bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal Learning Among Prefrontal and Striatal Ensembles
Authors: Emmons Eric , Tunes-Chiuffa Gabriela , Choi Jeeyu , Bruce R Austin , Weber Matthew A , Kim Youngcho , Narayanan Nandakumar S
Published: August 2020

Behavioral flexibility requires the prefrontal cortex and striatum, but it is unclear if these structures play similar or distinct roles in adapting to novel circumstances. Here, we investigate neuronal ensembles in the medial frontal cortex (MFC) and the dorsomedial striatum (DMS) during one form of behavioral flexibility: learning a new temporal interval. We studied corticostriatal neuronal activity as rodents trained to respond after a 12-s fixed interval (FI12) learned to respond at a shorter 3-s fixed interval (FI3). On FI12 trials, we found that a key form of temporal processing—time-related ramping activity—decreased in the MFC but did not change in the DMS as animals learned to respond at a shorter interval. However, while MFC and DMS ramping was stable with successive days of two-interval performance, temporal decoding by DMS ensembles improved on FI3 trials. Finally, when comparing FI12 versus FI3 trials, we found that more DMS neurons than MFC neurons exhibited differential interval-related activity early in two-interval performance. These data suggest that the MFC and DMS play distinct roles during temporal learning and provide insight into corticostriatal circuits.
Evaluation of an Alternative Small Stem Assay for Blight Resistance in American, Chinese, and Hybrid Chestnuts (Castanea spp.)
Authors: Cipollini Martin L. , Moss John Patten , Walker William , Bailey Natalie , Foster Cooper , Reece Hali , Jennings Caroline
Published: August 2020

We tested an alternative small stem assay (SSA) for blight resistance in chestnuts (Castanea spp.). Whereas standard SSAs are done by inoculating small incisions in stems, we cut off stems (4 to 5 mm diameter), inoculated the cut ends with discs of Cryphonectria parasitica inoculum, and covered them with plastic sleeves. This method was designed to be simple to implement, to consistently induce cankering, and to better enable seedlings to recover by developing shoots from the lower stem (standard SSAs delay removal of blighted stems until late in the growing season, if at all). We conducted six experiments with seedlings and orchard trees of Castanea dentata (susceptible), Castanea mollissima (resistant), and hybrids expected to vary in resistance. Experiments with seedlings and two of the three orchard experiments showed clear differentiation between susceptible and resistant types, especially >90 days postinoculation and when the orange-colored zone of the canker was measured. One orchard experiment failed to give clear results but was ended earlier (60 days) than the other experiments. We observed only two failed inoculations out of >200 performed. Comparisons with other studies suggest that this SSA method performs at least as well as the standard SSA method in distinguishing resistant and susceptible types, at least in seedlings. Survivorship after 1 year for seedlings inoculated in 2018 ranged from 70% for C. dentata to 100% for C. mollissima, and in 2019 they ranged from 40% in hybrids to 100% for C. mollissima. Deaths of seedlings after SSAs were mostly unrelated to the inoculations (e.g., root rot).
En Bloc Resection of Isolated Spinal Metastasis
Authors: Kieser David C. , Parker Jack , Reynolds Jeremy
Published: August 2020

Study Design:

This work was a systematic review.

Objective:

The objective of this work was to review the literature on the outcomes of en bloc resection of isolated spinal metastasis.

Of background data: En bloc resection of isolated spinal metastasis is rarely performed and its utility debated, with the last review of the literature being performed over a decade ago. With significant advances in adjunctive oncology treatments, an updated review of whether there remains a role for this type of surgery is necessary.

Methods:

The authors performed a systematic review of English literature over the last decade on en bloc resection of isolated spinal metastasis in adults using the PubMed, Google Scholar, OVID, and Cochrane database. They excluded studies with <5 reported cases. The studies were appraised by 2 coauthors and examined for the patient and tumor characteristics, surgical time, estimated blood loss, length of hospital stay, cost, complications, functional outcomes, rates of local recurrence, metastasis, and survival.

Results:

Only 5 articles (148 patients) were included in this study. The average operative time was 6.5 hours, and estimated blood loss was 1742 mL. Only 73% of patients maintained their functional independence, but 35.1% experienced a complication, 6.1% had local recurrence, and the overall survival was 52% with an average time to death of 15 months.

Conclusions:

There remains a paucity of data limiting the understanding of the value of en bloc resection for isolated spinal metastasis. However, despite this limitation, our literature review suggests that en bloc resection offers a low local recurrence rate (6.1%) and maintained functional independence (73%), but requires long operative times (mean 6.5 h), causes significant blood loss (mean 1742 mL), and results in high complication rates (35.1%) with poor overall survival (52% with an average time to death of 15 mo).
Lower response to trastuzumab emtansine in metastatic breast cancer patients with human epidermal growth factor receptor 2 immunohistochemistry score of 2 and fluorescence in situ hybridization positive compared with immunohistochemistry score of 3: a retrospective study
Authors: Yazaki Shu , Hashimoto Jun , Ogita Shin , Nakano Eriko , Suzuki Koyu , Yamauchi Teruo
Published: August 2020

