bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paper as Artistic Medium at the Ottoman Court
Authors: Fetvacı Emine 
Published: August 2024

Abstract
The arts of cutting and joining paper (katʿı and vas·s·¯ale) were much prized at the early-modern Ottoman court in Istanbul. This essay takes a single folio of katʿı prepared by the Ottoman paper joinery master (vas·s·¯al) Kalender Efendi (d. 1616) as a starting point from which to explore the essential role of paper in the administration and unification of the Ottoman Empire, shaping the state’s relationships with its subjects, and making possible the environment in which Kalender was educated and rose to prominence. Through his skillful manipulation of paper, Kalender created intricate artworks that served as resting place for the eye and mind, astonishing viewers with his skills, and encouraging them to engage in insightful looking. Paper thus served as the locus of intellectual, artistic, and economic encounters, and gave shape to relationships both in the moment and over time
BertTCR: a Bert-based deep learning framework for predicting cancer-related immune status based on T cell receptor repertoire
Authors: Zhang Min , Cheng Qi , Wei Zhenyu , Xu Jiayu , Wu Shiwei , Xu Nan , Zhao Chengkui , Yu Lei , Feng Weixing 
Published: August 2024

Abstract
The T cell receptor (TCR) repertoire is pivotal to the human immune system, and understanding its nuances can significantly enhance our ability to forecast cancer-related immune responses. However, existing methods often overlook the intra- and inter-sequence interactions of T cell receptors (TCRs), limiting the development of sequence-based cancer-related immune status predictions. To address this challenge, we propose BertTCR, an innovative deep learning framework designed to predict cancer-related immune status using TCRs. BertTCR combines a pre-trained protein large language model with deep learning architectures, enabling it to extract deeper contextual information from TCRs. Compared to three state-of-the-art sequence-based methods, BertTCR improves the AUC on an external validation set for thyroid cancer detection by 21 percentage points. Additionally, this model was trained on over 2000 publicly available TCR libraries covering 17 types of cancer and healthy samples, and it has been validated on multiple public external datasets for its ability to distinguish cancer patients from healthy individuals. Furthermore, BertTCR can accurately classify various cancer types and healthy individuals. Overall, BertTCR is the advancing method for cancer-related immune status forecasting based on TCRs, offering promising potential for a wide range of immune status prediction tasks.
Advanced image generation for cancer using diffusion models
Authors: Kidder Benjamin L 
Published: August 2024

Abstract
Deep neural networks have significantly advanced the field of medical image analysis, yet their full potential is often limited by relatively small dataset sizes. Generative modeling, particularly through diffusion models, has unlocked remarkable capabilities in synthesizing photorealistic images, thereby broadening the scope of their application in medical imaging. This study specifically investigates the use of diffusion models to generate high-quality brain MRI scans, including those depicting low-grade gliomas, as well as contrast-enhanced spectral mammography (CESM) and chest and lung X-ray images. By leveraging the DreamBooth platform, we have successfully trained stable diffusion models utilizing text prompts alongside class and instance images to generate diverse medical images. This approach not only preserves patient anonymity but also substantially mitigates the risk of patient re-identification during data exchange for research purposes. To evaluate the quality of our synthesized images, we used the Fréchet inception distance metric, demonstrating high fidelity between the synthesized and real images. Our application of diffusion models effectively captures oncology-specific attributes across different imaging modalities, establishing a robust framework that integrates artificial intelligence in the generation of oncological medical imagery.
Trajectories of cardiovascular ageing—from molecular mechanisms to clinical implementation
Authors: Ministrini Stefano , Wenzl Florian A , Lüscher Thomas F , Camici Giovanni G 
Published: August 2024

