bluuebunny/crossref_metadata_2025 huggingface dataset:
Best therapeutic practices for the use of antibacterial agents in finfish aquaculture: a particular view on European seabass (Dicentrarchus labrax) and gilthead seabream (Sparus aurata) in Mediterranean aquaculture
Authors: Rigos George , Kogiannou Dimitra , Padrós Francesc , Cristòfol Carles , Florio Daniela , Fioravanti Marialetizia , Zarza Carlos
Published: December 2020

Antibacterial therapy is still in many cases the only way to control bacterial disease outbreaks, with relevant economic issues. Nevertheless, this necessity should also be well balanced with other relevant aspects such as suitability, efficacy and refinement of the treatments but also with consumer and environmental welfare. With this aim, the literature pertaining to the use of antibacterials (i.e. oxytetracycline, oxolinic acid, flumequine and potentiated sulphonamides) in Mediterranean farmed European seabass (Dicentrarchus labrax) and gilthead seabream (Sparus aurata) was reviewed and addressed. Knowledge of drug pharmacokinetics along with the related legislation is also presented. The main criteria, technical aspects and constraints affecting the design of an appropriate antibacterial therapy are also discussed. An evaluation of available bibliography revealed the existence of considerable information on several registered antibacterials, while it is limited for others. Typically, minimum inhibitory concentrations (MIC) have been used as a reference for antibacterial selection. However, the methodologies used for MIC assessment require refinement and more sophisticated data such as epidemiological cut‐off breakpoint values. Due to the characteristics of farming systems, antibacterials are mostly delivered through medicated feeds. The large number of production units and number of fish per unit, together with a limited timeframe margin for efficient therapy, makes Mediterranean gilthead seabream and European seabass, one of the best examples where the metaphylactic concept has to be considered in aquatic medicine. The information presented in this review should guide future action taken to fulfil research gaps and promote effective and prudent antibacterial practices.
Privacy Accountability and Penalties for IoT Firms
Authors: Ciardiello Francesco , Di Liddo Andrea
Published: December 2020

Internet of things (IoT) business partnership are formed by technological partners and traditional manufacturers. IoT sensors and devices capture data from manufacturers' products. Data enforce product/service innovation thanks to data sharing among companies. However, data sharing among firms increases the risk of data breaches. The latter is due to two phenomena: information linkage and privacy interdependency. Data Protection Authorities (DPA) protect data users' rights and fine firms if there is an infringement of privacy laws. DPA sanction the responsible for the infringement of privacy laws. We present two different business scenarios: the first occurs when each firm is a data owner; the second occurs when only the manufacturer is the data owner. For both scenarios, we present two fair penalty schemes that suggest the following: total amount of the fine; and how to share the fine among participants. Penalties critically vary at how innovation networks are structured in IoT industries. Our penalties provide incentives to data sharing since they redistribute firms' responsibility against data breaches. Our penalties may mitigate the risk on the manufacturer if is the unique responsible for data handling.
Learning to teach science in urban schools: Context as content
Authors: Marco‐Bujosa Lisa M. , Friedman Audrey A. , Kramer Allison
Published: December 2020

The purpose of this phenomenological study was to explore how science teachers who persisted in urban schools interpreted and responded to the unique features of urban educational contexts. With 17 alumni who taught in metropolitan areas across seven states, the Science Educators for Urban Schools (SEUS) program provided a research setting that offered a unique view of science teachers’ development of knowledge of urban education contexts. Data sources included narratives of teaching experiences from interviews and open‐ended survey items. Findings were interpreted in light of context knowledge for urban educational settings. Findings indicated that science teaching in urban contexts was impacted by the education policy context, notably through accountability policies that narrowed and marginalized science instruction; community context, evident in teacher efforts to make science more relevant to students; and school contexts, notability their ability to creatively adjust for resource deficiencies and continue their own professional growth. Participants utilized this context knowledge to transform student opportunities to learn science. The study suggests that future science education research and teacher preparation efforts would benefit from further attention to the unique elements of urban contexts, specifically the out of classroom contexts that shape science teaching and learning.
Recognition of the new HLA‐DQB1*06 variant, HLA‐DQB1*06:03:41, in a Russian individual
Authors: Shagimardanova Elena , Ananeva Anastasiia , Leksina Yana , Gusev Oleg
Published: December 2020

One nucleotide substitution in codon 174 of HLA‐DQB1*06:03:01:01 results in a novel allele, HLA‐DQB1*06:03:41.
Motivators of and barriers to becoming a COVID‐19 convalescent plasma donor: A survey study
Authors: Masser Barbara M. , Ferguson Eamonn , Thorpe Rachel , Lawrence Claire , Davison Tanya E. , Hoad Veronica , Gosbell Iain B.
Published: December 2020

Objectives

To determine the motivators and barriers to COVID‐19 convalescent plasma donation by those in the United Kingdom who have been diagnosed with or who have had symptoms of SARS‐CoV‐2 (COVID‐19) but who have not donated.

