bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Dive Into Gaps and Barriers to Implementation of Antimicrobial Stewardship Programs in Hospitals in Latin America
Authors: Fabre Valeria , Secaira Clara , Cosgrove Sara E , Lessa Fernanda C , Patel Twisha S , Alvarez Andrea Alvarado , Anchiraico Lucy Marleni , del Carmen Bangher Maria , Barberis Maria Fernanda , Burokas Maria Sol , Castañeda Ximena , Colque Angel M , De Ascencao Gabriela , Esquivel Clara , Ezcurra Cecilia , Falleroni Leandro Abel , Frassone Natalia , Garzón Maria Isabel , Gomez Carlos , Gonzalez José Anel , Hernandez Daniela , Laplume Diego , Lemir César Guillermo , Maldonado Briones Herberth , Melgar Mario , Mesplet Florencia , Martinez Guadalupe , Pertuz Carlos Morales , Moreno Cristina , Nemirovsky Corina , Nuccetelli Yanina , Palacio Belén , Sandoval Nancy , Vergara Hernan , Videla Hugo , Villamandos Silvina , Villareal Olmedo , Viteri Alejandra , Quiros Rodolfo
Published: July 2023

Background

Antimicrobial resistance has worsened in Latin America. There is an urgent need to understand the development of antimicrobial stewardship programs (ASPs) and the barriers to implementing effective ASPs in light of limited national action plans or policies to promote ASPs in the region.

Methods

We performed a descriptive mixed-methods study of ASPs in 5 Latin American countries in March-July 2022. An electronic questionnaire with an associated scoring system (hospital ASP self-assessment) was used, and ASP development was classified based on the scores (inadequate, 0–25; basic, 26–50; intermediate, 51–75; or advanced, 76–100). Interviews among healthcare workers (HCWs) involved in antimicrobial stewardship (AS) inquired about behavioral and organizational factors that influence AS activities. Interview data were coded into themes. Results from the ASP self-assessment and interviews were integrated to create an explanatory framework.

Results

Twenty hospitals completed the self-assessment, and 46 AS stakeholders from these hospitals were interviewed. ASP development was inadequate/basic in 35% of hospitals, intermediate in 50%, and advanced in 15%. For-profit hospitals had higher scores than not-for-profit hospitals. Interview data validated the self-assessment findings and provided further insight into ASP implementation challenges, which included limited formal hospital leadership support, inadequate staffing and tools to perform AS work more efficiently, limited awareness of AS principles by HCWs, and limited training opportunities.

Conclusions

We identified several barriers to ASP development in Latin America, suggesting the need to create accurate business cases for ASPs to obtain the necessary funding for their effective implementation and sustainability.
Risk Factors for Colonization With Multidrug-Resistant Bacteria in Urban and Rural Communities in Kenya: An Antimicrobial Resistance in Communities and Hospitals (ARCH) Study
Authors: Caudell Mark A , Ayodo Charchil , Ita Teresa , Smith Rachel M , Luvsansharav Ulzii-Orshikh , Styczynski Ashley R , Ramay Brooke M , Kariuki Samuel , Palmer Guy H , Call Douglas R , Omulo Sylvia
Published: July 2023

Background

Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistant infections. We identified risk factors potentially associated with human colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low-income urban and rural communities in Kenya.

Methods

Fecal specimens, demographic and socioeconomic data were collected cross-sectionally from clustered random samples of respondents in urban (Kibera, Nairobi County) and rural (Asembo, Siaya County) communities between January 2019 and March 2020. Presumptive ESCrE isolates were confirmed and tested for antibiotic susceptibility using the VITEK2 instrument. We used a path analytic model to identify potential risk factors for colonization with ESCrE. Only 1 participant was included per household to minimize household cluster effects.

Results

Stool samples from 1148 adults (aged ≥18 years) and 268 children (aged <5 years) were analyzed. The likelihood of colonization increased by 12% with increasing visits to hospitals and clinics. Furthermore, individuals who kept poultry were 57% more likely to be colonized with ESCrE than those who did not. Respondents’ sex, age, use of improved toilet facilities, and residence in a rural or urban community were associated with healthcare contact patterns and/or poultry keeping and may indirectly affect ESCrE colonization. Prior antibiotic use was not significantly associated with ESCrE colonization in our analysis.

Conclusions

The risk factors associated with ESCrE colonization in communities include healthcare- and community-related factors, indicating that efforts to control antimicrobial resistance in community settings must include community- and hospital-level interventions.
Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Authors: Chowdhury Fahmida , Mah-E-Muneer Syeda , Bollinger Susan , Sharma Aditya , Ahmed Dilruba , Hossain Kamal , Hassan Md Zakiul , Rahman Mahmudur , Vanderende Daniel , Sen Debashis , Mozumder Palash , Khan Amin Ahmed , Sarker Moushumi , Smith Rachel M , Styczynski Ashley , Luvsansharav Ulzii-Orshikh
Published: July 2023

Background

Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers.

