bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a pharmacist‐driven azithromycin de‐escalation initiative for community‐acquired pneumonia
Authors: Shakeraneh Pegah , Steele Jeffrey M. , Seabury Robert W. , Thomas Stephen J. , Paolino Kristopher M. , Miller Christopher D. , Probst Luke A. , Kufel Wesley D. 
Published: September 2020

AbstractBackgroundCommunity‐acquired pneumonia (CAP) is a commonly encountered infection and cause of hospitalization. Discontinuation of atypical antibiotic coverage when atypical bacteria are the unlikely cause of CAP represents a potential antimicrobial stewardship opportunity.Study ObjectiveTo compare azithromycin duration, hospital length of stay (LOS), 30‐day all‐cause or pneumonia readmission, and in‐hospital mortality before and after implementation of a pharmacist‐driven azithromycin de‐escalation initiative in the setting of negative laboratory data for atypical bacteria in immunocompetent, nonintensive care unit (non‐ICU) patients treated for CAP.DesignSingle‐center, quasi‐experimental study.SettingA 472‐bed academic medical center in Syracuse, NY.PatientsPatients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative Biofire FilmArray Respiratory Panel for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU during hospitalization, prescribed azithromycin for an alternate indication, or had evidence of atypical bacteria.Measurements and Main ResultsA total of 983 patients received an azithromycin‐containing regimen for CAP during the study period with 458 and 525 patients in preintervention and postintervention cohorts, respectively. After exclusion criteria were applied, 90 and 100 patients were included in the preintervention and postintervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. A statistically significant reduction in azithromycin duration (2 days [interquartile range (IQR) 1‐2.75] vs 5 days [IQR 3‐6], P < .001) and hospital LOS (3 days [IQR 2‐5] vs 5 days [IQR 3‐8.25], P < .001) were observed in the postintervention cohort compared with the preintervention cohort. No statistically significant difference was identified for 30‐day all‐cause 30‐day readmission (15.6% vs 13.0%, P = .614), 30‐day readmission secondary to pneumonia (4.44% vs 2.0%, P = .926), or in‐hospital mortality (1.1% vs 1.0%, P = 1.000) between cohorts.ConclusionImplementation of a pharmacist‐driven azithromycin de‐escalation initiative for immunocompetent, non‐ICU patients with CAP was associated with a decrease in azithromycin duration and hospital LOS without increasing 30‐day all‐cause or pneumonia readmission, or in‐hospital mortality.
Therapeutic Protein Drug Interaction Potential in Subjects With Psoriasis: An Assessment Based on Population Pharmacokinetic Analyses of Sensitive Cytochrome P450 Probe Substrates
Authors: Sathe Abhishek G. , Othman Ahmed A. , Mohamed Mohamed‐Eslam F. 
Published: September 2020

AbstractElevated cytokine levels in inflammatory diseases are associated with downregulation of certain cytochrome P450 (CYP) enzymes. Upon treatment with some cytokine‐targeting therapeutic proteins, the CYP enzymes levels may be restored resulting in therapeutic protein–mediated drug interactions (TP‐DI). These analyses characterized the worst‐case scenario for CYP1A2, 2C9, and 3A‐based TP‐DI potential in patients with psoriasis by comparing the pharmacokinetics of probe substrates between healthy volunteers and subjects with moderate to severe psoriasis. Data for the CYP probe substrates midazolam (CYP3A), caffeine (CYP1A2), and S‐warfarin (CYP2C9) from 7 drug interaction studies (1 in patients with psoriasis and 6 in healthy subjects) were pooled to develop a population pharmacokinetics model for each substrate. A 2‐compartment model with absorption lag time for midazolam, a 1‐compartment model with 5 transit absorption compartments for caffeine, and a 3‐compartment model with absorption lag time for S‐warfarin best described the observed data. Apparent oral clearance and relative bioavailability for caffeine and S‐warfarin were not significantly different between the subject populations. Psoriasis patients were estimated to have 17% lower midazolam oral bioavailability than healthy volunteers. Compounded with other covariate effects, the ratio of median post hoc area under the plasma concentration–time estimates in subjects with psoriasis relative to healthy subjects was 0.96, 1.13, and 0.65 for midazolam, caffeine, and S‐warfarin, respectively. Therefore, inflammation in psoriasis had no relevant effect on reducing CYP1A2, 2C9, and 3A activities in vivo and no significant TP‐DIs mediated through these enzymes are expected in patients with psoriasis. This approach can potentially be used in lieu of dedicated TP‐DI studies to identify TP‐DI risks within a disease area.
Implementation of an online treatment planning exercise focused on vulnerable patient groups
Authors: Nair Rohit U. , Marchini Leonardo , Johnsen David C. , Xie Xian J. 
Published: September 2020

