bluuebunny/crossref_metadata_2025 huggingface dataset:
P475 Bee health and the antifungal activity of honey
Authors: Fernandes Kenya , Stanfield Bridie , Susantio Daniel , Carter Dee
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Various components have been identified which contribute to the antimicrobial properties of honey, many of which are secreted by bees into the honey as it is being processed. Here we investigate the relationship between bee and hive health and the antifungal properties of honey.

Methods

Samples of honey were collected from hives that were either healthy or experiencing some kind of distress as assessed by beekeepers. Healthy hives displayed strong population numbers and good brood patterns while distressed hives exhibited warning signs such as low population numbers, patchy brood patterns, evidence of chalkbrood fungal disease, or small hive beetle infestation. Honey samples were tested for antifungal activity against yeast and mold species via broth microdilution, tested for hydrogen peroxide levels via colorimetric assay, and spread on agar plates to assess the abundance and diversity of microbes present in the raw honey.

Results

Honey samples were effective against the yeast Cryptococcus deuterogattii and the dermatophyte mold Trichophyton interdigitale but ineffective against the yeast Candida dubliniensis and the mold Aspergillus flavus. The hydrogen peroxide levels of the honeys were variable and did not always align with activity. Less microbes in number and abundance were present on agar plates grown from healthy hive honey compared to distressed hive honey.

Conclusion

These results indicate that bee health may play a role in contributing to the antifungal properties of honey and that promoting strong and healthy hives is beneficial.
P476 Monitoring antifungal resistance in a global collection of Candida spp. surveillance isolates, including C. auris—analysis of resistance in antifungals (ARIA) 2020 study
Authors: Kothari Nimmi , Hawser Stephen , Olari Sara , Sartori Silvia , Mathur Tarun
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Analysis of resistance in antifungals (ARIA) is a recent longitudinal global surveillance initiative collecting yeast and fungal isolates from hospitals worldwide designed to determine susceptibility profiles and monitor the resistance trends among antifungal agents. ARIA reports the susceptibility patterns of data concerning echinocandins, second-generation triazoles, and fluconazole against clinical Candida spp., and filamentous fungal isolates from worldwide sources.

Methods

Candida spp. isolates (n = 662) were collected from hospitals worldwide during 2020 from 13 different sites—Argentina (n = 1), Australia (n = 2), Germany (n = 1), India (n = 2), Italy (n = 1), Panama (n = 1), Spain (n = 1), Turkey (n = 1), United Kingdom (n = 1), and United States (n = 2). These isolates were shipped to a central laboratory at IHMA Europe, Switzerland, and re-identified by MALDI-TOF or molecular methods. The MICs were performed by broth microdilution method in line with CLSI susceptibility testing standards—CLSI M27-A4 and M38-A2—methodologies and percentage susceptibility (%S) were calculated. Antifungals tested were amphotericin B (AMB), anidulafungin (ANID), fluconazole (FLU), isavuconazole (ISA), caspofungin (CASP), micafungin (MIC), posaconazole (POS), and voriconazole (VOR).

Results

Table 1: Summary MIC and susceptibility data of Candida spp. isolates for all countries combined

Conclusions

The data from the ARIA 2020 study indicate that overall antifungal resistance is low among the Candida spp. isolates except for C. glabrata and C. krusei where resistance to one or more antifungal agents was observed. However, there was no significant difference in susceptibility pattern was observed when susceptibility data of C. glabrata and C. krusei from different continents were compared. The emergence of resistance was evident among C. auris isolates as they have shown reduced susceptibility to azoles in this study.

Antifungal resistance surveillance and investigation into resistance mechanisms are of paramount importance. The ongoing ARIA surveillance study will provide resources to monitor antifungal resistance trends, provide key information to caregivers and provide essential information with respect to the development of novel antifungal agents.
P497 Candida DNA extraction from positive blood culture bottles
Authors: Balakumar Uthra , Subramanian Anitha , Kindo Anupma Jyoti
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Background

Molecular technique of detecting candida from blood is a quick method to identify candidemia. A major limitation of the molecular method is the difficulty associated with breaking fungal cell wall, the DNA extraction step still requires more than half of a working day.

The successful extraction of DNA involves effective disruption of cells, denaturation of protein, and nucleoprotein complexes, and inactivation of nucleases such as DNase. The extracted DNA should have low contamination of proteins.

Objectives

To perform DNA extraction using phenol-chloroform method.

2. To speciate candida using PCR-RFLP.

Methods

Candida DNA is isolated using phenol-chloroform method. The PCR products of different candida species obtained directly from blood samples were subjected to restriction enzyme (MspI).

Results

DNA was extracted from 50 samples, out of which 40 samples were from known positive blood culture bottles and the remaining 10 were known negative for candida. Of the 40 known positive blood culture bottles, 34 produced bands of various molecular weights and all 10 negative cultures did not show bands. Representative amplicon is shown in the gel picture (Figure 1).

Out of 40 candida-positive blood culture samples, 7 species have been identified using PCR- RFLP method.

