bluuebunny/crossref_metadata_2025 huggingface dataset:
O01 Nuances of implementing antibiotic stewardship in high-prescribing English general practices: an implementation study
Authors: Tonkin-Crine Sarah , McLeod Monsey , Borek Aleksandra , Campbell Anne , Anyanwu Phillip , Costelloe Ceire , Moore Mike , Hayhoe Benedict , Butler Chris C , Holmes Alison , Sarah Walker A
Published: June 2022

Background

Trials have identified several antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England and evidence is lacking around how to support high-prescribing general practices to implement AMS. We co-developed a customizable implementation intervention to improve adoption and use of three AMS strategies; enhanced communication strategies with/without patient leaflets, delayed prescriptions, and point-of-care C-reactive protein testing (POC-CRPT). This study aimed to investigate the use of the implementation intervention in high-prescribing practices and its effect on antibiotic prescribing.

Methods

Nine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via the ‘Antibiotic Optimisation’ website with practices required to identify an in-practice ‘Antibiotic Champion’. In a mixed-methods evaluation, we compared routinely collected prescribing data between 9 intervention and 45 matched control practices using a difference in differences analysis. Intervention material use was assessed through website monitoring and practice requests for supplies. Surveys and interviews were conducted with professionals at baseline and follow-up timepoints to capture experiences of using the intervention.

Results

There was no evidence that the intervention affected antibiotic prescribing. Engagement with intervention materials differed substantially between practices and depended on the individual Antibiotic Champion's preconceptions regarding the AMS strategies and opportunity to do the implementation tasks. Champions in five practices initiated changes to encourage use of at least one of the three AMS strategies, mostly POC-CRPT and patient leaflets. One Champion used the website resources to drive discussions about implementation of all three strategies in their practice. Elsewhere, lack of website engagement meant clinicians did not recognize novelty in the communication and delayed prescription content. POC-CRPT was used most often when equipment was allocated to one person in a practice.

Conclusions

AMS strategies are complex interventions and require clinicians to have detailed knowledge on how to adopt them in practice if they are to reduce antibiotic prescribing. Successful adoption may be achieved by allocating one or two persons to use an AMS strategy rather than all clinicians. Although effective in trials, remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.
O02 TRAIL, IP-10, CRP host-protein signature score distinguishes between viral and bacterial infection in sepsis patients
Authors: Stas Jeroen , Arias Cesar A , Bachur Richard , Esposito Susanna , Halabi Salim , Kaplan Sheldon K , Klein Adi , Motov Sergey M , Rothman Richard , Ryan Leticia M , Shiber Shachaf , Tenenbaum Tobias , Weissman Alexandra
Published: June 2022

Background

Sepsis is a life-threatening organ dysfunction syndrome caused by the body's response to infection. Timely and appropriate sepsis management, including appropriate treatment of bacterial infection, improves outcomes. MeMed BV (BV), a test for differentiating between bacterial and viral infection, is based on computational integration of the circulating levels of three proteins (TRAIL, IP-10, CRP). Here we evaluate its ability to differentiate bacterial from viral infection in sepsis patients.

Methods

This was a sub-analysis of sepsis patients recruited prospectively in the Apollo study (NCT04690569). Apollo eligibility required the attending physician's clinical suspicion of acute infection and reported fever. Sepsis was defined as two or more SIRS criteria and a suspected bacterial or viral infection classified by expert adjudication. A bacterial or viral classification required at least 2/3 experts to assign the same aetiology label with confidence ≥90% or all 3 assign with confidence ≥70%. BV was measured using a platform generating a bacterial likelihood score (0–100). Based on pre-defined thresholds, scores 0–34 indicated viral (or other non-bacterial) infection, scores 35 to 65 were equivocal and 66–100 indicated bacterial infection (or coinfection). BV performance was assessed against expert panel classifications.

Results

Seventy-nine out of 1016 eligible Apollo patients had missing heart rate and respiration rate data and a further 136 could not be classified by the experts. Out of the remaining 801 patients, 217 adults with median age of 41.8 years (IQR: 29.2–61) and 149 children with median age of 2.4 years (IQR: 1.4–5.4) had two or more SIRS criteria. A total of 119 patients had at least three SIRS criteria and 39.6% (145/366) of the patients were hospitalized with a median duration of 4 days (IQR: 3–6 days). In the sepsis cohort, 91 patients were classified as bacterial and 275 as viral. BV yielded sensitivity and specificity of 98.8% (95% CI: 93.6%–100%) and 89.7% (95% CI: 85.3%–93.2%) and NPV of 99.6% (95% CI: 97%–99.9%), outperforming PCT [cut-off 0.5 ng/mL; sensitivity 52.8% (95% CI: 42%–63.3%); specificity 86.2% (95% CI: 81.5%–90%); NPV 84.6% (95% CI: 81.5%–87.3%)].

Conclusions

BV accurately distinguished bacterial from viral infection in sepsis patients. This new triage tool has the potential to help with timely identification of bacterial infection, enabling prompt treatment.
P04 Solution fundamentals are lacking: time to seek practical ways to tackle the AMR crisis in Sudan and other similar settings
Authors: Ahmed Rehab
Published: June 2022

Background

A flood of data is showing that the silent pandemic is no longer silent. It is already here and impacting the entire world and is particularly severe in low- and middle-income countries.

