bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrofit or rebuild? The future of old residential buildings in urban areas of China based on the analysis of environmental benefits
Authors: Peng Zhen , Zhao Sanjun , Shen Luping , Ma Yuanli , Zhang Qianxi , Deng Wu
Published: September 2021

From the 1970s to the 1990s, over 3.5 billion square meters of residential building areas were completed in China to accommodate the increased population in cities. Most of the constructed buildings were built without insulation and proper ventilation. Currently, these buildings are reaching the end of their designed service lifetime. Therefore, retrofitting and rebuilding represent two different options to upgrade or completely replace these old buildings. However, material utilization levels of retrofitting and the rebuilding plans are completely different, resulting in different embodied energy consumption and operation energy consumption levels. This study examines the old residential buildings located in the cold climate zone of China. The study found that rebuilding these old residential buildings normally attain higher embodied energy consumption and embodied CO2 emissions due to high material input. Therefore, rebuilding plans might not be the highest priority, and government managers should consider the environmental impacts from the embodied energy consumption when formulating decisions regarding the future of these old residential buildings. Additionally, the insulation thickness is an important parameter for the main building fabrics of retrofitted and rebuilt buildings to reduce heating and cooling energy demand. Although, this study has identified that the rebuilt buildings cause higher CO2 emissions than retrofitted buildings. However, various parameters, such as the materials’ embodied coefficient, the carbon intensity of the operation energy sources and ratios of the surface areas of the glazing windows to the external walls, should be considered by decision-makers.
Research on fault diagnosis of microgrid based on variational sparse Bayesian fuzzy H-network
Authors: Xu Aoran , Gu Cailian , Liu Baoliang , Leng Xuemin
Published: September 2021

With the aggravation of energy crisis and environmental problems, microgrid has become a research and application hotspot in the field of electric energy, which puts forward higher requirements for the security and reliability of microgrid, so the research on fault diagnosis of microgrid has become the focus. In this paper, the domestic and foreign fault diagnosis research is analysed. Based on Bayesian, the theory of variational sparse Bayesian and fuzzy h-network is studied. The variational sparse Bayesian fuzzy h-network is used for fault diagnosis of microgrid, and the fault diagnosis model of variational sparse Bayesian fuzzy h-network is constructed. Based on the analysis of Bayesian signal processing, a diagnosis method combining fuzzy h-network and variational sparse Bayesian is proposed. The variational sparse algorithm is used to improve Bayesian, reduce the complexity and computation of signal processing and solve the uncertainty problem of microgrid fault diagnosis. The dual fault signal filter based on Bayesian is designed, and the fault diagnosis method of microgrid based on variational sparse Bayesian fuzzy h-network is further studied and designed. The effectiveness of the proposed signal extraction method and fault diagnosis method is verified by simulation in Matlab/Simulink platform. In this paper, a new fault diagnosis method of microgrid based on variational sparse Bayesian fuzzy h-network is proposed, which improves the speed and accuracy of microgrid fault diagnosis.
A Comparison of Geosampling and Random Walk Methods for Household Sample Selection in Uttar Pradesh, India
Authors: Lau Charles Q , Unangst Jennifer , Eckman Stephanie , Bhatt Pramod , Evans Jonathan , McRoy Martha , Starr Kelsey , Thalji Lisa , Allpress Justine , Jones Kasey , Cajka Jamie , Bunker John David
Published: September 2021

Our research evaluates an innovative sampling technique for household surveys called “geosampling” which leverages recent advances in geographic information systems, computer vision algorithms, and satellite imagery. We compare geosampling to the random walk method. We conducted two surveys in Uttar Pradesh, India: one using geosampling (1,026 completes) and another using random walk (939 completes). We compare the two sampling techniques along three dimensions: (a) performance indicators—response rates and contact attempts; (b) sample composition; and (c) components of variance. We help researchers understand the survey contexts for which geosampling and random walk are best suited.
Particularized Trust, Institutional Trust, and Generalized Trust: An Examination of Causal Pathways
Authors: Kim Seung Hyun , Kim Sangmook
Published: September 2021

This study attempts to resolve two issues in social trust research: the negative or positive effect of particularized trust (PT) and the causality between institutional trust (IT) and generalized trust (GT). It analyzes two types of data from South Korea: pooled data of cross-sectional national probability surveys; and online experimental three-wave panel data. Analyses of cross-sectional data suggest new classifications of trust types, family trust (FT) qualitatively different from PT, and the covariates of GT. Panel data analyses bolster the findings from cross-sectional data analysis and confirm a causal antecedence and lagged effects of IT. These findings imply that keys to achieving a high trust society are overcoming intense FT, expanding the radius of PT, and enhancing IT.
Flooding the Zone: How Exposure to Implausible Statements Shapes Subsequent Belief Judgments
Authors: Ulusoy Ezgi , Carnahan Dustin , Bergan Daniel E , Barry Rachel C , Ma Siyuan , Ahn Suhwoo , McGraw Johnny
Published: September 2021

