bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting carbapenemase-producing Enterobacterales (CPE): an evaluation of an enhanced CPE infection control and screening programme in acute care
Authors: Otter Jonathan A , Mookerjee Siddharth , Davies Frances , Bolt Frances , Dyakova Eleonora , Shersing Yeeshika , Boonyasiri Adhiratha , Weiße Andrea Y , Gilchrist Mark , Galletly Tracey J , Brannigan Eimear T , Holmes Alison H
Published: May 2020

Objectives

The transmission of carbapenemase-producing Enterobacterales (CPE) poses an increasing healthcare challenge. A range of infection prevention activities, including screening and contact precautions, are recommended by international and national guidelines. We evaluated the introduction of an enhanced screening programme in a multisite London hospital group.

Methods

In June 2015, an enhanced CPE policy was launched in response to a local rise in CPE detection. This increased infection prevention measures beyond the national recommendations, with enhanced admission screening, contact tracing and environmental disinfection, improved laboratory protocols and staff/patient education. We report the CPE incidence and trends of CPE in screening and clinical cultures and the adoption of enhanced CPE screening. All non-duplicate CPE isolates identified between April 2014 and March 2018 were included.

Results

The number of CPE screens increased progressively, from 4530 in July 2015 to 10 589 in March 2018. CPE detection increased from 18 patients in July 2015 (1.0 per 1000 admissions) to 50 patients in March 2018 (2.7 per 1000 admissions). The proportion of CPE-positive screening cultures remained at approximately 0.4% throughout, suggesting that whilst the CPE carriage rate was unchanged, carrier identification increased. Also, 123 patients were identified through positive CPE clinical cultures over the study period; there was no significant change in the rate of CPE from clinical cultures per 1000 admissions (P = 0.07).

Conclusions

Our findings suggest that whilst the enhanced screening programme identified a previously undetected reservoir of CPE colonization in our patient population, the rate of detection of CPE in clinical cultures did not increase.
A Bolognese collector rediscovered: Count Ludovico Caprara (1621–1695) and the seventeenth-century art market
Authors: Iseppi Giulia
Published: May 2020

This study concerns the discovery of a new figure in the field of seventeenth-century art collecting: Count Ludovico Caprara, a general under Ferdinand II de’ Medici. Newly discovered archival documents reveal that the Caprara family had one of the richest collections of paintings in Bologna, displayed in a palace close to the Piazza Maggiore; most of these works, however, remain untraced. Ludovico collected more than a hundred canvases, mostly portraits of contemporary painters. The discovery of a purchase note and an inventory of the picture gallery have allowed the role of Ludovico in contemporary collecting and his contacts with personalities in the art market of Seicento Bologna to be established. An attempt is made here to identify several paintings by Giovanni Andrea Sirani, Francesco Gessi and others, and to clarify certain aspects of Ludovico’s taste, especially his preference for the Bolognese school, despite spending his life at the Medici court.
HAGLROS is overexpressed and promotes non-small cell lung cancer migration and invasion
Authors: Chen Ying , Shen Tianle , Ding Xuping , Cheng Lei , Sheng Liming , Du Xianghui
Published: May 2020

Introduction

Non-small cell lung cancer was one of the most common and deadly cancers worldwide. Long non-coding RNAs had been implicated in multiple human cancers, including non-small cell lung cancer. In this study, we focused on a novel long non-coding RNA, HAGLROS, in non-small cell lung cancer.

Material and methods

In this study, we used GEPIA dataset to analyse the expression levels of HAGLROS in non-small cell lung cancer samples and normal tissues. Then, we analysed Kaplan–Meier Plotter database to reveal the association between HAGLROS expression and overall survival time in patients with non-small cell lung cancer. Moreover, we used small interfering RNA-mediated knockdown to reduce HAGLROS expression in A549 and H1299 cells. Cell Counting Kit-8 assay was used to detect the effect of HAGLROS on cell proliferation. Transwell assays were used to determine the effect of HAGLROS on cell migration and invasion. Co-expression analysis and bioinformatics analysis were conducted to predict the potential functions of HAGLROS in non-small cell lung cancer.

Results

We identified HAGLROS was significantly overexpressed in non-small cell lung cancer samples compared to normal tissues. Higher expression of HAGLROS was significantly associated with shorter overall survival time in patients with non-small cell lung cancer. Moreover, we found knockdown of HAGLROS in non-small cell lung cancer cells remarkably suppressed tumour proliferation, migration and invasion. By conducting bioinformatics analysis, we found HAGLROS was involved in regulating multiple cancer-related pathways, including Spliceosome, DNA replication, cell cycle, chromosome segregation and sister chromatid segregation.