Objectives

To highlight the scarcity of data about antimicrobial resistance (AMR) in Sudan, which is now devastated by the political unrest. Simultaneously the review is calling attention to the day-to-day deterioration in the infrastructural foundation necessary to combat AMR.

Methods

The review spans different topics related to AMR. It includes data and epidemiology of antimicrobial resistance, awareness and education about AMR, awareness about immunization, healthcare infrastructure, pharmacists’ viewpoints of their current roles in the healthcare.

Results

Few data about AMR are published. Resistance is reported mostly based on phenotypic data. Huge gaps in the knowledge, awareness and the curricula are evidenced to be present even among medical and veterinary students. Inefficiency of regulatory bodies and lack of coordination between them is reported. Published data reflect a wide acceptance of immunization in children under 5 years old. Pharmacists are unsatisfied by their current jobs and are ready to participate better in healthcare.

Conclusions

The radical solutions to AMR entail building robust infrastructure for healthcare and acquiring political will, which are currently and in the foreseeable future impractical and unattainable. However, solution opportunities still exist. I see three main opportunities represented in pharmacists, immunization programmes and non-profit organizations, mainly WHO. A great deal of potential lies in the sector of pharmacists. There is a substantial number of them who are willing to contribute better to healthcare. One example is the effective engagement of pharmacists who are graduating in high qualifications and education while doing minor roles. Their engagement could be incentivized by considering the participation part of their professional growth. Contrary to the case of adults, immunization of children under 5 years is accepted and implemented largely in Sudan even in remote areas. This is the second potential solution that is worthy of investment and would pay off. WHO and similar organizations at the very least could play the role of the missing coordinator, or even better they could devise pioneering know-how programmes ready to be implemented in these countries. In these programmes, WHO will be able to attract a lot of qualified volunteers to participate in awareness and education campaigns. They also could engage higher education institutions and ministries of health.
P06 The use of procalcitonin testing to improve antibiotic stewardship in all cause respiratory admissions: a retrospective analysis
Authors: Paterson S , Carey K , Murray E M , McCarron E , Rafferty P , Smyth B , Brady A , McKeeman G , Ryan K , Kidney J , Ong G
Published: June 2022

Background

Improving antibiotic stewardship whilst simultaneously optimizing patient safety is a perpetually vexing clinical conundrum, which has been compounded by the current COVID-19 pandemic. Procalcitonin (PCT) measurement has previously demonstrated utility in this regard, when combined with routine clinical investigation, in certain patient populations.

Objectives

To assess whether the inclusion of PCT measurement as part of routine clinical care, instituted during a quality improvement project (QIP), increases the appropriateness of antibiotic administration.

Methods

A retrospective analysis was performed on 6 month interim data obtained from May to October 2021 during a QIP, which assessed the effect of PCT measurement on antimicrobial stewardship. All patients included had a primary diagnosis of respiratory illness and were analysed both together and as COVID-19 and non-COVID-19 subgroups to assess how often antibiotics were commenced on admission, duration of treatment and appropriateness of use. Finally, as sending microbiological samples made up part of the protocol, sample sending frequency was also studied.

Results

Thirty patients were included in both the COVID-19 and non-COVID-19 baseline subgroups who did not have PCT testing performed. Fifty-two patients were included in the PCT subgroup (27 COVID-19 positive and 25 COVID-19 negative). Following introduction of PCT testing, commencement of antibiotics on admission was reduced overall and in the COVID-19 positive subgroup (P = 0.0426 and P = 0.0446, respectively) with a significant decrease in inappropriate antibiotic prescribing in these two groups (P = 0.011 and P = 0.0157, respectively) and a trend towards reduced prescribing of AWaRe watch group antibiotics such as ceftriaxone. However, once prescribed, there was no difference in duration of antibiotic treatment or the frequency of microbiological sampling.

Conclusions

The data from this interim data analysis demonstrate that PCT measurement, when combined with routine clinical investigations in the acute respiratory setting, can be used to reduce inappropriate antibiotic prescribing. This was significantly reduced overall and in the COVID-19 positive subgroup but lost statistical significance in the COVID-19 negative subgroup, where it could be hypothesized that heterogeneity and inclusion of respiratory diseases where PCT has previously encountered difficulty in determining the presence of acute bacterial infection may be the cause. The significant effect demonstrated in the COVID-19 positive subgroup suggests particular utility in this patient population.
P12 Antibiotic prescribing in hospitalized patients with COVID-19 as a function of inflammatory markers in Wave 1 versus Wave 2: a systematic review
Authors: Chatoo Saif Abbas , Thomas-Jones Emma , Pallmann Philip , Euden Joanne
Published: June 2022

Background

Less than 10% of hospitalized cases in the United Kingdom during the first wave of the pandemic had bacterial coinfection, but approximately 75% were prescribed antibiotics contrary to NICE guidelines. We have evaluated the relationship between antibiotic prescribing and biomarker use, in hospitalized adult patients with COVID-19 in the UK, as synthesis defined by the pandemic timeline, particularly during ‘Wave 2’ is lacking. Clinical outcomes were compared in the context of antimicrobial stewardship. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and white cell count (WCC) were selected based on clinical relevance.

Methods

Studies (n = 300) dated 2019–22 were identified via EMBASE and Web of Science databases, using relevant search terms. Wave 1 and Wave 2 parameters were defined by the Office for National Statistics. Literature selection was organized by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). PROSPERO registration was commenced mitigating unplanned duplication. Diagnostics, prescribing, clinical outcomes and demographics were tabulated. Ten percent of studies were cross-checked.

