bluuebunny/crossref_metadata_2025_split huggingface dataset:
P20 Addition of a pharmacy technician to the ward team improves antimicrobial stewardship and patient care and safety
Authors: Rodger R , Coulter Jonathan , Thompson Sharon 
Published: June 2023

Abstract

Background
Antimicrobial stewardship (AS) is essential in reducing the risk of antimicrobial resistance (AMR).1,2 Prospective feedback of AS issues and adopting a multidisciplinary approach are beneficial to patient care and safety.3 Within the multidisciplinary team, antimicrobial pharmacy technician (AMPT) roles are evolving and offer an excellent opportunity to support everyday AS.4 Documenting antibiotic stop dates and allergy status on the prescribing chart and restricting broad spectrum antimicrobials to ‘protected’ status can improve AS by ensuring patients receive the correct antibiotic for the appropriate duration.5 In addition, management of common antibiotic drug interactions with cation products such as oral iron and enteral feeds is important in preventing treatment failure and AMR.6

Objectives
This study set out to determine if introduction of an AMPT to the multidisciplinary team can improve AS, patient care and safety and reduce AMR risk.

Methods
A quality improvement approach was used to introduce an AMPT ward service to the Royal Alexandra Hospital (RAH) over a period of 6 months. The service was developed, standardized, piloted and agreed. The AMPT visited medical, surgical and older people service wards daily and screened prescribing charts for the following: (i) documented allergy status, (ii) documented antibiotic stop/review dates, (iii) completion of ‘protected’ antimicrobial order forms, and (iv) management of antibiotic cation interactions. AS issues identified were shared prospectively with the ward team and data displayed on run charts to measure improvement.

Results
Following introduction of the AMPT service documentation of allergy status and oral antibiotic stop dates improved from baseline in all wards. IV antibiotic stop/review documentation increased in all downstream medical and surgical wards with the greatest improvement achieved in the respiratory ward, increasing from a 0% baseline to a median of 37% after service introduction. Awareness and management of antibiotic cation interactions increased from a 41% baseline to a median of 86% and total antibiotic doses compromised by this interaction reduced from 66% at baseline to 21% post change. Completion of ‘protected’ antimicrobial forms improved from a baseline median of 53% to a median of 85% after service introduction.

Conclusions
Introduction of an AMPT service resulted in improved documentation of allergy status, oral and IV antibiotic stop/review dates, recognition and management of antibiotic cation interactions and compliance with the local ‘protected’ antimicrobial policy. These results demonstrate that introduction of an AMPT to the ward team can improve AS, patient care and safety and reduce the risk of AMR.
Successful antibiotic stewardship in the electronic era
Authors: Kiapi Gloria , Gonzalez Laura , Woodard Sarah-Louise , Urch Jonathan 
Published: June 2023

Abstract
A multi-faceted antimicrobial stewardship programme contributed to a 17.8% reduction in antibiotic consumption for our English NHS Trust. This dramatic achievement could be partially attributed to an empirical antibiotic guideline change, introduction of procalcitonin testing to guide in antibiotic decisions in SARS-CoV-2 inpatients and use of electronic antibiotic stewardship strategies.
In this article, we describe the multifaceted, step-by-step antibiotic stewardship approach that weathered the SARS-CoV-2 pandemic and led to this dramatic improvement. Also included for completeness are interventions that did not pass the plan, do, study, act (PDSA) cycle and were therefore discontinued.
Compound organic acid could improve the growth performance, immunity and antioxidant properties, and intestinal health by altering the microbiota profile of weaned piglets
Authors: Li Zhiqing , Liu Shuhan , Zhao Yirun , Wang Jiayi , Ma Xiaokang 
Published: June 2023

