bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Implementation of the Core Elements of Outpatient Antibiotic Stewardship Within Veterans Health Administration Emergency Departments and Primary Care Clinics on Antibiotic Prescribing and Patient Outcomes
Authors: Madaras-Kelly Karl , Hostler Christopher , Townsend Mary , Potter Emily M , Spivak Emily S , Hall Sarah K , Goetz Matthew Bidwell , Nevers McKenna , Ying Jian , Haaland Benjamin , Rovelsky Suzette A , Pontefract Benjamin , Fleming-Dutra Katherine , Hicks Lauri A , Samore Matthew H 
Published: December 2020

Abstract

Background
The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use. We report the impact of core elements implementation within Veterans Health Administration sites.

Methods
In this quasiexperimental controlled study, effects of an intervention targeting antibiotic prescription for uncomplicated acute respiratory tract infections (ARIs) were assessed. Outcomes included per-visit antibiotic prescribing, treatment appropriateness, ARI revisits, hospitalization, and ARI diagnostic changes over a 3-year pre-implementation period and 1-year post-implementation period. Logistic regression adjusted for covariates (odds ratio [OR], 95% confidence interval [CI]) and a difference-in-differences analysis compared outcomes between intervention and control sites.

Results
From 2014–2019, there were 16 712 and 51 275 patient visits within 10 intervention and 40 control sites, respectively. Antibiotic prescribing rates pre- and post-implementation within intervention sites were 59.7% and 41.5%, compared to 73.5% and 67.2% within control sites, respectively (difference-in-differences, P &lt; .001). Intervention site pre- and post-implementation OR to receive appropriate therapy increased (OR, 1.67; 95% CI, 1.31–2.14), which remained unchanged within control sites (OR,1.04; 95% CI, .91–1.19). ARI-related return visits post-implementation (–1.3% vs –2.0%; difference-in-differences P = .76) were not different, but all-cause hospitalization was lower within intervention sites (–0.5% vs –0.2%; difference-in-differences P = .02). The OR to diagnose non-specific ARI compared with non-ARI diagnoses increased post-implementation forintervention (OR, 1.27; 95% CI, 1.21 –1.34) but not control (OR, 0.97; 95% CI, .94–1.01) sites.

Conclusions
Implementation of the core elements was associated with reduced antibiotic prescribing for RIs and a reduction in hospitalizations. Diagnostic coding changes were observed.
Blood biochemical status of deep-sea sharks following longline capture in the Gulf of Mexico
Authors: Prohaska Bianca K , Talwar Brendan S , Grubbs R Dean 
Published: December 2020

ABSTRACTPrior to the Deepwater Horizon (DWH) oil spill, little research effort was focused on studying deep-sea sharks in the Gulf of Mexico (GoM). While the biology of these fishes remains virtually unknown, they are routinely captured in commercial fisheries as bycatch. In the absence of basic biological data, and with the probability of post-release survival unknown for most species, effective management plans cannot be formulated, making populations highly susceptible to overfishing. Any potential detrimental effects of the DWH oil spill, which occurred at 1500 m deep, are also unknown. Following longline capture, we characterized the physiological blood biochemical parameters related to secondary stress and compared them among seven shark species occurring on the continental shelf edge and slope in the GoM at depths ranging from 200 to 2000 m. We also investigated the relationship between blood parameters and depth as well as proximity to the oil spill site. The deep-sea sharks examined here exhibited variability in blood chemistry associated with the secondary stress response, with values falling within published records for previously studied elasmobranchs. Results suggested that there is greater relative physiological stress in shallower-dwelling sharks as well as smaller-bodied sharks. Further, the rate of core temperature warming was fastest in smaller bodied sharks, which likely contributes to greater physiological stress. The core temperatures of the larger-bodied, deeper-dwelling species were not altered as drastically as the smaller-bodied sharks after being hauled to the surface. Any chronic physiological effects of the oil spill were not detectable as there were no relevant correlations between blood chemistry metrics and proximity to the DWH oil spill site.
Age-growth relationships, temperature sensitivity and palaeoclimate-archive potential of the threatened Altiplano cactusEchinopsis atacamensis
Authors: English N B , Dettman D L , Hua Q , Mendoza J M , Muir D , Hultine K R , Williams D G 
Published: December 2020

