bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order
Authors: Santa Heather M , Amirova Samira G , Ventricelli Daniel J , Downs George E , Nowalk Alexandra A , Pringle Janice L , Aruru Meghana
Published: December 2020

Purpose

Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high.

Methods

To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols.

Results

Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation.

Conclusion

Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.
A New Device for Autologous Small Volume Fat Grafting
Authors: Yang Xiaonan , Brower Jonathan P , Kokai Lauren , Gusenoff Beth R , Gusenoff Jeffrey A
Published: December 2020

Background

Many techniques and devices have been developed to improve small volume fat grafting efficiency and consistency for use in the operating room and outpatient procedure room. These methods require cumbersome or messy processing to remove excess oil and fluid from adipose graft.

Objectives

The aim of this study was to compare the fat processing efficiency of a novel handheld device, the Push-to-Spin (P2S) system, with that of other common processing techniques and validate tissue quality after lipoaspirate processing.

Methods

Human lipoaspirate samples were processed by 1 of 3 methods: cotton gauze (Telfa) rolling, centrifugation (Coleman technique), or the P2S system. Efficiency of fat processing was evaluated in terms of total processing time, fat harvest ratio, and fat processed ratio. Histologic examination and immunohistochemical staining were used to compare tissue morphology and adipocyte viability, respectively. Experimental samples were compared with unprocessed lipoaspirate controls.

Results

Lipoaspirate processing was significantly faster with the P2S device than with other techniques. All 3 methods achieved similar fat harvest and fat processing ratios. Additionally, the P2S, Telfa, and Coleman techniques yielded grafts with similar cellularity and with similar perilipin and glycerol-3-phosphate dehydrogenase 1 expression. Measured differences between experimental and control samples were statistically significant.

Conclusions

The P2S device is an easy-to-use, efficient, and potentially cost-effective handheld device that can be used for lipoaspirate harvest, processing, and grafting in any procedural setting. The resulting adipocytes have similar morphology, viability, and function to those yielded by other techniques. This handheld technology decreases procedure time, thereby improving surgeon efficiency and patient experience.
Rapid and real-time identification of fungi up to species level with long amplicon nanopore sequencing from clinical samples
Authors: D’Andreano Sara , Cuscó Anna , Francino Olga
Published: December 2020

The availability of long-read technologies, like Oxford Nanopore Technologies, provides the opportunity to sequence longer fragments of the fungal ribosomal operon, up to 6 Kb (18S-ITS1-5.8S-ITS2-28S) and to improve the taxonomy assignment of the communities up to species level and in real-time. We assess the applicability for taxonomic assignment of amplicons targeting a 3.5 Kb region (V3 18S-ITS1-5.8S-ITS2-28S D2) and a 6 Kb region (V1 18S-ITS1-5.8S-ITS2-28S D12) with the What’s in my pot (WIMP) classifier. We used the ZymoBIOMICSTM mock community and different microbiological fungal cultures as positive controls. Long amplicon sequencing correctly identified Saccharomyces cerevisiae and Cryptococcus neoformans from the mock community and Malassezia pachydermatis, Microsporum canis and Aspergillus fumigatus from the microbiological cultures. Besides, we identified Rhodotorula graminis in a culture mislabelled as Candida spp. We applied the same approach to external otitis in dogs. Malassezia was the dominant fungal genus in dogs’ ear skin, whereas Ma. pachydermatis was the main species in the healthy sample. Conversely, we identified a higher representation of Ma. globosa and Ma. sympodialis in otitis affected samples. We demonstrate the suitability of long ribosomal amplicons to characterize the fungal community of complex samples, either healthy or with clinical signs of infection.
Cooking-energy transition in Nepal: trend review
Authors: Paudel Dipti , Jeuland Marc , Lohani Sunil Prasad
Published: December 2020

Clean-cooking energy is key to meeting climate-mitigation goals and a range of development objectives, especially for improving the well-being of women and children. Inefficient burning of solid biomass for cooking releases household air pollution that is hazardous to health, while putting pressure on forest resources. This paper provides an overview of the household-cooking-energy transition in Nepal to date. Despite numerous efforts by the government and other actors to speed this transition, energy data spanning the years 2000–18 reveal that ~69% of households nationwide still rely on solid fuels for cooking today. The proportion of solid-fuel users is especially high in rural regions, reaching >80%. Moreover, if the current rate of progress is not accelerated, the use of solid fuels will remain high even in 2030, preventing the achievement of Sustainable Development Goal (SDG) 7. Cooking-fuel choices are heavily constrained by accessibility, demographic and socio-economic factors. Thus, this paper recommends that evidence-based and integrated policies and strategies be urgently deployed to foster a more effective and rapid transition towards clean energy, which is critical to achieving SDG 7.
When should we use mesh in laparoscopic hiatal hernia repair? A systematic review
Authors: Laxague Francisco , Sadava Emmanuel E , Herbella Fernando , Schlottmann Francisco
Published: December 2020

