bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 vaccination and antirheumatic therapy
Authors: Arnold Jack , Winthrop Kevin , Emery Paul 
Published: March 2021

Abstract
The coronavirus disease 2019 (COVID-19) vaccination will be the largest vaccination programme in the history of the NHS. Patients on immunosuppressive therapy will be among the earliest to be vaccinated. Some evidence indicates immunosuppressive therapy inhibits humoral response to the influenza, pneumococcal and hepatitis B vaccines. The degree to which this will translate to impaired COVID-19 vaccine responses is unclear. Other evidence suggests withholding MTX for 2 weeks post-vaccination may improve responses. Rituximab has been shown to impair humoral responses for 6 months or longer post-administration. Decisions on withholding or interrupting immunosuppressive therapy around COVID-19 vaccination will need to be made prior to the availability of data on specific COVID-19 vaccine response in these patients. With this in mind, this article outlines the existing data on the effect of antirheumatic therapy on vaccine responses in patients with inflammatory arthritis and formulates a possible pragmatic management strategy for COVID-19 vaccination.
Spatiotemporal spread of chikungunya virus in Sarawak, Malaysia
Authors: Dass Sarat , Ngui Romano , Gill Balvinder Singh , Chan Yoke Fun , Wan Sulaiman Wan Yusoff , Lim Yvonne Ai Lian , Mudin Rose Nani , Chong Chee Kheong , Sulaiman Lokman Hakim , Sam I-Ching 
Published: March 2021

Abstract

Background
We studied the spatiotemporal spread of a chikungunya virus (CHIKV) outbreak in Sarawak state, Malaysia, during 2009–2010.

Methods
The residential addresses of 3054 notified CHIKV cases in 2009–2010 were georeferenced onto a base map of Sarawak with spatial data of rivers and roads using R software. The spatiotemporal spread was determined and clusters were detected using the space-time scan statistic with SaTScan.

Results
Overall CHIKV incidence was 127 per 100 000 population (range, 0–1125 within districts). The average speed of spread was 70.1 km/wk, with a peak of 228 cases/wk and the basic reproduction number (R0) was 3.1. The highest age-specific incidence rate was 228 per 100 000 in adults aged 50–54 y. Significantly more cases (79.4%) lived in rural areas compared with the general population (46.2%, p&lt;0.0001). Five CHIKV clusters were detected. Likely spread was mostly by road, but a fifth of rural cases were spread by river travel.

Conclusions
CHIKV initially spread quickly in rural areas mainly via roads, with lesser involvement of urban areas. Delayed spread occurred via river networks to more isolated areas in the rural interior. Understanding the patterns and timings of arboviral outbreak spread may allow targeted vector control measures at key transport hubs or in large transport vehicles.
Identification and Characterization of Fungicide Resistance in Botrytis Populations from Small Fruit Fields in the Mid-Atlantic United States
Authors: Cosseboom Scott , Hu Mengjun 
Published: March 2021

From 2014 to 2019, 249 isolates of Botrytis spp. were collected from blackberry, black raspberry, grape, red raspberry, and strawberry showing gray mold symptoms. All isolates were phylogenetically characterized as Botrytis cinerea. A mycelial growth assay determined the following overall frequencies of resistance to fungicides: 92% to pyraclostrobin, 86% to cyprodinil, 71% to thiophanate-methyl, 48% to fenhexamid, 47% to iprodione, 26% to boscalid, 11% to fludioxonil, 8% to penthiopyrad, 7% to benzovindiflupyr, 4% to pydiflumetofen, and 4% to isofetamid. Isolates collected from blackberry, red raspberry, and strawberry had a higher median chemical class resistance value compared with isolates from black raspberry and grape. Resistance-conferring mutations were found in a selection of isolates characterized as resistant to thiophanate-methyl, iprodione, pyraclostrobin, fenhexamid, and boscalid, including E198A in β-tubulin; I365N/S, Q369P, and N373S in bos1; G143A in cytb; P238S, N369D, and F412I/S in erg27; and P225F and H272R/Y in sdhB, respectively. Also, multiple drug resistance (MDR) phenotypes MDR1 and MDR1h were identified by analyzing fludioxonil sensitivity and mrr1 sequences. MDR1 and MDR1h isolates had multiple amino acid variations and two insertions in mrr1 that resembled the group S genotype. A detached grape assay confirmed that the aforementioned mutations in isolates from different small fruit crops resulted in field-relevant resistance. An additional in vitro assay found that values for the effective concentration that inhibits mycelial growth by 50% of B. cinerea isolates to pydiflumetofen and inpyrfluxam averaged 0.4 and 1.0, 0.8 and 0.7, 149.8 and 23.2, 0.9 and 0.9, and 38.8 and 48.8 µg/ml for the wild-type, H272R, H272Y, N230I, and P225F genotypes, respectively. These results revealed widespread fungicide resistance in B. cinerea from Mid-Atlantic small fruit fields, highlighting the need for resistance management alternatives.
Care Does Not Stop Following ROSC: A Quality Improvement Approach to Postcardiac Arrest Care
Authors: Pfeiffer Stephen , Zackoff Matthew , Bramble Katelyn , Jacobs Lindsey , Ruehlmann Kristen , Stalets Erika L. , Tegtmeyer Ken , Dewan Maya 
Published: March 2021