Much scholarly attention has been paid to the effects of misinformation on beliefs and attitudes, but rarely have studies investigated potential downstream effects of misinformation exposure on belief judgments involving subsequent factual statements. Drawing from work on anchoring-and-adjustment and defensive reasoning, this study examines how exposure to initial falsehoods that vary in terms of their plausibility shapes subsequent belief judgments. Across two survey experiments, we find that initial exposure to a less plausible statement decreases belief in subsequent statements, whether true or false. This order effect has implications for misinformation research, as studies examining audience responses to a single falsehood may fail to capture the full range of misinformation effects. Other implications are discussed in this article.
Southeast Asia and the 1951 Convention relating to the Status of Refugees: Substance without Form?
Authors: Moretti Sébastien
Published: September 2021

The 1951 Convention relating to the Status of Refugees, supplemented by its 1967 Protocol, is the most comprehensive and universal instrument adopted to date to safeguard the fundamental rights of refugees and to regulate their status in countries of asylum. Yet, 70 years after its adoption, many countries – most of them in Asia – are unwilling to accede to it. Focusing on the ASEAN States, this article explores the reasons behind Southeast Asia’s resistance to the Refugee Convention, thereby highlighting some of its limitations. Contrary to the so-called ‘rejection’ of the international refugee law approach that currently prevails in the region, this article argues that Southeast Asian States have long recognized that refugees, as defined in the Refugee Convention, need protection. This is evidenced by their de facto different treatment of refugees compared to other irregular migrants, especially when it comes to arrest, detention, and deportation. The fact that non-signatory States act in conformity with the provisions of a treaty by which they are not bound reinforces the relevance of the Convention, if not as a formal source of obligation, at least as a model to delineate the contours of refugee protection. Somewhat ironically, their practice also contributes to the strengthening of international refugee law.
Error analysis of a discretization for stochastic linear quadratic control problems governed by SDEs
Authors: Wang Yanqing
Published: September 2021

In this work, a time-implicit discretization for stochastic linear quadratic problems subject to stochastic differential equations with control-dependence noises is proposed, and the convergence rate of this discretization is proved. Compared to the existing results, the control variables are stochastic processes and can be contained in systems’ diffusion term. Based on this discretization, a gradient descent algorithm and its convergence rate are presented. Finally, a numerical example is provided to support the theoretical finding.
A least-squares Galerkin approach to gradient and Hessian recovery for nondivergence-form elliptic equations
Authors: Lakkis Omar , Mousavi Amireh
Published: September 2021

We propose a least-squares method involving the recovery of the gradient and possibly the Hessian for elliptic equation in nondivergence form. As our approach is based on the Lax–Milgram theorem with the curl-free constraint built into the target (or cost) functional, the discrete spaces require no inf-sup stabilization. We show that standard conforming finite elements can be used yielding a priori and a posteriori convergence results. We illustrate our findings with numerical experiments with uniform or adaptive mesh refinement.
Spectral Galerkin method for solving Helmholtz boundary integral equations on smooth screens
Authors: Jerez-Hanckes Carlos , Pinto José
Published: September 2021

We solve first-kind Fredholm boundary integral equations arising from Helmholtz and Laplace problems on bounded, smooth screens in three dimensions with either Dirichlet or Neumann conditions. The proposed Galerkin–Bubnov methods take as discretization elements pushed-forward weighted azimuthal projections of standard spherical harmonics onto the unit disk. By exactly depicting edge singular behaviors we show that these spectral or high-order bases yield super-algebraic error convergence in the corresponding energy norms whenever the screen is an analytic deformation of the unit disk. Moreover, we provide a fully discrete analysis of the method, including quadrature rules, based on analytic extensions of the spectral basis to complex neighborhoods. Finally, we include numerical experiments to support our claims as well as appendices with computational details for treating the associated singular integrals.
A Bombieri–Vinogradov Theorem for Higher-Rank Groups
Authors: Jiang Yujiao , Lü Guangshi , Thorner Jesse , Wang Zihao
Published: September 2021

We establish a result of Bombieri–Vinogradov type for the Dirichlet coefficients at prime ideals of the standard $L$-function associated to a self-dual cuspidal automorphic representation $\pi $ of $\operatorname {GL}_n$ over a number field $F$ when $\pi$ is not a quadratic twist of itself. Our result does not rely on any unproven progress towards the generalized Ramanujan conjecture or the nonexistence of Landau–Siegel zeros. In particular, when $\pi $ is fixed and not equal to a quadratic twist of itself, we prove the first unconditional Siegel-type lower bound for the twisted $L$-values $|L(1,\pi \otimes \chi )|$ in the $\chi $-aspect, where $\chi $ is a primitive quadratic Hecke character over $F$. Our result improves the levels of distribution in other works that relied on these unproven hypotheses. As applications, when $n=2,3,4$, we prove a $\textrm {GL}_n$ analogue of the Titchmarsh divisor problem and a nontrivial bound for a certain $\textrm {GL}_n\times \textrm {GL}_2$ shifted convolution sum.
Support for Integrable Hopf Algebras via Noncommutative Hypersurfaces
Authors: Negron Cris , Pevtsova Julia
Published: September 2021