AbstractThe tall (&gt;4 m), charismatic and threatened columnar cacti, pasacana [Echinopsis atacamensis (Vaupel) Friedrich & G.D. Rowley)], grows on the Bolivian Altiplano and provides environmental and economic value to these extremely cold, arid and high-elevation (~4000 m) ecosystems. Yet very little is known about their growth rates, ages, demography and climate sensitivity. Using radiocarbon in spine dating time series, we quantitatively estimate the growth rate (5.8 and 8.3 cm yr−1) and age of these cacti (up to 430 years). These data and our field measurements yield a survivorship curve that suggests precipitation on the Altiplano is important for this species’ recruitment. Our results also reveal a relationship between night-time temperatures on the Altiplano and the variation in oxygen isotope values in spines (δ18O). The annual δ18O minimums from 58 years of in-series spine tissue from pasacana on the Altiplano provides at least decadal proxy records of temperature (r = 0.58; P &lt; 0.0001), and evidence suggests that there are longer records connecting modern Altiplano temperatures to sea-surface temperatures (SSTs) in the Atlantic Ocean. While the role of Atlantic SSTs on the South American Summer Monsoon (SASM) and precipitation on the Bolivian Altiplano is well described, the impact of SSTs on Altiplano temperatures is disputed. Understanding the modern impact of SSTs on temperature on the Altiplano is important to both understand the impact of future climate change on pasacana cactus and to understand past climate changes on the Altiplano. This is the best quantitative evidence to date of one of the oldest known cactus in the world, although there are likely many older cacti on the Altiplano, or elsewhere, that have not yet been sampled. Together with growth, isotope and age data, this information should lead to better management and conservation outcomes for this threatened species and the Altiplano ecosystem.
One size does not fit all: inter- and intraspecific variation in the swimming performance of contrasting freshwater fish
Authors: Jones Peter E , Svendsen Jon C , Börger Luca , Champneys Toby , Consuegra Sofia , Jones Joshua A H , Garcia de Leaniz Carlos 
Published: December 2020

AbstractArtificial barriers cause widespread impacts on freshwater fish. Swimming performance is often used as the key metric in assessing fishes’ responses to river barriers. However, barrier mitigation is generally based on the swimming ability of salmonids and other strong swimmers because knowledge of swimming ability for most other freshwater fish is poor. Also, fish pass designs tend to adopt a ‘one size fits all’ approach because little is known about population or individual variability in swimming performance. Here, we assessed interspecific and intraspecific differences in the sustained swimming speed (Usus) of five freshwater fish with contrasting body sizes, morphologies and swimming modes: topmouth gudgeon, European minnow, stone loach, bullhead and brown trout. Significant Usus variation was identified at three organizational levels: species, populations and individual. Interspecific differences in Usus were as large as 64 cm s−1, upstream populations of brown trout showed mean Usus 27 cm s−1 higher than downstream populations, and species exhibited high individual variation (e.g. cv = 62% in European minnow). Sustained swimming speed (Usus) increased significantly with body size in topmouth gudgeon, European minnow and brown trout, but not in the two benthic species, bullhead and stone loach. Aerobic scope had a significant positive effect on Usus in European minnow, stone loach and brown trout. Sustained swimming speed (Usus) decreased with relative pectoral fin length in European minnow and brown trout, whereas body fineness was the best predictor in stone loach and bullhead. Hence, swimming performance correlated with a diverse range of traits that are rarely considered when predicting fish passage. Our study highlights the dangers of using species’ average swimming speeds and illustrates why a ‘one size fits all’ approach often fails to mitigate for barrier effects. We call for an evidence-based approach to barrier mitigation, one that recognizes natural variability at multiple hierarchical levels.
Assessing the post-release effects of capture, handling and placement of satellite telemetry devices on narwhal(Monodon monoceros)movement behaviour
Authors: Shuert Courtney R , Marcoux Marianne , Hussey Nigel E , Watt Cortney A , Auger-Méthé Marie 
Published: December 2020

