bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the cumulative impact of the US–China trade war along global value chains
Authors: Wu Jie , Wood Jacob , Oh Keunyeob , Jang Haejin
Published: March 2021

The US–China trade war has been a key aspect of empirical review in recent times. Using the OECD Inter‐Country Input–Output Model, this study proposes an improved incomplete tariff pass‐through measurement method of cumulative tariff costs incurred across GVCs. Such an approach provides a more accurate picture of the impact of the US–China trade war on not only themselves but also third‐party countries. Our study found that five rounds of tit‐for‐tat tariff escalation has resulted in an indirect tariff burden of around 23 billion US dollars (USD) in total, of which 67% was caused by the US’s tariffs on Chinese imports. Moreover, perhaps unsurprisingly, the United States and China have suffered most economically, and in addition to direct tariff costs, they have to bear the indirect tariff burden of approximately 10 and 6.5 billion USD, respectively. This was followed by the EU, Canada and Mexico, which incurred indirect tariff costs of around 700 million to 1.7 billion USD. In addition, the burden on third‐party countries is expected to rise by 30%–70%, if we consider the hypothesis of complete tariff pass‐through.
Bone marrow, blood, and clinical findings in dogs treated with phenobarbital
Authors: Scott Tiffany N. , Bailin H. Grady , Jutkowitz L. Ari , Scott Michael A. , Lucidi Cynthia A.
Published: March 2021

Background

Cytopenias have been reported in dogs treated with phenobarbital, but detailed descriptions of bone marrow findings and response to treatment are lacking.

Objectives

We aimed to characterize the hematologic findings and clinical outcomes of dogs that had been receiving phenobarbital at the time of marrow evaluation.

Methods

Archived bone marrow slides and clinicopathologic data were reviewed in dogs undergoing marrow evaluation for any hematologic problems that developed while receiving phenobarbital (2008‐2020). Dogs were excluded if marrow samples lacked diagnostic value, phenobarbital was withdrawn >1 day before marrow collection, a same‐day complete blood count (CBC) was lacking, or dogs had concurrent illness or therapy known to cause cytopenias.

Results

Thirteen dogs met inclusion criteria: eight pancytopenic, three anemic/thrombocytopenic, one neutropenic/thrombocytopenic, and one nearly neutropenic. Neutropenia was marked (<700/µL) in eight dogs; all neutrophil concentrations were low or low‐normal. Of the 11 anemic dogs (Hct = 12%‐42%, median = 29%), three had mild reticulocytosis (eight were tested). One dog had erythroid dysplasia in blood and marrow. All nine neutropenic dogs had evidence of ineffective neutropoiesis: neutrophilic hyperplasia with left shift (9) ± neutrophagocytosis (5). Eight of the 11 anemic dogs had evidence of ineffective erythropoiesis: erythroid hyperplasia (7), left shift (3), and/or rubriphagocytosis (6). No thrombocytopenic dog had megakaryocytic hypoplasia; seven dogs had megakaryocytic hyperplasia. One anemic/thrombocytopenic dog had marked collagen myelofibrosis. The noncytopenic dog had equivocal myeloid hypoplasia with neutrophagocytosis. Median maximal responses and resolution times for neutropenia (n = 6) were 14 days.

Conclusions

Phenobarbital‐induced cytopenias should be considered in dogs with multilineage ineffective hematopoiesis, particularly when neutropenia and myeloid hyperplasia are present. However, findings in dogs with immune‐mediated neutropenia or precursor‐targeted immune‐mediated anemia might be indistinguishable.
Zoonotic Giardiaduodenalis sub‐assemblage BIV in wild raccoons (Procyonlotor) from Germany and Luxembourg
Authors: Solarczyk Piotr , Dabert Miroslawa , Frantz Alain C. , Osten‐Sacken Natalia , Trzebny Artur , Wojtkowiak‐Giera Agnieszka , Heddergott Mike
Published: March 2021

