bluuebunny/crossref_metadata_2025 huggingface dataset:
Citizen Science Provides an Efficient Method for Broad-Scale Tick-Borne Pathogen Surveillance of Ixodes pacificus and Ixodes scapularis across the United States
Authors: Porter W. Tanner , Wachara Julie , Barrand Zachary A. , Nieto Nathan C. , Salkeld Daniel J.
Published: September 2021

In the 21st century, zoonotic pathogens continue to emerge, while previously discovered pathogens continue to have changes within their distribution and prevalence. Monitoring these pathogens is resource intensive, requiring both field and laboratory support; thus, data sets are often limited within their spatial and temporal extents.
Helicobacter pylori and Epstein-Barr Virus Coinfection Stimulates Aggressiveness in Gastric Cancer through the Regulation of Gankyrin
Authors: Kashyap Dharmendra , Baral Budhadev , Jakhmola Shweta , Singh Anil Kumar , Jha Hem Chandra
Published: September 2021

In the present study, we evaluated the synergistic effects of EBV and
H. pylori
infection on gastric epithelial cells in various coinfection models. These coinfection models were among the first to depict the exposures of gastric epithelial cells to EBV followed by
H. pylori
; however, coinfection models exist that narrated the scenario upon exposure to
H. pylori
followed by that to EBV.
Microbiota Influences Fitness and Timing of Reproduction in the Fruit Fly Drosophila melanogaster
Authors: Matthews Melinda K. , Malcolm Jaanna , Chaston John M.
Published: September 2021

The ability of associated microorganisms (“microbiota”) to influence animal life history traits has been recognized and investigated, especially in the past 2 decades. For many microbial communities, there is not always a clear definition of whether the microbiota or its members are beneficial, pathogenic, or relatively neutral to their hosts’ fitness.
RNA Sequencing of Medusavirus Suggests Remodeling of the Host Nuclear Environment at an Early Infection Stage
Authors: Zhang Ruixuan , Endo Hisashi , Takemura Masaharu , Ogata Hiroyuki
Published: September 2021

Medusavirus is an amoeba-infecting giant virus that was isolated from a hot spring in Japan. It belongs to the proposed family “
Medusaviridae
” in the phylum
Nucleocytoviricota
.
Risk Factors for Relapse in Acute Bacterial Prostatitis: the Impact of Antibiotic Regimens
Authors: Marquez-Algaba Ester , Pigrau Carles , Bosch-Nicolau Pau , Viñado Belen , Serra-Pladevall Judit , Almirante Benito , Burgos Joaquín
Published: September 2021

In the manuscript, we report a large series of acute bacterial prostatitis cases and describe data about the etiology, antibiotic resistance rate, and outcome, specially focused on the risk factors for relapse. We found high rates of resistance to the most frequently used antibiotics and a high relapse rate in patients whose treatment was not adjusted according to their microbiological susceptibility.
Generation of High Current Densities in Geobacter sulfurreducens Lacking the Putative Gene for the PilB Pilus Assembly Motor
Authors: Ueki Toshiyuki , Walker David J. F. , Nevin Kelly P. , Ward Joy E. , Woodard Trevor L. , Nonnenmann Stephen S. , Lovley Derek R.
Published: September 2021

Geobacter sulfurreducens
is a model microbe for the study of biogeochemically and technologically significant processes, such as the reduction of Fe(III) oxides in soils and sediments, bioelectrochemical applications that produce electric current from waste organic matter or drive useful processes with the consumption of renewable electricity, direct interspecies electron transfer in anaerobic digestors and methanogenic soils and sediments, and metal corrosion. Elucidating the phenotypes associated with gene deletions is an important strategy for determining the mechanisms for extracellular electron transfer in
G. sulfurreducens
.
Identification and Verification of the Prodigiosin Biosynthetic Gene Cluster (BGC) in Pseudoalteromonas rubra S4059
Authors: Wang Xiyan , Isbrandt Thomas , Christensen Emil Ørsted , Melchiorsen Jette , Larsen Thomas Ostenfeld , Zhang Sheng-Da , Gram Lone
Published: September 2021

Pigmented
Pseudoalteromonas
strains are renowned for their production of secondary metabolites, and genome mining has revealed a high number of biosynthetic gene clusters (BGCs) for which the chemistry is unknown. Identification of those BGCs is a prerequisite for linking products to gene clusters and for further exploitation through heterologous expression.
What is the onset mechanism of internal hernia after vertebral body fracture? A case of internal hernia secondary to traumatic vertebral fracture
Authors: Matsumoto Akiyo , Akao Takahiko , Matsumoto Hiroshi , Kobayashi Naoki , Kamiya Makoto
Published: September 2021

