bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Disclosure over Time on the Emotional Well-Being of Children with Perinatally Acquired HIV Infection in South Africa
Authors: Buckley Janice , Otwombe Kennedy , Joyce Celeste , Leshabane Given , Galvin Lisa , Ramsammy Candice , Lebotsa Moshoko Emily , Liberty Afaaf , Violari Avy
Published: September 2021

Objective:

The aim of this study was to describe the disclosure process in children with perinatally acquired HIV infection (PHIV+) and its impact on their emotional well-being and adherence to antiretroviral therapy (ART) in South Africa.

Methods:

This prospective cohort study followed PHIV+ children aged 7 to 13 years attending counseling over 18 months. Standardized disclosure tools were used by a counselor with both child and caregiver present. Assessments included the Child Behavior Checklist (CBCL), Vineland Adaptive Behavior Scale (VABS), Child Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS). Adherence to ART was recorded through pharmacy pill returns. Changes over time and their differences from baseline were assessed by linear mixed models.

Results:

Thirty children with median age 10 years (interquartile range [IQR]: 9.0–11.0) were enrolled. The median time to disclosure was 48 weeks (IQR: 48.0–54.6). There was a significant decrease from baseline (p < 0.0001) and over time (p = 0.0037) in the total CDI score. A positive trend in the changes from baseline and over time was observed for internalizing (p values < 0.0001) and externalizing (p values < 0.0001) CBCL scales and Total Anxiety score of the RCMAS (p < 0.0001 and p < 0.0002, respectively). Only the Defensiveness median T-score increased during the follow-up (p = 0.004) and in the change from baseline (p = 0.0005). The adaptive (p = 0.0092) and maladaptive (p < 0.0001) scores of the VABS showed a decrease from baseline. ART adherence remained high throughout this study.

Conclusion:

Disclosure does not worsen the child's emotional well-being and adherence to ART over time. This study adds to research from low- and middle-income countries to alleviate fears that disclosure may have an adverse outcome on children with PHIV+.
Pregnancy After Concussion: A Clarion Call for Attention?
Authors: Anto-Ocrah Martina , Cafferky Virginia , Lewis Vivian
Published: September 2021

Objective:

Emerging research shows that women who sustain a mild traumatic brain injury, also termed concussion, have a higher risk of menstrual irregularities and sexual dysfunctions. However, no research exists on how these reproductive disruptions affect women's subsequent pregnancies. The objective of this study was to evaluate pregnancy outcomes after concussion in a cohort of reproductive-aged women (aged 18-45 years), 24 months post-injury. We hypothesized that, compared with their extremity-injured peers in the same cohort, women with concussion will have lower incidence of pregnancies.

Setting:

Emergency department of a level 1 trauma center.

Participants:

Women of reproductive age (aged 18-45 years) seeking care for concussion or extremity injury.

Design:

Longitudinal cohort study that used data collected at 3 distinct time points: t0, baseline: an original cohort of 245 women recruited in January to July 2017 for exposure assessment; t1, 6(+4) weeks post-injury: evaluation of self-reported postinjury menstrual and sexual changes for subgroup analyses—data collected in March to September 2017 (n = 135); t2, 24 months post-injury: March 2020 chart review for documentation of pregnancies/pregnancy-related events (N = 245).

Main Measure:

Poisson regression estimates used to model the incidence rate (IR) of pregnancies, comparing concussion with extremity injury.

Results:

We reviewed the charts of 254 women from the t0 cohort. After excluding 9 patients who were either deceased or missing relevant data, we had the 245 (96.5%) charts of 102 concussed and 143 extremity-injured study participants. After adjusting for race and obstetric history, women with concussion had 80% lower incidence of pregnancies than their extremity-injured peers (adjusted [adj] IR = 0.20; 95% CI: 0.07-0.59; P = .003). When we excluded women who were using birth control, the IR of pregnancy for women with concussions was 76% lower than for those who had sustained extremity injuries (adj IR = 0.24; 95% CI: 0.07-0.81; P = .02). Pregnancy incidence remained consistently lower for concussed women in additional sensitivity analyses excluding assault/domestic violence victims and those with a prior/new concussion at t0 and t2. Subgroup analyses of the 135 women who had experienced menstrual and/or sexual dysfunctions at t1 showed 84% reduced incidence of pregnancy for women with concussions compared with those who had sustained an extremity injury (adj IR = 0.16; 95% CI: 0.04-0.73; P = .02).

Conclusion and Relevance:

Our study potentially serves as a clarion call to understand the long-term reproductive effects of female concussions.
Associations Between Sleep Quality and 10-Year Cardiovascular Disease Risk Among Female Nurses in Hong Kong
Authors: Yan Lin Jia , Xie Yao Jie
Published: September 2021

Background

Sleep problems are common among nurses compared with the general population. Poor sleep quality increases the risk of developing cardiovascular disease (CVD). The relationship between sleep quality and CVD risk has not been previously investigated among Hong Kong female nurses.

Objective

The authors of this study explored the association between sleep quality and CVD risk among Hong Kong female nurses.

Methods

Data were collected from the Hong Kong Women's Health Study cross-sectional survey between 2019 and 2020. Questionnaires were sent to female nurses (≥aged 30 years). Ten-year CVD risk was measured using the Framingham 10-year risk score, and the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Relationships were evaluated using adjusted multiple linear regression and binary logistic regression.

