bluuebunny/crossref_metadata_2025 huggingface dataset:
The Four Pillars of the Philosophy of Higher Education
Authors: Bengtsen Søren S.E. , Barnett Ronald
Published: August 2020

The research field of the philosophy of higher education is young, having emerged within the last half-century. However, at this stage four strands, or pillars, of thought may be detected in the core literature, around which the discussions and theorizing efforts cluster. The four pillars are (a) knowledge, (b) truth, (c) critical thinking, and (d) culture. The first pillar, “knowledge,” is concerned with the meaning of academic knowledge as forming a link between the knower and the surrounding world, thus not separating but connecting them. Under the second pillar, “truth,” are inquiries into the epistemic obligations and possibilities to seek and tell the truth universities and academics have in a “post-truth” world. The third pillar, “critical thinking,” addresses the matter as to what understandings of being critical are appropriate to higher education, not least against a background of heightening state interventions and self-interest on the part of students, especially in marketized systems of higher education. The fourth pillar, that of “culture,” is interested in the possibility and ability for academics and universities to intersect and contribute to public debates, events, and initiatives on mediating and solving conflicts between value and belief systems in culturally complex societies. When seen together, the four pillars of the research field constitute the philosophy of higher education resting on four foundational strands of an epistemic, communal, ethical, and cultural heritage and future.
Sustaining and Sustainable Superintendent Leadership
Authors: Wright Michael , Papa Rosemary
Published: August 2020

The educational environment of the 21st century is complex and dynamic, placing demands on school leaderships that are both considerable and constant. Societal challenges such as school shootings, drugs, alcohol, and other problems are more frequently finding their way into U.S. classroom settings, which only further complicates the role of the superintendent. At times, superintendents may believe U.S. public schools are under attack, especially given prevailing political forces driving the marketization and privatization of schools. The elements connected to the sustainment and sustainability of superintendents, especially superintendent turnover, as a result of the following pressures are defined: school safety and security, social media, less parental involvement, and increased federal influence; continued divestment in public education and declining student enrollment; and pressure to perform by public school administrators. Superintendent departure research further considers: factors contributing to longevity and the cost of turnover; differences between superintendents and board members; reasons superintendents leave; stakeholder expectations and political pressures; increased accountability; and differences in expectations between the board and superintendent. Sustainable leadership is required between the superintendent and the board. Teamwork leads to greater effectiveness.

Overall, the result of increased competition and dwindling levels of federal and state school funding very often means superintendents face complicated choices and difficult dilemmas—particularly relating to the allocation of scarce financial resources. For instance, school leaders nationwide are frequently forced to balance the tension existing between academic and non-academic programs, in a time when funding is woefully insufficient. Superintendents must often forgo hiring additional teachers, or purchasing required classroom support materials, and forgo school facility repairs, in order to enhance school safety and security. The increased accountability for school performance also weighs heavily on administrators, faculty, and staff, and especially the superintendent. Such pressures increase the level of superintendent turnover.
Bilingualism and Biliteracy
Authors: Collins Penelope , Ho Tien Thuy
Published: August 2020

Internationally, there has been growing commitment to bilingual education among policymakers, educators, and researchers. Bilingualism and biliteracy are not uncommon, as more than half the world’s population speaks and learns to read more than one language. Growing globalization in commerce and immigration have motivated countries across the globe to adopt policies promoting bilingual education.

Bilingual education reflects any curriculum that strategically uses two or more languages in instruction. These programs reflect one of two primary goals: supporting language-minority students in the acquisition of language, literacy skills, and academic content in the dominant language of the community; or enabling students to develop language, literacy, and academic skills in an additional language. Although most programs serving language-minority students are subtractive in nature, using the home language to serve language and academic achievement in the majority language, dual-language immersion programs are growing in popularity. Dual-language immersion programs and immersion programs serving language-majority students reflect additive approaches to bilingual education, and their students have been found to perform as well as or better than their monolingual peers.

Becoming biliterate requires students to develop skill in engaging with and making sense of texts in two languages that vary both orally and in their writing systems. Developing word-level and text-level skills in two languages involves a common set of cognitive processes that may transfer across languages. Instructional practices promoting language, literacy, and academic achievement in both languages include high-quality literacy instruction, translanguaging within classrooms, content-based instruction, and fostering responsive classroom climates that value linguistically diverse students and their home cultures.
Subjective Well-Being and Student Development
Authors: Fan Weiqiao
Published: August 2020

Subjective well-being (SWB) emphasizes individuals’ emotional evaluation and cognitive appraisal of life quality, taking life satisfaction (LS) (both general and specific), positive affect (PA), and negative affect (NA) into consideration. Traditionally, SWB research has been conducted on adults; that on adolescents and young students has been limited. Moreover, SWB has generally been explored as an outcome variable related to people’s learning, work, relationships, and health. However, SWB should be considered a dynamic and agentic system that may promote an individual’s self-development as well as social development. Among student populations, SWB has been proven to affect academic achievement, health, and developmental variables such as personality, life quality, school engagement, and career development.

