bluuebunny/crossref_metadata_2025_split huggingface dataset:
P06 Improving antibiotic prescribing practice in a tertiary burns and plastic surgery department
Authors: Parente Cristina , Joseph Annie 
Published: June 2023

Abstract

Background
Antimicrobial resistance is an ever-emerging global public health issue. In the healthcare setting, it is essential to use antimicrobials appropriately and manage infections effectively to help tackle antimicrobial resistance.

Objectives
To review local antibiotic resistance data, update the plastic surgery infection guidelines based on this data, implement interventions to facilitate compliance with the guidelines and re-audit to assess if these interventions have been effective.

Methods
A review was undertaken of the previous 3 months of antibiotic susceptibility results for significant staphylococci and streptococci species isolated from blood cultures and wound swabs, and the microbiology results of all local cases of necrotizing fasciitis over a 5-year period. The plastic surgery infection guidelines were updated to reflect the changes in local antibiotic resistance rates. Following implementation of the new guideline, various interventions were undertaken including provision of departmental teaching sessions, ensuring availability of appropriate antibiotics in the burns and plastics theatres and redesigning the guideline to include all plastic surgery and infection guidelines within the one document (previously multiple specific guidelines). Between each intervention, compliance with the guideline was measured to establish if the intervention had made a difference.

Results
Changes to the guideline included using clindamycin rather than doxycycline for the treatment of cellulitis in penicillin allergic patients, as 44% of Group A Streptococcus isolates identified in wound swabs were resistant to doxycycline. Other changes included the introduction of linezolid if the patient had received a recent or failed course of clindamycin, and the use of cefazolin rather than clindamycin for patients with severe cellulitis with a penicillin allergy, due to the increase in rates of clindamycin resistance. After the three intervention cycles, prescriber compliance with the guideline increased from 50% to 71% demonstrating the need for ongoing intervention and re-evaluation.

Conclusions
Co-amoxiclav and clindamycin were the most commonly prescribed antibiotics in those patients whose antibiotic prescriptions did not comply with the guidelines. The main reason for this is historical usage of these antibiotics within the specialty; this project demonstrates the challenges in changing established practices in individual clinicians. Interventions to ‘make it easy’ for prescribers to follow antibiotic guidelines (for example, the right antibiotic being easily available at the site of prescription), along with targeted education, can be effective but long-standing prescribing habits within specialist areas may be difficult to change.
P17 Aetiology of hospital-acquired Gram-negative bacteraemias over the COVID-19 pandemic: a single NHS Trust experience, UK
Authors: Dhillon Syra , Buchanan Oscar , Sargent Catherine 
Published: June 2023

Abstract

Background
Gram-negative bacteria (GNB) are the most common cause of healthcare-associated bacteraemias, most commonly caused by Escherichia coli, Klebsiella, and Pseudomonas.1 GNB carry significant mortality and morbidity; therefore, prompt and appropriate antibiotic therapy is important.2 However, there are also high rates of GNB resistance, posing a significant public health concern. Nationally, all NHS trusts are mandated to report their rates of GNB to the UK Health Security Agency as part of their plan to reduce incidence by 2025.3 The COVID-19 pandemic disrupted healthcare delivery from March 2020, with higher rates of GNB being recorded nationally.4

Methods
We retrospectively analysed 3 years of GNB data, using a 5-month sample of April to August each year, from University Sussex Hospital NHS Foundation Trust east hospitals. Looking at hospital-acquired data (defined as blood culture taking on or after ay 3 of admission), we analysed the demographics, incidence and resistance patterns of GNB using online medical and microbiology records. Data collection and analysis took place on Microsoft Excel.

Results
From 2019 to 2021, there were 29, 27 and 19 cases in each time 5-month sample, respectively. The median age of patients was 78, 64 and 73 years. Positive blood cultures were taken later into admission during 2020 (14 versus 8 and 9 days) with an increased length of median hospital stay (33 versus 23 and 24 days). The source of each GNB can be seen in Table 1 (created as per national record keeping guidelines), with 2020 attributing a higher proportion of cases to ‘other’, which includes iatrogenic procedures and surgical operations. Mortality rates were highest in 2020 (26.9 versus 21.4 and 21.1%), although not significantly, with transmission in neonates a risk factor. 2020 also carried the highest rate of multi-drug–resistant GNB (22%), both within and outside of an intensive care setting.