Conclusions

Our results for the first time demonstrated HAGLROS may serve as a target for new therapies in non-small cell lung cancer.
Voronoi volume function: a new probe of cosmology and galaxy evolution
Authors: Paranjape Aseem , Alam Shadab
Published: May 2020

We study the Voronoi volume function (VVF) – the distribution of cell volumes (or inverse local number density) in the Voronoi tessellation of any set of cosmological tracers (galaxies/haloes). We show that the shape of the VVF of biased tracers responds sensitively to physical properties such as halo mass, large-scale environment, substructure, and redshift-space effects, making this a hitherto unexplored probe of both primordial cosmology and galaxy evolution. Using convenient summary statistics – the width, median, and a low percentile of the VVF as functions of average tracer number density – we explore these effects for tracer populations in a suite of N-body simulations of a range of dark matter models. Our summary statistics sensitively probe primordial features such as small-scale oscillations in the initial matter power spectrum (as arise in models involving collisional effects in the dark sector), while being largely insensitive to a truncation of initial power (as in warm dark matter models). For vanilla cold dark matter (CDM) cosmologies, the summary statistics display strong evolution and redshift-space effects, and are also sensitive to cosmological parameter values for realistic tracer samples. Comparing the VVF of galaxies in the Galaxies & Mass Assembly (GAMA) survey with that of abundance-matched CDM (sub)haloes tentatively reveals environmental effects in GAMA beyond halo mass (modulo unmodelled satellite properties). Our exploratory analysis thus paves the way for using the VVF as a new probe of galaxy evolution physics as well as the nature of dark matter and dark energy.
A new class of discontinuous solar wind solutions
Authors: Shergelashvili Bidzina M , Melnik Velentin N , Dididze Grigol , Fichtner Horst , Brenn Günter , Poedts Stefaan , Foysi Holger , Khodachenko Maxim L , Zaqarashvili Teimuraz V
Published: May 2020

A new class of one-dimensional solar wind models is developed within the general polytropic, single-fluid hydrodynamic framework. The particular case of quasi-adiabatic radial expansion with a localized heating source is considered. We consider analytical solutions with continuous Mach number over the entire radial domain while allowing for jumps in the flow velocity, density, and temperature, provided that there exists an external source of energy in the vicinity of the critical point that supports such jumps in physical quantities. This is substantially distinct from both the standard Parker solar wind model and the original nozzle solutions, where such discontinuous solutions are not permissible. We obtain novel sample analytic solutions of the governing equations corresponding to both slow and fast winds.
Wobbly discs – corrugations seen in the dust lanes of edge-on galaxies
Authors: Narayan Chaitra A , Dettmar Ralf-Jürgen , Saha Kanak
Published: May 2020

We report the detection of small-scale bending waves, also known as corrugations, in the dust lanes of five nearby edge-on disc galaxies. This phenomenon, where the disc mid-plane bends to become wavy, just as in warps but on a smaller scale, is seen here for the first time, in the dust lanes running across the discs. Because they are seen in absorption, this feature must be present in the dust disc in the outskirts of these galaxies. We enhance the visibility of these features using unsharp masking, trace the dust mid-plane across the disc, measure the corrugation amplitude by eye and the corrugation wavelength using Fourier analysis. The corrugation amplitude is found to be in the range of 70–300pc and the wavelengths lie between 1 and 5 kpc. In this limited sample, we find that the amplitude of the corrugations tends to be larger for lower mass galaxies, whereas the wavelength of corrugation does not seem to depend on the mass of host galaxies. Linear stability analysis is performed to find out the dynamical state of these dust discs. Based on WKB analysis, we find that the dust corrugations in about half of our sample are stable. Further analysis, on a larger sample would be useful to strengthen the above results.
Multiple chemodynamic stellar populations of the Ursa Minor dwarf spheroidal galaxy
Authors: Pace Andrew B , Kaplinghat Manoj , Kirby Evan , Simon Joshua D , Tollerud Erik , Muñoz Ricardo R , Côté Patrick , Djorgovski S G , Geha Marla
Published: May 2020

We present a Bayesian method to identify multiple (chemodynamic) stellar populations in dwarf spheroidal galaxies (dSphs) using velocity, metallicity, and positional stellar data without the assumption of spherical symmetry. We apply this method to a new Keck/Deep Imaging Multi-Object Spectrograph (DEIMOS) spectroscopic survey of the Ursa Minor (UMi) dSph. We identify 892 likely members, making this the largest UMi sample with line-of-sight velocity and metallicity measurements. Our Bayesian method detects two distinct chemodynamic populations with high significance (in logarithmic Bayes factor, ln B ∼ 33). The metal-rich ([Fe/H] = −2.05 ± 0.03) population is kinematically colder (radial velocity dispersion of $\sigma _v=4.9_{-1.0}^{+0.8} \, \mathrm{km} \, \mathrm{s}^{-1}$) and more centrally concentrated than the metal-poor ($[{\rm Fe/H}]=-2.29_{-0.06}^{+0.05}$) and kinematically hotter population ($\sigma _v =11.5_{-0.8}^{+0.9}\, \mathrm{km} \, \mathrm{s}^{-1}$). Furthermore, we apply the same analysis to an independent Multiple Mirror Telescope (MMT)/Hectochelle data set and confirm the existence of two chemodynamic populations in UMi. In both data sets, the metal-rich population is significantly flattened (ϵ = 0.75 ± 0.03) and the metal-poor population is closer to spherical ($\epsilon =0.33_{-0.09}^{+0.12}$). Despite the presence of two populations, we are able to robustly estimate the slope of the dynamical mass profile. We found hints for prolate rotation of order ${\sim}2 \, \mathrm{km} \, \mathrm{s}^{-1}$ in the MMT data set, but further observations are required to verify this. The flattened metal-rich population invalidates assumptions built into simple dynamical mass estimators, so we computed new astrophysical dark matter annihilation (J) and decay profiles based on the rounder, hotter metal-poor population and inferred $\log _{10}{(J(0{^{\circ}_{.}}5)/{\rm GeV^{2} \, cm^{-5}})}\approx 19.1$ for the Keck data set. Our results paint a more complex picture of the evolution of UMi than previously discussed.
Resolved observations at 31 GHz of spinning dust emissivity variations in ρ Oph
Authors: Arce-Tord Carla , Vidal Matias , Casassus Simon , Cárcamo Miguel , Dickinson Clive , Hensley Brandon S , Génova-Santos Ricardo , Bond J Richard , Jones Michael E , Readhead Anthony C S , Taylor Angela C , Zensus J Anton
Published: May 2020

