bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating variations in the dust emissivity index in the Andromeda Galaxy
Authors: Athikkat-Eknath G , Eales S A , Smith M W L , Schruba A , Marsh K A , Whitworth A P
Published: October 2021

Over the past decade, studies of dust in the Andromeda Galaxy (M31) have shown radial variations in the dust emissivity index (β). Understanding the astrophysical reasons behind these radial variations may give clues about the chemical composition of dust grains, their physical structure, and the evolution of dust. We use 12CO(J = 1$\longrightarrow$0) observations taken by the Combined Array for Research in Millimeter-wave Astronomy and dust maps derived from Herschel images, both with an angular resolution of 8 arcsec and with spatial resolution of 30 pc, to study variations in β across an area of ≈18.6 kpc2 in M31. We extract sources, which we identify as molecular clouds, by applying the astrodendro algorithm to the 12CO and dust maps, which as a byproduct allows us to compare continuum emission from dust and CO emission as alternative ways of finding molecular clouds. We then use these catalogues to investigate whether there is evidence that β is different inside and outside molecular clouds. Our results confirm the radial variations of β seen in previous studies. However, we find little difference between the average β inside molecular clouds compared with that outside molecular clouds, in disagreement with models that predict an increase of β in dense environments. Finally, we find some clouds traced by dust with very little CO, which may be either clouds dominated by atomic gas or clouds of molecular gas that contain little CO.
The unusually high dark matter concentration of the galaxy group NGC 1600
Authors: Runge J , Walker S A , Mirakhor M S
Published: October 2021

We investigate the properties of the dark matter (DM) halo surrounding the nearby galaxy group NGC 1600. Through the use of deep (252 ks) Chandra observations and 64.3 ks of XMM–Newton observations, we construct surface brightness profiles in multiple energy bands in order to perform hydrostatic equilibrium analysis of the hot plasma within NGC 1600. Regardless of the DM model profile assumed, we measure a halo concentration (c200) that is an extreme, positive outlier of the ΛCDM c200–M200 relation. For a typical NFW DM profile, we measure c200 = 26.7 ± 1.4 and M200 = (2.0 ± 0.2) × 1013 M⊙; assuming a similar halo mass, the average concentration expected is c200 = 6 − 7 for the theoretical ΛCDM c–M relation. Such a high concentration is similar to that of well-known fossil groups MRK 1216 and NGC 6482. While NGC 1600 exhibits some properties of a fossil group, it fails to meet the X-ray luminosity threshold of LX > 5 × 1041 erg s−1. Whether or not it is considered a fossil group, the high concentration value makes it part of a select group of galaxy groups.
Data-Efficient Classification of Radio Galaxies
Authors: Samudre Ashwin , George Lijo T , Bansal Mahak , Wadadekar Yogesh
Published: October 2021

The continuum emission from radio galaxies can be generally classified into different morphological classes such as FRI, FRII, Bent, or Compact. In this paper, we explore the task of radio galaxy classification based on morphology using deep learning methods with a focus on using a small scale dataset (∼2000 samples). We apply few-shot learning techniques based on Twin Networks and transfer learning techniques using a pre-trained DenseNet model with advanced techniques like cyclical learning rate and discriminative learning to train the model rapidly. We achieve a classification accuracy of over 92% using our best performing model with the biggest source of confusion being between Bent and FRII type galaxies. Our results show that focusing on a small but curated dataset along with the use of best practices to train the neural network can lead to good results. Automated classification techniques will be crucial for upcoming surveys with next generation radio telescopes which are expected to detect hundreds of thousands of new radio galaxies in the near future.
Self-similarity of k-nearest neighbour distributions in scale-free simulations
Authors: Garrison Lehman H , Abel Tom , Eisenstein Daniel J
Published: October 2021

We use the k-nearest neighbour probability distribution function (kNN-PDF; Banerjee & Abel 2021a) to assess convergence in a scale-free N-body simulation. Compared to our previous two-point analysis, the kNN-PDF allows us to quantify our results in the language of haloes and numbers of particles, while also incorporating non-Gaussian information. We find good convergence for 32 particles and greater at densities typical of haloes, while 16 particles and fewer appear unconverged. Halving the softening length extends convergence to higher densities, but not to fewer particles. Our analysis is less sensitive to voids, but we analyse a limited range of underdensities and find evidence for convergence at 16 particles and greater even in sparse voids.
Static and dynamic solar coronal loops with cross-sectional area variations
Authors: Cargill P J , Bradshaw S J , Klimchuk J A , Barnes W T
Published: October 2021