We consider finite-dimensional Hopf algebras $u$ that admit a smooth deformation $U\to u$ by a Noetherian Hopf algebra $U$ of finite global dimension. Examples of such Hopf algebras include small quantum groups over the complex numbers, restricted enveloping algebras in finite characteristic, and Drinfeld doubles of height $1$ group schemes. We provide a means of analyzing (cohomological) support for representations over such $u$, via the singularity categories of the hypersurfaces $U/(f)$ associated with functions $f$ on the corresponding parametrization space. We use this hypersurface approach to establish the tensor product property for cohomological support, for the following examples: functions on a finite group scheme, Drinfeld doubles of certain height 1 solvable finite group schemes, bosonized quantum complete intersections, and the small quantum Borel in type $A$.
Local Variants of the Dixmier Property and Weak Centrality for C*-algebras
Authors: Archbold Robert J , Gogić Ilja , Robert Leonel
Published: September 2021

We study variants of the Dixmier property that apply to elements of a unital C*-algebra, rather than to the C*-algebra itself. By a Dixmier element in a C*-algebra we understand one that can be averaged into a central element by means of a sequence of unitary mixing operators. Examples include all self-commutators and all quasinilpotent elements. We do a parallel study of an element-wise version of weak centrality, where the averaging to the centre is done using unital completely positive elementary operators (as in Magajna’s characterization of weak centrality). We also obtain complete descriptions of more tractable sets of elements, where the corresponding averaging can be done arbitrarily close to the centre. This is achieved through several “spectral conditions”, involving numerical ranges and tracial states.
Baseline Severe Acute Respiratory Syndrome Viral Load Is Associated With Coronavirus Disease 2019 Severity and Clinical Outcomes: Post Hoc Analyses of a Phase 2/3 Trial
Authors: Boyapati Anita , Wipperman Matthew F , Ehmann Peter J , Hamon Sara , Lederer David J , Waldron Alpana , Flanagan John J , Karayusuf Elif , Bhore Rafia , Nivens Michael C , Hamilton Jennifer D , Sumner Giane , Sivapalasingam Sumathi
Published: September 2021

Background

Elucidating the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and clinical outcomes is critical for understanding coronavirus disease 2019 (COVID-19).

Methods

The SARS-CoV-2 levels were analyzed by quantitative real-time polymerase chain reaction (RT-qPCR) of nasopharyngeal or oropharyngeal swab specimens collected at baseline, and clinical outcomes were recorded over 60 days from 1362 COVID-19 hospitalized patients enrolled in a multicenter, randomized, placebo-controlled phase 2/3 trial of sarilumab for COVID-19 (ClinicalTrials.gov NCT04315298).

Results

In post hoc analyses, higher baseline viral load, measured by both RT-qPCR cycle threshold and log10 copies/mL, was associated with greater supplemental oxygenation requirements and disease severity at study entry. Higher baseline viral load was associated with higher mortality, lower likelihood of improvement in clinical status and supplemental oxygenation requirements, and lower rates of hospital discharge. Viral load was not impacted by sarilumab treatment over time versus placebo.

Conclusions

These data support viral load as an important determinant of clinical outcomes in hospitalized patients with COVID-19 requiring supplemental oxygen or assisted ventilation.
Hepatitis E in Bangladesh: Insights From a National Serosurvey
Authors: Azman Andrew S , Paul Kishor Kumar , Bhuiyan Taufiqur Rahman , Koyuncu Aybüke , Salje Henrik , Qadri Firdausi , Gurley Emily S
Published: September 2021

Background

Hepatitis E virus (HEV) genotypes 1 and 2 are a major cause of avoidable morbidity and mortality in South Asia. Despite the high risk of death among infected pregnant women, scarce incidence data has been a contributing factor to global policy recommendations against the introduction of licensed hepatitis E vaccines, one of the only effective prevention tools.

Methods

We tested serum from a nationally representative serosurvey in Bangladesh for anti-HEV immunoglobulin G and estimated seroprevalence. We used Bayesian geostatistical models to generate high-resolution maps of seropositivity and examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression.

Results

We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of 20% (95% confidence interval [CI], 17%–24%). Seropositivity increased with age and male sex (odds ratio, 2.2 male vs female; 95% CI, 1.8–2.8). Community-level seroprevalence ranged widely (0–78%) with higher seroprevalence in urban areas, including Dhaka, with a 3.0-fold (95% credible interval, 2.3–3.7) higher seroprevalence than the rest of the country.

Conclusions

Hepatitis E infections are common throughout Bangladesh. Strengthening surveillance for hepatitis E, especially in urban areas, can provide additional evidence to appropriately target interventions.
Typhoid Conjugate Vaccines: Advancing the Research and Public Health Agendas
Authors: Birkhold Megan , Mwisongo Aziza , Pollard Andrew J , Neuzil Kathleen M
Published: September 2021

The disease burden of typhoid fever remains high in endemic areas in Asia and Africa, especially in children. Recent clinical trials conducted by the Typhoid Vaccine Acceleration Consortium show typhoid conjugate vaccine (TCV) to be safe, immunogenic, and efficacious at preventing blood culture-confirmed typhoid fever in African and Asian children. Pakistan, Liberia, and Zimbabwe recently introduced TCV through campaigns and routine childhood immunizations, providing protection for this vulnerable population. It is essential to continue this momentum while simultaneously filling data gaps—including typhoid complications—to inform decision-making on TCV introduction. A multidisciplinary approach including surveillance, water, sanitation, and hygiene investments, and large-scale TCV introduction is needed to decrease the burden and mortality of typhoid fever.
Meningococcal Detoxified Outer Membrane Vesicle Vaccines Enhance Gonococcal Clearance in a Murine Infection Model
Authors: Matthias Kathryn A , Connolly Kristie L , Begum Afrin A , Jerse Ann E , Macintyre Andrew N , Sempowski Gregory D , Bash Margaret C
Published: September 2021

