bluuebunny/crossref_metadata_2025 huggingface dataset:
Could diffuse coevolution explain the generic eggshell color of the brown-headed cowbird?
Authors: Hanley Daniel , Moghaddame-Jafari Beheshteh , Rutledge Samantha L
Published: September 2021

The brown-headed cowbird (hereafter cowbird) is an avian brood parasite that produces an egg dissimilar to those produced by the majority of its diverse host community. The cowbird’s generic egg may result from a Jack-of-all-trades strategy; however, the evolutionary mechanisms that select for their generic eggs are unclear. Here we propose that the cowbird’s eggshell phenotypes have evolved via diffuse coevolution, which results from community-level selective pressures, rather than via pairwise coevolution that occurs between a particular host species and its brood parasite. Under diffuse coevolution the cowbird’s host community, with varying eggshell phenotypes and recognition abilities, would select for a cowbird eggshell phenotype intermediate to those of its host community. This selection is exerted by hosts that reject cowbird eggs, rather than those that accept them; therefore, we expect cowbird eggshell colors can be approximated by both the phenotypes and rejection abilities of their host community. Here we use eggshell reflectance data from 43 host species to demonstrate that the cowbird eggshell phenotypes are reasonably predicted (within 2 just noticeable differences) by the eggshell phenotypes and rejection rates of their hosts. These findings suggest that cowbird eggshell phenotypes, and potentially those of other some generalist parasites, may evolve via diffuse coevolution. Importantly, this research provides insight into the underlying evolutionary processes that explain observed phenotypic variation and provides a framework for studying selection on both specialist and generalist parasites’ traits.
Influence of mutuality on quality of life in heart failure patient with inadequate self-care and caregiver dyads: an actor–partner interdependence model analysis
Authors: Dellafiore Federica , Chung Misook L , Alvaro Rosaria , Zeffiro Valentina , Ercole Vellone , Pucciarelli Gianluca
Published: September 2021

Aims

Mutuality, a positive quality of the relationship between patients and their informal caregivers characterized by love and affection, shared pleasurable activities, shared values, and reciprocity, influences several patient–caregiver outcomes in chronic-condition cases, but it remains unknown whether it influences the heart failure (HF) patient–caregiver dyad quality of life (QOL). The aim of this study was to evaluate the influence of mutuality and its four dimensions (love and affection, shared pleasurable activities, shared values, and reciprocity) on QOL in HF patient–caregiver dyads

Methods and results

Cross-sectional study: Using the actor–partner interdependence model, we examined how an individual’s mutuality influenced his/her own QOL (actor effect) and his/her partner’s QOL (partner effect). Mutuality and physical and mental QOL were measured with the Mutuality Scale and Short Form 12, respectively. A total of 494 HF patient–caregiver dyads were enrolled in the study. Mutuality showed strong evidence of caregiver partner effects on the HF patients’ physical QOL (total score B = 2.503, P = 0.001; shared pleasurable activities B = 2.265, P < 0.001; shared values B = 1.174, P = 0.420 and reciprocity B = 1.888, P = 0.001). For the mental QOL, mutuality and its four subscales had actor effects only on the patients’ mental health (total mutuality B = 2.646, P = 0.003; love and affection B = 1.599, P = 0.360; shared pleasurable activities B = 2.599, P = 0.001; shared values B = 1.564, P = 0.001 and reciprocity B = 1.739, P = 0.020). In caregivers, mutuality had an actor effects on mental QOL (total score B = 1.548, P = 0.041 and reciprocity B = 1.526, P = 0.009).

Conclusion

Our results confirm the important role of mutuality in determining the physical and mental QOL in HF patient–caregiver dyads. Interventions aimed at improving the relationships within HF patient–caregiver dyads may have an impact on HF patients’ and caregivers’ QOL.
SimFFPE and FilterFFPE: improving structural variant calling in FFPE samples
Authors: Wei Lanying , Dugas Martin , Sandmann Sarah
Published: September 2021

Background

Artifact chimeric reads are enriched in next-generation sequencing data generated from formalin-fixed paraffin-embedded (FFPE) samples. Previous work indicated that these reads are characterized by erroneous split-read support that is interpreted as evidence of structural variants. Thus, a large number of false-positive structural variants are detected. To our knowledge, no tool is currently available to specifically call or filter structural variants in FFPE samples. To overcome this gap, we developed 2 R packages: SimFFPE and FilterFFPE.

Results

SimFFPE is a read simulator, specifically designed for next-generation sequencing data from FFPE samples. A mixture of characteristic artifact chimeric reads, as well as normal reads, is generated. FilterFFPE is a filtration algorithm, removing artifact chimeric reads from sequencing data while keeping real chimeric reads. To evaluate the performance of FilterFFPE, we performed structural variant calling with 3 common tools (Delly, Lumpy, and Manta) with and without prior filtration with FilterFFPE. After applying FilterFFPE, the mean positive predictive value improved from 0.27 to 0.48 in simulated samples and from 0.11 to 0.27 in real samples, while sensitivity remained basically unchanged or even slightly increased.

