bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial susceptibility in Clostridioides difficile varies according to European region and isolate source
Authors: Freeman Jane , Viprey Virginie , Ewin Duncan , Spittal William , Clark Emma , Vernon Jon , Fawley Warren , Davis Georgina , Tkalec Valerija , Wilcox Mark , Rupnik Maja , Davies Kerrie ,   COMBACTE-CDI Consortium, Bonten Marc , Davies Kerrie A , Wilcox Mark H , Kuijper Ed , Rupnik Maja , Wingen-Heimann Sebastian , Tacconelli Evelina , Vilken Tuba , Petrosillo Nicola
Published: July 2024

Objectives

Clostridioides difficile epidemiology is evolving with country-associated emerging and resistant ribotypes (RT). Antimicrobial susceptibility testing of C. difficile isolated from clinical and animal samples collected across Europe in 2018 was performed to provide antimicrobial resistance data and according to C. difficile RTs and source.

Methods

Samples were cultured for C. difficile and isolates PCR ribotyped. Metronidazole, vancomycin, fidaxomicin, moxifloxacin, clindamycin, imipenem, tigecycline, linezolid, rifampicin and meropenem minimum inhibitory concentrations (MICs) for 280 clinical and 126 animal isolates were determined by Wilkins–Chalgren agar dilution.

Results

Fidaxomicin was the most active antimicrobial (all isolates geometric mean MIC = 0.03 mg/L) with no evidence of reduced susceptibility. Metronidazole MICs were elevated among RT027 (1.87 mg/L) and RT181 clinical isolates (1.03 mg/L). RT027 and RT181 had elevated geometric mean moxifloxacin MICs (14.49 mg/L, 16.88 mg/L); clindamycin (7.5 mg/L, 9.1 mg/L) and rifampicin (0.6 mg/L, 21.5 mg/L). Five isolates (RT002, RT010 and RT016) were metronidazole resistant (MIC = 8 mg/L) and 10 (RT027; RT198) had intermediate resistance (4 mg/L). Metronidazole MICs were not elevated in animal isolates. Increased geometric mean vancomycin MICs were observed among RT078, mostly isolated from animals, but there was no resistance (MIC ≥ 4 mg/L). Clinical and animal isolates of multiple RTs showed resistance to moxifloxacin and clindamycin. No resistance to imipenem or meropenem was observed.

Conclusion

Increased antimicrobial resistance was detected in eastern Europe and mostly associated with RT027 and related emerging RT181, while clinical isolates from northern and western Europe had the lowest general levels of resistance.
Point-of-Care Testing Biosafety Decisions: An Investigation Summary Illustrating Current Decision-Making Process in Ontario, Canada
Authors: Tadros Manal , Shaw Julie L V , Chen Yan , Wong-Fung Matt , Koerner Tess , Ralevski Georgina , Kerr Elaine , Matukas Larissa M
Published: July 2024

Background

Point-of-care testing (POCT) is increasingly being used in healthcare, including hospitals, and POCT-style tests are also used within some laboratories. The principles of biosafety, including risk assessment and containment of biohazardous agents, can be utilized as a foundation to establish policies and procedures guiding safe performance of POCT. However, specific biosafety guidelines for POCT are generally lacking, particularly for those performed outside laboratories by healthcare workers. This study aims to explore POCT biosafety program decision-making infrastructure and oversight in Ontario.

Content

The Institute of Quality Management in Healthcare distributed a survey to 249 laboratories in Ontario. There were 11 questions on POCT biosafety practices.

The survey had a high response rate of 88.7%. How POCT biosafety decisions were made was variable among respondents. For POCT-style tests conducted within laboratories, the biosafety officer (BSO) and/or the microbiologist were involved in biosafety decisions in 95% of microbiology labs or 55% of other labs. Only 27% of the respondents reported that biosafety decisions were made by BSOs and/or microbiologists when POCT was conducted outside the laboratory. When POCT is performed outside the laboratory, biosafety decisions were made largely by Infection Prevention and Control (IPAC) and POCT laboratory staff. Similarly, training and auditing of staff who perform POCT were mainly done by IPAC and POCT laboratory staff. The survey showed that a wide variety of POCT was being conducted for COVID-19 patients during the pandemic.
Plant development and reproduction in a changing environment
Authors: Pagnussat Gabriela C , Gomez-Casati Diego F
Published: July 2024

Plants face the most diverse climatic conditions throughout their life cycle. As sessile organisms, they are remarkably resilient to adverse environments, which have been exacerbated in the current context of global change. The way in which plants sense and respond to various types of abiotic stresses varies depending on the severity of the stress and the developmental stage of the plant, affecting both vegetative and reproductive aspects. Understanding how plants respond and adapt to a changing environment is crucial for predicting and mitigating the impacts of climate change on ecosystems and ensuring the future survival and reproduction of plant species.
Underluminous tidal disruption events
Authors: Amaro Seoane Pau
Published: July 2024

