bluuebunny/crossref_metadata_2025 huggingface dataset:
Inclusive health and life insurance adoption: An empirical study in Guatemala
Authors: Roa Maria Jose , Di Giannatale Sonia , Barboza Jonathan , Arbelaez Juliana Gamboa
Published: January 2021

In this paper, we analyze the decision to buy inclusive health and life insurance in Guatemala within a theoretical framework driven by new personality and cognition theories combined with traditional insurance theory. We designed and conducted a survey of samples of both non‐insured individuals and clients of Seguros Universales, one of the principal inclusive insurance providers in Guatemala. Our results show that personality traits and time preferences are strongly associated with an individual's decision to hold an insurance contract. We also find evidence that certain combinations related to health habits and personality traits can have an impact on such a decision.
The rise and fall of cave pearl pools: Highly variable growth, recrystallization and demise of a mine pearl site
Authors: Melim Leslie A. , Spilde Michael N.
Published: January 2021

Speleothems form layered archives of the climate and local cave conditions during their formation. The origin of layering in cave pearls, however, is not well‐understood. Cave pearls grown in two adjacent mine sites between 2006 and 2014 elucidate the complexity of speleothem growth and recrystallization. Site A cave pearls grew under an active drip, while Site B cave pearls grew in small rimstone‐dam pools that filled with reverse‐graded fitted pearls between about 2009 and 2014. Despite the variation in pool setting, all samples are layered in grey and/or brown laminations and dendrites. The order and number of these layers varies widely, even between pearls growing millimetres apart in the same pool. However, stable isotope values reflect homogenized local precipitation. The variability between adjacent samples supports control by very local factors within each pool, likely related to CO2degassing at the water–air interface and water flow within the confined space of each pool. Recrystallization of calcite to calcite occurs resulting in triangular microspar patches and much less obvious bladed calcite. Laminations of brown or grey 1 to 5 µm calcite crystals recrystallize to bladed calcite up 100 µm long, all the while retaining a memory of the original layers in the form of ‘ghost’ layers, as revealed by gentle acid etching. Pearls at the top of rimstone‐dam pools grew faster than those just a few millimetres deeper, resulting in reverse grading. This model is applicable to reverse grading in marine and lacustrine pisolites. This study suggests that cave pearls in active flow regimes (drips or currents) are similar and largely abiogenic, in contrast to other locations with less flow, where more biological input is common. Recrystallization of calcite to calcite proceeds not only to equant spar (classic Ostwald ripening), but also to bladed calcite. Thus, bladed calcite in speleothems needs to be carefully evaluated for recrystallization even when aragonite is absent.
Social policy in the face of a global pandemic: Policy responses to the COVID‐19 crisis in Central and Eastern Europe
Authors: Aidukaite Jolanta , Saxonberg Steven , Szelewa Dorota , Szikra Dorottya
Published: January 2021

This article documents and compares the social policies that the governments in Central and Eastern Europe (CEE) implemented to combat the first wave of COVID‐19 pandemic by focusing on Hungary, Lithuania, Poland and Slovakia. Our findings show that governments in all four countries reacted to the COVID‐19 crisis by providing extensive protection for jobs and enterprises. Differences arise when it comes to solidaristic policy responses to care for the most vulnerable population, in which CEE countries show great variation. We find that social policy responses to the first wave of COVID‐19 have largely depended on precious social policy trajectories as well as the political situation of the country during the pandemic.
Soil quality and fertility in sustainable agriculture, with a contribution to the biological classification of agricultural soils
Authors: Sofo Adriano , Zanella Augusto , Ponge Jean‐François
Published: January 2021

Soils and crops are particularly vulnerable to climate change and environmental stresses. In many agrosystems, soil biodiversity and ecosystem services provided by soils are under threat from a range of natural and human drivers. Agricultural soils are often subject to agronomic practices that disrupt soil trophic networks and make soils less productive in the long term. In this scenario, sustainable soil use aimed at improving plant/root status, growth and development plays a crucial role for enhancing the biological capacity of agricultural soils. This commentary paper is divided into the following four main sections: (i) the contentious nature of soil organic matter; (ii) soil biological quality/fertility; (iii) soil classification; and, (iv) which agricultural practices can be defined as sustainable? The published literature was analyzed within a holistic framework, with agrosystems considered as living systems where soil, vegetation, fauna and microorganisms co‐evolve and are reciprocally influenced. Ultimately, this article will suggest a better stewardship of agricultural soils as a natural capital.
Leibniz on Intellectual Pleasure, Perception of Perfection, and Power
Authors: Parvizian Saja
Published: January 2021

Leibniz is unclear about the nature of pleasure. In some texts, he describes pleasure as a perceptionofperfection, while in other texts he describes pleasure as beingcausedby a perception of perfection. In this article, I disambiguate two senses of “perception of perfection”, which clarifies Leibniz's considered position. I argue that pleasure is a perception of anincrease in a substance's powerwhich is caused by a substance'sknowledge of a perfectionof the universe or God. This reading helps clarify the nature of Leibnizian happiness. Happiness is acognitive process(akin to amood), constituted fundamentally out of pleasure, which is grounded in increases in a substance's power. A rational substance will sustain its happiness so long as it is more powerful than it is weak, and it is engaging in activities that increase its power.
Phylogeny of Meloini blister beetles (Coleoptera, Meloidae) and patterns of island colonization in the Western Palaearctic
Authors: Sánchez‐Vialas Alberto , Recuero Ernesto , Jiménez‐Ruiz Yolanda , Ruiz José L. , Marí‐Mena Neus , García‐París Mario
Published: January 2021