Conclusions

FilterFFPE improves the performance of SV calling in FFPE samples. It was validated by analysis of simulated and real data.
Public health insurance and ethnic disparities in maternal health care: the case of vulnerable Mexican women over the last 25 years
Authors: Serván-Mori Edson , Orozco-Núñez Emanuel , Heredia-Pi Ileana , Armenta-Paulino Nancy , Wirtz Veronika J , Meneses-Navarro Sergio , Nigenda Gustavo
Published: September 2021

This article examines the coverage in the continuum of antenatal–postnatal care for vulnerable women in Mexico according to indigenous status and assesses the influence of public health insurance strategies on the evolution of coverage over the last 25 years. We studied a total of 19 613 567 Mexican women, aged 12–54 years at last birth, based on a pooled cross-sectional analysis of data from the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics. After describing sociodemographic characteristics and maternal-health coverage by indigenous status, we constructed a pooled fixed-effects and interaction multivariable regression model to assess the influence of the Seguro Popular programme on continuum of care. We estimated adjusted continuum of care coverage between 1994 and 2018 according to Seguro Popular affiliation and indigenous status. Prior to the Seguro Popular programme, crude coverage in the continuum of care for non-indigenous women stood at 14.5% [95% confidence interval (CI): 13.2–15.8%] or 11 percentage points higher than for indigenous women. During the last period of the programme, it rose to 46.5% [95% CI: 45.6–47.5%] and 34.1% [95% CI: 30.7–37.4%], respectively. Our regression analysis corroborated findings that, on average, indigenous women faced lower odds of benefiting from continuum of care [adjusted odds ratio (aOR) = 0.48, 95% CI: 0.40–0.57] than did their non-indigenous counterparts. It also revealed that coverage for indigenous women without Seguro Popular affiliation was 26.7% [95% CI: 23.3–30.1%] or 12 percentage points lower than for those with Seguro Popular affiliation (38.6%, 95% CI: 35.7–41.4%). Our regression results confirmed that the latter benefited from higher odds of continuum of care (aOR = 1.67, 95% CI: 1.36–2.26). Gaps between those of indigenous and non-indigenous status have persisted, but the Seguro Popular clearly contributed to reducing the coverage gaps between these two groups of women. Strategies yielding better outcomes are required to improve the structural conditions of indigenous populations.
Energetic Lifestyle Drives Size and Shape of Avian Erythrocytes
Authors: Soulsbury Carl D , Dobson Jessica , Deeming D Charles , Minias Piotr
Published: September 2021

The size and shape of red blood cells (erythrocytes) is determined by key life history strategies in vertebrates. They have a fundamental role to deliver oxygen to tissues, and their ability to do so is shaped by the tissue's need and their shape. Despite considerable interest in how other components of blood are shaped by ecology and life history, few studies have considered erythrocytes themselves. We tested how erythrocyte size and shape varied in relation to energetically demanding activities using a dataset of 631 bird species. We found that in general, birds undergoing greater activities such as long distance migration had smaller and more elongated cells, while those with greater male-male competition had smaller and rounder cells. Smaller, more elongated erythrocytes allow more rapid oxygenation/deoxygenation and support greater aerobic activity. The rounder erythrocytes found in species with strong male–male competition may stem from younger erythrocytes deriving from androgen-induced erythropoiesis rates. Finally, diving species of bird had larger erythrocytes, indicating that erythrocytes are acting as a vital oxygen store. In summary, erythrocyte size and shape in birds are driven by the need to deliver oxygen during energetically costly activities.
Analysis of an electroless plating problem
Authors: Girault Vivette , Pironneau Olivier , Wu Po-Yi
Published: September 2021

Electroless plating in microfluidic channels is a novel technology at the micrometer scale. As the microchannel depth varies with the flow of the chemicals, care must be taken for the channel not to run dry. Owing to the deposited chemical species the physical domain of the flow changes with time, leading to a free boundary problem. As the motion of the free boundary is small it is modelled by a transpiration approximation. With this simplification, the mathematical model consists of a Navier–Stokes flow and an equation for the concentration of the plating chemical coupled by nonstandard and nonlinear boundary conditions. Existence and uniqueness are proved for the concentration equation, assuming that the flow is given. Numerical analysis is carried out and justifies the proposed numerical schemes and the nonlinear algorithms. The numerical study is performed, in the two-dimensional case, with the finite element method and an implicit Euler time scheme for the coupled problem with the Navier–Stokes flow and the nonlinear concentration equation.
Expression Analyses of Vitellogenin and Target of Rapamycin of Sogatella furcifera (Hemiptera: Delphacidae), and Their Effects on Reproduction
Authors: Yi Jinyu , Li Fei , Xu Changyu , Liu Yudi , Hou Maolin
Published: September 2021

Vitellogenin (Vg) and the target of rapamycin (TOR) are important genes involved in insect reproduction regulation. In this work, the full lengths of the Vg (SfVg) and TOR (SfTOR) genes of the white-backed planthopper Sogatella furcifera were cloned. The expression pattern in females showed that SfVg was highly expressed in fat bodies, and SfTOR was highly expressed in Malpighian tubules. After silencing SfVg or SfTOR, female adults did not deposit eggs. Their ovarian development was delayed, and yolk protein deposition in the oocytes was reduced. However, wild-type females mated with SfTOR-silenced males could lay eggs and produce offsprings normally. The dissections of testes and accessory glands of males with SfTOR knockdown showed that their development was not affected. Therefore, the silencing of the SfVg or SfTOR genes can effectively inhibit female reproduction, but SfTOR knockdown has no significant effect on male reproductive capacity. Furthermore, silencing SfTOR can cause SfVg expression to decrease significantly. All of the above results revealed that SfVg and SfTOR are essential for white-backed planthopper reproduction and may provide a potential target for pest control.
Regional local integrated rockburst monitoring and early warning for multi-seam mining
Authors: Mu Hongwei , Song Dazhao , He Xueqiu , Li Zhenlei , Su Dongfang , Xue Yarong
Published: September 2021