We have evidence of X-ray flares in several galaxies consistent with a star being tidally disrupted by a supermassive black hole (MBH). If the star starts on a nearly parabolic orbit relative to the MBH, one can derive that the fallback rate follows a $t^{-5/3}$ decay. Depending on the penetration factor, β, a star will be torn apart differently, and relativistic effects play a role. We have modified the standard version of the smoothed-particle hydrodynamics (SPH) code Gadget to include a relativistic treatment of the gravitational forces between the gas particles of a main-sequence (MS) star and a MBH. We include non-spinning post-Newtonian corrections to incorporate the periapsis shift and the spin-orbit coupling up to next-to-lowest order. We find that tidal disruptions around MBHs in the relativistic cases are underluminous for values starting at $\beta \gtrapprox 2.25$, i.e. the fallback curves produced in the relativistic cases are progressively lower compared to the Newtonian simulations as the penetration parameter increases. While the Newtonian cases display a total disruption, we find that all relativistic counterparts feature a survival core for penetration factors going to values as high as 12.05. We perform a additional dynamical numerical study that shows that the geodesics of the elements in the star converge at periapsis. We confirm these findings with an analytical study of the geodesic separation equation. The luminosity of TDEs must be lower than predicted theoretically due to the fact that the star will partially survive when relativistic effects are taken into account. A survival core should consistently emerge from any TDE with $\beta \gtrapprox 2.25$.
Structural analysis of the BisI family of modification dependent restriction endonucleases
Authors: Szafran Katarzyna , Rafalski Dominik , Skowronek Krzysztof , Wojciechowski Marek , Kazrani Asgar Abbas , Gilski Mirosław , Xu Shuang-yong , Bochtler Matthias
Published: July 2024

The BisI family of restriction endonucleases is unique in requiring multiple methylated or hydroxymethylated cytosine residues within a short recognition sequence (GCNGC), and in cleaving directly within this sequence, rather than at a distance. Here, we report that the number of modified cytosines that are required for cleavage can be tuned by the salt concentration. We present crystal structures of two members of the BisI family, NhoI and Eco15I_Ntd (N-terminal domain of Eco15I), in the absence of DNA and in specific complexes with tetra-methylated GCNGC target DNA. The structures show that NhoI and Eco15I_Ntd sense modified cytosine bases in the context of double-stranded DNA (dsDNA) without base flipping. In the co-crystal structures of NhoI and Eco15I_Ntd with DNA, the internal methyl groups (G5mCNGC) interact with the side chains of an (H/R)(V/I/T/M) di-amino acid motif near the C-terminus of the distal enzyme subunit and arginine residue from the proximal subunit. The external methyl groups (GCNG5mC) interact with the proximal enzyme subunit, mostly through main chain contacts. Surface plasmon resonance analysis for Eco15I_Ntd shows that the internal and external methyl binding pockets contribute about equally to sensing of cytosine methyl groups.
Black Atlantic
Authors: Mankulam Dhanesh
Published: July 2024

The term “Black Atlantic” comes from the English sociologist and cultural studies scholar Paul Gilroy, who talked about a distinct Black Atlantic culture that incorporated elements from African, American, British, and Caribbean cultures and positioned itself as a counterculture to Western modernity. He used this term in his 1993 book The Black Atlantic: Modernity and Double Consciousness (cited under General Readings: The Context). Black Atlantic in this sense can be seen both as a critical concept as well as a method to approach this counterculture. Gilroy describes his objective in his book as marking the experiences of Black people as part of the idea of modernity. The idea is that if one traces back to the time of slave trade and transportation of people across the Atlantic Ocean, the routes alone will emerge like a map that connects the African diaspora people from the Americas, the Caribbean, Europe, and Africa across the Atlantic. Gilroy postulates that this itself brings up a sense of shared history, shared culture, and shared identity that can constitute a counterculture and a critical historical positionality. The proposition is that such a perspective and the presence of this Black Atlantic positionality will potentially alter the existing ideas, perspectives, narratives, and axiological categories that are predominantly Eurocentric. The history of African diaspora can be meaningfully studied only by taking into account this concept of a Black Atlantic counterculture that maps the historical transoceanic experience of the Black community, beginning with the first instances of slave trade. One important concept that the concept of Black Atlantic deals with is the idea of “double consciousness.” The famous African American sociologist, socialist, and historian W. E. B. Du Bois influentially discussed this notion in the early twentieth century. He postulated that a double consciousness emerged in the African diaspora identity from the tension between the individual’s self-image and the image projected in the White-centric discourses as its “other.” The Black Atlantic counterculture positions itself against such existing positionalities in the larger contexts of sociopolitical, historical, national, and identity discourses.
Advocacy Planning
Authors: Reardon Kenneth , Raciti Antonio
Published: July 2024

