bluuebunny/crossref_metadata_2025 huggingface dataset:
A narrative review of caudal epidural anaesthesia and analgesia in horses. Part 1: Safety and efficacy of epidural drugs
Authors: Rønnow Kjærulff L. N. , Lindegaard C.
Published: May 2021

The importance of adequate pain management in horses has gained increased clinical attention over the last decade or so, and many drugs and administration techniques have been investigated for the purpose of improving equine pain management. Caudal epidural anaesthesia and analgesia (CEAA) has the potential to be one of the most efficient techniques for management of moderate to severe pain of the pelvic limbs, the caudal part of the body and even the thoracic limbs. The epidural administration of many different drugs has been studied and clinically applied, most of them with good efficacy and minimal side‐effects. In order to guide the clinician on when and how to perform CEAA in horses, this 2‐part review provides a detailed review of the efficacy, safety, indications and techniques. Part 1 focuses on the efficacy and safety of epidurally administered drugs and Part 2 considers indications and contraindications, and provides a practical description on how to perform the epidural procedure.
Water flow and temperature interact to determine oxidative status, swimming performance, and dispersal of mosquitofish (Gambusia holbrooki)
Authors: Seebacher Frank , Kazerouni‐Ghanizadeh Ensiyeh
Published: May 2021

The health of running freshwater systems depends to a large extent on flow rates, which can co‐vary with other environmental variables such as temperature. Water flow and temperature can influence oxidative status of individual animals, thereby impacting muscle function and locomotion. Consequently, ecologically important behaviours such as dispersal may be disrupted.

Our aim was to determine whether the interactions between acclimation to flowing water (3 weeks at 0.06 m/s or still water), thermal acclimation (3 weeks at 18 and 28°C), and acute test temperatures (18–32°C) determine oxidative status, locomotor performance, and dispersal in mosquitofish (Gambusia holbrooki).

We show that swimming capacity was greater in fish living in flowing water compared to those in still water, and that this difference was greater in warm acclimated fish. However, dispersal was not dependent on maximal locomotor capacities. Fish initiated dispersal to a greater extent when acclimated to flowing water and cool temperature, although there were interactions with acute test temperature.

Dispersal speed was not affected by flow acclimation, but it was greater at cool test temperatures in cool acclimated fish, and vice versa for warm acclimated fish. Also, fish acclimated to flowing and cool water made a greater number of dispersal decisions. Oxidative damage to membranes and proteins did not change with flow or temperature treatments, but antioxidant capacities were greater in animals acclimated to flow and cool temperatures.

Trait‐specific approaches used to assess fish responses to altered flow regimes typically consider a range of morphological and life‐history traits to characterise species and predict the impact of environmental change. Physiological traits and responses such as those we describe here can be a useful addition to life‐history traits in predicting the impact of environmental change on movement. Consideration of the impacts of physiological traits on dispersal can increase the efficacy of management and restoration projects.
Non‐native species outperform natives in coastal marine ecosystems subjected to warming and freshening events
Authors: McKnight Ella , Spake Rebecca , Bates Amanda , Smale Dan A. , Rius Marc
Published: May 2021

Aims

Contemporary climate change and biological invasions are two main drivers of biodiversity redistribution. Interactive effects between these drivers have been reported in a variety of studies, yet results are conflicting. Some studies find that contemporary climate change facilitates the spread and success of non‐native species, especially those with broad physiological tolerances. Other studies conclude that non‐natives are vulnerable to current and future changes in climatic conditions. Given that most studies have focused on terrestrial species, here we contribute to this debate by analysing responses of marine native and non‐native fauna and flora to key climate‐related stressors, namely increased temperature (warming) and decreased salinity (freshening).

Location

Global.

Time period

2002–2019.

Major taxa studied

Marine benthic macrophytes and invertebrates.

Methods

We conducted a meta‐analysis of experiments investigating the performance (e.g. growth, survival and reproduction) of benthic species in response to warming and freshening.

Results

We found that non‐native species tended to respond positively to elevated temperature, whereas the performance of native species declined. Similarly, decreased salinity negatively affected the biological processes of native species, but non‐natives showed neutral or negative overall responses to freshening.

Main conclusions

We find evidence that non‐native species outperform natives under a wide variety of warming and freshening conditions. The growth and reproduction of non‐natives are enhanced by warmer temperatures, and thus ocean warming is expected to facilitate future spread and success of non‐native species. Increased freshening along future coastal areas, however, will likely have a negative impact in both native and non‐native species and thus is expected to be a driver of significant change in coastal marine ecosystems. Our comprehensive analysis highlighted the need to expand our understanding of climate change effects beyond warming and specifically, studies focusing on salinity changes.
Systematic preparation of high‐quality colloidal silica particles by sol–gel synthesis using reagents at low temperature
Authors: Zárate‐Reyes José‐Miguel , Flores‐Romero Erick , Cheang‐Wong Juan‐Carlos
Published: May 2021

