bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of the pathogenic mold
Aspergillus fumigatus
on high copper levels identifies novel resistance genes
Authors: Handelman Mariana , Meir Zohar , Shadkchan Yona , Abo Kandil Ammar , Amano Orin , Mariscal Melani , López-Berges Manuel Sánchez , Osherov Nir 
Published: May 2024

ABSTRACT

Aspergillus fumigatus
is the leading cause of severe mold infections in immunocompromised patients. This common fungus possesses innate attributes that allow it to evade the immune system, including its ability to survive the high copper (Cu) levels in phagosomes. Our previous work has revealed that under high Cu levels, the
A. fumigatus
transcription factor AceA is activated, inducing the expression of the copper exporter CrpA to expel excess Cu. To identify additional elements in Cu resistance, we evolved
A. fumigatus
wild-type and mutant Δ
aceA
or Δ
crpA
strains under increasing Cu concentrations. Sequencing of the resultant resistant strains identified both shared and unique evolutionary pathways to resistance. Reintroduction of three of the most common mutations in genes encoding Pma1 (plasma membrane H
+
-ATPase), Gcs1 (glutamate cysteine-ligase), and Cpa1 (carbamoyl-phosphate synthetase), alone and in combination, into wild-type
A. fumigatus
confirmed their additive role in conferring Cu resistance. Detailed analysis indicated that the
pma1
mutation L424I preserves Pma1 H
+
-ATPase activity under high Cu concentrations and that the
cpa1
mutation A37V confers a survival advantage to conidia in the presence of Cu. Interestingly, simultaneous mutations of all three genes did not alter virulence in infected mice. Our work has identified novel Cu-resistance pathways and provides an evolutionary approach for dissecting the molecular basis of
A. fumigatus
adaptation to diverse environmental challenges.

IMPORTANCE

Aspergillus fumigatus
is the most common mold infecting patients with weakened immunity. Infection is caused by the inhalation of mold spores into the lungs and is often fatal. In healthy individuals, spores are engulfed by lung immune cells and destroyed by a combination of enzymes, oxidants, and high levels of copper. However, the mold can protect itself by pumping out excess copper with specific transporters. Here, we evolved
A. fumigatus
under high copper levels and identified new genetic mutations that help it resist the toxic effects of copper. We studied how these mutations affect the mold’s ability to resist copper and how they impact its ability to cause disease. This is the first such study in a pathogenic mold, and it gives us a better understanding of how it manages to bypass our body’s defenses during an infection.
Clinical risk factors and outcomes of carbapenem-resistant
Escherichia coli
nosocomial infections in a Chinese teaching hospital: a retrospective study from 2013 to 2020
Authors: Kong Haifang , Hu Zhidong , Zhang Longtao , Chen Qianqian , Yang Ling , Li Jin , Tian Bin , Chai Yamin , Feng Xuequan 
Published: May 2024

ABSTRACT

The emergence of carbapenem-resistant
Escherichia coli
strains poses a considerable challenge to global public health, and little is known about carbapenemase-producing
E. coli
strains in Tianjin, China. This study aimed to investigate the risk factors for infections with carbapenem-resistant
E. coli
(CREC) strains. This retrospective case–control study was conducted at a tertiary teaching hospital. A total of 134 CREC clinical isolates were collected from the General Hospital of Tianjin Medical University between 2013 and 2020. The control group was selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible
E. coli
infection. Risk factors for nosocomial CREC infection and clinical outcomes were analyzed using univariate and multivariate analyses. Multivariate analysis revealed that cephalosporin exposure (odd ratio OR = 2.01), carbapenem exposure (OR = 1.96), glucocorticoid exposure (OR = 32.45), and surgical history (OR = 3.26) were independent risk factors for CREC infection. The in-hospital mortality rate in the CREC group was 29.1%, and age >65 years (OR = 3.19), carbapenem exposure (OR = 3.54), and central venous catheter insertion (OR = 4.19) were independent risk factors for in-hospital mortality in patients with CREC infections. Several factors were identified in the development of nosocomial CREC infections. The CREC isolates were resistant to most antibiotics. Reducing CREC mortality requires a comprehensive consideration of appropriate antibiotic use, underlying diseases, and invasive procedures.