The ρ Oph molecular cloud is one of the best examples of spinning dust emission, first detected by the cosmic background imager (CBI). Here, we present 4.5 arcmin observations with CBI 2 that confirm 31 GHz emission from ρ Oph W, the PDR exposed to B-type star HD 147889, and highlight the absence of signal from S1, the brightest IR nebula in the complex. In order to quantify an association with dust-related emission mechanisms, we calculated correlations at different angular resolutions between the 31 GHz map and proxies for the column density of IR emitters, dust radiance, and optical depth templates. We found that the 31 GHz emission correlates best with the PAH column density tracers, while the correlation with the dust radiance improves when considering emission that is more extended (from the shorter baselines), suggesting that the angular resolution of the observations affects the correlation results. A proxy for the spinning dust emissivity reveals large variations within the complex, with a dynamic range of 25 at 3σ and a variation by a factor of at least 23, at 3σ, between the peak in ρ Oph W and the location of S1, which means that environmental factors are responsible for boosting spinning dust emissivities locally.
Gradients Do Grow on Trees: A Linear-TimeO(N)-Dimensional Gradient for Statistical Phylogenetics
Authors: Ji Xiang , Zhang Zhenyu , Holbrook Andrew , Nishimura Akihiko , Baele Guy , Rambaut Andrew , Lemey Philippe , Suchard Marc A
Published: May 2020

Calculation of the log-likelihood stands as the computational bottleneck for many statistical phylogenetic algorithms. Even worse is its gradient evaluation, often used to target regions of high probability. Order O(N)-dimensional gradient calculations based on the standard pruning algorithm require O(N2) operations, where N is the number of sampled molecular sequences. With the advent of high-throughput sequencing, recent phylogenetic studies have analyzed hundreds to thousands of sequences, with an apparent trend toward even larger data sets as a result of advancing technology. Such large-scale analyses challenge phylogenetic reconstruction by requiring inference on larger sets of process parameters to model the increasing data heterogeneity. To make these analyses tractable, we present a linear-time algorithm for O(N)-dimensional gradient evaluation and apply it to general continuous-time Markov processes of sequence substitution on a phylogenetic tree without a need to assume either stationarity or reversibility. We apply this approach to learn the branch-specific evolutionary rates of three pathogenic viruses: West Nile virus, Dengue virus, and Lassa virus. Our proposed algorithm significantly improves inference efficiency with a 126- to 234-fold increase in maximum-likelihood optimization and a 16- to 33-fold computational performance increase in a Bayesian framework.
Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device—Part I: 2-Dimensional Operative Video and Technical Report
Authors: Khalifeh Jawad M , Dibble Christopher F , Stecher Priscilla , Dorward Ian , Hawasli Ammar H , Ray Wilson Z
Published: May 2020

BACKGROUND

Advances in operative techniques and minimally invasive technologies have evolved to maximize patient outcomes and radiographic results, while reducing morbidity and recovery time.

OBJECTIVE

To describe the operative technique for a transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) as a proposed modification to the standard approach MIS-TLIF.

METHODS

We present the case of a 72-yr-old man with left-sided lumbar radiculopathy. Preoperative imaging demonstrated degenerative lumbar anterolisthesis at L4-5, with associated canal and neuroforaminal stenosis. The patient underwent transfacet MIS-TLIF at L4-L5. We describe the preoperative planning, patient positioning, incision and dissection, pedicle screw insertion, transfacet approach to the working access corridor, discectomy, interbody device placement, fixation, and closure.

RESULTS

The transfacet MIS-TLIF utilizes 3 key techniques to safely maximize surgical correction: (1) a limited bony resection based on the superior articular process, leaving the medial inferior articular process, lateral superior articular process, and rostral pars intact, providing a working bony corridor that protects the traversing and exiting nerve roots; (2) decortication and release of the contralateral facet joint to provide additional capacity for indirect decompression and provide the first point of osseous fusion; and (3) placement of an expandable interbody device that provides additional indirect decompression to the working side and contralateral foramen.

