bluuebunny/crossref_metadata_2025 huggingface dataset:
Stratigraphy and sedimentary evolution of a modern macro‐tidal incised valley: An analogue for reservoir facies and architecture
Authors: McGhee Claire , Muhammed Dahiru , Simon Naboth , Acikalin Sanem , Utley James E. P. , Griffiths Joshua , Wooldridge Luke , Verhagen Iris T. E. , van der Land Cees , Worden Richard H.
Published: July 2021

Incised valley fills are complex as they correspond to multiple sea‐level cycles which makes interpretation and correlation of stratigraphic surfaces fraught with uncertainty. Despite numerous studies of the stratigraphy of incised valley fills, few have focused on extensive core coverage linked to high fidelity dating in a macro‐tidal, tide‐dominated setting. For this study nineteen sediment cores were drilled through the Holocene succession of the macro‐tidal Ravenglass Estuary in north‐west England, UK. A facies and stratigraphic model of the Ravenglass incised valley complex was constructed, to understand the lateral and vertical stacking patterns relative to the sea‐level changes. The Ravenglass Estuary formed in five main stages. First, incision by rivers (ca 11 500 to ca 10 500 yrs bp) cutting through the shelf during lowstand, which was a period of fluvial dominance. Secondly, a rapid transgression and landward migration of the shoreline (10 500 to 6000 yrs bp). Wave action was dominant, promoting spit formation. The third stage was a highstand at ca 6000 to ca 5000 yrs bp, creating maximum accommodation and the majority of backfilling. The spits narrowed the inlet and dampened wave action. The fourth stage was caused by a minor fall of sea level (ca 5000 to ca 226 yrs bp), which forced the system to shift basinward. The fifth and final stage (226 yrs bp to present) involved the backfilling of the River Irt, southward migration of the northerly (Drigg) spit and merging of the River Irt with the Rivers Esk and Mite. The final stage was synchronous with the development of the central basin. As an analogue for ancient and deeply buried sandstones, most of the estuarine sedimentation occurred after transgression, of which the coarsest and cleanest sands are found in the tidal inlet, on the foreshore and within in‐channel tidal bars. The best‐connected (up to 1 km) reservoir‐equivalent sands belong to the more stable channels.
Radish concretions grown in mud during compaction
Authors: Wetzel Andreas , Bojanowski Maciej
Published: July 2021

Radish concretions exhibit a typical columnar to pear‐shaped, stipe downward geometry. In Middle Jurassic mudrock in south‐west Germany, radish concretions started to form around an iron‐sulphide lined tube by pervasive cementation constituting an ellipsoidal parent domain in uncompacted sediment at burial depths of ≤5 to 8 m as recorded by 75 to 80% minus‐cement porosity. Thereafter, the concretions grew vertically in compacting sediment as evidenced by laminae within the concretions being increasingly inclined towards the tips, and concomitantly decreasing minus‐cement porosity. During early diagenesis, prior to septarian crack formation, bicarbonate generating the microbial cement originated within the sulphate reduction zone chiefly from anaerobic oxidation of methane and to a lesser degree of organoclastic material. Later, at 50 to 70 m burial depth, septarian cracks formed as evaluated by sedimentation–compaction analysis based on minus‐cement porosity data and compressibility of similarly composed sediments. The outward‐narrowing septarian cracks indicate that they formed when the concretions were still in a plastic state but already cemented sufficiently to be resistant against compaction. In this stage, up to one‐quarter of the pore volume of the concretions was still open as suggested by shrinkage experiments. This pore volume, and the septarian cracks, were filled with cement termed late diagenetic. In the study area, the decompacted net‐sedimentation rate was low, about 2 to 3 cm kyr−1, for ca 2.5 Myr, allowing the concretions to reside for a long time within the sulphate reduction zone and to grow. Radish concretions formed within the transition zone from thick, rapidly deposited to long‐term, slowly accumulating sediment.
Combining molecular datasets with strongly heterogeneous taxon coverage enlightens the peculiar biogeographic history of stoneflies (Insecta: Plecoptera)
Authors: Letsch Harald , Simon Sabrina , Frandsen Paul B. , Liu Shanlin , Machida Ryuichiro , Mayer Christoph , Misof Bernhard , Niehuis Oliver , Zhou Xin , Wipfler Benjamin
Published: July 2021

Extant members of the ancient insect order of stoneflies exhibit a disjunct, antitropical distribution, with one major lineage exclusively occurring in the Southern Hemisphere and the other, with few exceptions, on the Northern continents. Here, we address the biogeographic distribution and phylogenetic relationships of stoneflies using a phylogenetic workflow that combines both transcriptomic and Sanger sequence datasets with heterogeneous taxon coverage. We used a dataset comprising 2997 genes derived from the transcriptomes of 30 species and Sanger sequences of seven genes for 498 species. The backbone phylogeny was mainly inferred from the transcriptomic data, whereas the Sanger nucleotide sequence data provided high species density for divergence time estimation and diversification analyses. Our results show that the biogeographic pattern we observe today is primarily more likely shaped by long‐distance over‐land dispersal than by vicariance. We inferred that the ancestors of extant stoneflies originated in the Northern Hemisphere approximately 265 Ma and were presumably restricted to this area due to climatic and geographic boundaries. Our analyses suggest that with the break‐up of Pangaea around 200 Ma and the associated climatic and geographical changes, two groups of stoneflies, the Anarctoperlaria and the Notonemouridae, dispersed to Gondwana and subsequently went extinct on the northern continents. Both groups likely dispersed across Gondwana before its break‐up into the modern continents. At least one member of another group of ‘northern’ stoneflies, the Acroneuriinae, seems to have migrated from North America to South America around 67 Ma. We found four major net diversification rate shifts, indicating rapid radiation patterns that hampered a robust phylogenetic placement of these stonefly groups. Our study provides the first conclusive evolutionary explanation for the unique distribution pattern of stoneflies.
Integrative phylogenomics reveals a Permian origin of Adephaga beetles
Authors: Baca Stephen M. , Gustafson Grey T. , Alexander Alana M. , Gough Harlan M. , Toussaint Emmanuel F. A.
Published: July 2021

