bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative efficacy of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia in intensive care units: A systematic review and network meta‐analysis
Authors: Yang Li , Zhang Qin , Zhai Huaixiang 
Published: October 2022

AbstractBackgroundVentilator‐associated pneumonia is a common type of hospital‐acquired infection in critically ill patients. The implementation of effective oral care with chlorhexidine is known to be an effective intervention to prevent ventilator‐associated pneumonia. Nonetheless, no well‐supported evidence exists yet to rank the efficacy of various concentrations of chlorhexidine.AimTo compare the efficacy of different concentrations of chlorhexidine (0.12%, 0.20% and 2.0%) for prevention of ventilator‐associated pneumonia.Study DesignElectronic databases, as well as bibliographies, were systematically searched to find relevant studies published in English from inception until January 1, 2022. We included randomized controlled trials of mechanically ventilated adult patients in intensive care settings comparing at least two of the following treatments: 0.12% chlorhexidine, 0.2% chlorhexidine, 2.0% chlorhexidine, or placebo. The selected outcome was the incidence of ventilator‐associated pneumonia. A frequentist network meta‐analysis was performed. We ranked the concentrations of chlorhexidine for the selected outcome by p score (estimate of the probability of being the best treatment).ResultsWe included 19 trials with 3183 participants, conducted across nine countries. The use of 2.0% chlorhexidine and 0.12% chlorhexidine decreased the risk of ventilator‐associated pneumonia compared with placebo (OR 0.46, 95% CI = 0.28–0.75; OR 0.49, 95% CI = 0.33–0.71, respectively), whereas the effect resulting from 0.02% chlorhexidine remains unclear (OR 0.78, 95% CI = 0.54–1.13). Our network meta‐analysis ranked the 2.0% concentration as the most beneficial for ventilator‐associated pneumonia prevention (p score: 0.92).ConclusionThe 2.0% chlorhexidine and the 0.12% chlorhexidine reduce the risk of ventilator‐associated pneumonia in mechanically ventilated patients. According to the results of our network meta‐analysis, 2.0% chlorhexidine seems more beneficial. Chlorhexidine needs to be further evaluated in large‐scale controlled trials.Relevance to clinical practiceIn patients in intensive care units, and within the inevitable limitations of a network meta‐analysis, this study proposes that 2.0% chlorhexidine is superior to other chlorhexidine concentrations in terms of preventing ventilator‐associated pneumonia.
A Nomogram to Predict Delirium after Hip Replacement in Elderly Patients with Femoral Neck Fractures
Authors: Li Bingbing , Ju Jiabao , Zhao Jiaying , Qin Ying , Zhang Yan 
Published: October 2022

ObjectivePostoperative delirium (POD) is a common complication, and clinical practitioners have taken measures to improve the quality of life after hip replacement surgery. We aim to establish a nomogram to predict POD in elderly patients with femoral neck fractures (FNFs) after hip replacement.MethodsA total of 384 elderly patients (267 females) with an average age of 75.8 years who underwent hip replacement from June 2010 to May 2020 were retrospectively reviewed. Patients were divided into delirium and non‐delirium groups according to the confusion assessment method. The risk factors for POD were analyzed by multivariate logistic regression, and the nomogram was established based on the results.ResultsThe incidence of POD was 33.33% (128/384). Univariate analysis showed that advanced age, diabetes, lacunar cerebral infarction, surgery type, intraoperative blood loss, electrolyte imbalance, and anemia were risk factors for POD (p < 0.05). Multivariate logistic regression revealed that the independent risk factors for POD were age (OR = 1.332, 95% CI [1.224, 1.449], p < 0.01), surgery type (OR = 0.351, 95% CI [0.137, 0.900], p = 0.029), electrolyte imbalance (OR = 4.407, 95% CI [1.947, 9.977], p< 0.01), anemia (OR = 10.819, 95% CI [4.573, 25.598], p < 0.01). The prediction equation was established; logistic (p) = −25.469 + 0.277*X1(age[value = years of age]) + 1.293*X2(surgery[value = 0 for “total hip replacement” or value = 1 for “hemiarthroplasty”]) + 1.510*X3(electrolyte imbalance[value = 0 for “no” or value = 1 for “yes”]) + 2.157*X4(anemia[value = 1 for “hemoglobin with < 120g/L in male and < 110g/L in female patients” ]) or 2.975*X5(anemia[value = 1 for “hemoglobin with <90g/L"]). The area under the curve was 0.957 (95% CI [0.938, 0.976], p < 0.01).ConclusionThe incidence of POD in elderly patients with FNF after hip replacement is high. The nomogram incorporating age, surgery type, electrolyte imbalance, and anemia could provide an individualized prediction for POD among FNF patients after hip replacement, which may help the physician determine appropriate perioperative management.
Early maladaptive schemas and ICD‐11 CPTSD symptoms: Treatment considerations
Authors: Greenblatt‐Kimron Lee , Karatzias Thanos , Yonatan Maya , Shoham Adi , Hyland Philip , Ben‐Ezra Menachem , Shevlin Mark 
Published: October 2022

