bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent Community-Acquired Bacterial Meningitis in Adults
Authors: ter Horst Liora , Brouwer Matthijs C , van der Ende Arie , van de Beek Diederik
Published: October 2020

Background

Recurrent bacterial meningitis has been found to occur in about 5% of meningitis cases.

Methods

We analyzed adults with recurrent episodes in a prospective nationwide cohort study of community-acquired bacterial meningitis.

Results

Of 2264 episodes of community-acquired bacterial meningitis between 2006 and 2018, 143 (6%) were identified as recurrent episodes in 123 patients. The median age was 57 years (interquartile range [IQR], 43–66), and 57 episodes (46%) occurred in men. The median duration between the first and the current episode was 5 years (IQR, 1–15). For 82 of 123 patients (67%), it was the first recurrent episode, 31 patients had 2–5 previous episodes (25%), 2 had 6–10 episodes (2%), and 2 had >10 episodes (2%). Predisposing factors were identified in 87 of 118 patients (74%) and most commonly consisted of ear or sinus infections (43 of 120, 36%) and cerebrospinal fluid leakage (37 of 116, 32%). The most common pathogens were Streptococcus pneumoniae (93 of 143, 65%) and Haemophilus influenzae (19 of 143, 13%). The outcome was unfavorable (Glasgow outcome scale score, <5) in 24 episodes with recurrent meningitis (17%) vs 810 for nonrecurrent meningitis patients (39%, P < .001). Six of 143 died (4%) vs 362 of 2095 patients (17%, P < .001).

Conclusions

Recurrent meningitis occurs mainly in patients with ear or sinus infections and cerebrospinal fluid leakage. Predominant causative pathogens are S. pneumoniae and H. influenzae. The disease course is less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients.
Double trouble – thyro-pericarditis: rare presentation of Graves’ disease as pericarditis—a case report
Authors: Gondal Mohsin , Hussain Ali , Yousuf Hira , Haider Zahra
Published: October 2020

Background

Acute pericarditis is frequently encountered in clinical practice; however, pericarditis as the first presentation of Graves' disease is rare and mainly limited to case reports in the literature. We hereby report a case in which a young patient presented with pericarditis as the first manifestation of Graves’ disease.

Case summary

A 24-year-old male was admitted to hospital with presenting complaint of left-sided chest pain, gradual in onset, 6/10 in intensity, sharp in character, increased by deep breathing and improved by leaning forward. Patient also gave a history of insomnia, unintentional weight loss despite a good appetite, heat intolerance, and anxiety. On clinical examination, the patient had features of thyrotoxicosis, i.e., tachycardia, high volume pulse, and sweaty palms with fine tremors. There was no associated pericardial rub. Neck examination shows diffuse, non-tender goitre. Electrocardiogram findings were consistent with acute pericarditis. His thyroid function tests demonstrated hyperthyroidism and anti-thyroglobulin antibodies were also significantly elevated. Echocardiogram showed preserved left ventricular systolic function and a small global pericardial effusion without any signs of tamponade. He was diagnosed with Graves’ disease revealing itself as pericarditis and was started on ibuprofen, beta-blockers, and carbimazole. Patient had marked clinical and biochemical improvement on 3 monthly follow-ups.

Discussion

Thyro-pericarditis is a rare entity, and limited literature is available regarding this combination. The exact aetiology of Graves associated pericarditis is unknown. There is a possibility of interaction of autoantibodies with receptors on pericardium. Diagnosis is based on a detailed history, clinical examination, supplemented by relevant investigations (elevated free T4 and thyroid receptor antibodies, suppressed thyroid stimulating hormone (TSH) and Imaging via ultrasound). Mainstay of treatment includes non-steroidal anti-inflammatory drugs, beta-blockers, and anti-thyroidal medications.
Genetic association and characterization ofFSTL5in isolated clubfoot
Authors: Khanshour Anas M , Kidane Yared H , Kozlitina Julia , Cornelia Reuel , Rafipay Alexandra , De Mello Vanessa , Weston Mitchell , Paria Nandina , Khalid Aysha , Hecht Jacqueline T , Dobbs Matthew B , Richards B Stephens , Vargesson Neil , Hamra F Kent , Wilson Megan , Wise Carol , Gurnett Christina A , Rios Jonathan J
Published: October 2020

Talipes equinovarus (clubfoot, TEV) is a congenital rotational foot deformity occurring in 1 per 1000 births with increased prevalence in males compared with females. The genetic etiology of isolated clubfoot (iTEV) remains unclear. Using a genome-wide association study, we identified a locus within FSTL5, encoding follistatin-like 5, significantly associated with iTEV. FSTL5 is an uncharacterized gene whose potential role in embryonic and postnatal development was previously unstudied. Utilizing multiple model systems, we found that Fstl5 was expressed during later stages of embryonic hindlimb development, and, in mice, expression was restricted to the condensing cartilage anlage destined to form the limb skeleton. In the postnatal growth plate, Fstl5 was specifically expressed in prehypertrophic chondrocytes. As Fstl5 knockout rats displayed no gross malformations, we engineered a conditional transgenic mouse line (Fstl5LSL) to overexpress Fstl5 in skeletal osteochondroprogenitors. We observed that hindlimbs were slightly shorter and that bone mineral density was reduced in adult male, but not female, Prrx1-cre;Fstl5LSL mice compared with control. No overt clubfoot-like deformity was observed in Prrx1-cre;Fstl5LSL mice, suggesting FSTL5 may function in other cell types to contribute to iTEV pathogenesis. Interrogating published mouse embryonic single-cell expression data showed that Fstl5 was expressed in cell lineage subclusters whose transcriptomes were associated with neural system development. Moreover, our results suggest that lineage-specific expression of the Fstl genes correlates with their divergent roles as modulators of transforming growth factor beta and bone morphogenetic protein signaling. Results from this study associate FSTL5 with iTEV and suggest a potential sexually dimorphic role for Fstl5 in vivo.
The Psychology of Poverty: Evidence from the Field
Authors: Molotsky Adria , Handa Sudhanshu
Published: October 2020