Tumor human epidermal growth factor receptor 2 (HER2) status is defined by either protein expression using immunohistochemistry (IHC) or gene amplification using fluorescence in situ hybridization (FISH). Approximately 20% of HER2-positive breast cancer is HER2 IHC 2+/FISH-positive. Unlike trastuzumab, it has not been studied whether the response to trastuzumab emtansine (T-DM1) differs according to HER2-positive status. We retrospectively identified and reviewed medical records of all patients with HER2-positive advanced breast cancer (ABC) who received T-DM1 in our hospital from October 2013 to December 2016. We compared the objective response rate (ORR) and progression-free survival (PFS) between patients in the HER2 IHC 3+ group and those in the HER2 IHC 2+/FISH-positive group. A total of 39 patients (IHC 3+: n = 32; IHC 2+/FISH-positive: n = 7) were analyzed. Nineteen (48.7%), 13 (33.3%), and 29 (74.4%) patients had received at least one prior chemotherapy, more than three lines of chemotherapy, and prior pertuzumab for ABC, respectively. ORR was significantly higher in the IHC 3+ group than in the IHC 2+/FISH-positive group (53.3% vs. 0%, P = 0.024). Median PFS was 7.9 months in the IHC 3+ group versus 3.9 months in the IHC 2+/FISH-positive group (hazard ratio 0.68; 95% confidence interval 0.28–1.69, P = 0.408). Among the HER2-positive ABC patients treated with T-DM1, ORR was significantly worse in HER2 IHC 2+/FISH-positive than in HER2 IHC 3+ patients. Median PFS tended to be shorter in patients with HER2 IHC 2+/FISH-positive.
The positive correlation between drug addiction and drug dosage in vemurafenib-resistant melanoma cells is underpinned by activation of ERK1/2-FRA-1 pathway
Authors: Rao Minla , Shi Benyan , Yuan Yuan , Wang Ying , Chen Yilin , Liu Xiaoyu , Li Xiaoyi , Zhang Mingmeng , Liu Xinguang , Sun Xuerong
Published: August 2020

Malignant melanoma is a kind of highly invasive and deadly diseases. The BRAF inhibitor (BRAFi) such as vemurafenib could achieve a high response rate in melanoma patients with BRAFV600E mutation. However, melanoma cells could easily develop resistance as well as addiction to BRAFi. Based on the drug addiction, intermittent treatment has been proposed to select against BRAFi-resistant melanoma cells. Because different dosages of BRAFi might be used in patients, it is necessary to know about the relationship between drug dosage and the degree of addiction. To address the problem, four drug-resistant melanoma cell sublines (A375/R0.5, A375/R2.0, M14/R0.5 and M14/R2.0) were established by continuously exposure of melanoma A375 or M14 cells to 0.5 or 2.0 μM vemurafenib. Vemurafenib withdrawal resulted in much stronger suppression on clone formation in A375/R2.0 and M14/R2.0, compared with A375/R0.5 and M14/R0.5, respectively. Meanwhile, stronger upregulation of ERK1/2-FRA-1 pathway could be observed in A375/R2.0 and M14/R2.0. Further detection showed that some proinflammatory cytokines downstream of ERK1/2-FRA-1 pathway were upregulated after drug withdrawal, and the conditioned medium collected from the resistant A375 cells could inhibit clone formation. Furthermore, vemurafenib withdrawal resulted in suppressed cell proliferation rather than cell senescence, with stronger effect on A375/R2.0 compared with A375/R0.5. This study suggested that the depth of vemurafenib addiction in resistant melanoma cells is positively correlated to the drug dosage, which might be underpinned by the ERK1/2-FRA-1 pathway and the related cytokines.
Prediabetes and risk for myocardial infarction by hypertension status in a Chinese population: a prospective cohort study
Authors: Liu Xiaoxue , Song Qiaofeng , Wu Shouling , Zhou Wenhua , Wang Xizhu
Published: August 2020

Background:

Whether prediabetes alone or combined with hypertension is a more important risk factor for cardiovascular disease is controversial. In this study, we aimed to examine this association to fill the research gap.

Methods and results:

A total of 85 570 participants (mean age: 58.0 years) without diabetes and no previous myocardial infarction (MI) were recruited for this study. Participants were divided into four groups according to prediabetes status and were further stratified according to hypertension status. Hazard ratios with 95% confidence intervals (CIs) were calculated using Cox regression models. After a mean follow-up period of 11.0 years, 1122 (rate 1.19/1000 person-years) individuals developed MI. Compared with participants without either condition, the multivariable-adjusted hazard ratios for MI events among participants with prediabetes alone, hypertension alone, and both prediabetes and hypertension were 1.06 (95% CI: 0.84–1.36), 1.73 (95% CI 1.49–2.00), and 1.89 (95% CI 1.57–2.27), respectively. Among participants with and without hypertension, there was no association between prediabetes and an increased risk for MI (hazard ratio: 1.11 95% CI 0.94–1.32 and hazard ratio: 1.02 95% CI 0.80–1.30, respectively).

Conclusion:

The current study indicated that among the Chinese general population, the increased risk of MI associated with prediabetes is largely driven by concomitant hypertension rather than prediabetes per se.
Contribution of systemic blood flow to untreated or inadequately controlled systolic--diastolic or isolated systolic hypertension in a community sample of African ancestry
Authors: Mmopi Keneilwe N. , Norton Gavin R. , Bello Hamza , Libhaber Carlos D. , Peters Ferande , Sareli Pinhas , Peterson Vernice R. , Woodiwiss Angela J.
Published: August 2020

Aims:

Age-related increases in systemic blood flow [stroke volume (SV), cardiac output (CO), and aortic flow (Q)] contribute substantially to untreated or inadequately controlled (uncontrolled) blood pressure (BP) in Africa. We aimed to identify the haemodynamic determinants of uncontrolled systolic--diastolic (Syst--diast HT) versus uncontrolled isolated systolic (ISH) or diastolic (IDH) hypertension.

