bluuebunny/crossref_metadata_2025 huggingface dataset:
Structure of the ciliogenesis-associated CPLANE complex
Authors: Langousis Gerasimos , Cavadini Simone , Boegholm Niels , Lorentzen Esben , Kempf Georg , Matthias Patrick
Published: April 2022

Dysfunctional cilia cause pleiotropic human diseases termed ciliopathies. These hereditary maladies are often caused by defects in cilia assembly, a complex event that is regulated by the ciliogenesis and planar polarity effector (CPLANE) proteins Wdpcp, Inturned, and Fuzzy. CPLANE proteins are essential for building the cilium and are mutated in multiple ciliopathies, yet their structure and molecular functions remain elusive. Here, we show that mammalian CPLANE proteins comprise a bona fide complex and report the near-atomic resolution structures of the human Wdpcp-Inturned-Fuzzy complex and of the mouse Wdpcp-Inturned-Fuzzy complex bound to the small guanosine triphosphatase Rsg1. Notably, the crescent-shaped CPLANE complex binds phospholipids such as phosphatidylinositol 3-phosphate via multiple modules and a CPLANE ciliopathy mutant exhibits aberrant lipid binding. Our study provides critical structural and functional insights into an enigmatic ciliogenesis-associated complex as well as unexpected molecular rationales for ciliopathies.
Response to Comment on “Impact of neurodegenerative diseases on human adult hippocampal neurogenesis”
Authors: Terreros-Roncal J. , Moreno-Jiménez E. P. , Flor-García M. , Rodríguez-Moreno C. B. , Trinchero M. F. , Márquez-Valadez B. , Cafini F. , Rábano A. , Llorens-Martín M.
Published: April 2022

Rakic and colleagues challenge the use of extensively validated adult hippocampal neurogenesis (AHN) markers and postulate an alternative interpretation of some of the data included in our study. In Terreros-Roncal
et al
., reconstruction of the main stages encompassed by human AHN revealed enhanced vulnerability of this phenomenon to neurodegenerative diseases. Here, we clarify points and ambiguities raised by these authors.
Fullerenes make copper catalysis better
Authors: Gravel Edmond , Doris Eric
Published: April 2022

Ethylene glycol can be reliably produced by mild hydrogenation of dimethyl oxalate
Looking for trouble
Authors: Cohen Jon
Published: April 2022

Trapping bats with Supaporn Wacharapluesadee, who hunts for viruses to understand and prevent pandemic threats
CD45RA
+
CD62L
−
ILCs in human tissues represent a quiescent local reservoir for the generation of differentiated ILCs
Authors: Kokkinou Efthymia , Pandey Ram Vinay , Mazzurana Luca , Gutierrez-Perez Irene , Tibbitt Christopher Andrew , Weigel Whitney , Soini Tea , Carrasco Anna , Rao Anna , Nagasawa Maho , Bal Suzanne M. , Jangard Mattias , Friberg Danielle , Lindforss Ulrik , Nordenvall Caroline , Ljunggren Malin , Haapaniemi Staffan , Keita Åsa V. , Söderholm Johan , Hedin Charlotte , Spits Hergen , Bryceson Yenan T. , Mjösberg Jenny
Published: April 2022

Innate lymphoid cells (ILCs) are highly plastic and predominantly mucosal tissue-resident cells that contribute to both homeostasis and inflammation depending on the microenvironment. The discovery of naïve-like ILCs suggests an ILC differentiation process that is akin to naïve T cell differentiation. Delineating the mechanisms that underlie ILC differentiation in tissues is crucial for understanding ILC biology in health and disease. Here, we showed that tonsillar ILCs expressing CD45RA lacked proliferative activity, indicative of cellular quiescence. CD62L distinguished two subsets of CD45RA
+
ILCs. CD45RA
+
CD62L
+
ILCs (CD62L
+
ILCs) resembled circulating naïve ILCs because they lacked the transcriptional, metabolic, epigenetic, and cytokine production signatures of differentiated ILCs. CD45RA
+
CD62L
−
ILCs (CD62L
−
ILCs) were epigenetically similar to CD62L
+
ILCs but showed a transcriptional, metabolic, and cytokine production signature that was more akin to differentiated ILCs. CD62L
+
and CD62L
−
ILCs contained uni- and multipotent precursors of ILC1s/NK cells and ILC3s. Differentiation of CD62L
+
and CD62L
−
ILCs led to metabolic reprogramming including up-regulation of genes associated with glycolysis, which was needed for their effector functions after differentiation. CD62L
−
ILCs with preferential differentiation capacity toward IL-22–producing ILC3s accumulated in the inflamed mucosa of patients with inflammatory bowel disease. These data suggested distinct differentiation potential of CD62L
+
and CD62L
−
ILCs between tissue microenvironments and identified that manipulation of these cells is a possible approach to restore tissue-immune homeostasis.
A common framework of monocyte-derived macrophage activation
Authors: Sanin David E. , Ge Yan , Marinkovic Emilija , Kabat Agnieszka M. , Castoldi Angela , Caputa George , Grzes Katarzyna M. , Curtis Jonathan D. , Thompson Elizabeth A. , Willenborg Sebastian , Dichtl Stefanie , Reinhardt Susanne , Dahl Andreas , Pearce Erika L. , Eming Sabine A. , Gerbaulet Alexander , Roers Axel , Murray Peter J. , Pearce Edward J.
Published: April 2022