A 67-year-old man who had been pinned between a basket crane and a tree complained of severe pain in his lower back and a decreased appetite. Laparotomy after decompressing the gastrointestinal tract revealed incarceration of an ileal loop within a fractured third lumbar vertebra. The damaged bowel was resected, and an end-to-end anastomosis was performed. Once the patient’s condition had stabilised, posterior lumbar fixation was performed. There were no abdominal complications or lower limb neurological deficits during the follow-up period. Enhanced CT and MRI had been helpful in making the diagnoses. Histopathological examination revealed the aetiology of the traumatic incarceration: the intestine had been pinched as the disc space closed, and the body attempted to return to its original state by exerting countertraction.
Cervical osteomyelitis and soft tissue polymicrobial abscess in an immunocompetent 16-year-old patient
Authors: Guri Alex , Mahlab-Guri Keren , Adi Meital , Scheier Eric
Published: September 2021

A 16-year-old man was hospitalised with a painful space-occupying lesion in his posterior neck involving muscles, soft tissues, C1 cervical vertebra and vital cervical blood vessels. The true-cut biopsy showed inflammatory tissue. The microbiological analysis, which combined classical bacteriological and molecular methods, yielded at least four different anaerobic species. The patient was treated successfully with a prolonged course of ceftriaxone and metronidazole.
Life-saving with a vaginal condom catheter in postpartum haemorrhage due to vaginal lacerations in a low-resource setting
Authors: Piyadigama Indunil , Banagala Chinthaka , Kariyawasam Lakshman , Jayawardane Madura
Published: September 2021

Postpartum haemorrhage (PPH) due to multiple vaginal lacerations is difficult to manage and tamponade is used as a life-saving measure. Condom catheter with stay sutures at the vaginal introitus for this purpose has not been reported. We describe successfully managing PPH due to multiple vaginal lacerations following a forceps delivery using a condom tied to an 18 FG Foley catheter. The device was introduced to the vagina, inflated with 700 mL of normal saline and was held in situ by sealing the vaginal introitus with interrupted nylon stitches running between the labia minora. Condom catheter is cheap and freely available in low-resource settings. The preparation and application can be done by a less experienced operator.
Milky pleural effusion in a neonate and approach to investigating chylothorax
Authors: Senarathne Udara Dilrukshi , Rodrigo Ranmali , Dayanath Bolonghoge Krishantha Trixy Priyank
Published: September 2021

Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared ‘milky’ with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.
Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial
Authors: Gray Alasdair J , Roobottom Carl , Smith Jason E , Goodacre Steve , Oatey Katherine , O’Brien Rachel , Storey Robert F , Curzen Nick , Keating Liza , Kardos Attila , Felmeden Dirk , Lee Robert J , Thokala Praveen , Lewis Steff C , Newby David E
Published: September 2021

Objectives

To establish if the use of early computed tomography (CT) coronary angiography improves one year clinical outcomes in patients presenting to the emergency department with acute chest pain and at intermediate risk of acute coronary syndrome and subsequent clinical events.

Design

Randomised controlled trial.

Setting

37 hospitals in the UK.

Participants

Adults with suspected or a provisional diagnosis of acute coronary syndrome and one or more of previous coronary heart disease, raised levels of cardiac troponin, or abnormal electrocardiogram.

Interventions

Early CT coronary angiography and standard of care compared with standard of care only.

Main outcome measures

Primary endpoint was all cause death or subsequent type 1 or 4b myocardial infarction at one year.

Results

Between 23 March 2015 and 27 June 2019, 1748 participants (mean age 62 years (standard deviation 13), 64% men, mean global registry of acute coronary events (GRACE) score 115 (standard deviation 35)) were randomised to receive early CT coronary angiography (n=877) or standard of care only (n=871). Median time from randomisation to CT coronary angiography was 4.2 (interquartile range 1.6-21.6) hours. The primary endpoint occurred in 51 (5.8%) participants randomised to CT coronary angiography and 53 (6.1%) participants who received standard of care only (adjusted hazard ratio 0.91 (95% confidence interval 0.62 to 1.35), P=0.65). Invasive coronary angiography was performed in 474 (54.0%) participants randomised to CT coronary angiography and 530 (60.8%) participants who received standard of care only (adjusted hazard ratio 0.81 (0.72 to 0.92), P=0.001). There were no overall differences in coronary revascularisation, use of drug treatment for acute coronary syndrome, or subsequent preventive treatments between the two groups. Early CT coronary angiography was associated with a slightly longer time in hospital (median increase 0.21 (95% confidence interval 0.05 to 0.40) days from a median hospital stay of 2.0 to 2.2 days).