Individuals living in poverty are less likely to save and plan for the future, behaviour traditionally attributed to liquidity constraints and the associated need to address immediate consumption. Recent work on the behavioural consequences of poverty suggests that poverty induces stress and negative affect, which themselves directly influence economic decisions. We test this hypothesis using evaluation data from a national cash transfer program in Malawi in which some eligible households were randomly assigned to receive the transfer before others. We find that cash transfer reduces stress and improves positive affect, and positive affect has a direct effect on economic decisions.
The Vernacular Pulse of Sanskrit: Metre and More in Songs of theGītagovindaandBhāgavata Purāṇa
Authors: Pauwels Heidi
Published: October 2020

This article explores the metrical patterns of Gītagovinda’s songs, to investigate what they reveal about their origin and inspiration, building on previous scholarly research into the vernacular nature of the songs. Seemingly abstruse, metre lies at the heart of the performative nature of the text, but is often overlooked in a quest for meaning. The article starts with the approach of Sanskrit commentators, focusing on Mahārāṇā Kumbhakarṇa of Mewar’s fifteenth-century Rasikapriyā, interrelating with his theoretical work on music, the Saṃgītarāja. This reveals the problem of the discrepancy between metrical theory, or śāstra, and praxis, or prayoga, problematising the metrical pundits’ focus on classification and static definitions at the expense of rhythmical processes of actual performance. The article proposes an alternative by analysing Gītagovinda’s songs instead through the lens of New Indo-Aryan (NIA) poetry, which significantly enhances appreciation of the poetic craft of the author. Finally, comparison with selected Gopīgītas, or ‘Songs of the Gopīs’, from the ninth-century classic scripture of Krishna devotion, Bhāgavata Purāṇa, reveals parallels in both metre and oral formulae. Reading Gopīgītas in conjunction with Gītagovinda’s songs opens up a new perspective, revealing a vernacular pulse underlying some of the best-known and best-loved Sanskrit literature.
Quantification of the effect of site-specific histone acetylation on chromatin transcription rate
Authors: Wakamori Masatoshi , Okabe Kohki , Ura Kiyoe , Funatsu Takashi , Takinoue Masahiro , Umehara Takashi
Published: October 2020

Eukaryotic transcription is epigenetically regulated by chromatin structure and post-translational modifications (PTMs). For example, lysine acetylation in histone H4 is correlated with activation of RNA polymerase I-, II- and III-driven transcription from chromatin templates, which requires prior chromatin remodeling. However, quantitative understanding of the contribution of particular PTM states to the sequential steps of eukaryotic transcription has been hampered partially because reconstitution of a chromatin template with designed PTMs is difficult. In this study, we reconstituted a di-nucleosome with site-specifically acetylated or unmodified histone H4, which contained two copies of the Xenopus somatic 5S rRNA gene with addition of a unique sequence detectable by hybridization-assisted fluorescence correlation spectroscopy. Using a Xenopus oocyte nuclear extract, we analyzed the time course of accumulation of nascent 5S rRNA-derived transcripts generated on chromatin templates in vitro. Our mathematically described kinetic model and fitting analysis revealed that tetra-acetylation of histone H4 at K5/K8/K12/K16 increases the rate of transcriptionally competent chromatin formation ∼3-fold in comparison with the absence of acetylation. We provide a kinetic model for quantitative evaluation of the contribution of epigenetic modifications to chromatin transcription.
TriTag: an integrative tool to correlate chromatin dynamics and gene expression in living cells
Authors: Xu Haiyue , Wang Junyan , Liang Ying , Fu Yujuan , Li Sihui , Huang Jinghan , Xu Heng , Zou Wei , Chen Baohui
Published: October 2020

A wealth of single-cell imaging studies have contributed novel insights into chromatin organization and gene regulation. However, a comprehensive understanding of spatiotemporal gene regulation requires developing tools to combine multiple monitoring systems in a single study. Here, we report a versatile tag, termed TriTag, which integrates the functional capabilities of CRISPR-Tag (DNA labeling), MS2 aptamer (RNA imaging) and fluorescent protein (protein tracking). Using this tag, we correlate changes in chromatin dynamics with the progression of endogenous gene expression, by recording both transcriptional bursting and protein production. This strategy allows precise measurements of gene expression at single-allele resolution across the cell cycle or in response to stress. TriTag enables capturing an integrated picture of gene expression, thus providing a powerful tool to study transcriptional heterogeneity and regulation.
Assisted peritoneal dialysis and transfer to haemodialysis: a cause-specific analysis with data from the RDPLF
Authors: Lanot Antoine , Bechade Clémence , Boyer Annabel , Ficheux Maxence , Lobbedez Thierry
Published: October 2020

Background

Technique failure, defined as death or transfer to haemodialysis (HD), is a major concern in peritoneal dialysis (PD). Nurse-assisted PD is globally associated with a lower risk of transfer to HD. We aimed to evaluate the association between assisted PD and the risk of the different causes of transfer to HD.

