bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recommended antimicrobial therapy for common inpatient infections: a comparative review of guidelines across 51 hospital trusts in England
Authors: Pan Daniel , Hills George , Hamilton Ashley Ryan , Nash Tamsin , Hine Thomas , Whitehorn Sarah , Barlow Gavin 
Published: October 2020

ABSTRACTBackgroundThe number of different antimicrobial recommendations between hospital trusts for the same indication in England is unknown.AimWe aimed to evaluate the heterogeneity of antimicrobial recommendations for seven common inpatient infections across hospital trusts in England and evaluate changes to recommendations following introduction of national (National Institute for Healthcare and Excellence, NICE) and international (WHO) antimicrobial guidelines.MethodsGuidelines published on the MicroGuide smartphone application were collected from December 2017 to February 2018 and re-evaluated between December 2019 and February 2020. The following indications were assessed: community-acquired pneumonia (CAP) CURB65 score ≥3, hospital-acquired pneumonia (HAP), infective exacerbation of chronic obstructive pulmonary disease (iCOPD), cellulitis, uncomplicated urinary tract infection (uUTI), intra-abdominal infection (IAI) and sepsis of unknown source (SUS). On follow-up, compliance against WHO WATCH antibiotic and NICE recommendations was evaluated.ResultsGuidelines were obtained predominantly from England. Antibiotic regimens between hospitals became increasingly diverse across indications in the following order: uUTI, cellulitis, iCOPD, CAP, HAP, IAI and SUS. A piperacillin/tazobactam-based regimen was recommended in HAP (59%), SUS (39%) and IAI (30%). After 2 years, 107 changes were made to 357 antibiotic regimen recommendations; the overall number of regimens using piperacillin–tazobactam and WHO WATCH antibiotics remained similar. Compliance of recommendations with NICE guidelines as follows: iCOPD (100% adherent), uUTI (98%), cellulitis (90%), CAP (43%) and HAP (27%).ConclusionThe heterogeneity of antibiotic recommendations increased as the indicated infection was more severe, with broader underlying bacterial causes. Piperacillin–tazobactam remains favoured in antibiotic regimens, despite not recommended in WHO and NICE guidance.
Neighborhood-Level Redlining and Lending Bias Are Associated with Breast Cancer Mortality in a Large and Diverse Metropolitan Area
Authors: Collin Lindsay J. , Gaglioti Anne H. , Beyer Kristen M. , Zhou Yuhong , Moore Miranda A. , Nash Rebecca , Switchenko Jeffrey M. , Miller-Kleinhenz Jasmine M. , Ward Kevin C. , McCullough Lauren E. 
Published: October 2020

Abstract

Background:
Structural inequities have important implications for the health of marginalized groups. Neighborhood-level redlining and lending bias represent state-sponsored systems of segregation, potential drivers of adverse health outcomes. We sought to estimate the effect of redlining and lending bias on breast cancer mortality and explore differences by race.

Methods:
Using Georgia Cancer Registry data, we included 4,943 non-Hispanic White (NHW) and 3,580 non-Hispanic Black (NHB) women with a first primary invasive breast cancer diagnosis in metro-Atlanta (2010–2014). Redlining and lending bias were derived for census tracts using the Home Mortgage Disclosure Act database. We calculated hazard ratios and 95% confidence intervals (CI) for the associations of redlining, lending bias on breast cancer mortality and estimated race-stratified associations.

Results:
Overall, 20% of NHW and 80% of NHB women lived in redlined census tracts, and 60% of NHW and 26% of NHB women lived in census tracts with pronounced lending bias. Living in redlined census tracts was associated with a nearly 1.60-fold increase in breast cancer mortality (hazard ratio = 1.58; 95% CI, 1.37–1.82) while residing in areas with substantial lending bias reduced the hazard of breast cancer mortality (hazard ratio = 0.86; 95% CI, 0.75–0.99). Among NHB women living in redlined census tracts, we observed a slight increase in breast cancer mortality (hazard ratio = 1.13; 95% CI, 0.90–1.42); among NHW women the association was more pronounced (hazard ratio = 1.39; 95% CI, 1.09–1.78).

Conclusions:
These findings underscore the role of ecologic measures of structural racism on cancer outcomes.