Introduction:
Pediatric cardiac arrests carry significant morbidity and mortality. With increasing rates of return of spontaneous circulation, it is vital to optimize recovery conditions to decrease morbidity.

Methods:
We evaluated all patients who presented to a large quaternary pediatric intensive care unit with return of spontaneous circulation. We compared patient-specific postcardiac arrest care preimplementation and postimplementation of a standardized postcardiac arrest resuscitation pathway. We implemented evidence-based best practices using the Translating Research into Practice framework and Plan-Do-Study-Act cycles. Our primary aim was to increase the percent of postcardiac arrest care events meeting guideline targets for blood pressure and temperature within the first 12 hours by 50% within 18 months.

Results:
Eighty-one events occurred in the preintervention group (August 1, 2016–April 30, 2018) and 64 in the postintervention group (May 1, 2018–December 1, 2019). The percent of postcardiac arrest events meeting guideline targets for the entirety of their postarrest period improved from 10.9% for goal mean arterial blood pressure to 26.3%, P = 0.03, and increased from 23.4% for temperature to 71.9%, P < 0.0001.

Conclusions:
Implementing a postcardiac arrest standardized care plan improved adherence to evidence-based postcardiac arrest care metrics, specifically preventing hypotension and hyperthermia. Future multicenter research is needed to link guideline adherence to patient outcomes.
Risk Factors for Major Amputation for Midfoot Ulcers in Hospitalized Patients With Diabetes
Authors: Moon Kyung-Chul , Son Ji-Won , Han Seung-Kyu , Kim Jae-Yeon 
Published: March 2021

PURPOSE:
The purpose of this study was to investigate the risk factors for major amputation in persons hospitalized with diabetic foot ulcers involving the midfoot.

DESIGN:
Retrospective study.

SUBJECTS AND SETTING:
Between January 2003 and May 2019, a total of 1931 patients with diabetes were admitted to the diabetic wound center for the management of foot ulcers. Among the admitted patients, 169 patients with midfoot ulcers were included in this study. One hundred fifty-four patients (91%) healed without major amputation, while 15 patients (9%) healed post–major amputation.

METHODS:
Data related to 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology, and serology were collected from patients in these 2 groups for comparison. Univariate and multivariate logistic regression analyses were performed to analyze risk factors for major amputation.

RESULTS:
Among the 88 potential risk factors, 15 showed statistically significant differences between the 2 groups. Using univariate analysis of 88 potential risk factors, 8 showed statistically significant differences. Using stepwise multiple logistic regression analysis, 3 of the 8 risk factors remained statistically significant. Multivariate-adjusted odds ratios for deep ulcers invading bone, cardiac disorders, and Charcot foot were 26.718, 18.739, and 16.997, respectively.

CONCLUSION:
The risk factors for major amputation in patients hospitalized with diabetic midfoot ulcers included deep ulcers invading the bone, cardiac disorders, and Charcot foot.
Reducing the Incidence of Medical Device–Related Pressure Injuries From Use of CPAP/BiPAP Masks
Authors: Arundel Linda , Irani Evelyn , Barkema George 
Published: March 2021

PURPOSE:
The purpose of this work was to reduce the number of hospital-acquired pressure injuries on the nasal bridge resulting from the use of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy.

PARTICIPANTS AND SETTING:
Patients with medical device–related pressure injuries (MDRPI) receiving continuous/intermittent CPAP/BiPAP in a 12-bed critical care unit in a Magnet-designated, 182-bed community hospital in the mid-Atlantic region of the United States.

APPROACH:
An interprofessional team collaborated to assess factors contributing to an increase in MDRPI development in critical care unit patients using CPAP/BiPAP. Patient dependency on the high-pressurized oxygen results in nurse reluctance to remove the mask and consequently, conduct a partial or incomplete skin assessment. The project consisted of conducting a literature search on MDRPI, developing a standard work process for skin assessment and documentation in the medical record, using skin protection under the mask, and evaluating whether a different model of mask would minimize pressure on the nasal bridge.