Methods

This was a retrospective study using data from the French Language PD Registry of patients on incident PD from 2006 to 2015. The association between the use of assisted PD and the causes of transfer to HD was evaluated using survival analysis with competing events in unmatched and propensity score-matched cohorts.

Results

The study included 11 093 incident PD patients treated in 123 French PD units. There were 4273 deaths, 3330 transfers to HD and 2210 renal transplantations. The causes of transfer to HD were inadequate dialysis (1283), infection (524), catheter-related problems (334), social issues (250), other causes linked to PD (422), other causes not linked to PD (481) and encapsulating peritoneal sclerosis (6). Nurse-assisted PD patients were older and more comorbid. Assistance by nurse was associated with a higher risk of death [cause-specific hazard ratio (cs-HR) 2.49, 95% confidence interval (CI) 2.26–2.74], but with a lower risk of transfer to HD [subdistributionHR (sd-HR) 0.68, 95% CI 0.62–0.76], especially due to inadequate dialysis (cs-HR 0.83, 95% CI 0.75–0).

Conclusions

The lower risk of transfer to HD associated with nurse assistance should encourage decision makers to launch reimbursement programmes in countries where it is not available.
The Sweet Penance of Music
Authors: Vera Alejandro
Published: October 2020

This book provides a fresh, comprehensive view of the musical life and its cultural context in Santiago, Chile, from its foundation in 1541 to the end of the colonial period, roughly in 1810. Combining the study of archival documents, secondary sources, and music scores, it deals with different aspects of musical life in the cathedral (Chapter 1), convents and monasteries (Chapter 2), private houses (Chapter 3), and public spaces (Chapter 4), considering, as well, the life and function of musicians as crucial agents in the music field (Chapter 5). Despite its focus on a particular city of Latin America, it raises this issue from a broad perspective that explores its links with other urban centers (especially Lima), within the globalizing framework of the colonial system. The idea of music as a “sweet penance,” belonging to a nun harpist in a convent of Santiago at the end of the eighteenth century, gives rise to the consideration of duality as an essential trait of the period and its music.
Size reduction-induced properties modifications of antiferromagnetic dielectric nanocrystalline Ba2NiMO6 (M = W, Te) double perovskites
Authors: Bijelić Jelena , Tatar Dalibor , Sahu Manisha , Jagličić Zvonko , Djerdj Igor
Published: October 2020

The main objective of this work was to synthesize phase pure double perovskites Ba2NiTeO6 (BNTO) and Ba2NiWO6 (BNWO) in nanocrystalline form and to reveal the impact of nanocrystallinity on their magnetic and dielectric properties. The studied double perovskites were synthesized in nanocrystalline form by employing a citrate sol-gel route. A detailed investigation of their structure and properties using X-ray powder diffraction, scanning electron microscopy, Raman spectroscopy technique, energy-dispersive X-ray spectroscopy, SQUID magnetometry and electrical measurements is carefully described. Rietveld refinement of X-ray powder diffraction patterns revealed phase purity of both compounds: BNTO is trigonal (R-3m) while BNWO is cubic (Fm-3m). Raman spectroscopy studies reveal optical phonons that correspond to vibrations of Te6+/W6+O6 octahedra, while scanning electron microscopy images show irregular plate-like nanocrystals. Magnetic property measurements speak in favor of antiferromagnetic order but, in both compounds, size reduction affected their properties. BNTO has Néel temperature (TN) of 10.3 K which is higher than previously reported for its bulk form. Magnetic ground state of BNWO can be explained as canted antiferromagnetism with TN = 48.2 K. Room temperature measurements of dielectric constants at various frequencies suggest that these materials are high-κ dielectrics with low dielectric loss. The Nyquist plot reveals depressed a semicircle arc typical for non-Debye type of relaxation phenomena for BNWO ceramic, whereas for BNTO ceramic an almost straight line of Zʹʹ versus Z' has been observed, indicating its high insulating behavior. To conclude, size-dependent properties of studied double perovskites are discussed, introducing a possibility for implementation in electronic devices.
Frontostriatal Structural Connectivity and Striatal Glutamatergic Levels in Treatment-Resistant Schizophrenia: An Integrative Analysis of DTI and 1H-MRS
Authors: Ochi Ryo , Tarumi Ryosuke , Noda Yoshihiro , Tsugawa Sakiko , Plitman Eric , Wada Masataka , Honda Shiori , Matsushita Karin , Chakravarty M Mallar , Graff Guerrero Ariel , Fujii Shinya , Matsui Mie , Uchida Hiroyuki , Mimura Masaru , Nakajima Shinichiro
Published: October 2020

