bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective randomized trial of 2 versus 12‐weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection‐related kidney stones
Authors: Chew Ben H. , Reicherz Alina , Krambeck Amy E. , Miller Nicole L. , Hsi Ryan S. , Scotland Kymora B. , Miller David , Paterson Ryan F. , Wong Victor K. F. , Semins Michelle J. , Lange Dirk
Published: September 2022

Purpose

Treatment of struvite kidney stones requires complete surgical stone removal combined with antibiotic therapy to eliminate urinary tract infections and preventive measures to reduce stone recurrence. The optimal duration of antibiotic therapy is unknown. We sought to determine if 2‐ or 12‐weeks of antibiotics post percutaneous nephrolithotomy (PNL) for infection stones resulted in better outcomes for stone recurrence and positive urine cultures.

Material and methods

This multi‐center, prospective randomized trial evaluated patients with the clinical diagnosis of infection stones. Patients were randomized to 2‐ or 12‐weeks of postoperative oral antibiotics (nitrofurantoin or culture‐specific antibiotic) and included if residual fragments were ≤4 mm on computed tomography imaging after PNL. Imaging and urine analyses were performed at 3‐, 6‐, and 12‐months post‐procedure.

Results

Thirty‐eight patients were enrolled and randomized to either 2‐weeks (n = 20) or 12‐weeks (n = 18) of antibiotic therapy post‐PNL. Eleven patients were excluded due to residual fragments >4 mm, and 3 patients were lost to follow‐up. The primary outcome was the stone‐free rate (SFR) at 6 months post‐PNL. At 3‐, 6‐, and 12‐months follow‐up, SFRs were 72.7% versus 80.0%, 70.0% versus 57.1%, 80.0% versus 57.1% (p = ns), between 2‐ and 12‐week‐groups, respectively. At 3‐, 6‐, and 12‐months follow‐up, positive urine cultures were 50.0% versus 37.5%, 50.0% versus 83.3%, and 37.5% versus 100% between 2‐ and 12‐week groups, respectively (p = ns).

Conclusions

For patients with stone removal following PNL, neither 2‐weeks nor 12‐weeks of postoperative oral antibiotics is superior to prevent stones and recurrent positive urine cultures.
Trends in direct oral anticoagulant use in patients presenting with acute stroke
Authors: Teow Kang H. , Tan Peter S. , Frost Tanya , Dewey Helen M. , Borosak Marija , Choi Philip M. C.
Published: September 2022

Acute ischaemic strokes occur despite the use of direct oral anticoagulants (DOACs). A retrospective review was conducted at a high‐volume primary stroke centre over a 3‐year period to assess the acute management of stroke presentations in patients prescribed DOACs. During the time period of the study, 103 of 195 anticoagulated stroke patients presented within the timeframe for thrombolysis and only 15 patients had DOAC plasma level assays performed. Of these 103, 5 received thrombolysis; however, DOAC level was not a factor in these cases.
Perpetuating Crisis as a Supply Strategy: The Role of (Nativist) Populist Governments in EU Policymaking on Refugee Distribution
Authors: Zaun Natascha , Ripoll Servent Ariadna
Published: September 2022

We still know very little of how populist governments behave as compared to mainstream governments in Council decision‐making. Studying the ‘crucial case’ of negotiations around refugee distribution in the EU, an issue which allows populists to mobilize both anti‐EU and anti‐immigrant sentiment, we demonstrate that populist governments differ from mainstream ones in three important ways: First, they reject formal and informal rules of Council decision‐making if these are not conducive to their preferred outcome; second, they reject traditional means of ensuring compromise such as package‐deals and side‐payments; third, they reject the final solution and exploit the ensuing deadlock to prove that the EU is weak and dysfunctional. We show that populist governments adopt such a behaviour even when they would benefit from the adoption of a policy solution. However, we expect populists to engage in such political games only when the negative effects of non‐decisions are not immediate.
It's all about cognitive trajectory: Accuracy of the cognitive charts–MoCA in normal aging, MCI, and dementia
Authors: Bernier Patrick J. , Gourdeau Christian , Carmichael Pierre‐Hugues , Beauchemin Jean‐Pierre , Voyer Philippe , Hudon Carol , Laforce Robert
Published: September 2022

Background

The Montreal Cognitive Assessment (MoCA) is an established cognitive screening tool in older adults. It remains unclear, however, how to interpret its scores over time and distinguish age‐associated cognitive decline (AACD) from early neurodegeneration. We aimed to create cognitive charts using the MoCA for longitudinal evaluation of AACD in clinical practice.

Methods

We analyzed data from the National Alzheimer's Coordinating Center (9684 participants aged 60 years or older) who completed the MoCA at baseline. We developed a linear regression model for the MoCA score as a function of age and education. Based on this model, we generated the Cognitive Charts‐MoCA designed to optimize accuracy for distinguishing participants with MCI and dementia from healthy controls. We validated our model using two separate data sets.

Results

For longitudinal evaluation of the Cognitive Charts‐MoCA, sensitivity (SE) was 89%, 95% confidence interval (CI): [86%, 92%] and specificity (SP) 79%, 95% CI: [77%, 81%], hence showing better performance than fixed cutoffs of MoCA (SE 82%, 95% CI: [79%, 85%], SP 68%, 95% CI: [67%, 70%]). For current cognitive status or baseline measurement, the Cognitive Charts‐MoCA had a SE of 81%, 95% CI: [79%, 82%], SP of 84%, 95% CI: [83%, 85%] in distinguishing healthy controls from mild cognitive impairment or dementia. Results in two additional validation samples were comparable.