Rockburst has become a main problem affecting the safety and efficiency of coal mine production. Early warning of it is essentially important for safety management. The dynamic and static load sources of rockburst, induced by multi-coal seam mining, are more complex, making rockburst prediction more difficult. The problem of rockburst early warnings in multi-seam mining was addressed by establishing a regional local integrated rockburst monitoring and early warning method based on the following criteria. (i) In regional space, the microseismic (MS) frequency ratio index and dispersion index were used to predict the regional dynamic load. (ii) In the local excavation and mining space, the risk degree of local static load concentration was characterised by the overrun amplitude indexes of electromagnetic radiation (EMR) intensity and pulse. (iii) According to the predicted spatial location of dynamic load and the attenuation law of regional dynamic load, the influence weight of the regional dynamic load on the excavation and mining space was determined. Based on this, the danger degrees of regional dynamic load and local static load were superposed to realise the regional local integrated warning of rockburst. This prediction method was applied for predicting rockburst in the Xinzhouyao mine, and the result indicated that the method can effectively predict the occurrence of dynamic load, the risk degree of local static load and rockburst induced by multiple types of dynamic and static loading combined together. The reliability of this prediction method was verified by records of roadway deformation and rockburst, and detection results from passive velocity tomography.
Characterization and Developmental Expression Patterns of Four Hexamerin Genes in the Bumble Bee,Bombus terrestris(Hymenoptera: Apidae)
Authors: Tian Yakai , Qu Yingping , Dong Kun , He Shaoyu , Jie Wu , Huang Jiaxing
Published: September 2021

Hexamerins are members of the hemocyanin superfamily and play essential roles in providing amino acids and energy for the nonfeeding stages of insects. In this study, we cloned and analyzed the expression patterns of four hexamerin genes (hex 70a, hex 70b, hex 70c, and hex 110) at different worker development stages and queen diapause statuses in the bumble bee, Bombus terrestris. The results of this study showed that hex 110 has the longest open reading frame (ORF; 3,297 bp) compared to the ORFs of hex 70a (2,034 bp), hex 70b (2,067 bp), and hex 70c (2,055 bp). The putative translation product of Hex 70a, Hex 70b, Hex70c, and Hex 110 has 677, 688, 684, and 1,098aa with predicted molecular mass of 81.13, 79.69, 81.58, and 119 kDa. In the development stages of workers, the expression levels of hex 70a, hex 70b, and hex 70c increased gradually from the larval stage and exhibited high expression levels at the pink eyed and brown eyed pupae stage, whereas hex 110 exhibited the highest expression level at the larval period. Four hexamerin genes were highly expressed at the prediapause status of queen (P < 0.05), and compared to the eclosion queen, the lowest upregulation was 3.7-fold, and the highest upregulation was 1,742-fold. The expression levels of hex 70b, hex 70c, and hex 110 at diapause were significantly higher than those at postdiapause (P < 0.05). In conclusion, hexamerins may play important roles in queen diapause and metamorphosis of larval and pupal stages.
Transcriptomic profiling reveals gene expression in human peripheral blood after exposure to low-dose ionizing radiation
Authors: Fang Fang , Yu Xiaoling , Wang Xiaochun , Zhu Xiaojun , Liu Lantao , Rong Li , Niu Dongsheng , Li Jue
Published: September 2021

Although the health effects of exposure to low-dose ionizing radiation have been the focus of many studies, the affected biological functions and underlying regulatory mechanisms are not well-understood. In particular, the influence of radiation exposure at doses of less than 200 mGy on the regulation of genes and pathways remains unclear. To investigate the molecular alterations induced by varying doses of low-dose radiation (LDR), transcriptomic analysis was conducted based on ribonucleic acid (RNA) sequencing following exposure to 50 and 150 mGy doses. Human peripheral blood was collected, and the samples were divided into three groups, including two treatments and one control (no radiation). A total of 876 (318 upregulated and 558 downregulated) and 486 (202 upregulated and 284 downregulated) differentially expressed genes (DEGs) were identified after exposure to 50 mGy and 150 mGy, respectively. Most upregulated genes in both the 50 mGy and 150 mGy groups were associated with ‘antigen processing and presentation,’ which appeared to be the major targets affected by LDR exposure. Several interacting genes, including HLA-DQA1, HLA-DQA2, HLA-DQB2, HLA-DRB1, and HLA-DRB5 were mapped to ‘antigen processing and presentation,’ ‘immune system-related diseases’ and the ‘cytokine-mediated signaling pathway,’ suggesting that these genes might drive the downstream transmission of these signal transduction pathways. Our results suggest that exposure to LDR may elicit changes in key genes and associated pathways, probably helping further explore the biological processes and molecular mechanism responsible for low-dose occupational or environmental exposures in humans.
Semaphorin 3A Levels in Lupus with and without Secondary Antiphospholipid Antibody Syndrome and Renal Involvement
Authors: Kart Bayram Gözde Sevgi , Erden Abdulsamet , Bayram Doğan , Özdemir Bahar , Karakaş Özlem , Apaydın Hakan , Ateş Ortaç , Güven Serdar Can , Armağan Berkan , Gök Kevser , Maraş Yüksel , Omma Ahmet , Küçükşahin Orhan , Topçuoğlu Canan , Erten Şükran
Published: September 2021

Objective

The aim of this study is to evaluate semaphorin 3A levels in patients with systemic lupus erythematosus (SLE) with and without renal involvement and secondary antiphospholipid antibody syndrome (APS).