Beetles are arguably the most diverse group of animals on Earth with over 400 000 described species. Yet the timing of main diversification events among these insects remains debated. The use of phylogenomic data generated using next‐generation sequencing recently resolved most recalcitrant phylogenetic relationships across Coleoptera. However, limited taxon sampling for some major clades still prevents the use of important fossil calibrations that could provide more accurate estimates of the timing of lineage diversification events among beetles. Here, we present a new fossil‐based dated framework with a focus on the suborder Adephaga. We rely on an integrative phylogenomic approach using a combination of genomic, ultraconserved element and RNAseq transcriptomic datasets, further revealing the prevalent exonic nature of ultraconserved elements in Coleoptera. We infer a robust phylogenomic tree under various optimality criteria and analytical conditions. Our preferred phylogenetic reconstruction is consistent with those of previous phylogenomic studies in recovering the paraphyly of ‘Hydradephaga’, Gyrinidae as sister to all other Adephaga, the monophyly of Geadephaga and Haliplidae as sister to a monophyletic Dytiscoidea. We further recover strong support for paraphyly of Aspidytidae and the placement of Hygrobiidae as part of a clade comprising Aspidytes, Ribera, Beutel, Balke & Vogler, Sinaspidytes Balke, Beutel & Ribera and Amphizoidae. Using 23 carefully chosen fossil calibrations across Coleoptera, we infer the origin of modern beetles ca. 317 Ma in the mid‐Carboniferous, the divergence between Archostemata and Adephaga ca. 296 Ma in the early Permian, and the crown of Adephaga in the end‐Permian ca. 255 Ma. Importantly, our analyses provide more precise estimates of divergence times for internal splits within Adephaga, including ground beetles, tiger beetles and aquatic adephagan lineages. These results represent a major step forward in our understanding of beetle diversification and will serve as a fundamental framework to unravel the evolutionary history of many clades within Adephaga.
Review of diagnostic methods and results for HIV‐associated disseminated histoplasmosis: Pathologists are not sufficiently involved
Authors: Nacher Mathieu , Valdes Audrey , Adenis Antoine , Blaizot Romain , Ugo Françoise , Abboud Philippe , Demar Magalie , Djossou Félix , Epelboin Loïc , Misslin Caroline , Blanchet Denis , Couppié Pierre , Alsibai Kinan Drak
Published: July 2021

Objectives

Disseminated histoplasmosis is a major killer of HIV‐infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis.

Methods

Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis.

Results

Around 32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commonly sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63 (66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR = 1.5 (95%CI = 1–2.2)).

Conclusions

Opportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist.
Studies in Ecological Rationality
Authors: Hertwig Ralph , Leuker Christina , Pachur Thorsten , Spiliopoulos Leonidas , Pleskac Timothy J.
Published: July 2021

Ecological rationality represents an alternative to classic frameworks of rationality. Extending on Herbert Simon's concept of bounded rationality, it holds that cognitive processes, including simple heuristics, are not per se rational or irrational, but that their success rests on their degree of fit to relevant environmental structures. The key is therefore to understand how cognitive and environmental structures slot together. In recent years, a growing set of analyses of heuristic–environment systems has deepened the understanding of the human mind and how boundedly rational heuristics can result in successful decision making. This article is concerned with three conceptual challenges in the study of ecological rationality. First, do heuristics also succeed in dynamic contexts involving competitive agents? Second, can the mind adapt to environmental structures via an unsupervised learning process? Third, how can research go beyond mere descriptions of environmental structures to develop theories of the mechanisms that give rise to those structures? In addressing these questions, we illustrate that a successful theory of rationality will focus on the adaptive aspects of the mind and will need to account for three components: the mind's information processing, the environment to which the mind adapts, and the intersection between the environment and the mind.
Whole‐genome assembly and annotation of northern wild rice, Zizania palustris L., supports a whole‐genome duplication in the Zizania genus
Authors: Haas Matthew , Kono Thomas , Macchietto Marissa , Millas Reneth , McGilp Lillian , Shao Mingqin , Duquette Jacques , Qiu Yinjie , Hirsch Candice N. , Kimball Jennifer
Published: July 2021