AbstractObjectivesEarly maladaptive schemas (EMS) can result from adverse interpersonal traumatic experiences. The ICD‐11 updated the concept of disorders following traumatic experiences with the new disorder of complex post‐traumatic stress disorder (CPTSD). There is now a need to develop and test interventions for CPTSD. An essential step in identifying interventions that are particularly relevant to the treatment of CPTSD is to explore psychological constructs associated more closely with CPTSD compared to PTSD. The current study explored the associations of EMS with PTSD and CPTSD.DesignThe sample consisted of 603 adults (mean age = 41.65, SD = 13.8), recruited through social media and e‐mails, and who responded to an online questionnaire.MethodsParticipants completed measures of demographic, traumatic life events, EMS, PTSD and CPTSD symptoms.ResultsOverall, results suggest that participants with CPTSD present with higher schema elevations across all schemas compared to those with PTSD or no diagnosis. Secondly, the schemas of emotional deprivation, abandonment/instability, social isolation/alienation, defectiveness/shame, enmeshment/undeveloped self, subjugation, emotional inhibition and insufficient self‐control/self‐discipline were significantly associated with the symptom clusters of CPTSD. Finally, results indicate that different schemas form significant associations with the individual symptom clusters of CPTSD.ConclusionsAlthough results require replication in clinical samples, initial findings suggest that specific EMS may be important psychological correlates of CPTSD symptoms. Wider treatment considerations of these findings are discussed.
Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan
Authors: Tsuchihashi Tomoya , Kakimoto Nobuyuki , Kitano Naomi , Suenaga Tomohiro , Ikeda Kazuyuki , Izui Masafumi , Kobayashi Naho , Yoshimura Ken , Nakamura Yoshikazu , Suzuki Hiroyuki ,   the steering committee of the Society of Kinki Area Kawasaki Disease Research
Published: October 2022

AbstractBackgroundThe treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to the Z‐score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD.MethodsThe 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according to Z‐score, treatment by KD treatment stage, and predictors of CAAs.ResultsThe response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based on Z‐scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second‐line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third‐line treatment. A pretreatment maximum coronary artery Z‐score of ≥1.9 and age <1 year were associated with significantly higher incidences of CAAs.ConclusionsUsing the Z‐score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary artery Z‐score of ≥1.9 and age <1 year are useful predictors of CAAs.
Association analysis of PLIN2 gene polymorphisms and lambing performance in Qianbei Ma goats
Authors: Huang Jiajin , Chen Xiang , Dai Lingang , Xu Jiali , Xiao Meimei , Ruan Yong 
Published: October 2022

