bluuebunny/crossref_metadata_2025 huggingface dataset:
Rational Design of Ion‐Conductive Layer on Si Anode Enables Superior‐Stable Lithium‐Ion Batteries
Authors: Wang Ziyang , Yao Meng , Luo Hang , Xu Changhaoyue , Tian Hao , Wang Qian , Wu Hao , Zhang Qianyu , Wu Yuping
Published: September 2023

Silicon (Si) is considered a promising commercial material for the next‐generation of high‐energy density lithium‐ion battery (LIB) due to its high theoretical capacity. However, the severe volume changes and the poor conductivity hinder the practical application of Si anode. Herein, a novel core–shell heterostructure, Si as the core and V3O4@C as the shell (Si@V3O4@C), is proposed by a facile solvothermal reaction. Theoretical simulations have shown that the in‐situ‐formed V3O4 layer facilitates the rapid Li+ diffusion and lowers the energy barrier of Li transport from the carbon shell to the inner core. The 3D network structure constructed by amorphous carbon can effectively improve electronic conductivity and structural stability. Benefiting from the rationally designed structure, the optimized Si@V3O4@C electrode exhibits an excellent cycling stability of 1061.1 mAh g−1 at 0.5 A g−1 over 700 cycles (capacity retention of 70.0%) with an average Coulombic efficiency of 99.3%. In addition, the Si@V3O4@C||LiFePO4 full cell shows a superior capacity retention of 78.7% after 130 cycles at 0.5 C. This study opens a novel way for designing high‐performance silicon anode for advanced LIBs.
Theory of the third: A cybernetic approach to escalative conflict dynamics in business families
Authors: Nagel Lina , Roth Steffen , Kleve Heiko
Published: September 2023

This conceptual paper explores the surprising impact exerted by third elements on the escalation and de‐escalation of conflicts in business families. To this end, we draw on core concepts of Batesonian cybernetic theory to perform a reconceptualisation of pertinent literature on changing conflict dynamics gathered in family business research and consultancy. Based on this reconceptualisation, we identify explanations and key mechanisms for the impact of third elements on conflict dynamics. Our study thus contributes to research at the interface of family business research, conflict research and cybernetic theory development.
Biodegradation of septic tank fecal sludge using Priestia aryabhattai
Authors: Wardhani Widhowati Kesoema , Titah Harmin Sulistiyaning , Mardyanto Mas Agus , Soedjono Eddy Setiadi
Published: September 2023

The significant potential of microorganisms for fecal sludge degradation is an interesting area for investigation, primarily due to its current lack of attention. This study involved the identification of indigenous bacteria in septic tank fecal waste with the Polymerase Chain Reaction (PCR) 16S rRNA gene. Subsequently, selected bacteria strains were subjected to a potential assessment using a single method. Variables in this experiment included the addition of 2% (v/v) bacteria and sample sterilization. The results showed that the use of PCR 16S rRNA analysis led to the identification of Priestia aryabhattai, a member of the phylum Firmicutes, as the dominant species in the samples. This bacteria exhibited adaptability to both aerobic and anaerobic conditions. Sterile samples with the addition of P. aryabhattai 2% (v/v), showed the best removal efficiency percentages of 79.77%, 79.62%, 62.91%, and 70.48% for Chemical Oxygen Demand (COD), Biological Oxygen Demand (BOD), Total Suspended Solids (TSS), and Volatile Suspended Solids (VSS). Meanwhile, the total carbon and nitrogen decreased to 2895 mg/L C and 794.12 mg/L NH3‐N, respectively. Based on the results, Priestia aryabhattai has the potential to degrade organic waste but is not suitable for fecal sludge.
Performance of machine‐learning approach for prediction of pre‐eclampsia in a middle‐income country
Authors: Torres‐Torres J. , Villafan‐Bernal J. R. , Martinez‐Portilla R. J. , Hidalgo‐Carrera J. A. , Estrada‐Gutierrez G. , Adalid‐Martinez‐Cisneros R. , Rojas‐Zepeda L. , Acevedo‐Gallegos S. , Camarena‐Cabrera D. M. , Cruz‐Martínez M. Y. , Espino‐y‐Sosa S.
Published: September 2023

Objective

Pre‐eclampsia (PE) is a serious complication of pregnancy associated with maternal and fetal morbidity and mortality. As current prediction models have limitations and may not be applicable in resource‐limited settings, we aimed to develop a machine‐learning (ML) algorithm that offers a potential solution for developing accurate and efficient first‐trimester prediction of PE.

Methods

We conducted a prospective cohort study in Mexico City, Mexico to develop a first‐trimester prediction model for preterm PE (pPE) using ML. Maternal characteristics and locally derived multiples of the median (MoM) values for mean arterial pressure, uterine artery pulsatility index and serum placental growth factor were used for variable selection. The dataset was split into training, validation and test sets. An elastic‐net method was employed for predictor selection, and model performance was evaluated using area under the receiver‐operating‐characteristics curve (AUC) and detection rates (DR) at 10% false‐positive rates (FPR).

