bluuebunny/crossref_metadata_2025 huggingface dataset:
Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19)
Authors: Khouja Tumader , Mitsantisuk Kannop , Tadrous Mina , Suda Katie J
Published: January 2022

Background

Little is known about the effect of the COVID-19 pandemic on antimicrobial consumption worldwide.

Objectives

To describe the impact of the WHO Global Action Plan on Antimicrobial Resistance (GAP-AMR) on antimicrobial consumption pre-pandemic and to evaluate the impact of the COVID-19 pandemic on antimicrobial consumption worldwide.

Methods

A cross-sectional time-series analysis using a dataset of monthly purchases of antimicrobials (antibiotics, antivirals and antifungals) from August 2014 to August 2020. Antimicrobial consumption per 1000 population was assessed pre-pandemic by economic development status using linear regression models. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes with pandemic declaration (March 2020) and during its first stage from April to August 2020, worldwide and by country development status.

Results

Prior to the pandemic, antimicrobial consumption decreased worldwide, with a greater apparent decrease in developed versus developing countries (−8.4%, P = 0.020 versus −1.2%, P = 0.660). Relative to 2019, antimicrobial consumption increased by 11.2%, P < 0.001 in March 2020. The greatest increase was for antivirals in both developed and developing countries (48.2%, P < 0.001; 110.0%, P < 0.001) followed by antibiotics (6.9%, P < 0.001; 5.9%, P = 0.003). From April to August 2020, antimicrobial consumption decreased worldwide by 18.7% (P < 0.001) compared with the previous year. Specifically, antibiotic consumption significantly decreased in both developed and developing countries (−28.0%, P < 0.001; −16.8%, P < 0.001).

Conclusions

The global decrease in antimicrobial consumption pre-pandemic suggests a positive impact of the WHO GAP-AMR. During the pandemic, an initial increase in antimicrobial consumption was followed by a decrease worldwide. AMR plans should specify measures to ensure full implementation of AMR efforts during health crises such as the COVID-19 pandemic.
Determination of Cocoa Flavanols and Procyanidins (by Degree of Polymerization DP1-7) in Cocoa-Based Products by Hydrophilic Interaction Chromatography Coupled With Fluorescence Detection: Collaborative Study
Authors: Bussy Ugo , You Hong , Kwik-Uribe Catherine
Published: January 2022

Background

Cocoa flavanols and procyanidins (CF) are flavonoids whose consumption is associated with health benefits, resulting in increasing attention from consumers, industry, researchers, and regulators. Methods that can provide appropriate characterization and quantification of the distinct mixture found in cocoa-based products thus offer important scientific and commercial value.

Objective

This study validated the precision of AOAC Official Method of AnalysisSM2020.05, which measures CF with a degree of polymerization DP1-7.

Method

Method precision (repeatability and reproducibility) was evaluated for seven cocoa matrixes in blind duplicates with total CF content from 1.0 to 500 mg/g. Ten of the 12 laboratories from multiple sectors invited to implement the method returned data for statistical analysis. Precision was evaluated per AOAC INTERNATIONAL guidelines for collaborative studies using RSDr and RSDR as indicators of method repeatability and reproducibility.

Results

RSDr ranged from 1.6 to 4.8%, and RSDR ranged from 5.8 to 22.4%, demonstrating excellent within-laboratory repeatability and good method precision across different laboratories. RSDR values were below 10% with the exception of chocolate, potentially due to very low CF content and sampling inhomogeneity.

Conclusions

These data demonstrate that acceptable method repeatability and reproducibility is achieved when measuring cocoa flavanols and procyanidins using AOAC Method 2020.05 and support the advancement of the AOAC Official Method of Analysis status to Final Action for evaluated matrixes.

Highlights

This collaborative study evaluated the repeatability and reproducibility of AOAC Official Method of Analysis 2020.05.
Efficiency in the Endoscopy Unit: Can We ‘Turn Around’ Room Turnover? An Observational Quality Improvement Study
Authors: Tan Carolyn Michelle , Bernstein Michael , Raboud Janet , Mannino Benedetta , Tinmouth Jill
Published: January 2022

Background

Endoscopy units are being challenged to provide timely and quality care, despite limited resources and an ever-growing patient population. Decreasing procedure time is unlikely to create sufficient time savings and may compromise quality. Non-procedural factors, such as room turnover, are important contributors to efficiency and represent an ideal target for quality improvement efforts.

Aims

The objective of this quality improvement study was to identify practices that will improve endoscopy unit efficiency at our centre. The specific aims were to (a) understand practices at local hospitals that contribute to room turnover efficiency and (b) examine the magnitude and sources of variation in room turnover efficiency across endoscopists and nurses at our centre.

Methods

Interviews were conducted with team leads at five local hospitals. Routinely collected data from our centre were analyzed to understand the magnitude and variation in efficiency by provider and reasons for delays. Non-procedure time defined as ‘patient 1 scope out’ to ‘patient 2 scope in’ was our primary measure of efficiency.

Results

Over the 12-month period, 750 outpatient procedures met inclusion criteria. Median non-procedure time was 19 min (interquartile range: 16–22 min). The variation attributable to endoscopists was 14.7% compared to 80.4% for unmeasured factors.