Results

Final selection criteria yielded 29 papers, of which only 4 were from Wave 2. Cohort and retrospective studies accounted for 69% and 80%, respectively. Heterogeneity of studies prevented a meta-analysis. Determining disease severity or coinfection was the focus of ( n= 6) studies. The papers referencing WCC (n = 12) established that leucocytosis, like elevated CRP, was an efficient marker for bacterial infections. Additionally, CRP >100 mg/L was associated with increased prescribing. Another common theme was cut-off values to escalate (n = 9) or de-escalate (n = 12) prescribing. In PCT papers (n = 14), common de-escalation cut-offs were 0.25 ng/mL and 0.50 ng/mL. Lower admission PCT was associated with decreased mortality, admission duration and ICU admission rate. ESR use was unevaluable as it was only mentioned in one case study. During Wave 2, the use of immunomodulatory therapy may have contributed towards lower inflammatory markers. Hospital stays decreased while ICU duration increased. In ICU patient studies (n = 4) biomarker testing was more frequent. The higher 0.50 ng/mL PCT cut-off was employed but with higher mortality and ventilation rate.

Conclusions

More studies of Wave 2 cohorts are required. A weakness of the evidence base is that cohort study outcomes were reported in varying detail, a potential consequence of the need for rapidly published evidence. Nonetheless, PCT and CRP were demonstrated to be useful as prognosis indicators on hospital admission, and in timely antibiotic prescribing. Updated national guidelines should include standardized biomarker thresholds to improve antimicrobial stewardship.
P13 Every patient who could have OPAT, should have OPAT—the importance of data
Authors: Williams Steph , Bolton Hannah , Nye Rachel , Watson Millie , Wood Alli , Cole Ann
Published: June 2022

Background

Outpatient parenteral antimicrobial therapy (OPAT) has a clear role to play in optimizing antimicrobial stewardship and is listed as one of the Department of Health's five options for antimicrobial prescribing decision options to focus therapy. York and Scarborough Teaching Hospital NHSFT OPAT service has been operational since January 2019, treating over 438 patients and demonstrating year-on-year growth. Growth has been progressive, however a department vision established in 2021 stretched this to seek that ‘Every patient that could have OPAT, should have OPAT’—an ambitious target but not impossible with a robust evaluation of the service and a structured approach to scale.

Objectives

An in-depth assessment to understand the current OPAT service and to identify pathways for further expansion together with potential efficiency and productivity gains.

Methods

Working in partnership with Baxter Healthcare, a 3 month diagnostic process was undertaken with the multidisciplinary team, using a range of service and quality improvement tools to inform an in-depth assessment. A clear picture of the OPAT current state was developed through: (i) outcomes analysis; (ii) insights: pathway mapping and system flow; (iii) insights: patient experience; and (iv) insights: point of use.

Results

The assessment of OPAT services provided a clear demonstration of how the service has grown from 8.4 patients per month in 2019 to 20.8 in 2020 and 27.4 in 2021, saving over 10 500 bed-days in line with the department vision and antimicrobial stewardship team goals (Figure 1). Multiple metrics have been included demonstrating clear service expansion opportunities and growth as evidenced from an initial focus on vascular, surgical and orthopaedic patients, to now include provision for patients with diabetic foot infections, bronchiectasis and intra-abdominal infections. The service has significant peaks and troughs, impacted by a number of factors impacting capacity and flow including resource, points of referral and the ability to identify patients. The OPAT Good Practice Recommendation (GPR) Assessment Tool was utilized to review overall compliance with the BSAC OPAT GPRs and to plan further improvement initiatives.

Conclusions

Moving forward the focus is on predictability for sustainable growth creating a more consistent service, with multiple care pathways optimized to meet individual patient needs across North Yorkshire. The Baxter partnership has offered the Trust an opportunity to understand the service potential and meet their ambitious vision. Ultimately the goal is for 75% of patients in the OPAT service to be on a self-care pathway, thus releasing time to care.
P14 The antibiotic resistance profile of bacteria causing acute respiratory tract infections in Khartoum, Sudan
Authors: Faisal Shima , Suliman Mohmed A , Elnima Elamin , Ahmed Rehab
Published: June 2022

Background

Acute respiratory tract infections (ARTIs) are the most common indication for antibiotic prescriptions. This is associated with irrational prescription and correlated with antimicrobial resistance especially in low-income countries including Sudan. This is a cross-sectional study aimed at identifying bacterial pathogens causing ARTIs and their susceptibility to the commonly prescribed antibiotics.

Methods

Bacterial pathogens (51 isolates) were obtained from 29 ARTI patients from two hospitals in Khartoum in the time period March 2021 to March 2022. Samples were collected from each patient using both nasopharyngeal and oropharyngeal swabs. They were then cultured using blood and chocolate agar. The isolated colonies were identified using Gram staining technique, biochemical test, and selective media. Antibiotic susceptibility tests (AST) were done using the Kirby–Bauer disc diffusion susceptibility test protocol. Susceptible strains were determined following CLSI guidelines. The susceptibility of isolates was determined for different antibiotics representing the important classes including co-amoxiclav, cefixime, penicillin G, oxacillin, ceftriaxone, erythromycin, levofloxacin, ciprofloxacin and meropenem.