Impact:
Place-based measures are important contributors to health outcomes, an important unexplored area that offers potential interventions to address disparities.
Association Between Immune Checkpoint Inhibitors With Cardiovascular Events and Atherosclerotic Plaque
Authors: Drobni Zsofia D. , Alvi Raza M. , Taron Jana , Zafar Amna , Murphy Sean P. , Rambarat Paula K. , Mosarla Rayma C. , Lee Charlotte , Zlotoff Daniel A. , Raghu Vineet K. , Hartmann Sarah E. , Gilman Hannah K. , Gong Jingyi , Zubiri Leyre , Sullivan Ryan J. , Reynolds Kerry L. , Mayrhofer Thomas , Zhang Lili , Hoffmann Udo , Neilan Tomas G 
Published: October 2020

Background:
Immune checkpoint inhibitors (ICIs) treat an expanding range of cancers. Consistent basic data suggest that these same checkpoints are critical negative regulators of atherosclerosis. Therefore, our objectives were to test whether ICIs were associated with accelerated atherosclerosis and a higher risk of atherosclerosis-related cardiovascular events.

Methods:
The study was situated in a single academic medical center. The primary analysis evaluated whether exposure to an ICI was associated with atherosclerotic cardiovascular events in 2842 patients and 2842 controls matched by age, a history of cardiovascular events, and cancer type. In a second design, a case-crossover analysis was performed with an at-risk period defined as the 2-year period after and the control period as the 2-year period before treatment. The primary outcome was a composite of atherosclerotic cardiovascular events (myocardial infarction, coronary revascularization, and ischemic stroke). Secondary outcomes included the individual components of the primary outcome. In addition, in an imaging substudy (n=40), the rate of atherosclerotic plaque progression was compared from before to after the ICI was started. All study measures and outcomes were blindly adjudicated.

Results:

In the matched cohort study, there was a 3-fold higher risk for cardiovascular events after starting an ICI (hazard ratio, 3.3 [95% CI, 2.0–5.5];
P
<0.001). There was a similar increase in each of the individual components of the primary outcome. In the case-crossover, there was also an increase in cardiovascular events from 1.37 to 6.55 per 100 person-years at 2 years (adjusted hazard ratio, 4.8 [95% CI, 3.5–6.5];
P
<0.001). In the imaging study, the rate of progression of total aortic plaque volume was >3-fold higher with ICIs (from 2.1%/y before 6.7%/y after). This association between ICI use and increased atherosclerotic plaque progression was attenuated with concomitant use of statins or corticosteroids.

Conclusions:
Cardiovascular events were higher after initiation of ICIs, potentially mediated by accelerated progression of atherosclerosis. Optimization of cardiovascular risk factors and increased awareness of cardiovascular risk before, during, and after treatment should be considered among patients on an ICI.
Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy
Authors: Csecs Ibolya , Pashakhanloo Farhad , Paskavitz Amanda , Jang Jihye , Al‐Otaibi Talal , Neisius Ulf , Manning Warren J. , Nezafat Reza 
Published: October 2020

Background
In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy.

Methods and Results

We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE‐positive and LGE‐negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%;
P
=0.032) and more impaired global circumferential strain (−7.9±3.5% versus −9.7±4.4%;
P
=0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%;
P
=0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal‐only LGE (n=28) and free wall–only LGE (n=32) had similar fibrosis burden, the septal‐only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all
P
<0.05).

Conclusions
There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.
The Cardinal Importance of Names
Authors: Fletcher Matthew 
Published: October 2020

Abstract
Aleister Crowley’s The Book of Thoth makes four substantive changes to the traditional titles of the tarot trumps. Three of these relate to the cardinal virtues which had remained in the deck despite the almost complete esoteric revisioning of the tarot that had taken place over the preceding two centuries; the fourth is an integral part of the same topic. This article focuses on why Crowley felt impelled to make these changes as well as the significance of the new names (and associated iconography). The discussion centres around Crowley’s rejection of the cardinal virtues that underly Christian ethics in favour of the new system of morality laid out in The Book of the Law and subsequently encapsulated in Thelema. Consequently, the article first examines the development of the cardinal virtues in patristic and medieval theology and then shows how Crowley sought to overturn these values in his agenda of cultural reprogramming of which The Book of Thoth arguably constitutes the high-water mark.
Developmental speed affects ecological stoichiometry and adult fat reserves in Drosophila melanogaster
Authors: Krams Indrikis A. , Krams Ronalds , Jõers Priit , Munkevics Māris , Trakimas Giedrius , Luoto Severi , Eichler Sarah , Butler David M. , Merivee Enno , Must Anne , Rantala Markus J. , Contreras-Garduño Jorge , Krama Tatjana 
Published: October 2020