Methods:

Using central arterial pressure and aortic outflow tract velocity and diameter measurements (echocardiography), the haemodynamic correlates of BP were determined in 725 community participants of African ancestry (19.6% uncontrolled Syst--diast HT, 9.2% uncontrolled ISH, 11.3% uncontrolled IDH).

Results:

Independent of confounders, compared with those with a normotensive BP, those with uncontrolled Syst--diast HT had increases in SV, CO, Q, systemic vascular resistance (SVR) and aortic characteristic impedance (Z

c
) and decreases in total arterial compliance (TAC) (P < 0.05--P < 0.0001). In multivariate regression models, uncontrolled Syst--diast HT was as strongly associated with Q, SV or CO as with SVR (P = 0.04--P = 0.20), Z
c (P = 0.74--P < 0.0005) and TAC (P = 0.43--P < 0.005). Independent of confounders, compared with normotensive individuals those with uncontrolled ISH had increases in SV, CO, Q and Z
c but not SVR, and decreases in TAC (P < 0.05-P < 0.0001), and those with IDH only had increases in SVR (P < 0.0001). Uncontrolled ISH was more strongly associated with Q, SV and CO than with SVR (P < 0.0005), but less than with TAC (P < 0.05--P < 0.0005).

Conclusion:

In groups of African ancestry living in Africa, hypertension because of increases in either SBP or DBP is as strongly associated with increases in systemic flow (SV, Q) as with arterial and arteriolar effects (Z
c, TAC, SVR).
Myocardial mechano-energetic efficiency in primary aldosteronism
Authors: Salvetti Massimo , Paini Anna , Bertacchini Fabio , Aggiusti Carlo , Stassaldi Deborah , Capellini Sara , Arnoldi Chiara , Rizzoni Damiano , Agabiti Rosei Claudia , De Ciuceis Carolina , Muiesan Maria Lorenza
Published: August 2020

Background:

Available data indicate that patients with primary aldosteronism have an increased risk of cardiovascular events and cardiovascular risk seems to be, at least in part, independent of blood pressure (BP) values. Patients with primary aldosteronism have a greater prevalence of left ventricular (LV) hypertrophy and subtle alterations of ventricular function, which might contribute to the increase in cardiovascular risk. Recently, a noninvasive approach for the estimation of LV mechanical efficiency, obtained by echocardiography has been proposed.

Aim of the study:

To evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), in a large group of patients with primary aldosteronism (n = 99) and in a control group of essential hypertensive patients (n = 99) matched for age, sex and BP values.

Results:

No differences between groups for age, sex, BMI, BP values, glucose, lipid profile and renal function were observed. LV mass index was greater in primary aldosteronism vs. essential hypertensive patients (46.0 ± 16.7 vs. 36.9 ± 8.6 g/m2, P < 0.001); also relative wall thickness was greater in primary aldosteronism (0.36 ± 0.1 vs. 0.32 ± 0.4, P < 0.001). Left atrial dimensions were significantly greater in primary aldosteronism. Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in primary aldosteronism vs. essential hypertensive patients (40 ± 7 vs. 43 ± 6, and 18 ± 3 vs. 21 ± 2, both P < 0.01). MEEi was lower in primary aldosteronism vs. essential hypertensive patients (0.44 ± 0.14 vs. 0.52 ± 0.10 ml/s per g, P < 0.01). A negative correlation was observed between MEEi and aldosterone levels (r = −0.203, P < 0.05) and aldosterone : renin ratio (P = −0.172, P < 0.05); the correlation remained significant after adjustment for possible confounders.

Conclusion:

In patients with primary aldosteronism myocardial MEEi is lower as compared with essential hypertensive patients. A reduced MEEi may reflect an impairment of production and utilization of energy in the myocardium, which could lead to the occurrence of cardiovascular complications and therefore these findings may contribute to explain the increased risk of cardiovascular events in patients with primary aldosteronism.
Acute Time-Course Changes in CCL11, CCL2, and IL-10 Levels After Controlled Subconcussive Head Impacts: A Pilot Randomized Clinical Trial
Authors: Huibregtse Megan E. , Ejima Keisuke , Chen Zhongxue , Kalbfell Rachel M. , Koppineni Alekhya , Kawata Keisuke
Published: August 2020

Objective:

To examine changes in plasma levels of CCL11, CCL2, and IL-10 after 10 controlled soccer headers.

Setting:

Laboratory setting.

Participants:

Thirty-nine healthy soccer players with at least 3 years of soccer heading experience, between 18 and 26 years old, and enrolled at a large public university.

Design:

In this randomized clinical trial using a soccer heading model, participants were randomized into the heading (n = 22) or kicking-control (n = 17) groups to perform 10 headers or kicks.

Main Measures:

Plasma levels of CCL11, CCL2, and IL-10 at preintervention and 0, 2, and 24 hours postintervention.

Results:

Mixed-effects regression models did not reveal any significant group differences in changes of plasma CCL11, CCL2, or IL-10 levels from preintervention. Within the heading group, there was a statistically significant time by years of heading experience interaction with 2.0-pg/mL increase in plasma CCL11 each year of prior experience at 24 hours postintervention (P = .001).