Results

In 1344 respondents, the mean age was 46.12 ± 10.47 years, average PSQI score was 6.02 (3.35), and 52.4% reported poor sleeping quality (global PSQI score > 5). The mean 10-year CVD risk was 3.6% (3.3%). The 10-year CVD risk was significantly associated with sleep disturbance (β = 0.006) and daytime dysfunction (β = −0.002) (both Ps < .01). Participants who reported sleep disturbance had a higher CVD risk (odds ratio, 1.82; 95% confidence interval, 1.04–3.18). High daytime dysfunction decreased CVD risk (odds ratio, 0.63; 95% confidence interval, 0.46–0.85). Subgroup analysis showed stronger associations between sleep quality and Framingham 10-year risk score among those unemployed, undergoing postmenopause, or with a family history of CVDs.

Conclusions

Sleep disturbance and daytime dysfunction were associated with the 10-year CVD risk among Hong Kong female nurses. Nurses who were unemployed, were undergoing postmenopause, or with a family history of CVD were those with the highest risk.
Sex differences in blood pressure regulation during the isometric exercise under heated environment
Authors: Padilha Michelle C. S. V. , Ferreira Felipe C. , Oliveira Thiago L.S. , Soares Pedro Paulo S. , Rodrigues Gabriel D.
Published: September 2021

In the absence of heat stress, females increase blood pressure (BP) during isometric handgrip exercise due to cardiac output more than total peripheral resistance (TPR) compared to men. Although heat stress seems to blunt BP responses at rest and during handgrip, possible sex differences remained unknown. We hypothesized that BP responses during handgrip under a heated environment (HOT) will be different between men and women. Eight healthy men (29 ± 6 years) and eight women (26 ± 4 years) participated in this study. The experimental protocol was separated into two environmental conditions: HOT (~ 36 °C) and thermoneutral (TC; ~ 24 °C). In both conditions, participants rested for 30 min and performed the handgrip for 3 min. BP, heart rate (HR) stroke volume and cardiac output were continuously recorded, and TPR was calculated (TPR = mean blood pressure (MBP)/cardiac output). HOT reduced BP and TPR at baseline and during handgrip in females as compared to TC, while males showed similar responses in both thermal conditions. HR was higher under HOT in both groups. Cardiac output and stroke volume were not different under HOT compared to TC for females. In males, cardiac output increased at the last minute of handgrip under HOT through augmented HR, because stroke volume was unchanged. In conclusion, the main effect of HOT was to shift downwards BP and total peripheral resistance at rest and during isometric exercise in females. In males, the combination of handgrip and HOT increased cardiac output by augmented HR, whereas BP presented similar responses between thermal conditions during handgrip.
Personality Traits, Media Exposure, and Deterioration of Psychological Wellbeing in Japan During the COVID-19 Pandemic
Authors: Yamauchi Takashi , Suka Machi , Yanagisawa Hiroyuki
Published: September 2021

This study examined the associations among personality traits, media exposure regarding COVID-19, and deterioration of mental wellbeing among the public in Japan. We conducted a cross-sectional Web-based questionnaire survey among 8000 Japanese men and women aged 25 to 64 years. Approximately half of participants reported deterioration of mental wellbeing. Nearly 20% of participants reported “constant/excessive” exposure to media information regarding COVID-19. As compared with those with low “extraversion” and “less frequent” exposure to media information about COVID-19, those with high “extraversion” and “more frequent” media exposure reported significantly less deterioration of mental wellbeing. In addition, as compared with those with low “neuroticism” and media exposure, those with high “neuroticism” and “constant/excessive” exposure to COVID-19–related information significantly more frequently reported deterioration of mental wellbeing. Under the ongoing pandemic of COVID-19, measures for the promotion and maintenance of mental wellbeing should be implemented considering the interaction between personality traits and media exposure.
Exercise Training and Cognitive Function in Kidney Disease
Authors: Bronas Ulf G. , Hannan Mary , Lash James P. , Ajilore Olu , Zhou Xiaohong Joe , Lamar Melissa
Published: September 2021

Background

Chronic kidney disease (CKD) is extremely common in older adults and is associated with cognitive impairment. It is hypothesized that accelerated cognitive decline in CKD results from a vascular dysfunction-induced reduction in the integrity of the brain white matter.

Objective

The aim of this study was to describe the protocol for a study to evaluate whether exercise training provides a cerebroprotective effect by improving cerebrovascular health.

Methods

This is a randomized controlled trial investigating feasibility and effect size.

Results

Participants will be randomized to either a 24-week, home-based, walking program or a usual care group. Participants will undergo evaluation of cognitive function, brain structure via magnetic reasoning imaging, physical function, physical activity, and vascular function. The primary outcome is change in cognitive function.

Discussion

The findings of this study will help determine whether exercise training influences cognitive function during a therapeutic window in the disease process of cognitive impairment in older adults with CKD.