In the post–World War II era, American cities confronted increasing economic, social, and political challenges resulting from the combined impact of suburbanization, deindustrialization, and disinvestment. As growing numbers of large employers seeking less expensive real estate, lower taxes, better transportation access, and relief from unionization pressures moved to the suburbs, many of their middle-and-upper income employees followed them. This outmigration of businesses and residents resulted in growing residential and commercial vacancies and falling property values in many older neighborhoods within America’s central cities causing lenders to avoid investing in these areas. Further complicating these economic challenges was the arrival of increasing numbers of African American families displaced by the mechanization of Southern agriculture. Unable to access expanding employment and housing opportunities in the suburbs due to exclusionary zoning and building codes, these families were frequently forced to live in older urban neighborhoods with poor schools, deteriorating housing, declining retail services, and underfunded municipal services. Inspired by the example of Southern civil rights organizations, leaders from these communities demanded more redistributive urban policies and participatory decision-making processes. In the mid-1960s, the federal government responded to these pressures by increasing funding for public housing and initiating an ambitious “War on Poverty.” Aware of the tendency of federal programs to achieve their redevelopment goals through displacement of the poor, working-class communities of color fought for a meaningful voice in the design and implementation of these programs. In Boston, New York, Chicago, and other US cities, equity-oriented planners and architects began collaborating with leaders of threatened neighborhoods to challenge the assumptions, goals, analysis, and plans of centralized planning and redevelopment agencies. In 1965, Paul Davidoff, an Assistant Professor of Planning at the University of Pennsylvania, wrote “Advocacy and Pluralism in Planning” which offered a powerful critique of the rational model of comprehensive planning upon which these efforts were based. Davidoff questioned the physical emphasis of these plans, the possibility of value neutral planning, the existence of a unitary public interest, and the ability of a small group of planners to incorporate the interests of diverse communities into a single plan. Davidoff urged equity-minded planners to assist groups overlooked in public planning processes to generate their own empirically based plans designed to challenge the proposals of mainstream planning agencies. Davidoff’s call for advocacy planning led to a significant reform movement within North and South American and European planning that continues to have significant influence within the planning and design professions, municipal planning departments, graduate planning and design schools, and national urban programs in the United States, United Kingdom, and elsewhere.
Byzantine Science
Authors: Manolova Divna
Published: July 2024

The study of the sciences in Byzantium is not a recent trend in Byzantine studies scholarship. At the beginning of the twentieth century, mathematics, astronomy, medicine, and other sciences were defined as publication categories in the Byzantinische Zeitschrift bibliography. Despite this, critical editions were lacking until the 1980s and it is only since the 2010s that the existing research surpassed, in terms of both quantity and scope, a critical threshold that allowed it to form as an independent, sustainable, and growing field within Byzantine and Medieval Studies, as well as within the respective remits of history of science and history of knowledge. It is only in 2020 that the subfield received its first extensive and comprehensive synthetic overview, which employed a wide definition of Byzantine science, thus incorporating a paradigm larger than the commonly applied late antique framework of the four mathematical disciplines of the so-called quadrivium, or μαθηματικὴ τετρακτύς in Greek, that is, arithmetic, geometry, astronomy, and music (harmonics). In other words, Byzantine science as an independent subject of research has received recognition only recently and its scope includes non-mathematical disciplines as well, such as geography, zoology, botany and pharmacology, medicine, meteorology, and physics as well as the so-called occult sciences and the technology of warfare. Even so, the most persistent narrative regarding science (but also other cultural and intellectual products) of the Byzantine millennium is that of the absence of an “original contribution” and the important role Byzantium played, as a depository, preserving ancient and Hellenistic Greek heritage for it to be rediscovered by the Italian humanists and, more generally, by the West during the fourteenth and the fifteenth centuries. Instead, what should be taken into account in evaluating and understanding Byzantine science and intellectual culture more generally includes, first, the educational structures and underlying social, political (imperial and centralized), and institutional infrastructures, and, second, the characteristics of book production and circulation in Byzantium. Understanding the needs of the imperial and ecclesiastical administrations, the functioning of schools, and the structuring of curricula as evidenced in the extant manuscripts is thus essential for the study of the sciences in Byzantium on the terms of the historical actors involved in the creation of knowledge about the world and in its transfer.
Travel Writing (in the Atlantic World)
Authors: Haas Astrid
Published: July 2024