Results

Isolates were found to be mostly (82.3%) Gram positive (Staphylococcus aureus and Streptococcus pyogenes). Pseudomonas aeruginosa was the most abundant (17.9%) Gram-negative bacteria. S. aureus isolates were found to be 100% susceptible to levofloxacin, ciprofloxacin and meropenem. S. aureus exhibited less susceptibility to ceftriaxone (75%), and the least susceptibility to co-amoxiclav (37.5%), cefixime (31.3%), oxacillin (18.8) and erythromycin (25%). S. pyogenes isolates were found to be completely susceptible (100%) to co-amoxiclav, levofloxacin, ciprofloxacin and ceftriaxone. S. pyogenes had less susceptibility to vancomycin (92%), and the least susceptibility to cefixime (38.5%) and erythromycin (26.9%). P. aeruginosa isolates were found to be 100% susceptible to levofloxacin, ciprofloxacin and ceftriaxone, with less susceptibility to ceftriaxone (66%) and the least susceptibility to co-amoxiclav (22.2%), cefixime (33.3%), erythromycin (11.1%), vancomycin (11.1%) and oxacillin.

Conclusions

Co-amoxiclav is extensively used in Sudan empirically. The results show that S. aureus and P. aeruginosa are increasingly becoming resistant to this drug. However, S. pyogenes is still susceptible to it. Conversely resistance to erythromycin and cephalosporins is shown in all the different isolated species, however these drugs are still widely used without even culture and ASTs. Luckily, non-susceptibility to ciprofloxacin and levofloxacin was not detected here. Obviously, laboratory identification and ASTs are much needed along with surveillance programmes in hospitals. Together with rational use of antibiotics these measures will help to slow down the progress of the deadly AMR pandemic.
P18 Antimicrobial resistance patterns of Campylobacter species isolated from poultry in Mathira, Nyeri County, Kenya
Authors: Chege Edith
Published: June 2022

Background

Campylobacter species are zoonotic pathogens recognized as a cause of gastroenteritis in the human population and pose a major public health threat worldwide. The most important in the genus is Campylobacter jejuni, which causes diarrhoea in patients, mainly children under the age of 1 year, young adults and immunosuppressed persons. Campylobacter occurs in the gut of most animals as normal flora and is transferred to foods from the faeces during slaughter. It is acquired through consumption of undercooked poultry and other meat as well as water and unpasteurized milk. Fruits and vegetables can be contaminated from water containing faeces from birds and other animals. Campylobacter can also be transmitted through contact with dogs and cats’ faeces as well as drinking contaminated water. Campylobacter infections are common in low- and middle-income countries as well as developed countries.

Objectives

To assess the prevalence and determine the antimicrobial resistance patterns of Campylobacter spp. from poultry in Mathira Sub-County, Nyeri County.

Methods

A total of 380 cloacal swabs were collected randomly form 57 farmers in Mathira, Kenya. They were transported in sterile Amies charcoal swabs under cold chain and stored at 4°C. They were enriched in Preston broth and incubated for 24 h at 42°C, after which they were streaked onto mCCDA agar and incubated for 24 h at 42°C under microaerobic conditions generated by Campy Gen™ packs. Typical grey moist, swarming and discrete colonies were identified using MALDI-TOF. Antimicrobial susceptibility testing was done on ampicillin, tetracycline, ciprofloxacin, gentamicin, erythromycin and nalidixic acid by the disc diffusion method and disc diameters were measured and interpreted using the CLSI guidelines.

Results

In total, 272 out of 380 (71.32%) isolates were Campylobacter; 190 (50%) were C. jejuni while 81 (22) were Campylobacter coli. Resistance to ampicillin was 40% for C. coli and 30.53% for C. jejuni. Overall, 53.75% of C. coli isolates and 51.85% of C. jejuni isolates were resistant to tetracycline. We found 67.50% of C. coli were resistant to ciprofloxacin as compared with 38.42% of C. jejuni. Resistance to erythromycin for C. coli and C. jejuni was 10% and 16.935%, respectively. Finally, 65% of C. coli was resistant to nalidixic acid as compared with 38.42% of C. jejuni.

Conclusions

The study found that Campylobacter spp. show high levels of resistance to tetracyclines, ciprofloxacin and nalidixic acid and are MDR. Resistance to gentamicin and erythromycin is markedly low and these antibiotics can be reserved for treatment. Surveillance activities for AMR should be enhanced and laboratory capacity increased to support surveillance and diagnosis.
P20 Identification and detailed bio-evaluation of malabaricone B as a potent antistaphylococcal lead
Authors: Kaul Grace , Sivadas Neethu , Radhakrishnan K V , Chopra Sidharth
Published: June 2022

Background

The dearth of antimicrobials to treat MDR infections has led to search for novel moieties with potent activity. The most suitable compounds have been derived from mainly natural sources. In this context, the current study focused on identification and determination of antistaphylococcal activity of malabaricone B (MB), one of the naturally abundant secondary metabolites (malabaricones A–D) present in the Myristicaceae family. Malabaricones have previously been reported to possess various biological activities including antimicrobial activity but prospects of its effective utilization against Staphylococcus aureus infections in particular have not been explored in detail to the best of our knowledge.