Zizania palustris L. (northern wild rice, NWR) is an aquatic grass native to North America that is notable for its nutritious grain. This is an important species with ecological, cultural and agricultural significance, specifically in the Great Lakes region of the USA. Using flow cytometry, we first estimated the NWR genome size to be 1.8 Gb. Using long‐ and short‐range sequencing, Hi‐C scaffolding and RNA‐seq data from eight tissues, we generated an annotated whole‐genome de novo assembly of NWR. The assembly was 1.29 Gb in length, highly repetitive (approx. 76.0%) and contained 46 421 putative protein‐coding genes. The expansion of retrotransposons within the genome and a whole‐genome duplication (WGD) after the Zizania–Oryza speciation event have both led to an increase in the genome size of NWR in comparison with Oryza sativa L. and Zizania latifolia. Both events depict a genome rapidly undergoing change over a short evolutionary time. Comparative analyses revealed the conservation of large syntenic blocks between NWR and O. sativa, which were used to identify putative seed‐shattering genes. Estimates of divergence times revealed that the Zizania genus diverged from Oryza approximately 26–30 million years ago (26–30 MYA), whereas NWR and Z. latifolia diverged from one another approximately 6–8 MYA. Comparative genomics confirmed evidence of a WGD in the Zizania genus and provided support that the event occurred prior to the NWR–Z. latifolia speciation event. This genome assembly and annotation provides a valuable resource for comparative genomics in the Oryzeae tribe and provides an important resource for future conservation and breeding efforts of NWR.
New high‐quality peach (Prunus persica L. Batsch) genome assembly to analyze the molecular evolutionary mechanism of volatile compounds in peach fruits
Authors: Cao Ke , Yang Xuanwen , Li Yong , Zhu Gengrui , Fang Weichao , Chen Changwen , Wang Xinwei , Wu Jinlong , Wang Lirong
Published: July 2021

Peach (Prunus persica L. Batsch) is an economically important fruit crop worldwide. Although a high‐quality peach genome has previously been published, Sanger sequencing was used for its assembly, which generated short contigs. Here, we report a chromosome‐level genome assembly and sequence analysis of Chinese Cling, an important founder cultivar for peach breeding programs worldwide. The assembled genome contained 247.33 Mb with a contig N50 of 4.13 Mb and a scaffold N50 of 29.68 Mb, representing 99.8% of the estimated genome. Comparisons between this genome and the recently published one (Lovell peach) uncovered 685 407 single nucleotide polymorphisms, 162 655 insertions and deletions, and 16 248 structural variants. Gene family analysis highlighted the contraction of the gene families involved in flavone, flavonol, flavonoid, and monoterpenoid biosynthesis. Subsequently, the volatile compounds of 256 peach varieties were quantitated in mature fruits in 2015 and 2016 to perform a genome‐wide association analysis. A comparison with the identified domestication genomic regions allowed us to identify 25 quantitative trait loci, associated with seven volatile compounds, in the domestication region, which is consistent with the differences in volatile compounds between wild and cultivated peaches. Finally, a gene encoding terpene synthase, located within a previously reported quantitative trait loci region, was identified to be associated with linalool synthesis. Such findings highlight the importance of this new assembly for the analysis of evolutionary mechanisms and gene identification in peach species. Furthermore, this high‐quality peach genome provides valuable information for future fruit improvement.
Increased incidence of gastrointestinal toxicity in canine cancer patients treated with concurrent abdominal radiation therapy and toceranib phosphate
Authors: Prebble Amber R. , Weishaar Kristen M. , Thamm Douglas H. , Leary Del , LaRue Susan M. , Martin Tiffany , Boss Mary‐Keara
Published: July 2021

Receptor tyrosine kinase inhibitors (TKIs) are used to treat human and canine cancers and may be combined with radiation therapy (RT) to enhance tumor control due their anticancer and antiangiogenic effects; however, recent case reports have emerged describing incidences of gastrointestinal toxicity when antiangiogenic therapies are combined with hypofractionated radiotherapy in human cancer patients. We evaluated the incidence of gastrointestinal (GI) toxicity in dogs receiving concurrent hypofractionated abdominal RT and the TKI toceranib (TOC) compared to those receiving abdominal RT alone, TOC alone, or concurrent non‐abdominal RT and TOC. Medical records of canine cancer patients were retrospectively reviewed and identified dogs were included in the following treatment categories: dogs which received RT to a portion of the abdomen and concurrent TOC (n = 19), abdominal RT alone (n‐29), TOC alone (n = 20), or non‐abdominal RT plus TOC (n = 9). Toxicities were graded using the Veterinary Cooperative Oncology Group ‐ Common Terminology Criteria for Adverse Events criteria and compared to published data on TOC‐associated GI toxicity. Patients receiving TOC while undergoing abdominal RT had significantly increased rates of any grade of diarrhea (p = 0.002), hyporexia (p = 0.0045), and vomiting (p = 0.003), as well as severe hyporexia (p = 0.003) when compared across the treatment groups. This retrospective study reveals significantly increased incidences of GI toxicity when abdominal RT is combined with TOC in canine patients. These findings are in‐line with the clinical concerns reported for increased normal tissue toxicity in human patients when antiangiogenics are combined with RT.
Evaluation of the airway mechanics of modified toggle laryngoplasty constructs using a vacuum chamber airflow model
Authors: Gray Sarah M. , Gutierrez‐Nibeyro Santiago D. , Couëtil Laurent L. , Horn Gavin P. , Kesler Richard M. , McCoy Annette M. , Stewart Matt C. , Schaeffer David J.
Published: July 2021

Objective

To evaluate the airway mechanics of modified toggle LP constructs in an airflow chamber model and compare these to the airway mechanics of standard LP constructs.