Schools and higher educational environments are not only places in which young people acquire academic knowledge and capacities; they are also places in which students connect with others, develop their personalities, experience all facets of society, and construct their life meaning, sense of self-esteem, and career identity. Furthermore, from a developmental and constructive perspective, some empirical evidence supported the idea that SWB may be a pivotal variable affecting student development.

Nevertheless, whether SWB can benefit development among young students is controversial, as is whether SWB is a predictor of individual development or a developmental outcome. Therefore, in examining the research beyond the relationship between SWB and health or academic achievement, studies on the contribution of SWB to student development must be reviewed.
Enhancing Students’ Assessment Feedback Skills Within Higher Education
Authors: Evans Carol , Waring Michael
Published: August 2020

In higher education (HE) considerable attention is focused on the skills sets students need to meet the requirements of the fourth industrial revolution. The acquisition of high-level assessment feedback skills is fundamental to lifelong learning. HE has made significant investment in developing assessment feedback practices over the last 30 years; however, far less attention has been given to the development of inclusive agentic integrated assessment systems that promote student agency and autonomy in assessment feedback, and from an individual differences perspective.

“Inside the Black Box,” a seminal work, opened the potential of assessment as a supportive process in facilitating students in coming to know (understanding the requirements of a task and context, and their own learning) through the development of formative assessment. However, overall, the assessment for learning movement has not changed students’ perceptions, on entering HE, that feedback is something they receive rather than something they can generate and orchestrate despite being predicated on a self-regulatory approach. HE promotes students’ use of self-regulated learning approaches although these are not sufficiently integrated into curriculum systems. In moving forward assessment feedback, it is important to adopt a theoretically integrated approach that draws on self-regulatory frameworks, agentic engagement concepts, understanding of individual differences, and the situated nature of assessment.

Current emphases in HE focus on how we engage students as active participants in assessment, in coming to know assessment requirements as part of sustainable practices with students as co-constructors of assessment inputs and outputs. Assessment design should be challenging students to maximize their selective and appropriate use of assessment feedback skills for both immediate and longer-term learning gains. Addressing the professional development of lecturers and students in the acquisition and development of essential fourth industrial age assessment feedback competencies is fundamental to enhancing the quality of learning and teaching in HE.
Environmental Health in Latin American Countries
Authors: Galvao Luiz Augusto Cassanha , Câmara Volney , Buss Daniel
Published: August 2020

The relationship between environment and health is part of the history of medicine and has always been important to any study of human health and to public-health interventions. In Latin America many health improvements are related to environmental interventions, such as the provision of better water and sanitation services. Latin America’s development, industrialization, and sweeping urbanization have brought many improvements to the well-being of its populations; they have also inaugurated new societies, with new patterns of consumption. The region’s basic environmental-health interventions have needed to be updated and upgraded to include disciplines such as toxicology, environmental epidemiology, environmental engineering, and many others. Multidisciplinary and inter-sector approaches are paramount to understanding new profiles of health and well-being, and to promoting effective public-health interventions.

The new social, economic, labor, and consumption aspects of modern Latin American society have become more and more relevant to understanding the complex interactions in the region’s social, biological, and physical environment, which are essential to explaining some of the emerging and re-emerging public-health problems. Environmental health, as concept and as intervention, is simple and easily understood, but no longer sufficient to achieve the levels of health and well-being expected and required by these new realities. Many global changes such as climate change, biodiversity loss, and mass migrations has been identified as main cause of ill health and are at the center of the sustainable development challenges in general, and many are critical and specific public health. To face this development, other frameworks have emerged, such as planetary health and environmental and social determinants of health. Public health remains central to some, such as the improved environmental-health agenda, while others assign public health a relative position in a variety of overarching frameworks.
Science and Technology in 20th-century Brazil
Authors: Freire Junior Olival
Published: August 2020

Twentieth-century science and technology in Brazil were marked by the building of new institutions of higher education, research, and research funding as well as by the professionalization of scientific practice in the country. Most of these changes were state driven and state funded, while some support came from foreign philanthropic foundations and states and, on a smaller scale, from the private sector. The mid-20th-century was when most activity took place, for instance the founding of the University of São Paulo, as a reaction of the state of São Paulo to national political changes in 1930, and the establishment of funding agencies such as Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), as initiatives of the federal government. Throughout the century the institutionalization of science moved from a strictly pragmatic model toward the acknowledgement of science as the professional activity required for the production of new knowledge. In Brazil the development of science has been marked by a succession of ups and downs closely following economic cycles and political times, albeit not perfectly synchronously. Therefore, a major brain drain began in 1960 during a democratic regime, and the 1964 military dictatorship restrained civil rights while supporting science from 1970 on.

