bluuebunny/crossref_metadata_2025 huggingface dataset:
Nizar Qabbani
Authors: Barakat Ahmad
Published: June 2020

Nizar Qabbani was a Syrian poet, publisher, and diplomat. He was largely considered Syria’s national poet, and one of the most prominent contemporary figures in the Arab world. Born in Damascus on 21 March 1923, he studied law at Damascus University. After graduating in 1945, he worked for the Syrian Foreign Ministry, serving in several capital cities, including Beirut, Cairo, Istanbul, Madrid, and London. By the time he tendered his resignation in 1966, he had established a publishing house in Beirut, which carried his name. He died in London on 30 April 1998, and was buried in Damascus. His work was featured not only in his two dozen volumes of poetry and in regular contributions to the Arabic language newspaper Al-Hayat, but also in lyrics sung by Syrian, Lebanese, Egyptian, Iraqi, and other vocalists who helped popularize his work. He is one of the major Arab writers to have sparked major controversy and instigated change in Arab societies.
Ruzante Angelo Beolco
Authors: Carroll Linda
Published: June 2020

While much of the Italian literary world of the 16th century turned to measured Petrarchan modes expressed in stylized Tuscan, Angelo Beolco (b. c. 1494–d. 1542) (better known by his stage name Ruzante, Tuscanized by others as Ruzzante) wrote comic theatrical works of raw realism largely in regional dialects. Vaunting the “natural,” they featured the peasant Ruzante played by Beolco, the natural (illegitimate) son of a wealthy Paduan doctor and university administrator and probably a servant close to rural roots. Illegitimacy excluding him from heirship, Beolco joined the household of Alvise Cornaro, a wealthy non-patrician Venetian who lived in Padua and developed its farmlands while patronizing the arts. Beolco set some of his works in the country, peopled solely by peasants; others, set usually in Padua or Venice, add prosperous urbanites and play on differing social backgrounds and linguistic uses. Many questions concerning the works’ chronology remain, with several bearing signs of extensive rewriting. The Pastoral, which refers to the reopening of the University of Padua after the devastating wars of the League of Cambrai (1509–1517), is generally regarded as his first work. In 1521 and possibly 1518, he delivered a comic oration to Marco Cornaro as bishop of Padua. From 1520 to 1526, Venetian diarist Marin Sanudo (Marino Sanuto) recorded Beolco’s performances in Venice, usually together with his acting troupe. Invited by compagnie della calza, the societies of patrician youth that organized festivities, he enacted his plays at Carnival (Pastoral, Lettera giocosa, and others) and once even at a Ducal Palace wedding. Sanudo remarked on his facility with peasant dialect and on the inappropriate bawdiness and political insolence of some works and their staging. However, patrician interest was so great that one rehearsal caused important government committee meetings to be cancelled because their members were attending it (Betia?). While earlier research proposed that Alvise Cornaro’s patronage took Beolco to Venice, recent scholarship has demonstrated that the patrician families sponsoring and attending Beolco’s performances had conducted important financial transactions beginning in the 1460s with the Beolco family, which, as the richest family in Milan, financed the Sforza and sent members to conduct business in Venice; owned country property contiguous with theirs purchased with them; and had members who knew his father at the University of Padua. With the war, famine, and plague of the latter 1520s, Beolco’s works portrayed the sufferings of the peasants (Seconda oratione, Reduce, Bilora, and Dialogo facetissimo). From 1529 to 1532 he performed at the Este court in Ferrara and in 1533 in Padua (versions of the Moschetta, Fiorina, Piovana, Vacaria). His final works re-proposed the moral superiority of peasants (here urbanized servants) against the artifice and degeneracy of wealthy characters (Anconitana, 1534–1535?) and evoked the mythically peaceful farm of Lady Mirth (Lettera all’Alvaroto, 1536). He died in 1542 while rehearsing his friend Sperone Speroni’s Canace.
Tasso Torquato
Authors: Geekie Christopher
Published: June 2020

