bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunochemical study of diverse surface antigens of a Staphylococcus aureus isolate from an osteomyelitis patient and their role in in vitro phagocytosis
Authors: Karakawa W W , Young D A
Published: June 2021

The cellular antigens of a strain of Staphylococcus aureus, isolated from a bone fragment from osteomyelitis, were analyzed immunochemically and by interaction with human phagocytic cells. When this strain was allowed to interact with human polymorphonuclear cells in the presence of antiserum, the strain was shown to have specific antiphagocytic antigens. An acidic polysaccharide consisting of galactose and glucuronic acid was isolated from the cell surface of the organism, and in vitro opsonization tests indicated that this acidic antigen impeded in vitro phagocytosis by human polymorphonuclear cells. It was also observed that antibodies directed against the mucopeptide constituents of homologous and heterologous bacterial cell walls were effective in promoting the in vitro opsonization of the organism. In the presence of antimucopeptide serum and human polymorphonuclear cells, a variant strain was isolated from the wild type, and immunochemical analysis indicated that this strain consisted of galactose and immunodominant amino-galacturonic acid residues. In vitro phagocytosis studies employing this variant strain indicated that the homologous human convalescent serum contained higher levels of opsonins against the variant strain than the original isolate, the wild type. This observation is discussed.
Characterization and identification of 95 diphtheroid (group JK) cultures isolated from clinical specimens
Authors: Riley P S , Hollis D G , Utter G B , Weaver R E , Baker C N
Published: June 2021

Ninety-five cultures of group JK bacteria isolated from clinical specimens were characterized morphologically and biochemically. The microorganisms were isolated primarily from blood cultures. The bacterial cultures produced positive reactions when tested for catalase, Tween hydrolysis, and carbohydrate fermentation. Glucose and galactose were fermented by more than 90% of the organisms. Gas-liquid chromatography of trimethylsilyl derivatives of whole-cell hydrolysates of some of the group JK cultures yielded nearly identical elution profiles. The group JK microorganisms were susceptible to vancomycin but were resistant to most of the other 17 antimicrobial agents tested. A method is presented for differentiating the group JK microorganisms from other similar bacteria encountered in clinical specimens. Although these bacteria rarely occur in clinical specimens, they are capable of producing fatal infections (endocarditis and sepsis) in humans.
Sensitivity of enzyme-linked immunosorbent assay, complement fixation, and hemagglutination inhibition serological tests for detection of Sendai virus antibody in laboratory mice
Authors: Parker J C , O'Beirne A J , Collins M J
Published: June 2021

The enzyme-linked immunosorbent assay technique for detection of Sendai virus antibody in mice was approximately 100- and 300-fold more sensitive than the complement fixation and hemagglutination inhibition tests, respectively. The assay also permitted direct quantitative measurement of the amount of antibody on a single serum dilution rather than by the more traditional serial titration.
Solid-phase enzyme-linked immunosorbent assay for detection of hepatitis A-specific immunoglobulin M
Authors: Locarnini S A , Coulepis A G , Stratton A M , Kaldor J , Gust I D
Published: June 2021

A solid-phase enzyme linked immunosorbent assay was developed for the detection of immunoglobulin M antibody to hepatitis A virus. The system was capable of detecting hepatitis A-specific immunoglobulin M in a single dilution of serum and appears to be a reliable and rapid means of establishing a diagnosis of hepatitis A infection. Specific immunoglobulin M was only detected in patients with serologically confirmed hepatitis A and not in patients with other forms of hepatitis, chronic liver disease, or autoimmune disease. In patients with hepatitis A, specific immunoglobulin M was usually detectable for 6 weeks after the onset of dark urine, and the longest period for which it was present in any patient was 115 days. This enzyme-linked immunosorbent assay is rapid, simple to perform, and does not require complicated equipment. Provided adequate supplies of purified reagents can be obtained, this enzyme-linked immunosorbent assay procedure is likely to simplify hepatitis A serology, because the same antibody-coated plates can be utilized to detect hepatitis A virus, anti-hepatitis A virus, and hepatitis A-specific immunoglobulin M.
Laboratory and field evaluation of selective media for isolation of group B streptococci
Authors: Gray B M , Pass M A , Dillon H C
Published: June 2021

Problems encountered with currently recommended selective media for group B streptococci (GBS) (selective broth medium and CNA agar) prompted a searach for alternative culture methods in ongoing epidemiological studies. Previously recommended inhibitory agents were tested in vitro. Gentamicin, alone or in combination with nalidixic acid, proved inhibitory for many GBS strains. Among other agents tested, polymyxin was most complementary to the gram-negative spectrum of nalidixic acid, without compromising GBS growth. Crystal violet provided the simplest, most economical staphylococcal inhibitor. Broth and agar media, constituted with these three agents and designated NPC, were evaluated in vitro and in field studies. This investigation represents the first direct comparison of broth media containing inhibitory agents for the preferential isolation of GBS. In maternal colonization studies, NPC broth proved superior to Todd-Hewitt broth containing nalidixic acid and gentamicin at concentrations employed in the previously described selective broth medium (95% versus 59% recovery). Our comparisons were done without added sheep blood since GBS grow well in Todd-Hewitt broth. NPC broth proved more sensitive than NPC agar for detecting GBS colonization in newborns. The NPC agar medium was useful for further purification of broth cultures and quantitative culture techniques.
Use of an enzyme immunoassay test for characterizing the A and M antigens of Brucella
Authors: Thoen C O , Armbrust A L , Eacret W G , Harrington R , Brown G M
Published: June 2021