Results

The final analysis included 3050 pregnant women, of whom 124 (4.07%) developed PE. The ML model showed good performance, with AUCs of 0.897, 0.963 and 0.778 for pPE, early‐onset PE (ePE) and any type of PE (all‐PE), respectively. The DRs at 10% FPR were 76.5%, 88.2% and 50.1% for pPE, ePE and all‐PE, respectively.

Conclusions

Our ML model demonstrated high accuracy in predicting pPE and ePE using first‐trimester maternal characteristics and locally derived MoM. The model may provide an efficient and accessible tool for early prediction of PE, facilitating timely intervention and improved maternal and fetal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Revisiting conservation units for the endangered mountain yellow-legged frog species complex (Rana muscosa, Rana sierrae) using multiple genomic methods
Authors: Byrne Allison Q. , Rothstein Andrew P. , Smith Lydia L. , Kania Hannah , Knapp Roland A. , Boiano Daniel M. , Briggs Cheryl J. , Backlin Adam R. , Fisher Robert N. , Rosenblum Erica Bree
Published: September 2023

Insights from conservation genomics have dramatically improved recovery plans for numerous endangered species. However, most taxa have yet to benefit from the full application of genomic technologies. The mountain yellow-legged frog species complex, Rana muscosa and Rana sierrae, inhabits the Sierra Nevada mountains and Transverse/Peninsular Ranges of California and Nevada. Both species have declined precipitously throughout their historical distributions. Conservation management plans outline extensive ongoing recovery efforts but are still based on the genetic structure determined primarily using a single mitochondrial sequence. Our study used two different sequencing strategies – amplicon sequencing and exome capture – to refine our understanding of the population genetics of these imperiled amphibians. We used buccal swabs, museum tissue samples, and archived skin swabs to genotype frog populations across their range. Using the amplicon sequencing and exome capture datasets separately and combined, we document five major genetic clusters. Notably, we found evidence supporting previous species boundaries within Kings Canyon National Park with some exceptions at individual sites. Though we see evidence of genetic clustering, especially in the R. muscosa clade, we also found evidence of some admixture across cluster boundaries in the R. sierrae clade, suggesting a stepping-stone model of population structure. We also find that the southern R. muscosa cluster had large runs of homozygosity and the lowest overall heterozygosity of any of the clusters, consistent with previous reports of marked declines in this area. Overall, our results clarify management unit designations across the range of an endangered species and highlight the importance of sampling the entire range of a species, even when collecting genome-scale data.
Enacting multilingual learner core practices: a PST’s approximations of practice of mathematics language routines
Authors: Roberts Sarah A. , Olarte T. Royce
Published: September 2023

This study considered a preservice teacher’s (PST’s) attention to multilingual learner core practices within her approximations of practice of mathematics language routines during a secondary mathematics methods course. We used a framework of approximations of practice to understand how a PST enacted and developed an understanding of multilingual learner core practices. To provide a vision for what multilingual learner core practices can look like in nontraditional instructional contexts, we qualitatively analyzed four approximations of practice of mathematics language routines from a single PST during a single semester of a methods course. We share how she navigated the remote teaching context and engaged sample students in all of the multilingual learner core practices despite the challenges of the COVID-19 pandemic, providing an example of what these practices may look like in remote instruction. We also discuss how these multilingual learner core practices interact and complement one another. We consider possible implications, limitations, and future research directions.
Skills transfer from the DaVinci® system to the Hugo™ RAS system
Authors: Olsen Rikke Groth , Karas Vladimir , Bjerrum Flemming , Konge Lars , Stroomberg Hein Vincent , Dagnæs-Hansen Julia Abildgaard , Røder Andreas
Published: September 2023

Purpose

Recently, the robotic surgical system, Hugo™ was approved for clinical use. The transfer of skills is important for understanding the implementation of surgical innovation. We explored the transfer of skills from the DaVinci® to the Hugo™ by studying the learning curve and short-term patient outcomes during radical prostatectomy (RARP).

Methods

We examined the transfer of skills from one surgeon performing RARP from the first case with the Hugo™ system in April 2022. The surgeon had previously performed > 1000 RARPs using DaVinci®. Perioperative and clinical outcomes were collected for procedures on both Hugo™ and DaVinci®. Patient follow-up time was 3 months.

Results

Nineteen Hugo™ cases and 11 DaVinci® cases were recorded. No clinically relevant difference in procedure time was found when transferring to Hugo™. Patients operated using Hugo™ had more contacts postoperatively compared to the DaVinci®, all Clavien–Dindo (CD) grade 1 (53% vs 18%). Three patients from the Hugo™ group were re-admitted within 30 days with catheter malfunction (CD grade 1), infection without a focus (CD grade 2), and ileus due to a hernia in the port hole (CD grade 3b). The 3-month follow-up showed similar results in prostate-specific antigen levels (PSA) and erectile dysfunction between the two robotic systems, but a higher incidence of incontinence was found for the Hugo™.

