bluuebunny/crossref_metadata_2025 huggingface dataset:
Root-knot nematode chemotaxis is positively regulated by
l
-galactose sidechains of mucilage carbohydrate rhamnogalacturonan-I
Authors: Tsai Allen Yi-Lun , Iwamoto Yuka , Tsumuraya Yoichi , Oota Morihiro , Konishi Teruko , Ito Shinsaku , Kotake Toshihisa , Ishikawa Hayato , Sawa Shinichiro
Published: July 2021

Specific chemical structures of polysaccharides in flax mucilage are essential for attracting plant-parasitic nematodes.
Protection of K18-hACE2 mice and ferrets against SARS-CoV-2 challenge by a single-dose mucosal immunization with a parainfluenza virus 5–based COVID-19 vaccine
Authors: An Dong , Li Kun , Rowe Dawne K. , Diaz Maria Cristina Huertas , Griffin Emily F. , Beavis Ashley C. , Johnson Scott K. , Padykula Ian , Jones Cheryl A. , Briggs Kelsey , Li Geng , Lin Yuan , Huang Jiachen , Mousa Jarrod , Brindley Melinda , Sakamoto Kaori , Meyerholz David K. , McCray Paul B. , Tompkins S. Mark , He Biao
Published: July 2021

Single-dose intranasal COVID-19 vaccine prevents infection and inhibits transmission.
Supplemental Material: Superhydrous hematite and goethite: A potential water reservoir in the red dust of Mars?
Authors: Chen Si Athena , al. et
Published: July 2021

Materials, analytical methods, Figures S1–S8, and Tables S1–S3
Synovial sarcoma of the transverse colon metastatic to the chest wall after 3 years of follow-up
Authors: Hidalgo Mora Viviana Marcela , Baquero Zamarra David Ricardo , Cendales Maria Angelica , Figueroa Avendaño Carlos Edgar
Published: July 2021

We report a fifth case of a transverse colon primary synovial sarcoma. A 31-year-old man with history of grade I obesity presented to an outpatient clinic reporting 6 months of intermittent colicky abdominal pain associated with haematochezia and rectal bleeding. Colonoscopy reported a partially obstructive intraluminal tumour lesion located in the transverse colon. There was no evidence of metastatic disease in the extension studies, so the patient was admitted to the hospital for a laparoscopic subtotal colectomy. Histopathology demonstrated intermediate-grade synovial sarcoma. At the third year of follow-up, the patient presented metastases on the chest wall, which required extensive resection and complementary oncological management.
Management of severe hyponatremia with low-dose continuous kidney replacement therapy and peripheral D5W in an infant with acute kidney injury
Authors: Basalely Abby Miriam , Duong Minh Dien , Liu Diane , Zolotnitskaya Anna
Published: July 2021

We report a 7-month-old female infant who presented with anuric acute kidney injury and severe hyponatremia (serum sodium 110 mEq/L). The patient was treated with low-dose continuous kidney replacement therapy (CKRT), that is, 85% of total clearance dose divided equally between normonatric (Na 140 mEq/L) replacement and dialysate fluids. The remaining 15% of the clearance was provided by peripheral infusion of dextrose 5% (D5W). The patient’s sodium was maintained between 119 mEq/L and 121 mEq/L for the first 24 hours of CKRT. Over the next 2 days, the rate of D5W infusion was slowly decreased while replacement and dialysis flow rates were proportionately increased. Serum sodium was normalised by day 2 of the therapy. The patient had no neurologic sequelae associated with this therapy.
Intramammary melanoma micrometastasis within a silicone-implanted breast
Authors: Payne Anna , Welman Ted , Stodell Matthew
Published: July 2021

We present the case of a 53-year-old woman with silicone breast implants who underwent excision of an abdominal melanoma and sentinel lymph node biopsy. Two lymph nodes were excised; both lying in the breast parenchyma adjacent to the intact right breast capsule. The lymph node histology revealed a subcapsular melanoma deposit along with silicone lymphadenopathy in the sentinel node. This case highlights that sentinel lymph nodes can be located in alternative locations to the common lymphatic basins and, therefore, the importance of preoperative lymphoscintigraphy. We also discuss subclinical breast implant rupture as a causative factor for silicone lymphadenopathy.
Diffuse alveolar haemorrhage with suspected idiopathic pulmonary hemosiderosis and decrease in lung diffusing capacity and chronic respiratory failure
Authors: Iwasaki Kotaro , Matsuzawa Yasuo , Wakabayashi Hiroki , Kumano Kotaro
Published: July 2021

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown aetiology that causes recurrent episodes of diffuse alveolar haemorrhage (DAH). A male patient in his 50s had repeatedly experienced hemoptysis for the past 6 years, along with a decrease in the pulmonary diffusing capacity and chronic respiratory failure. After a 6-year follow-up, the patient experienced sudden exacerbation of hemoptysis and respiratory failure, and he was hospitalised. A CT of the chest revealed diffuse pulmonary infiltrates, whereas the bronchoalveolar lavage revealed hemosiderin-laden macrophages. Thus, the patient was diagnosed with DAH. As all diseases that cause DAH other than IPH were negative, the patient was suspected of IPH. He was treated with a combination of glucocorticoids and azathioprine, and his hemoptysis and chronic respiratory failure improved; however, the decrease in the pulmonary diffusing capacity did not improve. Treating adult-onset IPH with glucocorticoids and azathioprine might not improve pulmonary diffusing capacity.
Rare case of gastrointestinal mucormycosis with colonic perforation in an immunocompetent patient with COVID-19
Authors: Singh Ravinder Pal , Gupta Nishkarsh , Kaur Tanudeep , Gupta Anju
Published: July 2021