Conclusions

In intermediate risk patients with acute chest pain and suspected acute coronary syndrome, early CT coronary angiography did not alter overall coronary therapeutic interventions or one year clinical outcomes, but reduced rates of invasive angiography while modestly increasing length of hospital stay. These findings do not support the routine use of early CT coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome.

Trial registration

ISRCTN19102565
,
NCT02284191
.
What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews
Authors: Spiers Gemma F , Liddle Jennifer , Kunonga Tafadzwa Patience , Whitehead Ishbel Orla , Beyer Fiona , Stow Daniel , Welsh Claire , Ramsay Sheena E , Craig Dawn , Hanratty Barbara
Published: September 2021

Objectives

To identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population.

Design

A rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers’ health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced.

Results

Twelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers’ physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention.

Conclusions

Current evidence fails to fully quantify the impacts that caring for older people has on carers’ health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice.
Diagnostic role of urine specific gravity to detect kidney impairment on heat-exposed workers in a shoe factory in Indonesia: a cross-sectional study
Authors: Nainggolan Ginova , Soemarko Dewi , Siregar Parlindungan , Lydia Aida , Bardosono Saptawati , Prijanti Ani Retno , Aulia Diana
Published: September 2021

Objectives

Globally, there are increasing cases of chronic kidney disease of unknown origin among heat-exposed workers. We aimed to see the kidney damages of indoor heat-exposed workers and whether urine specific gravity can predict any kidney damages.

Design

A cross-sectional study.

Setting

A shoe-making factory in West Java, Indonesia.

Participants

119 subjects were included. Minimum total sample size was 62. Subjects were indoor heat-exposed workers who were exposed to occupational wet-bulb globe temperature (WBGT) of 28°C–30°C for 8 hours daily with 1 hour break, 5 days a week. The inclusion criterion was healthy subjects according to the result from annual medical check-up in 2019. The exclusion criteria were subjects who were taking vitamins and/or supplements that might cause disturbance in urine specific gravity and/or hydration status, pregnant and fasting.

Primary and secondary outcome measures

Area under the curve (AUC), sensitivity and specificity of urine specific gravity for the detection of urinary nephrin and urinary kidney injury molecule-1 (KIM-1) were analysed. Estimated glomerular filtration rate (eGFR) and quantitative albuminuria were also measured.

Results

WBGT in the work area of the subject was 28°C–30°C. There were 15 (12.6%) subjects who had eGFR <90 mL/min, but ≥60 mL/min. High serum vasopressin levels were found in 79 subjects with a mean of 6.54 (95% CI 5.94 to 7.14) ng/mL. Most subjects had nephrinuria (87.4%) with preserved renal function (87.4%). Several subjects had elevated urinary KIM-1 (10.9%) and albuminuria (7.6%). AUC of urine specific gravity for increased urinary nephrin was 81.7% (95% CI 68.8% to 94.6%) and statistically significant (p<0.001). Cut-off value of ≥1.018 for urine specific gravity has sensitivity of 71.2% and specificity of 80% for detecting elevation of urinary nephrin levels.

Conclusion

Urine specific gravity with a cut-off value of ≥1.018 could be used to detect nephrinuria among heat-exposed workers.
Association between systemic sclerosis and peripheral arterial disease: a nationwide observation retrospective claim records cohort study in Taiwan
Authors: Hsieh Ming-Chia , Chen Hsin-Hung , Chou Tzu-Yi , Su Ta-Wei , Lin Cheng-Li , Kao Chia-Hung
Published: September 2021

Objectives

Recent studies have proposed associations between systemic sclerosis (SSc) and atherosclerosis and between SSc and cardiovascular disease. However, in Asia, no large-scale studies have focused on the association between peripheral arterial disease (PAD) and SSc.

Setting

A nationwide observation retrospective cohort study.

Participants

The National Health Insurance Research Database was used for selecting patients diagnosed with SSc from 2000 to 2011. Patients diagnosed with PAD before the index date were excluded.

Primary and secondary outcome measures

The SSc cohort comprised 1106 patients with SSc, and the non-SSc cohort comprised 4424 matched controls. The Cox proportional hazards regression model was used for analysing the adjusted risk of PAD between the case and control patients.

Results

The SSc cohort exhibited a significantly higher risk (HR=2.15, 95% CI=1.47 to 3.14) of PAD than did the non-SSc cohort. Patients with heart failure exhibited the highest risk of PAD (adjusted HR=2.10, 95% CI=1.20 to 3.70). Moreover, even without any comorbidities, the SSc cohort exhibited a significantly higher risk (adjusted HR=4.17 fold, 95% CI=1.98 to 8.77) of PAD than did the non-SSc cohort.

