bluuebunny/crossref_metadata_2025 huggingface dataset:
Planned Induction Versus Spontaneous Delivery Among Women Using Prophylactic Anticoagulation Therapy: A Retrospective Study
Authors: Rottenstreich A. , Zacks N. , Kleinstern G. , Levin G. , Sompolinsky Y. , Mankuta D. , Ezra Y. , Rottenstreich M. , Yagel S. , Kalishc Y
Published: May 2021

(BJOG. 2020;127:1241–1248)

Venous thromboembolism (VTE) in pregnant women is commonly prevented using low-molecular weight heparin (LMWH), which does not cross the placenta. Women treated with LMWH often stop treatment for 24 hours prior to planned induction of labor or cesarean delivery to ensure safe neuraxial analgesia. It is unclear, however, how planned induction affects maternal outcomes compared with spontaneous delivery. This study aimed to fill a gap in the literature by comparing planned induction of labor and spontaneous onset of labor in pregnant patients using prophylactic LMWH therapy.
Hand Placement During Chest Compressions in Parturients: A Pilot Study to Identify the Location of the Left Ventricle Using Transthoracic Echocardiography
Authors: Delgado C. , Dawson K. , Schwaegler B. , Zachariah R. , Einav S. , Bollag L.
Published: May 2021

(Int J Obstet Anesthesia. 2020;43:31–35)

Current guidelines for cardiopulmonary resuscitation (CPR) in pregnant women recommend hand placement on the lower half of the sternum, as this is an easily identifiable landmark. However, the heart is rotated during pregnancy and one study found the left ventricle (LV) was located under the sternum in only about half of cases. This study used transthoracic echocardiography (TTE) to investigate the displacement of the LV by the gravid uterus and left uterine displacement.
The Influence of Obesity on Coagulation in Healthy Term Pregnancy as Assessed by Rotational Thromboelastometry
Authors: Lee J. , Eley V.A. , Wyssusek K.H. , Kimble R.M.N. , Way M. , Cohen J. , van Zundert A.A.
Published: May 2021

(Aust N Z J Obstet Gynaecol. 2020;60:714–719)

Rotational thromboelastometry (ROTEM), a point-of-care coagulation test, has demonstrated hypercoagulability in both the pregnant and obese populations. This enhanced clotting tendency in pregnant patients can prove crucial in preventing postpartum hemorrhage. This study aimed to assess the combined effect of pregnancy and obesity on coagulation in healthy women using ROTEM.
Maternal and Perinatal Outcomes for Women With Body Mass Index ≥50 kg/m2 in a Non-tertiary Hospital Setting
Authors: Pratt A. , Howat P. , Hui L.
Published: May 2021

(Aust N Z J Obstet Gynaecol. 2020;60:361–368)

It is well known that maternal obesity increases the risk of several obstetric complications and interventions. However, data is limited regarding maternal prevalence and obstetric outcomes for obese Australian women, particularly for those with BMI ≥50 kg/m2. This study aimed to assess the prevalence of women with BMI ≥50 kg/m2 in a non-tertiary setting and to analyze outcomes for pregnant women based on BMI, with an emphasis on women with BMI ≥50 kg/m2.
Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants
Authors: Kirpalani H. , Bell E.F. , Hintz S.F. , Tan S. , Schmidt B. , Chaudhary A.S. , Johnson K.J. , Crawford M.M. , Newman J.E. , Vohr B.R. , Carlo W.A. , D’Angio C.T. , Kennedy K.A. , Ohls R.K. , Poindexter B.B. , Schibler K. , Whyte R.K. , Widness J.A. , Zupancic J.A.F. , Wyckoff M.H. , Truog W.E. , Walsh M.C. , Chock V.Y. , Laptook A.R. , Sokol G.M. , Yoder B.A. , Patel R.M. , Cotten C.M. , Carmen C.F. , Devaskar U. , Chawla S. , Seabrook R. , Higgins R.D. , Das A.
Published: May 2021

(N Engl J Med. 2020;383:2639–2651)

Extremely-low birthweight infants are commonly treated with packed red-cell transfusions to treat low hemoglobin, but transfusion protocols vary. Randomized control trial (RCT) evidence is limited, and more evidence is needed to evaluate low and high hemoglobin thresholds in terms of complications. This study, informed by a previous study of more than 450 neonates, compared transfusions at low and high hemoglobin thresholds in terms of incidence of death or neurodevelopmental impairment in infants at 22 to 26 months of age.
Safety Guideline: Neurological Monitoring Associated With Obstetric Neuraxial Block 2020 A Joint Guideline by the Association of Anaesthetists and the Obstetric Anaesthetists’ Association
Authors: Yentis S.M. , Lucas D.N. , Brigante L. , Collis R. , Cowley P. , Denning S. , Fawcett W.J. , Gibson A.
Published: May 2021

(Anaesthesia. 2020;75:913–919)

Early detection of neurological complications following a neuraxial procedure is essential to minimizing harm. Previous guidelines for management of neuraxial anesthesia lack guidance on neurological monitoring or are not specific to obstetric patients. The recommendations in this paper were produced by representatives from the Association of Anesthetists and Obstetric Anesthetists’ Association with the goal to guide monitoring and management of neurologic recovery in obstetric patients following neuraxial block.
Incidence and Risk Factors for Maternal Hypoxaemia During Induction of General Anesthesia for Non-elective Caesarean Section: A Prospective Multicentre Study
Authors: Bonnet M.P. , Mercier F.J. , Vicaut E. , Galand A. , Keita H. , Baillard C
Published: May 2021

