bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leveraging healthcare standards-based improvement initiatives to support learning and continuous improvement: lessons from implementing the Ideal Clinic programme in Cape Town, South Africa
Authors: Motshweneng Oupa , Gilson Lucy , Engelbrecht Beth , Patientia Alfonso 
Published: April 2024

Abstract

Background
This paper draws on the experiences of a group of health system leaders and researchers in leading and supporting, respectively, the implementation of the Ideal Clinic Realisation and Maintenance Framework (ICRMF) in Cape Town, South Africa. The ICRMF is a national standards-based quality improvement initiative that seeks to improve the quality of care in public primary healthcare (PHC) facilities. We share lessons learned on how efforts to improve healthcare standards can be leveraged for learning and meaningful system change.

Methods
A three-pronged approach to improving the implementation of the ICRMF was used in 15 PHC facilities across two sub-districts. The approach included (i) nurturing trust, (ii) changing the ICRMF assessment strategy, and (iii) promoting a collaborative and collective sense-making approach to understanding performance and addressing gaps. Routine ICRMF quantitative data and qualitative feedback from both the ICRMF assessment process and routine management meetings were used to reflect on the experience of using this approach and to draw lessons. The results and conclusions were further confirmed through member-checking.

Results
We found that using the three-pronged approach, the ICRMF assessments were able to facilitate deep and reflexive conversations about everyday health system challenges facing healthcare delivery in the sub-districts, while encouraging collective sensemaking and collaboration. The ICRMF was often perceived as a compliance-driven exercise with limited value on the actual quality of care. The three-pronged approach helped shift some of these perceptions and improved the experiences of facility managers in implementing the programme.

Conclusion
When supported by trusting relationships, reflexive processes and multidisciplinary ownership and collaboration, healthcare standards programmes such as the ICRMF can provide powerful avenues for learning and meaningful change. Our limited dataset could not demonstrate if our approach addresses the challenge of maintaining standards or not (which is linked to continuous improvement).
Genetic determinants of resistance to antimicrobial therapeutics are rare in publicly available Clostridioides difficile genome sequences
Authors: Kolte Baban , Nübel Ulrich 
Published: April 2024

Abstract

Objectives
To determine the frequencies and clonal distributions of putative genetic determinants of resistance to antimicrobials applied for treatment of Clostridioides difficile infection (CDI), as documented in the genomic record.

Methods
We scanned 26 557 C. difficile genome sequences publicly available from the EnteroBase platform for plasmids, point mutations and gene truncations previously reported to reduce susceptibility to vancomycin, fidaxomicin or metronidazole, respectively. We measured the antimicrobial susceptibility of 143 selected C. difficile isolates.

Results
The frequency of mutations causing reduced susceptibility to vancomycin and metronidazole, respectively, increased strongly after 2000, peaking at up to 52% of all sequenced C. difficile genomes. However, both mutations declined sharply more recently, reflecting major changes in CDI epidemiology. We detected mutations associated with fidaxomicin resistance in several major genotypes, but found no evidence of international spread of resistant clones. The pCD-METRO plasmid, conferring metronidazole resistance, was detected in a single previously unreported C. difficile isolate, recovered from a hospital patient in Germany in 2008. The pX18-498 plasmid, putatively associated with decreased vancomycin susceptibility, was confined to related, recent isolates from the USA. Phenotype measurements confirmed that most of those genetic features were useful predictors of antibiotic susceptibility, even though ranges of MICs typically overlapped among isolates with and without specific mutations.

Conclusions
Genomic data suggested that resistance to therapeutic antimicrobial drugs is rare in C. difficile. Public antimicrobial resistance marker databases were not equipped to detect most of the genetic determinants relevant to antibiotic therapy of CDI.
In vitro activity of cefepime/taniborbactam and comparator agents against Gram-negative bacterial bloodstream pathogens recovered from patients with cancer
Authors: Gerges Bahgat , Rosenblatt Joel , Truong Y-Lan , Jiang Ying , Shelburne Samuel A , Chaftari Anne-Marie , Hachem Ray , Raad Issam 
Published: April 2024

Abstract

Background
Taniborbactam is a β-lactamase inhibitor that, when combined with cefepime, may offer a potential treatment option for patients with serious and resistant Gram-negative bacterial (GNB) pathogens.