Given that approximately one-third of patients with schizophrenia do not respond to antipsychotics, different neurobiological bases may underlie treatment resistance in schizophrenia. Previous studies showed that treatment response is associated with both frontostriatal connectivity and glutamatergic neurometabolite levels in the caudate in patients with schizophrenia, which leads to the hypothesis that the relationship between them may be altered, specifically in patients with treatment-resistant schizophrenia (TRS). Employing analyses of covariance and subsequent partial correlation analyses, we compared the relationship between glutamate+glutamine (Glx) levels in the caudate and fractional anisotropy (FA) values in the tract between the dorsolateral prefrontal cortex and caudate in 19 patients with TRS, 20 patients responsive to first-line antipsychotics (FL-Resp), and 19 healthy controls (HCs). TRS was defined by severe positive symptomatology despite first-line antipsychotic treatment. Patients with TRS had lower FA values in the bilateral frontostriatal tracts than patients with FL-Resp and HCs (P < .001), while no group differences were found in caudate Glx levels. There was a significant frontostriatal FA value-by-group interaction on caudate Glx levels (F = 7.37, P = .009). Frontostriatal FA values positively correlated with caudate Glx levels in HCs (r = −.55, P = .028), while they were negatively associated with caudate Glx levels in the TRS group (r = .53, P = .043). Furthermore, in the FL-Resp group, frontostriatal FA values did not significantly correlated with caudate Glx levels. The altered relationship between white matter integrity and the glutamate system in the frontostriatal circuit in the TRS group may reflect the pathophysiology underlying treatment response/resistance in schizophrenia.
Pain in Youth With Sickle Cell Disease
Authors: Alberts Nicole M. , Kang Guolian , Li Chen , Richardson Patricia A. , Hodges Jason , Hankins Jane S. , Klosky James L.
Published: October 2020

Objectives:

Pain is prevalent among youth with sickle cell disease (SCD). However, previous research has been limited by small sample sizes and lacked examinations of developmental differences in pain, which are critical to minimizing the development of chronic pain as youth transition into adulthood. The primary aim of the current study was to compare pain and pain interference across 4 developmental groups in a large sample of youth with SCD. The secondary aim was to identify risk factors for greater pain and pain interference.

Materials and Methods:

Utilizing a cross-sectional study design, the expression and predictors of pain and pain interference were compared across 4 developmental stages: toddlers/preschoolers (2 to 4 y), school-aged children (5 to 7 y), preadolescents (8 to 12 y), and adolescents (13 to 18 y). Participants included 386 youth with SCD and their caregivers.

Results:

Caregiver-reported pain and pain interference and youth-reported pain interference increased across developmental groups and plateaued approaching adolescence (multivariate analyses of varianceP=0.002 for pain andP<0.001 for pain interference). Elevated fatigue, anxiety, and perceived difficulties with pain management were the most robust predictors of higher youth- and caregiver-reported pain (βs ranging from 0.15 to 0.68;P<0.001) and pain interference (βs ranging from 0.18 to 0.64;P<0.001).

Discussion:

Disease and treatment-related variables were not associated with pain. Self-reported pain was elevated in older versus younger developmental groups and was largely linked to anxiety, fatigue, and perceptions of pain management, thus highlighting the modifiable nature of factors influencing pain among youth with SCD.
Investigating the Effects of Cuing Medication Availability on Patient-controlled Analgesia Pump Usage in Pediatric Patients
Authors: Hainsworth Keri R. , Czarnecki Michelle L. , Simpson Pippa M. , Zhang Liyun , Davies William H. , Mueller Devin , Weisman Steven J.
Published: October 2020

Objectives:

The study of patient-controlled analgesia (PCA) behaviors has led to a greater understanding of factors that affect the pain experience. Although PCA behaviors can be influenced by cues to medication availability, no studies have examined the effects of such cues in pediatric populations.

Materials and Methods:

This randomized controlled trial examined patient satisfaction with pain management, PCA behaviors, opioid consumption, and state anxiety in a sample of 125 postsurgical children and adolescents (7 to 17 y). Patients were randomized to a “light” group (lockout period status cued by light on the PCA button) or control group (no cues to medication availability).

Results:

Although cuing did not affect patient satisfaction with pain management (P=0.11), patients in the light group consumed significantly more opioid than those in the control group (adj. P=0.016). This effect was primarily because of children in the light group (median, 0.019; interquartile range, 0.012 to 0.036 mg/kg/h) consuming more opioid than children (12 y or younger) in control group (median, 0.015; interquartile range, 0.006 to 0.025 mg/kg/h) (P=0.007). In contrast to the control group, for patients in the light group, opioid consumption was unrelated to pain and the proportion of patients with a 1:1 injections:attempts ratio was higher (P<0.001) across the study period.

Discussion:

The overall pattern of results suggests that patients in the light group used their PCA in response to the light more than in response to their pain, which likely reflects operant influences on PCA behavior by pediatric patients.
Physical Therapy Interventions for a Patient Requiring Prolonged Intubation Due to Severe COVID-19: A Case Study
Authors: Black Katelyn , Walters Carly
Published: October 2020

There is little published information available to guide the acute care physical therapist in caring for acutely ill patients with COVID-19. Significant debility after prolonged stays in the intensive care unit can make rehabilitation more difficult. In this case, a 54-year-old man spent 1 month on mechanical ventilation before initiating therapies. Despite his poor medical prognosis, intensive therapies were initiated—including cardiopulmonary interventions, therapeutic exercise, and neuromuscular re-education. The patient displayed profound improvement and was able to discharge to an inpatient rehabilitation facility.
Measurement of Free Plasma Concentrations of Beta-Lactam Antibiotics: An Applicability Study in Intensive Care Unit Patients
Authors: Schießer Selina , Hitzenbichler Florian , Kees Martin G. , Kratzer Alexander , Lubnow Matthias , Salzberger Bernd , Kees Frieder , Dorn Christoph
Published: October 2020

Background:

The antibacterial effect of antibiotics is linked to the free drug concentration. This study investigated the applicability of an ultrafiltration method to determine free plasma concentrations of beta-lactam antibiotics in ICU patients.

