bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications for long COVID: A systematic review and meta‐aggregation of experience of patients diagnosed with COVID‐19
Authors: Zheng Xutong , Qian Min , Ye Xinxin , Zhang Man , Zhan Chenju , Li Hui , Luo Tiantian
Published: October 2022

Aims and Objectives

This review aims to synthesize the available evidence of what patients experience when infected with COVID‐19, both in hospital and post‐discharge settings.

Design

This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist.

Background

Coronavirus disease 2019 (COVID‐19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID‐19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real‐life experience of patients with COVID‐19 from diagnosis to post‐discharge can deepen the understanding of nurses, physicians and policymakers.

Methods

All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020.

Results

This systematic review aggregated patients’ experience of being diagnosed with COVID‐19 in both hospitalized and post‐discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta‐synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource.

Conclusions

The psychological burden of patients diagnosed with COVID‐19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization.

Relevance to clinical practice

Nurses should care about the persistent mental trauma of COVID‐19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.
Stability and relevance of marriage desires: Importance of age norms and partnering opportunities
Authors: Yu Wei‐Hsin , Hara Yuko
Published: October 2022

Objective

This study investigates shifts in marriage desires during singlehood and the potential consequences associated with these shifts in Japan, a country epitomizing later and less marriage without substantial increases in nonmarital childbearing.

Background

Despite researchers' long‐standing interest in values potentially motivating demographic changes, few have systematically examined marriage desires among unmarried adults. Even fewer have considered how marriage desires may change during adulthood and how relevant such changes are to marriage and family behavior.

Method

The analysis uses 11 waves of the Japan Life Course Panel Survey, which tracks singles' marriage desires yearly. Fixed effects models are estimated to demonstrate factors associated with within‐person changes and account for unobserved heterogeneity.

Results

Japanese singles' marriage desires decline with age but are stronger when they perceive greater opportunities to form romantic relationships or marriage. Singles experiencing an increase in the desire to marry are more likely to take actions to seek partners and to enter a romantic relationship or marriage subsequently. The associations between marriage desires and the various behavioral changes strengthen with age and feasibility of marriage. Increases in marriage desires also correspond to increases in single men's parenthood desires and ideal numbers of children, and the link between marriage desires and fertility preferences is stronger as they age.

Conclusion

Marriage desires are not always stable or equally relevant throughout singlehood. Our study suggests that age norms and partnering opportunities both contribute to the fluctuation of marriage desires and affect when such desires would have behavioral implications.
Rethinking aversive personality: Decomposing the Dark Triad traits into their common core and unique flavors
Authors: Bader Martina , Hilbig Benjamin E. , Zettler Ingo , Moshagen Morten
Published: October 2022

Objective

To explain and predict unethical behavior, much attention has been devoted to the “Dark Triad of Personality”, a set of three socially aversive personality traits: Machiavellianism, narcissism, and psychopathy. Despite its popularity, research on the Dark Triad has been beset by recurring concerns surrounding the distinctiveness of its components. Herein, we propose an alternative theoretical view that conceptualizes the Dark Triad traits as specific manifestations of the common core of aversive traits (conceptualized as the Dark Factor of Personality, D) flavored by unique, essentially non‐aversive characteristics.

Method

In two studies (total N > 1000), we test this idea by examining the conceptual and empirical overlap and specificity of the Dark Triad traits vis‐à‐vis D and each other.

Results

Findings support the conceptualization of the Dark Triad traits as flavored manifestations of D and also reveal a marked discrepancy between the current conceptualization of the Dark Triad traits and the empirical structure of its subdimensions. In fact, evidence clearly failed to support the existence of a triad of traits.

Conclusion

Conceptualizing single aversive traits as a conjunction of core D aspects and essentially non‐aversive characteristics (admiration; disinhibition vs. planfulness; vulnerability vs. boldness) holds promise to move the field forward.
‘This is the last episode’: the association between problematic binge‐watching and loneliness, emotion regulation, and sleep‐related factors in poor sleepers
Authors: Alfonsi Valentina , Varallo Giorgia , Scarpelli Serena , Gorgoni Maurizio , Filosa Maria , De Gennaro Luigi , Musetti Alessandro , Franceschini Christian
Published: October 2022

