bluuebunny/crossref_metadata_2025 huggingface dataset:
Why do shrimps leave the water? Mechanisms and functions of parading behaviour in freshwater shrimps
Authors: Hongjamrassilp W. , Maiphrom W. , Blumstein D. T.
Published: November 2020

An understanding of the mechanisms and functions of animal migratory behaviour may provide insights into its evolution. Furthermore, knowledge about migration may be important for conservation of rare species and may help to manage species in a rapidly changing world. Upstream migration is common in riverine animals, but little is known about proximate cues and functions of the upstream migration in aquatic macroinvertebrates. In Ubon Ratchathani, Thailand, locals have observed a synchronous mass migration of freshwater shrimps on land. This so‐called ‘parading behaviour' occurs annually during the rainy season and has become a large ecotourism event. Yet, we know little about the natural history, proximate causation and function of this extraordinary behaviour. Here we describe the natural history of parading behaviour and report the results from a series of experiments and observations to address its mechanisms and functions. Parading behaviour is not associated with breeding and spawning; rather, shrimps leave the water to escape strong currents. Conditions promoting shrimps to leave the water include low light, high water velocity and low air temperature. In addition, there is variation explained the specific location. River topology that creates hydrological variability and turbulence plays a role in triggering the shrimps to move out of water. Furthermore, turbidity and water chemistry were associated with shrimp activity. Finally, our results support that parading behaviour in freshwater shrimps is a mass movement upstream due to hydrological displacement. This study highlights the mechanisms that stimulate parading behaviour; a common activity in Macrobrachium and other decapod crustaceans.
Phylogenomics and species delimitation for effective conservation of manta and devil rays
Authors: Hosegood Jane , Humble Emily , Ogden Rob , de Bruyn Mark , Creer Simon , Stevens Guy M. W. , Abudaya Mohammed , Bassos‐Hull Kim , Bonfil Ramon , Fernando Daniel , Foote Andrew D. , Hipperson Helen , Jabado Rima W. , Kaden Jennifer , Moazzam Muhammad , Peel Lauren R , Pollett Stephen , Ponzo Alessandro , Poortvliet Marloes , Salah Jehad , Senn Helen , Stewart Joshua D. , Wintner Sabine , Carvalho Gary
Published: November 2020

Practical biodiversity conservation relies on delineation of biologically meaningful units. Manta and devil rays (Mobulidae) are threatened worldwide, yet morphological similarities and a succession of recent taxonomic changes impede the development of an effective conservation strategy. Here, we generate genome‐wide single nucleotide polymorphism (SNP) data from a geographically and taxonomically representative set of manta and devil ray samples to reconstruct phylogenetic relationships and evaluate species boundaries under the general lineage concept. We show that nominal species units supported by alternative data sources constitute independently evolving lineages, and find robust evidence for a putative new species of manta ray in the Gulf of Mexico. Additionally, we uncover substantial incomplete lineage sorting indicating that rapid speciation together with standing variation in ancestral populations has driven phylogenetic uncertainty within Mobulidae. Finally, we detect cryptic diversity in geographically distinct populations, demonstrating that management below the species level may be warranted in certain species. Overall, our study provides a framework for molecular genetic species delimitation that is relevant to wide‐ranging taxa of conservation concern, and highlights the potential for genomic data to support effective management, conservation and law enforcement strategies.
Integrating segmentation and parameter estimation for recreating vertical alignments
Authors: Song Zhanfeng , Yang Fei , Schonfeld Paul , Liu Huichun , Li Jun
Published: November 2020

A major problem of vertical alignment recreation is to automatically attribute the measured points to geometric elements (i.e., grades and vertical curves) and to efficiently recreate the vertical alignment with constraints. Most existing methods are nonoptimal in theory, semiautomatic, or inefficient in recreating an alignment. A new approach is proposed for automatically determining segmentation into geometric elements from measured points and efficiently optimizing a recreated alignment with constraints. First, independent parameters defining an alignment, are proposed to represent a vertical alignment. Then, a statistical deflection angle (SDA) method is proposed to determine segmentation by exploring statistical features of the geometric elements. Analysis shows that the SDA method outperforms the curvature method in distinguishing between grades and curves. Patterns of the segmentation process are found, and a segmentation algorithm is provided. Further, an optimization model is proposed to recreate the alignment with constraints. Experiment results demonstrate that this approach is highly efficient and effective compared with existing methods, reducing the number of searched alignments from tens of thousands to tens, while improving the value of the objective function.
Coagulation markers as predictors for clinical events in COPD
Authors: Husebø Gunnar R. , Gabazza Esteban C. , D'Alessandro Gabazza Corina , Yasuma Taro , Toda Masaaki , Aanerud Marianne , Nielsen Rune , Bakke Per S. , Eagan Tomas M.L.
Published: November 2020

Background and objective

Activation of the blood coagulation system is a common observation in inflammatory diseases. The role of coagulation in COPD is underexplored.