Conclusions

The Cognitive Charts‐MoCA showed high validity and diagnostic accuracy for determining whether older individuals show abnormal performance on serial MoCAs. This innovative model allows longitudinal cognitive evaluation and enables prompt initiation of investigation and treatment when appropriate.
Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses
Authors: Zhang Yalin , Guan Chang , Jiang Jianjun , Zhu Chuanmei , Hu Xiaolin
Published: September 2022

Aims and objectives

To detect the mediating effect of resilience on the relationship between perceived social support and burnout in Chinese palliative nurses.

Background

Palliative nurses are a group that is vulnerable to burnout. Perceived social support may contribute to decreasing palliative nurses' burnout and facilitating their personal resilience, and resilience may be associated with lower levels of burnout. However, these relationships were unclear in the Chinese context.

Design

A cross‐sectional design.

Methods

The STROBE guideline was performed to report this study. A mixed sampling method including convenience sampling and stratified sampling was used to recruit participants, and a total of 319 palliative nurses completed the Nursing Burnout Scale, the Perceived Social Support Scale and the Connor–Davidson Resilience Scale from May 2021 to September 2021. Influencing factors were primarily identified using independent‐sample t tests and one‐way ANOVA. Bootstrap method was used to detect the mediating effect of resilience.

Results

The level of burnout in palliative nurses (23.4 ± 7.68) was higher than that of general nurses in China. Education level, health condition and monthly income were influencing factors of burnout. Resilience was detected as a mediator in the relationships between perceived social support and dimensions of burnout.

Conclusions

Chinese palliative nurses experience a relatively high level of burnout, which may be influenced by several sociodemographic variables. Resilience could mediate the effect of perceived social support on the dimensions of burnout. Problem‐oriented and palliative‐tailored strategies should be developed to further address burnout in Chinese palliative nurses.

Relevance to clinical practice

Nurse managers and policy makers should support nurse ongoing education, adopt health‐promoting interventions and optimise salary systems. In addition, perceived social support resources and resilience training programmes are also warranted.

Patient or public contribution

All participants were invited to complete the informed consent form and paper questionnaires. Human resource managers helped us collect some subjective data through the personnel management system. Nurse managers of palliative units conducted regular staff meetings to promote the data collection process.
A 3‐year prospective cohort on the incidence of prosthodontic complications associated with three implant treatment options for the edentulous mandible
Authors: de Araújo Sara Cristina , Hartmann Roberto , Curado Thalita Fernandes Fleury , Schimmel Martin , Leles Cláudio Rodrigues
Published: September 2022

Objective

This prospective study assessed the number and reasons for post‐treatment visits due to prosthodontic complications in patients treated with three types of implant treatment for the edentulous mandible.

Methods

Study groups comprised patients treated with single‐implant overdenture (G‐I; n = 11), 2‐implant overdenture (G‐II; n = 13), and 4‐implant fixed prosthesis (G‐III; n = 13). Programmed recall visits occurred at the 6‐, 12‐ and 36‐month follow‐ups. The management of prosthodontic complications occurred continuously in unscheduled appointments. Data analysis included calculation of incidence rates, chi‐square and Kruskal‐Wallis tests, and Poisson regression with robust error variance to model the occurrence of visits due to prosthodontic complications.

Results

There were 89 unscheduled appointments during the entire follow‐up period, ranging from 0 to 7 (mean = 2.41; SD = 2.2) per patient. No between‐group differences were found regarding the frequency of unscheduled visits. However, the duration of the appointments (scheduled and unscheduled) was significantly higher for G‐III (p < .001). The length of follow‐up was the only predictor of the number of post‐insertion visits (p = .004). The frequency of prosthodontic events was higher for G‐I and G‐II compared to G‐III (p < .001). Nearly half of the events in G‐I and G‐II were matrix replacements, and artificial teeth fracture was more frequent in G‐III.

Conclusions

All patients were at risk of post‐delivery prosthodontic complications and required regular recall visits to achieve satisfactory function and to prevent further problems. Overdentures required higher rates of maintenance visits, particularly for replacement of the retentive inserts, while fixed implant prostheses required longer clinical times for management of complications when compared to overdentures.
Expression profile analysis of long noncoding RNA and messenger RNA during mouse cementoblast mineralization
Authors: Huang Hantao , Wang Xiaoxuan , Liao Haiqing , Ma Li , Jiang Chenxi , Yao Siqi , Liu Huan , Cao Zhengguo
Published: September 2022

Background and Objective

Emerging evidence has uncovered that long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) exert biofunctions on cellular mineralization and bone formation. In this study, we aimed to identify lncRNA–mRNA expression profiles and expression patterns, and explore their underlying biofunctions during cementoblast mineralization.

Materials and Methods

Cementoblasts were cultured in mineralized medium for 0, 7, and 14 days. We used quantitative real‐time polymerase chain reaction (qRT‐PCR) and western blot (WB) to detect expression levels of osteocalcin (OCN), bone sialoprotein (BSP), and Osterix (Osx). Alkaline phosphatase (ALP) staining and alizarin red staining (ARS) were conducted to detect ALP activity and number of mineralized nodule. Total RNA was extracted from cells and used for high‐throughput sequencing. EBSeq package was applied to analyze differentially expressed genes. Mfuzz R package was used to identify gene expression patterns. The weighted gene co‐expression network analysis (WGCNA) was performed to explore co‐expressed mRNAs of differentially expressed lncRNAs (DElncRNAs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were adopted by Clusterprofile R package.