The Enthalpy Based Thermal Evolution of Loops approximate model for static and dynamic coronal loops is developed to include the effect of a loop cross-sectional area which increases from the base of the transition region (TR) to the corona. The TR is defined as the part of a loop between the top of the chromosphere and the location where thermal conduction changes from an energy loss to an energy gain. There are significant differences from constant area loops due to the manner in which the reduced volume of the TR responds to conductive and enthalpy fluxes from the corona. For static loops with modest area variation the standard picture of loop energy balance is retained, with the corona and TR being primarily a balance between heating and conductive losses in the corona, and downward conduction and radiation to space in the TR. As the area at the loop apex increases, the TR becomes thicker and the density in TR and corona larger. For large apex areas, the coronal energy balance changes to one primarily between heating and radiation, with conduction playing an increasingly unimportant role, and the TR thickness becoming a significant fraction of the loop length. Approximate scaling laws are derived that give agreement with full numerical solutions for the density, but not the temperature. For non-uniform areas, dynamic loops have a higher peak temperature and are denser in the radiative cooling phase by of order 50 per cent than the constant area case for the examples considered. They also show a final rapid cooling and draining once the temperature approaches 1 MK. Although the magnitude of the emission measure will be enhanced in the radiative phase, there is little change in the important observational diagnostic of its temperature dependence.
Combining phosphate binder therapy with vitamin K2 inhibits vascular calcification in an experimental animal model of kidney failure
Authors: Neradova Aegida , Wasilewski Grzegorz , Prisco Selene , Leenders Peter , Caron Marjolein , Welting Tim , van Rietbergen Bert , Kramann Rafael , Floege Jürgen , Vervloet Marc G , Schurgers Leon J
Published: October 2021

Background

Hyperphosphataemia is strongly associated with cardiovascular disease and mortality. Recently, phosphate binders (PBs), which are used to bind intestinal phosphate, have been shown to bind vitamin K, thereby potentially aggravating vitamin K deficiency. This vitamin K binding by PBs may offset the beneficial effects of phosphate reduction in reducing vascular calcification (VC). Here we assessed whether combining PBs with vitamin K2 supplementation inhibits VC.

Methods

We performed 3/4 nephrectomy in rats, after which warfarin was given for 3 weeks to induce vitamin K deficiency. Next, animals were fed a high phosphate diet in the presence of low or high vitamin K2 and were randomized to either control or one of four different PBs for 8 weeks. The primary outcome was the amount of thoracic and abdominal aorta VC measured by high-resolution micro-computed tomography (µCT). Vitamin K status was measured by plasma MK7 levels and immunohistochemically analysed in vasculature using uncarboxylated matrix Gla protein (ucMGP) specific antibodies.

Results

The combination of a high vitamin K2 diet and PB treatment significantly reduced VC as measured by µCT for both the thoracic (P = 0.026) and abdominal aorta (P = 0.023), compared with MK7 or PB treatment alone. UcMGP stain was significantly more present in the low vitamin K2–treated groups in both the thoracic (P < 0.01) and abdominal aorta (P < 0.01) as compared with high vitamin K2–treated groups. Moreover, a high vitamin K diet and PBs led to reduced vascular oxidative stress.

Conclusion

In an animal model of kidney failure with vitamin K deficiency, neither PB therapy nor vitamin K2 supplementation alone prevented VC. However, the combination of high vitamin K2 with PB treatment significantly attenuated VC.
‘Where Are the Proxenoi?’ Social Network Analysis, Connectivity and the Greek Poleis
Authors: Mack William
Published: October 2021

The aim of this article is to establish a new basis for exploring the network of ancient Greek city-states during the Classical and Hellenistic periods by applying Social Network Analysis to the record of inscriptions recording grants of proxeny. Proxeny was a generalized institution for facilitating interactions between Greek political communities. Because it left a rich and idiosyncratic record in the form of thousands of honorific inscriptions, it represents an important test case for Social Network Analysis. By drawing on work on partial samples of network data, we can identify a clear and historically significant structure in this material, namely a massively unequal hierarchy in the extent to which different communities were the focus of links. This allows us to compare, systematically, the hundreds of Greek city-states in terms of their connectivity in the network. As a result it provides a new empirical basis for testing prevailing models and assumptions about why these communities forged links and mapping the limits of the network. By reading this hierarchy alongside the other information we have, we can identify the role that political, economic and geographic factors played in determining connectivity in this network, and the surprising unimportance of religion.
An Equilibrium Analysis of the Long-Term Care Insurance Market
Authors: Ko Ami
Published: October 2021

Informal care provided by adult children substitutes for formal long-term care services. However, information about children is not used in pricing long-term care insurance which pays only for formal care. I start by providing descriptive evidence that private information about children’s informal care likelihood results in adverse selection: the market attracts a disproportionate number of individuals who face higher formal care utilization risk due to a lower probability of receiving care from their children. To quantify the welfare consequence of adverse selection, I develop and estimate a dynamic intergenerational model featuring long-term care insurance, savings, informal care provision, and employment choices. Based on the estimated equilibrium insurance market framework, I show that using information about children in pricing insurance contracts reduces adverse selection and results in the average welfare gain of $6,200 per family. Using the non-cooperative feature of the model, I also quantify to what extent parents forgo long-term care insurance to avoid diminishing children’s informal care incentive.
Risk factors of impaired humoral response to COVID-19 vaccination in rituximab-treated patients
Authors: Avouac Jérôme , Miceli-Richard Corinne , Combier Alice , Steelandt Alexia , Fogel Olivier , Mariaggi Alice Andrée , Meritet Jean-François , Rozenberg Flore , Molto Anna , Allanore Yannick
Published: October 2021

Objective

To identify which factors influence humoral response to coronavirus disease 2019 (COVID-19) vaccination in rituximab (RTX)-treated patients.