(British J Anaesthesia. 2020;125:e81–e87)

General anesthesia, which can increase the risk of respiratory complications, is used in about 5% of deliveries and is mainly used in emergency cesarean sections. One study found that hypoxemia affected 2% of cesarean patients undergoing general anesthesia, but no risk factors were identified. This study aimed to determine the incidence and risk factors of hypoxemia in patients undergoing general anesthesia for non-elective cesarean delivery.
Enhanced Recovery After Caesarean Delivery Versus Standard Care Studies: A Systematic Review of Interventions and Outcomes
Authors: Sultan P. , Sharawi N. , Blake L. , Carvalho B.
Published: May 2021

(Int J Obstet Anesthesia. 2020;43:72–86)

Obstetric units worldwide are incorporating enhanced recovery after cesarean (ERAC) programs. These are multimodal care pathways aimed at improving outcomes, reducing complications and decreasing length of hospital stay. However, the ERAC interventions used, and the outcomes used to assess success of ERAC protocols vary widely. Given this, there is the need to assess the level of evidence supporting the use of ERAC. This review aimed to identify ERAC implementation studies that compared patients cared for with ERAC principles to a control group, identify specific interventions and outcome measures, and compare interventions with published guidelines, The study also reports on the impact of ERAC and the level of available evidence supporting the use of ERAC.
Inhalational Induction of General Anaesthesia for Elective Caesarean: Ethical Acceptability in Treatment-resistant Needle Phobia?
Authors: Parrott N. , Prabhu P. , Yeow C.
Published: May 2021

(Int J Obstet Anesthesia. 2020;43:27–29)

This case study describes the cesarean delivery of a woman with a severe needle phobia, which led her to decline regional anesthesia, IV access, or other processes involving needles while awake. The patient previously underwent general anesthesia for an emergency cesarean delivery and requested inhalational induction of anesthesia for her elective repeat cesarean.
A Call for a Patient Preference Predictor
Authors: Wendler David
Published: May 2021

OBJECTIVES:

When patients lose the capacity to make their own decisions, current practice relies on their family and loved ones to try to identify the treatment course the patient would have chosen for themselves. The fact that this approach has remained essentially unchanged for over 40 years raises the question of whether it successfully provides care that is consistent with patients’ treatment preferences.

DATA SOURCES:

Published studies on the outcomes and impact of surrogate decision-making.

STUDY SELECTION:

All identified articles.

DATA EXTRACTION:

Review by the author.

DATA SYNTHESIS:

Surrogates frequently are not able to identify the treatment preferences of decisionally incapacitated patients and can experience significant distress as a result of making decisions for them.

CONCLUSIONS:

Revisions to existing practice are needed to increase the extent to which surrogates are able to identify the treatment preferences of decisionally incapacitated patients. One possibility is to assess whether predicting patients’ treatment preferences based on the preferences of similar patients might increase the extent to which patients are treated consistent with their preferences and thereby reduce the burden on their surrogates.
Navigating the Doctor of Nursing Practice project within an academic practice partnership
Authors: Hartjes Tonja M. , Starr Kathryn , Kittelson Sheri , Duckworth Laurie
Published: May 2021

The Doctor of Nursing Practice (DNP) curriculum was initially developed in 2004. The DNP degree is a practice doctorate, which educates nurses to the highest level of clinical nursing practice. DNP students must complete a scholarly project in accordance with the American Association of Colleges of Nursing (AACN) guidelines. The project is an opportunity for the student to integrate skills into practice and demonstrate principles of advanced nursing practice. The AACN provides recommendations for the DNP project, but much confusion regarding the context and implementation of the project still exists. At one academic health sciences center, DNP project students often complete their projects within academic practice partnerships. Such partnerships are encouraged by the AACN. Several DNP quality improvement (QI) projects were submitted a hospital's interdisciplinary quality week event. Upon review, some of the abstracts were found to contain aspects of research. This finding prompted the review of all DNP project processes to standardize methods for faculty, students, the University, and the academic practice partner.
An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting
Authors: Bailey Teresa , Staebler Suzanne , Pont Molly , Christiansen Brittany , Champion Jane Dimmit
Published: May 2021

Background:

Perceptions of autonomy in practice affect Neonatal Nurse Practitioner (NNP) job satisfaction, retention, and motivation to pursue NNP roles. However, Novice to Expert theory describes the processes for transitioning to nurse practitioner roles are not in relationship with NNP practice autonomy.

Purpose:

Relationships between Advanced Practice Registered Nurse (APRN) practice authority, state restrictions, APRN volume, and health care access exist. However, do APRN perceptions of autonomy relate to motivation to pursue practice authority? This study provides an exploration of perceptions of NNP practice autonomy in this context.

Methodology:

Semistructured interviews conducted with NNPs and neonatologists practicing in a restricted setting explored perceptions of practice expertise and autonomy, based on Patricia Benner's Novice to Expert theoretical framework. Laddered methodology organized survey questions, and the Framework Method was used for analysis of results.

Results:

The majority of eligible NNPs (n = 12, 67%) and neonatologists (n = 8, 67%) agreed to study participation. Identified themes were grouped into larger concepts, including “NNP practice authority,” “NNP expertise,” and “NNP autonomy.” For example, “NNP expertise” included the theme “determining NNP expertise” and associated factors included “procedural skills,” “years and acuity of practice level,” and “confidence in management plan and emergent situations.”