Macrophages populate every organ during homeostasis and disease, displaying features of tissue imprinting and heterogeneous activation. The disconnected picture of macrophage biology that has emerged from these observations is a barrier for integration across models or with in vitro macrophage activation paradigms. We set out to contextualize macrophage heterogeneity across mouse tissues and inflammatory conditions, specifically aiming to define a common framework of macrophage activation. We built a predictive model with which we mapped the activation of macrophages across 12 tissues and 25 biological conditions, finding a notable commonality and finite number of transcriptional profiles, in particular among infiltrating macrophages, which we modeled as defined stages along four conserved activation paths. These activation paths include a “phagocytic” regulatory path, an “inflammatory” cytokine-producing path, an “oxidative stress” antimicrobial path, or a “remodeling” extracellular matrix deposition path. We verified this model with adoptive cell transfer experiments and identified transient RELMɑ expression as a feature of monocyte-derived macrophage tissue engraftment. We propose that this integrative approach of macrophage classification allows the establishment of a common predictive framework of monocyte-derived macrophage activation in inflammation and homeostasis.
Single-Cell Landscape of Lungs Reveals Key Role of Neutrophil-Mediated Immunopathology during Lethal SARS-CoV-2 Infection
Authors: Zheng Xiao-Shuang , Wang Qi , Min Juan , Shen Xu-Rui , Li Qian , Zhao Qiu-Chen , Wang Xi , Jiang Ren-Di , Geng Rong , Chen Ying , Zhu Yan , Li Bei , Zhang Wei , Li Ang , Xie Ting-Ting , Liu Mei-Qin , Cheng Liang , Shi Zheng-Li , Zhou Peng
Published: April 2022

We demonstrated the single-cell landscape in lung and spleen upon SARS-CoV-2 infection in an acute severe disease mouse model that replicated human symptoms, including severe lung pathology and lymphopenia. Our comprehensive study revealed the key role of neutrophil-mediated lung immunopathology in SARS-CoV-2-induced severe pneumonia, which not only helped our understanding of COVID-19 but also warranted the concept of neutrophil targeting therapeutics in COVID-19 treatment.
IFI16 Impacts Metabolic Reprogramming during Human Cytomegalovirus Infection
Authors: Griffante Gloria , Hewelt-Belka Weronika , Albano Camilla , Gugliesi Francesca , Pasquero Selina , Castillo Pacheco Sergio Fernando , Bajetto Greta , Porporato Paolo Ettore , Mina Erica , Vallino Marta , Krapp Christian , Jakobsen Martin Roelsgaard , Purdy John , von Einem Jens , Landolfo Santo , Dell’Oste Valentina , Biolatti Matteo
Published: April 2022

Human cytomegalovirus (HCMV) gathers all the substrates and enzymes necessary for the assembly of new virions from its host cell. For instance, HCMV is known to induce cellular metabolism of infected cells to favor virion assembly.
Supplemental Material: Kinematic evolution of the central Andean retroarc thrust belt in northwestern Argentina and implications for coupling between shortening and crustal thickening
Authors: Henriquez Susana , al. et
Published: April 2022

Figure S1: Radial plots for AFT samples in the Sierra Alta (Coraya and Yacoraite Valleys). Figure S2: Radial plots for AFT samples from the Tilcara Range, Cianzo area and east side of the Eastern Cordillera.
Availability of active therapeutic hypothermia at birth for neonatal hypoxic ischaemic encephalopathy: a UK population study from 2011 to 2018
Authors: Mistry Aarti , Shipley Lara , Ojha Shalini , Sharkey Don
Published: April 2022

Objective

Therapeutic hypothermia (TH) commenced soon after birth for neonatal hypoxic ischaemic encephalopathy (HIE) improves survival and reduces neurodisability. Availability of active TH at the place of birth (Immediate-TH) in the UK is unknown.

Design

Population-based observational study.

Setting

UK maternity centres.

Patients

5 975 056 births from 2011 to 2018.

Intervention methods

For each maternity centre, the year active Immediate-TH was available and the annual birth rates were established. Admission temperatures of infants with HIE transferred from non-tertiary centres with and without Immediate-TH were compared.

Main outcome measures

Quantify the annual number of births with access to Immediate-TH. Secondary outcomes included temporal changes in Immediate-TH and admission temperatures for infants requiring transfer to tertiary centres.

Results

In UK maternity centres, 75 of 194 (38.7%) provided Immediate-TH in 2011 rising to 95 of 192 (49.5%, p=0.003) in 2018 with marked regional variations. In 2011, 394 842 (51.2%) of 771 176 births had no access to Immediate-TH compared with 276 258 (39.3%) of 702 794 births in 2018 (p<0.001). More infants with HIE arrived in the therapeutic temperature range (76.5% vs 67.3%; OR 1.58, 95% CI 1.25 to 2.0, p<0.001) with less overcooling (10.6% vs 14.3%; OR 0.71, 95% CI 0.51 to 0.98, p=0.036) from centres with Immediate-TH compared with those without.