Conclusion

We observed that the skills of an experienced robotic surgeon are transferable from DaVinci® to Hugo™ when performing RARP. No obvious benefits were found for using Hugo™ compared to DaVinci® for RARP although this needs confirmatory studies.
Bronchoscopy-Related Infection and the Development of Single-Use Bronchoscopy Technology
Authors: Logan N. , Yurosko C. , Mehta A. , Chhabria M. , Kennedy M.P.
Published: September 2023

Purpose of Review

Bronchoscopy-related infection is recognized as a leading healthcare hazard, and this review delves into its incidence, causes, and prevention.

Recent Findings

Due to both the recognition of the scale of bronchoscopy-related infection and the COVID-19 pandemic, single-use or disposable bronchoscopy (SUFB) technology has progressed beyond the ICU setting to the bronchoscopy suite. A review of data related to currently available scopes, bench-top, and clinical data is also presented.

Not only does SUFB technology provide a portable and immediately accessible bronchoscope for procedures in the ICU and endoscopy suite, it also is a sterile option for standard bronchoscopy procedures thus avoiding infection related to scope contamination. Cost-effectiveness comparisons vary between single-use and reusable scopes depending on calculated incidence of scope-related infection. Although no one should suffer an infection related to bronchoscopy, SUFB technology lacks proper comparison to reusable scope quality. In the meantime, the most important intervention is proper cleaning and assessment of reusable scopes for damage.
Concurrent Carbon Capture and Biocementation through the Carbonic Anhydrase (CA) Activity of Microorganisms -a Review and Outlook
Authors: Mwandira Wilson , Mavroulidou Maria , Gunn Michael J. , Purchase Diane , Garelick Hemda , Garelick Jonathan
Published: September 2023

Biocementation, i.e., the production of biomimetic cement through the metabolic activity of microorganisms, offers exciting new prospects for various civil and environmental engineering applications. This paper presents a systematic literature review on a biocementation pathway, which uses the carbonic anhydrase (CA) activity of microorganisms that sequester CO2 to produce biocement. The aim is the future development of this technique for civil and (geo-)environmental engineering applications towards CO2-neutral or negative processes. After screening 248 potentially relevant peer-reviewed journal papers published between 2002 and 2023, 38 publications studying CA-biocementation were considered in the review. Some of these studies used pure CA enzyme rather than bacteria-produced CA. Of these studies, 7 used biocementation for self-healing concrete, 6 for CO2 sequestration, 10 for geotechnical applications, and 15 for (geo-)environmental applications. A total of 34 bacterial strains were studied, and optimal conditions for their growth and enzymatic activity were identified. The review concluded that the topic is little researched; more studies are required both in the laboratory and field (particularly long-term field experiments, which are totally lacking). No studies on the numerical modelling of CA-biocementation and the required kinetic parameters were found. The paper thus consulted the more widely researched field of CO2 sequestration using the CA-pathway, to identify other microorganisms recommended for further research and reaction kinetic parameters for numerical modelling. Finally, challenges to be addressed and future research needs were discussed.
LTACL: long-tail awareness contrastive learning for distantly supervised relation extraction
Authors: Yan Tianwei , Zhang Xiang , Luo Zhigang
Published: September 2023

Distantly supervised relation extraction is an automatically annotating method for large corpora by classifying a bound of sentences with two same entities and the relation. Recent works exploit sound performance by adopting contrastive learning to efficiently obtain instance representations under the multi-instance learning framework. Though these methods weaken the impact of noisy labels, it ignores the long-tail distribution problem in distantly supervised sets and fails to capture the mutual information of different parts. We are thus motivated to tackle these issues and establishing a long-tail awareness contrastive learning method for efficiently utilizing the long-tail data. Our model treats major and tail parts differently by adopting hyper-augmentation strategies. Moreover, the model provides various views by constructing novel positive and negative pairs in contrastive learning for gaining a better representation between different parts. The experimental results on the NYT10 dataset demonstrate our model surpasses the existing SOTA by more than 2.61% AUC score on relation extraction. In manual evaluation datasets including NYT10m and Wiki20m, our method obtains competitive results by achieving 59.42% and 79.19% AUC scores on relation extraction, respectively. Extensive discussions further confirm the effectiveness of our approach.
Structural characterization of char during co-gasification from torrefied sludge and Yangchangwan bituminous coal
Authors: Zhang Xinsha , Bai Yonghui , Qin Jie , Shi Shengli , Liu Jiazhong , Wang Shuaibing , Zhao Minhui , Shi Guiming , Ye Changbing , Yu Guangsuo
Published: September 2023

The present study aims to investigate the physico-chemical structural evolution characteristics of char structure of CO2 atmosphere torrefaction pretreated sludge with Yangchangwan bituminous coal (YC) during co-gasification. The co-gasification reactivity of torrefied sludge and YC was measured using a thermogravimetric analyzer. The co-gasification reactivity of torrefied sludge with YC was thoroughly explored in depth by in situ heating stage microscope coupled with traditional characterization means of char sample (Scanning electron microscope, nitrogen adsorption analyzer, laser Raman spectroscopy). The results show that the gasification reaction rate of sludge treated under CO2 atmosphere and coal blended char was better than other char samples at 1100–1200 °C. The torrefied sludge under CO2 atmosphere promoted its thermal decomposition to the maximum extent, so that it eventually was transformed into a large number of small broken particles. The specific surface area and ID1/IG ratio of blended char of torrefied sludge under CO2 atmosphere and YC were 1.70 and 1.07 times higher than that of YC, respectively. The in situ technique revealed that YC char with the addition of torrefied sludge undergo gasification by shrinking core modes and the presence of obvious ash melting flow phenomenon. It was more obvious than that of YC.
Preference-based hiring decisions and incentives
Authors: Gioia Francesca , Immordino Giovanni
Published: September 2023

