bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost‐effectiveness of strategies to improve HCV screening, linkage‐to‐care and treatment in remand prison settings in England
Authors: Mohamed Zameer , Scott Nick , Al‐Kurdi Deyaa , Selvapatt Nowlan , Thursz Mark R. , Lemoine Maud , Brown Ashley S. , Nayagam Shevanthi 
Published: August 2020

AbstractBackgroundA simplified cascade‐of‐care may improve screening and treatment uptake among incarcerated individuals. We assessed the cost‐effectiveness of traditional and simplified screening and treatment in a London remand prison.MethodsUsing empirical data from Her Majesty's Prison (HMP) Wormwood Scrubs, London, we designed a decision tree and Markov transition state model using national average data for HCV screening and treatment for the base‐case scenario. This compared two alternative strategies; (a) general prison population screening and treatment and (b) prioritising screening and treatment among people who inject drugs (PWID) combined with general prison population screening and treatment. Strategies varied the rates of screening (47%‐90%), linkage‐to‐care (60%‐86%) and treatment (21%‐85%). Cost, utility and disease transition rates were obtained from existing literature. Outcome measures were as follows: screening, treatment and disease‐related costs per admitted individual, quality‐adjusted life years (QALYs). Incremental cost‐effectiveness ratios (ICERs) were calculated for each intervention. All costs and utilities were discounted at a rate of 3.5% per annum. Both univariate and probabilistic sensitivity analyses have been conducted.ResultsIn our cohort of 5239 incarcerated individuals with an estimated chronic HCV prevalence of 2.6%, all strategy ICER values (£3565‐10 300) fell below the national willingness to pay threshold (£30 000). Increased successful treatment (7%‐54%) was observed by an optimising cascade‐of‐care. A robust sensitivity analysis identified treatment cost of, QALY for mild liver disease and probability of completing treatment as important factors that impact the ICER value.ConclusionIn our remand setting, optimising adherence to the cascade‐of‐care is cost‐effective. Where universal screening is not practical, a stratified approach focused on intensive screening and treatment of PWID also results in increased treatment uptake and is highly cost‐effective.
Prognosis predictability of serum and urine renal markers in patients with decompensated cirrhosis: A multicentre prospective study
Authors: Kim Tae Hyung , Seo Yeon Seok , Kang Seong Hee , Kim Moon Young , Kim Sang Gyune , Lee Hyo Young , Lee Jeong‐Hoon , Lee Young‐Sun , Kim Ji Hoon , Jeong Soung Won , Jang Jae Young , Suk Ki Tae , Jung Young Kul , An Hyonggin , Yim Hyung Joon , Kim Young Seok , Um Soon Ho ,   The Korean Study Group of Portal Hypertension
Published: August 2020

AbstractBackground and AimsThis prospective observational study aimed to evaluate the best serum and urine markers to assess predictability for the prognosis of patients with decompensated cirrhosis.MethodsSerum creatinine and cystatin C (CysC), and urinary N‐acetyl‐beta‐D glucosaminidase (uNAG) and neutrophil gelatinase‐associated lipocalin (uNGAL) levels were measured from hospitalized patients with decompensated cirrhosis.ResultsIn total, 328 patients (mean age, 57.2 ± 12.0 years; 237 men) with decompensated cirrhosis were included. Alcoholic liver disease was the most frequent underlying liver disease (68.0%). Acute kidney injury (AKI) was concomitantly present in 41 patients (12.5%) at baseline. INR, serum creatinine and CysC levels, and uNAG and uNGAL levels were significantly higher in patients with AKI. During hospitalization, AKI had progressed in 37 patients (11.3%). In 287 patients without AKI, the incidence of AKI at 3, 6, 9 and 12 months was 15.4%, 22.2%, 28.6% and 32.5% respectively. On multivariate analysis, serum CysC and uNAG levels were independent predictors of AKI, and their optimal cut‐off values were 1.055 mg/L and 23.1 U/g urinary Cr respectively. When patients were classified into three groups with these cut‐off values of serum CysC and uNAG levels (group 1, both low; group 2, one of two high; and group 3, both high), progression of AKI during hospitalization (P = .001), incidence of AKI in patients without AKI at baseline (P = .001) and mortality rate (P < .001) differed significantly according to serum CysC and uNAG levels.ConclusionSerum CysC and uNAG levels are useful prognostic markers for renal outcomes and mortality in patients with decompensated cirrhosis.
High‐resolution microstructural and compositional analyses of shock deformed apatite from the peak ring of the Chicxulub impact crater
Authors: Cox Morgan A. , Erickson Timmons M. , Schmieder Martin , Christoffersen Roy , Ross Daniel K. , Cavosie Aaron J. , Bland Phil A. , Kring David A. ,   IODP–ICDP Expedition 364 Scientists
Published: August 2020