Conclusions
Our data shows an increase in the mortality rate and antibiotic resistance in GNB during the height of the COVID-19 pandemic that returned to baseline the following year, likely due to a reduction in elective activity and fewer bed days. Ongoing evaluation of GNB aetiology, particularly resistance patterns, is vital to improve health outcomes.
P33 Using the Australian National Antimicrobial Prescribing Survey (NAPS) portal to undertake an annual point prevalence survey (PPS)
Authors: Ng Bee Yean , Parsons Teig , O’Riordan Bernadette , Pill Gemma , Dunsmure Louise , Jones Nicola 
Published: June 2023

Abstract

Background
Annual point prevalence surveys (PPS) are cornerstones in antimicrobial stewardship (AMS). The National Antimicrobial Prescribing Survey (NAPS) is a web-based qualitative auditing platform that provides a standardized and validated tool to assist hospitals in assessing the appropriateness of antimicrobial prescribing.

Objectives
To evaluate the usefulness of NAPS in a UK tertiary hospital setting.

Methods
Permission to use the platform was given by NAPS on a pilot basis. NAPS e-learning was completed by the AMS team. All patients on antimicrobials on a single day were extracted using the Cerner electronic prescribing system. Indication, appropriateness and compliance to guidelines were reviewed, anonymized and uploaded by the trained individuals to NAPS. Ethical approval was not required.

Results
695 patients were audited. 35% (n = 241) of the patients were prescribed antimicrobials. The total number of antimicrobial prescriptions was 326, and 46% (n = 190) of antimicrobial prescriptions were under general medicine and geratology. The most common indications for antimicrobials were respiratory 27% (n = 87) followed by intra-abdominal infection 11% (n = 37), sepsis and bacteraemia 11% (n = 37), urinary tract infection 10% (n = 34) and skin and soft tissue infection 8% (n = 25). The most prescribed agent was co-amoxiclav 34% (n = 111). Compliance with guidelines was achieved in 84% (n = 273) of prescriptions, and 72% (n = 236) were deemed appropriate. Inappropriate prescriptions were more prevalent for co-amoxiclav (38%) and ceftriaxone (43%) compared with amoxicillin (6%) and doxycycline (8%) (Figure 1). The most common reasons for inappropriate prescription were incorrect (prolonged) duration (44%) and spectrum too broad (28%).

Conclusions
Using NAPS, we identified that general medicine and geratology are the major users of antimicrobials, and pneumonia is the leading indication for prescribing. Co-amoxiclav is the main antibiotic prescribed, and appropriateness of this and other antibiotics, such as ceftriaxone, are below the 90% target. Consequently, targeted AMS efforts can be designed. PPS results are feedback to the respective teams and have been used in teaching sessions to encourage teams to take ownership of their data and influence prescribing patterns. We have found NAPS to be user friendly and reliable. Reports are produced immediately on completion of the survey to allow timely feedback. We would recommend NAPS as a useful tool in performing PPS and as a potential way to benchmark NHS trusts.
Narrowing the gap: expected versus deployment performance
Authors: Zhou Alice X , Aczon Melissa D , Laksana Eugene , Ledbetter David R , Wetzel Randall C 
Published: June 2023

Abstract

Objectives
Successful model development requires both an accurate a priori understanding of future performance and high performance on deployment. Optimistic estimations of model performance that are unrealized in real-world clinical settings can contribute to nonuse of predictive models. This study used 2 tasks, predicting ICU mortality and Bi-Level Positive Airway Pressure failure, to quantify: (1) how well internal test performances derived from different methods of partitioning data into development and test sets estimate future deployment performance of Recurrent Neural Network models and (2) the effects of including older data in the training set on models’ performance.