Conclusions:

Both neonatologists and NNPs perceived neonatologists as a practice authority with support for NNP autonomy. Factors indicating NNP expertise correlated with domains in Benner Novice to Expert theory.

Implications:

These findings support previous work concerning the evolution of expertise and transition to practice. More inquiry to understand perspectives of APRNs in restricted practice settings is indicated.
Comparing nurse practitioners/physician assistants and physicians in diagnosing pediatric abdominal pain for ESI level 3 patients seen in the emergency department
Authors: Hoyt Karen Sue , Agan Donna L. , Jordan Kathleen Sanders , Ramirez Elda , Nichols Stephen , Topp Robert
Published: May 2021

Background:

Accuracy of emergency department (ED) diagnosis affects care management including tests, discharges, and readmissions.

Purpose:

This retrospective study compared nurse practitioners/physician assistants (NPs/PAs) with physicians (MDs/DOs) on accuracy of diagnosing Emergency Severity Index (ESI) level 3 pediatric abdominal pain (AP) in the ED. Abdominal pain unrelated to trauma is a common ED pediatric visit.

Methodology:

Data acquired from four hospital sites of a multistate emergency group examined patients younger than 18 years who were initially admitted for AP ESI level 3.

Results:

The accuracy of AP ESI level 3 diagnoses was 94.9%, 90.9%, and 96.5% by physicians, NPs/PAs, and a collaboration of NP/PA/physician, respectively (χ2 = 13.187, p < .001). Accuracy of AP ESI level 3 diagnoses was greater with general admissions, intensive care unit admissions, transfers, or left against medical advice (100%) than with those who were discharged (χ2 = 11.058, p = .001). Abdominal pain complaints were segmented into five areas (i.e., AP, back pain, chest pain, epigastric pain, and pelvic pain). Irrespective of provider, those with a final diagnosis of AP or epigastric pain were correctly triaged and those with a final diagnosis of chest or back pain were incorrectly triaged as AP ESI level 3.

Conclusions:

When comparing providers in this subset (n = 43), there was no significant difference in the accuracy of assigning AP ESI level 3 (χ2 = 0.467, p = .495).

Implications:

Only cases with a final diagnosis of pelvic/genitourinary pain saw disparity in the accuracy (27 correct, 16 incorrect, χ2 = 1,681.80, p < .001).
Extending the radius of family-centered care in the pediatric cardiac intensive care unit through virtual rounding
Authors: Tallent Sarah , Turi Jennifer L. , Thompson Julie , Allareddy Veerajalandhar , Hueckel Rémi
Published: May 2021

Background:

The arrival of COVID-19 brought urgent limitation of visitation in hospitals across the country. Family-centered care and its delivery rapidly changed and left the family behind—unable to actively participate in their loved one's care.

Local problem:

A southeastern academic medical center pediatric cardiac intensive care unit (PCICU) needed to augment family-centered medical rounds when parents could not be at the bedside. No alternative to physical presence for daily medical rounds existed in the PCICU.

Methods:

A virtual rounding (VR) program was implemented allowing parents of patients admitted to PCICU to join medical rounds remotely through teleconferencing. Preintervention and postintervention rounding times, staff perceptions of the program, and parental satisfaction scores using the Pediatric Family Satisfaction in the Intensive Care Unit (pFS-ICU) tool were measured.

Interventions:

This quality improvement project implemented a VR program offered to all families of patients in the PCICU.

Results:

VR did not increase rounding times after implementation (p = .673). Staff satisfaction surveys revealed that staff felt the VR program did not prolong rounding times (p ≤ 0.001), workload impact perceptions improved after intervention (p = <0.001), and staff felt VR should be offered to families in PCICU (p ≤ 0.001). Only nine pFS-ICU surveys were completed giving the family a limited voice in the evaluation of this project.

Conclusions:

This project demonstrates that VR can be successfully implemented for family engagement without increased burden on staff.
Acantholytic Squamous Cell Carcinoma Arising From Lichen Sclerosus: A Rare Case Affecting Vulvar Skin
Authors: Barron Cynthia R. , Paczos Tamera A. , Varghese Sharlin , Smoller Bruce R.
Published: May 2021

We present the case of an 82-year-old female with acantholytic squamous cell carcinoma affecting vulvar skin. The patient had a history of perineal lichen sclerosus for 5 years before presentation. She was referred to a dermatologist for intractable severe pain associated with the lesions. Biopsies showed an infiltrative squamous cell carcinoma with histology consistent with the acantholytic subtype. Acantholytic squamous cell carcinoma is a rare histologic variant characterized by dyscohesive keratinocytes with pseudoglandular formation and dyskeratosis. It is associated with sun-damaged skin and most commonly occurs in the head and neck of elderly men. Few cases have been reported at nondermal sites and non–sun-exposed dermis. The patient underwent a radical vulvectomy and bilateral inguinal node dissection. The 1.6 cm tumor was diffusely acantholytic and pseudoglands were present. The tumor cells were diffusely positive for p63 immunohistochemical stain. As expected at this site, there was no solar elastosis identified histologically. However, vulvar intraepithelial neoplasia and chronic lichen sclerosus were apparent. This case represents a rare histologic subtype of squamous cell carcinoma in an unusual site associated with lichen sclerosus instead of solar elastosis.
Comparative Anatomical Study of Fronto-Orbito-Zygomatic and Fronto-Temporal Approach to the Central Skull Base
Authors: Spina Alfio , Gagliardi Filippo , Bailo Michele , Boari Nicola , Calvanese Francesco , Mortini Pietro
Published: May 2021

Despite the advances in microsurgery and neuroanatomy, surgery of the central skull base still represents a challenge. Fronto-temporal approach has represented the mainstay of surgical approaches to this region. With advances in skull base surgery, orbital and zygomatic extensions were added to fronto-temporal approach to improve exposure minimizing brain retraction.