We propose a new approach to obtain monodisperse submicrometer‐sized colloidal silica particles prepared via a modified Stöber synthesis method, leading to high‐quality spherical particles with a narrow size distribution. The novelty of this work consists in setting, previously to the synthesis reaction, the initial temperature of the reagents at low values (6−14°C) in comparison to the constant laboratory room temperature, while fixing other experimental parameters such as humidity and reagent concentrations. A series of samples of monodisperse colloidal silica particles were prepared, with diameters ranging from 600 to 1000 nm and exhibiting quite narrow particle size distributions. According to our results, it was established that the initial temperature of the reagent solutions constitutes a remarkable parameter, affecting the particle size, shape, and monodispersity. This experimental approach even allows the size tunability for the synthesis of large spherical silica particles in a one‐step process. Moreover, in combination with spin‐coating deposition, the proposed technique greatly favors the formation of ordered arrays of monodisperse silica particles over silicon substrates in areas as large as several mm2. This is ideal for thermal insulators, photonic crystals, nanosphere lithography, and other engineering and industrial applications requiring high‐quality extended arrays of monodisperse silica particles.
Are oral health conditions associated with schoolchildren’s performance and school attendance in the Kingdom of Bahrain? A life‐course perspective
Authors: Mohamed Seham A. S. , Baker Sarah R. , Deery Christopher , Vettore Mario V.
Published: May 2021

Background

The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children.

Aim

To investigate the relationship of oral conditions with schoolchildren's school performance and attendance using the life‐course approach.

Design

A cross‐sectional study was conducted with 466 schoolchildren aged 7‐8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children's current and at‐birth environmental characteristics were completed by their parents. Children's oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (pulp, ulcer, fistula, abscess), and DDE (developmental defects of enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression.

Results

The odds of excellent school performance were significantly lower for children with untreated dentinal caries (OR = 0.98; 95% CI: 0.96‐0.99). Children with caries‐treated teeth showed greater odds of excellent school performance (OR = 1.41; 95% CI: 1.15‐1.74). Disease Control and PreventionNone of the dental conditions were significantly associated with children’s school attendance. A permissive parental style was associated with poor school attendance (OR = 2.63; 95% CI: 1.08‐6.42).

Conclusion

Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance.
Γ‐robust linear complementarity problems with ellipsoidal uncertainty sets
Authors: Krebs Vanessa , Müller Michael , Schmidt Martin
Published: May 2021

We study uncertain linear complementarity problems (LCPs), that is, problems in which the LCP vector q or the LCP matrix M may contain uncertain parameters. To this end, we use the concept of Γ‐robust optimization applied to the gap function formulation of the LCP. Thus, this work builds upon Krebs and Schmidt (2020). There, we studied Γ‐robustified LCPs for ℓ1‐ and box‐uncertainty sets, whereas we now focus on ellipsoidal uncertainty sets. For uncertainty in q or M, we derive conditions for the tractability of the robust counterparts. For these counterparts, we also give conditions for the existence and uniqueness of their solutions. Finally, a case study for the uncertain traffic equilibrium problem is considered, which illustrates the effects of the values of Γ on the feasibility and quality of the respective robustified solutions.
“Second line medications” for supraventricular arrhythmias in children: In‐hospital efficacy and adverse events during treatment initiation of sotalol and flecainide
Authors: Kahr Peter C. , Moffett Brady S. , Miyake Christina Y. , Kim Jeffrey J. , Valdes Santiago O.
Published: May 2021

Introduction

Sotalol and flecainide are used as second line agents in children for the treatment of supraventricular arrhythmias (SA) refractory to anti‐beta adrenergic antiarrhythmics or digoxin. Efficacy and adverse events in this cohort have not been well described. Here, we report our institutional experience of second line treatment initiation for SA in children.

Methods and Results

Utilizing an institutional database, 247 patients initiated on sotalol and 81 patients initiated on flecainide were identified. Congenital heart disease (CHD) was present in 40% of patients. Arrhythmia‐free discharge on single or dual agent therapy (in combination with other antiarrhythmics) was 87% for sotalol and 91% for flecainide. Neither age, sex, dosing, presence of CHD nor arrhythmia subtype were associated with alterations in in‐hospital efficacy. Compared to baseline, QTc intervals in sotalol patients (436 [416–452 ms] vs. 415 [400–431 ms], p < .01) and QRS intervals in flecainide patients (75 [68–88 ms] vs. 62 [56–71 ms], p < .01) were prolonged. Dose reduction or discontinuation due to QRS prolongation occurred in 9% of patients on flecainide. QTc prolongation resulting in dose reduction/discontinuation of sotalol was encountered in 9 patients (4%) and death with documented torsade de pointes in 2 patients (1%), with 9 of 11 patients having underlying CHD.