Conclusion:

Findings from this study suggest that 10 soccer headers do not provoke an acute inflammatory response. However, the acute CCL11 response may be influenced by prior exposure to soccer headers, providing a precedent for future field studies that prospectively track head impact exposure and changes in CCL11.
Impact of Age on Plasma Inflammatory Biomarkers in the 6 Months Following Mild Traumatic Brain Injury
Authors: Thompson Hilaire J. , Martha Sarah R. , Wang Jin , Becker Kyra J.
Published: August 2020

Objective:

To compare plasma inflammatory biomarker concentrations to 6 months in young and older adults with and without mild traumatic brain injury (TBI).

Setting:

Level 1 trauma center.

Participants:

Younger (21-54 years) and older (55+) adults diagnosed with mild TBI along with age-/sex-matched noninjured controls (n = 313).

Design:

Prospective cohort study.

Main Measures:

Multiplex assays were used to quantify concentrations of selected plasma inflammatory markers at day 0, months 1 and 6.

Results:

Persistent aging-related differences were found between control groups in concentrations of 4 cytokines up to 6 months. At day 0, interleukin-6 (IL-6), IL-8, and fractalkine were higher in the older TBI compared with older control as well as the younger TBI groups, while IL-10 was higher in older TBI compared with controls. At month 1, significantly higher concentrations of IL-8, fractalkine, and tumor necrosis factor-α (TNF-α) were seen. At 6 months postinjury, significantly higher concentrations of IL-6 and IL-8 were seen, while a lower concentration of IL-7 was found in older versus younger TBI groups.

Conclusion:

The neuroinflammatory signature that accompanies mild TBI in older adults differs from that of younger adults. The differences seen are notable for their roles in neutrophil attraction (IL-8), neuronal-microglial-immune cell interactions (fractalkine), and chronic inflammation (IL-6).
Early Tranexamic Acid Administration After Traumatic Brain Injury Is Associated With Reduced Syndecan-1 and Angiopoietin-2 in Patients With Traumatic Intracranial Hemorrhage
Authors: Anderson Taylor N. , Hinson Holly E. , Dewey Elizabeth N. , Rick Elizabeth A. , Schreiber Martin A. , Rowell Susan E.
Published: August 2020

Objective:

To evaluate the effect of early tranexamic acid (TXA) administration on circulating markers of endotheliopathy.

Setting:

Twenty trauma centers in the United States and Canada.

Participants:

Patients with moderate-to-severe traumatic brain injury (TBI) (MS-TBI) and intracranial hemorrhage who were not in shock (systolic blood pressure ≥90 mm Hg).

Design:

TXA (2 g) or placebo administered prior to hospital arrival, less than 2 hours postinjury. Blood samples and head computed tomographic scan collected upon arrival. Plasma markers measured using Luminex analyte platform. Differences in median marker levels evaluated using t tests performed on log-transformed variables. Comparison groups were TXA versus placebo and less than 45 minutes versus 45 minutes or more from time of injury to treatment administration.

Main Measures:

Plasma levels of angiopoietin-1, angiopoietin-2, syndecan-1, thrombomodulin, thrombospondin-2, intercellular adhesion molecule 1, vascular adhesion molecule 1.

Results:

Demographics and Injury Severity Score were similar between the placebo (n = 129) and TXA (n = 158) groups. Levels of syndecan-1 were lower in the TXA group (median [interquartile range or IQR] = 254.6 pg/mL [200.7-322.0] vs 272.4 pg/mL [219.7-373.1], P = .05. Patients who received TXA less than 45 minutes postinjury had significantly lower levels of angiopoietin-2 (median [IQR] = 144.3 pg/mL [94.0-174.3] vs 154.6 pg/mL [110.4-209.8], P = .05). No differences were observed in remaining markers.

Conclusions:

TXA may inhibit early upregulation of syndecan-1 and angiopoietin-2 in patients with MS-TBI, suggesting attenuation of protease-mediated vascular glycocalyx breakdown. The findings of this exploratory analysis should be considered preliminary and require confirmation in future studies.
Foxo1 selectively regulates static mechanical pain by interacting with Nav1.7
Authors: Zhang Xiao-Long , Lai Ren-Chun , Chen Zi-Hang , Zhong Xiong-Xiong , Cao Xian-Ying , Zhang Xi , Xiao Yi-Bin , Wang Jun-Chao , Liu Xian-Guo , Xie Man-Xiu
Published: August 2020

Mechanical allodynia is a debilitating condition for millions of patients with chronic pain. Mechanical allodynia can manifest in distinct forms, including brush-evoked dynamic and filament-evoked static allodynia. In the nervous system, the forkhead protein Foxo1 plays a critical role in neuronal structures and functions. However, the role of Foxo1 in the somatosensory signal remains unclear. Here, we found that Foxo1 selectively regulated static mechanical pain. Foxo1 knockdown decreased sensitivity to static mechanical stimuli in normal rats and attenuated static mechanical allodynia in rat models for neuropathic, inflammatory, and chemotherapy pain. Conversely, Foxo1 overexpression selectively enhanced sensitivity to static mechanical stimuli and provoked static mechanical allodynia. Furthermore, Foxo1 interacted with voltage-gated sodium Nav1.7 channels and increased the Nav1.7 current density by accelerating activation rather than by changing the expression of Nav1.7 in dorsal root ganglia neurons. In addition, the serum level of Foxo1 was found to be increased in chronic pain patients and to be positively correlated with the severity of chronic pain. Altogether, our findings suggest that serum Foxo1 level could be used as a biological marker for prediction and diagnosis of chronic pain. Moreover, selective blockade of Foxo1/Nav1.7 interaction may offer a new therapeutic approach in patients with mechanical pain.
The STarT Back stratified care model for nonspecific low back pain: a model-based evaluation of long-term cost-effectiveness
Authors: Hall James A. , Jowett Sue , Lewis Martyn , Oppong Raymond , Konstantinou Kika
Published: August 2020