Methods

Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals’ catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level.

Results

The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73–83; and 82%; 95% CI, 79–85, respectively). Thirty-seven percent (95% CI, 34–41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6–13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8–14) in the community versus 7% (95% CI, 6–10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19–26 vs 21% (95% CI, 18–24).

Conclusions

The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital.
Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Authors: Omulo Sylvia , Ita Teresa , Mugoh Robert , Ayodo Charchil , Luvsansharav Ulzii , Bollinger Susan , Styczynski Ashley , Ramay Brooke M , Caudell Mark A , Palmer Guy H , Kariuki Samuel , Call Douglas R , Smith Rachel M
Published: July 2023

Background

The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya.

Methods

During a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures.

Results

Most (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6–3.37]; P < .001), intubated patients (1.73 [1.03–2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03–2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14–4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03–1.13]; P = .002).

Conclusions

While CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs.
Risk Factors for Community Colonization With Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Botswana: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Authors: Lautenbach Ebbing , Mosepele Mosepele , Smith Rachel M , Styczynski Ashley , Gross Robert , Cressman Leigh , Jaskowiak-Barr Anne , Alby Kevin , Glaser Laurel , Richard-Greenblatt Melissa , Cowden Laura , Sewawa Kgotlaetsile , Otukile Dimpho , Paganotti Giacomo M , Mokomane Margaret , Bilker Warren B , Mannathoko Naledi
Published: July 2023

Background

The epidemiology of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low- and middle-income countries (LMICs) is poorly described. Identifying risk factors for ESCrE colonization is critical to inform antibiotic resistance reduction strategies because colonization is typically a precursor to infection.

Methods

From 15 January 2020 to 4 September 2020, we surveyed a random sample of clinic patients at 6 sites in Botswana. We also invited each enrolled participant to refer up to 3 adults and children. All participants had rectal swabs collected that were inoculated onto chromogenic media followed by confirmatory testing. Data were collected on demographics, comorbidities, antibiotic use, healthcare exposures, travel, and farm and animal contact. Participants with ESCrE colonization (cases) were compared with noncolonized participants (controls) to identify risk factors for ESCrE colonization using bivariable, stratified, and multivariable analyses.

Results

A total of 2000 participants were enrolled. There were 959 (48.0%) clinic participants, 477 (23.9%) adult community participants, and 564 (28.2%) child community participants. The median (interquartile range) age was 30 (12–41) and 1463 (73%) were women. There were 555 cases and 1445 controls (ie, 27.8% of participants were ESCrE colonized). Independent risk factors (adjusted odds ratio [95% confidence interval]) for ESCrE included healthcare exposure (1.37 [1.08–1.73]), foreign travel [1.98 (1.04–3.77]), tending livestock (1.34 [1.03–1.73]), and presence of an ESCrE-colonized household member (1.57 [1.08–2.27]).

Conclusions

Our results suggest healthcare exposure may be important in driving ESCrE. The strong links to livestock exposure and household member ESCrE colonization highlight the potential role of common exposure or household transmission. These findings are critical to inform strategies to curb further emergence of ESCrE in LMICs.
Inflammatory Bowel Disease Is not Linked to a Higher Rate of Adverse Events in Colonoscopy—a Nationwide Population-based Study in Sweden
Authors: Alexandersson Bjarki T , Andreasson Anna , Hedin Charlotte , Broms Gabriella , Schmidt Peter T , Forsberg Anna
Published: July 2023

Background and Aims

Inflammatory bowel disease may cause long-standing inflammation and fibrosis and may increase the risk of adverse events in colonoscopy. We evaluated whether inflammatory bowel disease and other potential risk factors are associated with bleeding or perforation in a nationwide, population-based, Swedish study.

Methods

Data from 969 532 colonoscopies, including 164 012 [17%] on inflammatory bowel disease patients, between 2003 and 2019, were retrieved from the National Patient Registers. ICD-10 codes for bleeding [T810] and perforation [T812] within 30 days of the colonoscopy were recorded. Multivariable logistic regression was used to test if inflammatory bowel disease status, inpatient setting, time period, general anaesthesia, age, sex, endoscopic procedures, and antithrombotic treatment were associated with higher odds for bleeding and perforation.

Results

Bleeding and perforation were reported in 0.19% and 0.11% of all colonoscopies, respectively. Bleeding [odds ratio 0.66, p <0.001] and perforation [odds ratio 0.79, p <0.033] were less likely in colonoscopies in individuals with inflammatory bowel disease status. Bleeding and perforation were more common in inpatient than in outpatient inflammatory bowel disease colonoscopies. The odds for bleeding but not perforation increased between 2003 to 2019. General anaesthesia was associated with double the odds for perforation.