The use of mesh in laparoscopic hiatal hernia repair (LHHR) remains controversial. The aim of this systematic review was to determine the usefulness of mesh in patients with large hiatal hernia (HH), obesity, recurrent HH, and complicated HH. We performed a systematic review of the current literature regarding the outcomes of LHHR with mesh reinforcement. All articles between 2000 and 2020 describing LHHR with primary suturing, mesh reinforcement, or those comparing both techniques were included. Symptom improvement, quality of life (QoL) improvement, and recurrence rates were evaluated in patients with large HH, obesity, recurrent HH, and complicated HH. Reported outcomes of the use of mesh in patients with large HH had wide variability and heterogeneity. Morbidly obese patients with HH should undergo a weight-loss procedure. However, the benefits of HH repair with mesh are unclear in these patients. Mesh reinforcement during redo LHHR may be beneficial in terms of QoL improvement and hernia recurrence. There is scarce evidence supporting the use of mesh in patients undergoing LHHR for complicated HH. Current data are heterogeneous and have failed to find significant differences when comparing primary suturing with mesh reinforcement. Further research is needed to determine in which patients undergoing LHHR mesh placement would be beneficial.
Should a Poverty-Averse Donor Always Reward Better Governance? A Paradox of Aid Allocation
Authors: Bourguignon François , Platteau Jean-Philippe
Published: December 2020

This article revisits the inter-country aid allocation by a donor who must distribute a given aid amount and is sensitive to needs and governance considerations. Against conventional wisdom, if the donor has strong enough aversion to poverty, the share of a country whose governance has improved is reduced. Yet, the poor will still be better off. These results continue to hold when aid effectiveness depends on intrinsic governance and the volume of aid received, and when a more general dynamic specification is considered. Finally, using our approach, the allocation rules in international organisations appear as clearly privileging governance over needs.
Biochemical characterization of two chitinases from Bacillus cereus sensu lato B25 with antifungal activity against Fusarium verticillioides P03
Authors: Morales-Ruiz Estefanía , Priego-Rivera Ricardo , Figueroa-López Alejandro Miguel , Cazares-Álvarez Jesús Eduardo , Maldonado-Mendoza Ignacio E
Published: December 2020

Bacterial chitinases are a subject of intense scientific research due to their biotechnological applications, particularly their use as biological pesticides against phytopathogenic fungi as a green alternative to avoid the use of synthetic pesticides. Bacillus cereus sensu lato B25 is a rhizospheric bacterium that is a proven antagonist of Fusarium verticillioides, a major fungal pathogen of maize. This bacterium produces two chitinases that degrade the fungal cell wall and inhibit its growth. In this work, we used a heterologous expression system to purify both enzymes to investigate their biochemical traits in terms of Km, Vmax, optimal pH and temperature. ChiA and ChiB work as exochitinases, but ChiB exhibited a dual substrate activity and it is also an endochitinase. In this work, the direct addition of these chitinases inhibited fungal conidial germination and therefore they may play a major role in the antagonism against F. verticillioides.
Machine-learning-based detection of volcano seismicity using the spatial pattern of amplitudes
Authors: Maeda Yuta , Yamanaka Yoshiko , Ito Takeo , Horikawa Shinichiro
Published: December 2020

We propose a new algorithm, focusing on spatial amplitude patterns, to automatically detect volcano seismic events from continuous waveforms. Candidate seismic events are detected based on signal-to-noise ratios. The algorithm then utilizes supervised machine learning to classify the existing candidate events into true and false categories. The input learning data are the ratios of the number of time samples with amplitudes greater than the background noise level at 1 s intervals (large amplitude ratios) given at every station site, and a manual classification table in which ‘true’ or ‘false’ flags are assigned to candidate events. A two-step approach is implemented in our procedure. First, using the large amplitude ratios at all stations, a neural network model representing a continuous spatial distribution of large amplitude probabilities is investigated at 1 s intervals. Second, several features are extracted from these spatial distributions, and a relation between the features and classification to true and false events is learned by a support vector machine. This two-step approach is essential to account for temporal loss of data, or station installation, movement, or removal. We evaluated the algorithm using data from Mt. Ontake, Japan, during the first ten days of a dense observation trial in the summit region (2017 November 1–10). Results showed a classification accuracy of more than 97 per cent.
Empowering Dutch and Surinamese children to prevent viral infections: implications from an international education module
Authors: Shoker Kifah , Doornekamp Laura , Horjus Bob , Wagener Marlies N , Aron Georgina I , Goeijenbier Marco , van Gorp Eric C M
Published: December 2020

Viral infections have a large share in human morbidity and mortality. Next to vaccinations and hygiene measures, health education plays a role in preventing infections. Social scientists argue that empowerment should be included in health education, as increasing knowledge is insufficient to achieve sustainable behaviour change. Within the international education module ‘Viruskenner’, primary school students learn how to prevent virus infections by identifying health risks and developing interventions. This qualitative formative study explored to what extent Viruskenner creates conditions in which empowerment processes can arise and take place in the Netherlands and Suriname. Indicators of empowerment, as defined in the literature and placed in the attitude, social influence, and self-efficacy model, were assessed during semi-structured interviews (n = 24) with students, parents, teachers and facilitators. We conclude that Viruskenner is successful in creating conditions for empowerment processes to arise and take place, specifically in attitude and self-efficacy. According to interviewees, the module raised students’ motivation, skills and confidence to take action to improve health behaviour. Educators played a stimulating role in the participatory setting in both countries, while content relevance and community involvement differed between the Netherlands and Suriname. These outcomes could improve this module and possibly other health education programmes.
Reflection on modern methods: causal inference considerations for heterogeneous disease etiology
Authors: Nevo Daniel , Ogino Shuji , Wang Molin
Published: December 2020