Evidence on the relation between binge‐watching and sleep quality is still scarce and inconsistent and none has taken into account both the healthy and pathological dimensions of the phenomenon. This study aimed at filling this gap by investigating both aspects in healthy participants with high and low sleep quality. Further, we aimed at identifying sociodemographic, psychological and sleep‐related determinants of problematic binge‐watching in poor sleepers. We first conducted independent comparisons between good (n = 253) and poor sleepers (n = 209) on different binge‐watching symptoms and motives, assessed through ‘Binge‐watching Engagement and Symptoms’ and ‘Watching TV Series Motives’ questionnaires, respectively. Then, we focused on the problematic aspects of binge‐watching in poor sleepers, investigating the role of emotion regulation, loneliness, and sleep‐related factors using hierarchical multiple regressions. Comparisons between the two groups revealed a greater extent of binge‐watching behaviour (t = −2.80, p = 0.005) and greater use of this practise to cope with negative emotions (t = −4.17, p < 0.001) in poor sleepers. In addition, hierarchical multiple regressions showed that gender (β = −0.166, p = 0.008), alcohol consumption (β = −0.135, p = 0.035), emotional dysregulation (β = 0.260, p = 0.001; β = 0.298, p < 0.001), feelings of loneliness (β = 0.159, p = 0.029; β = 0.199, p = 0.003), and daytime sleepiness (β = 0.149, p = 0.016) are significant determinants of problematic binge‐watching in this population. In addition to showing for the first time the relationship between sleep quality and different aspects of binge‐watching, our findings indicate that emotional dysregulation, feelings of loneliness, and daytime sleepiness play a key role in determining problematic binge‐watching in poor sleepers, possibly due to the existence of a pathological vicious circle between these factors in poor sleepers.
Novel concepts on mechanisms underlying Hepatitis Delta virus persistence and related pathogenesis
Authors: Salpini Romina , D'Anna Stefano , Piermatteo Lorenzo , Svicher Valentina
Published: October 2022

Hepatitis Delta virus is the smallest known human virus, exploiting the HBV surface proteins (HBsAg) for the release of its progeny and de novo entry into hepatocytes. Ever growing evidence have highlighted the existence of multiple mechanisms underlying HDV persistence including integrated HBV‐DNA as a source of HBsAg production and the capability of the HDV genome to propagate through cell proliferation, thus supporting a potential HDV persistence even in the absence of HBV. Chronic HDV‐infection causes the most severe form of viral hepatitis, leading to the development of cirrhosis in 15% of cases within 1–2 years and in 50%–60% of cases within 5–10 years. The rates of hepatocellular carcinoma and hepatic decompensation are also 2–3‐fold higher than for HBV mono‐infection. There is the evidence that persistent viral replication plays a key role in triggering liver injury, suggesting the existence of direct viral cytopathic properties that can modulate, synergistically with immune‐responses, the progression towards end‐stage liver diseases. All these aspects can be further exacerbated by the extraordinary degree of viral genetic variability that can promote HDV evasion from immune responses and has enabled viral differentiation into genotypes and subgenotypes with potential different pathobiological properties. In this light, this review aims at providing comprehensive insights of mechanisms (with a focus on virological factors) underlying HDV persistence and pathogenesis, critical in shaping the clinical outcome of the infection. Dissecting these mechanisms is pivotal to optimize therapeutic strategies aimed at fully counteracting this fascinating and fearsome virus.
The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh
Authors: Thai Giang , Margolies Amy , Gelli Aulo , Sultana Nasrin , Choo Esther , Kumar Neha , Levin Carol
Published: October 2022

Bangladesh struggles with undernutrition in women and young children. Nutrition‐sensitive agriculture programmes can help address rural undernutrition. However, questions remain on the costs of multisectoral programmes. This study estimates the economic costs of the Targeting and Re‐aligning Agriculture to Improve Nutrition (TRAIN) programme, which integrated nutrition behaviour change and agricultural extension with a credit platform to support women's income generation. We used the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS‐Nutrition) approach. The approach aligns costs with a multisectoral nutrition typology, identifying inputs and costs along programme impact pathways. We measure and allocate costs for activities and inputs, combining expenditures and micro‐costing. Quantitative and qualitative data were collected retrospectively from implementers and beneficiaries. Expenditure data and economic costs were combined to calculate incremental economic costs. The intervention was designed around a randomised control trial. Incremental costs are presented by treatment arm. The total incremental cost was $795,040.34 for a 3.5‐year period. The annual incremental costs per household were US$65.37 (Arm 2), USD$114.15 (Arm 3) and $157.11 (Arm 4). Total costs were led by nutrition counselling (37%), agriculture extension (12%), supervision (12%), training (12%), monitoring and evaluation (9%) and community events (5%). Total input costs were led by personnel (68%), travel (12%) and supplies (7%). This study presents the total incremental costs of an agriculture‐nutrition intervention implemented through a microcredit platform. Costs per household compare favourably with similar interventions. Our results illustrate the value of a standardised costing approach for comparison with other multisectoral nutrition interventions.
Expression pattern of resynthesized allotetraploid Capsella is determined by hybridization, not whole‐genome duplication
Authors: Duan Tianlin , Sicard Adrien , Glémin Sylvain , Lascoux Martin
Published: October 2022

Polyploidization, the process leading to the increase in chromosome sets, is a major evolutionary transition in plants. Whole‐genome duplication (WGD) within the same species gives rise to autopolyploids, whereas allopolyploids result from a compound process with two distinct components: WGD and interspecific hybridization.