Results

Cementoblasts were successfully induced by osteogenic medium. Compared with those on day 0, 384 DElncRNAs and 4255 differentially expressed mRNAs (DEmRNAs), respectively, were found on day 7. Meanwhile, 645 DElncRNAs and 4717 DEmRNAs were detected on day 14. Both DElncRNAs and DEmRNAs were classified into six clusters with different expression patterns. DEmRNAs and co‐expressed mRNA of DElncRNAs were predominantly related to cell process, binding, phosphatidylinositol‐3 kinase (PI3K)‐Akt signaling pathway, hypoxia‐inducible factor‐1 (HIF‐1) signaling pathway, mitogen‐activated protein kinase (MAPK) signaling pathway, and hippo signaling pathway.

Conclusion

The results demonstrated that both noncoding and coding RNAs were involved in the process of mineralization in cementoblasts, which may provide a new database for further study.
The evolutionary rate of leaf osmotic strength drives diversification of Primulina species in karst regions
Authors: Wu Gui‐Lin , Ye Qing , Liu Hui , Chen De‐Xiang , Zhou Zhang , Kang Ming , Kong Hang‐Hui , Qiu Zhi‐Jing , Wang Hui
Published: September 2022

Leaf water storage capacity and osmotic strength are important traits enabling species to adapt to environments that are often moisture limited. However, whether these drought tolerance traits are correlated with the species diversification rate (DR) of plant lineages is yet to be determined. In this study, we selected a species‐rich genus (Primulina) of plants widely distributed in karst regions in which species frequently experience variable periods of drought. We measured water storage capacity‐related traits (including leaf thickness and water content per mass) and saturated osmotic strength in the leaves of 58 Primulina species growing in a common garden. Subsequently, using phylogenetic methods, we examined the relationships between the rate of species diversification and the drought tolerance traits and between the species DR and evolutionary rates of these traits. We found that neither water storage capacity nor saturated osmotic strength showed significant relationships with the rate of species diversification. However, the evolutionary rate of saturated osmotic strength showed a significant correlation with the species DR, although no comparable significant relationship was detected regarding the evolutionary rate of water storage capacity. Our study indicates that the diversification among Primulina species has typically been accompanied by an extensive divergence of leaf osmotic strength but not a divergence in leaf water storage capacity. These findings will enhance our current understanding of how drought tolerance influences the diversification of plant species in karst regions.
Significance of different milling methods on white proso millet flour physicochemical, rheological, and baking properties
Authors: Doddabematti Prakash Shivaprasad , Nkurikiye Eric , Rajpurohit Bipin , Li Yonghui , Siliveru Kaliramesh
Published: September 2022

Proso millet is a nutritious, sustainable, and gluten free food which is currently underutilized. They can be incorporated into the grain industry and provide much needed healthy alternatives. Efficient grinding method should be adopted for easy incorporation. This study aimed to investigate the effect of three different methods of grinding namely, roller milling (RM), pin milling (PM), and hammer milling (HM) on proso millet flour rheology and baking properties for food application. The milling flow sheet was developed toward the production of the quality whole grain flour. The particle size distribution of all the flours showed bi‐modal distribution except for the RM flour. The PM produced the flour with the finest particles with geometric mean diameter of 82 μm. The study also revealed that starch damage in the PM flour (4.64%) was higher than RM (2.46%) and HM flour (2.51%). The nutritional composition was not significantly affected by different grinding methods. Pasting properties of the flour were also affected by the grinding method applied. Rapid Visco Analysis profile showed pin mill flour to have a higher peak viscosity (PV) (2,295 cP) compared to HM (2,065 cP) and RM flour (2,130 cP). Finally, this study demonstrated that the production of bread from proso millet flour with desirable quality and texture is possible. The grinding method did not affect the specific volume of bread loaves and C‐cell characteristics. The specific volume of the breads ranged from 2.40 to 2.52 cm3/g. This study will help in promoting and producing value‐added proso millet food products with enhanced nutritional quality.
The exodomain of the impaired oomycete susceptibility 1 receptor mediates both endoplasmic reticulum stress responses and abscisic acid signalling during downy mildew infection of Arabidopsis
Authors: Giordano Laïla , Schimmerling Marion , Panabières Franck , Allasia Valérie , Keller Harald
Published: September 2022

The phytohormone abscisic acid (ABA) regulates cell growth and plant development, and contributes to defence responses to pathogens. We previously showed that the Arabidopsis malectin‐like domain leucine‐rich repeat receptor‐like kinase (MLD‐LRR‐RLK) impaired oomycete susceptibility 1 (IOS1) attenuates ABA signalling during infection with the oomycete downy mildew pathogen Hyaloperonospora arabidopsidis. The exodomain of IOS1 with its MLD retains the receptor in the endoplasmic reticulum (ER), where it interacts with the ribophorin HAP6 to dampen a pathogen‐induced ER stress response called the unfolded protein response (UPR). The down‐regulation of both ABA and UPR signalling probably provides the pathogen with an advantage for infection. Here, we show that ABA‐related phenotypes of the ios1‐1 mutant, such as up‐regulated expression of ABA‐responsive genes and hypersensitivity to exogenous ABA application, were reverted by expression of the IOS1 exodomain in the mutant background. Furthermore, knockdown mutants for ER‐resident HAP6 showed similarly reduced UPR and ABA signalling, indicating that HAP6 positively regulates both pathways. Our data suggest that the IOS1 exodomain and HAP6 contribute in the ER to the IOS1‐mediated interference with ABA and UPR signalling.
Refractive prescribing for preschool children by optometrists in England
Authors: Thompson Amy L. , Conway Miriam L. , Ctori Irene , Shah Rakhee , Suttle Catherine M.
Published: September 2022