Methods

This was an observational, prospective, usual care study including consecutive patients with inflammatory rheumatic diseases in maintenance therapy with RTX. All patients received a two-dose regimen COVID-19 vaccination. Serum IgG antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins were measured at the time of the new RTX infusion.

Results

From the recruited patients, 16/45 (36%) produced antibodies reaching the assay cut-off value of 15 AU/ml and 29/45 (64%) had a negative serology. Within RTX-treated patients, 25 (56%) had undetectable B cells. Negative serology was associated with undetectable B cells (24/25 vs 5/20, P < 0.001). Moreover, SARS-CoV-2 spike antibodies correlated with CD19 counts (r = 0.86, P < 0.001). The effect of RTX and MTX was additive in terms of seroconversion rates (23% vs 50% in patients receiving RTX in monotherapy, P = 0.12) and SARS-CoV-2 spike antibody levels [3.80 (95% CI 3.80, 7.50) vs 75 (95% CI 3.8, 353) AU/ml in patients receiving RTX in monotherapy; P = 0.025]. Multivariate analyses including demographics, disease characteristics, gammaglobulin levels, RTX and other therapies used, CD19 counts, and the time between the last RTX infusion and vaccination identified detectable B cells as the only variable independently associated with seropositivity [odds ratio 35.2 (95% CI 3.59, 344.20)].

Conclusions

B cell depletion is the main independent contributing factor of antibody response to SARS-CoV-2 vaccination in RTX-treated patients. Monitoring CD19 may be of interest to identify the most appropriate period to perform vaccination.
Giant R waves on electrocardiogram in children with asphyxia after cardiopulmonary resuscitation
Authors: Guo QiFeng , Chen YueE. , Xu XiangLin
Published: October 2021

Introduction:

Giant R waves on electrocardiogram (ECG) in pediatric patients is extremely rare. The present case report explores the giant R wave ECG characteristics and clinical features of children with asphyxia after cardiopulmonary resuscitation.

Patient concerns:

Two children presented with suffocation due to drowning and foreign body inhalation. Cardiopulmonary resuscitation was performed, and the children were admitted to the hospital.

Diagnosis:

On the day of admission, the two children were in a deep coma, with decreased blood pressure, elevated myocardial enzymes and glucose, and metabolic acidosis. However, ECG examination showed no obvious abnormalities. On the day after admission, the children experienced frequent convulsions. The ECG showed the features of giant R waves from three consecutive ECG readings.

Interventions:

Treatment measures during hospitalization included tracheal intubation assisted ventilation, ice cap to protect the brain to reduce basal brain metabolism, anti-infection, dehydration, lower intracranial pressure, correction of acidosis, adjustment of glucose levels, sedation, analgesia, normal saline to supplement blood volume and protect liver function.

Outcomes:

The giant R waves on ECG persisted until the children passed away three days after admission.

Conclusion:

Giant R waves on ECG in children with asphyxia after cardiopulmonary resuscitation may be related to the large release of catecholamines, which results in myocardial injury. Giant R waves on ECG indicates a serious illness and poor prognosis of the patient. In addition, giant R waves on ECG may be misdiagnosed as other arrhythmias and needs to be carefully differentiated.
Laparoscopic omental flap for rectovaginal fistula after low anterior resection
Authors: Kidate Kaoru , Kobayashi Hironori , Miyamoto Katsunari , Sakashita Yoshihiro , Yokoyama Yujirou , Hashimoto Yasushi , Toyota Kazuhiro , Hara Tetsuhiro , Doi Hirofumi , Kuhara Yuta
Published: October 2021

Introduction:

Nearly 1.8% to 9.9% of patients suffer from a rectovaginal fistula after a low anterior resection. The treatment and management of rectovaginal fistulas is challenging for surgeons. Here, we report a case of rectovaginal fistula after low anterior resection that was successfully treated with laparoscopic omental flap surgery.

Patient Concerns:

An 89-year-old woman underwent laparoscopic low anterior resection for stage IIA rectal adenocarcinoma. The patient noticed fecal discharge from her vagina 6 days postoperatively.

Diagnosis:

Enema examination results using a contrast agent showed a 1 cm rectovaginal fistula located 1 cm proximal to the anastomotic stapler line.

Interventions:

We performed laparoscopic rectovaginal fistula repair using an omental flap and laparoscopic transverse colostomy 12 days postoperatively. The omentum was placed between the vaginal and rectal walls and secured with sutures.

Outcomes:

Oral food intake was resumed 2 days postoperatively, and there were no signs of recurrence of the rectovaginal fistula. The patient underwent a procedure to close the colostomy 36 days after the second surgery.

