bluuebunny/crossref_metadata_2025 huggingface dataset:
CRISPR/Cas9‐mediated P‐CR domain‐specific engineering of CESA4 heterodimerization capacity alters cell wall architecture and improves saccharification efficiency in poplar
Authors: Nayeri Shahnoush , Baghban Kohnehrouz Bahram , Ahmadikhah Asadollah , Mahna Nasser
Published: March 2022

Cellulose is the most abundant unique biopolymer in nature with widespread applications in bioenergy and high‐value bioproducts. The large transmembrane‐localized cellulose synthase (CESA) complexes (CSCs) play a pivotal role in the biosynthesis and orientation of the para‐crystalline cellulose microfibrils during secondary cell wall (SCW) deposition. However, the hub CESA subunit with high potential homo/heterodimerization capacity and its functional effects on cell wall architecture, cellulose crystallinity, and saccharification efficiency remains unclear. Here, we reported the highly potent binding site containing four residues of Pro435, Trp436, Pro437, and Gly438 in the plant‐conserved region (P‐CR) of PalCESA4 subunit, which are involved in the CESA4‐CESA8 heterodimerization. The CRISPR/Cas9‐knockout mutagenesis in the predicted binding site results in physiological abnormalities, stunt growth, and deficient roots. The homozygous double substitution of W436Q and P437S and heterozygous double deletions of W436 and P437 residues potentially reduced CESA4‐binding affinity resulting in normal roots, 1.5–2‐fold higher plant growth and cell wall regeneration rates, 1.7‐fold thinner cell wall, high hemicellulose content, 37%–67% decrease in cellulose content, high cellulose DP, 25%–37% decrease in cellulose crystallinity, and 50% increase in saccharification efficiency. The heterozygous deletion of W436 increases about 2‐fold CESA4 homo/heterodimerization capacity led to the 50% decrease in plant growth and increase in cell walls thickness, cellulose content (33%), cellulose DP (20%), and CrI (8%). Our findings provide a strategy for introducing commercial CRISPR/Cas9‐mediated bioengineered poplars with promising cellulose applications. We anticipate our results could create an engineering revolution in bioenergy and cellulose‐based nanomaterial technologies.
Government‐led innovation acceleration: Case studies of US federal government innovation and technology acceleration organizations
Authors: Roberts Patrick S. , Schmid Jon
Published: March 2022

How can agencies that have operational activities as a primary focus improve the procurement and transition of innovative technologies, particularly from the private sector? This study seeks to inform scholars and public‐sector managers about organizational design for innovation and technology acceleration using a systems approach. It examines three organizations responsible for mission‐oriented innovation: In‐Q‐Tel, stood by up the Central Intelligence Agency; the FBI's Operational Technology Unit; and the National Institute for Occupational Safety and Health (NIOSH). It finds that collaboration and mission‐inspiration can bridge public–private sector divides, but that distance from operators can slow technology adoption. It recommends establishing metrics for innovation investments and outcomes and gaining a better understanding of end user needs. Venture capital characteristics in quasi‐government innovation organizations show promise but are untested outside of defense and intelligence. This study contributes to the literature by analyzing technology acceleration rather than initiation, development, adoption, or diffusion. It also adds to the study of technology acceleration in mission‐oriented agencies that are less often the focus of R&D scholarship on big science.
Chikungunya and Mayaro infective viruses in components of blood
Authors: dos Anjos Souza Ana Beatriz , Thomazelli Victória , Figueiredo Luiz Tadeu Moraes
Published: March 2022

Objective

Evaluate the infectivity of Alphavirus Chikungunya and Mayaro in blood products in plaque forming units (UFP/ml).

Background

Arboviruses are responsible for sporadic diseases or epidemics which cause serious public health issues. Due to the high number of asymptomatic infections and high viremia, blood donors may pass on these viruses by transfusion.

Methods/Materials

This study used blood bags that would be discarded after evaluation and certification of the absence of infections. The blood products obtained by centrifuging a unit of whole blood were called blood components. All blood bags were infected with viable viruses (previously quantified) compatible with Chikungunya and Mayaro viremia.

Results

Blood bags inoculated with both Chikungunya and Mayaro viruses were able to keep infective viruses during the processing of blood products (red blood cell concentrate, platelet concentrate and fresh frozen plasma) and also after the recommended storage for each component, which may infect individuals transfused with those.

Conclusion

The results indicate that in order to prevent infections by Mayaro and Chikungunya viruses in blood products it is necessary to stimulate the development and use of diagnostic tests for these pathogens in donated blood.
Leadership Communication Training: An Essential Part of Dental Education
Authors: Sahni Shibani , Slye Jill , Park Sang E.
Published: March 2022

Objective: The purpose of this study was to evaluate whether a newly implemented course of leadership communication in dental education helps dental professionals by providing tools for various career trajectories in academic dentistry and clinical practice.Methods: A new course entitled Communication and Leadership was introduced at XXXX to support the Master’s in Dental Education program. This course focused on developing a strong foundation in topics including public speaking, persuasion, listening, and resolving conflict. Personal interviews and guided reflections were performed with the participants and the responses were analyzed. A survey of the course directors of fifteen advanced graduate education programs was conducted to understand whether they felt the communication and leadership course was important for the students and whether they agreed that it should it be a part of the dental curriculum.Results: The curriculum was extremely well received, and the students were eager to use the tools and techniques provided during the course for their future presentations and communication in leadership roles. One hundred percent of the course directors either agreed or strongly agreed in its value in being added to the dental curriculum; however, they were unsure about available time in the students’ already packed schedules.Conclusion: The results of the analysis of the guided reflections and interview with the students, in combination with the survey evaluation of the course directors’ study, suggested that communication within the dental profession is essential and there are substantial benefits for the course being added to dental education programs.
La retroactividad de la jurisprudencia. Análisis del caso mexicano con base en los formantes normativo y jurisprudencial
Authors: Neria Govea Miguel de J. , Cavazos Guajardo Solís Alonso
Published: March 2022

