bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of multiple, compatible plasmids on the fitness of the bacterial host by inducing transcriptional changes
Authors: Lee Haejeong , Ko Kwan Soo
Published: June 2021

Objectives

Bacteria that acquire plasmids incur a biological cost. Despite this fact, clinical Enterobacteriaceae isolates commonly contain multiple co-existing plasmids harbouring carbapenemase genes.

Methods

Six different plasmids carrying blaNDM-1, blaNDM-5, blaCTX-M-15, blaKPC-2, blaOXA-181 and blaOXA-232 genes were obtained from Klebsiella pneumoniae and Escherichia coli clinical isolates. Using the E. coli DH5α strain as recipient, 14 transconjugants with diverse plasmid combinations (single or double plasmids) were generated. For each of these, the effects of plasmid carriage on the bacterial host were investigated using in vitro and in vivo competition assays; additionally, the effects were investigated in the context of biofilm formation, serum resistance and survival inside macrophages. Transcriptomic changes in single- and double-plasmid recipients were also investigated.

Results

Increased in vitro and in vivo competitiveness was observed when two plasmids carrying blaNDM-1 and blaOXA-232 were co-introduced into the host bacteria. However, DH5α::pNDM5 + pOXA232 and other double-plasmid recipients did not show such competitiveness. DH5α::pNDM5 + pOXA181 did not show any fitness cost compared with a plasmid-free host and single-plasmid transconjugants, while both the double-plasmid recipients with pCTXM15 or pKPC2 exhibited a fitness burden. The double-plasmid recipient DH5α::pNDM1 + pOXA232 also exhibited increased biofilm formation, serum resistance and survival inside macrophages. Transcriptomic analysis revealed that the genes of DH5α::pNDM1 + pOXA232 involved in metabolic pathways, transport and stress response were up-regulated, while those involved in translation were down-regulated.

Conclusions

Our study suggests that bacterial strains can gain fitness through the acquisition of multiple plasmids harbouring antibiotic resistance genes, which may be mediated by transcriptomic changes in the chromosomal genes of the bacterial host.
The relationship between cybersecurity ratings and the risk of hospital data breaches
Authors: Choi Sung J , Johnson M Eric
Published: June 2021

Objective

We investigated the progression of healthcare cybersecurity over 2014–2019 as measured by external risk ratings. We further examined the relationship between hospital data breaches and cybersecurity ratings.

Materials and Methods

Using Fortune 1000 firms as a benchmark, time trends in hospital cybersecurity ratings were compared using linear regression. Further, the relationship between hospital data breaches and cybersecurity ratings was modeled using logistic regression. Hospital breach data were collected from US HHS, and cybersecurity ratings were provided by BitSight. The resulting study sample yielded 3528 hospital-year observations.

Results

In aggregate, we found that hospitals had significantly lower cybersecurity ratings than Fortune 1000 firms, however, hospitals have closed the gap in recent years. We also found that hospitals with the low security ratings were associated with significant risk of a data breach, with the probability of a breach in a given year ranging from 14% to 33%.

Discussion

Recent cyber-attacks in healthcare continue to illustrate the need to better secure information systems. While hospitals have reduced cyber risk over the past decade, they remain statistically more vulnerable than the Fortune 1000 firms against botnets, spam, and malware.

Conclusion

Policy makers should continue encouraging acute-care hospitals to proactively invest in security controls that reduce cyber risk. Best practices from other sectors like the financial services sector could provide useful guides and benchmarks for improvement.
A Note on the Cardinalities of Sets of Scalar Alternatives
Authors: Mascarenhas Salvador
Published: June 2021

Formal theories of scalar implicature appeal crucially to a set of alternatives. These are the alternative statements that a speaker could have made but chose not to in pragmatic accounts, and the alternative statements that figure in the computation of exhaustivity operators in grammatical approaches. I show that the three sufficiently explicit theories of alternatives in the literature generate sets of alternatives that grow at least exponentially as a function of the input, and that these theories generate very large sets even for relatively small inputs. For pragmatic accounts of scalar implicature, I argue these results are hard or impossible to square with what we know independently about manipulating alternatives from the psychology of human reasoning. I propose that they pose a weaker but more general challenge for grammatical approaches, since alternatives as required by exhaustivity operators occur elsewhere in grammar, for example as part of the semantics of operators like “only” and “even.”
Decomposing the iron cross-correlation signal of the ultra-hot Jupiter WASP-76b in transmission using 3D Monte Carlo radiative transfer
Authors: Wardenier Joost P , Parmentier Vivien , Lee Elspeth K H , Line Michael R , Gharib-Nezhad Ehsan
Published: June 2021