Methods

Patients with SLE were grouped according to the presence of secondary APS or renal involvement. The control group consisted of age-matched, nonsmoking, healthy volunteers. Semaphorin 3A levels were compared among groups. All patients with SLE were regrouped according to the presence of thrombotic events, miscarriages, and proteinuria, and semaphorin 3A levels were investigated. Finally, semaphorin 3A levels of all patients with SLE as a single group were compared to those of the control patients.

Results

The mean semaphorin 3A values were 16.16 ± 2.84 ng/mL in the control group, 9.05 ± 5.65 ng/mL in patients with SLE without nephritis and APS, 11.28 ± 5.23 ng/mL in the SLE with APS group, and 8.53 ± 5.11 ng/mL in the lupus nephritis group. When all 3 patient groups were examined as a single group, the mean semaphorin 3A value was significantly lower than that of the control group. Semaphorin 3A was reduced in patients with SLE with thromboembolism and/or history of miscarriage.

Conclusion

Semaphorin 3A levels were lower in all patient groups compared to the control group. Moreover, the reduced semaphorin 3A levels in patients with a history of thromboembolism and/or miscarriage suggest that semaphorin 3A may play an important role in the pathogenesis of vasculopathy.
Fukomys anselli (Rodentia: Bathyergidae)
Authors: Begall Sabine , Burda Hynek , Caspar Kai R
Published: September 2021

Fukomys anselli (Burda, Zima, Scharff, Macholán, and Kawalika 1999) is a bathyergid commonly known as Ansell’s mole-rat. This tooth-digging subterranean rodent lives in cooperatively breeding family groups. It is a small-bodied representative of the genus Fukomys, whose members are distributed in sub-Saharan Africa. Fukomys anselli is endemic to central Zambia and occurs in mesic woodland and agricultural areas. In rural settings, F. anselli is frequently hunted for consumption, but it is unclear whether this significantly impacts its population integrity. Fukomys anselli is listed as “Least Concern” (LC) with a declining population trend by the International Union for Conservation of Nature Red List of Threatened Species.
Extracellular vesicles: The key for precision medicine in glioblastoma
Authors: Del Bene Massimiliano , Osti Daniela , Faletti Stefania , Beznoussenko Galina V , DiMeco Francesco , Pelicci Giuliana
Published: September 2021

Glioblastoma (GBM) represents the most aggressive and lethal disease of the central nervous system. Diagnosis is delayed following the occurrence of symptoms, and treatment is based on standardized approaches that are unable to cope with its heterogeneity, mutability, and invasiveness. The follow-up of patients relies on burdensome schedules for magnetic resonance imaging (MRI). However, to personalize treatment, biomarkers and liquid biopsy still represent unmet clinical needs. Extracellular vesicles (EVs) may be the key to revolutionize the entire process of care for patients with GBM. EVs can be collected noninvasively (eg, blood) and impressively possess multilayered information, which is constituted by their concentration and molecular cargo. EV-based liquid biopsy may facilitate GBM diagnosis and enable the implementation of personalized treatment, resulting in customized care for each patient and for each analyzed time point of the disease, thereby tackling the distinctive heterogeneity and mutability of GBM that confounds effective treatment. Herein, we discuss the limitations of current GBM treatment options and the rationale behind the need for personalized care. We also review the evidence supporting GBM-associated EVs as a promising tool capable of fulfilling the still unmet clinical need for effective and timely personalized care of patients with GBM.
Visit Trends and Factors Associated With Telemedicine Uptake Among Persons With HIV During the COVID-19 Pandemic
Authors: Wood Brian R , Lan Kristine F , Tao Yuan , Mose Eric Y , Aas Erin , Budak Jehan Z , Dhanireddy Shireesha , Kim H Nina
Published: September 2021

Background

In response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, clinicians in outpatient HIV practices began to routinely offer telemedicine (video and/or phone visits) to replace in-person appointments. Video visits are preferred over phone visits, but determinants of video visit uptake in HIV care settings have not been well described.

Methods

Trends in type of encounter (face-to-face, video, and phone) before and during the pandemic were reviewed for persons with HIV (PWH) at an urban, academic, outpatient HIV clinic in Seattle, Washington. Logistic regression was used to assess factors associated with video visit use including sociodemographic characteristics (age, race, ethnicity, language, insurance status, housing status) and electronic patient portal login.

Results

After an initial increase in video visits to 30% of all completed encounters, the proportion declined and plateaued at ~10%. A substantial proportion of face-to-face visits were replaced by phone visits (~50% of all visits were by phone early in the pandemic, now stable at 10%–20%). Logistic regression demonstrated that older age (>50 or >65 years old compared with 18–35 years old), Black, Asian, or Pacific Islander race (compared with White race), and Medicaid insurance (compared with private insurance) were significantly associated with never completing a video visit, whereas history of patient portal login was significantly associated with completing a video visit.

Conclusions

Since the pandemic began, an unexpectedly high proportion of telemedicine visits have been by phone instead of video. Several social determinants of health and patient portal usage are associated with video visit uptake.
Depressive Symptoms Moderate the Relationship Among Physical Capacity, Balance Self-Efficacy, and Participation in People After Stroke
Authors: French Margaret A , Miller Allison , Pohlig Ryan T , Reisman Darcy S
Published: September 2021

Objective

It was previously found that balance self-efficacy mediated the relationship between physical capacity and participation after stroke. The effect of other factors that influence participation, such as depression, on this relationship has not been explored. This study examined the effect of symptoms of depression on the mediated relationship between physical capacity and participation by balance self-efficacy in individuals after stroke.