Torquato Tasso (b. 1544–d. 1595) is best known today for his narrative poem Gerusalemme liberata (1581), often considered the first successful classical epic in the Italian vernacular. This work recounts the final year of the First Crusade (1099), combining a manifestly classical structure, based on the models of Virgil and Homer, with a profound attention to the passionate inner lives of its characters, both Christian and otherwise. Yet Tasso was a prolific writer, composing works across a wide range of genres, including lyric, pastoral, tragedy, as well as many philosophical dialogues. He was also an important theorist of poetic genre, working within a markedly Aristotelian paradigm. Born in Sorrento, Tasso traveled frequently in his youth among the courts of central and northern Italy accompanying his father Bernardo, a courtier and well-known poet. The younger Tasso later studied philosophy at the University of Padua, where he developed a substantial knowledge of Aristotelian philosophy. In the same period, he frequented literary salons, engaging enthusiastically in debates about literature. A precocious youth, Tasso published his first work, the chivalric romance Rinaldo (1562), when only eighteen years old. In the mid-1560s, his evident abilities led him to join the court of the powerful Este family in Ferrara, where he would compose his greatest works: the pastoral play Aminta (1573) and the epic Gerusalemme liberata (revised and completed by 1576). Following this period, his health, both physical and mental, began to deteriorate. In 1579, Alfonso II Duke of Ferrara imprisoned the poet in the Hospital of Sant’Anna, ostensibly for madness. During his confinement and after his eventual release in 1586, Tasso continued to write prolifically. He completed a large number of philosophical dialogues, the tragedy Il re Torrismondo (1587), a rewritten version of his epic known as Gerusalemme conquistata (1593), and the cosmological poem Il mondo creato (printed posthumously, 1607). During his lifetime, Tasso’s fame extended widely: Montaigne claims to have personally witnessed the poet’s “madness,” and Queen Elizabeth I was reported to have memorized sections of the Gerusalemme liberata and inquired about his health. Tasso’s work had an immediate influence not only on the course of European literature (such as on the works of Spenser, Cervantes, and Milton), but also on various other fields, including painting, music, and opera. This article offers an introductory bibliographical overview of Tasso, his large number of works, and his reception in literature and the arts.
Museum Education
Authors: Hein George E. , McCray Kimberly H.
Published: June 2020

Education has been associated with museums from their earliest days, back to the famous Hellenic Mouseion of Alexandria, a resource for scholars. The modern Western public museum’s origin is usually attributed to the 18th-century Enlightenment, when public institutions began to replace religious powers, guilds, and nobility in providing public services. By the mid-18th century the term museum referred to any kind of collection that was open to the public in theory, although admission was often restricted to upper-class visitors or scholars. Education frequently remained a minor activity compared to collection, preservation, research, and exhibition. Early efforts to reach broader audiences include Charles Willson Peale’s American Museum, which opened around 1800, and the British Victoria and Albert Museum, which opened in the mid-19th century. Museum education as an organized activity carried out by dedicated, trained staff did not arise until the 20th century and has come to prominence with its own professional associations, journals, and degree-granting academic programs only since World War II. Responsibilities of museum educators have shifted dramatically, going from mainly direct instruction to school pupils or lectures for adult visitors, to providing means for all visitors to interpret and make meaning of their museum experience. More recently, museums have reached out increasingly to communities to engage underserved populations and remain relevant at a time of dramatic social upheaval. These developments, described by some as a paradigm shift, have been influenced by increased recognition of 20th-century educational theories, criticism of traditional classification of objects, and increased recognition of the significance of people from different cultures as museum visitors. The results of museum visitor research (visitor studies), a field originally begun in the United States in the 1920s and heavily influenced by behaviorist educational theory, has also expanded over the past four decades to provide a larger range of methods to understand learning in and from museums. In the first two decades of the 21st century, museum educators have increasingly emphasized community engagement and broad accessibility to welcome an ever-wider range of visitors. Museum education has also expanded to include emotional responses, health, and well-being as desired outcomes of museum experiences. Advances in technology, especially the ability to greatly extend the possibility for visitors to rapidly gain information, interact with exhibitions, and share information or experiences, are also expanding our understanding of learning in museums and providing tools for museum educators to improve visitor experiences.
Economic Anthropology
Authors: Lockwood Peter , Smith Constance
Published: June 2020

Anthropology has a long and complicated history in Africa, and its study of economic life is no exception. In the early days of the discipline, in the 1930s and 1940s, anthropologists like Audrey Richards, Meyer Fortes, and E. E. Evans-Pritchard all departed for Africa to conduct fieldwork. In general, early British social anthropology was committed to holistic studies of small-scale societies, and thus what counted as “economic anthropology” was subsumed within broader studies of kinship and sociopolitical organization. Though later criticized by Manchester School anthropologists for their “bounding” of specific peoples, and by Marxist anthropologists for their neglect of “modes of production,” from a contemporary vantage point these early studies made the same point that anthropologists working in the substantivist tradition of Karl Polanyi also would: that the economy is embedded in social relations and practices. The growing influence of Marxist approaches from the 1960s, as well as growing sympathies between social anthropology and the historical study of Africa, introduced an appreciation of historical processes in the formation of local and regional economies. Feminist approaches expanded the frame of inquiry by demonstrating the gendered character of African economic life, and of the crucial role of women and households to markets and production. New analytical tools borrowed from political economy paved the way for studies of colonial economies—for instance, how the emergence of cash crop production shaped labor migration and land ownership, as well as the shift toward cash itself. The contemporary anthropological study of economic life in Africa has been transformed by pressing events in the latter part of the century—structural adjustment and economic liberalization, not to mention scholars’ identification of the “informal economy”—as key terrain for anthropological research. New attentiveness has been given to how Africans imagine and conceive of economic change, as well as the new types of wealth, credit, and debt brought about via access to foreign capital. The era of economic liberalization has transformed cities and African expectations of the future, sometimes in terms of improved living standards and “middle class” lifestyles, but also a growing disparity between rich and poor. Moving away from the narrative of crisis, newer work seeks to explore African attempts to pursue “the good life” amid ongoing economic turbulence. While anthropologists remain attuned to the effects of economic change, what continues to characterize their approach is an understanding of economies embedded in regional contexts, including their values and established practices.
Indigeneity
Authors: Aldama Arturo , Carroll Clint , Myhal Natasha , Ruiz Luz , Ruiz-Martinez Maria
Published: June 2020