Primary gastrointestinal mucormycosis is a rare disease associated with an increased mortality and is rarely reported in an immunocompetent host. We report the first case of mucormycosis-associated colonic perforation in a COVID-19 patient with a favourable outcome. A 48-year-old healthy male doctor in home isolation due to COVID-19 was admitted to COVID-19 intensive care unit when his symptoms deteriorated. The patient was put on non-invasive ventilation (NIV) using Bilevel Positive Airway Pressure (BiPAP) and treatment given as per existing hospital protocol. The patient improved clinically, and was discharged on day 10 of admission. Two days later, he presented with acute gastrointestinal symptoms to the emergency department. A diagnosis of perforation peritonitis was made, the patient was stabilised and sigmoid colectomy with descending colon colostomy was done. A diagnosis of gastrointestinal mucormycosis was made and injectable antifungal was started. The patient was discharged after his general conditions improved.
Impact of the National Endoscopy Database (NED) on colonoscopy withdrawal time: a tertiary centre experience
Authors: Shiha Mohamed G , Al-Rifaie Ammar , Thoufeeq Mo
Published: July 2021

Objective

Colonoscopy withdrawal time (CWT) is a key performance indicator affecting polyp detection rate (PDR) and adenoma detection rate (ADR). However, studies have shown wide variation in CWT and ADR between different endoscopists. The National Endoscopy Database (NED) was implemented to enable quality assurance in all endoscopy units across the UK and also to reduce variation in practice. We aimed to assess whether CWT changed since the introduction of NED and whether CWT affected PDR.

Methods

We used NED to retrospectively collect data regarding CWT and PDR of 25 endoscopists who performed (n=4459 colonoscopies) in the four quarters of 2019. We then compared this data to their performance in 2016, before using NED (n=4324 colonoscopies).

Results

Mean CWT increased from 7.66 min in 2016 to 9.25 min in 2019 (p=0.0001). Mean PDR in the two periods was 29.9% and 28.3% (p=0.64). 72% of endoscopists (18/25) had CWT>6 min in 2016 versus 100% (25/25) in 2019, the longer CWT in 2019 positively correlated with the PDR (r=0.50, p=0.01). Gastroenterology consultants and trainee endoscopists had longer CWT compared with colorectal surgeons both before and after using NED.

Conclusion

NED usage increased withdrawal times in colonoscopy. Longer withdrawal times were associated with higher PDR. A national colonoscopy audit using data from NED is required to evaluate whether wide variations in practice across endoscopy units in the UK still exist and to ensure minimum colonoscopy quality standards are achieved.
Evaluation of different stool extraction methods for metabolomics measurements in human faecal samples
Authors: Erben Vanessa , Poschet Gernot , Schrotz-King Petra , Brenner Hermann
Published: July 2021

Background

Metabolomics analysis of human stool samples is of great interest for a broad range of applications in biomedical research including early detection of colorectal neoplasms. However, due to the complexity of metabolites there is no consensus on how to process samples for stool metabolomics measurements to obtain a broad coverage of hydrophilic and hydrophobic substances.

Methods

We used frozen stool samples (50 mg) from healthy study participants. Stool samples were processed after thawing using eight different processing protocols and different solvents (solvents such as phosphate-buffered saline, isopropanol, methanol, ethanol, acetonitrile and solvent mixtures with or without following evaporation and concentration steps). Metabolites were measured afterwards using the MxP Quant 500 kit (Biocrates). The best performing protocol was subsequently applied to compare stool samples of participants with different dietary habits.

Results

In this study, we were able to determine up to 340 metabolites of various chemical classes extracted from stool samples of healthy study participants with eight different protocols. Polar metabolites such as amino acids could be measured with each method while other metabolite classes, particular lipid species (better with isopropanol and ethanol or methanol following a drying step), are more dependent on the solvent or combination of solvents used. Only a small number of triglycerides or acylcarnitines were detected in human faeces. Extraction efficiency was higher for protocols using isopropanol (131 metabolites>limit of detection (LOD)) or those using ethanol or methanol and methyl tert-butyl ether (MTBE) including an evaporation and concentration step (303 and 342 metabolites>LOD, respectively) than for other protocols. We detected significant faecal metabolite differences between vegetarians, semivegetarians and non-vegetarians.

Conclusion

For the evaluation of metabolites in faecal samples, we found protocols using solvents like isopropanol and those using ethanol or methanol, and MTBE including an evaporation and concentration step to be superior regarding the number of detected metabolites of different chemical classes over others tested in this study.
Association between low-density lipoprotein cholesterol level and mortality in patients with cardiogenic shock: a retrospective cohort study
Authors: Jin Jiali , Shi Zhewei , Pang Xiaomin
Published: July 2021

Aims

Inflammation plays a key role in the pathophysiology of cardiogenic shock (CS). Low-density lipoprotein cholesterol (LDL-C) is a biomarker of inflammation and is used to predict prognostic outcomes of several diseases. The primary purpose of this study was to evaluate if LDL-C can be used as a biomarker to predict the mortality of CS.

