bluuebunny/crossref_metadata_2025 huggingface dataset:
Mentoring Relationships and Gender Inequities in Academic Medicine: Findings From a Multi-Institutional Qualitative Study
Authors: Murphy Marie , Record Helena , Callander Jacquelyn K. , Dohan Daniel , Grandis Jennifer R.
Published: September 2021

Purpose

This study examined how mentoring relationships may reinforce or mitigate gender inequities in academic medicine.

Method

In-depth, semistructured interviews with medical school faculty members (52 women and 52 men) were conducted at 16 institutions across the United States in 2019. Institutions were recruited using a purposive sampling strategy to seek diversity in geography, ownership (private or public), and prestige. Within institutions, purposive sampling was used to recruit equal numbers of women and men and to seek diversity in degree type (MD, PhD), age, and career stage. A coding scheme was developed through iterative analysis of the interview transcripts. All interview transcripts were then coded with the goal of identifying intersections between mentorship and experiences of and responses to gender inequities.

Results

Four key themes at the intersection of mentoring relationships and gender inequities were identified. (1) Both women and men became aware of gender inequities in academic medicine through relationships with women mentors and mentees. (2) Both women and men mentors recognized the challenges their female mentees faced and made deliberate efforts to help them navigate an inequitable environment. (3) Both women and men mentors modeled work–family balance and created family friendly environments for their mentees. (4) Some women, but no men, reported being sexually harassed by mentors.

Conclusions

This study shows that mentoring relationships may be a context in which gender inequities are acknowledged and mitigated. It also shows that mentoring relationships may be a context in which gender inequities, such as sexual harassment, may occur. Sexual harassment in academic medicine has been widely documented, and gender inequity in academic medicine has proved persistent. While mentoring relationships may have the potential to identify and mitigate gender inequities, this study suggests that this potential remains largely unrealized.
Evaluating the Role of Otologic Biomarkers to Differentiate Meniere’s Disease and Vestibular Migraine
Authors: Naples James G. , Soda Drew , Rahman Kahlil , Ruckenstein Michael J. , Parham Kourosh
Published: September 2021

Objective:

To evaluate the role for prestin and otolin-1 as biomarkers for differentiating Meniere’s disease (MD) from vestibular migraine (VM).

Study Design:

It is a cross-sectional, cohort study.

Results:

There were 19 MD and 11 VM patients. In the 19 MD patients, the mean prestin level was 2.33 ng/ml compared to 0.64 ng/ml in VM patients (p = 0.238). Otolin-1 levels in MD patients were 109.67 pg/ml, while in VM patients, otolin-1 levels were 30.9 pg/ml (p = 0.102). In MD patients, prestin levels were correlated with word recognition scores, being strongest when prestin >2 ng/ml (rho = 0.9; p = 0.019).

Conclusions:

Prestin and otolin-1 levels differed between MD patients relative to VM patients. The relationship between prestin and word recognition scores in MD suggests that there may be a role for prestin as a marker for inner ear function, but its role in differentiating MD from VM remains to be elucidated.
Novel strategy for applying hierarchical density-based spatial clustering of applications with noise towards spectroscopic analysis and detection of melanocytic lesions
Authors: Ye Jason Yuan , Yu Christopher , Husman Tiffany , Chen Bryan , Trikala Aryaman
Published: September 2021

Advancements in dermoscopy techniques have elucidated identifiable characteristics of melanoma which revolve around the asymmetrical constitution of melanocytic lesions consequent of unfettered proliferative growth as a malignant lesion. This study explores the applications of hierarchical density-based spatial clustering of applications with noise (HDBSCAN) in terms of the direct diagnostic implications of applying agglomerative clustering in the spectroscopic analysis of malignant melanocytic lesions and benign dermatologic spots. 100 images of benign (n = 50) and malignant moles (n = 50) were sampled from the International Skin Imaging Collaboration Archive and processed through two separate Python algorithms. The first of which deconvolutes the three-digit tupled integer identifiers of pixel color in image composition into three separate matrices corresponding to the red, green and blue color channel. Statistical characterization of integer variance was utilized to determine the optimal channel for comparative analysis between malignant and benign image groups. The second applies HDBSCAN to the matrices, identifying agglomerative clustering in the dataset. The results indicate the potential diagnostic applications of HDBSCAN analysis in fast-processing dermoscopy, as optimization of clustering parameters according to a binary search strategy produced an accuracy of 85% in the classification of malignant and benign melanocytic lesions.
Diagnostic and prognostic value of Beclin 1 expression in melanoma: a meta-analysis
Authors: Chen Meiling , Li Qian , Chen Weimin , Bi Jiarui , Huang Ping
Published: September 2021