Study design

Ex‐vivo experimental study.

Sample population

Fifty‐one equine cadaveric larynges.

Methods

Bilateral LP constructs were performed using a modified toggle (n = 23) or a standard (n = 21) LP technique. Constructs were tested in an airflow model before and after cyclic loading which was designed to mimic postoperative swallowing. The cross‐sectional area (CSA), peak translaryngeal airflow (L/s), and impedance (cmH20/L/s) were determined and compared between LP constructs before and after cycling.

Results

The mean CSA of the rima glottidis of the modified toggle LP constructs was 15.2 ± 2.6 cm2before and 14.7 ± 2.6 cm2after cyclic loading, and the mean CSA of the rima glottidis of the standard LP constructs was 16.4 ± 2.9 cm2before and 15.7 ± 2.8 cm2after cyclic loading. The modified toggle LP constructs had similar peak translaryngeal impedance before and after cyclic loading (p = .13); however, the standard LP constructs had higher peak translaryngeal impedance after cyclic loading (p = .02).

Conclusion

The modified toggle and standard LP constructs had comparable airway mechanics in an ex‐vivo model.

Clinical significance

Further investigation is warranted to determine the extent to which the modified toggle LP technique restores normal airway function in horses with RLN.
Greenhouse Gas Emission Analysis of Integrated Production-Inventory-Transportation Supply Chain Enabled by Additive Manufacturing
Authors: Di Lei , Yang Yiran
Published: July 2021

Additive manufacturing (AM), owing to its unique layer-wise production method, can offer evident advantages such as faster production, lower cost, and less waste compared to traditional manufacturing (TM) technologies. The uses of AM in rapid tooling, prototyping, and manufacturing have been innovating the current manufacturing industry from the process level to the entire supply chain. Most existing research on AM is focused on process improvement and new materials, largely neglecting the potential economic and environmental benefits enabled by AM supply chains. This research investigates an innovative supply chain structure, i.e., the integrated production-inventory-transportation (PIT) structure that is uniquely enabled by AM because of its capability of fabricating the entire product with less or even no need for assembly and labor involvement. This paper quantifies and compares the greenhouse gas (GHG) emissions of TM and AM-enabled PIT supply chains. Since the manufacturing industry is a major source of GHG emissions in the U.S., it needs to be thoroughly studied to explore opportunities for reducing GHG emissions for environmental protection. Case study results suggest that a potential reduction of 26.43% of GHG emissions can be achieved by adopting the AM-enabled PIT supply chain structure. Sensitivity analysis results show that a 20% variation in GHG emission intensity (the amount of CO2eq emissions caused by generating a unit of electricity) can lead to a 6.26% change in the total GHG emissions from the AM-enabled PIT supply chain.
A New Pitch: Building an Innovative Sport Organization Through Sport Employees
Authors: Baer Nathan , Zvosec Claire C. , Oja Brent D. , Kim Minjung
Published: July 2021

Ben Davis has recently been hired to take over as the president of business operations for Major League Baseball’s newest expansion club, the Nashville Comets. He is faced with a challenging task: filling out the rest of his senior management staff. Ben knows he needs to meet certain initiatives set by the ownership group. Of these, the most important is that the ownership team wants to build an organization that will set itself apart in the crowded Nashville entertainment market, allowing it to flourish in the long term. While consulting with some of his industry colleagues, Ben has honed in on innovation, job crafting, and meaningful work as a means of doing so. Ben is seeking to develop an organization that inspires innovation in its employees, maximizing his staff as a resource for change. Using concepts like meaningful work and job crafting, students will be tasked with assisting Ben in fleshing out the Comets’ front office in a way that fosters creativity and innovation among their employees, contributing to the success of the organization.
Therapy Dog Intervention Decreases Stress and Increases Arousal in College Students
Authors: Cacolice Paul A. , Ebbs Corinne M.
Published: July 2021

Clinical Question: What is the effect of CT intervention on the stress and arousal levels of undergraduate students? Clinical Bottom Line: There is Level A–B evidence showing that the use of therapy dogs decreases stress and elevates arousal in female undergraduate students, with little evidence available for other populations.
Caffeine Mouth Rinse Does Not Improve Time to Exhaustion in Male Trained Cyclists
Authors: Nabuco Lara Lima , Saunders Bryan , Sousa da Silva Renato André , Molina Guilherme Eckhardt , Reis Caio Eduardo Gonçalves
Published: July 2021