Conclusions

Individuals with inflammatory bowel disease did not have more adverse events compared with individuals without inflammatory bowel disease status. However, the inpatient setting was associated with more adverse events, particularly in inflammatory bowel disease status. General anaesthesia was associated with a greater risk of perforation.
Path analysis of illness uncertainty and psychosocial adaptation of patients with Marfan syndrome
Authors: Kim Sujin , Jang Yeonsoo , Choi JiYeon , Song Kijun , Song Jae-kwan , Choi Mona
Published: July 2023

Aims

Marfan syndrome (MFS) is a genetic disorder that causes sudden or chronic cardiovascular problems, which can be fatal. Since MFS patients require regular close medical observation, it is important to understand the factors and pathways associated with psychosocial adaptation to the disease. This study aimed to identify the relationships among illness uncertainty, uncertainty appraisal, and psychosocial adaptation in MFS patients using path analysis.

Method and results

This descriptive cross-sectional survey study was conducted from October 2020 to March 2021, in compliance with STROBE guidelines. Using data from 179 participants aged older than 18 years, we constructed a hypothetical path model to identify determinants of illness uncertainty, uncertainty appraisal, and psychosocial adaptation. In the path analysis, disease severity, illness uncertainty, anxiety, and social support were significant factors influencing MFS patients’ psychosocial adaptation. Disease severity and illness uncertainty exerted direct effects, while anxiety and social support exerted both direct and indirect (through illness uncertainty) effects. Finally, anxiety showed the greatest total effect.

Conclusion

These findings are useful for enhancing MFS patients’ psychosocial adaptation. Medical professionals should focus on managing disease severity, decreasing anxiety, and increasing social support.
Prognosis of CRT-treated and CRT-untreated unselected population with LBBB in Stockholm County
Authors: Gatti Paolo , Lind Stefan , Kristjánsdóttir Ingibjörg , Azari Ava , Savarese Gianluigi , Anselmino Matteo , Linde Cecilia , Gadler Fredrik
Published: July 2023

Aims

Left bundle branch block (LBBB) might be the first finding of cardiovascular diseases but also the prerequisite for cardiac resynchronization therapy (CRT) in heart failure (HF) with reduced ejection fraction (HFrEF). The prognosis for patients with LBBB and the implications of CRT in an unselected real-world setting are the focus of our study.

Methods and results

A central electrocardiogram (ECG) database and national registers have been screened to identify patients with LBBB. Predictors of HF and the use of CRT were identified with Cox models. The hazard ratios (HRs) of death, cardiovascular death (CVD), and HF hospitalization (HFH) were estimated according to CRT use. Of 5359 patients with LBBB and QRS > 150 ms, median age 76 years, 36% were female. At the time of index ECG, 41% had a previous history of HF and 27% developed HF. Among 1053 patients with a class I indication for CRT, only 60% received CRT with a median delay of 137 days, and it was associated with a lower risk of death [HR: 0.45, 95% confidence interval (CI): 0.36–0.57], CVD (HR: 0.47, 95% CI: 0.35–0.63), and HFH (HR: 0.56, 95% CI: 0.48–0.66). The age of over 75 years and the diagnosis of dementia and chronic obstructive pulmonary disease were predictors of CRT non-use, while having a pacing/defibrillator device independently predicted CRT use.

Conclusion

In an unselected LBBB population, CRT is underused but of great value for HF patients. Therefore, it is crucial to find ways of better implementing and understanding CRT utilization and characteristics that influence the management of our patients.
Complex traits and candidate genes: estimation of genetic variance components across multiple genetic architectures
Authors: Feldmann Mitchell J , Covarrubias-Pazaran Giovanny , Piepho Hans-Peter
Published: July 2023

Large-effect loci—those statistically significant loci discovered by genome-wide association studies or linkage mapping—associated with key traits segregate amidst a background of minor, often undetectable, genetic effects in wild and domesticated plants and animals. Accurately attributing mean differences and variance explained to the correct components in the linear mixed model analysis is vital for selecting superior progeny and parents in plant and animal breeding, gene therapy, and medical genetics in humans. Marker-assisted prediction and its successor, genomic prediction, have many advantages for selecting superior individuals and understanding disease risk. However, these two approaches are less often integrated to study complex traits with different genetic architectures. This simulation study demonstrates that the average semivariance can be applied to models incorporating Mendelian, oligogenic, and polygenic terms simultaneously and yields accurate estimates of the variance explained for all relevant variables. Our previous research focused on large-effect loci and polygenic variance separately. This work aims to synthesize and expand the average semivariance framework to various genetic architectures and the corresponding mixed models. This framework independently accounts for the effects of large-effect loci and the polygenic genetic background and is universally applicable to genetics studies in humans, plants, animals, and microbes.
Associations of Days Spent at Home Before Hip Fracture With Postfracture Days at Home and 1-Year Mortality Among Medicare Beneficiaries Living With Alzheimer’s Disease or Related Dementias
Authors: Falvey Jason R , Chen Chixiang , Johnson Abree , Ryan Kathleen A , Shardell Michelle , Ren Haoyu , Reider Lisa , Magaziner Jay
Published: July 2023

