bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlated evolution between herbivory and gastrointestinal tract in a prolific lizard adaptive radiation
Authors: Pincheira-Donoso Daniel 
Published: March 2021

Abstract
Radiations of ectothermic vertebrates across cold climates depend on the coordinated evolution of multiple traits that compensate for the constraints imposed by limited and fluctuating resources, such as temperature, food and oxygen. One of nature’s most prolific such radiations, Liolaemus lizards, has diversified across the extreme cold climates of the Andes and Patagonia. Remarkably, the prevailing patterns of reptile herbivory are opposed by Liolaemus which, in contrast with lizards generally, have repeatedly evolved plant consumption across small-bodied species from cold climates. Herbivory is hypothesized to depend on the evolution of multiple traits that maximize absorption of nutrients from an intrinsically poor-quality diet, such as increases in gastrointestinal tract size and increases in the density of nematodes in the intestine that may assist with plant digestion. Here, a comparative phylogenetic approach across Liolaemus species is implemented to test these hypotheses, which have only been investigated nonphylogenetically. Results reveal that intestine length increases consistently with increasing herbivory, whereas stomach size or nematode load are not associated with plant consumption. Body size plays no role in herbivory either. Consequently, this evidence places emphasis on the enlargement of the intestine to facilitate the evolution of herbivory in cold climates.
A Pilot Test of the Association between Weather Comfort and Thermocomfort and Time Spent Outdoors
Authors: Harvey Mark L. , MacPhee Victoria 
Published: March 2021

AbstractEmerging scientific consensus reveals that spending time outdoors promotes wellness. However, several forces impede time spent outdoors, such as opportunity, safety, and adverse weather. While uncomfortable weather intuitively decreases time outdoors, acclimatization research suggests a counterintuitive process: outdoor exposure enhances physiological adaption to adverse weather, thereby increasing perceived comfort in subsequent outings and even during a single outing in some situations, which, in turn, increases time outdoors. Therefore, this study preliminarily investigated whether time spent outdoors is associated with perceptions of weather and ambient temperature, apart from actual weather. This study attempted to isolate the role of self-reported weather comfort and thermocomfort in predicting time spent outdoors by controlling for motivational and social factors. Residing in the same locale, participants were exposed to identical weather conditions. To enhance recall accuracy, participants daily reported time spent outdoors and weather comfort and thermocomfort across a 7-day period, producing 175 time-comfort entries. Cox regression analyses show that greater perceived comfort with weather and greater perceived comfort with the temperature are associated with significantly more time spent outdoors, adjusting for motivational and social factors. Results also show that participants who wanted to go outdoors, as compared with those who had to go outdoors, reported significantly greater weather comfort. Physiological and other relevant research findings on the human relationship with weather contextualize the study’s rationale and results.
Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study
Authors: Aran Pavitra , Lewis Andrew J , Watson Stuart J , Nguyen Thinh , Galbally Megan 
Published: March 2021

Objective: Poorer mother–infant interaction quality has been identified among women with major depression; however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother–infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control). Methods: Data were obtained for 127 mother–infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM-5 was used to diagnose major depressive disorder ( n = 60) and bipolar disorder ( n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant’s interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted. Results: After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores. Conclusions: Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring’s emotional availability at 6 months postpartum, particularly in maternal intrusiveness.
Neighborhood Disadvantage Measures and COVID-19 Cases in Boston, 2020
Authors: Samuels-Kalow Margaret E. , Dorner Stephen , Cash Rebecca E. , Dutta Sayon , White Benjamin , Ciccolo Gia E. , Brown David F.M. , Camargo Carlos A. 
Published: March 2021

Objective Understanding the pattern of population risk for coronavirus disease 2019 (COVID-19) is critically important for health systems and policy makers. The objective of this study was to describe the association between neighborhood factors and number of COVID-19 cases. We hypothesized an association between disadvantaged neighborhoods and clusters of COVID-19 cases. Methods We analyzed data on patients presenting to a large health care system in Boston during February 5–May 4, 2020. We used a bivariate local join-count procedure to determine colocation between census tracts with high rates of neighborhood demographic characteristics (eg, Hispanic race/ethnicity) and measures of disadvantage (eg, health insurance status) and COVID-19 cases. We used negative binomial models to assess independent associations between neighborhood factors and the incidence of COVID-19. Results A total of 9898 COVID-19 patients were in the cohort. The overall crude incidence in the study area was 32 cases per 10 000 population, and the adjusted incidence per census tract ranged from 2 to 405 per 10 000 population. We found significant colocation of several neighborhood factors and the top quintile of cases: percentage of population that was Hispanic, non-Hispanic Black, without health insurance, receiving Supplemental Nutrition Assistance Program benefits, and living in poverty. Factors associated with increased incidence of COVID-19 included percentage of population that is Hispanic (incidence rate ratio [IRR] = 1.25; 95% CI, 1.23-1.28) and percentage of households living in poverty (IRR = 1.25; 95% CI, 1.19-1.32). Conclusions We found a significant association between neighborhoods with high rates of disadvantage and COVID-19. Policy makers need to consider these health inequities when responding to the pandemic and planning for subsequent health needs.
Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic
Authors: Rizan Chantelle , Reed Malcolm , Bhutta Mahmood F 
Published: March 2021