Conclusion

SSc is associated with a significantly high risk of PAD. Further studies are required to reduce the PAD risk among patients with SSc.
Relative effectiveness of non-surgical interventions for pain management in knee osteoarthritis: a protocol for a component network meta-analysis of randomised controlled trials
Authors: Thompson Trevor , Ahmed Bawan , Weldon Sharon Marie , Efthimiou Orestis , Stubbs Brendon
Published: September 2021

Introduction

Knee osteoarthritis is a chronic degenerative disease associated with significant chronic pain, disability and impaired quality of life and is the most common form of osteoarthritis. There is no cure for knee osteoarthritis, and the main therapeutic goals are pain management and improving quality of life. The objective of this study is to evaluate the relative efficacy and acceptability of available interventions using network meta-analysis (NMA) to provide a comprehensive evidence base to inform future treatment guidelines.

Methods and analysis

A comprehensive literature search of major electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) and clinical trial registries will identify randomised control trials (RCTs) of interventions listed in NICE guidelines for the treatment of knee osteoarthritis in adults. We will perform an NMA to estimate relative intervention effects across the whole treatment network. If any studies use multicomponent intervention packages, we will employ a component NMA model to estimate the contribution of individual components. The quality of evidence will be assessed using the Confidence in Network Meta-Analysis approach, which is based on the traditional GRADE framework adapted for NMA. Risk of bias (RoB) will be assessed using the revised Cochrane RoB 2.0 tool for RCTs.

Ethics and dissemination

This study does not require ethical approval. Findings will be submitted to a peer-reviewed journal.

PROSPERO registration number

CRD42020184192.
Caregiver burden and associated factors among primary caregivers of patients with ALS in home care: a cross-sectional survey study
Authors: Tang Shan , Li Li , Xue Hongxia , Cao Shuyan , Li Chao , Han Kunjing , Wang Binquan
Published: September 2021

Objectives

This study aims to understand the caregiver burden experienced by the primary caregivers of patients with amyotrophic lateral sclerosis (ALS), and to explore the factors influencing caregiver burden.

Design

A cross-sectional survey design was used.

Setting

This study was conducted with ALS inpatients and follow-up outpatients at the neurology department of a tertiary general hospital in Taiyuan, Shanxi, China and their caregivers.

Participants

Patients with ALS and their caregivers (N=120 pairs) participated in a face-to-face interview.

Primary and secondary outcome measures

Primary outcome measures included the Zarit Burden Interview scores and personal/role burden scores. There were no secondary outcomes.

Results

Multiple linear and logistic regression analyses were performed to examine the factors influencing burden in ALS patient’s caregivers. Multiple linear regression showed that caregivers with higher Anxiety Index (AI) experienced greater personal (β=0.089, p<0.001), role (β=0.065, p<0.001) and overall (β=0.200, p<0.001) burden. Logistic regression analysis showed that AI (p=0.025; OR 1.351, 95% CI 1.038 to 1.759) and disease knowledge level (p=0.033; OR 0.305, 95% CI 0.107 to 0.593) are the influencing factors of ALS load classification.

Conclusions

Higher AI scores were associated with greater caregiver burden. Caregiver burden of caregivers who had no knowledge of the patient’s disease was 0.305 times that of those who had good knowledge. The level of disease knowledge and AI score can serve as key predictors of caregiver burden in ALS.
Is pulmonary embolism recurrence linked with the severity of the first event? A French retrospective cohort study
Authors: Ferrari Emile , Fourrier Etienne , Asarisi Florian , Heme Nathan , Redjimi Nassim , Berkane Nathalie , Labbaoui Mohamed , Breittmayer Jean Philippe , Bun Sok Sithikun , Moceri Pamela , Squara Fabien
Published: September 2021

Objectives

Severity of a first pulmonary embolism (PE) is sometimes proposed as a criterion for prolonging anticoagulant treatment. However, little evidence supports this idea. We attempted to determine the connection between severity of first PE and the risk of recurrence.

Participants

Patients admitted with PE between 2012 and 2018 and for whom anticoagulant treatment had been discontinued were followed. PEs were classified according to the severity into the following two groups: those with associated cardiac involvement (increased cardiac biomarker(s) and/or echocardiographic right ventricular dysfunction) and those with no cardiac involvement which were classified as non-severe. Recurrence-free survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.