This study investigated the effects of caffeine mouth rinse on cycling time to exhaustion (TTE) and physiological responses in trained cyclists. In a double-blinded randomized counterbalanced cross-over design, 10 recreationally trained male cyclists (mean ± SD: 32 ± 3 years, 72.8 ± 5.3 kg, 1.78 ± 0.06 m, 13.9% ± 3.3% body fat, peak power output = 289.4 ± 24.7 W) completed two TTE tests cycling at 75% of peak aerobic power following 24 hr of dietary and exercise standardization. Cyclists were administered 25-ml mouth rinses for 5 s containing either 85 mg of caffeine or control (water) every 5 min throughout the exercise tests. No significant improvement in TTE was shown with caffeine mouth rinse compared with control (33:24 ± 12:47 vs. 28:08 ± 10:18 min; Cohen’s dz effect size: 0.51, p = .14). Caffeine mouth rinse had no significant effect on ratings of perceived exertion (p = .31) or heart rate (p = .35) throughout the cycling TTE protocol. These data indicate that a repeated dose of caffeinated mouth rinse for 5 s does not improve cycling TTE in recreationally trained male cyclists. However, these findings should be taken with caution due to the small sample size and blinding ineffectiveness, while further well-design studies with larger samples are warranted.
Wetsuit Use During Open Water Swimming. Does It “Suit” Everybody? A Narrative Review
Authors: Quagliarotti Claudio , Cortesi Matteo , Gatta Giorgio , Bonifazi Marco , Zamparo Paola , Baldassarre Roberto , Vleck Veronica , Piacentini Maria Francesca
Published: July 2021

Purpose: Although wearing a wetsuit while swimming, when permitted, is primarily for safety reasons (ie, to protect against hypothermia), changes in buoyancy, biomechanics, and exercise performance have been reported. This narrative review covers the benefits of different wetsuit models on performance in swimming and triathlon. Methods: A computer search of online databases was conducted to locate relevant published research until March 2021. After the screening process, 17 studies were selected for analysis. Results: Most of the selected studies involved pool swimmers or triathletes completing short or middle distances in a pool while using a full or a long sleeveless wetsuit. Swimming with wetsuit elicited significant improvements in performance (maximum 11%), mainly by decreasing drag and energy cost, by increasing buoyancy, and by affecting technique. Different rates of change in each factor were found according to swimming ability and wetsuit model. In addition, wearing a wetsuit was often rated as uncomfortable by athletes. Conclusions: Although improvement in swimming performance by wearing a wetsuit has been reported in the literature, the amplitude of the improvement remains questionable. The enhancement in swimming performance is attributable merely to improvements in propulsion proficiency and buoyancy, as well as a reduction in drag. The extent to which athletes are familiar with the use of a wetsuit, their swimming ability, and the wetsuit model may play important roles in this improvement. More studies simulating competition and comparing elite versus nonelite athletes are needed.
Specific Protein-Membrane Interactions Promote Packaging of Metallo-β-Lactamases into Outer Membrane Vesicles
Authors: López Carolina , Prunotto Alessio , Bahr Guillermo , Bonomo Robert A. , González Lisandro J. , Dal Peraro Matteo , Vila Alejandro J.
Published: July 2021

Outer membrane vesicles (OMVs) act as carriers of bacterial products such as plasmids and resistance determinants, including metallo-β-lactamases. The lipidated, membrane-anchored metallo-β-lactamase NDM-1 can be detected in Gram-negative OMVs.
Mechanisms Involved in the Active Secretion of CTX-M-15 β-Lactamase by Pathogenic Escherichia coli ST131
Authors: Rangama Severine , Lidbury Ian D. E. A. , Holden Jennifer M. , Borsetto Chiara , Murphy Andrew R. J. , Hawkey Peter M. , Wellington Elizabeth M. H.
Published: July 2021

Infections caused by antimicrobial-resistant bacterial pathogens are fast becoming an important global health issue. Strains of
Escherichia coli
are common causal agents of urinary tract infection and can carry multiple resistance genes.
Immunogenicity and Efficacy of Live-Attenuated
Salmonella
Typhimurium Vaccine Candidate CVD 1926 in a Rhesus Macaque Model of Gastroenteritis
Authors: Higginson Ellen E. , Panda Aruna , Toapanta Franklin R. , Terzi Matthew C. , Jones Jennifer A. , Sen Sunil , Permala-Booth Jasnehta , Pasetti Marcela F. , Sztein Marcelo B. , DeTolla Louis , Levine Myron M. , Tennant Sharon M.
Published: July 2021

Salmonella Typhimurium
is a common cause of foodborne gastroenteritis and a less frequent but important cause of invasive disease, especially in developing countries. In our previous work, we showed that a live-attenuated
S. Typhimurium
A Rationally Designed c-di-AMP Förster Resonance Energy Transfer Biosensor To Monitor Nucleotide Dynamics
Authors: Pollock Alex J. , Choi Philip H. , Zaver Shivam A. , Tong Liang , Woodward Joshua J.
Published: July 2021

c-di-AMP is an important nucleotide second messenger for which detection methods are severely limited. In this work we engineered and implemented a c-di-AMP-specific FRET biosensor to remedy this dearth. We present this biosensor, CDA5, as a versatile tool to investigate previously intractable facets of c-di-AMP biology.
Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient
Authors: Wu Xiancheng , Sandhu Michael , Dhand Rajat , Alkukhun Leen , Lamichhane Jivan
Published: July 2021