Materials and Methods
The cohort consisted of patients admitted between 2010 and 2020 to the Pediatric Intensive Care Unit of a large quaternary children’s hospital. 2010–2018 data were partitioned into different development and test sets to measure internal test performance. Deployable models were trained on 2010–2018 data and assessed on 2019–2020 data, which was conceptualized to represent a real-world deployment scenario. Optimism, defined as the overestimation of the deployed performance by internal test performance, was measured. Performances of deployable models were also compared with each other to quantify the effect of including older data during training.

Results, Discussion, and Conclusion
Longitudinal partitioning methods, where models are tested on newer data than the development set, yielded the least optimism. Including older years in the training dataset did not degrade deployable model performance. Using all available data for model development fully leveraged longitudinal partitioning by measuring year-to-year performance.
Medicaid expansion and racial disparity in timely multidisciplinary treatment in muscle invasive bladder cancer
Authors: Jiang Changchuan , Perimbeti Stuthi , Deng Lei , Xing Jiazhang , Chatta Gurkamal S , Han Xuesong , Gopalakrishnan Dharmesh 
Published: June 2023

Abstract

Background
Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer (MIBC), a potentially curable illness. Medicaid expansion through Affordable Care Act (ACA) increased insurance coverage especially among patients of racial minorities. This study aims to investigate the association between Medicaid expansion and racial disparity in timely treatment in MIBC.

Methods
This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis.

Results
The study included 4991 (92.3% White, n = 4605; 7.7% Black, n = 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black–White patient disparity in timely receipt of MIBC treatment (95% confidence interval = 0.5% to 26.8%; P &lt; .01).

Conclusions
Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
Optimizing machine learning methods to discover strong gravitational lenses in the deep lens survey
Authors: Keerthi Vasan G C , Sheng Stephen , Jones Tucker , Choi Chi Po , Sharpnack James 
Published: June 2023

ABSTRACT
Machine learning models can greatly improve the search for strong gravitational lenses in imaging surveys by reducing the amount of human inspection required. In this work, we test the performance of supervised, semi-supervised, and unsupervised learning algorithms trained with the ResNetV2 neural network architecture on their ability to efficiently find strong gravitational lenses in the Deep Lens Survey (DLS). We use galaxy images from the survey, combined with simulated lensed sources, as labeled data in our training data sets. We find that models using semi-supervised learning along with data augmentations (transformations applied to an image during training, e.g. rotation) and Generative Adversarial Network (GAN) generated images yield the best performance. They offer 5 – 10 times better precision across all recall values compared to supervised algorithms. Applying the best performing models to the full 20 deg2 DLS survey, we find 3 Grade-A lens candidates within the top 17 image predictions from the model. This increases to 9 Grade-A and 13 Grade-B candidates when 1 per cent (∼2500 images) of the model predictions are visually inspected. This is ≳ 10 × the sky density of lens candidates compared to current shallower wide-area surveys (such as the Dark Energy Survey), indicating a trove of lenses awaiting discovery in upcoming deeper all-sky surveys. These results suggest that pipelines tasked with finding strong lens systems can be highly efficient, minimizing human effort. We additionally report spectroscopic confirmation of the lensing nature of two Grade-A candidates identified by our model, further validating our methods.
Probing the delay time of supermassive black hole binary mergers with gravitational waves
Authors: Fang Yun , Yang Huan 
Published: June 2023

ABSTRACT
Merging supermassive black hole binaries are expected as a consequence of galaxy mergers, yet the detailed evolution path and underlying merging mechanisms of these binaries are still subject to large theoretical uncertainties. In this work, we propose to combine the (future) gravitational wave measurements of supermassive black hole binary merger events with the galaxy merger rate distributions from galaxy surveys/cosmological simulations, to infer the delay time of binary mergers, as a function of binary mass. The delay time encodes key information about binary evolution, which can be used to test the predictions of various evolution models. With a Mock data set of supermassive black hole binary merger events, we discuss how to infer the distribution of delay time with hierarchical Bayesian inference and test evolution models with the Bayesian model selection method. The astrophysical model uncertainties are also considered in the hierarchical Bayesian inference and Bayesian model selection.
Accretion in the binary system GG Carinae and implications for B[e] supergiants
Authors: Kashi Amit 
Published: June 2023