Methods

Malabaricones (A–D) were screened against an ESKAPE pathogen panel via broth microdilution assays. The hit compounds were then tested against Vero cells via MTT assays to determine their selectivity index. As the next step, their activity against clinical drug-resistant strains was evaluated. Further, time–kill kinetics against S. aureus were determined along with the ability to synergize with approved drugs via chequerboard assays, which was further validated via combination time–kill kinetics assays. The hit compound's in vitro post-antibiotic effect (PAE) and propensity to generate resistance to S. aureus was determined. Its activity against intracellular S. aureus in a J774 macrophage model of infection and ability to eradicate pre-formed S. aureus biofilms in vitro was ascertained. Finally, the hit compound's in vivo efficacy was determined in a murine neutropenic S. aureus thigh infection model.

Results

Amongst the hits identified, MB demonstrated a potent in vitro antistaphylococcal profile including equipotent activity against clinical MDR S. aureus and Enterococcus sp. with MIC 1–2 mg/L. MB exhibited concentration-dependent bactericidal activity with complete killing at 5 × MIC within 15 min of exposure with no regrowth up to 24 h. MB also displayed PAE of ∼22 h at 10 × MIC. It also has very low propensity for generation of resistance to S. aureus ATCC 29213. MB significantly eradicated pre-formed S. aureus biofilms and reduced intracellular S. aureus in the J774 macrophage infection model as well. MB strongly synergized with gentamicin at 1 × MIC in vitro with complete killing at 24 h as compared with untreated S. aureus. MB also possessed significant in vivo activity against S. aureus at 50 mg/kg BID dose with ∼0.5 log10 cfu/g reduction in thigh compared with untreated mice.

Conclusions

MB demonstrates the potential to be further developed for infections caused by S. aureus owing to its excellent in vitro and in vivo activity.
Medroxyprogesterone acetate in reindeer bulls: testes histology, cfos activity in the brain, breeding success, and semen quality
Authors: Rowell Janice E , Blake John E , Roth Kathleen M , Sutton Courtney M , Sachse Colleen C , Cupp Andrea S , Geary Thomas W , Zezeski Abigail L , Alexander Brenda M , Ziegler Robert L , Shipka Milan P
Published: June 2022

A previous study reported that a 400-mg dose of medroxyprogesterone acetate (MPA) reduced male reindeer aggression and blocked development of secondary sexual characteristics but did not completely impair fertility. Here we have repeated that protocol in two separate trials. In 2017, tissues and blood samples, collected from MPA and control (CTL) reindeer bulls, euthanized at 30 and 60 d post-treatment were used to evaluate testes histology and morphometrics, cfos activity in the brain and androgen levels. While testes weight tended to decline from August to September in both groups, indices of spermatogenesis remained high. By September, indices of spermatogenesis were declining in both groups with sperm density lower (P = 0.05) in MPA compared to CTL bulls. Aug CTL bulls had the highest concentrations of androstenedione (A4) (P = 0.009) and testosterone (T) (P = 0.08), whereas these androgens were baseline in Aug MPA bulls. By September, A4 and T levels in CTL bulls declined to levels measured in MPA bulls. Cfos activity had a greater number (P = 0.02) of cfos positive neurons in the central amygdala in MPA compared to CTL bulls, suggesting a heightened fear response among the MPA bulls. In the second trial (2019), MPA-treated bulls, with (E, n = 4) and without (IE, n = 4) breeding experience, were blood sampled at key points from July through September when they were put in individual harems with estrous-synchronized cows. Concentrations of T were greatest (P < 0.001) among E bulls prior to MPA treatment but 1 mo after treatment, both T and A4 were baseline in all eight reindeer. Semen collected by electroejaculation at 60 d post-MPA treatment revealed only minor differences in sperm abnormalities between E and IE bulls using both fresh and frozen/thawed semen. Only three bulls (2 E and 1 IE) sired offspring. Breeding success was not related to previous breeding experience, body weight, or bull age. The failure of some MPA bulls to breed appears to be a behavioral, not a physiological, limitation. Limited application of MPA is clearly a useful tool for managing rut-aggression in non-breeding reindeer. However, the possibility that semen could be collected from MPA-treated bulls using restraint and mild sedation rather than general anesthesia should be investigated. This could improve the quality of semen collection while enhancing the safety of both handlers and animals.
Performing Plainness in Sarah Stickney Ellis’s Friends at Their Own Fireside: Or, Pictures of the Private Life of the People Called Quakers
Authors: Albassam Mona
Published: June 2022

While Quaker plainness has encapsulated multiple positive meanings such as piety, worldliness and even human equality, many were attentive to its rootedness in social discipline and surveillance. Drawing on nineteenth-century assessments of Quaker plainness, both in journals and fiction, this article explores the dynamics of self-fashioning and performance that are exposed to be an important part of these bodily experiences of Quaker plainness. Plainness is not only self-disciplining but also controls the social and visual dynamics of displaying, seeing, and interpreting the body. Sarah Stickney Ellis’s Friends at Their Own Fireside: Or, Pictures of the Private Life of the People Called Quakers (1858) provides an intriguing account of the private experiences of plain Quaker women and their resistance to forms of social control and scrutiny. I use the context of this novel to examine the subjective experience of Quaker women as wearers of plain dress in ways that expose their agency and involvement in observing and adhering to these codes rather than completely or obliviously succumbing to social authority and control. The exploration of female plainness in this novel, as I will argue, confounds the notions of discipline attached to Quaker plainness, and instead brings to light women’s agency in navigating their identity and personal space in such a context.
A detailed analysis of the dynamics of fast neutrino flavor conversions with scattering effects
Authors: Sasaki Hirokazu , Takiwaki Tomoya
Published: June 2022