Travel writing has been known since antiquity in parts of the Atlantic world. It is a hybrid genre that frequently incorporates elements of, and thereby blurs distinctions between, fictional and factual modes of narration, such as expedition reports, diaries, memoirs, or novels. Despite its frequent claims to truth and objectivity, travel writing is subjective, culturally mediated, and tends to affirm the views travelers share with their target audiences. Thus as a powerful tool of knowledge production and public debate, travel writing has played a prominent role in the history of political and cultural encounters across the circum-Atlantic. Atlantic travel writing reveals the societal inequalities that have governed access to mobility, literacy, and public discourses. It voices distinct reasons for traveling and writing, such as scientific inquiry, religious mission, diplomatic deployment, or intellectual exchange. Time and again, it has also been implicated in endeavors of conquest and colonization and their attendant exploitation of natural resources and human labor. While historians have always taken a more comprehensive look at the diverse purposes and narrative modes of the genre, literary scholars until the late twentieth century tended to focus on the smaller body of work penned by travelogue writers and intellectuals with a “literary purpose.” In a similar vein, academic research on travel writing in the Atlantic World tends to privilege the narratives of Western Europeans, especially the British and North American travelers over those hailing from other countries and regions. This has created an imbalance of cultural perceptions and representations among the regions surrounding the Atlantic that requires a rethinking of academic discourses and practices. This bibliography provides a step in this direction, as it focuses, wherever possible, on travelers’ reciprocal itineraries and cultural exchanges across the regions within and surrounding the Atlantic. It defines travel writing as the written accounts of actual journeys told by people who undertook them. The bibliography is limited, though, to covering only intercontinental travel writing across the Atlantic World—that is, Europe, Africa, the Caribbean, and the Americas, since the early modern era. It thus excludes not only narratives about adjacent regions such as Israel/Palestine and the Middle East, but also older accounts as well as works focusing exclusively on journeys within a single region. Moreover, for reasons of limited space, this bibliography does not specifically address works of travel writing resulting from enforced journeys, such as captivity narratives, slave narratives, and refugees’ accounts, some of which are discussed in other bibliographies in the series.
Archaeologies of Sexuality
Authors: Geller Pamela
Published: July 2024

Tracking back to the eighteenth century, antiquarians cultivated an interest in the materiality of sexuality, though one that bordered on fetishization, a focus on objects, images, and spaces presumed erotic or pornographic in function. Finds at Pompeii and Herculaneum (Italy)—mosaics, frescoes, vases, sculptures, bronze artifacts—hinted at culturally distinctive takes on pleasure, procreation, power, and same-sex and inter-species relations. But, come the nineteenth century, religious moralizing deemed such material culture decadent, repugnant, and shocking. Pots from Peru (Chimu, Moche, and Recuay cultures) with sexually explicit depictions garnered similar reactions. “Erotica” were then relegated to secret cabinets or rooms with restricted access. The silences generated around sexuality meant that a universalizing heteronormativity—one that reduced it to compulsory reproduction and penetrative heterosex—implicitly informed archaeologists’ reconstructions of past cultures for much of the twentieth century. To counter this deterministic, dichotomous, and ultimately fallacious framing of sexuality, thoughtful statements from archaeologists who drew on and adapted feminist theorizing occurred at the turning of the twenty-first century. These conversations have since benefitted from engagement with queer theory and an attention to intersectionality. In their discussions, archaeologists of sexuality now emphasize that the concept is related to but not interchangeable with sex and gender. (See the separate Oxford Bibliographies article Gender and Archaeology.) The consolidation of an archaeological interest in sexuality also attended to its historicity. A taxonomic distinction between homo- and heterosexuality consolidated in the late nineteenth century. Medico-scientific fields, as writers like Michel Foucault, Jonathan Katz, and David Halperin have explained, stigmatized the former and naturalized the latter in the service of universal and hoary Truths about family and labor, anatomical difference, and psychological constitution. This point about recent invention should not be lost on archaeologists who study the more distant past; that is, there is a history to our understanding of human nature. Instead, and with attention to culture-historical context, archaeologies of sexuality demonstrate that anatomy and acts do not necessarily determine sexual identities, though patterned behaviors can solidify into them with time. Reproductive concerns have long garnered investigation, but archaeologies of sexuality now also consider desire and celibacy, as well as labor and commerce. Sexual violence in past cultures and contemporary archaeological practice are also areas of interest. Ultimately, the archaeological study of sexuality makes for a more holistic and contextualized understanding of past cultures while offering valuable lessons about the different ways to be human.
English Mystery Plays
Authors: Napolitano Frank
Published: July 2024

The English mystery plays of the fourteenth to sixteenth centuries depicted short biblical or apocryphal episodes of Christianity’s salvation history. For generations, scholars believed that the standard format for the mysteries was the all-day (or multi-day) “cycle” of performances, produced by local craft guilds, on moving, one- or two-story “pageant wagons” at different stations throughout a city. The spectacle of wagons rumbling down narrow cobblestone streets, with actors embodying angels, demons, and members of the Trinity, would have captivated the town’s inhabitants. Many scholars rightly hold these performances as parts of the “popular culture” of the late-medieval city. While this conception of the mystery plays in performance likely remains accurate for the plays that survive from the northern cities of York and Chester, we now know it does not represent the majority of the plays that survive from this period. It may, in fact, have been the exception, rather than the norm. Some of the surviving texts that follow cyclical form may have been assembled for private reading and devotion, or even for governmental oversight of popular expressions of devotion. Our uncertainties about these plays’ creation and how audiences experienced them extends to the use of the term “mystery” itself. Scholars disagree on the term’s origins as well as its appropriateness for the texts that survive. “Mystery” may have come to us through one of several Old French or Middle English terms and may derive from the Latin mysterium (rite, worship) or from ministerium (occupation). Many scholars avoid the word mystery altogether and prefer “biblical,” “miracle,” “craft,” or “civic” in its place. Some of the sources in the General Overviews section take up this debate directly, and readers will see many of these variations in the following citations. However, since none of them serves as a one-size-fits-all label for the texts under discussion, these annotations alternate their use as deemed appropriate. This bibliography’s multiple sections attempt to provide the reader with a sense of the major scholarly conversations surrounding these texts. After a series of General Overviews about the subject, the reader will find sections on each of the main play collections, generally known as the York Cycle, the Towneley Plays, the N-Town Plays, and the Chester Cycle. Subsequent sections focus on particular lines of critical or theoretical inquiry, on the manuscripts themselves, and on how scholars prepare and present these texts for study.
Global Perspective on Diversity and Inclusion
Authors: Ozbilgin Mustafa , Erbil Cihat
Published: July 2024