Conclusion

This protocol describes a study to evaluate cognition and brain structure following a home-based exercise program to an at-risk population.
Focused Cardiac Ultrasound Findings in Children Presenting With Shock to a Tertiary Care Hospital in Rwanda
Authors: Chen Lei , Mutabandama Yves , McCall Natalie , Umuhoza Christian
Published: September 2021

Objectives

Shock remains a leading proximate cause of death in children. Children in sub-Saharan African (SSA) countries present with shock from a wide range of pathologies. Routine physiologic parameters may not reflect underlying physiology. No previous work has systematically described ultrasound findings in children with shock in an SSA country. We set out to perform focused cardiac ultrasound (FOCUS) on children with shock in Rwanda and describe the findings in this pilot study.

Methods

In a prospective descriptive study, we trained pediatric residents to perform FOCUS on children presenting with shock to an urban tertiary care pediatric emergency department in Kigali, Rwanda. Images were transmitted via cellphone network and reviewed by experts. Primary outcome was expert's description of the FOCUS findings. Secondary outcomes included mortality at 48-hour, change in assessment and treatment after FOCUS, and agreement of FOCUS findings between residents and experts.

Results

Between January 2020 and April 2020, 25 subjects were enrolled by 8 residents. Eleven of 25 (44%) were newly diagnosed with acquired or congenital heart disease. The 48-hour mortality rate was higher in this group compared with those without heart disease (8 of 11 vs 1 of 14). The resident reported changing assessment and treatment based on FOCUS findings in 60% of patients (15 of 25). There was good to excellent agreements between residents and FOCUS experts on left ventricle function, pericardial effusion, and intravascular volume.

Conclusions

In children presenting with signs and symptoms of shock in SSA, one could perform a screening FOCUS to distinguish between hypovolemic and cardiogenic shock.
The Voice of the Patient: Patient Roles in Antibiotic Management at the Hospital-to-Home Transition
Authors: Sharara Sima L. , Arbaje Alicia I. , Cosgrove Sara E. , Gurses Ayse P. , Dzintars Kathryn , Ladikos Nicholas , Qasba Sarojini Sonjia , Keller Sara C.
Published: September 2021

Objective

Our objective was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. Our overall goal was to understand patients’ role in managing antibiotics at the hospital-to-home transition.

Methods

We performed a qualitative study including semistructured interviews with health care workers and contextual inquiry with patients discharged home on oral antibiotics. The setting was one academic medical center and one community hospital. Participants included 37 health care workers and 16 patients. We coded interview transcripts and notes from contextual inquiry and developed themes.

Results

We identified 6 themes involving barriers or strategies for antibiotic MM. We identified dissonance between participant descriptions of the ease of antibiotic MM at the hospital-to-home transition and their experience of barriers. Similarly, patients did not always recognize when they were experiencing side effects. Lack of access to follow-up care led to unnecessarily long antibiotic courses. Instructions about completing antibiotics were not routinely provided. However, patients typically did not question the need for the prescribed antibiotic.

Conclusions

There are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition. Mismatches between patient perceptions and patient experiences around antibiotic MM at the hospital-to-home transition provide opportunities for health system improvement.
Influence of Psychological Safety and Organizational Support on the Impact of Humiliation on Trainee Well-Being
Authors: Appelbaum Nital P. , Santen Sally A. , Perera Robert A. , Rothstein William , Hylton Jordan B. , Hemphill Robin R.
Published: September 2021

Objectives

To develop physicians who can practice safely, we need better understanding of how the clinical learning environment affects trainee well-being. Two psychosocial constructs may help us understand the context: psychological safety (belief one can speak up without concerns) and perceived organizational support (degree to which members feel that their organization cares for them and values their contributions). The objective of this study is to test a moderated mediation model to determine how humiliation (X) impacts trainees’ well-being (Y) while taking into account psychological safety (mediator) and organizational support (moderator).

Methods

Between May and June 2018, a single health system recruited resident physicians across 19 programs to complete an anonymous electronic survey to assess facets of the clinical learning environment, well-being, and experiences of humiliation. In a moderated mediation analysis, mediation helps explain how a predictor variable (X) impacts an outcome variable (Y) through a mediating variable, whereas moderation helps explain under what conditions such a relationship exists.

Results

Of 428 residents, 303 responded (71%) to the survey across 19 training programs. The effects of humiliation on well-being were mitigated by psychological safety, which varied depending on the levels of perceived organizational support. Environments rated 1 SD below the mean on perceived organization support by residents had a stronger negative impact of public humiliation on psychological safety.

Conclusions

The findings suggest that humiliation is associated with well-being through the effects of psychological safety and influenced by organizational support. Further work might explore the relationship by investing resources (e.g., faculty development, mentorship) to increase psychological safety and reduce humiliation during training, especially within environments prone to be perceived as unsupportive of trainees.
Computed Tomography Imaging Characteristics: Potential Indicators of Epidermal Growth Factor Receptor Mutation in Lung Adenocarcinoma
Authors: Wang Bin , Yu Nan , Han Dong , Ren Zhanli , Jia Yongjun , Zhang Xirong , He Taiping
Published: September 2021

Purpose

The purpose of this study was to investigate the correlation between computed tomography imaging characteristics in lung adenocarcinoma and epidermal growth factor receptor (EGFR) mutations.

