bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous cyclosporine a infusion in patients with severe Kawasaki disease
Authors: Seki Mitsuru , Minami Takaomi , Suzuki Shun , Furui Sadahiro , Oka Kensuke , Yokomizo Akiko , Matsubara Daisuke , Sato Tomoyuki , Yamagata Takanori 
Published: October 2022

AbstractBackgroundThe efficacy and safety of continuous intravenous infusion of cyclosporine A (CICsA) in patients with intravenous immunoglobulin‐resistant Kawasaki disease are unclear.MethodsBetween 2010 and 2020, 83 patients with Kawasaki disease that was not responsive to intravenous immunoglobulin (total dose ≥ 4 g/kg) were enrolled. All patients were started on CICsA (3 mg/kg/day) and switched to oral cyclosporine A (CsA) (4–6 mg/kg/day). Treatment efficacy, occurrence of coronary artery lesions (CALs), and laboratory parameters were evaluated. Patients were divided into two groups according to CICsA response: the responder group (afebrile ≤24 h after CICsA without additional treatment) and the weak responder group (afebrile >24 h after CICsA requiring additional treatment).ResultsFifty‐five patients became afebrile within 24 and 74 h became afebrile in less than 72 h. Adverse events included hypertension in four and hyperkalemia in two patients. Thirty‐nine patients were defined as responders and 44 patients as weak responders. There were no significant differences in CAL between the two groups. In weak responders, white blood cells, neutrophils, and C‐reactive protein levels were higher, and albumin, immunoglobulin G, and CsA concentration were lower than in responders, indicating that weak responders had more severe inflammatory findings. However, there were no significant differences in CAL. Logistic regression analysis revealed that the response to treatment for CICsA was associated with immunoglobulin G levels at baseline and CsA concentrations the day after CICsA.ConclusionAlthough CICsA required additional treatments in about half of the cases, a favorable clinical course was observed by using this strategy, especially for reducing CAL.
Sparse Temporal Disaggregation
Authors: Mosley Luke , Eckley Idris A. , Gibberd Alex 
Published: October 2022

AbstractTemporal disaggregation is a method commonly used in official statistics to enable high-frequency estimates of key economic indicators, such as gross domestic product (GDP). Traditionally, such methods have relied on only a couple of high-frequency indicator series to produce estimates. However, the prevalence of large, and increasing, volumes of administrative and alternative data-sources motivates the need for such methods to be adapted for high-dimensional settings. In this article, we propose a novel sparse temporal-disaggregation procedure and contrast this with the classical Chow–Lin method. We demonstrate the performance of our proposed method through simulation study, highlighting various advantages realised. We also explore its application to disaggregation of UK GDP data, demonstrating the method's ability to operate when the number of potential indicators is greater than the number of low-frequency observations.
Current state of antimicrobial stewardship and organ transplantation in Thailand
Authors: Chotiprasitsakul Darunee , Bruminhent Jackrapong , Watcharananan Siriorn P. 
Published: October 2022

AbstractBackgroundAntimicrobial stewardship (AMS) is a coherent set of actions to optimize antimicrobial use, improve patient outcomes, and reduce antimicrobial resistance (AMR). Thailand's national strategic plan has included AMS since 2017. Due to an increased risk of infection and AMR, solid organ transplant (SOT) recipients can benefit from antimicrobial stewardship programs (ASPs). However, the AMS in SOT has not been well defined. Balancing ASPs with the need for early and frequent antimicrobial treatment in this population is challenging. This review assesses the barriers and potential strategies of AMS in SOT in the setting of Thailand.MethodsWe used PubMed to identify published articles on AMS in organ transplantation in Thailand from January 2013 to January 2022. We also searched local literature and local data from Google Scholar and Google. Finally, we described the AMS experience at Ramathibodi hospital as a proxy for transplant centers in Thailand.ResultsThere was no specific article on AMS in SOT in Thailand. At our hospital, ASPs have been part of the hospital's routine patient care, including the practice in the transplant unit. Modifiable challenges to AMS in SOT include prescriber opposition, diagnosis uncertainty, and lack of high quality. Both systems and individualized approaches should be implemented to overcome these barriers. The potential interventions include shortening antibiotic time‐out, updating clinical guidelines, continuing education, handshake ASP, adopting new technology, and further research.ConclusionsThere are limited data on AMS in organ transplantation in Thailand. Strategic priorities should focus on modifiable barriers tailored to organ transplantation. Quality improvement should be ensured by process and outcome measures.
Dissemination and implementation science and antimicrobial stewardship in solid organ transplantation: A perspective
Authors: Burnham Jason P. , Kwon Jennie H. , Newland Jason G. , McKay Virginia R. 
Published: October 2022

