December 2022

It is extremely important to understand the processes through which the thermal state of the inter-galactic medium (IGM) evolved in the early universe in order to study the evolution of HI 21-cm signal during cosmic dawn. Here, we consider the heating of the IGM due to cosmic ray (CR) protons generated by the supernovae from both early Pop III and Pop II stars. The low energy CR (cr protons from Pop III supernovae can escape from minihalos and heat the IGM via collision and ionization of hydrogen. Furthermore, high-energy protons generated in Pop II supernovae can escape the hosting halos and heat the IGM via magnetosonic Alfvén waves. We show that the heating due to these CR particles can significantly impact the IGM temperature and hence the global 21-cm signal at z ∼ 14−18. The depth, location, and duration of the 21-cm absorption profile are highly dependent on the efficiencies of CR heating. In particular, the Experiment to Detect the Epoch of Reionization Signature signal can be well fitted by the CR heating along with the Lyman-α coupling and the dark matter--baryon interaction that we consider to achieve a ‘colder IGM background’. Further, we argue that the properties of CRs and the nature of first generation of stars could be constrained by accurately measuring the global 21-cm absorption signal during the cosmic dawn.
Pre-implantation mouse embryo movement under hormonally altered conditions
Authors: Lufkin Hannah , Flores Diana , Raider Zachary , Madhavan Manoj , Dawson Madeline , Coronel Anna , Sharma Dhruv , Arora Ripla
Published: December 2022

Pre-implantation embryo movement is crucial to pregnancy success, but the role of ovarian hormones in modulating embryo movement is not understood. We ascertain the effects of altered hormonal environment on embryo location using two delayed implantation mouse models: natural lactational diapause (ND); and artificially induced diapause (AD), a laboratory version of ND generated by ovary removal and provision of supplemental progesterone (P4). Previously, we showed that embryos in a natural pregnancy (NP) first display unidirectional clustered movement, followed by bidirectional scattering and spacing movement. In the ND model, we discovered that embryos are present as clusters near the oviductal–uterine junction for ∼24 h longer than NP, followed by locations consistent with a unidirectional scattering and spacing movement. Intriguingly, the AD model resembles embryo location in NP and not ND. When measuring serum hormone levels, unlike the popular paradigm of reduced estrogen (E2) levels in diapause, we observed that E2 levels are comparable across NP, ND and AD. P4 levels are reduced in ND and highly increased in AD when compared to NP. Further, exogenous administration of E2 or P4 modifies embryo location during the unidirectional phase, while E2 treatment also affects embryo location in the bidirectional phase. Taken together, our data suggest that embryo movement can be modulated by both P4 and E2. Understanding natural hormonal adaptation in diapause provides an opportunity to determine key players that regulate embryo location, thus impacting implantation success. This knowledge can be leveraged to understand pregnancy survival and implantation success in hormonally altered conditions in the clinic.
Who Is Being Silenced?: Sociocultural and Privilege Dynamics Within Music Therapy Education
Authors: Gombert Debra Jelinek
Published: December 2022

This phenomenological study brought a critical lens to the views and contexts of seven music therapists. Semi-structured interviews examined participants’ experiences of the sociocultural and privilege dynamics within music therapy education. Purposive sampling allowed the researcher to center the perspectives of participants who collectively described themselves with intersections of the following identities: black, white, Latinx, Chinese, South East Asian, male, female, non-binary, disabled, non-disabled, straight, pansexual, and one self-identified dyke. An iterative inductive analysis revealed several emergent themes related to inequity and the decentering of minoritized voices within music therapy: the theme A Very White Lens focused on a Eurocentric approach in education and practice that, by failing to acknowledge and center a variety of perspectives, reduces equitable access to both students and clients; Silenced Experiences of Minoritized Voices included participant experiences of anti-Blackness, white privilege, and white fragility within music therapy; When Does Culture Matter? captured responses to and the dangers of an approach that ignores cultural differences; and How We Talk About Culture included concerns and suggestions about the structure of the discourse around cultural intersections, privilege, and race in music therapy education and practice. These findings bring to light some of the structures of power and privilege at the core of music therapists’ education and training. Themes highlighted in this paper center the experiences of individuals who belong to minoritized populations and in so doing, emphasize the need to listen to a greater diversity of voices in the conversation about equity and inclusion in music therapy.
(Un)Learning from Experience: An Exposition of Minoritized Voices on Music Therapy Training
Authors: Myerscough Francis , Wong Denise
Published: December 2022