Flightless, phoretic insects of the tribe Meloini include several widespread species able to inhabit both mainland and oceanic and continental islands. Relationships between phoretic and non‐phoretic species of Meloini are unclear, precluding broad evolutionary and biogeographic analyses within the group. We provide a robust molecular phylogenetic framework for Meloini, with finer sampling in the Western Palaearctic, by analysing two nuclear (Wg, 18S) and two mtDNA (cox1, 16S) gene fragments of 24 species representing eight subgenera of Meloe and Physomeloe. Our phylogenetic analyses revealed that Meloe, as currently recognized, is paraphyletic. Our phylogenetic hypothesis clarifies several controversial relationships within the group. We provide a new taxonomic framework that better reflects the evolutionary relationships of the group by raising to genus all previously considered subgenera: Afromeloe Schmidt, 1913, Alveomeloe Pripisnova, 1987, Chiromeloe Reitter, 1911, Desertimeloe Kaszab, 1964, Eurymeloe Reitter, 1911, Lampromeloe Reitter, 1911, Lasiomeloe Reitter, 1911, Listromeloe Reitter, 1911, Meloegonius Reitter, 1911, Mesomeloe Reitter, 1911, Meloenellus Reitter, 1911, Micromeloe Reitter, 1911, Taphromeloe Reitter, 1911 and Treiodous Dugès, 1869; while Anchomeloe Iablokoff‐Khnzorian, 1983, is recovered as subgenus of Meloe. In addition, we conducted an extensive intraspecific sampling for four phoretic taxa (Meloe proscarabaeus, Meloe autumnalis, Eurymeloe mediterraneus and Eurymeloe tuccia) and used mtDNA phylogeographic analyses to unveil patterns of overseas dispersal. Our phylogeographic analyses revealed a high level of geographically unstructured haplotype diversity within taxa, suggesting that transmarine dispersal events have occurred multiple times along the evolutionary history of phoretic species of blister beetles. Larval phoresy may explain the existence of idiosyncratic biogeographic and phylogeographic patterns in these flightless organisms.
Afrontamiento de docentes de enfermería ante la muerte del paciente en unidades de cuidado crítico
Authors: Duque Paula Andrea , Betancur Manrique Yanier , Franco Galvis Alejandra , Hoyos Castañeda Manuela , Valencia Hernández Esther Edith
Published: January 2021

Introducción. La muerte es un fenómeno que preocupa a la humanidad, por tanto, es objeto de cuidado por enfermería como parte de las competencias inherentes a la disciplina. Objetivo. Describir el nivel de afrontamiento de las enfermeras frente a la muerte de pacientes en unidades de cuidado crítico. Método. Estudio piloto observacional, de tipo descriptivo transversal, con método de muestreo probabilístico, teniendo en cuenta el número de enfermeras que se desempañaban como docentes de enfermería en el área de cuidado crítico de cuatro universidades de Pereira y Manizales (n = 30). Se aplicó encuesta autoadministrada, elaborada por las investigadoras, con datos sociodemográficos, curriculares y del perfil docente. Para evaluar el nivel de afrontamiento, se utilizó la escala de Bugen de afrontamiento de la muerte, validada al castellano. Resultados. El 100% de docentes de enfermería tuvo una experiencia cercana a la muerte con algún ser querido, y el 73.3% no había tenido ninguna preparación como enfermera acerca de la muerte, lo que se puso de manifiesto según la escala de Bugen, donde el 36.8% (n = 11) de la población puntuó por debajo del percentil 33, el 33.4% (n = 10) de la población por encima del percentil 66, y el 29.9% (n = 9) puntuó en la zona intermedia. Conclusión. Las enfermeras necesitan mejorar su nivel de afrontamiento ante la muerte, mediante una formación sólida en cuidados integrales al final de la vida y el buen morir, para lograr competencias específicas que puedan ser enseñadas en los actos docentes de manera consciente.
Relación entre la capacidad de agencia de autocuidado y la calidad de vida en personas con insuficiencia cardiaca
Authors: Molano Barrera Diana Yiseth , González Consuegra Renata Virginia
Published: January 2021