Issues of indigeneity, along with mestizaje—racial and cultural mixtures of African, indigenous, and Spanish ancestries and cultures that came as a result of the European colonization of the Americas—are core aspects of Chicana and Chicano and Latina and Latino identities, histories, and cultures. For Chicanas and Chicanos, understandings of indigeneity have shifted significantly since the early 1960s. During that time, tropes of cultural nationalism argued that all Mexican-origin people were descendants of the Aztecs, and that Aztlán—what many believed to be the conquered homelands of their Aztec ancestors encompassing the Four Corners region of the United States (Utah, New Mexico, Colorado, Arizona)—should be reclaimed. Today, a more nuanced understanding of Latinx/Chicanx indigeneity considers, for example, the complex politics of indigenous subjects migrating to settler colonial nation-states such as the United States, and the resulting negotiations of language and identity in this transnational space. Scholars of decolonial studies have added to this nuance by analyzing systems of heteropatriarchy (and the resulting gender binaries and practices of toxic masculinity) imposed through colonization and reinforced by such institutions as the Catholic Church. The editors seek to assemble and summarize key sources that speak to how indigeneity works within the transnational and transborder archives of colonization. This includes the differentiated ways that nation-states in the Americas have engaged with their indigenous pasts (including the sociopolitical and legal definitions of and practices toward indigenous communities and nations within the nation-state), as well as indigenous-led revitalization and sovereignty movements that envision decolonial futures. The goals of this bibliographic overview are to provide scholars interested in indigeneity in the Latinx context with key sources specific to Latinx communities and histories, while also considering important works that are grounded in Latin American, US, and Canadian indigenous contexts and histories. This bibliography thus invites scholars to explore the legal, political, social, and historical differences and similarities of indigeneity across hemispheric geographies. By juxtaposing the radical feminism of Gloria Anzaldúa (writing from the US-Mexico borderlands) with the decolonial visions of Michi Saagiig Nishnaabeg scholar Leanne Simpson (writing from her Canadian First Nation) the disjunctures and commonalities of indigeneity and decolonial thought are highlighted. The bibliography also include some key texts on indigeneity in Mexico, Guatemala, Honduras, Peru, and Bolivia that discuss places where the majority populations are mestiza/o and indigenous, and yet most indigenous communities, many whose first language is not Spanish, live in varying degrees of dispossession, poverty, and racial marginalization. The bibliography also invites scholars to consider Afro-Indigenous identities and community struggles in hemispheric frames.
Meiji Painting
Authors: Weston Victoria
Published: June 2020

The Meiji period (1868–1912) is a watershed moment in Japan’s long history, marking a shift from indigenous governance organized around a shogun and regional lords (daimyō) to constitutional monarchy. In the Edo period (1603–1868), Japan had limited international relations as leadership sought to maintain tight domestic control. This famous “isolation policy” (sakoku) was porous, however; Japan traded with its Asian neighbors and with Holland, through which it gained European goods and insight into foreign affairs. The arrival of an American naval squadron led by Matthew Perry (1853) marked the beginning of Japan’s reintegration into wide international relations. External threats to Japan’s sovereignty and internal pressures shattered its feudal government, and rebellion replaced feudal lords with an oligarchy of advisors to the emperor (Meiji) and ultimately a parliament. Meiji is the period of Japan’s Westernization, when it sought to catch up with the West technologically and gain equal treatment through social and political reforms. In the arts, Westernization brought new forms of architecture and decoration, sculpture, and oil painting. The central problem of the period was the degree to which Japan should Westernize while still remaining Japanese. Japanese painting experienced the problem as a basic divide: tradition-based painting (nihonga) versus Western oil-based painting (yōga). Critical reception of Meiji art was both domestic and international, as this was the heyday of international expositions, and art was seen as an index to the quality of national culture. Critics and artists within Japan engaged in dynamic processes of exploration and assimilation; Western critics, alarmed by industrialization, saw assimilation as destructive of “traditional” culture. Western critics and collectors valued art in two qualitative levels: fine and applied. Where applied arts, such as vases, integrated easily into interiors and posed no challenges to Western hierarchies, Japanese painting was alien and used materials more akin to drawing than oils. Scholarship on Meiji painting progressed along two opposing tracks: Western scholars stopped at the onset of Westernization—Japanese art was no longer “purely” Japanese after that point, which Japanese officials understood when constructing displays of art that ended with Edo at the 1964 Tokyo Olympics. Domestically, Japanese scholars organically studied succeeding periods, styles, and artists. Scholarship on Meiji painting in Western languages is limited, its growth coming only in the last couple of decades. Only in the 1990s did Western students begin to focus their careers on Meiji painting and beyond.
Decreased All-Cause and Liver-Related Mortality Risk in HIV/Hepatitis B Virus Coinfection Coinciding With the Introduction of Tenofovir-Containing Combination Antiretroviral Therapy
Authors: van Welzen Berend J , Smit Colette , Boyd Anders , Lieveld Faydra I , Mudrikova Tania , Reiss Peter , Brouwer Annemarie E , Hoepelman Andy I M , Arends Joop E
Published: June 2020