Giardia duodenalis is a cosmopolitan flagellate that causes giardiasis, one of the most significant gastrointestinal diseases in humans. This parasite can be a serious threat to public health because it can cause waterborne outbreaks as well as sporadic infections in humans. Invasive raccoons (Procyon lotor) may play a role in disseminating Giardia into the environment and transmitting it to humans and domestic animals because they live in high densities and deposit their faces in latrines near areas used by humans. While Giardia infections have been reported from raccoons in North America, it is unknown whether they carry G. duodenalis with zoonotic assemblage A and B, which have the potential to cause illness in humans. We collected faecal samples from 66 legally harvested raccoons in Germany and Luxembourg and examined for Giardia using molecular techniques. Using a quantitative PCR based on primers specific to Giardia genetic assemblages A and B, we detected the presence of zoonotic assemblage B in 27% (95% CI, 17.0–39.6) of all examined faecal samples from raccoons, including animals sampled in buildings. We did not detect genetic assemblage A in any of the samples. Sequences obtained from the glutamate dehydrogenase and beta‐giardin gene fragments from a selection of three of the positive samples showed that raccoons carried a zoonotic G. duodenalis genotype belonging to sub‐assemblage BIV, which is commonly found in humans and animals worldwide. Our results suggest that free‐ranging raccoons have the potential to play an increasingly important role in the epidemiology of Giardia and pose a threat to public health in Europe and other regions where this species is common and lives in close association with humans.
Fibrinogen, collagen, and transferrin adsorption to poly(3,4-ethylenedioxythiophene)-xylorhamno-uronic glycan composite conducting polymer biomaterials for wound healing applications
Authors: Molino Paul J. , Will John , Daikuara Luciana Yumiko , Harris Alexander R. , Yue Zhilian , Dinoro Jeremy , Winberg Pia , Wallace Gordon G.
Published: March 2021

We present the conducting polymer poly (3,4-ethylenedioxythiophene) (PEDOT) doped with an algal-derived glycan extract, Phycotrix™ [xylorhamno-uronic glycan (XRU84)], as an innovative electrically conductive material capable of providing beneficial biological and electrical cues for the promotion of favorable wound healing processes. Increased loading of the algal XRU84 into PEDOT resulted in a reduced surface nanoroughness and interfacial surface area and an increased static water contact angle. PEDOT-XRU84 films demonstrated good electrical stability and charge storage capacity and a reduced impedance relative to the control gold electrode. A quartz crystal microbalance with dissipation monitoring study of protein adsorption (transferrin, fibrinogen, and collagen) showed that collagen adsorption increased significantly with increased XRU84 loading, while transferrin adsorption was significantly reduced. The viscoelastic properties of adsorbed protein, characterized using the ΔD/Δf ratio, showed that for transferrin and fibrinogen, a rigid, dehydrated layer was formed at low XRU84 loadings. Cell studies using human dermal fibroblasts demonstrated excellent cell viability, with fluorescent staining of the cell cytoskeleton illustrating all polymers to present excellent cell adhesion and spreading after 24 h.
A guide for incorporating e-teaching of physics in a post-COVID world
Authors: O'Brien Daniel J.
Published: March 2021

Distance education has expanded significantly over the last decade, but the natural sciences have lagged in the implementation of this instructional mode. The abrupt onset of the COVID-19 pandemic left educational institutions scrambling to adapt curricula to distance modalities. With projected effects lasting through the 2020–2021 academic year, this problem will not go away soon. Analysis of the literature has elucidated the costs and benefits of, as well as obstacles to, the implementation of e-learning, with a focus on undergraduate physics education. Physics faculty report that a lack of time to learn about research-driven innovation is their primary barrier to implementing it. In response, this paper is intended to help physics lecturers and lab instructors re-think their courses now that distance learning is far more prevalent due to the pandemic. This paper serves as an all-in-one guide of recommendations for successful distanced educational practices, with an emphasis on smartphones and social media. These technologies were chosen for their utility in a virtual environment. Additionally, this paper can be used as a resource for university administrators to adapt to the changing needs associated with new teaching modalities.
A first encounter with the Hartree-Fock self-consistent-field method
Authors: Santra Robin , Obermeyer Michael
Published: March 2021

This paper is intended to serve as a bridge between introductory textbooks on quantum mechanics, which typically do not cover the Hartree-Fock self-consistent-field method, and more advanced ones which treat this important computational method for fermionic many-body systems in an abstract and formal way. We derive the Hartree-Fock equation for the 1s orbital of a realistic two-electron atom. By employing a two-dimensional basis-set representation, we avoid the use of variational calculus and are able to visualize key aspects of the method. We explain the basic self-consistent-field algorithm and provide a python script to illustrate how the algorithm works in practice. Utilizing perturbation theory, we perform an analysis of the convergence behavior of the self-consistent-field algorithm, thereby facilitating a deeper understanding of the numerical examples presented. We expect that this work will be useful for teaching computational techniques to physics students.
Tesla's fluidic diode and the electronic-hydraulic analogy
Authors: Nguyen Quynh M. , Huang Dean , Zauderer Evan , Romanelli Genevieve , Meyer Charlotte L. , Ristroph Leif
Published: March 2021