Introducción. La persona con insuficiencia cardiaca enfrenta cambios biopsicosociales que deterioran su calidad de vida. Es necesario conocer la relación existente entre el autocuidado y la calidad de vida, lo que puede orientar al profesional de enfermería en el diseño de intervenciones efectivas. Objetivo. Determinar la relación existente entre la capacidad de agencia de autocuidado y la calidad de vida relacionada con la salud en las personas con insuficiencia cardiaca, que son atendidas en el programa multidisciplinario de insuficiencia cardiaca en una institución de salud de cuarto nivel en Bogotá, Colombia. Método. Estudio descriptivo correlacional de corte transversal, realizado entre mayo y agosto de 2018; utilizando los instrumentos Appraisal of Self-care Agency Scale y el Cuestionario de Cardiomiopatía de Kansas City; la muestra correspondió a 107 pacientes, mayores de edad, con insuficiencia cardiaca estadio C y D. Resultados. La capacidad de agencia de autocuidado se encontró en categorías alta con 63.55% y muy alta con 34.57%; la calidad de vida relacionada con la salud se encontró preservada, con un puntaje general de 73.33; la relación existente entre las dos variables, según el coeficiente de correlación de Spearman, fue 0.316 con un valor p = 0.002, relación débil pero significativa. Conclusiones. Existe una relación entre las variables de interés, que se reafirma con las correlaciones significativas identificadas entre las dimensiones que las conforman. Estos hallazgos resaltan la pertinencia de abordar, en las intervenciones, temáticas que fortalezcan la capacidad de agencia de autocuidado, contribuyendo a mejorar la calidad de vida de estas personas.
Mobilities of a Spherical Particle Straddling the Interface of a Semi-Infinite Brinkman Flow
Authors: Faltas Mukhtar S. , Sherief Hany H. , Allam Allam A. , Ahmed Baraa A.
Published: January 2021

The motion of a spherical particle straddling the flat interface of a semi-infinite Brinkman flow is considered under the conditions of low Reynolds number and zero capillary number regime. The analysis is applied in the case of 90 deg contact angle and when the viscosity of the constituent fluid in the Brinkman region is much more than that of the adjacent fluid. Analytical expressions for the hydrodynamic scalar resistance coefficients are obtained and represented graphically as a function of the slip parameter at the surface of the particle and the permeability parameter of the porous region. The hydrodynamic mobilities are also obtained and represented in tables. The limiting cases of Stokes clear fluid and Darcy's flow are recovered.
Thermal ranges and figures of merit for gold-containing precursors for atomic layer deposition
Authors: Griffiths Matthew B. E. , Dubrawski Zachary S. , Gordon Peter G. , Junige Marcel , Barry Seán T.
Published: January 2021

This is a survey of known gold-containing chemical vapor deposition (CVD) and atomic layer deposition (ALD) precursors with a focus on collecting their volatilization and decomposition data. These data were applied to a figure of merit (σ) developed to easily assess the thermal characteristics (“volatilization temperature” and the onset of decomposition]) important in the initial assessment of molecules as potential ALD precursors. Of the 46 compounds that were identified, 23 had sufficient thermal data reported in the literature to determine a σ value. The two known gold ALD precursors (15, σ = 104 and 22, σ = 44) were both shown to be in a cluster of excellent precursors. They were each the best in their families of precursors, measured by their σ and their onset of volatility. It was also found that many potentially excellent gold ALD precursors had gold in the +3 oxidation state. Some gold(I) compounds were identified as having good figures of merit (28, σ = 78, 29, σ = 32, 36, σ = 31), but 28 and 29 were found to undergo a reductive elimination reaction at growing gold surfaces, which is a common CVD deposition route for gold(I) compounds. β-diketonates and β-ketoiminates of gold were the most encouraging family of compounds, with σ values of greater than 50. This family contained the precursor with the highest figure of merit (9, σ = 212). These compounds are difficult to make in high yield, but an alternate synthetic route that was identified during this survey might serve to make this class of gold compound competitive as a precursor.
“No Idea is a Bad Idea”: Exploring the Nature of Design Thinking Alignment in an Australian Sport Organization
Authors: Joachim Greg , Schulenkorf Nico , Schlenker Katie , Frawley Stephen , Cohen Adam
Published: January 2021

As research into sport innovation management continues to evolve, the innovation efforts of both for- and non-profit sport organizations are increasingly revealed to be focused on best serving the sport user. Design thinking—a human-centered approach to innovation—may hold promise for sport organizations attempting to identify and deliver on the unmet needs of their users. As such, we undertook a qualitative exploration of the innovation practices of a commercial sport organization, attempting to balance hybrid for- and non-profit service goals. Alignment with design thinking themes was discovered in the organization’s practice, as were performative components of design thinking practice. Our findings suggest that design thinking is suitable—and indeed desirable—for adoption into sport management practice, particularly as a means of enhancing innovation efforts, designing holistic sport experiences, and/or overcoming competing institutional demands.
The Relationship Between Fear Avoidance Beliefs, Muscle Strength, and Short-Term Disability After Surgical Repair of Shoulder Instability
Authors: Gottlieb Uri , Springer Shmuel
Published: January 2021