Autophagy plays a complicated role in the occurrence and development of cancer. Beclin 1 is a significant autophagy-related protein that plays an essential role in tumorigenesis, but its expression is controversial in melanoma. In this meta-analysis, we searched seven studies involving 638 melanoma patients. PubMed, Web of Science, Google Scholar, Elsevier, and Chinese National Knowledge Infrastructure were used for literature retrieval. The I2 index was used to assess heterogeneity. The expression of Beclin 1 in the primary melanoma group was significantly lower than the non-tumor group tissues (P < 0.01), while higher than the metastatic melanoma group (P < 0.01). Beclin 1 expression status could not distinguish between patients with melanoma by sex (male vs. female), lymph node metastasis (metastasis vs. non-metastasis), melanin deposition (present vs. absent), ulcer formation (present vs. absent), tumor necrosis status (present vs. absent), and Breslow thickness (<1.5 mm vs. ≥1.5 mm) for the subgroups (all P values > 0.05). Different expression intensities of Beclin 1 did not affect the overall survival and disease-free survival of melanoma patients. This study showed a trend of low expression of Beclin 1 in melanoma; patients with low expression of Beclin 1 were prone to the possibility of distant metastasis. The inconsistent profile of Beclin 1 expression in the prognosis of melanoma patients warrants further clinical investigation.
Prenatal exposure to valproic acid and treatment with intranasal oxytocin have sex-specific effects on behavior in Long Evans rats
Authors: Harding Shannon M. , Masters Ellen C. , D’Agata Christina M. , Agudelo Rivera Aura C. , Smith Emma C.
Published: September 2021

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social behaviors and communication. In rodents and humans, prenatal exposure to antiepileptic valproic acid is associated with an increased risk for autistic-like characteristics. One potential treatment is oxytocin, a prosocial neuropeptide that can be delivered intranasally. However, the sex-specific effects of valproic acid exposure and intranasal oxytocin treatment on behavior have not been fully explored. Pregnant Long Evans rats were administered valproic acid (500 mg/kg) or saline midday on gestational day 12, and after weaning, male and female pups were assigned to control (saline–saline), valproic acid–saline, or valproic acid–oxytocin groups. Oxytocin (0.8 IU/kg) or saline was delivered intranasally 30–60 min before tests for anxiety-like behaviors (elevated plus maze), social interactions (sociability) and sociosexual behaviors (partner preference, 50 kHz vocalizations and scent marking). Prenatal exposure to valproic acid resulted in sex-specific differences in behavior. When compared to controls, valproic acid males showed enhanced anxiety-like behaviors in adolescence and fewer scent marks in adulthood, while valproic acid females showed reduced sexual (partner) preference as adults. Intranasal oxytocin was anxiolytic for valproic acid males, but moderately anxiogenic for valproic acid females, and in both sexes it surprisingly impaired social interactions in the sociability test. Furthermore, intranasal oxytocin failed to improve sociosexual deficits in valproic acid rats. These findings highlight the importance of conducting preclinical studies in both sexes, and suggest that oxytocin may be an effective treatment in animal models with heightened anxiety-like behaviors.
Central-to-peripheral stiffness gradients determine diastolic pressure and flow fluctuation waveforms: time domain analysis of femoral artery pulse
Authors: Hashimoto Junichiro , Tagawa Kaname , Westerhof Berend E. , Ito Sadayoshi
Published: September 2021

Objective:

Blood pressure fluctuates during diastole to create a dicrotic wave but the mechanistic origin remains poorly understood. We sought to investigate the characteristics and determinants of diastolic pressure and flow fluctuations with a focus on stiffness gradients between the central aorta and peripheral arteries.

Methods:

Using applanation tonometry and duplex ultrasound, pulse waveforms were recorded on the femoral artery in 592 patients (age: 55 ± 14 years) to estimate the diastolic pressure fluctuation as a residual wave against the mono-exponential decay and the diastolic flow fluctuation as a bidirectional (forward and reverse) velocity wave. The radial, carotid, and dorsalis pedis pressures were also recorded to measure the peripheral/aortic pulse pressure (PP) and pulse wave velocity (PWV) ratios.

Results:

There were close resemblances between the femoral pressure and flow fluctuation waveforms. The pressure and flow fluctuations were mutually correlated in relative amplitude as indexed to the total pulse height (r = 0.63), and the former temporally followed the latter. In multivariate-adjusted models, higher peripheral/aortic PP and PWV ratios were independently associated with greater pressure and flow fluctuation indices (P < 0.001). Mediation analysis revealed that the associations of PP and PWV ratios with the pressure fluctuation index were largely mediated by the flow fluctuation index [indirect/total effect ratio: 57 (95% CI 42–80)% and 54 (30–100)%, respectively].

Conclusion:

These results suggest that central-to-peripheral pulse amplification and stiffness gradients contribute to triphasic flow fluctuations and dicrotic pressure waves. Diminished or inverted stiffness gradients caused by aortic stiffening may thus reduce diastolic runoff leading to ischemic organ damage.
Retinal and choroidal manifestations of COVID-19
Authors: Zhang Youning , Stewart Jay M.
Published: September 2021

Purpose of review

The novel coronavirus disease in 2019 (COVID-19) has a wide range of systemic manifestations. Ocular manifestations are now well recognized, with conjunctivitis being the most common. Posterior segment involvement is uncommon and has mainly been described in case reports. This review provides an overview of the posterior segment involvement of COVID-19.

Recent findings

Severe acute respiratory syndrome coronavirus 2 affects the retina and the choroid through either direct entry or triggering an indirect inflammatory response. Majority of the retinal findings is a result of microvascular derangement leading to cotton wool spots, intraretinal hemorrhages, paracentral acute middle maculopathy, acute macular neuroretinopathy, or retinal vein occlusions. Rarely, inflammation involving the retina or the choroid, or reactivation of previously quiescent uveitis, can be seen.