CONCLUSION

The transfacet MIS-TLIF uniquely leverages a bony working corridor to access the disc space for discectomy and interbody placement. Transfacet MIS-TLIF is a feasible solution for lumbar spinal reconstruction to maximize direct and indirect decompression of the neuroforamina and central spinal canal in patients with lumbar degenerative diseases and low-grade spondylolisthesis.
A Crisis of Missed Opportunities? Foreclosure Costs and Mortgage Modification During the Great Recession
Authors: Gabriel Stuart , Iacoviello Matteo , Lutz Chandler
Published: May 2020

We investigate the impact of Great Recession policies in California that substantially increased lender pecuniary and time costs of foreclosure. We estimate that the California Foreclosure Prevention Laws (CFPLs) prevented 250,000 California foreclosures (a 20% reduction) and created $\$$300 billion in housing wealth. The CFPLs boosted mortgage modifications and reduced borrower transitions into default. They also mitigated foreclosure externalities via increased maintenance spending on homes that entered foreclosure. The CFPLs had minimal adverse side effects on the availability of mortgage credit for new borrowers. Altogether, findings suggest that policy interventions that keep borrowers in their homes may be broadly beneficial during times of widespread housing distress.
Withdrawn as duplicate: Society of Behavioral Medicine (SBM) urges Congress to ensure efforts to increase and enhance broadband internet access in rural areas
Authors: Ford Sabrina , Buscemi Joanna , Hirko Kelly , Laitner Melissa , Newton Robert L , Jonassaint Charles , Fitzgibbon Marian , Klesges Lisa M
Published: May 2020

This article has been withdrawn due to a publisher error that caused the article to be duplicated. The definitive version of this article is published under DOI 10.1093/tbm/ibz035.
Single-Cell Analysis of the Gene Expression Effects of Developmental Lead (Pb) Exposure on the Mouse Hippocampus
Authors: Bakulski Kelly M , Dou John F , Thompson Robert C , Lee Christopher , Middleton Lauren Y , Perera Bambarendage P U , Ferris Sean P , Jones Tamara R , Neier Kari , Zhou Xiang , Sartor Maureen A , Hammoud Saher S , Dolinoy Dana C , Colacino Justin A
Published: May 2020

Lead (Pb) exposure is ubiquitous with permanent neurodevelopmental effects. The hippocampus brain region is involved in learning and memory with heterogeneous cellular composition. The hippocampus cell type-specific responses to Pb are unknown. The objective of this study is to examine perinatal Pb treatment effects on adult hippocampus gene expression, at the level of individual cells. In mice perinatally exposed to control water or a human physiologically relevant level (32 ppm in maternal drinking water) of Pb, 2 weeks prior to mating through weaning, we tested for hippocampus gene expression and cellular differences at 5 months of age. We sequenced RNA from 5258 hippocampal cells to (1) test for treatment gene expression differences averaged across all cells, (2) compare cell cluster composition by treatment, and (3) test for treatment gene expression and pathway differences within cell clusters. Gene expression patterns revealed 12 hippocampus cell clusters, mapping to major expected cell types (eg, microglia, astrocytes, neurons, and oligodendrocytes). Perinatal Pb treatment was associated with 12.4% more oligodendrocytes (p = 4.4 × 10−21) in adult mice. Across all cells, Pb treatment was associated with expression of cell cluster marker genes. Within cell clusters, Pb treatment (q < 0.05) caused differential gene expression in endothelial, microglial, pericyte, and astrocyte cells. Pb treatment upregulated protein folding pathways in microglia (p = 3.4 × 10−9) and stress response in oligodendrocytes (p = 3.2 × 10−5). Bulk tissue analysis may be influenced by changes in cell type composition, obscuring effects within vulnerable cell types. This study serves as a biological reference for future single-cell toxicant studies, to ultimately characterize molecular effects on cognition and behavior.
Pregnancy Outcomes in Women With Cardiovascular Disease: Evolving Trends Over 10 Years in the ESC Registry of Pregnancy and Cardiac Disease (ROPAC)
Authors: Roos-Hesselink Jolien , Baris Lucia , Johnson Mark , De Backer Julie , Otto Catherine , Marelli Ariane , Jondeau Guillaume , Budts Werner , Grewal Jasmine , Sliwa Karen , Parsonage William , Maggioni Aldo P. , van Hagen Iris , Vahanian Alec , Tavazzi Luigi , Elkayam Uri , Boersma Eric , Hall Roger
Published: May 2020

(Abstracted from Eur Heart J 2019;40:3848–3855)

The World Health Organization recognizes that the reduction of maternal mortality worldwide is a critical goal. Currently, 1% to 4% of pregnant women have maternal heart disease, which has translated into 15% of maternal deaths.
Blount Disease and Obstructive Sleep Apnea: An Under-recognized Association?
Authors: Jardaly Achraf , McGwin Gerald , Gilbert Shawn R.
Published: May 2020

Background:

Obesity is strongly associated with both Blount disease and obstructive sleep apnea (OSA). Obesity increases risks for anesthetic and postoperative complications, and OSA can further exacerbate these risks. Since children with Blount disease might have both conditions, we sought to determine the perioperative complications and the prevalence of OSA among these children.

Methods:

Patients younger than 18 years undergoing corrective surgery for Blount disease were identified from 2 sources as follows: a retrospective review of records at a single institution and querying of the Kids’ Inpatient Database, a nationally representative database.

Results:

At our institution, the prevalence of OSA among patients surgically treated for Blount disease was 23% (42/184). Blount patients were obese (100%), and predominately African American (89%), and male (68%). Patients were treated for OSA before surgery, and 2 patients (1%) had postoperative hypoxemia. In contrast, of 1059 cases of Blount disease from the Kids’ Inpatient Database, 3% were diagnosed with OSA. In total, 4.4% of all the Blount children experienced complications, including hypoxemia, respiratory insufficiency, atelectasis, and arrhythmias. Complications were associated with 4.3 additional days of hospitalization (P<0.0001) and 39% additional hospital charges (P=0.002).