Reasoning by analogy is powerful in physics for students and researchers alike, a case in point being electronics and hydraulics as analogous studies of electric currents and fluid flows. Around 100 years ago, Nikola Tesla proposed a flow control device intended to operate similarly to an electronic diode, allowing fluid to pass easily in one direction but providing high resistance in reverse. Here, we use experimental tests of Tesla's diode to illustrate principles of the electronic-hydraulic analogy. We design and construct a differential pressure chamber (akin to a battery) that is used to measure flow rate (current) and thus resistance of a given pipe or channel (circuit element). Our results prove the validity of Tesla's device, whose anisotropic resistance derives from its asymmetric internal geometry interacting with high-inertia flows, as quantified by the Reynolds number (here, Re∼103). Through the design and testing of new fluidic diodes, we explore the limitations of the analogy and the challenges of shape optimization in fluid mechanics. We also provide materials that may be incorporated into lesson plans for fluid dynamics courses, laboratory modules, and further research projects.
A semi-analytical model for the modal density of periodic mediums based on the symplectic method
Authors: Ma Yongbin , Deng Zichen
Published: March 2021

In this paper, a semi-analytical approach is provided for the modal density of periodic mediums based on the symplectic method. For two-dimensional periodic mediums with a plate component and one-dimensional periodic mediums with a beam component and truss component, the symplectic method is introduced to describe the conditions of continuity and periodicity of the unit cell. And then by virtue of the adjoint symplectic orthogonal relations, an eigenproblem is first established for the dispersion relation of the periodic mediums. The group velocity is then obtained semi-analytically by differentiating the eigenproblem with respect to frequency. Since the expressions of the kinematic and the kinetic variables of the unit cell involved in derivation processes are expressed in terms of symplectic analytical waves, the modal density of periodic mediums can be obtained with high efficiency and with high accuracy. Numerical examples including two-dimensional periodic mediums with a plate component and one-dimensional periodic mediums with a beam component and truss component are provided. The comparison of the present results with the results obtained from the finite element model confirms the effectiveness of the proposed method.
The Effect of Attending Physical Rehabilitation After the First Acute Lateral Ankle Sprain on Static Postural Control in Patients With Chronic Ankle Instability
Authors: Helly Katherine L. , Bain Katherine A. , Hoch Matthew C. , Heebner Nicholas R. , Gribble Phillip A. , Terada Masafumi , Kosik Kyle B.
Published: March 2021

Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. Objective: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. Design: Retrospective cohort. Setting: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. Intervention(s): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. Main Outcome Measures: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. Results: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior–posterior direction (P = .030), and higher TTB anterior–posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. Conclusions: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.
The short, strange life of quantum radar
Authors: Cho Adrian
Published: March 2021

In spite of military interest, quantum mechanics won't defeat stealth technologies.
Inducing metallicity in graphene nanoribbons via zero-mode superlattices
Authors: Rizzo Daniel J. , Veber Gregory , Jiang Jingwei , McCurdy Ryan , Cao Ting , Bronner Christopher , Chen Ting , Louie Steven G. , Fischer Felix R. , Crommie Michael F.
Published: March 2021

Making metallic ribbons

In its usual two-dimensional form, graphene does not have an energy gap in its electronic structure. However, one-dimensional ribbons made of the material are semiconducting and making them metallic is tricky. Rizzo
et al.
developed a strategy for synthesizing metallic graphene nanoribbons and demonstrated their metallicity using scanning tunneling spectroscopy. These metallic graphene nanoribbons may be useful for exploring exotic quantum phases in a single dimension.

Science
, this issue p.
1597
Large-scale RNAi screening uncovers therapeutic targets in the parasite
Schistosoma mansoni
Authors: Wang Jipeng , Paz Carlos , Padalino Gilda , Coghlan Avril , Lu Zhigang , Gradinaru Irina , Collins Julie N. R. , Berriman Matthew , Hoffmann Karl F. , Collins James J.
Published: March 2021

Schistosome biology illuminated

Schistosomiasis is caused by a parasitic flatworm about which little is known. Therefore, options to combat human disease caused by schistosome infection are limited. To aid in our quest to develop treatments, two studies undertook molecular investigations of the parasite
Schistosoma mansoni
. By generating a single-cell atlas, Wendt
et al.
identified the developmental trajectory of the flatworm, including the blood-feeding gut required for its survival in the host. From these data, they found a gene required for gut development that, when knocked out through RNA interference, confers reduced pathology in infected mice. Wang
et al.
performed a large-scale RNA interference survey of
S. mansoni
and identified an essential pair of protein kinases that can be targeted by approved pharmacological intervention (see the Perspective by Anderson and Duraisingh). These molecular investigations add to our understanding of the schistosome parasite and provide biological information that may help to combat this neglected tropical disease.