Conclusion:

Laparoscopic surgery is helpful in achieving good access during surgery, especially in narrow areas, such as the pelvis. It is essential to use a flap in good condition to treat a rectovaginal fistula. Omentum is an ideal flap with good blood flow that exerts no tension on the tissue. Hence, laparoscopic omental flap is a feasible treatment option for rectovaginal fistulas.
Aggression and criminality in androgen abusers
Authors: Chegeni Razieh , Pallesen Ståle , Sagoe Dominic
Published: October 2021

Purpose of review

To systematically review and meta-synthesize current (2019–2021) literature on aggression and criminality in androgen abusers. Results from 13 empirical human studies are discussed.

Recent findings

Some androgen abusers engage in aggressive and criminal behavior. Here, results show positive effects and associations between the administration of androgens and aggression, and descriptions of various patterns and kinds of aggression and criminality in androgen abusers. Still, this positive relationship seems to be mediated by various factors, such as cognition, neurobiology, personality, polypharmacy, and study methods.

The current literature on aggression and criminality in androgen abusers shows methodical diversity and underlines the need to synthesize the current evidence in order to draw overall conclusions as well as identify relevant and important knowledge gaps. On the basis of a systematic literature search, we identified 13 studies and categorized them by methodology. Of the 13 studies, 4 were meta-analyses and systematic reviews, 1 was a randomized controlled trial, 4 were cross-sectional studies, and 4 constituted case reports. Evidence on the relationship between androgen abuse and involvement in aggressive behavior seems to be mediated by cognition, neurobiology, personality, and polypharmacy as well as methodical factors, such as study design, aggression severity, type of measurement, and temporal proximity. Implications for practice and future research are presented.
Perceived versus Patient-Reported Significance of Surgeon Gender in Breast Reconstruction
Authors: Hsu Jessica J. , Kubiak Carrie A. , Billig Jessica I. , Qi Ji , Hamill Jennifer B. , Kim Hyungjin M. , Wilkins Edwin G. , Kung Theodore A.
Published: October 2021

Background:

Previous investigators demonstrated that female patients often prefer female providers. However, these studies have not determined whether there are gender preferences for breast reconstruction surgeons or whether the effects of surgeon gender impacts patient-reported outcomes.

Methods:

Adult women were crowdsourced using Amazon Mechanical Turk to characterize societal preferences for the gender of breast and plastic surgeons in a hypothetical scenario. The authors also used data from the Mastectomy Reconstruction Outcomes Consortium to determine the association between surgeon gender and patient satisfaction after breast reconstruction. The BREAST-Q questionnaire was used to assess patient-reported outcomes at 3 months and 2 years following reconstruction. Regression analyses were performed to investigate the effects of surgeon gender on patient-reported outcomes.

Results:

In total, 1413 surveys were collected. Forty-two percent preferred female plastic surgeons, 5 percent preferred male surgeons, and 53 percent reported no preference. The Mastectomy Reconstruction Outcomes Consortium analysis included 2236 patients of 55 male and nine female plastic surgeons. In this cohort, 1921 patients (82.2 percent) had male surgeons, whereas 415 patients (17.8 percent) had female surgeons. Regression analysis at 2 years revealed no differences in satisfaction with surgeon, outcome, or psychosocial well-being. Only satisfaction with information differed, as patients of female surgeons reported greater satisfaction in this category, with an adjusted mean difference of 2.82 (p = 0.018).

Conclusions:

Although nonpatient women hypothetically prefer female providers, surgeon gender makes little difference in actual patient satisfaction with breast reconstruction. More investigation is needed to determine whether the difference in information delivery is clinically significant and whether it reflects variations in practices between male and female surgeons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
A Matched Comparison of the Benefits of Breast Reduction on Health-Related Quality of Life
Authors: Elfanagely Omar , Othman Sammy , Rios-Diaz Arturo J. , Cunning Jessica R. , Whitely Cutler , Butler Paris , Fischer John P.
Published: October 2021

Background:

Breast reduction surgery has consistently fallen within the top 10 surgical procedures performed by plastic surgeons. This is because of its capability to relieve the physical and psychological impact of macromastia. Although numerous women pursue consultation, many never undergo the procedure. The authors aim to quantify the impact of breast reduction surgery on quality of life by comparing patients who underwent breast reduction surgery with those who did not.

Methods:

Patients seeking breast reduction surgery between 2016 and 2019 were identified. As standard-of-care, patients are surveyed during the consultation visit and postoperative visits using the BREAST-Q. The preoperative survey was readministered a second time for those who did not undergo breast reduction surgery. Propensity score matching, based on patient demographics, comorbidities, and breast examination, was used to balance baseline characteristics.

Results:

A total of 100 propensity-matched patients were identified (operative, n = 78; nonoperative, n = 22). Mean participant age was 39.5 ± 25 years and mean body mass index was 31.1 ± 7.4 kg/m2. Quality of life significantly improved in each domain for those in the operative group (p < 0.05). Those who did not undergo breast reduction surgery realized no improvement in quality of life and had a downward trend in quality of life across two of the four domains.