Abstract
Due to its peculiar structure and function, the cardiovascular system is particularly vulnerable to the detrimental effects of ageing. Current knowledge about the molecular mechanisms of ageing revealed the processes actively promoting ageing, e.g. progressive telomere shortening, and the mechanisms opposing it, e.g. endogenous production of antioxidant substances. This knowledge can be used to measure biological age at cellular and molecular levels and to interfere with it by pharmacological or non-pharmacological interventions. Biological ageing is determined by the simultaneous occurrence of independent hallmarks, which encompass a wide range of biological processes, from genomic changes to systemic inflammation and dysbiosis. This narrative review will summarize the role of ageing hallmarks in the cardiovascular system, how they can be measured, and what are the possible interventions to counteract their effects.
A dynamic variant of Takotsubo cardiomyopathy mimicking apical hypertrophic cardiomyopathy: a case report
Authors: Seyani Chitsa , Adam Robert , Gant David , Shambrook James , Flett Andrew 
Published: August 2024

Abstract

Background
Takotsubo cardiomyopathy usually presents with acute reversible left ventricular apical hypokinesia and apical ballooning with basal hyperdynamic function. We describe an underreported case of Takotsubo cardiomyopathy (TCM), misinterpreted as apical hypertrophic cardiomyopathy (HCM) due to transient apical oedema in the recovery phase of the condition.

Case summary
A 74-year-old Caucasian woman, presented to the emergency department complaining of retrosternal chest pain following, emotional stress. Her electrocardiogram (ECG) demonstrated poor R-wave progression in the right precordial leads raising the possibility of an anterior non-ST elevation myocardial infarction. High sensitivity troponin was elevated at 2232 ng/L, echocardiography demonstrating apical ballooning and left ventricular ejection fraction of 45%. Computed tomography coronary angiography revealed unobstructive coronary arteries. Cardiac magnetic resonance imaging (cMRI) demonstrated morphological features consistent with apical HCM. However, subsequent cMRI examination, illustrated resolution of the hypertrophic segments, with T1 parametric mapping and extracellular volume (ECV) favouring TCM over apical HCM.

Discussion
Following emotional stress, takotsubo cardiomyopathy is understood caused by various mechanisms: catecholamine surge, inflammation, or transient ischaemia event leading to dysregulated cellular mechanisms. This results in myocardial oedema and increased wall stiffness leading to non-type 1 coronary plaque event-related regional wall motion abnormalities.
In this instance, the initial two cMRI studies reported morphological features consistent with apical HCM, however, a subsequent examination demonstrated resolution of these features. The key to delineating these distinct pathologies lies in myocardial T1 times that exceeded what is normally observed in HCM, the absence of late gadolinium enhancement and ECV values which favour takotsubo cardiomyopathy.
Can Social Health Insurance Improve Mental Health? An Analysis of Supplementary High-Cost Illness Insurance in China
Authors: Zhang Yaru , Yang Wei , Zhang Siqian , Yu Zexuan , Li Jiajia 
Published: August 2024

Abstract

Objectives
China introduced an innovative Supplementary High-Cost Illness Insurance (SHCII) program to enhance existing social health insurance by providing extra financial support for individuals facing catastrophic illnesses in 2015. The SHCII has notably increased access to healthcare and alleviated financial strain for economically disadvantaged individuals. However, there is a lack of information regarding the program’s impact on the mental health of its beneficiaries. This study aims to assess the impact of SHCII on the mental well-being of middle-aged and older individuals.

Methods
Using data from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018), this study examined how SHCII affects mental health among middle-aged and older individuals in China using propensity score matching with the time-varying difference-in-differences method.

Results
We found that SHCII implementation can significantly reduce the Center for Epidemiologic Studies—Depression Scale scores of middle-aged and older individuals. This reduction was more pronounced among older individuals with poor self-rated health, chronic disease, and low household wealth when compared to their counterparts.