To dissect the instant effects of WGD and hybridization on gene expression and phenotype, we created a series of synthetic hybrid and polyploid Capsella plants, including diploid hybrids, autotetraploids of both parental species, and two kinds of resynthesized allotetraploids with different orders of WGD and hybridization.

Hybridization played a major role in shaping the relative expression pattern of the neo‐allopolyploids, whereas WGD had almost no immediate effect on relative gene expression pattern but, nonetheless, still affected phenotypes. No transposable element‐mediated genomic shock scenario was observed in either neo‐hybrids or neo‐polyploids. Finally, WGD and hybridization interacted and the distorting effects of WGD were less strong in hybrids. Whole‐genome duplication may even improve hybrid fertility.

In summary, while the initial relative gene expression pattern in neo‐allotetraploids was almost entirely determined by hybridization, WGD only had trivial effects on relative expression patterns, both processes interacted and had a strong impact on physical attributes and meiotic behaviors.
Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results
Authors: Jia Fei , Dou Xinyu , Liu Yu , Liu Xiaoguang , Du Chuanchao
Published: October 2022

Objective

Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation.

Methods

This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications.

Results

Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m2 (mean BMI of 27.5 kg/m2). The preoperative claudication distance was 160.00 ± 68.96 m (range 70–250 m), which was significantly extended on the 3‐month and 1‐year follow‐up (1020.00 ± 407.70 m and 1040.00 ± 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 ± 0.97 (range 4–7) and 6.40 ± 0.97 (range 5–8). The score on postoperative month 3 was 1.60 ± 0.52 (range 1–2) and 1.20 ± 0.79 (range 0–2), and the 1‐year follow‐up score was 1.90 ± 0.74 (range 1–3) and 1.60 ± 0.70 (range 1–3), respectively. The preoperative ODI was 72.23 ± 6.30 (range 64.4–82.2), the 3‐month follow‐up ODI was 31.12 ± 4.20 (range 24.4–35.6), and the 1‐year follow‐up ODI was 29.33 ± 5.92 (range 20.0–37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 ± 32.5 min vs. 214.9 ± 60.0 min) but the amount of blood loss decreased significantly (113.3 ± 26.7 ml vs. 366.8 ± 298.2 ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1‐year follow‐up.

Conclusion

OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.
Navigation Template Design and the Anatomic Measurement for Anterograde Transpubic Screws
Authors: Wu Chao , Shen Danwei , Deng Jiayan , Zeng Baifang , Wang Xiangyu , Li Hong , Xu Lian , Liu Xin , Huang Li
Published: October 2022

Objective

For pelvic ring fractures, screw fixation became a popular technique for its good biomechanical performance. The safe insertion of anterograde the transpubic screw is important for patients with anterior pelvic ring fractures. This paper is to research the anatomical parameters of the anterograde transpubic screw corridor and evaluate the safety of anterograde transpubic screw placement assisted by the assembled navigation template.

Methods

Fifty subjects with normal pelvic, 25 men and 25 women, age from 20 to 60 were enrolled, and their ilium were 3D reconstructed. The ilium was divided into zone I, zone II and zone III. Zone I and zone III was defined as medial and lateral to the obturator foramen, respectively. Zone II is located between zones I and III. The corridor A is formed by zone I and zone II and corridor B is formed by zone I, zone II and zone III. The diameter and length of the inner circle, the distance from the center of the inner circle to the posterior superior and to the inferior iliac spine of corridor A and corridor B were measured, respectively. Nine patients with pelvic fractures underwent anterograde transpubic screw and transverse sacroiliac screw placement assisted by the assembled navigation template and were retrospectively analyzed. Operation time, blood loss, incision length and fluoroscopy times were recorded. Grading score and Matta score were evaluated after surgery.

Results

In the 50 subjects, the diameter of corridor A was 11.16 ± 2.13 mm, and that of corridor B was 8.54 ± 1.52 mm. The length of corridor A was 86.39 ± 9.35 mm, and that of corridor B was 117.05 ± 5.91 mm. The surface distance from the screw entry point to the posterior superior iliac spine in corridor A was 109.31 ± 11.06 mm, and that in corridor B was 127.86 ± 8.23 mm. The surface distance from the screw entry point to the posterior inferior iliac spine in corridor A was 91.16 ± 10.34 mm, and that in corridor B was 106.92 ± 7.91 mm. A total of 18 sacroiliac transverse screws and 11 anterograde transpubic screws were inserted assisted by assembled navigation templates for nine patients. The average operation time was 108.75 ± 25.71 min, the blood loss was 141.11 ± 50.21 ml, the incision length was 14 ± 4.62 cm, and the intraoperative fluoroscopy was 17.89 ± 4.01 times.