Methods

The study included 413 COPD patients and 49 controls from the 3‐year Bergen COPD Cohort Study (BCCS). One hundred and forty‐eight COPD patients were also examined during AECOPD. The plasma markers of coagulation activation, TAT complex, APC–PCI complex and D‐dimer, were measured at baseline and during exacerbations by enzyme immunoassays. Differences in levels of the markers between stable COPD patients and controls, and between stable COPD and AECOPD were examined. The associations between coagulation markers and later AECOPD and mortality were examined by negative binomial and Cox regression analyses.

Results

TAT was significantly lower in stable COPD (1.03 ng/mL (0.76–1.44)) than in controls (1.28 (1.04–1.49), P = 0.002). During AECOPD, all markers were higher than in the stable state: TAT 2.56 versus 1.43 ng/mL, APC–PCI 489.3 versus 416.4 ng/mL and D‐dimer 763.5 versus 479.7 ng/mL (P < 0.001 for all). Higher D‐dimer in stable COPD predicted a higher mortality (HR: 1.60 (1.24–2.05), P < 0.001). Higher TAT was associated with both an increased risk of later exacerbations, with a yearly incidence rate ratio of 1.19 (1.04–1.37), and a faster time to the first exacerbation (HR: 1.25 (1.10–1.42), P = 0.001, all after adjustment).

Conclusion

Activation of the coagulation system is increased during COPD exacerbations. Coagulation markers are potential predictors of later COPD exacerbations and mortality.
A Dynamic Factor Model Approach to Incorporate Big Data in State Space Models for Official Statistics
Authors: Schiavoni Caterina , Palm Franz , Smeekes Stephan , van den Brakel Jan
Published: November 2020

In this paper we consider estimation of unobserved components in state space models using a dynamic factor approach to incorporate auxiliary information from high-dimensional data sources. We apply the methodology to unemployment estimation as done by Statistics Netherlands, who uses a multivariate state space model to produce monthly figures for unemployment using series observed with the labour force survey (LFS). We extend the model by including auxiliary series of Google Trends about job-search and economic uncertainty, and claimant counts, partially observed at higher frequencies. Our factor model allows for nowcasting the variable of interest, providing reliable unemployment estimates in real-time before LFS data become available.
The Possible Effects of the Extended Lockdown Period on the South African Economy: A CGE Analysis
Authors: Van Heerden Jan , Roos Elizabeth Louisa
Published: November 2020

The economic effects of the lockdown period in South Africa will be devastating. We simulated the industry level capacity constraints imposed by the lockdown regulations since 27 March 2020 on all industries in South Africa by reducing the amount of capital and labour available for production. We found a decrease in real GDP to 10% below the baseline level in 2020, and recovery of all industries and macroeconomic variables towards the baseline by 2027. Industries that are suffering and would continue to suffer are the hospitality and tourism industry and all industries related to it, such as transport services, as well as beverages and tobacco. Manufacturing in general is also hard hit because they were prohibited to let large groups of labourers enter their premises. The model shows that most manufacturing will suffer throughout the forecast period, which was modelled up to 2027.
Consistent practice for pressure ulcer prevention in long‐term older people care: A quasi‐experimental intervention study
Authors: Mäki‐Turja‐Rostedt Sirpa , Leino‐Kilpi Helena , Korhonen Teija , Vahlberg Tero , Haavisto Elina
Published: November 2020

Background

Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long‐term older people care.

Aim

To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long‐term older people care.

Design

A quasi‐experimental intervention study.

Methods

Two long‐term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence‐Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument.

Results

In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure‐relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices.

Conclusions

The results of this study support the implementation of PU prevention guidelines in long‐term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care.
The power of ideas in policymaking processes: The role of institutionalised knowledge production in state bureaucracies
Authors: Andersen Niklas A. , Breidahl Karen N.
Published: November 2020

In recent decades, several important contributions have been made to further our understanding of whether and how ideas affect policies. More recently, research have turned towards the question of why certain ideas gain prominence in policymaking processes at the expense of others. However, in answering this question there seems to be a continuing blind spot in terms of fully understanding the role of knowledge production within state bureaucracies in determining which ideas are inscribed into policy and which are not. This article offers new insights to the ideational literature by showing how the use of institutionalised and systematic production of knowledge within state bureaucracies is pivotal for explaining the power of ideas. This is demonstrated through an in‐depth and illustrative case study of the policymaking process leading up to a major reform of Danish activation policies in 2014. In this case, an evaluation system institutionalised within the Ministry of Employment significantly shaped the types of knowledge utilised in the policymaking process and the final design of the policy reform. Consequently, the evaluation system instated a bulwark against ideational shifts in every phase of the policymaking process. Thus, ultimately steering the policymaking process in the direction of ideas grounded in a Work First approach rather than the Human Capital approach initially promoted by the Minister of Employment.
Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta‐analysis
Authors: Hernandez Adrian V. , de Laurentis Laryssa , Souza Isadora , Pessanha Marcelo , Thota Priyaleela , Roman Yuani M. , Barboza‐Meca Joshuan , Boulware David R. , Vidal Jose E.
Published: November 2020