AbstractQianbei Ma goats are one of the three most valued local goat breeds in Guizhou, China; furthermore, it has lower litter size performance. The purpose of this study was to explore the correlation between SNP (single‐nucleotide polymorphisms) of PLIN2 gene and lambing performance. The bioinformatics analysis, DNA sequencing, RT‐qPCR and correlation analysis methods were used to analyse the evolutionary relationship of PLIN2 protein in 13 species, to detect the expression pattern of PLIN2 gene in the gonad axis of Qianbei sheep, to explore the dominant genotype of PLIN2 related to lambing traits and to screen molecular markers related to lambing performance to guide the breeding of Qianbei Ma goats. Results showed that the Qianbei Ma goat PLIN2 protein had the closest genetic relationship with sheep and the furthest from mice, there were significant or extremely significant differences in the expression levels of the PLIN2 gene in the gonadal axis of the mothers of single‐ and multi‐lamb groups. Compared with the reference sequence, four SNPs were found, which were g.1006 C → A and g.1171 A → G in the first and second intron regions of the PLIN2 gene, g.8514 C → T in the exon 8 region and g.9122 A → T in the 3′UTR. The correlation analysis showed that g.1006 C → A, g.8514 C → T and g.9122 A → T had significant indigenous effects on the lambing performance of Qianbei Ma goats (p < .05). The number of third births for diploid H2H5 was significantly higher than that of diploid H1H2, and the number of first to third births for diploid H2H5 was large and stable. The results showed that PLIN2 gene could be used as a candidate gene related to lambing traits of Qianbei Ma goat.
Policy beliefs, policy learning, and risk perception: Exploring the formation of local creative Placemaking‐catalyzed policy network
Authors: Guo Wen 
Published: October 2022

AbstractThis article studies the formation of a local Creative Placemaking (CPM) policy network based on the Advocacy Coalition Framework (ACF) and social capital perspective of policy networks. This article hypothesizes that policy beliefs, policy learning, social capital, and the perceived risks induced by defections, as well as macro‐level changes in the broader political and socio‐economic system, influence partner selection in the local CPM policy networks. The study collected survey data from policy actors participating in the Franklinton CPM‐catalyzed revitalization project in Columbus, Ohio. An exponential random graph model (ERGM) was applied to test the hypotheses. The findings partially support the hypotheses: policy learning, certain secondary policy beliefs, and risk perceptions of changes in economic and political factors are correlated with tie formation. The reciprocity‐driven bonding structure underlies the Franklinton CPM policy network, suggesting that policy actors perceive the Franklinton CPM policy network as a high‐defection‐risk network. This study has implications for policy makers in designing engagement strategies to better involve stakeholders holding different beliefs and occupying different network positions.
Non-parametric Calibration of Multiple Related Radiocarbon Determinations and their Calendar Age Summarisation
Authors: Heaton Timothy J. 
Published: October 2022

AbstractDue to fluctuations in past radiocarbon (14C) levels, calibration is required to convert 14C determinations Xi into calendar ages θi. In many studies, we wish to calibrate a set of related samples taken from the same site or context, which have calendar ages drawn from the same shared, but unknown, density f(θ). Calibration of X1,…,Xn can be improved significantly by incorporating the knowledge that the samples are related. Furthermore, summary estimates of the underlying shared f(θ) can provide valuable information on changes in population size/activity over time. Most current approaches require a parametric specification for f(θ) which is often not appropriate. We develop a rigorous non-parametric Bayesian approach using a Dirichlet process mixture model, with slice sampling to address the multi-modality typical within 14C calibration. Our approach simultaneously calibrates the set of 14C determinations and provides a predictive estimate for the underlying calendar age of a future sample. We show, in a simulation study, the improvement in calendar age estimation when jointly calibrating related samples using our approach, compared with calibration of each 14C determination independently. We also illustrate the use of the predictive calendar age estimate to provide insight on activity levels over time using three real-life case studies.
Experiences of romantic relationships among early adults who do not turn to their long‐term partner when in need of love and support
Authors: Järdmo Caroline , Frisén Ann , Wängqvist Maria 
Published: October 2022