An enzyme immunoassay test was developed for detecting the A and M antigens of brucellae. One hundred fifteen isolates, including 96 strains of Brucella abortus, 5 strains of B. suis, 1 strain of B. melitensis and 1 strain of B. neotomae, were accurately serotyped with the enzyme immunoassay test. No reactions were observed with 11 isolates of B. canis and 1 isolate of B. ovis. This rapid serological test provides for considerable savings in time and materials as compared with the standard tube agglutination test.
Comparison of the Minitek system with conventional methods for identification of nonfermentative and oxidase-positive fermentative gram-negative bacilli
Authors: Wellstood-Nuesse S
Published: June 2021

The Minitek system was compared with conventional test methods for identifying a wide range of nonfermentative and oxidase-positive fermentative gram-negative bacilli. A total of 230 isolates representing 33 species and biotypes were tested against 12 Minitek substrates and the corresponding conventional tube media. In addition, supplementary tests were included for 141 (61.3%) of the isolates. Overall, 88% of the positive reactions agreed, and negative reactions agreed 95.5%. Anaerobic dextrose, maltose, lactose, and citrate were responsible for 62.4% of the 93 discrepant positive reactions, and 51.8% of the 83 discrepant negative reactions involved the aerobic dextrose, nitrate, and citrate disks. Some discrepancies were related to specific organisms. The system and supplementary tests correctly identified 88.3% of the isolates to species level and 92.6% to correct genus. No particular organism or substrate was responsible for misidentification errors. In a test challenge with 19 selected organisms, 3 were incorrectly identified to species and 4 were misidentified to genus level. Most of the errors responsible for these incorect identifications were due to factors other than the Minitek disks and pointed out the importance of using appropriate supplemental data, and the need for a coding manual and a more enriched broth for certain types of isolates.
Sputum screening by Nomarski interference contrast microscopy
Authors: Welch D F , Kelly M T
Published: June 2021

Gram-stained smears of specimens submitted for sputum cultures were compared with direct wet mounts examined by Nomarski interference contrast microscopy (NIM) for enumeration of squamous epithelial cells (EPC) and leukocytes (WBC). The results obtained by the two methods were comparable, but specimens were more rapidly screened and cell types were more readily differentiated by NIM. Specimens submitted for sputum culture over a 3-month period were examined for EPC and WBC by NIM. Twenty-two percent of the specimens had greater than 25 EPC/field or a predominance of EPC (class I), 30% had greater than 25 EPC and greater than 25 WBC/field (class II), and 48% had greater than 25 WBC/field or a predominance of WBC (class III). The clinical relevance of the culture results was determined by reviewing the records of patients whose specimens were included in the study. Class I specimens provided only 30% clinically relevant culture results. Specimens in class II provided useful culture results in 63% of the patients, and 96% of those in class III provided clinically relevant information. The results confirm the value of sputum screening and demonstrate that NIM provides a rapid, simple, and accurate method for sputum screening.
Method for Rapid Separation of Immunoglobulin M from Immunoglobulin G Antibodies by Using Reorienting Gradients in Vertical Rotors
Authors: Wolf Hans J. , Frösner Gert G. , Deinhardt Friedrich
Published: June 2021

The parameters for the use of reorienting gradients in vertical rotors for rapid separation of immunoglobulin M from immunoglobulin G on a preparative scale for the rapid diagnosis of infectious diseases are described.
Serogroup identification of meningococci by a modified antiserum agar method
Authors: Craven D E , Frasch C E
Published: June 2021

Modifications in the antiserum agar method for serogroup identification of meningococci, which reduce the amount of group-specific antisera required and increase long-term storage of prepoured antiserum agar plates, are described.
New Medium for Differentiation of
Candida albicans
from
Candida stellatoidea
Authors: Salkin Ira F.
Published: June 2021

A simple medium effectively differentiated
Candida stellatoidea
from
Candida albicans
on the basis of a new criterion, relative sensitivity to cycloheximide.
Constricted Tube System for Presumptive Identification and Differentiation of Group D Streptococci
Authors: Takeguchi Milton M. , Simpson Lynn B.
Published: June 2021

A single, constricted tube containing two differential media to identify and differentiate group D streptococci was developed. Test results with a limited number of group D streptococcal isolates were in complete agreement with results of conventional procedures.
Detection of Legionella pneumonophila antigen in urine by enzyme-linked immunospecific assay
Authors: Berdal B P , Farshy C E , Feeley J C
Published: June 2021