Methods

A total of 124 patients with lung adenocarcinoma and known EGFR mutation status were collected in this retrospective study. Computed tomography quantitative parameters of each tumor, including total volume, total surface, surface-to-volume ratio (SVR), average diameter, maximum diameter, and average density, were determined using computer-aided detection software. The correlation between the EGFR mutation status and imaging characteristics was assessed. The predictive value of these imaging characteristics for EGFR mutation was calculated using the area under the receiver operating characteristic curve.

Result

Fifty-eight of 124 patients showed EGFR mutations. Patients who are female (P < 0.001) and nonsmokers (P < 0.001) and those with serum carcinoembryonic antigen (CEA) level of ≥5 (P = 0.035) were likely to have EGFR mutation. Computed tomography features including air bronchogram (P = 0.035), absence of cavitation (P = 0.010), and absence of pulmonary emphysema (P = 0.002) and quantitative parameters, such as smaller total surface (P = 0.002), smaller total volume (P = 0.001), higher SVR (P = 0.003), and smaller average diameter (P = 0.001), were associated with EGFR mutation. Logistic regression analysis revealed that the most significant independent prognostic factors of EGFR mutation for the model were nonsmoking (P = 0.035), CEA level of ≥5 (P = 0.004), presence of air bronchogram (P = 0.040), absence of cavitation (P = 0.021), and high SVR (P = 0.014). The area under the receiver operating characteristic curve, sensitivity, and specificity of the model for predicting EGFR mutation were 0.827, 75.8%, and 82.8%, respectively.

Conclusions

EGFR-mutated adenocarcinoma showed significantly increased CEA level, presence of air bronchogram, absence of cavitation, and higher quantitative parameter SVR than those with wild-type EGFR.
Magnetic Resonance Elastography of the Liver: A Single-Institution Review of Cases Performed in a 5-Year Interval
Authors: Morillo-Hernandez Carlos , Catania Roberta , Grosse Philip J. , Bollino Gideon , Borhani Amir A. , Furlan Alessandro
Published: September 2021

Objective

This study aimed to assess the diagnostic accuracy of magnetic resonance elastography (MRE) in detecting hepatic fibrosis and determining clinically relevant stiffness cutoff values per stage of fibrosis.

Methods

This retrospective study assessed 1488 hepatic MRE evaluations performed at a single institution for 5 years. Mean liver stiffness measurements were collected from 282 patients who had an MRE study within 1 year of histopathologic analysis. Areas under receiver operating characteristic curves were calculated for each stage of fibrosis with nonparametric ordinal measures of accuracy, and Youden Index was determined.

Results

Mean liver stiffness measurement values were as follows: F0, 2.5± 0.55 kPa; F1, 3.1± 0.80 kPa; F2, 3.4±0.95 kPa; F3, 4.7±1.44 kPa; and F4, 7.9± 2.64 kPa. Nonparametric ordinal measures of accuracy per fibrosis stage were as follows: F0: 0.934, P < 0.001; F0–F1: 0.917, P < 0.001; F0–F2: 0.944, P < 0.001; and F0–F3: 0.941, P < 0.001. Youden Index values for fibrosis stages F2, F3, and F4 were 3.9, 4.0, and 4.5 kPa, respectively.

Conclusions

Magnetic resonance elastography is an accurate diagnostic tool in assessing liver fibrosis.
Ultrahigh-Resolution Computed Tomography Improves Preoperative Computed Tomography Angiography for Deep Inferior Epigastric Artery Perforator Flap Reconstruction
Authors: Ide Sayaka , Urikura Atsushi , Yoshida Tsukasa , Nakaya Yoshihiro , Endo Masahiro , Aramaki Takeshi
Published: September 2021

Objective

The aim of the study was to compare computed tomography (CT) angiography (CTA) imaging of deep inferior epigastric artery perforator (DIEP) using the ultrahigh-resolution CT (UHRCT) and conventional multidetector CT (MDCT).

Methods

This retrospective study enrolled 20 patients who underwent CTA of DIEP flap with UHRCT and MDCT. Computed tomography values were measured at 4 large vessels (thoracic aorta, abdominal aorta, common iliac artery, and external iliac artery) and 5 peripheral vessels (proximal and distal internal thoracic artery, proximal and distal deep inferior epigastric artery, and DIEP).

Results

There were no significant differences in mean CT values of the major vessel between UHRCT and MDCT. Ultrahigh-resolution CT shows higher CT values of the peripheral vessels than MDCT (P < 0.05 for all). The median CT values of the DIEP in UHRCT were approximately 3 times higher than those in MDCT (P < 0.001).

Conclusions

Ultrahigh-resolution CT provides higher-quality CTA of DIEP compared with MDCT.
Sulforaphane-Dependent Up-Regulation of NRF2 Activity Alleviates Both Systemic Inflammatory Response and Lung Injury After Hemorrhagic Shock/Resuscitation in Mice
Authors: Liang Weiqiang , Greven Johannes , Fragoulis Athanassios , Horst Klemens , Bläsius Felix , Wruck Christoph , Pufe Thomas , Kobbe Philipp , Hildebrand Frank , Lichte Philipp
Published: September 2021