The authors compared fronto-temporal and fronto-orbitozygomatic approaches to the central skull base by using the previously described operability score, to three different anatomical targets: the ipsilateral anterior clinoid process, the contralateral anterior clinoid process, and the ipsilateral posterior clinoid process.

Based on the measurements taken, fronto-orbitozygomatic approache showed higher values at all 3 targets. The reported values were critically discussed.

The operability score has been reported as an effective method to compare surgical approaches. The present study demonstrated the maximal possibility of exposure of the two approaches. Based on the strong variability of this anatomical region, especially because of the different pathologies, the authors suggest considering the operability score as a further tool to better define the best surgical approach to this anatomical region.
Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients
Authors: Bazaraa Hafez , Roby Shereen , Salah ElShimaa , Algebaly HebatAllah
Published: May 2021

Background:

Pediatric shock has a high mortality rate because many of the early clinical signs are subtle and have poor sensitivity and specificity. Pediatric shock was categorized either: compensated with normal blood pressure, poor skin perfusion (CRT >2 s, mottled, cool peripheries, peripheral cyanosis), weak peripheral pulse, age specific tachycardia, tachypnoea, and oliguria or decompensated with hypotension (SBP < 70 + (2× age in years) mm Hg and decreased mental status. The perfusion index is a non-invasive method for assessing peripheral perfusion and may be a useful marker for identifying shock early in pediatric patients.

Objective:

This prospective cohort study (November 2019 to August 2020) evaluated whether the perfusion index, lactate, and/or lactate clearance could predict mortality among pediatric shock patients.

Methods:

Fifty children (68% male) with shock underwent assessments at presentation to the emergency room to evaluate their heart rate, blood pressure, capillary refill time, central venous pressure, perfusion index, cardiac index, systemic vascular resistance, central venous oxygen saturation, and lactate clearance.

Results:

The perfusion index range was 0.03 to 2.2 and ≤0.18 as the cut-off for mortality prediction providing 74% sensitivity and 78% specificity. The serum lactate concentration range was 0 to 16 mmol/L and >5.7 mmol/L as the cut-off for mortality prediction provided 70% sensitivity and 96% specificity at presentation to the emergency room. The lactate clearance range was 3% to 75% and >10% as the cut-off for survival prediction after resuscitation and at 6 h later.

Conclusion:

Perfusion index (PI), lactate, and lactate clearance provided comparable sensitivity and specificity for predicting outcomes among pediatric patients with shock Therefore, we suggest that the PI is an inexpensive, rapid, and non-invasive tool that can be used to predict illness severity and mortality in busy pediatric intensive care units and emergency departments. This tool may guide better patient triage and an earlier diagnosis of shock in this setting.
Pseudomonas campi sp. nov., a nitrate-reducing bacterium isolated from grassland soil
Authors: Timsy  , Spanner Tobias , Ulrich Andreas , Kublik Susanne , Foesel Bärbel U. , Kolb Steffen , Horn Marcus A. , Behrendt Undine
Published: May 2021

A novel strain was isolated from grassland soil that has the potential to assimilate ammonium by the reduction of nitrate in the presence of oxygen. Whole genome sequence analysis revealed the presence of an assimilatory cytoplasmic nitrate reductase gene nasA and the assimilatory nitrite reductase genes nirBD which are involved in the sequential reduction of nitrate to nitrite and further to ammonium, respectively. Phylogenetic analysis based on 16S rRNA gene sequences revealed that the isolate represents a member of the genus

Pseudomonas

. The closest phylogenetic neighbours based on 16S rRNA gene sequence analysis are the type strains of

Pseudomonas peli

(98.17%) and

Pseudomonas guineae

(98.03%). In contrast, phylogenomic analysis revealed a close relationship to

Pseudomonas alcaligenes

. Computation of the average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) with the closest phylogenetic neighbours of S1-A32-2T revealed genetic differences at the species level, which were further substantiated by differences in several physiological characteristics. On the basis of these results, it was concluded that the soil isolate represents a novel species of the genus Pseudomonas, for which the name Pseudomonas campi sp. nov. (type strain S1-A32-2T=LMG 31521T=DSM 110222T) is proposed.
Genomic and temporal analyses of Mycobacterium bovis in southern Brazil
Authors: Rodrigues Rudielle de Arruda , Ribeiro Araújo Flábio , Rivera Dávila Alberto Martín , Etges Rodrigo Nestor , Parkhill Julian , van Tonder Andries J.
Published: May 2021

Mycobacterium bovis

is a causal agent of bovine tuberculosis (bTB), one of the most important diseases currently facing the cattle industry worldwide. Tracing the source of

M. bovis

infections of livestock is an important tool for understanding the epidemiology of bTB and defining control/eradication strategies. In this study, whole genome sequencing (WGS) of 74

M

.

bovis

isolates sourced from naturally infected cattle in the State of Rio Grande do Sul (RS), southern Brazil, was used to evaluate the population structure of

