bluuebunny/crossref_metadata_2025_split huggingface dataset:
P17 Vancomycin therapeutic drug monitoring—a call for change?
Authors: Payne Lara , Buckingham Christian J. , Wade Paul , Brown Aisling F. 
Published: February 2022

Abstract

Objectives
Despite the widespread use of vancomycin, optimization of dosing can be difficult. Increased vancomycin concentrations are associated with nephrotoxicity, while subtherapeutic levels may lead to inadequate antibacterial therapy and risk development of antimicrobial resistance. Recent guidelines have recommended the use of loading doses and switching to AUC24 TDM, targeting an AUC24:MIC ratio of 400–600 μg·h/mL to minimize toxicity while maintaining similar effectiveness for the treatment of serious infections. We aimed to review adherence to current local vancomycin dosing and conventional trough monitoring guidelines, as well as record time to, and factors related to, achieving target vancomycin troughs.

Methods
Fifty consecutive electronic prescriptions were screened for IV vancomycin use in treatment of active infections in a single acute Trust during April/May 2021. These were cross-referenced with microbiological, clinical and biochemical data from patient records. Variables were analysed by parametric or non-parametric methods on the basis of their normality distribution using GraphPad Prism.

Results
Forty-one patients were included of which 39 had a vancomycin level measured. Mean age was 57 years (range 19–88) and BMI 28 (range 17–44). Nineteen had unstable renal function, including one receiving intermittent haemodialysis. Median CLCR was 95  mL/min (IQR 66–129). Indications were included on the prescription for 26. Median duration of vancomycin was 4 days (range 2–12), and half of patients ultimately switched therapy to an alternate agent . Target troughs were documented in 29 (70%), 9 of which had a target trough ≥15 μg/mL. Twenty-four had positive microbiology samples, 19 of which were organisms against which vancomycin would have expected activity. Five (13%) failed to achieve trough levels &gt;10, 6/39 (15%) achieved troughs of 10–15, 13/39 (33%) 15–20, and 15/39 (38%) had troughs of &gt;20 μg/mL (Figure 1). Where it was achieved, the median time to level ≥10 μg/mL was 46 h (range 11–202) and time to level ≥15 μg/mL was 68 h (range 18–243). Twenty-five (60%) patients required titration above the currently recommended initial dose, and 22 required doses of 1500 mg twice daily or higher. BMI did not correlate with vancomycin level achieved.

Conclusions
A significant proportion of patients with serious infections fail to achieve or have a considerable delay in achieving therapeutic vancomycin trough. An even greater proportion have troughs above target and are at risk of nephrotoxicity. These findings support a potential switch to more personalized regimens using loading doses and AUC24 monitoring where vancomycin is the drug of choice. This would complement other stewardship measures to limit overall vancomycin use, achieve earlier and more complete source control, and optimize use of alternative antimicrobial therapies with more predictable PK/PD.
P21 An assessment of knowledge and hand hygiene practices among healthcare workers at Dodoma Regional Referral hospital
Authors: Venant Erick , Ndesendo Valence , Wiedenmayer Karin , Ombaka Eva M. A. 
Published: February 2022

Abstract

Introduction
The WHO-promoted ‘My 5 moments for hand hygiene’ is designed to prevent the spread of infectious organisms in healthcare settings which occurs mostly via contaminated hands of healthcare workers (HCWs), items/equipment and the environment. Information on its implementation in Tanzania is needed.

Objectives
The main objective of the study was to assess knowledge, availability, and access to facilities for hand hygiene and the adherence to the WHO's five moments of hand hygiene by healthcare workers at Dodoma Regional Referral Hospital. The bacterial content of cell phones of HCWs was assessed as a source of microbial contamination.

Methods
This was a descriptive cross-sectional study. Three sets of data were collected through (i) questionnaires to assess knowledge, attitudes, and barriers to effective hand hygiene; (ii) observation to assess the adherence of five moments of hand hygiene; and (iii) laboratory examination of cell phones for bacterial contamination. Analysis used Statistical Package for Social Science (SPSS).