Hemorrhagic shock/resuscitation (HS/R) is closely associated with overwhelming oxidative stress and systemic inflammation. As an effective activator of the nuclear factor-erythroid factor 2 related factor 2 (Nrf2) pathway, sulforaphane (SFN) exerts antioxidant and anti-inflammatory effects. We explored SFN's effects on alveolar macrophages (AMs), systemic inflammation, and pulmonary damage in an isolated murine HS/R model. Male C57/BL6 wild type and transgenic antioxidant response element (ARE)-luciferase (luc) mice (both n = 6 per group) were exposed to either pressure-controlled HS/R (mean arterial pressure 35–45 mm Hg for 90 min) or sham procedure (surgery without HS/R) or were sacrificed without intervention (control group). Fluid resuscitation was performed via the reinfusion of withdrawn blood and 0.9% saline. Sulforaphane or 0.9% saline (vehicle) was administrated intraperitoneally. Mice were sacrificed 6, 24, or 72 h after resuscitation. Bioluminescence imaging of ARE-luc mice was conducted to measure pulmonary Nrf2 activity. Plasma was collected to determine systemic cytokine levels. Alveolar macrophages were isolated before measuring cytokines in the supernatant and performing immunofluorescence staining, as well as Western blot for intracellular Nrf2. Histological damage was assessed via the acute lung injury score and wet/dry ratio.

Hemorrhagic shock/resuscitation was associated with pulmonary Nrf2 activation. Sulforaphane enhanced pulmonary Nrf2 activity and the Nrf2 activation of AM, while it decreased lung damage. Sulforaphane exerted down-regulatory effects on AM-generated and systemic pro-inflammatory mediators, while it did not have such effects on IL-10.

In conclusion, SFN beneficially enhances pulmonary Nrf2 activity and promotes Nrf2 accumulation in AMs’ nuclei. This may exert not only local protective effects but also systemic effects via the down-regulation of pro-inflammatory cytokines. The administration of Nrf2 activator post-HS/R may represent an innovative treatment strategy.
Impact of Clinical Sepsis Phenotypes on Mortality and Fluid Status in Critically Ill Patients
Authors: Shald Elizabeth A. , Erdman Michael J. , Ferreira Jason A.
Published: September 2021

Background:

Sepsis is associated with high rates of in-hospital mortality, despite being the focus of medical research and public health initiatives for several years. The primary objective of this study was to determine the influence of septic phenotypes on rates of in-hospital mortality throughout intensive care unit (ICU) admission.

Patients and Methods:

Retrospective, single-center cohort study. Medical ICU of an academic medical center. Medical ICU patients admitted between January 2016 and August 2019 with a “sepsis alert” were screened for admitting diagnosis of “sepsis” or “septic shock.” Patients were classified into one of four clinical sepsis phenotypes: multi-organ failure (MOF), respiratory dysfunction (RD), neurologic dysfunction (ND), or other patients (OP).

Results:

An analysis of 320 patients was completed. In-hospital mortality was different between groups (P < 0.001). Patients with the MOF phenotype had the highest rate of mortality (48.4%), followed by the ND phenotype (39.7%), RD phenotype (20.8%), and OP phenotype (13.7%). There were differences in volume balances between phenotypes at 48 h (P = 0.001), 72 h (P < 0.001), and 96 h (P < 0.001) after hospital presentation, with the MOF and ND phenotypes having the largest volume balances at these time points. Ventilator-free days (P < 0.001) and ICU length of stay (LOS) (P = 0.030) were different between groups. There was no difference in hospital LOS (P = 0.479).

Conclusions:

This data supports the presence of marked intra-disease differences in septic patient presentation and correlation with clinical outcomes including mortality. Additionally, significantly more positive fluid balances were observed between survivors and non-survivors in some patient subsets. Using pragmatic clinical variables readily available to providers to classify patients into septic phenotypes has the propensity to guide treatment strategies in the future.
Enhanced Recovery After Urogynecologic Surgery: A Survey of Patient Experience
Authors: Trowbridge Elisa R. , Evans Sarah L. , Podwika Sarah , Subbarao Shalini , Sarosiek Bethany M. , Hullfish Kathie L.
Published: September 2021

Objectives

The aim of this study was to identify which aspects/components of the enhanced recovery program (ERP) were associated with a positive patient surgical experience for patients undergoing urogynecologic surgery.

Methods

A total of 198 patients who underwent pelvic reconstructive surgery requiring hospital admission were invited to complete questionnaires modeled after the validated Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey patient experience survey. Patients were asked about 3 phases of ERP interventions: (1) before surgery (patient education, carbohydrate loading), (2) during the hospital stay (pain control, nausea, early ambulation), and (3) after discharge (return of bladder and bowel function).

Results

One hundred patients completed the survey (51% response rate). Greater than 90% of patients rated their overall surgical experience favorably (≥8 on 1–10 scale) regardless of age (P = 0.98), race (P = 0.26), education level (P = 0.12), perception of overall health (P = 0.17), or number of prior surgical procedures (P = 0.86). Ninety-two percent of patients reported that preoperative teaching about surgery was “very helpful,” and specifically 90% reported that the ERP educational handbook was useful. Patients who reported a poor perception of their overall mental health were more likely to rate their surgical experience less favorably (<8 on 1–10 scale; P = 0.01), as were patients who left the hospital with a Foley catheter (P = 0.03).