Conclusions

The variation that remains unexplained by our model suggests that unmeasured factors play a substantial role in endoscopy unit efficiency and that our current endoscopy records are not capturing important contributors to efficiency. The next phase will involve focus groups and direct observation with the goal of identifying these unmeasured factors.
Work-to-Unlock Rewards: Leveraging Goals in Reward Systems to Increase Consumer Persistence
Authors: Sharif Marissa A , Woolley Kaitlin
Published: January 2022

Eight studies (N = 5,025) demonstrate that consumers persist more when they must complete a target number of goal-related actions before receiving continuous rewards (i.e., what we term work-to-unlock rewards) than when they receive continuous rewards for their effort right away (i.e., what we term work-to-receive rewards). The authors suggest that the motivating power of work-to-unlock rewards arises because these rewards (1) naturally encourage consumers to set an attainable goal to start earning rewards, motivating consumers initially through goal setting and (2) keep consumers engaged after reaching this goal due to low perceived progress in earning rewards. A work-to-unlock reward structure increases persistence relative to standard continuous rewards across a variety of consumer-relevant domains (e.g., exercising, flossing, evaluating products), and even when work-to-unlock rewards offer rewards of a lower magnitude. Further, a work-to-unlock reward structure outperforms other reward structures that encourage goal setting. Lastly, the authors identify a theoretically consistent boundary condition of this effect: the length of the unlocking period.
Weighted Single-Step GWAS for Body Mass Index and Scans for Recent Signatures of Selection in Yorkshire Pigs
Authors: Vahedi Seyed Milad , Salek Ardestani Siavash , Karimi Karim , Banabazi Mohammad Hossein
Published: January 2022

Controlling extra fat deposition is economically favorable in modern swine industry. Understanding the genetic architecture of fat deposition traits such as body mass index (BMI) can help in improving genomic selection for such traits. We utilized a weighted single-step genome-wide association study (WssGWAS) to detect genetic regions and candidate genes associated with BMI in a Yorkshire pig population. Three extended haplotype homozygosity (EHH)-related statistics were also incorporated within a de-correlated composite of multiple signals (DCMS) framework to detect recent selection signatures signals. Overall, the full pedigree consisted of 7016 pigs, of which 5561 had BMI records and 598 pigs were genotyped with an 80 K single nucleotide polymorphism (SNP) array. Results showed that the most significant windows (top 15) explained 9.35% of BMI genetic variance. Several genes were detected in regions previously associated with pig fat deposition traits and treated as potential candidate genes for BMI in Yorkshire pigs: FTMT, SRFBP1, KHDRBS3, FOXG1, SOD3, LRRC32, TSKU, ACER3, B3GNT6, CCDC201, ADCY1, RAMP3, TBRG4, CCM2. Signature of selection analysis revealed multiple candidate genes previously associated with various economic traits. However, BMI genetic variance explained by regions under selection pressure was minimal (1.31%). In conclusion, candidate genes associated with Yorkshire pigs’ BMI trait were identified using WssGWAS. Gene enrichment analysis indicated that the identified candidate genes were enriched in the insulin secretion pathway. We anticipate that these results further advance our understanding of the genetic architecture of BMI in Yorkshire pigs and provide information for genomic selection for fat deposition in this breed.
The Determinants of Volatility Timing Performance
Authors: Taylor Nick
Published: January 2022

The exact conditions under which volatility timing strategies yield value are documented. These conditions include: the ability to correctly forecast next period stochastic variance, and violation of a strict version of Merton’s intertemporal capital asset pricing model (ICAPM). While the empirical evidence supports the first of these conditions, the latter remains open to debate. Our empirical results confirm the former, but demonstrate a significant violation of the (strict) ICAPM. It follows that volatility timing strategies appear to have value. However, using reasonable parameter values plugged into the derived formulae, the results also show that extreme leverage is often required for success. A method of tempering leverage is proposed, which is somewhat able to loosen the requirement of high leverage while still maintaining a good performance level. Given the likely variation in (strict) ICAPM violations across time and assets, it follows that volatility timing success (or failure) is very much sample dependent.
ATM Germline-Mutated Gastroesophageal Junction Adenocarcinomas: Clinical Descriptors, Molecular Characteristics, and Potential Therapeutic Implications
Authors: El Jabbour Tony , Misyura Maksym , Cowzer Darren , Zimmermann Michal , Rimkunas Victoria , Marra Antonio , Derakhshan Fatemeh , Selenica Pier , Parilla Megan , Setton Jeremy S , Ceyhan-Birsoy Ozge , Kemel Yelena , Catchings Amanda , Ranganathan Megha , Ku Geoffrey Y , Janjigian Yelena Y , Zinda Michael , Koehler Maria , Stadler Zsofia , Shia Jinru , Reis-Filho Jorge S , Mandelker Diana
Published: January 2022

Background

Gastroesophageal junction (GEJ) adenocarcinoma is a rare cancer associated with poor prognosis. The genetic factors conferring predisposition to GEJ adenocarcinoma have yet to be identified.

Methods

We analyzed germline testing results from 23 381 cancer patients undergoing tumor-normal sequencing, of which 312 individuals had GEJ adenocarcinoma. Genomic profiles and clinico-pathologic features were analyzed for the GEJ adenocarcinomas. Silencing of ATM and ATR was performed using validated short-interfering RNA species in GEJ, esophageal, and gastric adenocarcinoma cell lines. All statistical tests were 2-sided.