Results
Over 75% of HCWs had formal training on hand hygiene and had access to handwashing facilities, but only 63% were aware of the WHO five moments. Of 270 doctors, nurses, and healthcare students only 7 (2.6%) complied with expected action with no difference between groups. No hand hygiene was observed after touching cell phones. Thirty-four percent of sampled cell phones were contaminated with staphylococci species, which were resistant to penicillin and had varying resistance to erythromycin, clindamycin and gentamicin.

Conclusions
Hand hygiene is the most effective way to reduce the risk of healthcare-associated infections. However, many healthcare workers do not adhere to recommended hand hygiene despite training and the availability of handwashing facilities. The low practice of hand hygiene means that cell phones of healthcare workers can easily act as a reservoir of transmissible organisms. The use of cell phones as a source of contamination must be included in the interventional training of HCW.
P28 Indications for central venous line access for treating infections and the appropriateness of the antimicrobial therapy: a clinical audit
Authors: Tin Kimberly Chong Shea , Shorten Robert John 
Published: February 2022

Abstract

Introduction
Central venous access devices (CVADs) are used to deliver medications, including antibiotics. CVAD requests should be monitored closely due to the risks associated with insertion and the potential complications of venous thromboembolism and line-associated bloodstream infections. Inappropriate antibiotic use is associated with side effects, including healthcare-associated infections such as Clostridioides difficile infection and the emergence of antimicrobial resistance (AMR).

Methods
An audit was performed to investigate the appropriateness of requests for CVAD insertion and the antimicrobials prescribed. In total, 52 patient records were analysed over a 1 month period.

Results
There was good evidence of infection requiring IV antibiotics in 49/52 cases. Antibiotic selection was in line with guidelines in 71.4% of cases, and the vast majority of the exceptions had been discussed with a microbiologist. Good compliance was seen with guidelines for requesting CVAD access, but poor online documentation meant that it was not possible to confirm this in all cases.

Conclusions
Despite some minor anomalies detected in this small patient size, there was an overall prominent demonstration of proficiency in clinical judgement by the central venous access team and microbiology team. The CVAD requests made by the clinical teams had definite indications and were predominantly appropriate. This highlights the importance of a multidisciplinary approach, particularly the microbiologist, when considering antimicrobial therapy via CVAD, in view of the risks associated with antibiotic misuse. In addition, patients undergoing CVAD placement should be closely monitored, and thus online record-keeping and documentation should be better improved to ensure quality healthcare practice and patient safety.
P45 Antimicrobial activity of ruthenium-based metallo-therapeutics against Pseudomonas aeruginosa
Authors: Britten Nicole S. , Butler Jonathan A. 
Published: February 2022

Abstract

Background
Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that is highly resistant to antibiotics and biocidal products used in both medical and industrial environments respectively. Metal-based compounds have been used as antimicrobial agents throughout history for a broad range of applications. More recently, it has been shown that ruthenium (Ru)-based compounds have potent antimicrobial properties and, in contrast to traditional antibiotics, these are thought to elicit antibacterial activity at multiple sites within the bacterial cell, which will undoubtedly reduce the possibility of resistance evolution.

Methods
MIC and MBC assays coupled with disc diffusion assays were used to screen a library of Ru-based compounds.

Results
One lead compound was identified that was highly active at inhibiting growth of multiple strains of P. aeruginosa at ≤32 mg/L. Crystal violet biofilm assays were performed, which showed a decrease in biomass following exposure over a 24 h period. Scanning electron microscopy was used to reveal morphological changes in the bacterial cell ultrastructure when exposed to the Ru-based compound, with evidence of membrane perturbation that supported a proposed mechanism of antimicrobial activity.