Molecular pathological epidemiology research provides information about pathogenic mechanisms. A common study goal is to evaluate whether the effects of risk factors on disease incidence vary between different disease subtypes. A popular approach to carrying out this type of research is to implement a multinomial regression in which each of the non-zero values corresponds to a bona fide disease subtype. Then, heterogeneity in the exposure effects across subtypes is examined by comparing the coefficients of the exposure between the different subtypes. In this paper, we explain why this common method potentially cannot recover causal effects, even when all confounders are measured, due to a particular type of selection bias. This bias can be explained by recognizing that the multinomial regression is equivalent to a series of logistic regressions; each compares cases of a certain subtype to the controls. We further explain how this bias arises using directed acyclic graphs and we demonstrate the potential magnitude of the bias by analysis of a hypothetical data set and by a simulation study.
Prevalence and characterization of mecC MRSA in bovine bulk tank milk in Great Britain, 2017–18
Authors: Cui Cheng , Ba Xiaoliang , Holmes Mark A
Published: December 2020

Objectives

To evaluate the current prevalence status of mecC MRSA among dairy farms in England and Wales 5 years after a previous survey conducted in 2011–12.

Methods

A convenience sample of 697 dairy farms in England and Wales was used for the study, conducted in 2017–18, testing bulk tank milk samples for the presence of mecC MRSA using high salt broth enrichment and chromogenic MRSA agar selection. All putative MRSA isolates were screened by PCR for the presence of mecA and mecC genes and subjected to antimicrobial susceptibility testing using both the disc diffusion method and VITEK® 2. MRSA isolates were also sequenced for genomic characterization.

Results

mecC MRSA were detected on 4 out of 697 dairy farms in England and Wales (prevalence 0.57%, 95% CI 0.16%–1.46%). Three of the mecC isolates were ST425 and one was ST4652 (in the CC130 lineage). Two mecA MRSA were also isolated: one ST5 and one ST398.

Conclusions

These results indicate that there has been a substantial reduction in the prevalence of mecC MRSA in England and Wales with a 72% reduction (2.15% to 0.57%) compared with a previous study. While the levels of mecA MRSA remain very low the continued presence of ST398, a livestock-associated MRSA, suggests that this lineage is established in the UK.
Burn Images Segmentation Based on Burn-GAN
Authors: Dai Fei , Zhang Dengyi , Su Kehua , Xin Ning
Published: December 2020

Burn injuries are severe problems for human. Accurate segmentation for burn wounds in patient surface can improve the calculation precision of %TBSA (total burn surface area), which is helpful in determining treatment plan. Recently, deep learning methods have been used to automatically segment wounds. However, owing to the difficulty of collecting relevant images as training data, those methods cannot often achieve fine segmentation. A burn image-generating framework is proposed in this paper to generate burn image datasets with annotations automatically. Those datasets can be used to increase segmentation accuracy and save the time of annotating. This paper brings forward an advanced burn image generation framework called Burn-GAN. The framework consists of four parts: Generating burn wounds based on the mainstream Style-GAN network; Fusing wounds with human skins by Color Adjusted Seamless Cloning (CASC); Simulating real burn scene in three-dimensional space; Acquiring annotated dataset through three-dimensional and local burn coordinates transformation. Using this framework, a large variety of burn image datasets can be obtained. Finally, standard metrics like precision, Pixel Accuracy (PA) and Dice Coefficient (DC) were utilized to assess the framework. With nonsaturating loss with R2 regularization (NSLR2) and CASC, the segmentation network gains the best results. The framework achieved precision at 90.75%, PA at 96.88% and improved the DC from 84.5 to 89.3%. A burn data-generating framework have been built to improve the segmentation network, which can automatically segment burn images with higher accuracy and less time than traditional methods.
Medical costs of Japanese lung cancer patients during end-of-life care
Authors: Awano Nobuyasu , Izumo Takehiro , Inomata Minoru , Kuse Naoyuki , Tone Mari , Takada Kohei , Muto Yutaka , Fujimoto Kazushi , Kimura Hitomi , Miyamoto Shingo , Igarashi Ataru , Kunitoh Hideo
Published: December 2020

Objective

The medical costs associated with cancer treatment have increased rapidly in Japan; however, little data exist on actual costs, especially for end-of-life care. Therefore, this study aimed to examine the medical costs of lung cancer patients during the last 3 months before death and to compare the costs with those of initial anticancer treatment.

Methods

We retrospectively evaluated all patients who died from lung cancer at the Japanese Red Cross Medical Center between 1 January 2008 and 31 August 2019. Patients were classified into three cohorts (2008–2011, 2012–2015 and 2016–2019) according to the year of death; the medical costs were evaluated for each cohort. Costs were then divided into outpatient and inpatient costs and calculated per month.