Background

Hip fracture is a disabling event experienced disproportionately by older adults with Alzheimer’s disease or related dementias (ADRD). Claims information recorded prior to a hip fracture could provide valuable insights into recovery potential for these patients. Thus, our objective was to identify distinct trajectories of claims-based days at home (DAH) before a hip fracture among older adults with ADRD and evaluate associations with postfracture DAH and 1-year mortality.

Methods

We conducted a cohort study of 16 576 Medicare beneficiaries living with ADRD who experienced hip fracture between 2010 and 2017. Growth mixture modeling was used to estimate trajectories of DAH assessed from 180 days prior to fracture until index fracture admission, and their joint associations with postfracture DAH trajectories and 1-year mortality.

Results

Before a hip fracture, a model with 3 distinct latent DAH trajectories was the best fit. Trajectories were characterized based on their temporal patterns as Consistently High (n = 14 980, 90.3%), Low but Increasing (n = 809, 5.3%), or Low and Decreasing (n = 787, 4.7%). Membership in the Low and Decreasing prefracture DAH trajectory was associated with less favorable postfracture DAH trajectories, and a 65% higher 1-year mortality rate (hazard ratio 1.65, 95% confidence interval 1.45–1.87) as compared to those in the Consistently High trajectory. Similar albeit weaker associations with these outcomes were observed for hip fracture survivors in the Low but Improving prefracture DAH trajectory.

Conclusions

Distinct prefracture DAH trajectories among hip fracture survivors with ADRD are strongly linked to postfracture DAH and 1-year mortality, which could guide development of tailored interventions.
Reconciling the conflicting extent of overriding plate deformation before and during megathrust earthquakes in South America, Sunda and northeast Japan
Authors: D'Acquisto Mario , Broerse Taco , Marsman Celine P , Govers Rob
Published: July 2023

We aim to better understand the overriding plate deformation during the megathrust earthquake cycle. We estimate the spatial patterns of interseismic GNSS velocities in South America, Southeast Asia and northern Japan and the associated uncertainties due to variations in network density and observation uncertainties. Interseismic velocities with respect to the overriding plate generally decrease with distance from the trench with a steep gradient up to a ‘hurdle’, beyond which the gradient is distinctly lower and velocities are small. The hurdle is located 500–1000 km away from the trench for the trench-perpendicular velocity component, and either at the same distance or closer for the trench-parallel component. Significant coseismic displacements were observed beyond these hurdles during the 2010 Maule, 2004 Sumatra–Andaman, and 2011 Tohoku earthquakes. We hypothesize that both the interseismic hurdle and the coseismic response result from a mechanical contrast in the overriding plate. We test our hypothesis using physically consistent, generic, 3-D finite element models of the earthquake cycle. Our models show a response similar to the interseismic and coseismic observations for a compliant near-trench overriding plate and an at least five times stiffer overriding plate beyond the contrast. The model results suggest that hurdles are more prominently expressed in observations near strongly locked megathrusts. Previous studies inferred major tectonic or geological boundaries and seismological contrasts located close to the observed hurdles in the studied overriding plates. The compliance contrast probably results from thermal, compositional and thickness contrasts and might cause the observed focusing of smaller-scale deformation like backthrusting.
Ionospheric disturbances observed over China after 2022 January 15 Tonga volcano eruption
Authors: Li Ting , Gao Yongxin , Chen Chieh-Hung , Zhang Xuemin , Sun Yang-Yi
Published: July 2023

At 04:14:45 UT on 2022 January 15, a powerful eruption of the submarine Hunga Tonga–Hunga Ha'apai volcano occurred at about 30 km south of the Ha'apai Islands in the Kingdom of Tonga (at −20.55° N, −175.39° E). This eruption caused atmospheric waves that spread worldwide. In this study, we investigate the the total electron content (TEC) variation over China using the BeiDou Navigation Satellite System. The particularly interesting feature of the data set compared to other ground-based TEC data is the exclusive use of the BeiDou geostationary satellites, which monitor the TEC variations for fixed ionospheric piercing points and can provide more accurate calculations of the travelling speed of the disturbance. For comparison, atmospheric pressure records were examined, which show that the Lamb wave passed by the same stations four times with a constant speed of 310 m s−1. However, the TEC results show that the ionospheric disturbances passing over China four times with different speeds within four days after the eruption, two travelling along the short-path direction and two along the long-path direction. The primary front of the first short-path event travels with a speed of 340 m s−1, which is higher than the Lamb wave. The faster speed suggests that the primary front cannot be fully attributed to the Lamb wave, and further studies need to explore its mechanism. The second short-path and first long-path events travel with speeds of 301 and 310 m s−1, respectively, close to the speed of the Lamb wave, and they may be caused by upward energy leakage during the propagation of the Lamb wave. The second long-path event travels with a speed of 264 m s−1, possibly induced by the gravity waves.
Boundary and volumetric sensitivity kernels of teleseismic receiver functions for mantle discontinuities in the transition zone
Authors: de Jong J H E , Paulssen H , Trampert J
Published: July 2023

