bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation-Centric Network (CCN) representation for microbial co-occurrence patterns: new insights for microbial ecology
Authors: Yang Pengshuo , Tan Chongyang , Han Maozhen , Cheng Lin , Cui Xuefeng , Ning Kang
Published: June 2020

Mainstream studies of microbial community focused on critical organisms and their physiology. Recent advances in large-scale metagenome analysis projects initiated new researches in the complex correlations between large microbial communities. Specifically, previous studies focused on the nodes (i.e. species) of the Species-Centric Networks (SCNs). However, little was understood about the change of correlation between network members (i.e. edges of the SCNs) when the network was disturbed. Here, we introduced a Correlation-Centric Network (CCN) to the microbial research based on the concept of edge networks. In CCN, each node represented a species–species correlation, and edge represented the species shared by two correlations. In this research, we investigated the CCNs and their corresponding SCNs on two large cohorts of microbiome. The results showed that CCNs not only retained the characteristics of SCNs, but also contained information that cannot be detected by SCNs. In addition, when the members of microbial communities were decreased (i.e. environmental disturbance), the CCNs fluctuated within a small range in terms of network connectivity. Therefore, by highlighting the important species correlations, CCNs could unveil new insights when studying not only the functions of target species, but also the stabilities of their residing microbial communities.
Iron in the NEEM ice core relative to Asian loess records over the last glacial–interglacial cycle
Authors: Xiao Cunde , Du Zhiheng , Handley Mike J , Mayewski Paul A , Cao Junji , Schüpbach Simon , Zhang Tong , Petit Jean-Robert , Li Chuanjin , Han Yeongcheol , Li Yuefang , Ren Jiawen
Published: June 2020

Mineral dust can indirectly affect the climate by supplying bioavailable iron (Fe) to the ocean. Here, we present the records of dissolved Fe (DFe) and total Fe (TDFe) in North Greenland Eemian Ice Drilling (NEEM) ice core over the past 110 kyr BP. The Fe records are significantly negatively correlated with the carbon-dioxide (CO2) concentrations during cold periods. The results suggest that the changes in Fe fluxes over the past 110 kyr BP in the NEEM ice core are consistent with those in Chinese loess records because the mineral-dust distribution is controlled by the East Asian deserts. Furthermore, the variations in the dust input on a global scale are most likely driven by changes in solar radiation during the last glacial–interglacial cycle in response to Earth's orbital cycles. In the last glacial–interglacial cycle, the DFe/TDFe ratios were higher during the warm periods (following the post-Industrial Revolution and during the Holocene and last interglacial period) than during the main cold period (i.e. the last glacial maximum (LGM)), indicating that the aeolian input of iron and the iron fertilization effect on the oceans have a non-linear relationship during different periods. Although the burning of biomass aerosols has released large amounts of DFe since the Industrial Revolution, no significant responses are observed in the DFe and TDFe variations during this period, indicating that severe anthropogenic contamination has no significant effect on the DFe (TDFe) release in the NEEM ice core.
Thing Theory
Authors: Wasserman Sarah
Published: June 2020

Thing theory names an approach that scholars use to investigate human-object relations in art, literature, culture, and everyday life. Though commonly thought of as a way to study physical artifacts, thing theory is rather a means to explore the dynamics between human subjects and inanimate objects. Thing theory emerges from the scholarly concern with commodity capitalism, and therefore has many antecedents in anthropology, art history, and museum studies. But it more precisely names the theoretical framework that developed within English departments in the 1990s, and prompted literary studies to turn upon the object matter of literature. The phrase “thing theory” came widely into use in 2001, in Bill Brown’s introduction to a special issue of Critical Inquiry titled Things. There, Brown describes the questions that thing theory raises as queries not into objects alone, but into subject-object relations in particular spaces, at particular times. Literature was central to these queries, not only because English departments in the 1990s were home to the “high theory” that Brown draws upon, but because, as he argues, it is a privileged medium for revealing the force of inanimate objects in human experience. In other words, literature makes the “thingness” of objects visible. This distinction comes from Heidegger, for whom objects become things when they can no longer serve their common or intended function. When an object breaks or is misused, it sheds its conventional role and becomes visible in new ways: it becomes a thing. Thing theory draws upon this notion of productive estrangement to consider the meaning that physical artifacts can have for human subjects. While thing theory entails discussions of “real” artifacts, it has primarily been used by scholars in the humanities to discuss the representation of such things in art and literature—specifically as a means to understand what meaning such representations hold. Around 2010, a number of books about the agency of objects by philosophers, political scientists, and media studies scholars inaugurated what might be called a second phase of thing theory. This second phase entailed scholars seeking to decenter the human subject in their materialist studies. These “new materialisms” are less confined to representational forms and have expanded the reach of thing theory well beyond literary studies. The new materialisms—some of which build directly on an older Marxist tradition of historical materialism—and other branches of thought that attempt to decenter the human, including object-oriented ontology, actor-network theory, ecocriticism, and posthumanism, draw upon thing theory but might best be thought of as a set of allied approaches interested in the agency of things. This bibliography tracks the initial phase of thing theory in literary studies, consolidates the earlier scholarship it draws on most consistently, outlines the second phase of thing theory across a variety of fields, and looks to work that has inaugurated new, future directions.
Roman Kingship
Authors: Smith Christopher
Published: June 2020