Conclusion

The turn-around time can be highly reduced by extracting DNA from positive blood culture bottles and then performing PCR and RFLP for speciation compared with the conventional method.
S1.5d Spectrum of etiological agents of mycotic keratitis: A n 11- year review
Authors: Thomas Philip Aloysius , Kaliamurthy Jayaraman
Published: September 2022

S1.5 Mycotic Keratitis, September 21, 2022, 11:00 AM - 12:30 PM

 

Background

To assess the spectrum of etiological agents of mycotic keratitis over an 11-year-period at a tertiary eye care center in southern India.

Methods

A retrospective review was made of microbiological data relating to corneal scrapings performed over a period of 11 years (January 2011-December 2021) on 1200 individuals who presented with suspected microbial keratitis. Each individual underwent corneal scraping and the scraped materials were subjected to meticulous microbiological analysis that included direct microscopy (Gram-stain and lactophenol cotton blue wet mount) and culture on multiple solid and liquid culture media.

Results

A total of 404 fungal isolates were recovered from the corneal scrapings of 1200 patients with suspected microbial keratitis. Of the 404 fungal isolates, Fusarium spp (133) were the predominant isolates, followed by Aspergillus flavus (104), Curvularia spp (24), Aspergillus fumigatus (17), Bipolaris sp (7), Alternaria sp (2), Colletrotrichum sp (2) Cylindrocarpon lichenicola (2) Exserohilum sp (1) and Drechslera sp (1); there were also 111 filamentous fungus isolates that defied identification in spite of various efforts made to induce sporulation. Of the 404 culture-proven cases of mycotic keratitis, 381 patients confirmed ocular trauma while engaged in agricultural activity.

Conclusion

Fusarium spp., followed by Aspergillus spp., were the most common organisms found in mycotic keratitis patients in this specific geographical area. Additional efforts are required to spread awareness among villagers about the dangers of not promptly treating mycotic and other forms of microbial keratitis so that blindness and visual disability caused by corneal scarring in rural areas can be reduced.
S10.3d Yeast Microbiome in patients with inflammatory bowel disease (IBD)
Authors: Vaezi Afsane , Fakhim Hamed , Jabbari Mehrdad , Nasri Elahe , Azar Mohammad Reza Hosseini , Diba Kambiz , Badali Hamid
Published: September 2022

S10.3 The mycobiome characterization: future perspectives or just a trend?, September 24, 2022, 10:30 AM - 12:00 PM

 

Objective

The intestinal microbiota plays major roles in host-protective functions and inflammatory bowel diseases (IBDs). Although some data suggest a role of the yeast microbiota in IBD pathogenesis, the available data are rare. The aim of this study was to evaluate the fecal yeast microbiota in patients with IBD.

Methods

Fungal isolates of the fecal microbiota of 120 patients with IBD and 30 healthy control individuals were determined using conventional and molecular (ITS sequencing and RFLP) methods.

Results

The mean age of the patients was 37.4 ± 12.2 years (range 15-72 years). Of 120 patients included, 67 had ulcerative colitis (55.8%) and 53 had Crohn's disease (44.2%). Ulcerative colitis was more prevalent in women than Crohn's disease (61.7% vs 50.2%, P <.005). The median time between the onset of symptoms and diagnosis was 9.58 ± 8.56 years. In total, 73 colonies of Candida spp. were isolated from 60 patients with IBD. The most common identified species of Candida were C. albicans (42.4%), C. glabrata (20.5%), and C. krusei (6.8%). The incidence of non-albicans Candida species (57.6%) was higher than C. albicans (42.4%). We observed an increased proportion of C. albicans compared with healthy individuals (28.5% vs 21.6%). The frequencies of C. glabrata were significantly higher among IBD patients rather than the control group (20.5% vs 9.8%).

Conclusion

Candida albicans were found to be increased in abundance in the IBD samples. These data emphasize the potential importance of yeast microbiota signatures as biomarkers. Moreover, we unravel here disease-specific-Candida species network alterations in IBD, suggesting that, Candida species might play a role in IBD pathogenesis.
S10.4b Pathophysiology, diagnosis, and management of chronic pulmonary Aspergillosis
Authors: Izumikawa Koichi
Published: September 2022

S10.4 Emerging antifungal resistant fungi, September 24, 2022, 10:30 AM – 12:00 PM

 

 

Chronic pulmonary Aspergillosis (CPA) is a complex disease that is difficult to diagnose and resistant to treatment. Many cases are missed and have unfortunate outcomes in clinical settings. Although CPA has long been classified into several types based on pathological findings, it is not always possible to make a pathological diagnosis in all cases, so a clinical diagnosis is often made. In addition, many have an underlying respiratory disease and complications by infections caused by other microorganisms, making treatment further difficult. The diagnosis of CPA requires clinical symptoms and findings, radiological, serological, pathological, and microbiological approaches, and standardization of these diagnostic criteria is challenging. The mainstay of treatment is outpatient oral therapy with azoles, and indications and therapeutic evidence for echinocandins, and polyenes are limited. The development of novel antifungals with different mechanisms of action from conventional agents is also awaited. Azole-resistance of Aspergillus caused by long-term treatment is also an issue. It has been reported that resistant strains have been found in CPA patients treated with long-term azole therapy, mutations in the cyp51A and others have also been identified and longer exposure to azoles are correlated with higher MIC values of them. This presentation will focus on epidemiology, pathogenesis, diagnosis, and management including drug resistance in CPA patients.
S10.4d A unique clinical appearance of Candida auris infection in Japan
Authors: Umeyama Takashi , Abe Masahiro , Shinohara Takayuki , Miyazaki Taiga , Miyazaki Yoshitsugu
Published: September 2022