Background

Despite decades of research efforts, development of a gonorrhea vaccine has remained elusive. Epidemiological studies suggest that detoxified outer membrane vesicle (dOMV) vaccines from Neisseria meningitidis (Nm) may protect against infection with Neisseria gonorrhoeae (Ng). We recently reported that Nm dOMVs lacking the major outer membrane proteins (OMPs) PorA, PorB, and RmpM induced greater antibody cross-reactivity against heterologous Nm strains than wild-type (WT) dOMVs and may represent an improved vaccine against gonorrhea.

Methods

We prepared dOMV vaccines from meningococcal strains that were sufficient or deleted for PorA, PorB, and RmpM. Vaccines were tested in a murine genital tract infection model and antisera were used to identify vaccine targets.

Results

Immunization with Nm dOMVs significantly and reproducibly enhanced gonococcal clearance for mice immunized with OMP-deficient dOMVs; significant clearance for WT dOMV-immunized mice was observed in one of two experiments. Clearance was associated with serum and vaginal anti-Nm dOMV immunoglobulin G (IgG) antibodies that cross-reacted with Ng. Serum IgG was used to identify putative Ng vaccine targets, including PilQ, MtrE, NlpD, and GuaB.

Conclusions

Meningococcal dOMVs elicited a protective effect against experimental gonococcal infection. Recognition and identification of Ng vaccine targets by Nm dOMV-induced antibodies supports the development of a cross-protective Neisseria vaccine.
Equity in telemedicine for older adults during the COVID-19 pandemic
Authors: Kuang Weihong , Zeng Guojun , Nie Yunbo , Cai Yan , Li Jin , Wan Yang , Qiu Peiyuan
Published: September 2021

The coronavirus disease 2019 (COVID-19) pandemic has spurred an unprecedented paradigm shift to telemedicine across healthcare fields in order to limit exposure to the virus. At the West China Hospital of Sichuan University, telemedicine has been used to perform COVID-19-related tele-education to health professionals and the general population, as well as tele-diagnosis, online treatment and internet-based drug prescription and delivery. However, many older adults could not make appointments with doctors due to difficulty using the internet-based platform. Careful attention needs to be paid by future researchers and policymakers in order to mitigate barriers older adults face when using telemedicine.
Peripheral nerve stimulation and immunity: the expanding opportunities for providing mechanistic insight and therapeutic intervention
Authors: Falvey Aidan , Metz Christine N , Tracey Kevin J , Pavlov Valentin A
Published: September 2021

Pre-clinical research advances our understanding of the vagus nerve-mediated regulation of immunity and clinical trials successfully utilize electrical vagus nerve stimulation in the treatment of patients with inflammatory disorders. This symbiotic relationship between pre-clinical and clinical research exploring the vagus nerve-based ‘inflammatory reflex’ has substantially contributed to establishing the field of bioelectronic medicine. Recent studies identify a crosstalk between the vagus nerve and other neural circuitries in controlling inflammation and delineate new neural immunoregulatory pathways. Here we outline current mechanistic insights into the role of vagal and non-vagal neural pathways in neuro-immune communication and inflammatory regulation. We also provide a timely overview of expanding opportunities for bioelectronic neuromodulation in the treatment of various inflammatory disorders.
Predictors of job satisfaction and intention to stay in the job among health-care providers in Uganda and Zambia
Authors: kim min kyung , arsenault catherine , Atuyambe Lynn m , Kruk Margaret e
Published: September 2021

Background

A shortage of competent health-care providers is a major contributor to poor quality health care in sub-Saharan Africa. To increase the retention of skilled health-care providers, we need to understand which factors make them feel satisfied with their work and want to stay in their job. This study investigates the relative contribution of provider, facility and contextual factors to job satisfaction and intention to stay on the job among health-care providers who performed obstetric care in Uganda and Zambia.

Methods

This study was a secondary analysis of data from a maternal and newborn health program implementation evaluation in Uganda and Zambia. Using a Likert scale, providers rated their job satisfaction and intention to stay in their job. Predictors included gender, cadre, satisfaction with various facility resources and country. We used the Shapley and Owen decomposition of R2 method to estimate the variance explained by individual factors and groups of factors, adjusting for covariates at the facility and provider levels.

Results

Of the 1134 providers included in the study, 68.3% were female, 32.4% were nurses and 77.1% worked in the public sector. Slightly more than half (52.3%) of providers were strongly satisfied with their job and 42.8% strongly agreed that they would continue to work at their facility for some time. A group of variables related to facility management explained most of the variance in both job satisfaction (37.6%) and intention to stay (43.1%). Among these, the most important individual variables were satisfaction with pay (20.57%) for job satisfaction and opinions being respected in the workplace (17.52%) for intention to stay. Doctors reported lower intention to stay than nurses. Provider demographics and facility level and ownership (public/private) were not associated with either outcome. There were also differences in job satisfaction and intention to stay between Ugandan and Zambian health-care providers.