AbstractAnimal-borne telemetry devices have become a popular and valuable means for studying the cryptic lives of cetaceans. Evaluating the effect of capture, handling and tagging procedures remains largely unassessed across species. Here, we examine the effect of capture, handling and tagging activities on an iconic Arctic cetacean, the narwhal (Monodon monoceros), which has previously been shown to exhibit an extreme response to extended capture and handling. Using accelerometry-derived metrics of behaviour, including activity level, energy expenditure and swimming activity, we quantify the post-release responses and time to recovery of 19 individuals following capture and tagging activities considering the intrinsic covariates of sex and individual size and the extrinsic covariates of handling time and presence of a ‘bolt-on’ satellite telemetry device. From accelerometer-derived behaviour, most narwhals appeared to return to mean baseline behaviour (recovery) within 24 hours after release, which was supported by longer-term measures of diving data. None of the covariates measured, however, had an effect on the time individuals took to recover following release. Using generalized additive models to describe changes in behaviour over time, we found handling time to be a significant predictor of activity levels, energy expenditure and swimming behaviour following release. Individuals held for the longest period (&gt;40 min) were found to display the largest effect in behaviour immediately following release with respect to swimming behaviour and activity levels. We also found some support for relationships between activity levels, energy expenditure and swimming activity and two other covariates: sex and the attachment of a bolt-on configuration satellite tags. Our results indicate that narwhals recover relatively quickly following capture, handling and tagging procedures, but we suggest that researchers should minimize handling time and further investigation is needed on how to mitigate potential effects of bolt-on satellite tags in these sensitive species.
Seasonal Abundance and Infectivity ofPhilaenus spumarius(Hemiptera: Aphrophoridae), a Vector ofXylella fastidiosain California Vineyards
Authors: Beal Dylan J , Cooper Monica , Daugherty Matthew P , Purcell Alexander H , Almeida Rodrigo P P 
Published: December 2020

AbstractThe meadow spittlebug, Philaenus spumarius (Linnaeus) (Hemiptera: Aphrophoridae), is a vector of the plant pathogen Xylella fastidiosa; however, its role in recent outbreaks of Pierce’s disease of grapevine (PD) in California is unclear. While the phenology and ecology of P. spumarius can help determine its contributions to PD epidemics, both remain poorly described in the North Coast vineyards of California. We assessed the phenology of P. spumarius in the region. Spittlemasses were first observed in February or March, while the emergence of adult spittlebugs did not occur until April or May depending on the year. Analysis of sweep and trap data from 2016 to 2018 revealed significant effects of survey month, vineyard site, and year on adult abundance in sweep and trap surveys. Spittlebug adults were present in the vineyards from April until December, with the greatest number of adults by sweep net in May or June, whereas adults on traps peaked between July and November. Analysis of natural infectivity in groups of field-collected spittlebug adults showed significant difference in transmission rates among months. Spittlebugs successfully transmitted Xylella fastidiosa (Wells) (Xanthomonadales: Xanthomonadaceae) to potted grapevines between July and December. The greatest risk of X. fastidiosa transmission by P. spumarius was in December (60%) followed by October (30%). However, the infectivity patterns of the meadow spittlebug did not align with the historical paradigm of California North Coast PD. We discuss alternative hypotheses in which P. spumarius could play a role in the epidemiology of this disease.
Novel risk score for predicting recurrence of atrial fibrillation after the Cryo-Maze procedure
Authors: Kakuta Takashi , Fukushima Satsuki , Minami Kimito , Saito Tetsuya , Kawamoto Naonori , Tadokoro Naoki , Ikuta Ayumi , Kobayashi Junjiro , Fujita Tomoyuki 
Published: December 2020