Purpose

Correction of refractive error in children is important for visual and educational development. The aim of this questionnaire‐based study was to explore paediatric refractive correction by optometrists in England.

Methods

An online questionnaire was piloted and distributed to optometrists in England. The questionnaire asked about respondents' characteristics (such as type of practice), management of refractive error in 1‐ and 3‐year‐old children and sources of information used as a basis for decisions on prescribing refractive error in children.

Results

Two hundred and ninety‐three questionnaires were returned, although only 139 (47%) were fully completed. In an average month, about half of respondents examined no children between 0 and 2 years of age, and about half examined no more than five children aged 3–4 years. A significant proportion indicated they would refer children aged 1 or 3 years with refractive error and no other signs or symptoms into the hospital eye service. Almost a quarter would prescribe in full or in part an isometropic refractive correction of +2.00 D for a 3‐year‐old (within the normal range) with no other signs or symptoms, suggesting a degree of unnecessary prescribing. Almost all would act in cases of clinically significant refractive error. Respondents made similar use of their colleagues, optometric or postgraduate/continuing education, professional guidance and peer‐reviewed research as sources of evidence on which to base decisions about prescribing for paediatric refractive errors. Most reported ‘never’ or ‘rarely’ using Cochrane reviews.

Conclusions

These results suggest optometrists often defer management of paediatric refractive error to the hospital eye service, with implications in terms of underutilisation of community optometric expertise and burden on the National Health Service. In some cases, the results indicate a mismatch between respondents' reported management and existing guidance/guidelines on paediatric prescribing.
Are Both Preoperative Full‐Spine 3Dimensional Computed Tomography Scans and X‐Ray Films Necessary for Patients with Ankylosing Spondylitis Kyphosis?
Authors: Zhang Zhen , Liu Chao , Hu Fanqi , You Yonggang , Hu Wenhao , Zhang Xuesong
Published: September 2022

Objective

This study is aimed to investigate whether both pre‐operative full‐spine 3Dimensional computed tomography scan (3D CT) and X‐ray film were necessary for patients with severe ankylosing spondylitis (AS) kyphosis deformity.

Methods

The research objects were selected from the inpatients with AS in our hospital from 2017 to 2019. A total of 42 patients were included in the study. On both the synthesized 2Dimensional (2D) lateral radiograph and X‐ray film, the globe kyphosis (GK), the lumber lordosis (LL), the thoracolumbar kyphosis (TLK) and the thoracic kyphosis (TK) were measured. And the angle seventh thoracic vertebra (T7), the angle twelfth thoracic vertebra (T12) and the angle third lumber vertebra (L3) were also measured. Two researchers with professional medical education were randomly selected to perform the measurement method and record the measurement data. Two researchers independently completed, recorded, and evaluated the accuracy and consistency of the measurement data. This study used intraclass correlation coefficient (ICC) to analyze the synthesized 2D lateral radiograph and general X‐ray film of 42 subjects by two researchers, in order to evaluate the consistency of data measurement results between the examiners. Through the comparison of the above parameters that the GK, LL, TLK, TK, angle T7, angle T12 and angle L3, the evaluation was made both pre‐operative full‐spine 3D CT and X‐ray film were necessary for patients with severe AS kyphosis deformity.

Results

There was no significant difference between the GK, LL, TLK, TK, angle T7, angle T12, angle L3 on the synthesized 2D lateral radiograph and that on X‐ray film (P = 0.240, 0.324, 0.199, 0.095, 0.421, 0.087, 0.478). Agreement two researchers was excellent with ICC of the GK, LL, TLK, TK, angle T7, angle T12, angle L3 (0.977, 0.969, 0.986, 0.945, 0.947, 0.915, 0.857) on the synthesized 2D lateral radiograph. The Bland–Altman plot results that the measurement results of examiners are reliable and stable.

Conclusion

By estimating the degree of spinal sagittal imbalance and measuring the Cobb angle, we can see that full‐length spine radiographs of the patients are unnecessary for patients with severe AS kyphosis deformity who will or have undergone preoperative spine 3D CT.
Hereditary fibrosing poikiloderma (POIKTMP syndrome) report of a new mutation and review of the literature
Authors: Hoeger Peter H. , Koehler Lisa M. , Reipschlaeger Maria , Mercier Sandra
Published: September 2022

Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) is a genodermatosis with autosomal dominant inheritance caused by mutations in FAM111B. We report another case with a new pathogenic variant and analyze all previously published 34 cases with a focus on sequence of clinical presentation and genotype–phenotype correlation. POIKTMP is characterized by marked age‐dependent clinical expressivity. FAM111B encodes a catalytic nuclear protein, expressed in many tissues, which contributes to impaired DNA repair affecting multiple systems. Specific inhibition of catalytic activity might be a future strategy to halt progression of this otherwise untreatable disease. Given the relentless progression of the disease, it would make sense to start such treatment as early as possible. In order to achieve this objective, children with suspected POIKTMP should therefore undergo early imaging of all relevant organ systems.
European beech dieback after premature leaf senescence during the 2018 drought in northern Switzerland
Authors: Frei E. R. , Gossner M. M. , Vitasse Y. , Queloz V. , Dubach V. , Gessler A. , Ginzler C. , Hagedorn F. , Meusburger K. , Moor M. , Samblás Vives E. , Rigling A. , Uitentuis I. , von Arx G. , Wohlgemuth T.
Published: September 2022

During the particularly severe hot summer drought in 2018, widespread premature leaf senescence was observed in several broadleaved tree species in Central Europe, particularly in European beech (Fagus sylvatica L.). For beech, it is yet unknown whether the drought evoked a decline towards tree mortality or whether trees can recover in the longer term.

In this study, we monitored crown dieback, tree mortality and secondary drought damage symptoms in 963 initially live beech trees that exhibited either premature or normal leaf senescence in 2018 in three regions in northern Switzerland from 2018 to 2021. We related the observed damage to multiple climate‐ and stand‐related parameters.

Cumulative tree mortality continuously increased up to 7.2% and 1.3% in 2021 for trees with premature and normal leaf senescence in 2018, respectively. Mean crown dieback in surviving trees peaked at 29.2% in 2020 and 8.1% in 2019 for trees with premature and normal leaf senescence, respectively. Thereafter, trees showed first signs of recovery. Crown damage was more pronounced and recovery was slower for trees that showed premature leaf senescence in 2018, for trees growing on drier sites, and for larger trees. The presence of bleeding cankers peaked at 24.6% in 2019 and 10.7% in 2020 for trees with premature and normal leaf senescence, respectively. The presence of bark beetle holes peaked at 22.8% and 14.8% in 2021 for trees with premature and normal leaf senescence, respectively. Both secondary damage symptoms occurred more frequently in trees that had higher proportions of crown dieback and/or showed premature senescence in 2018.

Our findings demonstrate context‐specific differences in beech mortality and recovery reflecting the importance of regional and local climate and soil conditions. Adapting management to increase forest resilience is gaining importance, given the expected further beech decline on dry sites in northern Switzerland.
Information needs, approaches, and case studies in human health risk communication
Authors: Gochfeld Michael
Published: September 2022

This article uses ten case studies to illustrate the information needs, various communication approaches, and the communicator's role in explaining environmental health risks from a variety of hazards, to a variety of audiences, over time frames from days to years, using in person consultation, lectures, zooms, and email formats. Events often had a long history before the communication began and may have had a long tail afterward. Audiences may be public officials, companies, workers, communities, or individuals. Each individual may have their own understanding or mental model regarding the hazard, exposure, and risk. The communicator's role or intention may be to reassure an audience that has unrealistic exaggerated concerns or fears or to protect a client if the fears are realistic. Or it may be altruistic to inform a complacent audience to take the risks it faces more seriously. Although risk assessment research has advanced the techniques for communicating abstruse probabilities to audiences with low numeracy, in my experience, audiences are unimpressed by precise‐sounding probability numbers, and are more interested in whether exposure is occurring or may occur and how to stop it. Often audiences have reason to be outraged and may be more concerned about punishing wrong doers than about the hazard itself, particularly when the exposure is past and cannot be undone. Thus, there is a difference between discussing the riskiness of a situation (risk communication) and what you are going to do about the situation (risk management). Risk communication is successful when the audience responds as intended, calming down or taking action. These case studies are drawn from a large number of risk communication experiences that I and my Rutgers colleagues have engaged in over the past four decades. Through the 20th century, New Jersey was the most densely industrialized State in United States. New Jersey experienced growth of the chemical and petrochemical industries and the unfortunately profligate disposal of toxic wastes. Having the most Superfund sites of any state is a dubious distinction, but New Jersey also has the most experience in evaluating and responding to these hazards.
Controls on the morphology of braided rivers and braid bars: An empirical characterization of numerical models
Authors: Li Wei , Colombera Luca , Yue Dali , Mountney Nigel P.
Published: September 2022

Braided rivers exhibit highly variable morphologies, morphodynamic behaviours and resulting depositional records. To evaluate relationships between characteristics of braided‐river channel belts and river depth, water discharge and streambed gradient, 39 numerical modelling experiments were conducted with the software Delft3D to simulate braided‐river evolution under a broad range of boundary conditions. Data from model outputs were integrated with observations from 63 natural braided rivers differing with respect to river depth and streambed gradient. The modelled rivers each underwent similar evolutions, yet each culminated in markedly different final river morphologies, dependent on discharge and riverbed gradient. The rivers underwent evolutionary stages of: (i) formation of transverse unit bars with limited relief from an initially featureless bed; (ii) channel development around bars and in some cases dissecting transverse unit bars; (iii) formation of relatively simpler compound bars; and (iv) amalgamation of these simpler compound bars into more complex compound bars. Quantitative relationships relating to braided‐river channel‐belt morphology and organization are established, and the following results are noted: (i) bar elongation (length‐to‐width ratio) is correlated positively with riverbed gradient; (ii) bar height and area are correlated positively with discharge, and negatively with riverbed gradient; (iii) the river depth is the main predictor of mean braid‐bar area; and (iv) the degree of braiding is primarily associated with river width‐to‐depth ratio and riverbed gradient. Results arising from this research improve our understanding of controls on the morphology and architectures of braided fluvial channel belts; they provide a novel empirical characterization that can be applied for predicting channel depth, bar morphology, streambed gradient, and degree of braiding of modern fluvial systems and of the formative rivers of ancient preserved successions.
Presence of antibodies against HLA class I and class II molecules in children before and after allo‐HSCT. Alloantibodies before and after HSCT
Authors: Morán‐Espinosa Maricarmen , Angeles‐Floriano Tania , Parra‐Ortega Israel , Gaytán‐Morales Félix , Castorena‐Villa Iván , López‐Martínez Briceida , Ortiz‐Navarrete Vianney , Olvera‐Gómez Irlanda
Published: September 2022

A severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) is graft failure (GF). Among others, donor‐specific anti‐HLA antibodies (DSA) are associated with graft rejection after allogeneic or haploidentical transplantation in adults. Knowledge of DSA and pediatric recipients is limited. Hence, we aimed to generate more information about the presence of DSA (pre‐ and post‐HSCT) and the clinical outcomes (graft rejection and poor function) in children. We identified DSA in 27% of the patients. We observed a higher frequency (50%) of DSA‐bearing patients with a benign disease diagnosis than those diagnosed with leukemia (16.66%). We observed graft rejection in one patient (with DSA against two alleles of HLA class I molecules) and poor function in three recipients during the first 30 days after HSCT in the absence of DSA. The presence of donor and nondonor HLA‐specific antibodies decreased substantially after transplantation. After the transplant, we identified two patients with DSA specific for HLA class I molecules (independent of clinical relevance), and four recipients showed PGF in the absence of DSA. We were unable to establish any association between the presence of DSA and a clinical outcome: graft failure or prevalence of viral infection.
False positive serology of prepandemic chagasic samples with SARS‐CoV‐2 antigen
Authors: Zuluaga Juan D. H. , Santos‐Barbosa Juan C. , Cuellar Adriana , Puerta Concepción J. , Gonzalez John M.
Published: September 2022

Objective

To determine whether prepandemic sera from patients with Chagas disease recognise SARS‐CoV‐2 antigens.

Materials and Methods

Forty sera from patients with Chagas disease were tested for the presence of IgG cross‐reactivity against the nucleocapsid protein (NP) and spike (S) SARS‐CoV‐2 proteins by ELISA. Positive samples were tested again using a different ELISA and CLIA, both against NP.

Results

None of the sera from patients with Chagas disease, previously confirmed as positive for the presence of anti‐Trypanosoma cruzi antibodies reacted against the SARS‐CoV‐2 S protein, and six samples tested positive for the NP antigen (15%). The six positive samples were re‐tested, five remained positive by ELISA and all were negative by CLIA.

Conclusion

According to our data, false‐positive results might be a concern in the detection of SARS‐CoV‐2 antibodies in patients with Chagas disease.
Haematological patients' perception of home transfusions: Effect of the COVID‐19 pandemic
Authors: Gutwein Odit , Herzog Tzarfati Katrin , Apel Arie , Rahimi‐Levene Naomi , Michaeli Hani , Barki‐Harrington Liza , Koren‐Michowitz Maya
Published: September 2022

Background and Objectives

The COVID‐19 pandemic has led to a growing interest in hospital‐at‐home programmes, including home transfusion services. We studied whether the pandemic had influenced patients' perception of home transfusions.

Materials and Methods

We conducted a survey among haematology patients who receive transfusions in the hospital day care facility. Patients were asked about the burden of day care transfusions and whether they would prefer receiving home transfusions. The survey was conducted during the COVID‐19 pandemic, and the results were compared with a survey performed before the pandemic (baseline).

Results

Sixty patients were included in the COVID‐19 cohort and 31 patients in the baseline cohort. There was a non‐significant decrease in the proportion of patients willing to receive home transfusions during the pandemic compared with baseline (35% vs. 47%, respectively, p = 0.28). More patients in the COVID‐19 cohort were afraid to receive home transfusions (60% compared with 48% at baseline, p = 0.29), and fewer patients believed that hospital transfusion impaired their quality of life (19% compared with 36% at baseline, p = 0.09). These unexpected results may be partly attributed to the shorter time needed to arrive at the hospital during the pandemic and a greater fear of having transfusion‐related adverse effects at home.

Conclusions

Our results show that the pandemic did not increase the willingness of patients to receive home transfusions, with a non‐significant drift towards refusal of home transfusions. Patients' opinions should be taken into consideration when planning for future home transfusion services, by creating a comprehensive approach to patients' needs.
Clinical and in vitro evaluation of red blood cells collected and stored in a non‐DEHP plasticized bag system
Authors: Vermeulen Christie , den Besten Gijs , van den Bos Annegeet G. , Go Mya , Gouwerok Eric , Vlaar Richard , Schipperus Martin R. , Spelmink Saskia E. , Janssen Mart , Lagerberg Johan W. , de Korte Dirk , Klei Thomas R. L.
Published: September 2022

Background and Objectives

Di‐ethyl‐hexyl‐phthalate (DEHP) is currently the main plasticizer used for whole blood collection systems. However, in Europe, after May 2025, DEHP may no longer be used above 0.1% (w/w) in medical devices. DEHP stabilizes red cell membranes, thereby suppressing haemolysis during storage. Here we compared in vitro quality parameters of red cell concentrates (RCCs) collected and stored in DEHP‐, DINCH‐ or DINCH/BTHC‐PVC hybrid blood bags with saline‐adenine‐glucose‐mannitol (SAGM) or phosphate‐adenine‐glucose‐guanosine‐saline‐mannitol (PAGGSM) storage solution. Last, we performed haemovigilance surveillance for RCC collected in DINCH‐PVC and stored in PAGGSM/BTHC‐PVC.