Conclusions

Availability of active Immediate-TH has slowly increased although many newborns still have no access and rely on transport team arrival to commence active TH. This is associated with delayed optimal hypothermic management. Provision of Immediate-TH across all units, with appropriate training and support, could improve care of infants with HIE.
Cardiac arrest resulting from an unidentified foreign object, later identified as a balloon cover, within the left anterior descending coronary artery
Authors: Visser Pascal Christiaan Jan , Vink Maarten A , Patterson Mark S , Yazdanbakhsh Aria , Arlan Fatih , Kuipers Remko S
Published: April 2022

A 31-year-old man with a history of hypertrophic cardiomyopathy and alcohol septal ablation one week before was presented after an out of hospital cardiac arrest in the setting of an anterior wall ST-elevation myocardial infarction. Immediate coronary angiography showed an unidentified foreign object within the left anterior descending coronary artery (LAD), later identified as the cover of a balloon that had been unintentionally inserted and abandoned within the LAD during the alcohol septum ablation one week earlier. Intracoronary imaging confirmed the presence of endothelial damage and thrombus formation within the LAD explaining acute myocardial infarction. The patient was treated by surgical retrieval of the balloon cover, extended septal myectomy and coronary artery bypass grafting (CABG) of the LAD. This case is both an example of unintentional neglect of unexpected objects, and the importance of multimodality imaging and multidisciplinary teamwork to get to a correct diagnosis and treatment.
The effects of text reminders on the use of family planning services: evidence from a randomised controlled trial in urban Mozambique
Authors: Leight Jessica , Hensly Catherine , Chissano Marcos , Safran Elana , Ali Liza , Dustan Domingos , Jamison Julian
Published: April 2022

Introduction

Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomised controlled trial in Mozambique analysing the effects of text messages encouraging use of family planning services.

Methods

This trial was conducted within a sample of women served by the Integrated Family Planning Program implemented by Population Services International, in which community health workers provide clinic referrals for family planning services. The evaluation enrolled 5370 women between 20 January and 18 December 2020 who received a referral, reported access to a mobile phone and provided consent. Women were randomly assigned to a treatment group that received a series of text message reminders encouraging them to visit a clinic or to a control arm. An intention-to-treat analysis was conducted to analyse the effect of reminders on the probability of a clinic visit and contraceptive uptake. The final analysis includes 3623 women; 1747 women were lost to follow-up.

Results

Women assigned to receive the text reminders are weakly more likely to visit a clinic (risk difference 2.3 percentage points, p=0.081) and to receive a contraceptive method at a clinic (2.2 percentage points, p=0.091), relative to a base rate of 48.0% and 46.9%, respectively. The effect on clinic visits is larger and statistically significant in the prespecified subsample of women enrolled prior to the COVID-19-related state of emergency (3.2 percentage points, p=0.042).

Conclusion

Evidence from this trial suggests that text message reminders are a promising nudge that increases the probability that women receive contraception.

Trial registration number

AEARCTR-0005383.
Measuring social norms related to handwashing: development and psychometric testing of measurement scales in a low-income urban setting in Abidjan, Côte d’Ivoire
Authors: Amon-Tanoh Maud Akissi , Lapinski Maria Knight , McCambridge Jim , Blon Patrice Konan , Kouamé Hermann Aka , Ploubidis George , Nguipdop-Djomo Patrick , Cousens Simon
Published: April 2022

Objectives

To design and test the psychometric properties of four context-specific norm-related scales around handwashing with soap after toilet use: (1) perceived handwashing descriptive norms (HWDN); (2) perceived handwashing injunctive norms (HWIN); (3) perceived handwashing behaviour publicness (HWP); and (4) perceived handwashing outcome expectations (HWOE).

Design

Scale items were developed based on previous work and pilot tested in an iterative process. Content experts and members of the study team assessed the face validity of the items. The psychometric properties of the scales were assessed in a cross-sectional study.

Setting

The study was conducted in communal housing compounds in Abidjan, Côte d’Ivoire.

Participants

A convenience sample of 201 adult residents (≥16 years old) from 60 housing compounds completed the final questionnaire.

Outcome measure

Confirmatory factor analysis was used to assess the goodness of fit of the global model. We assessed the internal consistency of each scale using Cronbach’s alpha (α) and the Spearman-Brown coefficient (ρ).

Results

The results of the psychometric tests supported the construct validity of three of the four scales, with no factor identified for the HWOE (α=0.15). The HWDN and HWP scales were internally consistent with correlations of ρ=0.74 and ρ=0.63, respectively. The HWIN scale appeared reliable (α=0.83).

Conclusion

We were able to design three reliable context-specific handwashing norm-related scales, specific to economically disadvantaged community settings in Abidjan, Côte d’Ivoire, but failed to construct a reliable scale to measure outcome expectations around handwashing. The social desirability of handwashing and the narrow content area of social norms constructs relating to handwashing present significant challenges when designing items to measure such constructs. Future studies attempting to measure handwashing norm-related constructs will need to take this into account when developing such scales, and take care to adapt their scales to their study context.
Quality of life, healthcare use and costs in ‘at-risk’ children after early antibiotic treatment versus placebo for influenza-like illness: within-trial descriptive economic analyses of the ARCHIE randomised controlled trial
Authors: Rombach Ines , Wang Kay , Tonner Sharon , Grabey Jenna , Harnden Anthony , Wolstenholme Jane
Published: April 2022

Objectives

To characterise the quality of life, healthcare use and costs associated with early antibiotic treatment of influenza-like illness (ILI) in ‘at-risk’ children.

Design

Economic analysis of a two-arm double-blind parallel group pragmatic randomised controlled trial.

Setting

Children were recruited from community-based healthcare settings, including general practices, walk-in centres and hospital ambulatory care.

Participants

Children with risk factors for influenza-related complications, including respiratory, cardiac and neurological conditions, who presented within the first 5 days of an ILI.