It is important to recognize the possible correlation between ophthalmic conditions and COVID-19 as it can aid in diagnosis, management, and mitigation of the disease.
Health Behavior Trajectories in High Cardiovascular Risk Populations
Authors: Lee Chiyoung , Yang Qing , Wolever Ruth Q. , Vorderstrasse Allison
Published: September 2021

Background

The application of latent class growth analysis (LCGA) has been limited in behavioral studies on high–cardiovascular-risk populations.

Aim

The current study aimed to identify distinct health behavior trajectories in high–cardiovascular-risk populations using LCGA. We also examined the baseline individual characteristics associated with different health behavior trajectories and determined which trajectory is associated with improved cardiovascular risk outcomes at 52 weeks.

Methods

This secondary analysis of a clinical trial included 200 patients admitted to primary care clinics. Latent class growth analysis was conducted to identify the trajectories of physical activity and dietary intake; these were measured at 4 different time points during a 52-week study period. Analysis of variance/χ2 test was used to assess the associations between baseline individual characteristics and trajectories, and logistic regression analysis was used to identify associations between trajectories and cardiovascular risk outcomes at 52 weeks.

Results

Three trajectories were identified for physical activity (low-, moderate-, and high-stable). Risk perception, patient activation, and depressive symptoms predicted the trajectories. High-stable trajectory for physical activity was associated with better cardiovascular risk outcomes at the 52-week follow-up. Two trajectories (low-stable and high-decreasing) were identified for percent energy from fat, but the factors that can predict trajectories were limited.

Conclusions

Interventions are needed to target patients who begin with a lower physical activity level, with the goal of enhanced cardiovascular health. The predictors identified in the study may facilitate earlier and more tailored interventions.
Alignment Between Objective and Subjective Assessments of Health System Performance: Findings From a Mixed-Methods Study
Authors: Khodyakov Dmitry , Buttorff Christine , Xenakis Lea , Damberg Cheryl L. , Ridgely M. Susan
Published: September 2021

EXECUTIVE SUMMARY

The article examines whether subjective performance assessments from health system executives match objective performance assessments and qualitatively explores ways to achieve high performance. We interviewed 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. We used maximum variation sampling to select health systems to achieve diversity in performance on objective measures of clinical performance. Our interviews focused on executives’ perceptions of their own health system’s performance and factors they thought generally contributed to high performance. In our analysis, we grouped health systems based on objective performance levels (high, medium, and low) used in sampling, compared objective performance ratings with executives’ subjective performance assessments, and used thematic analysis to identify reasons for subjective assessment of health system performance and levers of high performance in general. There was poor agreement between objective and subjective performance assessments (kappa = 0.082). Subjective assessments were higher than objective assessments and captured more factors than are typically considered in performance accountability and value-based payment initiatives. Executives whose views were inconsistent with objective performance assessments did not cite clinical care quality per se as the basis for their assessment, focusing instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics as the basis of their assessment offered subjective ratings consistent with objective ratings. Executives identified organizational culture, organizational governance, and staff engagement as levers for achieving high performance. Future research should explore the benefits and drawbacks of considering subjective performance assessments in value-based payment initiatives.
New peripheral nerve blocks and local anesthetics
Authors: Sari Sinem , Kumar Jennifer , Turan Alparslan
Published: September 2021

Purpose of review

To describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline.

Recent findings

There are multiple new blocks recently developed with the introduction of ultrasound to regional anesthesia and studies demonstrate effect in different surgical procedures. However, majority of the studies do not compare with gold standard and are relatively small to change clinical practice. Some of these blocks are: erector spinae plane block, infiltration between the popliteal artery and capsule of the posterior knee, pectoral nerve blocks, quadratus lumborum and transversus abdominis plane block. New local anesthetics and adjuvants have been developed in recent years. However, the studies with even with the oldest one introduced Exparel is currently questioned, large future studies are needed to determine efficacy and safety profile and compared with conventional local anesthetics.

New regional block techniques and new local anesthetics have been introduced recently. However, the efficacy/safety and comparison to conventional techniques and local anesthetics are still needed. Future studies must focus on prolonging analgesia with least invasive regional technique and compare new local anesthetics with current ones.
Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling
Authors: Chen Zhitao , Wang Tielong , Chen Chuanbao , Zhao Qiang , Ma Yihao , Guo Yiwen , Hong Xitao , Yu Jia , Huang Changjun , Ju Weiqiang , Chen Maogen , He Xiaoshun
Published: September 2021

Background.

Traditional liver transplant strategies with cold preservation usually result in ischemia-reperfusion injury (IRI) to the donor liver. Regular normothermic machine perfusion (NMP) donor livers suffer IRI twice. Here, we aimed to introduce a novel technique called continuous NMP without recooling to avoid a second IRI and its application in livers from extended criteria donors.

Methods.

Seven donor livers transplanted following continuous NMP without recooling, 7 donor livers transplanted following standard NMP, and 14 livers under static cold storage (SCS) were included in this study. Perioperative outcomes were recorded and analyzed between groups.

Results.