Conclusions:

Data from the national database showed a low rate of OSA prevalence but high respiratory and OSA-associated complications, perhaps indicating that OSA may be underdiagnosed in children with Blount disease. Affected patients, especially ones with untreated OSA, sustain increased surgical morbidity. A high index of suspicion and preoperative planning helps alleviate the burden of OSA among these patients.

Level of Evidence:

Level III—case-control study.
Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic
Authors: Bram Joshua T. , Johnson Mitchell A. , Magee Lacey C. , Mehta Nishank N. , Fazal Faris Z. , Baldwin Keith D. , Riley Jake , Shah Apurva S.
Published: May 2020

Background:

During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of school and organized sports. A resulting change in pediatric fracture epidemiology is expected. This study examines the impact of the COVID-19 pandemic on fracture incidence and characteristics.

Methods:

This is a retrospective cohort study comparing acute fractures presenting to a single level I pediatric trauma hospital during the COVID-19 pandemic with fractures during a prepandemic period at the same institution. The “pandemic” cohort was gathered from March 15 to April 15, 2020 and compared with a “prepandemic” cohort from the same time window in 2018 and 2019.

Results:

In total, 1745 patients presenting with acute fractures were included. There was a significant decrease in the incidence of fractures presenting to our practice during the pandemic (22.5±9.1/d vs. 9.6±5.1/d, P<0.001). The presenting age for all fractures decreased during the pandemic (7.5±4.3 vs. 9.4±4.4 y, P<0.001) because of decreased fracture burden among adolescents. There were also a decrease in the number of fractures requiring surgery (2.2±1.8/d vs. 0.8±0.8/d, P<0.001). During the pandemic, there was an increase in the proportion of injuries occurring at home (57.8% vs. 32.5%, P<0.001) or on bicycles (18.3% vs. 8.2%, P<0.001), but a decrease in those related to sports (7.2% vs. 26.0%, P<0.001) or playgrounds (5.2% vs. 9.0%, P<0.001). There was no increase in time-to-presentation. Patients with distal radius torus fractures were more likely to receive a velcro splint during the pandemic (44.2% vs. 25.9%, P=0.010).

Conclusions:

Pediatric fracture volume has decreased 2.5-fold during the COVID-19 pandemic, partially because of cessation of organized sports and decreased playground use. In endemic regions, lower trauma volume may allow redeployment of orthopaedic surgeons and staff to other clinical arenas. Given the rising proportion of bicycling injuries, an emphasis on basic safety precautions could improve public health. An observed increase in the prescription of velcro splints for distal radius fractures highlights an opportunity for simplified patient care during the pandemic.

Level of Evidence:

Level III.
One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure
Authors: Chen Mu , Wang Zhi-Quan , Wang Qun-Shan , Sun Jian , Zhang Peng-Pai , Feng Xiang-Fei , Li Wei , Yu Ying , Liu Bo , Mo Bin-Feng , Zhang Rui , Yang Mei , Gong Chang-Qi , Zhao Ming-Zhe , Yu Yi-Chi , Zhao Yan , Lu Qiu-Fen , Li Yi-Gang
Published: May 2020

Background

Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.

Methods

Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.

Results

A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.

Conclusion

Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.
Minocycline Intravenous for the Treatment of Serious Infections Due to Gram-Negative Nonpseudomonal Bacteria, Including Stenotrophomonas maltophilia, Acinetobacter baumannii, and Burkholderia cepacia
Authors: Sierra-Hoffman Miguel , Redell Mark , Benefield Russell , Caruso Patricia , Estrada Sandy , Leuthner Kimberly , Zappas Kristie , Kennedy Cynthia , Massey Jill
Published: May 2020

Background

Data on the role of minocycline intravenous (IV) in the treatment of serious gram-negative infections under real-world conditions are sparse. This study sought to provide evidence of real-world practices, including outcomes and safety.

Methods

A multicenter observational study was conducted of 71 consecutive adult inpatients enrolled at 6 geographically diverse US hospitals between May 2015 and February 2018 who were treated with minocycline IV for gram-negative infections for at least 48 hours as monotherapy or combination therapy.

Results

Infections included pneumonia (51%) and bacteremia (25%). The most prevalent gram-negative pathogens included Stenotrophomonas maltophilia (52%), Acinetobacter baumannii (30%), and Burkholderia complex (10%). In vitro susceptibility to minocycline was 100% for S. maltophilia. Clinical plus microbiologic response was observed in 80% of evaluable patients. Treatment of 29 evaluable patient infections due to S. maltophilia resulted in a clinical response rate of 79% and a microbiologic response rate of 72%. All patients with bacteremia due to S. maltophilia responded to minocycline IV. There were 17 (24%) in-hospital deaths of which 8 responded to minocycline. Minocycline was well tolerated.