The STarT Back approach comprises subgrouping patients with low back pain (LBP) according to the risk of persistent LBP-related disability, with appropriate matched treatments. In a 12-month clinical trial and implementation study, this stratified care approach was clinically and cost-effective compared with usual, nonstratified care. Despite the chronic nature of LBP and associated economic burden, model-based economic evaluations in LBP are rare and have shortcomings. This study therefore produces a de novo decision model of this stratified care approach for LBP management to estimate the long-term cost-effectiveness and address methodological concerns in LBP modelling. A cost-utility analysis from the National Health Service perspective compared stratified care with usual care in patients consulting in primary care with nonspecific LBP. A Markov state-transition model was constructed where patient prognosis over 10 years was dependent on physical function achieved at 12 months. Data from the clinical trial and implementation study provided short-term model parameters, with extrapolation using 2 cohort studies of usual care in LBP. Base-case results indicate this model of stratified care is cost-effective, delivering 0.14 additional quality-adjusted life years at a cost saving of £135.19 per patient over a time horizon of 10 years. Sensitivity analyses indicate the approach is likely to be cost-effective in all scenarios and cost saving in most. It is likely this stratified care model will help reduce unnecessary healthcare usage while improving the patient's quality of life. Although decision-analytic modelling is used in many conditions, its use has been underexplored in LBP, and this study also addresses associated methodological challenges.
LATCH Score at Discharge
Authors: Shah Mubashir Hassan , Roshan Reashma , Parikh Tushar , Sathe Sayali , Vaidya Umesh , Pandit Anand
Published: August 2020

Objectives:

World Health Organization recommends exclusive breastfeeding (EBF) for 6 months after birth. However, problems with the baby failing to latch properly are common in the postpartum period contributing to breastfeeding cessation. The aim of the study was to evaluate the utility of LATCH score to predict EBF and weight gain at 6 weeks postpartum along with an optimum LATCH score cutoff.

Patients and Methods:

This prospective cohort study was conducted in India. Ninety‐three mother‐infant dyads at term gestation were enrolled. Two LATCH score assessments were done by a lactation consultant: first within 24 hours of birth and second at discharge. Mothers with low LATCH scores were counselled before discharge. EBF rate and weight gain velocity were analyzed at 6 weeks.

Results:

LATCH score ≥6 at discharge has the highest sensitivity (92.1%) and specificity (66.7%) for predicting EBF at 6 weeks postpartum (RR, 95% CI; 5.63 [4.32–12.65], P = 0.0003). Receiver operating characteristic (ROC) of LATCH score at discharge and EBF at 6 weeks had an area under the curve of 0.785 with a cutoff ≥5.5, showing the highest sensitivity of 93.6% with a false‐positive rate of 30.1%. LATCH score >6 at discharge was significantly associated with higher EBF rate (RR, 95% CI; 0.61 [0.39–0.94]) and appropriate weight gain (≥ 20 grams/day) at 6 weeks of age (RR, 95% CI; 0.44 [0.25–0.75]). After counselling, the LATCH score significantly improved at discharge in mothers (n = 62) with an initial score <6 (P < 0.001).

Conclusion:

LATCH score is a simple tool to identify mothers who require breastfeeding support and counselling before discharge from the hospital to prevent early breastfeeding cessation.
Vascular Access Device Care and Management
Authors: Meyer Britt M. , Berndt Dawn , Biscossi Michele , Eld Melanie , Gillette-Kent Ginger , Malone Angie , Wuerz Lorelle
Published: August 2020

The Infusion Nurses Society asserts that a comprehensive organizational approach to vascular access device (VAD) care and management is imperative to ensure safe and efficacious patient care. It is essential that each organization (1) develops policies and procedures to align VAD care and management with recognized standards of practice; (2) integrates unique aspects of organization-selected VAD care products into policies and procedures and establishes expectations for adherence to these organizational directives; (3) develops a framework for gathering and analyzing clinical data related to patient outcomes for VAD care and management; (4) utilizes quality outcome data to facilitate evidence-based best practices within the organization; and (5) evaluates and facilitates educational programming to validate clinician competency.
Using Technology to Build Trusted Relationships Between Nurses
Authors: Samolis Kelly , Pointer Emma , Rolfes Chelsea , Spafford Courtney , Elsbernd Ashley , Black Stacie , Riddell Lindsey , Brown Casady , Lind Anna
Published: August 2020

The future of leadership and nurse engagement requires the use of technology. The nursing workforce is becoming more mobile, flexible, and dynamic. Technology can support nurses to build trusted professional relationships and enhance their professional practice. Nursing leaders need to learn how to effectively use technology in addition to in-person interactions to support their nursing workforce. This article provides tips and tricks for nurse leaders to build relationships with their teams through technology.
Implementation of Technology to Enhance Nursing Practice Peer Review Processes
Authors: Brunson Carrie A. , Johnson Karen L. , Spencer Neva
Published: August 2020