During the NMP without a recooling procedure, all livers cleared lactate quickly to normal levels in a median time of 100 min (interquartile range, 60–180) and remained stable until the end of perfusion. In the NMP without recooling and standard NMP groups, posttransplant peak aspartate aminotransferase and alanine aminotransferase levels were both significantly lower than those in the SCS group (P = 0.0015 and 0.016, respectively). The occurrence rate of early allograft dysfunction was significantly lower in the NMP without recooling group than in the SCS group (P = 0.022), whereas there was no difference in the NMP group with or without recooling (P = 0.462).

Conclusions

Our pilot study revealed a novel technique designed to avoid secondary IRI. This novel technique is shown to have at least a comparable effect on the standard NMP, although more data are needed to show its superiority in the future.
Waiting List Dynamics and Lung Transplantation Outcomes After Introduction of the Lung Allocation Score in The Netherlands
Authors: Hoffman Thijs W. , Hemke Aline C. , Zanen Pieter , Luijk Bart , Hoek Rogier A.S. , Verschuuren Erik A.M. , van Kessel Diana A.
Published: September 2021

Background.

The Netherlands was the third country to adopt the lung allocation score (LAS) for national allocation of donor lungs in April 2014. Evaluations of the introduction of the LAS in the United States and Germany showed mainly beneficial effects, including increased survival after transplantation.

Methods.

Data for transplant candidates from 2010 to 2019 were retrieved from the Dutch Transplant Foundation database. Diagnosis categories and outcomes were compared between the periods before and after the introduction of the LAS. Time-dependent Cox regression and Fine-Gray analyses were performed to compare the chance for transplantation before and after introduction of the LAS.

Results.

The cohort comprised 1276 patients. After introduction of the LAS, the annual number of transplantations and waiting list mortality did not change. The proportion of patients on the waiting list and transplanted patients with pulmonary fibrosis increased (25%–37%, P < 0.001; 22%–39%, P < 0.001). The chance of transplantation increased significantly for patients with pulmonary fibrosis after introduction of the LAS (hazard ratio 1.9 [95% confidence interval 1.4-2.9]). Patients who died on the waiting list had an increased LAS compared to the time of placement on the waiting list, reflecting clinical deterioration. This was not the case in patients with chronic obstructive pulmonary disease (P < 0.001). Overall survival was similar after introduction of the LAS (5-y survival 68%, compared to 74% [P = 0.171]).

Conclusions.

After the introduction of the LAS in The Netherlands, an increased proportion of transplantations was performed for patients with pulmonary fibrosis. Overall survival after transplantation did not change.
Kidney Transplantation From Hepatitis C Viremic Deceased Donors to Aviremic Recipients in a Real-world Setting
Authors: Concepcion Beatrice P. , Binari Laura A. , Schaefer Heidi , Rega Scott , Feurer Irene , Shawar Saed , Naik Ruchi , Hickman Laura , Walker Jasmine , Kapp Meghan , Birdwell Kelly A. , Langone Anthony , Helderman J. Harold , Ann Sarrell Bonnie , Kochar Guneet , Dubray Bernard , Smith Kristin , O’Dell Heather , DeMers April , Shelton Princess , Perri Roman , Shaffer David , Forbes Rachel C.
Published: September 2021

Background.

Transplantation of hepatitis C viremic (HCV+) deceased donor kidney transplants (DDKT) into aviremic (HCV–) recipients is a strategy to increase organ utilization. However, there are concerns around inferior recipient outcomes due to delayed initiation of direct-acting antiviral (DAA) therapy and sustained HCV replication when implemented outside of a research setting.

Methods.

This was a retrospective single-center matched cohort study of DDKT recipients of HCV+ donors (cases) who were matched 1:1 to recipients of HCV– donors (comparators) by age, gender, race, presence of diabetes, kidney donor profile index, and calculated panel-reactive antibody. Data were analyzed using summary statistics, t-tests, and chi-square tests for between-group comparisons, and linear mixed-effects models for longitudinal data.

Results.

Each group consisted of 50 recipients with no significant differences in baseline characteristics. The 6-mo longitudinal trajectory of serum creatinine and estimated glomerular filtration rate did not differ between groups. All recipients had similar rates of acute rejection and readmissions (all P > 0.05). One case lost the allograft 151 d posttransplant because of acute rejection, and 1 comparator died on postoperative day 7 from cardiac arrest. HCV+ recipients initiated DAA on average 29 ± 11 d posttransplant. Ninety-eight percent achieved sustained virologic response at 4 and 12 wks with the first course of therapy; 1 patient had persistent HCV infection and was cured with a second course of DAA.

Conclusions.

Aviremic recipients of HCV+ DDKT with delayed DAA initiation posttransplant had similar short-term outcomes compared with matched recipient comparators of HCV– donors.
Combination effect of exercise and environmental enrichment on cognitive functions and hippocampal neurogenesis markers of rat
Authors: Khodadadegan Mohammad Amin , Negah Sajad Sahab , Saheb Mahsa , Gholami Jamileh , Arabi Masoud Hashemi , Hajali Vahid
Published: September 2021

Objectives

Cognitive decline is one of the most prevalent health problems and is associated with increased healthcare utilization and economic burden. Physical and cognitive training both have positive effects on cognition but have been less applied in combination. We hypothesized that simultaneous cognitive–physical components would yield greater cognitive benefits than single-domain interventions in rats.