Background

Convalescent plasma from people recovered from COVID‐19 with sufficient antibody titres is a potential option for the treatment and prevention of COVID‐19. However, to date, recruiting and retaining COVID‐19 convalescent plasma donors has been challenging. Understanding why those eligible to donate COVID‐19 convalescent plasma have not donated is critical to developing recruitment campaigns.

Methods/Materials

A total of 419 UK residents who indicated that they had been infected with COVID‐19 and who lived within 50 km of sites collecting COVID‐19 convalescent plasma completed an online survey between 25th June and 5th July 2020. Respondents completed items assessing their awareness of convalescent plasma, motivations and barriers to donation and intention to donate COVID‐19 convalescent plasma.

Results

Awareness of COVID‐19 convalescent plasma was low. Exploratory factor analysis identified six motivations and seven barriers to donating. A stronger sense of altruism through adversity and moral and civic duty were positively related to intention to donate, whereas generic donation fears was negatively related.

Conclusions

Once potential donors are aware of convalescent plasma, interventions should focus on the gratitude and reciprocity that those eligible to donate feel, along with a focus on (potentially) helping family and norms of what people ought to do. Fears associated with donation should not be neglected, and strategies that have been successfully used tor recruit whole‐blood donors should be adapted and deployed to recruit COVID‐19 convalescent plasma donors.
Effect of patient blood management system and feedback programme on appropriateness of transfusion: An experience of Asia's first Bloodless Medicine Center on a hospital basis
Authors: Shin Hyeon Ju , Kim Jong Hun , Park Yujin , Ahn Ki Hoon , Jung Jae Seung , Park Jong Hoon ,   Korea University Bloodless Medicine Center Scientific Committee
Published: December 2020

Background

Patient blood management (PBM) programmes minimise red blood cell (RBC) transfusion and improve patient outcomes worldwide. This study evaluated the effect of a multidisciplinary, collaborative PBM programme on the appropriateness of RBC transfusion in medical and surgical departments at a hospital level.

Methods/Materials

In 2018, the revised PBM programme was launched at the Korea University Anam Hospital, a tertiary hospital with 1048 hospital beds and the first Asian institution where a new computer PBM programme was implemented. Monthly RBC usage and adequacy were analysed from January 2018 to December 2019. The trend of adequacy over time was assessed.

Results

A total of 2 201 021 patients were hospitalised and visited an outpatient clinic. The number of RBC units transfused per 10 000 patients decreased from 139.8 for 2018 to 137.3 for 2019. The proportion of patients with Hb <7 g/dL receiving RBC transfusion increased significantly: 29.1%, 34.5%, 40.4% and 40.6% for periods 1, 2, 3 and 4, respectively (p < 0.001). The appropriateness of RBC transfusion significantly increased for medical (35.2%, 41.5%, 49.6% and 74.3% for periods 1, 2, 3 and 4, respectively [p < 0.001]) and surgical (37.8%, 33.3%, 45.5% and 71.1% for periods 1, 2, 3 and 4, respectively [p < 0.001]) departments.

Conclusion

Implementation of a PBM programme through a multidisciplinary clinical community approach increased the appropriateness of RBC transfusion in medical and surgical departments. Therefore, expanding publicity and PBM education to health care providers is important to maintain the appropriateness of blood transfusion.
Occurrence of spilled genetically modified oilseed rape growing along a Japanese roadside over 10 years
Authors: Nakajima Nobuyoshi , Nishizawa Toru , Aono Mitsuko , Tamaoki Masanori , Saji Hikaru
Published: December 2020

To map the distribution of feral oilseed rape (Brassica napus L.) in Japan, we conducted a roadside survey along 19 km of Route 51 for 10 years, from 2005 to 2014. We found more than 2,000 plants in the first 2 years. The number decreased to 150–305 from 2007 to 2010, and to only 27 in 2014, likely owing to extensive road repairs. Three areas of high frequency were found. One area features frequent hills. The second was where the road narrows, likely where seeds spill from trucks as they decelerate or accelerate. The third is in a fenced patch, showing that if spilled seeds fall in places where they cannot be managed, they can perpetuate. Our survey confirms that feral oilseed rape has nearly disappeared from this road. The proportion of genetically modified (GM) oilseed rape in the feral population was low, and it decreased as the total number of rape plants decreased. Therefore, we conclude that the distribution of GM oilseed rape growing along Route 51 has no effect on biodiversity such as suppression of other species' distribution and introgressive hybridization with wild relatives. This is the first report of a long‐term survey on the fate of oilseed rapes growing along transportation route in Japan.
Investment Scenarios in the Clonal Conilon Coffee Planting with an Irrigated System: A Study in a City from Rondônia, Brazil
Authors: Morais Camila Dutra Santos de , Garcia Sandra Da Cruz , Militão Júlio Sancho , Da Silva Davy Ítalo Ribeiro , Júnior Francisco Cordeiro , Da Silva Viviane Barrozo , Garcia Sueli Da Cruz , Medeiros Haroldo De Sa
Published: December 2020

