bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Evidence for Extended He ii Reionization at z ≳ 3.5 from He ii Lyman Alpha and Beta Transmission Spikes*
Authors: Makan Kirill , Worseck Gábor , Davies Frederick B. , Hennawi Joseph F. , Prochaska J. Xavier , Richter Philipp 
Published: May 2021

Abstract
We present new high-resolution (R = λ/Δλ ∼ 14,000) spectra of the two brightest He ii-transparent quasars in the far-UV at z
em > 3.5, HE2QS J2311−1417 (z
em = 3.70) and HE2QS J1630+0435 (z
em = 3.81), obtained with the Cosmic Origins Spectrograph on the Hubble Space Telescope. In the predominantly saturated He ii absorption spectra, both sight lines show several isolated resolved (FWHM ≳ 50 km s−1) transmission spikes in He ii Lyα and He ii Lyβ. The incidence of such spikes decreases with increasing redshift, but both sight lines show significant spikes at z ≳ 3.5, signaling the presence of fully ionized regions in the z ≳ 3.5 intergalactic medium (IGM). We employ an automated algorithm to compare the number of detected He ii transmission spikes to predictions from mock spectra created from the outputs of a cubic (146 cMpc)3 optically thin Nyx hydrodynamical simulation, assuming a range of UV background photoionization rates ΓHe II
. From the incidence of Lyα and Lyβ transmission spikes we infer similar photoionization rates of

at 3.51 < z < 3.66 and ΓHe II
= (0.9 ± 0.3) × 10−15 s−1 at 3.460 < z < 3.685, respectively. Because the transmission spikes indicate fully ionized regions at z ≳ 3.5 along both lines of sight, our observations provide further evidence that He ii reionization had substantially progressed at these redshifts.
Psychanalyse de l’enfant, pédopsychiatrie et psychothérapie : enjeux actuels
Authors: Ribas Denys 
Published: May 2021

Les attaques contre la psychanalyse visent également aujourd’hui la pédopsychiatrie. Il est vrai que celle-ci doit beaucoup à la psychanalyse en France, permettant une prise en compte de la structuration psychique en termes psychopathologiques et jusque dans la classification française, maintenant interfacée avec la CIM 10. Si certains psychanalystes s’en sont défiés, l’évaluation de l’action de la psychanalyse est aujourd’hui vitale, et ce défi peut être relevé. La spécificité de la psychanalyse de l’enfant est discutée au sein de la psychanalyse et vis-à-vis des psychothérapies. Le problème épistémologique est posé du point de vue intrapsychique freudien quant à pouvoir rendre compte de l’aube de la vie psychique avant l’établissement d’une limite dedans/ dehors. Les conséquences des modifications sociétales sont également envisagées ; elles interrogent la transmission du surmoi. La spécificité de la formation à la psychanalyse de l’enfant est proposée, dégagée de l’enjeu de transmission de la cure.
An Examination and Comparison of Stethoscope Hygiene in Nursing Education Programs
Authors: Gaisser D'Arcy J. , Lowey Susan E. , Barbel Paula 
Published: May 2021

Background:
Improper stethoscope hygiene has been found to contribute to the development of health care associated infections, which affects approximately one in every 30 hospitalized patients. Various pathogens have been found on the stethoscopes of health care workers.

Method:
A correlational descriptive design was used to compare stethoscopes from 117 nursing students. Sterile swab samples were obtained from four separate areas of each stethoscope. Samples were plated and incubated for 24 to 48 hours.

Results:
Bacteria were found on all parts of the stethoscopes from both undergraduate and graduate nursing students, with the earpiece having the highest percentage of contamination. Staphylococcus was the most prevalent microbe found on all four swab sites.

Conclusion:

Educating students about stethoscope hygiene and consistently reinforcing it in practice are essential to reduce the transmission of pathogens in the health care environment. Nurses can model best practice with students and other disciplines to increase the likelihood of adherence.