Diversity and inclusion are two terms that provide an umbrella for efforts to tackle discrimination, exclusion, and inequality by valuing diversity and promoting inclusion for historically disadvantaged groups across social, organizational, and individual levels. Diversity and inclusion are now academic, political, and professional fields of study and practice. Diversity and inclusion efforts gain meaning and shape depending highly on the spatial, temporal, sociocultural, and symbolic context in which they manifest. There is a spatial dimension to diversity and inclusion, which means different things across different international, regional, national, and organizational contexts. While in some national and organizational contexts, there is support for diversity and inclusion in terms of recognizing, protecting, valuing, and promoting a more comprehensive range of diversity categories and tackling inequalities across these categories, other contexts remain hostile, unsupportive, and adversarial across some sorts of diversity. While eight types of discrimination are unlawful in the UK, class inequalities are not part of equality laws. In India caste caste-related inequalities are targeted by laws. In South Africa, the legal framework promotes reconciliation to address the detrimental consequences of Apartheid. In terms of temporal context, there is a time dimension to equality and diversity efforts. While earlier diversity and inclusion efforts primarily included generic (-etic) categories such as gender, ethnicity, and disability, recently legitimated diversity categories such as sexual orientation, belief, appearance, and age are considered in some countries. Further, there has been a posthumanist turn, which problematizes the domination of human diversity concerns above and beyond those of nature and technology. In recognition of this, diversity and inclusion research now includes new categories such as biodiversity, technological diversity, and interspecies diversity in the posthumanist landscape of diversity and inclusion. The sociocultural context of diversity and inclusion refers to the specific values, beliefs, and practices that shape and underpin how inclusion and exclusion, privilege and disadvantage, and equality and discrimination manifest in different cultural settings. Sociocultural context is highly varied across national and regional settings, making adopting a standardized, one-size-fits-all approach to diversity and inclusion ineffective. The legal context explains what aspects of diversity and inclusion are considered priority categories for protection against discrimination and inequality. Legal regulation and compliance-based work can set the floor and the baseline for diversity and equality interventions in organizations and nation states. Due to variations in regulatory systems, diversity and inclusion efforts at work emerge as idiosyncratic.
Science Fiction
Authors: Goodwin Matthew David , Stavans Ilan
Published: July 2024

Science fiction is often described as a genre of imaginative literature in which the events of the narrative are scientifically possible, as opposed to events that are magical, supernatural, or fantastical. Though not the most common genre historically used by US Latino writers, it has still had a strong presence. It has generally been overshadowed, though, by magical realism, a type of fantastic story in which magical events are seamlessly intertwined with a realistic narrative. The twenty-first century has, nevertheless, brought with it a burgeoning interest in Latino science fiction, as its creation has increased along with a body of scholarship that is recovering and critically analyzing past science fiction works. Science fiction is a large field and contains multiple subgenres (alien encounters, outer space voyages, dystopian fiction, and so on) and Latino writers have made use of them all. Furthermore, despite its designation as a “fiction,” science fiction is a multimedia field, and Latinos have been engaged in creating not only science fiction literature, but also comics, film, and television. Latino science fiction, as does much of science fiction, often takes current trends and extrapolates them into the future, and the themes that appear are of particular interest to Latino communities including migration, colonialism, and racism; Spanglish and code-switching; and encounters between Latinos and other ethnic groups. Latino writers are finding that science fiction is one of the most dynamic ways to imagine a Latino future.
Impact of Antifungal Prophylaxis Continuation or Discontinuation After Allogeneic Hematopoietic Cell Transplant on the Incidence of Invasive Mold Infection
Authors: Ross Justine Abella , Lee Brian , Ma Huiyan , Tegtmeier Bernard , Nanayakkara Deepa , Dickter Jana , Spielberger Ricardo , Smith Eileen , Pullarkat Vinod , Forman Stephen J , Taplitz Randy , Nakamura Ryotaro , Al Malki Monzr , Dadwal Sanjeet Singh
Published: July 2024

Background

Continuing antifungal prophylaxis (AFPx) to prevent invasive mold infections (IMIs) in recipients of allogeneic hematopoietic cell transplantation (alloHCT) after primary hospital discharge from alloHCT admission varies among transplant centers despite recommendations to continue prophylaxis through day +75. Characteristics driving AFPx prescribing at hospital discharge and outcomes are unknown.