Science
, this issue p.
1644
, p.
1649
; see also p.
1562
Impact of Accelerate Pheno and BacT/Alert Virtuo on Clinical Processes and Outcomes in Patients with Sepsis and Concurrent Gram-Negative Bacteremia
Authors: Babowicz Faith , LaPlante Reid , Mitchell Colby , O’Donnell J. Nicholas , Tobin Ellis , George Mary , Carreno Joseph J.
Published: March 2021

The Accelerate Pheno and BacT/Alert Virtuo systems may improve bacteremia management. Here, we evaluated the impact of both devices on outcomes in patients with sepsis and concurrent Gram-negative bacteremia.
Plant Diversity Enhances Soil Fungal Diversity and Microbial Resistance to Plant Invasion
Authors: Shen Congcong , Wang Jiang , He Ji-Zheng , Yu Fei-Hai , Ge Yuan
Published: March 2021

Our study newly showed that plant invasion significantly altered relationships between aboveground and belowground diversity. Specifically, plant richness indirectly promoted soil fungal richness through the increase of soil total carbon (TC) without plant invasion, while plant richness had a direct positive effect on soil fungal richness under plant invasion conditions.
Cell Type-Specific Biogenesis of Novel Vesicles Containing Viral Products in Human Cytomegalovirus Infection
Authors: Momtaz Samina , Molina Belen , Mlera Luwanika , Goodrum Felicia , Wilson Jean M.
Published: March 2021

Human cytomegalovirus (HCMV) is a herpesvirus that, like all herpesvirus, establishes a lifelong infection. HCMV remains a significant cause of morbidity and mortality in immunocompromised individuals and HCMV seropositivity is associated with age-related pathology.
Compartmentalization of Melanin Biosynthetic Enzymes Contributes to Self-Defense against Intermediate Compound Scytalone in
Botrytis cinerea
Authors: Chen Xue , Zhu Chuanxi , Na Yantao , Ren Dandan , Zhang Chenghua , He Yifan , Wang Yiwen , Xiang Sheng , Ren Weiheng , Jiang Yina , Xu Ling , Zhu Pinkuan
Published: March 2021

The devastating gray mold pathogen
Botrytis cinerea
propagates via melanized conidia and sclerotia. This study reveals that the sclerotial germination of
B. cinerea
is differentially affected by different enzymes in the melanin synthesis pathway.
Effect of HIV/HAART and Other Clinical Variables on the Oral Mycobiome Using Multivariate Analyses
Authors: Fidel Paul L. , Thompson Zach A. , Lilly Elizabeth A. , Granada Carolina , Treas Kelly , Dubois Kenneth R. , Cook Laura , Hashmi Shahr B. , Lisko Daniel J. , Mukherjee Chiranjit , Vazquez Jose A. , Hagensee Michael E. , Griffen Ann L. , Leys Eugene J. , Beall Clifford J.
Published: March 2021

The oral microbiome is likely a key element of homeostasis in the oral cavity. With >600 bacterial species and >160 fungal species comprising the oral microbiome, influences on its composition can have an impact on both local and systemic health.
Cytoplasmic CPSF6 Regulates HIV-1 Capsid Trafficking and Infection in a Cyclophilin A-Dependent Manner
Authors: Zhong Zhou , Ning Jiying , Boggs Emerson A. , Jang Sooin , Wallace Callen , Telmer Cheryl , Bruchez Marcel P. , Ahn Jinwoo , Engelman Alan N. , Zhang Peijun , Watkins Simon C. , Ambrose Zandrea
Published: March 2021

HIV is the causative agent of AIDS, which has no cure. The protein shell that encases the viral genome, the capsid, is critical for HIV replication in cells at multiple steps.
Biofilm Development on Urinary Catheters Promotes the Appearance of Viable but Nonculturable Bacteria
Authors: Wilks Sandra A. , Koerfer Verena V. , Prieto Jacqui A. , Fader Mandy , Keevil C. William
Published: March 2021

Several antimicrobial urinary catheter materials have been developed, but, although laboratory studies may show a benefit, none have significantly improved clinical outcomes. The use of poorly designed laboratory testing and lack of consideration of the impact of VBNC populations may be responsible.
Small-world dynamics drove Phanerozoic divergence of burrowing behaviors
Authors: Baucon Andrea , Carvalho Carlos Neto de , Felletti Fabrizio , Tosadori Gabriele , Antonelli Alexandre
Published: March 2021

Species of burrowing animals have changed substantially over evolutionary time scales, but, surprisingly, burrows display persisting morphological patterns throughout the Phanerozoic. Deep-sea burrows are geometrically patterned, whereas shallow-marine burrows display simpler morphologies. This divergence between burrow associations is one of the central conundrums of paleontology, but it has never been quantitatively demonstrated, and the organizing principles responsible for this structure remain unknown. We show that the divergence of burrow associations has been shaped by small-world dynamics, which is proposed as a major macroevolutionary force in marine environments. Using network analysis, our study reveals that the association patterns between burrow morphotypes in 45 paleontological sites span ∼500 m.y. Strong statistical support is demonstrated for a surprising association pattern, according to which the data set is optimally partitioned into two subgroups of tightly associated burrow types. These groups correspond to shallow- and deep-marine biomes. Our analysis demonstrates that across the Phanerozoic Eon, burrows did not assemble randomly nor regularly, following instead small-world assembly rules remarkably similar to those that shape human social networks. As such, small-world dynamics deeply influenced gene flow and natural variation in heritable behavior across evolutionary time.
Anaerobic oxidation of methane by Mn oxides in sulfate-poor environments
Authors: Cai Chunfang , Li Kaikai , Liu Dawei , John Cedric M. , Wang Daowei , Fu Bin , Fakhraee Mojtaba , He Hong , Feng Lianjun , Jiang Lei
Published: March 2021