OUTCOMES:
Through active collaboration, the interprofessional team implemented standard work processes, completed product evaluation of masks, and monitored key process indicators related to documentation of daily and every 4-hour skin assessments, implementation of a thin foam dressing under the CPAP/BiPAP mask for any nonblanchable or blanchable erythema, and escalation to the certified wound, ostomy, and continence nurse. In 2016, the unit identified 4 CPAP/BiPAP mask-related MDRPIs. By December 2017, only 1 stage 1 injury was identified and it resolved quickly after appropriate assessment and prompt interventions. This showed a 75% reduction in actual injuries with a zero escalation to stage 2 or greater injuries.

IMPLICATIONS FOR PRACTICE:
An interprofessional team approach to CPAP/BiPAP-related MDRPI improved patient outcomes in critical care unit patients.
Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults
Authors: Roveron Gabriele , Barbierato Maria , Rizzo Gianluca , Parini Dario , Bondurri Andrea , Veltri Marco , Pata Francesco , Cattaneo Francesco , Tafuri Alessandro , Forni Cristiana , Ferrara Francesco 
Published: March 2021

PURPOSE:
This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults.

METHODS:
Scoping review and generation of evidence and consensus-based clinical guidelines.

SEARCH STRATEGY:
The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: “stoma preparation,” “stoma creation,” “stoma complications,” “stoma care,” and “stoma reversal” (for enteral stomas).” All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication.

FINDINGS/CONCLUSIONS:
This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.
Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure
Authors: Lawrence Christie , Mohr Lynn D. , Geistkemper Anne , Murphy Sara , Fleming Kellianne 
Published: March 2021

PURPOSE:
The purpose of this interprofessional team–driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries.

PARTICIPANTS AND SETTING:
The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares.

APPROACH:
An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program.

OUTCOMES:
During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported.

IMPLICATIONS FOR PRACTICE:
The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.
Pelistega ratti sp. nov. from Rattus norvegicus of Hainan island
Authors: Zhou Xiaojun , Xuan Duanduan , Hu Shoukui , Du Jiang , Pu Ji , Jin Dong , Zhao Fan , Yin Feifei , Cui Xiuji , Huang Yi , Wang Gaoyu , Wu Qiang , Lu Gang , Niu Lina 
Published: March 2021

Two strains (NLN63T and NLN82) of Gram-stain-negative, oxidase- and catalase-positive, bacilli-shaped organisms were isolated from the faecal samples of two separate Rattus norvegicus in Baisha county of Hainan Province, Southern PR China. Phylogenetic analysis based on the near full-length 16S rRNA sequences revealed that strain NLN63T belongs to the genus

Pelistega

, having maximum similarity to

Pelistega suis

CCUG 64465T (97.1 %),

Pelistega europaea

CCUG 39967T (96.2 %) and

Pelistega indica

DSM 27484T (96.2 %), respectively. The phylogenomic tree built on 553 core genes from genomes of 20 species in the genus

Pelistega

and other adjacent genera further confirmed that strains NLN63T and NLN82 form a distinct subline and exhibit specific phylogenetic affinity with

P. europaea

CCUG 39967T. In digital DNA–DNA hybridization analyses, strain NLN63T showed low estimated DNA reassociation values (21.4–22.6 %) with the type strains of the species in the genus

Pelistega

. The DNA G+C contents of strains NLN63T and NLN82 were 37.3 and 37.1 mol%, respectively. Strain NLN63T had a unique MALDI-TOF MS profile, contained Q-8 as the major quinone and C16 : 0, summed feature 8 (C18 : 1
ω7c/C18 : 1
ω6c or both) and summed feature 3 (C16 : 1
ω7c/C16 : 1
ω6c or both) as the dominant fatty acids. Based upon these polyphasic characterization data obtained from the present study, a novel species of the genus

Pelistega

, Pelistega ratti sp. nov., is proposed with NLN63T (=GDMCC 1.1697T=JCM 33788T) as the type strain.
Immune response to SARS-CoV-2 variants of concern in vaccinated individuals
Authors: Becker Matthias , Dulovic Alex , Junker Daniel , Ruetalo Natalia , Kaiser Philipp D. , Pinilla Yudi T. , Heinzel Constanze , Haering Julia , Traenkle Bjoern , Wagner Teresa R. , Layer Mirjam , Mehrlaender Martin , Mirakaj Valbona , Held Jana , Planatscher Hannes , Schenke-Layland Katja , Krause Gérard , Strengert Monika , Bakchoul Tamam , Althaus Karina , Fendel Rolf , Kreidenweiss Andrea , Koeppen Michael , Rothbauer Ulrich , Schindler Michael , Schneiderhan-Marra Nicole 
Published: March 2021