Methods:

Eligible patients included adult ICU patients treated with ceftazidime (CAZ), meropenem (MEM), piperacillin (PIP)/tazobactam (TAZ), or flucloxacillin (FXN) by continuous infusion. Up to 2 arterial blood samples were drawn at steady state. Patients could be included more than once if they received another antibiotic. Free drug concentrations were determined by high-performance liquid chromatography with ultraviolet detection after ultrafiltration, using a method that maintained physiological conditions (pH 7.4/37°C). Total drug concentrations were determined to calculate the unbound fraction. In a post-hoc analysis, free concentrations were compared with the target value of 4× the epidemiological cut-off value (ECOFF) for Pseudomonas aeruginosa as a worst-case scenario for empirical therapy with CAZ, MEM or PIP/tazobactam and against methicillin-sensitive Staphylococcus aureus for targeted therapy with FXN.

Results:

Fifty different antibiotic treatment periods in 38 patients were evaluated. The concentrations of the antibiotics showed a wide range because of the fixed dosing regimen in a mixed population with variable kidney function. The mean unbound fractions (fu) of CAZ, MEM, and PIP were 102.5%, 98.4%, and 95.7%, with interpatient variability of <6%. The mean fu of FXN was 11.6%, with interpatient variability of 39%. It was observed that 2 of 12 free concentrations of CAZ, 1 of 40 concentrations of MEM, and 11 of 23 concentrations of PIP were below the applied target concentration of 4 × ECOFF for P. aeruginosa. All concentrations of FXN (9 samples from 6 patients) were >8 × ECOFF for methicillin-sensitive Staphylococcus aureus.

Conclusions:

For therapeutic drug monitoring purposes, measuring total or free concentrations of CAZ, MEM, or PIP is seemingly adequate. For highly protein-bound beta-lactams such as FXN, free concentrations should be favored in ICU patients with prevalent hypoalbuminemia.
Characteristics of Liver Functions in Patients With COVID-19 and Construction of a Prognostic Evaluation Decision Model Based on Liver Functions
Authors: Pan Tongtong , Chen Dazhi , Pan Chenwei , Kang Yi , Liu Junping , Su Feifei , Hong Liang , Li Huili , Zhao Hui , Lin Zhuo , Wang Xiaodong , Lin Hongwei , Du Qianjing , Cai Chao , Chen Yongping
Published: October 2020

A number of studies have suggested that coronavirus disease 2019 (COVID-19) can cause liver damage. However, clinical features and outcome of COVID-19 in patients with liver injury remain to be further investigated. In this study, the clinical data of 265 COVID-19 patients admitted to seven tertiary hospitals were collected. Based on a threshold for transaminase or total bilirubin levels at two times the normal upper limit, patients were divided into mild or moderate/severe liver injury groups. Among the 265 patients, 183 patients showed liver injury within 48 hours of admission. Aspartate aminotransferase levels were predominantly elevated in the liver injury group, but albumin levels were reduced. Moreover, fibrinogen and D-dimer were significantly increased. Furthermore, 68% of the patients with moderate/severe liver injury had one or more underlying diseases. Almost half of these patients developed acute respiratory distress syndrome (44%) and secondary infections (46%). These patients showed increased interleukin-6 and interleukin-10 levels and a decrease in PaO2 and the oxygenation index. In addition, levels of alanine aminotransferase, aspartate aminotransferase, and albumin were correlated with the oxygenation index, D-dimer and lymphocyte counts. Furthermore, a novel prognostic assessment model based on liver function was established, which accuracy reached 88% and was able to accurately assess the prognosis of COVID-19 patients.
How Negative Is Culture-Negative Endocarditis in the Presence of a Pacemaker?
Authors: Adjei Paul C.
Published: October 2020

A case report of a 70-year-old man with pacemaker placed for atrial fibrillation in 1999 (generator change in 2016). His illness began 4 months earlier with “hots-and-colds” sensation for which he was admitted to an outside hospital and treated for community-acquired pneumonia for 7 days. Fevers persisted after discharge, and he received a 7-day doxycycline course 1 week later. Persistent fevers led to a second admission at the outside hospital. Infectious workup was negative but transesophageal echocardiography showed mass on pacemaker lead so he was transferred to our hospital. No mass on repeat transesophageal echocardiography (TEE) was seen, so he was discharged as culture-negative endocarditis on a 6-week course of vancomycin and ceftriaxone. New fevers after antibiotics led to another admission. He was found to have a high-grade methicillin-susceptible Staphylococcus aureus bacteremia at this time but still negative TEE. Pacemaker was empirically extracted and was found to be encased in thrombus. Intraoperative TEE with bubble study showed patent foramen ovale with left atrial clot. Lead/thrombus cultures were positive for methicillin-susceptible Staphylococcus aureus and were treated with oxacillin.
Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Status in the Pregnancy
Authors: Sert Umit Yasemin , Engin-Ustun Yaprak , Saygan Sibel , Ozgu-Erdinc A. Seval
Published: October 2020

Background

Infections of hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) are serious health problems worldwide and require more attentive and different management strategies in the pregnancy because of the changes in women and concerns regarding the fetuses. The study aims to determine the prevalence of these infections in the pregnancy.