Chronological limits in this history are not turning points. On the one hand, as the 21st century began Brazilian academia suffered further ups and downs closely related to political and funding crises, which have worsened since President Jair Bolsonaro assumed office in 2019. On the other hand, the huge impact of the 20th-century changes in Brazilian academia should not detract from the production of science and technology in previous centuries.
Conjugation Class
Authors: Oltra-Massuet Isabel
Published: August 2020

Conjugation classes have been defined as the set of all forms of a verb that spell out all possible morphosyntactic categories of person, number, tense, aspect, mood, and/or other additional categories that the language expresses in verbs. Theme vowels instantiate conjugation classes as purely morphological markers; that is, they determine the verb’s morphophonological surface shape but not its syntactic or semantic properties. They typically split the vocabulary items of the category verb into groups that spellout morphosyntactic and morphosemantic feature specifications with the same inflectional affixes. The bond between verbs and their conjugational marking is idiosyncratic, and cannot be established on semantic, syntactic, or phonological grounds, although there have been serious attempts at finding a systematic correlation. The existence of theme vowels and arbitrary conjugation classes has been taken by lexicalist theories as empirical evidence to argue against syntactic approaches to word formation and are used as one of the main arguments for the autonomy of morphology. They further raise questions on the nature of basic morphological notions such as stems or paradigms and serve as a good empirical ground for theories of allomorphy and syncretism, or to test psycholinguistic and neurolinguistic theories of productivity, full decomposition, and storage. Conjugations and their instantiation via theme vowels may also be a challenge for theories of first language acquisition and the learning of morphological categories devoid of any semantic meaning or syntactic alignment that extend to second language acquisition as well. Thus, analyzing their nature, their representation, and their place in grammar is crucial as the approach to these units can have profound effects on linguistic theory and the architecture of grammar.
Tonogenesis
Authors: Michaud Alexis , Sands Bonny
Published: August 2020

Tonogenesis is the development of distinctive tone from earlier non-tonal contrasts. A well-understood case is Vietnamese (similar in its essentials to that of Chinese and many languages of the Tai-Kadai and Hmong-Mien language families), where the loss of final laryngeal consonants led to the creation of three tones, and the tones later multiplied as voicing oppositions on initial consonants waned. This is by no means the only attested diachronic scenario, however. Besides well-known cases of tonogenesis in East Asia, this survey includes discussions of less well-known cases of tonogenesis from language families including Athabaskan, Chadic, Khoe and Niger-Congo. There is tonogenetic potential in various series of phonemes: glottalized versus plain consonants, unvoiced versus voiced, aspirated versus unaspirated, geminates versus simple (and, more generally, tense versus lax), and even among vowels, whose intrinsic fundamental frequency can transphonologize to tone. We draw attention to tonogenetic triggers that are not so well-known, such as [+ATR] vowels, aspirates and morphotonological alternations. The ways in which these common phonetic precursors to tone play out in a given language depend on phonological factors, as well as on other dimensions of a language’s structure and on patterns of language contact, resulting in a great diversity of evolutionary paths in tone systems. In some language families (such as Niger-Congo and Khoe), recent tonal developments are increasingly well understood, but working out the origin of the earliest tonal contrasts (which are likely to date back thousands of years earlier than tonogenesis among Sino-Tibetan languages, for instance) remains a mid- to long-term research goal for comparative-historical research.
Agent-Based Modeling of Flood Insurance Futures
Authors: Geaves Linda
Published: August 2020