Teleseismic receiver functions are widely used to map the depth and topography of various major discontinuities in the Earth’s mantle. To determine what precisely contributes to the receiver functions, we applied the adjoint method of full waveform inversion to calculate their sensitivity kernels. These kernels illustrate the extend to which model parameters may influence the waveforms. We calculated synthetic data for a realistic event measured at a realistic receiver array, whereby we focused on the waveforms of the P410s and P660s phases, that convert a P to an S wave at the 410- and 660-discontinuity, respectively. We calculated both the volumetric sensitivity kernels for density, P- and S-wave speeds, as well as boundary kernels that illustrate receiver functions’ sensitivity to topography on the discontinuity. In the boundary kernels, we observe that receiver functions are highly sensitive to a discontinuity’s topography, in particular to an area surrounding the conversion point with a radius comparable to the Fresnel zone. However, the volumetric kernels illustrate a sensitivity to model parameters in large areas of the mantle. This includes sensitivity to the Fresnel zone of the converted wave far before the conversion, as well as sensitivity to scatterers of other phases. We therefore conclude that receiver functions are sensitive to the topography of discontinuities. However, effects of an incorrect velocity model, even far from the conversion point, may erroneously be projected onto the topography of the discontinuity. Therefore, a simultaneous inversion of topography and velocity parameters is required to image topography with high accuracy.
Phloem unloading in cultivated melon fruits follows an apoplasmic pathway during enlargement and ripening
Authors: Zhou Yixuan , Li Kexin , Wen Suying , Yang Dong , Gao Jun , Wang Ziwei , Zhu Peilu , Bie Zhilong , Cheng Jintao
Published: July 2023

Melon (Cucumis melo L.) has a long history of cultivation worldwide. During cultivation, domestication, and selection breeding, the sugar content of mature melon fruits has been significantly increased. Compared with unsweet melon and wild melon, rapid sucrose accumulation can occur in the middle and late stages of sweet melon fruit development. The phloem unloading pathway during the evolution and development of melon fruit has not been identified and analyzed. In this study, the phloem unloading pathway and the function of related sugar transporters in cultivated and wild melon fruits were analyzed by CFDA [5(6)-carbofluorescein diacetate] and esculin tracing, cytological pathway observation, qRT–PCR, and gene function analysis, etc. Results show that the phloem unloading pathway of wild melon fruit is largely symplastic, whereas the phloem unloading pathway of cultivated melon fruit shifts from symplastic to apoplasmic during development. According to a fruit grafting experiment, the fruit sink accumulates sugars independently. Correlation analysis showed that the expression amounts of several sucrose transporter genes were positively correlated with the sucrose content of melon fruit. Furthermore, CmSWEET10 was proved to be a sucrose transporter located on the plasma membrane of the phloem and highly expressed in the premature stage of sweet melon fruits, which means it may be involved in phloem apoplast unloading and sucrose accumulation in sweet melon fruits. Finally, we summarize a functional model of related enzymes and sugar transporters involved in the apoplast unloading of sweet melon fruits during enlargement and sucrose accumulation.
Functional diversity of subgroup 5 R2R3-MYBs promoting proanthocyanidin biosynthesis and their key residues and motifs in tea plant
Authors: Jiao Tianming , Huang Yipeng , Wu Ying-Ling , Jiang Ting , Li Tongtong , Liu Yanzhuo , Liu Yvchen , Han Yunyun , Liu Yajun , Jiang Xiaolan , Gao Liping , Xia Tao
Published: July 2023