AbstractThe coronavirus disease 2019 (COVID‐19) pandemic presented formidable challenges in our ability to impart in‐person extra‐mural clinical training, including the Geriatric and Special Needs Program, to a group of 20 fourth‐year dental students. A new course delivery format was developed wherein students used a validated Rapid Oral Health Deterioration (ROHD) risk assessment tool to critically appraise clinical case information relating to a young adult with special needs. In the alternative virtual educational approach that was created, students applied an interprofessional practice concept leading to patient treatment planning outcomes. Providing adequate information, additional reading resources, a response template, clear instructions and a process‐oriented assessment policy all ensured a good level of participation from students in the alternative learning format. An association was noted between students’ staging of risk for ROHD and their subsequent recommendations for treatment.
A new diagnostic indication device of a biomarker growth differentiation factor 15 for mitochondrial diseases: From laboratory to automated inspection
Authors: Koga Yasutoshi , Povalko Nataliya , Inoue Eisuke , Ishii Akiko , Fujii Katsunori , Fujii Tatsuya , Murayama Kei , Mogami Yukiko , Hata Ikue , Ikawa Masamichi , Fukami Kei , Fukumoto Yoshihiro , Nomura Masatoshi , Ichikawa Kazuki , Yoshida Kaori 
Published: September 2020

AbstractMitochondrial diseases (MDs) are occasionally difficult to diagnose. Growth differentiation factor 15 (GDF15) has been reported as a biomarker useful for not only diagnosing MDs, but also evaluating disease severity and therapeutic efficacy. To enable the measurement of serum GDF15 concentrations at medical institutions, we developed a new latex‐enhanced turbidimetric immunoassay (LTIA) as an automated diagnostic indication test for MDs. We also examined the equivalency of specificity and sensitivity in measuring serum GDF15 concentrations between a commercially available enzyme‐linked immunosorbent assay (ELISA) kit and a novel LTIA device in patients with MDs, disease controls, and healthy controls. A clinical performance study used a newly developed LTIA device and an existing ELISA kit to measure the concentrations of GDF15 in 35 MD patients, 111 disease controls, and 86 healthy controls. The median (first quartile‐third quartile) of serum GDF15 concentrations measured with the LTIA device was significantly higher (P < .001) in MD patients (1389.0 U/mL [869.5‐1776.0 U/mL]) than in healthy controls (380.5 U/mL [330.2‐471.8 U/mL]); the interquartile ranges did not overlap between MD patients and healthy controls. The areas under the curve in disease and healthy controls were 0.812 (95% confidence interval [CI]: 0.734‐0.886) and 0.951 (95% CI: 0.910‐0.992), respectively. The automated, high‐throughput technology‐based LTIA device has definite advantages over the ELISA kit in shorter processing time and lower estimated cost per sample measurement. The LTIA device of GDF15 may be a sufficiently reliable, frontline, diagnostic indicator of individuals with suspected MDs in the general population.
Anticoagulant activity of apixaban can be estimated by multiple regression analysis
Authors: Unami Naoko , Ise Yuya , Suzuki Hidenori 
Published: September 2020