Results

Pathogenic or likely pathogenic ATM variants were identified in 18 of 312 patients (5.8%), and bi-allelic inactivation of ATM through loss of heterozygosity of the wild-type allele was detected in all (16 of 16) samples with sufficient tumor content. Germline ATM-mutated GEJ adenocarcinomas largely lacked somatic mutations in TP53, were more likely to harbor MDM2 amplification, and harbored statistically significantly fewer somatic single nucleotide variants (2.0 mutations/Mb vs 7.9 mutations/Mb; P < .001). A statistically significantly higher proportion of germline ATM-mutated than ATM–wild-type GEJ adenocarcinoma patients underwent a curative resection (10 [100%] vs 92 [86.8%], P = .04; Fisher’s exact test.), A synthetic lethal interaction between short-interfering RNA silencing of ATM and ATR was observed in the models analyzed.

Conclusions

Our results indicate that germline pathogenic variants in ATM drive oncogenesis in GEJ adenocarcinoma and might result in a distinct clinical phenotype. Given the high prevalence of germline ATM-mutated GEJ adenocarcinomas, genetic testing for individuals with GEJ adenocarcinomas may be considered to better inform prognostication, treatment decisions, and future cancer risk.
Resisting or Facilitating Change? How Street-Level Managers’Situational WorkContributes to the Implementation of Public Reforms
Authors: Klemsdal Lars , Andreassen Tone Alm , Breit Eric
Published: January 2022

Managers of street-level organizations play an important role in the successful implementation of public reforms. A prevailing view within the public administration literature is that this work involves the adaptation between reforms and local contexts, where divergence is viewed as a form of resistance to change. The article challenges this prevalent reform-centric view by introducing a situation-centric perspective and coining the concept of situational work as a significant form of managerial work during implementation. Situational work encompasses managerial actions that ensure functional and well-ordered service delivery in local street-level organizations by accomodating everyday situational contingencies, including reform objectives, but also the interests and expectations of workers, clients, and local service partners. The concept of situational work, then, broadens the recognized scope of managerial activities that contribute to successful reform implementation, reconceptualizing divergence from reform design as constructive rather than as resistance to change. The article draws on an extensive multi-wave study of a major organizational reform in Norway, based on observations of meetings as well as qualitative interviews of managers, union representatives, frontline workers, and collaborating partners in six welfare service offices at three points in time (altogether 23 observation sessions and 173 interviews).
Just Like Any Other Worker? Class and Gender in the Regulation of Domestic Service in the Early Soviet Period
Authors: Klots Alissa
Published: January 2022

In the 1920s, the Soviet Union was the site of the first state-led effort to reimagine domestic servants as workers. Yet this effort is absent from the global history of domestic service. Analysis of Soviet discourse on paid domestic labor, as well as cases of domestics challenging their employers in courts and arbitration, reveals that assumptions about class and gender informed the implementation of labor laws. While the employment of domestics did not constitute exploitation in the Marxist sense, the practice was widely viewed as petty-bourgeois in the early years after the revolution. As a result, domestic workers were very likely to win cases against their employers. By the mid-1920s, however, the state became aware of the role domestic workers played in freeing up the labor of their employers. The recognition of housework as socially useful labor led to the reimagining of domestic service as a practice compatible with socialism. Employers were no longer seen as exploiters by default, making it much harder for domestic workers to win cases against them. However, this shift did not change preferential treatment of domestics in cases involving access to housing, as Soviet courts feared that homeless women would inevitably turn to prostitution.
Investigation of the Prompt SNe Ia progenitor nature through the analysis of the chemical composition of globular clusters and circumgalactic clouds
Authors: Acharova I A , Sharina M E , Kazakov E A
Published: January 2022

A method is proposed for determining the properties of Type Ia supernovae from short-lived precursors – Prompt SNIa. This method is based on the assumption that this subtype of Type Ia supernovae exploded into low-metallicity globular clusters (GCs), and is responsible for the enrichment of the high-metallicity subgroup of GCs and circumgalactic clouds (CGCs) with the iron peak elements. We justify that CGCs are the formation places of GCs of both subgroups. The accuracy of the method depends, first, on the number of GCs, the spectra of which have been studied in detail, and second, on the number of chemical elements, the abundances of which have been worked out. Only those elements are of interest for this method that are produced in supernova explosions and are not produced at the previous stage of the stellar evolution. Our estimates of nucleosynthesis in low-metallicity supernova GCs are in the best agreement with the following Prompt SNIa model: Single Degenerate Pure Deflagration Models of white dwarfs (WDs) burning with masses in the range from $\rm 1.30$ to $1.31\, {\rm M}_{\odot}$ if carbon explodes in the centre of a WD with a low central density from $\rm 0.5 \times 10^9$ to $\rm 10^9\, {\rm g\,cm^{-3}}$ (Leung & Nomoto 2018).
Notes on primordial black hole origin for thermal gamma-ray bursts
Authors: McMaken Tyler
Published: January 2022