M. bovis

in the region, identify potential transmission events and date the introduction of clonal complex (CC) European 2 (Eu2). In silico spoligotyping identified 11 distinct patterns including four new profiles and two CCs, European 1 (Eu1) and Eu2. The analyses revealed a high level of genetic diversity in the majority of herds and identified putative transmission clusters that suggested that within- and between-herd transmission is occurring in RS. In addition, a comparison with other published

M. bovis

isolates from Argentina, Brazil, Paraguay and Uruguay demonstrated some evidence for a possible cross-border transmission of CC Eu1 into RS from Uruguay or Argentina. An estimated date for the introduction of CC Eu2 into RS in the middle of the 19th century correlated with the historical introduction of cattle into RS to improve existing local breeds. These findings contribute to the understanding of the population structure of

M. bovis

in southern Brazil and highlight the potential of WGS in surveillance and helping to identify bTB transmission.
Spectrum of neurological manifestations and systematic evaluation of cerebrospinal fluid for SARS-CoV2 in patients admitted to hospital during the COVID-19 epidemic in South Africa
Authors: Davis Angharad G , Bremer Marise , Schäfer Georgia , Dixon Luke , Abrahams Fatima , Goliath Rene T , Maxebengula Mpumi , Proust Alize , Chavda Anesh , Black John , Wilkinson Robert J ,   And the HIATUS Study Consortium
Published: May 2021

Neurological manifestations of COVID-19 are increasingly described in the literature. There is uncertainty whether these occur due to direct neuroinvasion of the virus, para-infectious immunopathology, as result of systemic complications of disease such as hypercoagulability or due to a combination of these mechanisms. Here we describe clinical and radiological manifestations in a sequential cohort of patients presenting to a district hospital in South Africa with neurological symptoms with and without confirmed COVID-19 during the first peak of the epidemic. In these patients, where symptoms suggestive of meningitis and encephalitis were most common, thorough assessment of presence in CSF via PCR for SARS-CoV2 did not explain neurological presentations, notwithstanding very high rates of COVID-19 admissions. Although an understanding of potential neurotropic mechanisms remains an important area of research, these results provide rationale for greater focus towards the understanding of para-immune pathogenic processes and the contribution of systemic coagulopathy and their interaction with pre-existing risk factors in order to better manage neurological disease in the context of COVID-19. These results also inform the clinician that consideration of an alternative diagnosis and treatment for neurological presentations in this context is crucial, even in the patient with a confirmed diagnosis COVID-19.
Getting the Nod: Characterizing pediatric head motion in movie- and resting-state fMRI
Authors: Frew Simon , Samara Ahmad , Shearer Hallee , Eilbott Jeffrey , Vanderwal Tamara
Published: May 2021

Head motion continues to be a major problem in fMRI research, particularly in developmental studies where an inverse relationship exists between head motion and age. Despite multifaceted and costly efforts to mitigate motion and motion-related signal artifact, few studies have characterized in-scanner head motion itself.

This study leverages a large public dataset (N=1388, age 5-21y, The Healthy Brain Network Biobank) to characterize pediatric head motion in space, frequency, and time. We focus on practical aspects of head motion that could impact future study design, including comparing motion across groups (low, medium, and high movers), across conditions (movie-watching and rest), and between males and females.

Analyses showed that in all conditions, high movers exhibited a different pattern of motion than low and medium movers that was dominated by x-rotation, and z- and y-translation. High motion spikes (>0.3mm) from all participants also showed this pitch-z-y pattern. Problematic head motion is thus composed of a single type of biomechanical motion, which we infer to be a nodding movement, providing a focused target for motion reduction strategies. A second type of motion was evident via spectral analysis of raw displacement data. This was observed in low and medium movers and was consistent with respiration rates. We consider this to be a baseline of motion best targeted in data preprocessing. Further, we found that males moved more than, but not differently from, females.

Significant cross-condition differences in head motion were found. Movies had lower mean motion, and especially in high movers, movie-watching reduced within-run linear increases in head motion (i.e., temporal drift). Finally, we used intersubject correlations of framewise displacement (FD-ISCs) to assess for stimulus-correlated motion trends. Subject motion was more correlated in movie than rest and stimulus-correlated stillness occurred more often than stimulus-correlated motion. Possible reasons and future implications of these findings are discussed.
Seroconversion following SARS-CoV-2 Infection or Vaccination in Pediatric IBD Patients
Authors: Spencer Elizabeth A. , Klang Eyal , Dolinger Michael , Pittman Nanci , Dubinsky Marla C.
Published: May 2021

Objective

Inflammatory bowel disease (IBD) patients are commonly treated with immunomodulatory medications, and the effect of these medications on seroconversion to SARS-CoV-2 infection and vaccination are scant, particularly in pediatrics. We sought to determine serologic responses to SARS-CoV-2 infection and vaccination in pediatric IBD patients.

Design

We conducted a single-center, retrospective study of all pediatric (≤21 years old) IBD patients in whom a SARS-CoV-2 IgG Antibody Assay was performed between April 2020 and May 2021 at our tertiary care center. This assay measures IgG antibody to the full-length SARS-CoV-2 spike protein and was routinely collected at infusion and outpatient clinic visits. The primary outcome was SARS-CoV-2 seroconversion, and the secondary outcome was titer level, with high titer defined as ≥960 titer or >40 AU/mL. Clinical characteristics, including demographics, IBD location, behavior, activity, and therapy, SARS-CoV-2 exposures, COVID-19 testing and symptoms, SARS-CoV-2 infection status (WHO COVID-19: Case Definitions, 2020) and COVID-19 vaccination status and type, were gathered, and univariate analyses examined associations between clinical characteristics and outcome measures.