Objective To quantify the environmental impact of personal protective equipment (PPE) distributed for use by the health and social care system to control the spread of SARS-CoV-2 in England, and model strategies for mitigating the environmental impact. Design Life cycle assessment was used to determine environmental impacts of PPE distributed to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use and disposed of via clinical waste. Scenario modelling was used to determine the effect of environmental mitigation strategies: (1) eliminating international travel during supply; (2) eliminating glove use; (3) reusing gowns and face shields; and (4) maximal recycling. Setting Royal Sussex County Hospital, Brighton, UK. Main outcome measures The carbon footprint of PPE distributed during the study period totalled 106,478 tonnes CO2e, with greatest contributions from gloves, aprons, face shields and Type IIR surgical masks. The estimated damage to human health was 239 DALYs (disability-adjusted life years), impact on ecosystems was 0.47 species.year (loss of local species per year), and impact on resource depletion was costed at US $12.7m (GBP £9.3m). Scenario modelling indicated UK manufacture would have reduced the carbon footprint by 12%, eliminating gloves by 45%, reusing gowns and gloves by 10% and maximal recycling by 35%. Results A combination of strategies may have reduced the carbon footprint by 75% compared with the base scenario, and saved an estimated 183 DALYS, 0.34 species.year and US $7.4m (GBP £5.4m) due to resource depletion. Conclusion The environmental impact of PPE is large and could be reduced through domestic manufacture, rationalising glove use, using reusables where possible and optimising waste management.
An evaluation of the experiences of young people in Patient and Public Involvement for palliative care research
Authors: Mitchell Sarah J , Slowther Anne-Marie , Coad Jane , Khan Dena , Samani Mohini , Dale Jeremy 
Published: March 2021

Background: The active involvement of patients and the public in the design and conduct of research (Patient and Public Involvement) is important to add relevance and context. There are particular considerations for involving children and young people in research in potentially sensitive and emotional subject areas such as palliative care. Aim: To evaluate the experiences of young people of Patient and Public Involvement for a paediatric palliative care research study. Design: Anonymous written feedback was collected from group members about their experiences of Patient and Public Involvement in a paediatric palliative care research study. An inductive thematic analysis of the feedback was conducted using NVivo. Setting / Participants: Young people aged 12–22 years who were members of existing advisory groups at a children’s hospital, hospice and the clinical research network in the West Midlands, UK. Results: Feedback was provided by 30 young people at three meetings, held between December 2016 and February 2017. Three themes emerged: (1) Involvement: Young people have a desire to be involved in palliative care research, and recognise the importance of the subject area. (2) Impact: Researchers should demonstrate the impact of the involvement work on the research, by regularly providing feedback. (3) Learning: Opportunities to learn both about the topic and about research more widely were valued. Conclusions: Young people want to be involved in palliative care research, and recognise its importance. A continuous relationship with the researcher throughout the study, with clear demonstration of the impact that their input has on the research plans, are important.
Comparison of the effective orifice area of prosthetic mitral valves using two-dimensional versus three-dimensional transesophageal echocardiography
Authors: Zhou Lei , Wei Hai-yan , Ge Ya-li , Ding Zheng-nian , Shi Hong-wei 
Published: March 2021

Objective This study compared the continuity equation-based effective orifice area (EOA) of prosthetic mitral valves between two-dimensional (2D) and 3D transesophageal echocardiography (TEE). Methods Thirty-four patients without major aortic valve abnormalities underwent mitral valve replacement surgery. The EOAs of prosthetic mitral valves were calculated using the continuity equation with 2D and 3D TEE. For 18/34 patients using a biological valve prosthesis, the EOA of the prosthesis was obtained from commercial records. Results The EOA of prosthetic mitral valves significantly varied between the 2D and 3D methods (2.22 ± 0.71 vs 2.35 ± 0.70 cm2, n = 34). The area of the diameter of the left ventricular outflow tract as determined by the 3D method was significantly higher than that by the 2D method (mean difference: −0.14 ± 0.20 cm2), with 95% coherence boundaries of −0.53 and 0.25 cm2. The regression equation for the EOA by 3D and 2D TEE was y = 0.27 + 0.94x, with a good correlation. Conclusions The EOA of prosthetic mitral valves is underestimated using the 2D TEE method compared with the 3D TEE method. The 3D-TEE method has the advantage of higher precision over the 2D TEE method, and it may be helpful for better assessment of prosthetic mitral valves intraoperatively.
The interaction between high-level electronic medical record adoption and hospitalist staffing levels: A focus on value-based purchasing
Authors: Li Kate Jiayi , Al-Amin Mona 
Published: March 2021