An enzyme-linked immunospecific assay "sandwich" technique was developed for detecting soluble antigen from the Legionnaires disease bacterium (Legionella pneumophila). With this technique, antigen was detected in urine specimens from guinea pigs inoculated intraperitoneally with heat-killed Legionnaires disease bacteria and in urine specimens from three of four patients who attended the American Legion Convention in Philadelphia in 1976. Urine from a fifth pneumonia patient who attended the Eucharistic Congress (but who was a dubious seroconverter) was negative. Presumably, the test could also be used for detecting antigen in sputum or respiratory aspirates, but this has not been tried to date.
Presumptive identification of group A, B, and D streptococci on agar plate media
Authors: Facklam R R , Padula J F , Wortham E C , Cooksey R C , Rountree H A
Published: June 2021

Several presumptive tests were evaluated for their effectiveness in differentiating streptococci. When the tests were combined into a battery and the resulting reactions were interpreted as patterns, the overall presumptive identification rate was at least 97%. We used the hemolytic reaction, susceptibility to bacitracin and sulfamethoxazole plus trimethoprim (1.25 micrograms plus 23.75 micrograms), and standard CAMP reactions on sheep blood Trypticase soy agar, and bile-esculin and 6.5% NaCl agar tolerance tests with incubation in candle extinction jars. Subsequently, 98.9% of the group A; 95.3% of the group B; 100% of the beta-hemolytic non-group A, B, or D; 92.3% of group D enterococcal; 100% of the group D non-enterococcal; and 92.8% of the viridans streptococci were presumptively identified. We then used the hemolytic reactions, susceptibility of bacitracin and sulfamethoxazole-plus-trimethoprim disks, CAMP disk reactions on sheep blood Trypticase soy agar and bile-esculin and 6.5% NaCl agar tolerance tests with incubation in normal atmosphere. Subsequently, 98.1% of the group A; 98.6% of the group B; 99.2% of the beta hemolytic non-group A, B, or D; 97.5% of the group D entercoccal; 97.6% of the group D non-entercoccal; and 92.4% of the viridans strains were presumptively identified.
Rapid diagnosis of influenza A infection by direct immunofluorescence of nasopharyngeal aspirates in adults
Authors: Daisy J A , Lief F S , Friedman H M
Published: June 2021

The efficacy for direct immunofluorescence of a commercial conjugate for influenza A virus prepared against whole A/Udorn (H3NS) virus was studied. The conjugate was specific for influenza A virus, but its sensitivity varied depending upon the strain of influenza A tested. Nasopharyngeal aspirates collected from 25 patients during an outbreak of influenza were examined for viral antigen with the conjugates and inoculated onto monkey kidney (MK) cells for virus isolation. Fifteen patients had isolates for influenza A/USSR/90/77 (H1N1); nasopharyngeal secretions were fluorescent antibody positive in 12. Fluorescent antibody was copositive with culture in 11/15 patients (73.3%) and conegative in 9/10 (90%). The one fluorescent antibody-positive, culture-negative patient had negative serology for influenza A and the fluorescent antibody result was considered to be a false positive. At a 1:10 dilution, the conjugate stained nasopharyngeal and MK cells infected with A/USSR (H1N1) 2 to 3+, whereas cells infected with H3N2 virus stained 4+. A conjugate made specifically against the ribonucleoprotein antigen, which is universal to all influenza A strains, may improve the sensitivity of the direct immunofluorescent test.
Anaerobic Sulfur Oxidation Underlies Adaptation of a Chemosynthetic Symbiont to Oxic-Anoxic Interfaces
Authors: Paredes Gabriela F. , Viehboeck Tobias , Lee Raymond , Palatinszky Marton , Mausz Michaela A. , Reipert Siegfried , Schintlmeister Arno , Maier Andreas , Volland Jean-Marie , Hirschfeld Claudia , Wagner Michael , Berry David , Markert Stephanie , Bulgheresi Silvia , König Lena
Published: June 2021

Chemoautotrophic endosymbionts are famous for exploiting sulfur oxidization to feed marine organisms with fixed carbon. However, the physiology of thiotrophic bacteria thriving on the surface of animals (ectosymbionts) is less understood.
Out-of-phase Late Pleistocene glacial maxima in the Western Alps reflect past changes in North Atlantic atmospheric circulation
Authors: Gribenski Natacha , Valla Pierre G. , Preusser Frank , Roattino Thibault , Crouzet Christian , Buoncristiani Jean-François
Published: June 2021