Results

Seventy-nine small cell lung cancer and 213 non-small cell lung cancer patients were included. For small cell lung cancer and non-small cell lung cancer patients, most end-of-life medical costs were inpatient costs across all cohorts. The median monthly medical costs for the last 3 months among both small cell lung cancer and non-small cell lung cancer patients did not differ significantly among the cohorts, but the mean monthly costs for non-small cell lung cancer tended to increase. The monthly medical costs for the last 3 months were significantly higher than those for the first year in SCLC (P = 0.013) and non-small cell lung cancer (P < 0.001) patients and those for the first 3 months in non-small cell lung cancer patients (P = 0.005).

Conclusions

The medical costs during the end-of-life period for lung cancer were high and surpassed those for initial treatment.
The Importance of Oversight and Agency Capacity in Enhancing Performance in Public Service Delivery
Authors: Drolc Cody A , Keiser Lael R
Published: December 2020

Government agencies often encounter problems in service delivery when implementing public programs. This undermines effectiveness and raise questions about accountability. A central component of responsiveness and performance management is that agencies correct course when problems are identified. However, public agencies have an uneven record in responding to problems. In this article, we investigate whether, and to what extent, capacity both within the agency and within institutions performing oversight improves agency responsiveness to poor-performance indicators. Using panel data on eligibility determinations in the Social Security Disability program from US state agencies from 1991 to 2015 and fixed effects regression, we find that indicators of agency and oversight capacity moderate the relationship between poor performance and improvement. Our results suggest that investments in building capacity not only within agencies, but also within elected institutions, are important for successful policy implementation. However, we find evidence that while agency capacity alone can improve responsiveness to poor performance, the effect of oversight capacity on improving performance requires high agency capacity.
The Lost Works of Thomas Becon
Authors: Reimer Jonathan
Published: December 2020

This article attributes four lost works to the literary corpus of the English clergyman and bestselling Tudor devotional author Thomas Becon (1512–1567): The Shelde of Saluacion, An Heauenly Acte, Christen Prayers and Godly Meditacions, and The Resurreccion of the Masse. It ascribes these texts to Becon in light of three types of corroborating evidence: contemporary attribution, parallels of content, and early publication history. These four lost works not only furnish a fuller picture of his literary output, but also provide new insights into his career, rhetoric, and theology. As Becon was the most popular evangelical devotional author writing in English during the sixteenth century, this analysis of his hitherto unattributed books makes a valuable contribution to the bibliography of Tudor England, especially during the transformative years of the Henrician, Edwardine, Marian, and Elizabethan Reformations.
What Freedom in a Deterministic World Must Be
Authors: Looper Brian
Published: December 2020

Contrary to Lewis (1981) and Vihvelin (2013), I argue that free will in a deterministic world is an ability to break a law of nature or to change the remote past. Even if it were true, as Lewis and Vihvelin think, that an agent who is predetermined to perform a particular act might not break a law or change the remote past by doing otherwise, it would nevertheless be true that he is able to do otherwise only if he is able to break a law or to change the remote past.
Thick disc molecular gas fraction in NGC 6946
Authors: Patra Narendra Nath
Published: December 2020

Several recent studies reinforce the existence of a thick molecular disc in galaxies along with the dynamically cold thin disc. Assuming a two-component molecular disc, we model the disc of NGC 6946 as a four-component system consisting of stars, H i, thin disc molecular gas, and thick disc molecular gas in vertical hydrostatic equilibrium. Following, we set up the joint Poisson-Boltzmann equation of hydrostatic equilibrium and solve it numerically to obtain a three-dimensional density distribution of different baryonic components. Using the density solutions and the observed rotation curve, we further build a three-dimensional dynamical model of the molecular disc and consecutively produce simulated CO spectral cubes and spectral width profiles. We find that the simulated spectral width profiles distinguishably differ for different assumed thick disc molecular gas fractions. Several CO spectral width profiles are then produced for different assumed thick disc molecular gas fractions and compared with the observed one to obtain the best fit thick disc molecular gas fraction profile. We find that the thick disc molecular gas fraction in NGC 6946 largely remains constant across its molecular disc with a mean value of 0.70 ± 0.09. We also estimate the amount of extra-planar molecular gas in NGC 6946. We find $\sim 50\%$ of the total molecular gas is extra-planar at the central region, whereas this fraction reduces to ∼ 15% at the edge of the molecular disc. With our method, for the first time, we estimate the thick disc molecular gas fraction as a function of radius in an external galaxy with sub-kpc resolution.
Webs of Meaning in John Corigliano’s Tarantellas
Authors: Stroud Cara
Published: December 2020

The final movement of John Corigliano’s Gazebo Dances (1972)—a light-hearted suite for two pianos—and the second movement of his Symphony No. 1 (1988)—dedicated to friends lost to AIDS—use the same tarantella refrain as their main thematic material, revealing opposing associations possible with tarantellas. Corigliano’s earlier work exemplifies the witty virtuosity of what I describe as a “humorous” tarantella, while the later work forefronts associations with mental illness and death in what I describe as a “crisis” tarantella. The symphonic movement conveys a process of thematic disintegration that resonates with theories of narrative and irony.
Characterizing and circumventing sequence restrictions for synthesis of circular RNA in vitro
Authors: Rausch Jason W , Heinz William F , Payea Matthew J , Sherpa Chringma , Gorospe Myriam , Le Grice Stuart F J
Published: December 2020