S10.4 Emerging antifungal resistant fungi, September 24, 2022, 10:30 AM - 12:00 PM

It has only been 15 years since Candida auris was reported isolated from the ear canal of a 70-year-old Japanese woman in Tokyo, and no record of an isolate corresponding to this species has been found prior to 1996. It is a high public health priority concern in several regions of the world. This is because the fungus is multidrug-resistant and can acquire resistance to all three major groups of current antifungal drugs (azoles, echinocandins, and amphotericin B). Outbreaks in healthcare facilities are also a concern. The main reasons for this are as follows: unlike other Candida spp. that primarily inhabit the digestive and urinary systems, C. auris readily colonizes patient skin and can survive for several weeks on dry, non-living surfaces, contributing to infections and outbreaks in healthcare facilities.

 

In Japan, C. auris was first identified in 2009 in a discharge from the ear canal of a patient admitted to a Japanese hospital, and since then, all isolates have come from the ear canal, with only a few reported strains. For reasons unknown, as of 2022, C. auris has not been reported as a cause of invasive disease in Japan, and no nosocomial infections have occurred. Whole genome analysis suggests that all Japanese isolates belong to Clade II, affecting drug resistance and clinical characteristics.

 

In this symposium, I will present the current status of C. auris infection in Japan, the first country where C. auris infection originated, together with its unique clinical features and molecular epidemiological analysis.
S2.1d Incidence of mixed fungal infections in post-COVID-19 outbreak of Mucormycosis
Authors: Mohapatra Subhashree , Tanveer Nadeem , Gupta Kanika , Sharma Sonal , Das Shukla , Nirmal Kirti , Singh Narendra Pal
Published: September 2022

S2.1 Update on Mucormycosis, September 21, 2022, 3:00 PM - 4:30 PM

 

Introduction

Post-COVID-19 rhino orbital mucormycosis has emerged as an important life-threatening complication adding to mortality. Fungal infections are a major health challenge, especially in the immunocompromised.

Mucormycosis is a severe, frequently fatal fungal infection that has a unique predisposition to infect patients with diabetes. The most probable reasons for the emergence of these cases could be the extensive use of steroids in the management of coronavirus disease 2019 (COVID-19) patients and extensive dysregulated immune response due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. A prompt diagnosis is vital for the effective management of invasive rhino-orbital fungal infections due to their propensity for angioinvasion and destructive spread with brain involvement.

Materials and Methods

A total of 150 surgical pathology specimens received with a clinical suspicion of invasive fungal infection during the post-COVID-19 outbreak of mucormycosis were retrieved from the archives of the Department of histopathology. The cases were reviewed for the presence of Aspergillus fruiting bodies by senior pathologists and microbiologists on a multi-headed microscope. The morphological features of the fruiting bodies were noted and correlated with the fungal KOH and culture. The tissue reaction pattern, presence of oxalate crystals, and morphology of the fungal hyphae were also noted in each case showing Aspergillus fruiting bodies.

Results

A total of 8 out of 150 cases (5.3%) showed the presence of Aspergillus fruiting bodies. The histopathological diagnosis given in these 8 cases were—Aspergillus (1), combined Aspergillus and Mucorales (7). Two types of fungal hyphae were noted in all seven cases of combined infection. Granulomatous tissue reaction was noted in two out of seven cases of combined infection. Calcium oxalate crystals were noted in the single case of Aspergillosis and were absent in all cases of mixed infection.

Conclusion

To conclude Aspergillus fruiting bodies are found in a small but significant number of cases of post-COVID-19 Rhino-Orbital invasive mold infections so while reporting the surgical specimens with clinical suspicion of post-COVID-19 mucormycosis one should be aware of the possibility of mixed fungal infections and look for Aspergillus fruiting bodies as a tell-tale sign of mixed Mucorales and Aspergillus infection. However, their presence does not estimate the true incidence of mixed fungal infections for which immunohistochemistry and polymerase chain reaction are needed.
S7.4d Candida albicans SR-like protein kinases regulate different cellular processes: Sky1 is involved in thecontrol of ion homeostasis, while Sky2 is important for dipeptide utilization
Authors: Brandt Philipp , Gerwien Franziska , Wagner Lysett , Krüger Thomas , Ramírez-Zavala Bernardo , Mirhakkak Mohammad H. , Schäuble Sascha , Kniemeyer Olaf , Panagiotou Gianni , Brakhage Axel A. , Morschhäuser Joachim , Vylkova Slavena
Published: September 2022

S7.4 Pathogenesis and host defense, September 23, 2022, 10:30 AM - 12:00 PM

 

 