[
J Nurs Educ
. 2021;60(5):277–280.]
Transition of a Collaborative In-Person Health Care Innovation Course to Online Learning
Authors: Karwat Ariel , Richmond Therese S. , Leary Marion 
Published: May 2021

Background:
As COVID-19 forced in-person courses to transition online, an active learning course focused on design thinking in health and health care embraced the challenge. Lessons learned, mistakes made, and thoughts on the future of online education in nursing are discussed.

Method:
During the online transition, it was thought the flipped-classroom approach would transition well using the same design thinking methodology taught in the course. Because the course promoted rapid innovation and iteration, such a challenge served as a call to action, and the course became a valuable real-time case study.

Results:
Based on student surveys, the overall quality of the transitioned course increased slightly compared with the previous semester's in-person course, indicating schools of nursing can innovate both the way students are taught as well as what students are taught.

Conclusion:

Rather than mourn the loss of in-person learning, the newfound possibilities of virtual education should celebrated.

[
J Nurs Educ
. 2021;60(5):298–300.]

.
Dietary Fiber Drives IL-1β–Dependent Peritonitis Induced by Bacteroides fragilis via Activation of the NLRP3 Inflammasome
Authors: Jennings-Almeida Bruno , Castelpoggi Juliana P. , Ramos-Junior Erivan S. , Ferreira Eliane de Oliveira , Domingues Regina M. C. P. , Echevarria-Lima Juliana , Coutinho-Silva Robson , Moreira-Souza Aline C. A. , Mariño Eliana , Mackay Charles R. , Zamboni Dario S. , Bellio Maria , Scharfstein Julio , Lobo Leandro A. , Oliveira Ana Carolina 
Published: May 2021

Abstract
Intestinal barrier is essential for dietary products and microbiota compartmentalization and therefore gut homeostasis. When this barrier is broken, cecal content overflows into the peritoneal cavity, leading to local and systemic robust inflammatory response, characterizing peritonitis and sepsis. It has been shown that IL-1β contributes with inflammatory storm during peritonitis and sepsis and its inhibition has beneficial effects to the host. Therefore, we investigated the mechanisms underlying IL-1β secretion using a widely adopted murine model of experimental peritonitis. The combined injection of sterile cecal content (SCC) and the gut commensal bacteria Bacteroides fragilis leads to IL-1β–dependent peritonitis, which was mitigated in mice deficient in NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3) inflammasome components. Typically acting as a damage signal, SCC, but not B. fragilis, activates canonical pathway of NLRP3 promoting IL-1β secretion in vitro and in vivo. Strikingly, absence of fiber in the SCC drastically reduces IL-1β production, whereas high-fiber SCC conversely increases this response in an NLRP3-dependent manner. In addition, NLRP3 was also required for IL-1β production induced by purified dietary fiber in primed macrophages. Extending to the in vivo context, IL-1β–dependent peritonitis was worsened in mice injected with B. fragilis and high-fiber SCC, whereas zero-fiber SCC ameliorates the pathology. Corroborating with the proinflammatory role of dietary fiber, IL-1R–deficient mice were protected from peritonitis induced by B. fragilis and particulate bran. Overall, our study highlights a function, previously unknown, for dietary fibers in fueling peritonitis through NLRP3 activation and IL-1β secretion outside the gut.
Identification of a Long Noncoding RNA TRAF3IP2-AS1 as Key Regulator of IL-17 Signaling through the SRSF10–IRF1–Act1 Axis in Autoimmune Diseases
Authors: He Ruirui , Wu Songfang , Gao Ru , Chen Jianwen , Peng Qianwen , Hu Huijun , Zhu Liwen , Du Yanyun , Sun Wanwei , Ma Xiaojian , Zhang Huazhi , Cui Zhihui , Wang Heping , Martin Bradley N. , Wang Yueying , Zhang Cun-jin , Wang Chenhui 
Published: May 2021