AbstractBackgroundRecipients of solid organ transplants (SOTs) have unique risks for infections, but providers are often hesitant to apply the principles of antimicrobial stewardship to this patient population due to perceived excess risk. The methods of implementation science may move the field forward to simultaneously improve patient outcomes and patient safety.MethodsPerspective piece on implementation science in SOT patients.ResultsHerein, we provide explanation of implementation science as it relates to SOT patients. In addition, we provide examples of how implementation science can be applied to antimicrobial stewardship in SOT patients.ConclusionImplementation science may offer insights and solutions to the challenges of implementing evidence‐based antimicrobial stewardship interventions in patients with SOT, including uptake of new practices and the de‐implementation of outdated or low‐value practices.
Effects of reported beta‐lactam allergies on pneumonia outcomes in lung transplant recipients
Authors: Motzer Andrew R. , Holaday Eric , Axelrod Peter , Mishkin Aaron 
Published: October 2022

AbstractBackgroundThe effects of reported beta‐lactam allergies on clinical outcomes have been understudied in lung transplant recipients. We evaluated reported beta‐lactam allergies on clinical outcomes in this population.MethodsA single‐center retrospective cohort analysis was performed. One hundred and nine lung transplant recipients were identified and screened for a diagnosis of pneumonia. This cohort was divided into those with a reported beta‐lactam allergy and those without a beta‐lactam allergy. Antibiotic use was compared between groups. We also compared several clinical metrics, including rates of readmission, mortality, Clostridium difficile infection (CDI), allograft dysfunction, and isolation of carbapenem or fluoroquinolone non‐susceptible organisms after treatment.ResultsOf the 109 lung transplant recipients, 18 (16.5%) were identified as having a reported beta‐lactam allergy. Patients with a beta‐lactam allergy label (BLAL) were found to have decreased utilization of beta‐lactams (p < .001) and a trend toward increased use of carbapenems (p = .062) and aztreonam (p = .080). BLAL patients were found to have higher rates of CDI (p = .049) but were not found to have increased readmissions, mortality, allograft dysfunction, or isolation of carbapenem or fluoroquinolone non‐susceptible organisms. Patients without a BLAL were found to have higher rates of acute kidney injury (AKI) (p = .035).ConclusionsLung transplant recipients with BLAL are more likely to develop CDI, possibly due to increased use of carbapenems. We also found that patients without beta‐lactam allergy were more likely to develop AKI. A multicenter study with a larger sample size might clarify the individual contributions of mutually confounding clinical parameters.
Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation
Authors: Kinn Patrick Michael , Ince Dilek 
Published: October 2022

AbstractBackgroundThe consequences of inappropriate antimicrobial use including resistance are increasingly recognized as a global public health threat and many steps have been taken over the last few decades to advance antimicrobial stewardship initiatives with most organ transplant centers currently part of institutions with active antimicrobial stewardship programs.MethodsA review of the literature was conducted and articles were categorized according to the topic and relevance in the judgment of the two authors.ResultsA summary review of the currently available literature was created with a focus on periprocedural and outpatient antimicrobial stewardship. Limitations in the data were significant and discussed in the review.ConclusionThe principles of antimicrobial stewardship remain important throughout all phases starting with periprocedural prophylactic antimicrobial selection all the way through to discharge and subsequent healthcare encounters. Despite the broad advances in stewardship initiatives and the rapidly progressing supportive data overall there continue to be significant opportunities for additional research within various special patient populations including recipients of solid organ transplantation (SOT). The recent white paper published in the American Journal of Transplantation called to action the transplant and stewardship communities to have an increased focus and awareness of the issues that antimicrobial overuse can present in the SOT patient population. This is an important step that will hopefully generate more data in this group of patients that arguably faces the greatest vulnerability to the consequences of increased antimicrobial resistance.
Computing antimicrobial use/antimicrobial resistance ratios: A novel way to assess inpatient antimicrobial utilization using current National Healthcare Safety Network metrics
Authors: Santos Carlos A. Q. , Martinez Ashley I. , Won Sarah Y. , Varughese Christy A. , Tseng Marion , Zhang Huiyuan , Trick William E. 
Published: October 2022