Objectives
This study evaluated in vitro activity of cefepime/taniborbactam and comparator agents against GNB pathogens isolated from patients with cancer at our institution.

Methods
A total of 270 GNB pathogens (2019–23) isolated from patients with cancer were tested against cefepime/taniborbactam and comparator agents commonly used for these patients. CLSI-approved broth microdilution methods were used. MIC50, MIC90, MIC range and percentage of susceptibility calculations were made using FDA breakpoints when available.

Results
Cefepime/taniborbactam showed highly potent activity against tested Enterobacterales, including isolates producing ESBLs and carbapenem-resistant Enterobacterales. At a provisional breakpoint of ≤16/4 mg/L, cefepime/taniborbactam inhibited most tested species of GNB pathogens, with overall 98.9% susceptibility, which was significantly (P &lt; 0.0001) higher than the susceptibility of the GNB isolates to all other tested comparator agents, ranging from 39.6% for cefepime to 86.3% for ceftazidime/avibactam.

Conclusions
Our results showed that taniborbactam in combination with cefepime improved in vitro activity against GNB pathogens isolated from patients with cancer, including MDR Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales, ESBL-producing Enterobacterales and Stenotrophomonas maltophilia isolates, with highest activity compared with all tested comparator agents, including other β-lactam/β-lactamase inhibitor combinations. Further studies are warranted to explore the efficacy of cefepime/taniborbactam for empirical initial treatment of GNB infections in cancer patients with high rates of febrile neutropenia requiring hospitalization.
Generative artificial intelligence responses to patient messages in the electronic health record: early lessons learned
Authors: Baxter Sally L , Longhurst Christopher A , Millen Marlene , Sitapati Amy M , Tai-Seale Ming 
Published: April 2024

Abstract

Background
Electronic health record (EHR)-based patient messages can contribute to burnout. Messages with a negative tone are particularly challenging to address. In this perspective, we describe our initial evaluation of large language model (LLM)-generated responses to negative EHR patient messages and contend that using LLMs to generate initial drafts may be feasible, although refinement will be needed.

Methods
A retrospective sample (n = 50) of negative patient messages was extracted from a health system EHR, de-identified, and inputted into an LLM (ChatGPT). Qualitative analyses were conducted to compare LLM responses to actual care team responses.

Results
Some LLM-generated draft responses varied from human responses in relational connection, informational content, and recommendations for next steps. Occasionally, the LLM draft responses could have potentially escalated emotionally charged conversations.

Conclusion
Further work is needed to optimize the use of LLMs for responding to negative patient messages in the EHR.
Listening to Things and Spaces: Sound Archives for Design Historians
Authors: Candela Emily 
Published: April 2024

Abstract
Sound archives, beyond those of oral histories, have great potential to enrich design history discourse on key themes, invite new methodological approaches, and help expand the field’s subject breadth. Sound is, after all, a pervasive part of the designed world. It is intertwined with materiality, and is an important factor in how many users interact in and with spaces and artifacts. Yet the sonic qualities of designed objects, spaces, and systems are often “unheard” in design history literature and in conventional archives. This article outlines the potential of sound-focused research in design history through a discussion of several sound archives that reflect design history subject matter and concerns. The archives covered focus on the sounds of artifacts and spaces, which have seen less use in design history than those of oral histories. The sound-focused sources introduced here speak to design historical discourses on materiality, use, subjectivity, the everyday, environmental ecologies, and historical contingency. I argue, finally, that using sonic evidence invites the use of methodologies for listening and contributes to a rethinking of epistemological hierarchies in design history research.
Evolutionary potential under heat and drought stress at the southern range edge of North American Arabidopsis lyrata
Authors: Heblack Jessica , Schepers Judith R , Willi Yvonne 
Published: April 2024