Agent-based models have facilitated greater understanding of flood insurance futures, and will continue to advance this field as modeling technology develops further. As the pressures of climate-change increase and global populations grow, the insurance industry will be required to adapt to a less predictable operating environment. Complicating the future of flood insurance is the role flood insurance plays within a state, as well as how insurers impact the interests of other stakeholders, such as mortgage providers, property developers, and householders. As such, flood insurance is inextricably linked with the politics, economy, and social welfare of a state, and can be considered as part of a complex system of changing environments and diverse stakeholders. Agent-based models are capable of modeling complex systems, and, as such, have utility for flood insurance systems. These models can be considered as a platform in which the actions of autonomous agents, both individuals and collectives, are simulated. Cellular automata are the lowest level of an agent-based model and are discrete and abstract computational systems. These automata, which operate within a local and/or universal environment, can be programmed with characteristics of stakeholders and can act independently or interact collectively. Due to this, agent-based models can capture the complexities of a multi-stakeholder environment displaying diversity of behavior and, concurrently, can cater for the changing flood environment. Agent-based models of flood insurance futures have primarily been developed for predictive purposes, such as understanding the impact of introductions of policy instruments. However, the ways in which these situations have been approached by researchers have varied; some have focused on recreating consumer behavior and psychology, while others have sought to recreate agent interactions within a flood environment. The opportunities for agent-based models are likely to become more pronounced as online data becomes more readily available and artificial intelligence technology supports model development.
Data Infrastructures in Ecology: An Infrastructure Studies Perspective
Authors: Millerand Florence , Baker Karen S.
Published: August 2020

The development of information infrastructures that make ecological research data available has increased in recent years, contributing to fundamental changes in ecological research. Science and Technology Studies (STS) and the subfield of Infrastructure Studies, which aims at informing infrastructures’ design, use, and maintenance from a social science point of view, provide conceptual tools for understanding data infrastructures in ecology. This perspective moves away from the language of engineering, with its discourse on physical structures and systems, to use a lexicon more “social” than “technical” to understand data infrastructures in their informational, sociological, and historical dimensions. It takes a holistic approach that addresses not only the needs of ecological research but also the diversity and dynamics of data, data work, and data management. STS research, having focused for some time on studying scientific practices, digital devices, and information systems, is expanding to investigate new kinds of data infrastructures and their interdependencies across the data landscape. In ecology, data sharing and data infrastructures create new responsibilities that require scientists to engage in opportunities to plan, experiment, learn, and reshape data arrangements. STS and Infrastructure Studies scholars are suggesting that ecologists as well as data specialists and social scientists would benefit from active partnerships to ensure the growth of data infrastructures that effectively support scientific investigative processes in the digital era.
Child Soldiers
Authors: Guyot-Diangone Julie
Published: August 2020

This article provides an overview of the phenomenon of child soldiers in war theaters around the world. Research studies are used to illustrate the deficits approach frequently applied to young people’s involvement in armed combat. In addition to a review of the legal protections surrounding the involvement of children in armed conflict, this article broadens the discourse on child soldiers. Diversity is introduced to counter the monolithic characterization of the child soldier, including descriptions of the various forms, levels, and dimensions participation may take, affecting all spheres of life—providing a holistic, community-level view not limited to individualized intrapsychic experiences. The subject of the child soldier has been approached through scholarship from a number of disciplines and centers on reintegration practices, the use of children as a military strategy, the process of weaponizing children, children’s moral development, and the use of traditional healing practices. Core social work ethics, along with the discipline’s strengths-based approach to inquiry are employed to further counter the narrative of “brokenness” that is prevalent in these fields. The introduction of resilience factors is used to broaden awareness of the diversity of outcomes among the various cohorts studied. Childhood as a social construction is discussed, along with its Western-informed biases. Humanitarian aid and development bodies have structured educational programs and livelihood opportunities to assist former child soldiers reintegrate into post-conflict societies, and Western understandings of childhood influence the architecture of these efforts. Although protections surrounding the involvement of minors in armed conflict have grown, the use of child soldiers remains. The article uses the Convention of the Rights of the Child along with the African Charter on Children in Armed Conflict to help unpack the disparate meanings of what it means to be a child within various sociocultural contexts.
Genocide
Authors: Meshelemiah Jacquelyn C.A. , Lynch Raven E.
Published: August 2020

Genocides have persisted around the world for centuries, yet the debate persists about what intentions and subsequent actions constitute an actual genocide. As a result, some crimes against humanity, targeted rape campaigns, and widespread displacement of marginalized groups of people around the globe have not been formally recognized as a genocide by world powers while others have. The 1948 Convention on the Prevention and Punishment of the Crime of Genocide set out to provide clarity about what constituted a genocide and the corresponding expected behaviors of nations that bear witness to it. Still, even with this United Nations document in place, there remains some debate about genocides. The United States, a superpower on the world stage, did not sign on to the Convention on the Prevention and Punishment of the Crime of Genocide until 1988 due to a belief that its participation was not necessary as a civilized world leader that had its own checks and balances. More genocides have taken place since the enactment of this 1948 legislation. Genocides that have taken place pre- and post-1948 affirm the need for nations around the world to agree to a set of behaviors that protect targeted groups of people from mass destruction and prescribe punishment for those who perpetrate such atrocities. Although it may seem that identifying genocidal behaviors toward a group of people would be clear and convincing based on witnesses and/or deaths of targeted members, history has shown this not to be the case time and time again. Perpetrators tend to deny such behaviors or claim innocence in the name of self-defense. Regardless of any acknowledgment of wrongdoing, genocides are the world’s greatest crime against humanity.
Post-Disaster Trauma and Recovery
Authors: Powell Tara M. , Billiot Shannondora , Saltzman Leia Y.
Published: August 2020

