bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the use of a powered dermatome an aerosol-generating procedure (AGP)? Implications for personal protection against COVID-19 virus
Authors: Shokrollahi Kayvan , Kyriazidis Ioannis , Zak-Williams Shomari , Jones Claire , Murgatroyd Elisa , Gurusinghe Dilnath 
Published: September 2020

Introduction: Many healthcare workers have contracted SARS-CoV-2 during the pandemic, many cases of which have resulted in severe illness and death. No studies have assessed the potential for powered dermatomes to generate aerosol, an essential technique in burns and plastic surgery. The primary aim of the present study was to capture video footage to illustrate the potential for a powered dermatome to generate significant spray and hence aerosol. Methods: We utilised a simulated skin graft harvest experimental method. Fluorescein-stained saline was used with ultraviolet (UV) backlighting to demonstrate fluorescent spray from a popular brand of air-powered dermatome. Ultra-slow-motion (960 frames/s) video was used to demonstrate the oscillation of the dermatome blade and the origin within the machine of any spray generated, and the extent of spray generated. Results: The key finding from this study is the captured video footage linked with this paper. Droplets of various sizes are seen spraying out from the leading edge at the sides where the blade oscillates. UV backlighting provides a clear demonstration of the dermatome generating fine spray. Conclusion: Our study demonstrates that powered dermatome usage is likely to generate aerosol from blood or blood-contaminated fluid, but does not demonstrate or quantify to what extent this may be clinically relevant in terms of viral transmission potential. We suggest ways to reduce the risk of spray from dermatomes including limiting donor-site bleeding and avoiding a wet donor area. Lay Summary A dermatome is a device used by surgeons to harvest split skin grafts (SSGs). SSGs are an essential component of burns and reconstructive plastic surgery. Aerosol-generating procedures (AGPs) have implications for transmission of viruses including COVID-19. It has not previously been formally assessed whether use of a dermatome should be classified as an AGP. This study uses a fluorescent dye in the context of simulated surgery using a dermatome to see if any, and how much, fine spray is generated from the device and also utilises ultra-slow-motion videography to see how any spray may be generated. At the heart of this study is the included video footage that demonstrates considerable fine spray generation which suggests it is best to assume that dermatomes are likely to generate some degree of aerosol depending on the clinical scenario and how it is used. However, this information does not translate to providing any information about the risk of transmission of the virus from using a dermatome, especially in relation to COVID-19, and separate research would be required to answer this.
The profile and support needs of parents in paediatric palliative care: comparing cancer and non-cancer groups
Authors: Aoun Samar M. , Gill Fenella J. , Phillips Marianne B. , Momber Suzanne , Cuddeford Lisa , Deleuil Renee , Stegmann Roswitha , Howting Denise , Lyon Maureen E. 
Published: September 2020

Background: Parents of children with life-limiting illnesses experience considerable burden and distress, yet few interventions have targeted their well-being. Objectives: Evaluate the use and feasibility of the Paediatric Carer Support Needs Assessment Tool (pCSNAT) in assessing and addressing parents’ needs caring for cancer and non-cancer conditions. Carer well-being outcomes were also tested. Methods: A non-randomised prospective intervention pilot study. Twenty-eight parents (out of 42 approached) and 5 health professionals working in paediatric palliative care services in Western Australia (2018–2019) completed the pilot study. Results: Two-thirds of eligible parents completed the study. The highest support needs included having time for yourself; practical help in the home; knowing what to expect in the future; financial, legal or work issues; and knowing who to contact if you are concerned. Almost all needs were considerably more pronounced for the non-cancer group. The pCSNAT seemed feasible and outcomes demonstrated a tendency to improve. Conclusion: Using the pCSNAT provided a concise and comprehensive ‘one stop shop’ for health professionals to evaluate difficulties encountered by parents. The disadvantages reported by the non-cancer group warrant increased attention. Paediatric palliative care should adopt routine assessment of parents’ support needs to anticipate early and tailored supports including partnerships with the community.
Selecting suitable reference genes for qPCR normalization: a comprehensive analysis in MCF-7 breast cancer cell line
Authors: Jain Nityanand , Nitisa Dina , Pirsko Valdis , Cakstina Inese 
Published: September 2020

Abstract
Background
MCF-7 breast cancer cell line is undoubtedly amongst the most extensively studied patient-derived research models, providing pivotal results that have over the decades translated to constantly improving patient care. Many research groups, have previously identified suitable reference genes for qPCR normalization in MCF-7 cell line. However, over the course of identification of suitable reference genes, a comparative analysis comprising these genes together in a single study has not been reported. Furthermore, the expression dynamics of these reference genes within sub-clones cultured over multiple passages (p) has attracted limited attention from research groups. Therefore, we investigated the expression dynamics of 12 previously suggested reference genes within two sub-clones (culture A1 and A2) cultured identically over multiple passages. Additionally, the effect of nutrient stress on reference gene expression was examined to postulate an evidence-based recommendation of the least variable reference genes that could be employed in future gene expression studies.