Abstract
The warm edges of species’ distributions are vulnerable to global warming. Evidence is the recent range retraction from there found in many species. It is unclear why populations cannot easily adapt to warmer, drier, or combined hot and dry conditions and locally persist. Here, we assessed the ability to adapt to these stressors in the temperate species Arabidopsis lyrata. We grew plants from replicate seed families of a central population with high genetic diversity under a temperature and precipitation regime typical of the low-latitude margin or under hotter and/or drier conditions within naturally occurring amplitudes. We then estimated genetic variance–covariance (G-) matrices of traits depicting growth and allocation as well as selection vectors to compare the predicted adaptation potential under the different climate-stress regimes. We found that the sum of genetic variances and genetic correlations were not significantly different under stress as compared to benign conditions. However, under drought and heat drought, the predicted ability to adapt was severely constrained due to strong selection and selection pointing in a direction with less multivariate genetic variation. The much-reduced ability to adapt to dry and hot-dry conditions is likely to reduce the persistence of populations at the low-latitude margin of the species’ distribution and contribute to the local extinction of the species under further warming.
Focus on ... Students and New Professionals: Policy Internships: Stepping Stones to Your Career
Authors: Scardina A.V. , Marcus N.J. , Neznek R. 
Published: April 2024

Abstract
Forest policy internships are excellent opportunities for students to make their first connection with the real world of professional forestry. Here are some hints on how and where to look for internships and how to make your internship a positive experience for you and your employer.
Emerald Ash Borer: Invasion of the Urban Forest and the Threat to North America’s Ash Resource
Authors: Poland Therese M. , McCullough Deborah G. 
Published: April 2024

Abstract
The emerald ash borer (EAB), a phloem-feeding beetle native to Asia, was discovered killing ash trees in southeastern Michigan and Windsor, Ontario, in 2002. Like several other invasive forest pests, the EAB likely was introduced and became established in a highly urbanized setting, facilitated by international trade and abundant hosts. Up to 15 million ash trees in urban and forested settings have been killed by the EAB. Quarantines in the United States and Canada restrict the movement of ash trees, logs, and firewood to prevent new introductions. Research studies are underway to assist managers leading eradication and containment efforts. Long-term efforts will be needed to protect ash in urban and forested settings across North America.
Challenges and Approaches in Planning Fuel Treatments across Fire-Excluded Forested Landscapes
Authors: Collins Brandon M. , Stephens Scott L. , Moghaddas Jason J. , Battles John 
Published: April 2024

Abstract
Placing fuel reduction treatments across entire landscapes such that impacts associated with high-intensity fire are lessened is a difficult goal to achieve, largely because of the immense area needing treatment. As such, fire scientists and managers have conceptually developed and are refining methodologies for strategic placement of fuel treatments that more efficiently limit the spread and severity of fire across forested landscapes. Although these methodologies undoubtedly improve managers' ability to plan and evaluate various landscape fuel treatment scenarios, there is still a considerable gap between modeling landscape fuel treatments and actually implementing these treatments “on the ground.” In this article we explore this gap in light of decisions managers make with regards to the type, intensity, placement/pattern, and size of fuel treatments. Additionally, we highlight several critical constraints acting on managers when implementing fuel treatments across landscapes and offer some suggestions for dealing with these constraints.
Short-Term Impacts of Laurel Wilt on Redbay (Persea borbonia [L.] Spreng.) in a Mixed Evergreen-Deciduous Forest in Northern Florida
Authors: Shields Joshua , Jose Shibu , Freeman Johanna , Bunyan Milind , Celis Gerardo , Hagan Donald , Morgan Michael , Pieterson E. Corrie , Zak Joel 
Published: April 2024

Abstract
We examined the immediate effects of laurel wilt on redbay (Persea borbonia [L.] Spreng.) and stand-level characteristics in a mixed evergreen-deciduous forest at Etoniah Creek State Forest in Florida. Percent mortality of redbay in the overstory, sapling, and seedling layers were 100%, 30.2%, and 1.8%, respectively, in the year after the first signs of infection were observed. The diameter distribution of redbay shifted from a reverse “J” pattern to a distribution where the only remaining living stems were &lt;4-in. dbh. Mortality of redbay also resulted in significant reductions in overstory redbay importance values and stand-level density and basal area. Our results suggest that (1) laurel wilt has a more pronounced effect on overstory redbays than smaller stems and (2) redbay mortality caused by laurel wilt can result in modest but significant changes in stand structure.
Why Natural Resources Educators Should Welcome Online Education
Authors: Sener John 
Published: April 2024