Interventions

Co-amoxiclav 400/57 suspension or placebo.

Outcome measures

This economic analysis focused on quality of life measured by the EQ-5D-Y, symptoms assessed by the Canadian Acute Respiratory Infection and Flu Scale (CARIFS), healthcare use and costs including medication, hospital visits and admissions, general practitioner and nurse contacts. Outcomes were assessed for up to 28 days post randomisation.

Results

Information on resource use, EQ-5D-Y (day 28) and CARIFS (day 7) was available for 265 (98%), 72 (27%) and 123 (45%) out of 271 participants, respectively. Average costs in the co-amoxiclav group were £25 lower (95% CI −£113 to £65), but this difference was not statistically significant (p=0.566). The difference in EQ-5D-Y scores between groups was also not statistically significant (−0.014 (95% CI −0.124 to 0.096), p=0.798). However, day 7 CARIFS scores were 3.5 points lower in the co-amoxiclav arm (95% CI −6.9 to −0.1, p=0.044).

Conclusions

Our findings did not show evidence that early co-amoxiclav treatment improves quality of life or reduces healthcare use and costs in ‘at-risk’ children with ILI, but may reduce symptom severity though confirmation from further research would be important. Reliable data collection from children’s parents/carers was challenging, and resulted in high levels of missing data, which is common in pragmatic trials involving children with acute respiratory tract infections.

Trial registration number

ISRCTN70714783; EudraCT 2013-002822-21.
Multiple symptoms and health anxiety in primary care: a qualitative study of tensions and collaboration between patients and family physicians
Authors: Le Thao Lan , Mylopoulos Maria , Bearss Erin , Geist Rose , Maunder Robert
Published: April 2022

Background

Patients with multiple, persistent symptoms and health anxiety often report poor health outcomes. Patients who are difficult to reassure are challenging for family physicians. The therapeutic alliance between a physician and a patient can influence the prognosis of these patients. Optimising the quality of the physician–patient alliance may depend on a better understanding of the interpersonal processes that influence this relationship.

Objective

The purpose of this study is to understand the experiences of patients who experience multiple persistent symptoms or high health anxiety and their physicians when they interact.

Design, participants and setting

A qualitative study was conducted using grounded theory of 18 patients, purposively sampled to select patients who reported high physical symptom severity, high health anxiety or both, and 7 family physicians in the same clinic. This study was conducted at a family medicine clinic in a teaching hospital.

Results

A model of interpersonal tension and collaboration for patients and physicians in primary care was developed. Helpful attitudes and actions as well as troublesome topics influence crucial dilemmas between patients and physicians. These dilemmas include if patients feel heard and validated and the alignment of goals and mutual respect of expertise and experience between patients and physicians. These experiences contribute to a constructive collaboration and in turn positive outcomes.

Conclusions

This model of patient–physician interaction may facilitate providers to turn their attention away from the contentious topics and towards actions and attitudes that promote beneficial outcomes.
Perspectives on the treatment of sequelae after cancer: protocol of an interview study of primary care physiotherapists
Authors: Toftdahl Anne Katrine Skjølstrup , Hjoernholm Laura Hvidaa , Simonsen Mia , Stapelfeldt Christina M , Thomsen Janus Laust , Kongsgaard Marianne , Riis Allan
Published: April 2022

Introduction

An increasing number of patients are living with fatigue, pain and other sequelae after cancer. About 30% of these patients express a need for physical rehabilitation and patients prefer to be involved in medical decision-making. This includes being offered individualised treatment with patient-defined goals and education during all aspects of treatment by physiotherapists with empathic skills. However, physiotherapists are often unaware of the relationship between cancer and its presenting symptoms. This can lead to inappropriate care and unrealistic goalsetting for rehabilitation. This calls for greater attention towards physiotherapist’s treatment and their current perspectives on how treatment can be improved in physiotherapy clinics. The aim of this study is to explore physiotherapists perspectives on barriers, facilitators and potential solutions to improve the care of sequelae after cancer in physiotherapy clinics.

Methods and analysis

This is a qualitative interview study using individual semistructured interviews with physiotherapists using a phenomenological approach to explore their lifeworld at work. We will recruit physiotherapists working in private clinics based on a variation in gender and years of working experience in private clinics. We will conduct between 10 and 16 interviews online via Microsoft Teams and thematically analyse data supported by NVivo software. Interviewing is scheduled to take place from April 2022.

Ethics and dissemination

This is a non-intervention and qualitative study, and the local Ethics Committee in the North Denmark Region has stated that their approval is not needed. Informants will provide a written informed consent. Study information will be sent to the informant at least 3 days prior to the interview session and information will be summarised by the interviewer before the interview.

Aside from publication, results will be disseminated by two teaching institutions, a regional health care provider and DEFACTUM (a public Danish research institution focusing on increasing social equality in health).
Accumulated unhealthy behaviours and insomnia in Japanese dwellers with and without cardiovascular risk factors: a cross-sectional study
Authors: Kato Suzuka , Harada Sei , Iida Miho , Kuwabara Kazuyo , Sugiyama Daisuke , Takeuchi Ayano , Sata Mizuki , Matsumoto Minako , Kurihara Ayako , Hirata Aya , Okamura Tomonori , Takebayashi Toru
Published: April 2022

Objectives

To date, the association between accumulated unhealthy behaviours and insomnia in individuals stratified according to the presence or absence of major cardiovascular risk factors is unclear. This study aimed to examine the effect of accumulated unhealthy behaviours on insomnia in Japanese dwellers.