This article aims to analyze the financial feasibility of implementing a clonal conilon coffee crop in the State of Rondônia. For this, a research with quantitative procedures was carried out, having as a locus of research a property in the municipality of Nova Brasilândia D’Oeste, interior of the state of Rondônia (Brazil). Based on the assumption that investments are made to generate value for the investor, the expenses incurred and estimates of future expenses were measured, with two scenarios, the first with the presence of the plague (scale) and the second without the presence of the same. Therefore, it became possible to analyze the valuation methods through the projections of Net Present Value, Internal Rate of Return and Payback. With these results, an analysis of the financial viability of the crop in question was carried out, which demonstrated a significant expense in the first years for the small producer, having a return from the fifth year on, proving to be financially viable and advantageous.
Bone metastases induce metabolic changes and mitophagy in mice
Authors: Wilcox‐Hagerty Jenna , Xu Haifang , Hain Brian A. , Arnold Amy C. , Waning David L.
Published: December 2020

New Findings

What is the central question of this study?

Cachexia causes severe changes in skeletal muscle metabolism and function and is a key predictor of negative outcomes in cancer patients: what are the changes in whole animal energy metabolism and mitochondria in skeletal muscle?

What is the main finding and its importance?

There is decreased whole animal energy expenditure in mice with cachexia. They displayed highly dysmorphic mitochondria and mitophagy in skeletal muscle.

Cachexia causes changes in skeletal muscle metabolism. Mice with MDA‐MB‐231 breast cancer bone metastases and cachexia have decreased whole animal energy metabolism and increased skeletal muscle mitophagy. We examined whole animal energy metabolism by indirect calorimetry in mice with MDA‐MB‐231 breast cancer bone metastases, and showed decreased energy expenditure. We also examined skeletal muscle mitochondria and found that mitochondria in mice with MDA‐MB‐231 bone metastases are highly dysmorphic and have altered protein markers of mitochondrial biogenesis and dynamics. In addition, LC3B protein was increased in mitochondria of skeletal muscle from cachectic mice, and colocalized with the mitochondrial protein Tom20. Our data demonstrate the importance of mitophagy in cachexia. Understanding these changes will help contribute to defining treatments for cancer cachexia.
Priming the cardiodynamic phase of pulmonary oxygen uptake through voluntary modulations of the respiratory pump at the onset of exercise
Authors: Stucky Frédéric , Aliverti Andrea , Kayser Bengt , Uva Barbara
Published: December 2020

New Findings

What is the central question of this study?

The initial increase in oxygen uptake () at exercise onset results from pulmonary perfusion changes secondary to an increased venous return. Breathing mechanics contribute to venous return through abdominal and intrathoracic pressures variation. Can voluntary breathing techniques (abdominal or rib cage breathing) increase venous return and improve at exercise onset?

What is the main finding and its importance?

Abdominal and rib cage breathing increase venous return and at exercise onset. This mechanism could be clinically relevant in patients with impaired cardiac function limiting oxygen transport.

We examined how different breathing patterns can modulate venous return and alveolar gas transfer during exercise transients in humans. Ten healthy men transitioned from rest to moderate cycling while breathing spontaneously (SP) or with voluntary increases in abdominal (AB) or intrathoracic (RC) pressure swings. We used double body plethysmography to determine blood displacements between the trunk and the extremities (Vbs). From continuous signals of airflow and O2 fraction, we calculated breath‐by‐breath oxygen uptake at the mouth and used optoelectronic plethysmography to correct for lung O2 store changes and calculate alveolar O2 transfer (). Oesophageal (Poes) and gastric (Pga) pressures were monitored using balloon‐tipped catheters. Cardiac stroke volume was measured using impedance cardiography. During the cardiodynamic phase (Φ1) of ‐on kinetics (20 s following exercise onset), AB and RC increased total alveolar oxygen transfer compared to SP (227 ± 32, P = 0.019 vs. 235 ± 27, P = 0.001 vs. 206 ± 20 ml, mean ± SD). Pga and Poes swings increased with AB (by 24.4 ± 9.6 cmH2O, P < 0.001) and RC (by 14.5 ± 5.7 cmH2O, P < 0.001), respectively. AB yielded a greater increase in intra‐breath Vbs swings compared with RC and SP (+0.30 ± 0.14 vs. +0.16 ± 0.11, P < 0.001 vs. +0.10 ± 0.05 ml, P = 0.006) and increased the sum of stroke volumes compared to SP (4.47 ± 1.28 vs. 3.89 ± 0.96 litres, P = 0.053), while RC produced significant central blood translocation from the extremities compared with SP (by 493 ± 311 ml, P < 0.001). Our findings indicate that combining exercise onset with AB or RC increases venous return, thus increasing mass oxygen transport above metabolic consumption during Φ1 and limiting the oxygen deficit incurred.
Maximum axonal following frequency separates classes of cutaneous unmyelinated nociceptors in the pig
Authors: Werland Fiona , Hirth Michael , Rukwied Roman , Ringkamp Matthias , Turnquist Brian , Jorum Ellen , Namer Barbara , Schmelz Martin , Obreja Otilia
Published: December 2020

Key points

C‐nociceptors are generally assumed to have a low maximum discharge frequency of 10–30 Hz. However, only mechano‐insensitive ‘silent’ C‐nociceptors cannot follow electrical stimulation at 5 Hz (75 pulses) whereas polymodal C‐nociceptors in the pig follow stimulation at up to 100 Hz without conduction failure.