AbstractThe mineral apatite, Ca5(PO4)3(F,Cl,OH), is a ubiquitous accessory mineral, with its volatile content and isotopic compositions used to interpret the evolution of H2O on planetary bodies. During hypervelocity impact, extreme pressures shock target rocks resulting in deformation of minerals; however, relatively few microstructural studies of apatite have been undertaken. Given its widespread distribution in the solar system, it is important to understand how apatite responds to progressive shock metamorphism. Here, we present detailed microstructural analyses of shock deformation in ~560 apatite grains throughout ~550 m of shocked granitoid rock from the peak ring of the Chicxulub impact structure, Mexico. A combination of high‐resolution backscattered electron (BSE) imaging, electron backscatter diffraction mapping, transmission Kikuchi diffraction mapping, and transmission electron microscopy is used to characterize deformation within apatite grains. Systematic, crystallographically controlled deformation bands are present within apatite, consistent with tilt boundaries that contain the <c> (axis) and result from slip in <> (direction) on (plane) during shock deformation. Deformation bands contain complex subgrain domains, isolated dislocations, and low‐angle boundaries of ~1° to 2°. Planar fractures within apatite form conjugate sets that are oriented within either {, {, {, or . Complementary electron microprobe analyses (EPMA) of a subset of recrystallized and partially recrystallized apatite grains show that there is an apparent change in MgO content in shock‐recrystallized apatite compositions. This study shows that the response of apatite to shock deformation can be highly variable, and that application of a combined microstructural and chemical analysis workflow can reveal complex deformation histories in apatite grains, some of which result in changes to crystal structure and composition, which are important for understanding the genesis of apatite in both terrestrial and extraterrestrial environments.
Kinetics in thermal evolution of Raman spectra of chondritic organic matter to evaluate thermal history of their parent bodies
Authors: Kiryu Kento , Kebukawa Yoko , Igisu Motoko , Shibuya Takazo , Zolensky Michael E. , Kobayashi Kensei 
Published: August 2020

AbstractIn order to establish kinetic expressions for Raman spectroscopic parameters of organic matter in chondritic meteorites with heating, a series of heating experiments (at 600–900 °C for 3–48 h) of the Murchison (CM2) meteorite was conducted. For comparison, several carbonaceous chondrites with various metamorphic degrees—Allende (CV3.2), Moss (CO3.6), Yamato (Y‐) 793321 (heated CM2), and Tagish Lake (ungrouped C2)—were also analyzed by the Raman spectrometer. Changes in the full width at half maximum of the D1 band (ΓD) of heated Murchison correlated well with temperature and time, and showed similar trends of chondrites with various metamorphic degrees. We obtained the kinetic expressions for the changes in ΓD by heating to estimate the time–temperature history of thermally metamorphosed type 3 chondrites and heated CM chondrites. Our results may also be useful for asteroids which are the targets of Hayabusa2 and OSIRIS‐REx missions.
Illuminating the impact of diel vertical migration on visual gene expression in deep‐sea shrimp
Authors: DeLeo Danielle M. , Bracken‐Grissom Heather D. 
Published: August 2020