Just as eukaryotic circular RNA (circRNA) is a product of intracellular backsplicing, custom circRNA can be synthesized in vitro using a transcription template in which transposed halves of a split group I intron flank the sequence of the RNA to be circularized. Such permuted intron–exon (PIE) constructs have been used to produce circRNA versions of ribozymes, mimics of viral RNA motifs, a streptavidin aptamer, and protein expression vectors for genetic engineering and vaccine development. One limitation of this approach is the obligatory incorporation of small RNA segments (E1 and E2) into nascent circRNA at the site of end-joining. This restriction may preclude synthesis of small circRNA therapeutics and RNA nanoparticles that are sensitive to extraneous sequence, as well as larger circRNA mimics whose sequences must precisely match those of the native species on which they are modelled. In this work, we used serial mutagenesis and in vitro selection to determine how varying E1 and E2 sequences in a thymidylate synthase (td) group I intron PIE transcription template construct affects circRNA synthesis yield. Based on our collective findings, we present guidelines for the design of custom-tailored PIE transcription templates from which synthetic circRNAs of almost any sequence may be efficiently synthesized.
Microbial single-strand annealing proteins enable CRISPR gene-editing tools with improved knock-in efficiencies and reduced off-target effects
Authors: Wang Chengkun , Cheng Jason K W , Zhang Qianhe , Hughes Nicholas W , Xia Qiong , Winslow Monte M , Cong Le
Published: December 2020

Several existing technologies enable short genomic alterations including generating indels and short nucleotide variants, however, engineering more significant genomic changes is more challenging due to reduced efficiency and precision. Here, we developed RecT Editor via Designer-Cas9-Initiated Targeting (REDIT), which leverages phage single-stranded DNA-annealing proteins (SSAP) RecT for mammalian genome engineering. Relative to Cas9-mediated homology-directed repair (HDR), REDIT yielded up to a 5-fold increase of efficiency to insert kilobase-scale exogenous sequences at defined genomic regions. We validated our REDIT approach using different formats and lengths of knock-in templates. We further demonstrated that REDIT tools using Cas9 nickase have efficient gene-editing activities and reduced off-target errors, measured using a combination of targeted sequencing, genome-wide indel, and insertion mapping assays. Our experiments inhibiting repair enzyme activities suggested that REDIT has the potential to overcome limitations of endogenous DNA repair steps. Finally, our REDIT method is applicable across cell types including human stem cells, and is generalizable to different Cas9 enzymes.
A Coronavirus Disease 2019 (COVID-19) Mystery: Persistent Fevers and Leukocytosis in a Patient With Severe COVID-19
Authors: Sasson Arielle , Aijaz Amna , Chernyavsky Svetlana , Salomon Nadim
Published: December 2020

Short-course glucocorticosteroids are being used and tocilizumab (TCZ) had been used to treat patients with severe coronavirus disease 2019 (COVID-19) disease. These agents, when administered individually, have been associated with tuberculosis (TB) during chronic use. We report a case of TB in a 44-year-old male with diabetes and severe COVID-19 who received high-dose short-course glucocorticosteroids and a single dose of TCZ. The clinical presentation was atypical with unresolving fevers and leukocytosis, progressive lower lobe cavities, and hilar adenopathy. Delayed diagnosis led to prolonged hospitalization and extensive antibiotic use.
Incidence and Severity of Drug Interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment-Experienced Patients
Authors: Schafer Jason J , Pandit Neha S , Cha Agnes , Huesgen Emily , Badowski Melissa , Sherman Elizabeth M , Cocohoba Jennifer , Shimada Ayako , Keith Scott W
Published: December 2020

Background

Switching antiretroviral therapy (ART) in people with HIV (PWH) can influence their risk for drug–drug interactions (DDIs). The purpose of this study was to assess changes in the incidence and severity of DDIs among PWH who switched their ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF).

Methods

This was a multicenter retrospective cohort study of PWH on ART and at least 1 concomitant medication (CM) who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV Drug Interaction Database, 2 DDI analyses were performed for each patient. The first assessed patients’ preswitch ART regimens with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). A paired t test analyzed changes in total DDI scores following ART switches, and linear regression examined factors contributing to DDI score reductions.

Results

Among 411 patients, 236 (57%) had at least 1 DDI present at baseline. On average, baseline DDI scores (SD) were 1.4 (1.8) and decreased by 1 point (95% CI, –1.1 to –0.8) after patients switched to BIC/FTC/TAF (P < .0001). After adjusting for demographics, baseline ART, and CM categories, switching to BIC/FTC/TAF led to significant DDI score reductions in patients receiving CMs for cardiovascular disease, neurologic/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions, and conditions requiring hormonal therapy.