This article replicates an experiment by Coffman et al. (Manag Sci 67(6):3551–3569, 2021) who separated taste-based and statistical discrimination by comparing employer choices in one of two hiring environments (treatments). Both treatments were characterized by the same ability distributions of workers in tasks on which men are found to outperform women on average, but only one allowed for gender-specific considerations. We found statistical discrimination against women when they are presented to employers not as women, but as people belonging to a low-performance group, but discrimination in their favor when their gender is revealed to potential employers. This discrimination in favor of women was observed in both male and female employers. It was greater when employers were women and disappeared when monetary incentives to employ more productive workers were higher for employers.
Asymptotic Fermat for signatures (r, r, p) using the modular approach
Authors: Mocanu Diana
Published: September 2023

LetKbe a totally real field, and$$r\ge 5$$r≥5a fixed rational prime. In this paper, we use the modular method as presented in the work of Freitas and Siksek to study non-trivial, primitive solutions$$(x,y,z) \in \mathcal {O}_K^3$$(x,y,z)∈OK3of the signature (r, r, p) equation$$x^r+y^r=z^p$$xr+yr=zp(wherepis a prime that varies). An adaptation of the modular method is needed, and we follow the work of Freitas which constructs Frey curves over totally real subfields of$$K(\zeta _r)$$K(ζr). When$$K=\mathbb {Q}$$K=Qwe get that for most of the primes$$r<150$$r<150with$$r \not \equiv 1 \mod 8$$r≢1mod8there are no non-trivial, primitive integer solutions (x, y, z) with 2|zfor signatures (r, r, p) whenpis sufficiently large. Similar results hold for quadratic fields, for example when$$K=\mathbb {Q}(\sqrt{2})$$K=Q(2)there are no non-trivial, primitive solutions$$(x,y,z)\in \mathcal {O}_K^3$$(x,y,z)∈OK3with$$\sqrt{2}|z$$2|zfor signatures (5, 5, p), (11, 11, p), (13, 13, p) and sufficiently largep.
Comparison of treatment with insulin detemir and NPH in women with gestational diabetes mellitus: glycemic control and pregnancy outcomes. A retrospective study
Authors: Kazakou Paraskevi , Paschou Stavroula A. , Mitropoulou Marina , Vasileiou Vasiliki , Sarantopoulou Vasiliki , Anastasiou Eleni
Published: September 2023

Purpose

The objective of this retrospective study was to compare glycemic control, pregnancy outcomes, and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with (a) insulin detemir and (b) insulin neutral protamine Hagedorn (NPH).

Methods

A total of 192 women with GDM were included in the analysis. Ninety-eight women received detemir, while 94 women received NPH. Data regarding medical history, glycemic control, and time and mode of delivery, as well as neonatal outcomes, were recorded.

Results

Baseline characteristics were comparable between the two groups. There were no differences with respect to the week of insulin initiation, total insulin dose, duration of insulin therapy, daily insulin dose/weight in early and late pregnancy, or the number of insulin injections per day. Maternal overall weight gain during pregnancy and weight gain per week did not differ either. The detemir group had slightly lower HbA1c levels at the end of gestation [median: det 5.2% (33 mmol/mol) vs NPH 5.4% (36 mmol/mol), p=0.035). There were no cases of hypoglycemia or allergic reactions in the two groups. There were also no differences regarding neonatal outcomes according to the available data, given that data in some cases were missing.

Conclusion

The use of insulin detemir was found to be equally effective and safe compared to NPH in women with GDM.
A machine learning approach to predict the parameters of COVID‐19 severity to improve the diagnosis protocol in Oman
Authors: Al Shaqsi Jamil , Borghan Mohamed , Drogham Osama , Al Whahaibi Salim
Published: September 2023