Paleoglacier reconstructions in the northern and southern forelands of the European Alps indicate a synchronous Late Pleistocene glacial maximum during Marine Isotope Stage (MIS) 2, in phase with global ice volume records. However, strong controversy remains for the western foreland, where scarce and indirect dating as well as modeling studies suggest glacial maxima out of phase with the rest of the Alps. New luminescence dating brings the first direct Late Pleistocene glacial chronology for the western Alpine foreland and reveals two major glacier advances of similar maximum extent, at ca. 75–60 and ca. 40–30 ka, coinciding with MIS 4 and late MIS 3. We propose that asynchrony in glacial maxima between the western and the northern and southern Alpine forelands results from a progressive spatial reorganization of the atmospheric circulation over the North Atlantic in response to Northern Hemisphere ice-sheet fluctuations. While such a feedback mechanism has emerged from general circulation models, our Late Pleistocene paleoglacial reconstruction permits tracking of the spatiotemporal evolution of moisture advection patterns over Western Europe.
Raising the West: Mid-Cenozoic Colorado-plano related to subvolcanic batholith assembly in the Southern Rocky Mountains (USA)?
Authors: Lipman Peter W.
Published: June 2021

The Southern Rocky Mountains of Colorado, United States, have the highest regional elevation in North America, but present-day crustal thickness (∼42–47 km) is no greater than for the adjacent, topographically lower High Plains and Colorado Plateau. The chemistry of continental-arc rocks of the mid-Cenozoic Southern Rocky Mountain volcanic field, calibrated to compositions and Moho depths at young arcs, suggests that paleocrustal thickness may have been 20%–35% greater than at present and elevations accordingly higher. Thick mid-Cenozoic Rocky Mountain crust and high paleo-elevations, comparable to those inferred for the Nevadaplano farther west in the United States from analogous volcanic chemistry, could be consistent with otherwise-perplexing evidence for widespread rapid erosion during volcanism. Variable mid-Cenozoic crustal thickening and uplift could have resulted from composite batholith growth during volcanism, superimposed on prior crustal thickening during early Cenozoic (Laramide) compression. Alternatively, the arc–crustal thickness calibration may be inappropriate for high-potassium continental arcs, in which case other published interpretations using similar methods may also be unreliable.
Serpentinized peridotite versus thick mafic crust at the Romanche oceanic transform fault
Authors: Gregory Emma P.M. , Singh Satish C. , Marjanović Milena , Wang Zhikai
Published: June 2021

The crust beneath transform faults at slow-spreading ridges has been considered to be thin, comprising a thin mafic layer overlying serpentinized peridotite. Using wide-angle seismic data, we report the presence of a Moho at ∼6 km depth and a low-velocity anomaly extending down to 9 km beneath the 20-km-wide Romanche transform valley floor in the equatorial Atlantic Ocean. The low crustal velocities above the Moho could be due to either highly serpentinized mantle peridotite or fractured mafic rocks. The existence of clear Moho reflections and the occurrence of a large crustal-depth rupture during the 2016 magnitude 7.1 earthquake suggest that the crust likely consists of fractured mafic material. Furthermore, the presence of low velocities below the Moho advocates for extensive serpentinization of the mantle, indicating that the Moho reflection is unlikely to be produced by a serpentinization front. The crust to the north of the transform fault likely consists of mafic material, but that in the south appears to be more amagmatic, possibly containing serpentinized peridotite. Our results imply that the transform fault structure is complex and highly heterogeneous, and thus would have significant influence on earthquake rupture and alteration processes.
Supplemental Material: U-Pb geochronology of apatite crystallized within a terrestrial impact melt sheet: Manicouagan as a geochronometer test site
Authors: McGregor Maree , al. et
Published: June 2021

Raw LA-ICP-MS data and figures supplemental to the main text
Fifteen-minute guide to managing oligoarticular juvenile idiopathic arthritis
Authors: McKenna Dearbhla , McLaughlin Diarmuid , Campbell Cathy , Mulholland Melissa , Thompson Andrew , Loughran Clare , Jackson Paul , Rooney Madeleine
Published: June 2021

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease affecting children and young people today. However, it is not a single disease entity, but an umbrella term that gathers together a heterogeneous collection of complex, chronic inflammatory conditions with oligoarticular JIA the most common form in both Europe and North America. Due to its relative rarity in daily practice and potential to mimic other conditions, oligoarticular JIA can present a diagnostic and management challenge to healthcare professionals in both primary care and general paediatrics. The aim of this article is to provide a summary of the key aspects of diagnosis, investigation and management of this condition, with the hopes of building clinicians’ confidence when facing a possible case of oligoarticular JIA.
Hand sanitiser–fuelled fire performance and thermal injury: case report
Authors: Murphy Samantha T , Cancio Leopoldo C
Published: June 2021

A 23-year-old man presented to our burn center after sustaining a 62.5% total body surface area burn during a fire performance, in which he applied alcohol-based hand sanitiser to his body and ignited it. The patient underwent 6 operations at this facility and was discharged after 41 days. Fire-performance art is a growing pastime and profession. This case demonstrates the hazards of using hand sanitiser during such activities.
DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus
Authors: van Mark Gesine , Tittel Sascha R , Welp Reinhard , Gloyer Jörg , Sziegoleit Stefan , Barion Ralf , Jehle Peter M , Erath Dieter , Bramlage Peter , Lanzinger Stefanie
Published: June 2021

Introduction

The aims of this study were to characterize insulin-treated individuals aged ≥75 years with type 2 diabetes using basal insulin analogs (BIA) or regular insulins (human insulin (HI)/neutral protamine Hagedorn (NPH)) and to compare the benefits and risks.