Abstract
Online education (the use of online technologies for teaching and learning) will play an increasingly important role in natural resources education. Because it has entered the mainstream of higher education in recent years and is projected to grow in size and importance for the foreseeable future, there are many excellent reasons for natural resources educators to get involved with online education. Many natural resources educators already have an established track record of delivering online education effectively. There is substantial research that indicates its effectiveness and abundant evidence that getting involved in online education is rewarding for instructors and students. Although possible conflicts with research and scholarships as competing priorities need to be considered, on balance the ascendency of online education is a welcome development for natural resources educators.
What Is Limiting More Flexible Fire Management—Public or Agency Pressure?
Authors: Steelman Toddi A. , McCaffrey Sarah M. 
Published: April 2024

Abstract
Conventional wisdom within American federal fire management agencies suggests that external influence such as community or political pressure for aggressive suppression are key factors circumscribing the ability to execute less aggressive fire management strategies. Thus, a better understanding of external constraints on fire management options is essential. This entails validating or refuting the perceptions of fire managers about the relative constraints that external pressures place on their ability to implement more flexible fire management options. In the summer of 2008, our research team traveled to two fires—the Gap in California and Gunbarrel in Wyoming—each of which used a different strategy for managing the fire. At each site, we interviewed key agency individuals and asked them about internal and external factors that influenced their fire management decisions. We also interviewed community members to understand whether they sought to influence fire management. Internal factors included procedural requirements and agency beliefs and attitudes. External factors included political and community pressures from the public who are often perceived to demand an aggressive suppression response. This article details how these internal and external factors influence flexibility in fire management. Our findings did not wholly support conventional wisdom and suggest that internal pressures are as important as external pressure in shaping fire management strategy.
Global Competency and Issues in Contemporary Education / Agroforestry
Authors: Moore Susan , Sills Erin , Allen Lee , Frederick Douglas , Cubbage Frederick , Garland John , Lydick Julie , Holley Gordon , Roberts Jodi , Grado Stephen , Ning Zhu , Fowler Shannon , Munsell John , Seiler John , Orr Blair , Savage James , Brantley Elizabeth , Houghton Craig , O'Hara Kevin , Redelsheimer Carol , Jones Michelle , Schultz Emma , Wagner Robert , Fox Bruce , Kim Yeon-Su , Allen James , Wagner Michael , Englberger Lois , Lorens Adelino , Johnson Emihner , Tara Mona , Susumu Gibson , Vander Velde Nancy , Kusto Karness , Vander Velde Brian , Elevitch Craig , Idol Travis , Friday James , Chamberlain James , Falanruw Marjorie , Mason Andy , Friday Kathleen , Nazario-Leary Cynthia , Idol Travis , Barden Charles , Mason Andy , Chamberlain James , Munsell John , Gold Michael , Jose Shibu , Barden Charles , Munsell John , Trozzo Katie , Ragone Diane , Drew Mark , Lorens Adelino , Phillips Jackson , Raynor Bill , Sucre Eric , Leggett Zakiya , Hughes Glenn , Vlosky Rich , Blazier Michael , Jose Shibu , Jacobson Michael 
Published: April 2024