Context: Arthroscopic surgical repair of the shoulder is recommended when conservative treatment for shoulder instability (SI) fails. However, many patients undergoing this procedure do not return to same level of activity. Psychological factors and muscle strength have been shown to be associated with postoperative outcomes in other musculoskeletal conditions. Objective: To investigate the association between fear avoidance, muscle strength, and short-term function in patients after surgical SI repair. Methods: Twenty-five male patients who underwent shoulder surgery following at least one event of SI were included in this study. Evaluations of fear avoidance related to physical activity and disability were performed at baseline (during the first encounter with the physical therapist) and 7 to 8 weeks postsurgery. Fear avoidance beliefs were assessed using the Fear Avoidance Beliefs Questionnaire. Disability was assessed using the Disabilities of Arm, Shoulder, and Hand questionnaire and the Western Ontario SI index. The follow-up evaluation (weeks 7–8) included measurement of maximal isometric strength of the internal and external rotators. Nonparametric Kendall tau was used to determine the correlations between baseline fear avoidance, muscle strength, and disability at follow-up. Results: Disabilities of Arm, Shoulder, and Hand questionnaire at follow-up was significantly correlated with baseline Disabilities of Arm, Shoulder, and Hand questionnaire (τ = .520, P < .001), baseline fear avoidance (τ = .399, P = .008), and both internal rotator (τ = −.400, P = .005) and external rotator strength (τ = −.353, P = .014). Western Ontario SI index at follow-up was moderately correlated with baseline Western Ontario SI index (τ = .387, P = .007), internal rotator (τ = −.427, P = .003), and external rotator (τ = −.307, P = .032), but not with baseline Fear Avoidance Beliefs Questionnaire (τ = .22, P = .145). Conclusions: The results indicate a possible association between fear avoidance beliefs and short-term disability. Further studies are warranted to better explore and understand these relationships.
Regulation of tumor immune suppression and cancer cell survival by CXCL1/2 elevation in glioblastoma multiforme
Authors: Hu Jiemiao , Zhao Qingnan , Kong Ling-Yuan , Wang Jian , Yan Jun , Xia Xueqing , Jia Zhiliang , Heimberger Amy B. , Li Shulin
Published: January 2021

CXCL1/2, elevated in GBM to promote tumor progression, hold potential as clinical targets in GBM treatment.
Anisotropic electrostatic screening of charged colloids in nematic solvents
Authors: Everts Jeffrey C. , Senyuk Bohdan , Mundoor Haridas , Ravnik Miha , Smalyukh Ivan I.
Published: January 2021

Anisotropic electrostatic screening in charged nematic colloids is demonstrated using a combination of theory and experiments.
Spatially resolved 3D metabolomic profiling in tissues
Authors: Ganesh Shambavi , Hu Thomas , Woods Eric , Allam Mayar , Cai Shuangyi , Henderson Walter , Coskun Ahmet F.
Published: January 2021

Spatially resolved metabolic profiling and isotope-tagged protein analysis revealed unique lipid distributions in tissues.
Women temporarily synchronize their menstrual cycles with the luminance and gravimetric cycles of the Moon
Authors: Helfrich-Förster C. , Monecke S. , Spiousas I. , Hovestadt T. , Mitesser O. , Wehr T. A.
Published: January 2021

Women can synchronize their menstrual cycles with the Moon.
Single-cell molecular profiling of all three components of the HPA axis reveals adrenal ABCB1 as a regulator of stress adaptation
Authors: Lopez Juan Pablo , Brivio Elena , Santambrogio Alice , De Donno Carlo , Kos Aron , Peters Miriam , Rost Nicolas , Czamara Darina , Brückl Tanja M. , Roeh Simone , Pöhlmann Max L. , Engelhardt Clara , Ressle Andrea , Stoffel Rainer , Tontsch Alina , Villamizar Javier M. , Reincke Martin , Riester Anna , Sbiera Silviu , Fassnacht Martin , Mayberg Helen S. , Craighead W. Edward , Dunlop Boadie W. , Nemeroff Charles B. , Schmidt Mathias V. , Binder Elisabeth B. , Theis Fabian J. , Beuschlein Felix , Andoniadou Cynthia L. , Chen Alon
Published: January 2021

Dissection of the HPA axis using single-cell RNA sequencing uncovers adrenal ABCB1 as an important player of stress adaptation.
Complexes of the neurotensin receptor 1 with small-molecule ligands reveal structural determinants of full, partial, and inverse agonism
Authors: Deluigi Mattia , Klipp Alexander , Klenk Christoph , Merklinger Lisa , Eberle Stefanie A. , Morstein Lena , Heine Philipp , Mittl Peer R. E. , Ernst Patrick , Kamenecka Theodore M. , He Yuanjun , Vacca Santiago , Egloff Pascal , Honegger Annemarie , Plückthun Andreas
Published: January 2021

Crystal structures of NTSR1 bound to agonists, inverse agonists, and in the apo state enabled by a novel fusion to DARPin D12.
Experimental taphonomy of organelles and the fossil record of early eukaryote evolution
Authors: Carlisle Emily M. , Jobbins Melina , Pankhania Vanisa , Cunningham John A. , Donoghue Philip C. J.
Published: January 2021

Taphonomy experiments reveal the potential for a fossil record of the origin of complex life.
Visualizing antibody production in a human lymph node in a dish
Authors: Morris Gerald P.
Published: January 2021

Development of a human lymphoid organoid system enables in vitro modeling of immune responses and antibody formation.
In Vivo
Antibacterial Activity of Acetazolamide
Authors: Abutaleb Nader S. , Elkashif Ahmed , Flaherty Daniel P. , Seleem Mohamed N.
Published: January 2021

Vancomycin-resistant enterococci (VRE) represent a major public health threat that requires the development of new therapeutics. In the present study, acetazolamide (AZM) was evaluated against enterococci.
Diazadispiroalkane Derivatives Are New Viral Entry Inhibitors
Authors: Adfeldt Rebekka , Schmitz Janna , Kropff Barbara , Thomas Marco , Monakhova Natalia , Hölper Julia E. , Klupp Barbara G. , Mettenleiter Thomas C. , Makarov Vadim , Bogner Elke
Published: January 2021