Conclusion

In children requiring second line agents for treatment of SA, both sotalol and flecainide appear to be highly efficacious. Although predominantly safe in otherwise healthy patients, electrocardiogram changes can occur and children with underlying cardiac disease may have an increased risk of adverse events and rhythm‐related side effects during initiation.
Gender associated disparities in atrioventricular nodal reentrant tachycardia: A review article
Authors: Etaee Farshid , Elayi Claude S. , Catanzarro John , Delisle Brian , Ogunbayo Gbolahan , Di Biase Luigi , Natale Andrea , Darrat Yousef
Published: May 2021

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common sustained supraventricular arrhythmias. An understanding of gender‐related differences in AVNRT epidemiology, diagnosis, treatment, outcome, and complications can help guide a more effective diagnosis and treatment of the condition. The study aimed to perform a review of the available literature regarding all aspects of gender‐related differences of AVNRT. We focused on all aspects of gender‐related differences regarding AVNRT between men and women. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. Many investigations have demonstrated that the prevalence of AVNRT exhibited a twofold women‐to‐men predominance. The potential mechanism behind this difference due to sex hormones and autonomic tone. Despite being more common in women, there is a delay in offering and performing the first‐line therapy (catheter ablation) compared to men. There were no significant gender‐related discrepancies in patients who underwent ablation therapy for AVNRT, regarding the acute success rate of the procedure, long‐term success rate, and recurrence of AVNRT. AVNRT is more common in women due to physiological factors such as sex hormones and autonomic tone. Catheter ablation is equally safe and efficacious in men and women; however, the time between the onset of symptoms and ablation is significantly prolonged in women. It is important for the medical community to be aware of this discrepancy and to strive to eliminate such disparities that are not related to patients' choices.
Allopatric differentiation in the Enteromius anoplus complex in South Africa, with the revalidation of Enteromius cernuus and Enteromius oraniensis, and description of a new species, Enteromius mandelai (Teleostei: Cyprinidae)
Authors: Kambikambi Manda J. , Kadye Wilbert T. , Chakona Albert
Published: May 2021

The chubbyhead barb, Enteromius anoplus, as currently described, is the most widely distributed freshwater fish in South Africa. The species occurs in almost all the major river systems across the country, with the exception of the small coastal drainages on the south coast. The use of a comprehensive data set of mitochondrial (mtDNA) cytochrome b (cyt b) sequences uncovered the presence of four distinct lineages or operational taxonomic units (OTUs) within E. anoplus: (a) the Gouritz lineage endemic to the Gouritz River system, (b) the Olifants lineage endemic to the Olifants‐Doring River system, (c) the Orange lineage endemic to the Orange River system and (d) the Eastern Cape lineage which is distributed across six river systems from the Great Fish to the Buffalo rivers in the Eastern Cape Province of South Africa. The present study provides a new diagnosis for E. anoplus s.s. (the Gouritz lineage), revalidates Enteromius cernuus (the Olifants lineage) and Enteromius oraniensis (the Orange lineage) as distinct species. The study also provides a description for a new species, Enteromius mandelai sp. nov (the Eastern Cape lineage). E. cernuus and E. mandelai differ from both E. anoplus and E. oraniensis by having a complete lateral line (vs. an incomplete lateral line in the latter species). E. cernuus further differs from the other three species by having long maxillary barbels which reach or exceed the vertical through the middle of the eye and the lowest number of circumpendicular scales (10–12 vs. 12–16 for the other three species). E. oraniensis is distinctive from the other three species by having inconspicuous barbels. These findings add to the growing body of literature that shows that the freshwater fishes of the Cape Fold and adjacent freshwater ecoregions have narrow geographic ranges. This has ramifications for conservation planning and management, as well as the understanding of the evolutionary history of the stream fishes in these global endemic hotspots.
ADVANCE: Methodology of a qualitative study
Authors: Lopez Ruth Palan , McCarthy Ellen P. , Mazor Kathleen M. , Hendricksen Meghan , McLennon Susan , Johnson Kimberly S. , Mitchell Susan L.
Published: May 2021

Background/Objectives

Quantitative studies have documented persistent regional, facility, and racial differences in the intensity of care provided to nursing home (NH) residents with advanced dementia including, greater intensity in the Southeastern United States, among black residents, and wide variation among NHs in the same hospital referral region (HRR). The reasons for these differences are poorly understood, and the appropriate way to study them is poorly described.

Design

Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life (ADVANCE) is a large qualitative study to elucidate factors related to NH organizational culture and proxy perspectives contributing to differences in the intensity of advanced dementia care. Using nationwide 2016–2017 Minimum DataSet information, four HRRs were identified in which the relative intensity of advanced dementia care was high (N = 2 HRRs) and low (N = 2 HRRs) based on hospital transfer and tube‐feeding rates among residents with this condition. Within those HRRs, we identified facilities providing high (N = 2 NHs) and low (N = 2 NHs) intensity care relative to all NHs in that HRR (N = 16 total facilities; 4 facilities/HRR).