Recently, an alleged plausible astrophysical scenario was proposed for the production of observed thermal gamma-ray bursts, via Hawking radiation emitted from a primordial black hole (PBH) freely falling into a more massive black hole. Here, the implausibility of that scenario is demonstrated, and the key flaws in that paper’s calculations and assumptions are elucidated through a discussion of some common misconceptions concerning black holes and general relativity. In particular, the predicted radiance observed from Earth is found to be orders of magnitude lower than what any instrument could detect, and the PBH–BH merger signature would be completely overwhelmed by the background Hawking signature from free PBHs.
First CH3D detection in Class 0/I proto-brown dwarfs: constraints on CH4 abundances
Authors: Riaz B , Thi W-F
Published: January 2022

We report the first detection in the JK = 10–00 rotational transition line of CH3D towards three Class 0/I proto-brown dwarfs (proto-BDs) from IRAM 30-m observations. Assuming a rotational temperature of 25 K, the CH3D abundances (relative to H2) are in the range of (2.3–14.5) × 10−7. The CH4 abundances derived from the CH3D abundances and assuming the DCO+/HCO+ ratios are in the range of (0.05–4.8) × 10−5. The gas-phase formation of CH3D via CH2D+ is enhanced at high densities of 108–1010 cm−3 and our observations are likely probing the innermost dense and warm regions in proto-BDs. Thermal and/or non-thermal desorption can return the CH3D and CH4 molecules formed at an early stage on grain surfaces to the gas-phase. The gas-phase abundances are indicative of warm carbon-chain chemistry in proto-BDs where carbon-chain molecules are synthesized in a lukewarm (∼20–30 K) region close to the central source.
Vimentin binds to G-quadruplex repeats found at telomeres and gene promoters
Authors: Ceschi Silvia , Berselli Michele , Cozzaglio Marta , Giantin Mery , Toppo Stefano , Spolaore Barbara , Sissi Claudia
Published: January 2022

G-quadruplex (G4) structures that can form at guanine-rich genomic sites, including telomeres and gene promoters, are actively involved in genome maintenance, replication, and transcription, through finely tuned interactions with protein networks. In the present study, we identified the intermediate filament protein Vimentin as a binder with nanomolar affinity for those G-rich sequences that give rise to at least two adjacent G4 units, named G4 repeats. This interaction is supported by the N-terminal domains of soluble Vimentin tetramers. The selectivity of Vimentin for G4 repeats versus individual G4s provides an unprecedented result. Based on GO enrichment analysis performed on genes having putative G4 repeats within their core promoters, we suggest that Vimentin recruitment at these sites may contribute to the regulation of gene expression during cell development and migration, possibly by reshaping the local higher-order genome topology, as already reported for lamin B.
Commonality in Credit Spread Changes: Dealer Inventory and Intermediary Distress
Authors: He Zhiguo , Khorrami Paymon , Song Zhaogang
Published: January 2022

Two intermediary-based factors—a corporate bond dealer inventory measure and a broad intermediary distress measure—explain more than 40$\%$ of the puzzling common variation in credit spread changes beyond canonical structural factors. A simple intermediary-based model with partial market segmentation accounts for intermediary factors’ explanatory power and delivers three further implications with empirical support. First, whereas bond sorts on risk-related variables produce monotonic loading patterns on intermediary factors, non-risk-related sorts produce no pattern. Second, dealer inventory comoves with corporate-credit assets only, whereas intermediary distress comoves with both corporate-credit and non-corporate-credit assets. Third, dealers’ inventory responds to (instrumented) bond sales by institutional investors.
Sources of Value Creation in Private Equity Buyouts of Private Firms
Authors: Cohn Jonathan B , Hotchkiss Edith S , Towery Erin M
Published: January 2022

Despite the prevalence of private equity (PE) buyouts of private firms, little is known about how these transactions create value. We provide evidence that PE acquirers disproportionately target private firms with weak operating profitability and those that have growth potential but are highly levered and dependent on external financing. Target firms grow rapidly post-buyout, especially those undertaking add-on acquisitions, and profitability increases for both profitable and unprofitable targets. Our evidence suggests that PE acquirers create value by relaxing financing constraints for firms with strong investment opportunities and improving the performance of weak firms, while financial engineering plays a limited role.
RADIOACTIVITY CONTENT OF BUILDING MATERIALS USED IN KUTAHYA PROVINCE, TURKEY
Authors: Çetinkaya Hakan , Manisa Kaan , Işık Ulaş
Published: January 2022

Radioactivity concentrations of primordial radionuclides Ra-226, Th-232 and K-40 for 31 samples of seven different types of construction materials used in Kütahya Province, Turkey, were analyzed using NaI(Tl) gamma spectroscopy. Ra-226, Th-232 and K-40 activities of all samples ranged between <2.0 and 81.3 ± 1.5, <1.0 and 24.8 ± 0.5 and <7.8 and 819.1 ± 5.5 Bq kg −1, respectively. Radium equivalent activity and Gamma index of sampled building materials were calculated and presented. All results were found to be below the safety limits.
Assessing Adequate Homes and Proper Parenthood: How Gendered and Racialized Family Norms Legitimize the Deportation of Unaccompanied Minors in Belgium and the Netherlands
Authors: Cleton Laura
Published: January 2022

This article analyzes the ways in which the Belgian and Dutch governments legitimize the deportation of unaccompanied minors, by focusing on the interplay of intersectional boundary work and bordering practices. Building on the work of postcolonial feminists and scholars studying the role of identity and cultural values in migration policy, the article highlights that deportation relies on and reifies gendered, racialized, and classed representations of the family, child-rearing practices, and the roles attributed to children. A paternalistic attitude that spurs the moral necessity to protect children mediates the exclusionary potential of such boundaries for deporting states.
Greater than the Sum of the Parts? Evidence on Mechanisms Operating in Women's Groups
Authors: Díaz-Martin Lucía , Gopalan Akshara , Guarnieri Eleonora , Jayachandran Seema
Published: January 2022