Discussion
The implementation of SHCII has had a significant and positive impact on mental health outcomes. We recommend that governments consider expanding the program to other areas within China, focusing especially on the most economically disadvantaged segments of the population.
Effects of Somatosensory Games on Heart Rate Variability and Sleep-Related Biomarkers in Menopausal Women With Poor Sleep Quality
Authors: Lin Yi-Yuan , Liao Yi-Hung , Ting Hua , Masodsai Kunanya , Chen Chi 
Published: August 2024

Abstract

Background and Objectives
The aim of this study was to investigate the effects of 12-week somatosensory games on heart rate variability and sleep-related biomarkers in middle-aged women with poor sleep quality.

Research Design and Methods
Twenty-nine women with poor sleep quality were recruited as participants randomly assigned into ring fit adventure exergame group (RFA, n = 15) and control group (CON, n = 14). The RFA group received ring fit adventure exergame for 60 min each time, 2 times a week, for 12 weeks. The CON group was not allowed to participate in intervention activities during the study period. Heart rate variability, sleep quality, cortisol, serotonin, and high-sensitive C-reactive protein were measured before and after the 12-week intervention.

Results
The Pittsburgh Sleep Quality Index total score in the RFA group was significantly lower compared with the CON group. The value of the standard deviation of normal NN intervals and the root mean square of the successive RR Differences were significantly increased in the RFA group, when compared with the CON group. The change in the logarithm of high frequency (log HF) was significantly higher and change in the logarithm of low frequency to high frequency ratio (log LF/HF) was significantly lower in the RFA group, when compared to the CON group. The change level of serotonin in the RFA group was significantly higher compared with the CON group.

Discussion and Implications
The results suggest that somatosensory games might improve sleep quality, increase serotonin level, and decrease sympathetic nerve activities in middle-aged women with poor sleep quality.
O03 Scale and spread of a quality improvement initiative promoting metronidazole IV to oral switch (IVOST) in the acute hospital setting: antimicrobial stewardship, patient safety, workforce and environmental sustainability benefits
Authors: Rodger R , Robertson A , Thompson E , Downie K , Thompson S , Ray G , Chisholm L , Hillson R 
Published: August 2024

Abstract

Background
In-hospital promotion of the oral route and IV to oral switch (IVOST)1 are key antimicrobial stewardship (AS) initiatives providing benefits for patients, staff and the environment, including reduced risk of line infections, medicine costs, nursing workload and plastic waste.1,2 A recent quality improvement (QI) initiative highlighting the environmental sustainability benefits of switching to oral metronidazole (bioavailability &gt;90%) in surgical wards at the Royal Alexandra Hospital (RAH) resulted in a 45% median reduction in IV administrations.3

Objectives
To scale and spread this QI initiative to all inpatient wards in NHSGGC Clyde hospitals (RAH, Inverclyde Royal and Vale of Leven) and measure the impact on AS, drug costs, nursing workload and environmental sustainability.

Methods
A QI scale and spread approach was used including: targeted pharmacist/pharmacy technician prospective audit and feedback; presentations to medical, nursing and pharmacy teams; eye-catching posters on wards/electronic guideline platform; staff champions; and HEPMA IVOST prompts when prescribing or administering IV metronidazole.4 Oral and IV metronidazole usage data was calculated at baseline and for 36 months post-change. Benefits in terms of reduced IV administrations, drug costs and nursing time saved5 were calculated. Plastic waste reduction (giving sets, single use plastic containers, cannula, safety needles, gloves and aprons) associated with switching from IV to oral metronidazole was calculated in terms of carbon dioxide equivalent (CO2e) emissions using a hybrid carbon footprinting methodology and emissions factor databases.6,7

Results
There was a 64% median reduction in IV metronidazole defined daily doses (DDDs) (Figure 1) equating to 1977 and 23 724 fewer IV metronidazole administrations monthly and annually, respectively. The equivalent nursing time saved was 659 h per month and 7908 h per year. There was a 26% median shift in percentage IV metronidazole of total (IV plus oral) use (Figure 2). There was a 38% median reduction in metronidazole drug cost (Figure 3). The carbon footprint saving achieved from switching from IV to oral metronidazole was calculated as 1.48111 kg CO2e per dose, equating to 2928 kg CO2e per month and an annual carbon footprint saving of 35.1 tonnes CO2e; refer to Table 1 for equivalents.