The purpose of this study is to utilize a Machine Learning-based methodology for predicting the key parameters contributing to severe COVID-19 cases among patients in Oman. To carry out the investigation, a comprehensive dataset of patient information, encompassing a range of blood parameters, was acquired from major government hospitals in Oman. Diverse machine learning algorithms were deployed to uncover underlying trends within the acquired dataset. The outcomes of this research delineated the determinants of severe cases into two categories: non-blood-related parameters and blood-related parameters. Among non-blood-related factors, advanced age, gender, and the presence of chronic kidney disease emerged as risk factors contributing to unfavorable prognoses, particularly in elderly patients. In the realm of blood parameters, male patients with blood types O-positive and A-positive exhibited heightened susceptibility to severe illness compared to their female counterparts. Additionally, deviations in Hemoglobin levels, Mean Cell Volume, and Eosinophil counts were identified as drivers of poor prognoses among elderly patients. The implications of these research findings extend to aiding healthcare decision-makers in quantifying the associated risks, health benefits, and cost-effectiveness pertaining to COVID-19. Furthermore, the acquired insights can empower decision-makers to refine the management of COVID-19, expediting treatment protocols and minimizing the risk of mortality. Interestingly, the study unveiled a correlation linking blood type to disease progression. A notable finding indicated that a staggering 96.5% of patients succumbed to the disease even when their blood sodium levels remained in the standard range of 136–145 mmol/L. These insights hold immense value for healthcare institution decision-makers, allowing a more in-depth evaluation of the risks, health benefits, and the cost-effectiveness related to COVID-19. Consequently, the findings offer a guiding light for implementing pivotal measures, optimizing treatment protocols, and substantially reducing mortality risks associated with the virus.
Genome-Scale Algorithm Design
Authors: Mäkinen Veli , Belazzougui Djamal , Cunial Fabio , Tomescu Alexandru I.
Published: September 2023

Presenting the fundamental algorithms and data structures that power bioinformatics workflows, this book covers a range of topics from the foundations of sequence analysis (alignments and hidden Markov models) to classical index structures (k-mer indexes, suffix arrays, and suffix trees), Burrows–Wheeler indexes, graph algorithms, network flows, and a number of advanced omics applications. The chapters feature numerous examples, algorithm visualizations, and exercises, providing graduate students, researchers, and practitioners with a powerful algorithmic toolkit for the applications of high-throughput sequencing. An accompanying website (www.genome-scale.info) offers supporting teaching material. The second edition strengthens the toolkit by covering minimizers and other advanced data structures and their use in emerging pangenomics approaches.
Post-Truth American Politics
Authors: Ricci David
Published: September 2023

David Ricci has written two books on 'political stories,' providing the foundations for Post-Truth Democracy. Yet the present book is arguably the most important yet. The author writes that we need stories to make our way in the world. But many stories, say from identity politics, are necessarily false because they are simplifications of some larger reality. However, not all stories are equally false or equally harmful. Some lead to bad outcomes, and it is the responsibility of scholars to counter harmful stories with other stories leading to better outcomes. Therefore, stories are an especially potent form of political power, deserving of scholarly and journalistic attention.
Keepers of the flame: songspirals are a university for us
Authors: Country Bawaka
Published: September 2023

“Songspirals are a university for us, they are a map of understandings” (Gay’wu Group of Women, 2019, p. 33).

This paper is authored by Bawaka Country, acknowledging Country’s ability to teach and share. Country is homeland and place. Country is everything and the relationships that bring everything to life. Country is knowledge. This paper is shaped and enabled by songspirals. Songspirals are sung and cried by Yolŋu people in north east Arnhem Land, Australia, to awaken Country, to make and remake the life-giving connections between people and place.

The Goŋ-gurtha songspiral leads this paper, showing us how a Yolŋu Country-led pedagogy centres Country’s active agency by learning through, with, and as Country. This pedagogy shares with us the ongoing connections within and between generations to ensure that knowledge remains strong and that sharing is done the right way, according to Yolŋu Rom, Law/Lore. This learning is predicated on relationality and responsibility. It is a more-than-human learning in which human knowing is decentred and Country is knowledgeable. It is a learning which recognises and respects its limits and it is a learning in which the ongoing sovereignty of Yolŋu people is front and centre.
Learning to care for Dangaba
Authors: Poelina Anne , Paradies Yin , Wooltorton Sandra , Mulligan Edwin Lee , Guimond Laurie , Jackson-Barrett Libby , Blaise Mindy
Published: September 2023

In a Kimberley place-based cultural story, Dangaba is a woman whose Country holds poison gas. Her story shows the importance of cultural ways of understanding and caring for Country, especially hazardous places. The authors contrast this with a corporate story of fossil fuel, illustrating the divergent discourses and approaches to place. Indigenous and local peoples and their knowledge, cultures, laws, philosophies and practices are vitally important to Indigenous lifeways and livelihoods, and critically significant to the long-term health and well-being of people and place in our locality, region and world. We call for storying and narratives from the pluriverse of sociocultural voices to be a meaningful part of environmental education and to be implemented in multiple places of learning. To know how to hear, understand and apply the learnings from place-based story is to know how to move beyond a normalised worldview of separation, alienation, individualism, infinite growth, consumption, extraction, commodification and craving. To know how to see, feel, describe and reflect upon experience, concepts and practice is to find ways to move towards radical generosity, mutuality of becoming, embodied kinship, wisdom, humility and respect.
Low infectivity among asymptomatic patients with a positive SARS-CoV-2 admission test at a tertiary-care center, 2020–2022
Authors: Tayyar Ralph , Kiener Melanie , Liang Jane W. , Anez Gustavo Contreras , Nava Guillermo Rodriguez , Zimmet Alex , Contag Caitlin A. , Srinivasan Krithika , Tompkins Lucy , Subramanian Aruna , Shepard John , Pinsky Benjamin A. , Salinas Jorge
Published: September 2023