Methods

In this cross-sectional study, 282 persons with chronic stroke (>6 months) were classified as having either low or high Geriatric Depression Scale scores. This study used a multiple group structural equation model to test moderated mediation by comparing a constrained model (indicating no effect of depression on the mediation) and an unconstrained model (indicating an effect of depression on the mediation). The models were compared using a chi-squared difference test.

Results

The chi-squared difference test suggested that the unconstrained model was a better fit, indicating that depressive symptoms moderated the mediated relationship between physical capacity and participation (χ2(3, N = 282) = 9.0). In the Low Depression group, a significant indirect effect indicated that balance self-efficacy did mediate the relationship between physical capacity and participation. There was no significant indirect effect in the High Depression group.

Conclusion

The results suggest the relationship between physical capacity and participation appears to be mediated by balance self-efficacy in individuals after stroke with low reports of depressive symptoms, but in those with high reports of depressive symptoms, physical capacity and balance self-efficacy are unrelated to participation.

Impact

Targeting balance self-efficacy to improve post-stroke participation may be beneficial only for individuals with low reports of depression. In individuals after stroke with high reports of depression, treatment should include and emphasize the treatment of those depressive symptoms. Additional work further examining these complex relationships is warranted.
Neural Substrates of Psychotic Depression: Findings From the Global ECT-MRI Research Collaboration
Authors: Takamiya Akihiro , Dols Annemiek , Emsell Louise , Abbott Christopher , Yrondi Antoine , Soriano Mas Carles , Jorgensen Martin Balslev , Nordanskog Pia , Rhebergen Didi , van Exel Eric , Oudega Mardien L , Bouckaert Filip , Vandenbulcke Mathieu , Sienaert Pascal , Péran Patrice , Cano Marta , Cardoner Narcis , Jorgensen Anders , Paulson Olaf B , Hamilton Paul , Kampe Robin , Bruin Willem , Bartsch Hauke , Ousdal Olga Therese , Kessler Ute , van Wingen Guido , Oltedal Leif , Kishimoto Taishiro
Published: September 2021

Psychotic major depression (PMD) is hypothesized to be a distinct clinical entity from nonpsychotic major depression (NPMD). However, neurobiological evidence supporting this notion is scarce. The aim of this study is to identify gray matter volume (GMV) differences between PMD and NPMD and their longitudinal change following electroconvulsive therapy (ECT). Structural magnetic resonance imaging (MRI) data from 8 independent sites in the Global ECT-MRI Research Collaboration (GEMRIC) database (n = 108; 56 PMD and 52 NPMD; mean age 71.7 in PMD and 70.2 in NPMD) were analyzed. All participants underwent MRI before and after ECT. First, cross-sectional whole-brain voxel-wise GMV comparisons between PMD and NPMD were conducted at both time points. Second, in a flexible factorial model, a main effect of time and a group-by-time interaction were examined to identify longitudinal effects of ECT on GMV and longitudinal differential effects of ECT between PMD and NPMD, respectively. Compared with NPMD, PMD showed lower GMV in the prefrontal, temporal and parietal cortex before ECT; PMD showed lower GMV in the medial prefrontal cortex (MPFC) after ECT. Although there was a significant main effect of time on GMV in several brain regions in both PMD and NPMD, there was no significant group-by-time interaction. Lower GMV in the MPFC was consistently identified in PMD, suggesting this may be a trait-like neural substrate of PMD. Longitudinal effect of ECT on GMV may not explain superior ECT response in PMD, and further investigation is needed.
Cross-Sectional Studies
Authors: Capili Bernadette
Published: September 2021

Editor's note: This article is one in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the author. To see all the articles in the series, go to http://links.lww.com/AJN/A204.
Money Talks: Pilot Financial Wellness Programs to Promote Positive Financial Planning Behaviors Among Residents
Authors: Ng Patricia , Raghavan Sreekala , Zhang Christiana , Pan Jing-Yu , O’Rourke Paul , Wong Rachel
Published: September 2021

Problem

Graduate medical education programs and national organizations are becoming more involved in promoting trainee financial wellness. Current literature reports residents have poor financial knowledge, high debt levels, low concern about their finances, and deficits in financial preparedness, but there has been little published on best practices for implementing financial wellness programs for residents or measuring meaningful outcomes of such programs.

Approach

From June 2017 to 2019, the authors invited 277 internal medicine residents from the Stony Brook University Hospital, Montefiore Medical Center, and Johns Hopkins Bayview Medical Center residency programs to participate in financial wellness programs. Each institution held at least one 90-minute financial planning session; Stony Brook also had biannual financial wellness check-ins. Participants were invited to complete a presession, an immediate postsession, and a year-end survey to assess changes in financial planning behaviors.

Outcomes

Survey response rates were 49% (135/277) for the presession survey, 47% (130/277) for the immediate postsession survey, and 22% (61/277) for the year-end survey. Ninety-six percent (125/130) found the sessions helpful and 98% (120/123) recommended continuing the program in the future. At year-end, the most frequent completed financial planning actions prompted by the session included saving emergency funds, creating a monthly budget, consolidating loans via the Public Service Loan Forgiveness program, contributing to retirement savings, and participating in an employer’s retirement plan. Residents liked that some sessions were during intern orientation before the selection of retirement plans. Postgraduate year (PGY) 1 residents were more likely to complete positive financial planning actions and to agree or strongly agree that the session prompted them to take financial planning actions than PGY-2 and PGY-3 residents.