Results

417 patients with PEs (186 with cardiac involvement) were followed for at least 1 year after discontinuation of treatment with a mean follow-up of: 3.5±1.9 years. 72 patients (17.3%) experienced venous thromboembolism recurrence: 24 (5.8%), 44 (12 %) and 72 (28.3 %) respectively, at 1, 2 and 5 years. In 63 patients (88%), recurrence was a PE. Mean time to onset of recurrence was 24.9±19.9 months. At 5 years, the recurrence rate is higher when the first PE was associated with cardiac involvement p=0.043. In contrast, in patients with provoked PE, the recurrence rate is higher when the first PE event was associated with cardiac involvement: p=0.032. Multivariate analysis demonstrates that PE severity is an independent factor of recurrence (HR 1.634 (1.015–2.632), p=0.043).

Conclusion

We report for the first time a possible link between a higher recurrence rate and the severity of the first PE. This result which must be confirmed in a dedicated prospective trial could become an important criterion for the duration of anticoagulant therapy after a PE.

Trial registration number

NCT04980924.
Mixed methods protocol to examine the acceptability and clinical characteristics of a remote monitoring programme for delivery of COVID-19 care, among healthcare staff and patients
Authors: Fox Robert , Mulcahy Symmons Sophie , De Brún Aoife , Joyce David , Muldoon Eavan G , McGinty Tara , O"Reilly Katherine M A , O’Connor Eileen , McAuliffe Eilish
Published: September 2021

Introduction

The use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff.

Methods and analysis

Discharged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis.

Ethics and dissemination

Ethical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.
Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA
Authors: Fiori Kevin P , Heller Caroline G , Flattau Anna , Harris-Hollingsworth Nicole R , Parsons Amanda , Rinke Michael L , Chambers Earle , Hodgson Sybil , Chodon Tashi , Racine Andrew D
Published: September 2021

Objectives

There has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network.

Setting

Academic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA).

Participants

This retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices.

Methods

We organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices.

Results

Between April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient.

Conclusions

These findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.
Using lean management approach in improving clinical team leader handover process: nursing services
Authors: Obaid Lina Mohammed , Al Baker Ahmad , Husain Jessalie Ann , Cabania Gretchen , Roque Sherryl
Published: September 2021

This report describes the result of the study using lean management approach in improving clinical team leader handover process in nursing services at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East with 511-bed capacity and more than 20 nursing inpatient units. Clinical handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another pehealthcare system is a crson or professional group on a temporary or permanent basis. It is in fact a valuable and essential part of the care processes in the hospitals. However, clinical team leaders face a challenging role during handover due to prolonged process, causing extra nursing working hour beyond their 12-hour scheduled shift, resulting in additional burden and exhaustion. The aim of this project was to test the effectivity of the lean management approach in improving the duration of clinical handover by reducing the handover time frame to 50% through eliminating unnecessary steps towards a more efficient, sustainable and effective communication between clinical nursing team leaders. The project results demonstrated the effectiveness and efficiency of the team leader clinical handover process by decreasing the duration by 50%. One hundred per cent of nursing units that were involved in the project were able to start and end their team leader handover process by the average of the selection target of 20–30 min of handover duration.
Clinical relevance of MRI knee abnormalities in Australian rules football players: a longitudinal study
Authors: Aitken Dawn , Balogun Saliu , Foong Yi Chao , Humphries David , Laslett Laura , Pitchford Nathan , Khan Hussain , Martel-Pelletier Johanne , Pelletier Jean-Pierre , Abram Francois , Jin Xingzhong , Jones Graeme , Winzenberg Tania
Published: September 2021

Background/Aim

The clinical relevance of MRI knee abnormalities in athletes is unclear. This study aimed to determine the prevalence of MRI knee abnormalities in Australian Rules Football (ARF) players and describe their associations with pain, function, past and incident injury and surgery history.

Methods

75 male players (mean age 21, range 16–30) from the Tasmanian State Football League were examined early in the playing season (baseline). History of knee injury/surgery and knee pain and function were assessed. Players underwent MRI scans of both knees at baseline. Clinical measurements and MRI scans were repeated at the end of the season, and incident knee injuries during the season were recorded.

Results

MRI knee abnormalities were common at baseline (67% bone marrow lesions, 16% meniscal tear/extrusion, 43% cartilage defects, 67% effusion synovitis). Meniscal tears/extrusion and synovial fluid volume were positively associated with knee symptoms, but these associations were small in magnitude and did not persist after further accounting for injury history. Players with a history of injury were at a greater risk of having meniscal tears/extrusion, effusion synovitis and greater synovial fluid volume. In contrast, players with a history of surgery were at a greater risk of having cartilage defects and meniscal tears/extrusion. Incident injuries were significantly associated with worsening symptoms, BML development and incident meniscal damage.