The tea plant (Camellia sinensis) is rich in polyphenolic compounds. Particularly, flavan-3-ols and proanthocyanidins (PAs) are essential for the flavor and disease-resistance property of tea leaves. The fifth subgroup of R2R3-MYB transcription factors comprises the primary activators of PA biosynthesis. This study showed that subgroup 5 R2R3-MYBs in tea plants contained at least nine genes belonging to the TT2, MYB5, and MYBPA types. Tannin-rich plants showed an expansion in the number of subgroup 5 R2R3-MYB genes compared with other dicotyledonous and monocot plants. The MYBPA-type genes of tea plant were slightly expanded. qRT–PCR analysis and GUS staining analysis of promoter activity under a series of treatments revealed the differential responses of CsMYB5s to biotic and abiotic stresses. In particular, CsMYB5a, CsMYB5b, and CsMYB5e responded to high-intensity light, high temperature, MeJA, and mechanical wounding, whereas CsMYB5f and CsMYB5g were only induced by wounding. Three genetic transformation systems (C. sinensis, Nicotiana tabacum, and Arabidopsis thaliana) were used to verify the biological function of CsMYB5s. The results show that CsMYB5a, CsMYB5b, and CsMYB5e could promote the gene expression of CsLAR and CsANR. However, CsMYB5f and CsMYB5g could only upregulate the gene expression of CsLAR but not CsANR. A series of site-directed mutation and domain-swapping experiments were used to verify functional domains and key amino acids of CsMYB5s responsible for the regulation of PA biosynthesis. This study aimed to provide insight into the induced expression and functional diversity model of PA biosynthesis regulation in tea plants.
Population ageing and national security in Asia
Authors: Sciubba Jennifer D
Published: July 2023

Population aging is pervasive in powerful states in the Asia—Pacific region, but the effects of and responses to it vary in ways that do not neatly fit with what initial theories anticipated. Why have many of these states' foreign policies been far more aggressive or militaristic than expected for their demographics? The key to understanding population and national security is an institutional perspective that recognizes how demographic changes interact with other factors. The range of institutions among the Asia—Pacific powers explains some of the variation in their foreign policies; policies intended to respond to or adapt to those demographic shifts explain the rest. Understanding how aging shapes states' external behaviours is increasingly important as population aging is becoming the predominant demographic trend globally. Those forecasting the effects of population aging must accurately account for the ways institutions mediate demographic change, or risk severely underestimating or overestimating the capabilities and intentions of allies and adversaries. An illustrative discussion of institutional arrangements and military manpower adaptations demonstrates why the effect of population aging has been diluted in China and Russia thus far but suggests that Japan is well positioned to manage the economic risks posed by an aging population.
NEO-SAFE: a clinical model for patients and healthcare personnel safety in primary level hospitals
Authors: Cetica Federica , Ciantelli Massimiliano , Carcione Simona , Scaramuzzo Rosa T , Bottone Ugo , Pellegrini Alessandra , Caiazzo Debora , Gagliardi Luigi , Luzi Cinzia , Lenzini Andrea , Bardelli Serena , Filippi Luca , Bellandi Tommaso , Cuttano Armando
Published: July 2023

Patient safety is a major concern in medicine. Approximately, 4 million infants die each year worldwide and 23% of these deaths are caused by perinatal asphyxia. To prevent the long-term damage of asphyxia, the resuscitation flowchart must be perfectly and promptly performed. However, high effectiveness in performing resuscitation can only be achieved and maintained if the algorithm is frequently executed. Therefore, maintaining a high level of patient care is difficult in some remote centres. The aim of this study was to evaluate the effectiveness of a new organizational model of care-network between Hub & Spoke hospitals to improve both the safety of the newborns in hospitals with a low number of births and the well-being of operators. Our project, NEO-SAFE (NEOnatal SAFety and training Elba), began in 2017 and involved the neonatal intensive care unit and the NINA Center of the Pisa University Hospital (hub) and the Hospital of Elba Island (spoke). It consisted of a continuous training program, both with ‘classic’ training course and ‘on-job tutoring’ (on side and remotely), of the health workers at spoke (i.e. nurses, midwives, and paediatricians). All four milestones of the study design were achieved. During the project, NINA Center instructors organized training courses for the staff in Portoferraio. These courses were based on learning technical and non-technical skills in a training course of increasing difficulty. Staff training needs were also monitored during the project by means of periodic questionnaires, sentinel events, and specific requests. The curve described by the rate of newborns transfer to the Pisa neonatal intensive care unit (hub) shows a monotonous decreasing trend line. On the other hand, this project allowed operators to develop greater self-confidence and greater safety in managing emergency situations, reducing stress for them and improving patient safety. The project allowed the creation of a safe, effective, low-cost, and reproducible organizational model for centres with a low number of births. Moreover, the tele-medicine approach is an important improvement in the assistance and is a window on the future.
Nondestructive, reagent-free, low-volume fluidic set-up to study biofilms by using a transparent electrode, allowing simultaneous electrochemical and optical measurements
Authors: Saavedra Albert , Martínez-Casillas Diana C , Collet-Lacoste Jean R , Cortón Eduardo
Published: July 2023

Aims

The aim was to develop an electrochemical/optical set-up and correlate it (as validation) with other chemical and physical methods to obtain a simple and cost-effective system to study biofilm formation.