Conclusions
These findings make a significant contribution towards the search for novel bactericidal agents and further research is now focused on determining the potential for use as novel adjuvants within medicinal applications such as wound care management.
In an Era of Enhanced Cybersecurity: The Effect of Disclosing a Third Party’s Role in Confidentiality Pledges on Response Propensity
Authors: Redline Cleo , Tuttle Alfred D 
Published: February 2022

Abstract
Federal surveys often pledge that personally identifiable information (PII) will be used for statistical purposes only and that the willful disclosure of PII by employees who have been sworn to confidentiality is subject to penalties. In 2015, the passing of the Cybersecurity Enhancement Act required the Department of Homeland Security (DHS) to monitor federal computers for cyber threats. Since DHS personnel are not bound to the confidentiality pledges used by the statistical agencies, the question became how to inform respondents about these changes without alarming them and harming response rates. This paper reports on an experiment conducted in a survey of public-school principals with a simple random sample (n = 4,122). The experiment examined differences in response rates across three versions of pledges disclosing the cybersecurity monitor: one pledge specified explicitly the role of DHS, one referred to the monitors as “Federal employees and contractors,” and a control version referred implicitly to DHS monitors via a legal citation. Half of the pledges included the penalty language, and the other half did not. There were no statistically significant differences between any of the experimental comparisons. We conclude that, of the pledges studied, the DHS version of the pledge with penalty language provides respondents with the most accurate information for deciding whether to participate in the survey without harming response rates.
Sex Differences in Susceptibility to Coccidioidomycosis
Authors: McHardy Ian , Reagan Krystle L , Sebastian Jamie F , Barker Bridget , Bays Derek J , Dandekar Satya , Cohen Stuart H , Jennings Kathleen E , Sykes Jane , Thompson George R 
Published: February 2022

Abstract
To assess sex-specific differences in coccidioidomycosis, a retrospective analysis of human patients, nonhuman primates, and veterinary patients (including the neutered status of the animal) was performed. We found higher rates of infection and severity in males. This observed increased infection risk suggests deeper biological underpinnings than solely occupational/exposure risks.
Defining the Deficit
Authors: Salomone Rosemary 
Published: February 2022

Abstract
This chapter examines the “foreign language deficit” in the United States. It begins with the failure of the government to address the problem beyond isolated programs and intermittent “calls to action” in response to crises. It considers the country’s history as a “settler nation” and its conflicted views on language in attempting to preserve a national identity in the face of successive waves of newcomers. It looks at declining numbers in foreign language programs and enrollments from elementary school through university while recognizing the rising popularity of Korean as a culturally driven phenomenon and the growing interest in streaming foreign language media. It uncovers concerns that affect access and opportunity tied to social capital and systemic exclusion. The chapter notes the potential of students from immigrant families who could meet the demand for bilingual service providers in immigrant communities. It further underscores the risks of monolingualism to foreign diplomacy.
Suspending the Hustle
Authors: Ticona Julia 
Published: February 2022

Abstract
Chapter 4 compares how high- and low-wage workers both used and refused to use their digital technologies in strategies to resist work. While both groups of workers talked about digital technologies in their efforts to resist work and carve out spaces of autonomy for themselves, they did so in very different ways, depending on the forms of managerial control they faced. Low-wage workers resisted direct control over their bodies and attention by diving into their phones to create a kind of absent presence. By contrast, high-wage workers refused to use their digital technologies to limit their affective commitment to jobs that demanded their devotion. However, this chapter also explores how these strategies weren’t available to all workers in the same ways. This chapter explains how race, sexuality, and gender constrained workers’ strategies to use their digital technologies to resist work.
Christianity, Scripture, and “Reading” the World, from Augustine to Bishop Berkeley
Authors: Cassedy Steven 
Published: February 2022