Conclusion

Our study suggests that managers play a crucial role in retaining a sufficient number of satisfied health-care providers providing obstetric care in two sub-Saharan African countries, Uganda and Zambia. Prioritizing and investing in health management systems and health managers are essential foundations for high-quality health systems.
Nationality versus Gender? The Administrative Politics of Gender Parity in the United Nations and the Implementation of SCR1325
Authors: Davies Hannah
Published: September 2021

This article will shed light on an under-researched aspect of the implementation of gender policies in the UN Secretariat—the administrative and budgetary committees that establish the staff regulations for civilian personnel. The article will explore how the politics of UN recruitment invokes two primary identities—nationality and gender—and how these conflict with each other. Using demographic analysis of UN civilian staff in peace operations and a micro-case study of an ongoing attempt by the Secretary-General to change the staff rules and regulations to introduce a form of affirmative action to reach gender parity, this article finds that efforts to achieve the representative provisions of UN Security Council Resolution 1325, including through gender parity of civilians in peace operations, are hampered by the primacy of national identity in international organizations as well as by the highly politicized and nation state-driven process of administrative and budgetary decision-making. By focusing on the inner dynamics of decision-making in the United Nations, the article contributes to the literature on international organizations and gender by demonstrating how normative goals can be undermined by competition among member states over internal administrative processes arising from complex principal–agent relationships.
Eating Identity: Theorizing the Everyday Foreign Policy Assemblage
Authors: Gaufman Elizaveta
Published: September 2021

While everyday high-level practices have become an important area of study in foreign policy research, the every day of every (wo)man has been overlooked both in theoretical and empirical conceptualizations. Building on feminist, sociological, and ethnographic research, this article argues that everyday foreign policy is an assemblage—a combination of physical and cultural practices that inhabit digital and bodily spaces. Following the feminist call to liberate international relations from the straitjacket of high politics, this article aims to contextualize foreign policy within daily practices of regular citizens, who enact foreign policy at home, at the supermarket, and online. In effect, everyday foreign policy is not just about discussing identity, it is also about embodying and literally eating it. This article focuses on the grassroots of foreign policy sanctions in Russia in the aftermath of the annexation of Crimea.
Priming Effect of Colour on Aiding the Attentional Reorientation in Sequential Presentations of Temporal Data Visualization: Evidence From Eye-Tracking
Authors: Peng Ningyue , Xue Chengqi , Wang Haiyan , Niu Yafeng , Wu Lei
Published: September 2021

In the present study, we focus on the priming effect of colour on mitigating the attentional reorientation cost, which is led by re-constructing the frame of reference for attention shift and visual search in sequential presentations of temporal data visualization. The study involves two experiments using complementary recordings of behavioural performance and eye-tracking events. Two aspects of colour primes are highlighted: the prime validity and the colour perceptual accessibility. A task paradigm integrating the feature search and keeping-track task was adopted in our experiments. In Experiment 1 (with a group of 16 participants), we confirmed the colour priming effect by comparing the priming condition to the neutral baseline. Furthermore, global colours that are with high perceptual accessibility generated more evident priming effects than local colours. However, more interferences in misguiding the attention to task-irrelevant regions were found when the global primes were invalid. In Experiment 2 (with another group of 15 participants), we verify the finding in Experiment 1 that global colours produced more pronounced priming effects in alleviating the attentional reorientation cost by comparing two groups of real-world visualizations with either global or local colours as the prime. Large saccades were initiated much earlier, and the search efficiency got improved when provided with global colours. We conjecture that the facilitatory effect from global colours may stem from its benefit on the pre-attentive processing of the search field. The research findings provide evidence for utilizing colours as the primes in mitigating the attentional reorientation cost and accelerating visual search in sequential presentations.
Comparison of in vitro activities of plazomicin and other aminoglycosides against clinical isolates of Klebsiella pneumoniae and Escherichia coli
Authors: İnce Gizem , Mirza Hasan Cenk , Üsküdar Güçlü Aylin , Gümüş Hale , Erol Çiğdem , Başustaoğlu Ahmet
Published: September 2021

Objectives

To compare the in vitro activity of plazomicin and two older aminoglycosides (gentamicin and amikacin) against 180 isolates of Escherichia coli and Klebsiella pneumoniae, including subsets of 60 non-ESBL-producing, 60 ESBL-producing and 60 carbapenem-resistant (46 carrying blaOXA-48, 11 carrying blaNDM and 3 carrying blaOXA-48 and blaNDM) strains.

Methods

MICs of plazomicin, gentamicin and amikacin were determined by a gradient diffusion method. Gentamicin and amikacin MICs were interpreted according to CLSI criteria and EUCAST breakpoint tables. Plazomicin MICs were interpreted using FDA-defined breakpoints.