Abstract
IL-17A plays an essential role in the pathogenesis of many autoimmune diseases, including psoriasis and multiple sclerosis. Act1 is a critical adaptor in the IL-17A signaling pathway. In this study, we report that an anti-sense long noncoding RNA, TRAF3IP2-AS1, regulates Act1 expression and IL-17A signaling by recruiting SRSF10, which downregulates the expression of IRF1, a transcriptional factor of Act1. Interestingly, we found that a psoriasis-susceptible variant of TRAF3IP2-AS1 A4165G (rs13210247) is a gain-of-function mutant. Furthermore, we identified a mouse gene E130307A14-Rik that is homologous to TRAF3IP2-AS1 and has a similar ability to regulate Act1 expression and IL-17A signaling. Importantly, treatment with lentiviruses expressing E130307A14-Rik or SRSF10 yielded therapeutic effects in mouse models of psoriasis and experimental autoimmune encephalomyelitis. These findings suggest that TRAF3IP2-AS1 and/or SRSF10 may represent attractive therapeutic targets in the treatment of IL-17–related autoimmune diseases, such as psoriasis and multiple sclerosis.
A study of biophysical profile of inguinal skin
Authors: Bhargava Puneet , Singdia Heena , Nijhawan Shivi , Mathur Deepak K. , Bhargava Rishi K. 
Published: May 2021

Context:
Inguinal skin is prone to various infectious dermatological conditions such as erythrasma, intertrigo, hidradenitis suppurativa, folliculitis, dermatophytic infection, and various sexually transmitted diseases, as compared to the skin elsewhere.

Aim:
Our study attempts to compare the biophysical profile parameters (BPPs) of the genital skin with that of the rest of the body, while taking skin of the upper back as control. It also attempts to find out if there is a difference in BPPs of the two sites and that how the change in the BPPs, bring about change in microbiome and make inguinal skin more prone to infections.

Materials and Methods:
This was a hospital-based comparative study conducted over 976 patients (600 males and 376 females) of age group 18–60 years, where BPP parameters such as hydration, skin pH, transepidermal water loss (TEWL), and sebum content were measured over the skin of the upper back and right inguinal region, and the results were summarized and presented as proportions (%). Chi-square test was used to compare abnormal findings. P ≤ 0.05 was taken as statistically significant. MedCalc 16.4 version software was used for all statistical calculations.

Results:
Significant difference was noted in skin pH and TEWL, where P value came out to be <0.05, which was statistically significant, whereas there was minimal difference in sebum content and skin hydration in both the areas, in males and females.

Conclusion:
Raised skin pH disturbs organization of lipid bilayers (disturbed barrier), decreases lipid processing (impaired SC cohesion), and increases serine protease activity (reduced AMP). Increased TEWL (defect in physical barrier) and decreased hydration predispose the genital skin to infections. Use of pH buffered solutions (3–4), barrier repair creams containing ceramides, and barrier protective creams with dimethicone can help prevent these inguinal dermatoses.
Clinical profile and disease progression of HIV in adolescents and young adults in Vadodara, India
Authors: Madan-Patel Geetika , Mazumdar Vihang 
Published: May 2021

Introduction:
Adolescents are vulnerable to HIV for many reasons. Unfortunately, there are little data available on adolescents and young adults who have contracted HIV. Only few studies have been conducted in India with an aim to assess the clinical presentation, disease progression, and clinical profile of HIV in adolescents.

Materials and Methods:
There was a cohort study conducted at the antiretroviral therapy (ART) center at a teaching hospital in Western India. The study participants were kept under observation for 1 year. The end point of the cohort analysis was HIV disease progression. Patient details such as sociodemographic profile, CD4 counts at presentation, date of initiation of ART, WHO clinical stage of HIV at presentation, episodes of opportunistic infections, and laboratory investigations were recorded. Descriptive statistics and survival analysis were used for analyzing disease progression, improvement in health conditions, and factors affecting the same.

Results:
Of 155 participants, 100 were followed up till the end of the study. Seventy-two percent participants were adolescents and 53% were female. The mean age at presentation was 16.7 years, and the common modes of transmission were mother-to-child transmission (MTCT) (48%), heterosexual relationships (23%), and blood transfusion (12%). CD4 counts at presentation were <350 cells/mm3 among 70 participants. Among those infected through MTCT, the median survival duration was 15 years (95% confidence interval: 12.98–17.07). The risk of progression of the disease among young adults was thrice than that of adolescents (P < 0.05).