Objective This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction. Materials and methods We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals’ total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics. Results Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS. Discussion Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each. Conclusion Hospitalists staffing level and EMR capability are both positively correlated with hospitals’ TPS, and they act independently to bolster hospital performance.
Identifying Barriers to and Facilitators of Using a Mobile Fruit and Vegetable Market Intervention Delivered to Low-Income Housing Sites: A Concept Mapping Study
Authors: Dulin Akilah , Mealy Rachel , Whittaker Shannon , Cardel Michelle , Wang Jeremy , Risica Patricia M. , Gans Kim 
Published: March 2021

Background Mobile fruit and vegetable (F&V) markets may be a promising strategy to improve F&V intake among low-income and racial/ethnic minority groups. However, challenges remain in terms of maximizing the reach and utilization of such markets. Therefore, this study identifies perceived barriers to and facilitators of utilizing a mobile F&V market among residents who lived in low-income housing that received the markets. Specifically, this article reports the results of the follow-up acceptability study of the “Live Well, Viva Bien” (LWVB) intervention. Method We conducted concept mapping with residents in housing communities that received the Fresh to You (FTY) markets. Participants generated, sorted, and rated statements concerning barriers to and facilitators of market use. We compared the rating data by residents’ level of market utilization and created a map representing how statements clustered into conceptual themes. Results We retained 66 unique participant-generated statements. Eight thematic clusters emerged; four pertained to barriers: financial/promotion, produce-related, scheduling/knowledge, and logistic/awareness barriers, and four related to facilitators: produce/staffing, promotion, accessibility, and multilevel market facilitators. There was a strong correlation in ratings between participants who more frequently versus less frequently shopped at the markets ( r = 0.94). Conclusions Participants identified financial barriers, market promotion, ease of market accessibility, produce variety and quality, and staffing as key factors influencing FTY market use. This study highlights the importance of identifying the perceived barriers to and facilitators of mobile F&V market use among target populations to inform future efforts to scale up such approaches.
Ultrasound-guided cannulation of the brachiocephalic vein in newborns: A novel approach with a supraclavicular view for tip navigation and tip location
Authors: Spagnuolo Ferdinando , Vacchiano Teresa 
Published: March 2021

Purpose: Central vascular catheters (CVCs) are frequently used in newborns in NICU. Ultrasound (US) guided supraclavicular venipuncture of the brachiocephalic vein (BCV) is usually performed with a 12 MHz linear probe and then a catheter tip location is verified with an 8 MHz micro-convex probe or intracavitary ECG (IC-ECG). We explored the feasibility of an US guided puncture using a 7 MHz sector probe, positioned on the clavicular sternal joint. We also explored the opportunity of performing it with a probe tilting tip navigation and tip location. Design: This is a monocentric retrospective observational study made in the neonatal intensive care unit L. Vanvitelli University Hospital of Naples, Italy. Patients: Forty newborns in NICU scheduled for an ultrasound guided CVC. Interventions: US guided brachiocephalic vein catheterization. We used A long axis in plane supraclavicular approach to the BCV for real time puncture, for tip navigation and tip location, using a 7 MHz sector transducer. We executed an ultrasound pre-scan of the Y-shape (right and left BCV, superior vena cava (SVC)) and of the right pulmonary artery (RPA), and then we performed a guided sterile puncture on middle third of supraclavicular fossa next to clavicular sternal joint with a 7 MHz. We used the same probe for tip navigation by this supraclavicular short axis of ascending aorta view. Tip location was confirmed with the ultrasound and IC-ECG. Results: In all infants the ultrasound tip navigation and tip location were successful and were confirmed by IC-ECG. No misplacement, arterial puncture or pneumothorax occurred. Conclusions: The supraclavicular view performed with a 7 MHz sector probe has proved to be completely safe and to be a method with 100% feasibility.
Tunneling technique of PICCs and Midline catheters
Authors: Giustivi Davide , Gidaro Antonio , Baroni Monica , Paglia Stefano 
Published: March 2021