Methods and results

Records of critically ill patients with CS were identified from the Medical Information Mart for Intensive Care III database. A multivariate Cox regression model was employed to adjust for imbalances by incorporating parameters and potential confounders.

A total of 551 critically ill patients with CS were enrolled for this analysis, including 207 with LDL-C <1.8 mmol/L and 344 with LDL-C ≥1.8 mmol/L. Results of multivariate Cox regression models found that higher concentration of LDL-C (LDL-C ≥1.8mmol/L) was associated with a reduced risk of in-hospital mortality (HR 0.66, 95% CI 0.50 to 0.87; p=0.003) and 28-day mortality (HR 0.61, 95% CI 0.46 to 0.80; p=0.002) LDL-C in patients with CS. Patients with LDL-C ≥1.8 mmol/L were independently associated with improved in-hospital survival (HR 0.32, 95% CI 0.20 to 0.52, p<0.001) and 28-day survival (HR 0.51, 95% CI 0.33 to 0.73, p=0.002) compared with patients with LDL-C <1.8 mmol/L. The impact of LDL-C on in-hospital mortality and 28-day mortality persisted in patients with acute coronary syndrome (ACS) and was not statistically significant in the non-ACS subgroup.

Conclusions

Our study observed that increased LDL-C level was related with improved survival in patients with CS, but not with improved outcomes in patients with uncomplicated ACS. The results need to be verified in randomised controlled trials.
Effectiveness of exercise for osteosarcopenia in older adults: a systematic review protocol
Authors: Vinícius-Souza Guilherme Elias , Noll Matias , Silveira Erika Aparecida
Published: July 2021

Introduction

Osteosarcopenia is defined as the concomitant occurrence of sarcopenia and osteopenia or osteoporosis. Older adults with this syndrome have a greater fragility and mortality risk compared with those without these conditions. Based on separate interventions with individuals with sarcopenia and osteoporosis, exercise has been recommended as a treatment for osteosarcopenia. However, there is no evidence of its efficacy. Our objective is to identify whether physical exercise can improve osteosarcopenia in older adults and lead to good health outcomes.

Methods and analysis

We will perform a systematic review in the following databases: PubMed, Embase, Cochrane and Scopus. The criterion of inclusion will be clinical trials involving physical exercise interventions in older adults diagnosed with osteosarcopenia. To assess the risk of bias, the Grading of Recommendations, Assessment, Development and Evaluation and Downs and Black tools will be used. For each search result, the quality of the evidence will ultimately receive one of four grades: high, moderate, low or very low. The outcome of this study is to demonstrate the effectiveness of physical exercise in improving the parameters that lead to the diagnosis of osteosarcopenia (bone mineral density, quality of muscle mass, muscle strength and physical function) in older adults. The possibility of meta-analysis will be assessed according to the homogeneity of the studies, using the methods of fixed or random effects. Sensitivity analyses will be performed, and the funnel plot will be used to assess publication bias. The proposed statistical analyses will be performed using STATA software, V.14.0.

Ethics and dissemination

The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. As we will not use individual patient data, ethical approval is not required.

Trial registration number

CRD42020215659.
Educational and training interventions aimed at healthcare workers in the detection and management of people with mental health conditions in South and Southeast Asia: systematic review protocol
Authors: Koly Kamrun Nahar , Baskin Cleo , Lata Ivy , Rao Mala , Rasheed Sabrina , Law Graham , Gnani Shamini
Published: July 2021

Introduction

The mental health burden and treatment gap in South and Southeast Asia is high and significant. Capacity building of healthcare workers is essential to support programmes related to the detection and management of patients with mental health conditions. We aim to conduct a systematic review to summarise the research on educational, training and capacity-building interventions aimed at the healthcare workforce in detection and management of mental health conditions in South and Southeast Asia.

Objective

To synthesise evidence on (1) the types of educational and training interventions that have been used to improve the knowledge, skills and attitudes of healthcare workers in South and Southeast Asian countries in the detection and management of mental health conditions; (2) the effectiveness, including cost-effectiveness of the interventions; and (3) the enabling factors and barriers that influence the effectiveness of these interventions.

Methods and analysis

This review will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We will search six electronic databases: MEDLINE, EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Global Health for empirical studies published from 1 January 2000 to 31 August 2020. Search results from each database will be combined and uploaded in Covidence library. Title, abstract and full-text screening, and data extraction of each included study will be performed by two independent reviewers. Disagreements between reviewers will be resolved by a third reviewer and study team. Quality of included studies will be assessed by the modified Cochrane Collaboration tool and ROBINS-I tool. Data will be synthesised and if a meta-analysis is not appropriate, a stepwise thematic analysis will be performed.

Ethics and dissemination

Ethics approval is not required for this study. Findings will be disseminated through peer-reviewed publications, fact sheets, multimedia press briefings, conferences, seminars and symposia.

PROSPERO registration number

CRD42020203955.
Parkinson’s disease and cancer: a systematic review and meta-analysis of over 17 million participants
Authors: Zhang Xinyuan , Guarin David , Mohammadzadehhonarvar Niyaz , Chen Xiqun , Gao Xiang
Published: July 2021

Objective

To systematically review and qualitatively evaluate epidemiological evidence on associations between Parkinson’s disease (PD) and cancer via meta-analysis.

Data sources

MEDLINE via PubMed, Web of Science and EMBASE, until March 2021.