Women's groups are a popular approach to promoting women's and girls’ empowerment. Yet, whether and how creating and supporting women's groups and delivering interventions through them offers unique benefits compared to individual-based interventions remains an open question. We review the experimental and quasi-experimental literature on women's livelihoods and financial groups, health groups, and adolescent groups, and analyze the causal mechanisms through which these models improved outcomes for women and girls in low and middle-income countries. We distinguish between mechanisms that leveraged groups as a platform for intervention delivery and mechanisms that leveraged interactions among group members. We conclude that the primary benefit of group models is to offer a platform to reach many women at once with resources, information, and training. Nonetheless, some evidence suggests that group models can achieve positive impacts by fostering or harnessing interactions among group members, which would be harder or impossible to achieve through individual-based interventions. We offer some suggestions regarding the implications of these findings for programming and future research.
Detection, Identification, and Molecular Characterization of the 16SrII-V Subgroup Phytoplasma Strain Associated with Digera muricata in Taiwan
Authors: Mejia Helen Mae , Liao Pei-Qing , Chen Yuh-Kun , Lee Ya-Chien , Tan Choon Meng , Chiu Yi-Ching , Yang Jun-Yi
Published: January 2022

Digera muricata (L.) Mart. is a pantropical annual herb belonging to the Amaranthaceae family. In August 2021, D. muricata with indicative phytoplasma symptoms of phyllody, witches’-broom, and virescence was discovered adjacent to a peanut field in Mailiao, Yunlin, Taiwan. The causal agent of the observed symptoms was detected and identified by a series of molecular characterizations. Sieve elements of the phloem tissue were perused under the transmission electron microscope and revealed the presence of pleomorphic phytoplasma-like organisms. Nested PCR using phytoplasma universal primer pairs P1/P7 and R16F2n/R16R2 was able to amplify a 1.2-kb DNA fragment for the 16S rRNA gene only from the symptomatic D. muricata. The 16S rRNA-based phylogenetic analysis and the iPhyClassifier-based virtual RFLP further affirmed that the phytoplasma associated with the diseased D. muricata can be classified into the 16SrII-V subgroup. Moreover, displayed evident symptoms were explained by the concomitant detection of PHYL1 and SAP11, the virulence genes responsible for the development of leaf-like flowers and shoot proliferation, respectively. Although phytoplasma infection on the noncrop species does not have a direct economic impact, its role in disease spread and perpetuation is indubitable.
A Multicenter Comparison of Open Versus Arthroscopic Fixation for Pediatric Tibial Spine Fractures
Authors: Shimberg Jilan L. , Leska Tomasina M. , Cruz Aristides I. , Patel Neeraj M. , Ellis Henry B. , Ganley Theodore J. , Johnson Ben , Milbrandt Todd A. , Yen Yi-Meng ,   Tibial Spine Research Interest Group, Mistovich R. Justin
Published: January 2022

Background:

When operative treatment is indicated, tibial spine fractures can be successfully managed with open or arthroscopic reduction and internal fixation (ARIF). The purpose of the study is to evaluate short-term treatment outcomes of tibial spine fractures in patients treated with both open and arthroscopic fracture reduction.

Methods:

We performed an Institutional Review Board (IRB)-approved retrospective cohort study of pediatric tibial spine fractures presenting between January 1, 2000 and January 31, 2019 at 10 institutions. Patients were categorized into 2 cohorts based on treatment: ARIF and open reduction and internal fixation (ORIF). Short-term surgical outcomes, the incidence of concomitant injuries, and surgeon demographics were compared between groups.

Results:

There were 477 patients with tibial spine fractures who met inclusion criteria, 420 of whom (88.1%) were treated with ARIF, while 57 (11.9%) were treated with ORIF. Average follow-up was 1.12 years. Patients treated with ARIF were more likely to have an identified concomitant injury (41.4%) compared with those treated with ORIF (24.6%, P=0.021). Most concomitant injuries (74.5%) were treated with intervention. The most common treatment complications included arthrofibrosis (6.9% in ARIF patients, 7.0% in ORIF patients, P=1.00) and subsequent anterior cruciate ligament injury (2.1% in ARIF patients and 3.5% in ORIF, P=0.86). The rate of short-term complications, return to the operating room, and failure to return to full range of motion were similar between treatment groups. Twenty surgeons with sports subspecialty training completed 85.0% of ARIF cases; the remaining 15.0% were performed by 12 surgeons without additional sports training. The majority (56.1%) of ORIF cases were completed by 14 surgeons without sports subspecialty training.

Conclusion:

This study demonstrated no difference in outcomes or nonunion following ARIF or ORIF, with a significantly higher rate of concomitant injuries identified in patients treated with ARIF. The majority of identified concomitant injuries were treated with surgical intervention. Extensive surgical evaluation or pretreatment magnetic resonance imaging should be considered in the workup of tibial spine fractures to increase concomitant injury identification.