We calculate the dynamics of fast neutrino flavor conversions with Boltzmann collisions of neutrino scatterings in a homogeneous system. We find the enhancement or suppression of the flavor conversions in various setups of the collision terms. We analyze the mechanism of fast flavor conversions based on the motion of polarization vectors in the cylindrical coordinate analogous to a pendulum motion. The phases of the all the polarization vectors synchronize in the linear evolution phase, and the phase deviation from the Hamiltonian governs the neutrino flavor conversions. In a non-linear regime of flavor conversions, the collision terms induce a spiral motion of the polarization vector and gradually make the phase space smaller. The collision terms align all of the polarization vectors, and the flavor conversions eventually settle into equilibrium when the distributions of neutrinos become isotropic. Though our current analysis does not fully clarify the non-linear phenomena of fast flavor conversions, the framework of the pendulum motion gives a new insight into this complicated phenomenon that will be helpful in further studies.
Biochemical and Molecular Characterization of Prochloraz Resistance in Lasiodiplodia theobromae Field Isolates
Authors: Wang Chenguang , Xu Luxi , Liang Xiaoyu , Zhang Yu , Zheng HuiYing , Chen JunLiu , Yang Ye
Published: June 2022

Stem-end rot (SER), caused by Lasiodiplodia theobromae, is one of the most critical diseases of mango in China. The demethylation inhibitor fungicide prochloraz has been widely used in China to control mango diseases. Isolates (n = 139) of L. theobromae were collected in 2019 from six mango-producing regions in Hainan Province, China. The fungicide sensitivity of L. theobromae isolates to prochloraz revealed that the EC50 (50% effective concentration) values ranged from 0.0006 to 16.4131 µg/ml. In total, 21 of the 139 isolates were categorized as resistant to prochloraz. The resistant isolates sprayed with prochloraz could not be effectively controlled in detached fruit. The mycelial growth, conidia germination, and ability to grow at temperatures ranging from 12 to 35°C of resistant isolates decreased, suggesting fitness penalties. The experiment showed that, after treatment with prochloraz at 10 µg/ml, the content of ergosterol in the mycelia of the sensitive isolate decreased by 80.23%, whereas the resistant strain decreased by only 57.52%. The damage to membranes in the sensitive isolates was more serious than for resistant isolates. The target gene CYP51 and the ATP-binding cassette (ABC) subfamily ABCG gene were cloned but no mutation was found. When treated with prochloraz, the expression of CYP51 and ABCG in resistant isolates was significantly higher than in the sensitive isolates. Thus, induced expression of its target gene combined with the induction of expression drug efflux transporters appeared to mediate the prochloraz resistance of L. theobromae.
Prediction of Central Visual Field Severity in Glaucoma
Authors: Chakravarti Tutul , Moghimi Sasan , Weinreb Robert N.
Published: June 2022

Précis:

The severity of central visual field (VF) defects on 24-2 VF and related scotomas on 10-2 VF may be predicted by assessing perimetric defects at abnormal central 12 points on 24-2 VF in early glaucoma.

Purpose:

Investigating the association between perimetric parameters at abnormal central 12 points on 24-2 VF and the severity of central visual field defects (CVFDs) on 24-2 VF and related parafoveal scotomas on 10-2 VF.

Methods:

We examined 64 eyes of 56 glaucoma patients with CVFDs on 24-2 VF with a mean deviation better than −7 dB and completed 24-2 and 10-2 VF testing within 6 months. On the basis of 10-2 VFs’ pattern defects, eyes were grouped into 3: an arcuate parafoveal scotoma, severe defect; partial arcuate, moderate defect; and minimal defect. VF parameters at abnormal points (P<1%) within the central-most 4 and paracentral 8 points on total deviation/pattern deviation plots on 24-2 VF were analyzed to predict the severity of CVFDs.

Results:

Eyes with arcuate scotoma showed more functional loss than eyes without arcuate scotoma on 10-2 VF (P<0.001). A significant association was observed between abnormal 24-2 VF points’ (<1%) threshold sensitivity lower than 20 dB [odds ratio (OR)=7.2; P=0.002 and OR=5.1; P=0.003 for the central 4 and paracentral 8 points, respectively] and defect values worse than −15 dB (OR=8.0 and 5.6 for the central 4 and paracentral 8 points, respectively, P=0.005) with arcuate scotoma on 10-2 VF. Superior nasal defect in the central 5 degrees on 24-2 VF was significantly associated with an arcuate defect on 10-2 VF (P<0.001).

Conclusion:

Clinicians may predict the severity of CVFDs on 24-2 VF and parafoveal scotomas on 10-2 VF by measuring threshold sensitivities and defect values at abnormal central 12 points (<1%) on 24-2 VF in early glaucoma.
Applicability of the Greulich and Pyle bone age standards to Taiwanese children: A Taipei experience
Authors: Yuh Yeong-Seng , Chou Ting Ywan , Chow Jeffrey C.
Published: June 2022

Background:

The Greulich and Pyle (GP) method is one of the most common radiographic techniques for bone age (BA) assessment. The applicability of this method to ethnic populations outside of the United States has been investigated in several recent studies worldwide. Currently, limited data are available on the accuracy of the GP method for the Taiwanese population. The purpose of this study was to determine whether the GP standards are applicable to contemporary Taipei children.