Conclusion:
HIV/AIDS screening and health services shall be tailored to address the special needs of adolescents and young adults. Teaching hospitals shall explore opportunities for student-involved longitudinal research studies to better understand the source of HIV infection, treatment seeking behavior, disease progression and outcome in a comprehensive manner.
Dietary Pattern of Undernourished Children and Their Vitamin A Status in Institute of Child Health Ahmadu Bello University Teaching Hospital Zaria
Authors: Abdullahi Sakinatu Mahadi , Alhassan Yakubu Mela , Bugaje Mairo Adamu , Akuyam Shehu Abubakar 
Published: May 2021

Context:
Vitamin A deficiency (VAD) affects an estimated six million pre school children in Nigeria and 20 million in Africa. When associated with severe undernutrition, it increases both morbidity and mortality of under five children.

Aims:
The study was aimed to determine the dietary pattern and its relationship with Vitamin A levels in undernourished children and controls in Institute of Child Health (ICH), Ahmadu Bello University Teaching Hospital Zaria.

Settings and Design:
This was a case–control, hospital based descriptive study carried out at the ICH Banzazzau, Zaria.

Materials and Methods:
Systematic sampling method was adopted to select undernourished children aged 6–59 months for the study. A semi-quantitative food frequency questionnaire was developed following the International Vitamin A Consultative Group guidelines for dietary assessment of Vitamin A intake. The questionnaire consisted of a list of 22 food items obtained during survey from local markets. Serum Vitamin A level was analysed by high performance liquid chromatography. The frequency of values below a cut off, usually taken as 0.70 μmol/L (20 μg/dl) for low and 0.35 μmol/L (10 μg/dl) for deficiency. Statistical analysis: The data were analysed using the Statistical Package for the Social Sciences version 20.0.

Results:
The prevalence of low serum Vitamin A level (10–<20 μg/dl) in this study among the cases is 16.7%, with the highest prevalence of 15.9% seen in severe wasting. However, the prevalence of cases with deficient serum Vitamin A (<10 μg/dl) was 4.5% in which severe wasting accounted for all the cases. Interestingly, the prevalence of low serum Vitamin A levels among the controls was also found to be 16.7%, and there was no VAD among the control groups. About 20% of children in Zaria (controls) were moderate to high risk of poor intake, while 37.3% were at low risk and 42.7% had satisfactory intake of Vitamin A rich foods. Among the malnourished patients, 53.4% were at moderate to high risk of poor intake, while 21.3% were at low risk and 25.3% had satisfactory intake of Vitamin A rich foods.

Conclusion:
This study simply demonstrated low intake of Vitamin A among undernourished children in Zaria.
Obstetric Performance of Women with Advanced Maternal Age in Ahmadu Bello University Teaching Hospital, Zaria
Authors: Bawa Umma Suleiman , Kolawole Abimbola Omolara D. , Randawa Abdullahi Jibril 
Published: May 2021

Context:
Consequent upon changes in social norms over the years, there has been an increase in the age of marriage and childbirth in women. The older parturient poses a great challenge to the managing obstetrician and a greater challenge to attaining safe motherhood.

Aim:
To determine the obstetric performance and complications developed during pregnancy and delivery of women with advanced maternal age.

Settings and Design:
This was a retrospective (case–control) study.

Setting:
This study was conducted in an ANC and labour ward of ABUTH, Zaria, Nigeria.

Materials and Methods:
The antenatal and delivery records of women with advanced maternal age (≥35 years) and those within 20–25 years of age from 2002 to 2006 were reviewed. Records of 294 women with advanced maternal age, and 322 of those aged 20–25 years were used.

Results:
A total of 57% of women with advanced maternal age developed complications compared with 24% in those aged 20–25 years. A total of 13% had chronic hypertension, while 26.2% had pregnancy-induced hypertension. Labour was augmented in 12.2% of those who had spontaneous vertex delivery and 6.2% had EMLSC/S. Low birth weight babies occurred in 11.6% necessitating admission into the SCBU and 5.4% had stillborn.