Research design and methods

The analysis was based on data from the DPV (Diabetes-Patienten-Verlaufsdokumentation) and DIVE (DIabetes Versorgungs-Evaluation) registries. To balance for confounders, propensity score matching for age, sex, diabetes duration, body mass index and hemoglobin A1c (HbA1c) as covariates was performed.

Results

Among 167 300 patients aged ≥75 years with type 2 diabetes (mean age, 80.3 years), 9601 subjects used insulin regimens with basal insulin (HI/NPH or BIA). Of these 8022 propensity score-matched subjects were identified. The mean diabetes duration was ~12 years and half of the patients were male. At the time of switch, patients provided with BIA experienced more dyslipidemia (89.3% vs 85.9%; p=0.002) and took a greater number of medications (4.3 vs 3.7; p<0.001) and depression was more prevalent (8.4% vs 6.5%; p=0.01). Aggregated to the most actual treatment year, BIA was associated with a higher percentage of patients using basal-supported oral therapy (42.6% vs 14.4%) and intensified conventional insulin therapy (44.3% vs 29.4%) and lower total daily insulin doses (0.24 IU/kg/day vs 0.30 IU/kg/day; p<0.001). The study did not reveal significant differences in efficacy (HbA1c 7.4% vs 7.3%; p=0.06), hospitalizations (0.7 vs 0.8 per patient-year (PY); p=0.15), length of stay (16.3 vs 16.1 days per PY; p=0.53), or rates of severe hypoglycemia (4.07 vs 4.40 per 100 PY; p=0.88), hypoglycemia with coma (3.64 vs 3.26 per 100 PY; p=0.88) and diabetic ketoacidosis (0.01 vs 0.03 per 100 PY; p=0.36).

Conclusion

BIA were used in more individually and patient-centered therapy regimens compared with HI/NPH in patients with a mean age of 80 years. Both groups were slightly overtreated with mean HbA1c <7.5%. The risk of severe hypoglycemia was low and independent of insulin type. Further analyses of elderly patients with type 2 diabetes are needed to provide evidence for best practice approaches in this age group.
Use of ColonFlag score for prioritisation of endoscopy in colorectal cancer
Authors: Ayling Ruth M , Wong A , Cotter Finbarr
Published: June 2021

Objective

Colorectal cancer (CRC) is the fourth most common cancer in UK. Symptomatic patients are referred via an urgent pathway and although most are investigated with colonoscopy <4% are diagnosed with cancer. There is therefore a need for a suitable triage tool to prioritise investigations. This study retrospectively examined performance of various triage tools in patients awaiting investigation on the urgent lower gastrointestinal cancer pathway

Design

All patients over 40 years of age on the urgent pathway awaiting investigation for suspected CRC on 1 May were included. After 6 months, outcomes were evaluated and the performance of the faecal immunochemical test (FIT), faecal haemoglobin concentration, age and sex test (FAST) and the artificial intelligence algorithm ColonFlag were examined.

Results

532 completed investigations and received a diagnosis; 15 had CRC. 388 had a valid FIT result, of whom 11 had CRC; FAST Score ≥4.5 had sensitivity of 72.7%, specificity of 80.6% and would have failed to detect three tumours. Faecal haemoglobin (f-Hb) at cut-off of 10 µg/g and ColonFlag had equal sensitivity of 81.82%, ColonFlag had greater specificity 73.47%, compared with 64.99%. Both tests would have failed to detect two tumours but not in the same patients; when used in combination, sensitivity and specificity were 100% and 49.4%. When ColonFlag was applied to the cohort of 532, an additional four tumours would have been detected in patients without a valid FIT.

Conclusion

This study showed ColonFlag to have equal sensitivity and greater specificity than f-Hb at a cut-off of 10 µg/g as a triage tool for CRC
Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations
Authors: Mattison Cristina , Bourret Kirsty , Hebert Emmanuelle , Leshabari Sebalda , Kabeya Ambrocckha , Achiga Patrick , Robinson Jamie , Darling Elizabeth
Published: June 2021

Introduction

Midwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengthening.

Methods

A critical interpretive synthesis complemented by key informant interviews, focus groups, observations, and document review was used to inform the development of concepts and theory. Three electronic bibliographical databases (CINAHL, EMBASE and MEDLINE) were searched through to 2 September 2020. A coding structure was created to guide the synthesis across the five sources of evidence.

Results

A total of 1634 records were retrieved through electronic searches and 57 documents were included in the critical interpretive synthesis. Thirty-one (31) key informant interviews and five focus groups were completed including observations (255 pages) and audio recordings. Twenty-four (24) programme documents were reviewed. The resulting theoretical framework outlines the key factors by context, describes the system drivers that impact the sustainability of midwifery associations and identifies the key-enabling elements involved in designing programmes that strengthen midwifery associations.