Methods

A total of 40 male Wistar rats were divided into four treatment groups: the control, enriched environment (EE), exercise (EX), and EE + EX. Animals in EE groups housed in the large cages (50 × 50 × 50 cm) contained differently shaped objects for 3 weeks. EX animals were forced to run on a treadmill once daily for 3 consecutive weeks. Morris water maze test was used for the assessment of spatial learning and memory. Real-time PCR was performed to assess the expression of nestin, and Sox2 in the hippocampus.

Results

EX and EE animals separately did not show a significantly enhanced function in spatial memory in comparison with the control group. When animals were treated with EE and EX simultaneously, they exhibited significantly superior performance in spatial memory than control, EX, or EE groups separately. The hippocampal expression of Sox2 was significantly higher in EE + EX group than in the control, EX, and EE alone.

Conclusions

These results may have clinical implications for behavioral interventions in conditions with cognitive deficiencies.
Annexin A2 degradation contributes to dopaminergic cell apoptosis via regulating p53 in neurodegenerative conditions
Authors: Li Da-Wei , Qi Xiao-Dan , Zhang Chuan-Hui , Sun Wen-Ping
Published: September 2021

Background

P53 overexpression has been shown to involve in mitochondria-mediated dapaminergic neuron cell death in Parkinson’s disease. However, the exactly molecular mechanisms responsible for the p53-dependent intrinsic cell death in neurodegenerative conditions remain unclearly. Annexin A2 is a multifunctional protein that negatively regulates p53 expression. The purpose of this study was to explore the mechanism of p53 dependent dopaminergic cell death and implication of Annexin A2 in cellular apoptosis in 1-methyl-4-phenylpyridinium (MPP+)-induced PC12 cells.

Methods

The cell viability of neural PC12 cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltet-razolium bromide assay. Flow cytometry was used to evaluate the apoptosis and mitochondrial transmembrane potential of neural PC12 cells. The expression of p53 and Annexin A2 was analyzed by western blot assay.

Results

The present study showed that the exposure of PC12 cells to neurotoxin MPP+ increased the expression levels of p53 and the discharge of mitochondrial transmembrane potential. Notably, Annexin A2 degradation was also observed in this cellular model of Parkinson’s disease, in a time and dose-dependent manner. This expressing change of Annexin A2 was in direct proportion to the loss of cell viability of PC12 cells, and this expression pattern was in inverse proportion to p53 levels in this cellular model of Parkinson’s disease.

Conclusion

These results indicated that Annexin A2 degradation plays a crucial role the degeneration of dapaminergic cells of Parkinson’s disease, and Annexin A2 downregulation-mediated the cell death is closely associated with mitochondrial dysfunction via p53-dependent pathway; thus provide a novel therapeutic target for Parkinson’s disease treatment.
Management of Cutaneous Manifestations of Genetic Epidermolysis Bullosa
Authors: Miura Yukiko , Nakagomi Satoko
Published: September 2021

BACKGROUND:

Epidermolysis bullosa (EB) is a rare disease characterized by blistering and erosion of the skin and mucus membranes in response to minor external forces. Research focusing on daily skin care in EB patients is sparse. Two international clinical practice guidelines (CPGs) have been published in English, but they have not yet been translated into other languages such as Japanese. Therefore, their recommendations have not been adapted to multiple geographic regions in the world. This multiple case series describes our approach to the skin care of 3 Japanese patients with EB.

RESULTS:

All 3 patients were diagnosed with genetic EB. A 13-year-old male patient had dominant dystrophic EB and suffered skin breakdown covering nearly 1% to 6% of his total body surface area (TBSA) during a 21-week data collection period. A 3-year-old male patient had EB simplex; he suffered skin breakdown covering 2% to 40% of his TBSA during a 36-week data collection period. The third case was a 5-year-old male patient with recessive dystrophic EB who experienced skin breakdown covering 2% to 40% of his TBSA during a 35-week data collection period. Blisters were punctured daily and treated with a soft silicone dressing. Daily application of moisturizers was undertaken to prevent the skin from drying out and itching.

CONCLUSION:

Our experience suggests that application of published CPGs promoted wound healing. Nevertheless, given the nature of the disease, a complete resolution to an individual's vulnerability to skin lesions even with relatively minor trauma remains elusive. Additional research is needed to explore interventions for skin and ulcer care, along with symptom management, including pain and pruritus.
Reducing Nares Acquired Pressure Injuries “Protect the Nares Because I Care” Project in Adult Inpatients
Authors: Sermersheim Emily Read , Hall Lillian , Boudreau Lisa , Ambutas Shirley , Gulczynski Barbara
Published: September 2021

PURPOSE:

The purpose of this quality improvement (QI) project was to develop a preventive care bundle to reduce the incidence of nares acquired pressure injuries (NAPIs) to 3% in the adult inpatient population.

PARTICIPANTS AND SETTING:

Participants included adult inpatients in a large, Magnet-designated, 664-bed academic medical center in the Midwestern United States.