Conclusions

Greater than 90% of women surveyed who rated undergoing inpatient pelvic reconstructive surgery positively perceived their surgical experience within the ERP. The majority of patients who had a positive perception of the perioperative experience found the preoperative patient education useful.
What do we know about the global methane budget? Results from four decades of atmospheric CH4observations and the way forward
Authors: Lan Xin , Nisbet Euan G. , Dlugokencky Edward J. , Michel Sylvia E.
Published: September 2021

Atmospheric CH4is arguably the most interesting of the anthropogenically influenced, long-lived greenhouse gases. It has a diverse suite of sources, each presenting its own challenges in quantifying emissions, and while its main sink, atmospheric oxidation initiated by reaction with hydroxyl radical (OH), is well-known, determining the magnitude and trend in this and other smaller sinks remains challenging. Here, we provide an overview of the state of knowledge of the dynamic atmospheric CH4budget of sources and sinks determined from measurements of CH4andδ13CCH4in air samples collected predominantly at background air sampling sites. While nearly four decades of direct measurements provide a strong foundation of understanding, large uncertainties in some aspects of the global CH4budget still remain. More complete understanding of the global CH4budget requires significantly more observations, not just of CH4itself, but other parameters to better constrain key, but still uncertain, processes like wetlands and sinks.

This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.
The impact of spatially varying wetland source signatures on the atmospheric variability ofδD-CH4
Authors: Stell Angharad C. , Douglas Peter M. J. , Rigby Matthew , Ganesan Anita L.
Published: September 2021

We present the first spatially resolved distribution of theδD-CH4signature of wetland methane emissions and assess its impact on atmosphericδD-CH4. TheδD-CH4signature map is derived by relatingδD-H2Oof precipitation to measuredδD-CH4of methane wetland emissions at a variety of wetland types and locations. This results in strong latitudinal variation in the wetlandδD-CH4source signature. WhenδD-CH4is simulated in a global atmospheric model, little difference is found in global mean, inter-hemispheric difference and seasonal cycle if the spatially varyingδD-CH4source signature distribution is used instead of a globally uniform value. This is because atmosphericδD-CH4is largely controlled by OH fractionation. However, we show that despite these small differences, using atmospheric records ofδD-CH4to infer changes in the wetland emissions distribution requires the use of the more accurate spatially varyingδD-CH4source signature. We find that models will only be sensitive to changes in emissions distribution if spatial information can be exploited through the spatially resolved source signatures. In addition, we also find that on a regional scale, at sites measuring excursions ofδD-CH4from background levels, substantial differences are simulated in atmosphericδD-CH4if using spatially varying or uniform source signatures.

This article is part of a discussion meeting issue ‘Rising methane: is warming feeding warming? (part 1)’.
Methods for quantifying methane emissions using unmanned aerial vehicles: a review
Authors: Shaw Jacob T. , Shah Adil , Yong Han , Allen Grant
Published: September 2021

Methane is an important greenhouse gas, emissions of which have vital consequences for global climate change. Understanding and quantifying the sources (and sinks) of atmospheric methane is integral for climate change mitigation and emission reduction strategies, such as those outlined in the 2015 UN Paris Agreement on Climate Change. There are ongoing international efforts to constrain the global methane budget, using a wide variety of measurement platforms across a range of spatial and temporal scales. The advancements in unmanned aerial vehicle (UAV) technology over the past decade have opened up a new avenue for methane emission quantification. UAVs can be uniquely equipped to monitor natural and anthropogenic emissions at local scales, displaying clear advantages in versatility and manoeuvrability relative to other platforms. Their use is not without challenge, however: further miniaturization of high-performance methane instrumentation is needed to fully use the benefits UAVs afford. Developments in the models used to simulate atmospheric transport and dispersion across small, local scales are also crucial to improved flux accuracy and precision. This paper aims to provide an overview of currently available UAV-based technologies and sampling methodologies which can be used to quantify methane emission fluxes at local scales.

This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.
How necessary and feasible are reductions of methane emissions from livestock to support stringent temperature goals?
Authors: Reisinger Andy , Clark Harry , Cowie Annette L. , Emmet-Booth Jeremy , Gonzalez Fischer Carlos , Herrero Mario , Howden Mark , Leahy Sinead
Published: September 2021

Agriculture is the largest single source of global anthropogenic methane (CH
4
) emissions, with ruminants the dominant contributor. Livestock CH
4
emissions are projected to grow another 30% by 2050 under current policies, yet few countries have set targets or are implementing policies to reduce emissions in absolute terms. The reason for this limited ambition may be linked not only to the underpinning role of livestock for nutrition and livelihoods in many countries but also diverging perspectives on the importance of mitigating these emissions, given the short atmospheric lifetime of CH
4
. Here, we show that in mitigation pathways that limit warming to 1.5°C, which include cost-effective reductions from all emission sources, the contribution of future livestock CH
4
emissions to global warming in 2050 is about one-third of that from future net carbon dioxide emissions. Future livestock CH
4
emissions, therefore, significantly constrain the remaining carbon budget and the ability to meet stringent temperature limits. We review options to address livestock CH
4
emissions through more efficient production, technological advances and demand-side changes, and their interactions with land-based carbon sequestration. We conclude that bringing livestock into mainstream mitigation policies, while recognizing their unique social, cultural and economic roles, would make an important contribution towards reaching the temperature goal of the Paris Agreement and is vital for a limit of 1.5°C.