Results/Conclusions

To date, the research team conducted 275 h of observation in 13 NHs and interviewed 158 NH providers from varied disciplines to assess physical environment, care processes, decision‐making processes, and values. We interviewed 44 proxies (black, N = 19; white, N = 25) about their perceptions of advance care planning, decision‐making, values, communication, support, trust, literacy, beliefs about death, and spirituality. This report describes ADVANCE study design and the facilitators and challenges of its implementation, providing a template for the successful application of large qualitative studies focused on quality care in NHs.
Beliefs: A challenge in neuropsychological disorders
Authors: Seitz Rüdiger J.
Published: May 2021

Introduction

Beliefs have recently been defined as the neural product of perception of objects and events in the external world and of an affirmative internal affective state reflecting personal meaning. It is, however, undetermined in which way diseases of the brain affect these integrative processes.

Methods

Here, the formation and updating of abnormal beliefs in cerebral disorders are described.

Results

It will be shown that well‐defined neuropsychological syndromes resulting from brain lesions also interfere with the neural processes that enable the formation, up‐dating and communication of beliefs. Similarly, in neuropsychiatric disorders abnormal and delusional beliefs appear to be caused by altered perception and/or misattribution of aversive meaning.

Conclusion

Given the importance of beliefs for ordinary social behaviour, abnormal beliefs are a challenge in neuropsychological disorders.
Does Religious Group Population Share Affect the Religiosity of the Next Generation?
Authors: Mikoski Charissa , Olson Daniel V. A.
Published: May 2021

Are teens more religious when (consistent with “religious monopoly” arguments) they live in an area where many people share their parents’ religious identity? Or are teens more religious when (as religious economies models suggest) they live in areas where their parent's religious identity has a smaller population share (or “market share”)? We examine these questions using Wave 1 of the National Study of Youth and Religion combined with county‐level variables from the 2000 Religious Congregations and Membership Study and the 2000 U.S. Census. Parental religiosity has a huge effect on teen's religiosity, so much so that when parents are very religious, the religious context of the surrounding county does not matter. However, when parents are not very religious, results are consistent with the religious monopolies model but not the religious economies model. The percent of the county in the parents’ religious tradition tends to boost teen's religiosity.
Immigration, diversity and institutions
Authors: Roupakias Stelios , Dimou Spiridoula
Published: May 2021

This paper examines the relationship between immigration and host countries' institutional quality, using international migration data for a sample of 130 countries over the 1990–2015 period. We employ two composite metrics of political institutions, encompassing multiple dimensions of governance. To reduce endogeneity concerns, related to immigrant settlement patterns, we employ pseudo‐gravity‐based instruments in a 2SLS setting. Overall, our findings withstand several robustness checks and suggest that immigration has a negative and statistically significant impact on the level of institutional development of the countries analyzed in this study. However, there is substantial heterogeneity, since the impact of migrants appears to be somewhat stronger in less developed host countries. Interestingly, these findings are entirely driven by migrants stemming from countries displaying low institutional development.
U.S. government deception in the Luis Posada scandal: Information manipulation theory
Authors: Matusitz Jonathan , Simi Demi
Published: May 2021

This article examines the role of U.S. government deception in the handling of the anti‐Castro terrorist Luis Posada. The Luis Posada scandal involved more than just the terrorist; it also involved the questionable collaboration of several U.S. presidents, government officials, and agencies with entities in Cuban‐exile communities. The theoretical framework used in this analysis is information manipulation theory, which postulates that information is packaged through manipulative messages; it is transmitted from a sender who gives false information to a receiver, the audience. An important conclusion of this analysis is that U.S. federal employees propagated lies and deception for political gain. They also contributed to deceiving the U.S. audience by breaking the oath that no anti‐Castro terrorists such as Luis Posada would be harbored or protected.
Speciation and secondary contact in a fossorial island endemic, the São Tomé caecilian
Authors: O’Connell Kyle A. , Prates Ivan , Scheinberg Lauren A. , Mulder Kevin P. , Bell Rayna C.
Published: May 2021