ABSTRACTBackgroundCurrent methods for benchmarking inpatient antimicrobial use (AU) could benefit from combining AU with antimicrobial resistance (AR) information to provide metrics benchmarked to microbiological data; this may yield more instructive and better risk‐adjusted measurements than AU and AR in isolation.MethodsIn this retrospective single‐center study, we computed facility‐wide AU/AR ratios from 2019 to 2020 for specific antimicrobial agents and corresponding AR events, and compared median monthly AU/AR ratios between March 2019 through December 2019 (pre‐COVID period) and March 2020 through December 2020 (COVID period). Aggregate AU was expressed as a ratio to aggregate AR events for antimicrobials that typically have activity against the AR organism and are frequently used to treat the AR organism in clinical practice. We also computed AU/AR ratios in our surgical intensive care unit in the pre‐COVID period.ResultsHigh‐median facility‐wide monthly AU/AR ratios were observed for intravenous vancomycin/methicillin‐resistant Staphylococcus aureus, with 130.0 in the pre‐COVID period and 121.3 in the COVID period (p =.520). Decreases in facility‐wide median monthly AU/AR ratios were observed between periods for meropenem/ESBL Enterobacterales (20.9 vs. 7.9, p < .001), linezolid/vancomycin‐resistant Enterococcus (48.5 vs. 15.8, p =.004), and daptomycin/vancomycin‐resistant Enterococcus (32.2 vs. 4.8, p = .002). Increases in facility‐wide median monthly AU/AR ratios were observed between periods for ceftazidime‐avibactam/carbapenem‐resistant Enterobacterales (0.0 vs. 3.2, p = .020) and ceftazidime‐avibactam/multidrug‐resistant Pseudomonas aeruginosa (0.0 vs. 4.0, p = .017). The AU/AR ratio for intravenous vancomycin/methicillin‐resistant S. aureus in the surgical intensive care unit was 191.5 in the pre‐COVID period.ConclusionsAU/AR ratios may be used to supplement current AU and AR metrics. Future directions should include the development of more AU metrics benchmarked to microbiological information. AU metrics more specific to transplant infectious diseases should be developed.
Japan perspective on antimicrobial stewardship and solid organ transplantation
Authors: Kitaura Satoshi , Jindai Kazuaki , Okamoto Koh 
Published: October 2022

AbstractBackgroundThe current situation, challenges, and opportunities related to antimicrobial stewardship for solid organ transplantations (SOTs) patients in Japan are not well known.MethodsWe searched English and Japanese literature using Pubmed and Ichushi‐Web (the Japanese medical literature search system provided by the Japan Medical Abstract Society) with relevant keywords including solid organ transplant, antimicrobial stewardship, and Japan. Hand searches of the references from the retrieved literature, including conference proceedings of The Japanese Association for Infectious Diseases, were conducted.ResultsThe Japanese National Action Plan for antimicrobial resistance has brought attention to the importance of antimicrobial stewardship programs (ASPs) in Japan. According to national surveillance, the proportion of methicillin resistance among Staphylococcus aureus was 48%, while the proportion of vancomycin‐resistance among Enterococcus faecium was 1.5% in 2019. Resistance against imipenem in Escherichia coli and Klebsiella pneumoniae in 2019 were 0.1% and 0.2%, respectively. Exploration of SOT‐specific data on antimicrobial usage and drug resistance are warranted. A large questionnaire survey revealed a low proportion of hospitals with >500 beds implementing ASP toward immunocompromised patients. While the annual number of SOT in Japan has increased, the implementation of SOT‐specific ASP varies among institutions.ConclusionA coordinated ASP and exploration of the burden of antimicrobial resistance are needed for SOT patients in Japan. Promoting both intrainstitutional and interinstitutional collaboration is vital to the advancement of SOT‐specific ASP in Japan.
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Could cell‐free DNA and host biomarkers assist in antimicrobial stewardship with organ transplant recipients?
Authors: Chang Sandy Y. , Santos Carlos A. Q. 
Published: October 2022