Abstract
The elemental composition of organisms belongs to a suite of functional traits that change during development in response to environmental conditions. However, associations between adaptive variations in developmental speed and elemental body composition are not well understood. We compared body mass, elemental body composition, food uptake and fat metabolism of Drosophila melanogaster male fruit flies in relation to their larval development speed. Slowly developing flies had higher body carbon concentration than rapidly developing and intermediate flies. Rapidly developing flies had the highest body nitrogen concentration, while slowly developing flies had higher body nitrogen levels than flies with intermediate speed of development. The carbon-to-nitrogen ratio was therefore lower in rapidly developing flies than in slow and intermediate flies. We also had a group of flies grown individually and their body mass and elemental body composition were similar to those of rapidly developing individuals grown in groups. This suggests that rapid growth is not suppressed by stress. Feeding rates were lowest in the slowly developing flies. The amount of triacylglycerides was highest in the flies with intermediate developmental speed which optimizes development under many climatic conditions. Although low food intake slows down developmental speed and the accumulation of body fat reserves in slowly developing flies, their phenotype conceivably facilitates survival under higher stochasticity of their environments. Rapidly developing flies grew with less emphasis on storage build-up. Overall, this study shoes that a combination of bet-hedging, adaptive tracking and developmental plasticity enables fruit flies to respond adaptively to environmental uncertainty.
Addressing Impact Evaluation Gaps in Belt and Road Initiative Projects in Africa: The Standard Gauge Railway Project in Kenya as a Proof of Concept
Authors: Zhu Keren , Dossani Rafiq , Bouey Jennifer 
Published: October 2020

Abstract
The impact of the Belt and Road Initiative (BRI) to global development will be unprecedented and significant, and developmental impact evaluation is therefore central to understanding BRI projects and making informed decisions. Compared with evaluations of individual projects and programs, evaluation of large and mega infrastructure projects under the BRI is particularly challenging and complex in integrating stakeholder objectives, accounting for social benefit and costs, and tracking long-term project impact. In this paper, we summarize the key drawbacks of existing BRI evaluation frameworks, propose a systematic evaluation framework elicitation method based on the inputs from BRI subject matter experts and verified through stakeholder participation, and apply an interim evaluation framework in understanding the Mombasa-Nairobi Standard Gauge Railway project in Kenya, as a proof of concept of a comprehensive evaluation framework. In doing so, we seek to provide a tool for BRI decision makers and stakeholders to assess these projects holistically at planning, construction and operation stages.
The Economic Implications of Belt and Road Initiative in the Development of Railway Transport Infrastructure in Africa: The Case of the Standard Gauge Railway in Kenya
Authors: Irandu Evaristus M. , Owilla Hesbon Hansen 
Published: October 2020

Abstract
The purpose of this paper is to examine the potential economic benefits the Standard Gauge Railway (SGR) project under Belt and Road Initiative (BRI) may bring to Kenya. This will contribute to the ongoing debate on whether Chinese investments on BRI infrastructure projects in Africa are mutually beneficial or not. The key issues discussed include the economic benefits of SGR in Kenya, the economic risks or challenges of SGR given the emergent issues of debt burden in Kenya and how China and Kenya would engage in the future to deepen Sino-Africa relations in BRI projects especially transport infrastructure. The paper relies on secondary information from available published literature on railway transport infrastructure in Africa with specific reference to SGR in Kenya. Information from key informants drawn from the Ministry of Transport and Infrastructure and the United States University based in Nairobi was used to enrich literature review. The main findings of the paper are: (1) SGR will lead to socio-economic development of the country (2) it will contribute revenue to the Government through the railway development levy levied on containerized transportation from the port of Mombasa, and (3) will boost trade and regional integration through better rail connectivity. To make BRI projects more transparent, it is recommended that there is need for more stakeholder engagement in these projects. It is also recommended that the funding mechanism should be reviewed to make borrowing more affordable.
Ecological characteristics of high quality wild ornamental plants in South China
Authors: Cong Linlin , Han Dong 
Published: October 2020

Abstract
Around 6.000 plant species in China have ornamental uses. This study aims to identify new ornamental plant species that are able to survive in urban environments of China and not stand out from the landscaping plants growing in the local parks, gardens, and walkways. The list of ornamental plants includes exclusively open-ground plants. The study on 29 wild plant species commonly found across Southern China involved growing plants from 9.200 seeds and measuring their survival at the first (herbals) and the fifth 5 year of age (shrubs and trees). Of all study plants, 16 showed high germination and survival rates (over 50%) and can be used in park and city landscaping, whereas other specimens demonstrated survival rates lower than 50%. For lianas, the number of species suitable for landscaping is 3. Low germination rates did not determine a rapid decline in survival during the first and fifth years. Herbals turned out to have the highest germination rates (over 50% in 6 out of 7 specimens). Among trees, species that may be planted together along sidewalks to form groves and plantations include Ilex latifolia, Delavaya toxocarpa, and Vernicia fordii. Among vines, Trachelospermum jasminoides or star jasmine can be used as a tree climber. Among shrubs and herbals, Melastoma dodecandrum and Corydalis edulis can be planted in flower beds and rock gardens. This work examines plant species not only from the decorative prospective but also in terms of suitability for growing in urban conditions.
Biomechanical Analysis of Patellar Tendon Repair With Knotless Suture Anchor Tape Versus Transosseous Suture
Authors: Massey Patrick A. , Myers Mitchell , McClary Kaylan , Brown Jimmy , Barton R. Shane , Solitro Giovanni F. 
Published: October 2020