APPROACH:

Through our organization's “RUSH Way” QI model, we developed an evidence-based NAPI Bundle comprising a “T”-shaped hydrocolloid thin barrier, a tube holder securement device, patient assessments, and site checks. The project was initiated by a team of clinicians and administrators. An incidence report was conducted of hospital-wide existing NAPIs in 2015. A pilot QI project of the NAPI Bundle was implemented in the surgical intensive care unit (SICU) from January 2016 to May 2016 and then hospital-wide implementation began in June 2016. Data were collected on the incidence of NAPIs, and documentation of hydrocolloid dressing on the nose and intact, incidence of adverse events with hydrocolloid dressing, and hydrocolloid dressing changed every 3 days were evaluated.

RESULTS:

In 2015, the house-wide baseline NAPI incidence rate was 4.9%. Data from the SICU pilot confirmed Bundle effectiveness, as zero NAPIs occurred during the pilot period. The hospital-wide expanded pilot in 2016 showed the NAPI rate to be 3.2%, and in 2017, the incidence rate was reduced to 1.4%, well below the 3% goal.

CONCLUSION:

The NAPI Bundle implemented in our organization by RNs substantially reduced the incidence of adult inpatient NAPIs.
Classification of Pressure Injury Stages and Skin Damage Photographs by RNs and Nursing Students in Spain
Authors: Rodriguez-Calero Miguel Angel , Fullana-Matas Antonia , Miró-Bonet Rosa
Published: September 2021

PURPOSE:

The purpose of this study was to evaluate and classify pressure injuries (PIs) and other skin lesions according to the judgment of hospital-based RNs and nursing students who recently trained in wound care using photographs and comparing findings to those of wound care experts.

DESIGN:

Cross-sectional observational survey.

SUBJECT AND SETTING:

RNs working at Manacor Hospital, Mallorca, Spain, and third-year nursing students from the University of the Balearic Islands. Data were collected in June 2017.

METHODS:

The survey instrument was accompanied by a set of 24 photographs in 7 categories of skin lesions, such as PIs or moisture-associated skin damage, which the respondents were asked to classify. Descriptive analysis of the classifications was carried out, and levels of agreement using the chi-square test were compared with evaluations/classifications of a panel of experts.

RESULTS:

In total, 314 surveys (199 RNs and 115 students) were included in the analyses. Findings showed a wide variability among participants with levels of agreement, with expert opinion ranging from 91.4% to 15.61%. The levels of agreement were substantially lower for unstageable PIs (47.92%), those caused by moisture (53.50%), and mixed etiology (38.37%) than for stages 1-4 PIs. Of note, 62.12% of RNs had not received PI training or continuing education during the previous 2 years. This lack of education was statistically significantly associated with the accuracy of the classification made by the RNs for some of the photographs evaluated such as moisture-associated skin damage.

CONCLUSIONS:

We found discrepancies in the classification of PIs and other wounds/lesions among experts, RNs, and students. The regular provision of up-to-date information in training and continuing education programs is imperative to maintain nurses' abilities to identify and classify PIs and other skin-related damage.
From tissue retrieval to electron tomography: nanoscale characterization of the interface between bone and bioactive glass
Authors: Micheletti Chiara , Gomes-Ferreira Pedro Henrique Silva , Casagrande Travis , Lisboa-Filho Paulo Noronha , Okamoto Roberta , Grandfield Kathryn
Published: September 2021

The success of biomaterials for bone regeneration relies on many factors, among which osseointegration plays a key role. Biogran (BG) is a bioactive glass commonly employed as a bone graft in dental procedures. Despite its use in clinical practice, the capability of BG to promote osseointegration has never been resolved at the nanoscale. In this paper, we present the workflow for characterizing the interface between newly formed bone and BG in a preclinical rat model. Areas of bone–BG contact were first identified by backscattered electron imaging in a scanning electron microscope. A focused ion beamin situlift-out protocol was employed to prepare ultrathin samples for transmission electron microscopy analysis. The bone–BG gradual interface, i.e. the biointerphase, was visualized at the nanoscale with unprecedented resolution thanks to scanning transmission electron microscopy. Finally, we present a method to view the bone–BG interface in three dimensions using electron tomography.
Of stumps and stipes: comparisons between the cultures and identities of Yorkshire cricket and mycology at the turn of the twentieth century
Authors: Smith Nathan
Published: September 2021

Mycology, the study of fungi, is a relatively young and underexplored discipline with a strong culture of field collection and study. The Yorkshire Mycological Committee (YMC) of the Yorkshire Naturalist's Union, formed in 1892, became the first permanent mycological organization within Great Britain. Well renowned and highly competent, the members of the YMC espoused a distinctive philosophy and practice of science that led them into a drawn-out conflict with the newly established British Mycological Society that continues to impact the practice of British field mycology today. This paper explores the philosophy, practice, and hierarchy of the Yorkshire mycologists and fungal collectors through the lens of their regional identity. To do so, it examines similarities and differences between the Yorkshire expressions of mycology and cricket around the turn of the twentieth century, with the latter already well established as a major vehicle for expressions of the region's identity. It argues that both activities stem from a distinct Yorkshire identity and culture that both superseded and intersected with other factors such as class and authority. In doing so, it highlights the importance of provincial identities and scientific movements in informing and influencing wider disciplinary philosophies and practices.
Social touch deprivation during COVID-19: effects on psychological wellbeing and craving interpersonal touch
Authors: von Mohr Mariana , Kirsch Louise P. , Fotopoulou Aikaterini
Published: September 2021