Este artículo es producto de una investigación soportada en una metodología de análisis de datos. El principal objetivo es estudiar la posición teórica de la Suprema Corte de Justicia mexicana y del Poder Judicial de la Federación, tanto antes como después de la expedición de la nueva Ley de Amparo, en torno a la aplicabilidad del principio de irretroactividad tratándose de la jurisprudencia (el sistema de precedentes en México). Teniendo como principal hallazgo que, aun cuando la doctrina tradicional de la Suprema Corte de Justicia al respecto fue superada por el Poder Legislativo, al establecerse en la Ley de Amparo esa garantía para el gobernado en el ámbito de los precedentes judiciales, el desarrollo propio de la doctrina judicial en la jurisprudencia del Poder Judicial ha sido reticente para lograr una posición congruente en el tema.
La hacienda “El Playón” y su liga campesina. Tensiones y conflictos por la tierra en Santander
Authors: Martín Peré Elisa M.
Published: March 2022

Este artículo es fruto de una investigación que aborda la conflictividad por la tierra en Santander en la primera mitad del siglo XX, desde un enfoque teórico interdisciplinar. Para ello se consultó fuente judicial penal, notarial, prensa, normativa, informes oficiales y bibliografía, con el objeto de reconstruir parte de la historia de la hacienda “El Playón”, así como del funcionamiento, finalidad y reclamos de la “Liga de Trabajadores Campesinos del Playón”. Se concluye que durante esa etapa hubo un problema de envergadura en la hacienda, en el marco de un panorama de tensiones generalizado, enfrentando en ocasiones a hacendados y grupos de campesinos desde la legalidad y la violencia.
Responsabilidad del Estado y narrativa jurisprudencial: el caso del incendio de Rionegro en 1949
Authors: González Jácome Jorge , Barreto Rozo Antonio
Published: March 2022

Este artículo de investigación analiza una sentencia emblemática de la Corte Suprema de Justicia decidida en 1958 en la que se declaró la responsabilidad extracontractual del estado por hechos ocurridos en 1949, al inicio de la época de “La Violencia”. Utilizando herramientas del movimiento de derecho y literatura, el artículo ofrece una propuesta de lectura de jurisprudencia que se concentra no solo en la identificación del derecho vigente, sino en la forma como las decisiones judiciales pueden leerse como fuentes que plantean interpretaciones polémicas sobre el pasado. El artículo sostiene que la Corte Suprema optó por narrar la historia de la violencia reciente de 1949 sin comprometerse con una interpretación definitiva sobre un pasado que aún estaba en disputa. La sentencia y su opción narrativa muestran que el derecho no es solo un espacio de cierre del pasado a través de la fuerza del derecho, sino que puede erigirse como un sitio contradictorio, plural e indeciso.
Insight Into the Interaction Between Flow Field and Acoustic Field of Turning Flow Into a Side Branch Against a Deadleg
Authors: Botros K. K. , Clavelle E. , Satish H.
Published: March 2022

Acoustic resonances in internal flows can cause noise, vibration, and even equipment damage. One geometry prone to acoustic resonance is a deadleg at the point where the main flow turns into a side branch. Here, we report experimental and computational fluid dynamics (CFD) studies of flow-generated pulsation in such a geometry over a wide range of mean flow velocities. Experimental results of the normalized pulsation pressure amplitudes (P*) versus Strouhal number characterized the flow–acoustic field for acoustically tuned and detuned systems and for branch to main pipe diameter ratio of 1.0. The unsteady CFD simulations revealed the characteristic volume integral of the cross-product of the vorticity field and the velocity field (ω×U) in the vicinity of the T-junction which helped in quantifying the acoustic source power for different conditions. In addition, the cross-product (ω×U) in the direction along the main line is almost exactly out of phase with the acoustic velocity at the T-junction. The pressure amplitude at the closed end of the deadleg reaches maximum when two conditions are met: (i) the system overall acoustic resonance frequency matches closely the frequency of the oscillating component of the cross-product (ω×U) characterized by a Strouhal number and (ii) the deadleg length is tuned to an odd number of ¼ wavelength of this frequency such that maximum acoustic velocity is reached at the T-junction. Synchronized images generated from the unsteady CFD simulations revealed valuable insight into the velocity and vorticity field in the region of the T-junction in support of Howe's acoustic source power equation.
Effect of Dynamic Load on Adhesive Friction at the Interface Between Friction Lining and Wire Rope of Hoist
Authors: Feng Cunao , Zhang Dekun , Chen Kai , Wang Dagang , Li Xiaowei , Cao Yang
Published: March 2022