Conclusion:
This shows the considerable risk in pregnancies of women with advanced maternal age. It is recommended that to minimise complications; preconception care, antenatal care and skilled attendant at delivery are paramount.
Profile of Glaucoma in the Eastern Region of Saudi Arabia
Authors: Helayel Halah Bin , AlOqab Aysha , Subaie Majed Al , Habash Ahmed Al 
Published: May 2021

Background:
Glaucomas remain asymptomatic until severe, indicating that the actual number of affected individuals may be higher than those diagnosed.

Objective:
To study the clinical patterns of glaucoma cases in the Eastern Province of Saudi Arabia.

Patients and Methods:
This retrospective study was conducted at King Fahd Hospital of the University, Al-Khobar, and Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia. The medical records of all patients with glaucoma who visited these hospitals from January 2015 to December 2018 were critically reviewed. Data regarding patients' demographic characteristic, clinical data and their medical and surgical management techniques were collected and analyzed.

Results:
A total of 999 patients were included, of which 52.9% were males, 94.8% were Saudi, and the mean age was 58.8 years. Bilateral involvement was observed in 82.3% of cases. Primary open-angle glaucoma (POAG) was the most prevalent type of glaucoma (27.7%), followed by secondary glaucomas (26.7%), primary angle-closure glaucoma (PACG) (18.2%), primary congenital glaucoma (2.7%), and juvenile open-angle glaucoma (2.2%), which were the most frequent glaucoma subsets.

Conclusion:
The study population was most affected by POAG, secondary glaucomas and PACG. Knowledge regarding prevalence of glaucoma is important to plan services, allocate resources, and prevent blindness.
Survival and Prognostic Factors of HIV-positive Patients after Antiretroviral Therapy Initiation at a Malaysian Referral Hospital
Authors: Chet Lee Sing , Hamid Siti Azrin Ab , Bachok Norsa'adah , Chidambaram Suresh Kumar , Adnan Wan Nor Asyikeen Wan 
Published: May 2021

Background:
Antiretroviral therapy (ART) has transformed the management of human immunodeficiency virus (HIV) infection and significantly improved survival rates, but there is lack of such survival data from Malaysia.

Objective:
The objective was to determine the survival rates and prognostic factors of survival in HIV-infected adults treated with ART in Malaysia.

Materials and Methods:
This retrospective cohort study considered all HIV-positive adult patients registered in Sungai Buloh Hospital, a major referral center in Malaysia, between January 1, 2007 and December 31, 2016. Then, patients were selected through a systematic sampling method. Demographic, clinical, and treatment data were extracted from electronic medical records. Person–years at risk and incidence of mortality rate per 100 person–years were calculated. The Kaplan–Meier survival curve and log-rank test were used to compare the overall survival rates. Cox proportional hazards regression was applied to determine the prognostic factors for survival.

Results:
A total of 339 patients were included. The estimated overall survival rates were 93.8%, 90.4%, 84.9%, and 72.8% at 1, 3, 5, and 10 years, respectively, from ART initiation. The results of multiple Cox proportional hazard regression indicated that anemic patients were at a 3.76 times higher risk of mortality (95% confidence interval [CI]: 1.97–7.18; P < 0.001). The hazard risk was 2.09 times higher for HIV patients co-infected with tuberculosis (95% CI: 1.10, 3.96; P = 0.024).

Conclusion:
The overall survival rates among HIV-infected adults in this study are higher than that from low-income countries but lower than that from high-income countries. Low baseline hemoglobin levels of <11 g/dL and tuberculosis co-infection were strong prognostic factors for survival.
Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique
Authors: Nnabugwu Ikenna Ifeanyi , Ugwumba Fredrick Obiefuna , Ilukwe Anthony Alex 
Published: May 2021

Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the medium- to longterm outcome of using the technique.
Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented.
Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s (mean: 21 mL/s). The longest duration of follow-up was 34 months, and all patients were voiding satisfactorily.
Conclusions: A satisfactory and durable outcome can be obtained from nibbling at the bone from the inferior margin of the pubic bone to achieve PIP. This is of interest to lower urinary tract reconstructive surgeons who have concerns with chiseling-out wedge of the inferior pubis.
Keywords: Bone nibbling, Partial inferior pubectomy, PFUI, Posterior urethra, Urethral anastomosis