Herpesviruses are widespread and can cause serious illness. Many currently available antiviral drugs have limited effects, result in rapid development of resistance, and often exhibit dose-dependent toxicity.
Arid Ecosystem Vegetation Canopy-Gap Dichotomy: Influence on Soil Microbial Composition and Nutrient Cycling Functional Potential
Authors: Kushwaha Priyanka , Neilson Julia W. , Barberán Albert , Chen Yongjian , Fontana Catherine G. , Butterfield Bradley J. , Maier Raina M.
Published: January 2021

Increasing aridity will drive a shift in desert vegetation and interspace gap (microsite) structure toward gap expansion. To evaluate the impact of gap expansion, we assess microsite effects on soil nutrients, microbiome community composition and functional capacity, and the potential of gap soils to serve as microbial reservoirs for plant root-associated microbiomes in an arid ecosystem.
Loss of the Vaccinia Virus 35-Amino-Acid Hydrophobic O3 Protein Is Partially Compensated by Mutations in the Transmembrane Domains of Other Entry Proteins
Authors: Tak Andrew I. , Americo Jeffrey L. , Diesterbeck Ulrike S. , Moss Bernard
Published: January 2021

Entry into cells is an essential first step in virus replication and an important target of vaccine-elicited immunity. For enveloped viruses, this step involves the fusion of viral and host membranes to form a pore allowing entry of the genome and associated proteins.
More than a Pore: Nonlytic Antimicrobial Functions of Complement and Bacterial Strategies for Evasion
Authors: Bjanes Elisabet , Nizet Victor
Published: January 2021

The complement system is an evolutionarily ancient defense mechanism against foreign substances. Consisting of three proteolytic activation pathways, complement converges on a common effector cascade terminating in the formation of a lytic pore on the target surface.
Absence of KpsM (Slr0977) Impairs the Secretion of Extracellular Polymeric Substances (EPS) and Impacts Carbon Fluxes in
Synechocystis
sp. PCC 6803
Authors: Santos Marina , Pereira Sara B. , Flores Carlos , Príncipe Catarina , Couto Narciso , Karunakaran Esther , Cravo Sara M. , Oliveira Paulo , Tamagnini Paula
Published: January 2021

Most cyanobacteria produce extracellular polymeric substances (EPS) that fulfill different biological roles depending on the strain/environmental conditions. The interest in the cyanobacterial EPS synthesis/export pathways has been increasing, not only to optimize EPS production but also to efficiently redirect carbon flux toward the production of other compounds, allowing the implementation of industrial systems based on cyanobacterial cell factories.
Ceftolozane/Tazobactam Resistance and Mechanisms in Carbapenem-Nonsusceptible Pseudomonas aeruginosa
Authors: Teo Jocelyn Qi-Min , Lim Jie Chong , Tang Cheng Yee , Lee Shannon Jing-Yi , Tan Si Hui , Sim James Heng-Chiak , Ong Rick Twee-Hee , Kwa Andrea Lay-Hoon
Published: January 2021

Pseudomonas aeruginosa
infection is one of the most difficult health care-associated infections to treat due to the ability of the organism to acquire a multitude of resistance mechanisms and express the multidrug resistance phenotype. Ceftolozane/tazobactam (C/T), a novel
β
-lactam/
β
-lactamase inhibitor combination, addresses an unmet medical need in patients with these multidrug-resistant
P. aeruginosa
infections.
Complete Genome Sequencing of Acinetobacter baumannii AC1633 and Acinetobacter nosocomialis AC1530 Unveils a Large Multidrug-Resistant Plasmid Encoding the NDM-1 and OXA-58 Carbapenemases
Authors: Alattraqchi Ahmed Ghazi , Mohd Rani Farahiyah , A. Rahman Nor Iza , Ismail Salwani , Cleary David W. , Clarke Stuart C. , Yeo Chew Chieng
Published: January 2021

Bacteria of the genus
Acinetobacter
are important hospital-acquired pathogens, with carbapenem-resistant
A. baumannii
listed by the World Health Organization as the one of the top priority pathogens. Whole-genome sequencing of carbapenem-resistant
A. baumannii
AC1633 and
A. nosocomialis
AC1530, which were isolated from the main tertiary hospital in Terengganu, Malaysia, led to the discovery of a large, ca. 170-kb plasmid that harbored genes encoding the New Delhi metallo-β-lactamase-1 (NDM-1) and OXA-58 carbapenemases alongside genes that conferred resistance to aminoglycosides, macrolides, and sulfonamides.
New Insights and Enhanced Human Norovirus Cultivation in Human Intestinal Enteroids
Authors: Ettayebi Khalil , Tenge Victoria R. , Cortes-Penfield Nicolas W. , Crawford Sue E. , Neill Frederick H. , Zeng Xi-Lei , Yu Xiaomin , Ayyar B. Vijayalakshmi , Burrin Douglas , Ramani Sasirekha , Atmar Robert L. , Estes Mary K.
Published: January 2021