Results
The analysis revealed the presence of differential reference gene expression within the sub-clones of MCF-7. In culture A1, GAPDH-CCSER2 were identified as the least variable reference genes while for culture A2, GAPDH-RNA28S were identified. However, upon validation using genes of interest, both these pairs were found to be unsuitable control pairs. Normalization of AURKA and KRT19 with triplet pair GAPDH-CCSER2-PCBP1 yielded successful results. The triplet also proved its capability to handle variations arising from nutrient stress.

Conclusions
The variance in expression behavior amongst sub-clones highlights the potential need for exercising caution while selecting reference genes for MCF-7. GAPDH-CCSER2-PCBP1 triplet offers a reliable alternative to otherwise traditionally used internal controls for optimizing intra- and inter-assay gene expression differences. Furthermore, we suggest avoiding the use of ACTB, GAPDH and PGK1 as single internal controls.
Role of diversity-generating retroelements for regulatory pathway tuning in cyanobacteria
Authors: Vallota-Eastman Alec , Arrington Eleanor C. , Meeken Siobhan , Roux Simon , Dasari Krishna , Rosen Sydney , Miller Jeff F. , Valentine David L. , Paul Blair G. 
Published: September 2020

Abstract
Background
Cyanobacteria maintain extensive repertoires of regulatory genes that are vital for adaptation to environmental stress. Some cyanobacterial genomes have been noted to encode diversity-generating retroelements (DGRs), which promote protein hypervariation through localized retrohoming and codon rewriting in target genes. Past research has shown DGRs to mainly diversify proteins involved in cell-cell attachment or viral-host attachment within viral, bacterial, and archaeal lineages. However, these elements may be critical in driving variation for proteins involved in other core cellular processes.

Results
Members of 31 cyanobacterial genera encode at least one DGR, and together, their retroelements form a monophyletic clade of closely-related reverse transcriptases. This class of retroelements diversifies target proteins with unique domain architectures: modular ligand-binding domains often paired with a second domain that is linked to signal response or regulation. Comparative analysis indicates recent intragenomic duplication of DGR targets as paralogs, but also apparent intergenomic exchange of DGR components. The prevalence of DGRs and the paralogs of their targets is disproportionately high among colonial and filamentous strains of cyanobacteria.

Conclusion
We find that colonial and filamentous cyanobacteria have recruited DGRs to optimize a ligand-binding module for apparent function in signal response or regulation. These represent a unique class of hypervariable proteins, which might offer cyanobacteria a form of plasticity to adapt to environmental stress. This analysis supports the hypothesis that DGR-driven mutation modulates signaling and regulatory networks in cyanobacteria, suggestive of a new framework for the utility of localized genetic hypervariation.
Comparative transcriptomic analysis of Rickettsia conorii during in vitro infection of human and tick host cells
Authors: Narra Hema P. , Sahni Abha , Alsing Jessica , Schroeder Casey L. C. , Golovko George , Nia Anna M. , Fofanov Yuriy , Khanipov Kamil , Sahni Sanjeev K. 
Published: September 2020

Abstract
Background
Pathogenic Rickettsia species belonging to the spotted fever group are arthropod-borne, obligate intracellular bacteria which exhibit preferential tropism for host microvascular endothelium in the mammalian hosts, resulting in disease manifestations attributed primarily to endothelial damage or dysfunction. Although rickettsiae are known to undergo evolution through genomic reduction, the mechanisms by which these pathogens regulate their transcriptome to ensure survival in tick vectors and maintenance by transovarial/transstadial transmission, in contrast to their ability to cause debilitating infections in human hosts remain unknown. In this study, we compare the expression profiles of rickettsial sRNAome/transcriptome and determine the transcriptional start sites (TSSs) of R. conorii transcripts during in vitro infection of human and tick host cells.

Results
We performed deep sequencing on total RNA from Amblyomma americanum AAE2 cells and human microvascular endothelial cells (HMECs) infected with R. conorii. Strand-specific RNA sequencing of R. conorii transcripts revealed the expression 32 small RNAs (Rc_sR’s), which were preferentially expressed above the limit of detection during tick cell infection, and confirmed the expression of Rc_sR61, sR71, and sR74 by quantitative RT-PCR. Intriguingly, a total of 305 and 132 R. conorii coding genes were differentially upregulated (> 2-fold) in AAE2 cells and HMECs, respectively. Further, enrichment for primary transcripts by treatment with Terminator 5′-Phosphate-dependent Exonuclease resulted in the identification of 3903 and 2555 transcription start sites (TSSs), including 214 and 181 primary TSSs in R. conorii during the infection to tick and human host cells, respectively. Seventy-five coding genes exhibited different TSSs depending on the host environment. Finally, we also observed differential expression of 6S RNA during host-pathogen and vector-pathogen interactions in vitro, implicating an important role for this noncoding RNA in the regulation of rickettsial transcriptome depending on the supportive host niche.