Next Steps

While financial wellness programs are well received by internal medicine residents, more robust evidence is needed on curricular delivery methods and program features that promote positive financial planning behaviors.
Outcome of correction of complex femoral rotational deformities using Taylor Spatial Frame in skeletally immature patients: a retrospective case series
Authors: Meselhy Mohammed Anter , Essawy Osama M.
Published: September 2021

Background:

Although the incidence of rotational lower-limb deformity caused by malunited femoral fractures is low, it can alter the force transition across lower limb joints. The aim of the current study was to evaluate the effectiveness of the Taylor Spatial Frame (TSF) in the treatment of severe rotational lower-limb deformities that were caused by neglected malunited femoral fractures in pediatric and adolescent patients.

Methods:

Fifteen skeletally immature patients, six boys and nine girls with mean age of 10.17 yr (range: 7 to 14 yr), who had rotational deformities of the lower limbs and had osteotomies and application of TSF from March 2012 to February 2016 underwent clinical and radiographic assessments.

Results:

The osteotomy site was at the middle third of the femur in 12 patients and at the supracondylar region in three patients. The mean correction time for the femoral rotational deformity was 19.6 days (range: 15 to 28 days). The mean time for fixator removal after full correction of rotational deformity and lengthening was 172.67 days (range: 150 to 180 days). The mean preoperative leg-length discrepancy (LLD) was 4.31 cm (range: 2 to 10 cm), and the mean postoperative LLD was 0.27 cm (range: 0 to 2 cm; P<0.001). Femoral torsion was internal in 10 patients and external in five patients. The mean preoperative rotational deformity was 81 degrees (range: 60 to 180 degrees); the mean postoperative rotational deformity decreased significantly to 3.53 degrees (range: 0 to 7 degrees; P<0.001).

Conclusions:

TSF was effective in treating severe rotational deformities of the lower limbs that were caused by neglected malunited femoral fractures in pediatric and adolescent patients.

Level of Evidence:

Level IV.
Effects of bronchial thermoplasty and cryoablation on airway smooth muscle
Authors: Li Xuan , Xie Shuan-Shuan , Li Guo-Shu , Zeng Jie , Duan Hong-Xia , Wang Chang-Hui
Published: September 2021

Background:

The effectiveness of bronchial thermoplasty (BT) has been reported in patients with severe asthma. This study compared the effects of BT and cryoballoon ablation (CBA) therapy on the airway smooth muscle (ASM).

Methods:

Eight healthy male beagle dogs were included in this experiment. In the preliminary experiment, one dog received BT treatment for both lower lobe bronchus, another dog received CBA treatment for 7 s on the upper and lower lobe of right bronchus, and 30 s on the left upper and lower lobe. The treatments were performed twice at an interval of 1 month. In subsequent experiments, the right lower lobe bronchus was treated with BT, and the left lower lobe bronchus was treated with CBA. The effects of treatment were observed after 1 (n = 3) month and 6 months (n = 3). Hematoxylin-eosin staining, Masson trichrome staining, and immunohistochemical staining were used to compare the effects of BT and CBA therapy on the ASM thickness, collagen fibers synthesis, and M3 receptor expression after treatment. One-way analysis of variance with Dunnett post hoc test was used to analyze the differences among groups.

Results:

In the preliminary experiment, the ASM ablation effect of 30-s CBA was equivalent to that of 7-s CBA (ASM thickness: 30.52 ± 7.75 μm vs. 17.57 ± 15.20 μm, P = 0.128), but the bronchial mucociliary epithelium did not recover, and large numbers of inflammatory cells had infiltrated the mucosal epithelium at 1-month post-CBA with 30-s freezing. Therefore, we chose 7 s as the CBA treatment time in our follow-up experiments. Compared with the control group (35.81 ± 11.02 μm), BT group and CBA group (13.41 ± 4.40 μm and 4.81 ± 4.44 μm, respectively) had significantly decreased ASM thickness after 1 month (P < 0.001). Furthermore, the ASM thickness was significantly lower in the 1-month post-CBA group than in the 1-month post-BT group (P = 0.015). There was no significant difference in ASM thickness between the BT and CBA groups after six months (9.92 ± 4.42 μm vs. 7.41 ± 7.20 μm, P = 0.540). Compared with the control group (0.161 ± 0.013), the average optical density of the ASM M3 receptor was significantly decreased in 6-month post-BT, 1-month post-CBA, and 6-month post-CBA groups (0.070 ± 0.022, 0.072 ± 0.012, 0.074 ± 0.008, respectively; all P < 0.001). There was no significant difference in the average optical density of ASM M3 receptor between the BT and CBA therapy groups after six months (P = 0.613).