Conclusions

Treatment-experienced PWH eligible to switch their ART may experience significant declines in number and severity of DDIs if switched to BIC/FTC/TAF.
The Springs of Wandel
Authors: Ruskin John
Published: December 2020

[The reader must be advised that the first two chapters are reprinted, with slight revision, from Fors Clavigera, having been written there chiefly for the political lessons, which appear now introduced somewhat violently.*]

1. I am, and my father was before...
Crossmount
Authors: Ruskin John
Published: December 2020

183. My best readers cannot but be alike astonished and disappointed that I have nothing set down of the conversation, cordial always, and if George Richmond were there, better than brilliant, which flowed at these above described Vandalic feasts. But it seemed to...
Chapter XII
Authors: Collins Wilkie
Published: December 2020

Two days passed, and I perceived another change in Mr Engelman.

He was now transformed into a serious and reticent man. Had he committed indiscretions which might expose him to ridicule if they were known? Or had the widow warned him not to be too...
I
Authors: Collins Wilkie
Published: December 2020

Be pleased to read the following letter from Mr Lawyer’s-Clerk-Schmuckle to Mr Town-Councillor-Hof:

‘My honoured Sir,—I beg to report that you may make your mind easy on the subject of Madame Fontaine. If she leaves Frankfort, she will not slip away privately as she did...
Chapter IV
Authors: Collins Wilkie
Published: December 2020

After leaving Mrs Wagner, the widow considered with herself, and then turned away from the commercial regions of the house, in search of her daughter.

She opened the dining-room door, and found the bagatelle-board* on the table. Fritz and Minna were playing a...
IV
Authors: Collins Wilkie
Published: December 2020

‘Do you remember how Mr Keller’s illness was cured?’ the doctor began.

Those words instantly reminded me, not only of Doctor Dormann’s mysterious suspicions at the time of the illness, but of Jack’s extraordinary question to me, on the morning when I left Frankfort. The...
Chapter V
Authors: Walpole Horace
Published: December 2020

Every reflection which Manfred made on the friar’s behaviour, conspired to persuade him that Jerome was privy to an amour between Isabella and Theodore. But Jerome’s new presumption, so dissonant from his former meekness, suggested still deeper apprehensions. The prince even suspected that the...
Chapter II
Authors: Lewis Matthew
Published: December 2020

Fòrse sé tu gustassi una sòl volta

La millésima parte délle giòje,

Ché gusta un còr amato riamando,

Diresti ripentita sospirando,

Perduto è tutto il tempo

Ché in amar non si spènde.*

Tasso.

Hadst Thou but tasted once the thousandth part

Of joys, which...
Inscription In An Hermitage
Authors: Lewis Matthew
Published: December 2020

Who-e’er Thou art these lines now reading,

Think not, though from the world receding

I joy my lonely days to lead in

This Desart* drear,

That with remorse a conscience bleeding

Hath led me here.

No thought of guilt my bosom sowrs:

Free-willed I...
Love And Age
Authors: Lewis Matthew
Published: December 2020

The night was dark; The wind blew cold;

Anacreon,* grown morose and old,

Sat by his fire, and fed the chearful flame:

Sudden the Cottage-door expands,

And lo! before him Cupid stands,

Casts round a friendly glance, and greets him by his name.

‘What...
Midnight Hymn
Authors: Lewis Matthew
Published: December 2020

Now all is hushed; The solemn chime

No longer swells the nightly gale:

Thy awful presence, Hour sublime,

With spotless heart once more I hail.

’Tis now the moment still and dread,

When Sorcerers use their baleful power;

When Graves give up their buried dead...
Love-Sick
Authors: Trollope Anthony
Published: December 2020

Roger Carbury said well that it was very improbable that he and his cousin, the widow, should agree in their opinions as to the expedience of fortune-hunting by marriage. It was impossible that they should ever understand each other. To Lady Carbury the prospect...
Lady Carbury at Home
Authors: Trollope Anthony
Published: December 2020

During the last six weeks Lady Carbury had lived a life of very mixed depression and elevation. Her great work had come out,—the Criminal Queens,—and had been very widely reviewed. In this matter it had been by no means all pleasure, inasmuch...
Lady Monogram
Authors: Trollope Anthony
Published: December 2020

Georgiana Longestaffe had now been staying with the Melmottes for a fortnight, and her prospects in regard to the London season had not much improved. Her brother had troubled her no further, and her family at Caversham had not, as far as she was...
John Crumb
Authors: Trollope Anthony
Published: December 2020

Sir Felix Carbury made an appointment for meeting Ruby Ruggles a second time at the bottom of the kitchen-garden belonging to Sheep’s Acre farm, which appointment he neglected, and had, indeed, made without any intention of keeping it. But Ruby was there, and remained...
Melmotte’s Glory
Authors: Trollope Anthony
Published: December 2020

Augustus Melmotte was becoming greater and greater in every direction,—mightier and mightier every day. He was learning to despise mere lords, and to feel that he might almost domineer over a duke.* In truth he did recognize it as a fact that...
‘I Do Love Him’
Authors: Trollope Anthony
Published: December 2020