Social touch has positive effects on social affiliation and stress alleviation. However, its ubiquitous presence in human life does not allow the study of social touch deprivation ‘in the wild’. Nevertheless, COVID-19-related restrictions such as social distancing allowed the systematic study of the degree to which social distancing affects tactile experiences and mental health. In this study, 1746 participants completed an online survey to examine intimate, friendly and professional touch experiences during COVID-19-related restrictions, their impact on mental health and the extent to which touch deprivation results in craving touch. We found that intimate touch deprivation during COVID-19-related restrictions is associated with higher anxiety and greater loneliness even though this type of touch is still the most experienced during the pandemic. Moreover, intimate touch is reported as the type of touch most craved during this period, thus being more prominent as the days practising social distancing increase. However, our results also show that the degree to which individuals crave touch during this period depends on individual differences in attachment style: the more anxiously attached, the more touch is craved; with the reverse pattern for avoidantly attached. These findings point to the important role of interpersonal and particularly intimate touch in times of distress and uncertainty.
Adult gonococcal conjunctivitis: Prevalence, clinical features and complications
Authors: Cuesta Chasco Genoveva , Carreras-Castañer Xavier , Zboromyrska Yuliya , Pitart Cristina , Palma-Carvajal Francisco , Bosch Jordi , Figueroa-Vercellino Juan Pablo
Published: September 2021

Introduction. Gonorrhoea is a sexually transmitted disease whose incidence has increased in recent years and adult gonococcal conjunctivitis (AGC) is a relatively uncommon complication.

Hypothesis/Gap Statement. AGC is associated with increased incidence of genital gonorrhoea and must be treated correctly to avoid serious corneal complications.

Aims. To report the prevalence, clinical features, and complications of AGC in a tertiary ophthalmology centre in Barcelona, Spain. Present epidemiological data, clinical features, ocular complications, and antibiotic susceptibility. Design: Single-centre, descriptive, retrospective case series.

Methodology. Systematic case-defined search in medical records and further retrospective chart review study of microbiologically confirmed AGC attending outpatient clinic and/or emergency room from 2012 to 2020. We analysed the clinical presentation, treatments, antibiotic susceptibility, complications and ocular sequelae.

Results. Thirteen patients were diagnosed of AGC. Eleven patients had unilateral presentation. Two patients had bilateral presentation. In ten cases there was abundant mucopurulent discharge, three cases presented periocular pain and periocular inflammation requiring a CT scan to rule out post-septal cellulitis. The diagnosis was confirmed by culture. In total, 100 % of strains were susceptible to ceftriaxone, 58 % were ciprofloxacin resistant and no beta-lactamase production was detected. Three patients required hospital admission. One patient developed a complication presenting with ptosis caused by superior symblepharon.

Conclusion. AGC is a rare disease which is difficult to diagnose as it requires a high index of suspicion to prevent corneal perforation but in an important number of cases it may mimic orbital cellulitis. It is crucial that treatment starts as soon as possible to avoid serious corneal damage. Patients should promptly receive complete and correct treatment when admitted to the emergency room since an elevated number of patients do not attend their medical follow-up visit. Azithromycin or aminoglycoside eye drops are probably the best option to complete the treatment, due to high quinolone resistance.
Role of the amino acid mutations in the HA gene of H9N2 avian influenza virus under selective pressure in escape vaccine antibodies
Authors: Zhu Rui , Xu Shunshun , Sun Wangyangji , Li Quan , Shi Huoying , Wang Shifeng , Liu Xiufan
Published: September 2021

It has been well-documented that some amino acid mutations in hemagglutinin (HA) of H9N2 avian influenza virus (H9N2 virus) alter the viral antigenicity, but little is reported about the role of antibody escape mutations in escape vaccine antibodies. In this study, we found that the evolution of F/98 strain in chicken embryos or chickens resulted in significant differences in immune escape, and identify the contribution of HA mutations to the antigenic variation and immune escape of H9N2 virus. Among amino acid mutations in the HA of the antigen variant viruses occurring in embryonated chicken eggs and/or chickens with or without the selection pressure of vaccine antibodies, the mutations, S145N, Q164L, A168T, A198V, M224K and Q234L, affect the antigen drift of H9N2 virus. Specially, the A198V mutation, located at the receptor-binding site on the head domain of HA, significantly contributed the antigenic variation of H9N2 virus. The mutation A198V or Q234L significantly improved the receptor binding activity, while S145N mutation decreased the receptor binding activity. Single S145N mutation could promote viral escape from polyclonal antibodies (pAbs) by preventing Ab binding physically, and single A198V mutation could promote viral escape from pAbs by enhancing the receptor binding activity. Additionally, either the mutation S145N or A198V did interfere with the immunogenicity of the inactivated vaccine, resulting in reduction of the protective efficiency of H9N2 inactivated vaccine, which contributed escape from the antibody-based immunity. Our findings provided an important reference for the accurate evaluation of the role of the amino acids mutation in HA affecting the antigenicity of H9N2 virus on immune escape, and delivered a new perspective for monitoring the adaptive evolution of H9N2 virus.