The Romans developed an account of their early history which was organized by the reigns of seven kings. By the 1st century bce, they had settled on a standard chronology for these kings, and in the following sequence: Romulus 753–717, Numa Pompilius 716–674, Tullus Hostilius 673–642, Ancus Marcius 641–617, Tarquinius Priscus 616–578, Servius Tullius 578–534, Tarquinius Superbus 534–509. It is clear from archaeological evidence that Rome from the 8th to the 6th century bce was in a period of significant growth and transformation. There are a number of exciting finds which have been related to the historical account. This account however was the product of a long period of development, and the narrative as it developed came to reflect the contemporary concerns of Roman politics. So research on Roman kingship has to take account of both the possibility of genuine history underlying the account, and the literary and artistic motivations which led to the transformations of the story over time. The relationship between these two is the subject of significant methodological discussion, on a spectrum from attempts to directly relate the historical account to archaeological finds, to significantly more skeptical claims that connections are coincidental and that the historical record is wholly unreliable. The third strand of investigation is institutional history and includes the controversy over the so-called leges regiae, the alleged legal precursors to the codification of law in the Twelve Tables from the mid-5th century bce, and the transformation of the Roman constitution into one characterized by shared time-limited office-holding. A quite different approach sees the kings as encoding deep mythological structures, and argues for a reconceptualization of the early history of Rome as a mythical rather than a historical sequence. Although this has been less popular recently, aspects of this scholarly approach have been influential in other fields of study. This is particularly true of social anthropology and the history of religion, where Dumézil’s classification of the Roman kings has been influential but controversial (see section Roman Kings and Indo-European Mythology).
Gallicanism
Authors: Parsons Jotham
Published: June 2020

“Gallicanism” is a 19th-century term used to refer to a range of ecclesiological and political theories extending from the High Middle Ages to at least the French Revolution that sought to decrease papal or increase royal control over the Roman Catholic Church in France. Its boundaries are poorly defined: it often formed part of larger ideological complexes with elements that might be defined as absolutist, constitutionalist, or Jansenist and it had complex but important relationships with similar movements in other polities and even, for example, with Protestant Erastianism. Typically, Gallicanism is understood as an erudite discourse among learned jurists and theologians, and scholarly interest in it has usually been undertaken within the context of the intellectual history of state formation in the Early Modern period and of Conciliarist and post-Tridentine Catholic theology. In the 16th century it was closely entwined with the rise of humanism and the Reformation; in the 17th century, with royal absolutism, religious revival, and the Jansenist controversy. More recent studies have investigated it as a broadly shared religious and national culture among French Catholics of varied backgrounds and ideological orientations. Its influence beyond France proper was complex and did not fully develop until the 18th century, but it has been the subject of some interesting work.
Sree Narayana Guru
Authors: Pati George
Published: June 2020

Sree Narayana Guru (b. 1856?–d. 1928), a member of the Īzhava caste, a low-caste group in the fourfold caste system of Kerala, and a pioneer in socioreligious reform in early-20th-century Kerala, was born in Chempazhanthi, Kerala, possibly on August 20, 1856. A learned man, he was fluent in Malayalam, Sanskrit, and Tamil. From 1876 to 1879 he studied Sanskrit at Puthupalli in Karunagapally taluk, and was broadly trained in various traditions, including vyākarṇa (grammar), nyāya (logic), Vedānta, kāvya (poetry), nātaka (drama), and alaṁkāra (rhetoric), in addition to Ayurveda and astrology. After his formal education, he was more interested in finding the truth about the self and its relation to the Ultimate Reality. Once he had attained aṟivu (self-knowledge), he returned to his village and became an itinerant sanyāsin, recognized as a saint, and people from all strata of the caste-oriented Kerala society—Nāyars, Īzhavas, Christians, and Muslims—sought his teachings and blessings. In his teachings Guru emphasized the knowledge of self as essential to his notion of oneness. He claimed that oneness depends on consciousness of the self in relation to others and plays a significant role in spiritual and social emancipation. Guru, who at one point in life was a devotee of Viṣṇu, after attaining self-realization, emphasized the concept of “one God” and the unity of all being in a singular divinity. This oneness was not confined to his concept of God, but he considered the whole world to be of one family—vasudhaiva kudumbakam. In 1903 Guru founded the Śrī Nārāyaṇa Dharma Paripālana Yōgam (SNDP), with its manifesto, “One Caste, One Religion, One God for Mankind,” which directed the many Hindus of Kerala from belief in many gods to belief in one God. Narayana Guru had the support of Dr. Palpu, a medical doctor and social revolutionary, and Kumaran Asan, a disciple and poet, and founding secretary of the SNDP. The oneness of God and unity of all humankind became apparent when Narayana Guru propelled religious and social reforms in Kerala. More importantly, his exposure to the inhumane condition of people in the lower castes and his education in the various philosophical schools, especially Advaita Vedānta, or nondualism, served as a foundation for his literary works and social and religious reforms in Kerala. On September 20, 1928, Guru attained samādhi (liberation upon death). Since his death, the SNDP organization has continued to function, propelled by those who follow Guru’s teachings, who hold regular meetings and worship services affirming Guru as a divine being.
Art and Artists
Authors: Mansfield Elizabeth , Hagen Emily
Published: June 2020