Design

Cross-sectional study.

Setting

Baseline data between April 2012 and March 2015.

Participants

Our study used cross-sectional data among Japanese aged 35–74 years in a rural community (N=9565), the attendees of annual municipal or work site health check-up programmes.

Main outcome measures

Insomnia was assessed by Athens Insomnia Scale, which was set at 6 points and greater; other scales were given. Participants were categorised into three groups by their number of unhealthy behaviours (no exercise habit, smoking, alcohol drinking, skipping breakfast and obesity): 0–1, 2–3, 4 or more. The association between accumulated unhealthy behaviours and insomnia was estimated by logistic regression analysis. Further analysis was done after stratification of cardiovascular risk factors assessed by anthropometrics and clinical biochemistry measurements.

Results

The overall prevalence of insomnia was 13.3% for men and 19.3% for women. Men with unhealthy behaviour factors were more likely to have insomnia after adjusting for potential confounders, compared with the least unhealthy group (trend p=0.013). Women with four or more unhealthy behaviour factors were more likely to have insomnia, compared with the lowest groups (OR 1.175, 95% CI 1.077 to 1.282). Insomnia has an association with the unhealthy behaviours among men without cardiovascular risk factors (lowest groups: OR 1.133, 95% CI 1.037 to 1.238, trend p=0.026). Women without hypertension were more likely to have suspected insomnia, compared with the lowest group (OR 1.215, 95% CI 1.101 to 1.341).

Conclusion

The results showed accumulated unhealthy behaviours were associated with increased risk of insomnia in Japanese dwellers. For healthy population without cardiovascular risk factors, unhealthy behaviours should be considered as background conditions for insomnia.
Assessing impact of ventilation on airborne transmission of SARS-CoV-2: a cross-sectional analysis of naturally ventilated healthcare settings in Bangladesh
Authors: Styczynski Ashley , Hemlock Caitlin , Hoque Kazi Injamamul , Verma Renu , LeBoa Chris , Bhuiyan Md. Omar Faruk , Nag Auddithio , Harun Md. Golam Dostogir , Amin Mohammed Badrul , Andrews Jason R
Published: April 2022

Objectives

To evaluate the risk of exposure to SARS-CoV-2 in naturally ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling.

Study design

Cross-sectional study.

Study setting and study sample

The study sample included nine hospitals in Dhaka, Bangladesh. Ventilation characteristics and air samples were collected from 86 healthcare spaces during October 2020 to February 2021.

Primary outcome

Risk of cumulative SARS-CoV-2 infection by type of healthcare area.

Secondary outcomes

Ventilation rates by healthcare space; risk of airborne detection of SARS-CoV-2 across healthcare spaces; impact of room characteristics on absolute ventilation; SARS-CoV-2 detection by naturally ventilated versus mechanically ventilated spaces.

Results

The majority (78.7%) of naturally ventilated patient care rooms had ventilation rates that fell short of the recommended ventilation rate of 60 L/s/p. Using a modified Wells-Riley equation and local COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (7.7%). SARS-CoV-2 RNA was most frequently detected in air samples from non-COVID wards (50.0%) followed by outpatient departments (42.9%). Naturally ventilated spaces (22.6%) had higher rates of SARS-CoV-2 detection compared with mechanically ventilated spaces (8.3%), though the difference was not statistically significant (p=0.128). In multivariable linear regression with calculated elasticity, open door area and cross-ventilation were found to have a significant impact on ventilation.

Conclusion

Our findings provide evidence that naturally ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID-designated spaces, but improving parameters of ventilation can mitigate this risk.
Effect of different oesophagojejunostomy methods on the quality of life of gastric cancer patients after totally laparoscopic total gastrectomy with self-pulling and latter transected technique: study protocol for a randomised trial
Authors: Wang Jian , Tseng Yujen , Hong Jun , Hua Lu-Chun , Wang Ya-Ping , Hao Han-Kun
Published: April 2022

Introduction

Gastric cancer is the fifth most common cancer worldwide and the detection rate of proximal gastric cancer has been increasing. Currently, surgical resection using gastrectomy and proper perigastric lymphadenectomy is the only treatment option to enhance the survival rate of patients with gastric cancer. Laparoscopic total gastrectomy (LTG) is increasingly performed for adenocarcinoma of the oesophagogastric junction. However, totally LTG (TLTG) is only performed by a few surgeons due to difficulty associated with oesophagojejunostomy (OJ), in which there is no consensus on a standardised anastomosis technique. We propose a randomised trial to compare functional end-to-end anastomosis (FETE) and side-to-side anastomosis (Overlap) for OJ.

Methods and analysis

A prospective, randomised, open-label, single-centre, interventional trial has been designed to evaluate the quality of life (QoL) outcomes and safety of FETE and Overlap, with a 1-year follow-up as the primary endpoint. The trial began in 2020 and is scheduled to enrol 96 patients according to a previous sample size calculation. Patients were randomly allocated to the FETE or Overlap groups with a follow-up of 1 year to assess QoL after the procedure. All relevant clinical data including biological markers were collected. The primary indicator is the D-value between the postoperative and preoperative QoL. Student’s t-tests will be used to compare continuous variables, while χ2 tests or Fisher’s exact tests will be used to compare categorical variables. Statistical analysis will be performed with SPSS V.23.0 statistical software. A p<0.05 will be considered statistically significant.