Nursing Peer Review is a foundational and essential element of professional nursing practice. It is a systematic methodology to improve nurse and patient outcomes. The process can be labor-intensive and cumbersome in managing data from diverse data sources, especially if the process is manual. Directors of Professional Practice in a health care system partnered with an external vendor to create an interactive software platform where technology was leveraged to streamline the review process including review of aggregate data and trend analyses and generate reports using an electronic database. This resulted in a 75% reduction in the number of steps and subsequently the time required to complete the review process from initial screening to referral and closure. The generation of actionable data facilitated active engagement of clinical nurses in addressing identified clinical issues using process improvement and evidence-based practice methods. A critical feature of the software platform is that it provides actionable data that can be used to improve patient safety and fosters accountability for clinical nurses to promote self-regulation of nursing practice.
Variation in zoobenthic blue carbon in the Arctic's Barents Sea shelf sediments
Authors: Souster T. A. , Barnes D. K. A. , Hopkins J.
Published: August 2020

The flow of carbon from atmosphere to sediment fauna and sediments reduces atmospheric CO2, which in turn reduces warming. Here, during the Changing Arctic Ocean Seafloor programme, we use comparable methods to those used in the Antarctic (vertical, calibrated camera drops and trawl-collected specimens) to calculate the standing stock of zoobenthic carbon throughout the Barents Sea. The highest numbers of morphotypes, functional groups and individuals were found in the northernmost sites (80–81.3° N, 29–30° E). Ordination (non-metric multidimensional scaling) suggested a cline of faunal transition from south to north. The functional group dominance differed across all six sites, despite all being apparently similar muds. Of the environmental variables we measured, only water current speed could significantly explain any of our spatial carbon differences. We found no obvious relationship with sea ice loss and thus no evidence of Arctic blue carbon–climate feedback. Blue carbon in the Barents Sea can be comparable with the highest levels in Antarctic shelf sediments.

This article is part of the theme issue ‘The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.
Transformation of organic matter in a Barents Sea sediment profile: coupled geochemical and microbiological processes
Authors: Stevenson Mark A. , Faust Johan C. , Andrade Luiza L. , Freitas Felipe S. , Gray Neil D. , Tait Karen , Hendry Katharine R. , Hilton Robert G. , Henley Sian F. , Tessin Allyson , Leary Peter , Papadaki Sonia , Ford Ailbe , März Christian , Abbott Geoffrey D.
Published: August 2020

Process-based, mechanistic investigations of organic matter transformation and diagenesis directly beneath the sediment–water interface (SWI) in Arctic continental shelves are vital as these regions are at greatest risk of future change. This is in part due to disruptions in benthic–pelagic coupling associated with ocean current change and sea ice retreat. Here, we focus on a high-resolution, multi-disciplinary set of measurements that illustrate how microbial processes involved in the degradation of organic matter are directly coupled with inorganic and organic geochemical sediment properties (measured and modelled) as well as the extent/depth of bioturbation. We find direct links between aerobic processes, reactive organic carbon and highest abundances of bacteria and archaea in the uppermost layer (0–4.5 cm depth) followed by dominance of microbes involved in nitrate/nitrite and iron/manganese reduction across the oxic-anoxic redox boundary (approx. 4.5–10.5 cm depth). Sulfate reducers dominate in the deeper (approx. 10.5–33 cm) anoxic sediments which is consistent with the modelled reactive transport framework. Importantly, organic matter reactivity as tracked by organic geochemical parameters (
n
-alkanes,
n
-alkanoic acids,
n
-alkanols and sterols) changes most dramatically at and directly below the SWI together with sedimentology and biological activity but remained relatively unchanged across deeper changes in sedimentology.

This article is part of the theme issue ‘The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning’.
Evaluation of the comparative risk of aerosol generation by tracheal intubation and extubation in the operating theatre
Authors: Brown Jules , Gregson Florence K.A. , Shrimpton Andrew , Bzdek Bryan R. , Pickering Anthony E. , Reid Jonathan P.
Published: August 2020

Background

Transmission of SARS-CoV-2 by bioaerosols is of increasing concern. The enhanced levels of personal protective equipment (PPE) and preventative measures to attenuate viral transmission during aerosol generating procedures (AGPs) are having a huge impact on healthcare provision. There is no quantitative evidence on the number and size of airborne particles produced during AGPs to inform risk assessments.

Methods

Real-time, high-resolution environmental monitoring was conducted in ultraclean ventilation operating theatres. Continuous sampling with an optical particle sizer allowed characterization of aerosol generation within the airway management zone during endotracheal intubation and extubation for urgent orthopaedic trauma or neuro-surgery.

Results

Aerosol monitoring showed a very low background particle count allowing resolution of the transient airborne particle plume produced by reference volitional coughs (maximum concentration, 1,690±140 particles.L-1,n=38). By comparison, endotracheal intubation including mask ventilation produced negligible quantities of aerosolized particles (maximum concentration, 80±10 L-1,n=14, P<0·001 vs cough). Extubation, particularly when the patient coughed, produced a detectable aerosol plume but with a smaller number of particles (<25%) than a volitional cough.