A period of isolation in allopatry typically precedes local adaptation and subsequent divergence among lineages. Alternatively, locally adapted phenotypes may arise and persist in the face of gene flow, resulting in strong correlations between ecologically‐relevant phenotypic variation and corresponding environmental gradients. Quantifying genetic, ecological, and phenotypic divergence in such lineages can provide insights into the abiotic and biotic mechanisms that structure populations and drive the accumulation of phenotypic and taxonomic diversity. Low‐vagility organisms whose distributions span ephemeral geographic barriers present the ideal evolutionary context within which to address these questions. Here, we combine genetic (mtDNA and genome‐wide SNPs) and phenotypic data to investigate the divergence history of caecilians (Amphibia: Gymnophiona) endemic to the oceanic island of São Tomé in the Gulf of Guinea archipelago. Consistent with a previous mtDNA study, we find two phenotypically and genetically distinct lineages that occur along a north‐to‐south axis with extensive admixture in the centre of the island. Demographic modelling supports divergence in allopatry (~300 kya) followed by secondary contact (~95 kya). Consequently, in contrast to a morphological study that interpreted latitudinal phenotypic variation in these caecilians as a cline within a single widespread species, our analyses suggest a history of allopatric lineage divergence and subsequent hybridization that may have blurred species boundaries. We propose that late Pleistocene volcanic activity favoured allopatric divergence between these lineages with local adaptation to climate maintaining a stable hybrid zone in the centre of São Tomé Island. Our study joins a growing number of systems demonstrating lineage divergence on volcanic islands with stark environmental transitions across small geographic distances.
Neutrophil extracellular traps (NETs) infiltrate haematoma and surrounding brain tissue after intracerebral haemorrhage: A post‐mortem study
Authors: Puy Laurent , Corseaux Delphine , Perbet Romain , Deramecourt Vincent , Cordonnier Charlotte , Bérézowski Vincent
Published: May 2021

Aims

Because of their prothrombotic and neuroinflammatory effects, neutrophils and neutrophil extracellular traps (NETs) represent interesting therapeutic targets for spontaneous intracerebral haemorrhage (sICH). We investigated the presence, spatial and temporal distribution of NETs in a human sICH post‐mortem study.

Methods

From 2005 to 2019, all sICH patients who came to autopsy within the first month after stroke were included and grouped according to the timing of death: 72 h, 4–7 days, 8–15 days and >15 days after ICH onset. Paraffin‐embedded tissue was extracted from four strategic areas: haematoma, peri‐haematomal area, ipsilateral surrounding brain tissue and a control contralateral area. Myeloperoxidase and histone H3 citrulline were immunolabelled to detect neutrophils and NETs respectively.

Results

Neutrophils were present in the brains of the 14 cases (4 men, median age: 78 years) and NETs were found in 7/14 cases. Both neutrophils and NETs were detected within the haematoma but also in the surrounding tissue. The appearance of neutrophils and NETs was time‐dependent, following a two‐wave pattern: during the first 72 h and between 8 and 15 days after ICH onset. Qualitative examination showed that neutrophils and NETs were mainly located around dense fibrin fibres within the haematoma.

Conclusions

These observations provide evidence for NETs infiltration in the brain of patients who die from sICH. NETs might interact with early haemostasis within the haematoma core, and with the surrounding neuroinflammatory response. These findings open research perspectives for NETs in the treatment of sICH injuries.
Specific patterns of executive functioning weaknesses among children after heart transplant
Authors: Jassal Yasmine R. , Christofferson Elizabeth S. , Everitt Melanie D. , Wolfe Kelly R.
Published: May 2021

Background

Children with a history of heart transplant (HT) are at risk of executive functioning weaknesses secondary to heart disease and associated morbidity. However, specific executive functioning weaknesses have not been identified.

Method

The present study, anchored in Anderson's (2002) Developmental Model of Executive Functioning, provides a detailed, retrospective analysis of executive functioning in the areas of goal setting, cognitive flexibility, attentional control, and information processing for a clinically referred sample of 53 pediatric HT recipients who underwent neuropsychological evaluations as part of typical clinical care.

Results

Broadly, the sample demonstrated mild‐to‐moderate deficits across cognitive, adaptive behavior, executive functioning, and academic domains, as well as elevated parent‐reported concerns for depression and anxiety. Executive functioning weaknesses, while global, persisted after controlling for the effects of depression and anxiety and were most prominent in cognitive flexibility. In addition, poor cognitive flexibility predicted lower adaptive behavior, IQ, and academic outcomes among this population, placing them at considerable risk of extensive impairment in several domains of their lives.

Conclusions

Taken together, children with a history of HT demonstrated broad difficulties across several areas of functioning, with particular concerns for working memory. As such, interventions and accommodations specifically targeting working memory may help provide the most optimal outcomes for this population.
On analyticity of scattered fields in layered structures with interfacial graphene
Authors: Nicholls David P.
Published: May 2021

Two‐dimensional materials such as graphene have become crucial components of most state‐of‐the‐art plasmonic devices. The possibility of not only generating plasmons in the terahertz regime, but also tuning them in real time via chemical doping or electrical gating make them compelling materials for engineers seeking to build accurate sensors. Thus, the faithful modeling of the propagation of linear waves in a layered, periodic structure with such materials at the interfaces is of paramount importance in many branches of the applied sciences. In this paper, we present a novel formulation of the problem featuring surface currents to model the two‐dimensional materials which not only is free of the artificial singularities present in related approaches, but also can be used to deliver a proof of existence, uniqueness, and analytic dependence of solutions. We advocate for a surface integral formulation which is phrased in terms of well‐chosen Impedance–Impedance Operators that are immune to the Dirichlet eigenvalues which plague the Dirichlet–Neumann Operators that appear in classical formulations. With a High‐Order Perturbation of Surfaces approach we are able to give a straightforward demonstration of this new well‐posedness result which only requires the verification that a finite collection of explicitly stated transcendental expressions be nonzero. We further illustrate the utility of this formulation by displaying results of a High‐Order Spectral numerical implementation which is flexible, rapid, and robust.
The paradox of teaching wellness: Lessons from a national obstetrics and gynaecology resident curriculum
Authors: Winkel Abigail Ford , Fitzmaurice Laura E. , Jhaveri Stacie A. , Tristan Sigrid B. , Woodland Mark B. , Morgan Helen Kang
Published: May 2021