Abstract
To get to the idea that we can find meanings not just in conventional signifying objects (words, stories) but in the world and hence envision a “book of nature,” we need to reimagine signification itself. This chapter examines how, beginning with St. Augustine, Christian thinkers proposed various schemes for seeking and discovering meanings in nature just as we do in Holy Scripture. This is because, as Augustine explains, signs are things that “point beyond themselves,” and natural objects can function as signs. Accepting that natural signs point beyond themselves to something else requires accepting a form of idealism according to which there are truths and qualities that dwell in a realm removed from that of direct experience. The “book of nature” conceit was temporarily brought to an end by the Protestant Reformation and the rise of modern science—the former through the motto “sola scriptura” (by Scripture alone), which pushed readers to seek fixed meanings in the holy texts, and the latter through its insistence that natural objects possess not metaphysical meanings but only empirically discoverable properties. Then the “book of nature” conceit returned in the work of George Berkeley (1685–1753) and his philosophy of immaterialism, according to which we lack all direct perceptual access to objects in the world, and so those supposed objects are equivalent to the “meanings” that lie behind our perceptions.
Two Russian Titans Weigh In
Authors: Cassedy Steven 
Published: February 2022

Abstract
This chapter examines the contribution that two Russian literary greats, Lev Tolstoy and Fedor Dostoevsky, made to the evolution of meaning in its metaphysical senses. The Russian word commonly translated as “meaning” is smysl and is connected through its etymological root with thought and thus carries such sub-definitions as “comprehension,” “sense” (the sense of a word), “reason,” and, of course, “meaning.” Smysl zhizni (the meaning of life) and smysl by itself appear in Tolstoy’s writings innumerable times. Smysl appears to have a range of senses: “meaning,” “aim,” “goal,” “purpose.” In the author’s two lengthy novels, it represents the end of a personal quest, but an end that is elusive, as neither the hero of War and Peace nor the hero of Anna Karenina truly uncovers the “meaning” he seeks. Dostoevsky turned his attention to “the meaning of life” relatively late in life, when he came to associate it with what he regarded as an epidemic of suicide in his homeland: young people take their lives upon losing “the highest meaning of life,” which he equated with belief in the immortality of the soul. And yet “the meaning of life” takes on an odd resonance in Dostoevsky’s writing, where it serves as a kind of bridge phrase, whose ambiguity allows skeptics and believers to refer to a religious concept that the former reject and the latter embrace.
Julius Caesar in Britain
Authors: Hingley Richard 
Published: February 2022

Abstract
This chapter is an exploration of the two campaigns led by the great Roman commander in 55 and 54 bce. Caesar left a vitally important account of his invasions of south-eastern Britain which provides information about his campaigns and addresses the Iron Age peoples of Britain. Significant archaeological discoveries have supplemented, and often challenged, this narrative. These include the recent discovery of Caesar’s probable landing site from his second campaign (at Ebbsfleet, Kent) and the uncovering of a high-status Iron Age warrior burial at North Bersted (West Sussex). Caesar brought around 20,000 soldiers to Britain during his second campaign and forced the surrender of several of the kings of south-eastern Britain, including a great warrior named Cassivellaunus, who attempted to unite the opposition to Rome. Caesar described the martial valour of the Britons he fought, including their use of slingshots and chariots. Departing from Britain to return to Gaul, he took hostages and slaves, imposing a tribute on the kings of Britain. Commius was a Gallic ally of Caesar who assisted him during his invasions of Britain and eventually appears to have settled to rule over a people living to the south of the Thames. He was the first of a series of friendly kings established by Roman rulers in Britain. The North Bersted warrior may have been a member of a retinue of cavalry soldiers who accompanied Commius to Britain after Caesar had withdrawn.
Subduing Ocean
Authors: Hingley Richard 
Published: February 2022