Protein kinases play a crucial role in regulating cellular processes such as growth, proliferation, environmental adaptation, and stress responses. Candida albicans genome comprises of 108 predicted protein kinases, of which the exact role of nearly half of those kinases remains unknown. One family of protein kinases is serine-arginine (SR) protein kinases, which are highly conserved in eukaryotes and regulate fundamental processes such as constitutive and alternative splicing, mRNA processing, and ion homeostasis. The C. albicans genome encodes two (Sky1, Sky2) and the C. glabrata genome has one homolog (Sky1) of the human SR protein kinase 1, but their functions have not yet been investigated. We used deletion strains of the corresponding genes in both fungi to study their cellular functions. C. glabrata and C. albicans strains lacking SKY1 exhibited higher resistance to osmotic stress and toxic polyamine concentrations, similar to their ortholog Sky1 in Saccharomyces cerevisiae. Deletion of SKY2 in C. albicans resulted in impaired utilization of various dipeptides as the sole nitrogen source which was shown by utilizing a high-throughput phenotypic screen. Subsequent phosphoproteomic analysis identified the di- and tri-peptide transporter Ptr22 as a potential Sky2 substrate. Our data suggest that Sky2 seems to be involved in Ptr22 regulation since overexpression of PTR22 in the sky2∆ mutant restored the ability to grow on dipeptides and made the cells more susceptible to the dipeptide antifungals Polyoxin D and Nikkomycin Z. Altogether, our results demonstrate that C. albicans and C. glabrata Sky1 protein kinases are functionally similar to Sky1 in S. cerevisiae, whereas C. albicans Sky2, a unique kinase of the CTG clade, likely regulates dipeptide uptake via Ptr22.
S8.5d Cryptococcus neoformans and Cryptococcus gattii clinical isolates from Colombia develop heteroresistance to fluconazole at high concentrations
Authors: Melendres Javier , Carvajal-Valencia Silvia , Escandón Patricia , Firacative Carolina
Published: September 2022

S8.5 Genotyping of Cryptococcus neoformans and C. gattii, September 23, 2022, 3:00 PM - 4:30 PM

 

Introduction

Cryptococcosis is a worldwide mycosis caused by Cryptococcus neoformans and Cryptococcus gattii. Although resistance to antifungals is infrequent, isolates with decreased susceptibility to fluconazole have been reported globally, including Colombia, which may be due to 1) heteroresistance, defined as the ability to adapt to increasing concentrations of this azolic antifungal, and 2) point mutations in the EGR11 gene encoding the fluconazole target enzyme, lanosterol 14-α-demethylase.

Objective

To determine the development of heteroresistance to fluconazole in C. neoformans and C. gattii clinical isolates from Colombia and to amplify and sequence the ERG11 gene of the isolates to seek for mutations that might characterize resistant or heteroresistant phenotypes.

Methods

The minimum inhibitory concentration (MIC) to fluconazole was determined in 31 and 24 isolates of C. neoformans and C. gattii, respectively, using broth microdilution. Heteroresistance was evaluated by plating each isolate on YPD agar that contained fluconazole at concentrations equal to the MIC of each isolate. Heteroresistant colonies were then replated at increasing concentrations of fluconazole, as high as 128 μg/ml.

Results

All isolates were susceptible to fluconazole with MICs of 1 μg/ml (n = 3), 2 μg/ml (n = 6), 4 μg/ml (n = 17), 8 μg/ml (n = 23), 16 μg/ml (n = 5), and 32 μg/ml (n = 1). However, all isolates developed heteroresistant colonies, with increments in the MIC from 2 to 6 dilutions. Notably, 5 (16.1%) isolates of C. neoformans and 8 (33.3%) of C. gattii, grew up to 64 μg/ml of fluconazole, which is the MIC that defines resistance to this azole, and 1 (3,2%) isolate of C. neoformans and 4 (16.7%) of C. gattii grew up to 128 μg/ml of fluconazole. Currently, the ERG11 gene is being amplified for further sequencing. Conclusion: clinical isolates of C. neoformans and C. gattii that develop heteroresistance to fluconazole in high concentrations circulate in Colombia, which is important since this characteristic contributes to the relapse of cryptococcosis during therapy with this triazole.
Using machine learning to evaluate large-scale brain networks in patients with brain tumors: Traditional and non-traditional eloquent areas
Authors: Morell Alexis A , Eichberg Daniel G , Shah Ashish H , Luther Evan , Lu Victor M , Kader Michael , Higgins Dominique M O , Merenzon Martin , Patel Nitesh V , Komotar Ricardo J , Ivan Michael E
Published: September 2022

Background

Large-scale brain networks and higher cognitive functions are frequently altered in neuro-oncology patients, but comprehensive non-invasive brain mapping is difficult to achieve in the clinical setting. The objective of our study is to evaluate traditional and non-traditional eloquent areas in brain tumor patients using a machine-learning platform.

Methods

We retrospectively included patients who underwent surgery for brain tumor resection at our Institution. Preoperative MRI with T1-weighted and DTI sequences were uploaded into the Quicktome platform. We categorized the integrity of nine large-scale brain networks: language, sensorimotor, visual, ventral attention, central executive, default mode, dorsal attention, salience and limbic. Network integrity was correlated with preoperative clinical data.

Results

One-hundred patients were included in the study. The most affected network was the central executive network (49%), followed by the default mode network (43%) and dorsal attention network (32%). Patients with preoperative deficits showed a significantly higher number of altered networks before the surgery (3.42 vs 2.19, P < .001), compared to patients without deficits. Furthermore, we found that patients without neurologic deficits had an average 2.19 networks affected and 1.51 networks at-risk, with most of them being related to non-traditional eloquent areas (P < .001).