Objective

This systematic review evaluated the diagnostic accuracy of Xpert MTB/RIF to detect tuberculous meningitis (TBM).

Methods

PubMed and five other databases were systematically searched through March 2019. All studies evaluating diagnostic accuracy of Xpert MTB/RIF on cerebrospinal fluid (CSF) samples were included. Reference standards were definitive or definite plus probable TBM. The quality of studies was assessed by the QUADAS‐2 tool. We performed bivariate random‐effects meta‐analysis and calculated summary diagnostic statistics.

Results

We identified 30 studies (n = 3972 participants), including 5 cohort studies and 25 cross‐sectional studies. Reference standards were definite TB (n = 28 studies) or definite plus probable TBM (n = 6 studies). The pooled Xpert MTB/RIF sensitivity was 85% (95% CI, 70–93%), and specificity was 98% (95% CI, 97–99%) with a negative likelihood ratio of 0.15 (95% CI, 0.04–0.27) for definite TBM. For probable TBM cases, pooled sensitivity was 81% (95% CI, 66–90%), and specificity was 99% (95% CI, 97–99%). For both reference standard types, meta‐analyses showed a C‐statistic area under the curve of 0.98. The QUADAS‐2 tool revealed low risk of bias as well as low concerns regarding applicability. Methodological heterogeneity was high among studies.

Conclusions

Xpert MTB/RIF showed high accuracy for TBM diagnosis, but a negative Xpert MTB/RIF test does not rule out TBM. Repeat Xpert testing may be necessary. In clinical practice, Xpert MTB/RIF adds speed and sensitivity when compared to classic TBM diagnostic methods or previous commercial nucleic acid amplification techniques. More studies and better strategies for rapidly confirming a diagnosis of TBM in children are urgently needed.
Medical anti‐glaucoma therapy: Beyond the drop
Authors: Miller Paul E. , Eaton Joshua Seth
Published: November 2020

Barriers to effective medical therapy are numerous and include difficulties with effective and sustained control of intraocular pressure (IOP) and adherence to prescribed anti‐glaucoma drop regimens. In an effort to circumvent these challenges, a number of new anti‐glaucoma therapies with sustained effects have emerged. Methods for sustained delivery of prostaglandin analogs are being intensely investigated and many are in human clinical trials. Intracameral devices include the following: Allergan's Durysta™ Bimatoprost SR, Envisia Therapeutics’ ENV515 travoprost implant, Glaukos’ iDose™, Ocular Therapeutix's OTX‐TIC travoprost implant, and Santen's polycaprolactone implant with PGE2‐derivative DE‐117. Other prostaglandin‐based technologies include Allergan's bimatoprost ring (placed in the conjunctival fornix), Ocular Therapeutics’ OTX‐TP intracanalicular travoprost implant, subconjunctival latanoprost in a liposomal formulation, and the PGE2 derivative PGN 9856‐isopropyl ester that is applied to the periorbital skin. Exciting breakthroughs in gene therapy include using viral vectors to correct defective genes such as MYOC or to modulate gonioimplant fibrosis, CRISPR technology to edit MYOC or to alter aquaporin to reduce aqueous humor production, and siRNA technology to silence specific genes. Stem cell technology can repopulate depleted tissues or, in the case of Neurotech's Renexus® NT‐501 intravitreal implant, serve as a living drug delivery device that continuously secretes neurotrophic factors. Other unique approaches involve nanotechnology, nasal sprays that deliver drug directly to the optic nerve and noninvasive alternating current stimulation of surviving cells in the optic nerve. Over time these modalities are likely to challenge the preeminent role that drops currently play in the medical treatment of glaucoma in animals.
Second outbreak of Trichinella pseudospiralis in Europe: clinical patterns, epidemiological investigation and identification of the etiological agent based on the western blot patterns of the patients' serum
Authors: Gómez‐Morales Maria Angeles , Mazzarello Giovanni , Bondi Elisabetta , Arenare Laura , Bisso Maria Cristina , Ludovisi Alessandra , Amati Marco , Viscoli Claudio , Castagnola Elio , Orefice Giovanni , Magnè Federica , Pezzotti Patrizio , Pozio Edoardo
Published: November 2020