Ultra-hot Jupiters are tidally locked gas giants with dayside temperatures high enough to dissociate hydrogen and other molecules. Their atmospheres are vastly non-uniform in terms of chemistry, temperature, and dynamics, and this makes their high-resolution transmission spectra and cross-correlation signal difficult to interpret. In this work, we use the SPARC/MITgcm global circulation model to simulate the atmosphere of the ultra-hot Jupiter WASP-76b under different conditions, such as atmospheric drag and the absence of TiO and VO. We then employ a 3D Monte Carlo radiative transfer code, hires-mcrt, to self-consistently model high-resolution transmission spectra with iron (Fe i) lines at different phases during the transit. To untangle the structure of the resulting cross-correlation map, we decompose the limb of the planet into four sectors, and we analyse each of their contributions separately. Our experiments demonstrate that the cross-correlation signal of an ultra-hot Jupiter is primarily driven by its temperature structure, rotation, and dynamics, while being less sensitive to the precise distribution of iron across the atmosphere. We also show that the previously published iron signal of WASP-76b can be reproduced by a model featuring iron condensation on the leading limb. Alternatively, the signal may be explained by a substantial temperature asymmetry between the trailing and leading limb, where iron condensation is not strictly required to match the data. Finally, we compute the Kp–Vsys maps of the simulated WASP-76b atmospheres, and we show that rotation and dynamics can lead to multiple peaks that are displaced from zero in the planetary rest frame.
Plastic Rewiring of Sef1 Transcriptional Networks and the Potential of Nonfunctional Transcription Factor Binding in Facilitating Adaptive Evolution
Authors: Hsu Po-Chen , Lu Tzu-Chiao , Hung Po-Hsiang , Jhou Yu-Ting , Amine Ahmed A A , Liao Chia-Wei , Leu Jun-Yi
Published: June 2021

Prior and extensive plastic rewiring of a transcriptional network, followed by a functional switch of the conserved transcriptional regulator, can shape the evolution of a new network with diverged functions. The presence of three distinct iron regulatory systems in fungi that use orthologous transcriptional regulators suggests that these systems evolved in that manner. Orthologs of the transcriptional activator Sef1 are believed to be central to how iron regulatory systems developed in fungi, involving gene gain, plastic network rewiring, and switches in regulatory function. We show that, in the protoploid yeast Lachancea kluyveri, plastic rewiring of the L. kluyveri Sef1 (Lk-Sef1) network, together with a functional switch, enabled Lk-Sef1 to regulate TCA cycle genes, unlike Candida albicans Sef1 that mainly regulates iron-uptake genes. Moreover, we observed pervasive nonfunctional binding of Sef1 to its target genes. Enhancing Lk-Sef1 activity resuscitated the corresponding transcriptional network, providing immediate adaptive benefits in changing environments. Our study not only sheds light on the evolution of Sef1-centered transcriptional networks but also shows the adaptive potential of nonfunctional transcription factor binding for evolving phenotypic novelty and diversity.
Adaptive Resistance Mutations at Suprainhibitory Concentrations Independent of SOS Mutagenesis
Authors: Gutiérrez Ricardo , Ram Yoav , Berman Judith , de Sousa Keyla Carstens Marques , Nachum-Biala Yaarit , Britzi Malka , Elad Daniel , Glaser Gad , Covo Shay , Harrus Shimon
Published: June 2021

Emergence of resistant bacteria during antimicrobial treatment is one of the most critical and universal health threats. It is known that several stress-induced mutagenesis and heteroresistance mechanisms can enhance microbial adaptation to antibiotics. Here, we demonstrate that the pathogen Bartonella can undergo stress-induced mutagenesis despite the fact it lacks error-prone polymerases, the rpoS gene and functional UV-induced mutagenesis. We demonstrate that Bartonella acquire de novo single mutations during rifampicin exposure at suprainhibitory concentrations at a much higher rate than expected from spontaneous fluctuations. This is while exhibiting a minimal heteroresistance capacity. The emerged resistant mutants acquired a single rpoB mutation, whereas no other mutations were found in their whole genome. Interestingly, the emergence of resistance in Bartonella occurred only during gradual exposure to the antibiotic, indicating that Bartonella sense and react to the changing environment. Using a mathematical model, we demonstrated that, to reproduce the experimental results, mutation rates should be transiently increased over 1,000-folds, and a larger population size or greater heteroresistance capacity is required. RNA expression analysis suggests that the increased mutation rate is due to downregulation of key DNA repair genes (mutS, mutY, and recA), associated with DNA breaks caused by massive prophage inductions. These results provide new evidence of the hazard of antibiotic overuse in medicine and agriculture.
RqcH and RqcP catalyze processive poly-alanine synthesis in a reconstituted ribosome-associated quality control system
Authors: Takada Hiraku , Crowe-McAuliffe Caillan , Polte Christine , Sidorova Zhanna Yu , Murina Victoriia , Atkinson Gemma C , Konevega Andrey L , Ignatova Zoya , Wilson Daniel N , Hauryliuk Vasili
Published: June 2021