The conceptual framework of Atlantic history calls for a nuanced understanding of the designations “art” and “artist.” As self-evident as these terms might seem, they are in fact dynamic categories whose meanings have shifted—and continue to shift—in response to historical circumstances. Awareness of the historiography of these terms helps to clarify their past use and current meanings in relation to Atlantic history. Abiding within the terms art and artist are associations with Eurocentric concepts like originality, masterpiece, and genius. This is no surprise. The study of art as a distinct field of history emerged in Europe in the 18th century, and the resulting discipline of art history encoded Enlightenment assumptions regarding the superiority of certain social institutions, cultural forms, and kinds of knowledge. As a category of cultural artifact, art was ascribed a primarily aesthetic function that could be appreciated by all viewers, regardless of cultural origin. The problem with this understanding of art was its internal contradiction: to exist, “art” depends simultaneously on highly subjective judgments about aesthetic merit and on claims of universality. Historically, reliance on this understanding of art excluded the visual and material culture of non-Europeans, including indigenous peoples, from art historical valuation. Constraints imposed by the term “artist” were similar. Conventionally applied to individuals engaged in the deliberate production of objects recognized for their primarily aesthetic value, the category “artist” was closed to those working outside a specifically Western and modern cultural economy. Consideration of art and artists within the context of Atlantic history has provided an opportunity to re-examine these categories. In the early 21st century, most scholars of Atlantic history use the terms art and artist inclusively, without implying aesthetic judgment or intent. Those seeking to distance themselves further from historical prejudices may rely instead on such terms as “visual culture” and “maker” in place of “art” and “artist.” Rather than dispensing with the terms art and artist, this article proceeds from the belief that these concepts retain historiographic usefulness. Strangeness is an inevitable part of cultural encounter, and so is commensurability. To highlight the importance of interconnectedness for the study of art and artists in Atlantic history, this article is organized around networks of cultural exchange, encounter, and exploitation.
Higher Education in Africa
Authors: Teeroovengadum Viraiyan
Published: June 2020

Africa is known as the cradle of humanity; scientific evidence shows that the continent is where it all started for the human species. Unsurprisingly, it is contended that early forms of higher education existed in Africa well before the contemporary universities came into existence. However, today the large majority of least developed countries are found in Africa and the continent’s higher education institutions have been struggling to keep pace with the standards set by those in the developed countries. The present higher education landscape in Africa is an extremely dynamic one and research in African higher education has contributed in finding solutions to the practical problems that the sector faces. This article provides an overview of key resources on higher education in Africa. First, resources that provide comprehensive overviews of the generic issues pertaining to African higher education are presented. Subsequently, studies on higher education in Africa are grouped in key themes that correspond to key research areas. The themes are General Overviews, National Development, Policies and Governance, Access and Equity, Research, Assessment of Education Quality, Academic Profession, and Internationalization. While the themes can be seen as reasonably distinct from each other based on their primary focus, they do possess some conceptual similarities. For example, some studies under the internationalization category also relate to the academic profession or students’ outcomes.
Deaccessioning
Authors: Piazzai Michele , Vecco Marilena
Published: June 2020