Background: The tunneling technique is currently widely used for placement of CVC. Recently, some clinicians have used this technique for peripherally inserted central catheters (PICC), or Midline catheters (MCs). Objective: To describe a safe antegrade tunneling technique for PICCs and MCs insertion with a blunt tunneler. Methods: This retrospective monocentric survey collected ASST Lodi hospital data from January 1st to December 31st, 2019. The indication for PICCs and MCs tunneled implant was to respect the correct vein/catheter ratio or special clinical situation (children, burns, wounds, and wider catheter 5/6 fr). Contraindications included the operator’s low skills and severe risk of bleeding (INR > 3; Platelet count <50’000). Results: About 390 PICCs (327 4 fr and 63 5 fr) and 183 MCs were placed. One hundred and sixty-five PICCs (42%) and 110 MCs (60%) were tunneled. Five fr PICCs were more present among tunneled catheters (54/165 [32.7%] vs 9/225 [4%] p < 0.0001). In the majority tunneling was necessary to respect the correct catheter/vein ratio. The exit site was shifted only for four special clinical situations: skin infections (one PICC and two MCs); burns (one MC). No early complication (intraprocedural, major bleeding), catheter related thrombosis, or device fractures occurred. Two catheter-related bloodstream infections (one PICC, one MC), nine dislocations (four PICCs, five MCs), one MC occlusion were recorded. Conclusions: The antegrade tunneling technique with blunt tunneler of PICCs and MCs is simple, rapid and is regarded as a safe maneuver. More in-depth and future prospective studies are needed to evaluate the impact of tunneling on early and late complications.
Management of Systemic Sclerosis Patients in the COVID-19 Era: The Experience of an Expert Specialist Reference Center
Authors: Spinella Amelia , Magnani Luca , De Pinto Marco , Marvisi Chiara , Parenti Luca , Bajocchi Gianluigi , Salvarani Carlo , Mascia Maria Teresa , Giuggioli Dilia 
Published: March 2021

Objective: COVID-19 pandemic represents a serious health emergency that severely compromised our Public Health system, resulting in a rapid and forced reorganization and involved the management of chronic diseases too. The Scleroderma Unit of Modena and Reggio Emilia follows more than 600 patients suffering from systemic sclerosis (SSc) and recently became the referral center (HUB) in Emilia-Romagna for this rare connective tissue disease. The aim of the present study was to evaluate the extent by which the lockdown and the pandemic has impacted the activity of admissions to Scleroderma Unit of Modena and Reggio Emilia. Methods: Our daily clinical activity is characterized by outpatient visits, videocapillaroscopy exam, ulcers treatment, therapeutic infusions in day hospital regimen, multidisciplinary visits following our dedicated SSc care pathway, and clinical trials. Our activity has been quickly rescheduled to ensure the proper assistance to our SSc patients during the COVID-19 pressure. Results: The use of telemedicine has certainly assured a robust continuity of health care. Furthermore, telephone pre-triage, nurse/medical triage, proper physical distancing and use of PPE/DPI allowed us to re-organize and continue SSc daily activity. Specifically, therapeutic infusions in day hospital regimen and outpatient visits, including ulcers treatment, was guaranteed and maximized. Conclusion: The management of scleroderma patients by an expert specialist reference center is crucial in order to ensure continuity of care and pursue the best SSc practice.
Donor Gamma-Glutamyl Transferase Is Associated With Liver Allograft Discard and Failure
Authors: Zhang Theodore , Hickner Brian , Cotton Ronald , Nguyen Galvan Nhu Thao , Vierling John M , O’Mahony Christine , Goss John A , Rana Abbas 
Published: March 2021

Introduction: The disparity between the number of individuals on the wait list and available liver allografts creates the need for a system that maximizes donor liver utilization and predicts graft failure. Research Question: This study aimed to determine the relationship between donor Gamma-Glutamyl Transferase (GGT), liver discard, and graft failure. Design: Through multivariate analysis from 53 966 deceased liver donors, we adjusted for donor clinical and demographic characteristics and compared donor GGT with allograft discard. We compared donor GGT ranges with graft failure and analyzed data from 47 269 liver recipients. Results: After adjusting for other factors, donor GGT was significantly associated with liver discard, with GGT over 200 U/L being most significant (OR 2.74, CI 2.51-2.99). Donor GGT under 20 U/L was also found to be a protective factor for post-transplant graft failure (HR 0.91, CI 0.83 – 1.00). Conclusion: Going forward, GGT should be included among other characteristics associated with allograft discard considered during the procurement process.