Human noroviruses (HuNoVs) are highly contagious and cause acute and sporadic diarrheal illness in all age groups. In addition, chronic infections occur in immunocompromised cancer and transplant patients.
Supplemental Material: Imaging the Late Triassic lithospheric architecture of the Yidun Terrane, eastern Tibetan Plateau: Observations and interpretations
Authors: Zhan Qiong-Yao , Zhu Di-Cheng , al. et
Published: January 2021

Detailed descriptions of analytical methods, additional supporting figures and tables.
Delayed presentation of postcaesarean section vesicouterine fistula repaired robotically
Authors: Latif Edward Ramez , Quaraishi Mohammed Kamil , Mitchell Davon , Streeter Edward
Published: January 2021

A premenopausal patient in her late forties presented with a 15-year history of urinary incontinence starting shortly after a caesarean section performed for her fourth delivery and more recently associated episodic light haematuria and passage of clots per vagina. The haematuria was intermittent over several months and associated with per-vaginal bleeding. She had symptomatic anaemia. Flexible cystoscopy and MRI showed a vesicouterine fistula. She underwent a robotic-assisted hysterectomy and multi-layered repair of the bladder with omental interposition. She remained in the hospital for 4 days, though recovered well and underwent catheter removal at 14 days following a normal cystogram. At 3 months, she was well with no incontinence or urinary symptoms. This case demonstrates the need for vigilance in assessing patients with persistent incontinence, particularly in the context of prior caesarean section. It highlights the feasibility of robotic surgery for correcting these defects in a society where minimally invasive surgery is becoming the norm, and cosmesis is a priority for patients.
Anaphylaxis to simultaneous administration of inactivated tissue culture hepatitis A vaccine and purified chick embryo cell rabies vaccine after multiple doses
Authors: Hasegawa Kohei , Ohji Goh , Iwata Kentaro
Published: January 2021

Both the inactivated hepatitis A vaccine (Aimmugen) and purified chick embryo cell rabies vaccine (PCECV, Rabipur) are well tolerated. Anaphylaxis has rarely been reported as an adverse reaction of these vaccines. There have been no reports or published case reports of anaphylaxis due to Aimmugen. According to the Japanese Ministry of Health, Labour and Welfare Aimmugen adverse reaction report, no cases of anaphylaxis have been reported from April 2013 to August 2016. Twenty cases of anaphylaxis due to PCECV (RabAvert) have been reported from 1997 to 2005 in USA, whereas 2 cases have been reported from 2006 to 2016. We report a case of anaphylaxis after multiple vaccinations in a 24-year-old man with ulcerative colitis, previous medical history of tonsillectomy for IgA nephropathy and no history of allergies.
The retrieval of a surgical blade broken within the alveolar bone during minimally traumatic tooth extraction
Authors: Koshy Eldo , Annamma Lovely M , George Biji Thomas , Menezes Godfred Antony
Published: January 2021

Minimally traumatic tooth removal is the norm for removing teeth when a dental implant is planned at that site. The quantity of available bone is the primary requisite to place an implant. The initial use of a scalpel blade to widen the periodontal space followed by the use of luxators is one of the techniques that is being followed for atraumatic extraction. A case of accidental breakage of a number 11 scalpel blade while attempting tooth removal and the method adopted in removing this portion of the blade without further bone destruction is reported here. The authors have not found any previously published cases, reporting the breakage of a scalpel blade during the bone expansion procedure and its management.
Bilateral vocal cord paralysis in Miller Fisher syndrome/Guillain-Barre overlap syndrome and a review of previous case series
Authors: Bahk Jeeyune , Yang Wanding , Fishman Jonathan
Published: January 2021

Miller Fisher syndrome (MFS), an acute demyelinating neuropathy, is characterised by a triad of areflexia, ataxia and ophthalmoplegia. It is the most common variant of Guillain-Barre Syndrome (GBS). In about 5.6%–7.1% of MFS cases, patients also suffer from progressive motor weakness of the limbs. This condition is termed MFS/GBS overlap syndrome. Whether it is in MFS or GBS, bilateral vocal cord paralysis (BVCP) is a rare manifestation with limited cases reported in the literature. We report an extremely rare case where a 65-year-old man developed BVCP in an MFS/GBS overlap syndrome. We have also reviewed previous case reports in the literature for comparison.
Assessment of automated clinical trial recruitment and enrolment using patient-facing technology
Authors: Bardach Naomi S , Lam Regina , Jasik Carolyn B
Published: January 2021

Objective

Interactive patient care systems (IPCS) at the bedside are becoming increasingly common, but evidence is limited as to their potential for innovative clinical trial implementation. The objective of this study was to test the hypothesis that the IPCS could feasibly be used to automate recruitment and enrolment for a clinical trial.

Methods

In medical-surgical units, we used the IPCS to randomise, recruit and consent eligible subjects. For participants not interacting with IPCS study materials within 48 hours, study staff-initiated recruitment in-person. Eligible study population included all caregivers and any patients >6 years old admitted to medical-surgical units and oncology units September 2015 to January 2016. Outcomes: randomisation assessed using between-group comparisons of patient characteristics; recruitment success assessed by rates of consent; paperless implementation using successful acquisition of electronic signature and email address. We used χ2analysis to assess success of randomisation and recruitment.