Conclusion

Midwifery associations act as the web that holds the profession together and are key to the integration of the profession in health systems, supporting enabling environments and improving gender inequities. Our findings highlight that in order to strengthen midwifery (education, regulation and services), we have to lead with association strengthening. Building strong associations is the foundation necessary to create formal quality midwifery education systems and to support midwifery regulation and accreditation mechanisms.
A partisan pandemic: state government public health policies to combat COVID-19 in Brazil
Authors: Touchton Michael , Knaul Felicia Marie , Arreola-Ornelas Héctor , Porteny Thalia , Sánchez Mariano , Méndez Oscar , Faganello Marco , Edelson Vaugh , Gygi Benjamin , Hummel Calla , Otero Silvia , Insua Jorge , Undurraga Eduardo , Rosado Julio Antonio
Published: June 2021

Introduction

To present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs).

Materials and methods

We collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil’s 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic.

Results

Brazil’s national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation.

Conclusions

The study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States’ NPIs and their scores on the composite policy index both align with the governors’ political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.
Novel equipment used in the UK Role 2 medical treatment facility as part of Operation TRENTON in South Sudan
Authors: Ralph James , Hutley E J , Nordmann G
Published: June 2021

The deployment of a UK military Role 2 Medical Treatment Facility (MTF) to South Sudan during Operation TRENTON into an isolated location and austere environment with a prolonged hold produced potential medical planning challenges. The MTF was augmented with both specific personnel and equipment in order to meet these challenges. This paper discusses equipment available in this facility not previously used at Role 2 before and how it could be used to supplement medical operational deployments in future.
Comorbidities of deformational plagiocephaly in infancy: a scoping review protocol
Authors: Charalambous Lia , Hadders-Algra Mijna , N. Yamasaki Edna , Lampropoulou Sofia
Published: June 2021

Introduction

Deformational plagiocephaly (DP) is one of the most common cranial shape disorders in infancy. It is characterised by unilateral flattening of the skull due to head preference to one side. The literature suggests that DP is associated with comorbidities such as developmental delay, but the nature and prevalence of the comorbid impairments are still unclear and controversial. Therefore, our scoping review (ScR) aims to explore systematically the extent and nature of literature by identifying, mapping and categorising the most relevant comorbidities of DP in children up to the age of 2 years.

Methods and analysis

This protocol is based on the framework outlined by Arksey and O’Malley. A systematic search will be conducted to identify relevant full text studies from 1992 to 2021 using the databases of Cochrane, MEDLINE, Google Scholar, EMBASE, PubMed and University of Nicosia EBSCO. Two independent reviewers will screen abstracts and full articles in parallel, using specific inclusion and exclusion criteria. Specifically, this review will consider studies investigating DP and relevant comorbidities in children up to the age of 2 years of life without craniosynostosis, torticollis and any other diagnosed neurodevelopmental deficiency.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for ScR Checklist will be considered for results’ analysis and reporting. The results will be described in a narrative form in relation to the research question and in the context of the overall study purpose.

Ethics and dissemination

Research ethics approval is not required for this ScR since data will be retrieved from publicly available studies. Dissemination activities will include research findings’ submission for publication in a relevant peer-reviewed journal and presentation of the results at relevant conferences.

Registration

Our protocol was registered prospectively with the Open Science Framework (https://osf.io/48am3/).
‘More than biological’: Cherie Dimaline’sThe Marrow Thievesas Indigenous countergenetic fiction
Authors: Pravinchandra Shital
Published: June 2021

This article reads Métis writer Cherie Dimaline’s novelThe Marrow Thievesas one among a growing number of Indigenous countergenetic fictions. Dimaline targets two initiatives that reductively define indigeneity as residing in so-called Native American DNA: (1) direct-to-consumer genetic testing, through which an increasing number of people lay dubious claim to Indigenous ancestry, and (2) population genetics projects that seek urgently to sample Indigenous genetic diversity before Indigenous Peoples become too admixed and therefore extinct. Dimaline unabashedly incorporates the terminology of genetics into her novel, but I argue that she does so in order ultimately to underscore that genetics is ill-equipped to understand Indigenous ways of articulating kinship and belonging. The novel carefully articulates the full complexity of Indigenous self-recognition practices, urging us to wrestle with the importance of both the biological (DNA, blood and relation) and the ‘more than biological’ (story, memory, reciprocal ties of obligation and language) for Indigenous self-recognition and continuity. The novel shows that,to grasp Indigenous modes of self-recognition is to understand that Indigenous belonging exceeds any superficial sense of connection that a DNA test may produce and that, contrary to population geneticists’ claims, Indigenous Peoples are not vanishing but instead are actively engaged in everyday practices of survival. Finally, I point out that Dimaline—who identifies as Two-Spirit—does not idealise Indigenous communities and their ways of recognising their own;The Marrow Thievesalso explicitly gestures to the ways in which Indigenous kinship-making practices themselves need to be rethought in order to be more inclusive of queer Indigenous Peoples.
Heavy alcohol drinking and subclinical echocardiographic abnormalities of structure and function
Authors: Iakunchykova Olena , Schirmer Henrik , Leong Darryl , Malyutina Sofia , Ryabikov Andrew , Averina Maria , Kudryavtsev Alexander , Kornev Mikhail , Voronina Ekaterina , Paramonov Andrey , Wilsgaard Tom , Leon David
Published: June 2021

Objective

The aim of the study is to assess changes in heart structure and function associated with heavy alcohol use by comparing echocardiographic indices in a population-based sample to those in patients admitted to an inpatient facility with severe alcohol problems.