This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.
Coal seam gas industry methane emissions in the Surat Basin, Australia: comparing airborne measurements with inventories
Authors: Neininger Bruno G. , Kelly Bryce F. J. , Hacker Jorg M. , LU Xinyi , Schwietzke Stefan
Published: September 2021

Coal seam gas (CSG) accounts for about one-quarter of natural gas production in Australia and rapidly increasing amounts globally. This is the first study worldwide using airborne measurement techniques to quantify methane (CH4) emissions from a producing CSG field: the Surat Basin, Queensland, Australia. Spatially resolved CH4emissions were quantified from all major sources based on top-down (TD) and bottom-up (BU) approaches, the latter using Australia's UNFCCC reporting workflow. Based on our TD-validated BU inventory, CSG sources emit about 0.4% of the produced gas, comparable to onshore dry gas fields in the USA and The Netherlands, but substantially smaller than in other onshore regions, especially those where oil is co-produced (wet gas). The CSG CH4emission per unit of gas production determined in this study is two to three times higher than existing inventories for the region. Our results indicate that the BU emission factors for feedlots and grazing cattle need review, possibly requiring an increase for Queensland's conditions. In some subregions, the BU estimate for gathering and boosting stations is potentially too high. The results from our iterative BU inventory process, which feeds into TD data, illustrate how global characterization of CH4emissions could be improved by incorporating empirical TD verification surveys into national reporting.

This article is part of a discussion meeting issue ‘Rising methane: is warming feeding warming? (part 1)’.
Methane removal and the proportional reductions in surface temperature and ozone
Authors: Abernethy S. , O'Connor F. M. , Jones C. D. , Jackson R. B.
Published: September 2021

Mitigating climate change requires a diverse portfolio of technologies and approaches, including negative emissions or removal of greenhouse gases. Previous literature focuses primarily on carbon dioxide removal, but methane removal may be an important complement to future efforts. Methane removal has at least two key benefits: reducing temperature more rapidly than carbon dioxide removal and improving air quality by reducing surface ozone concentration. While some removal technologies are being developed, modelling of their impacts is limited. Here, we conduct the first simulations using a methane emissions-driven Earth System Model to quantify the climate and air quality co-benefits of methane removal, including different rates and timings of removal. We define a novel metric, the effective cumulative removal, and use it to show that each effective petagram of methane removed causes a mean global surface temperature reduction of 0.21 ± 0.04°C and a mean global surface ozone reduction of 1.0 ± 0.2 parts per billion. Our results demonstrate the effectiveness of methane removal in delaying warming thresholds and reducing peak temperatures, and also allow for direct comparisons between the impacts of methane and carbon dioxide removal that could guide future research and climate policy.

This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.
Double reduction estimation and equilibrium tests in natural autopolyploid populations
Authors: Gerard David
Published: September 2021

Many bioinformatics pipelines include tests for equilibrium. Tests for diploids are well studied and widely available, but extending these approaches to autopolyploids is hampered by the presence of double reduction, the co-migration of sister chromatid segments into the same gamete during meiosis. Though a hindrance for equilibrium tests, double reduction rates are quantities of interest in their own right, as they provide insights about the meiotic behavior of autopolyploid organisms. Here, we develop procedures to (i) test for equilibrium while accounting for double reduction, and (ii) estimate double reduction given equilibrium. To do so, we take two approaches: a likelihood approach, and a novel U-statistic minimization approach that we show generalizes the classical equilibrium χ2 test in diploids. For small sample sizes and uncertain genotypes, we further develop a bootstrap procedure based on our U-statistic to test for equilibrium. Finally, we highlight the difficulty in distinguishing between random mating and equilibrium in tetraploids at biallelic loci. Our methods are implemented in the hwep R package on GitHub https://github.com/dcgerard/hwep.
SARS-CoV-2 spike-specific memory B cells express markers of durable immunity after non-severe COVID-19 but not after severe disease
Authors: Reyes Raphael A. , Clarke Kathleen , Gonzales S. Jake , Cantwell Angelene M. , Garza Rolando , Catano Gabriel , Tragus Robin E. , Patterson Thomas F. , Bol Sebastiaan , Bunnik Evelien M.
Published: September 2021

SARS-CoV-2 infection elicits a robust B cell response, resulting in the generation of long-lived plasma cells and memory B cells. Here, we aimed to determine the effect of COVID-19 severity on the memory B cell response and characterize changes in the memory B cell compartment between recovery and five months post-symptom onset. Using high-parameter spectral flow cytometry, we analyzed the phenotype of memory B cells with reactivity against the SARS-CoV-2 spike protein or the spike receptor binding domain (RBD) in recovered individuals who had been hospitalized with non-severe (n=8) or severe (n=5) COVID-19. One month after symptom onset, a substantial proportion of spike-specific IgG+B cells showed an activated phenotype. In individuals who experienced non-severe disease, spike-specific IgG+B cells showed increased expression of markers associated with durable B cell memory, including T-bet, FcRL5, and CD11c, which was not observed after severe disease. Five months post-symptom onset, the majority of spike-specific memory B cells had a resting phenotype and the percentage of spike-specific T-bet+IgG+memory B cells decreased to baseline levels. Collectively, our results suggest that the memory B cell response elicited during non-severe COVID-19 may be of higher quality than the response after severe disease.
COVID-19 attack ratio among children critically depends on the time to removal and activity levels
Authors: Wu Jianhong , Bragazzi Nicola Luigi , Scarabel Francesca , McCarthy Zachary , David Jummy ,   the LIAM/ADERSIM COVID-19 Reopening and Recovery Modeling Group
Published: September 2021