Conclusions:

Breast reduction surgery offers a significant improvement in quality of life for macromastia. This matched study demonstrates that patients who are able to undergo breast reduction surgery have a statistically significant improvement in all aspects of quality of life, whereas nonsurgical patients experience no benefit with time, with a trend toward deterioration in specific domains.
Ear Reconstruction with the Combination of Expanded Skin Flap and Medpor Framework: 20 Years of Experience in a Single Center
Authors: Wang Yongzhen , Zhang Jinming , Liang Weiqiang , Xiao Xiaolian , Zhang Jiaqi , Zhang Jian , Su Zheng , Liu Meng , Chen Yuhong , Ji Chenyang
Published: October 2021

Background:

In ear reconstruction, the difficulty lies in reestablishing the ear’s bionic form with adequate skin coverage and an appropriate framework. Skin expansion and a porous polyethylene (i.e., Medpor) framework are often used for ear reconstruction. However, a long-term review of the combined application of the expanded skin and Medpor framework has not been reported. This article reviews ear reconstruction combining these two factors over the past 20 years in the authors’ center to summarize the surgical technique and analyze the postoperative results and complications.

Methods:

A retrospective review was performed that included all patients who underwent ear reconstruction with expanded skin and Medpor framework in the authors’ center between 1998 and 2018.

Results:

A total of 68 patients with microtia who were admitted to the authors’ center for surgical ear reconstruction were included, and 70 ears were reconstructed. Fifty-seven of the patients (83.82 percent) felt satisfied with their reconstructed ear, five patients (7.35 percent) were not satisfied with the reconstructed ear, and six patients (8.82 percent) had the frameworks removed. Fifteen patients (22.06 percent) developed complications, including framework exposure (13.24 percent), infection (4.41 percent), scar hypertrophy (4.41 percent), and hematoma (2.94 percent).

Conclusions:

Framework exposure limits the combined application of expanded skin flap and Medpor framework when reconstructing the ear without additional fascial interposition. Using a temporoparietal fascia or postauricular fascia flap during the operation is effective to decrease the exposure rate; however, this complication cannot be completely avoided. Using postauricular fascia and skin graft may lead to scar hypertrophy; thus, these techniques should be used with caution.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Risk Factors for Complications after J Medial Thighplasty following Massive Weight Loss: A Multivariate Analysis of 94 Consecutive Patients
Authors: Bertheuil Nicolas , Duisit Jérôme , Bekara Farid , Watier Eric , Gandolfi Silvia , Bergeat Damien
Published: October 2021

Background:

Bariatric surgery has increased the number of patients requiring medial thighplasty after massive weight loss. However, despite the various complications, the procedure improves quality of life. The authors report postoperative complications of vertical J-shaped medial thigh lift in a series of patients and identify preoperative risk factors.

Methods:

For almost 5 years, the details of all J medial thighplasties performed by a single surgeon were recorded; detailed medical records were also available. Complications can be major (e.g., need for early surgical revision or readmission) or minor (delayed wound healing).

Results:

During the study period, 94 patients were treated and only minor complications were recorded (42.5 percent). On multivariate analysis, older age (OR, 1.05; 95 percent CI, 1.01 to 1.10) and a body mass index greater than or equal to 30 kg/m2 (OR, 2.82; 95 percent CI, 1.10 to 7.22) were independent risk factors for postoperative complications.

Conclusions:

As with other postbariatric operations, medial thighplasty is associated with significant morbidity, but the risk thereof can be easily established and managed. Specific algorithms for determining the risk of postoperative complications based on age and body mass index are needed to guide preoperative discussions with patients and perform patient selection.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Immunosuppressive adherence after kidney transplantation in adult patients treated at an outpatient clinic: a better practice implementation project
Authors: Campos Caroline S. , Ferreira Gustavo F. , Bastos Kamille V. , da Costa Carbogim Fábio , de Brito Poveda Vanessa , de Araújo Püschel Vilanice A. , dos Santos Kelli B.
Published: October 2021

Objective:

To evaluate the compliance of the practice with the evidence-based criteria in relation to interventions developed to improve the immunosuppressive adherence of adults in postkidney transplantation.

Method:

A best practice implementation project, based on the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in health practice, was conducted. A baseline and a follow-up audit were conducted in a kidney transplant clinic, including a sample of kidney transplant patients with a maximum of 30 days postoperatively, and health professionals working in the post-transplant period.

Results:

The basic audit revealed that the parameters related to the professionals’ knowledge did not reach adequate compliance; the involvement of patients in strategies to overcome barriers that interfere with nonadherence; guidelines for specific therapeutic regimens for patients and the prescription of immunosuppressants according to the patient's routine. To solve the identified weaknesses, training strategies were implemented with the professionals, follow-up by telephone contact with the patients and the elaboration and distribution of an educational booklet with guidance on the use of immunosuppressants, leading to an increase from 50 to 87.5% of conformity in the evaluated service.