Results

All non-ESBL-producing and ESBL-producing isolates were susceptible to plazomicin. The plazomicin susceptibility rate (71.7%) in carbapenem-resistant isolates was significantly higher than those observed for gentamicin (45%) and amikacin (56.7% and 51.7% according to CLSI and EUCAST breakpoints, respectively). Gentamicin, amikacin and plazomicin susceptibility rates (35.6% for gentamicin; 44.4% and 37.8% for amikacin according to CLSI and EUCAST breakpoints, respectively; 64.4% for plazomicin) in carbapenem-resistant K. pneumoniae were significantly lower than those observed for carbapenem-resistant E. coli isolates (73.3% for gentamicin; 93.3% for amikacin and plazomicin). Gentamicin, amikacin and plazomicin susceptibility rates for blaNDM-positive isolates were lower than those observed for blaOXA-48-positive isolates, but differences were not statistically significant. Among the isolates that were non-susceptible to both gentamicin and amikacin, the plazomicin susceptibility rate was less than 30%.

Conclusions

Although plazomicin showed excellent in vitro activity against carbapenem-susceptible isolates, the plazomicin resistance rate increased to 35.6% among carbapenem-resistant K. pneumoniae and further increased to 45.5% among blaNDM-positive isolates.
Double deletion of cpxR and tolC significantly increases the susceptibility of Salmonella enterica serovar Typhimurium to colistin
Authors: Zhang Meng-Ke , Zhang Meng-Yao , Liu Shuo-Bo , Yang Ying-Ying , Zhai Ya-Jun , He Dan-Dan , Wu Hua , Pan Yu-Shan , Liu Jian-Hua , Yuan Li , Hu Gong-Zheng
Published: September 2021

Background

The increasing use of colistin causes a serious breach in our last line of defence against MDR Gram-negative pathogens. Our previous study showed that CpxR overexpression increases the susceptibility of acrB and cpxR double-deleted Salmonella enterica serovar Typhimurium to colistin.

Objectives

To identify the mechanism of CpxAR and efflux pumps that synergistically enhance the susceptibility of S. Typhimurium to colistin.

Methods

A series of cpxR- and tolC-deleted mutants and a cpxR-complemented strain from a multidrug-susceptible standard strain of S. Typhimurium (JS) were generated in our previous study. Herein, we investigated the susceptibility of these strains to colistin through the broth microdilution method, time–kill curves and survival assays. Growth curves were measured by OD600 in LB broth, tryptone-soy broth (TSB) and M9-glucose (0.2%) minimal media. Finally, molecular mechanisms underlying the mode of action were elucidated by transcriptomic analysis.

Results

We found that in contrast to JS (0.8 mg/L), the MIC of colistin for JSΔtolC::kan showed a 16-fold decrease (0.05 mg/L). Notably, JSΔcpxRΔtolC and JSΔcpxRΔtolC/pcpxR were associated with a 256-fold decrease (0.0031 mg/L) compared with JS. Growth curves identified that JSΔcpxRΔtolC and JSΔcpxRΔtolC/pcpxR displayed a markedly lower growth rate and poorer adaptability. In addition, time–kill curves and survival assays showed that JSΔcpxRΔtolC and JSΔcpxRΔtolC/pcpxR were more susceptible to colistin. Lastly, double deletion of cpxR and tolC enhanced oxidative damage through promoting oxidative phosphorylation, the tricarboxylic acid (TCA) cycle and trimethylamine N-oxide (TMAO) respiration.

Conclusions

Our findings revealed that double deletion of cpxR and tolC significantly increases the susceptibility of S. Typhimurium to colistin.
Efficacy of doxycycline versus azithromycin for the treatment of rectal chlamydia: a systematic review and meta-analysis
Authors: Chen Liang-Fu , Wang Ting-Cheng , Chen Fu-Lun , Hsu Shih-Chang , Hsu Chin-Wang , Bai Chyi-Huey , Hsu Yuan-Pin
Published: September 2021

Background

Chlamydia trachomatis infection is the most common sexually transmitted infectious disease and carries a risk of complications. However, the optimal treatment for rectal chlamydial infection remains unclear.

Objectives

To compare the efficacy of doxycycline and azithromycin for the treatment of rectal chlamydia by undertaking a systematic review and meta-analysis of published data.

Methods

We searched PubMed, EMBASE, Cochrane Library, Web of Science and clinicaltrials.gov databases from inception to 7 July 2021 for randomized controlled trials (RCTs) and observational studies that compared the efficacy of doxycycline and single-dose azithromycin on rectal chlamydia cure rates. Data were synthesized using a random-effects model, and subgroup analysis was conducted.

Results

All included studies were conducted in developed countries. Two RCTs and nine observational studies, with a total of 2457 patients, were analysed. Doxycycline had a higher microbiological cure rate than azithromycin (risk ratio = 1.21; 95% CI = 1.15–1.28; P < 0.05). Pooled results from two RCTs also revealed a higher microbiological cure rate for doxycycline than azithromycin (risk ratio = 1.27; 95% CI = 1.20–1.35; P < 0.05). The results remained consistent in subgroups of different study designs, countries and sexes.

Conclusions

On the basis of our findings, we recommend doxycycline rather than azithromycin as a first-line treatment for rectal chlamydia in developed countries. More RCTs from developing countries are warranted.
Selection and characterization of mutational resistance to aztreonam/avibactam in β-lactamase-producing Enterobacterales
Authors: Mushtaq Shazad , Vickers Anna , Ellaby Nicholas , Woodford Neil , Livermore David M
Published: September 2021

Background

Aztreonam/avibactam is being developed for its broad activity against carbapenemase-producing Enterobacterales, including those with metallo-β-lactamases (MBLs). Its potential to select resistance in target pathogens was explored. Findings are compared with previous data for ceftazidime/avibactam and ceftaroline/avibactam.