Study selection

Included were publications that (1) were original epidemiological studies on PD and cancer; (2) reported risk estimates; (3) were in English. Exclusion criteria included: (1) review/comments; (2) biological studies; (3) case report/autopsy studies; (4) irrelevant exposure/outcome; (5) treated cases; (6) no measure of risk estimates; (7) no confidence intervals/exact p values and (8) duplicates.

Data extraction and synthesis

PRISMA and MOOSE guidelines were followed in data extraction. Two-step screening was performed by two authors blinded to each other. A random-effects model was used to calculate pooled relative risk (RR).

Main outcomes and measures

We included publications that assessed the risk of PD in individuals with vs without cancer and the risk of cancer in individuals with vs without PD.

Results

A total of 63 studies and 17 994 584 participants were included. Meta-analysis generated a pooled RR of 0.82 (n=33; 95% CI 0.76 to 0.88; p<0.001) for association between PD and total cancer, 0.76 (n=21; 95% CI 0.67 to 0.85; p<0.001) for PD and smoking-related cancer and 0.92 (n=19; 95% CI 0.84 to 0.99; p=0.03) for non-smoking-related cancer. PD was associated with an increased risk of melanoma (n=29; pooled RR=1.75; 95% CI 1.43 to 2.14; p<0.001) but not for other skin cancers (n=17; pooled RR=0.90; 95% CI 0.60 to 1.34; p=0.60).

Conclusions

PD and total cancer were inversely associated. This inverse association persisted for both smoking-related and non-smoking-related cancers. PD was positively associated with melanoma. These results provide evidence for further investigations for possible mechanistic associations between PD and cancer.

Prospero registration number

CRD42020162103.
Developing a core outcome set on traditional Chinese medicine (COS-TCM) for chronic heart failure (CHF): a study protocol
Authors: Zhang Mingyan , Chua Hui Zi , Zhang Junhua , Niu Bohan , Zheng Wenke , Li Kai , Zhang Boli
Published: July 2021

Introduction

Chronic heart failure (CHF) is a serious and advanced stage of various cardiovascular diseases and portends poor prognosis. An increase in clinical studies has reported the effectiveness of traditional Chinese medicine (TCM). For example, intravenous Chinese medicine can significantly improve cardiac function and biomarkers in patients with CHF. However, there exists inconsistency, lack of practicality and unclear reporting of outcomes in these clinical trials causing difficulty in the comparison of results across similar studies during data synthesis. A core outcome set (COS) can help in the standardisation of outcomes reported across studies from the same healthcare area. The aim of this study is to develop a COS on TCM for CHF (COS-TCM-CHF) to reduce heterogeneity in reporting and improve quality assessment in clinical trials to support data synthesis in addressing the effectiveness of TCM treatment.

Methods and analysis

This study will include constructing an outcome pool which will identify potential outcomes through systematic reviews of TCM randomised clinical trials, two clinical registry databases, semi-structured interviews of patients and the clinicians’ questionnaire. According to the characteristics of TCM and a taxonomy recommended by the Core Outcome Measures in Effectiveness Trials (COMET) initiative, all outcomes in the outcome pool will be classified into different domains. A preliminary list of outcomes which will then be used in the Delphi survey is generated using a certain criteria based on the length of the pool. The Delphi survey will include two rounds with seven key stakeholder groups to select candidate items for a consensus meeting. A final COS-TCM-CHF will be developed at a face-to-face consensus meeting involving representatives from the different stakeholders.

Ethics and dissemination

Ethical approval of this study has been granted by Evidence-based Medicine Centre of Tianjin University of Traditional Chinese Medicine Research Ethics Committee (TJUTCMEC201200002). We will disseminate our research findings of the final COS on the website of Chinese Clinical Trials for Core Outcome Set, with open access publications and present at international conferences to reach a wide range of knowledge users.

Trial registration number

http://www.comet-initiative.org/studies/details/1486.
Helicobacter pyloriinfection-induced changes in the intestinal microbiota of 14-year-old or 15-year-old Japanese adolescents: a cross-sectional study
Authors: Kakiuchi Toshihiko , Tanaka Yoshiki , Ohno Hiroshi , Matsuo Muneaki , Fujimoto Kazuma
Published: July 2021

Objective

The relationship betweenHelicobacter pyloriand the intestinal microbiota has not yet been clearly demonstrated in children and adolescents. The present study aimed at evaluating howH. pyloriinfection could affect the intestinal microbiota in adolescents using genetic analysis.

Design

Cross-sectional study.

Setting and participants

We included subjects from a longitudinal project involvingH. pyloriscreening and treatment of junior high school third-grade students (aged 14 or 15 years) in Saga Prefecture. The study included a control group (n=79) and anH. pylorigroup (n=80) tested negative and positive for the anti-H. pyloriantibody in the urine andH. pyloriantigen in stool specimens, respectively.

Interventions

The intestinal microbiota was evaluated in stool specimens using 16S rRNA gene/DNA/amplicon sequencing with next-generation sequencing.

Primary and secondary outcome measures

We assessed alpha and beta diversity, just as well as relative abundances within the bacterial composition at the genus level in both groups.

Results

As shown by the alpha diversity of the 16S rRNA gene/DNA/amplicon sequence data, the control group exhibited lower microbial species richness with lower alpha diversity compared with theH. pylorigroup (p<0.001). The beta diversity of the intestinal microbiota profile also differed between the two groups (p<0.01). The relative abundance of thePrevotellagenus was higher in theH. pylorigroup (p<0.01) concomitant with a gain in body mass index (BMI) in theH. pylorigroup (p<0.01) compared with the control group.