Sensitization by nerve growth factor increases the maximum following frequency of ‘silent’ nociceptors in pig skin and might thereby contribute in particular to intense pain sensations in chronic inflammation.

A distinct class of C‐nociceptors with mechanical thresholds >150 mN resembles ‘silent’ nociceptors at low stimulation frequencies in pigs and humans, but is capable of 100 Hz discharge and thus is suited to encode painfulness of noxious mechanical stimuli.

Using extracellular single‐fibre recordings from the saphenous nerve in pig in vivo, we investigated peak following frequencies (5–100 Hz) in different classes of C‐nociceptors and their modulation by nerve growth factor. Classes were defined by sensory (mechano‐sensitivity) and axonal characteristics (activity dependent slowing of conduction, ADS).

Mechano‐insensitive C‐nociceptors (CMi) showed the highest ADS (34% ± 8%), followed only 66% ± 27% of 75 pulses at 5 Hz and increasingly blocked conduction at higher frequencies. Three weeks following intradermal injections of nerve growth factor, peak following frequency increased specifically in the sensitized mechano‐insensitive nociceptors (20% ± 16% to 38% ± 23% response rate after 72 pulses at 100 Hz). In contrast, untreated polymodal nociceptors with moderate ADS (15.2% ± 10.2%) followed stimulation frequencies of 100 Hz without conduction failure (98.5% ± 6%). A distinct class of C‐nociceptors was exclusively sensitive to strong forces above 150 mN. This class had a high ADS (27.2% ± 7.6%), but displayed almost no propagation failure even at 100 Hz stimulation (84.7% ± 17%). Also, among human mechanosensitive nociceptors (n = 153) those with thresholds above 150 mN (n = 5) showed ADS typical of silent nociceptors. C‐fibres with particularly high mechanical thresholds and high following frequency form a distinct nociceptor class ideally suited to encode noxious mechanical stimulation under normal conditions when regular silent nociceptors are inactive. Sensitization by nerve growth factor increases maximum discharge frequency of silent nociceptors, thereby increasing the frequency range beyond their physiological limit, which possibly contributes to excruciating pain under inflammatory conditions.
Abnormal cerebellar function and tremor in a mouse model for non‐manifesting partially penetrant dystonia type 6
Authors: van der Heijden Meike E. , Kizek Dominic J. , Perez Ross , Ruff Elena K. , Ehrlich Michelle E. , Sillitoe Roy V.
Published: December 2020

Key points

Loss‐of‐function mutations in the Thap1 gene cause partially penetrant dystonia type 6 (DYT6).

Some non‐manifesting DYT6 mutation carriers have tremor and abnormal cerebello‐thalamo‐cortical signalling.

We show that Thap1 heterozygote mice have action tremor, a reduction in cerebellar neuron number, and abnormal electrophysiological signals in the remaining neurons.

These results underscore the importance of Thap1 levels for cerebellar function.

These results uncover how cerebellar abnormalities contribute to different dystonia‐associated motor symptoms.

Loss‐of‐function mutations in the Thanatos‐associated domain‐containing apoptosis‐associated protein 1 (THAP1) gene cause partially penetrant autosomal dominant dystonia type 6 (DYT6). However, the neural abnormalities that promote the resultant motor dysfunctions remain elusive. Studies in humans show that some non‐manifesting DYT6 carriers have altered cerebello‐thalamo‐cortical function with subtle but reproducible tremor. Here, we uncover that Thap1 heterozygote mice have action tremor that rises above normal baseline values even though they do not exhibit overt dystonia‐like twisting behaviour. At the neural circuit level, we show using in vivo recordings in awake Thap1+/− mice that Purkinje cells have abnormal firing patterns and that cerebellar nuclei neurons, which connect the cerebellum to the thalamus, fire at a lower frequency. Although the Thap1+/− mice have fewer Purkinje cells and cerebellar nuclei neurons, the number of long‐range excitatory outflow projection neurons is unaltered. The preservation of interregional connectivity suggests that abnormal neural function rather than neuron loss instigates the network dysfunction and the tremor in Thap1+/− mice. Accordingly, we report an inverse correlation between the average firing rate of cerebellar nuclei neurons and tremor power. Our data show that cerebellar circuitry is vulnerable to Thap1 mutations and that cerebellar dysfunction may be a primary cause of tremor in non‐manifesting DYT6 carriers and a trigger for the abnormal postures in manifesting patients.
Energy, Exergy, Economic and Environmental Analyses of Air-Based High-Temperature Thermal Energy and Electricity Storage: Impacts of Off-Design Operation
Authors: Rahbari Hamid Reza , Arabkoohsar Ahmad , Jannatabadi Mohsen
Published: December 2020