Trichinellosis is a zoonotic disease due to the ingestion of raw or undercooked meat from animals infected with the larvae of nematodes belonging to the genus Trichinella. In January–February 2015, an outbreak of trichinellosis occurred in Genoa, Northern Italy. The epidemiological link was traced back to a dinner served at an agritourism farm on 31 December 2014, where a majority of the 52 guests had consumed the ‘beef’ steak tartare. The source of infection was not traced; however, it was noted that the amount of beef purchased officially for providing at the dinner did not correspond with that served, suggesting that meat of a different origin had been added to the beef to prepare the steak tartare. Clinical and laboratory data of 30 individuals out of the 52 (57.7%), of which four were hospitalized, were consistent with that of the case definition of trichinellosis. Western blot patterns of the sera from patients with confirmed trichinellosis were similar to the diagnostic pattern identified for the reference sera of Trichinella pseudospiralis but different from those of the control sera tested for patients infected with Trichinella spiralis and Trichinella britovi. Identification of T. pseudospiralis as the aetiological agent responsible for the outbreak of trichinellosis using an indirect tool represents an advancement in the epidemiological investigation of this zoonotic disease.
Flow Analysis in a Steam Turbine Control Valve With Through-Flow Valve Chamber
Authors: Slama Vaclav , Mrozek Lukas , Tajc Ladislav , Klimko Marek , Zitek Pavel
Published: November 2020

A nuclear power plant also includes a secondary cycle, which main component is a steam turbine. The steam turbine processes the thermal and pressure energy of steam and converts it into mechanical energy. Reliable and safe operation of the steam turbine, thus of the entire block, is ensured by valves. The flow in a pair of control valves, where the steam flows through the valve chamber past the first valve to the second valve, is investigated in this paper. The experimentally determined flow characteristics of both valves were evaluated and results were generalized. The experiments were carried out in the Aerodynamic laboratory of the Institute of Thermomechanics of the Czech Academy of Sciences in Novy Knin where a wind tunnel for high speeds could be used. Data of the distribution of pressures in selected places were evaluated. The energy loss in the valves was compared with the loss in a separate diffuser with varying degrees of expansion. The influence of a valve strainer, which is a part situated upstream of the control valve cone, was also investigated. It was found out in which case and where there is a significant disturbance of the velocity flow field. The first valve in the chamber is more sensitive to pressure losses in contrast to the second valve which is comparable to an ideal design of the diffuser, which indicates that this part of the valve assembly is optimal. Regarding the strainers, it was found out that the strainer helps to balance the velocity ratios at the inlet to the valve which has a positive effect on reducing the total energy pressure loss. As a result, the loss in the first valve can be significantly reduced which helps to increase the efficiency of the whole turbine.
Mechanism of SiN etching rate fluctuation in atomic layer etching
Authors: Hirata Akiko , Fukasawa Masanaga , Kugimiya Katsuhisa , Nagaoka Kojiro , Karahashi Kazuhiro , Hamaguchi Satoshi , Iwamoto Hayato
Published: November 2020

Atomic layer etching (ALE) enables atomic-precision control of the surface reaction for device fabrication. In this study, we investigate SiN ALE with process optimization of the surface adsorption and desorption steps, and we clarify the rate fluctuation mechanism. When we attempted CH3F/Ar plasma adsorption followed by the subsequent Ar desorption step, an etch stop was observed owing to the excess deposition (>6 nm) of a protective film on the surface. X-ray photoelectron spectroscopy analysis revealed that a high number of C–C bonds was detected. As the bonding energy of C–C (6.4 eV) is high, these bonds remain after the desorption step. The excess C-rich polymer deposition after ALE originates from the residual C–C bonds. To suppress the C-rich polymer deposition, we studied stable SiN ALE using a desorption step with Ar/O2 plasma (0.36 nm/cycle) and a two-step sequential desorption with Ar and O2 plasma (0.6 nm/cycle), which resulted in stable SiN ALE processes. Because the surface condition is able to fluctuate with the number of cycles, precise surface control is strongly required to achieve stable ALE. Control of the plasma–wall interaction is also important for stable SiN ALE. We intentionally changed the chamber wall conditions and found that the polymer-deposited wall caused a fluctuation of the etched amount, which resulted from CFx desorption from the deposited polymer. Thus, it is also important to control the influence of desorbed species from the chamber components for suppression of the ALE fluctuation.
Identification of Zinc-Dependent Mechanisms Used by Group B
Streptococcus
To Overcome Calprotectin-Mediated Stress
Authors: Burcham Lindsey R. , Le Breton Yoann , Radin Jana N. , Spencer Brady L. , Deng Liwen , Hiron Aurélia , Ransom Monica R. , Mendonça Jéssica da C. , Belew Ashton T. , El-Sayed Najib M. , McIver Kevin S. , Kehl-Fie Thomas E. , Doran Kelly S.
Published: November 2020