IMPORTANCE

Escherichia coli
is an opportunistic pathogen that causes severe hospital-acquired infections. The spread of carbapenem-resistant
E. coli
is a global threat to public health, and only a few antibiotics are effective against these infections. Consequently, these infections are usually associated with poor prognosis and high mortality. Therefore, understanding the risk factors associated with the causes and outcomes of these infections is crucial to reduce their incidence and initiate appropriate therapies. In our study, several factors were found to be involved in nosocomial carbapenem-resistant
E. coli
(CREC) infections, and CREC isolates were resistant to most antibiotics. Reducing CREC mortality needs a comprehensive consideration of whether antibiotics are used appropriately, underlying diseases, and invasive interventions. These findings provide valuable evidence for the development of anti-infective therapy, infection prevention, and control of CREC-positive infections.
Basement, belt, and batholith: Bedrock geology of the Idaho Panhandle
Authors: Gaschnig* Richard , Lewis Reed S. , Buddington Andy , Mato Klementina 
Published: May 2024

ABSTRACTThis trip explores the three main bedrock geology elements in the Idaho Panhandle region and the Priest River metamorphic complex: basement gneisses, the Belt Supergroup (Purcell Supergroup in Canada), and the Kaniksu batholith. The Priest River metamorphic complex includes two areas with Precambrian basement gneisses, informally termed the Pend Oreille and Cougar Gulch complexes. The Pend Oreille complex contains a 2.67 Ga orthogneiss and a 1.58 Ga orthogneiss, the latter notable for falling in the “North American magmatic gap” (NAMG) age range. The Cougar Gulch complex is dominated by ca. 1.86 Ga orthogneisses with ca. 2.67 Ga amphibolites. Overlying the basement rocks in both areas are thin graphitic quartzites that have been correlated with the Neihart quartzite and thick paragneiss sequences that have been correlated with the Prichard Formation of the Belt Supergroup.The upper plate of the Priest River complex contains substantial exposures of only weakly metamorphosed Belt Supergroup. The Belt Supergroup is a very thick sequence of fine-grained clastic sedimentary rocks deposited in an intracontinental extensional setting between ca. 1.46 and 1.40 Ga. Its main formal divisions are the Prichard Formation, Ravalli Group, Piegan Group, and Missoula Group. The Prichard Formation consists of deep-water turbidites interlayered with contemporaneous mafic sills, whereas the other units of the Belt Supergroup accumulated in shallow-water environments. Both the Prichard Formation and Ravalli Group typically contain detrital zircons with ages in the NAMG that have long been interpreted to have originated on another previously connected continent block when North America was part of the Nuna supercontinent. The balance of evidence based on correlations with the basement units and study of Belt provenance strongly suggests that the Gawler craton of southern Australia was adjacent to this region in Nuna during deposition of early Belt units.The Kaniksu batholith forms the bulk of both the upper and lower plates of the Priest River metamorphic complex. New U-Pb zircon dating indicates that most of the batholith was constructed between 120 and 100 Ma with much less magmatism continuing to 72 Ma. The batholith is the southern end of the Omineca Belt of the Canadian Cordillera and is compositionally diverse, with isotope data suggesting at least three different crustal source components involved in its genesis. The batholith appears to have formed well to the rear of the Cretaceous Cordilleran arc front (i.e., the Coast Mountains batholith), and was thus probably not directly related to subduction but instead likely formed through episodic crustal thickening.
Effect of Shear Loading Conditions on the Measured Strength of Ice Adhesion to Superhydrophobic Surfaces
Authors: Emelyanenko K. A. , Emelyanenko A. M. , Boinovich L. B. 
Published: May 2024