Methods

In this retrospective analysis, we reviewed patients continuing AFPx vs no AFPx at hospital discharge. We included patients with a hospital stay ≥7 days and ≤40 days. We excluded patients with a history of IMI prior to alloHCT, new IMI during admission, or death prior to discharge. Our primary objective was incidence of probable or proven IMI per the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Our secondary objectives were nonrelapse mortality at day +100, overall survival at day +100, and characteristics driving AFPx discontinuation at hospital discharge.

Results

Of the 430 patients identified, 387 met inclusion criteria. At discharge, 56% (217/387) continued AFPx, and 44% (170/387) had no AFPx. At day +100, 3 probable IMI cases occurred in the group with continued AFPx vs 1 probable IMI case in the no-AFPx group (no proven IMI). Univariate analysis showed no difference in cumulative incidence of probable IMI (P = .440), nonrelapse mortality (P = .072), and overall survival (P = .855) between groups. Multivariable logistic regression demonstrated that patients were less likely to continue AFPx if they had a diagnosis other than acute myeloid leukemia, a length of stay ≤30 days, acute graft-vs-host disease grade 0 or 1, and corticosteroid use ≤5 days.

Conclusions

There was no difference in probable IMI at day +100 after alloHCT based on continuing vs discontinuing AFPx at hospital discharge after alloHCT admission supporting a risk-adapted prophylaxis approach.
Transcriptional regulation of transcription factor genes WRI1 and LAFL during Brassica napus seed development
Authors: Han Xu , Peng Yan , Yin Sijie , Zhao Hu , Zong Zhanxiang , Tan Zengdong , Zhang Yuting , Ma Wei , Guo Liang
Published: July 2024

The WRINKLED1 (WRI1) and LAFL (LEAFY COTYLEDON1 [LEC1], ABSCISIC ACID INSENSITIVE3 [ABI3], FUSCA3 [FUS3], and LEC2) transcription factors play essential roles in governing seed development and oil biosynthesis. To gain a comprehensive understanding of the transcriptional regulation of WRI1 and LAFL, we conducted genome-wide association studies for the expression profiles of WRI1 and LAFL in developing seeds at 20 and 40 days after flowering (DAF) using 302 rapeseed (Brassica napus) accessions. We identified a total of 237 expression quantitative trait nucleotides (eQTNs) and 51 expression QTN-by-environment interactions (eQEIs) associated with WRI1 and LAFL. Around these eQTNs and eQEIs, we pinpointed 41 and 8 candidate genes with known transcriptional regulations or protein interactions with their expression traits, respectively. Based on RNA-sequencing and assay for transposase-accessible chromatin with high-throughput sequencing data, we employed the Extreme Gradient Boosting and Basenji models which predicted 15 candidate genes potentially regulating the expression of WRI1 and LAFL. We further validated the predictions via tissue expression profile, haplotype analysis, and expression correlation analysis and verified the transcriptional activation activity of BnaC03.MYB56 (R2R3-MYB transcription factor 56) on the expression of BnaA09.LEC1 by dual-luciferase reporter and yeast 1-hybrid assays. BnaA10.AGL15 (AGAMOUS-LIKE 15), BnaC04.VAL1 (VIVIPAROUS1/ABSCISIC ACID INSENSITIVE3-LIKE 1), BnaC03.MYB56, and BnaA10.MYB56 were coexpressed with WRI1 and LAFL at 20 DAF in M35, a key module for seed development and oil biosynthesis. We further validated the positive regulation of MYB56 on seed oil accumulation using Arabidopsis (Arabidopsis thaliana) mutants. This study not only delivers a framework for future eQEI identification but also offers insights into the developmental regulation of seed oil accumulation.
Authentic assessment in medical education: exploring AI integration and student-as-partners collaboration
Authors: Fatima Syeda Sadia , Sheikh Nabeel Ashfaque , Osama Athar
Published: July 2024

Background

Traditional assessments often lack flexibility, personalized feedback, real-world applicability, and the ability to measure skills beyond rote memorization. These may not adequately accommodate diverse learning styles and preferences, nor do they always foster critical thinking or creativity. The inclusion of Artificial Intelligence (AI), especially Generative Pre-trained Transformers, in medical education marks a significant shift, offering both exciting opportunities and notable challenges for authentic assessment practices. Various fields, including anatomy, physiology, pharmacy, dentistry, and pathology, are anticipated to employ the metaverse for authentic assessments increasingly. This innovative approach will likely enable students to engage in immersive, project-based learning experiences, facilitating interdisciplinary collaboration and providing a platform for real-world application of knowledge and skills.

Methods

This commentary paper explores how AI, authentic assessment, and Student-as-Partners (SaP) methodologies can work together to reshape assessment practices in medical education.