Deaccessioning is the technical term referring to the expulsion of objects from museum collections. This would be considered an ordinary aspect of museum administration if museums did not play a crucial role in the conservation of cultural heritage. Both linguistically and factually, deaccessioning represents the undoing of accessioning operations, by which objects newly acquired by museums are inscribed into museum registers. Because the act of accessioning constitutes a conferral of status, an expert acknowledgment that the object is worthy of preservation, deaccessioning comes to represent the revocation of this status; that is, it entails the object’s return to the mundane sphere. Deaccessioning usually occurs with the intent of selling the object. The practice first came into the spotlight on 27 February 1972, when in a New York Times article titled “Very Quiet and Very Dangerous,” the art critic and historian John Canaday denounced the Metropolitan Museum of Art’s rumored sale of many prominent artworks earlier that year, including two Manets, a Cézanne, a Renoir, a Gauguin, and a Picasso, questioning the operation on both ethical and financial grounds. The episode became widely known as the “Hoving affair,” from the name of then-director of the Metropolitan Museum, Thomas Hoving, and left a stigma about the practice of selling artworks from museum collections. Since then, deaccessioning has remained an uncomfortable aspect of museum administration, considered by some a legitimate curatorial tool, by others a necessary evil in times of financial stress, and by still others a mark of museum managers’ betrayal of the public trust. To this day, deaccessioning continues to be discussed primarily in relation to art museums and the sale of artworks; however, the term rightfully applies to non-artistic objects, such as books, archival records, or archaeological items, and it does not strictly refer to objects’ sales but more generally to their disposals. Therefore, it also applies to cases where the objects are expelled from collections because of loss, damage, donation, restitution, or repatriation. Deaccessioning can occur for reasons that appear easily defensible. It may occur, for example, because new legislation forces a change of ownership, or because the museum cannot properly care for the object. Nevertheless, it often occurs for dubious reasons, perhaps because the item is considered redundant, uninteresting, or commercially valuable. This bibliography entry draws on interdisciplinary literature to review common arguments both in favor and against deaccessioning. It begins with legal considerations, because the legal profession was the first to develop scholarly interest in this practice, and was later followed by the fields of economics and management. After introducing selected literature from these fields, this entry introduces key sources on deaccessioning policy, representative case studies, and publications oriented toward students and practitioners.
Margaret Mead
Authors: Yans Virginia , Shin Ji-Hye
Published: June 2020

Margaret Mead (b. 1901–d. 1978), one of the 20th century’s most accomplished and controversial anthropologists, pioneered modern childhood studies. Her ethnographies and popular writings established child socialization as a centerpiece for the transmission of human culture. Mead understood human behavior as a product of complex interactions between biology and the ways in which various human cultures shaped and embellished biological inheritance beginning at birth. When Mead began her career in the 1920s, anthropology’s unique fieldwork methodology and the impending disappearance of “whole cultures” required female scientists: most small pre-literate societies in remote areas of the world would not accept male “participant observers” of women’s daily activities which, of course, included child rearing. Mead’s early 1920s and 1930s fieldwork in Samoa, New Guinea, and Bali emphasized different cultural patterns of child rearing practices and child behavior. Her controversial finding that Samoan adolescent girls moved through adolescence without turmoil initiated her fame. As a young woman cultural anthropologist specializing in child behavior, Mead both engaged and disputed established Western scientific notions of universal, “normal” developmental stages including Freud’s psychosexual stages and Piaget’s innate cognitive development models. The early Samoa and New Guinea fieldwork initiated Mead’s trademark practice of using anthropological knowledge as a social reform tool. Returning to the developed Western world with her field research, for example, she encouraged lay audiences to examine their own child rearing practices. During the 1930s and 1940s, Mead joined the “culture and personality” and “national character” schools of anthropology, two early iterations of today’s psychological anthropology. As an example, her Balinese field studies conducted with her third husband Gregory Bateson (a trained biologist and ethnographer) worked within a neo-Freudian framework emphasizing parent-child interaction and cultural influences. The Balinese field work method involving both hundreds of unstaged, but carefully photographed and filmed, parent-child interactions and accompanying detailed field notes followed her earlier use of projective testing of New Guinea children, all now recognized as innovations. In the post–World War II era Mead’s interests turned to evolutionary change but she retained her interest in youth recognizing that the children of the 1960s faced an unprecedented historical change colloquially known as the “generation gap.” Mead presciently predicted a reversal of thousands of years of generational roles: 20th-century children, she correctly foresaw, would be teaching their less experienced elders how to navigate and survive in a world of rapid social and technological change into which the young were born.
Propaganda
Authors: Doll Katy
Published: June 2020

Propaganda has a rich history and an equally rich literature. Scholars do not always agree on a single definition of propaganda, but Jowett and O’Donnell’s 2019 book, Propaganda and Persuasion (Los Angeles: SAGE), defines it as a “deliberate, systematic attempt to shape perceptions, manipulate cognitions, and direct behavior to achieve a response that furthers the desired intent of the propagandist.” Persuasive communication itself has been used since the beginning of communication. The term “propaganda,” however, did not come into use until the 1600s and was first associated with disseminating or promoting particular ideas, such as propagating religious faith. Historical analysis of propaganda has focused on the 20th and 21st century when propaganda was considered a widespread issue and has increasingly become an accepted area of study. Given the widespread use of atrocity propaganda in World War I and the power of the Nazi propaganda machine in World War II, 20th-century wars generally receive the most attention from scholars. Historians and communications scholars have attempted to remedy this more modern focus with major anthologies spanning earlier periods. However, as propaganda can often take a host of forms and did not come into the general modern meaning of the word until the 20th century, studies of earlier periods often focus on communication or iconography. Much of the English-language work done on propaganda also skews extremely toward the United States and the United Kingdom. Some of the earliest works on propaganda came from those who worked in propaganda in some capacity. These early works have gradually been supplemented with rigorous historical and communication analyses. The two fields are the most prolific in their study of propaganda, but art historians have also added to the understanding of the visual culture of propaganda and scholars in other fields such as sociology, politics, and rhetoric have also added to the literature on propaganda. Scholars also have devoted attention to the close relationship between propaganda and technology. Together these efforts make for a diverse field that examines propaganda products, their creation, their dissemination, and their purpose. Because of the ephemeral nature of most propaganda and the way various archives have or have not been available to scholars, propaganda can be a challenging topic of study. Some works attempt to study the reception of propaganda while others focus on the creation and dissemination process. Monographs focusing on a single country or conflict outnumber those works spanning conflicts and continents. Several notable exceptions have comparative analysis or bring together works from multiple perspectives. Propaganda will continue to be of vital interest to scholars and hopefully will include works from scholars with increasing language skills and access to diverse archives.
A Retrospective Chart Review on the Role of Suppressive Therapy in the Management of Spinal Infections Involving Hardware
Authors: Beydoun Nour , Tandon Sonia , Krengel Sonia , Johnson Eric , Palacio Bedoya Federico , Moore Michael , Refai Daniel , Rouphael Nadine
Published: June 2020