Conclusion

H. pyloriinfection significantly affected the intestinal microbiota in Japanese adolescents. In addition, the prevalence of thePrevotellagenus is concomitantly increased along with the BMI inH. pylori-infected students.

Trial registration number

UMIN000028721.
India’s pragmatic vaccination strategy against COVID-19: a mathematical modelling-based analysis
Authors: Mandal Sandip , Arinaminpathy Nimalan , Bhargava Balram , Panda Samiran
Published: July 2021

Objectives

To investigate the impact of targeted vaccination strategies on morbidity and mortality due to COVID-19, as well as on the incidence of SARS-CoV-2, in India.

Design

Mathematical modelling.

Settings

Indian epidemic of COVID-19 and vulnerable population.

Data sources

Country-specific and age-segregated pattern of social contact, case fatality rate and demographic data obtained from peer-reviewed literature and public domain.

Model

An age-structured dynamical model describing SARS-CoV-2 transmission in India incorporating uncertainty in natural history parameters was constructed.

Interventions

Comparison of different vaccine strategies by targeting priority groups such as keyworkers including healthcare professionals, individuals with comorbidities (24–60 years old) and all above 60.

Main outcome measures

Incidence reduction and averted deaths in different scenarios, assuming that the current restrictions are fully lifted as vaccination is implemented.

Results

The priority groups together account for about 18% of India’s population. An infection-preventing vaccine with 60% efficacy covering all these groups would reduce peak symptomatic incidence by 20.6% (95% uncertainty intervals (UI) 16.7–25.4) and cumulative mortality by 29.7% (95% CrI 25.8–33.8). A similar vaccine with ability to prevent symptoms (but not infection) will reduce peak incidence of symptomatic cases by 10.4% (95% CrI 8.4–13.0) and cumulative mortality by 32.9% (95% CrI 28.6–37.3). In the event of insufficient vaccine supply to cover all priority groups, model projections suggest that after keyworkers, vaccine strategy should prioritise all who are >60 and subsequently individuals with comorbidities. In settings with weakest transmission, such as sparsely populated rural areas, those with comorbidities should be prioritised after keyworkers.

Conclusions

An appropriately targeted vaccination strategy would witness substantial mitigation of impact of COVID-19 in a country like India with wide heterogeneity. ‘Smart vaccination’, based on public health considerations, rather than mass vaccination, appears prudent.
Nationwide analysis of incidence and predictors of 30-day readmissions in patients with decompensated cirrhosis
Authors: Gajendran Mahesh , Umapathy Chandraprakash , Perisetti Abhilash , Loganathan Priyadarshini , Dwivedi Alok , Alvarado Luis A , Zuckerman Marc J , Goyal Hemant , Elhanafi Sherif
Published: July 2021

Background and objective

Cirrhosis is the number one cause of non-cancer deaths among gastrointestinal diseases and is responsible for significant morbidity and healthcare utilisation. The objectives were to measure the 30-day readmissions rate following index hospitalisation, to determine the predictors of readmission, and to estimate the cost of 30-day readmission in patients with decompensated cirrhosis.

Methods

We performed a retrospective cohort study of patients with decompensated cirrhosis using 2014 Nationwide Readmission Database from January to November. Decompensated cirrhosis was identified based on the presence of at least one of the following: ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis and hepatorenal syndrome. We excluded patients less than 18 years of age, pregnant patients, patients with missing length of stay data, and those who died during the index admission.

Results

Among 57 305 unique patients with decompensated cirrhosis, the 30-day readmission rate was 23.2%. The top three predictors of 30-day readmission were leaving against medical advice (AMA), ascites and acute kidney injury, which increased the risk of readmission by 47%, 22% and 20%, respectively. Index admission for variceal bleeding was associated with a lower 30-day readmission rate by 18%. The estimated total cost associated with 30-day readmission in our study population was US$234.4 million.

Conclusion

In a nationwide population study, decompensated cirrhosis is associated with a 30-day readmission rate of 23%. Leaving AMA, ascites and acute kidney injury are positively associated with readmission. Targeted interventions and quality improvement efforts should be directed toward these potential risk factors to reduce readmissions.
‘You withhold what you are feeling so you can have a family’: Latinas’ perceptions on community values and postpartum depression
Authors: Sampson McClain , Yu Miao , Mauldin Rebecca , Mayorga Angelina , Gonzalez Lorena G
Published: July 2021

Objective

The purpose of this study was to explore the postpartum depression (PPD) beliefs and experiences of mothers who access local community faith-based organisations providing family services to low-income, predominantly immigrant Latino populations.

Design

Using a qualitative research design, we conducted 18 focus groups with Latina mothers to inquire about their community values and beliefs of PPD. All groups were conducted in Spanish.

Setting

An academic research team located in Houston, Texas, USA, partnered with six faith-based organisations in five cities to recruit and host focus groups at the site of the organisation.

Participants

One hundred and thirty-three women participated in the focus groups across all sites. Thirty-seven of them (27.8%) had given birth to a child in less than 1 year. Inclusion criteria included mothers 18 years and older and Latino ethnicity.