Group B
Streptococcus
(GBS) asymptomatically colonizes the female reproductive tract but is a common causative agent of meningitis. GBS meningitis is characterized by extensive infiltration of neutrophils carrying high concentrations of calprotectin, a metal chelator. To persist within inflammatory sites and cause invasive disease, GBS must circumvent host starvation attempts. Here, we identified global requirements for GBS survival during calprotectin challenge, including known and putative systems involved in metal ion transport. We characterized the role of zinc import in tolerating calprotectin stress
in vitro
and in a mouse model of infection. We observed that a global zinc uptake mutant was less virulent than the parental GBS strain and found calprotectin knockout mice to be equally susceptible to infection by wild-type (WT) and mutant strains. These findings suggest that calprotectin production at the site of infection results in a zinc-limited environment and reveals the importance of GBS metal homeostasis to invasive disease.
Different Routes of Protein Folding Contribute to Improved Protein Production in Saccharomyces cerevisiae
Authors: Qi Qi , Li Feiran , Yu Rosemary , Engqvist Martin K. M. , Siewers Verena , Fuchs Johannes , Nielsen Jens
Published: November 2020

Protein folding plays an important role in protein maturation and secretion. In recombinant protein production, many studies have focused on the folding pathway to improve productivity. Here, we identified two different routes for improving protein production by yeast. We found that improving folding precision is a better strategy. Dysfunction of this process is also associated with several aberrant protein-associated human diseases. Here, our findings about the role of glucosidase Cwh41p in the precision control system and the characterization of the strain with a more precise folding process could contribute to the development of novel therapeutic strategies.
Subcellular Localization and Assembly Process of the Nisin Biosynthesis Machinery in Lactococcus lactis
Authors: Chen Jingqi , van Heel Auke J. , Kuipers Oscar P.
Published: November 2020

Nisin is the model peptide for LanBC-modified lantibiotics that are commonly modified and exported by a putative synthetase complex. Although the mechanism of maturation, transport, immunity, and regulation is relatively well understood, and structural information is available for some of the proteins involved (B. Li, J. P. J. Yu, J. S. Brunzelle, G. N. Moll, et al., Science 311:1464–1467, 2006,
https://doi.org/10.1126/science.1121422
; M. A. Ortega, Y. Hao, Q. Zhang, M. C. Walker, et al., Nature 517:509–512, 2015,
https://doi.org/10.1038/nature13888
; C. Hacker, N. A. Christ, E. Duchardt-Ferner, S. Korn, et al., J Biol Chem 290:28869–28886, 2015,
https://doi.org/10.1074/jbc.M115.679969
; Y. Y. Xu, X. Li, R. Q. Li, S. S. Li, et al., Acta Crystallogr D Biol Crystallogr 70:1499–1505, 2014,
https://doi.org/10.1107/S1399004714004234
), the subcellular localization and assembly process of the biosynthesis complex remain to be elucidated. In this study, we determined the spatial distribution of nisin synthesis-related enzymes and the transporter, revealing that the modification and secretion of the precursor nisin mainly occur at the old cell poles of
L. lactis
and that the transporter NisT is probably recruited later to this spot after the completion of the modification reactions by NisB and NisC. Fluorescently labeled nisin biosynthesis machinery was visualized directly by fluorescence microscopy. To our knowledge, this is the first study to provide direct evidence of the existence of such a complex
in vivo
. Importantly, the elucidation of the “order of assembly” of the complex will facilitate future endeavors in the investigation of the nisin secretion mechanism and even the isolation and structural characterization of the complete complex.
A Persisting Nontropical Focus of Burkholderia pseudomallei with Limited Genome Evolution over Five Decades
Authors: Webb Jessica R. , Buller Nicky , Rachlin Audrey , Golledge Clayton , Sarovich Derek S. , Price Erin P. , Mayo Mark , Currie Bart J.
Published: November 2020

Burkholderia pseudomallei
is predominantly a tropical pathogen uncommonly found in the environment of temperate climatic regions. It is unclear if introduction into temperate regions is sporadic and temporary or if
B. pseudomallei
can persist in such environments.
B. pseudomallei
was identified in the environment of southwest Western Australia with melioidosis cases between 1966 and 1991. We report a new cluster with 23 animal fatalities in the same region from 2017, with
B. pseudomallei
again being recovered from the environment. Comparison of the isolates from the first and second clusters using genomics revealed a single sequence type, high clonality, and limited recombination, even though the time of recovery of the isolates spanned 51 years. This is a major contrast to the extensive genomic diversity seen in the tropics. Our data support the suggestion that
B. pseudomallei
has the ability to persist in nontropical environments, potentially in a latent state, and has the ability to activate following favorable conditions (rainfall) and then infect animals and humans.
Incidentally detected primary corneal squamous neoplasia in an elderly man presenting with cataract
Authors: Agarwal Rinky , Jain Vatika , Sen Seema , Maharana Prafulla Kumar
Published: November 2020