Methods and results

We used data from the Know Your Heart study (2015–2017) which is a cross-sectional study that recruited 2479 participants aged 35–69 years from the general population of the city of Arkhangelsk in Northwest Russia and 278 patients from the Arkhangelsk Regional Psychiatric Hospital with a primary diagnosis related to chronic alcohol use (narcology clinic subsample). The drinking patterns of the population-based sample were characterised in detail. We used regression models controlling for age, sex, smoking, education and waist to hip ratio to evaluate the differences in echocardiographic indices in participants with different drinking patterns. The means of left ventricular end-diastolic diameter and indexed left atrial systolic diameter were increased among heavy drinkers (narcology clinic subsample), while mean left ventricular ejection fraction was decreased in this group compared with the population-based sample. In contrast, the harmful and hazardous drinkers in the population-based sample did not differ from non-problem drinkers with respect to echocardiographic indices of systolic and diastolic function.

Conclusions

Extremely heavy drinking is associated with a specific set of structural and functional abnormalities of the heart that may be regarded as precursors of alcohol-related dilated cardiomyopathy.
Narrowing antibiotic spectrum of activity for trauma-associated pneumonia through the use of a disease-specific antibiogram
Authors: Ting Michelle H , Radosevich John J , Weinberg Jordan A , Nailor Michael D
Published: June 2021

Background

Organism susceptibilities for trauma-associated pneumonia (TAP) differ from those in other patient populations, including the critically ill. The purpose of this study was to identify common organisms and their susceptibilities in the respiratory isolates of trauma patients diagnosed with pneumonia within the first 7 days of hospital admission, and to create a TAP-specific disease-state antibiogram to guide empiric antibiotic therapy in this patient population.

Methods

This study was a retrospective review of adult trauma patients with pneumonia admitted between September 1, 2015 and August 31, 2018. Patients included were diagnosed with and treated for pneumonia, with respiratory cultures drawn within the first 7 hospital-days; both culture-positive and culture-negative patients were included. Subgroup antibiograms were made for diagnosis made on days 1–3, 4–5, and 6–7.

Results

There were 131 patients included with a median age of 45; 85% were male, and 31% were illicit drug users. Most patients (63%) had ventilator-associated pneumonia, and most respiratory samples (77%) were obtained via bronchoalveolar lavage. Cultures were positive in 109 patients and negative in 22. There were 144 total isolates; 54% were Gram-negative bacteria. The most common Gram-negative pathogens wereHaemophilus influenzae(16%) andKlebsiella pneumoniae(15%). The most common Gram-positive pathogen wasStaphylococcus aureus; methicillin-resistantS. aureus(MRSA) constituted 8% of all isolates. With culture-negative patients counted as susceptible, ceftriaxone monotherapy and ceftriaxone+vancomycin susceptibilities were 85% and 94%, respectively. Susceptibilities to cefazolin, ampicillin/sulbactam, cefepime, piperacillin/tazobactam, and levofloxacin were 49%, 69%, 91%, 90%, and 92%, respectively. Illicit drug use and day of pneumonia diagnosis did not appreciably affect antibiotic susceptibilities.

Conclusions

For TAP diagnosed within the first 7 days of hospital admission, ceftriaxone monotherapy is adequate as empiric therapy, including in ventilated patients. The addition of vancomycin can be considered in patients with MRSA risk factors or who are critically ill.

Level of evidence

Level III, prognostic and epidemiological.
Pattern of trauma admission and outcome among patients presented to Jimma University Specialized Hospital, south-western Ethiopia
Authors: Bayissa Badhaasaa Beyene , Alemu Seifu
Published: June 2021

Background

Trauma is an ever evolving world problem that needs close attention and devising means to prevent and treat. The aim of the study is to identify the main reason for trauma admissions and assess the patient outcome after intervention. Therefore, knowing its actual nature might aid in postulating possible intervention as well as prevention measures.

Method

A cross-sectional study was conducted from August to December 2015 in Jimma University Specialized Hospital, which is located in south-western Ethiopia. Two hundred and eleven consecutive trauma admissions to surgery department were included in the study. Data were collected and analyzed using computer software SPSS V.23.