AbstractThe SARS-CoV-2 pandemic virus is consistently evolving with mutations within the receptor binding domain (RBD)1 being of particular concern2-4. To date, there is little research into protection offered following vaccination or infection against RBD mutants in emerging variants of concern (UK3, South African5, Mink6 and Southern California7). To investigate this, serum and saliva samples were obtained from groups of vaccinated (Pfizer BNT-162b28), infected and uninfected individuals. Antibody responses among groups, including salivary antibody response and antibody binding to RBD mutant strains were examined. The neutralization capacity of the antibody response against a patient-isolated South African variant was tested by viral neutralization tests and further verified by an ACE2 competition assay. We found that humoral responses in vaccinated individuals showed a robust response after the second dose. Interestingly, IgG antibodies were detected in large titers in the saliva of vaccinated subjects. Antibody responses showed considerable differences in binding to RBD mutants in emerging variants of concern. A substantial reduction in RBD binding and neutralization was detected for the South African variant. Taken together our data reinforces the importance of administering the second dose of Pfizer BNT-162b2 to acquire high levels of neutralizing antibodies. High antibody titers in saliva suggest that vaccinated individuals may have reduced transmission potential. Substantially reduced neutralization for the South African variant highlights importance of surveillance strategies to detect new variants and targeting these in future vaccines.
Trends over time in the risk of adverse outcomes among patients with SARS-CoV-2 infection
Authors: Ioannou George N. , O’Hare Ann M. , Berry Kristin , Fan Vincent S , Crothers Kristina , Eastment McKenna C. , Locke Emily , Green Pamela , Shah Javeed A. , Dominitz Jason A. 
Published: March 2021

AbstractObjectivesWe aimed to describe trends in the incidence of adverse outcomes among patients who tested positive for SARS-CoV-2 between February and September 2020 within a national healthcare system.SettingUS Veterans Affairs national healthcare system.ParticipantsEnrollees in the VA healthcare system who tested positive for SARS-CoV-2 between 2/28/2020 and 9/30/2020 (n=55,952).OutcomesDeath, hospitalization, intensive care unit (ICU) admission and mechanical ventilation within 30 days of testing positive.The incidence of these outcomes was examined among patients infected each month and trends were evaluated using an interrupted time-series analysis.ResultsBetween February and July 2020, during the first wave of the US pandemic, there were marked downward trends in the 30-day incidence of hospitalization (44.2% to 15.8%), ICU admission (20.3% to 5.3%), mechanical ventilation (12.7% to 2.2%), and death (12.5% to 4.4%), with subsequent stabilization between July and September 2020. These trends persisted after adjustment for sociodemographic characteristics, comorbid conditions, and documented symptoms and after additional adjustment for laboratory test results among hospitalized patients, including among subgroups admitted to the ICU and treated with mechanical ventilation. Among hospitalized patients, use of hydroxychloroquine (56.5% to 0%), azithromycin (48.3% to 16.6%) vasopressors (20.6% to 8.7%), and dialysis (11.6% to 3.8%) decreased while use of dexamethasone (3.4% to 53.1%), other corticosteroids (4.9% to 29.0%) and remdesivir (1.7% to 45.4%) increased from February to September.ConclusionsAmong patients who tested positive for SARS-CoV-2 in a large national US healthcare system, risk for a range of adverse outcomes decreased markedly between February and July, with subsequent stabilization from July to September. These trends were not explained by changes in measured baseline patient characteristics.
Limited metacognitive access to one’s own facial expressions
Authors: Ciston Anthony B , Forster Carina , Brick Timothy R , Kühn Simone , Verrel Julius , Filevich Elisa 
Published: March 2021

AbstractAs humans we communicate important information through fine nuances in our facial expressions, but because conscious motor representations are noisy, we might not be able to report these fine but meaningful movements. Here we measured how much explicit metacognitive information young adults have about their own facial expressions. Participants imitated pictures of themselves making facial expressions and triggered a camera to take a picture of them while doing so. They then rated confidence (how well they thought they imitated each expression). We defined metacognitive access to facial expressions as the relationship between objective performance (how well the two pictures matched) and subjective confidence ratings. Metacognitive access to facial expressions was very poor when we considered all face features indiscriminately. Instead, machine learning analyses revealed that participants rated confidence based on idiosyncratic subsets of features. We conclude that metacognitive access to own facial expressions is partial, and surprisingly limited.