Abstract
Despite the significant interest of researchers, icing of aircraft, vehicles, ships, and equipment of offshore oil structures remains to be an urgent problem. This paper considers the factors that promote a decrease in the strength of the contact between ice and surfaces under an applied shear load. The main attention is focused on studying the influence of the rate of shear loading on the fracture of the interfacial contact between ice and superhydrophobic coatings. The strength of the adhesive contact under the conditions of controlled variations in the applied load is measured using a technique based on the detachment of ice from a surface under the influence of centrifugal force. The study is carried out for large ensembles of samples in the temperature range from −5 to −20°C, thereby making it possible to evaluate the influence of the quasi-liquid layer and the Rehbinder effect on a decrease in the shear adhesive strength. The results obtained indicate that the contact between ice and a superhydrophobic coating is fractured through a mixed viscous–brittle mechanism. In this case, a decrease in temperature or an increase in the loading rate causes a transition from the viscous to the brittle fracture. These results indicate a potential acceleration of ice shedding with an increase in the growth rate of the shear stress.
Association of the Achondroplasia Foramen Magnum Score and intraoperative neuromonitoring
Authors: Craven Claudia , Jankovic Ivana , Dyson Edward , Boyd Stewart G , D'Arco Felice , Cheung Moira Shang-Mei , Thompson Dominic 
Published: May 2024

IntroductionForamen magnum stenosis in achondroplasia carries a risk of sudden death. A proportion of these patients benefit from foramen magnum decompression (FMD). The Achondroplasia Foramen Magnum Score (AFMS) was developed to stratify those most at risk. We hypothesise that this score may be reflected in neurophysiological findings.MethodsPatients with achondroplasia who had undergone FMD (n=20) were retrospectively grouped into AFMS 2, 3 and 4. Amplitude from tibialis anterior (TA) and the percentage change in somatosensory evoked potential (SSEP) latency after FMD were reported.ResultsBaseline motor evoked potential amplitudes for patients with AFMS=4 were significantly lower left (p=0.0017 and p=0.02 for right and left TA, respectively) compared with AFMS grades 2 and 3. Median reduction (% change) in SSEP latency (ms) after surgery was not significantly different in any of the patients.ConclusionsThis short report cross-references AFMS to intraoperative neuromonitoring. Baseline amplitudes were noticeably lower in the most severe AFMS group. This observation supports the notion that AFMS can help risk stratify patients and aid in surgical selection.
Clinical characteristics of recurrent non-arteritic retinal artery occlusion
Authors: Kim Hyeong Min , Woo Se Joon 
Published: May 2024

ObjectivesTo investigate the recurrent non-arteritic retinal artery occlusion (RAO) in the same or opposite eye.MethodsWe searched the RAO registry at Seoul National University Bundang Hospital and included patients with recurrent RAO in the present study. Ophthalmic and systemic features were analysed to identify risk factors and visual outcomes.ResultsOf the 850 patients in the non-arteritic RAO cohort, 11 (1.3%) experienced a second RAO recurrence, either in the same (5 patients; 0.6%) or opposite (6 patients; 0.7%) eye. The same eye group experienced an earlier recurrence (1–2 months, median 1 month) than the opposite eye group, where the time to recurrence was notably longer (8–66 months, median 22 months). Best corrected visual acuity (BCVA) in the same eye group decreased after the recurrence of RAO. In the same eye group, initial BCVA ranged from 20/200 to counting fingers (CF), while BCVA during RAO recurrence ranged from CF to hand motion. When RAO recurred in the opposite eye, the reduction in visual acuity was less severe than the reduction of the initial episode: initial episode ranged from 20/400 to light perception and recurrent episode ranged from 20/25 to 20/400. Patients exhibited varying degrees of carotid (81.8%) and cerebral (9.1%) artery occlusions. Additionally, one patient in each group (total 2 patients, 18.2%) experienced a stroke 6 months after RAO recurrence.ConclusionsSince the RAO recurrences could lead to devastating visual impairment, it is essential to emphasise the importance of risk factor screening to patients while collaborating with neurologists and cardiologists.
Rapid implementation of blood pressure self-monitoring in pregnancy at a UK NHS Trust during the COVID-19 pandemic: a quality improvement evaluation
Authors: Lavallee Layla , Roman Cristian , Brace Emily , Mackillop Lucy , Yang Yaling , Cairns Alexandra , Dockree Samuel , Tarassenko Lionel , McManus Richard J , Wilson Hannah , Tucker Katherine 
Published: May 2024