The attack ratio in a subpopulation is defined as the total number of infections over the total number of individuals in this subpopulation. Using a methodology based on modified age-stratified transmission dynamics model, we estimated the attack ratio of COVID-19 among children (individuals 0-11 years) in Ontario, Canada when a large proportion of individuals eligible for vaccination (age 12 and above) are vaccinated to achieve herd immunity among this subpopulation, or the effective herd immunity with additional physical distancing measures (hence effective herd immunity). We describe the relationship between this attack ratio among children, the time to remove infected individuals from the transmission chain and the children-to-children daily contact rate, while considering the increased transmissibility of virus variants (using the Delta variant as an example). We further illustrate the generality and applicability of the methodology established by performing an analysis of the attack ratio of COVID-19 among children in the Canadian population. The clinical attack ratio, the number of symptomatic infections over the total population can be informed from the attack ratio, and both can be reduced substantially via a combination of higher vaccine coverage in the vaccine eligible population, reduced social mixing among children, and rapid testing and isolation.
Evaluation of SIGLEC1 in the diagnosis of suspected systemic lupus erythematosus
Authors: Zorn-Pauly Lydia , von Stuckrad Anne Sae Lim , Klotsche Jens , Rose Thomas , Kallinich Tilmann , Enghard Philipp , Ostendorf Lennard , Burns Marie , Doerner Thomas , Meisel Christian , Schneider Udo , Unterwalder Nadine , Burmester Gerd , Hiepe Falk , Alexander Tobias , Biesen Robert
Published: September 2021

Objectives

To evaluate and compare the diagnostic accuracy of SIGLEC1, a surrogate marker of type I IFN, with established biomarkers in an inception cohort of systemic lupus erythematosus (SLE).

Methods

SIGLEC1 was analysed by flow cytometry in 232 patients referred to our institution with suspected SLE between October 2015 and September 2020.

Results

SLE was confirmed in 76 of 232 patients (32.8%) according to the 2019 EULAR/ACR classification criteria and their SIGLEC1 values were significantly higher compared to patients without SLE (p<0.0001). A sensitivity of 98.7 %, a specificity of 82.1 %, a negative predictive value (NPV) of 99.2 % and a positive predictive value (PPV) of 72.8 % were calculated for SIGLEC1. Adjusted to the highest reported prevalence of SLE, the NPV and PPV were > 99.9 % and 0.1 %, respectively. Using ROC analysis and Delong testing, the area under the curve (AUC) for SIGLEC1 (AUC=0.95) was significantly higher than for ANA (AUC=0.88, p=0.031), C3 (AUC=0.83, p=0.001) and C4 (AUC=0.83, p=0.002) but not for anti-dsDNA antibodies (AUC=0.90, p=0.163).

Conclusion

IFN-I pathway activation is detectable in almost all newly diagnosed SLE patients. Thus, a negative test result for SIGLEC1 is powerful to exclude SLE in suspected cases.
Age-Specific Changes in Virulence Associated with SARS-CoV-2 Variants of Concern
Authors: Fisman David N. , Tuite Ashleigh R.
Published: September 2021

Background

Novel variants of concern (VOCs) have been associated with both increased infectivity and virulence of SARS-CoV-2. The virulence of SARS-CoV-2 is closely linked to age. Whether relative increases in virulence of novel VOCs is similar across the age spectrum, or is limited to some age groups, is unknown.

Methods

We created a retrospective cohort of people in Ontario, Canada testing positive for SARS-CoV-2 and screened for VOCs, with dates of test report between February 7 and August 30, 2021 (n=233,799). Cases were classified as N501Y-positive VOC, probable Delta VOC, or VOC undetected. We constructed age-specific logistic regression models to evaluate the effects of N501Y-postive or Delta VOC infections on infection severity, using hospitalization, intensive care unit (ICU) admission, and death as outcome variables. Models were adjusted for sex, time, health unit, vaccination status, comorbidities, immune compromise, long-term care residence, healthcare worker status, and pregnancy.

Results

Infection with either N501Y-positive or Delta VOCs was associated with significant elevations in risk of hospitalization, ICU admission, and death in younger and older adults, compared to infections where a VOC was not detected. Delta VOC increased hospitalization risk in children under 10 by a factor of 2.5 (adjusted odds ratio, 95% confidence interval: 1.2 to 5.1) compared to non-VOC. For most VOC-outcome combinations there was no heterogeneity in adverse outcomes by age. However, there was an inverse relationship between age and relative increase in risk of death with delta VOC, with younger age groups showing a greater relative increase in risk of death than older individuals.

Interpretation

SARS-CoV-2 VOCs appear to be associated with increased relative virulence of infection in all age groups, though low absolute numbers of outcomes in younger individuals make estimates in these groups imprecise.