Background

In response to high rates of burnout among trainees, educators in obstetrics and gynaecology introduced a six‐session wellness curriculum that improved professional fulfilment and resident burnout in participants with greater attendance. The implementation of the curriculum varied based on local variables and contextual factors.

Objective

To analyse the reactions of participants and curriculum leaders across the diverse settings of the pilot experience in order to identify the best practices for implementation of a wellness curriculum.

Methods

Twenty‐five US OBGYN residency programmes completed the curriculum in the 2017–2018 academic year. OBGYN residents in all the years of training participated. Faculty members and fellows were workshop facilitators and course leaders. All participants completed post‐intervention surveys. A qualitative, descriptive thematic analysis explored free‐text responses from residents and workshop facilitators.

Results

Among 592 eligible resident participants, 387 (65%) responded to the post‐intervention survey. Workshop facilitators submitted 65 surveys (47% response) on curriculum elements, rating the activities as ‘good’ or ‘excellent’ in 90.8% of cases. Qualitative analysis of workshop facilitators’ and resident comments pointed to three themes, namely disagreement about the purpose of the curriculum, the social value of the curriculum in the residency programme and the need to open a broader discussion and take action to address structural barriers to wellness.

Conclusions

Residents and faculty members involved in a wellness curriculum pilot had polarised reactions. While participants found value in learning skills and connecting to colleagues, efforts to promote wellness skills should be accompanied by communication and action to address drivers of burnout.
Non‐invasive monitoring of red blood cells during cold storage using handheld Raman spectroscopy
Authors: Vardaki Martha Z. , Schulze Hans Georg , Serrano Katherine , Blades Michael W. , Devine Dana V. , Turner Robin F. B.
Published: May 2021

Background

The current best practices allow for the red blood cells (RBCs) to be stored for prolonged periods in blood banks worldwide. However, due to the individual‐related variability in donated blood and RBCs continual degradation within transfusion bags, the quality of stored blood varies considerably. There is currently no method for assessing the blood product quality without compromising the sterility of the unit. This study demonstrates the feasibility of monitoring storage lesion of RBCs in situ while maintaining sterility using an optical approach.

Study design and methods

A handheld spatially offset Raman spectroscopy (RS) device was employed to non‐invasively monitor hemolysis and metabolic changes in 12 red cell concentrate (RCC) units within standard sealed transfusion bags over 7 weeks of cold storage. The donated blood was analyzed in parallel by biochemical (chemical analysis, spectrophotometry, hematology analysis) and RS measurements, which were then correlated through multisource correlation analysis.

Results

Raman bands of lactate (857 cm−1), glucose (787 cm−1), and hemolysis (1003 cm−1) were found to correlate strongly with bioanalytical data over the length of storage, with correlation values 0.98 (95% confidence interval [CI]: 0.86–1.00; p = .0001), 0.95 (95% CI: 0.71–0.99; p = .0008) and 0.97 (95% CI: 0.79–1.00; p = .0004) respectively.

Discussion

This study demonstrates the potential of collecting information on the clinical quality of blood units without breaching the sterility using Raman technology. This could significantly benefit quality control of RCC units, patient safety and inventory management in blood banks and hospitals.
Young Children’s Mobile Device Use in Public Places: Immersion, Distraction, and Co-Use
Authors: Floegel Diana , Elias Nelly , Lemish Dafna
Published: May 2021

Though prior research has examined how parents use mobile devices in public, we know less about children’s use of mobile devices outside the home. The present study therefore explores how children use mobile devices in public places they visit with their parents in order to conceptualize how device use affects children’s interactions with their parents and environments. We used naturalistic non-participant observational methods in three locations in the US: eateries, laundromats, and airports. We observed 77 families with at least one parent and one child estimated to be between 2-6 years old. The observers wrote detailed field notes that we analyzed qualitatively using thematic analysis. We found that children used mobile devices in 31% of the observed families. We categorized children’s behaviors under three themes: immersion, distraction, and co-use. Children were highly engaged with their parents and environment during co-use. However, when children asked for a device or were provided with a device that they used on their own, they were less engaged with parents and environments. Engagement levels between children and parents therefore corresponded with the circumstances of children’s device use and whether they used devices with their parents or in isolation from them. The themes we develop here may be applied to future qualitative and quantitative studies of children’s mobile device use in public and at home.
Sedación para procedimientos en el servicio de urgencias
Authors: Rodriguez Prada Catalina , Peñaloza Rey Nicolás Felipe , Parra Córdoba Jóse Fernando , Moreno Carillo Atilio
Published: May 2021