Conclusions

Using a volitional cough as a reference we have been able to produce a relative risk ranking for endotracheal intubation and extubation as potential AGPs. The study does not support the assignation of endotracheal intubation by direct laryngoscopy with manual ventilation as an AGP. Extubation does generate aerosols, particularly if the patient coughs, but these are weaker than a standard reference. These findings indicate the need for a reappraisal of guidance on PPE for AGPs.
Disease-dependent interaction policies to support health and economic outcomes during the COVID-19 epidemic
Authors: Li Guanlin , Shivam Shashwat , Hochberg Michael E. , Wardi Yorai , Weitz Joshua S.
Published: August 2020

Lockdowns and stay-at-home orders have partially mitigated the spread of Covid-19. However, the indiscriminate nature of mitigation — applying to all individuals irrespective of disease status — has come with substantial socioeconomic costs. Here, we explore how to leverage the increasing reliability and scale of both molecular and serological tests to balance transmission risks with economic costs involved in responding to Covid-19 epidemics. First, we introduce an optimal control approach that identifies personalized interaction rates according to an individual’s test status; such that infected individuals isolate, recovered individuals can elevate their interactions, and activity of susceptible individuals varies over time. Critically, the extent to which susceptible individuals can return to work depends strongly on isolation efficiency. As we show, optimal control policies can yield mitigation policies with similar infection rates to total shutdown but lower socioeconomic costs. However, optimal control policies can be fragile given mis-specification of parameters or mis-estimation of the current disease state. Hence, we leverage insights from the optimal control solutions and propose a feedback control approach based on monitoring of the epidemic state. We utilize genetic algorithms to identify a ‘switching’ policy such that susceptible individuals (both PCR and serological test negative) return to work after lockdowns insofar as recovered fraction is much higher than the circulating infected prevalence. This feedback control policy exhibits similar performance results to optimal control, but with greater robustness to uncertainty. Overall, our analysis shows that test-driven improvements in isolation efficiency of infectious individuals can inform disease-dependent interaction policies that mitigate transmission while enhancing the return of individuals to pre-pandemic economic activity.
Interplay of antibody and cytokine production reveals CXCL-13 as a potential novel biomarker of lethal SARS-CoV-2 infection
Authors: Horspool Alexander M. , Kieffer Theodore , Russ Brynnan P. , DeJong Megan A. , Wolf M. Allison , Karakiozis Jacqueline M. , Hickey Brice J. , Fagone Paolo , Tacker Danyel H. , Bevere Justin R. , Martinez Ivan , Barbier Mariette , Perrotta Peter L. , Damron F. Heath
Published: August 2020

The SARS-CoV-2 pandemic is continuing to impact the global population. This study was designed to assess the interplay of antibodies with the systemic cytokine response in SARS-CoV-2 patients. We demonstrate that significant anti-SARS-CoV-2 antibody production to Receptor Binding Domain (RBD), Nucleocapsid (N), and Spike S1 subunit (S1) of SARS-CoV-2 develops over the first 10 to 20 days of infection. The majority of patients produced antibodies against all three antigens (219/255 SARS-CoV-2 positive patient specimens, 86%) suggesting a broad response to viral proteins. Patient mortality, sex, blood type, and age were all associated with differences in antibody production to SARS-CoV-2 antigens which may help explain variation in immunity between these populations. To better understand the systemic immune response, we analyzed the production of 20 cytokines by SARS-CoV-2 patients over the course of infection. Cytokine analysis of SARS-CoV-2 positive patients exhibited increases in proinflammatory markers (IL-6, IL-8, IL-18) and chemotactic markers (IP-10, SDF-1, MIP-1β, MCP-1, and eotaxin) relative to healthy individuals. Patients who succumbed to infection produced decreased IL-2, IL-4, IL-12, IL-13, RANTES, TNF-α, GRO-α, and MIP-1α relative to patients who survived infection. We also observed that the chemokine CXCL13 was particularly elevated in patients that succumbed to infection. CXCL13 is involved in B cell activation, germinal center development, and antibody maturation, and we observed that CXCL13 levels in blood trended with anti-SARS-CoV-2 antibody production. Furthermore, patients that succumbed to infection produced high CXCL13 and also tended to have high ratio of nucleocapsid to RBD antibodies. This study provides insights into SARS-CoV-2 immunity implicating the magnitude and specificity of response in relation to patient outcomes.
Correction of Daily Positivity Rates for contribution of various test protocols being used in a pandemic
Authors: Bansal Bhavik
Published: August 2020

Daily positivity rate (DPR) is a popular metric to judge the prevalence of an infection in the population and the testing response to it as a single number. It has been widely implicated in predicting future course of the SARS CoV-2 pandemic in India. With increasing use of multiple testing protocols with varying sensitivity and specificity in various proportions, the naïve calculation loses meaning particularly during comparison between states/countries with large daily variations in contribution of different testing protocols to the testing response. We propose an adjustment to the naïve DPR based on the testing parameters and the relative proportional use of each such protocol. Such a correction has become essential for comparing testing response of Indian states from Jun 2020 – Aug 2020 because of steep variations in testing protocol in certain states.
Neighborhood-Level Public Facilities and COVID-19 Transmission: A Nationwide Geospatial Study In China
Authors: Jin Xurui , Leng Yu , Gong Enying , Xiong Shangzhi , Yao Yao , Vedanthan Rajesh , Wu Chenkai , Yan Lijing L.
Published: August 2020