Ethics and dissemination

This study has been approved by the Hospital Institutional Review Board of Huashan Hospital, Fudan University (2020-1055). The results will be submitted for publication in peer-reviewed journals.

Trial registration number

ChiCTR2000035583.
Considerations for developing and implementing an online community-based exercise intervention with adults living with HIV: a qualitative study
Authors: Lau Bernice , Sharma Isha , Manku Sukhbir , Kobylianski Julia , Wong Li Yin , Ibáñez-Carrasco Francisco , Carusone Soo Chan , O'Brien Kelly K
Published: April 2022

Objectives

To describe the need for, and utility of, online community-based exercise (CBE) interventions with adults living with HIV and identify factors to consider in developing and implementing an online CBE intervention with adults living with HIV.

Design

Qualitative descriptive study using web-based semistructured interviews.

Participants

We recruited adults representing at least one of five stakeholder groups with experience in CBE and/or HIV: (1) adults living with HIV, (2) rehabilitation professionals, (3) fitness personnel, (4) educators with eLearning experience and (5) representatives from HIV community-based organisations (CBOs).

Data collection

We asked participants to describe their experiences with online CBE, need and utility for online CBE and factors in developing and implementing online CBE interventions. We analysed data using a group-based thematic analytical approach.

Results

Among the 11 participants, most had experience working with adults living with HIV (73%) or with telehealth/rehabilitation/coaching in HIV or other chronic conditions (91%). Participants (eight women; two men; one non-binary; median age: 49 years), identified the need and utility for online CBE interventions to increase accessibility and continuity of care with adults living with HIV. Six factors to consider in developing and implementing online CBE included: (1) person-specific considerations (episodic nature of HIV, stigma, HIV disclosure), (2) accessibility of programme (physical space to exercise, reliable internet, access to devices, digital literacy), (3) programme delivery and technology (live vs prerecorded online classes, multiple online platforms for delivery, physical activity tracking, troubleshooting technology), (4) attributes of programme personnel (working with CBOs, relatable instructors, diverse staff), (5) programme content and design (tailored exercise classes, educational sessions) and (6) building community (shared experiences, peer support, social opportunities).

Conclusions

There is a need and utility for online CBE in the context of HIV. Considerations for development and implementation span individual, structural and technical, and community dimensions. Results can inform the future development and implementation of online CBE with adults living with HIV and other chronic episodic conditions.
Incidence, aetiology and serotype coverage for pneumococcal vaccines of community-acquired pneumonia in adults: a population-based prospective active surveillance study in Brazil
Authors: Duarte Fernanda Gross , Barberino Maria Goreth , da Silva Moreira Sandra , Reis Joice Neves , Spinardi Julia Regazzini , de Almeida Rodrigo Sini , Allen Kristen E , Alexander-Parrish Ronika , Brim Rosa , de Araújo Neto César Augusto , Moreira Edson Duarte
Published: April 2022

Objectives

To determine the incidence, aetiology and pneumococcal serotype distribution of community-acquired pneumonia (CAP) in Brazilian adults during a 2-year period.

Design

Prospective population-based surveillance study.

Setting

Patients from two emergency hospitals in Brazil were consecutively included in this study.

Participants

A total of 111 adults aged 50 years and older with radiographically-confirmed CAP requiring an emergency department visit were prospectively enrolled between January 2018 and January 2020.

Main outcome measures

Incidence rates of CAP were calculated according to age and pathogen. Pathogens were identified by conventional microbiological methods. Additionally, a novel, Luminex-based serotype specific urinary antigen detection assay was used to detect serotypes included in pneumococcal vaccines.

Results

Mean age of participants was 64 years and 31% were aged ≥70 years. Aetiology was established in 61 (57%) patients; among identified cases, the most common pathogens were Streptococcus pneumoniae (42/61, 69%) and influenza (4/61, 7%). Among serotypes identified from the 42 cases of pneumococcal CAP, estimated coverage ranged by pneumococcal vaccine formulations from 47.6% (13-valent), 59.5% (20-valent, licenced in the USA only) and 71.4% (23-valent). In patients with CAP, 20-valent pneumococcal vaccine serotypes were identified 2.5 times more frequently than 10-valent pneumococcal vaccine serotypes (22.5% vs 9.0%). The incidence rate for CAP in adults aged ≥50 years was 20.1 per 10 000 person-years. In general, the incidence of CAP increased consistently with age, reaching 54.4 (95% CI 36.8 to −76.6) per 10 000 in adults 80 years or older.

Conclusions

We observed a high burden of pneumococcal CAP among adults in Brazil. Despite the routine immunisation of children and high-risk adults against pneumococcal disease in the Brazilian national vaccination programme, a persistent burden of pneumococcal CAP caused by vaccine serotypes remains in this population.
Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study
Authors: Braun Emilie J , Singh Siddhartha , Penlesky Annie C , Strong Erin A , Holt Jeana M , Fletcher Kathlyn E , Stadler Michael E , Nattinger Ann B , Crotty Bradley H
Published: April 2022

Background

Unrecognised changes in a hospitalised patient’s clinical course may lead to a preventable adverse event. Early warning systems (EWS) use patient data, such as vital signs, nursing assessments and laboratory values, to aid in the detection of early clinical deterioration. In 2018, an EWS programme was deployed at an academic hospital that consisted of a commercially available EWS algorithm and a centralised virtual nurse team to monitor alerts. Our objective was to understand the nursing perspective on the use of an EWS programme with centralised monitoring.