Conclusions
In sum, the findings of this study authenticate the presence of novel Rc_sR’s in R. conorii, reveal the first evidence for differential expression of coding transcripts and utilization of alternate transcriptional start sites depending on the host niche, and implicate a role for 6S RNA in the regulation of coding transcriptome during tripartite host-pathogen-vector interactions.
Measurement of drug concentration and bacterial contamination after diluting morphine for intrathecal administration: an experimental study
Authors: Teunissen Aart Jan W. , Koning Mark V. , Ruijgrok Elisabeth J. , Liefers Willem J. , de Bruijn Bart , Koopman Seppe A. 
Published: September 2020

Abstract
Background
Low concentrations of morphine are required for safe dosing for intrathecal injections. Sometimes, manual dilution of morphine is performed to achieve these low concentrations, but risks dilution errors and bacterial contamination. The primary goal was to compare the concentrations of morphine and bupivacaine between four groups of syringes. The secondary goal was to investigate the difference in contamination rate between these groups.

Methods
Twenty-five experienced anesthesia providers were asked to prepare a mixture of bupivacaine 2.0 mg/ml and morphine 60 μg/ml using 3 different methods as clean and precise as possible. The fourth method used was the aspiration of ampoules prepared by the pharmacy. The concentrations of morphine and bupivacaine were measured by High-Pressure Liquid Chromatography (HPLC). The medication was cultured for bacterial contamination.

Results
Group 1 (median 60 μg/ml; 95% CI: 59–110 μg/ml) yielded 3 outliers above 180 μg/ml morphine concentration. Group 2 (76 μg/ml; 95% CI: 72–80 μg/ml) and 3 (69 μg/ml; 95% CI: 66–71 μg/ml) were consistently higher than the target concentration of 60 μg. The group “pharmacy” was precise and accurate (59 μg/ml; 95% CI: 59–59 μg/ml). Group 2 and “pharmacy” had one contaminated sample with a spore-forming aerobic gram-positive rod.

Conclusion
Manually diluted morphine is at risk for deviating concentrations, which could lead to increased side-effects. Medication produced by the hospital pharmacy was highly accurate. Furthermore, even when precautions are undertaken, contamination of the medication is a serious risk and appeared to be unrelated to the dilution process.
Liver fibrosis assessments using FibroScan, virtual-touch tissue quantification, the FIB-4 index, and mac-2 binding protein glycosylation isomer levels compared with pathological findings of liver resection specimens in patients with hepatitis C infection
Authors: Ueda Naoyuki , Kawaoka Tomokazu , Imamura Michio , Aikata Hiroshi , Nakahara Takashi , Murakami Eisuke , Tsuge Masataka , Hiramatsu Akira , Hayes C. Nelson , Yokozaki Michiya , Chayama Kazuaki 
Published: September 2020

Abstract
Background
Evaluation of fibrosis stage is important to monitor progression of liver disease and risk of hepatocellular carcinoma (HCC). While liver biopsy is the gold standard, the method is invasive and faces several limitations. The aim of this study was to determine correlations among METAVIR scores and FibroScan, Virtual-Touch tissue quantification (VTQ), fibrosis index based on four factors (FIB-4 index), and Mac-2 binding protein glycosylation isomer (M2BPGi) level, and for examine differences in the reliability of non-invasive methods to evaluate fibrosis.

Methods
We used liver resection specimens from patients with hepatitis C virus (HCV), correlations were assessed between METAVIR scores and non-invasive method. Receiver operating characteristic (ROC) curves were generated to determine the sensitivity, specificity, and cut off values of the methods.