Abstract OBJECTIVESThis study aimed to develop a novel risk score model for quantitative prediction of the rate of atrial fibrillation (AF) recurrence after the Cryo-Maze procedure in patients with persistent AF.METHODSWe enrolled 450 consecutive patients who underwent the Cryo-Maze procedure for persistent AF concomitant with other cardiac procedures in our institute between 2001 and 2019. We randomly divided the cohort into two groups. We derived a model in a ‘development cohort’ (270 patients; 60%) and validated it in a ‘test cohort’ (180 patients; 40%) by receiver operating characteristic curve analysis.RESULTSThe median follow-up was 5.2 (interquartile range: 2.0–9.9) years. The 1-, 5-, 10- and 15-year rates of freedom from AF recurrence in the entire cohort were 91.4%, 83.5%, 76.2% and 57.1%, respectively. Risk factors for AF recurrence examined by logistic regression analysis included F-wave voltage in V1 &lt; 0.2 mV, preoperative AF duration &gt;5 years and left atrial volume index &gt;100 ml/m2. Points were assigned to each risk factor according to its odds ratio. A novel risk score model was developed using these three variables and age, with a range up to 10 points. High score (&gt;7) predicted high rates of AF recurrence after the Cryo-Maze procedure. The area under the receiver operating characteristic curve of the novel risk model score was 0.78 (95% confidence interval: 0.65–0.91) in the test cohort.CONCLUSIONSUse of the Cryo-Maze procedure should be carefully considered in patients with a higher model score because of a higher risk of AF recurrence.
Evolution of P-wave indices during long-term follow-up as markers of atrial substrate progression in arrhythmogenic right ventricular cardiomyopathy
Authors: Baturova Maria A , Svensson Anneli , Aneq Meriam Åström , Svendsen Jesper H , Risum Niels , Sherina Valeriia , Bundgaard Henning , Meurling Carl , Lundin Catarina , Carlson Jonas , Platonov Pyotr G 
Published: December 2020

AbstractAimsPatients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have increased prevalence of atrial arrhythmias indicating atrial involvement in the disease. We aimed to assess the long-term evolution of P-wave indices as electrocardiographic (ECG) markers of atrial substrate during ARVC progression.Methods and resultsWe included 100 patients with a definite ARVC diagnosis according to 2010 Task Force criteria [34% females, median age 41 (inter-quartile range 30–55) years]. All available sinus rhythm ECGs (n = 1504) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. P-wave duration, P-wave area, P-wave frontal axis, and prevalence of abnormal P terminal force in lead V1 (aPTF-V1) were assessed and compared at ARVC diagnosis, 10 years before and up to 15 years after diagnosis.Prior to ARVC diagnosis, none of the P-wave indices differed significantly from the data at ARVC diagnosis. After ascertainment of ARVC diagnosis, P-wave area in lead V1 decreased from −1 to −30 µV ms at 5 years (P = 0.002). P-wave area in lead V2 decreased from 82 µV ms at ARVC diagnosis to 42 µV ms 10 years after ARVC diagnosis (P = 0.006). The prevalence of aPTF-V1 increased from 5% at ARVC diagnosis to 18% by the 15th year of follow-up (P = 0.004). P-wave duration and frontal axis did not change during disease progression.ConclusionInitial ARVC progression was associated with P-wave flattening in right precordial leads and in later disease stages an increased prevalence of aPTF-V1 was seen.
Exploring the cause of conduction delays in patients with repaired Tetralogy of Fallot
Authors: Verzaal Nienke J , Massé Stéphane , Downar Eugene , Nanthakumar Kumaraswamy , Delhaas Tammo , Prinzen Frits W 
Published: December 2020

Abstract

Aims
Cardiac dyssynchrony in patients with repaired Tetralogy of Fallot (rToF) has been attributed to right bundle branch block (RBBB), fibrosis and/or the patches that are inserted during repair surgery. We aimed to investigate the basis of abnormal activation in rToF patients by mapping the electrical activation sequence during sinus rhythm (SR) and right ventricular (RV) pacing.

Methods and Results
A total of 17 patients were studied [13 with rToF, 2 with left bundle branch block (LBBB), and 2 without RBBB or LBBB (non-BBB)] during medically indicated cardiac surgery. During SR and RV pacing, measurements were performed using 112-electrode RV endocardial balloons (rToF only) and biventricular epicardial sock arrays (four of the rToF and all non-rToF patients). During SR, functional lines of block occurred in five rToF patients, while RV pacing caused functional blocks in four rToF patients. The line of block persisted during both SR and RV pacing in only 2 out of 13 rToF patients. Compared to SR, RV pacing increased dispersion of septal activation, but not dispersion of endocardial and epicardial activation of the RV free wall. During pacing, RV and left ventricular activation dispersion in rToF patients were comparable to that of the non-rToF patients.