Background

The development of efficacious combination antiretroviral therapy (cART) has led to a dramatic decrease in mortality in HIV-positive patients. Specific data on the impact in HIV/hepatitis B virus (HBV)–coinfected patients are lacking. In this study, all-cause and cause-specific mortality risks stratified per era of diagnosis are investigated.

Methods

Data were analyzed from HIV/HBV-coinfected patients enrolled in the ATHENA cohort between January 1, 1998, and December 31, 2017. Risk for (cause-specific) mortality was calculated using Cox proportional hazard regression analysis, comparing patients diagnosed before 2003 with those diagnosed ≥2003. Risk factors for all-cause and liver-related mortality were also assessed using Cox proportional hazard regression analysis.

Results

A total of 1301 HIV/HBV-coinfected patients were included (14 882 person-years of follow-up). One-hundred ninety-eight patients (15%) died during follow-up. The adjusted hazard ratio (aHR) for all-cause mortality in patients diagnosed in or after 2003 was 0.50 (95% CI, 0.35–0.72) relative to patients diagnosed before 2003. Similar risk reduction was observed for liver-related (aHR, 0.29; 95% CI, 0.11–0.75) and AIDS-related mortality (aHR, 0.44; 95% CI, 0.22–0.87). Use of a tenofovir-containing regimen was independently associated with a reduced risk of all-cause and liver-related mortality. Prior exposure to didanosine/stavudine was strongly associated with liver-related mortality. Ten percent of the population used only lamivudine as treatment for HBV.

Conclusions

All-cause, liver-related, and AIDS-related mortality risk in HIV/HBV-coinfected patients has markedly decreased over the years, coinciding with the introduction of tenofovir. Tenofovir-containing regimens, in absence of major contraindications, should be strongly encouraged in this population.
Renal Impairment,C. difficileRecurrence, and the Differential Effect of Bezlotoxumab: A Post Hoc Analysis of Pooled Data From 2 Randomized Clinical Trials
Authors: Golan Yoav , DuPont Herbert L , Aldomiro Fernando , Jensen Erin H , Hanson Mary E , Dorr Mary Beth
Published: June 2020

Background

Renal impairment is not a consistently cited risk factor for recurrent Clostridioides difficile infection (rCDI). We examined the association between renal impairment and rCDI and the effect of bezlotoxumab, an anti–toxin B monoclonal antibody, in reducing rCDI in participants with renal impairment.

Methods

We pooled data from 2 randomized, double-blind, placebo-controlled, multicenter, phase 3 clinical trials conducted in participants receiving bezlotoxumab or placebo infusion during oral antibacterial drug treatment for CDI. We assessed the association between renal impairment and rCDI in placebo-treated participants and evaluated the effect of bezlotoxumab vs placebo in reducing rCDI among participants with renal impairment, defined as an estimated glomerular filtration rate <90 mL/min.

Results

The proportion of placebo-treated participants experiencing rCDI within 12 weeks was higher in those with renal impairment (n = 919) vs those without renal impairment (n = 612; 36.6% and 27.7%, respectively; difference, 8.9%; 95% CI, 1.3% to 16.3%). Renal impairment was significantly associated with a higher rate of recurrence in placebo-treated participants lacking commonly recognized risk factors for rCDI (renal impairment as only risk factor, 28.8%; vs normal renal function and no risk factors, 12.5%; difference, 16.3%; 95% CI, 3.4% to 28.8%). Among all participants with renal impairment, the rate of rCDI was 19.5% among bezlotoxumab-treated vs 36.6% among placebo-treated participants (difference, –17.1%; 95% CI, –23.4% to –10.6%).