Primary corneal neoplasia (PCN) is a rare cancerous lesion of cornea usually encountered in elderly. The clinical symptoms are generally non-specific, with ocular irritation, redness, cosmetic disfigurement and varying degrees of visual disturbances depending on visual axis involvement. Corneal neoplasia is usually associated with surrounding conjunctival lesions and incidentally detected PCN is rarely encountered in clinical practice. Presently, we report a case of isolated unilateral PCN diagnosed incidentally in an elderly man presenting with cataract. In vivo confocal microscopy aided in its diagnosis after impression cytology was repeatedly negative. Cataract surgery was deferred and the patient was administered three cycles of mitomycin C 0.04% 4 times/day. The tumour margins receded as evident on clinical examination and on anterior segment optical coherence tomography. We discuss the role of various corneal imaging modalities in diagnosis and management of PCN besides highlighting importance of comprehensive slit-lamp examination in patients planned for cataract surgery.
Familial hypocalciuric hypercalcaemia type 3:AP2S1missense mutation
Authors: Kerut Sarah , Kovvuru Karthik Reddy , Yanes-Cardozo Licy , Garla Vishnu Vardhan
Published: November 2020

A 45-year-old man was referred to endocrine for the evaluation of hypercalcaemia. The calcium was elevated, vitamin D was low with a normal parathyroid hormone. Dual-energy X-ray absorptiometry scan revealed osteoporosis at the lumbar spine and femoral neck. A 24-hour urine collection revealed low urinary calcium, which was believed to be secondary to vitamin D deficiency. A diagnosis of primary hyperparathyroidism was made. The patient underwent a four-gland parathyroid exploration surgery in which three of his parathyroid glands were removed. The pathology was consistent with benign parathyroid tissue. Post surgery, the patient had persistently elevated calcium levels. He was then started on bisphosphonate and cinacalcet for osteoporosis and hypercalcaemia, respectively. Genetic analysis of familial hypocalciuric hypercalcaemia (FHH) showed a p.arg15cys mutation in theAP2S1gene, confirming the diagnosis of FHH type 3.
Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin
Authors: Bhullar Justin S , Leung Joseph MWS , Almehthel Mohammed S
Published: November 2020

A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin. Management involved a multimodal approach in an attempt to reduce tumour burden and achieve euglycaemia, which proved to be a significant challenge in the face of refractory hypoglycaemia despite the administration of multiple prohyperglycaemic agents in combination. Unfortunately, given the burden of metastatic disease and multiple medical complications that ensued, the patient passed away. This case highlights the clinical history of a NET co-secreting serotonin and insulin, the use of combination therapy in the treatment of refractory hypoglycaemia in a metastatic insulin-producing tumour and emerging therapeutic modalities in the treatment of these rare malignancies.
Epiglottic aplasia in an infant with Joubert syndrome
Authors: Shehee Lindsey , Downs Jaye , Clemmens Clarice
Published: November 2020

Congenital aplasia of the epiglottis is a rare condition with variable presentation ranging from respiratory distress requiring surgical airway to an asymptomatic finding. Epiglottic aplasia is presumed to be caused by arrest of development of laryngeal structures and is most commonly associated with syndromic conditions, though isolated episodes of aplasia of the epiglottis do exist. In this report, we present a term infant with multiple congenital anomalies who was noted to have a hoarse cry prompting laryngoscopy. This showed complete absence of the epiglottis. Subsequent genetic testing showed mutations in the CPLANE1 gene that is associated with Joubert syndrome. Our patient was able to be discharged home on a thickened formula diet and is eating and gaining weight appropriately. Here, we present a review of the currently available literature of other cases of congenital epiglottic aplasia or hypoplasia discussing the presentation, management and outcomes in these cases.
A systematic review of the burden of hypertension, access to services and patient views of hypertension in humanitarian crisis settings
Authors: Keasley James , Oyebode Oyinlola , Shantikumar Saran , Proto William , McGranahan Majel , Sabouni Amar , Kidy Farah
Published: November 2020

Introduction

Globally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension.

Methods

A literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate.

Results

Sixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations.