Conclusions

MRI abnormalities are common in ARF players, are linked to a previous knee injury and surgery history, as well as incident injury but do not dictate clinical symptomatology.
Leveraging the Treg-intrinsic CTLA4–PKCη signaling pathway for cancer immunotherapy
Authors: Liu Hsin-Yu , Pedros Christophe , Kong Kok-Fai , Canonigo-Balancio Ann J , Xue Wen , Altman Amnon
Published: September 2021

Background

Our previous studies revealed a critical role of a novel CTLA4-protein kinase C-eta (PKCη) signaling axis in mediating the suppressive activity of regulatory T cells (Tregs) in antitumor immunity. These studies have employed adoptive transfer of germline PKCη-deficient (Prkch−/−) Tregs into Prkch+/+ mice prior to tumor implantation. Here, we extended these findings into a biologically and clinically more relevant context.

Methods

We have analyzed the role of PKCη in antitumor immunity and the tumor microenvironment (TME) in intact tumor-bearing mice with Treg-specific or CD8+ T cell-specific Prkch deletion, including in a therapeutic model of combinatorial treatment. In addition to measuring tumor growth, we analyzed the phenotype and functional attributes of tumor-infiltrating immune cells, particularly Tregs and dendritic cells (DCs).

Results

Using two models of mouse transplantable cancer and a genetically engineered autochthonous hepatocellular carcinoma (HCC) model, we found, first, that mice with Treg-specific Prkch deletion displayed a significantly reduced growth of B16–F10 melanoma and TRAMP-C1 adenocarcinoma tumors. Tumor growth reduction was associated with a less immunosuppressive TME, indicated by increased numbers and function of tumor-infiltrating CD8+ effector T cells and elevated expression of the costimulatory ligand CD86 on intratumoral DCs. In contrast, CD8+ T cell-specific Prkch deletion had no effect on tumor growth or the abundance and functionality of CD8+ effector T cells, consistent with findings that Prkch−/− CD8+ T cells proliferated normally in response to in vitro polyclonal or specific antigen stimulation. Similar beneficial antitumor effects were found in mice with germline or Treg-specific Prkch deletion that were induced to develop an autochthonous HCC. Lastly, using a therapeutic model, we found that monotherapies consisting of Treg-specific Prkch deletion or vaccination with irradiated Fms-like tyrosine kinase 3 ligand (Flt3L)-expressing B16–F10 tumor cells post-tumor implantation significantly delayed tumor growth. This effect was more pronounced in mice receiving a combination of the two immunotherapies.

Conclusion

These findings demonstrate the potential utility of PKCη inhibition as a viable clinical approach to treat patients with cancer, especially when combined with adjuvant therapies.
In vitro evaluation of disease-modifying antirheumatic drugs against rheumatoid arthritis associated pathogens of the oral microflora
Authors: Kussmann Manuel , Obermueller Markus , Spettel Kathrin , Winkler Stefan , Aletaha Daniel
Published: September 2021

Objectives

In the past, the human microbiome has consistently been associated with rheumatoid arthritis (RA) and disease activity. Here, we investigate the antimicrobial activity of disease-modifying antirheumatic drugs (DMARDs) against typical representatives of the oral microflora that have been associated with RA.

Methods

DMARDs were screened for antimicrobial activity against bacteria that are associated with the pathogenesis of the disease and/or frequently isolated from the oral microflora of patients with RA. Screening was done by an agar diffusion assay and minimum inhibitory concentrations (MICs) of antimicrobial active substances were then determined by broth dilution.

Results

Aurothiomalate and sulfasalazine demonstrated broad-spectrum antimicrobial activity, but with MICs ranging from 18 to >280 µg/mL and 150 to >600 µg/mL, respectively, only at supratherapeutic concentrations. Methotrexate showed antimicrobial activity only against Fusobacterium nucleatum and Viridans streptococci. The corresponding MICs were 3.75 to >30 µg/mL and 0.5–15 µg/mL, respectively, thus at least for streptococci, within the therapeutically achievable range. No other DMARD tested showed antimicrobial activity in the agar diffusion screening assay.