Abstract
This study aimed to investigate the impact of compound organic acid (COA) and chlortetracycline (CTC) on serum biochemical parameters, intestinal health, and growth performance of weaned piglets. Twenty-four piglets (24 d of age) were randomly allocated into three treatments with eight replicate pens (one piglet per pen). Feed the basal diet or a diet containing 3,000 mg/kg COA or 75 mg/kg CTC, respectively. Results showed that both COA and CTC significantly increased average daily gain and reduced diarrhea rates (P &lt; 0.05). They also upregulated serum total antioxidant capacity and downregulated serum interleukin (IL-10) levels (P &lt; 0.05), increased crude protein digestibility and propionic acid concentration in the colon, and decreased spermidine and putrescine contents (P &lt; 0.05). Intestinal microbiota analysis revealed that both COA and CTC increased the Shannon and Chao1 index and decreased the relative abundance of Blautia and Roseburia, but increased the relative abundance of Clostridium-sensu-stricto-1. Correlation analysis indicated that Clostridium-sensu-stricto-1 may be closely related to inflammation levels and microbial metabolites in piglets. Based on the results, COA may be a potential substitute for CTC to reduce antibiotic use and biogenic amine emission while improving piglet growth and intestinal health.
Protective effects of genistein on the production performance and lipid metabolism disorders in laying hens with fatty liver hemorrhagic syndrome by activation of the GPER–AMPK signaling pathways
Authors: Li Longlong , Wang Yulei , Wang Huihui , Yang Ying , Ma Haitian 
Published: June 2023

Abstract
The aim of this study was to evaluate the beneficial effects and potential mechanisms of genistein (GEN) on production performance impairments and lipid metabolism disorders in laying hens fed a high-energy and low-protein (HELP) diet. A total of 120 Hy-line Brown laying hens were fed with the standard diet and HELP diet supplemented with 0, 50, 100, and 200 mg/kg GEN for 80 d. The results showed that the declines in laying rate (P &lt; 0.01), average egg weight (P &lt; 0.01), and egg yield (P &lt; 0.01), and the increase of the ratio of feed to egg (P &lt; 0.01) induced by HELP diet were markedly improved by 100 and 200 mg/kg of GEN treatment in laying hens (P &lt; 0.05). Moreover, the hepatic steatosis and increases of lipid contents (P &lt; 0.01) in serum and liver caused by HELP diet were significantly alleviated by treatment with 100 and 200 mg/kg of GEN in laying hens (P &lt; 0.05). The liver index and abdominal fat index of laying hens in the HELP group were higher than subjects in the control group (P &lt; 0.01), which were evidently attenuated by dietary 50 to 200 mg/kg of GEN supplementation (P &lt; 0.05). Dietary 100 and 200 mg/kg of GEN supplementation significantly reduced the upregulations of genes related to fatty acid transport and synthesis (P &lt; 0.01) but enhanced the downregulations of genes associated with fatty acid oxidation (P &lt; 0.01) caused by HELP in the liver of laying hens (P &lt; 0.05). Importantly, 100 and 200 mg/kg of GEN supplementation markedly increased G protein-coupled estrogen receptor (GPER) mRNA and protein expression levels and activated the AMP-activated protein kinase (AMPK) signaling pathway in the liver of laying hens fed a HELP diet (P &lt; 0.05). These data indicated that the protective effects of GEN against the decline of production performance and lipid metabolism disorders caused by HELP diet in laying hens may be related to the activation of the GPER–AMPK signaling pathways. These data not only provide compelling evidence for the protective effect of GEN against fatty liver hemorrhagic syndrome in laying hens but also provide the theoretical basis for GEN as an additive to alleviate metabolic disorders in poultry.
An adaptive marine predator algorithm based optimization method for hood lightweight design
Authors: Zhang Chenglin , He Zhicheng , Li Qiqi , Chen Yong , Chen Shaowei , Nie Xin 
Published: June 2023