Conclusion

Our results show that large-scale brain networks are frequently affected in patients with brain tumors, even when presenting without evident neurologic deficits. In our study, the most commonly affected brain networks were related to non-traditional eloquent areas. Integrating non-invasive brain mapping machine-learning techniques into the clinical setting may help elucidate how to preserve higher-order cognitive functions associated with those networks.
Robust twin-field quantum key distribution through sending or not sending
Authors: Jiang Cong , Yu Zong-Wen , Hu Xiao-Long , Wang Xiang-Bin
Published: September 2022

The sending-or-not-sending (SNS) protocol is one of the most major variants of the twin-field (TF) quantum key distribution (QKD) protocol and has been realized in a 511-km field fiber, the farthest field experiment to date. In practice, however, all decoy-state methods have unavoidable source errors, and the source errors may be non-random, which compromises the security condition of the existing TF-QKD protocols. In this study, we present a general approach for efficiently calculating the SNS protocol’s secure key rate with source errors, by establishing the equivalent protocols through virtual attenuation and the tagged model. This makes the first result for TF QKD in practice where source intensity cannot be controlled exactly. Our method can be combined with the two-way classical communication method such as active odd-parity pairing to further improve the key rate. The numerical results show that if the intensity error is within a few percent, the key rate and secure distance only decrease marginally. The key rate of the recent SNS experiment in the 511-km field fiber is still positive using our method presented here, even if there is a $\pm 9.5\%$ intensity fluctuation. This shows that the SNS protocol is robust against source errors.
Comparison of Suspected and Confirmed Internal External Ventricular Drain-Related Infections: A Prospective Multicenter United Kingdom Observational Study
Authors: Sohn Sei Yon , Russell Clark D , Jamjoom Aimun A B , Poon Michael T , Lawson McLean Aaron , Ahmed Aminul I ,   British Neurosurgical Trainee Research Collaborative, Abdulla MAH , Alalade A , Bailey M , Basu S , Baudracco I , Bayston R , Bhattacharya A , Bodkin P , Boissaud-Cooke M , Bojanic S , Brennan PM , Bulters DO , Buxton N , Chari A , Corns R , Coulter C , Coulter I , Critchley G , Dando A , Dardis R , Duddy J , Dyson E , Edwards R , Garnett M , Gatcher S , Georges H , Glancz LJ , Gray WP , Hallet J , Harte J , Haylock-Vize P , Hutchinson PJ , Humphreys H , Jenkinson MD , Joannides AJ , Kandasamy J , Kitchen J , Kolias AG , Loan JJM , Ma R , Madder H , Mallucci CL , Manning A , Mcelligott S , Mukerji N , Narayanamurthy H , O’Brien D , Okasha M , Papadopoulos M , Phan V , Phang I , Poots J , Rajaraman C , Roach J , Ross N , Sharouf F , Shastin D , Simms N , Steele L , Solth A , Tajsic T , Talibi S , Thanabalasundaram G , Vintu M , Wan Y , Wang D , Watkins L , Whitehouse K , Whitfield PC , Williams A , Zaben M
Published: September 2022

Background

Diagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI.

Methods

Data on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion.

Results

Internal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range {IQR}, 7–24.5] for confirmed cases and 9.5 days [IQR, 5.75–14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes.

Conclusions

Suspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship.
Routine Antiretroviral Pharmacy Refill Information Can Predict Failure Postpartum in Previously Suppressed South African Women With HIV
Authors: Gawler Nicola , Reynolds Steven J , Hsiao Nei-Yuan , Clarke William , Maartens Gary , Abrams Elaine J , Myer Landon , Redd Andrew D , Phillips Tamsin K
Published: September 2022

Background

Detection of antiretrovirals (ARVs) in biological specimens is a reliable, objective way to measure adherence. However, routine ARV testing is not feasible in many high-burden settings. This study explored if pharmacy data could accurately predict HIV viremia postpartum in previously virally suppressed women.

Methods

South African women with HIV who initiated antiretroviral therapy (ART) during pregnancy and achieved viral suppression (VS; viral load [VL]≤50 copies/mL) were followed postpartum; during follow-up, plasma VL was measured and ARV adherence self-reported. A portion of samples were tested for the presence of ARV using mass spectrometry. Patient-level routine pharmacy data were used to classify if women should have the drug in hand for the past 7 days before the visit date. Logistic regressions were used to calculate associations between adherence and viral nonsuppression (VNS; VL > 50) or failure (VF; VL > 1000) at the first study visit of women who had ARV measured. Data for all women were examined for associations of self-reported adherence and drug in hand with VS and VF at 2, 6, and 12 months postpartum.

Results

Women with no ARV detected were significantly more likely to have VNS (odds ratio [OR], 26.4). Having no drug in hand for 7 days was also predictive of VNS in these same women (OR, 7.0) and the full cohort (n = 572) at 3 (OR, 2.9), 6 (OR, 8.7), and 12 months (OR, 14.5). Similar results were seen for VF.