Results

A six-step process was used to apply thematic analysis to sort data into the themes. All mothers had heard of depression after childbirth, some had experienced it and most remarked that the personal experience and community acceptance of it vary by family. The main findings suggest that mothers take pride in parenting by instilling values to support family and the value of relying on family for emotional support. Findings reveal that many mothers suffer and sacrifice for their children, they feel judged and feel they must hide their emotions. Factors such as birth and postpartum customs from a native country, gender roles and beliefs of what a good mother shape their beliefs and messages about PPD.

Conclusion

Our findings indicate that programme developers should consider family and community focused education and intervention efforts to help decrease stigma and increase understanding of PPD.
Exercise and the immune system: taking steps to improve responses to cancer immunotherapy
Authors: Gustafson Michael P , Wheatley-Guy Courtney M , Rosenthal Allison C , Gastineau Dennis A , Katsanis Emmanuel , Johnson Bruce D , Simpson Richard J
Published: July 2021

The remarkable success of cancer immunotherapies has provided new hope to cancer patients. Unfortunately, a significant proportion of patients remain unable to respond to immunotherapy or maintain durable clinical responses. The lack of objective responses likely results from profound immune dysfunction often observed in patients with cancer. There is substantial evidence that exercise and physical activity can reduce incidence and improve outcomes in cancer patients. As the immune system is highly responsive to exercise, one potential avenue to improve immune function is through exercise and physical activity. A single event of dynamic exercise results in the substantial mobilization of leukocytes with increased functional capacities into the circulation. Chronic, or long-term, exercise leads to higher physical fitness in terms of greater cardiorespiratory function and/or muscle strength and endurance. High aerobic capacity, as measured by maximal oxygen uptake, has been associated with the reduction of dysfunctional T cells and improvements in the abundance of some T cell populations. To be sure, however, the mechanisms of exercise-mediated immune changes are both extensive and diverse. Here, we examine the evidence and theorize how acute and chronic exercise could be used to improve responses to cancer immunotherapies including immune checkpoint inhibitors, dendritic cell vaccines, natural killer cell therapies, and adoptive T cell therapies such as chimeric antigen receptor (CAR) T cells. Although the parameters of optimal exercise to yield defined outcomes remain to be determined, the available current data provide a compelling justification for additional human studies and clinical trials investigating the adjuvant use of exercise in immuno-oncology.
Immune-related adverse events associated with immune checkpoint inhibitors: a call to action for collecting and sharing clinical trial and real-world data
Authors: Reynolds Kerry L , Arora Shaily , Elayavilli Ravikumar Komandur , Louv William C , Schaller Teilo H , Khandelwal Aakanksha , Rothenberg Mace , Khozin Sean , Guidon Amanda C , Dougan Michael , Zubiri Leyre , Petrillo Laura , Sise Meghan E , Villani Alexandra-Chloe , Johnson Douglas B , Rahma Osama , Sharon Elad
Published: July 2021

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer, improving outcomes in patients with advanced malignancies. The use of ICIs in clinical practice, and the number of ICI clinical trials, are rapidly increasing. The use of ICIs in combination with other forms of cancer therapy, such as chemotherapy, radiotherapy, or targeted therapy, is also expanding. However, immune-related adverse events (irAEs) can be serious in up to a third of patients. Critical questions remain surrounding the characteristics and outcomes of irAEs, and how they may affect the overall risk–benefit relationship for combination therapies. This article proposes a framework for irAE classification and reporting, and identifies limitations in the capture and sharing of data on irAEs from current clinical trial and real-world data. We outline key gaps and suggestions for clinicians, clinical investigators, drug sponsors, patients, and other stakeholders to make these critical data more available to researchers for pooled analysis, to advance contemporary understanding of irAEs, and ultimately improve the efficacy of ICIs.
Progressive supranuclear palsy: diagnosis and management
Authors: Rowe James B , Holland Negin , Rittman Timothy
Published: July 2021

Treating patients with progressive supranuclear palsy (PSP) is both effective and rewarding. This review aims to share our experience in the proactive management of PSP, considering the patient, the family and the medical context in which the illness unfolds. There are many opportunities to assist your patients, ameliorate their symptoms, reduce their risks and harm, and guide them through the complex medical, social and legal minefield that characterises life with chronic neurological illness. We summarise the challenges of early diagnosis, consider PSP mimics and the role of investigations in excluding these, and discuss the available pharmacological and non-pharmacological treatment strategies to tackle the common and challenging symptoms of PSP. The best treatment will be patient centred and as part of a multidisciplinary team.
Long-term open-label continuation study of the safety and efficacy of belimumab for up to 7 years in patients with systemic lupus erythematosus from Japan and South Korea
Authors: Tanaka Yoshiya , Bae Sang-Cheol , Bass Damon , Curtis Paula , Chu Myron , DeRose Kathleen , Ji Beulah , Kurrasch Regina , Lowe Jenny , Meizlik Paige , Roth David A
Published: July 2021

Objectives

To evaluate the long-term safety and efficacy of belimumab in patients with systemic lupus erythematosus (SLE) from Japan and South Korea.

Methods

In this phase III, open-label continuation study (BEL114333;NCT01597622), eligible completers of BEL113750 (NCT01345253) or BEL112341 (NCT01484496) received intravenous belimumab 10 mg/kg every 28 days for ≤7 years. Primary endpoint was safety. Secondary endpoints: SLE Responder Index (SRI)4 response rate, proportion of patients meeting individual SRI4 criteria, SLE flares and prednisone use. Analyses were based on observed data from the first belimumab exposure (either in parent or current study) through to study end.