AbstractDiel vertical migration (DVM) of marine animals represents one of the largest migrations on our planet. Migrating fauna are subjected to a variety of light fields and environmental conditions that can have notable impacts on sensory mechanisms, including an organism's visual capabilities. Among deep‐sea migrators are oplophorid shrimp that vertically migrate hundreds of metres to feed in shallow waters at night. These species also have bioluminescent light organs that emit light during migrations to aid in camouflage. The organs have recently been shown to contain visual proteins (opsins) and genes that infer light sensitivity. Knowledge regarding the impacts of vertical migratory behaviour, and fluctuating environmental conditions, on sensory system evolution is unknown. In this study, the oplophorid Systellaspis debilis was either collected during the day from deep waters or at night from relatively shallow waters to ensure sampling across the vertical distributional range. De novo transcriptomes of light‐sensitive tissues (eyes/photophores) from the day/night specimens were sequenced and analysed to characterize opsin diversity and visual/light interaction genes. Gene expression analyses were also conducted to quantify expression differences associated with DVM. Our results revealed an expanded opsin repertoire among the shrimp and differential opsin expression that may be linked to spectral tuning during the migratory process. This study sheds light on the sensory systems of a bioluminescent invertebrate and provides additional evidence for extraocular light sensitivity. Our findings further suggest opsin co‐expression and subsequent fluctuations in opsin expression may play an important role in diversifying the visual responses of vertical migrators.
Warning bells: How clinicians leverage their discomfort to manage moments of uncertainty
Authors: Ilgen Jonathan S. , Teunissen Pim W. , de Bruin Anique B. H. , Bowen Judith L. , Regehr Glenn 
Published: August 2020

AbstractObjectivesIt remains unclear how medical educators can more effectively bridge the gap between trainees’ intolerance of uncertainty and the tolerance that experienced physicians demonstrate in practice. Exploring how experienced clinicians experience, appraise and respond to discomfort arising from uncertainty could provide new insights regarding the kinds of behaviours we are trying to help trainees achieve.MethodsWe used a constructivist grounded theory approach to explore how emergency medicine faculty experienced, managed and responded to discomfort in settings of uncertainty. Using a critical incident technique, we asked participants to describe case‐based experiences of uncertainty immediately following a clinical shift. We used probing questions to explore cognitive, emotional and somatic manifestations of discomfort, how participants had appraised and responded to these cues, and how they had used available resources to act in these moments of uncertainty. Two investigators coded the data line by line using constant comparative analysis and organised transcripts into focused codes. The entire research team discussed relationships between codes and categories, and developed a conceptual framework that reflected the possible relationships between themes.ResultsParticipants identified varying levels of discomfort in their case descriptions. They described multiple cues alerting them to problems that were evolving in unexpected ways or problems with aspects of management that were beyond their abilities. Discomfort served as a trigger for participants to monitor a situation with greater attention and to proceed more intentionally. It also served as a prompt for participants to think deliberately about the types of human and material resources they might call upon strategically to manage these uncertain situations.ConclusionsDiscomfort served as a dynamic means to manage and respond to uncertainty. To be ‘tolerant’ of uncertainty thus requires clinicians to embrace discomfort as a powerful tool with which to grapple with the complex problems pervasive in clinical practice.
Coordinated regulation of anthranilate metabolism and bacterial virulence by the GntR family regulator MpaR in Pseudomonas aeruginosa
Authors: Wang Tietao , Qi Yihang , Wang Zhihan , Zhao Jingru , Ji Linxuan , Li Jun , Cai Zhao , Yang Liang , Wu Min , Liang Haihua 
Published: August 2020