Natural and man-made disasters have become much more frequent since the start of the 21st century. Disasters have numerous deleterious impacts. They disrupt individuals, families, and communities, causing displacement, food insecurity, injury, loss of livelihoods, conflict, and epidemics. The physical and mental health impact of a disaster can have extensive short- and long-term consequences. Immediately after a traumatic event, individuals may experience an array of reactions such as anxiety, depression, acute stress symptoms, shock, dissociation, allergies, injuries, or breathing problems. Given the economic and human impact of disasters, social workers are often quick to respond. Historically, the social work profession has provided services on the individual level, but initiatives have expanded to address community preparedness, response, and recovery.

This article will explore the complexities of disaster response and recovery. Health and mental health impacts will be examined. Resilience and posttraumatic growth will then be discussed, exploring how individuals overcome adversity and trauma. Individual and community level preparedness mitigation, response, and recovery will explore how the field of social work has evolved as disasters have increased. Followed by an exploration of how social work has evolved to develop individual and community level preparedness, mitigation, response, and recovery activities as disasters have increased. Finally, the article will examine special populations, including those with disabilities, children, indigenous people, older adults, and social service workers in all phases of disasters. As disasters grow more frequent it is vital for social work professionals to improve their efforts. We will conclude the chapter by examining the coordinated efforts the social work profession is involved in to help communities recover and even thrive after a traumatic event.
Austin, David M.
Authors: Logan Sadye L. M.
Published: August 2020

David M. Austin (1923–2008), who served as Bert Kruger Smith Centennial Professor at the University of Texas at Austin School of Social Work (now University of Texas at Austin Steve Hicks School of Social Work), has left an outstanding legacy in the students and colleagues whom he has mentored and inspired. He was a tireless leader, practical researcher, and brilliant scholar in the field of social work.
Stern, Leonard William
Authors: Logan Sadye L. M.
Published: August 2020

William Leonard Stern (1926–2019) had a long and distinguished career as a social worker and member of the National Association of Social Workers (NASW). Over more than five decades, he developed policies, built and managed programs, and provided consultation and evaluation services to a variety of human service organizations, professional associations, and governmental agencies.
Epithelioid Sarcoma of the Peripheral Nerve: Clinicopathologic Series of Three Cases and Literature Review
Authors: Diaz-Perez Julio A , Spasic Smiljana , Velez-Torres Jaylou M , McCarthy Edward F , Rosenberg Andrew E
Published: August 2020

Objectives

Epithelioid sarcoma (ES) rarely arises in the nerve. To increase our understanding of this unusual tumor originating in the nerve, we describe the features of three cases and review the literature.

Methods

Clinical data, imaging, pathology, treatment, and follow-up are detailed. A systematic literature review was conducted.

Results

Two patients were male and one female; the median age was 24 years. The patients had neurologic symptoms, and the tumors arose in large nerves and ranged from 2.4 to 5.8 cm. The tumors were avid on positron emission tomography–computed tomography and showed increased signal intensity on T2-weighted magnetic resonance imaging. Centered in the nerve, the tumors grew with an infiltrative pattern and encased the nerve fascicles. All were treated with wide resection, and adjuvant treatment included combinations of chemotherapy and radiation. One recurred, and the limb was amputated. Metastases were documented to lymph nodes, lung, pleura, and skin. One patient died of disease after 54 months. Literature review including our cases showed that tumors stained with pancytokeratin (9/9), EMA (4/4), and CD34 (7/7); there was loss of INI1 in all six cases tested.

Conclusions

ES rarely arises in the peripheral nerve, and its infiltrative nature often requires morbid surgery. The differential includes a variety of benign and malignant epithelioid neoplasms.
Sine-skewed toroidal distributions and their application in protein bioinformatics
Authors: Ameijeiras-Alonso Jose , Ley Christophe
Published: August 2020