Abstract
The lightweight design of the hood is crucial for the structural optimization of an entire vehicle. However, traditional high-fidelity-based lightweight methods are time-consuming due to the complex structures of the hood, and the lightweight results heavily rely on engineering experiences. To this end, an improved adaptive marine predator algorithm (AMPA) is proposed to solve this problem. Compared to the original marine predator algorithm (MPA), the proposed AMPA adapts to optimization problems through three enhancements, including chaotic theory-based initialization, a mixed search strategy, and dynamic partitioning of iteration phases. Experimental comparisons of AMPA, MPA, and eight state-of-the-art algorithms are conducted on IEEE CEC2017 benchmark functions. AMPA outperforms the others in both 30- and 50-dimensional experiments. Friedman and Wilcoxon’s sign-rank tests further confirm AMPA’s superiority and statistical significance. An implicit parametric model of the hood is generated, and the critical design variables are determined through global sensitivity analysis to realize hood lightweight. The stacking method is employed to construct a surrogate meta-model of the hood to accelerate the optimization efficiency of the vehicle hood. Utilizing the meta-model and the proposed AMPA, the hood mass is reduced by 7.43% while all six static and dynamic stiffness metrics are enhanced. The effectiveness of the proposed optimization method is validated through finite element analysis.
The Role of Children in Household Transmission of SARS-CoV-2 Across Four Waves of the Pandemic
Authors: Fuller Trevon L , Bastos Leonardo , Carvalho Marilia Sá , Resende Paola Cristina , Damasceno Luana , Cruz Oswaldo Gonçalves , Medeiros Fernando , Calvet Guilherme , Guaraldo Lusiele , Nielsen-Saines Karin , Whitworth James , Smith Christopher , Siqueira Marilda , Brasil Patrícia 
Published: June 2023

Abstract

Background
It is important to understand the dynamics of SARS-CoV-2 transmission in close-contact settings such as households. We hypothesized that children would most often acquire SARS-CoV-2 from a symptomatic adult caregiver.

Methods
This prospective cohort study was conducted from April 2020 to July 2022 in a low-resource, urban settlement in Brazil. We recruited families who brought their children to a public clinic. We collected nasopharyngeal and oral swabs from household members and tracked symptoms and vaccination.

Results
In total, 1256 participants in 298 households were tested for SARS-CoV-2. A total of 4073 RT–PCR tests were run with 893 SARS-CoV-2 positive results (21.9%). SARS-CoV-2 cases were defined as isolated cases (N = 158) or well-defined transmission events (N = 175). The risk of household transmission was lower if the index case was a child (OR: 0.3 [95% CI: 0.16–0.55], P &lt; .001) or was vaccinated (OR: 0.29 [95% CI: 0.1–0.85], P = .024), and higher if the index was symptomatic (OR: 2.53 [95% CI: 1.51–4.26], P &lt; .001). The secondary attack rate for child index cases to child contacts was 0.29, whereas the secondary attack rate for adult index cases to child contacts was 0.47 (P = .08).

Conclusions
In this community, children were significantly less infectious to their household contacts than adolescents or adults. Most children were infected by a symptomatic adult, usually their mother. There was a double benefit of vaccination as it protected the vaccine from severe illness and prevented onward transmission to household contacts. Our findings may also be valid for similar populations throughout Latin America.
From sodium-vapour to LEDs: how an outdoor lighting retrofit affects insects in Singapore
Authors: Coleman Joanna L , Lum Deon Wen Hao , Yao Xinyi 
Published: June 2023

Abstract
In the Anthropocene, the planet is warming and global biodiversity, including of insects, is being lost at an unprecedented rate. One largely urban sustainability solution, shifting to energy-efficient, light-emitting diode (LED) bulbs on outdoor lighting, has impacts on insects that are inadequately understood, especially in the tropics and brightly lit cities. Working in Singapore—a highly urbanised and light-polluted tropical city-state—we performed a field experiment to test the hypothesis that newly retrofitted LED lights are more attractive (i.e., detrimental) to insects compared to the high-pressure sodium (HPS) lamps they replace. Instead, our sticky traps, which we mounted on both light types, caught statistically equal numbers of arthropods (individuals and families). Traps on LED lamps also attracted proportionally fewer dipterans and more hemipterans and hymenopterans, but these effects were site-specific. Overall, we found no support for our hypothesis—our findings may reflect differential emissions of ultraviolet wavelengths by both light types and/or the possibility that urban insect assemblages with historic exposure to light pollution may not respond as expected to the retrofit. We caution against extrapolating findings from impact studies to untested contexts and highlight the need for (1) more studies in the rapidly urbanising tropics and (2) field tests of the effectiveness of measures to limit any negative ecological impacts of LED lighting, including other lethal and sublethal effects that we did not assess. We also discuss possible implications for ecosystem services and insect conservation.
A brown dwarf donor and an optically thin accretion disc with a complex stream impact region in the period-bouncer candidate BW Sculptoris
Authors: Neustroev Vitaly V , Mäntynen Iikka 
Published: June 2023