Having met teaching at a local university around inclusive healthcare practice, the authors came together to write a reflective exploration of our experiences as minoritized music therapy trainees in the United Kingdom (UK). This subject has received limited attention in music therapy publications, in particular with the attention to the intersectionality of multiple and/or different axes of oppression. Originally from Hong Kong, Denise came to the UK a decade ago; she shared her experiences in navigating incidents of discrimination and microaggression while living in the UK. Francis considered how their experience of training was impacted by their positioning as someone transgender (trans), queer, and disabled, and by other aspects of their life history. We devised an interview schedule upon which to base a shared discussion and identified themes arising, which we analyze here. The themes discussed are self, self-experience & self-presentation; insider–outsider; inequity & minoritized labor; landscape of minority stress; power & institutional culture; fear & negative impacts; communication & feedback; positive experiences; and personal growth & reflexivity. In particular, we emphasize the importance of reflexivity both at the trainers’ individual level and the level of the wider training institution. This requires a commitment to sustained learning and improvement within and beyond training across the profession.
The multilayered hierarchical gene regulatory network reveals interaction of transcription factors in response to cadmium inTamarix hispidaroots
Authors: Xie Qingjun , Wang Yuanyuan , Wang Danni , Li Jinghang , Liu Baichao , Liu Zhongyuan , Wang Peilong , Zhang Hao , Yang Kaiye , Gao Caiqiu
Published: December 2022

Cadmium (Cd) is a toxic metal that affects the normal growth and development of plants. Roots may directly contact Cd and thus serve as the first barrier in the defense responses of plants. In this study, Tamarix hispida (T. hispida) roots treated with 150 μM CdCl2 were collected for RNA-seq. A total of 2004 differentially expressed genes (DEGs) were identified at different time points. Kyoto Encyclopedia of Genes and Genomes enrichment revealed that the DEGs were significantly enriched in phenylpropanoid biosynthesis, flavonoid biosynthesis and other metabolic pathways. To explore the regulatory role of transcription factors (TFs) involved in the Cd stress response, a multilayer hierarchical gene regulatory network (ML-hGRN) was constructed, including 53 TFs and 54 structural genes in ML-hGRN, with 341 predicted regulatory relationships. Binding of DRE1A, MYC1, FEZ, ERF4 and ERF17 to predicted target genes was detected by ChIP-PCR, and DRE1A, MYC1 and FEZ were transiently overexpressed in T. hispida. The results suggest that these TFs play a key role in the Cd stress response by scavenging reactive oxygen species. In conclusion, this study predicts some Cd-responsive TFs that may have an important function under Cd stress and provides useful information for molecular breeding.
Environmental factors and building conditions for risk of cutaneous leishmaniasis in the northeast of Iran: a population-based case–control study
Authors: Shahryari Ali , Charkazi Abdurrhman , Rajabi Abdolhalim
Published: December 2022

Background

Leishmaniasis is a tropical disease that significantly affects countries in the developing world. This study evaluated the environmental factors and building conditions associated with cutaneous leishmaniasis (CL) in northeast Iran.

Methods

A population-based case–control study was performed between 1 July 2018 and 1 March 2021 in northeast Iran; two controls were selected for each case. Patients and controls were compared for environmental factors, building conditions and demographic characteristics.

Results

There were 170 confirmed leishmaniasis cases during the study period. Familiarity with people with active leishmaniasis in open areas of the body increased the odds of getting the disease (odds ratio [OR] 2.41 [95% confidence interval {CI} 1.18 to 4.93]). In the case group, the history of contact with animals such as sheep, goats, cows, mice and camels was significantly higher. Housewives (OR 0.08 [95% CI 0.02 to 0.27]) and self-employed people (OR 0.22 [95% CI 0.07 to 0.70]) were less likely to become infected. The individuals who lived in houses with asbestos cement roofs were more likely to become infected (OR 4.77 [95% CI 1.34 to 16.91]) compared with those who lived in houses with bituminous roofs.