Conclusions

Minocycline demonstrated that high in vitro susceptibility against problematic gram-negative pathogens and administered as an IV formulation was associated with good clinical and microbiologic outcomes alone or in combination in a seriously ill patient population.
Silent but Deadly
Authors: Kalunian Anne , Salas Natalie Mariam
Published: May 2020

Legionella species are a rare cause of culture-negative endocarditis. We report the first case of bioprosthetic valve endocarditis due to Legionella maceachernii. This case highlights the importance of the use of DNA target sequencing to identify the cause of culture-negative endocarditis, as standard empiric therapy would not have covered the identified organism.
Outcomes of Obese Patients Bridged to Heart Transplantation with a Left Ventricular Assist Device
Authors: Okoh Alexis K. , Selevany Mariam , Heaton Joseph , Al-Obaidi Nawar , Vucicevic Darko , Tayal Rajiv , Zucker Mark J. , Camacho Margarita , Lee Leonard Y. , Russo Mark J.
Published: May 2020

The current study aims to investigate the impact of left ventricular assist device (LVAD) implantation on weight loss and functional status in obese patients bridged to transplantation (BTT). The United Network for Organ Sharing (UNOS) database was queried to identify patients with body mass index (BMI) ≥ 30 who underwent LVAD implantation as BTT from 2008 to 2018. Patients were divided into three groups based the World Health Organization classification of obesity: obesity class I (BMI, 30.0–34.9 kg/m2), obesity class II (BMI, 35–39.9 kg/m2), and obesity class III (BMI, >40 kg/m2). Patients with incomplete data on BMI were excluded. The primary outcome was a change in BMI while listed. Secondary outcomes included a change in functional status after LVAD implantation and posttransplant morbidity and survival. Out of 14,191 patients who had an LVAD while listed within the study period, 5,354 (37.7%) had a BMI ≥30 kg/m2. Obesity was classified as class I in 3,909 (73%), class II in 1,275 (23.8%), and class III in 170 (3.2%) patients. Among patients with complete data on BMI, 18.9% (n = 394) reported a change in BMI, leading to an improvement in their obesity class, and this was similar for all obesity classes (22% [n = 331], 50% [n = 111], and 60% [n = 43] for classes I, II, and III, respectively). All groups reported an improvement in functional status (65% vs. 62% and 61% for classes I, II, and III, respectively). Posttransplant survival was not significantly different between obese groups (p = 0.787). Compared with classes I and II, the incidence of thrombosis (p = 0.0006) and device malfunction (p = 0.036) was significantly higher in the class III group. About one out of every five obese patients listed for heart transplantation with an LVAD loses weight, leading to a change in their BMI class. Most patients reported a significant improvement in their functional status. Among those successfully BTT, posttransplant survival was similar.
The Diverse Involvement of Cigarette Smoking in Pancreatic Cancer Development and Prognosis
Authors: Weissman Simcha , Takakura Kazuki , Eibl Guido , Pandol Stephen J. , Saruta Masayuki
Published: May 2020

Despite extensive research in the pathogenesis, early detection, and therapeutic approaches of pancreatic ductal adenocarcinoma (PDAC), it remains a devastating and incurable disease. As the global incidence and prevalence of PDAC continue to rise, there is a pressing need to place strong emphasis on its prevention. Although it is widely recognized that cigarette smoking, a potentially modifiable risk factor, has been linked to PDAC development, its contribution to prognosis is still uncertain. Moreover, the mechanistic pathways of PDAC progression secondary to smoking are various and lack a summative narration. Herein, we update and summarize the direct and indirect roles cigarette smoking plays on PDAC development, review literature to conclude the impact cigarette smoking has on prognosis, and postulate a comprehensive mechanism for cigarette smoking–induced PDAC.
Evaluation of an Innovative Model of Care for a Limited-Stay Pediatric Unit
Authors: Johnson-Salerno Elizabeth , Bachman Stacey O. , Jones Chalanda Evan , Hancox David , Haut Catherine , Mericle Jane
Published: May 2020

Information about pediatric observation and limited-stay unit design and function is lacking in the literature. A quality improvement approach was used to create new care processes on an inpatient unit within a large children's hospital. Outcomes included the use of advanced practice nurse patient care management, creation of 30 clinical pathways to model care, and consistent and faster transfer from emergency department to inpatient unit, resulting in high-level parent and patient satisfaction and decreased nursing turnover.
Designing a Process for Cardiology Patient Transfers: A Quality Improvement, Descriptive Study on Interprovider Communication and Resident Education
Authors: Kulesa John T. , Balsara Sheri L. , Ghebremariam Emanuel T. , Colyer Jessica
Published: May 2020

Background:

Patient transitions create vulnerability for care teams. Failures in the handoff process result in communication errors and knowledge gaps, mainly when the handoff occurs between resident and expert-level subspecialty clinicians. The authors set out to develop a standardized handoff using resident comfort as a proxy for implementation. The primary measurable aim of this study was to increase the percentage of pediatric residents who self-reported comfort in assuming care of patients transitioned from the cardiac intensive care unit to the cardiology acute care unit.

Methods:

Investigators surveyed residents at a 323-bed pediatric hospital on their handoff experiences. The study team performed a Failure Mode Effect Analysis and created a key driver diagram. Interventions included a transfer checklist and algorithm, a huddle between care teams, and education surrounding the transfer process.

Results:

Residents completed a survey before (n = 74) or after (n = 23) intervention. The percentage of residents who reported feeling “always” or “very often” prepared to care for patients at the time of transfer increased from 15% to 83%. The percentage of residents who reported that they “always” or “very often” had concerns about floor appropriateness decreased from 23% to 4%.