Strongly 13C-depleted authigenic carbonates (e.g., δ13CVPDB <−30‰; VPDB—Vienna Peedee belemnite) in nature are generally believed to form by sulfate-dependent anaerobic oxidation of methane (AOM). However, we demonstrate using geochemical data and thermodynamic calculation that such calcites are most likely derived from biogenic oxidation of methane in sulfate-poor, nonmarine environments during early diagenesis, as observed in the Triassic sandy conglomerates from the Junggar Basin, northwestern China. This process operated through preferential oxidation of 13C-depleted methane by Mn oxides in closed conditions, producing calcites with higher Mn contents and δ13C values in association with more 13C-enriched residual methane as a result of kinetic isotope fractionation. Thus, the Mn-rich and 13C-depleted carbonates are proposed as tracers of Mn-dependent AOM, which should have served as an important sink of greenhouse methane in low-sulfate early Earth's oceans.
Ice-sheet melt drove methane emissions in the Arctic during the last two interglacials
Authors: Dessandier P.-A. , Knies J. , Plaza-Faverola A. , Labrousse C. , Renoult M. , Panieri G.
Published: March 2021

Circum-Arctic glacial ice is melting in an unprecedented mode, and release of currently trapped geological methane may act as a positive feedback on ice-sheet retreat during global warming. Evidence for methane release during the penultimate (Eemian, ca. 125 ka) interglacial, a period with less glacial sea ice and higher temperatures than today, is currently absent. Here, we argue that based on foraminiferal isotope studies on drill holes from offshore Svalbard, Norway, methane leakage occurred upon the abrupt Eurasian ice-sheet wastage during terminations of the last (Weichselian) and penultimate (Saalian) glaciations. Progressive increase of methane emissions seems to be first recorded by depleted benthic foraminiferal δ13C. This is quickly followed by the precipitation of methane-derived authigenic carbonate as overgrowth inside and outside foraminiferal shells, characterized by heavy δ18O and depleted δ13C of both benthic and planktonic foraminifera. The similarities between the events observed over both terminations advocate for a common driver for the episodic release of geological methane stocks. Our favored model is recurrent leakage of shallow gas reservoirs below the gas hydrate stability zone along the margin of western Svalbard that can be reactivated upon initial instability of the grounded, marine-based ice sheets. Analogous to this model, with the current acceleration of the Greenland ice melt, instabilities of existing methane reservoirs below and nearby the ice sheet are likely.
Maturation experiments reveal bias in the chemistry of fossil melanosomes
Authors: Rossi Valentina , Webb Samuel M. , McNamara Maria
Published: March 2021

Fossil melanosomes are a major focus of paleobiological research because they can inform on the original coloration, phylogenetic affinities, and internal anatomy of ancient animals. Recent studies of vertebrate melanosomes revealed tissue-specific trends in melanosome-metal associations that can persist in fossils. In some fossil vertebrates, however, melanosomes from all body regions are enriched only in Cu, suggesting diagenetic overprinting of original chemistry. We tested this hypothesis using laboratory experiments on melanosomes from skin and liver of the African clawed frog Xenopus laevis. After maturation in Cu-rich media, the metal chemistry of melanosomes from these tissues converged toward a common composition, and original differences in Cu oxidation state were lost. Elevated Cu concentrations and a pervasive Cu(II) signal are likely indicators of diagenetically altered melanosomes. These results provide a robust experimental basis for interpretating the chemistry of fossil melanosomes.
Clinical presentation and improvised management of neonatal pneumothorax in the setting of a low-resource country: Conakry, Guinea
Authors: Merscher Alves Maria Bea , Conté N'fanly , Sory Diallo Ibrahima , Roth-Kleiner Matthias
Published: March 2021