In the cell, stalled ribosomes are rescued through ribosome-associated protein quality-control (RQC) pathways. After splitting of the stalled ribosome, a C-terminal polyalanine ‘tail’ is added to the unfinished polypeptide attached to the tRNA on the 50S ribosomal subunit. In Bacillus subtilis, polyalanine tailing is catalyzed by the NEMF family protein RqcH, in cooperation with RqcP. However, the mechanistic details of this process remain unclear. Here we demonstrate that RqcH is responsible for tRNAAla selection during RQC elongation, whereas RqcP lacks any tRNA specificity. The ribosomal protein uL11 is crucial for RqcH, but not RqcP, recruitment to the 50S subunit, and B. subtilis lacking uL11 are RQC-deficient. Through mutational mapping, we identify critical residues within RqcH and RqcP that are important for interaction with the P-site tRNA and/or the 50S subunit. Additionally, we have reconstituted polyalanine-tailing in vitro and can demonstrate that RqcH and RqcP are necessary and sufficient for processivity in a minimal system. Moreover, the in vitro reconstituted system recapitulates our in vivo findings by reproducing the importance of conserved residues of RqcH and RqcP for functionality. Collectively, our findings provide mechanistic insight into the role of RqcH and RqcP in the bacterial RQC pathway.
Single molecule analysis indicates stimulation of MUTYH by UV-DDB through enzyme turnover
Authors: Jang Sunbok , Schaich Matthew A , Khuu Cindy , Schnable Brittani L , Majumdar Chandrima , Watkins Simon C , David Sheila S , Van Houten Bennett
Published: June 2021

The oxidative base damage, 8-oxo-7,8-dihydroguanine (8-oxoG) is a highly mutagenic lesion because replicative DNA polymerases insert adenine (A) opposite 8-oxoG. In mammalian cells, the removal of A incorporated across from 8-oxoG is mediated by the glycosylase MUTYH during base excision repair (BER). After A excision, MUTYH binds avidly to the abasic site and is thus product inhibited. We have previously reported that UV-DDB plays a non-canonical role in BER during the removal of 8-oxoG by 8-oxoG glycosylase, OGG1 and presented preliminary data that UV-DDB can also increase MUTYH activity. In this present study we examine the mechanism of how UV-DDB stimulates MUTYH. Bulk kinetic assays show that UV-DDB can stimulate the turnover rate of MUTYH excision of A across from 8-oxoG by 4–5-fold. Electrophoretic mobility shift assays and atomic force microscopy suggest transient complex formation between MUTYH and UV-DDB, which displaces MUTYH from abasic sites. Using single molecule fluorescence analysis of MUTYH bound to abasic sites, we show that UV-DDB interacts directly with MUTYH and increases the mobility and dissociation rate of MUTYH. UV-DDB decreases MUTYH half-life on abasic sites in DNA from 8800 to 590 seconds. Together these data suggest that UV-DDB facilitates productive turnover of MUTYH at abasic sites during 8-oxoG:A repair.
SNO and EANO practice guideline update: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors
Authors: Walbert Tobias , Harrison Rebecca A , Schiff David , Avila Edward K , Chen Merry , Kandula Padmaja , Lee Jong Woo , Le Rhun Emilie , Stevens Glen H J , Vogelbaum Michael A , Wick Wolfgang , Weller Michael , Wen Patrick Y , Gerstner Elizabeth R
Published: June 2021

Objective

To update the 2000 American Academy of Neurology (AAN) practice parameter on anticonvulsant prophylaxis in patients with newly diagnosed brain tumors.

Methods

Following the 2017 AAN methodologies, a systematic literature review utilizing PubMed, EMBASE Library, Cochrane, and Web of Science databases was performed. The studies were rated based on the AAN therapeutic or causation classification of evidence (class I-IV).

Results

Thirty-seven articles were selected for final analysis. There were limited high-level, class I studies and mostly class II and III studies. The AAN affirmed the value of these guidelines.

Recommendations

In patients with newly diagnosed brain tumors who have not had a seizure, clinicians should not prescribe antiepileptic drugs (AEDs) to reduce the risk of seizures (level A). In brain tumor patients undergoing surgery, there is insufficient evidence to recommend prescribing AEDs to reduce the risk of seizures in the peri- or postoperative period (level C). There is insufficient evidence to support prescribing valproic acid or levetiracetam with the intent to prolong progression-free or overall survival (level C). Physicians may consider the use of levetiracetam over older AEDs to reduce side effects (level C). There is insufficient evidence to support using tumor location, histology, grade, molecular/imaging features when deciding whether or not to prescribe prophylactic AEDs (level U).
Description of the ‘pronation manoeuvre’ for the diagnosis of developmental hip dysplasia
Authors: de-la-Garza-Salazar José Fernando , Rodríguez-de-Ita Julieta , Garza-Ornelas Bárbara M , Martínez-Cardona Jorge A
Published: June 2021

Introduction

Without a prompt diagnosis, developmental dysplasia of the hip (DDH) in infants can lead to severe sequelae. Current screening strategies emphasize the use of Ortolani and Barlow physical examination manoeuvres, yet they exhibit low sensitivity. The purpose of this study is to evaluate the performance of a new physical examination tool (the pronation manoeuvre) as a screening tool for DDH.