Methods

Pregnant women from our antenatal clinic who were tested for hepatitis B (HB), hepatitis C (HC) from 2008 to 2018 were recruited from medical records. The prevalence of seropositivity was evaluated.

Results

The prevalence rates of HBsAg, anti-HBs, anti-HCV, and anti-HIV were 1.28%, 30%, 0.18%, and 0.015%, respectively.

Conclusions

In Turkey, the prevalence of hepatitis and HIV was not found as high as endemic regions of the world. It is essential to identify the infection of hepatitis and HIV for the treatment, follow-up, and fetal infection in the pregnancy.
Validity and Reliability of the Turkish Version of the Prosthesis Donning and Doffing Questionnaire for Persons with Transtibial Amputations
Authors: Giray Esra , Eshraghi Arezoo , Gündüz Osman Hakan
Published: October 2020

Introduction

Satisfaction with the donning and doffing procedure of prosthesis is related to the quality of life of individuals with amputation, and it should be assessed to gather information about related challenges, thus forming the basis for possible solutions. This study aimed to investigate the construct validity and reliability of the Turkish version of the Prosthesis Donning and Doffing Questionnaire for individuals with transtibial amputation.

Materials and Methods

After a translation/retranslation process, 30 individuals with transtibial amputation were recruited to evaluate the validity and reliability of the questionnaire. The participants were asked to fill in the Turkish version of the Prosthesis Donning and Doffing Questionnaire, Satisfaction with Prosthesis Survey, and the Nottingham Health Profile. The Prosthesis Donning and Doffing Questionnaire was readministered after 3 days.

Results

Test-retest reliability showed good intraclass correlation coefficient (ICC, 0.739; 95% confidence interval, 0.46–0.87). There was a statistically significant correlation between the Prosthesis Donning and Doffing Questionnaire, the Satisfaction with the Prosthesis Survey (rho = 0.419, P = 0.02), and Nottingham Health Profile (rho = −0.656, P = 0.0001), and its subsets (P < 0.05) showed construct validity.

Conclusions

The Turkish version of the Prosthesis Donning and Doffing Questionnaire is a reliable and valid tool to assess donning and doffing of prostheses for individuals with transtibial amputation.
Pediatric Preparedness of the Emergency Departments
Authors: Ang Peck Har , Chong Shu-Ling , Ong Yong-Kwang Gene , Pek Jen Heng
Published: October 2020

Objectives

Emergency departments (EDs) varied in their preparedness to provide pediatric emergency care, with mortality rates being higher when EDs were unprepared. Guidelines are available to aid EDs in their preparedness. We aimed to determine the preparedness of EDs in our healthcare cluster using the guidelines from the Royal College of Pediatrics and Child Health (RCPCH) and International Federation for Emergency Medicine (IFEM) as references for audit.

Methods

This was a cross-sectional study involving a pediatric ED and 3 general EDs within a healthcare cluster. A survey was completed by a pediatric representative at each ED who assessed his/her own ED's effort against each recommended standard with reference to calendar year of 2018. The availability of pediatric equipment, supplies, and medications was checked against the items recommended list by the IFEM.

Results

The response rate was 100%. The proportion of agreement with reference standards was lower for general EDs (RCPCH: 11.4%–70.0% and IFEM: 39.6%–84.0%) than pediatric ED (RCPCH: 85.7% and IFEM: 91.7%). Unmet standards were predominantly in the categories of management of pediatric patients with complex medical needs, management of pediatric death, adolescents, mental health and substance misuse, protection and safeguarding of pediatric patients, as well as advanced training and research. The proportion of available equipment, supplies, and medications was also lower for general EDs (77.2%–82.0%) than pediatric ED (89.4%).

Conclusions

The standards of pediatric emergency care were met to different extents in the healthcare cluster. Using available references, EDs should identify lapses unique to their own settings to improve the delivery of pediatric emergency care.
The aerobic mitochondrial ATP synthesis from a comprehensive point of view
Authors: Morelli Alessandro Maria , Ravera Silvia , Panfoli Isabella
Published: October 2020

Most of the ATP to satisfy the energetic demands of the cell is produced by the F
1
F
o
-ATP synthase (ATP synthase) which can also function outside the mitochondria. Active oxidative phosphorylation (OxPhos) was shown to operate in the photoreceptor outer segment, myelin sheath, exosomes, microvesicles, cell plasma membranes and platelets. The mitochondria would possess the exclusive ability to assemble the OxPhos molecular machinery so to share it with the endoplasmic reticulum (ER) and eventually export the ability to aerobically synthesize ATP in true extra-mitochondrial districts. The ER lipid rafts expressing OxPhos components is indicative of the close contact of the two organelles, bearing different evolutionary origins, to maximize the OxPhos efficiency, exiting in molecular transfer from the mitochondria to the ER. This implies that its malfunctioning could trigger a generalized oxidative stress. This is consistent with the most recent interpretations of the evolutionary symbiotic process whose necessary prerequisite appears to be the presence of the internal membrane system inside the eukaryote precursor, of probable archaeal origin allowing the engulfing of the α-proteobacterial precursor of mitochondria. The process of OxPhos in myelin is here studied in depth. A model is provided contemplating the biface arrangement of the nanomotor ATP synthase in the myelin sheath.
The structure and function of deubiquitinases: lessons from budding yeast
Authors: Suresh Harsha Garadi , Pascoe Natasha , Andrews Brenda
Published: October 2020