The acceleration, deceleration, and inertia of the friction hoist during lifting and lowering will cause the vibration of the wire rope. This vibration will cause the lifting load to become dynamic, which adversely affects the stability of the friction interface. In this paper, the relationship between the dynamic alternating load and the frictional vibration was established. The fully sliding critical value of dynamic alternating load was revealed. At the fully sliding critical value, the friction force and friction coefficient were the smallest, the adhesive friction was the smallest, and the vibration amplitude increased sharply. This is the most dangerous situation for friction systems. The fully sliding critical value is of great significance to the anti-skidding design of the hoist.
Dynamic Stress Concentration Factor Around a Spherical Nanocavity Under a Plane P-Wave
Authors: Jia Ning , Peng Zhilong , Yao Yin , Wei Peijun , Chen Shaohua
Published: March 2022

Scattering of an elastic wave by cavities yields dynamic stress concentration around the cavities. When the characteristic size of the cavities shrinks to the nanometer scale, the surface effect becomes prominent. Based on a recently proposed theory of surface elastodynamics, the dynamic stress concentration factor (DSCF) in the scattering of a plane P-wave by a spherical nanocavity has been investigated. Not only the surface energy effect but also the surface inertial effect is considered. The former depends on two easily determined surface material parameters, namely, the bulk surface energy density and the surface relaxation parameter, whereas the latter is related to the surface mass density. Interestingly, due to the surface relaxation of nanocavity, a constant elastic field exists in the elastic medium even without any dynamic loadings. Furthermore, it is found that when the radius of the cavity is at the nanoscale, the surface energy effect as well as the surface inertial effect has a significant influence on DSCF. The former attenuates the maximum DSCF, whereas the latter enhances it. With the increasing incident P-wave frequency, the dominant role transits from the surface energy effect to the surface inertial effect. This indicates that the DSCF around the nanocavity can be properly tuned by adjusting the incident wave frequency, the cavity radius, and the surface material parameters. The results can not only enable a deeper understanding of the surface effects on DSCF around the nanocavities but also provide a guide for designing nanoporous materials exhibiting efficient dynamic performance.
Wave propagation across the skull under bone conduction: Dependence on coupling methods
Authors: Farahmandi Tahmine S. , Dobrev Ivo , Kim Namkeun , Lim Jongwoo , Pfiffner Flurin , Huber Alexander M. , Röösli Christof
Published: March 2022

This study is aimed at the quantitative investigation of wave propagation through the skull bone and its dependence on different coupling methods of the bone conduction hearing aid (BCHA). Experiments were conducted on five Thiel embalmed whole head cadaver specimens. An electromagnetic actuator from a commercial BCHA was mounted on a 5-Newton steel headband, at the mastoid, on a percutaneously implanted screw (Baha® Connect), and transcutaneously with a Baha® Attract (Cochlear Limited, Sydney, Australia), at the clinical bone anchored hearing aid (BAHA) location. Surface motion was quantified by sequentially measuring ∼200 points on the skull surface via a three-dimensional laser Doppler vibrometer (3D LDV) system. The experimental procedure was repeated virtually, using a modified LiUHead finite element model (FEM). Both experiential and FEM methods showed an onset of deformations; first near the stimulation area, at 250–500 Hz, which then extended to the inferior ipsilateral skull surface, at 0.5–2 kHz, and spread across the whole skull above 3–4 kHz. Overall, stiffer coupling (Connect versus Headband), applied at a location with lower mechanical stiffness (the BAHA location versus mastoid), led to a faster transition and lower transition frequency to local deformations and wave motion. This behaviour was more evident at the BAHA location, as the mastoid was more agnostic to coupling condition.
A Commentary on Whitall and Colleagues’ 2020 Article “Motor Development Research: II. The First Two Decades of the 21st Century Shaping Our Future”
Authors: Gabbard Carl
Published: March 2022

This commentary reflects on the discussions of Whitall et al.’s paper “Motor Development Research: II. The First Two Decades of the 21st Century Shaping Our Future.” Comments focus on (a) the emergence and importance of the Developmental Systems approach to motor development, (b) the perceived ambiguity between Dynamic and Developmental Systems approaches, and (c) a case for the evolution of Developmental Motor Neuroscience from the field of Developmental Cognitive Neuroscience.
Electromyostimulation Application on Peroneus Longus Muscle Improves Balance and Strength in American Football Players
Authors: Lima Yavuz , Ozkaya Ozgur , Balci Gorkem A. , Aydinoglu Ramazan , Islegen Cetin
Published: March 2022

Purpose: The aim of this study was to evaluate the effect of 5 weeks of electromyostimulation (EMS) of the peroneus longus muscle on balance and muscle strength in American Football (AmF) players. Methods: Thirty-two healthy male athletes (4 American Football team training sessions per week, college level) were randomly divided into the EMS and control groups. The EMS applications were conducted on the dominant peroneus longus muscle 3 times per week for 5 weeks, with each application lasting 25 minutes. Before and after the interventions, the strength of ankle dorsiflexion–plantar flexion and foot eversion–inversion was measured with isometric dynamometer and anterior–posterior sway, mediolateral sway, perimeter, and ellipse area were measured with the Technobody Balance System in unilateral stance positions, while eyes were open. Results: Changes between initial and final tests for dorsiflexion and eversion strength, and mediolateral sway for dynamic balance in the groups were significantly different (P = .039, P = .027, P = .030, respectively). Conclusion: The EMS application had positive effects on muscle strength and dynamic balance of AmF players. The EMS can be used to improve isometric strength and dynamic balance in AmF players.
Science ties to Russia cut after Ukraine invasion
Authors: Stone Richard
Published: March 2022

Institutions struggle to remain neutral as Western nations take hardline stances
New class of killer T cells may prevent autoimmune diseases
Authors: Leslie Mitch
Published: March 2022