Methods

To evaluate the new manoeuvre, a cross-sectional and analytic study was performed with a nonprobabilistic sampling method. Patients with either a positive Ortolani or Barlow manoeuver were evaluated with the new manoeuvre and hip ultrasound. Controls were infants with negative Ortolani, Barlow and pronation manoeuvres and also had ultrasound performed.

Results

DDH was confirmed in 83 of 130 cases (64%) and 2 of 130 controls (2%). The new pronation manoeuvre had a sensitivity of 76% and a specificity of 94% as compared to the Ortolani and Barlow manoeuvres (sensitivity 31 to 32%, specificity 93 to 100%) (P<0.05).

Conclusion

This new physical examination manoeuvre could serve as another clinical tool for the initial screening of DDH in newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with DDH.
Resources for image-based high-throughput phenotyping in crops and data sharing challenges
Authors: Danilevicz Monica F. , Bayer Philipp E. , Nestor Benjamin J. , Bennamoun Mohammed , Edwards David
Published: June 2021

High-throughput phenotyping (HTP) platforms are capable of monitoring the phenotypic variation of plants through multiple types of sensors, such as red green and blue (RGB) cameras, hyperspectral sensors, and computed tomography, which can be associated with environmental and genotypic data. Because of the wide range of information provided, HTP datasets represent a valuable asset to characterize crop phenotypes. As HTP becomes widely employed with more tools and data being released, it is important that researchers are aware of these resources and how they can be applied to accelerate crop improvement. Researchers may exploit these datasets either for phenotype comparison or employ them as a benchmark to assess tool performance and to support the development of tools that are better at generalizing between different crops and environments. In this review, we describe the use of image-based HTP for yield prediction, root phenotyping, development of climate-resilient crops, detecting pathogen and pest infestation, and quantitative trait measurement. We emphasize the need for researchers to share phenotypic data, and offer a comprehensive list of available datasets to assist crop breeders and tool developers to leverage these resources in order to accelerate crop breeding.
Confirmation of interpersonal expectations is intrinsically rewarding
Authors: Reggev Niv , Chowdhary Anoushka , Mitchell Jason P
Published: June 2021

People want to interact successfully with other individuals, and they invest significant efforts in attempting to do so. Decades of research have demonstrated that to simplify the dauntingly complex task of interpersonal communication, perceivers predict the responses of individuals in their environment using stereotypes and other sources of prior knowledge. Here, we show that these top-down expectations can also shape the subjective value of expectation-consistent and expectation-violating targets. Specifically, in two neuroimaging experiments (n = 58), we observed increased activation in brain regions associated with reward processing—including the nucleus accumbens—when perceivers observed information consistent with their social expectations. In two additional behavioral experiments (n = 704), we observed that perceivers were willing to forgo money to encounter an expectation-consistent target and avoid an expectation-violating target. Together, these findings suggest that perceivers value having their social expectations confirmed, much like food or monetary rewards.
Which drug is best for a patient with type 2 diabetes and heart failure?
Authors: Clawson Rebecca , Weidman-Evans Emily , Fort Ashley
Published: June 2021

Heart failure is twice as common in men with type 2 diabetes than those without it and is almost five times greater in women with diabetes. Ideally, effective treatment for one condition also will help with the other; certainly, clinicians should not prescribe a medication that will potentially worsen one of the conditions, if avoiding it is at all possible. This article reviews the effects of diabetes medications on heart failure outcomes.
Evaluation of the returning traveler with fever and neurologic symptoms
Authors: Garcia Alison M. , Watkins Elyse
Published: June 2021

Exposure to infectious disease increases in tandem with international travel rates. Globally, up to 70% of travelers to developing countries report health problems while traveling, most being self-limiting. Few travelers are ill enough to seek medical care while abroad or upon returning home. Although fever is one of the more common symptoms in these travelers, little attention has been paid to those who return with fever and neurologic symptoms. This article describes conditions that can present with fever and neurologic changes and how to evaluate patients in a timely manner to prevent progression of neural dysfunction and spread of disease in local communities.
Enhancing the Relevance and Use of Information Literacy in Future Nurse Educators
Authors: Matthias April D. , Scott Melissa D. , Ivins Tammy , Osinski John
Published: June 2021

Nurse educators require information literacy (IL) to use evidence-based practices to design, develop, deliver, and evaluate education; to participate in research and scholarship of teaching and learning; and to disseminate new practices and evidence to the nursing education community. A needs assessment of students and faculty revealed knowledge deficits with IL for master of science in nursing-nurse educator students. A multidisciplinary team, guided by relevant theories, created an online applied learning and reflective tutorial to address the identified needs. Evaluation of students’ participation indicated the tutorial served as an engaging resource and provided foundational knowledge of IL skills.
A Training Simulator for Fractional Dilation and Curettage With Visualized Force-Position Feedback and Quantitative Evaluation
Authors: Zheng Yijia , Wang Kaile , Zhang Kai , An Jian , Wu Junjie , Feng Zhiheng , Liu Chunlan , Wang Jianliu , Lu Qun , Zhang Jue
Published: June 2021

BACKGROUND:

Dilation and curettage (D&C) is a basic, but important procedure with many applications in obstetrics and gynecology. Fractional D&C provides comprehensive sampling of the endocervix and subsequently the uterus. This study designs and validates a novel fractional D&C training simulator visualizing the intrauterine operation in real time and quantitatively assessing technical skills.