Conclusions:

CBA therapy effectively ablates the ASM, and its ablation effect is equivalent to that of BT with a shorter onset time. A neural mechanism is involved in both BT and CBA therapy.
Standardized Training for Physicians Practicing Pediatric Cardiac Critical Care
Authors: Tabbutt Sarah , Krawczeski Catherine , McBride Mary , Amirnovin Rambod , Owens Gabe , Smith Andrew , Wolf Michael , Rhodes Leslie , Hehir David , Asija Ritu , Teele Sarah A. , Ghanayem Nancy , Zyblewski Sinai , Thiagarajan Ravi , Yeh Justin , Shin Andrew Y. , Schwartz Steve M. , Schuette Jennifer , Scahill Carly , Roth Stephen J. , Hoffman Timothy M. , Cooper David S. , Byrnes Jonathan , Bergstrom Charges , Vesel Travis , Scott Jake P. , Rossi Anthony , Kwiatkowski David , DiPietro Lisa M. , Connor Chad , Chen Jodi , Charpie John , Bochkoris Matt , Affolter Jeremy , Bronicki Ronald A.
Published: September 2021

OBJECTIVES:

In the vast majority of Children’s Hospitals, the critically ill patient can be found in one of three locations: the PICU, the neonatal ICU, and the cardiac ICU. Training, certification, and maintenance of certification for neonatology and critical care medicine are over seen by the Accreditation Council for Graduate Medical Education and American Board of Pediatrics. There is no standardization of training or oversight of certification and maintenance of certification for pediatric cardiac critical care.

DATA SOURCES:

The curricula from the twenty 4th year pediatric cardiac critical care training programs were collated, along with the learning objectives from the Pediatric Cardiac Intensive Care Society published “Curriculum for Pediatric Cardiac Critical Care Medicine.”

STUDY SELECTION:

This initiative is endorsed by the Pediatric Cardiac Intensive Care Society as a first step toward Accreditation Council for Graduate Medical Education oversight of training and American Board of Pediatrics oversight of maintenance of certification.

DATA EXTRACTION:

A taskforce was established of cardiac intensivists, including the directors of all 4th year pediatric cardiac critical care training programs.

DATA SYNTHESIS:

Using modified Delphi methodology, learning objectives, rotational requirements, and institutional requirements for providing training were developed.

CONCLUSIONS:

In the current era of increasing specialized care in pediatric cardiac critical care, standardized training for pediatric cardiac critical care is paramount to optimizing outcomes.
Outcomes of Catheter-Related Arterial and Venous Thrombosis After Enoxaparin Therapy in Neonates and Infants With Congenital Heart Disease
Authors: Saini Ashish , Cavalcante Rodrigo , Crisanto Liliam Aquino , Sasaki Jun
Published: September 2021

OBJECTIVES:

Outcomes of catheter-related arterial and venous thrombosis after enoxaparin therapy in neonates and infants with congenital heart disease.

DESIGN:

A single-center retrospective cohort study.

SETTING:

Cardiac ICU.

PATIENTS:

Patients under 1 year old cared for in the cardiac ICU at Nicklaus Children’s Hospital from January 2015 to January 2019 and treated with enoxaparin for central vascular catheter-related arterial and venous thrombosis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

One-hundred fifty-six events of central catheter-related arterial and venous thrombosis were included in the study. Arterial thrombi accounted for 109 (69.9%) and venous thrombi for 47 (30.1%) of the events. Femoral vessels were the most commonly affected site (88.5%). Therapeutic outcomes were analyzed in 106 events, excluding those without follow-up imaging. The analysis was stratified by age into neonates and infants and catheter types into arterial and venous catheter groups. Therapeutic dose of enoxaparin was higher in neonates (median 1.8 mg/kg/dose) compared with infants (1.6 mg/kg/dose; p = 0.001). Complete resolution was seen in 68%, partial resolution in 19%, nonresolution in 13% of the events. The complete resolution was higher for arterial than venous (85% vs 65.6%; p = 0.032) thrombi with a shorter duration of enoxaparin treatment (23 vs 43 d; p = 0.014). Complete resolution was lowest in neonates with venous thrombosis (42.9%). The median time to complete resolution by Kaplan-Meier analysis was 24.9 days in the overall cohort, 34.3 days in neonates, 24.9 days in infants, 20 days in arterial, and 44.9 days in venous catheter group.

CONCLUSIONS:

A high proportion of vascular catheter-related thrombi identified in infants with congenital heart disease resolve with enoxaparin treatment. In all patients with thrombosis, arterial versus venous thrombosis is associated with greater odds of resolution.
Establishing Entrustable Professional Activities in Pediatric Cardiac Critical Care*
Authors: Werho David K. , DeWitt Aaron G. , Owens Sonal T. , McBride Mary E. , van Schaik Sandrijn , Roth Stephen J.
Published: September 2021

OBJECTIVES:

Define a set of entrustable professional activities for pediatric cardiac critical care that are recognized as the core activities of the subspecialty by a diverse group of pediatric cardiac critical care physicians and that can be broadly and consistently applied irrespective of training pathway.

DESIGN:

Mixed methods study with sequential integration of qualitative and quantitative data.

SETTING:

Structured telephone interviews of pediatric cardiac critical care medical directors at Pediatric Cardiac Critical Care Consortium centers followed by an electronic survey of pediatric cardiac critical care physician members of the Pediatric Cardiac Intensive Care Society from across the United States and internationally.

SUBJECTS:

Pediatric cardiac intensive care physicians.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Twenty-four of 26 eligible Pediatric Cardiac Critical Care Consortium medical directors participated in the interviews. Based on qualitative analyses of interview data, we identified an initial set of nine entrustable professional activities. Fifty-eight of 185 eligible physicians completed a subsequent survey asking them to rate their agreement with the entrustable professional activities. It showed consensus (> 80% agreement) with the entire initial set of entrustable professional activities, with greater than 96% agreement in most cases. The feedback from free-text survey responses was incorporated to generate a final set of entrustable professional activities.