AbstractBackgroundInformation on apixaban anticoagulant activity is required to prevent major bleeding or thrombosis during its use.MethodsWe enrolled 194 patients with nonvalvular atrial fibrillation (NVAF) in whom warfarin was replaced with apixaban: 105 (54.1%) received the standard dose of apixaban (5 mg twice daily [BID]; 5 mg group) and 89 (45.9%) received a reduced dose (2.5 mg BID; 2.5 mg group). Multiple regression analysis was performed to predict the prothrombin time of apixaban (PTa) based on factors including age, body weight (BW), serum creatinine, and CHA2DS2‐VASc score.ResultsPTa and PT of warfarin (PTw) were significantly correlated in both groups (correlation coefficient R = 0.239 [P = .014] in the 5 mg group; R = 0.248 [P = .019] in the 2.5 mg group). PTa in the 5 mg group was predicted as follows: 16.952‐0.036 × BW +0.299 × CHA2DS2‐VASc score (P < .0004; R = 0.378). However, in the 2.5 mg group, PTa could not be predicted. The mean of the predicted and measured PTa values in the 5 mg group was 15.6 s, which was similar to the mean measured PTa of 15.5 s in the 2.5 mg group.ConclusionsPT can be predicted by a formula including simple clinical parameters in patients receiving the standard dose of apixaban. This simple predictive formula may help to stratify bleeding and thrombosis risks in patients treated with apixaban.
Atomic force microscopy imaging for nanoscale and microscale assessments of extracellular matrix in intervertebral disc and degeneration
Authors: Cauble Meagan A. , Mancini Nickolas S. , Kalinowski Judith , Lykotrafitis George , Moss Isaac L. 
Published: September 2020

AbstractDegeneration of the intervertebral disc (IVD) is a condition that is often associated with debilitating back pain. There are no disease‐modifying treatments available to halt the progression of this ubiquitous disorder. This is partly due to a lack of understanding of extracellular matrix (ECM) changes that occur at the micro‐ and nanometer size scales as the disease progresses. Over the past decade, atomic force microscopy (AFM) has been utilized as a tool to investigate the impact of disease on nanoscale structure of ECM in bone, skin, tendon, and dentin. We have expanded this methodology to include the IVD and report the first quantitative analysis of ECM structure at submicron size scales in a murine model for progressive IVD degeneration. Collagen D‐spacing, a metric of nanoscale structure at the fibril level, was observed as a distribution of values with an overall average value of 62.5 ± 2.5 nm. In degenerative discs, the fibril D‐spacing distribution shifted towards higher values in both the annulus fibrosus and nucleus pulposus (NP) (P < .05). A novel microstructural feature, collagen toroids, defined by a topographical pit enclosed by fibril‐forming matrix was observed in the NP. With degeneration, these microstructures became more numerous and the morphology was altered from circular (aspect ratio 1.0 ± 0.1) to oval (aspect ratio 1.5 ± 0.4), P < .005. These analyses provide ECM structural details of the IVD at size scales that have historically been missing in studies of disc degeneration. Knowledge gained from these insights may aid the development of novel disease‐modifying therapeutics.
Diels‐Alder reaction rate in the solid state and the evidence of the location of molecular complexes between the reagents on the reaction pathway
Authors: Kiselev Vladimir D. , Kolesnikova Anastasia O. , Dinikaev Ildar F. , Shulyatiev Alexey A. , Klimovitskii Alexander E. , Kornilov Dmitry A. 
Published: September 2020

AbstractThe rate of reactions in the solid phase with uniform grinding of crystals of dienes, anthracene, and 9,10‐dimethylanthracene, with dienophiles, tetracyanoethylene, N‐phenylmaleimide, and 4‐phenyl‐1,2,4‐triazoline‐3,5‐dione, has been studied. It was shown that, despite the high difference in the reaction rates in solution, the rates of these reactions in the solid phase are much closer. For anthracene‐tetracyanoethylene and 9,10‐dimethylanthracene‐tetracyanoethylene pairs, it was concluded that their intermolecular complexes are on the reaction pathway.
CSF Leaks due to Electric Scooter Injury
Authors: Kim Jee‐hong , Ge Marshall , Su Peiyi , Suh Jeffrey D. , Ference Elisabeth H. 
Published: September 2020

BackgroundThere has been a rapid increase in electric motorized scooter (e‐scooter) usage after the introduction of dockless, shareable devices.MethodsCase series from three tertiary hospitals in Los Angeles between May‐September 2019.ResultsFive patients had skull base fractures and CSF leaks or pneumocephalus after e‐scooter accident, none wore helmets. Two patients were treated with observation alone, two patients were treated with lumbar drain or external ventriculostomy placement, and one patient died of their injuries prior to definitive management.ConclusionWithout appropriate safety policies in place, the number of such injuries may increase as the use of e‐scooters increase. Laryngoscope, 131:E1035–E1037, 2021
From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer
Authors: Lorntzsen Bianca , Brøndbo Kjell , Osnes Terje 
Published: September 2020