METHOD:

The fractional D&C training simulator, consisting of measurement hardware and visual software, can display the curette tip's trajectory and force in the uterus in real time. The simulator also presents assessment indices (the cervical coverage index, cervical overlap index, uterine coverage index, uterine overlap index) to indicate the completion degree and quality of surgical performance.

EXPERIENCE:

Seventy-five participants with three levels of D&C experience, including 26 novices, 24 intermediates, and 25 experts, were recruited to perform fractional D&C using the training simulator and asked to fill in a postprocedure questionnaire. All assessment indices of the novices were significantly lower than those of experienced surgeons (experts and intermediates) (P<.05). The simulator was highly regarded as a teaching tool and identified frequent areas of incomplete curettage even by experienced surgeons.

CONCLUSION:

The fractional D&C training simulator provides valuable visualized force-position feedback and quantitative evaluation and may be beneficial for surgical training.
Cochrane Review Summaries—July 2021
Authors: Minalt Nicole , Haas David M. , Jahanfar Shayesteh , Scifres Christina M.
Published: June 2021

In this month’s issue, the journal continues to bring new insights from Cochrane systematic reviews to the readers of Obstetrics & Gynecology. This month, we highlight the use of intrauterine progestins for the treatment of endometrial hyperplasia and an overview review of interventions to prevent gestational diabetes. The summaries are published below. The complete references with hyperlinks are listed in Box 1.
Esophageal Achalasia Induced by Ipilimumab and Nivolumab Combination: A Rare Neurological Manifestation of Immune-related Autonomic Neuropathy
Authors: Montes Gaëlle , Duval Fanny , Eldani Céline , Amico Séverine , Gérard Emilie , Dutriaux Caroline , Herran Cécile , Poullenot Florian , Sole Guilhem , Carla Louis , Guerin Clémence , Célerier Philippe , Prey Sorilla
Published: June 2021

Immunotherapy with immune checkpoint inhibitors (ICIs) has improved the prognosis of many cancers; a combination of nivolumab (anti–programmed cell death protein 1) and ipilimumab (anti–cytotoxic T-lymphocyte–associated protein 4) is approved as first-line therapy for advanced melanoma, with objective responses obtained in more than half of patients. However, this combination is associated with a high rate of immune-related adverse events, which are often severe and multiple. Neurological immune-related adverse events are rare but feared because they can be life-threatening, their diagnosis and management are challenging, and patients can have irreversible sequelae. We reported a case of a young patient treated by nivolumab and ipilimumab combination for metastatic melanoma. Severe dysphagia with regurgitations, major weight loss, uveitis, and vitiligo occurred after 3 infusions of nivolumab and ipilimumab. Magnetic resonance imaging and positron emission tomography scan showed complete remission of melanoma. The endoscopic examination did not find any digestive toxicity. Esophageal manometry revealed achalasia. This was associated with mydriasis, pathologic deep breath test, and alteration of the cutaneous sympathetic response on electromyogram, which was consistent with autonomic neuropathy. This rare etiology of atypical vomiting under ICI should be known by prescribers, as ICI prescription is widening in many new cancers.
Circ_0010283/miR-377-3p/Cyclin D1 Axis Is Associated With Proliferation, Apoptosis, Migration, and Inflammation of Oxidized Low-density Lipoprotein-Stimulated Vascular Smooth Muscle Cells
Authors: Zhang Pu , Wang Weiping , Li Meilan
Published: June 2021

Circular RNAs have been reported as vital regulators and promising therapeutic targets in multiple human diseases, including atherosclerosis (AS). However, the functional roles of circ_0010283 in AS remain unclear. The real-time quantitative polymerase chain reaction was used to determine the expression levels of circ_0010283, microRNA (miR)-377-3p, and cyclin D1 (CCND1) in serum samples. The vascular smooth muscle cells (VSMCs) were treated with oxidized low-density lipoprotein (ox-LDL) to establish the in vitro cell model of AS. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazol-3-ium bromide and clonal colony-forming assays were performed to assess cell proliferation. The apoptosis was determined by flow cytometry assay. The migration of VSMCs was examined by wound healing and transwell assays. Western blot analysis was used to quantify protein expression. The association among circ_0010283, miR-377-3p, and CCND1 was confirmed by dual-luciferase reporter assay. We found that the serum level of circ_0010283 was upregulated in patients with AS and treatment with ox-LDL also increased the expression of circ_0010283 in VSMCs. Treatment with ox-LDL also increased proliferation, migration, and inflammation while inhibited apoptosis in VSMCs, which was overturned by silencing of circ_0010283. Moreover, miR-377-3p was a target of circ_0010283, and downregulation of miR-377-3p counteracted circ_0010283 silencing-induced effects on ox-LDL–stimulated VSMCs. The overexpression of miR-377-3p inhibited proliferation, migration, and inflammation while induced apoptosis of VSMCs by targeting CCND1. CCND1 was a target of miR-377-3p, and circ_0010283 acted as the miR-377-3p sponge to increase CCND1 expression. Circ_0010283 regulated proliferation, apoptosis, migration, and inflammation of ox-LDL–stimulated VSMCs through modulating miR-377-3p and CCND1.
A decision tree analysis on multiple factors related to menopausal symptoms
Authors: Im Eun-Ok , Yi Jee-Seon , Chee Wonshik
Published: June 2021