Methods:

Clinical data from October 1, 2010, to March 31, 2020, were retrospectively collected from a general hospital in Taipei. BA was determined by a senior pediatrician and was reviewed by a senior pediatric radiologist according to the GP standards. Comparison of BA and chronological age (CA) was performed in children with body weight and height in the 15th to the 85th percentiles of normal children. Ethnic variations in the maturation process in the ulnar bone were investigated. All data were statistically analyzed.

Results:

In total, 2465 medical records were collected. After excluding those with diseases and unqualified data, 654 records of boys and 809 of girls were analyzed. In boys, the mean BA was significantly delayed between 6 and 9 years of age compared with the CA. In girls, the mean BA was generally advanced between 7 and 15 years of age. Ulnar bone maturation tended to be delayed in young boys.

Conclusion:

A significant discrepancy between CA and BA was observed in our population. Delayed ulnar bone maturation in young boys was confirmed. Children in Taipei exhibit a different maturation pattern than children on whom the GP standards were based.
Increased antibiotic exposure in early life is associated with adverse outcomes in very low birth weight infants
Authors: Chen Wen-Yin , Lo Yu-Cheng , Huang Po-Han , Chen Yu-Xuan , Tsao Pei-Chen , Lee Yu-Sheng , Jeng Mei-Jy , Hung Miao-Chiu
Published: June 2022

Background:

The use of antibiotics in the early lives of premature infants may alter the microbiota and influence their clinical outcomes. However, whether the administration of probiotics can influence these outcomes remains unknown. In our study, probiotics were routinely administered unless contraindicated. We explored whether increased antibiotic exposure with the routine use of probiotics was associated with necrotizing enterocolitis (NEC) or bronchopulmonary dysplasia (BPD).

Methods:

A retrospective cohort study was conducted, enrolling very low birth weight (VLBW) infants admitted between January 1, 2016, and March 31, 2020 to a medical center. Days of antibiotic exposure in the first 14 days of life were recorded. The primary outcomes were NEC and BPD. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable regression analyses to assess risk factors.

Results:

Of 185 VLBW infants admitted to the medical center, 132 met the inclusion criteria. Each additional day of antibiotic treatment was associated with increased odds of NEC (aOR, 1.278; 95% CI, 1.025-1.593) and BPD (aOR, 1.630; 95% CI, 1.233-2.156). The association remained in the NEC analysis after adjustment for probiotic use.

Conclusion:

Increased antibiotic exposure in the early lives of VLBW infants was associated with increased risks of NEC and BPD. The probiotics did not influence the outcomes. Our findings suggest that clinicians should be alerted to the adverse outcomes of antibiotic use in infants with VLBWs.
Use of expert consensus to improve the diagnosis and management of type 1 diabetes mellitus
Authors: Lin Chia-Hung , Tung Yi-Ching , Chang Tien-Jyun , Huang Chien-Ning , Hwu Chii-Min ,   for Taiwan Type 1 DM Consortium
Published: June 2022

Background:

Although type 1 diabetes mellitus (T1DM) is recognized as a catastrophic disease among the different types of diabetes, it is often confusedly diagnosed in clinical practice and difficult in care. The objective of this study is to reach a multidisciplinary consensus for the establishment of clinical recommendations on T1DM to optimize its undoubtedly diagnostic evaluation and transitional care.

Methods:

Scientific evidence was reviewed by a committee of researchers, based on which recommendations related to T1DM diagnosis were formulated. A two-round method was conducted to compare the opinions of a panel of 32 specialists (adult endocrinologists [53.1%], pediatric endocrinologists [43.8%], a diabetes educator for child and adolescent [3.1%]) on these issues.

Results:

The panel reached consensus on two of the six items discussed. The four items on which no consensus was reached were related to autoantibody detection and age of onset. Up to 80% of the panelists favored items related to the glucagon test and diabetic ketoacidosis history for T1DM diagnosis. Consensus regarding transitional care through diabetes educators was established.

Conclusion:

The assessment conducted by experts on T1DM showed a high level of professional agreement regarding the proposed diagnostic and transitional care recommendations. A comprehensive analysis of the latest evidence is warranted for the items on which consensus was not established.
Biological Response to Sintered Titanium in Left Ventricular Assist Devices: Pseudoneointima, Neointima, and Pannus
Authors: He Wenxuan , Butcher Jonathan T. , Rowlands Grant W. , Antaki James F.
Published: June 2022

Titanium alloys have traditionally been used in blood-contacting cardiovascular devices, including left ventricular assist devices (LVADs). However, titanium surfaces are susceptible to adverse coagulation, leading to thrombogenesis and stroke. To improve hemocompatibility, LVAD manufacturers introduced powder sintering on blood-wetted surfaces in the 1980s to induce endothelialization. This technique has been employed in multiple contemporary LVADs on the pump housing, as well as the interior and exterior of the inflow cannula. Despite the wide adoption of sintered titanium, reported biologic response over the past several decades has been highly variable and apparently unpredictable—including combinations of neointima, pseudoneoimtima, thrombus, and pannus. We present a history of sintered titanium used in LVAD, a review of accumulated clinical outcomes, and a synopsis of gross appearance and composition of various depositions found clinically and in animal studies, which is unfortunately confounded by the variability and inconsistency in terminology. Therefore, this review endeavors to introduce a unified taxonomy to harmonize published observations of biologic response to sintered titanium in LVADs. From these data, we are able to deduce the natural history of the biologic response to sintered titanium, toward development of a deterministic model of the genesis of a hemocompatible neointima.
Cell-free DNA in lung transplantation: research tool or clinical workhorse?
Authors: Keller Michael , Agbor-Enoh Sean
Published: June 2022

Purpose of review

Recent evidence indicates that plasma donor-derived cell-free DNA (dd-cfDNA) is a sensitive biomarker for the detection of underlying allograft injury, including rejection and infection. In this review, we will cover the latest evidence revolving around dd-cfDNA in lung transplantation and its role in both advancing mechanistic insight into disease states in lung transplant recipients as well as its potential clinical utility.