Study finds human version of mouse immune regulators
Structure-Based Design and Antigenic Validation of Respiratory Syncytial Virus G Immunogens
Authors: Nuñez Castrejon Ana M. , O’Rourke Sara M. , Kauvar Lawrence M. , DuBois Rebecca M.
Published: March 2022

Respiratory syncytial virus (RSV) causes severe lower respiratory diseases of children, the elderly, and immunocompromised populations. There currently are no FDA-approved RSV vaccines.
Characterization of SARS-CoV-2 Variants B.1.617.1 (Kappa), B.1.617.2 (Delta), and B.1.618 by Cell Entry and Immune Evasion
Authors: Ren Wenlin , Ju Xiaohui , Gong Mingli , Lan Jun , Yu Yanying , Long Quanxin , Kenney Devin J. , O’Connell Aoife K. , Zhang Yu , Zhong Jin , Zhong Guocai , Douam Florian , Wang Xinquan , Huang Ailong , Zhang Rong , Ding Qiang
Published: March 2022

SARS-CoV-2, the causative agent of pandemic COVID-19, is rapidly evolving to be more transmissible and to exhibit evasive immune properties, compromising neutralization by antibodies from vaccinated individuals or convalescent-phase sera. Recently, SARS-CoV-2 variants B.1.617.1 (Kappa), B.1.617.2 (Delta), and B.1.618 with mutations within the spike proteins were identified in India.
A Glyphosate-Based Herbicide Cross-Selects for Antibiotic Resistance Genes in Bacterioplankton Communities
Authors: Barbosa da Costa Naíla , Hébert Marie-Pier , Fugère Vincent , Terrat Yves , Fussmann Gregor F. , Gonzalez Andrew , Shapiro B. Jesse
Published: March 2022

Glyphosate-based herbicides (GBHs) such as Roundup formulations may have the unintended consequence of selecting for antibiotic resistance genes (ARGs), as demonstrated in previous experiments. However, the effects of GBHs on ARGs remain unknown in natural aquatic communities, which are often contaminated with pesticides from agricultural runoff.
Phosphorus and Zinc Are Strongly Associated with Belowground Fungal Communities in Wheat Field under Long-Term Fertilization
Authors: Wu Di , Ma Yuying , Yang Teng , Gao Guifeng , Wang Daozhong , Guo Xisheng , Chu Haiyan
Published: March 2022

Fungi, an essential component in nutrient cycling and plant growth, are highly sensitive to fertilization. However, there are limited studies on fungi in root endosphere under long-term fertilization management.
Performance of Immunoglobulin G Serology on Finger Prick Capillary Dried Blood Spot Samples to Detect a SARS-CoV-2 Antibody Response
Authors: Nikiforuk Aidan M. , McMillan Brynn , Bartlett Sofia R. , Márquez Ana Citlali , Pidduck Tamara , Kustra Jesse , Goldfarb David M. , Barakauskas Vilte , Sinclair Graham , Patrick David M. , Sadarangani Manish , Ogilvie Gina S. , Krajden Mel , Morshed Muhammad , Sekirov Inna , Jassem Agatha N.
Published: March 2022

Dried blood spot samples have comparable diagnostic accuracy to serum collected by venipuncture when tested by an electrochemiluminescent assay for antibodies and should be considered to reliably detect seropositivity following SARS-CoV-2 infection and/or vaccination.
Guillain-Barre syndrome (GBS) associated with COVID-19 infection that resolved without treatment in a child
Authors: Kanou Samir , Wardeh Lama , Govindarajan Sandhya , Macnay Kayleigh
Published: March 2022

A 9-year-old boy presented with unbalanced gait, back pain and lower limb weakness. His physical examination revealed almost absent lower limbs reflexes and cerebro-spinal fluid (CSF) showed albuminocytologic dissociation. The brain and spine MRI with contrast illustrated abnormal enhancement—suggestive of Guillain-Barré syndrome.

The case had limited distribution and it did not progress beyond the presenting clinical involvements. They did not need immunotherapy, self-recovered, managed conservatively using painkillers and gabapentin along with physiotherapy—with a wait and see approach. The child is now almost back to normal after 8–12 weeks.
Undiagnosed laryngocele: an airway emergency
Authors: Trivedi Saurabh , Karna Sunaina Tejpal , Baghel Kaushal Singh , Thaware Pooja
Published: March 2022

Laryngoceles are rare dilated laryngeal saccules that can present as acute airway obstruction and lead to airway emergencies. A man, presented to the emergency room, with difficulty in breathing and change in voice. An unevaluated pulsatile swelling was present on the left side of neck. Since, the patient was in stridor, an awake fiberoptic bronchoscopy (FOB)-guided intubation was planned with readiness for emergency tracheostomy, if needed. On FOB, an edematous supraglottic area with a narrowed glottic opening was observed. The procedure was abandoned and a surgical tracheostomy was performed to secure the airway. Postoperative contrast-enhanced CT neck revealed a huge laryngocele in left cervical region. We recommend that a high index of suspicion for presence of laryngocele should be kept in mind when a patient presents with stridor with pulsatile neck swelling. Timely aspiration of laryngocele may help in amelioration of the respiratory distress avoiding emergency tracheostomy.
Prosthetic hip infection due toCampylobacter jejuni
Authors: Simms Andrew Joseph , Kobayashi Takaaki , Schwartzhoff Patrick V , Sekar Poorani
Published: March 2022