Background

One percent to 8% of patients undergoing spinal instrumentation surgeries develop infections. There is no consensus on the medical and surgical management of these infections.

Methods

We conducted a retrospective chart review based on International Classification of Diseases, Ninth Revision, and Common Procedural Terminology codes relevant to spinal infections with hardware within Emory Healthcare over a 10-year period. Extracted data included patient demographics, clinical presentation, laboratory and microbiologic results, and surgical and medical management including choice and duration of suppressive therapy. Multivariable logistic regression was used to assess the association of length of use of suppressive antibiotics with treatment success and to identify predictors of use of suppressive antibiotics.

Results

Of 869 records, 124 met inclusion criteria. Fifty patients (40.3%) had an infection that occurred after hardware placement, mostly within 3 months postsurgery, while the remainder had vertebral osteomyelitis that required hardware placement. After initial intravenous antibiotic treatment for ≥4 weeks, 72 patients (64.5%) were given suppressive antibiotics. The overall treatment success rate was 78.2%. In spinal infections involving hardware with gram-negative rods, patients were less likely to receive suppressive antibiotics, less likely to have hardware removed, and less likely to have treatment success compared with patients with infections with Staphylococcus species.

Conclusions

Management of spinal infections involving hardware should be tailored to the timing of onset of infection and causative organism. Further studies are needed to determine best management practices, particularly for gram-negative rod infections where the role of further suppressive antibiotics and hardware removal may be warranted.
The Pandemic Academy: Reflections of Infectious Diseases Fellows During COVID-19
Authors: Beh Darius L L , Ng Dorothy H L , Ong Sean W X , Sutjipto Stephanie , Lee Pei Hua , Oon Jolene , Wong Chen Seong , Archuleta Sophia
Published: June 2020

The COVID-19 pandemic has taken over the world at an unprecedented scale. As Infectious Diseases fellows, this has come straight into the heart of our specialty and created a unique impact on our training progress and perspective. Here, we reflect on our early experiences during the first three months of battling COVID-19 in Singapore and glean some lessons for this pandemic and beyond.
Systemic Lupus Erythematosus
Authors: Petri Michelle
Published: June 2020

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease most commonly involving skin, joints, and kidneys. Usually, it presents in women in puberty or early adulthood. This monograph provides an overview of the role of an obstetrician–gynecologist (ob-gyn) in the treatment of SLE patients. An ob-gyn is uniquely placed in the health care continuum throughout the life cycle of a woman. Notably, an ob-gyn often is the first physician to notice SLE-related rash, swollen joints, cytopenias, or proteinuria in a patient and is the first to provide initial management. Obstetrician–gynecologists must be familiar with SLE effects on reproductive issues, such as SLE effects on the choice of birth control, pregnancy outcomes, and the risks of hormone therapy use, as well as the pregnancy effects on the risk of lupus nephritis flares. Human papillomavirus and associated cancer also are of concern in patients with SLE. Providing care to women with SLE is multifaceted; therefore, ob-gyns often will need to liaise with rheumatologists and other specialists.
Sepsis and the Obesity Paradox: Size Matters in More Than One Way
Authors: Jagan Nikhil , Morrow Lee E. , Walters Ryan W. , Plambeck Robert W. , Wallen Tanner J. , Patel Tej M. , Malesker Mark A.
Published: June 2020

Objectives:

Multiple studies have demonstrated an obesity paradox such that obese ICU patients have lower mortality and better outcomes. We conducted this study to determine if the mortality benefit conferred by obesity is affected by baseline serum lactate and mean arterial pressure.

Design:

Retrospective analysis of prospectively collected clinical data.

Setting:

Five community-based and one academic medical center in the Omaha, NE.

Patients:

7,967 adults hospitalized with sepsis.

Interventions:

None.