Conclusions

These data show that routine pharmacy data can act as a highly predictive mechanism for identifying patients at risk of VNS and VF due to nonadherence.
Hindu Eschatology
Authors: Knipe David M.
Published: September 2022

In a survey of the extensive, complex, and cumulative history of Hinduism, it might be opportune to divide personal and cosmic eschatologies. Similarly, it could be convenient to separate the early from the classical history of Hinduism and concentrate solely on the latter. The early history, framed by a sacrificial world view and veering toward an almost mechanistic understanding of gods and the cosmos, is entirely dependent upon the eternal Vedas. With certain sectarian and modernizing exceptions, a generally acknowledged set of contemporary Hindu beliefs and practices would include the following: acceptance of the Vedas as basic authority, belief in transmigration and the effects of human action (karma) on rebirths, devoted recognition of certain divine beings (gods, goddesses, living and departed saints), acknowledgment of a class and caste social hierarchy, ritual attention to ancestors, and a general understanding of life as moral progress toward an eventual liberation from rebirths. This article examines Hindu eschatology, focusing on Hindu beliefs such as immortality, metaphors of regeneration, brahman, Aranyakas, Upanishads, classical Sanskrit texts, preta, and world dissolution.
Fundamentalist Theology
Authors: Clouse Robert G.
Published: September 2022

As a historical movement, evangelicalism developed in the United States from the revivals of the eighteenth century and became the leading force in the nation in the nineteenth century. Since then the movement has gone through four major phases. The first period can be dated from 1870 to the end of World War I (1919), when evangelicalism was arguably the controlling force in the country. The antecedents of contemporary fundamentalism during this period remained in the major denominations but rejected the liberal accommodation to modern thought. The second stage of fundamentalist historical development occurred from 1919 to 1926, the third from 1926 to about 1945, and the fourth from the mid-1940s to the present. This article examines fundamentalist theology and discusses eschatology and the Christian Right, Tim LaHaye and the Left Behind series, and progressive dispensationalism.
Universalism
Authors: Talbott Thomas
Published: September 2022

Universalism is the religious doctrine that every created person will sooner or later be reconciled to God, the loving source of all that is, and will in the process be reconciled to all other persons as well. Insofar as Christianity is a historical religion and includes substantive beliefs about the death and resurrection of Jesus Christ, Christians are indeed committed to the view that anyone who denies this historical event is mistaken and anyone who does not understand its theological significance has not yet grasped the full truth of the matter. John Hick, the best-known proponent of universalism among twentieth-century philosophers of religion, has also been one of the most outspoken defenders of religious pluralism. This article discusses universalism and other Christian doctrines, including salvation. It also examines free will and the problem of hell, libertarian free will, and the role of human freedom in universal reconciliation.
Modernity, History, and Eschatology
Authors: Pannenberg Wolfhart
Published: September 2022

Traditional Christian eschatology affirmed an end of the present world of nature and of human history, when in the future the risen Christ will come again to hold a final judgment, to raise the dead, and to receive those who believe in him to participate in his eternal life that he shares with God the Father. The kingdom of God to come, which had been understood in moral and even political terms by Martin Bucer in the sixteenth century and afterward under his influence, had been reconceived later on in terms of the Christological doctrine of the kingdom of grace entrusted to Christ by the Father, exercised in the life of the church and to be completed in the future kingdom of glory. This article examines modernity, history, and eschatology. It considers Gotthold Ephraim Lessing's conception of history as a process of divine education, the further development of a philosophy of history and theology, and Georg Wilhelm Friedrich Hegel's contributions in the secularization of Christian eschatology.
Human Nature, Personal Identity, and Eschatology
Authors: Taliaferro Charles
Published: September 2022

Traditional Christian doctrine holds that all persons who have died will be resurrected at the end of time and will survive forever, either in the presence of God in heaven, or in hell, separated from him. Not only Roman Catholics with their doctrine of purgatory, but Protestants as well, have subscribed to belief in an intermediate state between death and resurrection. While questions about human nature should not be decided on the basis of eschatology alone, eschatology is nevertheless for Christian thinkers an important consideration for a fully informed account of human nature. This article argues that the belief in an afterlife has important connections with the philosophy of human nature and personal identity that go beyond questions about the bare possibility of survival. It examines the arguments over the positive case both for and against the possibility of an afterlife. It also considers relevant concerns involving freedom and values, material bodies and immaterial souls, difficulties facing materialism, a positive case for dualism, and the virtues of dualism.
Jewish Eschatology
Authors: Novak David
Published: September 2022

Classical Jewish eschatology has always been concerned with the rewards due to righteous individuals and the punishments due to wicked ones in the other world. Eschatology is best conceived in a phenomenology of human hope, originating in this world but intending another. It is a fundamental divine concern, hence it is theological—theology being more of what God has revealed to humans about what he desires from them than what humans themselves can desire from God on their own. When engaging in eschatological research, one should begin with the categories formulated in the rabbinic writings (the Talmud and related literature). The rabbis believed that their eschatological faith was hinted at even in the revelation of the Torah, and that the prophets had prophesied about it even more explicitly. The centerpiece of classical Jewish eschatology is the doctrine of the resurrection of the dead. Interest in the Messiah and messianism has always been at the heart of the dispute between Jews and Christians.
Polarization calibration of the Tandem Etalon Magnetograph of the Solar Magnetic Activity Research Telescope at Hida Observatory
Authors: Yamasaki Daiki , Nagata Shin’ichi , Ichimoto Kiyoshi
Published: September 2022