As most early adults in long‐term romantic relationships rely on their partner to fulfill their relational needs, relationships with romantic partners are very important to many people at this time of life. However, there is a group of individuals for whom their long‐term partner is not the most important person when they need love and support. This study explored experiences of romantic relationships among early adults who do not turn to their long‐term partner to meet these needs. Twelve individuals in early adulthood (Mage = 33.3 years; SD = 0.54) were selected from a larger community sample (N = 124) based on their answers on a questionnaire about who they turn to when in need of love and support. A thematic analysis of their answers in interviews about romantic relationships resulted in three main themes: Distancing attitudes toward romantic relationships, Desirable aspects of romantic relationships, and Not thinking about romantic relationships. The results show that these early adults' reflections on romantic relationships were characterized by ambivalence, striving toward independence, and relating to their partner as a person to have fun with rather than someone to share a deep connection with. Participants also expressed disagreement with what they perceived as norms concerning romantic relationships. Taken together, this study illustrates that the experiences of early adults who do not turn to their long‐term partner to meet needs of love and support are characterized by a complex interaction between contradictory feelings, values, and behaviors.
Current state of antimicrobial stewardship in solid organ transplantation in Israel
Authors: Hoffman Tomer , Atamna Alaa , Katchman Eugene , Orenbuch‐Harroch Efrat , Nesher Lior , Bitterman Roni , Yahav Dafna , Nutman Amir 
Published: October 2022

AbstractBackgroundWe aimed to review the current state, challenges, and needs of antimicrobial stewardship programs (ASPs) in adult solid organ transplantation (SOT) centers in Israel.MethodsWe conducted a survey using electronic questionnaires sent during February 2022 to infectious disease (ID) consultants of SOT centers, encompassing general and organ‐specific ASP issues.ResultsAll six centers performing adult SOTs in Israel participated. The institutional ASPs in all centers included SOT recipients, and five centers had specific stewardship activities targeting SOT recipients. ASP activities were performed by ID consultants in all centers, with clinical pharmacists in most. ASP protocols and activity scope were highly variable. Formulary restriction with pre‐authorization was used in all centers. Antibiotic allergy was addressed in ASP guidelines in half of the centers. Peri‐transplantation antibiotic, antifungal, and antiviral prophylactic regimens varied based on center, transplanted organ, and patient risk group. Approaches to surveillance cultures, diagnosis and treatment of various graft infections were also variable. ASP outcome measurement was not performed in all centers. The main challenges and barriers to successful ASP implementation were difficulty in defining appropriate durations of therapy for certain infections, high rates of antimicrobial resistance (AMR), and lack of dedicated ASP teams.ConclusionAntimicrobial stewardship in SOT centers in Israel is performed by ID consultants and practices vary. Challenges are related to high AMR rates, insufficient evidence to support practices, lack of dedicated ASP teams, and lack of outcome measurement. There is an urgent need to establish a national collaborative program including all SOT centers.
Antifungal stewardship in solid‐organ transplantation: What is needed?
Authors: Whitney Laura , Armstrong‐James Darius , Lyster Haifa S. , Reed Anna K. , Dunning John , Nwankwo Lisa , Cheong Jamie 
Published: October 2022

AbstractBackgroundAntifungal stewardship (AFS) lags behind antimicrobial stewardship (AMS) in terms of implementation, evidence base, and workforce experience. Solid‐organ transplantation (SOT) carries a significant risk of invasive fungal infection, with high associated mortality, and is therefore associated with significant opportunities to optimize antifungal use.MethodsA literature search for the terms “antifungal stewardship” and “solid‐organ transplant” revealed a small evidence base to support AFS programs in this patient group.ResultsThere is significant overlap in the methodology used in AMS and AFS programs, with notable differences in diagnostics, which are discussed in detail. The primary AFS interventions tested in SOT recipients are implementation of clinical guidelines and care bundles, digital enablers of AFS, and post‐prescription review/audit and feedback.ConclusionThere is an urgent need for further research to support effective AFS strategies in this highly susceptible population.
Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients
Authors: Imlay Hannah , Spellberg Brad 
Published: October 2022