Materials and Methods

In vitro quality parameters of RCC were determined during 42 days of storage. Haemovigilance surveillance was conducted to compare the frequency and type of transfusion reaction.

Results

Haemolysis levels were increased in SAGM/BTHC‐PVC as compared to SAGM/DEHP‐PVC (0.66% ± 0.18% vs. 0.36% ± 0.17%). PAGGSM storage solution was able to adequately suppress haemolysis to levels observed during storage in SAGM/DEHP‐PVC, both in BTHC‐PVC (0.38% ± 0.12%), and to a slightly lesser extent in DINCH‐PVC (0.48% ± 0.17%). A total of 1650 PAGGSM/BTHC‐PVC and 5662 SAGM/DEHP‐PVC RCC were transfused yielding a transfusion reaction frequency of 0.24% (95% CI 0.0000–0.0048) and 0.44% (95% CI 0.0027–0.0061) respectively.

Conclusion

The in vitro quality of RCC stored in PAGGSM/BTHC‐PVC and SAGM/DEHP‐PVC is comparable. There is no indication that transfusion of erythrocytes stored in PAGGSM/BTHC‐PVC results in increased transfusion reaction frequency. These initial results provide a basis for further clinical evaluation to narrow down the confidence interval of transfusion reaction frequency.
Single‐exon approach to non‐invasive fetal RHD screening in early pregnancy: An update after 10 years' experience
Authors: Uzunel Mehmet , Tiblad Eleonor , Mörtberg Anette , Wikman Agneta
Published: September 2022

Background and Objectives

Anti‐D prophylaxis, administered to RhD‐negative women, has significantly reduced the incidence of RhD immunization. Non‐invasive fetal RHD screening has been used in Stockholm for more than 10 years to identify women who will benefit from prophylaxis. The method is based on a single‐exon approach and is used in early pregnancy. The aim of this study was to update the performance of the method.

Materials and Methods

The single exon assay from Devyser AB is a multiplex kit detecting both exon 4 of the RHD gene and the housekeeping gene GAPDH. Cell‐free DNA was extracted from 1 ml of plasma from EDTA blood taken during early pregnancy, weeks 10–12. The genetic RHD results were compared with serological typing of newborns for a determination of sensitivity and specificity.

Results

In total, 4337 pregnancies were included in the study; 44 samples (1%) were inconclusive either due to maternal RHD gene variants (n = 34) or technical reasons (n = 10). Of the remaining 4293 pregnancies, a total number of nine discrepant results were found. False positive results (n = 7) were mainly (n = 4) due to RHD gene variants in the child. False‐negative results were found in two cases, of which one was caused by a technical error. None of the false‐negative cases was due to RHD gene variants. Overall, the sensitivity of the method was 99.93% and specificity 99.56%.

Conclusion

The single‐exon assay used in this study is correlated with high sensitivity and specificity.
Explainable haemoglobin deferral predictions using machine learning models: Interpretation and consequences for the blood supply
Authors: Vinkenoog Marieke , van Leeuwen Matthijs , Janssen Mart P.
Published: September 2022

Background and Objectives

Accurate predictions of haemoglobin (Hb) deferral for whole‐blood donors could aid blood banks in reducing deferral rates and increasing efficiency and donor motivation. Complex models are needed to make accurate predictions, but predictions must also be explainable. Before the implementation of a prediction model, its impact on the blood supply should be estimated to avoid shortages.

Materials and Methods

Donation visits between October 2017 and December 2021 were selected from Sanquin's database system. The following variables were available for each visit: donor sex, age, donation start time, month, number of donations in the last 24 months, most recent ferritin level, days since last ferritin measurement, Hb at nth previous visit (n between 1 and 5), days since the nth previous visit. Outcome Hb deferral has two classes: deferred and not deferred. Support vector machines were used as prediction models, and SHapley Additive exPlanations values were used to quantify the contribution of each variable to the model predictions. Performance was assessed using precision and recall. The potential impact on blood supply was estimated by predicting deferral at earlier or later donation dates.

Results

We present a model that predicts Hb deferral in an explainable way. If used in practice, 64% of non‐deferred donors would be invited on or before their original donation date, while 80% of deferred donors would be invited later.

Conclusion

By using this model to invite donors, the number of blood bank visits would increase by 15%, while deferral rates would decrease by 60% (currently 3% for women and 1% for men).
Plasma transfusion practices: A multicentre electronic audit
Authors: Khandelwal Aditi , Minuk Leigh , Liu Yang , Arnold Donald M. , Heddle Nancy M. , Barty Rebecca , Hsia Cyrus , Solh Ziad , Shehata Nadine , Thompson Troy , Tinmouth Alan , Perelman Iris , Skeate Robert , Kron Amie T. , Callum Jeannie
Published: September 2022

Background and Objectives

Plasma is often transfused to patients with bleeding or requiring invasive procedures and with abnormal tests of coagulation. Chart audits find half of plasma transfusions unnecessary, resulting in avoidable complications and costs. This multicentre electronic audit was conducted to determine the proportion of plasma transfused without an indication and/or at a sub‐therapeutic dose.