Two neonates were presented at the Neonatology Department of the Institute of Child Nutrition and Health in Conakry, Guinea, with tension pneumothoraces as confirmed by chest X-ray. They were initially managed with needle thoracentesis but required continuous thoracic drainage. Due to scarce resources in the public health sector, no prepacked and dedicated pleural drainage systems were available as is the case in many developing countries. Therefore, we fabricated an improvised underwater seal drain out of a plastic infusion bottle and a Heimlich valve out of a vicryl fingerstall. Both devices have shown to be effective. Pneumothorax is a common and potentially life-threatening disease in neonates that often requires prompt treatment. This case series demonstrates how tension pneumothorax in two newborns was successfully managed by improvising different chest drainage systems. The depicted techniques shall serve as an instruction manual to healthcare professionals working in low-resource settings and facing similar challenges.
Phleboliths mistaken for intraperitoneal copper-containing intrauterine device in the presence of missing strings
Authors: Nguyen Viet , Lindley Alexa R , Mansoori Bahar , Godfrey Emily Maria
Published: March 2021

Although rare, pelvic phleboliths may confound the diagnosis of an intraperitoneal or malpositioned intrauterine device (IUD). Pelvic phleboliths are focal calcifications in pelvic veins, often in multiples near the ureters, occurring in about 40% of adult patients. We treated a 35-year-old woman requesting removal of her copper-containing IUD (TCu380A IUD). She had missing IUD strings on clinical examination. A clinic-based transvaginal ultrasound and anteroposterior abdominal radiograph that followed suggested prior TCu380A IUD expulsion. A radiologist later interpreted several ambiguous radiodensities in the abdominal radiograph as a possible intraperitoneal or malpositioned IUD. In collaboration with radiologists and family planning specialists, it was suggested that the patient further undergo a three-dimensional ultrasonography and a CT of the pelvis. The radiodensities first noted on the radiograph were revealed to be phleboliths, a diagnostic possibility not initially considered by any of the primary clinical care team, radiologists or family planning specialists.
Herlyn-Werner-Wunderlich (HWW) syndrome with kyphoscoliosis: a rare urogenital anomaly in a teenage girl
Authors: Jhirwal Manisha , Singh Pratibha , Sharma Charu , Khera Pushpinder
Published: March 2021

The obstructed haemivagina with ipsilateral renal agenesis (OHVIRA) syndrome also known as Herlyn-Werner-Wunderlich syndrome, a rare congenital malformation in females, results due to developmental abnormality in the müllerian duct. We are reporting a case of a 14-year-old girl who presented with pain and a lump in abdomen for the last 5 months. The MRI abdomen and pelvis confirmed the diagnosis of OHVIRA syndrome. The patient underwent haematocolpos and haematometra drainage, followed by vaginal septum resection.
Successful primary repair of oesophageal atresia and distal tracheo-oesophageal fistula in a 525 g neonate, the smallest reported in literature
Authors: Singh Rashmi Roshan , Hird Michael , Joshi Ashwini
Published: March 2021

Advances in neonatal intensive care have meant improved survival of the extremely low birth weight neonate. We report the successful primary repair of a preterm neonate born with an oesophageal atresia and tracheo-oesophageal fistula with a birth weight of just 525 g, on day 1 of life, the smallest survivor so far reported in the literature, now followed up for 5 years.
Left pneumonectomy for primary lung cancer with Trousseau’s syndrome
Authors: Ichinokawa Hideomi , Nagasaki Yusuke , Koike Yutaro , Suzuki Kenji
Published: March 2021

Trousseau’s syndrome is a paraneoplastic syndrome and a pathological condition that causes cerebral stroke symptoms due to hypercoagulation associated with malignant tumours. There have been many cases of advanced lung cancer, but few reports have described surgery for lung cancer with Trousseau’s syndrome. We encountered a 76-year-old man suspected of having Trousseau’s syndrome associated with lung cancer. He was transferred to our hospital on the second day after the onset. After admission, he was treated with heparin and edaravone, and his condition improved. On the 12th day after the onset, we performed left pneumonectomy and lymph node dissection (ND2a-2). The final pathological results were adenocarcinoma, pathological stage was T4 (tumour size: 77 mm, pulmonary artery invasion) N1(#11, #12u) M0, stage IIIA. He has been recurrence free for 23 months since the surgery. In the future, we need to follow his condition carefully.
Compartment syndrome of the hand following iatrogenic intra-arterial administration of epinephrine during cardiopulmonary resuscitation
Authors: Robinson Patrick , Leow Jun Min , Brown Iain
Published: March 2021

A 26-year-old woman developed acute compartment syndrome (ACS) of her right hand secondary to reperfusion syndrome. She suffered an out-of-hospital cardiac arrest following a pregabalin overdose. Attending paramedics mistakenly gave intra-arterial epinephrine into her right brachial artery. On resolution of her brachial artery spasm, she developed a reperfusion injury to her right hand and subsequently ACS. A four-incision fasciotomy with carpal tunnel decompression was performed and was successful in reversing focal ischaemia and an irreversible functional deficit. This case demonstrates an unusual case of hand ACS secondary to temporary limb ischaemia and reperfusion syndrome following iatrogenic intra-arterial epinephrine administration. We also summarise the current available literature on ACS of the hand including the aetiology, treatment and use of an intracompartmental monitor.
New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic
Authors: Tham Yih-Chung , Husain Rahat , Teo Kelvin Yi Chong , Tan Anna Cheng Sim , Chew Annabel Chee Yen , Ting Daniel S , Cheng Ching-Yu , Tan Gavin Siew Wei , Wong Tien Yin
Published: March 2021