Los pacientes en el departamento de urgencias a menudo necesitan someterse a procedimientos diagnósticos y terapéuticos dolorosos, angustiosos o desagradables como parte de su atención. El uso de varios analgésicos, sedantes y anestésicos se ha descrito en varias guías bien referenciadas. Las diferentes opciones para la administración de sedación en urgencias actualmente permiten que se realice de forma mas efectiva y segura, además de facilitar el llevar a cabo ciertos procedimientos que de otra forma tendrían que requerir anestesia en el quírofano, de esta forma agilizando el manejo de los paciente y disminuyendo el tiempo de estancia intrahospitalaria de los pacientes.
Trade-Offs between Antibacterial Resistance and Fitness Cost in the Production of Metallo-β-Lactamases by Enteric Bacteria Manifest as Sporadic Emergence of Carbapenem Resistance in a Clinical Setting
Authors: Cheung Ching Hei Phoebe , Alorabi Mohammed , Hamilton Fergus , Takebayashi Yuiko , Mounsey Oliver , Heesom Kate J. , Williams Philip B. , Williams O. Martin , Albur Mahableshwar , MacGowan Alasdair P. , Avison Matthew B.
Published: May 2021

Meropenem is a clinically important antibacterial reserved for treatment of multiresistant infections. In meropenem-resistant bacteria of the family
Enterobacterales
, New Delhi metallo-β-lactamase 1 (NDM-1) is considerably more common than IMP-1, despite both metallo-β-lactamases (MBLs) hydrolyzing meropenem with almost identical kinetics.
Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Virus and Viral RNA in Relation to Surface Type and Contamination Concentration
Authors: Paton Susan , Spencer Antony , Garratt Isobel , Thompson Katy-Anne , Dinesh Ikshitaa , Aranega-Bou Paz , Stevenson David , Clark Simon , Dunning Jake , Bennett Allan , Pottage Thomas
Published: May 2021

This study shows the impact of material type on the viability of SARS-CoV-2 on surfaces. It demonstrates that the decay rate of viable SARS-CoV-2 is independent of starting concentration.
Analytical Performance Characteristics of a New Transcription-Mediated Amplification Assay for Treponema pallidum
Authors: Getman Damon , Lin Mike , Barakat Nesreen , Skvoretz Rhonda , Godornes Charmie , Swenson Paul , Nenninger Ashley , Golden Matthew R. , Lukehart Sheila A.
Published: May 2021

This study evaluated the performance characteristics of a new research-use-only transcription-mediated amplification (TMA) assay for the detection of rRNA from
Treponema pallidum
. Analytical sensitivity determined using dark-field microscopy-quantitated
T. pallidum
was 1.4 organisms/ml (95% confidence interval [CI], 0.7 to 6.33 organisms/ml).
Positive Selection Inhibits Plasmid Coexistence in Bacterial Genomes
Authors: Carrilero Laura , Kottara Anastasia , Guymer David , Harrison Ellie , Hall James P. J. , Brockhurst Michael A.
Published: May 2021

Bacterial genomes often contain multiple coexisting plasmids that provide important functions like antibiotic resistance. Using lab experiments, we show that such plasmid coexistence within a genome is stable only in environments where the function they encode is useless but is unstable if the function is useful and beneficial for bacterial fitness.
The Chaperonin GroESL Facilitates Caulobacter crescentus Cell Division by Supporting the Functions of the Z-Ring Regulators FtsA and FzlA
Authors: Schroeder Kristen , Heinrich Kristina , Neuwirth Ines , Jonas Kristina
Published: May 2021

All organisms depend on mechanisms that protect proteins from misfolding and aggregation. GroESL is a highly conserved molecular chaperone that functions to prevent protein aggregation in organisms ranging from bacteria to humans.
Network Properties of Local Fungal Communities Reveal the Anthropogenic Disturbance Consequences of Farming Practices in Vineyard Soils
Authors: Ortiz-Álvarez Rüdiger , Ortega-Arranz Héctor , Ontiveros Vicente J. , de Celis Miguel , Ravarani Charles , Acedo Alberto , Belda Ignacio
Published: May 2021

Soil fungal communities play a key role in agroecosystem sustainability. The complexity of fungal communities, at both taxonomic and functional levels, makes it difficult to find clear patterns connecting community composition with ecosystem function and to understand the impact of biotic (interspecies interactions) and abiotic (e.g., climate or anthropogenic disturbances) factors on it.
Mycobacteria Tolerate Carbon Monoxide by Remodeling Their Respiratory Chain
Authors: Bayly Katherine , Cordero Paul R. F. , Kropp Ashleigh , Huang Cheng , Schittenhelm Ralf B. , Grinter Rhys , Greening Chris
Published: May 2021