Abstract
34We performed a five year integrated research, extension and education project aimed at strengthening global competence of students and faculty through collaboration in forestry. We sought to improve our students' ability to cooperate, increase their understanding of global dynamics of forestry markets and enhance their knowledge of various approaches to forest management and conservation with Chile as the focus. The project had four key components: (1) facilitate faculty and student involvement in Chile through Spanish language training, a website, and visits by Chilean faculty; (2) support NC State faculty and student research and study in Chile through travel grants and study tours; (3) build on faculty sabbaticals in Chile by funding student research assistants; and (4) disseminate information from Chile through multiple channels to both the university and professional communities. The faculty exchange visits; graduate student research; and participation of NCSU students, faculty and staff in the study tours to Chile had substantial effects when the participants returned to the US and disseminated information about their experiences through both formal and informal mechanisms. Both students and faculty at NCSU are more aware of forestry research, policy and management in Chile. Faculty at NCSU and Chilean universities Universidad de Concepción and Universidad de Austral have established a strong basis for collaboration and are continuing to work together on funding proposals, research, and papers. Students who participated in the study tours learned about both the culture and forestry in Chile, including similarities, differences, and lessons for the US. This presentation will describe the activities, outcomes and ongoing impacts of the project.
Forest Management, Engineering, and Operations / Global Competency and Issues in Contemporary Education
Authors: Antony Finto , Jordan Lewis , Schimleck Laurie , Daniels Richard , Kantavichai Rapeepan , Hansen Lara , Hitt Jessica , Hubbard William , Boyd Gwendolyn , Boyles Ryan , Dinon Heather , Idassi Joshua , Megalos Mark , Monroe Martha , Taylor Eric , Boby Leslie , Parajuli Rajan , Bradford John , D'Amato Anthony , Lifshitz Ian , Guth Erin , Litton Creighton , A. Lepczyk Christopher , Chan-Halbrendt Catherine , Zamora Rene , Adams Paul , Sessions John , Lee Yohan , Fried Jeremy , Albers Heidi , Haight Robert , Franklin Jean , Schipper Jan , Parmenter Robert , Cramer Jennifer , Chang Sun , Gazo Rado , Jensen Ed , Zahler David , Hughes Calvin , Tesch Steven , Bowden Richard , Trunzo Alessandra , Gillen Stacia-Fe , Ream Kelsey , Deem Lauren , Darby Kate , Bensel Terrence , Haviarova Eva , Gale Charles , Abdollahi Kamran , Ning Zhu , Johnson Andra 
Published: April 2024

Abstract
31Maps depicting spatial variation in wood properties are important for forest product industries as they aid decision making regarding raw material procurement, can assist in product categorization and help improve utilization. Loblolly pine is an important commercial species grown throughout the southern Unites States of America (USA). Wood Quality Consortium (WQC)—a joint collaboration between the University of Georgia, USDA Forest Service and industries—was established in 1999 with the objective of characterizing wood property variation of plantation grown loblolly pine. Data on wood specific gravity (SG), modulus of elasticity (MOE) and modulus of rupture (MOR) collected by the WQC was utilized in this study. Maps showing spatial variation in SG at different stand ages and SG, MOE and MOR at different heights within a tree were developed using appropriate spatial prediction methods (kriging). The geographical variation of these wood properties across southeastern USA was demonstrated here.
The Forest Survey in the Bottomland Hardwoods of the Mississippi Delta
Authors: Lentz G. H. 
Published: April 2024

Abstract
A current major project of interest to foresters and lumbermen, especially those concerned with the economics of the forest industries, is the forest survey now being pushed so energetically by the Forest Service in several regions. The hardwoods have always received less attention than the conifers. It is gratifying, therefore, that this important group is to be included so early. Mr. Lentz describes the problems peculiar to the hardwood survey and offers classifications of sites and types. Mr. Putnam's comments which follow the principal paper enlarge upon and further clarify some of Mr. Lentz' statements.
Cutting Methods in Relation to Resource Use in Central Rocky Mountain Spruce-Fir Forests
Authors: Alexander Robert R. 
Published: April 2024

Abstract
In terms of any of the goods and services usually aimed for under multiple-use management, the spruce-fir type is the largest and most valuable forest resource in the central Rocky Mountains. Engelmann spruce (Picea engelmannii Parry), the most desirable timber tree in the type, needs mineral soil seedbeds and partial shade for best establishment and early growth. Spruce can be harvested and regenerated by all silvicultural systems except the seed tree method--subject to limitations imposed by stand conditions.