A woman in her 60s with a left hip prosthesis was presented with left hip pain and fever. She had an elevated white blood cell count and inflammatory markers. Synovial fluid Gram stain demonstrated curved Gram-negative rods identified as Campylobacter jejuni. The patient initially refused surgery and after 3 months underwent one-stage exchange after which she was treated with 12 weeks of levofloxacin. Her inflammatory markers normalised and she was clinically doing well at her 6-month follow-up.C. jejuniis a rare cause of prosthetic joint infection and should be included in the differential diagnosis when a patient has risk factors even without significant preceding gastrointestinal symptoms. Per most recent Infectious Diseases Society of America guidelines, treatment after one-stage revision includes 4–6 weeks of intravenous antimicrobials followed by possible oral suppression therapy, while the European guidelines recommend 12 weeks of orally bioavailable antibiotics.
Tailored endoscopic treatment of tracheo-oesophageal fistula using preoperative holographic assessment and a cardiac septal occluder
Authors: Siboni Stefano , D'Aiello Angelo Fabio , Chessa Massimo , Bonavina Luigi
Published: March 2022

Devices originally designed for closure of cardiac septal defects have also been proposed for the treatment of acquired tracheo-oesophageal fistula (TOF). Choosing the right occluder device to match TOF size and shape is essential for a tailored treatment. We report the successful endoscopic closure of a post-radiotherapy TOF using preprocedural CT scan with holographic three-dimensional reconstruction and an Amplatzer atrial septal device. Complete TOF sealing was achieved with resolution of respiratory symptoms, and the patient was maintaining his ability to eat at 4-month follow-up.
13q32.1 as a candidate region for physiological anisocoria
Authors: Bosten Jenny M , Lawrance-Owen Adam J , Bargary Gary , Goodbourn Patrick T , Mollon John D
Published: March 2022

Background

Physiological anisocoria is an asymmetry of pupil size in the absence of pathology.

Methods

Images of the pupils under standard illumination were collected in the course of a whole-genome association study of a range of visual functions in 1060 healthy adults. DNA for each participant was extracted from saliva samples.

Results

We found no relationship between anisocoria and the difference in refraction between the eyes, nor between anisocoria and difference in acuity. There was a small but significant relationship with lightness of the iris, in that the eye with the smaller pupil was associated with the lighter iris. There was a strong association between anisocoria and a local region of chromosome 13 (13q32.1), a region lying between the genesGPR180andSOX21. The strongest association was with the single-nucleotide polymorphism rs9524583.

Conclusion

The very specific region associated with anisocoria is one where microdeletions (or microduplications) are known to lead to abnormal development of pupil dilator muscle and hence to the autosomal dominant condition of microcoria. It is possible that alterations at 13q32.1 act by altering the expression ofSOX21, which encodes a nuclear transcription factor.
Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database
Authors: Hardoon Sarah , Hayes Joseph , Viding Essi , McCrory Eamon , Walters Kate , Osborn David
Published: March 2022

Objectives

To investigate the extent of antipsychotic prescribing to people with recorded personality disorder (PD) in UK primary care and factors associated with such prescribing.

Design

Retrospective cohort study.

Setting

General practices contributing to The Health Improvement Network UK-wide primary care database, 1 January 2000–31 December 2016.

Participants

46 210 people registered with participating general practices who had a record of PD in their general practice notes. 1358 (2.9%) people with missing deprivation information were excluded from regression analyses; no other missing data.

Main outcome measures

Prescriptions for antipsychotics in general practice records and length of time in receipt of antipsychotic prescriptions.

Results

Of 46 210 people with recorded PD, 15 562 (34%) were ever prescribed antipsychotics. Among the subgroup of 36 875 people with recorded PD, but no recorded severe mental illness (SMI), 9208 (25%) were prescribed antipsychotics; prescribing was lower in less deprived areas (adjusted rate ratio (aRR) comparing least to most deprived quintile: 0.56, 95% CI 0.48 to 0.66, p<0.001), was higher in females (aRR:1.25, 95% CI 1.16 to 1.34, p<0.001) and with a history of adverse childhood experiences (aRR:1.44, 95% CI 1.28 to 1.56, p<0.001). Median time prescribed antipsychotics was 605 days (IQR 197–1639 days). Prescribing frequency has increased over time.

Conclusions

Contrary to current UK guidelines, antipsychotics are frequently and increasingly prescribed for extended periods to people with recorded PD, but with no history of SMI. An urgent review of clinical practice is warranted, including the effectiveness of such prescribing and the need to monitor for adverse effects, including metabolic complications.
Age and gender differences in diagnostic decision-making of early heart failure: results of a mixed-methods interview-study using video vignettes
Authors: Marx Gabriella , Koens Sarah , von dem Knesebeck Olaf , Scherer Martin
Published: March 2022

Objectives

Men and women at any age show similar symptoms and signs of heart failure (HF). Since early HF symptoms are ambiguous, doctors may overlook HF as possible cause and misinterpret the signs. The aim was to analyse differences in general practitioners’ (GPs) HF diagnosis and diagnostic certainty by patient age and gender and to identify reasons for possible differences.

Design

Factorial design with video vignettes presenting patients (played by professional actors) with early HF symptoms was used. Video vignettes differed regarding patients’ gender (male/female), age (55 years/75 years) and migration background (no/yes: Turkish), while the dialogue was identical. GPs were asked about possible diagnoses and certainty of diagnoses (quantitative) and to narrate their thoughts on considered diagnoses (qualitative).