ABSTRACT
We simulate the hydrodynamics of the wind flow in the B[e] supergiant binary system GG Carinae and obtain the mass accretion rate on to the secondary and the observed light curve. We find an inhomogeneous Bondi–Hoyle–Lyttleton accretion into a curved accretion tail, and confirm that the accretion rate is modulated along the orbit, with a maximum close to periastron. We show that the accretion itself cannot account for the periodical variation in brightness. Instead, we explain the observed variation in the light curve with absorption by the accretion tail. Our results are in general agreement with previously derived stellar masses, orbital parameters, and the system orientation, but imply that the B[e] supergiant is more luminous. We find an effect related to the orbital motion of the two stars, in which the accretion tail is cut by the primary, and we term it the Lizard Autotomy Effect. As part of the effect, the primary is self accreting wind that it ejected earlier. The Lizard Autotomy Effect creates an outwardly expanding spiral shell made up of broken segments. We suggest that such a tail exists in other B[e] supergiant systems and can be the source of the circumstellar material observed in such systems. The accretion also forms a disc around the secondary near periastron that later vanishes. We suggest that the formation of such a disc can launch jets that account for the bipolar structure observed around some B[e] supergiants.
Topological data analysis reveals differences between simulated galaxies and dark matter haloes
Authors: Ouellette Aaron , Holder Gilbert , Kerman Ely 
Published: June 2023

ABSTRACT
We use topological summaries based on Betti curves to characterize the large-scale spatial distribution of simulated dark matter haloes and galaxies. Using the IllustrisTNG and CAMELS-SAM simulations, we show that the topology of the galaxy distribution is significantly different from the topology of the dark matter halo distribution. Further, there are significant differences between the distributions of star-forming and quiescent galaxies. These topological differences are broadly consistent across all simulations, while at the same time there are noticeable differences when comparing between different models. Finally, using the CAMELS-SAM simulations, we show that the topology of the quiescent galaxies, in particular, depends strongly on the amount of supernova feedback. These results suggest that topological summary statistics could be used to help better understand the processes of galaxy formation and evolution.
The cosmic web in Lyman-alpha emission
Authors: Byrohl Chris , Nelson Dylan 
Published: June 2023

ABSTRACT
We develop a comprehensive theoretical model for Lyman-alpha (Ly α) emission, from the scale of individual Ly α emitters (LAEs) to Ly α haloes (LAHs), Ly α blobs (LABs), and Ly α filaments (LAFs) of the diffuse cosmic web itself. To do so, we post-process the high-resolution TNG50 cosmological magnetohydrodynamical simulation with a Monte Carlo radiative transfer method to capture the resonant scattering process of Ly α photons. We build an emission model incorporating recombinations and collisions in diffuse gas, including radiative effects from nearby AGN, as well as emission sourced by stellar populations. Our treatment includes a physically motivated dust model, which we empirically calibrate to the observed LAE luminosity function. We then focus on the observability and physical origin of the z = 2 Ly α cosmic web, studying the dominant emission mechanisms and spatial origins. We find that diffuse Ly α filaments are, in fact, illuminated by photons that originate not only from the intergalactic medium itself but also from within galaxies and their gaseous haloes. In our model, this emission is primarily sourced by intermediate mass haloes (1010–1011 M⊙), principally due to collisional excitations in their circumgalactic media as well as central, young stellar populations. Observationally, we make predictions for the abundance, area, linear size, and embedded halo/emitter populations within filaments. Adopting an isophotal surface brightness threshold of 10−20 erg s−1 cm−2 arcsec−2, we predict a volume abundance of Ly α filaments of ∼10−3 cMpc−3 for lengths above 400 pkpc. Given sufficiently large survey footprints, detection of the Ly α cosmic web is within reach of modern integral field spectrographs, including MUSE, VIRUS, and KCWI.
#2640 SINGLE TUBULE RNASEQ FROM GITLEMAN SYNDROME MICE REVEALING MAGNESIUM HANDLING IN DISTAL RENAL TUBULES
Authors: Sung Chih-Chien , Hsu Yu-Juei , Lin Chien-Ming , Lin Shih-Hua 
Published: June 2023

Abstract

Background and Aims
Gitelman syndrome (GS) is characterized by salt-losing hypotension, hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria caused by a specific mutation in the thiazide-sensitive sodium chloride co-transporter (NCC) gene SLC12A3. However, magnesium (Mg2+) associated gene in the distal renal tubules remains unclear.