Results

There were 340 pediatric patients with SARS-CoV-2 Antibody Testing; 15% for confirmed or probable COVID-19, 2% for suspected COVID-19, 16% for asymptomatic exposure to a close contact with SARS-CoV-2 infection, 61% without any prior symptoms or exposures, and 6% for history of COVID-19 vaccination. Patients with confirmed or probable COVID-19 infection had a 90% rate of seroconversion, with 76% of these patients on biologic therapy. Patients post-infection without seroconversion had a significantly longer interval between infection and antibody assay (P=0.03). Within those with asymptomatic SARS-CoV-2 exposure, 43% had seroconversion, and there were no identified clinical characteristics associated with positive titer.

All pediatric patients who received vaccination seroconverted, and all who received mRNA vaccinations, including one after a single dose, achieved high titer levels; 100% of those who received vaccination were on biologic or small molecule therapy, including one on combination therapy with ustekinumab and tofacitinib.

Conclusion

Pediatric IBD patients have strong serologic antibody responses to SARS-CoV-2 infection and COVID-19 vaccination despite high rates of immunomodulatory therapy.
Telecommuting frequency and preference among Japanese workers according to regional cumulative COVID-19 incidence: a cross-sectional study
Authors: Baba Hiroka , Ikegami Kazunori , Ando Hajime , Eguchi Hisashi , Tsuji Mayumi , Tateishi Seiichiro , Nagata Masako , Matsuda Shinya , Fujino Yoshihisa ,   for the CORoNaWork Project
Published: May 2021

This study aimed to examine the relationship between telecommuting and the regional cumulative COVID-19 incidence. This was a cross-sectional study analyzing 13,468 office workers. The participant groups, according to the level of cumulative COVID-19 incidence by prefecture, were used as the predictor variable, and telecommuting frequency and preference were used as outcomes. We employed an ordinal logistic regression analysis. In regions with a high cumulative COVID-19 incidence, the proportion of participants who telecommuted more than two days per week was 34.7%, which was approximately 20% higher than in other regions. Telecommuting preference was stronger in areas with higher COVID-19 influence. However, in other regions, the proportion of participants who did not want to telecommute was higher than that of those who wanted to telecommute. We found that telecommuting frequency and preference were higher in regions with high cumulative COVID-19 incidence.
Modeling waning and boosting of COVID-19 in Canada with vaccination
Authors: Childs Lauren , Dick David W , Feng Zhilan , Heffernan Jane M , Li Jing , Röst Gergely
Published: May 2021

SARS-CoV-2, the causative agent of COVID-19, has caused devastating health and economic impacts around the globe since its appearance in late 2019. The advent of effective vaccines leads to open questions on how best to vaccinate the population. To address such questions, we developed a model of COVID-19 infection by age that includes the waning and boosting of immunity against SARS-CoV-2 in the context of infection and vaccination. The model also accounts for changes to infectivity of the virus, such as public health mitigation protocols over time, increases in the transmissibility of variants of concern, changes in compliance to mask wearing and social distancing, and changes in testing rates. The model is employed to study public health mitigation and vaccination of the COVID-19 epidemic in Canada, including different vaccination programs (rollout by age), and delays between doses in a two-dose vaccine. We find that the decision to delay the second dose of vaccine is appropriate in the Canadian context. We also find that the benefits of a COVID-19 vaccination program in terms of reductions in infections is increased if vaccination of 15-19 year olds are included in the vaccine rollout.
Peripheral Nerve Magnetoneurography with Optically Pumped Magnetometers
Authors: Bu Yifeng , Prince Jacob , Mojtahed Hamed , Kimball Donald , Shah Vishal , Coleman Todd , Sarkar Mahasweta , Rao Ramesh , Huang Mingxiong , Schwindt Peter , Borna Amir , Lerman Imanuel
Published: May 2021

Electrodiagnosis is routinely integrated into clinical neurophysiology practice for peripheral nerve disease diagnoses such as neuropathy, demyelinating disorders, nerve entrapment/impingement, plexopathy or radiculopathy. Measured with conventional surface electrodes, the propagation of peripheral nerve action potentials along a nerve is the result of ionic current flow which, according to Ampere’s Law, generates a small magnetic field that is also detected as an “action current” by magnetometers such as superconducting quantum interference device (SQUID) Magnetoencephalography (MEG) systems. Optically pumped magnetometers (OPMs) are an emerging class of quantum magnetic sensors with a demonstrated sensitivity at the 1 fT/√Hz level, capable of cortical action current detection. But OPMs were ostensibly constrained to low bandwidth therefore precluding their use in peripheral nerve electrodiagnosis. With careful OPM bandwidth characterization, we hypothesized OPMs may also detect compound action current signatures consistent with both Sensory Nerve Action Potential (SNAP) and the Hoffmann Reflex (H-Reflex). In as much, our work confirms OPMs enabled with expanded bandwidth can detect the magnetic signature of both the SNAP and H-Reflex. Taken together, OPMs now show potential as an emerging electrodiagnostic tool.
Partial loss of succinate dehydrogenase reduces high red cell distribution width and promotes healthy survival in chronically hypoxic mice
Authors: Baysal Bora E. , Tabaczynski Debra , Curtin Leslie , Seshadri Mukund , Sexton Sandra
Published: May 2021