Conclusions

This post hoc analysis adds to the literature suggesting an association of renal impairment as an independent risk factor for rCDI and provides preliminary evidence that patients with renal impairment who suffer with CDI may benefit from adjunctive treatment with bezlotoxumab.
African histoplasmosis of the penis
Authors: Darré Tchin , Kpatcha Matchonna , Djiwa Toukilnan , Sewa Edoé , Dorkenoo Améyo Monique , Kouyaté Mouhamed , Napo-Koura Gado
Published: June 2020

African Histoplasmosis is deep mycosis caused by Histoplasma duboisii and genitourinary involvement is extremely rare. We report a case of African histoplasmosis in a 27-year-old subject with painful penis ulcer. Ulcer edge biopsy had revealed inflammatory granulomas made of epithelioid cells, lymphoplasmocytes, polynuclear eosinophils and giant multinucleated cells, with ovoid yeasts surrounded by a clear halo. PAS and Grocott stains revealed numerous fungal structures with a morphology measuring 7 to 15 nm. The diagnosis Histoplasma capsulatum var. duboisii was placed and the patient put on itraconazole (400 mg/day) for six months with a good course. African histoplasmosis of the subject penis is an extremely rare entity. The diagnosis of certainty often makes use of histology and mycological examination, and makes it possible to eliminate differential diagnoses such as cryptoccocosis, tuberculosis or cancer.
A Human-Specific Schizophrenia Risk Tandem Repeat Affects Alternative Splicing of a Human-Unique Isoform AS3MTd2d3 and Mushroom Dendritic Spine Density
Authors: Cai Xin , Yang Zhi-Hui , Li Hui-Juan , Xiao Xiao , Li Ming , Chang Hong
Published: June 2020

Recent advances in functional genomics have facilitated the identification of multiple genes and isoforms associated with the genetic risk of schizophrenia, yet the causal variations remain largely unclear. A previous study reported that the schizophrenia risk single-nucleotide polymorphism (SNP) rs7085104 at 10q24.32 was in high linkage disequilibrium (LD) with a human-specific variable number of tandem repeat (VNTR), and both were significantly associated with the brain mRNA expression of a human-unique AS3MTd2d3 isoform in Europeans and African Americans. In this study, we have shown the direct regulation of the AS3MTd2d3 mRNA expression by this VNTR through an in vitro minigene splicing assay, suggesting that it is likely a causative functional variation. Intriguingly, we have further confirmed that the VNTR and rs7085104 are significantly associated with AS3MTd2d3 mRNA expression in brains of Han Chinese donors, and rs7085104 is also associated with risk of schizophrenia in East Asians. Finally, the overexpression of AS3MTd2d3 in cultured primary hippocampal neurons results in significantly reduced densities of mushroom dendritic spines, implicating its potential functional impact. Considering the crucial roles of dendritic spines in neuroplasticity, these results reveal the potential regulatory impact of the schizophrenia risk VNTR on AS3MTd2d3 and provide insights into the underlying biological mechanisms.
The impact of porcine spray-dried plasma protein and dried egg protein harvested from hyper-immunized hens, provided in the presence or absence of subtherapeutic levels of antibiotics in the feed, on growth and indicators of intestinal function and physiology of nursery pigs
Authors: Ruckman Leigh A , Petry Amy L , Gould Stacie A , Patience John F
Published: June 2020

The objective of this experiment was to compare the effects of spray-dried plasma protein (SDPP) and dried egg protein (DEP), without (AB−) or with (AB+) in-feed antibiotics, on growth performance and markers of intestinal health in nursery pigs raised in commercial conditions. This 42-d experiment utilized 1,230 pigs (4.93 ± 0.04 kg body weight; approximately 15–18 d of age). Pigs were randomly assigned to one of six dietary treatments that were arranged as a 2 × 3 factorial of in-feed antibiotics (AB− vs. AB+) and a specialty protein additive (none [CON], porcine SDPP, or DEP). Diets were fed in four phases with phases 3 and 4 as a common diet across all treatments. Specialty protein additives were fed in phases 1 (0–13 d; 3% SDPP, and 0.20% DEP) and 2 (13–26 d; 2% SDPP, and 0.10% DEP). Antibiotics were fed in phases 1–3 (662 mg chlortetracycline [CTC]/kg, 28 mg carbadox/kg, and 441 mg CTC/kg, respectively). Ileal tissue and blood samples were collected from 48 pigs (8 per treatment) on d 20. Data were analyzed using PROC MIXED of SAS (9.4) with pen as the experimental unit; protein additives, antibiotics, and their interaction were fixed effects and block was a random effect. The pigs experienced naturally occurring health challenges in weeks 2 and 4. In the AB− diets, SDPP and DEP increased average daily gain (ADG; P = 0.036) and average daily feed intake (ADFI; P = 0.040) compared to CON; in the AB+ diets, neither SDPP nor DEP increased ADG or ADFI compared to CON but SDPP did increase these parameters over DEP. The SDPP and DEP diets decreased the number of individual medical treatments compared to CON (P = 0.001). The AB+ increased ileal mucosal interleukin (IL)-1 receptor antagonist (P = 0.017). Feeding DEP reduced the concentration of mucosal IL-1β compared to CON, but not SDPP (P = 0.022). There was a trend for SDPP and DEP to increase villus height:crypt depth compared to CON (P = 0.066). Neither antibiotics or protein additive affected serum malondialdehyde concentration or ileal mRNA abundance of claudin-3 or 4, occludin, or zonula occludens-1 (P > 0.10). In conclusion, SDPP and DEP improved growth performance of weaned pigs in the absence of antibiotics but neither improved growth compared to CON when feeding standard antibiotic levels. The specialty proteins had a positive effect on health; specialty proteins and antibiotics were able to modulate some markers of intestinal inflammation and morphology.
VI The Sixteenth Century: Excluding Drama after 1550
Authors: Archer Harriet , Wood Richard
Published: June 2020