ABSTRACT
We present an analysis of multi-epoch spectroscopic and photometric observations of the WZ Sge-type dwarf nova BW Scl, a period-bouncer candidate. We detected multiple irradiation-induced emission lines from the donor star allowing the radial velocity variations to be measured with high accuracy. Also, using the absorption lines Mg ii 4481 Å and Ca ii K originated in the photosphere of the accreting white dwarf (WD), we measured the radial velocity semi-amplitude of the WD and its gravitational redshift. We find that the WD has a mass of 0.85 ± 0.04 M⊙, while the donor is a low-mass object with a mass of 0.051 ± 0.006 M⊙, well below the hydrogen-burning limit. Using NIR data, we put an upper limit on the effective temperature of the donor to be ≲1600 K, corresponding to a brown dwarf of T spectral type. The optically thin accretion disc in BW Scl has a very low luminosity ≲4 × 1030 erg s−1 which corresponds to a very low-mass accretion rate of ≲7 × 10−13 M⊙ yr−1. The outer parts of the disc have a low density allowing the stream to flow down to the inner disc regions. The brightest part of the hotspot is located close to the circularization radius of the disc. The hotspot is optically thick and has a complex elongated structure. Based on the measured system parameters, we discuss the evolutionary status of the system.
#3139 PREVALENCE OF INFECTIONS ASSOCIATED WITH THE HEMODIALYSIS CATHETER IN MEXICO CITY
Authors: Rodríguez Rosa María Zaragoza , Flores Jose Andres Santos , Zaragoza Aldo Antonio Moreno 
Published: June 2023

Abstract

Background and Aims
In hemodialysis, intravenous catheter is the most frequent vascular access to begin treatment in patients with chronic kidney disease. Infectious complications are a frequent adverse effect of the vascular access, they may cause vascular access retreat and serious diseases like septic shock, bacterial endocarditis, septic arthritis, venous thromboembolism and death (between 5 and 10%). Leading microorganisms of hemodialysis infection are Gram positive bacteria, while Gram negative are less common.

Method
Study type and design: Used a descriptive, retrospective, open, observational and analytical cross-sectional study. Sampling type: Non-probabilistic of consecutive cases. Population: Patients diagnosed with CKD 5 KDIGO on renal function replacement therapy with hemodialysis through a temporary or permanent catheter in a private kidney care unit in Mexico City from October 2014 to September 2022.

Results
We identified 168 cases of CRBSI throughout the 8 years of the study. We found a prevalence of 0.86% for every 100 hemodialysis and a cumulative incidence of 4.97% for every 100 hemodialysis. Leading etiology pathogens of CRBSI in the kidney care unit were Gram negative bacteria (76.8%), mainly Enterobacter cloacae (20.8%), Escherichia coli (13.7%), Stenotrophomonas maltophilia (11.9%) and Burkholderia cepacia (4.2%). We found that 51,8% of the Gram negative CRBSI were due to multiresistant bacteria, which led to 5 directly related deaths. On the other hand, Gram positive bacteria caused 23.2% of CRBSI. Staphylococcus aureus and Staphylococcus epidermidis were the most frequent with 8.9% and 8.3%, respectively, with no related deaths.

Conclusion
Unlike international literature, in our study, gram negative bacteria were the main agents of CRBSI. The prevalence of CRBSI in our study was high, however, infection directly related mortality remained low. These results led us to investigate the origin of the vascular access infection. In an attempt to reduce the number of CRBSI, we emphasized preventive measures, especially hand hygiene of healthcare professionals within the kidney care unit and with the patient's personal environment at home. We would like to recall that empirical therapy should be based on the results of the kidney care unit microbiology and antibiotic sensitivity, to reduce CRBSI episodes and bacterial resistance.
#3165 ASSOCIATION BETWEEN CKD-MBD AND MORTALITY IN OLDER PATIENTS WITH ADVANCED CKD – RESULTS FROM THE EQUAL STUDY
Authors: Magagnoli Lorenza , Cozzolino Mario Gennaro , Caskey Fergus , Evans Marie , Torino Claudia , Szymczak Maciej , Dekker Friedo W , Wanner Christoph , Chesnaye Nicholas , Jager Kitty J 
Published: June 2023

Abstract

Background and Aims
Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD) is a common complication of CKD, associated with higher mortality in dialysis patients. Its impact in non-dialysis patients remains mostly unknown. We investigate the associations between parathyroid hormone (PTH), phosphate, and calcium (and their interactions) and all-cause, cardiovascular (CV), and non-CV mortality in older non-dialysis patients with advanced CKD.