Methods and Results

A simple microfluidic cell and methods allowed continuous monitoring of the first, critical steps of microbial attachment. We monitored sulfate-reducing bacteria (SRB) at the early stages of biofilm formation. Herein, we studied the formation and adherence of SRB consortium biofilms over an indium tin oxide (ITO) conducting surface using microbiological and chemical methods, microscopic observations [scanning electron microscopy (SEM) and optical], and electrochemical impedance spectroscopy (EIS) measurements. The SRB biofilm formation was evaluated for 30 d by SEM and EIS. Charge transfer resistance decreased when the microbial population colonized the electrode. The monitoring of early-stage biofilm formation was performed using EIS at a single frequency of 1 Hz during the first 36 h.

Conclusions

The simultaneous use of optical, analytical, and microbiological methods allowed us to connect the kinetics of the growth of the microbial consortium to the values obtained via the electrochemical technique. The simple setup we present here can help laboratories with limited resources to study biofilm attachment and facilitates the development of various strategies to control biofilm development in order to avoid damage to metallic structures (microbiologically influenced corrosion, MIC) or the colonization of other industrial structures and medical devices.
Impact of notification policy on patient-before-clinician review of immediately released test results
Authors: Steitz Bryan D , Padi-Adjirackor Nana Addo , Griffith Kevin N , Reese Thomas J , Rosenbloom S Trent , Ancker Jessica S
Published: July 2023

The 21st Century Cures Act mandates immediate availability of test results upon request. The Cures Act does not require that patients be informed of results, but many organizations send notifications when results become available. Our medical center implemented 2 sequential policies: immediate notifications for all results, and notifications only to patients who opt in. We used over 2 years of data from Vanderbilt University Medical Center to measure the effect of these policies on rates of patient-before-clinician result review and patient-initiated messaging using interrupted time series analysis. When releasing test results with immediate notification, the proportion of patient-before-clinician review increased 4-fold and the proportion of patients who sent messages rose 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%. Replacing automated notifications with an opt-in policy provides patients flexibility to indicate their preferences but may not substantially alleviate clinicians’ messaging workload.
A certified de-identification system for all clinical text documents for information extraction at scale
Authors: Radhakrishnan Lakshmi , Schenk Gundolf , Muenzen Kathleen , Oskotsky Boris , Ashouri Choshali Habibeh , Plunkett Thomas , Israni Sharat , Butte Atul J
Published: July 2023

Objectives

Clinical notes are a veritable treasure trove of information on a patient’s disease progression, medical history, and treatment plans, yet are locked in secured databases accessible for research only after extensive ethics review. Removing personally identifying and protected health information (PII/PHI) from the records can reduce the need for additional Institutional Review Boards (IRB) reviews. In this project, our goals were to: (1) develop a robust and scalable clinical text de-identification pipeline that is compliant with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule for de-identification standards and (2) share routinely updated de-identified clinical notes with researchers.

Materials and Methods

Building on our open-source de-identification software called Philter, we added features to: (1) make the algorithm and the de-identified data HIPAA compliant, which also implies type 2 error-free redaction, as certified via external audit; (2) reduce over-redaction errors; and (3) normalize and shift date PHI. We also established a streamlined de-identification pipeline using MongoDB to automatically extract clinical notes and provide truly de-identified notes to researchers with periodic monthly refreshes at our institution.

Results

To the best of our knowledge, the Philter V1.0 pipeline is currently the first and only certified, de-identified redaction pipeline that makes clinical notes available to researchers for nonhuman subjects’ research, without further IRB approval needed. To date, we have made over 130 million certified de-identified clinical notes available to over 600 UCSF researchers. These notes were collected over the past 40 years, and represent data from 2757016 UCSF patients.
Forages and pastures symposium: an update on in vitro and in situ experimental techniques for approximation of ruminal fiber degradation
Authors: Foster Jamie L , Smith William B , Rouquette F Monte , Tedeschi Luis O
Published: July 2023

Static quantification measures of chemical components are commonly used to make certain assumptions about forage or feed nutritive value and quality. In order for modern nutrient requirement models to estimate intake and digestibility more accurately, kinetic measures of ruminal fiber degradation are necessary. Compared to in vivo experiments, in vitro (IV) and in situ (IS) experimental techniques are relatively simple and inexpensive methods to determine the extent and rate of ruminal fiber degradation. This paper summarizes limitations of these techniques and statistical analyses of the resulting data, highlights key updates to these techniques in the last 30 yr, and presents opportunities for further improvements to these techniques regarding ruminal fiber degradation. The principle biological component of these techniques, ruminal fluid, is still highly variable because it is influenced by ruminally fistulated animal diet type and timing of feeding, and in the case of the IV technique by collection and transport procedures. Commercialization has contributed to the standardization, mechanization, and automation of the IV true digestibility technique, for example, the well-known DaisyII Incubator. There has been limited commercialization of supplies for the IS technique and several review papers focused on standardization in the last 30 yr; however, the IS experimental technique is not standardized and there remains variation within and among laboratories. Regardless of improved precision resulting from enhancements of these techniques, the accuracy and precision of determining the indigestible fraction are fundamental to modeling digestion kinetics and the use of these estimates in more complex dynamic nutritional modeling. Opportunities for focused research and development are additional commercialization and standardization, methods to improve the precision and accuracy of indigestible fiber fraction, data science applications, and statistical analyses of results, especially for IS data. In situ data is typically fitted to one of a few first-order kinetic models, and parameters are estimated without determining if the selected model has the best fit. Animal experimentation will be fundamental to the future of ruminant nutrition and IV and IS techniques will remain vital to bring together nutritive value with forage quality. It is feasible and important to focus efforts on improving the precision and accuracy of IV and IS results.
Follow the Boots: A Case Study of Design and Global Value Chains
Authors: Hodson Elise
Published: July 2023