Background: Many hospitals have implemented admission SARS-CoV-2 testing to evaluate for the need for transmission-based precautions. However, a positive test in an asymptomatic patient may represent (1) active infection, signifying infectiousness; (2) false positivity; or (3) past infection with prolonged viral shedding. We used a strand-specific SARS-CoV-2 reverse real-time polymerase chain reaction (rRT-PCR) assay to assess infectivity among asymptomatic patients with a positive SARS-CoV-2 PCR admission test. Methods: We used a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. We reviewed records of patients with a positive SARS-CoV-2 PCR who were also tested for the strand-specific SARS-CoV-2 PCR within 2 days of admission at Stanford Health Care during July 2020–April 2022. We restricted our analysis to each patient’s first test. We calculated the percentage of detectable minus strand-specific tests among asymptomatic patients over time and gathered descriptive statistics for age, sex, and immunocompromised state. Results: In total, 848 admitted patients had strand-specific SARS-CoV-2 assays performed. Of 532 patients with a strand-specific assay done within 2 days of admission, 242 (45%) were asymp
tomatic. Among asymptomatic patients, the mean age was 56 years (range, 19–99), 133 (55%) were male, 50 (21%) had immunocompromising conditions, and 30 (12%) were admitted for a surgical procedure. In total, 21 (9%; range, 4%–25% per quarter) had detectable minus strand-specific assays (Fig. 1). Conclusions: Most asymptomatic patients tested for SARS-CoV-2 on admission were not infectious. Hospitals using SARS-CoV-2 PCR admission testing may need to re-evaluate the continued use of this practice.

Fig. 1. Minus strand-specific SARS-CoV-2 assay percentage positivity per quarter among asymptomatic patients tested within 2 days of admission. The peak positivity in November 2021–January 2022 quarter coincided with the SARS-CoV-2 omicron variant surge in our county.

Disclosure: None
Hospital-onset COVID-19: Associations with population- and hospital-level measures to guide infection prevention efforts
Authors: Schmitz Emily , Anderson Laura , Hatas Gabrielle , Schweizer Marin , Safdar Nasia , Shirley Daniel
Published: September 2023

Objective: To characterize hospital-onset COVID-19 cases and to investigate the associations between these rates and population and hospital-level rates including trends in healthcare worker infections (HCW), community cases, and COVID-19 wastewater data. Design: Retrospective cohort study from January 1, 2021, to November 23, 2022. Setting: This study was conducted at a 589-bed urban Midwestern tertiary-care hospital system. Participants and interventions: The infection prevention team reviewed the electronic medical records (EMR) of patients who were admitted for >48 hours and subsequently tested positive for SARS-CoV-2 to determine whether COVID-19 was likely to be hospital-onset illness. Each case was further categorized as definite, probable, or possible based on viral sequencing, caregiver tracing analysis, symptoms, and cycle threshold values. Patients were excluded if there was a known exposure prior to admission. Clinical data including vaccination status were collected from the EMR. HCW case data were collected via our institution’s employee health services. Community cases and wastewater data were collected via the Wisconsin Department of Health Services database. Additionally, we evaluated the timing of changes in infection prevention guidance such as visitor restrictions. Results: In total, 156 patients met criteria for hospital-onset COVID-19. Overall, 6% of cases were categorized as definite, 24% were probable, and 70% were possible hospital-onset illness. Most patients were tested prior to a procedure (31%), for new symptoms (30%), and for discharge planning (30%). Also, 53% were symptomatic and 41% received treatment for their COVID-19. Overall, 38% of patients were immunocompromised and 27% were unvaccinated. Overall, 12% of patients died within 1 month of their positive SARS-CoV-2 test, and 11% required ICU admission during their hospital stay. Hospital-onset COVID-19 increased in fall of 2022. Specifically, October 2022 had 16 cases, whereas fall of 2021 (September–November) only had 3 cases total. Finally, similar peaks were observed in total cases by week between healthcare workers, county cases, and COVID-19 wastewater levels. These peaks correspond with the SARS-CoV-2 delta and omicron variant surges, respectively. Conclusions: Hospital-onset cases followed similar trends as population and hospital-level data throughout the study period. However, hospital-onset rate did not correlate as strongly in the second half of 2022 when cases were disproportionately high. Given that hospital-onset cases can result in significant morbidity, continued enhanced infection prevention efforts and low threshold for testing are warranted in the inpatient environment.

Disclosure: None
Assessment of ventilation in low-resource healthcare settings: Montserrado County, Liberia—2022−2023
Authors: Srinivasan Krithika , Arthur Ronan , Styczynski Ashley , Bell Ethan , Baer Thomas , Salinas Jorge
Published: September 2023

Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO2) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO2 meters were concurrently utilized to measure CO2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO2 was noted in well-ventilated rooms compared to 895 ppm mean CO2 in inadequately ventilated rooms.

Initial qualitative observations showed that facilities with lower CO2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts.