The Tandem Etalon Magnetograph (TEM) is one of the instruments of the Solar Magnetic Activity Research Telescope of Hida Observatory. The TEM is a partial disk (320″ × 240″) filter magnetograph which scans the wavelength around a Fe i line at 6303 Å and achieves polarimetric sensitivity of <5 × 10−4 for each wavelength. To obtain the polarimeter response matrix of the instrument, we have carried out end-to-end polarization calibrations of the instrument. We have also measured the polarization characteristics of the polarization beam splitter (PBS), which is a crucial component of the instrument. As a result of end-to-end calibration, we found significant spatial variation in the response matrix across the field of view. From a laboratory test, we found that $1\%$ of the magnitude of a circular diattenuation of the PBS was due to the retardation caused by the stress in the cube and the linear diattenuation of the film. Although the spatial variation across the field of view is more than 10 times larger, to achieve the polarimetric sensitivity of <5 × 10−4, this can be well explained by the polarization characteristic of the PBS and corrected by using the response matrix obtained in the end-to-end calibration. In addition, we also obtained the daily variation of the polarization property of the TEM. We found that the crosstalk from Stokes Q to V changes by an amount comparable to the tolerance through a day. In the present configuration, we require a pixel-by-pixel calibration every 100 min to meet the accuracy requirement.
Epidemiology of Neonatal Stroke: A Population-Based Study
Authors: Clive B , Vincer M , Ahmad T , Khan N , Kuhle S , Afifi J , El-Naggar W
Published: September 2022

BACKGROUND: Neonatal stroke (NS) is a known cause of cerebral palsy, epilepsy and cognitive deficits in up to 50% of patients. Understanding its epidemiology can help in early identification of affected patients and in improving outcomes.

OBJECTIVES: To obtain population-based data on the incidence, clinical presentation, treatment, imaging features and outcomes of patients with all types of neonatal stroke.

DESIGN/METHODS: Full term neonates born to mothers living in Nova Scotia between 2007 and 2013 and diagnosed with NS were identified through the province’s Perinatal Follow-up Program Database. Neonates with significant congenital anomalies or hypoxic ischemic encephalopathy were excluded. Perinatal data and neonatal course were reviewed. Neurodevelopmental outcomes were assessed at 18 months of age using the standardized cognitive adaptive test/clinical linguistic auditory milestone scale (CAT/CLAMS).

RESULTS: Twenty-nine neonates (47 per 100,000 live births) with NS were identified during the study period. The mean gestational age was 39±1 weeks and mean birth weight was 3278±579 g. In twenty-two (76%), NS was due to neonatal arterial ischemic stroke (NAIS), 2 (7%) to cerebral sinovenous thrombosis, and 5 (17%) to intracerebral hemorrhage. Seizures were the most common presenting sign. [table] The median length of stay in hospital was 7 days (4-21). At 18 months of age, only 2 patients (7%) were found to have cerebral palsy and one had epilepsy (3%). CONCLUSION: The majority of patients with NS had NAIS and presented with seizures on the first day of life. The incidence of NS in Nova Scotia is higher than reported in the literature, however the neurodevelop-mental outcomes are better.
A Randomized Double-Blind Trial Comparing the Effect on Pain of An Oral Sucrose Solution Versus Placebo in Children 1 To 3 Months Old Needing Urethral Catheterization
Authors: Desjardins MP , Gouin S , Gaucher N , Lebel D , Gravel J
Published: September 2022

BACKGROUND: Oral sweet solutions have been accepted as effective analgesics for procedures in the neonatal population. However, there have been a limited number of trials in older infants. These studies have conflicting results.

OBJECTIVES: To compare the efficacy of an oral sucrose solution versus placebo in reducing pain during urethral catheterization in infants 1 to 3 months old in the Emergency Department (ED).

DESIGN/METHODS: A randomized, double-blind clinical trial was conducted in a pediatric university-affiliated hospital ED. Infants, 1 to 3 months of age, were recruited and randomly allocated to receive 2 ml of 88% sucrose solution (SUC) or 2 ml of placebo solution (PLA) orally, 2 minutes before planned urethral catheterization. The primary outcome measure was the difference in pain scores as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale during at 1 min post procedure. Secondary outcome measures were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, variations in heart rate and adverse events.

RESULTS: Seventy-six participants were recruited and completed the study, 37 (group SUC) and 39 (group PLA) respectively. The mean difference in FLACC scores compared to baseline was 5.62±1.32 (SUC) vs. 6.21±1.15 (PLA) (p=.51) during catheterization and 2.70±1.21 (SUC) vs. 2.26±1.41 (PLA) at 1 min (p=.64) and 0.66±1.32 (SUC) vs. 1.26±1.00 (PLA) at 3 mins (p=.38). For the NIPS scores, it was 4.27±1.06 (SUC) vs. 4.69±0.92 (PLA) (p=.56) during procedure and 2.05±0.91 (SUC) vs. 1.97±1.19 (PLA) (p=.92) at 1 min and 0.49±0.89 (SUC) vs. 0.89±0.97 (PLA) (p=.54) at 3 mins. The difference in the mean crying time was not different between both groups: 99±34 secs (SUC) vs. 100±25 (PLA) (p=.99). No significant difference was found in participants’ heart rate variations during procedure 23±8 BPM (SUC) vs. 26±7 (PLA) (p=.60) and after 1 min 19±12 BPM (SUC) vs. 17±7 (PLA) (p=.76) and after 3 mins -1±12 BPM (SUC) vs. 3±6 (PLA) (p=.53). No adverse events were reported. The blinding was successful.