Methods

Single-step mutants were sought from 52 Enterobacterales with AmpC, ESBL, KPC, MBL and OXA-48-like enzymes. Mutation frequencies were calculated. MICs were determined by CLSI agar dilution. Genomes were sequenced using Illumina methodology.

Results

Irrespective of β-lactamase type and of whether avibactam was used at 1 or 4 mg/L, mutants could rarely be obtained at >4× the starting MIC, and most MIC rises were correspondingly small. Putative resistance (MIC >8 + 4 mg/L) associated with changes to β-lactamases was seen only for mutants of AmpC, where it was associated with Asn346Tyr and Tyr150Cys substitutions. Asn346Tyr led to broad resistance to avibactam combinations; Tyr150Cys significantly affected only aztreonam/avibactam. MIC rises up to 4 + 4 mg/L were seen for producers of mutant KPC-2 or -3 enzymes, and were associated with Trp105Arg, Ser106Pro and Ser109Pro substitutions, which all reduced the MICs of other β-lactams. For producers of other β-lactamase types, we largely found mutants with lesions in baeRS or envZ, putatively affecting drug accumulation. Single mutants had lesions in ampD, affecting AmpC expression or ftsI, encoding PBP3.

Conclusions

The risk of mutational resistance to aztreonam/avibactam appears smaller than for ceftazidime/avibactam, where Asp179Tyr arises readily in KPC enzymes, conferring frank resistance. Asn346 substitutions in AmpC enzymes may remain a risk, having been repeatedly selected with multiple avibactam combinations in vitro.
Myositis Antibodies and Interstitial Lung Disease
Authors: Basuita Manpreet , Fidler Lee M
Published: September 2021

Background

Interstitial lung disease (ILD) comprises a heterogeneous group of inflammatory and fibrotic conditions, often resulting in progressive lung function decline and increased mortality. Connective tissue disease (CTD) should be considered in all patients with ILD, as distinguishing between CTD-ILD and other forms of fibrotic lung disease has important therapeutic and prognostic implications. The idiopathic inflammatory myopathies (IIM) represent a CTD subtype of growing interest to ILD experts. The expansion and availability of myositis-specific and myositis-associated antibody testing has allowed for improved disease detection and characterization.

Content

In this review, we highlight the relationship between myositis antibodies and ILD. Select forms of IIM, such as the antisynthetase syndrome and clinically amyopathic dermatomyositis can present with rapidly progressive ILD, warranting timely disease diagnosis and management. Disease phenotypes, prevalence, laboratory testing, prognosis, and management strategies are described according to select myositis antibodies.

Myositis antibodies provide valuable information for clinicians managing patients with ILD. This review aims to increase awareness of their role in disease detection, pathophysiology, and possibly therapeutics.
Cast suppression in radiographs by generative adversarial networks
Authors: Hržić Franko , Žužić Ivana , Tschauner Sebastian , Štajduhar Ivan
Published: September 2021

Injured extremities commonly need to be immobilized by casts to allow proper healing. We propose a method to suppress cast superimpositions in pediatric wrist radiographs based on the cycle generative adversarial network (CycleGAN) model. We retrospectively reviewed unpaired pediatric wrist radiographs (n = 9672) and sampled them into 2 equal groups, with and without cast. The test subset consisted of 718 radiographs with cast. We evaluated different quadratic input sizes (256, 512, and 1024 pixels) for U-Net and ResNet-based CycleGAN architectures in cast suppression, quantitatively and qualitatively. The mean age was 11 ± 3 years in images containing cast (n = 4836), and 11 ± 4 years in castless samples (n = 4836). A total of 5956 X-rays had been done in males and 3716 in females. A U-Net 512 CycleGAN performed best (P ≤ .001). CycleGAN models successfully suppressed casts in pediatric wrist radiographs, allowing the development of a related software tool for radiology image viewers.
Documentation and review of social determinants of health data in the EHR: measures and associated insights
Authors: Wang Michael , Pantell Matthew S , Gottlieb Laura M , Adler-Milstein Julia
Published: September 2021

Objective

Electronic Health Records (EHRs) increasingly include designated fields to capture social determinants of health (SDOH). We developed measures to characterize their use, and use of other SDOH data types, to optimize SDOH data integration.

Materials and Methods

We developed 3 measures that accommodate different EHR data types on an encounter or patient-year basis. We implemented these measures—documented during encounter (DDE) captures documentation occurring during the encounter; documented by discharge (DBD) includes DDE plus documentation occurring any time prior to admission; and reviewed during encounter (RDE) captures whether anyone reviewed documented data—for the newly available structured SDOH fields and 4 other comparator SDOH data types (problem list, inpatient nursing question, social history free text, and social work notes) on a hospital encounter basis (with patient-year metrics in the Supplementary Appendix). Our sample included all patients (n = 27 127) with at least one hospitalization at UCSF Health (a large, urban, tertiary medical center) over a 1-year period.