Recent findings

Plasma dd-cfDNA increases in the setting of allograft injury, including in primary graft dysfunction, acute cellular rejection, antibody-mediated rejection and infection. Dd-cfDNA has demonstrated good performance characteristics for the detection of various allograft injury states, most notably with a high negative-predictive value for detection of acute rejection. Elevated levels of dd-cfDNA in the early posttransplant period, reflecting molecular evidence of lung allograft injury, are associated with increased risk of chronic lung allograft dysfunction and death.

As a quantitative, molecular biomarker of lung allograft injury, dd-cfDNA holds great promise in clinical and research settings for advancing methods of posttransplant surveillance monitoring, diagnosis of allograft injury states, monitoring adequacy of immunosuppression, risk stratification and unlocking pathophysiological mechanisms of various disease.
A Simple, Atraumatic Technique for Tendon Retrieval and Holding During Tendon Repair
Authors: Chakraborty Sourabh Shankar , Sahu Ranjit Kumar , Acharya Sudeshna
Published: June 2022

In this report, we describe an atraumatic technique that can be used intraoperatively to hold and retrieve tendons during tendon repair procedures. To use this technique, the surgeon transfixes a 24-gauge needle 1.5–3.5 cm from the cut ends of the tendon and then uses a Kocher artery curved forceps to loop the end of the needle upon itself up to 180°. The surgeon can then use the needle to retrieve or hold the tendon during the repair. This simple, low-cost technique can be very effective and efficient when used in primary care centers, emergency departments, or other treatment areas.
The Effect of Preoperative Fiber on Postoperative Bowel Function After Pelvic Reconstructive Surgery: A Randomized Controlled Trial
Authors: Maheshwari Deepali , Hall Cynthia D. , Jia Xibei , Tangada Abhilasha , Wu Emily K. , Leung Katherine , Flynn Michael K.
Published: June 2022

Importance

There are limited studies evaluating the effect of preoperative interventions on postoperative bowel function after prolapse surgery.

Objective

The objective of this study was to evaluate if preoperative fiber intake reduces time to first bowel movement after surgery for pelvic organ prolapse.

Study Design

We performed a randomized controlled trial of women undergoing pelvic organ prolapse surgery between July 2019 and May 2021. Participants were recruited at their preoperative visit and randomized to receive either 3.4 g psyllium fiber supplementation twice a day for 1 week before surgery or no fiber supplementation before surgery. Postoperative bowel regimen was standardized for both groups. Participants completed a bowel diary for their first postoperative bowel movement after surgery characterized by the Bristol Stool Scale and any associated pain or urgency. The primary outcome was time to first bowel movement. Secondary outcomes included pain associated with first bowel movement.

Results

Eighty-four patients were enrolled in the study. Seventy-one patients had complete data for primary analysis, with 35 patients in the intervention group and 36 patients in the control group. Demographic and perioperative characteristics were similar between the groups. There was no difference found between the groups with respect to time to first bowel movement (control: 68.3 [SD, 25] hours vs intervention: 66.5 [SD, 23] hours, P = 0.749). There was no difference found with pain associated with first bowel movement (visual analog scale median [interquartile range] control: 2.0 [0.0–4.0] vs intervention: 2.0 [1.0–4.0]; P = 0.655).

Conclusions

Preoperative fiber supplementation before prolapse surgery does not improve time to first bowel movement after surgery.
Nocardioides panacis sp. nov., isolated from soil of a ginseng field
Authors: Park Yuna , Liu Qingzhen , Maeng Soohyun , Choi Won Jung , Chang Yoonjee , Im Wan-Taek
Published: June 2022

A bacterial strain designated as G188T was isolated from ginseng field soil in the Republic of Korea. Phylogenetic analysis of 16S rRNA gene sequences showed that strain G188T formed a distinct lineage within the genus Nocardioides, family

Nocardioidaceae

, order

Propionibacteriales

. Sequence similarity revealed that strain G188T was most closely related to

Nocardioides iriomotensis

IR27-S3T (97.7 % 16S rRNA similarity). The genome size of strain G188T was 4 901 775 bp, and the genomic DNA G+C content was 72.3 mol%. The average nucleotide identity and DNA–DNA hybridization values with other

Nocardioides

species were less than 75.6 and 20.1 %, respectively. The main fatty acids of strain G188T were C17 : 0, C17 : 1
 ω8c and iso-C16 : 0. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol, and phosphatidylinositol, and the major respiratory quinone was menaquinone 8, supporting that strain G188T was affiliated with the genus

Nocardioides

. Based on biochemical, chemotaxonomic and phylogenetic analyses, the novel species Nocardioides panacis G188T (KACC 21695T=LMG 31733T) is proposed.