Protein ubiquitination is a key post-translational modification that regulates diverse cellular processes in eukaryotic cells. The specificity of ubiquitin (Ub) signalling for different bioprocesses and pathways is dictated by the large variety of mono-ubiquitination and polyubiquitination events, including many possible chain architectures. Deubiquitinases (DUBs) reverse or edit Ub signals with high sophistication and specificity, forming an integral arm of the Ub signalling machinery, thus impinging on fundamental cellular processes including DNA damage repair, gene expression, protein quality control and organellar integrity. In this review, we discuss the many layers of DUB function and regulation, with a focus on insights gained from budding yeast. Our review provides a framework to understand key aspects of DUB biology.
Tides: A key environmental driver of osteichthyan evolution and the fish-tetrapod transition?
Authors: Byrne H. M. , Green J. A. M. , Balbus S. A. , Ahlberg P. E.
Published: October 2020

Tides are a major component of the interaction between the marine and terrestrial environments, and thus play an important part in shaping the environmental context for the evolution of shallow marine and coastal organisms. Here, we use a dedicated tidal model and palaeogeographic reconstructions from the Late Silurian to early Late Devonian (420 Ma, 400 Ma and 380 Ma, Ma = millions of years ago) to explore the potential significance of tides for the evolution of osteichthyans (bony fish) and tetrapods (land vertebrates). The earliest members of the osteichthyan crown-group date to the Late Silurian, approximately 425 Ma, while the earliest evidence for tetrapods is provided by trackways from the Middle Devonian, dated to approximately 393 Ma, and the oldest tetrapod body fossils are Late Devonian, approximately 373 Ma. Large tidal ranges could have fostered both the evolution of air-breathing organs in osteichthyans to facilitate breathing in oxygen-depleted tidal pools, and the development of weight-bearing tetrapod limbs to aid navigation within the intertidal zones. We find that tidal ranges over 4 m were present around areas of evolutionary significance for the origin of osteichthyans and the fish-tetrapod transition, highlighting the possible importance of tidal dynamics as a driver for these evolutionary processes.
Enhanced models for the nonlinear bending of planar rods: localization phenomena and multistability
Authors: Brunetti Matteo , Favata Antonino , Vidoli Stefano
Published: October 2020

We deduce a one-dimensional model of elastic planar rods starting from the Föppl–von Kármán model of thin shells. Such model is enhanced by additional kinematical descriptors that keep explicit track of the compatibility condition requested in the two-dimensional parent continuum, that in the standard rods models are identically satisfied after the dimensional reduction. An inextensible model is also proposed, starting from the nonlinear Koiter model of inextensible shells. These enhanced models describe the nonlinear planar bending of rods and allow to account for some phenomena of preeminent importance even in one-dimensional bodies, such as formation of singularities and localization (d-cones), otherwise inaccessible by the classical one-dimensional models. Moreover, the effects of the compatibility translate into the possibility to obtain multiple stable equilibrium configurations.
Capillary imbibition of non-Newtonian fluids in a microfluidic channel: analysis and experiments
Authors: Gorthi Srinivas R. , Meher Sanjaya Kumar , Biswas Gautam , Mondal Pranab Kumar
Published: October 2020

We have presented an experimental analysis on the investigations of capillary filling dynamics of inelastic non-Newtonian fluids in the regime of surface tension dominated flows. We use the Ostwald–de Waele power-law model to describe the rheology of the non-Newtonian fluids. Our analysis primarily focuses on the experimental observations and revisits the theoretical understanding of the capillary dynamics from the perspective of filling kinematics at the interfacial scale. Notably, theoretical predictions of the filling length into the capillary largely endorse our experimental results. We study the effects of the shear-thinning nature of the fluid on the underlying filling phenomenon in the capillary-driven regime through a quantitative analysis. We further show that the dynamics of contact line motion in this regime plays an essential role in advancing the fluid front in the capillary. Our experimental results on the filling in a horizontal capillary re-establish the applicability of the Washburn analysis in predicting the filling characteristics of non-Newtonian fluids in a vertical capillary during early stage of filling (Digilov 2008
Langmuir
24
, 13 663–13 667 (
doi:10.1021/la801807j
)). Finally, through a scaling analysis, we suggest that the late stage of filling by the shear-thinning fluids closely follows the variation

x
~

t

. Such a regime can be called the modified Washburn regime (Washburn 1921
Phys. Rev.
17
, 273–283 (
doi:10.1103/PhysRev.17.273
)).
Extreme developmental instability associated with wing plasticity in pea aphids
Authors: Hammelman Rachel E. , Heusinkveld Carrie L. , Hung Emily T. , Meinecke Alydia , Parker Benjamin J. , Brisson Jennifer A.
Published: October 2020

A key focus of evolutionary developmental biology is on how phenotypic diversity is generated. In particular, both plasticity and developmental instability contribute to phenotypic variation among genetically identical individuals, but the interactions between the two phenomena and their general fitness impacts are unclear. We discovered a striking example of asymmetry in pea aphids: the presence of wings on one side and the complete or partial absence of wings on the opposite side. We used this asymmetric phenotype to study the connection between plasticity, developmental instability and fitness. We found that this asymmetric wing development (i) occurred equally on both sides and thus is a developmental instability; (ii) is present in some genetically unique lines but not others, and thus has a genetic basis; and (iii) has intermediate levels of fecundity, and thus does not necessarily have negative fitness consequences. We conclude that this dramatic asymmetry may arise from incomplete switching between developmental targets, linking plasticity and developmental instability. We suspect that what we have observed may be a more widespread phenomenon, occurring across species that routinely produce distinct, alternative phenotypes.
Young frigatebirds learn how to compensate for wind drift
Authors: Wynn Joe , Collet Julien , Prudor Aurélien , Corbeau Alexandre , Padget Oliver , Guilford Tim , Weimerskirch Henri
Published: October 2020