Setting

General practices in northern Germany.

Participants

128 GPs stratified by gender and length of clinical experience (≤15 years or >15 years).

Results

GPs considered HF more often in women than men (predicted probabilities with 95% CI: 0.83 (0.68 to 0.92) vs 0.63 (0.44 to 0.79), p=0.02), especially in older women compared with younger men (predicted probabilities with 95% CI: 0.89 (0.68 to 0.96) vs 0.52 (0.31 to 0.72), p=0,03). Suspected HF was not reasoned by the patient’s gender and only seldom by the patient’s age, but by reported symptoms. Diagnostic certainty of HF was higher in women than in men (predicted proportions with 95% CI: 0.48 (0.39 to 0.58) vs 0.36 (0.27 to 0.45), p=0.01), with highest certainty in older women and lowest in younger men (0.57 (0.45 to 0.69) vs 0.27 (0.17 to 0.37), p<0.01). GPs explained their certainty referring to both typical HF symptoms and their gut feeling.

Conclusion

Despite an identical dialogue, the study showed differences by patients’ gender and age in frequency and certainty of HF diagnosis. In order to avoid that GPs overlook or misinterpret early signs of HF, it is important to critically reflect diagnostic decisions and possible social influences.
Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis
Authors: Wambua Steven , Malla Lucas , Mbevi George , Kandiah Joel , Nwosu Amen-Patrick , Tuti Timothy , Paton Chris , Wambu Bernard , English Mike , Okiro Emelda A
Published: March 2022

Objective

In this study, we assess the indirect impact of COVID-19 on utilisation of immunisation and outpatient services in Kenya.

Design

Longitudinal study.

Setting

Data were analysed from all healthcare facilities reporting to Kenya’s health information system from January 2018 to March 2021. Multiple imputation was used to address missing data, interrupted time series analysis was used to quantify the changes in utilisation of services and sensitivity analysis was carried out to assess robustness of estimates.

Exposure of interest

COVID-19 outbreak and associated interventions.

Outcome measures

Monthly attendance to health facilities. We assessed changes in immunisation and various outpatient services nationally.

Results

Before the first case of COVID-19 and pursuant intervention measures in March 2020, uptake of health services was consistent with historical levels. There was significant drops in attendance (level changes) in April 2020 for overall outpatient visits for under-fives (rate ratio, RR 0.50, 95% CI 0.44 to 0.57), under-fives with pneumonia (RR 0.43, 95% CI 0.38 to 0.47), overall over-five visits (RR 0.65, 95% CI 0.57 to 0.75), over-fives with pneumonia (RR 0.62, 95% CI 0.55 to 0.70), fourth antenatal care visit (RR 0.86, 95% CI 0.80 to 0.93), total hypertension (RR 0.89, 95% CI 0.82 to 0.96), diabetes cases (RR 0.95 95% CI, 0.93 to 0.97) and HIV testing (RR 0.97, 95% CI 0.94 to 0.99). Immunisation services, first antenatal care visits, new cases of hypertension and diabetes were not affected. The post-COVID-19 trend was increasing, with more recent data suggesting reversal of effects and health services reverting to expected levels as of March 2021.

Conclusion

COVID-19 pandemic has had varied indirect effects on utilisation of health services in Kenya. There is need for proactive and targeted interventions to reverse these effects as part of the pandemic’s response to avert non-COVID-19 indirect mortality.
HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa: a cross-sectional survey
Authors: Ngandu Nobubelo Kwanele , Lombard Carl J , Mbira Thandiwe Elsie , Puren Adrian , Waitt Catriona , Prendergast Andrew J , Tylleskär Thorkild , Van de Perre Philippe , Goga Ameena Ebrahim
Published: March 2022

Objectives

We aimed to measure the prevalence of maternal HIV viral load (VL) non-suppression and assess associated factors, to evaluate progress towards United Nations-AIDS (UNAIDS) targets.

Design

Cross-sectional study.

Setting

The eight largest community health centres of Ehlanzeni, a rural district in northeast South Africa.

Participants

Pregnant women living with HIV (WLHIV) in their third trimester and postpartum WLHIV and their biological infants, recruited equally across all stages of the first 24 months post partum, were included. A sample of 612 mothers participated from a target of 1000.

Primary outcome measures

The primary outcome was maternal VL (mVL) non-suppression (defined here as mVL >1000 copies/mL). We collected information on antiretroviral use, healthcare visits and sociodemographics through interviews and measured plasma mVL. Descriptive statistics, χ2tests and multivariable logistic regression analysis were conducted.

Results

All mothers (median age: 30 years) were on antiretroviral therapy (ART) and 24.9% were on ART ≤12 months. The prevalence of mVL non-suppression was 14.7% (95% CI: 11.3% to 19.0%), while 13.8% had low-level viraemia (50–1000 copies/mL). Most (68.9%) women had initiated breast feeding and 37.6% were currently breast feeding their infants. Being younger than 25 years (adjusted odds ratio (AOR): 2.6 (95% CI: 1.1 to 6.4)), on first-line ART (AOR: 2.3 (95% CI: 1.1 to 4.6)) and married/cohabiting (AOR: 1.9 (95% CI: 1.0 to 3.7)) were significantly associated with increased odds of mVL non-suppression.