Results

Randomisation was successful (n=1012 randomised, p>0.05 for all between-group comparisons). For the subset of eligible, randomised patients who were recruited, IPCS-only recruitment (consented: 2.4% of n=213) was less successful than in-person recruitment (61.4% of n=87 eligible recruited, p<0.001). For those consenting (n=61), 96.7% provided an electronic signature and 68.9% provided email addresses.

Conclusions

Our results suggest that as a tool at the bedside, the IPCS offers key efficiencies for study implementation, including randomisation and collecting e-consent and contact information, but does not offer recruitment efficiencies. Further research could assess the value that interactive technologies bring to recruitment when paired with in-person efforts, potentially focusing on more intensive user-interface testing for recruitment materials.

Trial registration number

NCT02491190.
Does vitamin D supplementation prevent SARS-CoV-2 infection in military personnel? Review of the evidence
Authors: Parsons Iain T , Gifford R M , Stacey M J , Lamb L E , O'Shea M K , Woods D R
Published: January 2021

For most individuals residing in Northwestern Europe, maintaining replete vitamin D status throughout the year is unlikely without vitamin D supplementation and deficiency remains common. Military studies have investigated the association with vitamin D status, and subsequent supplementation, with the risk of stress fractures particularly during recruit training. The expression of nuclear vitamin D receptors and vitamin D metabolic enzymes in immune cells additionally provides a rationale for the potential role of vitamin D in maintaining immune homeostasis. One particular area of interest has been in the prevention of acute respiratory tract infections (ARTIs). The aims of this review were to consider the evidence of vitamin D supplementation in military populations in the prevention of ARTIs, including SARS-CoV-2 infection and consequent COVID-19 illness. The occupational/organisational importance of reducing transmission of SARS-CoV-2, especially where infected young adults may be asymptomatic, presymptomatic or paucisymptomatic, is also discussed.
Sexual and reproductive health and attitudes towards sex of young adults in China
Authors: Zou Siyu , Cao Wenzhen , Jia Yawen , Wang Zhicheng , Qi Xinran , Shen Jiashu , Tang Kun
Published: January 2021

Background

The study aimed to discuss the importance of socioeconomic status (SES) and family sexual attitudes and investigate their association with sexual and reproductive health in a large sample of Chinese young adults.

Methods

We analysed a large sample of 53 508 youth aged 15–24 years from an internet-based survey from November 2019 to February 2020. Multivariable logistic regression analyses were employed to examine the association between SES, family sexual attitudes, and sexual and reproductive health (SRH), stratified by sex and adjusting for potential confounders.

Results

Individuals with the highest expenditure were more likely to engage in early sexual intercourse (female: OR 4.19, 95% CI 3.00 to 5.87; male: OR 3.82, 95% CI 2.84 to 5.12). For both sexes, the likelihood of young adult sexual risk-taking such as first intercourse without using a condom, acquiring sexually transmitted infections, and pregnancy was lower in those with higher maternal educational attainment, whereas it was higher in those with open family sexual attitudes.

Conclusions

Lower SES and open family attitudes toward sex had a significant association with a range of adverse young adulthood SRH outcomes. Public health policies should focus on more deprived populations and advocate suitable parental participation to reduce risky sexual behaviours in youth.
Brick in the wall? Linking quality of debriefing to participant learning in team training of interprofessional students
Authors: Paige John T , Garbee Deborah D , Yu Qingzhao , Zahmjahn John , Baroni de Carvalho Raquel , Zhu Lin , Rusnak Vadym , Kiselov Vladimir J
Published: January 2021

Background

The evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants.

Methods

Forty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores.

Results

Statistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis.

Conclusions

Quality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.
Disrupted spermatogenesis in a metabolic syndrome model: the role of vitamin A metabolism in the gut–testis axis
Authors: Zhang Teng , Sun Peng , Geng Qi , Fan Haitao , Gong Yutian , Hu Yanting , Shan Liying , Sun Yuanchao , Shen Wei , Zhou Yang
Published: January 2021

Objective

Effects of the diet-induced gut microbiota dysbiosis reach far beyond the gut. We aim to uncover the direct evidence involving the gut–testis axis in the aetiology of impaired spermatogenesis.

Design

An excessive-energy diet-induced metabolic syndrome (MetS) sheep model was established. The testicular samples, host metabolomes and gut microbiome were analysed. Faecal microbiota transplantation (FMT) confirmed the linkage between gut microbiota and spermatogenesis.

Results

We demonstrated that the number of arrested spermatogonia was markedly elevated by using 10× single-cell RNA-seq in the MetS model. Furthermore, through using metabolomics profiling and 16S rDNA-seq, we discovered that the absorption of vitamin A in the gut was abolished due to a notable reduction of bile acid levels, which was significantly associated with reduced abundance of Ruminococcaceae_NK4A214_group. Notably, the abnormal metabolic effects of vitamin A were transferable to the testicular cells through the circulating blood, which contributed to abnormal spermatogenesis, as confirmed by FMT.