AbstractThe GntR family regulators are widely distributed in bacteria and play critical roles in metabolic processes and bacterial pathogenicity. In this study, we describe a GntR family protein encoded by PA4132 that we named MpaR (MvfR‐mediated PQS and anthranilate regulator) for its regulation of Pseudomonas quinolone signal (PQS) production and anthranilate metabolism in Pseudomonas aeruginosa. The deletion of mpaR increased biofilm formation and reduced pyocyanin production. RNA sequencing analysis revealed that the mRNA levels of antABC encoding enzymes for the synthesis of catechol from anthranilate, a precursor of the PQS, were most affected by mpaR deletion. Data showed that MpaR directly activates the expression of mvfR, a master regulator of pqs system, and subsequently promotes PQS production. Accordingly, deletion of mpaR activates the expression of antABC genes, and thus, increases catechol production. We also demonstrated that MpaR represses the rhl quorum‐sensing (QS) system, which has been shown to control antABC activity. These results suggested that MpaR function is integrated into the QS regulatory network. Moreover, mutation of mpaR promotes bacterial survival in a mouse model of acute pneumonia infection. Collectively, this study identified a novel regulator of pqs system, which coordinately controls anthranilate metabolism and bacterial virulence in P. aeruginosa.
Invasive Scedosporium and Lomentosora infections in the era of antifungal prophylaxis: A 20‐year experience from a single centre in Spain
Authors: Álvarez‐Uría Ana , Guinea Jesus Vicente , Escribano Pilar , Gómez‐Castellá Javier , Valerio Maricela , Galar Alicia , Vena Antonio , Bouza Emilio , Muñoz Patricia 
Published: August 2020

SummaryBackgroundNon‐Aspergillus mould infections such as those caused by Scedosporium apiospermum or Lomentospora prolificans are an emerging threat. Few studies have monitored their long‐term incidence.ObjectivesTo analyse the epidemiology, risk factors, clinical features and incidence of patients with proven and probable infections.Patients/MethodsPatients admitted to Gregorio Marañón Hospital between 1998 and 2017 and from whom Scedosporium/Lomentospora was isolated were studied. Subjects were classified as having a probable/proven invasive fungal infection or colonization. Molecular identification and antifungal susceptibility testing of isolates causing infection were performed, as well as a description of the patients and incidence of infection.ResultsOne or more Scedosporium/Lomentospora isolates were identified in 67 patients. Sixteen (23.9%) patients had developed infection: 11 scedosporiosis and 5 lomentosporiosis. Stable incidence was observed throughout the study period. Most patients were immunosuppressed and the most common underlying diseases were haematologic malignancy (25%), solid organ transplantation (25%) and chronic corticoid therapy (25%). Breakthrough infection occurred in four patients, 2/11 (18.2%) cases of scedosporiosis and 2/5 (40%) of lomentosporiosis. Overall mortality was 54.5% (6/11) and 80% (4/5) in subjects with scedosporiosis and lomentosporiosis, respectively. High MICs of amphotericin B and remarkable inter‐species susceptibility variability to triazoles was observed for most isolates.ConclusionsIn contrast to previous studies, the incidence of scedosporiosis and lomentosporiosis has not increased at our hospital over the years. The tendency to cause disseminated infection and a reduced susceptibility to most antifungal agents leads to high mortality.
The analysis of epidermal nerve fibre spatial distribution improves the diagnostic yield of skin biopsy
Authors: Piscosquito G. , Provitera V. , Mozzillo S. , Caporaso G. , Borreca I. , Stancanelli A. , Manganelli F. , Santoro L. , Nolano M. 
Published: August 2020

AimSmall fibre neuropathy (SFN) diagnosis represents a challenge for neurologists. The diagnostic gold standard is intraepidermal nerve fibre (IENF) density, but in about 10–20% of patients with symptoms/signs and abnormalities on functional tests, it remains within normal range. We propose an adjunctive parameter to improve the efficiency of skin biopsy diagnosis.MethodsWe recruited 31 patients with SFN symptoms/signs, normal nerve conduction study, abnormal quantitative sensory testing and normal IENF density. We also included 31 healthy controls and 31 SFN patients with reduced IENF density as control groups.ResultsWe measured the distance between consecutive IENFs in the three groups. Mean inter‐fibre distances did not differ between patients with normal counts and healthy controls (66.7 ± 14.5 μm vs. 76.7 ± 13.4 μm; P = 0.052), while the relative standard deviation was significantly (P < 0.001) higher in patients (79.3 ± 29.9) compared to controls (51.6 ± 12.2). Using ROC analysis, we identified an inter‐fibre distance of 350 µm as the measure that better differentiated patients from controls (AUC = 0.85, sensitivity: 74%, specificity: 94%). At least one such segment was also observed in all patients with reduced IENF count.ConclusionIrregular spatial distribution is an SFN intrinsic feature preceding actual nerve loss. The presence of a stretch of denervated epidermis longer than 350 µm is a parameter able to increase the diagnostic efficiency of skin biopsy.
Critical care nurses' experiences of nursing intoxicated patients after abuse of drugs
Authors: Wedin Adam , Sandström Stina , Sandström Linda , Forsberg Angelica 
Published: August 2020