Conclusion

Methotrexate, sulfasalazine and aurothiomalate showed antimicrobial activity against a broad spectrum of RA associated pathogens of the oral microflora. While methotrexate showed relevant antimicrobial activity, and to a more limited extent aurothiomalate, sulfasalazine was active only at far supratherapeutic systemic concentrations. Nevertheless, given the highly species-dependent antimicrobial activity and the multiple ways it can affect the human microbiome, our results suggest a link between antimicrobially active antirheumatic drugs and their potential effect in the treatment of RA.
Computational studies on photolyase (Phr) proteins of cyanobacteria
Authors: Rajneesh  , Mondal Soumila , Pathak Jainendra , Singh Prashant R. , Singh Shailendra P. , Sinha Rajeshwar P.
Published: September 2021

Photolyases (Phrs) are enzymes that utilize the blue/ultraviolet (UV-A) region of light for repairing UV-induced cyclopyramidine dimers. We studied Phr groups by bioinformatic analyses as well as active-site and structural modeling. Analysis of 238 amino acid sequences from 85 completely sequenced cyanobacterial genomes revealed five classes of Phrs, CPD Gr I, 6-4 Phrs/cryptochrome, Cry-DASH, Fe-S bacteria Phrs, and a group with fewer amino acids (276–385) in length. The distribution of Phr groups in cyanobacteria belonging to the order Synechococcales was found to be influenced by the habitats of the organisms. Class V Phrs are exclusively present in cyanobacteria. Unique motifs and binding sites were reported in groups II and III. The Fe-S protein binding site was only present in group V and the active site residues and putative CPD/6-4PP binding residues are charged amino acids present on the surface of the proteins. The majority of hydrophilic amino acid residues were present on the surface of the Phrs. Sequence analysis confirmed the diverse nature of Phrs, although sequence diversity did not affect the overall three-dimensional structure. Protein–ligand interaction analysis identified novel CPD/6-4PP binding sites on Phrs. This structural information of Phrs can be used for the preparation of efficient Phr-based formulations.
Inhibition of endoplasmic reticulum stress combined with activation of angiotensin-converting enzyme 2: novel approach for the prevention of endothelial dysfunction in type 1 diabetic rats
Authors: Sankrityayan Himanshu , Kale Ajinath , Gaikwad Anil Bhanudas
Published: September 2021

Persistent hyperglycemia in type 1 diabetes triggers numerous signaling pathways, which may prove deleterious to the endothelium. As hyperglycemia damages the endothelial layer via multiple signaling pathways, including enhanced oxidative stress, downregulation of angiotensin-converting enzyme 2 signaling, and exacerbation of endoplasmic reticulum (ER) stress, it becomes difficult to prevent injury using monotherapy. Thus, the present study was conceived to evaluate the combined effect of ER stress inhibition along with angiotensin-converting enzyme 2 activation, two major contributors to hyperglycemia-induced endothelial dysfunction, in preventing endothelial dysfunction associated with type 1 diabetes. Streptozotocin-induced diabetic animals were treated with either diminazene aceturate (5 mg·kg−1 per day, p.o.) or tauroursodeoxycholic acid, sodium salt (200 mg·kg−1 per day i.p.), or both for 4 weeks. Endothelial dysfunction was evaluated using vasoreactivity assay, where acetylcholine-induced relaxation was assessed in phenylephrine pre-contracted rings. Combination therapy significantly improved vascular relaxation when compared with diabetic control as well as monotherapy. Restoration of nitrite levels along with prevention of collagen led to improved vasodilatation. Moreover, there was an overall reduction in aortic oxidative stress. We conclude that by simultaneously inhibiting ER stress and activating angiotensin-converting enzyme 2 deleterious effects of hyperglycemia on endothelium were significantly alleviated. This could serve as a novel strategy for the prevention of endothelial dysfunction.
On classical and quantum deformations of gauge theories
Authors: Buchbinder I. L. , Lavrov P. M.
Published: September 2021

We elaborate the generalizations of the approach to gauge-invariant deformations of the gauge theories developed in our previous work (Buchbinder and Lavrov in JHEP 06:097, 2021). In the given paper we construct the exact transformations defying the gauge-invariant deformed theory on the base of initial gauge theory with irreducible open gauge algebra. Like in [1], for the theories with open gauge algebras these transformations are the shifts of the initial gauge fields $$A \rightarrow A+h(A)$$

A
→
A
+
h
(
A
)

, with the help of the arbitrary and in general non-local functions h(A). The results are applied to study the quantum aspects of the deformed theories. We derive the exact relation between the quantum effective actions for the above classical theories, where one is obtained from another with the help of the deformation.
Drivers of Innovation in Finance: How Important is Materialism for Crowdfunding Investors?
Authors: Morales-Alonso Gustavo , Núñez Yilsy , Fernández-Angulo J. Manuel , Hidalgo Antonio
Published: September 2021