Conclusion

Transpubic screw corridor can be obtained by 3D reconstruction. For the majority of patients, the anterograde pubic ramus corridor accommodated a 6.5 mm diameter screw. It is safe to use anterograde transpubic screw placement assisted by an assembled navigation template.
Outcomes of Eight‐Plate Epiphysiodesis for Residual Clubfoot Deformities
Authors: Zhao Haoyu , Ruan Hongjiang , Cao Yuting , Yuan Hengfeng , Kang Qinglin
Published: October 2022

Objective

The outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight‐plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot.

Methods

We retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid‐foot, which in detail, an eight‐plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight‐bearing radiographic measurements including talo‐first metatarsal angle, calcaneo‐fifth metatarsal angle and medial‐to‐lateral column length.

Results

A total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow‐up (range, 28 to 54 months). The average talo‐first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo‐fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow‐up. The mean ratio of the medial‐to‐lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t = 3.566; P < 0.001).

Conclusions

Eight‐plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy.
Continuous cyclosporine a infusion in patients with severe Kawasaki disease
Authors: Seki Mitsuru , Minami Takaomi , Suzuki Shun , Furui Sadahiro , Oka Kensuke , Yokomizo Akiko , Matsubara Daisuke , Sato Tomoyuki , Yamagata Takanori
Published: October 2022

Background

The efficacy and safety of continuous intravenous infusion of cyclosporine A (CICsA) in patients with intravenous immunoglobulin‐resistant Kawasaki disease are unclear.

Methods

Between 2010 and 2020, 83 patients with Kawasaki disease that was not responsive to intravenous immunoglobulin (total dose ≥ 4 g/kg) were enrolled. All patients were started on CICsA (3 mg/kg/day) and switched to oral cyclosporine A (CsA) (4–6 mg/kg/day). Treatment efficacy, occurrence of coronary artery lesions (CALs), and laboratory parameters were evaluated. Patients were divided into two groups according to CICsA response: the responder group (afebrile ≤24 h after CICsA without additional treatment) and the weak responder group (afebrile >24 h after CICsA requiring additional treatment).

Results

Fifty‐five patients became afebrile within 24 and 74 h became afebrile in less than 72 h. Adverse events included hypertension in four and hyperkalemia in two patients. Thirty‐nine patients were defined as responders and 44 patients as weak responders. There were no significant differences in CAL between the two groups. In weak responders, white blood cells, neutrophils, and C‐reactive protein levels were higher, and albumin, immunoglobulin G, and CsA concentration were lower than in responders, indicating that weak responders had more severe inflammatory findings. However, there were no significant differences in CAL. Logistic regression analysis revealed that the response to treatment for CICsA was associated with immunoglobulin G levels at baseline and CsA concentrations the day after CICsA.

Conclusion

Although CICsA required additional treatments in about half of the cases, a favorable clinical course was observed by using this strategy, especially for reducing CAL.
Sparse Temporal Disaggregation
Authors: Mosley Luke , Eckley Idris A. , Gibberd Alex
Published: October 2022

Temporal disaggregation is a method commonly used in official statistics to enable high-frequency estimates of key economic indicators, such as gross domestic product (GDP). Traditionally, such methods have relied on only a couple of high-frequency indicator series to produce estimates. However, the prevalence of large, and increasing, volumes of administrative and alternative data-sources motivates the need for such methods to be adapted for high-dimensional settings. In this article, we propose a novel sparse temporal-disaggregation procedure and contrast this with the classical Chow–Lin method. We demonstrate the performance of our proposed method through simulation study, highlighting various advantages realised. We also explore its application to disaggregation of UK GDP data, demonstrating the method's ability to operate when the number of potential indicators is greater than the number of low-frequency observations.
Current state of antimicrobial stewardship and organ transplantation in Thailand
Authors: Chotiprasitsakul Darunee , Bruminhent Jackrapong , Watcharananan Siriorn P.
Published: October 2022

Background

Antimicrobial stewardship (AMS) is a coherent set of actions to optimize antimicrobial use, improve patient outcomes, and reduce antimicrobial resistance (AMR). Thailand's national strategic plan has included AMS since 2017. Due to an increased risk of infection and AMR, solid organ transplant (SOT) recipients can benefit from antimicrobial stewardship programs (ASPs). However, the AMS in SOT has not been well defined. Balancing ASPs with the need for early and frequent antimicrobial treatment in this population is challenging. This review assesses the barriers and potential strategies of AMS in SOT in the setting of Thailand.

Methods

We used PubMed to identify published articles on AMS in organ transplantation in Thailand from January 2013 to January 2022. We also searched local literature and local data from Google Scholar and Google. Finally, we described the AMS experience at Ramathibodi hospital as a proxy for transplant centers in Thailand.