This chapter has three sections: 1. General; 2. Sidney; 3. Spenser. Section 1 is by Harriet Archer; sections 2 and 3 are by Richard Wood.
First Report of Downy Mildew, Caused by Peronospora effusa, on Spinach (Spinacia oleracea) in North Carolina
Authors: Standish Jeffrey R. , Sharpe Suzette , Butler Shawn , Quesada-Ocampo Lina M. , Meadows Inga
Published: June 2020

In this brief, we report the first observation of downy mildew caused by Peronospora effusa on spinach grown in North Carolina. To this end, we characterized the morphology of sporangiophores and sporangia, and compared the internal transcribed spacer region and cytochrome oxidase I sequences to confirm pathogen identity.
Mechanical Ventilation Strategy Guided by Transpulmonary Pressure in Severe Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation
Authors: Wang Rui , Sun Bing , Li Xuyan , Tang Xiao , He Hangyong , Li Ying , Yuan Xue , Li Haichao , Chu Huiwen , Tong Zhaohui
Published: June 2020

Objectives:

Previous studies have suggested that adjusting ventilator settings based on transpulmonary pressure measurements may minimize ventilator-induced lung injury, but this has never been investigated in patients with severe acute respiratory distress syndrome supported with venovenous extracorporeal membrane oxygenation. We aimed to evaluate whether a transpulmonary pressure-guided ventilation strategy would increase the proportion of patients successfully weaned from venovenous extracorporeal membrane oxygenation support in patients with severe acute respiratory distress syndrome.

Design:

Single-center, prospective, randomized controlled trial.

Setting:

Sixteen-bed, respiratory ICU at a tertiary academic medical center.

Patients:

Severe acute respiratory distress syndrome patients receiving venovenous extracorporeal membrane oxygenation.

Interventions:

One-hundred four patients were randomized to transpulmonary pressure-guided ventilation group (n = 52) or lung rest strategy group (n = 52) groups. Two patients had cardiac arrest during establishment of venovenous extracorporeal membrane oxygenation in the lung rest group did not receive the assigned intervention. Thus, 102 patients were included in the analysis.

Measurements and Main Results:

The proportion of patients successfully weaned from venovenous extracorporeal membrane oxygenation in the transpulmonary pressure-guided group was significantly higher than that in the lung rest group (71.2% vs 48.0%; p = 0.017). Compared with the lung rest group, driving pressure, tidal volumes, and mechanical power were significantly lower, and positive end-expiratory pressure was significantly higher, in the transpulmonary pressure-guided group during venovenous extracorporeal membrane oxygenation support. In the transpulmonary pressure-guided group, levels of interleukin-1β, interleukin-6, and interleukin-8 were significantly lower, and interleukin-10 was significantly higher, than those of the lung rest group over time. Lung density was significantly lower in the transpulmonary pressure-guided group after venovenous extracorporeal membrane oxygenation support than in the lung rest group.

Conclusions:

A transpulmonary pressure-guided ventilation strategy could increase the proportion of patients with severe acute respiratory distress syndrome successfully weaned from venovenous extracorporeal membrane oxygenation.
Rates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children*
Authors: Patel Nital , Petersen Tara L. , Simpson Pippa M. , Feng Mingen , Hanson Sheila J.
Published: June 2020

Objectives:

Central venous access devices, including peripherally inserted central catheters and central venous catheters, are often needed in critically ill patients, but also are associated with complications, including central-line associated bloodstream infections and venous thromboembolism. We compared different central venous access device types and these complications in the PICU.

Design:

Multicenter, cohort study.

Setting:

One hundred forty-eight participating Virtual PICU Systems, LLC, hospital PICU sites.

Patients:

Pediatric patients with central venous access placed from January 1, 2010, to December 31, 2015.

Interventions:

None.