Conclusions

The prevalence of mVL ≤1000 copies/mL of 85.3% among pregnant and postpartum WLHIV and attending public healthcare centres in this rural district is below the 2020 90–90–90 and 2030 95–95–95 UNAIDS targets. Given that low-level viraemia may also increase the risk of vertical HIV transmission, we recommend strengthened implementation of the new guidelines which include better ART options, improved ART regimen switching and mVL monitoring schedules, and intensified psychosocial support for younger women, while exploring district-level complementary interventions, to sustain VLs below 50 copies/mL among all women.
Experiences of patients and health care professionals on the quality of telephone follow-up care during the COVID-19 pandemic: a large qualitative study in a multidisciplinary academic setting
Authors: van Erkel Famke M , Pet Myrthe J , Bossink Elles HM , van de Graaf Cathy F M , Hodes Marije T J , van Ogtrop Sonja N , Mourits Marian J E , Welker Gera A , Halmos Gyorgy B , van Leeuwen Barbara , Racz Emoke , Reyners Anna K L , van Munster Barbara C , van der Zaag-Loonen Hester J
Published: March 2022

Objective

To evaluate the perceived quality of follow-up telephone consultations (TCs) from the perspective of patients and healthcare professionals (HCPs) of multiple medical disciplines during the COVID-19 pandemic.

Design

A qualitative study using semi-structured interviews and reflexive thematic analysis.

Setting

Seven medical disciplines (general dermatology, dermato-oncology, head and neck oncology, internal medicine, medical oncology, gynaecological oncology and surgical oncology) at a large university hospital in the Netherlands.

Participants

Patients who received and HCPs who provided TCs as a substitute for outpatient follow-up appointments during the COVID-19 pandemic.

Results

Eighty-two patients and 58 HCPs were interviewed. Predominantly, patients and HCPs were satisfied with the quality of care by TCs. They regarded TCs as efficient, accessible and of acceptable quality, provided there was an established patient-HCP relationship, medical complaints were absent and physical examination was not indicated. However, most patients were worried about the accuracy of their health assessment in the absence of physical examination and non-verbal communication. Both patients and HCPs wish to use TCs in the future alternatively with face-to-face consultations.

Conclusion

This study concludes that TCs seem a valuable contribution to the context of follow-up care and could partially replace face-to-face consultations. TCs can be performed in stable, chronic patients with whom a doctor-patient relationship has already been established. Face-to-face consultations are considered more appropriate in the case of new patients, challenging or emotionally charged consultations and when clinically relevant physical examination is indicated. Due to the context-dependent nature of experiences of patients and HCPs, TCs should be used with an individually customised approach based on patient and disease specifics, in which shared decision-making plays an extensive role. Before major implementation is considered, sufficient data on the safety regarding missed diagnoses or cancer recurrences should be assembled first.
Testing and treatment for latent tuberculosis infection in people living with HIV and substance dependence: a prospective cohort study
Authors: Runels Tessa , Ragan Elizabeth J , Ventura Alicia S , Winter Michael R , White Laura F , Horsburgh C Robert , Samet Jeffrey H , Saitz Richard , Jacobson Karen R
Published: March 2022

Objective

To quantify the proportion of people living with HIV (PLWH) with other tuberculosis (TB) risk factors that completed the latent tuberculosis infection (LTBI) care cascade and describe factors associated with attrition. The care cascade was defined as follows: (1) receipt of an LTBI test and result, (2) initiation of LTBI treatment and (3) completion of LTBI treatment.

Design

Prospective cohort study.

Setting

Reactivation of LTBI remains a large source of active TB disease in the USA. PLWH and those who use substances are at greater risk and are harder to engage and retain in care.

Participants

Participants enrolled in a Boston cohort of PLWH from 2012 to 2014.

Primary and secondary outcome measures

Our primary outcome was the number and proportion of participants who completed each stage of the cascade and the factors associated with completing each stage. Our secondary outcomes were differences between participants tested with an interferon gamma release assay (IGRA) versus tuberculin skin test and differences between participants who tested positive versus negative for LTBI.

Results

Only 189 of 219 (86.3%) participants completed testing. Five of the 11 with LTBI initiated and three completed treatment. Participants tested with an IGRA were more likely to complete testing (OR 3.87, 95% CI 1.05 to 14.30) while among participants successfully tested, being foreign-born was associated with a positive test result (OR 3.95; 95% CI 1.13 to 13.77).

Conclusions

Although the majority completed LTBI testing, our findings warrant further investigation in a larger cohort to better understand factors that lead to suboptimal treatment initiation and completion in a low-burden country.
Establishing and evaluating a quality improvement collaborative to address hospital to home transitions for older people
Authors: Laver Kate , Lynch Elizabeth , Rupa Jesmin , Mcnamara Carmel , Crotty Maria , Harvey Gillian
Published: March 2022

Introduction

Hospital use increases with age. Older people and their families have reported poor experiences of care at the time of discharge home from hospital. As part of a larger project, we established and evaluated a quality improvement collaborative to address hospital to home transitions for older people.

Methods

We convened an expert panel of 34 stakeholders to identify modifiable issues in the hospital-home transition period. We established a collaborative involving health professionals across a range of agencies working to common goals. Teams were supported by a network manager, three learning sessions and quality improvement methodology to address their identified area for improvement. We used mixed methods to evaluate whether the establishment of the quality improvement collaborative built networks, built capacity in the health professionals and improved the quality of care for older people. Evaluation methods included interviews, surveys, network mapping and case studies.