Objectives:

The purpose of this study was to examine the specific characteristics that were directly linked to menopausal symptoms of midlife women from four major racial/ethnic groups in the United States using a decision tree analysis.

Methods:

This was a secondary analysis of the data from 1,027 midlife women from 2 larger Internet-based studies. The parent studies used the Midlife Women's Symptom Index with multiple questions on background characteristics and health and menopausal status. The data were analyzed using ANOVA and decision tree analyses.

Results:

Across all the racial/ethnic groups, menopausal stage and country of birth were significantly related to the total number and total severity scores of menopausal symptoms (P < 0.001). In each racial/ethnic group, different combined characteristics of the participants were closely linked to the total number and total severity scores of menopausal symptoms (P < 0.05). For instance, in African Americans, the total severity scores of menopausal symptoms increased among those who were postmenopausal (P < 0.001), US born (P < 0.001), and with low family income (P = 0.030).

Conclusions:

Specific risk groups by the combined characteristics need to be considered in future practice with midlife women.
Preseptal Versus Orbital Cellulitis in Children: An Observational Study
Authors: Miranda-Barrios Javier , Bravo-Queipo-de-Llano Blanca , Baquero-Artigao Fernando , Granados-Fernandez María , Noval Susana , Rabanal Ignacio , Méndez-Echevarría Ana , del Rosal Teresa , Sainz Talía , Aracil Javier , Calvo Cristina
Published: June 2021

Background:

Preseptal and orbital cellulitis are two types of infection surrounding the orbital septum with very different potential outcomes. Our aim was to describe key differential features of both conditions, laying special emphasis on diagnostic and therapeutic tools.

Methods:

A retrospective review of patients admitted to a tertiary hospital over a 15-year period (January 2004–October 2019) was conducted. We included 198 patients with preseptal and 45 with orbital cellulitis. Descriptive statistics were performed to examine the available information.

Results:

Statistically significant differences were found between patients with preseptal and orbital cellulitis regarding age (3.9 ± 2.14 vs. 7.5 ± 4.24 years), presence of fever (51.5% vs. 82.2%), and preexisting sinusitis (2% vs. 77.8%) (all P < 0.001). Diplopia, ophthalmoplegia and proptosis were only present in orbital cellulitis (P < 0.001). Median values of C-reactive protein were significantly higher among children with orbital involvement [136.35 mg/L (IQR 74.08–168.98) vs. 17.85 (IQR 6.33–50.10), P < 0.0001]. A CRP>120 mg/L cut-off point for orbital cellulitis was obtained. Early CT scans were performed in 75.6% of suspected orbital cellulitis and helped detecting complications at an early stage. Abscesses were revealed in 70.6% of cases, especially medial subperiosteal abscesses (58.8%). All patients received intravenous antibiotics, whereas corticosteroids were preferred in patients with orbital implication (8.6% vs. 73.3%, P < 0.001). Only 26.7% of patients required additional surgery.

Conclusions:

Clinical presentation and CRP are extremely sensitive for differential diagnosis of preseptal and orbital cellulitis. Prompt initiation of intravenous antibiotics is mandatory and can prevent surgical procedures even in cases with incipient abscesses.
Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy
Authors: Verhoeven Roel L.J. , van der Sterren William , Kong Wens , Langereis Sander , van der Tol Pieternel , van der Heijden Erik H.F.M.
Published: June 2021

Background:

The endobronchial diagnosis of peripheral lung lesions suspected of lung cancer remains a challenge from a navigation as well as an adequate tissue sampling perspective. Cone-beam computed tomography (CBCT) guidance is a relatively new technology and allows for 3-dimensional imaging confirmation as well as navigation and biopsy guidance, but, also involves radiation. This study investigates how radiation exposure and diagnostic accuracy in the CBCT-guided navigation bronchoscopy evolves with increasing experience, and, with a specific tailoring of CBCT and fluoroscopic imaging protocols towards the procedure.

Patients and Methods:

In this observational clinical trial, all 238 consecutive patients undergoing a CBCT-guided navigation bronchoscopy from the start of our CBCT-guided navigation bronchoscopy program (December 2017) until June 2020 were included. Procedural dose characteristics and diagnostic accuracy are reported as a function of time.