AbstractBackgroundPatients intoxicated after abusing illicit drugs constitute a significant proportion of patients cared for in intensive care units. Intensive critical care nurses who nurse accidentally intoxicated patients face complex and demanding situations, and there is a lack of studies regarding this topic.Aims and objectivesTo illuminate Swedish intensive critical care nurses' experiences of nursing accidentally intoxicated patients after abuse of illicit drugs.DesignA qualitative design with an inductive approach was used.MethodsSemi‐structured interviews were conducted with eight intensive critical care nurses at an intensive care unit in Sweden. Data were analysed using qualitative content analysis.FindingsThe themes found illuminate intensive critical care nurses' experiences of nursing accidentally intoxicated patients after their abuse of illicit drugs: feeling empathy and a wish to provide dignified care; dreading nursing the patient and feeling a lack of empathy; feeling frustration and questioning the care; lacking knowledge about a complex and challenging situation.ConclusionsIt is essential to respond to intoxicated patients with empathy and dignity. Intensive critical care nurses should learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations in intensive care units.Relevance to clinical practiceTo create a caring environment where the interaction becomes more positive and harmonious, an intensive care nurse needs a deep understanding of what a drug abuse disorder means. Moreover, the ability to see the person behind the abuse and to provide non‐judgemental support is required.What is known about this topic
Patients intoxicated after abuse of illicit drugs constitute a significant proportion of patients cared for in ICUs worldwide.
Intensive critical nurses who nurse accidentally intoxicated patients face complex and demanding situations, and few studies have addressed this topic.
What this paper contributes
It is essential to respond to intoxicated patients who are admitted to the ICU with empathy and dignity, as well as to learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations.
Education is warranted and must be enhanced, including knowledge about drug abuse and training in communication and empathy
Nursing should include an understanding of what the disease of drug abuse means and the development of the ability to see the person behind the abuse and to provide non‐judgemental support.
Insights on arrhythmia termination and type 2 breaks after ICD therapy delivery
Authors: Gagno Giulia , Zoppo Franco 
Published: August 2020

AbstractIntroduction of anti‐tachycardia pacing (ATP) therapy and longer detection intervals delivery have allowed to safely reduce unnecessary shocks, improving survival and quality of life in implantable cardioverter defibrillator (ICD) patients. However, there are still outstanding issues, especially regarding the mode of arrhythmias termination after ATP or shock delivery. Regardless of ICD therapy efficacy, the arrhythmia interruption does not always occur abruptly, indeed both nonsustained tachy‐ or bradyarrhythmias have been described after ICD therapy delivery, being the former classified as type 2 interruption. Several physiopathological mechanisms have been suggested to be responsible for this phenomenon. Our aim is to review current data on postshock and post‐ATP arrhythmias and to give insights on their possible mechanisms.
Early cutis marmorata telangiectatica congenita masquerading as ulcerated retiform purpura: a diagnostic trap
Authors: MacGibeny Margaret A. , John Ann M. , Milgraum David M. , Wassef Cindy , Milgraum Sandy S. 
Published: August 2020

AbstractCutis marmorata telangiectatica congenita (CMTC) is a rare congenital cutaneous vascular anomaly with a reticular marbled erythematous pattern, which can result in isolated benign skin lesions or less commonly be associated with systemic anomalies. Occasionally, the characteristic pattern of CMTC lesions is masked on initial presentation, creating a diagnostic conundrum that can result in unnecessary workups to rule out vasculopathy. We present the case of a female newborn with a red‐blue ulcerated skin lesion on the right leg and foot, which initially appeared as retiform purpura but evolved to exhibit the mottled pattern of CMTC by 5 days of age. Clinicians must be made aware of this potential diagnostic trap in early CMTC to avoid invasive skin biopsies and unnecessary laboratory testing in neonates.