Method
We used data from the EQUAL study, which included patients aged ≥65 with eGFR ≤20 ml/min/1.73m2 from six European countries. Cox models were used to assess the association between baseline and time-dependent CKD-MBD biomarkers and all-cause, CV, and non-CV mortality. Models were sequentially adjusted for other mineral biomarkers, age, sex, country, eGFR, albumin, BMI, comorbidities and medications. Effect modification between biomarkers was also assessed.

Results
In 1294 patients, the prevalence of CKD-MBD at baseline was 94%. Both PTH (aHR 1.12, 95%CI 1.03-1.23, p 0.01) and phosphate (aHR 1.35, 95%CI 1.00-1.84, p 0.05), but not calcium (aHR 1.11, 95%CI 0.57-2.17, p 0.76), were associated with all-cause mortality. Calcium was not independently associated with mortality, but modified the effect of phosphate, with the highest mortality risk found in patients with both hypercalcemia and hyperphosphatemia. PTH level was associated with CV mortality, but not with non-CV mortality, whereas phosphate was associated with both CV and non-CV mortality.

Conclusion
CKD-MBD is very common in older non-dialysis patients with advanced CKD. PTH and phosphate are independently associated with all-cause mortality in this population. While PTH level is only associated with CV mortality, phosphate seems to be associated with both CV and non-CV mortality.
#3472 PRELIMINARY DATA FROM MOTHER HDX STUDY: A MULTICENTRE OPEN-LABEL RCT STUDY TO EXPLORE THE MORBIMORTALITY WITH THE THERANOVA HDX VS OL-HDF
Authors: Ortiz Patricia De Sequera , García Rafael Pérez , Vega Almudena , Maduell Francisco 
Published: June 2023

Abstract

Background and Aims
Dialysis patients have a high rate of cardiovascular morbidity and mortality. For this reason, new technical advances are necessary to be introduced in clinical practice. Medium cut-off (MCO) membranes are a new generation of membranes that allow the removal of a greater number of medium-sized molecules compared to high-flux hemodialysis (HF-HD) but retaining albumin. Theranova, a MCO membrane has an increased permeability and also produces high convective volume in the form of internal filtration. For these special properties, MCO generated a new concept of therapy called expanded HD (HDx). Until now, online hemodiafiltration (OL-HDF) has demonstrated its superiority, in terms of survival, compared to HF-HD. But the comparison between OL-HDF and HDx is a question not solved.

Method
The MOTheR HDx study trial (NCT03714386) is an open-label, multicentric, prospective, 1:1 randomized, parallel-group trial designed to evaluate the efficacy and safety of HDx compared to OL-HDF in incident HD patients in Spain for up to 36 months. The main endpoint is to determinate if HDx is non inferior to OL-HDF at reducing the combined outcome of all-cause dead and stroke (ischemic or hemorrhagic), acute coronary syndrome (angina and myocardial infarction), peripheral arterial disease (amputation or revascularization) and ischemic colitis (mesenteric thrombosis).

Results
Now we have enrolled 513 patients, 44 excluded and 469 were randomized. 229 were allocated to HDx and 240 to OL-HDF. No differences were found in neither baseline characteristics, hemodialysis or pharmacological treatment, nor laboratory parameters. Follow up time was similar in both groups: 15.06 (12.8) vs 13.73 (11.51) months [HR 0.84 (0.50-1.40)] without differences in mortality: 29 (12.7%) vs 31 (12.9%) [HR 0.89 (0.54-1.48)] in HDx and HDF respectively (Figure 1).

Conclusion
These preliminary results from Mother study support that HDx is not inferior to OL-HDF in reducing the all-cause mortality outcome.