Results:

Procedural radiation exposure as measured by the dose area product initially was 47.5 Gy·cm2 (effective dose: 14.3 mSv) and gradually reduced to 25.4 Gy·cm2 (5.8 mSv). The reduction in fluoroscopic dose area product was highest, from 19.0 Gy·cm2 (5.2 mSv) to 2.2 Gy·cm2 (0.37 mSv, 88% reduction), despite a significant increase of fluoroscopy time. The diagnostic accuracy of navigation bronchoscopy increased from 72% to 90%.

Conclusion:

A significant learning effect can be seen in the radiation safety and diagnostic accuracy of a CBCT-guided and augmented fluoroscopy–guided navigation bronchoscopy. With increasing experience and tailoring of imaging protocols to the procedure, the procedural accuracy improved, while the effective dose for patients and staff was reduced.
Will Improvements in Patient Experience With Care Impact Clinical and Quality of Care Outcomes?
Authors: Navarro Stephanie , Ochoa Carol Y. , Chan Emily , Du Senxi , Farias Albert J.
Published: June 2021

Background:

Patient experiences with health care have been widely used as benchmark indicators of quality for providers, health care practices, and health plans.

Objective:

The objective of this study was to summarize the literature regarding the associations between Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experiences and clinical and quality outcomes.

Research Design:

A systematic review of the literature was completed using PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature on December 14, 2019. Separate searches were conducted to query terms identifying CAHPS surveys with clinical and quality outcomes of care. Two reviewers completed all components of the search process.

Study Selection:

Studies investigating associations between CAHPS composite ratings and health care sensitive clinical outcomes or quality measures of care were included in this review. Studies were excluded if they did not investigate patient experiences using CAHPS composite ratings or if CAHPS composites were not treated as the independent variable.

Results:

Nineteen studies met inclusion criteria, 10 investigating associations of CAHPS composite ratings with clinical outcomes and 9 investigating these associations with quality measures. Patient-provider communication was the most studied CAHPS composite rating and was significantly associated with self-reported physical and mental health, frequency of emergency room visits and inpatient hospital stays, hospitalization length, and CAHPS personal physician global ratings.

Conclusions:

Ratings of patient experience with care may influence clinical and quality outcomes of care. However, key inconsistencies between studies affirm that more research is needed to solidify this conclusion and investigate how patient experiences differentially relate to outcomes for various patient groups.
Continuity of Nursing Care in Home Health
Authors: Ma Chenjuan , McDonald Margaret V. , Feldman Penny H. , Miner Sarah , Jones Simon , Squires Allison
Published: June 2021

Background:

Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality.

Objective:

The objective of this study was to examine the association between continuity of nursing care in HHC and rehospitalization among PWD.

Research Design:

This is a retrospective cohort study using multiple years (2010−2015) of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency.

Subjects:

This study included 23,886 PWD receiving HHC following a hospitalization.

Measures:

Continuity of nursing care was calculated using the Bice and Boxerman method, which considered the number of total visits, nurses, and visits from each nurse during an HHC episode. The outcome was all-cause rehospitalization during HHC. Risk-adjusted logistic regression was used for analysis.

Results:

Approximately 24% of PWD were rehospitalized. The mean continuity of nursing care score was 0.56 (SD=0.33). Eight percent of PWD received each nursing visit from a different nurse (no continuity), and 26% received all visits from one nurse during an HHC episode (full continuity). Compared with those receiving high continuity of nursing care (third tertile), PWD receiving low (first tertile) or moderate (second tertile) continuity of nursing care had an adjusted odds ratio of 1.33 (95% confidence interval: 1.25−1.46) and 1.30 (95% confidence interval: 1.22−1.43), respectively, for being rehospitalized.

Conclusions:

Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
Narrative Analysis of Childbearing Experiences During the COVID-19 Pandemic
Authors: Ajayi Kobi V. , Harvey Idethia S. , Panjwani Sonya , Uwak Inyang , Garney Whitney , Page Robin L.
Published: June 2021

Purpose:

The COVID-19 pandemic has disrupted health care delivery and services around the world causing rapid changes to maternity care protocols and pregnant women to give birth with tight restrictions and significant uncertainties. There is a gap in evidence about expectant and new mothers' experiences with birthing during the pandemic. We sought to describe and understand pregnant and new mothers' lived experiences during the COVID-19 pandemic using authentic birth stories.

Study Design and Methods:

Using a narrative analysis framework, we extracted relevant YouTube birth stories using predetermined search terms and inclusion criteria. Mothers' birth stories were narrated in their second or third trimester or those who had recently given birth during the pandemic. Birth stories were analyzed using an inductive and deductive approach to capture different and salient aspects of the birthing experience.

Results:

N = 83 birth stories were analyzed. Within these birth stories, four broad themes and 13 subthemes were identified. Key themes included a sense of loss, hospital experiences, experiences with health care providers, and unique experiences during birth and postpartum. The birth stories revealed that the COVID-19 pandemic brought unexpected circumstances, both positive and negative, that had an impact on mothers' overall birthing experience.