In the bioinformatics field, there has been a growing interest in modeling dihedral angles of amino acids by viewing them as data on the torus. This has motivated, over the past years, new proposals of distributions on the torus. The main drawback of most of these models is that the related densities are (pointwise) symmetric, despite the fact that the data usually present asymmetric patterns. This motivates the need to find a new way of constructing asymmetric toroidal distributions starting from a symmetric distribution. We tackle this problem in this article by introducing the sine-skewed toroidal distributions. The general properties of the new models are derived. Based on the initial symmetric model, explicit expressions for the shape and dependence measures are obtained, a simple algorithm for generating random numbers is provided, and asymptotic results for the maximum likelihood estimators are established. An important feature of our construction is that no extra normalizing constant needs to be calculated, leading to more flexible distributions without increasing the complexity of the models. The benefit of employing these new sine-skewed toroidal distributions is shown on the basis of protein data, where, in general, the new models outperform their symmetric antecedents.
Re-empowering into voice: experiments in organic community co-production
Authors: Green Roger , Baker Chris
Published: August 2020

This article explores and extrapolates an emerging concept within community practice: namely that of organic community co-production. The concept is influenced by previous uses of the term ‘organic’, specifically as applied by Tönnies in relation to certain types of community, and Gramsci in respect of a concept of leadership. Our development of the term has been generated within the context of reflective practitioner experience, located in a community-led action campaign Voice4Deptford, in South East London. The case study explores the interdisciplinary roots of this form of co-production. It highlights the way that these pre-existing principles and methods have been adapted, reflected upon and improvised in the light of 30 years’ grassroots engagement by Green to evolve a bespoke approach that we are proposing to call ‘organic community coproduction’.

The case study outlines several original dimensions or modalities of community organic co-production including; stepping aside; the academic as a non-expert and giving voice. It unpacks the different elements of impact and transformation, that are consequent upon organic community co-production. These include; evidence of change; working together and community reflective time. The article concludes with a discussion of the issues involved in reframing of local power, the campaigns early successes and its continuing challenges.
Postprescription Review With Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years
Authors: Mani Nandita S , Lan Kristine F , Jain Rupali , Bryson-Cahn Chloe , Lynch John B , Krantz Elizabeth M , Bryan Andrew , Liu Catherine , Chan Jeannie D , Pottinger Paul S , Kim H Nina
Published: August 2020

Background

Following a meropenem shortage, we implemented a postprescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses > 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering.

Methods

A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and postintervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1000 patient-days, and data were analyzed by an interrupted time series.

Results

There were 4066 and 2552 patients in the pre- and postintervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1000 patient-days occurred at both hospitals (UWMC: percentage change −72.1% (95% confidence interval [CI] −76.6, −66.9), P < .001; HMC: percentage change −43.6% (95% CI −59.9, −20.7), P = .001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the postintervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P < .001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P < .001) at HMC.

Conclusions

PPRF and mandatory ID consultation for meropenem and imipenem use beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage.
Household Transmission of Carbapenemase-producing Enterobacterales in Ontario, Canada
Authors: Jamal Alainna J , Faheem Amna , Farooqi Lubna , Zhong Xi Zoe , Armstrong Irene , Boyd David A , Borgundvaag Emily , Coleman Brenda L , Green Karen , Jayasinghe Kithsiri , Johnstone Jennie , Katz Kevin , Kohler Philipp , Li Angel X , Mataseje Laura , Melano Roberto , Muller Matthew P , Mulvey Michael R , Nayani Sarah , Patel Samir N , Paterson Aimee , Poutanen Susan , Rebbapragada Anu , Richardson David , Sarabia Alicia , Shafinaz Shumona , Simor Andrew E , Willey Barbara M , Wisely Laura , McGeer Allison J
Published: August 2020

Background

Data on household transmission of carbapenemase-producing Enterobacterales (CPE) remain limited. We studied risk of CPE household co-colonization and transmission in Ontario, Canada.

Methods

We enrolled CPE index cases (identified via population-based surveillance from January 2015 to October 2018) and their household contacts. At months 0, 3, 6, 9, and 12, participants provided rectal and groin swabs. Swabs were cultured for CPE until September 2017, when direct polymerase chain reaction (PCR; with culture of specimens if a carbapenemase gene was detected) replaced culture. CPE risk factor data were collected by interview and combined with isolate whole-genome sequencing to determine likelihood of household transmission. Risk factors for household contact colonization were explored using a multivariable logistic regression model with generalized estimating equations.

Results

Ninety-five households with 177 household contacts participated. Sixteen (9%) household contacts in 16 (17%) households were CPE-colonized. Household transmission was confirmed in 3/177 (2%) cases, probable in 2/177 (1%), possible in 9/177 (5%), and unlikely in 2/177 (1%). Household contacts were more likely to be colonized if they were the index case’s spouse (odds ratio [OR], 6.17; 95% confidence interval [CI], 1.05–36.35), if their index case remained CPE-colonized at household enrollment (OR, 7.00; 95% CI, 1.92–25.49), or if they had at least 1 set of specimens processed after direct PCR was introduced (OR, 6.46; 95% CI, 1.52–27.40).