Methods

We conducted and audio-recorded semistructured focus groups during nurse staff meetings on six inpatient units, stratified by alert frequency (high: >100 alerts/month; medium: 50–100 alerts/month; low: <50 alerts/month). Discussion topics included EWS programme experiences, perception of EWS programme utility and EWS programme implementation. Investigators analysed the focus group transcripts using a grounded theory approach.

Results

We conducted 28 focus groups with 227 bedside nurses across all shifts. We identified six principal themes: (1) Alert timeliness, nurses reported being aware of the patient’s deterioration before the EWS alert, (2) Lack of accuracy, nurses perceived most alerts as false positives, (3) Workflow interruptions caused by EWS alerts, (4) Questions of actionability of alerts, nurses were often uncertain about next steps, (5) Concerns around an underappreciation of core nursing skills via reliance on the EWS programme and (6) The opportunity cost of deploying the EWS programme.

Conclusion

This qualitative study of nurses demonstrates the importance of earning user trust, ensuring timeliness and outlining actionable next steps when implementing an EWS. Careful attention to user workflow is required to maximise EWS impact on improving hospital quality and patient safety.
Palliative radiotherapy: a one-week course in advanced head and neck cancer – quality of life outcomes
Authors: Prakash Sadanand , Chakrabarti Deep , Kumar Rajendra , Agrawal Manas Mani , Verma Mrinalini , Singh Sudhir , Gupta Seema , Srivastava Kirti , Gupta Rajeev , Bhatt Madan Lal Brahma
Published: April 2022

Objectives

Palliative radiotherapy regimens for advanced head and neck cancers vary in doses and treatment times. Their quality of life (QoL) implications are not clearly established.

Methods

We randomised patients with advanced, non-metastatic, head and neck squamous cell carcinomas (stage IVA-B) with WHO performance score of 2 or higher to receive 30 Gy in 10 fractions over two weeks (arm A) or 20 Gy in 5 fractions over one week (arm B). QoL was assessed using European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-H&N35 questionnaires at baseline and postradiotherapy. The primary endpoint was the EORTC-defined global health status. Secondary endpoints were functional and symptom scores of QoL, response to radiotherapy and acute toxicities. The primary aim was to evaluate the one-week regimen in terms of QoL to the longer regimen.

Results

110 patients were randomised, the number of patients in the final analysis was 95: 49 in arm A and 46 in arm B. Baseline characteristics were similar. Clinical outcomes post-treatment were comparable. Postradiotherapy, there were improved scores for functional and symptom scales, the differences were non-significant. The duration of treatment was significantly reduced in arm B (p<0.01) with a lower score for financial difficulty (p<0.001). The difference in global health status (primary endpoint) was non-significant (p=0.82). The median overall survival was 7 months, the median progression-free survival was 5 months and these did not vary between the two groups.

Conclusion

One-week palliative radiotherapy for head and neck cancers achieves similar QoL and clinical outcomes as more protracted radiotherapy schedules with significantly reduced treatment time and financial toxicity.
Tale of two countries: attitudes towards older persons in Italy and Israel during the COVID-19 pandemic as seen through the looking-glass of the media
Authors: Fantinati Jacopo , Sabin Irina , Crosignani Silvia , Zilbershlag Yael , Cesari Matteo , Dwolatzky Tzvi
Published: April 2022

The COVID-19 pandemic has exposed the many challenges and difficulties of healthcare systems caring for older frail people. This public health crisis has indeed jeopardised the concept of the welfare state, in particular the right of older people to uncompromised healthcare. Together with the clinical challenges facing the geriatric patient and the organisational difficulties of the healthcare systems, sociocultural factors may have also played a substantial role in the strategies that countries have applied in coping with the pandemic. In this opinion article, we report attitudes towards the older populations of two countries, Italy and Israel, during the COVID-19 pandemic as viewed through the looking-glass of the media.
Subacute thyroiditis following recovery from COVID-19 infection: novel clinical findings from an Eastern Indian cohort
Authors: Mondal Sunetra , DasGupta Riddhi , Lodh Moushumi , Ganguly Arunangshu
Published: April 2022

Objective

Recent reports have suggested a link between COVID-19 infection and subacute thyroiditis (SAT). We aimed to describe variations in clinical and biochemical parameters in patients developing post-COVID SAT.

Design

Ours was a combined retrospective-prospective study on patients presenting with SAT within 3 months of recovery from COVID-19 infection, who were subsequently followed up for a further 6 months since diagnosis of SAT.

Results

Out of 670 patients with COVID-19, 11 patients presented with post-COVID-19 SAT (6.8%). Those with painless SAT (PLSAT, n = 5) presented earlier, had more severe thyrotoxic manifestations and exhibited higher C-reactive protein, interleukin 6 (IL-6), neutrophil-lymphocyte ratio and lower absolute lymphocyte count than those with painful SAT (PFSAT, n = 6). There were significant correlations of total and free T4 and total and free T3 levels with serum IL-6 levels (pall <0.04). No differences were observed between patients with post-COVID SAT presenting during the first and second waves. Oral glucocorticoids were needed for symptomatic relief in 66.67% of patients with PFSAT. At 6 months of follow-up, majority (n = 9, 82%) achieved euthyroidism, while subclinical and overt hypothyroidism were found in one patient each.