Conclusion
The results of the present study indicate that the delayed activation in the right ventricle of rToF patients is predominantly due to block(s) in the Purkinje system and that conduction in RV tissue is fairly normal.
Cycle length statistics during human atrial fibrillation reveal refractory properties of the underlying substrate: a combined in silico and clinical test of concept study
Authors: Unger Laura A , Azzolin Luca , Nothstein Mark , Sánchez Jorge , Luik Armin , Seemann Gunnar , Yeshwant Srinath , Oesterlein Tobias , Dössel Olaf , Schmitt Claus , Spector Peter , Loewe Axel 
Published: December 2020

Abstract

Aims
The treatment of atrial fibrillation beyond pulmonary vein isolation has remained an unsolved challenge. Targeting regions identified by different substrate mapping approaches for ablation resulted in ambiguous outcomes. With the effective refractory period being a fundamental prerequisite for the maintenance of fibrillatory conduction, this study aims at estimating the effective refractory period with clinically available measurements.

Methods and results
A set of 240 simulations in a spherical model of the left atrium with varying model initialization, combination of cellular refractory properties, and size of a region of lowered effective refractory period was implemented to analyse the capabilities and limitations of cycle length mapping. The minimum observed cycle length and the 25% quantile were compared to the underlying effective refractory period. The density of phase singularities was used as a measure for the complexity of the excitation pattern. Finally, we employed the method in a clinical test of concept including five patients. Areas of lowered effective refractory period could be distinguished from their surroundings in simulated scenarios with successfully induced multi-wavelet re-entry. Larger areas and higher gradients in effective refractory period as well as complex activation patterns favour the method. The 25% quantile of cycle lengths in patients with persistent atrial fibrillation was found to range from 85 to 190 ms.

Conclusion
Cycle length mapping is capable of highlighting regions of pathologic refractory properties. In combination with complementary substrate mapping approaches, the method fosters confidence to enhance the treatment of atrial fibrillation beyond pulmonary vein isolation particularly in patients with complex activation patterns.
The association between migration and smoke-free families: how do migrants from different world regions compare?
Authors: Mlinarić Martin , Kohler Emma , Kunst Anton E , Lorant Vincent , Rimpelä Arja , Hoffmann Laura , Anastasi Daniela , Richter Matthias 
Published: December 2020

Abstract

Background
Studies on adolescent secondhand smoke exposure within the family often dichotomously operationalize migration background without paying attention to social and cultural diversity within migrant populations. As a result, little is known about variation within migrant groups in smoke-free family environments (SFFEs). This study analyses the association between SFFEs and parental migration from different world regions.

Methods
Data from 14- to 16-year-old adolescents (N = 17 144) on SFFEs and parental migration were obtained from cross-sectional repeated SILNE-R surveys. A multivariable multinomial regression was applied, presenting relative risks (RRs) with 95% confidence intervals (CIs) for maternal or paternal tobacco smoking and home smoking bans. Variation in migration background was measured according to parental sex and place of birth.

Results
Approximately 18% of adolescents are exposed to maternal smoking, and 25% are exposed to paternal smoking. Almost half of the respondents do not live in SFFEs but are subject to permissive (5%) or partial (39%) smoking bans at home. We found that adolescents of Eastern European descent are at a higher risk of being exposed to both paternal and maternal smoking. A sex difference in parental smoking was found among Arabic/Islamic migrants, where mothers are less likely to be smokers. Maternal and paternal African origins are associated with prohibitive smoking bans at home. Eastern European mothers show higher odds of permissiveness and freely allowing smoking at home.

Conclusion
Notable within-differences according to parental sex and place of birth were found for SFFEs and should be taken into account when implementing equity-sensitive tobacco prevention programs.