Conclusions

Nine percent of household contacts were CPE-colonized; 3% were a result of household transmission. Hospitals may consider admission screening for patients known to have CPE-colonized household contacts.
Fatty Liver Disease in a Prospective North American Cohort of Adults With Human Immunodeficiency Virus and Hepatitis B Virus Coinfection
Authors: Khalili Mandana , King Wendy C , Kleiner David E , Jain Mamta K , Chung Raymond T , Sulkowski Mark , Lisker-Melman Mauricio , Wong David K , Ghany Marc , Sanyal Arun , Sterling Richard K
Published: August 2020

Background

Hepatitis B virus (HBV) and fatty liver disease (FLD) are common in human immunodeficiency virus (HIV). Correlates of FLD and its relationship with alanine aminotransferase (ALT) were examined longitudinally in HIV-HBV coinfection.

Methods

From 28/4/2014–7/11/2018, 114 HIV-HBV adults had liver biopsy and were followed for a median of 3 years (ancillary study of Hepatitis B Research Network). Steatohepatitis was based on presence of steatosis, ballooning, and perisinusoidal fibrosis. FLD was defined as ≥5% steatosis and/or steatohepatitis.

Results

Median age was 49 years, 93% were male, 51% black, 93% had HIV RNA <400 copies/mL and 83% HBV DNA <1000 IU/mL. Thirty percent had FLD (20% steatosis, 10% steatohepatitis). Those with FLD had higher median triglyceride (171 vs 100 mg/dL, P < .01) and small, dense LDL (44 vs 29 mg/dL, P < .01) and lower HDL-2-C (9 vs 12 mg/dL, P = .001). After adjusting for age, sex, and alcohol use, white and other versus black race (ORs, 8.49 and 16.54, respectively), ALT (OR, 3.13/doubling), hypertension (OR, 10.93), hyperlipidemia (OR, 4.36), and diabetes family history (OR, 5.38) were associated with having FLD (all P < .05). Steatohepatitis or steatosis alone (vs none) was associated with higher ALT over time (1.93 and 1.34 times higher, respectively; P < .001), with adjustment for age, sex, and HBV DNA.

Conclusions

About 30% with HIV-HBV coinfection had FLD including 10% with steatohepatitis. FLD was associated with non-black race, metabolic risks, an atherogenic lipid profile, and elevated ALT over time. Thus, identification of FLD and management of adverse metabolic profiles are critically important in HIV-HBV coinfection.

Clinical Trial Registration. NCT 01924455.
ANMCO POSITION PAPER: Considerations on in-hospital cardiological consultations and cardiology outpatient clinics during the COVID-19 pandemic
Authors: Valente Serafina , Colivicchi Furio , Caldarola Pasquale , Murrone Adriano , Di Lenarda Andrea , Roncon Loris , Amodeo Enzo , Aspromonte Nadia , Cipriani Manlio Gianni , Domenicucci Stefano , Francese Giuseppina Maura , Imazio Massimo , Scotto di Uccio Fortunato , Urbinati Stefano , Gulizia Michele Massimo , Gabrielli Domenico
Published: August 2020

Infections by SARS CoV2 - COVID-19 have become in a short time a worldwide health emergency. Due to cardiovascular implications of COVID-19 and to very frequent previous cardiovascular disorders of COVID-19 patients, it is presently crucial that Cardiologists are fully aware of COVID-19 related epidemiological, pathophysiological and therapeutic problems, in order to manage at best the present emergency by appropriate protocols developed on the basis of the competences acquired and shared on the field. The aim of this document is to propose algorithms for the management of cardiovascular diseases during COVID-19 emergency with the objective of providing patients with optimal care, minimizing contagion risk and appropriately managing personal protective equipment.
ANMCO POSITION PAPER: The cardiological clinical activities in the transition phase of the COVID-19 pandemic
Authors: Valente Serafina , Colivicchi Furio , Francese Maura Giuseppina , Di Lenarda Andrea , Roncon Loris , Murrone Adriano , Caldarola Pasquale , Bilato Claudio , Amodeo Enzo , Aspromonte Nadia , Cipriani Manlio , Domenicucci Stefano , Imazio Massimo , Scotto di Uccio Fortunato , Urbinati Stefano , Gulizia Michele Massimo , Gabrielli Domenico
Published: August 2020