Conclusions:

The authors designed a transfer process to improve communication, resident-level education, and psychological safety among team members to ensure safe, thorough handoffs between providers with different levels of training. Although we cannot definitively conclude that resident comfort improved due to a small “n” postintervention, we offer a description outlining process changes, barriers to implementation, and lessons learned.
Physician-to-Nurse Handover: A Systematic Review on the Effectiveness of Different Models
Authors: Odone Anna , Bossi Eleonora , Scardoni Alessandro , Balzarini Federica , Orlandi Carlo , Arrigoni Cristina , Signorelli Carlo , Garancini Paola
Published: May 2020

Objectives

Effective professional communication and accurate transfer of relevant clinical information are crucial components of healthcare delivery. National and international health authorities strongly recommend the adoption of effective handover practice. Still, scant evidence is available on the impact of different multiprofessional handover models.

Methods

We carried out a systematic review following the Prepared Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool, and critically appraise the available evidence on the effectiveness of different physician-to-nurse handover models adopted in inpatient settings.

Results

We identified 1.243 citations searching the databases Medline, Embase, and CINAHL. After screening, 10 studies were included in the review reporting results on the effectiveness of 8 different handover models, measured on 44 different outcomes, grouped into: (1) process of care and efficiency outcomes, (2) patients’ outcomes, and (3) healthcare professionals–related outcomes. Overall, applying structured handover tools improve healthcare practice and selected outcomes; however, not only solid evidence on the effectiveness of different handover models is scant but also global consensus is lacking on which standardized measures and indicators to use to assess their impact.

Conclusions

In times of healthcare delivery models of growing complexity, multiprofessional handover is a key component of care paths. Although there is overall consensus on the need for improving the quality and safety of multiprofessional handover, the evidence on the tools available to achieve it and the metrics to measure their impact is heterogeneous. We urge that rigorous studies are conducted to inform the planning, implementation, and monitoring of effective handover, with the ultimate aim of improving quality of care and patient safety.
A Mixed-Methods Systematic Review of the Effectiveness and Experiences of Quality Improvement Interventions in Radiology
Authors: Jabin MD Shafiqur Rahman , Schultz Tim , Mandel Catherine , Bessen Taryn , Hibbert Peter , Wiles Louise , Runciman William
Published: May 2020

Objective

This study aimed to compile and synthesize evidence regarding the effectiveness of quality improvement interventions in radiology and the experiences and perspectives of staff and patients.

Methods

Databases searched for both published and unpublished studies were as follows: EMBASE, MEDLINE, CINAHL, Joanna Briggs Institute, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, Web of Science, Mednar, Trove, Google Gray, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative studies of patients undergoing radiological examinations and/or medical imaging health care professionals; a broad range of quality improvement interventions including introduction of health information technology, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; context of radiological setting; a broad range of outcomes including patient safety; and a result-based convergent synthesis design.

Results

Eighteen studies were selected from 4846 identified by a systematic literature search. Five groups of interventions were identified: health information technology (n = 6), training and education (n = 6), immediate and critical reporting (n = 3), safety programs (n = 2), and the introduction of mobile radiography (n = 1), with demonstrated improvements in outcomes, such as improved operational and workflow efficiency, report turnaround time, and teamwork and communication.

Conclusions

The findings were constrained by the limited range of interventions and outcome measures. Further research should be conducted with study designs that might produce findings that are more generalizable, examine the other dimensions of quality, and address the issues of cost and risk versus benefit.
The Effect of Various β Values on Image Quality and Semiquantitative Measurements in 68Ga-RM2 and 68Ga-PSMA-11 PET/MRI Images Reconstructed With a Block Sequential Regularized Expectation Maximization Algorithm
Authors: Baratto Lucia , Duan Heying , Ferri Valentina , Khalighi Mehdi , Iagaru Andrei
Published: May 2020

Purpose

To compare the block sequential regularized expectation maximization (BSREM) algorithm with the ordered subsets expectation maximization (OSEM) algorithm and to evaluate how different penalty factors (bvalues) influence image quality and SUV measurements.

Methods

We analyzed data from 78 prostate cancer patients who underwent68Ga-RM2 (n = 42) or68Ga-prostate-specific membrane antigen (PSMA)-11 (n = 36) PET/MRI. The raw PET data were retrospectively reconstructed using both time-of-flight (TOF)–BSREM withbvalues of 250, 350, 500, 750, and 1000 and TOF-OSEM. Each reconstruction was reviewed independently by 3 nuclear medicine physicians and scored qualitatively using a Likert scale (1 = poor, 5 = excellent quality). SUV measurements were analyzed as well.

Results

Fifty-seven lesions were detected (21 on68Ga-RM2 and 36 on68Ga-PSMA-11 PET/MRI); SUVmax decreased with the increase of β values for both tracers. Background noise (SUVsd) decreased with increasing of β values for both tracers. The mean ± SD scores for68Ga-RM2 PET images were 2.4 ± 0.5 forb= 250 reconstructions, 3.2 ± 0.6 forb= 350, 4 ± 0.6 forb= 500, 4.5 ± 0.5 forb= 750, 4.4 ± 0.7 forb= 1000, and 3.4 ± 0.6 for TOF-OSEM. The mean ± SD scores for68Ga-PSMA-11 PET images were 3.2 ± 0.8 forb= 250 reconstructions, 4.1 ± 0.8 forb= 350, 4.7 ± 0.6 forb= 500, 4.8 ± 0.4 forb= 750, 4.7 ± 0.6 forb= 1000, and 3.8 ± 0.5 for TOF-OSEM.