Conclusion:

The evidence implementation project provided improvements in clinical practice behaviors. It demonstrated that there are strategies that facilitate the implementation of evidence regarding the promotion of interventions to improve immunosuppressive adherence. Additional audits are still needed to improve and assess the quality of interventions promoted by professionals regarding drug adherence in the post-transplant period, as well as to verify the behavior of patients, ensuring that the project will be maintained and supported.
Sharps injuries prevention among healthcare providers in surgical, medical and pediatric wards of a public hospital in Jimma Zone: a best practice implementation project
Authors: Asefa Yisalemush , Admassu Bitiya , Wondimnew Tesaka , Morankar Sudhakar
Published: October 2021

Background:

Sharps injuries are a serious public health problem that healthcare providers face and constitute a major risk for the transmission of blood-borne infections. Prevention of sharps injuries in hospitals requires that healthcare providers comply with universal precautions.

Objectives:

The aim of this study was to assess and improve the compliance of healthcare providers with protocols based on best available evidence for prevention of sharps injuries in medical, surgical and pediatric wards of the hospital.

Methods:

A three-phase clinical audit was carried out using the online JBI Practical Application of Clinical Evidence System and Getting Research into Practice Program. Six audit criteria based on available evidence were used. Phase 1 of the project was the baseline audit, phase 2 the implementation of the best practice, and phase 3 the follow-up audit. Data were collected through observation, interview and resource inventory.

Results:

The postintervention compliance report showed maximum improvement in compliance in criterion 1 (sharps containers are not filled above the mark that indicates the bin is full) and criterion 2 (sharps containers are positioned out of the reach of children at a height that enables safe disposal by staff). Between the baseline and postintervention audits, the compliance rate for these criteria improved by more than half (criterion 1) and by nine-fold (criterion 2) (from 38 to 100% and 0 to 93%, respectively). During baseline, two nurses reported experiencing sharps injuries, noting that they think it is not important to report the injury if the patient is negative for HIV, and when they do not know where to report it, regardless. At the postintervention audit no injuries were reported.

Conclusion:

The best practice recommendations using a clinical audit process was an effective intervention for improving knowledge and compliance of healthcare workers with protocols for the prevention of sharps injuries in low-resource settings.
Prevention of deep venous thrombosis in stroke: a best practice implementation project
Authors: Luo Yansi , Zhou Chunlan , Deng Qiulin , Xu Weihao , Zhang Xiaomei
Published: October 2021

Objectives:

The current evidence implementation project aims to promote evidence-based practice in the care of patients with stroke, specifically around the prevention of deep venous thrombosis (DVT), in the neurology department of a tertiary hospital in Guangzhou, China.

Introduction:

The prevalence of DVT within 14 days after stroke is 10–75%. Approximately 20% of patients with DVT develop pulmonary embolism, the third most common cause of death in patients with stroke and the most common cause of autopsy-verified death between the second and fourth week after stroke. Several risk factors are associated with the development of DVT, many of which can be alleviated by evidence-based strategies that can prevent or reduce the risk of DVT.

Methods:

The current evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program and involved 30 patients in each audit criterion. Interventions included staff education, involvement of rehabilitation staff, and building a patient education bundle. A postimplementation reaudit was undertaken including the same number of patient samples.

Results:

The baseline audit results showed that the compliances for two audit criteria (patient mobilization and patient education) were under 20%, whereas those for the other criteria were at least 60%. After implementing the strategies, there were significant improvements especially in the two weak-compliance criteria. In addition, the overall compliance for most criteria increased.

Conclusion:

The project standardized the DVT prevention process in the Neurology Department of Nanfang Hospital. The overall compliance with DVT prevention for patients with stroke in the department improved.
Overcoming barriers to maintain hemodialysis adequacy amongst hemodialysis patients in hospital: a best practice implementation project
Authors: Tseng Peng-Lin , Lin Ni-Ni , Hsu Li-Ping , Tasi Yu-Mei , Chen Bao-Chen , Mu Pei-Fan
Published: October 2021

Objective:

The aim of this evidence implementation project was to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain hemodialysis adequacy among hemodialysis patients with end-stage renal disease.

Introduction:

Assessing adequacy of hemodialysis and improving quality of life are important issues for patients with end-stage renal disease. However, they are often inadequately addressed, and evidence-based practices are not always followed.

Methods:

A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice approaches. Seven audit criteria that represent best practice recommendations for maintaining hemodialysis adequacy among hemodialysis patients were used. A baseline audit was performed, which was followed by the implementation of multiple improvement strategies over 20 weeks and the outcomes finalized using a follow-up audit to determine the change to be implemented in practice.

Results:

The baseline audit results showed that most audit criteria were less than 77% in practice. The compliance rates for nurses who had received education regarding hemodialysis, checking the prescription order for each patient at each session, and using the prescribed dialyzer for every session were determined to have reached 100% at the follow-up audit. The compliance rates for completion prehemodialysis checks, using a sterile technique when inserting an arteriovenous catheter, matching a blood flow rate with the prescription, and maintaining a blood flow rate throughout the treatment session were found to be 73–95% at the follow-up audit. The most significant finding was the proportion of hemodialysis patients with inadequate urea reduction ratio was reduced from 4.6 to 3.2% after implementation of the best practice approaches.