So it was. Lady Carbury had returned home from the soirée of learned people, and had brought Roger Carbury with her. They both came up to the drawing-room and found Paul and Henrietta together. It need hardly be said that they were both surprised....
Mr Melmotte Is Pressed for Time
Authors: Trollope Anthony
Published: December 2020

About this time, a fortnight or nearly so before the election, Mr Longestaffe came up to town and saw Mr Melmotte very frequently. He could not go into his own house, as he had let that for a month to the great financier, nor...
Mrs Hurtle at Lowestoft
Authors: Trollope Anthony
Published: December 2020

When Paul got down into the dining-room Mrs Hurtle was already there, and the waiter was standing by the side of the table ready to take the cover off the soup. She was radiant with smiles and made herself especially pleasant during...
The Journey to Liverpool
Authors: Trollope Anthony
Published: December 2020

Marie Melmotte, as she had promised, sat up all night, as did also the faithful Didon. I think that to Marie the night was full of pleasure,—or at any rate of pleasurable excitement. With her door locked, she packed and unpacked and repacked her...
The Results of Love and Wine
Authors: Trollope Anthony
Published: December 2020

Two, three, four, and even five o’clock still found Sir Felix Carbury in bed on that fatal Thursday. More than once or twice his mother crept up to his room, but on each occasion he feigned to be fast asleep and made no reply...
The Party
Authors: Trollope Anthony
Published: December 2020

Lady Monogram retired from Mr Melmotte’s house in disgust as soon as she was able to escape; but we must return to it for a short time. When the guests were once in the drawing-room the immediate sense of failure passed away. The crowd...
In Bruton Street
Authors: Trollope Anthony
Published: December 2020

Mr Squercum all this time was in a perfect fever of hard work and anxiety. It may be said of him that he had been quite sharp enough to perceive the whole truth. He did really know it all,—if he could prove that which...
The Brehgert Correspondence
Authors: Trollope Anthony
Published: December 2020

Mr Longestaffe had brought his daughter down to Caversham on a Wednesday. During the Thursday and Friday she had passed a very sad time, not knowing whether she was or was not engaged to marry Mr Brehgert. Her father had declared to her that...
John Crumb’s Victory
Authors: Trollope Anthony
Published: December 2020

In the meantime great preparations were going on down in Suffolk for the marriage of that happiest of lovers, John Crumb. John Crumb had been up to London, had been formally reconciled to Ruby,—who had submitted to his floury embraces, not with the best...
Chapter I
Authors: Equiano Olaudah
Published: December 2020

The author’s account of his country, and their manners and customs—Administration of justice—Embrenche—Marriage ceremony, and public entertainments—Mode of living—Dress— Manufactures—Buildings—Commerce—Agriculture—War and religion—Superstition of the natives—Funeral ceremonies of the priests or magicians—Curious mode of discovering poison—Some hints concerning the origin of the author’s countrymen, with the...
Chapter VIII
Authors: Equiano Olaudah
Published: December 2020

The author, to oblige Mr. King, once more embarks for Georgia in one of his vessels—A new captain is appointed—They sail, and steer a new course—Three remarkable dreams—The vessel is shipwrecked on the Bahama bank, but the crew are preserved, principally by means of...
Chapter XI
Authors: Equiano Olaudah
Published: December 2020

The author embarks on board a ship bound for Cadiz—Is near being shipwrecked—Goes to Malaga—Remarkable fine cathedral there— The author disputes with a popish priest—Picking up eleven miserable men at sea in returning to England—Engages again with Doctor Irving to accompany him to Jamaica and...
Chapter II: Mr Tulliver, of Dorlcote Mill, Declares His Resolution about Tom
Authors: Eliot George
Published: December 2020

‘What I want, you know,’ said Mr Tulliver—‘what I want is to give Tom a good eddication; an eddication as’ll be a bread to him. That was what I was thinking of when I gave notice for him to leave the ’cademy at...
Chapter V: Tom Comes Home
Authors: Eliot George
Published: December 2020

Tom was to arrive early in the afternoon, and there was another fluttering heart besides Maggie’s when it was late enough for the sound of the gig-wheels to be expected; for if Mrs Tulliver had a strong feeling, it was fondness for her boy....
Chapter X: Maggie Behaves Worse Than She Expected
Authors: Eliot George
Published: December 2020

The startling object which thus made an epoch for uncle Pullet was no other than little Lucy, with one side of her person, from her small foot to her bonnet-crown, wet and discoloured with mud, holding out two tiny blackened hands, and making a...
Chapter III: The New Schoolfellow
Authors: Eliot George
Published: December 2020

It Was a cold, wet February day on which Tom went back to school: a day quite in keeping with this severe phase of his destiny. If he had not carried in his pocket a parcel of sugar-candy and a small Dutch doll for...
Chapter III: The Family Council
Authors: Eliot George
Published: December 2020

It Was at eleven o’clock the next morning that the aunts and uncles came to hold their consultation. The fire was lighted in the large parlour, and poor Mrs Tulliver, with a confused impression that it was a great occasion, like a funeral, unbagged...
CHAPTER VI: Tending to Refute The Popular Prejudice Against the Present of a Pocket-Knife
Authors: Eliot George
Published: December 2020