Disclosure: None
Carbapenemase genes and mortality in patients with carbapenem-resistant Enterobacterales, Atlanta, Georgia, 2011–2020
Authors: Witt Lucy , Babike Ahmed , Smith Gillian , Satola Sarah , Sexton Mary Elizabeth , Jacob Jesse
Published: September 2023

Background: Carbapenemase genes in carbapenem-resistant Enterobacterales (CP-CRE) may be transmitted between patients and bacteria. Reported rates of carbapenemase genes vary widely, and it is unclear whether having a carbapenemase gene portends worse outcomes given that all patients with CRE infections have limited treatment options. Methods: Using active population- and laboratory-based active surveillance data collected by the US CDC-funded Georgia Emerging Infections Program from 2011 to 2020, we assessed the frequency of carbapenemase genes in a convenience sample of CRE isolates using whole-genome sequencing (WGS), and we investigated risk factors for carbapenemase positivity. Only the first isolate per patient in a 30-day period was included. We compared characteristics of patients with CP-CRE and non–CP-CRE. Using multivariable log binomial regression, we assessed the association of carbapenemase gene positivity and 90-day mortality. Results: Of 284 CRE isolates, 171 isolates (60.2%) possessed a carbapenemase gene (Table 1), and KPC-3 was the most common carbapenemase gene (80.7%), with only 7 isolates possessing NDM (Table 2). No isolates possessed >1 carbapenemase gene, and most isolates were from urine (82.4%) (Table 1). Carbapenemase gene positivity was associated with lower age, male sex, black race, infection with Klebsiella pneumoniae, polymicrobial infection, having an indwelling medical device, receiving chronic dialysis, and prior stay in a long-term acute-care hospital, long-term care facility, and/or prior hospitalization in the last year. The 90-day mortality rates were similar in patients with non–CP-CRE and CP-CRE: 24.8% versus 25.7% (P = .86). In multivariable analysis, carbapenemase gene presence was not associated with 90-day mortality (adjusted risk ratio, 0.82; 95% CI, 0.50–1.35) when adjusting for CCI, infection with Klebsiella pneumoniae, and chronic dialysis use. Conclusions: The frequency of CP-CRE among CRE was high in this study, but unlike prior studies, the 90-day mortality rates wer similar in patients with CP-CRE compared to non–CP-CRE. Our results provide novel associations (eg, lower age, male sex, infection with Klebsiella pneumoniae, and indwelling medical devices) that infection preventionists could use to target high-risk patients for screening or isolation prior to CP-CRE detection.

Disclosure: None
Overview of infection control in nursing research in Korea over the last 10 years: Text network analysis and topic modeling
Authors: Kim EunJo , Kang JaHyun
Published: September 2023

Background: With the emergence of new infectious diseases, infection control nursing (ICN) in hospitals has become increasingly significant. Consequently, research on ICN has been actively performed. We examined the knowledge structure and trends addressed in Korean ICN research. Methods: From 5 web-based Korean academic databases (DBpia, KISS, KMbase, KoreaMed, and RISS), 2,244 studies published between 2013 and 2022 were retrieved using ICN-related search terms (eg, “nurse” or “nursing” along with “infection control,” “infection prevention,” “healthcare-associated infection,” or “standard precautions”). After deleting duplicates, the authors assessed titles and abstracts and included 250 research abstracts in this study. Using NetMiner 4.4 software (Cyram, Seoul, Korea), words from abstracts of published articles were extracted and refined, then text network analysis and topic modeling were performed. A text network was structured based on the co-occurrence matrix of key words (semantic morphemes) and was analyzed to identify the main key words. Through topic modeling using the Latent Dirichlet Allocation algorithm, latent topics in the research abstracts were extracted. The authors verified the key words comprising the topic and the result of classifying the documents by topic and named topics. Results: The number of studies, which increased following the outbreak of Middle East respiratory syndrome in 2015, has declined over time but peaked in 2021 with the COVID-19 pandemic. The text network composed of the key words of the research abstracts was generated and visualized (Fig. 1). As a result of text network analysis, the 5 most common key words were ‘nurse,’ ‘infection control,’ ‘nursing care,’ ‘practice,’ and ‘perception’ in terms of degree and betweenness centrality. Other prominent main keywords were also identified: ‘knowledge,’ ‘compliance,’ ‘education,’ ‘intervention,’ ‘intention,’ and ‘safety.’ With the application of topic modeling to the research abstracts, 5 topics were derived and named as follows (Fig. 2): “infection control in nursing care for patient safety,” “infection control measures for healthcare personnel safety,” “burdens and obstacles for infection control among nurses,” “infection control for multidrug-resistant organisms,” and “knowledge, attitude, practice for infection control among nurses.” Conclusions: By applying text-network analysis and topic modeling, we obtained insights into Korean ICN research trends. To explore global ICN research trends, further study is necessary to analyze internationally published studies reflecting each country’s nursing work conditions.