Results

There was no specific article on AMS in SOT in Thailand. At our hospital, ASPs have been part of the hospital's routine patient care, including the practice in the transplant unit. Modifiable challenges to AMS in SOT include prescriber opposition, diagnosis uncertainty, and lack of high quality. Both systems and individualized approaches should be implemented to overcome these barriers. The potential interventions include shortening antibiotic time‐out, updating clinical guidelines, continuing education, handshake ASP, adopting new technology, and further research.

Conclusions

There are limited data on AMS in organ transplantation in Thailand. Strategic priorities should focus on modifiable barriers tailored to organ transplantation. Quality improvement should be ensured by process and outcome measures.
Dissemination and implementation science and antimicrobial stewardship in solid organ transplantation: A perspective
Authors: Burnham Jason P. , Kwon Jennie H. , Newland Jason G. , McKay Virginia R.
Published: October 2022

Background

Recipients of solid organ transplants (SOTs) have unique risks for infections, but providers are often hesitant to apply the principles of antimicrobial stewardship to this patient population due to perceived excess risk. The methods of implementation science may move the field forward to simultaneously improve patient outcomes and patient safety.

Methods

Perspective piece on implementation science in SOT patients.

Results

Herein, we provide explanation of implementation science as it relates to SOT patients. In addition, we provide examples of how implementation science can be applied to antimicrobial stewardship in SOT patients.

Conclusion

Implementation science may offer insights and solutions to the challenges of implementing evidence‐based antimicrobial stewardship interventions in patients with SOT, including uptake of new practices and the de‐implementation of outdated or low‐value practices.
Effects of reported beta‐lactam allergies on pneumonia outcomes in lung transplant recipients
Authors: Motzer Andrew R. , Holaday Eric , Axelrod Peter , Mishkin Aaron
Published: October 2022

Background

The effects of reported beta‐lactam allergies on clinical outcomes have been understudied in lung transplant recipients. We evaluated reported beta‐lactam allergies on clinical outcomes in this population.

Methods

A single‐center retrospective cohort analysis was performed. One hundred and nine lung transplant recipients were identified and screened for a diagnosis of pneumonia. This cohort was divided into those with a reported beta‐lactam allergy and those without a beta‐lactam allergy. Antibiotic use was compared between groups. We also compared several clinical metrics, including rates of readmission, mortality, Clostridium difficile infection (CDI), allograft dysfunction, and isolation of carbapenem or fluoroquinolone non‐susceptible organisms after treatment.

Results

Of the 109 lung transplant recipients, 18 (16.5%) were identified as having a reported beta‐lactam allergy. Patients with a beta‐lactam allergy label (BLAL) were found to have decreased utilization of beta‐lactams (p < .001) and a trend toward increased use of carbapenems (p = .062) and aztreonam (p = .080). BLAL patients were found to have higher rates of CDI (p = .049) but were not found to have increased readmissions, mortality, allograft dysfunction, or isolation of carbapenem or fluoroquinolone non‐susceptible organisms. Patients without a BLAL were found to have higher rates of acute kidney injury (AKI) (p = .035).

Conclusions

Lung transplant recipients with BLAL are more likely to develop CDI, possibly due to increased use of carbapenems. We also found that patients without beta‐lactam allergy were more likely to develop AKI. A multicenter study with a larger sample size might clarify the individual contributions of mutually confounding clinical parameters.
Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation
Authors: Kinn Patrick Michael , Ince Dilek
Published: October 2022

Background

The consequences of inappropriate antimicrobial use including resistance are increasingly recognized as a global public health threat and many steps have been taken over the last few decades to advance antimicrobial stewardship initiatives with most organ transplant centers currently part of institutions with active antimicrobial stewardship programs.

Methods

A review of the literature was conducted and articles were categorized according to the topic and relevance in the judgment of the two authors.

Results

A summary review of the currently available literature was created with a focus on periprocedural and outpatient antimicrobial stewardship. Limitations in the data were significant and discussed in the review.

Conclusion

The principles of antimicrobial stewardship remain important throughout all phases starting with periprocedural prophylactic antimicrobial selection all the way through to discharge and subsequent healthcare encounters. Despite the broad advances in stewardship initiatives and the rapidly progressing supportive data overall there continue to be significant opportunities for additional research within various special patient populations including recipients of solid organ transplantation (SOT). The recent white paper published in the American Journal of Transplantation called to action the transplant and stewardship communities to have an increased focus and awareness of the issues that antimicrobial overuse can present in the SOT patient population. This is an important step that will hopefully generate more data in this group of patients that arguably faces the greatest vulnerability to the consequences of increased antimicrobial resistance.
Computing antimicrobial use/antimicrobial resistance ratios: A novel way to assess inpatient antimicrobial utilization using current National Healthcare Safety Network metrics
Authors: Santos Carlos A. Q. , Martinez Ashley I. , Won Sarah Y. , Varughese Christy A. , Tseng Marion , Zhang Huiyuan , Trick William E.
Published: October 2022

Background

Current methods for benchmarking inpatient antimicrobial use (AU) could benefit from combining AU with antimicrobial resistance (AR) information to provide metrics benchmarked to microbiological data; this may yield more instructive and better risk‐adjusted measurements than AU and AR in isolation.