In That dark time of December, the sale of the household furniture lasted beyond the middle of the second day. Mr Tulliver, who had begun, in his intervals of consciousness, to manifest an irritability which often appeared to have as a direct effect the...
Chapter VI: The Hard-Won Triumph
Authors: Eliot George
Published: December 2020

Three weeks later, when Dorlcote Mill was at its prettiest moment in all the year—the great chestnuts in blossom, and the grass all deep and daisied—Tom Tulliver came home to it earlier than usual in the evening, and as he passed over the bridge,...
Chapter V
Authors: Dostoevsky Fyodor
Published: December 2020

‘True enough, not so long ago I meant to ask Razumikhin for work—get him to find me some lessons or something like that…’ recalled Raskolnikov, ‘but how can he help me right now? I suppose he could get me some lessons; I suppose...
Chapter V
Authors: Dostoevsky Fyodor
Published: December 2020

This was a middle-aged gentleman, prim and self-important, with a cautious and irritable expression. He first paused in the doorway, looking around him with offensive and ill-disguised astonishment as if to say: ‘Where on earth have I landed up?’ He inspected Raskolnikov’s narrow, low-ceilinged...
Chapter VI
Authors: Dostoevsky Fyodor
Published: December 2020

‘I don’t believe it! I can’t believe it!’ repeated Razumikhin in perplexity, trying his hardest to refute Raskolnikov’s arguments. They were already approaching Bakaleyev’s rooms, where Pulkheria Alexandrovna and Dunia had long been expecting them. Razumikhin kept stopping still, in the heat of...
Chapter III
Authors: Dostoevsky Fyodor
Published: December 2020

The main thing was that up to the very last minute he had not at all expected things to end this way. He had maintained his overbearing manner without letting up, never believing it possible that two poor and defenceless women might escape from...
Chapter IV
Authors: Dostoevsky Fyodor
Published: December 2020

Raskolnikov had defended Sonia vigorously and effectively against Luzhin, despite carrying so much horror and suffering in his own heart. But having endured such anguish that morning, he was almost glad of the chance to escape his own worries, which were becoming unbearable; besides,...
Chapter II
Authors: Dostoevsky Fyodor
Published: December 2020

‘Oh, these cigarettes!’ Porfiry Petrovich finally began, after lighting up and inhaling. ‘They’re bad for you, really bad, but I can’t give them up! I cough, and my throat tickles, and I get breathless. You know, I’m such a coward, I recently went...
Chapter V
Authors: Dostoevsky Fyodor
Published: December 2020

Raskolnikov followed him.

‘What’s the meaning of this?’ cried Svidrigailov, turning back. ‘I thought I told you…’

‘What it means is that I’m not letting you out of my sight.’

‘Wha-a-at?’

They both stopped still and stared at one another, as if taking each other’s...
Chapter VIII
Authors: Dostoevsky Fyodor
Published: December 2020

Dusk was falling when he reached Sonia’s room. She had been waiting for him all day, in a state of dreadful anxiety. Dunia had been with her: she had come in the morning, remembering Svidrigailov’s words of the day before, that ‘Sonia knows it...
X. A Perilous Passage in the Slave Girl’s Life
Authors: Jacobs Harriet
Published: December 2020

After my lover went away, Dr. Flint contrived a new plan. He seemed to have an idea that my fear of my mistress was his greatest obstacle. In the blandest tones, he told me that he was going to build a small house for...
XXVII. New Destination for the Children
Authors: Jacobs Harriet
Published: December 2020

Mrs.
Flint proclaimed her intention of informing Mrs. Sands who was the father of my children. She likewise proposed to tell her what an artful devil I was; that I had made a great deal of trouble in her family; that when...
XXXIII. A Home Found
Authors: Jacobs Harriet
Published: December 2020

My greatest anxiety now was to obtain employment. My health was greatly improved, though my limbs continued to trouble me with swelling whenever I walked much. The greatest difficulty in my way was, that those who employed strangers required a recommendation; and in my...
XXXV. Prejudice against Color
Authors: Jacobs Harriet
Published: December 2020

It was a relief to my mind to see preparations for leaving the city. We went to Albany in the steamboat Knickerbocker.* When the gong sounded for tea, Mrs. Bruce said, “Linda, it is late, and you and baby had better come...
XLI. Free at Last
Authors: Jacobs Harriet
Published: December 2020

Mrs.
Bruce, and every member of her family, were exceedingly kind to me. I was thankful for the blessings of my lot, yet I could not always wear a cheerful countenance. I was doing harm to no one; on the contrary, I was doing...
Chapter I Introductory
Authors: Scott Sir Walter
Published: December 2020

The title of this work has not been chosen without the grave and solid deliberation which matters of importance demand from the prudent. Even its first, or general denomination, was the result of no common research or selection, although, according to the example of...
Chapter XII Repentance, and a Reconciliation
Authors: Scott Sir Walter
Published: December 2020

Waverley was unaccustomed to the use of wine, excepting with great temperance. He slept therefore soundly till late in the succeeding morning, and then awakened to a painful recollection of the scene of the preceding evening. He had received a personal affront,—he, a gentleman,...