Conclusion:

The implementation of institution-specific evidence-based resources brought about immediate improvements in hemodialysis adequacy management and practice. A variety of strategies contributed to the success of this implementation project, such as scenario simulation education, Objective Structured Clinical Examination, the interrelation response system Kahoot, the use of hemodialysis International Organization for Standardization job descriptions, regular weekly audits, and collaboration with physicians when caring for patients during clinical practice.
Ribosomal protein database profiling lends clarity to ribosomal protein evolution and mass distribution
Authors: Ng Wenfa
Published: October 2021

Existence of theoretical ribosomal protein mass fingerprint as well as utility of ribosomal protein as biomarkers in mass spectrometry microbial identification suggests phylogenetic significance for this class of proteins. To serve the above two functions, facile means of identifying and extracting important attributes of ribosomal proteins from proteome data file of microbial species must be found. Additionally, there is a need to calculate important properties of ribosomal proteins such as molecular weight and nucleotide sequence based on amino acid sequence information from FASTA proteome file. This work sought to support the above endeavour through developing a MATLAB software that extracts the amino acid sequence information of all ribosomal proteins from the FASTA proteome datafile of a microbial species downloaded from UniProt. Built-in functions in MATLAB are subsequently employed to calculate important properties of extracted ribosomal proteins such as number of amino acid residue, molecular weight and nucleotide sequence. All information above are output, as a database, to an Excel file for ease of storage and retrieval. Data available from the analysis of an Escherichia coli K-12 proteome revealed that the bacterium possess a total of 59 ribosomal proteins distributed between the large and small ribosome subunits. The ribosomal protein ranges in sequence length from 38 (50S ribosomal protein L36) to 557 (30S ribosomal protein S1). In terms of molecular weight distribution, the profiled ribosomal proteins range in weight from 4364.305 Da (50S ribosomal protein L36) to 61157.66 Da (30S ribosomal protein S1). More important, analysis of the distribution of the molecular weight of different ribosomal proteins in E. coli reveals a smooth curve that suggests strong co-evolution of ribosomal protein sequence and mass given the tight constraints that a functional ribosome presents. Finally, cluster analysis reveals a preponderance of small ribosomal proteins compared to larger ones, which remains to be a mystery to evolutionary biologists. Overall, the information encapsulated in the ribosomal protein database should find use in gaining a better appreciation for the molecular weight distribution of ribosomal proteins in a species, as well as delivering information for using ribosomal protein biomarkers in identifying particular microbial species in mass spectrometry microbial identification.
Spatial covariance analysis of FDG-PET and HMPAO-SPECT for the differential diagnosis of dementia with Lewy bodies and Alzheimer’s disease
Authors: Ingram Matthew , Colloby Sean J. , Firbank Michael J. , Lloyd Jim J. , O’Brien John T. , Taylor John-Paul
Published: October 2021

We investigated diagnostic characteristics of spatial covariance analysis (SCA) of FDG-PET and HMPAO-SPECT scans in the differential diagnosis of dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD), in comparison with visual ratings and region of interest (ROI) analysis. Sixty-seven patients (DLB 29, AD 38) had both HMPAO-SPECT and FDG-PET scans. Spatial covariance patterns were used to separate AD and DLB in an initial derivation group (DLB n=15, AD n=19), before being forward applied to an independent group (DLB n=14, AD n=19). Visual ratings were by consensus, with ROI analysis utilising medial occipital/medial temporal uptake ratios. SCA of HMPAO-SPECT performed poorly (AUC 0.59±0.10), whilst SCA of FDG-PET (AUC 0.83±0.07) was significantly better. For FDG-PET, SCA showed similar diagnostic performance to ROI analysis (AUC 0.84±0.08) and visual rating (AUC 0.82±0.08). In contrast to ROI analysis, there was little concordance between SCA and visual ratings of FDG-PET scans. We conclude that SCA of FDG-PET outperforms that of HMPAO-SPECT and performed similarly to other analytical approaches, with the potential to improve with larger derivation groups. Compared to visual rating, SCA of FDG-PET relies on different sources of group variance to separate DLB from AD.
Are reaching and grasping effector-independent? Similarities and differences in reaching and grasping kinematics between the hand and foot
Authors: Liu Yuqi , Caracoglia James , Sen Sriparna , Freud Erez , Striem-Amit Ella
Published: October 2021

While reaching and grasping are highly prevalentmanualactions, neuroimaging studies provide evidence that their neural representations may be shared between different body parts, i.e. effectors. If these actions are guided by effector-independent mechanisms, similar kinematics should be observed when the action is performed by the hand or by a cortically remote and less experienced effector, such as the foot. We tested this hypothesis with two characteristic components of action: the initial ballistic stage of reaching, and the preshaping of the digits during grasping based on object size. We examined if these kinematic features reflect effector-independent mechanisms by asking participants to reach toward and to grasp objects of different widths with their hand and foot. First, during both reaching and grasping, the velocity profile up to peak velocity matched between the hand and the foot, indicating a shared ballistic acceleration phase. Secondly, maximum grip aperture and time of maximum grip aperture of grasping increased with object size for both effectors, indicating encoding of object size during transport. Differences between the hand and foot were found in the deceleration phase and time of maximum grip aperture, likely due to biomechanical differences and the participants’ inexperience with foot actions. These findings provide evidence for effector-independent visuomotor mechanisms of reaching and grasping that generalize across body parts.
Understanding the Genetics of Viral Drug Resistance by Integrating Clinical Data and Mining of the Scientific Literature
Authors: Goto An , Rodriguez-Esteban Raul , Scharf Sebastian H. , Morris Garrett M.
Published: October 2021