Results

The paper provides practical insights into effectively utilizing AI tools to create authentic assessments, offering educators actionable guidance to enhance their teaching practices. It also addresses the challenges and ethical considerations inherent in implementing AI-driven assessments, emphasizing the need for responsible and inclusive practices within medical education. Advocating for a collaborative approach between AI and SaP methodologies, the commentary proposes a robust plan to ensure ethical use while upholding academic integrity.

Conclusion

Through navigating emerging assessment paradigms and promoting genuine evaluation of medical knowledge and proficiency, this collaborative effort aims to elevate the quality of medical education and better prepare learners for the complexities of clinical practice.
A Phenomenological Exploration of Physicians’ Moral Distress: Situating Emotion Within Lived Experiences
Authors: Chang Derek C. , Kelly Martina , Eva Kevin W.
Published: July 2024

Purpose

Physicians often experience moral distress from being prevented from taking what they believe to be the right course of action. Although causes and consequences of moral distress have been studied, little research offers insight into the significance of feeling morally challenged, especially in medicine. This study was undertaken to advance understanding of what physicians experience when encountering morally challenging situations and to examine how those experiences influence their interactions with the world of health care.

Method

Guided by hermeneutic phenomenology, the authors conducted semistructured interviews with purposefully sampled Canadian physicians from September 2022 to January 2023. Analysis used Van Manen’s 6 activities of hermeneutic research and included “story crafting” to sharpen insights. Late in that process, Van Manen’s “lived existentials” was determined to provide a strong framework for physicians’ experiences of moral distress.

Results

Of the 12 physicians interviewed, all experienced varied and long-lasting emotional reactions to morally challenging experiences. The emotions associated with moral distress, reported as inevitable, were experienced in ways that aligned with the lived existentials of body, space, time, and relations.

Conclusions

A richer understanding of physicians’ lived experiences with moral distress can help mentors and educators more thoughtfully engage in conversations about it with colleagues and learners. This study highlights the core dimensions of moral distress through body, space, time, and relations, thereby providing a means to enrich discussion about emotions and their transformational power. Through such nuanced consideration, calls for emotional candor may be strengthened to enhance practice by acknowledging the scope of impact that efforts to deliver care are likely to provoke.
Using digital communication tools to improve interprofessional collaboration and satisfaction in a student-run free clinic
Authors: Alam Tracy , Pardee Michelle , Ammerman Beth , Eagle Megan , Shakoor Kelly , Jones Heather
Published: July 2024

Background:

Interprofessional collaboration can improve the quality of care in complex health conditions often seen in underserved populations. Communication is key to effective collaboration, and digital communication tools can enhance information sharing, collaboration, and satisfaction between professionals, especially when teams are distanced.

Local problem:

In a semirural student-run free clinic that provides care to uninsured and underinsured patients with multifaceted health issues, there is a gap in communication and collaboration across interprofessional teams because of the frequent rotation of various staff, part-time hours, and electronic health record (EHR) function and interoperability limitations.

Methods:

The aim of this nurse practitioner-led quality improvement project was to determine whether implementing digital communication tools could enhance communication and improve provider collaboration and satisfaction during clinical decision-making among the several interprofessional teams at the student-run free clinic.

Interventions:

Digital communication tools were implemented in a two-part intervention: (1) virtual case conferences to discuss patient care plans and (2) an EHR-linked tool to document the care plans.

Results:

Survey evaluation across six virtual case conferences found above-average ratings for collaboration, satisfaction, and usability of the EHR-linked tool. There was a 15.78% improvement in global collaboration from the first to third conference, with a sustained improvement of 11.49%. Satisfaction improved by 4.62% from the first to the fourth conference.

Conclusion:

Digital communication tools can facilitate efficient communication and collaboration among staff while providing a more streamlined approach to patient care. These technologies can be useful in similar settings, especially when teams are distanced.
Caregiver Intent and Willingness to Accept COVID-19 Vaccine in the Pediatric Emergency Department
Authors: Hart Rebecca J. , Srivisetty Harshini , Ahmed Anam , Kerley Taryn , Swartz Madison , Bryant Kristina A. , Stevenson Michelle D.
Published: July 2024

Background

While COVID-19 vaccine (CV) acceptance is improving, little is known about parental acceptance of CV in the pediatric emergency department (PED).

Objectives

The aims of the study are to assess rates of CV uptake among eligible children presenting to the PED, describe caregiver willingness to accept CV in the PED, and assess potential ED-based interventions to increase CV acceptance.

Methods

We surveyed caregivers of 384 children aged ≥6 months presenting to the PED for minor illness/injury. Demographics, COVID-19/other vaccine history, and intent/willingness to receive CV were recorded. Participants were recontacted by phone 6–12 months after vaccine eligibility to assess CV status, barriers to CV, willingness to receive CV in the ED, and preferences for ED-based vaccine-related interventions. Data were analyzed using standard descriptive statistics.