Conclusions

Ours is the largest single-centre cohort of post-COVID-19 SAT reported until, demonstrating two distinct clinical presentations—without and with neck pain—depending on time elapsed since COVID-19 diagnosis. Persistent lymphopaenia during the immediate post-COVID recovery period could be a key driver of early,painless SAT. Close monitoring of thyroid functions for at least 6 months is warranted in all cases.
Phase 3, long-term, open-label extension period of safety and efficacy of belimumab in patients with systemic lupus erythematosus in China, for up to 6 years
Authors: Zhang Fengchun , Zheng Jie , Li Yang , Wang Guochun , Wang Mingjun , Su Yin , Gu Jieruo , Li Xingfu , Bass Damon , Chu Myron , Curtis Paula , DeRose Kathleen , Kurrasch Regina , Lowe Jenny , Meizlik Paige , Roth David A
Published: April 2022

Objectives

To evaluate the long-term safety and efficacy of belimumab in patients with systemic lupus erythematosus (SLE) in China.

Methods

In this phase 3, open-label extension period, eligible completers of study BEL113750 (NCT01345253) received intravenous belimumab 10 mg/kg monthly for ≤6 years. The primary endpoint was safety. Secondary endpoints included the SLE Responder Index (SRI)-4 response rate, severe SLE flares and changes in prednisone use. Analyses were based on observed data from the first dose of belimumab through to study end.

Results

Of the 424 patients who received belimumab, 215 (50.7%) completed the study, 208 (49.1%) withdrew and 1 patient died. Overall, 359/424 (84.7%) patients had adverse events (AEs), and 96/424 (22.6%) had serious AEs. 26/424 (6.1%) patients discontinued study treatment/withdrew from the study due to AEs. Postinfusion systemic reaction rate was 1.5 events/100 patient-years. Herpes zoster infection rate was 3.0 events/100 patient-years, of which 0.4 events/100 patient-years were serious events. One papillary thyroid cancer and one vaginal cancer were reported in year 0–1 and year 3–4, respectively. There were no completed suicides/suicide attempts and no reports of serious depression. The proportion of SRI-4 responders increased progressively (year 1, week 24: 190/346 (54.9%); year 5, week 48: 66/82 (80.5%)). Severe flares were experienced by 55/396 (13.9%) patients. For 335 patients with baseline prednisone-equivalent dose >7.5 mg/day, the number of patients with a dose reduction to ≤7.5 mg/day increased over time (year 1, week 24: 30/333 (9.0%); year 5, week 48: 36/67 (53.7%)).

Conclusions

Favourable safety profile and disease control appeared to be maintained in patients with SLE in China for ≤6 years, consistent with previous belimumab studies.
Monitoring 13 years of drastic catchment change and the hydroecological responses of a drained thermokarst lake
Authors: Turner Kevin W. , Wolfe Brent B. , McDonald Ian
Published: April 2022

Catastrophic drainage of thermokarst lakes transform portions of former lakebed to terrestrial settings, which have largely unknown consequences for the remaining aquatic habitat. Old Crow Flats, northern Yukon (Canada), is a lake-rich area that has recently experienced a climate-driven increase in lake drainage frequency. A notable example occurred during June 2007 when Zelma Lake (originally 12 km2) lost over 80% of its volume. Here we integrate remote sensing techniques with in-situ hydrological and limnological measurements over 13 years following drainage to 1) monitor water surface area and terrestrial land cover change and 2) identify associated effects on aquatic conditions. An airborne drone system was used to provide training data for land cover classification of AVIRIS-NG data, which indicated that tall willow shrubs covered 30.8% of the former lake area by 2017. Lake water isotope-derived deuterium-excess increased during the 13-year record indicating that hydrological input increased with greater snowpack accumulation within encroaching vegetation. Limnological conditions were highly variable and eutrophic during the first few years following drainage but became more stable as vegetation colonized the former lakebed. This long-term study provides insight of aquatic responses to thermokarst lake drainage and shrub vegetation proliferation, which are increasing in Arctic and subarctic regions.
Structural–Acoustic Response Analysis of Variable Stiffness Laminates with Inherent Material Damping
Authors: Gunasekaran Vijay , Gulhane Saurav , Gupta Somya , Pitchaimani Jeyaraj , Rajamohan Vasudevan , Manickam Ganapathi
Published: April 2022

Sound radiation and transmission loss characteristics of variable stiffness composite plate reinforced with the curvilinear fibers are investigated numerically. The formulation is developed using higher-order shear flexible finite element model combined with Helmholtz wave equation. The governing equations obtained using Hamilton’s approach are further solved through the modal super position method to analyze the vibration response under steady state excitation. The inherent material damping of the laminate is accounted through the modal damping calculated using the modal strain energy approach. The acoustic pressure of the variable stiffness laminates is estimated using the Raleigh integral. Subsequently, acoustic response characteristics such as acoustic power level, radiation efficiency, directivity pattern, and transmission loss from the laminates are predicted using the estimated sound pressure for various forcing frequencies. A parametric study covering a wide range of design variables including center and edge fiber angles, lamination scheme, thickness ratio, and boundary conditions on the acoustic sound behavior arising from the vibration of curvilinear fiber composite plate is detailed. This study reveals that the acoustic response of the curvilinear fiber composite plate is significantly influenced by the curvilinear fiber angles at the center/edge fiber angle of the layers. It is hoped that the results obtained here will be useful for designers in developing structures with desired acoustic response characteristics.