Conclusions
A QI scale and spread approach to raise awareness of the multidisciplinary team to the benefits of appropriate switch from IV to oral metronidazole resulted in a change in prescribing behaviour and a significant reduction in IV administrations. This is important in terms of improved AS, patient safety, workforce cost and efficiency and environmental sustainability.
P10 Risk management of clinical false positives with multiplex PCR blood culture panels: a lesson in diagnostic stewardship for microbiology trainees
Authors: Gregg S , Mulrooney C , Leonard M , Flanagan M , Nashev D , Cormican M 
Published: August 2024

Abstract

Background
The processing of blood cultures is technically difficult and time consuming. Nucleic acid amplification tests (NAATs) can supplement this process, with some commercial systems offering NAAT for multiple pathogens simultaneously. These platforms also present distinct challenges, including managing false positive identifications. The use of broad multiplex NAAT in cases of low pre-test probability carries an inherent risk of low positive predictive value. We describe a series of detections of Candida tropicalis targets from positive blood cultures where C. tropicalis was not present and subsequent management.

Incident
Biofire Filmarray BCID2 was introduced in May 2022 in a General Hospital to aid laboratory workflow. The BCID2 panel is used 5–10 times weekly on positive blood cultures. BC specimens are then sent to an associated hospital for sub-culture, identification and antimicrobial susceptibility testing. In August 2023 a blood culture with Gram-positive cocci on Gram stain was positive for C. tropicalis and Staphylococcus spp. targets on BFBCID2. The consultant microbiologist did not advise antifungal treatment based on Gram stain and assessment of patient clinical features. Only Staphylococcus spp. was identified on culture. bioMérieux UK Ltd subsequently released a Field Safety Notice in August 2023 highlighting the risk of false positive identification of C. tropicalis and other organisms using BCID and BCID2 panels. This may be related to yeast DNA in the culture media. C. tropicalis has been detected from 18 additional blood cultures up to March 2024 from multiple batches of blood culture bottles and multiple BCID and BCID2 panels.

Risk management
Laboratory practices were reviewed to address the possibility of sample contamination. Of note, C. tropicalis was not cultured from blood in the laboratory in the year prior August 2023. All scientific and medical staff in the laboratory were alerted to the issue. Use of the BCID and BCID2 panels was continued because of the clinical value of rapid on-site identification of key pathogens such as S. aureus and differentiation from CoNS. In each case of C. tropicalis identification, the Gram stain and clinical features were reviewed. No patients received inappropriate antifungal treatment.

Lessons for trainees
(i) The combination of two technologies (blood culture and multiplex NAAT) can generate unanticipated challenges. (ii) Use of NAATs in samples with a low pre-test probability is associated with the risk of low positive predictive value. (iii) Potential risk can be mitigated by correlation of results of molecular testing with Gram stain and assessment of clinical features.

Conclusions
Learning for microbiology trainees relates to the need for caution in interpretation of new technologies and the importance of pre-test probability in interpreting a positive result in any assay.
P16 Analysis of antibiotic resistance in wounded servicemen with infectious complications
Authors: Viltsaniuk Oksana , Syvak Viktor , Tkachuk Nataliia 
Published: August 2024

Abstract

Background
The problem of antibiotic resistance has now become a global challenge. Infectious complications are the cause of death in 80% of wounded soldiers whose deaths occur late after a military injury. This confirms that the fight against wound infection is one of the priority tasks in the treatment of combat trauma.

Objectives
To investigate the species composition and susceptibility of microorganisms in servicemen with gunshot wounds and severe infectious complications.

Materials and methods
The study analysed 34 case histories of wounded servicemen with infectious complications (sepsis, pneumonia).