Conclusions

The most significant risk factor identified in the present study was the type and condition of the home's roof. Housing construction improvement is vital to prevent leishmaniasis in northeast Iran.
Depression, anxiety and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic
Authors: Tibebu Nebiyu Solomon , Kassie Belayneh Ayanaw , Anteneh Tazeb Alemu , Rade Bayew Kelkay
Published: December 2022

Background

Assessing the maternal mental health status during the coronavirus disease 2019 (COVID-19) pandemic is necessary to prevent the occurrence of severe mental disorders. Prenatal depression, anxiety and stress disorders are prominent in pregnant women living with human immunodeficiency virus (HIV) and highly associated with poor maternal and neonatal outcomes. Therefore this study aimed to assess the level of depression, anxiety, and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic.

Methods

An institution-based cross-sectional study was conducted in Amhara region referral hospitals from 17 October 2020 to 1 March 2021. A systematic random sampling technique was used to select 423 eligible women. A structured, pretested and interviewer-administered questionnaire was employed to collect the data. A multivariable logistic regression analysis was implemented to identify factors associated with women's depression, anxiety and stress. Statistical association was certain based on the adjusted odds ratio (AOR) with its 95% confidence interval (CI) and p-values ≤0.05.

Results

Prenatal depression, anxiety and stress among HIV-positive pregnant women were 37.6% (95% CI 33 to 42.3), 42.1 (95% CI 37.7 to 46.7) and 34.8% (95% CI 30.3 to 39.2), respectively. Having an HIV-negative sexual partner (AOR 1.91 [95% CI 1.16 to 3.15]) and being on antiretroviral therapy >1 year (AOR 2.18 [95% CI 1.41 to 3.36]) were found to be statistically significant with women's antenatal depression, while unplanned pregnancy (AOR 1.09 [95% CI 1.02 to 2.33]) and did not discuss with the sexual partner about HIV (AOR 3.21 [95% CI 2.12 to 7.07]) were the factors associated with prenatal anxiety.

Conclusions

In this study, more than one in three HIV-positive pregnant women had depression and anxiety. Thus, implementing strategies to prevent unplanned pregnancy and advocating open discussion with sexual partners about HIV will play a large role in reducing pregnancy-related depression and anxiety.
Relapsed Congenital Vertical Talus Deformity: Outcomes of a Modified Minimally Invasive Method
Authors: Cummings Jason L. , Hosseinzadeh Pooya
Published: December 2022

Background:

To date, there is little literature that describes the optimal management for recurrent talonavicular subluxation after an initial attempt at surgical correction in children with congenital vertical talus (CVT). The purpose of this study is to evaluate the outcomes of a modified minimally invasive technique for the management of recurrent talonavicular subluxation in patients with CVT who have previously undergone at least 1 attempt at surgical correction.

Methods:

International Classification of Diseases codes were used to identify all patients with recurrent CVT deformity treated at our institution between 2006 and 2021. Retrospective chart review, including radiographic measurements of talocalcaneal and talar axis-first metatarsal base angles (TAMBA), was performed. Complications including recurrent talonavicular subluxation (lateral TAMBA >30 degrees) and hindfoot valgus (Anteroposterior talocalcaneal >40 degrees) were recorded. All statistical analysis was performed using an alpha of 0.05.

Results:

Seventeen patients (24 feet) met all inclusion criteria, 9 (52.9%) of whom had underlying neurological syndromes. The average age at repeat treatment initiation was 26±17 months (range: 7 to 60 mo). Talonavicular reduction was achieved in all patients as evidenced by an average of 24.6 degrees and 54.9 degrees of correction in the Anteroposterior and lateral TAMBA, respectively. Radiographic recurrence of the talonavicular deformity was seen in 12 feet (50.0%). Six (25.0%) of the feet in 4 patients required a revision surgery, all of which occurred in patients with underlying syndromes (P=0.02). The average patient-reported outcome measurement information system scores in the pain interference, mobility, and peer relations domains were 44.5±7.7, 44.1±13.5, and 54.8±9.9, respectively.

Conclusions:

Our midterm results suggest that many cases of recurrent CVT can be effectively managed through a modified minimally invasive revision surgery consistent with what has been described by Dobbs and colleagues for initial treatment. Further prospective studies with longer-term follow-up are warranted to confirm these findings.

Level of Evidence:

Level III.