Results
All Patients group: In F0–2 vs F3–4, the areas under the ROC curve (AUC) (0.85) of FibroScan was significantly higher than that (0.67) of FIB-4 index (p = 0.002) and that (0.67) of M2BPGi (p = 0.001). The AUC (0.83) of VTQ was significantly higher than that (0.67) of FIB-4 index (p = 0.01) and that (0.67) of M2BPGi (p = 0.002). In F0–3 vs F4, the AUC (0.86) of VTQ was significantly higher than that (0.65) of FIB-4 index (p = 0.04). The AUC (0.89) of FibroScan was significantly higher than that (0.65) of FIB-4 index (p = 0.002) and that (0.76) of M2BPGi (p = 0.02).
Non-SVR group: In F0–2 vs F3–4, the AUC (0.85) of FibroScan was significantly higher than that (0.84) of FIB-4 index (p = 0.02) and that (0.73) of M2BPGi (p = 0.003). The AUC (0.84) of VTQ was significantly higher than that (0.74) of FIB-4 index (p = 0.04). In F0–3 vs F4, the AUC (0.91) of FibroScan was significantly higher than that (0.67) of FIB-4 index (p = 0.003) and that (0.78) of M2BPGi (p = 0.02). The AUC (0.88) of VTQ was significantly higher than that of FIB-4 index (0.67) and that of M2BPGi (0.78) (p = 0.04).

Conclusions
FibroScan and VTQ best reflected the results of hepatic fibrosis diagnosis using liver resection specimens among the four examination methods evaluated.
Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
Authors: Axelsson Raja Anna , Warming Peder E. , Nielsen Ture L. , Plesner Louis L. , Ersbøll Mads , Dalsgaard Morten , Schou Morten , Rydahl Casper , Brandi Lisbet , Iversen Kasper 
Published: September 2020

Abstract
Background
Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis.

Methods
Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%.

Results
Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]).

Conclusion
Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.
Depressive symptoms among orphans and vulnerable adolescents in childcare homes in Nepal: a cross-sectional study
Authors: Bhatt Kumari Bandana , Apidechkul Tawatchai , Srichan Peeradone , Bhatt Navin 
Published: September 2020

Abstract
Background
Orphans and vulnerable adolescents (OVAs) living in child care homes (CCHs) are vulnerable to depressive symptoms due to a poor environment and a lack of receiving good care and love from their parents. This study aimed to estimate the presence of depressive symptoms and determine factors associated with it among OVAs living in CCHs in Nepal.

Methods
A cross-sectional study was conducted to collect the information from OVAs aged 13–17 years living in 22 CCHs from five districts of Nepal. The CCHs were selected by a simple random method. A validated questionnaire and the Beck Depression Inventory-II (BDI-II) were used to assess depressive symptoms among the participants. Those with mild to severe BDI-II scores were defined as having clinically relevant depressive symptoms. Logistic regression was used to detect associations between variables at the significance level α = 0.05.

Results
A total of 602 adolescents participated in the study; 51.0% were females, the average age was 14.7 years, and 32.2% were members of indigenous groups. The overall presence of clinically relevant depressive symptoms was 33.2%. After controlling for all potential confounding factors, five factors were found to be associated with depress among OVAs. Females were 1.96 times more likely to develop depressive symptoms than males (95% CI = 1.36–2.83). Those adolescents who used alcohol were 3.42 times more likely to develop depressive symptoms than those who did not (95% CI = 1.16–10.12). Those who had health problems were 2.00 times more likely to develop depressive symptoms than those who did not (95% CI = 1.36–2.94). Those who had low social support were 1.81 times more likely to develop depressive symptoms than those who had high social support (95% CI = 1.08–3.03), and those who had been bullied were 1.97 times more likely to develop depressive symptoms than those who were not bullied (95% CI = 1.23–3.15).

Conclusion
The magnitude of clinically relevant depressive symptoms in adolescents living in CCHs was found to be high in Nepal. There is an urgent need for effective intervention to curtail this problem among OVAs in CCHs in Nepal, with a focus on females, alcohol users, those with physical health problems and with less social support, and those who are bullied.
Trick or treat? – when children with childhood food allergies lead parents into unhealthy food choices
Authors: Mahmoud Ali B. , Hack-Polay Dieu , Fuxman Leonora , Naquiallah Dina , Grigoriou Nicholas 
Published: September 2020

AbstractBackgroundThis study examines the relationships between childhood food allergy and parental unhealthy food choices for their children across attitudes towards childhood obesity as mediators and parental gender, income and education as potential moderators.MethodsWe surveyed parents with at least one child between the ages of 6 and 12 living in Canada and the United States. We received 483 valid responses that were analysed using structural equation modelling approach with bootstrapping to test the hypothetical path model and its invariance across the moderators.ResultsThe analysis revealed that pressure to eat fully mediated the effects of childhood food allergy and restriction on parental unhealthy food choices for their children. Finally, we found that parental gender moderated the relationship between childhood food allergy and the pressure to eat.ConclusionsThe paper contributes to the literature on food allergies among children and the marginalisation of families with allergies. Our explorative model is a first of its kind and offers a fresh perspective on complex relationships between variables under consideration. Although our data collection took place prior to Covid-19 outbreak, this paper bears yet particular significance as it casts light on how families with allergies should be part of the priority groups to have access to food supply during crisis periods.