An 89-year-old man with a history of multiple abdominal surgeries and ventriculoperitoneal (VP) shunt placement for normal pressure hydrocephalus presented for intractable abdominal bloating and scrotal swelling, for which imaging revealed massive ascites, bilateral hydrocele and small bilateral pleural effusions. Cardiac, hepatic and renal workup were insignificant. Culture and cytology of ascitic fluid were negative for infection or malignancy. Aetiology of the ascites as secondary to Cerebrospinal fluid (CSF) from the VP shunt was confirmed via ligation of the shunt. Sterile CSF ascites, hydrothorax and hydrocele are rare complications of VP shunt for hydrocephalus and are mostly presented in paediatric patients. We report the first known case of concurrent CSF ascites, hydrothorax and hydrocele in an elderly patient. We examine the difficulty of shunt replacement as a diagnostic and treatment modality in this age group and propose the use of reversible shunt ligation as a diagnostic modality.
CDK4/6 inhibitor-induced colitis: a case report and review of the literature
Authors: Malik Azhar Abbas , Abbas Haider , Oo Zin Mar , Lim Zerlene
Published: July 2021

A 72-year-old woman with metastatic ER/PR-positive breast cancer who had been on ribociclib and letrozole for 1 year developed severe life-threatening colitis. She presented to emergency department with features of acute abdomen and diarrhoea. The diagnosis of colitis was confirmed radiologically as well as by histopathological examination of the biopsy specimen and the patient clinically improved after withholding ribociclib and receiving corticosteroids compatible with ribociclib-induced colitis. The mechanism of injury in CDK 4/6 inhibitor-induced colitis is unknown but may be related to recruitment of inflammatory cells. Whether the development of colitis is associated with tumour response is an interesting and unanswered question.
Bartter syndrome and hypothyroidism masquerading cystinosis in a 3-year-old girl: rare manifestation of a rare disease
Authors: Das Gargi , Nanda Pamali Mahasweta , Kaur Anupriya , Kumar Rakesh
Published: July 2021

Cystinosis is a multisystem disorder with varied presentations secondary to deposition of cystine crystals in different organ systems. Children with cystinosis typically present with renal tubular acidosis and failure to thrive. We report a 3-year-old girl, born to a third-degree consanguineous couple, who presented with failure to thrive and polyuria. Laboratory investigations showed metabolic alkalosis suggestive of a Bartter-like syndrome and acquired hypothyroidism. Although metabolic alkalosis is a rare manifestation of cystinosis, the presence of renal tubular dysfunction and hypothyroidism prompted consideration of a probable diagnosis of cystinosis in the index child. Slit-lamp examination revealed cystine crystals in the cornea and genetic analysis showed a mutation in exon 9 of the CTNS (cystinosin, lysosomal cystine transporter) gene on chromosome 17. We highlight the importance of considering cystinosis as a differential diagnosis for Bartter syndrome and hypothyroidism.
Primary cardiac B cell lymphoma in an immunocompetent patient
Authors: Miyawaki Masashi , Aoyama Rie , Ishikawa Joji , Harada Kazumasa
Published: July 2021

Primary cardiac lymphoma is a rare entity of extranodal lymphoma and is observed with increasing frequency in immunocompromised hosts. However, a considerable proportion of cardiac lymphomas still occur in immunocompetent patients. We report the case of a 55-year-old immunocompetent Japanese man with a large amount of pericardial fluid and the presentation of heart failure secondary to primary cardiac B cell lymphoma, which was diagnosed by cytological examination of pericardial fluid and imaging. The right atrium, right ventricle and pericardium were affected by the tumour, which encased the mid/distal portion of the right coronary artery (RCA). Pretreatment optical coherence tomography of the RCA demonstrated no tumour extension into the vascular structure but a focal mural thrombus. We initiated chemotherapy (steroid therapy then COP at half dose/R-CHOP/R-CHASE) [COP (C: Cyclophosphamide, O: Oncovin, P: Prednisolone) R-CHOP (R: Rituximab, C: Cyclophosphamide, H: Doxorubicin Hydrochloride, O: Oncovin, P: Prednisolone) R-CHASE (R: Rituximab, C: Cyclophosphamide, HA: high dose Cytarabine, S: Steroid, E: Etoposide)]with administration of low-dose aspirin to prevent possible ischaemic events. The patient had a good clinical course without adverse events except for transient pericarditis.
Perioperative challenges in a morbidly obese former COVID-19 patient undergoing elective spine surgery
Authors: Leo Zhen Hao , Mohammad Iskandar Fathir Fath , Yeap Tat Boon , Bong Chin Pei
Published: July 2021

Anaesthesia for patients with severe lung fibrosis post COVID-19 infection requires special consideration. This is due to its propensity to cause perioperative anaesthetic catastrophe and possibility of cross infection among healthcare workers if not properly managed. This interesting article elaborates in detail the anaesthetic and surgical challenges in a morbidly obese patient who had a severe COVID-19 infection presenting for an elective spine surgery.
Cold agglutinin disease and COVID-19 requiring therapeutic plasma exchange
Authors: Ahmed Yousuf , Khandelwal Aditi , Walker Laura
Published: July 2021