Methods

In this retrospective single‐center study, we computed facility‐wide AU/AR ratios from 2019 to 2020 for specific antimicrobial agents and corresponding AR events, and compared median monthly AU/AR ratios between March 2019 through December 2019 (pre‐COVID period) and March 2020 through December 2020 (COVID period). Aggregate AU was expressed as a ratio to aggregate AR events for antimicrobials that typically have activity against the AR organism and are frequently used to treat the AR organism in clinical practice. We also computed AU/AR ratios in our surgical intensive care unit in the pre‐COVID period.

Results

High‐median facility‐wide monthly AU/AR ratios were observed for intravenous vancomycin/methicillin‐resistant Staphylococcus aureus, with 130.0 in the pre‐COVID period and 121.3 in the COVID period (p =.520). Decreases in facility‐wide median monthly AU/AR ratios were observed between periods for meropenem/ESBL Enterobacterales (20.9 vs. 7.9, p < .001), linezolid/vancomycin‐resistant Enterococcus (48.5 vs. 15.8, p =.004), and daptomycin/vancomycin‐resistant Enterococcus (32.2 vs. 4.8, p = .002). Increases in facility‐wide median monthly AU/AR ratios were observed between periods for ceftazidime‐avibactam/carbapenem‐resistant Enterobacterales (0.0 vs. 3.2, p = .020) and ceftazidime‐avibactam/multidrug‐resistant Pseudomonas aeruginosa (0.0 vs. 4.0, p = .017). The AU/AR ratio for intravenous vancomycin/methicillin‐resistant S. aureus in the surgical intensive care unit was 191.5 in the pre‐COVID period.

Conclusions

AU/AR ratios may be used to supplement current AU and AR metrics. Future directions should include the development of more AU metrics benchmarked to microbiological information. AU metrics more specific to transplant infectious diseases should be developed.
Japan perspective on antimicrobial stewardship and solid organ transplantation
Authors: Kitaura Satoshi , Jindai Kazuaki , Okamoto Koh
Published: October 2022

Background

The current situation, challenges, and opportunities related to antimicrobial stewardship for solid organ transplantations (SOTs) patients in Japan are not well known.

Methods

We searched English and Japanese literature using Pubmed and Ichushi‐Web (the Japanese medical literature search system provided by the Japan Medical Abstract Society) with relevant keywords including solid organ transplant, antimicrobial stewardship, and Japan. Hand searches of the references from the retrieved literature, including conference proceedings of The Japanese Association for Infectious Diseases, were conducted.

Results

The Japanese National Action Plan for antimicrobial resistance has brought attention to the importance of antimicrobial stewardship programs (ASPs) in Japan. According to national surveillance, the proportion of methicillin resistance among Staphylococcus aureus was 48%, while the proportion of vancomycin‐resistance among Enterococcus faecium was 1.5% in 2019. Resistance against imipenem in Escherichia coli and Klebsiella pneumoniae in 2019 were 0.1% and 0.2%, respectively. Exploration of SOT‐specific data on antimicrobial usage and drug resistance are warranted. A large questionnaire survey revealed a low proportion of hospitals with >500 beds implementing ASP toward immunocompromised patients. While the annual number of SOT in Japan has increased, the implementation of SOT‐specific ASP varies among institutions.

Conclusion

A coordinated ASP and exploration of the burden of antimicrobial resistance are needed for SOT patients in Japan. Promoting both intrainstitutional and interinstitutional collaboration is vital to the advancement of SOT‐specific ASP in Japan.

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Could cell‐free DNA and host biomarkers assist in antimicrobial stewardship with organ transplant recipients?
Authors: Chang Sandy Y. , Santos Carlos A. Q.
Published: October 2022

Background

Antimicrobial stewardship in solid organ transplant (SOT) recipients is important to prevent antimicrobial‐associated complications, but traditional stewardship principles are challenging to implement for SOT patients. Newer methodologies to optimize stewardship efforts are needed.

Methods

PubMed was searched using the keywords “cell free DNA,” “metagenomic sequencing,” “host biomarker,” “antimicrobial stewardship,” and “SOT.”

Results

Metagenomic sequencing of cell free DNA has the potential to be a stewardship tool for SOT recipients. Various studies have shown its use for antimicrobial de‐escalation and duration shortening. Host gene expression profiles can differentiate between infectious and noninfectious syndromes and may assist in stewardship efforts. However, information in immunocompromised hosts is conflicting.