CONCLUSIONS:

We generated a set of nine entrustable professional activities, which we believe can be broadly applied to any physician training in pediatric cardiac critical care, irrespective of individual training pathway. Next steps include incorporation of these entrustable professional activities into curriculum design and trainee assessment tools.
Undiagnosed Metachromatic Leukodystrophy Presenting as Severe Gastrointestinal Bleeding and Cholestasis from Hemobilia
Authors: Stevens James P. , Dakshinamoorthy Janani , Gill Anne Elizabeth , Parker Paul , Geem Duke , Berauer John-Paul , Schoen Bess , Gupta Nitika , Romero Rene
Published: September 2021

Metachromatic leukodystrophy (MLD) is a neurodegenerative disorder caused by the accumulation of lipids called sulfatides throughout the nervous system. Sulfatides can also collect in other organs throughout the body including the gallbladder where they form polyps. Gallbladder polyps rarely have been found to bleed in patients with known MLD, presumably due to polyp shearing. Here we present a case of a child with autism presenting with severe gastrointestinal bleeding and direct hyperbilirubinemia, requiring significant resuscitation and biliary drain placement to tamponade ongoing bleeding. Subsequent neurologic and genetic investigation led to the diagnosis of MLD, with laparoscopic cholecystectomy revealing extensive, elongated gallbladder polyps. Clinicians who care for patients with MLD, including gastroenterologists who manage their progressive oropharyngeal dysphagia, should be aware of the risk for this life-threatening complication. Moreover, pediatric gastroenterologists and hepatologists should maintain a high index of suspicion for MLD in new patients presenting with developmental regression and gastrointestinal bleeding.
Hepatocellular Carcinoma in the Absence of Cirrhosis in a Child With Inactive Chronic Hepatitis B Infection
Authors: Rajan Charanya , Chiou Fang Kuan , Merchant Khurshid , Phua Kong Boo
Published: September 2021

Chronic hepatitis B infection has been identified as an important risk factor for developing hepatocellular carcinoma (HCC) especially in the presence of hepatitis and liver cirrhosis. However, here we describe an unusual case of a child with chronic hepatitis B infection who developed HCC in the absence of active hepatitis or cirrhosis. This case serves to highlight the importance of regular HCC surveillance for all children with chronic hepatitis B, regardless of presence or absence of hepatitis or cirrhosis.
A Quality Improvement Project to Delay Umbilical Cord Clamping Time
Authors: Pauley Amanda N. , Roy Amy , Balfaqih Yaslam , Casey Erin , Marteney Rachel , Evans Joseph E.
Published: September 2021

Introduction:

Delayed cord clamping (DCC) has numerous benefits to the neonate, including increased hemoglobin levels, decreased need for red blood cell transfusions, and decreased incidence of necrotizing enterocolitis and intraventricular hemorrhage. A preliminary observational study at our institution demonstrated 12% of the observed deliveries met the DCC standard, defined as umbilical cord clamping at least 30–60 seconds after birth. Therefore, we designed a quality improvement project to increase the percentage of deliveries using DCC.

Methods:

We planned a quality improvement project aiming to increase DCC rates on the university obstetrics service. Our interventions included provider education, installation of timers in the delivery suites, and modification to documentation in the electronic health record. We measured our results through the documented status of cord clamping, either: (1) greater than or equal to 30 seconds or (2) less than 30 seconds. We analyzed the DCC rates weekly and compared those results to the DCC goal of 80% of all deliveries.

Results:

Postintervention DCC rates were 96% overall. Rates of DCC met our aim of 80% or greater each of the 6 weeks we collected data.

Conclusion:

Simple and inexpensive interventions quickly led to improvements in DCC rates on our university obstetrics service. Our interventions including, provider education, installation of timers in delivery suites, and modification to cord clamping documentation in the electronic health record can be easily instituted at other hospitals. Additionally, the simplicity of this system can produce long-term sustainability of DCC.
Effectiveness of COVID-19 Vaccines: Eight Months Post Single Dose Vaccination
Authors: Alharbi Naif Khalaf , Al-Tawfiq Jaffar A. , Alghnam Suliman , Alwehaibe Amal , Alasmari Abrar , Alsagaby Suliman A. , Alotaibi Faizah , Alsubaie Faisal , Alshomrani Majid , Farahat Fayssal M. , Bosaeed Mohammad , Alharbi Ahmad , Aldibasi Omar , Assiri Abdullah M.
Published: September 2021

Objectives

To describe the real-world data on the effectiveness of Pfizer-BioNtech BNT162b2 and AstraZeneca-Oxford AZD1222 vaccines against COVID-19 in a large cohort in the Kingdom of Saudi Arabia (KSA).

Methods

A total of 18,543 subjects received a single-dose of either of the vaccines at one vaccination centre in KSA, and were followed up for three to eight months. Clinical data from medical records, adverse events (AEs) from a self-reporting system, and COVID-19 infection data from the national databases were retrieved and analysed.

Results

Subjects median age was 33 years old with an average of 27.3 body mass index and the majority were male (60.1%). 92.17% of the subjects had no COVID-19 infection post-vaccination. Diabetes mellitus (p=0.0325), organ transplantation (p=0.0254), and morbid obesity (p=0.0014) were risk factors for infection post-vaccination. Unlike vaccine type, being Saudi, male, or obese was more likely to get the infection earlier. AE reports from 1084 subjects included injection site pain, fatigue, fever, myalgia, headache.

Conclusion

Single-dose COVID-19 vaccines in KSA showed an effectiveness rate of 92.17% up to eight months follow-up. The rate for AZD1222 was higher than what have been previously reported. Side effects and AEs were within what has been reported in clinical trials.