Conclusions

Time-of-flight–BSREM algorithm improves image quality. Differentbvalues should be used for different68Ga-labeled radiopharmaceuticals such as those targeting GRPR and PSMA receptors. Once selected, the samebvalue should be consistently used because SUVmax measurements differ with differentbvalues.
Cardiac Variation of Internal Jugular Vein as a Marker of Volume Change in Hemorrhagic Shock
Authors: Tokunaga Kurato , Nakamura Kensuke , Inokuchi Ryota , Hayase Naoki , Terada Rui , Tomioka Yuji , Ikeda Toshiyuki , Kobayashi Etsuko , Okazaki Hitoshi , Sakuma Ichiro , Doi Kent , Morimura Naoto
Published: May 2020

Background:

Fluid resuscitation, which is critical to counter acute hemorrhagic shock, requires prompt and accurate intravascular volume estimation for optimal fluid administration. This study aimed to evaluate whether cardiac variation of internal jugular vein (IJV), evaluated by ultrasonography, could detect hypovolemic status and predict response to fluid resuscitation.

Methods:

Patients undergoing autologous blood transfusion for elective surgery who were prospectively enrolled at the study blood donation center between August 2014 and January 2015. Vertical B-mode ultrasonography movies of IJV were recorded at five timepoints during blood donation: before donation, during donation, end of donation, end of fluid replacement, and after hemostasis. Cardiac variation of the IJV area and circumference were objectively measured using an automated extraction program together with blood pressure and heart rate.

Results:

A total of 140 patients were screened, and data from 104 patients were included in the final analyses. Among the variables analyzed, only collapse index area and collapse index circumference could detect both intravascular volume loss and response to fluid administration.

Conclusions:

Cardiac variation of IJV may be a reliable indicator of intravascular volume loss and response to fluid administration in hemorrhagic shock.
Serum Hydrogen Sulfide and Outcome Association in Pneumonia by the SARS-CoV-2 Coronavirus
Authors: Renieris Georgios , Katrini Konstantina , Damoulari Christina , Akinosoglou Karolina , Psarrakis Christos , Kyriakopoulou Magdalini , Dimopoulos George , Lada Malvina , Koufargyris Panagiotis , Giamarellos-Bourboulis Evangelos J.
Published: May 2020

Background:

The pneumonia of COVID-19 illness has often a subtle initial presentation making mandatory the use of biomarkers for evaluation of severity and prediction of final patient disposition. We evaluated the use of hydrogen sulfide (H2S) for the outcome of COVID-19 pneumonia.

Patients and Methods:

We studied 74 patients with COVID-19. Clinical data were collected, and survival predictors were calculated. Blood was collected within 24 h after admission (day 1) and on day 7. H2S was measured in sera by monobromobimane derivation followed by high-performance liquid chromatography and correlated to other markers like procalcitonin and C-reactive protein (CRP). Tumor necrosis factor alpha and interleukin (IL)-6 were also measured in serum.

Results:

Survivors had significantly higher H2S levels on days 1 and 7 after admission. A cut-off point of 150.44 μM could discriminate survivors from non-survivors with 80% sensitivity, 73.4% specificity, and negative predictive value 95.9%. Mortality after 28 days was 32% with admission levels lower than or equal to 150.44 μM and 4.1% with levels above 150.44 μM (P: 0.0008). Mortality was significantly greater among patients with a decrease of H2S levels from day 1 to day 7 greater than or equal to 36% (p: 0.0005). Serum H2S on day 1 was negatively correlated with IL-6 and CRP and positively correlated with the absolute lymphocyte count in peripheral blood.

Conclusion:

It is concluded that H2S is a potential marker for severity and final outcome of pneumonia by the SARS-CoV-2 coronavirus. Its correlation with IL-6 suggests anti-inflammatory properties.
DCD Renal Transplantation From Donors With Acute Kidney Injury
Authors: Lia Daniel , Singer Pamela , Nair Vinay , Yang Jingyan , Teperman Lewis , Grodstein Elliot
Published: May 2020

Background.

Deceased donor kidneys with acute kidney injury (AKI) and donation after circulatory death (DCD) kidneys are viable sources of organs. The outcomes of renal transplantation from DCD donors with AKI are not known.

Methods.

A retrospective review of deceased donor renal transplants performed from 2006 to 2016 was conducted using the United Network for Organ Sharing dataset. Donors were stratified by DCD or brain dead status and by AKI stage. Recipients were followed until graft failure or the end of study. Cox regression was used to adjust for donor, recipient, and transplant covariates known to affect the incidence of delayed graft function and graft survival.

Results.

A total of 135 644 patients were included in the study. The odds of delayed graft function among DCD recipients were significantly higher across all donor AKI stages. The unadjusted risk of overall and death-censored graft failure were similar between the 2 groups. After adjusting for covariates, there was a significant increase in the risk of overall graft failure in recipients of DCD allografts from donors with stage 2 AKI. There was also a higher risk of death-censored graft failure among stage 1 and 2 AKI DCD recipients.

Conclusions.

DCD renal allografts from donors experiencing stage 1 and 2 AKI have a higher adjusted risk of death-censored graft failure than AKI stage-matched donation after brain death renal allografts. Their use, however, is still associated with improved outcomes compared with waitlist mortality.