BackgroundThis service evaluation describes the rapid implementation of self-monitoring of blood pressure (SMBP) into maternity care at a tertiary referral centre during the COVID-19 pandemic. It summarises findings, identifies knowledge gaps and provides recommendations for further research and practice.InterventionPregnant and postpartum women monitored their blood pressure (BP) at home, with instructions on actions to take if their BP exceeded pre-determined thresholds. Some also conducted proteinuria self-testing.Data collection and analysisMaternity records, app data and staff feedback were used in interim evaluations to assess process effectiveness and guide adjustments, employing a Plan-Do-Study-Act and root cause analysis approach.ResultsBetween March 2020 and August 2021, a total of 605 women agreed to self-monitor their BP, including 10 women with limited English. 491 registered for telemonitoring (81.2%). 21 (3.5%) took part in urine self-testing. Engagement was high and increased over time with no safety issues. Biggest concerns related to monitor supply and postnatal monitoring. In December 2020, SMBP was integrated into the standard maternity care pathway.ConclusionsThis project demonstrated successful integration of SMBP into maternity care. Early stakeholder engagement and clear guidance were crucial and community midwifery support essential. Supplying BP monitors throughout pregnancy and post partum could improve the service and fully digitised maternity records would aid data collection. More research is needed on SMBP in the postnatal period and among non-English speakers. These findings support efforts to implement app-supported self-monitoring and guide future research.
Enhancing patient safety: detection of in-hospital hazards and effect of training on detection (by training in a low-fidelity simulation Room of Improvement based on hospital-specific CIRS cases)
Authors: Graf Carina , Rüst Christoph Alexander , Koppenberg Joachim , Filipovic Miodrag , Hautz Wolf , Kaemmer Juliane , Pietsch Urs 
Published: May 2024

ImportanceAdequate situational awareness in patient care increases patient safety and quality of care. To improve situational awareness, an innovative, low-fidelity simulation method referred to as Room of Improvement, has proven effective in various clinical settings.ObjectiveTo investigate the impact after 3 months of Room of Improvement training on the ability to detect patient safety hazards during an intensive care unit shift handover, based on critical incident reporting system (CIRS) cases reported in the same hospital.MethodsIn this educational intervention, 130 healthcare professionals observed safety hazards in a Room of Improvement in a 2 (time 1 vs time 2)×2 (alone vs in a team) factorial design. The hazards were divided into immediately critical and non-critical.ResultsThe results of 130 participants were included in the analysis. At time 1, no statistically significant differences were found between individuals and teams, either overall or for non-critical errors. At time 2, there was an increase in the detection rate of all implemented errors for teams compared with time 1, but not for individuals. The detection rate for critical errors was higher than for non-critical errors at both time points, with individual and group results at time 2 not significantly different from those at time 1. An increase in the perception of safety culture was found in the pre-post test for the questions whether the handling of errors is open and professional and whether errors are discussed in the team.DiscussionOur results indicate a sustained learning effect after 12 weeks, with collaboration in teams leading to a significantly better outcome. The training improved the actual error detection rates, and participants reported improved handling and discussion of errors in their daily work. This indicates a subjectively improved safety culture among healthcare workers as a result of the situational awareness training in the Room of Improvement. As this method promotes a culture of safety, it is a promising tool for a well-functioning CIRS that closes the loop.
Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit
Authors: Kar Shrutiprajna , Jarain Veneza Zareen Lyngdoh , Karmakar Soumi , Devi Usha , Som Tapas Kumar , Mohanty Pankaj Kumar , Sahoo Tanushree , Sahoo Jagdish Prasad , Jeyaraman Saranya , Acharya Sangeeta 
Published: May 2024