CONCLUSION: In infants 1 to 3 months of age undergoing urethral catheterization in the ED, administration of an oral sweet solution did not statistically decrease pain scores as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying time were not significantly decreased when sucrose was provided.
The Heads-Ed: A Brief Mental Health Screening Tool for Use in the emergency department
Authors: Gray C , Cloutier P , Cappelli M , Kennedy A , Zemek R
Published: September 2022

BACKGROUND: The hospital emergency department (ED) is an important entry point for children and youth into the mental health (MH) and addicitons system. Many EDs are challenged in managing child and youth MD/addictions due to lack of clinical resources, standardized screening tools and/or training. Currently, there is no standard of practic or tool used to guide the assessment and disposition of MH concerns within the ED. In fact, researchers have found that only a small minority (<10%) of ED physicians indicate using evidence based screening methods to assess MH concerns. The American Academy of Pediatrics called for improved screening of MH issues in the ED. In response, we developed HEADS-ED, a rapid screening tool that represents Home, Education, Activities/peers, Drugs/alcohol, Suicidality, Emotions/behaviour, Discharge resources.

OBJECTIVES: This presentation will summarize 3 studies completed to date examining the inter rater reliability, sensitivity & specificity of the HEADS-ED. In addition, data will be presented regarding the utility of the HEADS-ED in predicting consultation with psychiatry and admission to hospital.

DESIGN/METHODS: In Study #1, Crisis Intervention Workers (CIWs) completed the HEADS-ED and the Child and Adolescent Needs and Strength tool (CANS-MH 3.0) on patients presenting to the ED with MH concerns between March 1 and May 30, 2011. In Study #2, ED physicians completed the HEADS-ED for patients presenting to the ED with MH concerns between May 5, 2013 and February 10, 2014.

RESULTS: In Study #1, there were 313 participants (M=14.3 years, SD = 2.63 years, 58.1% female). Inter rater reliability analysis revealed strong agreement between raters (r=.79). The HEADS-EDitems were significantly correlated with CANS-MH 3.0 scores on related items. The HEADS-ED also predicted consultation with psychiatry and admission to hospital (sensitivity 82%, specificity 87%). In Study #2, there were 589 participants (M = 15.13 years; SD = 1.41; 72.7% female) seen by the ED physicians. The HEADS-ED predicted consultation to psychiatry/crisis team (sensitivity 92.1%, specificity 72.3%).

CONCLUSION: Results provide evidence to supor the psychometric properties of the HEADS-ED. The HEADS-ED is a useful tool to standardize the language used to discuss and assess pediatric MH patients int he ED. The brief, inuitive measure has the potential to determine referral for psychiatric consultation, admission decisions and help guide selection of discharge resources.
Rapid, Non-Invasive Urine Collection is Feasible in Infants Up To 12 Months Old
Authors: Bethune P , Mills J. A , German G J.
Published: September 2022

BACKGROUND: In non-toilet trained children, collection of non-contaminated urine specimens for culture is done by urethral catheterization or suprapubic aspiration,both invasive procedures, or by clean-catch technique, which is time-consuming. A rapid, non-invasive method of urine collection from neonates has been recently described:a stimulated clean-catch technique, with an 87% success rate within 5 minutes (Herreros et al, Arch Dis Child 2013; 98:27-29).

OBJECTIVES: To determine: 1) the success rate in obtaining urine specimens within 5 minutes from infants (birth-12 months) via this stimulated clean-catch method; and 2) the time to collection of a urine specimen, via the stimulated clean-catch method.

DESIGN/METHODS: Subjects were consecutive infants requiring a urine specimen for urinalysis and/or urine culture, identified by nursing or medical staff in either the inpatient or outpatient areas of a regional hospital. Verbal consent was obtained from the parent or guardian. 10- 60 minutes after a feeding, the infant’s genitalia were cleaned, and a stimulated clean-catch urine collection was attempted. The method consists of holding the infant under the axillae, with legs dangling, and stimulating voiding by rapidly tapping the suprapubic area for 30 seconds, then gently massaging in a circular pattern over the paralumbar area bilaterally for 30 seconds. The tapping and massage are repeated alternately until the infant voids, and the urine is collected “mid-stream”.

RESULTS: Urine collection was attempted 51times, from 43infants, and was successful within 5 minutes in 37of 51attempts (72%). In infants 0-30 days old, the success rate was 64% (14 of 22 attempts). In infants 31-90 days old, the success rate was 93% (14 of 15 attempts). In infants 3-6 months old, the success rate was 67% (4 of 6 attempts). In infants 6-12 months old, the success rate was 63% (5 of 8attempts). The time to successful urine collection was recorded in 26cases, with both a median and a mean time of 85seconds. In 77% of the successful collections, the urine was obtained within 2 minutes.

CONCLUSION: The stimulated clean-catch method of urine collection is useful in infants up to 1 year of age. In most cases of successful urine collection, the infant will void within 2 minutes.