AbstractBackgroundProlonged antibiotics are associated with toxicity, selection for resistant organisms, and secondary infections such as Clostridioides difficile colitis. Emerging clinical data suggest that short courses of antibiotics can be used for common bacterial infections among immune competent patients, but for many randomized controlled trials (RCTs), immunocompromised patients, including solid organ transplant recipients (SOTRs), have been excluded.MethodsPeer‐reviewed publications were identified through PubMed and Embase searches.ResultsWe review data examining shorter antibiotic courses among immunocompetent and immunocompromised patients and the rationale for use of short antibiotic courses in SOTRs.ConclusionThere are known harms associated with antibiotics and, when studied, existing data do not demonstrate harm associated with shorter courses of antibiotics among SOTRs. Furthermore, several RCTs did include some immune compromised patients and found shorter therapy to result in similar clinical efficacy with diminished adverse effects. Shorter antibiotic durations should be considered in SOTRs, and questions of antibiotic duration among SOTRs should be prioritized for study in clinical trials.
An Australian perspective on antimicrobial stewardship programs and transplantation
Authors: Stewart Adam G. , Isler Burcu , Paterson David L. 
Published: October 2022

AbstractBackgroundOver 1000 solid‐organ and close to 2000 stem‐cell transplants are performed annually in Australia.MethodsAntimicrobial stewardship activities in transplant units in Australia were reviewed.ResultsAll health service organizations, and thus all transplant centers, in Australia are required to have an antimicrobial stewardship program. Despite this, in one recent survey, 23.5% of hospital antibiotic prescriptions were inappropriate. Vigorous efforts are being made to implement antifungal stewardship in Australian transplant programs, with guidelines for implementation published in December 2021. These guidelines include therapeutic antifungal drug monitoring and diagnostic stewardship as it pertains to the investigation of suspected invasive fungal infections.ConclusionsInfections with multidrug resistant pathogens and invasive fungi are sporadic issues in Australian transplant units, but stewardship efforts can optimize patient outcomes.
Rapid molecular testing for antimicrobial stewardship and solid organ transplantation
Authors: Vega Ana D. , Abbo Lilian M. 
Published: October 2022

AbstractBackgroundSeveral molecular platforms now exist for early detection of infectious pathogens. In this review, we present the currently available literature summarizing clinical outcomes using rapid diagnostic tests (RDTs) in the solid organ transplant (SOT) population. We also present potential benefits and drawbacks of these technologies for SOT patients.MethodsWe completed a PubMed search querying for 31 specific RDTs AND (“SOT”). We also queried PubMed for studies on RDT outcomes in the general population. References of the resulting relevant studies were reviewed and incorporated if the study population included at least one SOT patient. All culture specimen types were included. Only full‐text peer‐reviewed publications in English were examined.ResultsOur search yielded eleven studies. Across these studies, integrating RDTs with ASP intervention led to faster species identification and susceptibility results, faster time‐to‐optimal therapy, decreased hospital length‐of‐stay and costs, and decreased mortality. Potential drawbacks of RDTs in the SOT population included: overdiagnosis due to increased sensitivity (i.e., Clostridium difficile), decreased yield of tests for respiratory pathogens, and lack of identification of important pathogens in this population such as, Aspergillus species.ConclusionsAlthough there is a scarcity of studies involving SOT patients, current available data suggests that the use of RDTs helps improve patient outcomes and minimizes inappropriate antimicrobial use when coupled with proactive ASPs. Future studies should focus on clinical outcomes in SOT patients specifically, as well as how to optimize the use of RDTs in conjunction with traditional microbiology methods.