Infections by SARS CoV2 - COVID-19 became in a short time a worldwide health emergency. The present SARS-CoV-2 pandemic induced in a short time, an unprecedented impact on public health and on the pre-existing care pathways. In order to appropriately address this epidemiological emergency, urgent solutions were needed, such as remodelling or stopping hospitalization and deferrable clinical activities to avoid spreading the SARS-CoV-2 infection. After the first emergency lockdown phase, care pathways must guarantee healthcare to patients and preserve the safety of the healthcare personnel and of all the other subjects that refer to the cardiological surgeries. Rigorous prescriptive appropriateness of the requested exams with consequent reduction of unnecessary examinations is an essential requirement to preserve prioritized diagnostic and care pathways to patients in need, minimizing the risks connected to the SARS-CoV-2 contagion in hospitals. Telemedicine services represent a valid answer to cardiovascular disease patients’ need for care and assistance, including those in quarantine and voluntary isolation. These services successfully contribute to fight the spread of the virus guaranteeing at the same time therapy and support through remote services that must therefore be considered a resource to be implemented and enhanced. This document has to be used by the healthcare personnel working in hospitals and in district offices, if applicable, and aims at managing patients, in complete safety and considered not suspect/not probable (‘not at risk’) of SARS-CoV-2 infection, eligible for diagnostic activity and subsequent therapy in outpatient surgeries. In particular, this document provides indications for patient evaluation to prevent COVID-19 exposure, gives general indications on managing appointments and waiting rooms, on how to strictly adhere to environmental safety measures, on the proper use of Individual Protective Equipment (IPE). It also provides specific indications for outpatient service procedures, like electrocardiogram, cardiologic examination, cardiologic checkup, Dynamic Holter Electrocardiogram, Transthoracic Echocardiography, Echo Stress, Transoesophageal Echocardiography, Bike Ergometer stress test, Ergospirometry, Outpatient Checkup of implantable electronic cardiac devices.
Family medicine physicians’ report strong support, barriers and preferences for Registered Dietitian Nutritionist care in the primary care setting
Authors: Sastre Lauren R , Van Horn Leslie T
Published: August 2020

Background

Previous studies have examined barriers (e.g. time) for Family Medicine Providers (FMPs) to provide nutrition and lifestyle counseling, however, to date no studies have examined access or interest to Registered Dietitian Nutritionist (RDN) care for patients.

Objective

The objective of this study was to explore FMP access, referral practices, barriers and preferences for RDN care.

Methods

A cross-sectional online survey, with content and face validation was conducted with Family Medicine Departments within large academic health care systems in the Southeastern United States. The main variables of interest included: FMP access, interest, current referrals and referral preferences for RDN care, barriers to referrals and overall perceptions regarding RDN care. Descriptive analysis of close-ended responses was performed with SPSS 26.0. Open-ended responses were analysed using inductive content analysis.

Results

Over half of the respondents (n = 151) did not have an RDN on-site (64%) yet were highly interested in integrating an RDN (94.9%), with reported preferences for full-time on-site, part-time on-site or off-site RDN care (49.1%, 39.5% and 11.4% respectively). The greatest reported barriers to RDN referrals were perceived cost for the patient (64.47%) and uncertainty how to find a local RDN (48.6%). The most consistent theme reported in the open-ended responses were concerns regarding reimbursement, e.g. ‘Insurance does not cover all of the ways I would like to use an RDN’.

Conclusions

FMPs report interest and value in RDN services despite multiple perceived barriers accessing RDNs care. Opportunities exist for interprofessional collaboration between dietetic and FMP professional groups to address barriers.
ScanITD: Detecting internal tandem duplication with robust variant allele frequency estimation
Authors: Wang Ting-You , Yang Rendong
Published: August 2020

Background

Internal tandem duplications (ITDs) are tandem duplications within coding exons and are important prognostic markers and drug targets for acute myeloid leukemia (AML). Next-generation sequencing has enabled the discovery of ITD at single-nucleotide resolution. ITD allele frequency is used in the risk stratification of patients with AML; higher ITD allele frequency is associated with poorer clinical outcomes. However, the ITD allele frequency data are often unavailable to treating physicians and the detection of ITDs with accurate variant allele frequency (VAF) estimation remains challenging for short-read sequencing.

Results

Here we present the ScanITD approach, which performs a stepwise seed-and-realignment procedure for ITD detection with accurate VAF prediction. The evaluations on simulated and real data demonstrate that ScanITD outperforms 3 state-of-the-art ITD detectors, especially for VAF estimation. Importantly, ScanITD yields better accuracy than general-purpose structural variation callers for predicting ITD size range duplications.

Conclusions

ScanITD enables the accurate identification of ITDs with robust VAF estimation. ScanITD is written in Python and is open-source software that is freely accessible at https://github.com/ylab-hi/ScanITD.