COVID-19 has led to massive disruptions in societal, economic and healthcare systems globally. While COVID-19 has sparked a surge and expansion of new digital business models in different industries, healthcare has been slower to adapt to digital solutions. The majority of ophthalmology clinical practices are still operating through a traditional model of ‘brick-and-mortar’ facilities and ‘face-to-face’ patient–physician interaction. In the current climate of COVID-19, there is a need to fuel implementation of digital health models for ophthalmology. In this article, we highlight the current limitations in traditional clinical models as we confront COVID-19, review the current lack of digital initiatives in ophthalmology sphere despite the presence of COVID-19, propose new digital models of care for ophthalmology and discuss potential barriers that need to be considered for sustainable transformation to take place.
Impact of the coronavirus infectious disease (COVID-19) pandemic on the provision of inflammatory bowel disease (IBD) antenatal care and outcomes of pregnancies in women with IBD
Authors: Selinger Christian Philipp , Fraser Aileen , Collins Paul , Gunn Melanie , Chew Thean Soon , Kerry Georgina , Patel Kamal V , Roysam Maya , Bel Kok Klaartje , Bancil Aaron , Hall Veronica , Cooney Rachel , Smith Lyn , Steed Helen , Segal Jonathan , Kent Alexandra , Limdi Jimmy , Sebastian Shaji
Published: March 2021

Background

The impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes.

Methods

Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters.

Results

We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded.

Conclusion

IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.
Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations
Authors: Dixon Sharon , Duddy Claire , Harrison Gabrielle , Papoutsi Chrysanthi , Ziebland Sue , Griffiths Frances
Published: March 2021

Objectives

Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.

Setting

Primary care in England.

Data sources

Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.

Primary outcome measure

This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.

Results

124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.

Conclusions

There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.

PROSPERO registration number

CRD42018091996.
Socioeconomic status and vitamin D deficiency among women of childbearing age: a population-based, case–control study in rural northern China
Authors: Lin Shiqi , Jiang Lifang , Zhang Yuan , Chai Jian , Li Jiajia , Song Xinming , Pei Lijun
Published: March 2021

Objective

To explore the association between socioeconomic status (SES) and vitamin D deficiency/insufficiency of women of childbearing age in rural northern China.

Design

A population-based, case–control study was conducted.

Setting

Four counties of Henan Province, China from 2009 to 2010.

Participants

1151 non-pregnant healthy women between 18 and 40 years old.

Primary and secondary outcome measures

Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using high-performance liquid chromatography-tandem mass spectrometry. Vitamin D insufficiency was defined as serum 25(OH)D ≥20 ng/mL and <30 ng/mL, deficiency as ≥10 ng/mL and <20 ng/mL, and severe deficiency as <10 ng/mL. SES was measured separately by women’s and their husbands’ education level and occupation, household income and expenditure, as well as aggregately by SES index constructed with principal component analysis.

Results

The median serum 25(OH)D level was 20.90 (13.60–34.60) ng/mL, and the prevalence of vitamin D insufficiency, deficiency and severe deficiency was 20.16%, 31.80% and 15.99%, respectively. After adjustment, household annual income <¥10 000 was associated with increased risk of vitamin D insufficiency (adjusted OR (aOR): 2.10, 95% CI 1.41 to 3.14), deficiency (aOR: 1.58, 95% CI 1.09 to 2.29) and severe deficiency (aOR: 2.79, 95% CI 1.78 to 4.38); inadequate household income for expenditure was associated with elevated risk of vitamin D insufficiency (aOR: 1.66, 95% CI 1.08 to 2.54) and deficiency (aOR: 1.81, 95% CI 1.26 to 2.62); low SES index was associated with elevated risk of vitamin D insufficiency (aOR: 2.40, 95% CI 1.52 to 3.80) and deficiency (aOR: 1.64, 95% CI 1.08 to 2.50); and both middle and low SES index were associated with increased risk of vitamin D severe deficiency (aOR: 1.70, 95% CI 1.02 to 2.84; aOR: 2.45, 95% CI 1.45 to 4.14).