Disclosure: None
Perspectives on nonprescription antibiotic use among Hispanic patients in the Houston metroplex: A qualitative study
Authors: Laytner Lindsey , Chen Patricia , Nash Susan , Paasche-Orlow Michael , Olmeda Kiara , Salinas Juanita , Street Richard , Zoorob Roger , Trautner Barbara , Grigoryan Larissa
Published: September 2023

Background: Nonprescription antibiotic use includes taking an antibiotic without medical guidance (eg, leftover antibiotics, antibiotics from friends or relatives, or antibiotics purchased without a prescription). Nonprescription use contributes to antimicrobial resistance, adverse drug reactions, interactions, and superinfections such as Clostridioides difficile colitis. Qualitative studies exploring perspectives regarding nonprescription use among Hispanic patients are lacking. We used the Kilbourne Framework for Advancing Health Disparities Research to identify factors influencing Hispanic patients’ nonprescription use and to organize our findings. Methods: Our study includes Hispanic primary-care clinic patients with different types of health coverage in the Houston metroplex who endorsed nonprescription use in a previous quantitative survey. Semistructured interviews explored the factors promoting nonprescription use in Hispanic adults. Interviews were conducted remotely, in English or Spanish, between May 2020 and October 2021. We used inductive coding and thematic analysis to identify the factors and motives for nonprescription use. Results: Of the 35 Hispanic participants surveyed, 69% were female and between the ages of 27 and 66. All participants had some form of healthcare coverage (eg, Medicare or private insurance, Medicaid, or the county financial assistance program). Participants reported obtaining antibiotics from their own leftover prescriptions and through trusted persons (eg, herbalists, pharmacists, friends/relatives, and others), buying them under the counter in US markets, and purchasing them without a prescription outside the United States. Thematic analysis revealed the factors contributing to nonprescription use (Fig. 1). Themes included beliefs that the ‘doctor visit was unnecessary,’ ‘limited direct access to healthcare’ in the United States (due to limited insurance coverage, high costs of the doctor’s visits and medications, and long clinic wait times), ‘more open indirect access to healthcare’ abroad and under the counter in the United States, and communication difficulties (eg, language barriers with clinicians, perceived staff rudeness, and gaps in health literacy). Figure 2 shows representative quotes across thematic domains. Participants expressed having confidence in medical recommendations from pharmacists and trusted community members in their social networks. Conclusions: Antibiotic stewardship interventions that include pharmacist-driven patient education regarding appropriate antibiotic use may decrease nonprescription antibiotic use in Hispanic communities. Additionally, improving access to care while addressing communication barriers and cultural competency in clinics may improve primary care delivery and reduce potentially unsafe antibiotic use.

Disclosure: None
Length of antibiotic therapy among adults aged ≥65 years hospitalized with uncomplicated community-acquired pneumonia, 2013-2020
Authors: McCarthy Natalie , Wolford Hannah , Kazakova Sophia , Baggs James , Attell Brandon , Kabbani Sarah , Neuhauser Melinda , Yi Sarah , Hatfield Kelly , Reddy Sujan , Hicks Lauri
Published: September 2023

Background: The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. Clinical guidelines recommend treating uncomplicated CAP with a minimum of 5 days of antibiotic therapy. Total length of therapy (LOT) >7 days or >3 days after clinical improvement is rarely necessary. In a previous study estimating LOT in uncomplicated CAP patients, 71% of patients ≥65 years exceeded recommended duration of antibiotics in 2012–2013 (Yi et al, 2018). We evaluated annual trends in LOT in adults ≥65 years hospitalized with uncomplicated CAP from 2013 to 2020. Methods: We conducted a retrospective cohort study among patients in the CMS database with a primary diagnosis of bacterial or unspecified pneumonia using International Classification of Diseases 9th and 10th Revision codes, length of stay (LOS) of 2–10 days, discharged home with self-care, and not rehospitalized in the 3 days following discharge. Discharge home was used as a surrogate for clinical improvement. Because inpatient LOT is not available in CMS data, we used linear regression to model inpatient LOT as a function of LOS using data on CAP patients ≥65 years from the PINC AI healthcare database. Postdischarge LOT was based on prescriptions filled following discharge. Total LOT was calculated by summing estimated inpatient LOT and actual postdischarge LOT (Fig. 1). Total LOT >7 days and postdischarge LOT >3 days were considered indicators of likely excessive LOT. We reported trends in the proportion of patients with likely excessive LOT during the study period. Results: From 2013 through 2020, there were 400,928 uncomplicated CAP hospitalizations among patients aged ≥65 years. Patients were more likely to be female (55%), and they had a median age of 76 years and a median LOS of 3 days. The median total LOT decreased from 9.5 days in 2013 to 7.7 days in 2020. The proportion of patients with total LOT >7 days decreased from 68% in 2013 to 50% in 2020 (% change, −27%); the proportion with postdischarge LOT >3 days decreased from 73% in 2013 to 62% in 2020 (% change, −16%) (Fig. 2). Conclusions: Likely excessive total LOT for adults ≥65 years hospitalized with uncomplicated CAP decreased by 27% in 2020, a considerable improvement from 2013. However, the high proportion of patients with likely excessive postdischarge LOT in 2020 (62%) demonstrates the need for antibiotic stewardship to optimize prescribing at hospital discharge.

Disclosures: None