AbstractObjectivesWe aimed to evaluate the outcomes of tracheal window resection and reconstruction using a vascularized periosteal flap (intended for calcification) harvested from the medial clavicle. This is one of several surgical techniques for tracheal resection and reconstruction used for patients with thyroid carcinoma invading the trachea. Importantly, in partial tracheal resection postoperative dynamic airway collapse must be prevented. Reconstruction of the tracheal defect with a vascularized periosteal flap is one method of achieving a stable airway.MethodsTwelve patients with locally advanced thyroid carcinoma who underwent tracheal resection and reconstruction at Oslo University Hospital from 2004 to 2017 were studied retrospectively. The primary outcome was a stable airway not requiring airway stenting. The secondary outcomes were the time to decannulation, morbidity, and survival.ResultsEleven of 12 patients did not require airway stenting postoperatively after a median of 111 days. Seven patients developed postoperative complications. The median observation time was 74.8 months (range 10.5‐153.5) for all patients. The median disease‐free survival was 40 months (range 0‐147). By February 1, 2020, seven patients were alive, of whom five showed no evidence of disease.ConclusionsTracheal reconstruction with a vascularized periosteal flap yielded good results in terms of establishing a stable airway. This procedure is a viable reconstructive option that allows for decannulation by preventing airway collapse, thereby potentially mitigating the need for end‐to‐end (ETE) anastomosis or sleeve resections. For selected patients, this procedure may prevent local fatal complications from thyroid cancer invading the trachea.Level of evidenceLevel 4.
Predicting benthic macroalgal abundance in shallow coastal lagoons from geomorphology and hydrologic flow patterns
Authors: Besterman Alice F. , McGlathery Karen J. , Reidenbach Matthew A. , Wiberg Patricia L. , Pace Michael L. 
Published: September 2020

AbstractMacroalgae structure coastal ecosystems affecting metabolism, nutrient dynamics, and food webs. Spatially explicit prediction of macroalgal abundance is critical for understanding coastal ecosystems and trajectories. However, models of macroalgal distribution tend to be mechanistic and generalize poorly, or biogeographic and too coarse to use over spatial scales most appropriate to ecosystem research and management (1–100 km2). Our objective was to develop spatial distribution models for benthic macroalgae in soft‐sediment environments. We compared macroalgal abundance quantified as percent cover, with environmental drivers on 1 ha intertidal flats in a > 900 km2 lagoon system along the Atlantic Coast of Virginia, U.S.A. Physical drivers of macroalgae (e.g., depth‐mediated light availability, exposure to waves) are related to bed morphology. We developed a novel topographic index (τ) to determine whether bed morphology predicts macroalgal abundance. This topographic index described variation in elevation occurring over spatial scales relevant to macroalgae, ranging from smooth to hummocky (τ = 0.01–1.07). Models tested τ along with mean elevation, fetch, and water residence time as predictors of macroalgal abundance. τ, and the interaction with water residence time, were most strongly related to macroalgal abundance. Hummocky flats accumulated less macroalgae than smoother flats, but exceptions occurred with short residence times. Model error (root mean square error) was low, varying between 8% and 18% across models. These models, based on readily measured physical features, are a useful approach for assessing macroalgal abundance in relation to shoreline hardening, species invasions, sea‐level rise, and changing sedimentation affecting coastal ecosystems.
The drivers of multiple dimensions of stream macroinvertebrate beta diversity across a large montane landscape
Authors: Li Zhengfei , Heino Jani , Liu Zhenyuan , Meng Xingliang , Chen Xiao , Ge Yihao , Xie Zhicai 
Published: September 2020