Level of Evidence:

Level III.
Impacts of the Affordable Care Act’s Medicaid Expansion on Live Births
Authors: Gartner Danielle R. , Kaestner Robert , Margerison Claire E.
Published: January 2022

Background:

We hypothesize that the Affordable Care Act’s (ACA) Medicaid expansion, which extended health insurance coverage to preconception, between-conception, and postconception periods for women meeting income eligibility guidelines, impacted the number of live births in the United States by increasing access to contraception and financial well-being. These impacts may differ by maternal socioeconomic and demographic characteristics.

Methods:

Using data from birth certificates aggregated to the state–year level and a difference-in-differences design, we estimated the association between Medicaid expansion and count of live births. We also examined whether associations differed by socioeconomic and demographic characteristics.

Results:

Overall, Medicaid expansion was not meaningfully associated with the count of births (difference-in-differences ß = 0.002; 95% confidence interval [CI] = –0.010, 0.015). However, among certain groups, Medicaid expansion was associated with meaningful changes in the count of live births, though all confidence intervals included the null value. The estimate of the relation between Medicaid expansion and the count of live births was –0.025 (95% CI = –0.052, 0.001) for those ages 18–24 years; –0.078 (95% CI = –0.231, 0.075) for those who were married, and –0.035 (95% CI = –0.104, 0.034) for those who were unmarried.

Conclusions:

Despite its potential to impact live births, our results indicate that the ACA’s Medicaid expansion was not, in general, associated with live births of US residents of reproductive age. However, for younger, married, and unmarried women, the magnitude of estimates supports the hypothesis of a potentially meaningful effect of Medicaid expansions on live births.
Cardiotoxicity of Chemotherapeutic Drugs: An Update and Future Perspectives
Authors: Bannister Clare , Cannata Antonio , Bromage Daniel I. , McDonagh Theresa
Published: January 2022

Rapid advancements in oncological treatments over the past few decades have led to a significant improvement in cancer outcomes. Chemotherapeutic agents play a pivotal role in cancer treatment, with almost one-third of patients receiving them during their cancer treatment in the United Kingdom. The success of chemotherapeutic drugs has, however, resulted in an increasing incidence of cardiovascular side effects and complications. The most common cardiac manifestation is the development of cardiotoxicity, defined as the development of left ventricular systolic dysfunction, after treatment. This article provides an up-to-date review of the commonly used chemotherapeutic agents that cause cardiotoxicity and discusses current treatment options and evidence gaps.
ASSOCIATION OF PREDIABETES WITH RETINAL MICROVASCULATURE ON SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN THE ELDERLY
Authors: Wang You , Toyama Taku , Hashimoto Yohei , Kawai Hisashi , Azuma Kunihiro , Shiraya Tomoyasu , Kato Satoshi , Watanabe Yutaka , Hirano Hirohiko , Fujiwara Yoshinori , Ihara Kazushige , Kim Hunkyung , Numaga Jiro , Obuchi Shuichi , Ueta Takashi
Published: January 2022

Purpose:

To investigate the retinal microvasculature in the elderly persons with prediabetes mellitus (preDM) and type 2 DM.

Methods:

This cross-sectional study included a total of 452 eyes without retinal pathologies of 301 elderly volunteers aged ≥65 years, and they were categorized into nonDM (225 eyes), preDM (177 eyes), and DM (50 eyes) groups based on their HbA1c. Fundus photography, swept-source optical coherence tomography and angiography, and comprehensive systemic examinations were conducted. Vessel density (VD) and foveal avascular zone in superficial and deep retinal microvasculature were investigated for their association with DM stages using linear mixed model.

Results:

Superficial VD (sVD) mean values in nonDM, preDM, and DM groups were 35.2%, 34.9%, and 34.8%, respectively. sVD in preDM was equivalent to sVD in DM, whereas significantly lower compared with sVD in nonDM (difference [95% CI] −0.19 [−0.33 to −0.049], P = 0.009). Deep VD (dVD) mean values in nonDM, preDM, and DM groups were 35.0%, 35.0%, and 34.4%, respectively. dVD in preDM was equivalent to dVD in nonDM, whereas significantly higher compared with dVD in DM (difference [95% CI] 0.31 [0.046–0.57], P = 0.02). There was no significant association between foveal avascular zone area and DM stages.

Conclusion:

Retinal microvasculature may be affected at the prediabetic stage in the elderly.
Antimicrobial Stewardship at Birth in Preterm Infants
Authors: Stritzke Amelie , Tierney Anne , Keister Faith , Srivastava Ankur , Dersch-Mills Deonne , Hamilton Claire , Lodha Abhay , Abou Mehrem Ayman
Published: January 2022

Background:

Early-onset sepsis results in increased morbidity and mortality in preterm infants. Antimicrobial Stewardship Programs (ASPs) address the need to balance adverse effects of antibiotic exposure with the need for empiric treatment for infants at the highest risk for early-onset sepsis.

Methods:

All preterm infants <34 weeks gestational age born during a 6-month period before (January 2017–June 2017) and a 6-month period after (January 2019–June 2019) implementation of ASP in May 2018 were reviewed. The presence of perinatal sepsis risk factors, eligibility for, versus treatment with initial empiric antibiotics was compared.