Abstract
When the emperor Claudius succeeded Caligula, he needed a significant victory to secure his rule and he chose to invade Britain. Claudius instructed the commander Aulus Plautius to lead the initial invasion in 43 and arrived in person to lead the campaign after the collapse of the main opposition. He arrived at the oppidum of Camulodunum in time to receive the submission of several British kings and then returned to Rome to receive a victory. Southern Britain was conquered by Plautius within four years, building on the establishment of six friendly kingdoms. The friendly rulers, including Togidubnus, Cartimandua, and Prasutagus (the partner of Boudica), enabled Rome to direct its military might against the peoples of the south who did not immediately surrender. The future emperor Vespasian played a significant role in these campaigns. After Plautius was replaced as provincial governor by Ostorius Scapula in 47, Roman attention turned to the conquest of Wales, which was to take many decades, as the result of sustained resistance from the Iron Age peoples, including the Silures. Even the defeat and capture of Caratacus, widely famed for his resistance, during the ninth year of the conquest (51) did not defeat the resistance, which continued for another three decades. When Claudius died in 54, the conquest of Britain, portrayed as the subduing of Ocean, was viewed as the most important achievement of his reign.
Rebellion
Authors: Hingley Richard 
Published: February 2022

Abstract
The initial years of the emperor Nero’s reign witnessed the expansion of Roman territory in Britain, as campaigns extended the province into south-western, western, and central Britain. One notable event was a marital dispute between the friendly queen Cartimandua of the Brigantes and her husband, Venutius. Roman troops marched to the north to defend her from the uprising against her rule. The provincial governor, Suetonius Paulinus, was campaigning in north-west Wales to conquer the island of Anglesey in 60 when a serious uprising broke out in eastern Britain as Boudica led the Iceni and the Trinovantes in an attempt to drive the Romans out of Britain. The Britons burnt the newly established colony at Camulodunum and its temple of Claudius and then turned their ire on the populations of the newly established port town of London and the pro-Roman oppidum at Verulamium. For a while it looked as if Rome might have to withdraw from Britain, although Paulinus won a significant battle against far larger numbers of Britons, and Boudica died. Not all the Britons turned against Rome, and the support of the friendly king Togidubnus was a vital factor in Rome’s recovery of the province. Paulinus embarked on severe retribution against the Britons who had rebelled and had to be replaced by a governor who followed a more diplomatic path. By the time Nero committed suicide in Rome in 68, southern Britain was again fully under Roman control.
Introduction: High Expectations
Authors: Shneiderman Ben 
Published: February 2022

Abstract
This book proposes a new synthesis in which AI-based intelligent algorithms are combined with human-centered thinking to make HCAI. This approach will increase the chance that technology will empower rather than replace people. In the past, researchers and developers focused on building AI algorithms and systems, stressing machine autonomy and measuring algorithm performance. The new synthesis gives equal attention to human users and other stakeholders by raising the value of user experience design and by measuring human performance. Researchers and developers for HCAI systems value meaningful human control, putting people first by serving human values such as rights, justice, and dignity, and supporting goals such as self-efficacy, creativity, responsibility, and social connections.
Defining Reliable, Safe, and Trustworthy Systems
Authors: Shneiderman Ben 
Published: February 2022

Abstract
While machine autonomy remains a popular goal, the goal of human autonomy should remain equally strong in designers’ minds. Machine and human autonomy are both valuable in certain contexts, but a combined strategy uses automation when it is reliable and human control when it is necessary. To guide design improvements it will be helpful to focus on the attributes that make HCAI systems reliable, safe, and trustworthy. Designers of reliable, safe, and trustworthy systems will also promote resilience, clarify responsibility, increase quality, and encourage creativity. Still broader goals are to ensure privacy, increase cybersecurity, support social justice, and protect the environment.
Design Guidelines and Examples
Authors: Shneiderman Ben 
Published: February 2022

Abstract
Successful designs are comprehensible, predictable, and controllable, thereby increasing the users’ self-efficacy, leading to reliable, safe, and trustworthy systems. These successes require careful design of the fine structure of interaction, which emerges from validated theories, clear principles, and actionable guidelines. In turn, this knowledge becomes easy to apply when it is embedded in programming tools that favor human control. The examples clarify the key ideas of supporting users to express their intent through visual interfaces (although auditory and haptic interfaces are also valuable in many situations and for users with disabilities). These designs give users informative feedback about the machine state, with progress indicators and completion reports, thereby giving users meaningful control.