Measurements and Main Results:

Patient and central venous access device variables postulated to be associated with central-line associated bloodstream infection and venous thromboembolism were included. Data were analyzed using Pearson chi-square test or Fisher exact test for categorical variables, Mann-Whitney U test for continuous variables, and logistic regression and classification trees for multivariable analysis that examined significant predictors of venous thromboembolism or central-line associated bloodstream infection. Analysis included 74,196 first lines including 4,493 peripherally inserted central catheters and 66,194 central venous catheters. An increased rate of venous thromboembolism (peripherally inserted central catheter: 0.93%, central venous catheter: 0.52%; p = 0.001) (peripherally inserted central catheter: 8.65/1,000 line days, central venous catheter: 6.29/1,000 line days) and central-line associated bloodstream infection (peripherally inserted central catheter: 0.73%, central venous catheter: 0.24%; p = 0.001) (peripherally inserted central catheter: 10.82/1,000 line days, central venous catheter: 4.97/1,000 line days) occurred in peripherally inserted central catheters. In multivariable analysis, central venous catheters had decreased association with central-line associated bloodstream infection (odds ratio, 0.505; 95% CI, 0.336–0.759; p = 0.001) and venous thromboembolism (odds ratio, 0.569; 95% CI, 0.330–0.982; p = 0.043) compared with peripherally inserted central catheters.

Conclusions:

Peripherally inserted central catheters are associated with higher rates of central-line associated bloodstream infection and venous thromboembolism than central venous catheters in children admitted to the PICU.
Clinical Features of Coronavirus Disease 2019 Patients With Mechanical Ventilation: A Nationwide Study in China*
Authors: Wang Tao , Tang Chunli , Chen Ruchong , Ruan Honglian , Liang Wenhua , Guan Weijie , Sang Ling , Tang Ruidi , Zhong Nanshan , Li Shiyue
Published: June 2020

Objectives:

The outbreak of coronavirus disease 2019 is becoming a worldwide pandemic. Mechanical ventilation is lifesaving for respiratory distress, this study was designed to delineate the clinical features of the coronavirus disease 2019 patients with mechanical ventilation from a national cohort in China.

Design:

Prospective observational study.

Setting:

The rapid spread of severe acute respiratory syndrome coronavirus 2 has infected more than 7.7 million people and caused more than 423,000 deaths.

Patients:

Adult hospitalized coronavirus disease 2019 patients with mechanical ventilation from 557 hospitals from China.

Interventions:

None.

Measurements and Main Results:

From a nationwide cohort, 141 coronavirus disease 2019 cases with mechanical ventilation were extracted from 1,590 cases. Cigarette smoke, advanced age, coexisting chronic illness, elevated systolic blood pressure, high body temperature, and abnormal laboratory findings are common in these ventilated cases. Multivariate regression analysis showed that higher odds of in-hospital death was associated with invasive mechanical ventilation requirement (hazard ratio: 2.95; 95% CI, 1.40–6.23; p = 0.005), and coexisting chronic obstructive pulmonary disease (hazard ratio, 4.57; 95% CI, 1.65–12.69; p = 0.004) and chronic renal disease (hazard ratio, 5.45; 95% CI, 1.85–16.12; p = 0.002). Compared with patients with noninvasive mechanical ventilation, patients who needs invasive mechanical ventilation showed higher rate of elevated d-dimer (> 1.5 mg/L) at admission (hazard ratio, 3.28, 95% CI, 1.07–10.10; p = 0.039).

Conclusions:

The potential risk factors of elevated d-dimer level could help clinicians to identify invasive mechanical ventilation requirement at an early stage, and coexisting chronic obstructive pulmonary disease or chronic renal disease are independent risk factors associated with fatal outcome in coronavirus disease 2019 patients with mechanical ventilation.
A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention
Authors: Michelson Kelly N. , Frader Joel , Charleston Elizabeth , Rychlik Karen , Aniciete Danica Y. , Ciolino Jody D. , Sorce Lauren R. , Clayman Marla L. , Brown Melanie , Fragen Patricia , Malakooti Marcelo , Derrington Sabrina , White Douglas ,   on behalf of The Navigate Study Investigators
Published: June 2020

Objectives:

Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure.

Design:

Patient-level, randomized trial.

Setting:

Two university-based, tertiary-care children’s hospital PICUs.

Participants:

Parents of patients requiring more than 24 hours in the PICU.

Interventions:

PICU Supports included adding a trained navigator to the patient’s healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers.

Measurements and Main Results:

The primary outcome was percentage of “excellent” responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3–5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3–5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; se, 4.53; 95% CI, –5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as “extremely” or “somewhat” helpful.

Conclusions:

Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
Current Clinical Practice in Point-of-Care Ultrasound Use in the PICUs Across Europe
Authors: Humblet Martien H. , Singh Yogen , Tissot Cecile , De Luca Daniele , Leroy Piet L.
Published: June 2020

Objectives:

1) To investigate the current practice in point-of-care ultrasound use in PICUs across Europe; 2) to understand the barriers for point-of-care ultrasound implementation in the clinical practice; 3) to identify existing point-of-care ultrasound training programs; and 4) to assess training needs.