Measurements and Main Results:

Patients were categorized by body mass index as underweight, normal weight, overweight, or obese. Multivariable logistic regression models were used to estimate the odds of in-hospital death by body mass index category; two-way interactions between body mass index and each covariate were also evaluated. Subgroup and sensitivity analyses were conducted using an ICU cohort and Acute Physiology and Chronic Health Evaluation III scores, respectively. The overall unadjusted mortality rate was 12.1% and was consistently lower in higher body mass index categories (all comparisons, p < 0.007). The adjusted mortality benefit observed in patients with higher body mass index was smaller in patients with higher lactate levels with no mortality benefit in higher body mass index categories observed at lactate greater than 5 mmol/L. By contrast, the association between lower MAP and higher mortality was constant across body mass index categories. Similar results were observed in the ICU cohort. Finally, the obesity paradox was not observed after including Acute Physiology and Chronic Health Evaluation III scores as a covariate.

Conclusions:

Our retrospective analysis suggests that although patient size (i.e., body mass index) is a predictor of in-hospital death among all-comers with sepsis—providing further evidence to the obesity paradox—it adds that illness severity is critically important whether quantified as higher lactate or by Acute Physiology and Chronic Health Evaluation III score. Our results highlight that the obesity paradox is more than a simple association between body mass index and mortality and reinforces the importance of illness severity.
The 10-Year Prognosis and Prevalence of Brugada-Type Electrocardiograms in Elderly Women
Authors: Yeh Sherri Shih-Fan , Chen Ching-Yu Julius , Wu I-Chien , Hsu Chih-Cheng , Chen Tzu-Yu , Tseng Wei-Ting , Tang Feng-Cheng , Wang Chi-Chung , Juan Chung-Chou , Chiu Hou-Chang , Lo Huey-Ming , Yang Dun-Hui , Juang Jyh-Ming Jimmy , Hsiung Chao Agnes
Published: June 2020

Background

Brugada syndrome is a disorder associated with sudden cardiac death and characterized by an abnormal electrocardiogram (ECG). Previous studies were predominantly conducted in men, and the data on long-term prognosis are limited. Information about women, especially elderly women, is lacking.

Objective

The aim of this study was to investigate the long-term prognosis of the Brugada ECG pattern in elderly women.

Method

We investigated the 10-year prognosis of the Brugada ECG pattern in elderly women in a nationwide community-based population in Taiwan. Community-dwelling women older than 55 years were prospectively recruited from December 2008 to March 2013 by a stratified random sampling method. All enrolled individuals were followed up annually until April 2019, and the cause of death was documented by citizen death records.

Results

Among 2597 women, 60 (2.31%) had a Brugada-type ECG, and this prevalence was higher than the mean global prevalence of 0.23%. One woman had a type 1 ECG (0.04%), whereas 15 (0.58%) and 44 (1.70%) women had type 2 and type 3 ECG patterns, respectively. Cox survival analysis revealed that all-cause mortality and cardiac mortality were similar in the individuals with and without a Brugada-type ECG during a mean follow-up of 96.1 ± 20.5 months.

Conclusions

Our findings suggest that Brugada ECG patterns are not infrequent in elderly women but are not associated with increased risk of mortality in long-term follow-up; these findings may help reduce unnecessary anxiety for physicians, nurses, allied health caregivers, and patients.
Deployment of a Clinical Pathway to Improve Postcardiac Arrest Care: A Before-After Study*
Authors: Fowler Jessica C. , Wolfe Heather A. , Xiao Rui , Kumar Sitara P. , Whitney Jane E. , Hutchins Larissa , Sutton Robert M. , Nadkarni Vinay M. , Berg Robert A. , Topjian Alexis A.
Published: June 2020

Objectives:

Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes.

Design:

Single-center retrospective before-after study.

Setting:

Academic PICU.

Patients:

Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation.

Intervention:

Deployment of a postcardiac arrest clinical pathway and computerized order entry system.

Measurements and Main Results:

There were 380 patients included—163 in the pre-pathway period and 217 in the post-pathway period. Primary outcome was percent adherence to pathway clinical goals at 0–6 and 6–24 hours post-return of circulation and to diagnostics (continuous electroencephalogram monitoring, head CT for out-of-hospital cardiac arrests, echocardiogram). Secondary outcomes included survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). The pre-pathway and post-pathway groups differed in their baseline Pediatric Cerebral Performance Category scores and the following causes of arrest: airway obstruction, arrhythmias, and electrolyte abnormalities. Pathway adherence was not significantly different between the pre-pathway and post-pathway groups, with the exception of higher rates of continuous electroencephalogram monitoring (45% vs 64%; p < 0.001). There was no difference in survival to hospital discharge between the two groups (56% vs 67%; adjusted odds ratio, 1.68; 95% CI, 0.95–2.84; p = 0.05). Survival to discharge was higher in the post-pathway group for the in-hospital cardiac arrest cohort (55% vs 76%; adjusted odds ratio, 3.06; 95% CI, 1.44–6.51; p < 0.01). There was no difference in favorable neurologic outcome between all patients (adjusted odds ratio, 1.21; 95% CI, 0.72–2.04) or among survivors (adjusted odds ratio, 0.72; 95% CI, 0.27–1.43).