AbstractEnvironmental filtering and spatial processes have been associated with variation in ecological communities and biodiversity; however, their relative importance on multiple dimensions of beta diversity has not been fully explored in montane streams. Here, we examined the relative contribution of local, catchment and climate environmental variables and spatial factors to variation in three dimensions of macroinvertebrate beta diversity in the upper Han River Basin. Taxonomic, functional, and phylogenetic beta diversities and their respective turnover and nestedness components were calculated for macroinvertebrate assemblages sampled in a total of 130 stream sites across a large mountainous landscape. We investigated the correlations between beta diversity facets using MSR‐Mantel procedure and then examined the relative influence of each set of ecological factors through redundancy analysis and variance partitioning. Our results revealed relatively low spatial congruence among beta diversity dimensions, indicating these diversity dimensions are independent measures which offer complementary information of community assembly. Beta diversity dimensions and components were best explained by spatial and local environmental factors, whereas the large‐scale catchment and climate factors appeared less influential. Moreover, spatial and environmental factors generally exerted different controls on beta diversity depending on the dimensions under consideration. Taxonomic and phylogenetic beta diversities were more strongly determined by spatial factors via dispersal limitation, while functional beta diversity was mainly associated to local environments through habitat filtering. Our results challenge the perspective that using one diversity facet as a surrogate for others is enough, and highlight the need to integrate multiple diversity dimensions in metacommunity and biodiversity research.
TRUST: THE FOUNDATION OF LEADERSHIP
Authors: Frei Frances , Morriss Anne 
Published: September 2020

AbstractThe authors contend that if leadership is about empowering others, in your presence and your absence, then trust is the emotional framework that allows that service to be freely exchanged. Based on their experiences advising individuals and organizations, their basic formula for building trust is: people tend to trust you when they think they are interacting with the real you (authenticity), when they have faith in your judgment and competence (logic), and when they believe that you care about them (empathy). When trust is lost, it can almost always be traced back to a breakdown in one of these core trust drivers. We don't always realize what information (or more often, misinformation) we're putting out about our own trustworthiness. And stress tends to amplify the problem. Your wobble is the driver that's most likely to get shaky in periods of low trust. Everyone has a wobble, though a small change in behavior can go a long way. Tools are provided within each area of authenticity, logic, and empathy. For instance, within the latter, if you do nothing else, put down your phone. You'll be amazed at the immediate uptick in trust—and you may even get to end meetings sooner.
Functional facial reconstruction in a patient with severe burn sequelae with a prelaminated parascapular free flap based on a three‐dimensional model: A case report
Authors: Horta Ricardo , Monteiro Diana , Órfão Tiago , Nascimento Ricardo , Frias Francisca , Silva Alvaro 
Published: September 2020

AbstractSignificant evolution has been made concerning resuscitation and emergency management of severely burned patients, and nowadays most patients will survive and deal with burns sequelae. They constitute a reconstructive challenge, mainly because options and donor areas are frequently compromised, results are often limited, and other options should then be considered. A 27‐year‐old male patient with 55% total burn surface area, presented with severe facial disfigurement including ectropion, upper/lower lip retraction, and partial loss of the nose. In order to improve the patient's condition, autologous reconstruction was considered. The only unburned area in the body was the left dorsal region, and a three‐stage reconstruction was planned using a paraescapular flap. In a first stage, an elective surgery was performed to identify and tag the recipient vessels in the neck. After 3 months, the prelamination process was initiated with the drawing of a facial model, and a nose and lips were opened inside the flap. This was based on a three‐dimensional latex model as a print of the patient's face, which allowed us to calculate distances and estimate the length of the vascular pedicles. After 3 months, the flap (18 × 8 cm) was transferred and microvascular anastomoses were performed. No major complications were seen after surgeries, and after 28 months, an extremely important functional gain was obtained. Despite the number of surgeries required and less than optimal aesthetic results, this method may offer a satisfactory solution for complex acquired facial burn sequelae when other local or distant flap options are not available.
Comparison between GaN and InN quantum‐dot semiconductor optical amplifiers
Authors: Al‐Shatravi Ali Gehad , Abdullah Muaffak , Al‐Khursan Amin Habbeb 
Published: September 2020

AbstractGaN/Al0.5Ga0.5N and InN/Al0.5Ga0.5N as a III‐nitride quantum dot semiconductor optical amplifiers (QD‐SOAs) are studied in detail in this paper. The optical gain, spontaneous emission rate, and lineshape function are calculated using non‐Markovian relaxation compared with Markovian one. Gain is then connected with the rate equations model to obtain a dB gain, output power, and shot noise in these SOAs. GaN peaked at 351 nm which is preferred in optical coherence tomography applications. InN is peaked at 1028 nm which can be used in gas detection and environmental pollution monitoring. Both structures studied have high gain and low noise and nearly equivalent TE and TM gain which makes them adequate for the use in both these two modes. These calculations show the importance of InN and GaN QD nanostructure in the applications.