A 70-year-old man with known cold autoimmune haemolytic anaemia was referred to the emergency department with increased shortness of breath on exertion. He had been confirmed positive for non-variant COVID-19 infection 1 week earlier based on nasopharyngeal swab PCR assay. CT thorax demonstrated diffuse patchy bilateral ground glass opacities, consistent with COVID-19 pneumonia. Bloodwork demonstrated severe cold agglutinin mediated haemolytic anaemia. To help stabilise the patient, he was transferred to a tertiary care hospital for urgent therapeutic plasma exchange. Key supportive therapy included folic acid supplementation, ensuring the patient was kept warm and warmed infusions including transfusions via the apheresis machine. The patient made a good recovery following plasma exchange, and his haemoglobin levels remained stable by discharge.
Long covid—mechanisms, risk factors, and management
Authors: Crook Harry , Raza Sanara , Nowell Joseph , Young Megan , Edison Paul
Published: July 2021

Since its emergence in Wuhan, China, covid-19 has spread and had a profound effect on the lives and health of people around the globe. As of 4 July 2021, more than 183 million confirmed cases of covid-19 had been recorded worldwide, and 3.97 million deaths. Recent evidence has shown that a range of persistent symptoms can remain long after the acute SARS-CoV-2 infection, and this condition is now coined long covid by recognized research institutes. Studies have shown that long covid can affect the whole spectrum of people with covid-19, from those with very mild acute disease to the most severe forms. Like acute covid-19, long covid can involve multiple organs and can affect many systems including, but not limited to, the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems. The symptoms of long covid include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, symptoms of post-traumatic stress disorder, muscle pain, concentration problems, and headache. This review summarizes studies of the long term effects of covid-19 in hospitalized and non-hospitalized patients and describes the persistent symptoms they endure. Risk factors for acute covid-19 and long covid and possible therapeutic options are also discussed.
Assessing exposure to Kilkari: a big data analysis of a large maternal mobile messaging service across 13 states in India
Authors: Bashingwa Jean Juste Harrisson , Mohan Diwakar , Chamberlain Sara , Arora Salil , Mendiratta Jai , Rahul Sai , Chauhan Vinod , Scott Kerry , Shah Neha , Ummer Osama , Ved Rajani , Mulder Nicola , LeFevre Amnesty Elizabeth
Published: July 2021

The Kilkari programme is being implemented by the Government of India in 13 states. Designed by BBC Media Action and scaled in collaboration with the Ministry of Health and Family Welfare from January 2016, Kilkari had provided mobile health information to over 10 million subscribers by the time BBC Media Action transitioned the service to the government in April 2019. Despite the reach of Kilkari in terms of the absolute number of subscribers, no longitudinal analysis of subscriber exposure to health information content over time has been conducted, which may underpin effectiveness and changes in health outcomes. In this analysis, we draw from call data records to explore exposure to the Kilkari programme in India for the 2018 cohort of subscribers. We start by assessing the timing of the first successful call answered by subscribers on entry to the programme during pregnancy or postpartum, and then assess call volume, delivery, answering and listening rates over time. Findings suggest that over half of subscribers answer their first call after childbirth, with the remaining starting in the pregnancy period. The system handles upwards of 1.2 million calls per day on average. On average, 50% of calls are picked up on the first call attempt, 76% by the third and 99.5% by the ninth call attempt. Among calls picked up, over 48% were listened to for at least 50% of the total content duration and 43% were listened to for at least 75%. This is the first analysis of its kind of a maternal mobile messaging programme at scale in India. Study analyses suggest that multiple call attempts may be required to reach subscribers. However, once answered, subscribers tend to listen the majority of the call—a figure consistent across states, over time, and by health content area.
SMS feedback system as a quality assurance mechanism: experience from a household survey in rural India
Authors: Shah Neha , Ummer Osama , Scott Kerry , Bashingwa Jean Juste Harrisson , Penugonda Nehru , Chakraborty Arpita , Sahore Agrima , Mohan Diwakar , LeFevre Amnesty Elizabeth
Published: July 2021

The increasing use of digital health solutions to support data capture both as part of routine delivery of health services and through special surveys presents unique opportunities to enhance quality assurance measures. This study aims to demonstrate the feasibility and acceptability of using back-end data analytics and machine learning to identify impediments in data quality and feedback issues requiring follow-up to field teams using automated short messaging service (SMS) text messages. Data were collected as part of a postpartum women’s survey (n=5095) in four districts of Madhya Pradesh, India, from October 2019 to February 2020. SMSs on common errors found in the data were sent to supervisors and coordinators. Before/after differences in time to correction of errors were examined, and qualitative interviews conducted with supervisors, coordinators, and enumerators. Study activities resulted in declines in the average number of errors per week after the implementation of automated feedback loops. Supervisors and coordinators found the direct format, complete information, and automated nature of feedback convenient to work with and valued the more rapid notification of errors. However, coordinators and supervisors reported preferring group WhatsApp messages as compared with individual SMSs to each supervisor/coordinator. In contrast, enumerators preferred the SMS system over in-person group meetings where data quality impediments were discussed. This study demonstrates that automated SMS feedback loops can be used to enhance survey data quality at minimal cost. Testing is needed among data capture applications in use by frontline health workers in India and elsewhere globally.
Can health information through mobile phones close the divide in health behaviours among the marginalised? An equity analysis of Kilkari in Madhya Pradesh, India
Authors: Mohan Diwakar , Scott Kerry , Shah Neha , Bashingwa Jean Juste Harrisson , Chakraborty Arpita , Ummer Osama , Godfrey Anna , Dutt Priyanka , Chamberlain Sara , LeFevre Amnesty Elizabeth
Published: July 2021