Results

Nine teams (n=41 participants) formed the collaborative and attended all meetings. Mapping showed an increase in networks between participants and organisations at the conclusion of the collaborative. Interview data showed that building relationships across services was one of the most important parts of the collaborative. Survey results revealed that most (77%) believed their quality improvement skills had developed through participation. Advice and regular meetings to progress project work were considered important in ensuring teams stayed focused. In terms of improving the quality of care, some participants indicated that they achieved the stated aims of their project better than expected (21%), most (41%) felt they achieved their aim as expected, 26% got close to their aim and the rest did not know the outcome (13%).

Conclusions

Establishing a quality improvement collaborative was a positive activity in terms of building a network across organisations and progressing quality improvement projects which aimed to achieve the same overall goal.
Prevalence and burden of COPD misclassification in the Canadian Longitudinal Study on Aging (CLSA)
Authors: Farooqi M A Malik , Ma Jinhui , Ali Muhammad Usman , Zaman Michele , Huang Julie , Xie Yangqing , Dragoman Alex , Chen Steven Jiatong , Raina Parminder S , Duong MyLinh
Published: March 2022

Introduction

To examine the prevalence of chronic obstructive pulmonary disease (COPD) misclassification and the associated burden of symptoms, healthcare utilisation and physical performance status in the Canadian general population. This information is presently lacking from large population-based studies with high-quality spirometry data that can be generalised to the general population.

Methods

The prevalence of self-reported physician-diagnosed COPD and the concordance with spirometry airflow obstruction (AO) were assessed in a cross-sectional cohort of Canadian older adults. The associations between confirmed COPD, under-diagnosis and over-diagnosis with self-reported respiratory symptoms, healthcare utilisation and physical performance (timed up and go, handgrip strength and 4 metres walk test) were assessed, adjusting for baseline characteristics using multivariable linear and logistic models.

Results

A total of 21 242 participants (mean age 64 (SD 10) years; 42% men) with high quality spirometry were included. Physician-diagnosed COPD was reported in (n=973) 5% of the participants. Only (n=217) 1% of the entire cohort had confirmed COPD supported by spirometry AO. Discordance between self-reported COPD and spirometry findings was observed in (n=1565) 8%: with 4% representing under-diagnosis cases (no self-reported COPD but AO) and 4% representing over-diagnosis cases (self-reported COPD but no AO). Compared with normals (no self-reported COPD and normal spirometry), those with confirmed, under-diagnosed or over-diagnosed COPD showed higher risks for respiratory symptoms (adjusted OR (aOR) 2.1 (95% CI: 1.6 to 2.7); aOR 1.8 (95% CI: 1.6 to 2.1]; aOR 1.6 (95% CI: 1.4 to 1.9)); healthcare utilisation in the prior 12 months (β coefficient 0.8 (95% CI: 0.2 to 2.6); β 0.9 (95% CI: 0.5 to 1.5); β 1.6 (95% CI: 0.7 to 4.0)). Mood disorders were higher in confirmed and over-diagnosed COPD (aOR 1.7 (95% CI: 1.3 to 2.4); 1.7 (95% CI: 1.4 to 2.0), respectively). Physical performance was lower for COPD groups.

Conclusions

The prevalence of COPD misclassification is high in the general population of older adults. These were associated with significantly high burden of respiratory symptoms, healthcare utilisation and low physical performance compared with the general population with normal spirometry and no self-reported COPD. These findings highlight the high burden of COPD misclassification, which may be substantially reduced with greater accessibility to spirometry measurements in the community.
Hospital visit histories of suicide decedents: a study in Utah
Authors: Berrigan John , Miller Matthew , Zhang Wilson , Azrael Deborah , Barber Catherine
Published: March 2022

The study aims to describe the 3-year hospital visit histories of suicide decedents in Utah grouped by the suicide method they used. Hospital visit histories from the Utah Office of Health Care Statistics were linked to a census of suicide mortality data from the National Violent Death Reporting System in 2014 and 2015. Overall, 14% of suicide decedents had visited a hospital for deliberate self-harm (DSH) and 49% for a behavioural health issue (BHI), including DSH, suicidal ideation, mental health and substance abuse, prior to their death. Firearms suicide decedents made up over half of all suicides but were the least likely to have a history of DSH or BHI prior to their death (8% and 41%, respectively). Few suicide decedents visited a hospital for DSH prior to their death, although half had visits for BHI. Hospital-based interventions that aim to prevent suicide should not be limited to visits for DSH.
Rapid serum clot tubes reduce haemolysis due to pneumatic tube transport
Authors: Koch Christopher D , Vera Michael A , El-Khoury Joe M
Published: March 2022

Aims

Pneumatic tube systems (PTSs) are critical for modern hospital operations, allowing for rapid sample transport. Despite widespread use, PTSs can compromise specimen integrity and affect laboratory values. Our objective was to prove that rapid serum clot tubes (RST) provide protective benefits over plasma during PTS transport and can be a practical solution for certain PTS routes.

Methods

In this study, we compared the effects of PTS transport on cell lysis indicators: h-index, lactate dehydrogenase (LDH) and potassium (K+), in RST versus lithium heparin gel separator tubes using 10 volunteers.

Results

In comparison with plasma, RST showed a median reduction in PTS-induced haemolysis of 80.4% (p=0.0049), with a reduction in post-PTS median LDH concentration (49.7%, p=0.04) and K+ concentration (50.0%, p=0.0273).

Conclusion

This study demonstrates RST tubes can significantly reduce PTS-induced haemolysis and can be recommended for poor PTS routes.