Conclusions:

After controlling for known potential confounders, the creation and deployment of a postcardiac arrest care pathway and computerized order entry set were not associated with improvement in pathway adherence or overall outcomes, but was associated with increased survival to hospital discharge for children with in-hospital cardiac arrests.
Hospital-Acquired Infection in Pediatric Subjects With Congenital Heart Disease Postcardiotomy Supported on Extracorporeal Membrane Oxygenation*
Authors: Herrup Elizabeth A. , Yuerek Mahsun , Griffis Heather M. , Connelly James T. , Thiagarajan Ravi , Rycus Peter , Blinder Joshua J.
Published: June 2020

Objective:

To determine prevalence of and risk factors for infection in pediatric subjects with congenital heart disease status postcardiotomy supported on extracorporeal membrane oxygenation, as well as outcomes of these subjects.

Design:

Retrospective cohort from the Extracorporeal Life Support Organization.

Setting:

U.S. and international medical centers providing care to children with congenital heart disease status postcardiotomy.

Patients:

Critically ill pediatric subjects less than 8 years old admitted to medical centers between January 1, 2013, and December 31, 2015, who underwent cardiac surgery for congenital heart disease and required extracorporeal membrane oxygenation support within the first 14 postoperative days. Subjects were excluded if they underwent orthotopic heart transplantation, required preoperative extracorporeal membrane oxygenation, and had more than one postoperative extracorporeal membrane oxygenation run.

Interventions:

None.

Measurements and Main Results:

A total of 1,314 extracorporeal membrane oxygenation subject encounters in the Extracorporeal Life Support Organization registry met inclusion criteria. Neonates comprised 53% (n = 696) of the cohort, whereas infants made up 33% (n = 435). Of the 994 subjects with Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery categorizable surgery, 33% (n = 325) were in Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 4 and 23% (n = 231) in Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 5. While on extracorporeal membrane oxygenation, 229 subjects (17%) acquired one or more extracorporeal membrane oxygenation–related infections, which represents an occurrence rate of 67 infections per 1,000 extracorporeal membrane oxygenation days. Gram-negative (62%) and Gram-positive (42%) infections occurred most commonly. Forty percent had positive blood cultures. Infants and children were at higher infection risk compared with neonatal subjects; subjects undergoing less complex surgery had higher infection rates. Unadjusted survival to hospital discharge was lower in infected subjects compared with noninfected subjects (43% vs 51%; p = 0.01). After adjusting for confounders via propensity matching, we identified no significant mortality difference between infected and noninfected subjects.

Conclusions:

Neonatal and pediatric subjects in this study have a high rate of acquired infection. Infants and children were at higher infection risk compared with neonatal subjects. There was not, however, a significant association between extracorporeal membrane oxygenation–related infection and survival to hospital discharge after propensity matching.
Accuracy of Bedside Ultrasound Femoral Vein Diameter Measurement by PICU Providers*
Authors: Good Ryan J. , Levin Melanie , Feder Susan , Loi Michele M. , Kim John S. , Branchford Brian R. , Czaja Angela S. , Carpenter Todd C.
Published: June 2020

Objectives:

Perform a needs assessment by evaluating accuracy of PICU provider bedside ultrasound measurement of femoral vein diameter prior to utilization of the catheter-to-vein ratio for central venous catheter size selection.

Design:

Prospective observational cohort study.

Setting:

PICU within a quaternary care children’s hospital.

Patients:

PICU patients greater than 30 days and less than 6 years without a femoral central venous catheter.

Interventions:

None.

Measurements and Main Results:

Gold-standard femoral vein diameter measurements were made by a radiologist, sonographer, or bedside ultrasound expert. PICU providers then repeated the femoral vein diameter measurements, and results were compared by Bland-Altman analysis with a priori accuracy goal of limits of agreement ± 15%. Among recruited patients (n = 27), the median age was 1.1 years (interquartile range 0.5–2.3 yr), weight was 9.0 kg (interquartile range 7.0–11.5 kg), and reference femoral vein diameter was 0.36 cm (interquartile range 0.28–0.45 cm). Providers performed 148 femoral vein diameter measurements and did not meet goal accuracy when compared with the reference measurement with a bias of 4% (95% of limits of agreement –62% to 70%). A majority of patients would have a catheter-to-vein ratio greater than 0.5 using either age-based central venous catheter size selection criterion (14/27) or the provider bedside ultrasound femoral vein diameter measurement (18/27).