Conclusions

Lower SES was associated with higher risk of vitamin D deficiency/insufficiency in women of childbearing age in rural northern China. More should be done to explore potential mechanisms and to narrow down SES inequalities in vitamin D status.
Structured, multifactorial randomised controlled intervention to investigate physical activity levels, body composition and diet in obese and overweight adolescents
Authors: Srivastav Prateek , K Vaishali , Bhat Vinod H , Broadbent Suzanne
Published: March 2021

Introduction

There has been a steep increase in the prevalence of adolescent overweight and obesity globally and in India, demonstrating that present prevention strategies are insufficient. Available evidence suggests that multifactorial interventions may improve short-term physical activity (PA), nutrition and psychological behaviour of overweight and obese adolescents but long-term follow-ups and strategies are needed. This study will investigate the effects of a structured multifactorial (school-based and family-based) intervention on adolescent obesity, compared with a single or no intervention.

Methods and analysis

A pragmatic, clustered randomised controlled trial with 12 weeks of interventions and 3-month, 6-month and 12-month follow-ups will be conducted at multiple participating schools in Karnataka, India. The participants will be overweight and obese male and female adolescents aged 11–16 years and will be randomly assigned by school into three groups: group A (multifactorial intervention, exercise and dietary advice); group B (exercise only); and group C (controls, no interventions). Primary outcome measures are the level of PA and body composition. Secondary outcomes are dietary change, behaviour change, food behaviours, cardiovascular and muscular fitness, quality of life, parental behaviours (physical and mental) and family functioning. Positive intervention results may reduce obesity in adolescents and promote a healthier lifestyle for students and families. A larger, culturally diverse population can benefit from a similar methodology.

Ethics and dissemination

The study has been approved by the Institutional Research and Ethics Committee (IEC 536-2018), Kasturba Hospital, Manipal, Udupi District, Karnataka, India. A written and verbal informed consent (supplemental material) will be provided to the participants prior to participation. On completion of the trial, the results can be communicated to adolescents and their parents on request, and will be published at national and international conferences and in peer-reviewed journals.

Trial registration number

CTRI/2019/04/018834.
Development, implementation, evaluation and scaling-up of physical activity referral schemes in Germany: protocol for a study using a co-production approach
Authors: Weissenfels Anja , Geidl Wolfgang , Mino Eriselda , Naber Inga , Klamroth Sarah , Gelius Peter , Abu-Omar Karim , Pfeifer Klaus
Published: March 2021

Introduction

Physical activity referral schemes (PARSs) are recommended to promote physical activity (PA) among adults at risk of developing or with established non-communicable diseases (NCDs). In Germany, this kind of referral schemes has not yet been implemented systematically and nationwide. In this study protocol, we present the methodological design of a co-production research study aimed at establishing a PARS for adults with NCDs in German primary healthcare.

Methods and analysis

We will employ a co-production approach consistently throughout the four project phases: (1) development of the PARS; (2) preparation period; (3) implementation and evaluation; (4) development of a strategic plan for scaling up the PARS to the national level as part of standard care. The first phase will additionally include a status quo analysis of the existing physical activity pathways nationwide as well as an overview of international PARS models. A pragmatic trial design will be used for evaluating the developed PARS. The co-production approach will involve relevant actors in the German healthcare system, namely, healthcare service providers (eg, physicians, exercise professionals), health insurance providers, exercise providers, patients’ representatives, experts in the development and implementation of educational concepts, and scientists from the fields of sports science and public health.

Ethics and dissemination

The project has been reviewed and approved by the ethics committee of the Friedrich-Alexander-University Erlangen-Nürnberg (ethics approval number: 331_20 B). Through cooperation agreements, the stakeholders involved gave their consent to participate and were informed about the study in detail. The results of this study will be disseminated by international conference presentations and peer-reviewed publications, and if possible, a manual for the use of the PARS will be provided.
How to manage a high-output stoma
Authors: Nightingale Jeremy M D
Published: March 2021

A high-output stoma (HOS) or fistula is when small bowel output causes water, sodium and often magnesium depletion. This tends to occur when the output is >1.5 -2.0 L/24 hours though varies according to the amount of food/drink taken orally. An HOS occurs in up to 31% of small bowel stomas. A high-output enterocutaneous fistula may, if from the proximal small bowel, behave in the same way and its fluid management will be the same as for an HOS.

The clinical assessment consists of excluding causes other than a short bowel and treating them (especially partial or intermittent obstruction). A contrast follow through study gives an approximate measurement of residual small intestinal length (if not known from surgery) and may show the quality of the remaining small bowel.

If HOS is due to a short bowel, the first step is to rehydrate the patient so stopping severe thirst. When thirst has resolved and renal function returned to normal, oral hypotonic fluid is restricted and a glucose-saline solution is sipped. Medication to slow transit (loperamide often in high dose) or to reduce secretions (omeprazole for gastric acid) may be helpful. Subcutaneous fluid (usually saline with added magnesium) may be given before intravenous fluids though can take 10–12 hours to infuse. Generally parenteral support is needed when less than 100 cm of functioning jejunum remains. If there is defunctioned bowel in situ, consideration should be given to bringing it back into continuity.