Innovation permeates the financial sector by means of collaborative finance. Crowdfunding, as an activity based on peer-to-peer lending through a platform, is an innovative way to finance start-ups. A better understanding is needed of the motivational factors of backers to participate in crowdfunding campaigns. This study used the empirical data to investigate this issue, paying attention to the participation in four platform types (reward-based, lending-based, equity-based, and donation-based crowdfunding). Results indicate that the extrinsic and intrinsic motivators are constructs that drive actual behaviors. Extrinsic motivators are the prevalent driver of participants in crowdfunding, regardless of which platform type is used.
COVID-19 Pandemic Impacts Decision-Making and Psychosocial Behavior in Women Seeking Fertility Treatment in APAC—an ASPIRE Patient Experience Report
Authors: Wiweko Budi , Ho Tuong M. , Tanaka Atsushi , Raggio Vanessa , Lee Jung-Ryeol , Patil Milind , Chan Carina Chi-Wai , Wutayavanich Teraporn , Diao Feiyang , Nair Suresh , Mendiola Rudie Frederick
Published: September 2021

Background: ASPIRE (Asia-Pacific Initiative on Reproduction) aims to develop a “patient-centered” guide to provide fertility treatment based on patient preferences, needs, and concerns during and beyond the SARS-Cov-2 pandemic.

Methods: Women, aged 20–45 years old, trying to conceive for more than 6 months and contemplating for pregnancy including IVF treatment. A country wise analysis of patient behavior, attitudes and concerns, reasons for disruption of treatment and availability of assistance from fertility clinics during SARS-Cov-2 pandemic was performed. Six problem statements addressing patient concerns were identified and corresponding solutions to improve patient experience were formulated. A two-tier recommendation was developed. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were [Formula: see text]60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” together was >60%.

Results: Women in countries that have better infection control and are living a new normal were less worried about the pandemic influencing their lifestyle and finances. The proportion of women choosing not to continue IVF/IUI treatment during COVID-19 was similar across countries. Sixty-five percent of women in Group A intend to continue treatment during COVID-19 pandemic. Nine out of 10 patients are expected to resume or start treatment once fertility clinics are accessible. A patient-centered guide focusing on management of patient safety concerns, reduction in difficulty of access to hospitals, prioritization of patients, provision of emotional support, and improvement in patient education and acceptance of remote health services was developed.

Conclusion: This ASPIRE patient experience report highlights a patient-centered guide on provision of safe fertility treatment across the Asia-Pacific region, which can be adapted to suit country-specific requirements depending on the stage of the pandemic, local restrictions, and availability of resources.
Higher Doses of FSH Used for Superovulation Do Not Adversely Affect Embryonic Ploidy: A Randomized Controlled Trial (STimulation Resulting in Embryonic Aneuploidy using Menopur (STREAM) Trial)
Authors: Shyamsunder Akshara , Hardy Tristan , Yazdani Anusch , Polyakov Alex , Norman Robert , Hart Roger , Agresta Franca , Rombauts Luk , Boothroyd Clare , Chapman Michael , Sweeten Prudence , Somerville Eleanor , Jose Rachel , Wand Handan , Ledger William L.
Published: September 2021

Research Question: Does the dose of gonadotropin used for superovulation in IVF affect the proportion of euploid blastocysts obtained after fertilization?

Study Design: Multicentre randomized controlled trial recruiting 57 women who were treated with ovarian stimulation using either 150 or 300 IU Menopur per day. Both groups received GnRH antagonist from day 5 of ovarian stimulation and final oocyte maturation was induced using a leuprolide GnRH (gonadotropin releasing hormone) agonist trigger when three or more follicles reached 17 mm diameter. Oocyte collection was scheduled 36–38 hours post trigger. In vitro fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) were performed according to individual unit protocol and embryos were cultured to blastocyst stage. A trophectoderm biopsy was performed on day 5 of embryo culture and used for preimplantation genetic testing for aneuploidy. Euploid embryos were transferred in subsequent frozen embryo transfer cycles with appropriate endometrial preparation.

Results: The number of oocytes obtained from women randomized to 150 IU Menopur was between 3 and 17 (mean = 9), whereas the number of oocytes obtained from women randomized to 300 IU Menopur was between 3 and 24 (mean = 11). There was a positive linear relationship between serum AMH concentration and oocyte yield in both the 150 and 300 IU Menopur groups ([Formula: see text] = 0.3359, [Formula: see text] = 0.1129 and [Formula: see text] = 0.3741, [Formula: see text] = 0.1399). The percentage of euploid to aneuploid embryos in the 150 IU Menopur group was 63% and in the 300 IU Menopur group, the proportion was 75%, which was not significantly different ([Formula: see text] = 0.17).

Conclusion: The higher dose ovarian stimulation protocol did not significantly increase the number of oocytes retrieved, nor did the higher dose protocol reduce the proportion of euploid embryos created. This study does not support the hypothesis that use of higher doses of gonadotropin for ovarian stimulation results in a reduction in the proportion of euploid embryos obtained after IVF.