Importance

In this study, the role of the HA mutations of H9N2 virus occurring with and without antibody selective pressure on escaping from the antibody-based immune response in host was analyzed. The results demonstrated that (i) the HA mutations S145N, Q164L, A168T, A198V, M224K, and Q234L occurring in the process of the adaptive evolution of H9N2 virus in embryonated chicken eggs and/or chickens could affect the antigenic variation of H9N2 virus. Among these mutations, the HA mutation A198V had the most significant effect on the antigenic variation; (ii) S145N mutation promoted viral escape from pAbs by preventing Abs binding physically; (iii) A198V mutation did promote viral escape from pAbs by enhancing the receptor binding activity; (iv) neither the HA mutation S145N or A198V interfered with the immunogenicity of the inactivated vaccine, resulting in reduction of the protective efficiency of H9N2 inactivated vaccine.
Observation of substrate diffusion and ligand binding in enzyme crystals using high-repetition-rate mix-and-inject serial crystallography
Authors: Pandey Suraj , Calvey George , Katz Andrea M. , Malla Tek Narsingh , Koua Faisal H. M. , Martin-Garcia Jose M. , Poudyal Ishwor , Yang Jay-How , Vakili Mohammad , Yefanov Oleksandr , Zielinski Kara A. , Bajt Sasa , Awel Salah , Doerner Katarina , Frank Matthias , Gelisio Luca , Jernigan Rebecca , Kirkwood Henry , Kloos Marco , Koliyadu Jayanath , Mariani Valerio , Miller Mitchell D. , Mills Grant , Nelson Garrett , Olmos Jose L. , Sadri Alireza , Sato Tokushi , Tolstikova Alexandra , Xu Weijun , Ourmazd Abbas , Spence John C. H. , Schwander Peter , Barty Anton , Chapman Henry N. , Fromme Petra , Mancuso Adrian P. , Phillips George N. , Bean Richard , Pollack Lois , Schmidt Marius
Published: September 2021

Here, we illustrate what happens inside the catalytic cleft of an enzyme when substrate or ligand binds on single-millisecond timescales. The initial phase of the enzymatic cycle is observed with near-atomic resolution using the most advanced X-ray source currently available: the European XFEL (EuXFEL). The high repetition rate of the EuXFEL combined with our mix-and-inject technology enables the initial phase of ceftriaxone binding to the Mycobacterium tuberculosis β-lactamase to be followed using time-resolved crystallography in real time. It is shown how a diffusion coefficient in enzyme crystals can be derived directly from the X-ray data, enabling the determination of ligand and enzyme–ligand concentrations at any position in the crystal volume as a function of time. In addition, the structure of the irreversible inhibitor sulbactam bound to the enzyme at a 66 ms time delay after mixing is described. This demonstrates that the EuXFEL can be used as an important tool for biomedically relevant research.
Experimental evidence for the benefits of higher X-ray energies for macromolecular crystallography
Authors: Storm Selina L. S. , Axford Danny , Owen Robin L.
Published: September 2021

X-ray-induced radiation damage is a limiting factor for the macromolecular crystallographer and data must often be merged from many crystals to yield complete data sets for the structure solution of challenging samples. Increasing the X-ray energy beyond the typical 10–15 keV range promises to provide an extension of crystal lifetime via an increase in diffraction efficiency. To date, however, hardware limitations have negated any possible gains. Through the first use of a cadmium telluride EIGER2 detector and a beamline optimized for high-energy data collection, it is shown that at higher energies fewer crystals will be required to obtain complete data, as the diffracted intensity per unit dose increases by a factor of more than two between 12.4 and 25 keV. Additionally, these higher energy data can provide more information, as shown by a systematic increase in the high-resolution cutoff of the data collected. Taken together, these gains point to a high-energy future for synchrotron-based macromolecular crystallography.
Transport infrastructure, accessibility and residential property values: evidence from Hong Kong
Authors: Wadu Mesthrige Jayantha , Maqsood Tayyab
Published: September 2021

Purpose

Hong Kong, like many other developed cities and countries, invests heavily in transport development. This study investigates whether the speculative benefits of future improvements in accessibility, brought about by impending transport development, will be capitalized into nearby residential property values even prior to the opening of the development.

Design/methodology/approach

Deviating from the standard hedonic price approach, the present study employed a fixed-effects model with a large data set of residential property transactions in the vicinity of three-stations situated along a newly proposed mass-transit-railway line in Hong Kong.

Findings

The results suggest that the values of residential properties close to stations do reflect the accessibility enhancements to be brought about by transport improvements even before the opening of the line. Results revealed a 6.5% of property value premium after the announcement of construction; and higher up to 6.7% after the operation of the line. This indicates that forthcoming new transport-infrastructure development produces changes in spatial price-gradients for neighbouring residential properties. Findings indicate that potential buyers/investors recognized the positive benefits of the planned transportation development, even before completion of the project, and are ready to pay a premium for those properties close to railway stations, representing clear evidence that residential property prices/values, near stations, reflect anticipated accessibility enhancements brought about by transport improvements.

Originality/value

This study, using a novel approach – a fixed-effects model to capture the speculative benefits of future improvements in transport infrastructure – provides a positive hypothesis that expected benefits of future improvements in accessibility are capitalized into property values.