Results

Of 142 enrolled patients who received belimumab, 73.2% completed the study. The study population comprised patients with moderate SLE, mean (SD) Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) baseline score of 9.3 (3.9) and 98.6% receiving corticosteroids. Most patients (97.9%) experienced adverse events (AEs); 33.8% experienced serious AEs. Increase in SRI4 (Year 1, Week 24: 47.8%; Year 6, Week 48: 68.2%) and SELENA-SLEDAI responders suggested reductions in disease activity. Proportions of patients with no worsening in Physician Global Assessment/no new organ damage remained stable throughout. Severe SLE flares occurred in 14.8% of patients. Among patients with baseline prednisone-equivalent dose >7.5 mg/day (n=81), the median (min, max) number of days anytime post-baseline that the daily dose was ≤7.5 mg/day or had been reduced by 50% from baseline was 584 (0, 2267).

Conclusions

Favourable safety profile and treatment responses were maintained for ≤7 years in patients with SLE from Japan and South Korea.
Hydroxychloroquine in patients with inflammatory and erosive osteoarthritis of the hands: results of the OA-TREAT study—a randomised, double-blind, placebo-controlled, multicentre, investigator-initiated trial
Authors: Kedor Claudia , Detert Jacqueline , Rau Rolf , Wassenberg Siegfried , Listing Joachim , Klaus Pascal , Braun Tanja , Hermann Walter , Weiner Stefan Markus , Buttgereit Frank , Burmester Gerd R
Published: July 2021

Objectives

Hand osteoarthritis (OA) is a condition characterised by cartilage degradation and frequently erosive changes. Analgesics and non-steroidal anti-inflammatory drugs are used for symptomatic relief but are often poorly tolerated or contraindicated. Previous publications suggest hydroxychloroquine (HCQ) as a possible treatment for hand OA. The OA-TREAT study aimed to investigate the efficacy and safety of HCQ in patients with inflammatory and erosive hand OA (EOA).

Methods

OA-TREAT was an investigator-initiated, multicentre, randomised, double-blind, placebo (PBO)-controlled trial. Patients with inflammatory and EOA, according to the ACR criteria, with radiographically erosive disease were randomised 1:1 to HCQ 200–400 mg/day or PBO for 52 weeks (W52). Both groups received stable standard therapy. The primary endpoint was Australian Canadian Hand Osteoarthritis Index (AUSCAN) for pain and hand disability at W52.

Results

75 patients were randomised to HCQ and 78 to PBO. At W52, mean AUSCAN pain was 26.7 in HCQ and 26.5 in PBO patients (p=0.92). Hand disability measured by AUSCAN function (mean) was 48.1 in HCQ and 51.3 in PBO patients (p=0.36). Changes in radiographic scores did not differ significantly (p>0.05) between treatment groups. There were 7 serious adverse events in the HCQ and 15 in the PBO group.

Conclusions

OA-TREAT is the first large randomised PBO controlled trial focusing on EOA. HCQ was no more effective than PBO for changes in pain, function and radiographic scores in the 52-week period. Overall safety findings were consistent with the known profile of HCQ.
Frame covariant formalism for fermionic theories
Authors: Finn Kieran , Karamitsos Sotirios , Pilaftsis Apostolos
Published: July 2021

We present a frame- and reparametrisation-invariant formalism for quantum field theories that include fermionic degrees of freedom. We achieve this using methods of field-space covariance and the Vilkovisky–DeWitt (VDW) effective action. We explicitly construct a field-space supermanifold on which the quantum fields act as coordinates. We show how to define field-space tensors on this supermanifold from the classical action that are covariant under field reparametrisations. We then employ these tensors to equip the field-space supermanifold with a metric, thus solving a long-standing problem concerning the proper definition of a metric for fermionic theories. With the metric thus defined, we use well-established field-space techniques to extend the VDW effective action and express any fermionic theory in a frame- and field-reparametrisation-invariant manner.
Exact $$\beta $$-functions for $$\mathcal{N}=1$$ supersymmetric theories finite in the lowest loops
Authors: Stepanyantz K. V.
Published: July 2021

We consider a one-loop finite $$\mathcal{N}=1$$

N
=
1

supersymmetric theory in such a renormalization scheme that the first L contributions to the gauge $$\beta $$
β
-function and the first $$(L-1)$$

(
L
-
1
)

contributions to the anomalous dimension of the matter superfields and to the Yukawa $$\beta $$
β
-function vanish. It is demonstrated that in this case the NSVZ equation and the exact equation for the Yukawa $$\beta $$
β
-function in the first nontrivial order are valid for an arbitrary renormalization prescription respecting the above assumption. This implies that under this assumption the $$(L+1)$$

(
L
+
1
)

-loop contribution to the gauge $$\beta $$
β
-function and the L-loop contribution to the Yukawa $$\beta $$
β
-function are always expressed in terms of the L-loop contribution to the anomalous dimension of the matter superfields. This statement generalizes the result of Grisaru, Milewski, and Zanon that for a theory finite in L loops the $$(L+1)$$

(
L
+
1
)

-loop contribution to the $$\beta $$
β
-function also vanishes. In particular, it gives a simple explanation why their result is valid although the NSVZ equation does not hold in an arbitrary subtraction scheme.
Model-independent extraction of the proton charge radius from PRad data
Authors: Paz Gil
Published: July 2021