Design:

Cross-sectional electronic survey.

Subjects:

Medical directors of European PICUs.

Measurements and Main Results:

The response rate was 42.3%; 142 of the 336 invited PICU medical directors from 26 European countries completed the survey. The clinicians in almost all the PICUs across Europe were reported to use point-of-care ultrasound in some form. A significant variation in the clinical practice according to the patient characteristics and presence of a fellowship training program was observed. PICUs with cardiosurgical patients reported using point-of-care ultrasound significantly more often than others. Ultrasound-guided vascular access was the most common point-of-care ultrasound indication, except in PICUs providing joint care for neonates and children. Units with a fellowship training program reported an increased use of point-of-care ultrasound for hemodynamic evaluation, during resuscitation and a positive impact on collaboration with imaging specialties. Although no barrier was deemed substantial to impede point-of-care ultrasound implementation, a number of potential hindrances to its implementation were reported—such as lack of formal training curriculum, collaborative learning opportunities, and quality assurance processes. Bedside informal teaching in point-of-care ultrasound was reported the most common method to acquire point-of-care ultrasound skills.

Conclusions:

Point-of-care ultrasound is being used extensively across heterogeneously organized PICU settings in Europe. However, there remains a significant variation in the clinical practice across the units. Clear needs for improved point-of-care ultrasound training programs and clinical governance structure were identified. Evidence-based point-of-care ultrasound guidelines, structured training programs dedicated to neonatal and pediatric intensive care settings, and educational research in point-of-care ultrasound use may help in strengthening clinical governance, making clinical practice uniform and enhancing quality assurance.
Gender and Authorship in Pediatric Critical Care Randomized Control Trials*
Authors: Xu Grace M. , Zavalkoff Samara , de Wildt Saskia N. , Duffett Mark
Published: June 2020

Objectives:

To examine the gender distribution of authorship of pediatric critical care randomized control trials.

Data Sources:

The 415 randomized control trials in pediatric critical care published before 2019.

Study Selection:

We included all randomized control trials enrolling children in a PICU. We used PICUtrials.net, which uses comprehensive search strategies of multiple databases, to identify published randomized control trials.

Data Extraction:

We manually extracted the name and profession of each listed author from each publication and classified each author as male or female based on their name.

Results:

We included 2,146 authors and were able to classify 1,888 (88%) as men or women. Overall, 38% of authors were women, this varied with the authorship position: 37% of first, 38% of middle, and 25% of last authors were women (p < 0.001). The three most common professions were physician (63%), nonclinician (11%), and nurse (6%)—of which 30%, 45%, and 97%, respectively, were women. The percentage of female authorship overall has increased from 28% in 1985–1989 to 39% in 2015–2018 (p for trend = 0.004). There were no significant differences in the characteristics of randomized control trials published with a female first or last author versus those with both male first and last authors with respect to the median number of children randomized (60 vs. 50; p = 0.41), multicentred trials (17% vs. 24%; p = 0.12), trials at low risk of bias (50% vs. 66%; p = 0.26), reporting any funding (55% vs. 51%; p = 0.66), or median number of citations per year (1.5 vs. 2.4; p = 0.09).

Conclusions:

Although increasing over time, the percentage of researchers publishing pediatric critical care randomized control trials who are women still lags behind the percentage clinicians who are women. Trials that female researchers publish are similar in characteristics and impact as male researchers. Further work should identify barriers to gender diversity and potential solutions in pediatric critical care research.
Design and Rationale for Common Data Elements for Clinical Research in Pediatric Critical Care Medicine
Authors: Ward Shan L. , Flori Heidi R. , Bennett Tellen D. , Sapru Anil , Mourani Peter M. , Thomas Neal J. , Khemani Robinder G.
Published: June 2020

Objectives:

Common data elements are a combination of a precisely defined question paired with a specified set of responses. Common data elements contribute to the National Institutes of Health–supported principle of Findable, Accessible, Interoperable, and Reusableness of research data. Routine use of Common data elements and standardized definitions within pediatric critical care research are likely to promote collaboration, improve quality, and consistency of data collection, improve overall efficiency of study or trial setup, and facilitate cross-study comparisons, meta-analysis, and merging of study cohorts. The purpose of this Pediatric Critical Care Medicine Perspective is to establish a road map for the development of multinational, multidisciplinary consensus–based common data elements that could be adapted for use within any pediatric critical care subject area.

Methods:

We describe a multistep process for the creation of “core domains” of research (e.g. patient outcomes, health-related conditions, or aspects of health) and the development of common data elements within each core domain. We define a tiered approach to data collection based on relevance of each common data element to future studies and clinical practice within the field of interest. Additionally, we describe the use of the Delphi methods to achieve consensus of these common data element documents using an international, multidisciplinary panel of experts.