Results:

Our cohort comprised 479 infants with a mean of 30 weeks gestation and birth weight of 1400 g. Demographics were comparable, with more Cesarean section deliveries in the post-ASP cohort. Any sepsis risk factor was present in 73.6% versus 68.4% in the pre- versus post-ASP cohorts (P = 0.23). Fewer infants were treated with antibiotics in the later cohort (60.4%) compared with the earlier cohort (69.7%; P = 0.04). Despite the presence of risk factors (preterm labor in 93% and rupture of membranes in 60%), 42% of infants did not receive initial antibiotics. Twenty percent with no perinatal sepsis risk factors were deemed low-risk and not treated.

Conclusions:

Implementation of a neonatal ASP decreased antibiotic initiation at birth. Antibiotic use decreased (appropriately) in the subgroup with no perinatal sepsis risk factors. Of concern, some infants were not treated despite risk factors, such as preterm labor/rupture of membrane. Neonatal ASP teams need to be aware of potentially unintended consequences of their initiatives.
Elizabethkingia anophelis: An Important Emerging Cause of Neonatal Sepsis and Meningitis in China
Authors: Wang Beibei , Cheng Rui , Feng Yun , Guo Yan , Kan Qing , Qian Aimin , Zhao Li
Published: January 2022

Elizabethkingia anophelis, originally isolated from the midgut of Anopheles gambiae in 2011, is an important cause of sepsis in adults and children and meningitis in newborns, with several reported outbreaks worldwide. Accumulating molecular biological and whole-genome sequencing (WGS) evidence suggests that E. anophelis is the major human pathogen belonging to the genus Elizabethkingia. The source of infection, routes of transmission and pathogenicity of E. anophelis are unclear and should be better understood as the bacterium is capable of causing sepsis and meningitis in newborns, with complications and high mortality rates. Here, we describe two healthy neonates who developed meningitis caused by Elizabethkingia infection. Initial conventional laboratory results revealed that the pathogen was E. meningoseptica; metagenomic findings later confirmed it as E. anophelis. We also summarize reported E. anophelis infections among newborns in China and elsewhere and describe the clinical, pathogenic and genetic characteristics of this bacillus.
Evaluating a Cluster and the Overall Trend of Invasive Haemophilus influenzae Serotype b in Alaska 2005–2019
Authors: Nolen Leisha D. , Topaz Nadav , Miernyk Karen , Bressler Sara , Massay Stephanie C. , Geist Mary , Zulz Tammy , Singleton Rosalyn
Published: January 2022

Background:

In 2019, 5 cases of invasive Haemophilus influenzae serotype b (Hib) occurred in the Anchorage region of Alaska over a period of 16 days. No cases had occurred in Alaska in the preceding 26 months.

Methods:

Alaska Hib isolates from 2005 through 2019 were analyzed using whole-genome sequencing (WGS). Rates were compared with the CDC’s Active Bacterial Core surveillance (ABCs) data.

Results:

A total of 33 cases of invasive Hib occurred in Alaska from 2005 through 2019. Of the 5 cases associated with the cluster, 2 (40%) occurred in adults and all occurred in the Anchorage region. In contrast, only 14% (4/28) of the noncluster cases occurred in this region (P < 0.01). Two cluster cases were linked epidemiologically and the bacteria were nearly identical. The other 3 cluster cases were caused by 3 genetically distinct bacteria. When the full period was evaluated, the unadjusted rate of invasive Hib disease in Alaska was 15.5 times higher in Alaska Native (AN) people than non-AN people [1.3/100,000 vs. 0.07/100,000, 95% confidence intervals (CI): 10.2–22.5). The age-adjusted rate of invasive Hib disease in Alaska was 9.4 times higher than the ABCs rate (95% CI: 6.3–14.1).

Conclusions:

While clustered in time and space, the 5 cases in 2019 were not due to a single bacterial strain. AN people continue to have elevated rates of invasive Hib infection compared with both non-AN people in Alaska and the ABCs population.
Distinct Effects of Antidepressants in Association With Mood Stabilizers and/or Antipsychotics in Unipolar and Bipolar Depression
Authors: Moderie Christophe , Nuñez Nicolas , Comai Stefano , Saint-Laurent Marie , Fielding Allan , Low Nancy , Gobbi Gabriella
Published: January 2022

Purpose/Background

There is a dearth of studies comparing the clinical outcomes of patients with treatment-resistant unipolar (TRD) depression and depression in bipolar disorder (BD) despite similar treatment strategies. We aimed to evaluate the effects of the pharmacological combinations (antidepressants [AD], mood stabilizers [MS], and/or antipsychotics [AP]) used for TRD and BD at the McGill University Health Center.

Methods/Procedures

We reviewed health records of 206 patients (76 TRD 130 BD) with TRD and BD treated with similar augmentation strategies including AD with MS (AD+MS) or AP (AD+AP) or combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the 17-time Hamilton Depression Rating Scale (HAMD-17), Quick Inventory of Depressive Symptomatology, and Clinical Global Impression-Severity of Illness at the beginning (T0) and after 3 months of an unchanged treatment (T3).

Findings/Results

Baseline HAMD-17 scores in TRD were higher than in BD (P < 0.001), but TRD patients had a greater improvement at end point (P = 0.003). Antidepressants with AP generated greater reductions in HAMD-17 in TRD compared with BD (P = 0.02). Importantly, in BD patients, the addition of AD compared with other treatment strategies failed to improve the outcome. The limitations of this study include possibly unrepresentative subjects from tertiary care settings, incomplete matching of BD and TRD subjects, nonrandomized treatment with unmatched agents, doses, and times, unknown treatment adherence, and nonblinded retrospective outcome assessments. Nevertheless, the findings may reflect real-world interactions of clinically selected pharmacotherapies.