Results
Sixty-eight samples of materials were taken, of which 56 samples of biomaterial were isolated from wounds, blood and sputum, and pathogens were isolated. A monoculture was isolated in 85% of cases, in 10% of cases there was a combination of Staphylococcus aureus and Klebsiella pneumoniae, and in 5% of cases different triple combinations of S. aureus with Staphylococcus lentus, Enterobacter, Proteus or Lelliottia amnigena were identified. Most commonly detected were K. pneumoniae (43%) and S. aureus (21%), followed by equal proportions of Enterobacter and Proteus (both 9%), Bacillus spp. (7%) and, in rare cases, L. amnigena, S. epidermidis, S. haemolyticus and S. lentus were isolated (1% each, respectively). Considering that S. aureus and K. pneumoniae were the most frequently isolated pathogens, we analysed their susceptibility. K. pneumoniae was resistant to cefazolin in all cases, and the highest resistance was found to amikacin, amoxicillin, ciprofloxacin, cefepime and piperacillin/tazobactam. The highest levels of susceptibility were found for levofloxacin and meropenem. Susceptibility analysis of S. aureus revealed that this pathogen was not susceptible to azithromycin, amoxicillin, levofloxacin, moxifloxacin, ofloxacin, piperacillin/tazobactam or cefazolin. Linezolid had the highest susceptibility of 90%.

Conclusions
The choice of antibiotic therapy for wounded soldiers should take into account the possibility of infection with highly virulent pathogens that can cause secondary purulent complications. In addition, it should be noted that due to the phasing of care from the battlefield to tertiary care, the risk of developing resistance increases as pathogens constantly migrate and change their susceptibility to antibiotics.
P25 Pharmacovigilance assessment of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) with antibacterial drugs using FDA adverse event reporting system data
Authors: Radhakrishnan Sriram , Velmani Vaishnavi , Shailaja K 
Published: August 2024

Abstract

Background
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and potentially life-threatening skin reactions associated with certain medications, including antibacterial drugs. This study outlines a comprehensive pharmacovigilance study using the US FDA Adverse Event Reporting System (FAERS) data to assess this association.

Methods
All SJS/TEN cases of antibacterial drugs as primary suspected drugs were extracted from the US FDA FAERS from 2004 to 2023. Descriptive analyses were performed to evaluate the prevalence of SJS/TEN among antibacterial drug users. Disproportionate analyses were conducted by estimating the reporting odds ratio (ROR) and the information component (IC).

Results
Out of a total of 38 185 cases of SJS/TEN reported in the FAERS, 16 104 (42.17%) cases are due to antibacterial drug use suspects. 332 cases of SJS/TEN overlap from the year 2019 reported. Gender analysis of SJS/TEN shows females (51.2%) are more prone than males (39.29%) and not specified (9.51%). Mortality rate of SJS/TEN due to drug adverse reaction is 21% (7995). The SJS/TEN signal was detected majorly in cotrimoxazole, amoxicillin, ciprofloxacin, vancomycin, levofloxacin, piperacillin sodium/tazobactam sodium, amoxicillin/clavulanate potassium and clarithromycin. The ROR (95% CI) of cotrimoxazole, amoxicillin, ciprofloxacin, vancomycin, levofloxacin, piperacillin sodium/tazobactam sodium, amoxicillin/clavulanate potassium and clarithromycin were 53.74 (57.62–50.12), 0.67 (0.72–0.63), 0.54 (0.58–0.50), 0.85 (0.91–0.79), 0.30 (0.32–0.27), 0.89 (0.96–0.82), 11.27 (12.39–10.25) and 0.50, (0.55–0.46), respectively.

Conclusions
This pharmacovigilance assessment of FAERS shows 42.17% association of antibacterial drugs in suspected cases of SJS/TEN. This reminds the medical workers to pay attention to the severe adverse effects of antibacterial drugs leading to SJS/TEN.