Background: Patellar tendon ruptures have routinely been repaired with transosseous suture tunnels. The use of knotless suture anchors for repair has been suggested as an alternative. Purpose: To compare the load to failure and gap formation of patellar tendon repair at the inferior pole of the patella with knotless suture anchor tape versus transosseous sutures. A secondary objective was to investigate whether either technique shows an association between bone density and load to failure. Study Design: Controlled laboratory study. Methods: A total of 20 human tibias with attached patellar and quadriceps tendons were sharply incised at the bone-tendon junction at the inferior pole of the patella. A total of 10 tendons were repaired using 2 knotless suture anchors in the inferior pole of the patella and a single suture tape with 2 core sutures. The other 10 tendons were repaired using No. 2 suture passed through 3 transosseous tunnels. A distracting force was then applied through the suture in the quadriceps tendon. Gap distance through load cycling at the repair site and maximum load at repair failure were then measured. Bone density was measured using computed tomography scanning. Results: No difference was found in the mean load to failure of knotless patellar tendon repair versus transosseous suture repair (367.6 ± 112.2 vs 433.9 ± 99 N, respectively; P = .12). After 250 cycles, the mean repair site gap distance was 0.85 ± 0.45 mm for the knotless patellar tendon repair versus 2.94 ± 2.03 mm for the transosseous suture repair ( P = .03). A small correlation, although not statistically significant, was found between bone density and load to failure for the knotless tape repair ( R 2 = 0.228; P = .66). No correlation was found between bone density and load to failure for the transosseous repair ( R 2 = 0.086; P = .83). Conclusion: Suture tape repair with knotless anchors for repair of patellar tendon rupture has comparable load to failure with less gap formation than transosseous suture repair. There is a small correlation between bone density and failure load for knotless anchor repair, which may benefit from further investigation. Clinical Relevance: Using knotless suture anchors for patellar tendon rupture repair would allow for a smaller incision, less dissection, and likely shorter operating time.
Modified R.E.N.A.L nephrometry score for predicting the outcome following partial nephrectomy
Authors: Salah Mohammed , ElSheemy Mohammed S. , Ghoneima Waleed , Abd El Hamid Mahmoud , Kassem Ayman , Ashmawy Ahmed Abdallah , Saad Ismail R. , Mosharafa Ashraf A. , Salem Hosni Khairy , Badawy Hesham , Salem Ahmed 
Published: October 2020

AbstractBackgroundIt was difficult to compare the outcome of partial nephrectomy among different studies due to the absence of standardized description of different renal masses. This problem led to the development of nephrometry scoring systems. R.E.N.A.L. is among the commonest nephrometry scoring systems; however, some studies failed to find any relation between R.E.N.A.L. with perioperative outcome. We evaluated our designed newly modified nephrometry score in prediction of outcome following partial nephrectomy and compared its predictability versus original R.E.N.A.L.MethodsFifty-one patients with cT1-2N0M0renal masses amenable for partial nephrectomy were included prospectively. Different perioperative outcome variables were compared according to complexity level in R.E.N.A.L. and the newly modified nephrometry score.ResultsClinical staging was T1a (21.6%), T1b (49%), T2a (25.5%), T2b (3.9%). Median R.E.N.A.L. was 9 (4–12). Hilar position and intrarenal pelvis were detected in 19.6% and 68.6%. Low, moderate and high complexity masses were found in 21.6%, 39.2% and 39.2%. Complications and rate of conversion to radical nephrectomy were 17 (33.3%) and 4 (7.8%). The only significantly affected variable (p = 0.039) by R.E.N.A.L. was rate of secondary intervention, but it was higher in low than in high complexity level. In the newly modified nephrometry score, complications (p = 0.037) and rate of positive surgical margin (p = 0.049) were significantly higher with increased complexity level. Although other variables (pelvi-calyceal system entry, operative time, blood loss, hemoglobin loss, blood transfusion and conversion to radical nephrectomy) did not show statistically significant difference according to both scores, they were better associated with the complexity level in the newly modified nephrometry score with their remarkable increase in the high when compared to the low complexity level.ConclusionsThe newly modified nephrometry score was associated with better prediction of outcome of partial nephrectomy when compared to R.E.N.A.L.