The proton radius puzzle has motivated several new experiments that aim to extract the proton charge radius and resolve the puzzle. Recently, PRad, a new electron–proton scattering experiment at Jefferson Lab, reported a proton charge radius of [Formula: see text]. The value was obtained by using a rational function model for the proton electric form factor. We perform a model-independent extraction using [Formula: see text]-expansion of the proton charge radius from PRad data. We find that the model-independent statistical error is more than 50% larger compared to the statistical error reported by PRad.
Algebraic solution and coherent states for the Dirac oscillator interacting with the Aharonov–Casher system in the cosmic string background
Authors: Salazar-Ramírez M. , Ojeda-Guillén D. , Mota R. D. , Martínez-Nuño J. A. , Cordero-López M. R.
Published: July 2021

In this paper, we introduce an SU(1, 1) algebraic approach to study the (2 + 1)-Dirac oscillator in the presence of the Aharonov–Casher effect coupled to an external electromagnetic field in the Minkowski spacetime and the cosmic string spacetime. This approach is based on a quantum mechanics factorization method that allows us to obtain the su(1, 1) algebra generators, the energy spectrum and the eigenfunctions. We obtain the coherent states and their temporal evolution for each spinor component of this problem. Finally, for these problems, we calculate some matrix elements and the Schrödinger uncertainty relationship for two general SU(1, 1) operators.
Toward Targeted Interventions: Examining the Science Behind Interventions for Youth Who Offend
Authors: Baskin-Sommers Arielle , Chang Shou-An , Estrada Suzanne , Chan Lena
Published: July 2021

Youthful offending is a complex behavior that develops from an interaction between social experiences and individual differences in thinking patterns and emotional reactions favoring antisociality. The combination of factors associated with offending varies across individuals and influences the ways in which youth perceive, interpret, and respond to a wide range of experiences. Programs must consider the specific environmental (e.g., community), institutional (e.g., schools, parents, peers), and individual factors impacting youth as essential targets for intervention. We synthesize research on family-focused, school-focused, peer- and community-focused, trauma-focused, cognitive-behavioral, and multisystem interventions in terms of their targets and note variability in their effectiveness. Furthermore, we highlight the continued need for developmentally appropriate interventions that accurately target the mechanisms of action, do no harm, are delivered with fidelity, and encourage active engagement by both interveners and youth.
Facilitating Power Grid Decarbonization with Distributed Energy Resources: Lessons from the United States
Authors: Shen Bo , Kahrl Fredrich , Satchwell Andrew J.
Published: July 2021

Decarbonizing power grids is an essential pillar of global efforts to mitigate climate change impacts. Renewable energy generation is expected to play an important role in electricity decarbonization, although its variability and uncertainty are creating new flexibility challenges for electric grid operators that must match supply with constantly changing demand. Distributed energy resources (DERs)—including distributed generation, demand response, and distributed energy storage—can play an important role in providing the flexibility needed to integrate high penetrations of renewable energy. This article examines federal and state enabling policies and regulations for DER, market strategies and business models that have facilitated DER expansion, and key emerging challenges for DER in the United States. Based on a review of the US experience, the article offers lessons for other countries, focusing on the role and limits of policy, the facilitative role of utility regulatory reform, the need to balance different interests in tariff design, the benefits of DER participation in wholesale markets, and the importance of proactive interconnection policies.
Agricultural Labor Supply
Authors: Hill Alexandra E. , Ornelas Izaac , Taylor J. Edward
Published: July 2021

The labor supply response to agricultural wages is critical to the viability of crop production in high-income countries, which hire a largely foreign farm work force, as well as in low-income countries, where domestic workers move off the farm as the agricultural transformation unfolds. Modeling agricultural labor supply is more challenging than modeling the supply of other agricultural inputs or of labor to other sectors of the economy owing to unique features of agricultural production and farm labor markets. Data and econometric challenges abound, and estimates of agricultural labor supply elasticities are sparse. This review explains the importance and challenges of modeling farm labor supply and describes researchers’ efforts to address these challenges. It summarizes estimates of agricultural labor supply elasticities over the last 80 years, provides insights into variation in these estimates, identifies priority areas for future research, and reviews the most influential empirical work related to this important topic.
A novel system for mapping regional electrical properties and characterizing arrhythmia in isolated intact rat atria
Authors: Ramlugun Girish S. , Sands Gregory B. , Zhao Jichao , LeGrice Ian J. , Smaill Bruce H.
Published: July 2021

Despite wide-ranging optical mapping studies, detailed information on regional atrial electrical properties in small animal models of heart disease and how these contribute to reentrant arrhythmia remains limited. We have developed a novel experimental platform that enables both to be achieved in a geometrically intact isolated rat bi-atrial preparation.
On the assessment of arterial compliance from carotid pressure waveform
Authors: Bikia Vasiliki , Segers Patrick , Rovas Georgios , Pagoulatou Stamatia , Stergiopulos Nikolaos
Published: July 2021

This article introduces a novel artificial intelligence method to estimate total arterial compliance (CT) via exploiting the information provided by an uncalibrated carotid blood pressure waveform as well as typical clinical variables. The major finding of this study is that CT, which is usually acquired using both pressure and flow waveforms, can be accurately derived by the use of the pressure wave alone. This method could potentially facilitate easily applicable and convenient monitoring of CT.