Increased red cell distribution width (RDW), which measures erythrocyte size variability (anisocytosis), has been linked to early mortality in many diseases and normal aged population through unknown mechanisms. Hypoxia has been proposed to increase both RDW and mortality. However, experimental evidence, especially in animal models, is lacking. Here, we show that chronic hypobaric hypoxia (~10% O2) increases erythrocyte numbers, hemoglobin and RDW, while reducing longevity in male mice. Compound heterozygous knockout (chKO) mutations in succinate dehydrogenase (Sdh; mitochondrial complex II) genes Sdhb, Sdhc and Sdhd reduce high RDW and immature reticulocyte fraction, and increase healthy lifespan in chronic hypoxia. Hemoglobin and erythrocyte numbers in hypoxia do not show statistically significant differences between Sdh chKO and WT mice. These results identify a mitochondrial mechanism regulating both RDW and organismal adaptation to chronic hypoxia, and suggest SDH as a potential therapeutic target to reduce high RDW-associated clinical mortality.
Estimating animal density with camera traps: a practitioner’s guide of the REST model
Authors: Nakashima Yoshihiro , Yajima Gota , Hongo Shun
Published: May 2021

Camera traps are increasingly popular in wildlife research and have the potential to be reliable and cost-effective for estimating animal density. Although density estimation using this automatic technique has long been restricted to species with individually recognizable markings, several analytical approaches have been proposed to target animals lacking such markings (i.e., unmarked populations). Among these approaches, the random encounter and staying time (REST) model may be an efficient and cost-effective approach, even though the procedures for the implementations have not yet been shared with researchers. This paper presents a working protocol for implementing the REST model our research group has been developing. We also present the R code to perform parameter estimation with a maximum likelihood and Bayesian approach. We suggest that this model has potential for further development. We strongly hope that this paper will encourage many researchers to use the REST for density estimation in a wide variety of species in various habitats and make a significant contribution to advancing wildlife conservation and management.
Regions of visual cortex responding to tactile stimulation in an individual with longstanding low vision are not causally involved in tactile processing performance
Authors: Silson Edward H. , Gouws Andre D. , Legge Gordon E. , Morland Antony B.
Published: May 2021

Braille reading and other tactile discrimination tasks recruit the visual cortex of both blind and normally sighted individuals undergoing short-term visual deprivation. Prior functional magnetic resonance imaging (fMRI) work in patient ‘S’, a visually impaired adult with the rare ability to read both highly magnified print visually and Braille by touch, found that foveal representations of S’s visual cortex were recruited during tactile perception, whereas peripheral regions were recruited during visual perception. Here, we test the causal nature of tactile responses in the visual cortex of S by combining tactile and visual psychophysics with repetitive transcranial magnetic stimulation (rTMS). First, we replicate this prior fMRI work in S. Second, we demonstrate that transient disruption of S’s foveal visual cortex has no measurable impact on S’s tactile processing performance compared to that of healthy controls – a pattern not predicted by the fMRI results. Third, stimulation of foveal visual cortex maximally disrupted visual processing performance in both S and controls, suggesting the possibility of preserved visual function within S’s foveal cortex. Finally, stimulation of somatosensory cortex induced the expected disruption to tactile processing performance in both S and controls. These data suggest that tactile responses in S’s foveal representation reflect unmasking of latent connections between visual and somatosensory cortices and not behaviourally relevant cross-modal plasticity. Unlike studies in congenitally blind individuals, it is possible that the absence of complete visual loss in S has limited the degree of causally impactful cross-modal reorganisation.

Significance statement

Prior fMRI work in patient ‘S’ identified that foveal portions of S’s visual cortex respond more to tactile processing, whereas peripheral portions respond more to visual processing. Here, we tested whether this foveal processing was causally related to either tactile or visual processing. First, using fMRI we replicate prior work. Second, we demonstrate that TMS of the foveal representation and of somatosensory cortex interfered with visual and tactile discriminations respectively in controls and crucially also in S. The foveal representation in S, which is responsive to tactile stimulation, does not however play a causal role in mediating S’s ability to discriminate Braille characters and likely reflects the unmasking of latent connections between visual and somatosensory cortices.
Silencing long ascending propriospinal neurons after spinal cord injury improves hindlimb stepping in the adult rat
Authors: Shepard Courtney T. , Pocratsky Amanda M. , Brown Brandon L. , Van Rijswijck Morgan A. , Zalla Rachel M. , Burke Darlene A. , Morehouse Johnny M. , Reigler Amberly S. , Whittemore Scott R. , Magnuson David S.K.
Published: May 2021