Results

In initial surveys, 31.6% of caregivers planned to vaccinate their child; 32.2% would likely accept CV in the PED. Follow-up data was available for 302 (78.6%) previously unvaccinated participants; only 59 (19.5%) had received CV at follow-up. Of those unvaccinated at follow-up, 27 (28.7%) intended to vaccinate, nearly all of whom would accept CV in the PED. Factors associated with increased likelihood of vaccination included initial intent to vaccinate (P = 0.004), definite/probable acceptance of CV in the PED (P = 0.035), and child age 5+ (P = 0.005). Nearly one-fourth of unvaccinated families reported barriers to CV access. Interventions most likely to persuade families to vaccinate included: discussing CV with a provider (25.5%), receiving an information sheet (23.4%), and offering CV without an ED visit (22.3%).

Conclusions

CV acceptance was low in this cohort. A gap population of unvaccinated children whose caregivers intend to vaccinate exists, and many of these would accept CV in the ED. This data supports the presence of CV programs in the ED to close this gap.
Impact of the COVID-19 Pandemic on the State Enteric Disease Public Health Workforce in the Western United States, March-April 2022
Authors: Zarella Olivia , White Alice E. , Ramsey Eliza , Elson Gabriel , Melius Beth , Hewitson Ingrid , Baseman Janet , Walter Elaine Scallan
Published: July 2024

Objective:

To assess the impact of the COVID-19 pandemic on the state-level enteric disease workforce and routine enteric disease surveillance and outbreak investigation activities in the western United States.

Design and Setting:

Key informant interviews conducted using bidirectional video from March to April 2022.

Participants:

Enteric disease epidemiologists at state public health agencies in the western states served by the Colorado and Washington Integrated Food Safety Centers of Excellence.

Main Outcomes:

Key themes were identified using grounded theory.

Results:

Nine themes were identified including excessive workload, shifts in local and state responsibilities, challenges with retention and hiring, importance of student teams, laboratory supplies shortages, changes to case and outbreak investigation priorities, transitioning back to enterics, adoption of new methods and technology, and current and future needs.

Conclusions:

The COVID-19 pandemic response had a substantial impact on state-level enteric disease activities in western states, with many staff members diverted from routine responsibilities and a de-prioritization of enteric disease work. There is a need for sustainable solutions to address staffing shortages, prioritize employee mental health, and effectively manage routine workloads when responding to emergencies.
Lessons From Leading During a Pandemic: An Exploratory Study of Public Health Leadership Insights on Training, Preparation, and Experiences From the Field During COVID-19
Authors: Singh Amay V. , Niu Lijie , Johnson C. Anderson , Orr Jay E. , Palmer Paula H.
Published: July 2024

Context:

The public health workforce encountered challenges during the COVID-19 pandemic that exposed areas for improvement in preparation for future public health threats. Key among these is well-trained public health leaders equipped with an array of crisis leadership skills.

Objectives:

To examine the training background, assess the perceived preparedness, and garner recommendations for training of the future public health workforce from public health leaders who navigated the COVID-19 pandemic.

Design:

This exploratory research gleaned information by utilizing an online questionnaire and interviews to provide lessons learned regarding improvements needed for public health leader preparedness.

Setting:

Three California public health departments representing urban, suburban, and rural populations.

Participants:

Thirty public health leaders who were directly involved in public health work for ≥3 years in a leadership/management role and involved in COVID-19-related work for at least 6 months participated.

Results:

Questionnaire findings revealed gaps in crisis leadership, communication, and collaboration training. Interview results supported and expanded upon the quantitative findings, including the value of various competencies and recommendations to improve the preparedness of future public health leaders.

Conclusions:

The findings suggested that although many of the skills needed are competencies for accredited public health training programs, effective leadership during public health emergencies may require additional training beyond what is generally provided. Recommendations include integrating study findings into public health training programs to address competency gaps, leveraging results to enhance leadership skills, and promoting collaboration between public health departments and academic institutions to develop evidence-informed crisis leadership training. These findings inform strategies to ensure the preparedness of the public health workforce for future crises.
Local Excision for Early-Stage Rectal Adenocarcinomas
Authors: Donohue Kristen , Rossi Alexander , Deek Matthew P. , Feingold Daniel , Patel Nell Maloney , Jabbour Salma K.
Published: July 2024

Although total mesorectal excision (TME) remains the standard of care for rectal cancer, including early-stage T1/T2 rectal adenocarcinoma, local excision may be warranted for these early-stage tumors in a select group of patients who may decline surgery or may be nonoptimal surgical candidates. Operative approaches for transanal local excision include transanal endoscopic microsurgery or transanal minimally invasive surgery for tumors <4 cm, occupying <40% of the rectal circumference and <10 cm from the dentate line. The use of preoperative chemoradiation therapy may help to downstage tumors and allow for more limited resections, and chemoradiation may also be employed postoperatively. Local excision approaches appear to result in improved quality of life compared with TME, but limited resections may also compromise survival rates compared with TME. Multidisciplinary management and shared decision-making can allow for the desired patient outcomes.