Conclusions:

PICU provider measurement of femoral vein diameter by bedside ultrasound is inaccurate when compared with expert reference measurement. Central venous catheter size selection based on age or PICU provider femoral vein diameter measurement can lead to a catheter-to-vein ratio greater than 0.5 and potentially increase the risk of catheter-associated venous thromboembolism. Structured bedside ultrasound training with assessment of accuracy is necessary prior to implementation of venous thromboembolism reduction efforts based on catheter-to-vein ratio recommendations.
Long-Axis In-Plane Approach Versus Short-Axis Out-of-Plane Approach for Ultrasound-Guided Central Venous Catheterization in Pediatric Patients: A Randomized Controlled Trial*
Authors: Takeshita Jun , Tachibana Kazuya , Nakajima Yasufumi , Nagai Gaku , Fujiwara Ai , Hamaba Hirofumi , Matsuura Hideki , Yamashita Tomonori , Shime Nobuaki
Published: June 2020

Objectives:

The aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia.

Design:

Prospective randomized controlled trial.

Setting:

Operating room of Osaka Women’s and Children’s Hospital.

Patients:

Pediatric patients less than 5 years old who underwent cardiovascular surgery.

Interventions:

Ultrasound-guided central venous catheterization using the long-axis in-plane approach and short-axis out-of-plane approach.

Measurements and Main Results:

The occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided central venous catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided central venous catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076–0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78–1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90–1.11; p = 0.98).

Conclusions:

The long-axis in-plane approach for ultrasound-guided central venous catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.
Caproicibacter fermentans gen. nov., sp. nov., a new caproate-producing bacterium and emended description of the genus Caproiciproducens
Authors: Flaiz Maximilian , Baur Tina , Brahner Sven , Poehlein Anja , Daniel Rolf , Bengelsdorf Frank R.
Published: June 2020

A strictly anaerobic bacterial strain designated EA1Twas isolated from an enrichment culture inoculated with biogas reactor content. Cells of strain EA1Tare spore-forming rods (1–3×0.4–0.8 µm) and stain Gram-negative, albeit they possess a Gram-positive type of cell-wall ultrastructure. Growth of strain EA1Twas observed at 30 and 37 °C and within a pH range of pH 5–9. The major components recovered in the fatty acid fraction were C14:0, C16:0, C16:0DMA (dimethyl acetal) and C16:1ω7c. Strain EA1Tfermented several mono- and disaccharides. Metabolic end products from fructose were acetate, butyrate, caproate and lactate. Furthermore, ethanol, CO2and H2were identified as products. The genome consists of a chromosome (3.9 Mbp) with 3797 predicted protein-encoding genes and a G+C content of 51.25 mol%. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain EA1Trepresents a novel taxon within the familyOscillospiraceae. The most closely related type strains of EA1T, based on 16S rRNA gene sequence identity, areCaproiciproducens galactitolivoransBS-1T(94.9 %), [Clostridium]leptumDSM 753T(93.8 %), [Clostridium]sporosphaeroidesDSM 1294T(91.7 %) andRuminococcus bromiiATCC 27255T(91.0 %). Further phenotypic characteristics of strain EA1Tdifferentiate it from related, validly described bacterial species. Strain EA1Trepresents a novel genus and novel species within the familyOscillospiraceae. The proposed name isCaproicibacter fermentansgen. nov., sp. nov. The type strain is EA1T(DSM 107079T=JCM 33110T).
In vitro synergistic activity of the sulbactam/avibactam combination against extensively drug-resistant Acinetobacter baumannii
Authors: Rodriguez Carlos Hernán , Brune Adriana , Nastro Marcela , Vay Carlos , Famiglietti Angela
Published: June 2020

Introduction. The therapeutic options to treat

Acinetobacter baumannii

infections are very limited.

Aim. Our aim was to evaluate the activity of sulbactam combined directly with avibactam or the ampicillin-sulbactam/ceftazidime-avibactam combination against extensively drug-resistant

A. baumannii

isolates.

Methodology. Extensively drug-resistant

A. baumannii

isolates (n=127) collected at several South American hospitals were studied. Synergy with the sulbactam/avibactam combination was assessed in all isolates using the agar dilution method. Avibactam was used at a fixed concentration of 4 mg l−1. A disc diffusion synergy test was also performed. Synergy by a time-kill experiment was performed in a selected isolate.

Results. Synergy with sulbactam/avibactam was demonstrated in 124 isolates and it showed MIC values ≤4 mg l−1. This synergy was not detected in the three New Delhi metallo-β-lactamase-harbouring isolates. Similar results were observed with the disc diffusion synergy test of ampicillin-sulbactam/ceftazidime-avibactam. In the time-kill experiments, sulbactam/avibactam showed a rapid synergistic and bactericidal activity in ampicillin-sulbactam-resistant isolates.

Conclusions. This study demonstrated that the sulbactam/avibactam combination displayed synergistic activity against

A. baumannii

isolates. This synergy was observed when both inhibitors were also used as part of the commercially available combinations: ampicillin-sulbactam and ceftazidime-avibactam.