The present study presents a comprehensive assessment of the impacts of the off-design operation of an air-based high-temperature thermal energy and electricity storage (also known as high-temperature heat and power storage) system on its energy, exergy, economic, and environmental aspects. Here, the effects of load variations on the mass flowrate, pressure ratio, and isentropic efficiency of the turbomachinery are considered to give the most accurate possible picture of the techno-economic aspects of the performance of the system. The results of such an assessment will be extremely useful in achieving the optimal performance of the energy storage system while working parallel with solar and wind power plants. The results prove that the system will present high overall energy and exergy efficiencies of 91.5% and 88.16% when working at full load all the time. These indices, however, will be as low as 67.8% and 65.9% at an annual average operation load of 70% and even further lower to 34% and 32.7% at 40% load, respectively. The payback period of the system will decrease from 11 to 23 years when the operation load falls from 100% to 80%. The environmental effects of such an energy storage unit for an energy market like Denmark (for instance) will be about 6355, 3227, and 823 tonnes of reduced equivalent carbon-dioxide when working at 100%, 70%, and 40% loads, respectively.
Technoeconomic Design of a Geothermal-Enabled Cold Climate Zero Energy Community
Authors: Becker William , Christensen Dane , Cutler Dylan , Maguire Jeff , McCabe Kevin , Reese Samantha , Speake Andrew
Published: December 2020

Development of a zero energy community is more costly in northern cold climates than in moderate regions. Building energy loads are higher, thanks to the colder weather, and site solar photovoltaics (PV) are less productive due to lower solar incidence and misalignment with the buildings’ energy needs (summer production, winter demands). Geothermal energy production can support a zero energy community through application of energy efficiency (demand design), geothermal production (supply design), and asset dispatch as an integrated techno-economic package. This article presents the process used to explore geothermal system integration, our findings, and technical challenges for community-scale adoption of geothermal as an electric and thermal resource. We show that under a wide range of conditions, community-scale geothermal electric power and direct-use thermal energy is economically competitive with “business-as-usual” design and construction practices for zero energy communities. Furthermore, geothermal-produced energy will be self-consumed to a much greater extent than PV, resulting in significant reductions in site energy import and export. We conclude that under appropriate conditions, community-scale geothermal can be the most economically favorable energy resource for northern-climate zero energy community developments. Ongoing geothermal research and development to improve performance and reduce costs will further enhance the value proposition for community-scale geothermal technologies. We expect that including geothermal power and thermal energy in zero energy community design can improve its cost-effectiveness and therefore enhance the benefits of zero energy in more northern climates.
Fiber-Filled Hybrid Hydrogel for Bio-Manufacturing
Authors: Habib Ahasan , Khoda Bashir
Published: December 2020

Extrusion-based three-dimensional (3D) bio-printing deposits cell-laden bio-ink with high spatial resolution and may offer living tissue regeneration. Due to the biocompatibility, very low cytotoxicity, and high-water content, natural hydrogels are commonly considered as the cell-laden bio-ink for scaffold fabrication. However, due to the low mechanical integrity, a large-scale scaffold (>10 layers) with intricate architecture is a challenge. In this paper, we developed and characterized a novel bio-ink consisting of alginate, carboxymethyl cellulose (CMC), and 2,2,6,6 tetramethyl-1-piperidinyloxy (TEMPO)-mediated nanofibrillated cellulose (TO-NFC) for bio-printing applications. The potential of cellulose derivatives in terms of rheological property to satisfy scaffold architecture and cell viability is explored with a relatively small amount of solid content (<5%). By combining alginate, CMC, and TO-NFC as a hybrid hydrogel, we design to overcome their individual challenges as bio-ink. At the design stage, we have considered two main characteristics: printability and shape fidelity with quantitative indices following their rheological characteristics. Our proposed hydrogel blend (5% solid content) demonstrates a 0% collapse rate for 3-mm pillar distance and 25% fusion rate for 5 mm × 5 mm pore size which can ensure shape fidelity. We fabricated 42 layers and a 9-mm tall scaffold structure with relatively lower applied pressure (10 psi). The proposed hybrid hydrogel is used to prepare bio-ink encapsulating cells, and cell viability is measured as 90% after 10 days of incubation.
Exploration of the Patterns of Physical Education Teachers’ Participation Within Self-Directed Online Professional Development
Authors: Lee Okseon , Choi Euichang , Goodyear Victoria , Griffiths Mark , Son Hyukjun , Jung Hyunsoo , Lee Wonhee
Published: December 2020