Kilkari is one of the largest maternal mobile messaging programmes in the world. It makes weekly prerecorded calls to new and expectant mothers and their families from the fourth month of pregnancy until 1-year post partum. The programme delivers reproductive, maternal, neonatal and child health information directly to subscribers’ phones. However, little is known about the reach of Kilkari among different subgroups in the population, or the differentiated benefits of the programme among these subgroups. In this analysis, we assess differentials in eligibility, enrolment, reach, exposure and impact across well-known proxies of socioeconomic position—that is, education, caste and wealth. Data are drawn from a randomised controlled trial (RCT) in Madhya Pradesh, India, including call data records from Kilkari subscribers in the RCT intervention arm, and the National Family Health Survey-4, 2015. The analysis identifies that disparities in household phone ownership and women’s access to phones create inequities in the population eligible to receive Kilkari, and that among enrolled Kilkari subscribers, marginalised caste groups and those without education are under-represented. An analysis of who is left behind by such interventions and how to reach those groups through alternative communication channels and platforms should be undertaken at the intervention design phase to set reasonable expectations of impact. Results suggest that exposure to Kilkari has improved levels of some health behaviours across marginalised groups but has not completely closed pre-existing gaps in indicators such as wealth and education.
Assessment of surgical capacity in Chiapas, Mexico: a cross-sectional study of the public and private sector
Authors: Roa Lina , Moeller Ellie , Fowler Zachary , Carrillo Fernando , Mohar Sebastian , Williams Wendy , Meara John G , Riviello Robert , Uribe-Leitz Tarsicio , Macias Valeria
Published: July 2021

Introduction

Surgical, anaesthesia and obstetric (SAO) care are essential, life-saving components of universal healthcare. In Chiapas, Mexico’s southernmost state, the capacity of SAO care is unknown. This study aims to assess the surgical capacity in Chiapas, Mexico, as it relates to access, infrastructure, service delivery, surgical volume, quality, workforce and financial risk protection.

Methods

A cross-sectional study of Ministry of Health public hospitals and private hospitals in Chiapas was performed. The translated Surgical Assessment Tool (SAT) was implemented in sampled hospitals. Surgical volume was collected retrospectively from hospital logbooks. Fisher’s exact test and Mann-Whitney U test were used to compare public and private hospitals. Catastrophic expenditure from surgical care was calculated.

Results

Data were collected from 17 public hospitals and 20 private hospitals in Chiapas. Private hospitals were smaller than public hospitals and public hospitals performed more surgeries per operating room. Not all hospitals reported consistent electricity, running water or oxygen, but private hospitals were more likely to have these basic infrastructure components compared with public hospitals (84% vs 95%; 60% vs 100%; 94.1% vs 100%, respectively). Bellwether surgical procedures performed in private hospitals cost significantly more, and posed a higher risk of catastrophic expenditure, than those performed in public hospitals.

Conclusion

Capacity limitations are greater in public hospitals compared with private hospitals. However, the cost of care in the private sector is significantly higher than the public sector and may result in catastrophic expenditures. Targeted interventions to improve the infrastructure, workforce availability and data collection are needed.
VAScular and Chronic Obstructive Lung disease (VASCOL): a longitudinal study on morbidity, symptoms and quality of life among older men in Blekinge county, Sweden
Authors: Olsson Max , Engström Gunnar , Currow David C , Johnson Miriam , Sandberg Jacob , Ekström Magnus Per
Published: July 2021

Purpose

Despite data showing breathlessness to be more prevalent in older adults, we have little detail about the severity or multidimensional characteristics of breathlessness and other self-reported measures (such as quality of life and other cardiorespiratory-related symptoms) in this group at the population level. We also know little about the relationship between multidimensional breathlessness, other symptoms, comorbidities and future clinical outcomes such as quality of life, hospitalisation and mortality. This paper reports the design and descriptive findings from the first two waves of a longitudinal prospective cohort study in older adults.

Participants

Between 2010 and 2011, 1900 men in a region in southern Sweden aged 65 years were invited to attend for VAScular and Chronic Obstructive Lung disease (VASCOL) baseline (Wave 1) assessments which included physiological measurements, blood sampling and a self-report survey of lifestyle and previous medical conditions. In 2019, follow-up postal survey data (Wave 2) were collected with additional self-report measures for breathlessness, other symptoms and quality of life. At each wave, data are cross-linked with nationwide Swedish registry data of diseases, treatment, hospitalisation and cause of death.

Findings to date

1302/1900 (68%) of invited men participated in Wave 1, which include 56% of all 65-year-old men in the region. 5% reported asthma, 2% chronic obstructive pulmonary disease, 56% hypertension, 10% diabetes and 19% had airflow limitation. The VASCOL cohort had comparable characteristics to those of similarly aged men in Sweden. By 2019, 109/1302 (8.4%) had died. 907/1193 (76%) of the remainder participated in Wave 2. Internal data completeness of 95% or more was achieved for most Wave 2 measures.

Future plans

A third wave will be conducted within 4 years, and the cohort will be followed through repeated follow-ups planned every fourth year, as well as national registry data of diagnosis, treatments and cause of death.