IntroductionSick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit.Aims and objectivesWe aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023.Material & methodsWith the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan—Do—Study—Act cycles were implemented based on the identified risk factors recognised during recurring team discussions.ResultsWe demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding ‘skin injury prevention’ bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months.ConclusionImplementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.
Assessing nourishment problems at a hospital: what can we learn from them?
Authors: Clausen Mette Kring , Bogh Søren Bie , Schmidt-Petersen Mathilde , Morsø Lars 
Published: May 2024

IntroductionPatient safety is a high priority in the Danish health care system, including that hospital patients get the proper nutrition during their stay. A Nutrition Committee at Odense University Hospital is responsible for policy regarding nourishment at the hospital. If patients experience suboptimal treatment, i.e. improper nourishment, in the Danish health care system, they have the right to file a complaint. These complaints enable the improvement potentials based on the patients’ first hand experiences. Therefore, our aim was to examine the nutrition complaint pattern and to get a deeper understanding of the context surrounding nutrition problems, allowing the extraction of learning potentials.MethodsWe analysed complaints submitted to Odense University Hospital between 2018 and 2022 using the Healthcare Complaint Analysis Tool. The complaints were categorised into categories, levels of severity and overall patient harm. The complaints containing a high-severity nutrition problem were read through and thematised into aspects not defined in the Healthcare Complaint Analysis Tool.ResultsBetween 2018 and 2022, 60 complaint cases containing 89 nutrition problems were filed to Odense University Hospital. Most (58.3%) of these were filed by the patients’ relatives. The nutrition problems were mostly of low severity (56.2%), while 23.6% were severe, and 20.2% were very severe. The reading of 18 very severe nutrition complaints revealed a cascade of problems triggered by the nutrition problem in six cases. Moreover, we saw that two high-severity nutrition problems led to catastrophic harm.DiscussionA low proportion of nutrition problems may express an underestimation regarding nourishment at the hospital. A patient’s threshold may not be exceeded by suboptimal nutrition and therefore does not file a complaint. However, complaints contain important insights contributing to wider learning, given that improvements at the hospital so far are based on clinicians’ reporting, overlooking the patient perspective.
CareFirst-FundLater (CareFFuL): an end-of-life home care quality improvement project
Authors: Morrison Jo , Robinson Fiona , Witney Ally , Greene Helen , Marks Clare , Davis Charles 
Published: May 2024

Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able to die at home. The average time to discharge was 6.3 days and 29% died in hospital, as median survival was only 15 days.We aimed to support discharge to home within 1 day by December 2023 for patients, wishing to die at home, referred to the end-of-life discharge team in a medium-sized district general hospital in Southwest England.In phase 1, we identified 13 people on a patient-by-patient basis, learning from obstacles. Barriers identified included sourcing of equipment, communication between teams and clunky paperwork. Median time to discharge was 2 days (range within 24 hours to 8 days) with 2/13 (15.4%) dying prior to discharge. In phase 2, we extended the pilot, and 104 patients were identified; 94 people were discharged to home, with a median of wait of 1 day (range 0–7) to discharge, and 10 (9.6%) died prior to discharge (median 1 day; range 0–4). Median survival from discharge for the 94 who achieved their wishes to go home to die was 9 days (range 1–205 days). Only 26/94 (27.7%) people survived more than 30 days.Rapid decision-making and structures to support home-based end-of-life care can support more people to die in their preferred place of care, by using a community-based rapid response team instead of, or in parallel with continuing healthcare fast-track funding referral applications. Current pathways and funding models are not fit for purpose in an urgent care scenario when we have only one chance to get it right.