Individual-level studies on the coronavirus disease 2019 (COVID-19) have proliferated; however, research on neighborhood-level factors associated with COVID-19 is limited. We gathered the geographic data of all publically released COVID-19 cases in China and used a case-control (1:4 ratio) design to investigate the association between having COVID-19 cases in a neighborhood and number and types of public facilities nearby. Having more restaurants, shopping centers, hotels, living facilities, recreational facilities, public transits, educational institutions, and health service facilities was associated with significantly higher odds of having COVID-19 cases in a neighborhood. The associations for restaurants, hotels, reactional and education facilities were more pronounced in cities with fewer than six million people than those in larger cities. Our results have implications for designing targeted prevention strategies at the neighborhood level to reduce the burden of COVID-19.
Trying to Find the Answer for Two Questions in Patients with COVID-19:1. Is pulmonary infiltrate of COVID-19 infective or inflammatory in nature (Pneumonia or Pneumonitis)? 2. Is Hydroxychloroquine plus Azithromycin or Favipiravir plus Dexamethasone more effective in the COVID-19 treatment?
Authors: Dirican Adem , Uzar Tugce , Karaman Irem , Uluisik Aziz , Ozkaya Sevket
Published: August 2020

Background

During the current pandemic, a great effort is made to understand the COVID-19 and find an effective treatment. As of 17 August 2020, there is no specific drug or biologic agent which have been approved by the FDA for the prevention or treatment of COVID-19.

Methods

We retrospectively analyzed the clinical and radiological findings of 211 COVID-19 in-patients that were treated between March - August 2020. Confirmation of a COVID-19 diagnosis was made according to a positive RT-PCR result with a consistent high-resolution-CT (HRCT) finding. Radiological images and the rate of clinical response of patients were investigated.

Result

While 128 patients (58.7) did not develop pneumonia, the mild, moderate and severe pneumonia ratios were 28(13.2%), 31(18.7%) and 27(22.9%). 72 patients (34.1%) whose PCR tests were positive did not show any symptom and they were followed in isolation without treatment. 52 patients (24.6%) received hydroxychloroquine plus azithromycin, 57 patients (27%) received favipiravir and 30 patients (14.2%) received favipiravir plus dexamethasone as the first line of treatment. 63.1% of pneumonia patients who received hydroxychloroquine plus azithyromycine, 28.3% of patients who received favipiravir and 10% of patients who received favipiravir plus dexamethasone showed a failure of treatment.

Conclusion

The pulmonary infiltrates of COVID-19 are not infective; therefore, the characteristic of the disease should be described as COVID-19 pneumonitis instead of pneumonia. The favipiravir plus dexamethasone seems to be the only drug combination to achieve the improvement of radiological presentation and clinical symptoms in COVID-19 pneumonia patients.
Perturbations in the mononuclear phagocyte landscape associated with COVID-19 disease severity
Authors: Kvedaraite Egle , Hertwig Laura , Sinha Indranil , Ponzetta Andrea , Myrberg Ida Hed , Lourda Magda , Dzidic Majda , Akber Mira , Klingström Jonas , Folkesson Elin , Muvva Jagadeeswara Rao , Chen Puran , Brighenti Susanna , Norrby-Teglund Anna , Eriksson Lars I. , Rooyackers Olav , Aleman Soo , Strålin Kristoffer , Ljunggren Hans-Gustaf , Ginhoux Florent , Björkström Niklas K. , Henter Jan-Inge , Svensson Mattias ,   Karolinska COVID-19 Study Group
Published: August 2020

Monocytes and dendritic cells are crucial mediators of innate and adaptive immune responses during viral infection, but misdirected responses by these cells might contribute to immunopathology. A comprehensive map of the mononuclear phagocyte (MNP) landscape during SARS-CoV-2 infection and concomitant COVID-19 disease is lacking. We performed 25-color flow cytometry-analysis focusing on MNP lineages in SARS-CoV-2 infected patients with moderate and severe COVID-19. While redistribution of monocytes towards intermediate subset and decrease in circulating DCs occurred in response to infection, severe disease associated with appearance of Mo-MDSC-like cells and a higher frequency of pre-DC2. Furthermore, phenotypic alterations in MNPs, and their late precursors, were cell-lineage specific and in select cases associated with severe disease. Finally, unsupervised analysis revealed that the MNP profile, alone, could identify a cluster of COVID-19 non-survivors. This study provides a reference for the MNP response to clinical SARS-CoV-2 infection and unravel myeloid dysregulation associated with severe COVID-19.
“I walk around like my hands are covered in mud”: food safety and hand hygiene behaviours of Canadians during the COVID-19 pandemic
Authors: Haas Robyn , Sekercioglu Fatih , Meldrum Richard , Young Ian
Published: August 2020

Objectives

To investigate how and why Canadians engaged in different food handling and hand hygiene behaviours during the COVID-19 pandemic.

Methods

Seven online, text-based focus groups were conducted with a total of 42 participants. Eligible participants included adults living in Canada that prepared meals at home at least once per week. Focus groups took place from May-June 2020 and followed a semi-structured question guide. Participants were asked about their practices relating to food preparation habits at home; food purchasing, handling, and storage; hand hygiene and sanitation; and information sources about food safety concerning the COVID-19 pandemic. A thematic analysis was conducted using the Theoretical Domains Framework as a coding guide.

Results

The most notable changes in behaviour since the onset of the pandemic were seen in participants’ handwashing, sanitation, and grocery shopping practices. Participants tended to perceive grocery store employees, shoppers, and food service staff as having inadequate sanitation precautions and, therefore, as a source of COVID- 19 transmission risk. They heavily relied on public health, medical, and government officials as sources of information. Feelings of stress and anxiety appeared to be linked to certain sanitation behaviours. Many participants displayed a general apathy toward routine food safety practices such as safe food storage at home.

Conclusion

This work supports the need for clear and concise messaging for hand hygiene and food safety behaviours during the COVID-19 pandemic and in future times of crisis. It also highlights a need for ongoing food safety messaging.