Conclusion

Hypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.
Worldwide epidemiology of foot and ankle injuries during military training: a systematic review
Authors: Fenn Brian P. , Song J , Casey J , Waryasz G R , DiGiovanni C W , Lubberts B , Guss D
Published: November 2020

Introduction

Musculoskeletal foot and ankle injuries are commonly experienced by soldiers during military training. We performed a systematic review to assess epidemiological patterns of foot and ankle injuries occurring during military training.

Methods

A review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search, done on 14 February 2019, resulted in 1603 reports on PubMed, 565 on Embase and 3 on the Cochrane Library. After reading the remaining full-text articles, we included 91 studies.

Results

Among a population of 8 092 281 soldiers from 15 countries, 788 469 (9.74%) foot and ankle injuries were recorded. Among the 49 studies that reported on length of training, there were 36 770/295 040 (18.17%) injuries recorded among women and 248 660/1 501 672 (16.56%) injuries recorded among men over a pooled mean (±SD) training period of 4.51±2.34 months. Ankle injuries were roughly 7 times more common than foot injuries, and acute injuries were roughly 24 times more common than non-acute injuries. Our findings indicated that, during a 3-month training period, soldiers have a 3.14% chance of sustaining a foot and ankle injury. The incidence of foot or ankle injury during military parachutist training was 3.1 injuries per thousand jumps.

Conclusions

Our findings provide an overview of epidemiological patterns of foot and ankle injuries during military training. These data can be used to compare incidence rates of foot and ankle injuries due to acute or non-acute mechanisms during training. Cost-effective methods of preventing acute ankle injuries and non-acute foot injuries are needed to address this problem.
Post hoc study to investigate the potential causes of poor quality of cardiovascular medicines collected in sub-Saharan countries
Authors: Secretan Philippe-Henri , Antignac Marie , Yagoubi Najet , Bernard Mélisande , Perier Marie Cécile , Takombe Jean Laurent , Balde Dadhi , N'Guetta Roland , Ikama Méo Stéphane , Zabsonre Patrice , Sidi Aly Abdallahi , Jouven Xavier , Do Bernard
Published: November 2020

Objectives

The incidence of cardiovascular diseases is increasing and there is a growing need to provide access to quality cardio drugs in Africa. In the SEVEN study, we analysed 1530 cardiovascular drug samples randomly collected from 10 African countries. By that time, of the seven drugs products analysed, only those containing amlodipine and captopril had very low assay values with active substance contents that could be less than 75% of those expected. In this article we investigate complementary aspects of the amlodipine and captopril samples so to explain the previously observed low assays for these two drugs.

Design

Post hoc analysis of the captopril and amlodipine drugs samples and their packages collected in the context of the SEVEN study.

Setting

10 countries were concerned: Benin, Burkina Faso, Congo, Democratic Republic of the Congo, Guinea, Côte d’Ivoire, Mauritania, Niger, Senegal and Togo.

Participants

Local scientists and hospital practitioners collected the drug samples in the 10 African countries.

Outcome measures

The drug amount and the relative amounts of drug impurities, as well as the main compounds of the drugs packaging, were analysed.

Results

Identification of the blister packaging of the samples led to separate both amlodipine and captopril drug samples in two groups. Mann Whitney’s bilateral test showed a significant difference (p<0.0001) between the median value of the captopril dosage when tablets are packaged in blisters providing higher protection to humidity (n=105) as opposed to the tablets packaged in blisters providing lower humidity protection (n=130).

Conclusion

Based on these results, particular attention should be paid to the materials and types of packaging used in order to minimise the lack of control over the exposures and drug circuits present in these different countries.
Effect of particulate matter exposure on patients with COPD and risk reduction through behavioural interventions: the protocol of a prospective panel study
Authors: Park Shinhee , Ra Seung Won , Kang Sung Yoon , Kim Hwan-Cheol , Lee Sei Won
Published: November 2020

Introduction

Patients with chronic obstructive pulmonary disease (COPD) are vulnerable to particulate matter (PM) exposure which can increase acute exacerbations and hospitalisation. Interventions to avoid PM exposure are important but evidence-based guidance is lacking. This study aims to assess the impact of PM on lung function, quality of life and exacerbations in patients with COPD using a panel design study; it will also provide evidence for interventional measures to reduce harm from PM exposure.

Methods and analysis

A prospective panel study of patients with COPD aged ≥40 years will be conducted. Patients will be required to have a forced expiratory volume in one second <80% of the predicted value at enrolment. A total of 120 patients from three different regions will be enrolled, 60 from the metropolitan area, 30 from an industrialised area and 30 from a clean rural area. Clinical outcomes will be assessed through COPD assessment test scores, the St. George’s Respiratory Questionnaire for patients with COPD and pulmonary function testing. Indoor and outdoor PM in the patients’ environments will be measured using gravimetric and light scattering platforms. To estimate the individual dose of PM exposure, a time–activity diary, Geographic Information System and land use regression model will be combined in every season for 1 year. The correlation between PM exposure and the health status of patients with COPD will be evaluated. In addition, 40 patients with the lowest score of life behaviour score to reduce environmental PM exposure will be randomised to a control or intervention group, who will receive in-depth education on risk-reducing behaviours.