Carbon monoxide has an infamous reputation as a toxic gas, and it has been suggested that it has potential as an antibacterial agent. Despite this, how bacteria resist its toxic effects is not well understood.
Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle
Authors: Soni Roopali , Tscherning Wel-Wel Charlotte , Robertson Nicola J
Published: May 2021

Advances in neonatal–perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.
Scalp malignant trichilemmal tumour with bony erosion: a new clinical entity
Authors: Virdi Amrita , Borghol Khaled , Edwards Bethan , Barnard Neal
Published: May 2021

Trichilemmoma is a benign tumour which arises from the hair follicle root sheath, and commonly occurs in the head and neck area. Malignant transformation and locally aggressive growth of these tumours are very rare. Surgical excision remains the mainstay of management, with scarce evidence for other treatment modalities. We describe our experience of a malignant trichilemmal tumour which demonstrated bony erosion with intracranial extension. Our patient was treated with radical radiotherapy, with a good response at 6 months of follow-up. This case highlights the need to consider malignant potential in recurrent skin lesions, along with the potential for trichilemmoma to erode bone, necessitating the consideration of different treatment modalities.
Linking prediction models to government ordinances to support hospital operations during the COVID-19 pandemic
Authors: Warde Prem Rajendra , Patel Samira S , Ferreira Tanira D , Gershengorn Hayley B , Bhatia Monisha C , Parekh Dipen J , Manni Kymberlee J , Shukla Bhavarth S
Published: May 2021

Objectives

We describe a hospital’s implementation of predictive models to optimise emergency response to the COVID-19 pandemic.

Methods

We were tasked to construct and evaluate COVID-19 driven predictive models to identify possible planning and resource utilisation scenarios. We used system dynamics to derive a series of chain susceptible, infected and recovered (SIR) models. We then built a discrete event simulation using the system dynamics output and bootstrapped electronic medical record data to approximate the weekly effect of tuning surgical volume on hospital census. We evaluated performance via a model fit assessment and cross-model comparison.

Results

We outlined the design and implementation of predictive models to support management decision making around areas impacted by COVID-19. The fit assessments indicated the models were most useful after 30 days from onset of local cases. We found our subreports were most accurate up to 7 days after model run.

Discusssion

Our model allowed us to shape our health system’s executive policy response to implement a ‘hospital within a hospital’—one for patients with COVID-19 within a hospital able to care for the regular non-COVID-19 population. The surgical schedule is modified according to models that predict the number of new patients with Covid-19 who require admission. This enabled our hospital to coordinate resources to continue to support the community at large. Challenges included the need to frequently adjust or create new models to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders. The model we created can be adapted to other health systems, provide a mechanism to predict local peaks in cases and inform hospital leadership regarding bed allocation, surgical volumes, staffing, and supplies one for COVID-19 patients within a hospital able to care for the regular non-COVID-19 population.

Conclusion

Predictive models are essential tools in supporting decision making when coordinating clinical operations during a pandemic.
Supporting people to implement a reduced carbohydrate diet: a qualitative study in family practice
Authors: Cupit Caroline , Redman Emma
Published: May 2021

Introduction

Much of the science behind dietary guidelines for risk reduction and chronic disease management is equivocal, and there are well-accepted uncertainties and complexities relating to diet in everyday life, as well as physiological processes. Guidelines have therefore stopped short of aligning with one particular approach, instead highlighting several evidence-based options. However, reduced carbohydrate, or ‘low-carb’, diets have increasing traction in the media and with patients, practitioners and the general public. This qualitative study examines healthcare practitioner (HCP) experiences of implementing a reduced carbohydrate diet.

Methods

Semistructured, qualitative interviews were conducted with 19 HCPs in the UK family practice (including general practitioners, practice nurses and non-medical practitioners), recruited through a special interest forum, and social media. Data analysis employed social science theory and methods to produce key themes.

Results

All participants self-identified as ‘low-carb practitioners’ who, over time, had introduced a specific focus around carbohydrate reduction into their work. They reported transformations in patients’ metabolic markers, patient enthusiasm for the approach and renewed job satisfaction. Key themes highlight experiences of: (1) discovering low-carb as a new ‘tool-in-the-box’; (2) promoting and supporting incremental low-carb experimentation; and (3) diverging from established dietary guidelines.

Conclusions

This study provides important experience-based evidence on a topical dietary intervention. Participants strongly advocated for the use of low-carb diets. The successes described draw attention to the need for pragmatic, formative evaluation of low-carb advice and support as a ‘complex intervention’ (alongside physiological research), to justify, challenge and/or shape low-carb intervention in clinical practice. The findings raise important questions about the contribution of particularcare practicesto the apparent success of low-carb. Social science analyses can elucidate how dietary intervention is carried out across different healthcare settings (eg, dietetics, endocrinology) and patient groups, how healthcare practices intersect with people’s everyday self-management and how different forms of evidence are invoked and prioritised.