Although physical education (PE) teachers have increased access to digital/online continuous professional development activities, there are few robust accounts of how they engage with and experience these environments.Purpose: The purpose of this study was to examine PE teachers’ participation patterns within self-directed online PE continuous professional development activities using mobile instant messenger.Methods: Data were generated from (a) 5,246 messages exchanged in the mobile instant messenger chatroom from 281 teachers, (b) semistructured interviews with 10 teachers, and (c) 1,275 messages posted by the 10 interviewed teachers. Quantitative data were analyzed for measures of central tendency, and qualitative data were analyzed inductively.Findings: Five patterns of PE teachers’ usage of mobile instant messenger were identified: (a) ringmasters, (b) passive uploaders, (c) active uploaders, (d) requesters, and (e) bystanders.Discussion: The findings suggest that each engagement pattern illustrates the differential goals of learning, types of interaction, and forms of participation by teachers engaged in online continuous professional development.
Coach Like a Woman: Learnings From a Pilot Coach Education Program
Authors: Carson Fraser , McCormack Clara , McGovern Paula , Ralston Samara , Walsh Julia
Published: December 2020

This best practice paper reflects on a pilot coach education program designed for women coaching Australian Rules football. Focused on enhancing self-regulation, and underpinned by a growth mindset framework, the “Coach like a Woman” program was delivered to a selected group of female coaches either working in or having been identified with the potential to coach at high-performance levels. This manuscript describes the program content and discusses the key insights identified by the delivery team. Creating a community of practice encouraged the transfer of knowledge and experience between the enrolled coaches, which increased competence and self-confidence. Providing an understanding of behavioral tendencies enhanced positive self-talk and aided self-regulation by the coaches. The delivery of the program and challenges experienced are also discussed. This reflection on the program is provided to assist future developments in coach education.
Comprehensive care of a patient with obesity of BMI >70 kg/m2
Authors: Kabir Shaila , Hossain ABM Tofazzal , Shimmi Sadia Choudhury , Jie Choo Si
Published: December 2020

A 31-year-old woman, with a body mass index of 70.31 kg/m2, presented with progressive worsening of dyspnoea for 3 days. She had multiple comorbidities, including obesity hypoventilation syndrome. The patient developed type II respiratory failure with respiratory acidosis along with multiorgan failure. She was intubated and put on a mechanical ventilator and treated with intravenous diuretics, subcutaneous low-molecular-weight heparin and other supportive measures. Later, she was on noninvasive, continuous positive airway pressure ventilation overnight. She was prescribed a very-low-calorie diet along with physiotherapy and exercise. The patient underwent bariatric surgery 2 months after resolution of acute illness. Ten months after surgery, her body weight reduced from 180 kg to 121 kg, and her general condition improved. Successful management before and after surgical intervention depends on multidisciplinary teamwork, which includes the dietician, physiotherapist, endocrinologist, pulmonologist, nursing care and other supportive care.
Delayed urticaria or anaphylaxis after consumption of red meat with evidence of alpha-gal sensitisation
Authors: Garcia Maria Beatriz , Gomez-Samper Andres F , Garcia Elizabeth , Peñaranda Augusto
Published: December 2020

Food allergies to red meat, specifically to galactose-alpha-1,3-galactose (alpha-gal), a mammalian oligosaccharide, are considered to be very rare, especially in Asia and Latin America. Most of the cases reported are characterised by symptoms of delayed urticaria or anaphylaxis after the consumption of red meat. Sensitisation to red meat has been linked to the use of cetuximab or tick bites, especially from theAmblyomma americanumandIxodes sppspecies. Here, we documented a case study from a Colombian male patient with symptoms of delayed urticaria and anaphylaxis with a history of tick bites in Colombia. The patient presented with IgE antibodies specific to alpha-gal, which is the most common epitope linked to red meat allergy induced by tick bites.
Necrotising fungal scleritis with full-thickness scleral melt and circumferential progression: a novel debridement approach
Authors: Karkhur Samendra , Soni Deepak , Sharma Bhavana
Published: December 2020

A 44-year-old Asian Indian woman presented with a history of pain and redness in the left eye for 3 weeks. Scleral congestion with a nodular swelling was present inferotemporally. Raised C reactive protein and positive antinuclear and perinuclear antineutrophil cytoplasmic antibodies suggested autoimmune scleritis. The patient was therefore managed with corticosteroids. Nevertheless, the development of severe pain associated with a scleral abscess led to a revised diagnosis of infectious scleritis. Corticosteroids therapy was halted and urgent debridement was performed. Microbiology confirmed fungal scleritis due toCoprinopsis cinerea. Multiple full-thickness circumferential debridements with antifungal therapy resulted in satisfactory anatomical and visual outcomes. This case presented a unique challenge, since laboratory results were misleading, and corticosteroids resulted in a fulminant clinical course. Therefore, aggressive circumferential debridement was performed to achieve the elimination of a rare fungal aetiology of scleritis, which has not been reported previously to cause human infection.
Cardiac tamponade from anticoagulant-related spontaneous haemopericardium in a patient with ischaemic cardiomyopathy and heart failure
Authors: Lefas Alicia , Bodagh Neil , Pan Jiliu , Vazir Ali
Published: December 2020

We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.
Obturator hernia of Richter type: a diagnostic dilemma
Authors: Hayes Cathal , Schmidt Karl , Neduchelyn Yuwaraja , Ivanovski Ivan
Published: December 2020