Ethics and dissemination

This study was approved by the Institutional Review Board of each site. The participants received comprehensive information and provided informed consent. The result of this study will be discussed in the form of conference presentations and peer-reviewed publications.

Trial registration number

NCT04020237.
Frontal theta brain activity varies as a function of surgical experience and task error
Authors: Balkhoyor Ahmed Mohammed , Awais Muhammad , Biyani Shekhar , Schaefer Alexandre , Craddock Matt , Jones Olivia , Manogue Michael , Mon-Williams Mark A , Mushtaq Faisal
Published: November 2020

Objective

Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes governing performance. We used scalp-recorded EEG to examine whether surgical expertise and task performance could be differentiated according to an oscillatory brain activity signal known as frontal theta—a putative biomarker for cognitive control processes.

Design, setting, and participants

Behavioral and EEG data were acquired from dental surgery trainees with 1 year (n=25) and 4 years of experience (n=20) while they performed low and high difficulty drilling tasks on a virtual reality surgical simulator. EEG power in the 4–7 Hz range in frontal electrodes (indexing frontal theta) was examined as a function of experience, task difficulty and error rate.

Results

Frontal theta power was greater for novices relative to experts (p=0.001), but did not vary according to task difficulty (p=0.15) and there was no Experience × Difficulty interaction (p=0.87). Brain–behavior correlations revealed a significant negative relationship between frontal theta and error in the experienced group for the difficult task (r=−0.594, p=0.0058), but no such relationship emerged for novices.

Conclusion

We find frontal theta power differentiates between surgical experiences but correlates only with error rates for experienced surgeons while performing difficult tasks. These results provide a novel perspective on the relationship between expertise and surgical performance.
Academic Collaborations with Industry: Lessons for the Future
Authors: Reddy S. Sethu K. , Chao Shing
Published: November 2020

Academic centers and industry partners have had love–hate relationships for more than a century. Despite many examples of socially beneficial collaborations between academia and industry, it has become increasingly difficult to find an arrangement where neither clinicians/researchers working with industry nor industry itself is demonized. Regardless, we must incentivize innovation. Preclinical research is primarily funded by the government, whereas 70% of clinical research is supported by industry. Due to external political pressure and industry's concern about lack of control over content, industry's support of continuing medical education (CME) has shrunk to 10% from 40% and has led to diversion of funding to non-CME events. Despite scrutiny of clinical faculty members’ interactions with industry, corporate philanthropy is much sought after by academic institutions. Developing new therapeutics requires both academia and industry to transparently and ethically partner with creation of innovative start-ups, sharing of non-proprietary clinical trial data, and in postmarketing surveillance. The search continues for truly symbiotic relationships between academia and industry.
Delirium in intensive care: violence, loss and humanity
Authors: Hume Victoria Jane
Published: November 2020

Delirium in intensive care is an altered state that can bring with it persecutory paranoias, and sometimes expressions of violence on the part of the patient; it can be deeply disturbing for the person experiencing it as well as for those around them. Although the impacts of delirium on patients’ recovery and long-term mental health are well documented, qualitative research in this area remains rare. This article is derived from a narrative and musical study of the experience of delirium in hospital, undertaken better to understand the perspectives of people who have experienced delirium, as well as the healthcare professionals and family members who care for them. Data were collected in South Africa between 2015 and 2017. The study took the form of interviews and focus groups with a total of 15 participants, as well as periods of observation and audio recording in a hospital intensive care unit. Thematic and narrative analysis of the data were carried out alongside the composition of new music incorporating audio recordings from the study. Analysis suggested three key themes emerging from the data. First, the violence experienced and expressed by patients, both within delirious hallucination and in observable reality. Second, the interconnected losses undergone by patients in spaces of intensive care. Third, healthcare professionals’ attempts to bring greater humanity into the potentially dehumanising space of intensive care. The results and discussion point to possible relationships between delirium and the working cultures and physical environment of intensive care, and may reinforce the need for sensitive and committed communication between healthcare professionals and patients.
Risk factors associated with higher pain levels among pediatric burn patients: a retrospective cohort study
Authors: Holbert Maleea D , Kimble Roy M , Jones Lee V , Ahmed Samiul H , Griffin Bronwyn R
Published: November 2020

Introduction

There is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.

Methods

A retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children’s Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.

Results

Factors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child’s first dressings change.

Discussion

It is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.