Conclusion

These findings define a starting point for linking the testicular function and regulation of gut microbiota via host metabolomes and will be of potential value for the treatment of male infertility in MetS.
Tumor-associated macrophages: potential therapeutic strategies and future prospects in cancer
Authors: Li Chunxiao , Xu Xiaofei , Wei Shuhua , Jiang Ping , Xue Lixiang , Wang Junjie
Published: January 2021

Macrophages are the most important phagocytes in vivo. However, the tumor microenvironment can affect the function and polarization of macrophages and form tumor-associated macrophages (TAMs). Usually, the abundance of TAMs in tumors is closely associated with poor prognosis. Preclinical studies have identified important pathways regulating the infiltration and polarization of TAMs during tumor progression. Furthermore, potential therapeutic strategies targeting TAMs in tumors have been studied, including inhibition of macrophage recruitment to tumors, functional repolarization of TAMs toward an antitumor phenotype, and other therapeutic strategies that elicit macrophage-mediated extracellular phagocytosis and intracellular destruction of cancer cells. Therefore, with the increasing impact of tumor immunotherapy, new antitumor strategies to target TAMs are now being discussed.
A review of the diagnosis and management of sudden hearing loss in the military population
Authors: Henderson A , Waddell A , Pearson C
Published: January 2021

Sudden hearing loss can be both an immediately debilitating and long-term career-threatening condition within the military population. Careful assessment is key, particularly in an environment where heightened occupational risk factors may contribute to or confound diagnoses, and where access to basic investigation may be limited.

This article looks at the patient with a new presentation of sudden hearing loss in a military setting and, by providing key features and a structured approach to examination and basic investigation, how to consider key diagnoses through clinical assessment alone.

The acute management of sudden sensorineural hearing loss (SNHL) remains a difficult issue, particularly regarding the efficacy of treatment regimes to restore hearing. We have reviewed the evidence to help military medical personnel make well-informed decisions when treating and making occupational assessment of those they have diagnosed with sudden hearing loss.
Acute shoulder injuries: A clinical review of diagnosis and management in the deployed Naval environment
Authors: Thomas RL , Penn-Barwell JG , Hand CJ
Published: January 2021

Musculoskeletal injuries of the shoulder are a common presentation in primary care. Injuries to this highly mobile region can have a profound impact on the range of movement, resulting in severe functional limitation. The shoulder can also be one of the more complicated regions to examine due to its high mobility, poor localisation of pain and numerous supporting structures. This article aims to review the anatomy of the shoulder, examination technique and the pathology underlying common acute injuries in order to provide guidance to medical personnel deployed with the Royal Navy and Royal Marines.
Popliteal artery entrapment syndrome: an important differential diagnosis to consider in young military personnel presenting with calf claudication
Authors: Reid J , Ablett D J
Published: January 2021

Popliteal artery entrapment syndrome is a rare but important condition, which all military health practitioners should be aware of. It should be considered in all young military personnel presenting with symptoms of calf claudication.

This article explains the condition, its classification and the key examination findings, allowing differentiation from other diagnoses, as well as advice on management, definitive treatment and prognosis.
Persuasion, not coercion or incentivisation, is the best means of promoting COVID-19 vaccination
Authors: Pennings Susan , Symons Xavier
Published: January 2021

Savulescu (forthcoming) argues that it may be ethically acceptable for governments to require citizens be vaccinated against COVID-19. He also recommends that governments consider providing monetary or in-kind incentives to citizens to increase vaccination rates. In this response, we argue against mandatory vaccination and vaccine incentivisation, and instead suggest that targeted public health messaging and a greater responsiveness to the concerns of vaccine-hesitant individuals would be the best strategy to address low vaccination rates.
Prospective multicentre cohort study of transthoracic echocardiography provision in the South West of the UK during the first wave of SARS-CoV-2 pandemic
Authors: Crook Rebecca Lucy , Williams Howell , Green Mary , Brown Stewart , Morris Richard , Fletcher Hannah , Walters Sarah , Walsh Catherine , Price Anna , King Samantha , McAloon Christopher James
Published: January 2021

Aims

It was predicted internationally that transthoracic echocardiography (TTE) would be vital during the SARS-CoV-2 outbreak. We therefore, designed a study to report the demand for TTE in two large District General Hospitals during the rise in the first wave of the SARS-CoV-2 pandemic in the UK. A primary clinical outcome of 30-day mortality was also assessed.

Methods

The TTE service across two hospitals was reconfigured to maximise access to inpatient scanning. All TTEs of suspected or confirmed SARS-CoV-2 patients over a 3-week period were included in the study. All patients were followed up until at least day 30 after their scan at which point the primary clinical outcome of mortality was recorded. Comparative analysis based on mortality was conducted for all TTE results, biochemical markers and demographics.

Results

27 patients with confirmed SARS-CoV-2 had a TTE within the inclusion window. Mortality comparative analysis showed the deceased group were significantly older (mean 68.4, SD 11.9 vs 60.5, SD 13.0, p=0.03) and more commonly reported fatigue in their presenting symptoms (29.6% vs 71.4%, p=0.01). No other differences were identified in the demographic or biochemical data. Left ventricular systolic dysfunction was noted in 7.4% of patients and right ventricular impairment or dilation was seen in 18.5% patients. TTE results were not significantly different in mortality comparative analysis.

Conclusion

This study demonstrates an achievable approach to TTE services when under increased pressure. Data analysis supports the limited available data suggesting right ventricular abnormalities are the most commonly identified echocardiographic change in SARS-CoV-2 patients. No association can be demonstrated between mortality and TTE results.