As manufacturing has become globally fragmented, so too has the work of design. Complex supply chains conceal sources of creativity and innovation, posing new challenges for researching design history. There is little understanding of how the globalization of manufacturing in the late-twentieth and early-twenty-first centuries has affected design practice or how design authorship might be identified in mass-produced objects. This case study follows a pair of steel-toed boots named Vanessa from concept through design, development, and production, moving from Canada to Italy, Mexico, and beyond. It maps components, equipment, and expertise, making it possible to trace sources and relationships of design. Analysis reveals how the boots reflect shifts in global trade and the concentration of knowledge and resources in new locations. It also shows how the globalization of production has influenced the role of the product designer who acts as intermediary within transnational networks, combining predesigned components and practices from around the world. The manufacturer, Mellow Walk, has experienced the transition from a regional manufacturing economy to one that is globally integrated. The company was founded in the 1990s when most Canadian footwear factories had closed due to global competition. It is unique as the last fully integrated footwear factory in Ontario, meaning that management, design, production, sales, and shipping happen under one roof. Mellow Walk nevertheless depends on international suppliers and, in this sense, represents many other footwear brands around the world.
Acaricide exposure impairs predatory behavior of the phytoseiid miteNeoseiulus idaeus(Acari: Phytoseiidae)
Authors: de Sousa Neto Eduardo P , Mendes Jairo de Almeida , Filgueiras Rosenya Michely Cintra , de Lima Debora B , Guedes Raul Narciso C , Melo José W S
Published: July 2023

Predation is an important interaction that can change the structure of arthropod communities across both temporal and spatial scales. In agricultural systems predation can reduce the population levels of several arthropod pest species of a community. This predator–prey interaction involves the predator searching and handling behaviors. Several factors can affect this interaction, such as pesticide exposure, which is a frequent feature in agroecosystems. Thus, the hypothesis of our study is that the predatory behavior of the phytoseiid mite Neoseiulus idaeus Denmark & Muma, an important natural enemy of spider mites, is affected by acaricide exposure. To test that hypothesis, the predatory mite was exposed to the acaricides abamectin, fenpyroximate, and azadirachtin in 4 exposure scenarios. The predatory behavior of N. idaeus was negatively affected by acaricide exposure when the leaf surface containing both prey and predator was sprayed leading to a reduction in the frequency of transitions between predator walking and meeting preys. Prey handling and consumption were also compromised by acaricide exposure through contaminated leaf surface and prey, and contaminated leaf surface, prey, and predator. Abamectin compromised predation regardless of the exposure scenario. Acaricide-exposure reduced the number of prey found, number of attacks, and number prey killed by N. idaeus. Moreover, partial prey consumption was observed with acaricide-exposed mites. Thus, caution is necessary while attempting to integrate acaricide applications and mass release of N. idaeus for spider mite management.
Vintage factor analysis with Varimax performs statistical inference
Authors: Rohe Karl , Zeng Muzhe
Published: July 2023

In the 1930s, Psychologists began developing Multiple-Factor Analysis to decompose multivariate data into a small number of interpretable factors without any a priori knowledge about those factors. In this form of factor analysis, the Varimax factor rotation redraws the axes through the multi-dimensional factors to make them sparse and thus make them more interpretable. Charles Spearman and many others objected to factor rotations because the factors seem to be rotationally invariant. Despite the controversy, factor rotations have remained widely popular among people analyzing data. Reversing nearly a century of statistical thinking on the topic, we show that the rotation makes the factors easier to interpret because the Varimax performs statistical inference; in particular, principal components analysis (PCA) with a Varimax rotation provides a unified spectral estimation strategy for a broad class of semi-parametric factor models, including the Stochastic Blockmodel and a natural variation of Latent Dirichlet Allocation. In addition, we show that Thurstone’s widely employed sparsity diagnostics implicitly assess a key leptokurtic condition that makes the axes statistically identifiable in these models. PCA with Varimax is fast, stable, and practical. Combined with Thurstone’s straightforward diagnostics, this vintage approach is suitable for a wide array of modern applications.