Results

We observed substantial variation in the use of different SDOH EHR data types. Notably, social history question fields (newly added at study period start) were rarely used (DDE: 0.03% of encounters, DBD: 0.26%, RDE: 0.03%). Free-text patient social history fields had higher use (DDE: 12.1%, DBD: 49.0%, RDE: 14.4%).

Discussion

Our measures of real-world SDOH data use can guide current efforts to capture and leverage these data. For our institution, measures revealed substantial variation across data types, suggesting the need to engage in efforts such as EHR-user education and targeted workflow integration.

Conclusion

Measures revealed opportunities to optimize SDOH data documentation and review.
Interoperable genetic lab test reports: mapping key data elements to HL7 FHIR specifications and professional reporting guidelines
Authors: Khalifa Aly , Mason Clinton C , Garvin Jennifer Hornung , Williams Marc S , Del Fiol Guilherme , Jackson Brian R , Bleyl Steven B , Alterovitz Gil , Huff Stanley M
Published: September 2021

Objective

In many cases, genetic testing labs provide their test reports as portable document format files or scanned images, which limits the availability of the contained information to advanced informatics solutions, such as automated clinical decision support systems. One of the promising standards that aims to address this limitation is Health Level Seven International (HL7) Fast Healthcare Interoperability Resources Clinical Genomics Implementation Guide-Release 1 (FHIR CG IG STU1). This study aims to identify various data content of some genetic lab test reports and map them to FHIR CG IG specification to assess its coverage and to provide some suggestions for standard development and implementation.

Materials and Methods

We analyzed sample reports of 4 genetic tests and relevant professional reporting guidelines to identify their key data elements (KDEs) that were then mapped to FHIR CG IG.

Results

We identified 36 common KDEs among the analyzed genetic test reports, in addition to other unique KDEs for each genetic test. Relevant suggestions were made to guide the standard implementation and development.

Discussion and Conclusion

The FHIR CG IG covers the majority of the identified KDEs. However, we suggested some FHIR extensions that might better represent some KDEs. These extensions may be relevant to FHIR implementations or future FHIR updates.

The FHIR CG IG is an excellent step toward the interoperability of genetic lab test reports. However, it is a work-in-progress that needs informative and continuous input from the clinical genetics’ community, specifically professional organizations, systems implementers, and genetic knowledgebase providers.
Deep significance clustering: a novel approach for identifying risk-stratified and predictive patient subgroups
Authors: Huang Yufang , Liu Yifan , Steel Peter A D , Axsom Kelly M , Lee John R , Tummalapalli Sri Lekha , Wang Fei , Pathak Jyotishman , Subramanian Lakshminarayanan , Zhang Yiye
Published: September 2021

Objective

Deep significance clustering (DICE) is a self-supervised learning framework. DICE identifies clinically similar and risk-stratified subgroups that neither unsupervised clustering algorithms nor supervised risk prediction algorithms alone are guaranteed to generate.

Materials and Methods

Enabled by an optimization process that enforces statistical significance between the outcome and subgroup membership, DICE jointly trains 3 components, representation learning, clustering, and outcome prediction while providing interpretability to the deep representations. DICE also allows unseen patients to be predicted into trained subgroups for population-level risk stratification. We evaluated DICE using electronic health record datasets derived from 2 urban hospitals. Outcomes and patient cohorts used include discharge disposition to home among heart failure (HF) patients and acute kidney injury among COVID-19 (Cov-AKI) patients, respectively.

Results

Compared to baseline approaches including principal component analysis, DICE demonstrated superior performance in the cluster purity metrics: Silhouette score (0.48 for HF, 0.51 for Cov-AKI), Calinski-Harabasz index (212 for HF, 254 for Cov-AKI), and Davies-Bouldin index (0.86 for HF, 0.66 for Cov-AKI), and prediction metric: area under the Receiver operating characteristic (ROC) curve (0.83 for HF, 0.78 for Cov-AKI). Clinical evaluation of DICE-generated subgroups revealed more meaningful distributions of member characteristics across subgroups, and higher risk ratios between subgroups. Furthermore, DICE-generated subgroup membership alone was moderately predictive of outcomes.

Discussion

DICE addresses a gap in current machine learning approaches where predicted risk may not lead directly to actionable clinical steps.

Conclusion

DICE demonstrated the potential to apply in heterogeneous populations, where having the same quantitative risk does not equate with having a similar clinical profile.
Use of machine learning to transform complex standardized nursing care plan data into meaningful research variables: a palliative care exemplar
Authors: Macieira Tamara G R , Yao Yingwei , Keenan Gail M
Published: September 2021

The aim of this article was to describe a novel methodology for transforming complex nursing care plan data into meaningful variables to assess the impact of nursing care. We extracted standardized care plan data for older adults from the electronic health records of 4 hospitals. We created a palliative care framework with 8 categories. A subset of the data was manually classified under the framework, which was then used to train random forest machine learning algorithms that performed automated classification. Two expert raters achieved a 78% agreement rate. Random forest classifiers trained using the expert consensus achieved accuracy (agreement with consensus) between 77% and 89%. The best classifier was utilized for the automated classification of the remaining data. Utilizing machine learning reduces the cost of transforming raw data into representative constructs that can be used in research and practice to understand the essence of nursing specialty care, such as palliative care.