Compensating for wind drift can improve goalward flight efficiency in animal taxa, especially among those that rely on thermal soaring to travel large distances. Little is known, however, about how animals acquire this ability. The great frigatebird (
Fregata minor
) exemplifies the challenges of wind drift compensation because it lives a highly pelagic lifestyle, travelling very long distances over the open ocean but without the ability to land on water. Using GPS tracks from fledgling frigatebirds, we followed young frigatebirds from the moment of fledging to investigate whether wind drift compensation was learnt and, if so, what sensory inputs underpinned it. We found that the effect of wind drift reduced significantly with both experience and access to visual landmark cues. Further, we found that the effect of experience on wind drift compensation was more pronounced when birds were out of sight of land. Our results suggest that improvement in wind drift compensation is not solely the product of either physical maturation or general improvements in flight control. Instead, we believe it is likely that they reflect how frigatebirds learn to process sensory information so as to reduce wind drift and maintain a constant course during goalward movement.
Prevalence and risk factors of chronic kidney disease in a populated area with highly moving populations
Authors: Khajedaluee Mohammad , Ghezeldasht Sanaz Ahmadi , Mosavat Arman , Hekmat Reza , Rezaee Seyed Abdolrahim , Hassannia Tahereh
Published: October 2020

Background

Chronic kidney disease (CKD) is a major public health problem worldwide. Prevalence and associated risk factors of CKD was evaluated in the greater Mashhad, a highly populated pilgrimage city, in 2018 on 2,976 subjects.

Methods

This study was carried out in the greater Mashhad, a highly populated pilgrimage city, in 2018 on 2,976 subjects. For each participant a standard questionnaire, a physical examination and clinical history were completed. Then biochemical and hematologic tests for kidney function were performed.

Results

Obesity was observed more frequently in subjects with CKD, thus BMI was positively correlated with the prevalence of CKD (p<0.001). Moderately reduced GFR was found in 17.6% and 7.1%, and severely reduce GFR at 0.7% and 0.5%, of males and females, respectively (p<0.001).Drug abuse also showed a strong association with CKD (p=0.004), but smoking did not. Using univariate and multivariate logistic regression of decreased estimated GFR<60 showed that age (OR=1.06), gender (OR=2.14), diabetes (OR=1.07), hypertension (OR=1.39) and drug usage (OR=3.29) were risk factors for CKD; BMI was not. The same statistics showed that only age (OR=1.02), diabetes (OR=2.61) and hypertension (OR=1.16) were risk factors for albuminuria. The prevalence of hypertension (22.1%) was a risk factor for CKD, and vice versa. BMI and drug abuse were also risk factors for hypertension, but not smoking.

Conclusion

These findings demonstrated that progression of CKD and hypertension in any population should be considered in the context of changes in human behaviours, etiology, disease severity, co-occurring diseases, addiction and priority of therapy over prevention.
Discussion of Mental Illness and Mental Health By NBA Players on Twitter
Authors: Kamal Shaan , El-Gabalawy Osama , Kamal Shahan , Malik Mohammed H.
Published: October 2020

In 2019, the National Basketball Association (NBA) expanded its mental health rules to include mandating that each team have at least one mental health professional on their full-time staff and to retain a licensed psychiatrist to assist when needed. In this work, we investigate the NBA players’ discussion of mental health using historical data from players’ public Twitter accounts. All current and former NBA players with Twitter accounts were identified, and each of their last 800 tweets were scraped, yielding 920,000 tweets. A list of search terms derived from the DSM5 diagnoses was then created and used to search all of the nearly one million tweets. In this work, we present the most common search terms used to identify tweets about mental health, present the change in month-by-month tweets about mental health, and identify the impact of players discussing their own mental health struggles on their box score statistics before and after their first tweet discussing their own mental health struggles.
Stretch and Twist of HEAT Repeats Leads to Activation of DNA-PK Kinase
Authors: Chen Xuemin , Xu Xiang , Chen Yun , Cheung Joyce C. , Wang Huaibin , Jiang Jiansen , de Val Natalia , Fox Tara , Gellert Martin , Yang Wei
Published: October 2020

Phosphatidylinositol 3-kinase-related kinases (PIKKs) are composed of conserved FAT and kinase domains (FATKIN) along with varied solenoid structures made of HEAT repeats. These kinases are activated in response to cellular stress signals, but the mechanisms governing activation and regulation remain unresolved. For DNA-dependent protein kinase (DNA-PK), all existing structures represent inactive states with resolution limited to 4.3 Å at best. Here we report the cryoEM structures of DNA-PKcs (catalytic subunit) bound to a DNA end, or complexed with Ku70/80 and DNA, in both inactive and activated forms at resolutions of 3.7 Å overall, and 3.2 Å for FATKIN. These structures reveal the sequential transition of DNA-PK from inactive to activated forms. Most notably, activation of the kinase involves previously unknown stretching and twisting within individual solenoid segments and coordinated shifts of neighboring segments in opposite directions. This unprecedented structural plasticity of helical repeats may be a general feature of HEAT-repeat proteins.