Implications/Conclusions

Combination of augmentation strategies such as AD+AP and/or MS showed a better clinical improvement in patients with TRD compared with BD suggesting a limited evidence for AD potentiation in BD.
Mitigating COVID-19 Vaccine Waste Through a Multidisciplinary Inpatient Vaccination Initiative
Authors: Baumann Natalie , Chen Sara , McDonald Jay R. , Davis Matifadza Hlatshwayo , Petroff Courtney , McKelvy Patricia
Published: January 2022

A multidisciplinary team at a tertiary care Veterans Health Administration medical center created a standardized process to identify medically stable inpatients, to notify inpatient staff of available COVID-19 vaccine doses, and to coordinate inpatient vaccine administration. The team's goals were to mitigate vaccine waste while safely vaccinating as many patients as possible. Using a unique set of exclusion criteria and clinical judgment, a quality improvement team reviewed patients admitted to medicine teams to determine medical stability. Eligible, interested patients were listed in a secure shared file, and outpatient vaccine clinic staff communicated with inpatient nurse leaders regarding the availability of unadministered doses. Doses were transported to the hospital from the clinic and administered by inpatient nurses. Between January 8 and April 26, 2021, 105 patients were vaccinated with either the Moderna or the Pfizer-BioNTech COVID-19 vaccine during admission. Sixty-nine percent of the patients received a first dose, 27% received a second dose, and 4% received both doses. Forty-two percent of the patients vaccinated while inpatient identified as Black or African American compared with 28% of the vaccinated outpatients. No vaccine-related safety events were reported. This process demonstrates a viable approach to mitigating waste of COVID-19 vaccines and safely, efficiently, and equitably vaccinating an inpatient population.
Electrical Impedance as a Noninvasive Metric of Quality in Allografts Undergoing Normothermic Ex Vivo Lung Perfusion
Authors: Peterson Danielle M. , Beal Eliza W. , Reader Brenda F. , Dumond Curtis , Black Sylvester M. , Whitson Bryan. A.
Published: January 2022

Ex vivo lung perfusion (EVLP) increases the pool of suitable organs for transplant by facilitating assessment and repair at normothermia, thereby improving identification of quality of marginal organs. However, there exists no current objective approach for assessing total organ edema. We sought to evaluate the use of electrical impedance as a metric to assess total organ edema in lungs undergoing EVLP. Adult porcine lungs (40 kg) underwent normothermic EVLP for 4 hours. To induce varying degrees of lung injury, the allografts were perfused with either Steen, a modified cell culture media, or 0.9% normal saline. Physiologic parameters (peak airway pressure and compliance), pulmonary artery and left atrial blood gases, and extravascular lung water measurements were evaluated over time. Wet-to-dry ratios were evaluated postperfusion. Modified Murray scoring was used to calculate lung injury. Impedance values were associated with lung injury scores (p = 0.007). Peak airway pressure (p = 0.01) and PaO2/FiO2 ratios (p = 0.005) were both significantly associated with reduced impedance. Compliance was not associated with impedance (p = 0.07). Wet/dry ratios were significantly associated with impedance and Murray Scoring within perfusion groups of Steen, Saline, and Modified Cell Culture (p = 0.0186, 0.0142, 0.0002, respectively). Electrical impedance offers a noninvasive modality for measuring lung quality as assessed by tissue edema in a porcine model of normothermic EVLP. Further studies evaluating the use of impedance to assess organ edema as a quality marker in human clinical models and abdominal organs undergoing ex vivo perfusion warrant investigation.
Translational control by heme-regulated elF2α kinase during erythropoiesis
Authors: Chen Jane-Jane , Zhang Shuping
Published: January 2022

Purpose of review

HRI is the heme-regulated elF2α kinase that phosphorylates the α-subunit of elF2. Although the role of HRI in inhibiting globin synthesis in erythroid cells is well established, broader roles of HRI in translation have been uncovered recently. This review is to summarize the new discoveries of HRI in stress erythropoiesis and in fetal γ-globin expression.

Recent findings

HRI and activating transcription factor 4 (ATF4) mRNAs are highly expressed in early erythroblasts. Inhibition of protein synthesis by HRI-phosphorylated elF2α (elF2αP) is necessary to maintain protein homeostasis in both the cytoplasm and mitochondria. In addition, HRI-elF2αP specifically enhances translation of ATF4 mRNA leading to the repression of mechanistic target of rapamycin complex 1 (mTORC1) signaling. ATF4-target genes are most highly activated during iron deficiency to maintain mitochondrial function, redox homeostasis, and to enable erythroid differentiation. HRI is therefore a master translation regulator of erythropoiesis sensing intracellular heme concentrations and oxidative stress for effective erythropoiesis. Intriguingly, HRI-elF2αP-ATF4 signaling also inhibits fetal hemoglobin production in human erythroid cells.

The primary function of HRI is to maintain protein homeostasis accompanied by the induction of ATF4 to mitigate stress. Role of HRI-ATF4 in γ-globin expression raises the potential of HRI as a therapeutic target for hemoglobinopathy.