Conclusion

Microbial cell free DNA sequencing and host gene expression profiling show promise as stewardship tools in SOT recipients. Future studies on antimicrobial stewardship in SOT recipients should focus on their clinical use and feasibility.
Inducible deletion of raptor and mTOR from adult skeletal muscle impairs muscle contractility and relaxation
Authors: Baraldo Martina , Zorzato Sabrina , Dondjang Achille Homère Tchampda , Geremia Alessia , Nogara Leonardo , Dumitras Ana Georgia , Canato Marta , Marcucci Lorenzo , Nolte Hendrik , Blaauw Bert
Published: October 2022

Skeletal muscle weakness has been associated with different pathological conditions, including sarcopenia and muscular dystrophy, and is accompanied by altered mammalian target of rapamycin (mTOR) signalling. We wanted to elucidate the functional role of mTOR in muscle contractility. Most loss‐of‐function studies for mTOR signalling have used the drug rapamycin to inhibit some of the signalling downstream of mTOR. However, given that rapamycin does not inhibit all mTOR signalling completely, we generated a double knockout for mTOR and for the scaffold protein of mTORC1, raptor, in skeletal muscle. We found that double knockout in mice results in a more severe phenotype compared with deletion of raptor or mTOR alone. Indeed, these animals display muscle weakness, increased fibre denervation and a slower muscle relaxation following tetanic stimulation. This is accompanied by a shift towards slow‐twitch fibres and changes in the expression levels of calcium‐related genes, such as Serca1 and Casq1. Double knockout mice show a decrease in calcium decay kinetics after tetanus in vivo, suggestive of a reduced calcium reuptake. In addition, RNA sequencing analysis revealed that many downregulated genes, such as Tcap and Fhod3, are linked to sarcomere organization. These results suggest a key role for mTOR signalling in maintaining proper fibre relaxation in skeletal muscle.

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Key points

Skeletal muscle wasting and weakness have been associated with different pathological conditions, including sarcopenia and muscular dystrophy, and are accompanied by altered mammalian target of rapamycin (mTOR) signalling.

Mammalian target of rapamycin plays a crucial role in the maintenance of muscle mass and functionality.

We found that the loss of both mTOR and raptor results in contractile abnormalities, with severe muscle weakness and delayed relaxation following tetanic stimulation.

These results are associated with alterations in the expression of genes involved in sarcomere organization and calcium handling and with an impairment in calcium reuptake after contraction.

Taken together, these results provide a mechanistic insight into the role of mTOR in muscle contractility.
Dyno-Kinematic Leg Design for High Energy Robotic Locomotion
Authors: Austin Max , Brown Jason , Nicholson John , Clark Jonathan
Published: October 2022

Animal legs are capable of a tremendous breadth of distinct dynamic behaviors. As robots pursue this same degree of flexibility in their behavioral repertoire, the design of the power transition mechanism from joint to operational space (the leg) becomes increasingly significant given the limitations current actuator technology. To address the challenges of designing legs capable of meeting the competing requirements of various dynamic behaviors, this paper proposes a technique which prioritizes explicitly encoding a set of dynamics into a robot’s leg design, called dyno-kinematic leg design (DKLD). This paper also augments the design technique with a method of evaluating the suitability of an individual leg’s workspace to perform dynamic behaviors, called the effective dynamic workspace (EDW). These concepts are shown to effectively determine optimal leg designs within a set of three, increasingly complex, case studies on different robots. These new legs designs enable a 5 kg robot to climb vertical surfaces at 3 Hz, allow a 60 kg robot to efficiently perform a range of behaviors useful for navigation (including a run at 2 m/s), and endow a small quadrupedal robot with all of the necessary behaviors to produce running and climbing multimodality. This design methodology proves robust enough to determine advantageous legs for a diverse range of dynamic requirements, leg morphologies, and cost functions, therefore demonstrating its possible application to many legged robotic platforms.
Effect of Material Distribution in the Unit Cell on Effective Thermal Conductivity and Young's Modulus of Cellular Structure
Authors: Wagh Akshay , Deshmukh Sagar , Ramamoorthy Sripriya , Krishnan Shankar
Published: October 2022