Clinical Implications:

Results provided a detailed description of women's lived experience with giving birth during the COVID-19 pandemic. Maternity nurses should try to provide clear communication and compassionate patient-centered care to relieve women's anxieties about uncertain and unpredictable policy changes on COVID-19 as the pandemic continues to evolve.
Large Ovarian Follicle Cyst: Benign Mimic of Cystic Adult Granulosa Cell Tumor
Authors: McMullen Emily R. , Huang Tao , Skala Stephanie L.
Published: June 2021

While most ovarian follicle cysts are <8 cm in greatest dimension, much larger follicle cysts (up to 18.5 cm) have been reported. To our knowledge, the FOXL2 mutation status of such cases has not been documented in the literature. Here, we report the features of a 14 cm ovarian cyst with no FOXL2 mutation detected by targeted next-generation sequencing. While adult granulosa cell tumor was the chief entity in our differential diagnosis, the absence of convincing nuclear grooves, lack of architectural variability, presence of a theca layer, and absence of FOXL2 mutation were consistent with a diagnosis of ovarian follicle cyst.
A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project
Authors: Patel *Hetal K. , Duong *Yen T. , Birhanu Sehin , Dobbs Trudy , Lupoli Kathryn , Moore Carole , Detorio Mervi , Sleeman Katrina , Manjengwa Julius , Wray-Gordon Floris , Yavo Daniel , Jackson Keisha , Domaoal Robert A. , Yufenyuy Ernest L. , Vedapuri Shanmugam , Ndongmo Clement B. , Ogollah Francis M. , Dzinamarira Tafadzwa , Rubinstein Paul , Sachathep Karampreet K. , Metz Melissa , Longwe Herbert , Saito Suzue , Brown Kristin , Voetsch Andrew C. , Parekh Bharat S.
Published: June 2021

Background:

Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys.

Methods:

Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results.

Results:

Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160–387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing.

Conclusions:

Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
Data Architecture to Support Real-Time Data Analytics for the Population-Based HIV Impact Assessments
Authors: Metz Melissa , Smith Rebecca , Mitchell Rick , Duong Yen T. , Brown Kristin , Kinchen Steve , Lee Kiwon , Ogollah Francis M. , Dzinamarira Tafadzwa , Maliwa Vusumuzi , Moore Carole , Patel Hetal , Chung Hannah , Mtengo Helecks , Saito Suzue
Published: June 2021

Background and Setting:

Electronic data capture facilitates timely use of data. Population-based HIV impact assessments (PHIAs) were led by host governments, with funding from the President's Emergency Plan for AIDS Relief, technical assistance from the Centers for Disease Control, and implementation support from ICAP at Columbia University. We described data architectures, code-based processes, and resulting data volume and quality for 14 national PHIA surveys with concurrent timelines and varied country-level data governance (2015–2020).

Methods:

PHIA project data were collected through tablets, point-of-care and laboratory testing instruments, and inventory management systems, using open-source software, vendor solutions, and custom-built software. Data were securely uploaded to the PHIA data warehouse daily or weekly and then used to populate survey-monitoring dashboards and return timely laboratory-based test results on an ongoing basis. Automated data processing allowed timely reporting of survey results.

Results:

Fourteen data architectures were successfully established, and data from more than 450,000 participants in 30,000 files across 13 countries with completed PHIAs, and blood draws producing approximately 6000 aliquots each week per country, were securely collected, transmitted, and processed by 17 full-time equivalent staff. More than 25,600 viral load results were returned to clinics of participants' choice. Data cleaning was not needed for 98.5% of household and 99.2% of individual questionnaires.

Conclusion:

The PHIA data architecture permitted secure, simultaneous collection and transmission of high-quality interview and biomarker data across multiple countries, quick turnaround time of laboratory-based biomarker results, and rapid dissemination of survey outcomes to guide President's Emergency Plan for AIDS Relief epidemic control.
Postoperative Outcomes of Closed Versus Nonclosed Mesentery Laparoscopic Colectomy: A Retrospective Single-center Study
Authors: Nitta Takeo , Ebihara Yuma , Hirano Satoshi
Published: June 2021

Purpose:

This study aimed to clarify the clinical significance of closing the mesenteric defect in laparoscopic colectomy.

Materials and Methods:

We retrospectively evaluated 369 patients who underwent left-sided or right-sided resection via laparoscopic colectomy at our institute. Patients were stratified by open versus closed handling of the mesenteric defect. The perioperative clinical factors, surgical maneuvers, and postoperative complications were statistically analyzed.

Results:

No significant intergroup differences were found in the perioperative clinical factors or surgical maneuvers except for number of days to the first soft diet (P=0.0214) and postoperative complications (P=0.0379). Among the postoperative complications, only ileus occurred more frequently in the closed group than in the open group (P=0.0227).

Conclusions:

This study revealed that closure of the mesenteric defect following laparoscopic colectomy might be associated with an increased incidence of postoperative ileus.