Drug resistance caused by mutations is a public health threat for existing and emerging viral diseases. A wealth of evidence about these mutations and their clinically-associated phenotypes is scattered across the literature, but a comprehensive perspective is usually lacking. This work aimed to produce a clinically-relevant view for the case of Hepatitis B virus (HBV) mutations by combining a chronic HBV clinical study with a compendium of genetic mutations systematically gathered from the scientific literature. We enriched clinical mutation data by systematically mining 2,472,725 scientific articles from PubMed Central in order to gather information about the HBV mutational landscape. By performing this analysis, we were able to identify mutational hotspots for each HBV genotype (A-E) and gene (C, X, P, S), as well as the location of disulfide bonds associated with these mutations. Through a modelling study, we also identified a mutational position common in both the clinical data and the literature that is located at the binding pocket for a known anti-HBV drug, namely entecavir. The results of this novel approach shows the potential of integrated analyses to assist in the development of new drugs for viral diseases that are more robust to resistance. Such analyses should be of particular interest due to the increasing importance of viral resistance in established and emerging viruses, such as for newly-developed drugs against SARS-CoV-2.
Succinate dehydrogenase/complex II is critical for metabolic and epigenetic regulation of T cell proliferation and inflammation
Authors: Chen Xuyong , Sunkel Benjamin , Wang Meng , Kang Siwen , Wang Tingting , Gnanaprakasam JN Rashida , Liu Lingling , Cassel Teresa A. , Scott David A. , Muñoz-Cabello Ana M. , Lopez-Barneo Jose , Yang Jun , Lane Andrew N. , Xin Gang , Stanton Benjamin , Fan Teresa W.-M. , Wang Ruoning
Published: October 2021

Robust and effective T cell-mediated immune responses require the proper allocation of metabolic resources to sustain energetically costly processes like growth, proliferation, and cytokine production. Epigenetic control of the genome also governs T cell transcriptome and T cell lineage commitment and maintenance. Cellular metabolic programs interact with epigenetic regulation by providing substrates for covalent modifications of chromatin. By employing complementary genetic, epigenetic, and metabolic approaches, we revealed that tricarboxylic acid (TCA) cycle flux fuels biosynthetic processes while controlling the ratio of α-ketoglutarate/succinate to modulate the activities of dioxygenases that are critical for driving T cell inflammation. In contrast to cancer cells, where succinate dehydrogenase (SDH)/complex II inactivation drives cell transformation and growth, SDH/complex II deficiency in T cells causes proliferation and survival defects when the TCA cycle is truncated, blocking carbon flux to support nucleosides biosynthesis. Accordingly, replenishing the intracellular nucleoside pool partially relieved the dependence of T cells on SDH/complex II for proliferation and survival. Conversely, SDH deficiency induces a pro-inflammatory gene signature in T cells and promotes T helper 1 (TH1) and T helper 17 (TH17) lineage differentiation. Mechanistically, the hypoxia-inducible factor 1 (HIF-1) is not required for succinate-induced inflammation in T cells. A reduced α-ketoglutarate/succinate ratio in SDH deficient T cells promotes inflammation through changing the pattern of the transcriptional and chromatin-accessibility signatures and consequentially increasing the expression of the transcription factor, B lymphocyte-induced maturation protein-1 (Blimp-1). Collectively, our studies revealed a critical role of SDH/complex II in allocating carbon resources for anabolic processes and epigenetic regulation in T cell proliferation and inflammation.
Sign inversion in selection on ploidy
Authors: Raynes Yevgeniy , Weinreich Daniel M.
Published: October 2021

Ploidy – the number of homologous chromosome sets in a cell – is remarkably variable across the natural world, yet the evolutionary processes that have resulted in such diversity remain poorly understood. Here we use stochastic agent-based simulations to model ploidy evolution under the influence of indirect selection, i.e., selection mediated solely by statistical associations with fitness-affecting mutations. We find that in non-equilibrium asexual populations, the sign of selection on ploidy can change with population size – a phenomenon we have previously termed sign inversion. In large populations, ploidy dynamics are dominated by indirect effects of selection on beneficial mutations, which favors haploids over diploids. However, as population size declines, selection for beneficial mutations is neutralized by random genetic drift before drift can overwhelm selection against the cost of the deleterious mutational load. As a result, in small populations indirect selection is dominated by the cost of the deleterious load, which favors diploids over haploids. Our work adds to the growing body of evidence challenging established evolutionary theory that population size can affect only the efficiency, but not the sign, of natural selection.