Result

A total of 211 admitted trauma patients were studied with male to female ratio of 3.14. The leading cause of trauma admission was road traffic collision at 84 (39.8%) and the least being bullet injury which was 6 (2.8%). Hospital mortality was 31 (14.7%). Factors associated with outcome of patients before discharge from hospital were male sex, adjusted OR (AOR)=2.3, 95% CI 1.08 to 4.75; Glasgow Coma Scale score 15/15, AOR=0.04, 95% CI 0.00 to 0.46; and hemoglobin >10 g/L, AOR=0.225, 95% CI 0.074 to 0.464, p<0.05.

Conclusion

Road traffic collision takes the top position from all causes of trauma and unlike other developed countries and low and middle-income countries, pedestrians and motorcyclists were the major victims of the collision in this study.

Level of evidence VI (This level of effectiveness rating scheme is based on the following: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008).Evidence-based nursing care guidelines: Medical-surgical interventions.(p. 7).St. Louis, MO: Mosby Elsevier.
Disinfection mechanism of the photocatalytic activity of SnO2 thin films against Candida albicans, proposed from experimental and simulated perspectives
Authors: Faudoa-Arzate Alejandro , Camarillo-Cisneros Javier , Castillo-González Alva Rocío , Favila-Pérez María Alejandra , Sáenz-Hernández Renee Joselin , Realyvazquez-Guevara Paula Rebeca , Arzate-Quintana Carlos
Published: June 2021

Nosocomial infections are an important health problem and cause of complications and death in hospitalized patients. This problem should be solved from the preventive angle, avoiding the spread of infections by designing disinfection methods based on the photocatalytic activity of semiconductor materials such as tin oxide (SnO2). The antimicrobial activity of UV light was tested by using inoculation with Candida albicans ATCC10231 on SnO2 thin films and counting colony forming units (CFU). The interaction of UV light with SnO2 was analyzed by density functional theory (DFT) and the extension to the Hubbard model (DFT+U) schemes to predict the electron behavior at the subatomic level. After exposure to UV light, C. albicans showed a reduction of 36.5% in viable cells, and when SnO2 was included, cell viability was reduced by 60.2%. Measurements of the electronic structure obtained by the first-principle calculations under the DFT and DFT+U schemes showed that the O-p orbitals mediate the oxidation process in the bulk semiconductor. By including the surface effects when cleaving the (1 0 0) plane, the three orbitals O-p, Sn-p, and Sn-s are the mediators. SnO2 films are promising antimicrobial coatings because UV light has a synergic activity with thin films, resulting in faster disinfection.
Dynamic characteristics of threshold values and extension field selections for a vacuum-blowing cleaning system
Authors: Xi Yuan , Dai Yan , Zhang Xilong , He Gaohong
Published: June 2021

To provide theoretical guidelines for threshold value selection on the performance characteristics of an extension field, the flow characteristics in a vacuum-blowing cleaning system was simulated using the average velocity and pressure at the front inlet surface and the average velocity of the outlet surface as indices to evaluate the effects of the extension field’s structural parameters. We found that the extension field parameters have implications for the simulation calculations, and that each parameter has a corresponding threshold. If the structural parameter is greater than the corresponding threshold, the calculation result is not affected and the threshold values are analyzed using computational fluid dynamics. The dimensions of the front, back, left, and right extension fields were as follows: lf = lb = ll = lr = 210 mm, and θf = θb = θl = θr = 55°. The flow field distribution characteristics are not distinctly different, with or without the extension field corner. The extension field with a corner can be used if high accuracy is required; however, to reduce the need for grid computation and shorten the calculation time, the corner extension field model is not recommended. Finally, the simulation results were verified experimentally, and can be used to improve the accuracy of the calculations and reduce the required computational resources.
Using an analytic hierarchy process-based index and geographic information system in geochemical exploration of gold
Authors: Yılmazer Erkan , Kavurmaci Murat , Bozan Sercan
Published: June 2021

In this study, a gold exploration index (GEI) that reduces financial expenditure and time losses during exploration studies has been developed using the analytical hierarchy process in a region where a high-sulfidation epithermal gold (Au) deposit exists. The GEI can be used to predict the location of the target element by evaluating the maps obtained from related element distributions together with a GEI-based prediction map. The hierarchical structure of the index has been established based on geochemistry of the rock samples. The elements used in the design of the hierarchical structure are arsenic (As), silver (Ag), antimony (Sb), copper (Cu), manganese (Mn), lead (Pb) and zinc (Zn), which are determined by the correlation analysis and experts’ opinions. The efficiency scores of the alternatives are converted into prediction maps called GEI-based anomaly distribution maps. These are compared with the maps derived from both geographic information system-based overlay analysis of the rock samples and spatial gold distribution. The efficiency scores of the alternatives in these maps are categorized into three groups as ‘high’, ‘medium’ and ‘weak’ in terms of gold potential. Comparison of the results with those derived using principal component analysis, weighted sum and weighted product models shows that the produced index yields reliable information that can be used to determine where gold enrichment occurs, especially in high-sulfidation epithermal environments.

Supplementary material:
Geochemical analysis results are available at
https://doi.org/10.6084/m9.figshare.c.5443218