Methods

Data were extracted on adult inpatients in 2017 at five academic sites from the hospital electronic chart, laboratory information systems and the Canadian Institute for Health Information Discharge Abstract Database. Electronic criteria for plasma transfusion outside recommended indications were: (1) international normalized ratio (INR) < 1.5 with no to moderate bleeding; (2) INR ≥ 1.5, with no to mild bleeding and no planned procedures; and (3) no INR before or after plasma infusion. Sub‐therapeutic dose was defined as ≤2 units transfused.

Results

In 1 year, 2590 patients received 6088 plasma transfusions encompassing 11,490 units of plasma occurred at the five sites. 77.7% of events were either outside indications or under‐dosed. Of these, 34.8% of plasma orders had no indication identified, and 62% of these occurred in non‐bleeding patients and no planned procedure with an isolated elevated INR. 70.7% of transfusions were under‐dosed. Most plasma transfusions occurred in the intensive care unit or the operating room. Inter‐hospital variability in peri‐transfusion testing and dosing was observed.

Conclusion

The majority of plasma transfusions are sub‐optimal. Local hospital culture may be an important driver. Electronic audits, with definitions employed in this study, may be a practical alternative to costly chart audits.
Molecular biology analysis of ABO blood group variants caused by natural chimaerism
Authors: Wang Yuqing , Mou Qiuju , Lei Hang , Heililahong Hasiyati , Zou Wei , Wang Xuefeng , Qian Chengrui , Cai Xiaohong
Published: September 2022

Background and Objectives

The chimaerism phenomenon constitutes a significant mechanism underlying ABO phenotype discrepancies; however, its detection has technical challenges. In the current study, we explored different techniques to establish the chimaeric status of ABO blood types.

Materials and Methods

Fifteen individuals with possible chimaeric ABO blood type, as suggested by standard tube or column agglutination method and RBC adsorption‐elution test, were enrolled in the study. The red blood cells from 11 investigated subjects showed mix‐field agglutination with anti‐A or anti‐B in blood typing; weak A or B antigens on the other four individuals' RBCs were detected by adsorption‐elution tests. The genetic study was conducted with PCR‐SSP genotype, DNA sequencing of the ABO gene, STR analysis and ddPCR.

Results

The genetic chimaeric status was confirmed in four (27%) individuals by SSP test alone. The ABO gene sequencing identified an additional ABO allele and enabled chimaerism detection in 10 (67%) subjects. The STR analyses established the chimaerism status in 13 (87%) individuals. In the two cases where neither of the tests mentioned above had positive findings, the ddPCR was adopted, and microchimaerism, with an extremely low degree of chimaerism (0.77% and 0.12%), was revealed. The ddPCR revealed the unequal haplotypes (29.5% B vs. 70.5% O) in one subject and distinguished this B/O‐O/O chimaera from certain B subgroups (B/O genotype without any mutation) like B3.

Conclusion

The ABO blood type chimaerism can be genetically established by comprehensive molecular methods, including PCR‐SSP/DNA sequencing, STR and ddPCR, which is particularly sensitive for the detection of microchimaerism.
Wound swabs versus biopsies to detect methicillin resistant Staphylococcus aureus in experimental equine wounds
Authors: Brock Abbi K. , Chamoun‐Emanuelli Ana M. , Howard Emily A. , Huntzinger Katie D. , Lawhon Sara D. , Bryan Laura K. , Cosgriff‐Hernandez Elizabeth M. , Cohen Noah D. , Whitfield‐Cargile Canaan M.
Published: September 2022

Objective

To compare: (1) the load and diversity of cultivatable bacterial species isolated from tissue biopsies with cultures from surface swabs, and (2) the ability of each technique to detect methicillin‐resistant Staphylococcus aureus (MRSA) in a model of MRSA‐infected equine wounds.

Study design

Experimental in vivo study.

Animals

Three light‐breed adult horses.

Methods

Four 2.5 × 2.5 cm full‐thickness skin wounds were created on the dorsolateral aspect of each forelimb. Five days later, each wound was inoculated with a pure culture of MRSA (ATCC 43300). One hundred microlitres of 0, 5 × 108, 5 × 109 or 5 × 1010 colony forming units (CFU)/ml was used to inoculate each wound. Surface swabs (Levine technique) and tissue biopsy samples (3 mm punch biopsy) were obtained at 2, 7, 14, and 21 days after inoculation. Quantitative aerobic culture was performed using routine clinical techniques.

Results

A similar bacterial profile was identified from the culture of each wound‐sampling technique and there was moderate correlation (R = 0.49, P < .001) between the bacterial bioburdens. Agreement was fair (κ = 0.31; 95% CI, 0.129‐0.505) between the sampling techniques in identification of MRSA. Methicillin‐resistant Staphylococcus aureus was isolated more frequently (P = .016) from cultures of tissue biopsies (79%; 76/96) than from surface swabs (62%; 60/96).

Conclusion

Bacterial load and diversity did not differ between sampling techniques but MRSA was detected more often from the cultures of tissue biopsies.

Clinical significance

Tissue biopsy should be preferred to culture swab in wounds where MRSA is suspected.