Method
We performed small samples RNA-seq from manual microdissection of distal convoluted tubules (DCT1s) in nonsense Ncc Ser707X (S707X) homozygous knockin mice (NccS707X/S707X mice) (n = 4) and wild-type (WT, n = 4). Cortical thick ascending limbs of Henle (cTALs), connecting tubule (CNT), cortical collecting duct (CCD) were also microdissected.

Results
Among DCT makers, Slc12a3 (NCC) and Pvalb (Parabumin) were significantly downregulated (Log2TPMS707X/WT: −4.45, P = 0.0003; −6.888258295, P = 0.0003, respectively). Mg2+ transporters of Trpm6 gene expression were significantly downregulated. In addition, Egf and Cnnm2 have been reported to increase TRPM6 trafficking or activity, were also decreased in DCT segment. Rack1 was also decreased in DCT1. Claudins including Cldn10, Cldn16, and Cldn19, involving paracellularly reabsorption of Ca2+and Mg2+, were not changed in cTALs. All findings indicate chronic hypokalemia may mediate DCT1 remodeling and affect development.

Conclusion
Our small samples RNA-Seq from dissected DCT highlight the possible molecular pathway of hypomagnesemia in GS. Chronic hypokalemia caused by inactivation of Slc12A3 gene may affect the DCT development causing loss of Mg2+ associated transporters.
#3973 EXCELLENT EFFICACY AND BENEFICIAL SAFETY DURING FIVE YEAR FOLLOW-UP OF RAPID STEROID WITHDRAWAL AFTER RENAL TRANSPLANTATION (HARMONY STUDY)
Authors: Stumpf Julian , Thomusch Oliver , Opgenoorth Mirian , Wiesener Michael , Pascher Andreas , Woitas Rainer , Suwelack Barbara , Rentsch Markus , Witzke Oliver , Rath Thomas , Banas Bernhard , Benck Urs , Sommerer Claudia , Kurschat Christine , Lopau Kai , Weinmann-Menke Julia , Jänigen Bernd , Trips Evelyn , Hugo Christian 
Published: June 2023

Abstract

Background and Aims
We previously reported excellent efficacy and improved safety aspects of rapid steroid withdrawal in the randomized controlled one year “Harmony” trial with 587 predominantly deceased-donor kidney transplant recipients randomized either to basiliximab or rabbit antithymocyte globulin induction therapy and compared to standard immunosuppressive therapy consisting of basiliximab, low tacrolimus once daily, mycophenolate mofetil, and corticosteroids. The five-year post-trial follow-up (FU) data reported here were obtained in an observational manner to evaluate, how these excellent short-term surrogate parameters will translate into hard long-term outcome parameters like patient death/graft loss.

Method
The five-year post-trial follow-up data were obtained in an observational manner at a three and a five-year visit for patients who consented to participate and covered clinical events that occurred from the second year onwards.

Results
Biopsy-proven acute rejection and death-censored graft loss rates remained low and independent of rapid steroid withdrawal (see Figure 1). Rapid steroid withdrawal was an independent positive factor for patient survival (adjusted hazard ratio 0.554, 95 % confidence interval 0.314 to 0.976; p = 0.041, see Table 1). The reduced incidence of post-transplantation diabetes mellitus in rapid steroid withdrawal patients during the original one-year study period was not compensated by later incidences during follow-up. Incidences of other important outcome parameters such as opportunistic infections, malignancies, cardiovascular morbidity/risk factors, donor specific antibody formation, or kidney function did not differ during follow-up period.

Conclusion
The Harmony follow-up trial confirms excellent efficacy and beneficial safety aspects of rapid steroid withdrawal under modern immunosuppressive therapy demonstrating for the first time increased patient survival in an immunologically low-risk, elderly population of Caucasian kidney transplant recipients.