Long ascending propriospinal neurons (LAPNs) are a subpopulation of spinal cord interneurons that directly connect the lumbar and cervical enlargements. In uninjured animals, conditionally silencing LAPNs resulted in disrupted left-right coordination of the hindlimbs and forelimbs in a context-dependent manner, demonstrating that LAPNs secure alternation of the fore- and hindlimb pairs during overground stepping in the adult rat. Given their ventrolateral location in the spinal cord white matter, many LAPN axons likely remain intact following thoracic spinal cord injury (SCI), suggesting a potential role in the recovery of stepping. Thus, we hypothesized that silencing LAPNs after SCI would result in diminished hindlimb locomotor function. We found instead that silencing of spared LAPNs post-SCI restored the left-right hindlimb coordination associated with alternating gaits that was lost as a result of SCI. Several other fundamental characteristics of hindlimb stepping were also improved and the number of abnormal steps were reduced. However, hindlimb-forelimb coordination was not restored. These data suggest that the temporal information carried between the enlargements by the LAPNs after SCI may be detrimental to hindlimb locomotor function. These observations have implications for our understanding of the relationship between injury severity and functional outcome, for the efforts to develop neuro- and axo-protective therapeutic strategies, and also for the clinical study/implementation of spinal stimulation and neuromodulation.
Cardiovascular Autonomic Neuropathy in Type 1 Diabetes is Associated with Several Metabolic Pathways – New Risk Markers on the Horizon
Authors: Hansen Christian S , Suvitaival Tommi , Theilade Simone , Mattila Ismo , Lajer Maria , Trošt Kajetan , Ahonen Linda , Hansen Tine W , Legido-Quigley Cristina , Rossing Peter , Ahluwalia Tarunveer S
Published: May 2021

Objective

Cardiovascular autonomic neuropathy (CAN) in diabetes is associated with increased mortality and morbidity and is a non-treatable complication. We investigated associations between circulating metabolites and presence of CAN in persons with type 1 diabetes (T1D).

Methods

CAN was assessed by cardiovascular reflex tests (CARTs) in 302 persons with T1D as heart rate response to: deep breathing; lying-to-standing test; and the Valsalva manoeuvre. More than 1 pathological CART defined the CAN diagnosis.

Serum metabolomics and lipidomics profiles were analysed with two complementary non-targeted massspectrometry methods. Cross-sectional associations between single metabolites and CAN were assessed by linear regression. Models were fitted with and without adjustments for relevant confounders and multiple testing.

Results

Participants were mean (IQR) aged 55(49, 63) years, 50% males, with diabetes duration 39(32, 47) years, HbA1c 63(55,69) mmol/mol and 34% had the CAN diagnosis.

A total of 75 metabolites and 106 lipids were examined. In crude models, CAN diagnosis was associated with higher levels of hydroxy fatty acids (2,4- and 3,4-dihydroxybutanoic acids, 4–deoxytetronic acid), creatinine, sugar derivates (ribitol, ribonic acid, myo-inositol), citric acid, glycerol, phenols, phosphatidylcholines and lower levels of free fatty acids and amino acid methionine (p<0.05). Upon adjustment, positive associations with CAN were retained with hydroxy fatty acids, tricarboxylic acid (TCA) cycle-based sugar derivates, and citric acid and phenols (Padjusted<0.05).

Conclusions

Metabolic pathways, including the TCA cycle, hydroxy fatty acids, phosphatidylcholines and sugar derivatives, were associated with CAN in T1D. These novel metabolic pathways associated with CAN could prove to be future modifiable risk factors.
Continuous Seizure Emergency Evoked in Mice with Pharmacological, Electrographic, and Pathological Features Distinct from Status Epilepticus
Authors: Knox Kevin M. , Zierath Dannielle K. , White H. Steve , Barker-Haliski Melissa
Published: May 2021

Objectives

Benzodiazepines are the standard of care for the management of sustained seizure emergencies, including status epilepticus (SE) and seizure clusters. Seizure clusters are a variably defined seizure emergency wherein a patient has multiple seizures above a baseline rate, with intervening periods of recovery, distinguishing clusters from SE. While phenotypically distinct, the precise pathophysiological and mechanistic differences between SE and seizure clusters are under studied. Preclinical interrogation is needed to help uncover the behavioral, physiological, and pathological mechanisms associated with seizure emergencies in order to better manage these events in the susceptible individual.

Methods

Herein, we characterize a novel model of sustained seizure emergency induced in CF-1 mice through the combined administration of high-dose phenytoin (PHT; 50 mg/kg, i.p.) and pentylenetetrazol (PTZ; 100 mg/kg, s.c.).

Results

In the present manuscript we describe a mouse model of sustained seizure emergency that is physiologically, pharmacologically, and histologically distinct from SE. Acute administration of PHT 1 hour prior to s.c.PTZ led to significantly more mice with continuous seizure activity (CSA; 73.4%) versus vehicle-pretreated mice (13.8%; p<0.0001). CSA was sensitive to lorazepam and valproic acid when administered at seizure onset, as well as 30-minutes post-seizure onset. Carbamazepine worsened seizure control and post-CSA survival. Mice in CSA exhibited EEG patterns distinct from kainic acid-induced SE and s.c.PTZ alone, clearly differentiating CSA from SE and s.c.PTZ-induced myoclonic seizures. Neuropathological assessment by FluoroJade-C staining of brains collected 24-hours later revealed no neurodegeneration in any mice with CSA, whereas there was widespread neuronal death in brains from KA-SE mice.

Significance

This study defines a novel mouse model on which to elucidate the mechanistic differences between sustained seizure emergencies (i.e. SE and seizure clusters) to improve discovery of effective clinical interventions and define mechanisms of seizure termination.

Key Points Box

Seizure clusters are a variably defined seizure emergency that is sensitive to benzodiazepines, distinct from status epilepticus.

The mechanistic differences between seizure clusters and status epilepticus are not well defined.

We report a mouse seizure emergency model that is phenotypically, pathologically, and pharmacologically distinct from status epilepticus.

This mouse model provides a novel platform on which to further interrogate the mechanisms underlying seizure emergencies.