An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians.
Lumbosacral spondylodiscitis complicated by sepsis, osteomyelitis, epidural abscess formation and deep vein thrombosis
Authors: Ceci Bonello Etienne , Vassallo Christian , Cassar Paul John
Published: December 2020

A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2–3 and L5–S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient’s clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.
Bilateral adrenal haemorrhage complicated by sepsis, coagulopathy, influenza A and adrenal crisis
Authors: Mulvihill Eanna , Gannon Martin , Balasubramaniam Ananthapadmanaban , Fitzpatrick John
Published: December 2020

Bilateral adrenal haemorrhage is a rare and often fatal condition that most commonly occurs under conditions of severe physiological stress. We describe a 33-year-old male patient with ulcerative colitis who presented with acute worsening epigastric pain, vomiting and raised inflammatory markers. Initial differentials included gastritis and peptic ulceration. Gastroscopy revealed no abnormalities. By day 3, he had developed sepsis with a sequential organ failure assessment score of 2 as well as coagulopathy. A subsequent CT scan diagnosed bilateral adrenal haemorrhage. A short Synacthen Test confirmed adrenal insufficiency and he was treated with replacement steroids and antibiotics for a possible urinary tract infection or pyelonephritis and he recovered well. Several days later he developed fever, dyspnoea and a productive cough. Subsequently, he became hypotensive (Blood Pressure (BP) 95/65 mm Hg) and unresponsive with a Glasgow Coma Scale of 7 and was hyponatraemic and hyperkalaemic. He was intubated and transferred to a tertiary hospital for intensive care unit management where investigations confirmed the patient to be influenza A positive.
Central ossifying fibroma of mandible
Authors: Nilesh Kumar , Punde Prashant , Patil Nitin Shivajirao , Gautam Amol
Published: December 2020

Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.
Risk factors for mental illness in adults with atopic eczema or psoriasis: protocol for a systematic review
Authors: Adesanya Elizabeth I , Schonmann Yochai , Hayes Joseph F , Mathur Rohini , Mulick Amy R , Rayner Lauren , Smeeth Liam , Smith Catherine H , Langan Sinéad M , Mansfield Kathryn E
Published: December 2020

Introduction

Evidence indicates that people with the common inflammatory skin diseases atopic eczema or psoriasis are at increased risk of mental illness. However, the reasons for the relationship between skin disease and common mental disorders (ie, depression and anxiety) or severe mental illnesses (ie, schizophrenia, bipolar disorder and other psychoses) are unclear. Therefore, we aim to synthesise the available evidence regarding the risk factors for mental illness in adults with atopic eczema or psoriasis.

Methods and analysis

We will conduct a systematic review of randomised controlled trials, cohort, case–control and cross-sectional studies. We will search the following databases from inception to March 2020: Medline, Embase, Global Health, Scopus, the Cochrane Library, Web of Science, Base, PsycInfo, the Global Resource of Eczema Trials, and the grey literature databases Open Grey, PsycExtra and the New York Academy of Medicine Grey Literature Report. We will also search the bibliographies of eligible studies and relevant systematic reviews to identify additional relevant studies. Citation searching of large summary papers will be used to further identify relevant publications. Two reviewers will initially review study titles and abstracts for eligibility, followed by full text screening. We will extract data using a standardised data extraction form. We will assess the risk of bias of included studies using the Quality in Prognosis Studies tool. We will synthesise data narratively, and if studies are sufficiently homogenous, we will consider a meta-analysis. We will assess the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework.

Ethics and dissemination

Ethical approval is not required for a systematic review. Results of the review will be published in a peer-reviewed journal and disseminated through conferences.

PROSPERO registration number

CRD42020163941.
Cardiovascular risk prediction using physical performance measures in COPD: results from a multicentre observational study
Authors: Fermont Jilles M , Fisk Marie , Bolton Charlotte E , MacNee William , Cockcroft John R , Fuld Jonathan , Cheriyan Joseph , Mohan Divya , Mäki-Petäjä Kaisa M , Al-Hadithi Ali B , Tal-Singer Ruth , Müllerova Hana , Polkey Michael I , Wood Angela M , McEniery Carmel M , Wilkinson Ian B
Published: December 2020

Objectives

Although cardiovascular disease (CVD) is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), it is unknown how to improve prediction of cardiovascular (CV) risk in individuals with COPD. Traditional CV risk scores have been tested in different populations but not uniquely in COPD. The potential of alternative markers to improve CV risk prediction in individuals with COPD is unknown. We aimed to determine the predictive value of conventional CVD risk factors in COPD and to determine if additional markers improve prediction beyond conventional factors.

Design

Data from the Evaluation of the Role of Inflammation in Chronic Airways disease cohort, which enrolled 729 individuals with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II–IV COPD were used. Linked hospital episode statistics and survival data were prospectively collected for a median 4.6 years of follow-up.

Setting

Five UK centres interested in COPD.

Participants

Population-based sample including 714 individuals with spirometry-defined COPD, smoked at least 10 pack years and who were clinically stable for >4 weeks.