Effective thermal conductivity and Young's modulus of periodic unit cell geometries are widely studied in the literature. This paper compares and contrasts strut-based unit cells against surface-based unit cells obtained by subtracting spheres from a solid cube. In order to understand the reason for the difference in the behavior of effective thermal conductivity of surface-based and strut-based unit cell geometries and the difference in the behavior of Young's modulus of surface-based and strut-based unit cell geometries, the effect of material distribution on effective thermal conductivity and Young's modulus is studied here. The material in the unit cell is varied in two ways, i.e., by changing the material distribution on the cell wall (partially closed unit cell) and changing the material distribution across the strut of unit cell geometry. It is found that the distribution of material on the wall of the unit cell improves the effective thermal conductivity and Young's modulus. In contrast, a narrow cross-section area in the unit cell reduces the effective thermal conductivity and Young's modulus. Using the studied effect of material distribution on effective thermal conductivity and Young's modulus, the reason for the difference in properties of surface-based and strut-based unit cell geometry is qualitatively explained. Partially closed unit cell geometries introduced here for studying the effect of material distribution on cell walls give a wide range of effective thermal conductivity and Young's modulus for the same porosity with a change in pore opening ratio.
Coupling of a Magnetic Field With Instability for Multimodal and Multistep Deformations of a Curved Beam With Asymmetric Magnetic Torque
Authors: Zou Bihui , Liang Zihe , Ju Jaehyung
Published: October 2022

A bistable curved beam with magnetic-torque-driven actuation has the potential for fast and untethered reconfiguration of metamaterials. However, there is currently no modeling method for a bistable curved beam for which the instability is coupled with an external magnetic field for the design of active metamaterials. The second-mode (S-shape) generation of a bistable curved beam is essential for a multimodal and multistep reconfiguration of metamaterials and has not yet been explored. Herein, we aim to construct an analytical model of the deformation of a bistable curved beam triggered by an external magnetic field, providing magnetic-torque-driven multimodal and multistep deformations. We also implement symmetric and asymmetric magnet arrangements to the model to enable variation of the external magnetic fields to identify the range of the magnetic field’s direction on the bistable and doubly curved transformations. Our instability model coupled with a magnetic field predicts multimodal and multistep deformations of bistable curved beams with magnetic torques triggered by the orientation and magnitude of the magnetic field. Our model reveals that (i) a bistable curved beam without prestressing and (ii) the asymmetric magnet arrangement design are favorable for generating an extensive range of the S-shape, which is significant for the design of multimodal transformation of metamaterials.
Transient Three-Dimensional Thermal Simulation of a Fin Field-Effect Transistor With Electron–Phonon Heat Generation, Three Phonon Scattering, and Drift With Periodic Switching
Authors: Medlar Michael P. , Hensel Edward C.
Published: October 2022

The International Roadmap for Devices and Systems shows Fin field-effect transistor (FET) array transistors as the mainstream structure for logic devices. Traditional methods of Fourier heat transfer analysis that are typical of Technology computer-aided design (tcad) software are invalid at the length and time scales associated with these devices. Traditional models for phonon transport modeling have not demonstrated the ability to accurately model three dimensional (3-d), transient transistor thermal responses. An engineering design tool is needed to accurately predict the thermal response of FinFET transistor arrays. The statistical phonon transport model (SPTM) was applied in a 3-d, transient manner to predict nonequilibrium phonon transport in an silicon-on-insulator (SOI)-FinFET array transistor with a 60 nm long fin and a 20 nm channel length. A heat generation profile from electron–phonon scattering was applied in a transient manner to model switching. Simulation results indicated an excess build-up of up to 17% optical phonons giving rise to transient local temperature hot spots of 37 K in the drain region. The local build-up of excess optical phonons in the drain region has implications on performance and reliability. The SPTM is a valid engineering design tool for evaluating the thermal performance of emergent proposed FinFET transistor designs. The phonon fidelity of the SPTM is greater than Monte Carlo and the Boltzmann Transport Equation and the length scale and time scale fidelity of the SPTM is better than direct atomic simulation.
Heat Transfer and Fluid Dynamics Study in Solar Air Heater Employing Impinging Circular Air Jet Array for Effective Jet Stability
Authors: Chaurasiya Shailendra Kumar , Singh Satyender
Published: October 2022

This experimental and numerical investigation is intended to increase heat transfer, reduce pumping power, and present important guidelines on the use of confined submerged air jet impingement in solar air heater designs that employ an array of circular air jets for high thermohydraulic performance. In order to increase thermohydraulic performance, a novel approach is adopted, i.e., by improving jet stability and consequently jet deflection that gives origination to four solar air heater designs for this investigation. The obtained numerical results revealed that thermohydraulic performance improves significantly by stabilizing the air jet array, which means lowering the jet deflection. The thermohydraulic performance of design-I is high compared to design-II, design-III, and design-IV, both at equal mass flow rate and Reynolds number. Moreover, design-I presents 20%, 33%, and 52% relative improvement in deviation angle of the jet core compared to design-II, design-III, and design-IV, respectively, at a minimum mass flow rate of 0.01 kg/s and Reynolds number of Re=2000, respectively. In addition, correlations to define heat transfer and fluid dynamics characteristics are established. An important guideline upon the use of solar air heater with jet impingement is that a solar air heater of short length and height (jet and plate spacing), and large width should be used for high thermohydraulic performance.