Interventions

Baseline measurements included aortic pulse wave velocity (aPWV), carotid intima–media thickness (CIMT), C reactive protein (CRP), fibrinogen, spirometry and Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) Index, 6 min walk test (6MWT) and 4 m gait speed (4MGS) test.

Primary and secondary outcome measures

New occurrence (first event) of fatal or non-fatal hospitalised CVD, and all-cause and cause-specific mortality.

Results

Out of 714 participants, 192 (27%) had CV hospitalisation and 6 died due to CVD. The overall CV risk model C-statistic was 0.689 (95% CI 0.688 to 0.691). aPWV and CIMT neither had an association with study outcome nor improved model prediction. CRP, fibrinogen, GOLD stage, BODE Index, 4MGS and 6MWT were associated with the outcome, independently of conventional risk factors (p<0.05 for all). However, only 6MWT improved model discrimination (C=0.727, 95% CI 0.726 to 0.728).

Conclusion

Poor physical performance defined by the 6MWT improves prediction of CV hospitalisation in individuals with COPD.

Trial registration number

ID 11101.
Protocol to assess the efficacy of carnosine supplementation in mitigating the adverse cardiovascular responses to particulate matter (PM) exposure: the Nucleophilic Defense Against PM Toxicity (NEAT) trial
Authors: O"Toole Timothy E. , Amraotkar Alok A. , DeFilippis Andrew P. , Rai Shesh N. , Keith Rachel J. , Baba Shahid P. , Lorkiewicz Pawel , Crandell Catherine E. , Pariser Gina L. , Wingard Christopher J. , Pope III C. Arden , Bhatnagar Aruni
Published: December 2020

Introduction

Exposure to airborne particulate matter (PM) is associated with cardiovascular disease. These outcomes are believed to originate from pulmonary oxidative stress and the systemic delivery of oxidised biomolecules (eg, aldehydes) generated in the lungs. Carnosine is an endogenous di-peptide (β-alanine-L-histidine) which promotes physiological homeostasis in part by conjugating to and neutralising toxic aldehydes. We hypothesise that an increase of endogenous carnosine by dietary supplementation would mitigate the adverse cardiovascular outcomes associated with PM exposure in humans.

Methods and analysis

To test this, we designed the Nucleophilic Defense Against PM Toxicity trial. This trial will enroll 240 participants over 2 years and determine if carnosine supplementation mitigates the adverse effects of PM inhalation. The participants will have low levels of endogenous carnosine to facilitate identification of supplementation-specific outcomes. At enrollment, we will measure several indices of inflammation, preclinical cardiovascular disease and physical function. Participants will be randomly allocated to carnosine or placebo groups and instructed to take their oral supplement for 12 weeks with two return clinical visits and repeated assessments during times of peak PM exposure (June–September) in Louisville, Kentucky, USA. Statistical modelling approaches will be used to assess the efficacy of carnosine supplementation in mitigating adverse outcomes.

Ethics and dissemination

This study protocol has been approved by the Institutional Review Board at the University of Louisville. Results from this study will be disseminated at scientific conferences and in peer-reviewed publications.

Trial registration:NCT03314987; Pre-results
Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study
Authors: van Maanen Rosanne , Kingma Annelieke E C , Oudega Ruud , Rutten Frans H , Moons Karel , Geersing Geert-Jan
Published: December 2020

Objective

Clinical prediction rules (CPRs) followed by D-dimer testing were shown to safely rule out venous thromboembolism (VTE) in about half of all suspected patients in controlled and experienced study settings. Yet, its real-life impact in primary care is unknown. The aim of this study was to determine the real-life impact of CPRs for suspected VTE in primary care.

Design

Cross-sectional cohort study.

Setting

Primary care in the Netherlands.

Participants

Patients with suspected deep venous thrombosis (n=993) and suspected pulmonary embolism (n=484).

Interventions

General practitioners received an educational instruction on how to use CPRs in suspected VTE. We did not rectify incorrect application of the CPR in order to mimic daily clinical care.

Main outcome measures

Primary outcomes were the diagnostic failure rate, defined as the 3-month incidence of VTE in the non-referred group, and the efficiency, defined as the proportion of non-referred patients in the total study population. Secondary outcomes were determinants for and consequences of incorrect application of the CPRs.

Results

In 267 of the included 1477 patients, VTE was confirmed. When CPRs were correctly applied, the failure rate was 1.51% (95% CI 0.77 to 2.86), and the efficiency was 58.1% (95% CI 55.2 to 61.0). However, the CPRs were incorrectly applied in 339 patients, which resulted in an increased failure rate of 3.31% (95% CI 1.07 to 8.76) and a decreased efficiency of 35.7% (95% CI 30.6 to 41.1). The presence of concurrent heart failure increased the likelihood of incorrect application (adjusted OR 3.26; 95% CI 1.47 to 7.21).

Conclusions

Correct application of CPRs for VTE in primary care is associated with an acceptable low failure rate at a high efficiency. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a higher failure rate and a considerably lower efficiency.