AbstractBackgroundAntimicrobial stewardship in solid organ transplant (SOT) recipients is important to prevent antimicrobial‐associated complications, but traditional stewardship principles are challenging to implement for SOT patients. Newer methodologies to optimize stewardship efforts are needed.MethodsPubMed was searched using the keywords “cell free DNA,” “metagenomic sequencing,” “host biomarker,” “antimicrobial stewardship,” and “SOT.”ResultsMetagenomic sequencing of cell free DNA has the potential to be a stewardship tool for SOT recipients. Various studies have shown its use for antimicrobial de‐escalation and duration shortening. Host gene expression profiles can differentiate between infectious and noninfectious syndromes and may assist in stewardship efforts. However, information in immunocompromised hosts is conflicting.ConclusionMicrobial cell free DNA sequencing and host gene expression profiling show promise as stewardship tools in SOT recipients. Future studies on antimicrobial stewardship in SOT recipients should focus on their clinical use and feasibility.
Inducible deletion of raptor and mTOR from adult skeletal muscle impairs muscle contractility and relaxation
Authors: Baraldo Martina , Zorzato Sabrina , Dondjang Achille Homère Tchampda , Geremia Alessia , Nogara Leonardo , Dumitras Ana Georgia , Canato Marta , Marcucci Lorenzo , Nolte Hendrik , Blaauw Bert 
Published: October 2022

AbstractSkeletal muscle weakness has been associated with different pathological conditions, including sarcopenia and muscular dystrophy, and is accompanied by altered mammalian target of rapamycin (mTOR) signalling. We wanted to elucidate the functional role of mTOR in muscle contractility. Most loss‐of‐function studies for mTOR signalling have used the drug rapamycin to inhibit some of the signalling downstream of mTOR. However, given that rapamycin does not inhibit all mTOR signalling completely, we generated a double knockout for mTOR and for the scaffold protein of mTORC1, raptor, in skeletal muscle. We found that double knockout in mice results in a more severe phenotype compared with deletion of raptor or mTOR alone. Indeed, these animals display muscle weakness, increased fibre denervation and a slower muscle relaxation following tetanic stimulation. This is accompanied by a shift towards slow‐twitch fibres and changes in the expression levels of calcium‐related genes, such as Serca1 and Casq1. Double knockout mice show a decrease in calcium decay kinetics after tetanus in vivo, suggestive of a reduced calcium reuptake. In addition, RNA sequencing analysis revealed that many downregulated genes, such as Tcap and Fhod3, are linked to sarcomere organization. These results suggest a key role for mTOR signalling in maintaining proper fibre relaxation in skeletal muscle.
imageKey points
Skeletal muscle wasting and weakness have been associated with different pathological conditions, including sarcopenia and muscular dystrophy, and are accompanied by altered mammalian target of rapamycin (mTOR) signalling.
Mammalian target of rapamycin plays a crucial role in the maintenance of muscle mass and functionality.
We found that the loss of both mTOR and raptor results in contractile abnormalities, with severe muscle weakness and delayed relaxation following tetanic stimulation.
These results are associated with alterations in the expression of genes involved in sarcomere organization and calcium handling and with an impairment in calcium reuptake after contraction.
Taken together, these results provide a mechanistic insight into the role of mTOR in muscle contractility.
Dyno-Kinematic Leg Design for High Energy Robotic Locomotion
Authors: Austin Max , Brown Jason , Nicholson John , Clark Jonathan 
Published: October 2022

Abstract
Animal legs are capable of a tremendous breadth of distinct dynamic behaviors. As robots pursue this same degree of flexibility in their behavioral repertoire, the design of the power transition mechanism from joint to operational space (the leg) becomes increasingly significant given the limitations current actuator technology. To address the challenges of designing legs capable of meeting the competing requirements of various dynamic behaviors, this paper proposes a technique which prioritizes explicitly encoding a set of dynamics into a robot’s leg design, called dyno-kinematic leg design (DKLD). This paper also augments the design technique with a method of evaluating the suitability of an individual leg’s workspace to perform dynamic behaviors, called the effective dynamic workspace (EDW). These concepts are shown to effectively determine optimal leg designs within a set of three, increasingly complex, case studies on different robots. These new legs designs enable a 5 kg robot to climb vertical surfaces at 3 Hz, allow a 60 kg robot to efficiently perform a range of behaviors useful for navigation (including a run at 2 m/s), and endow a small quadrupedal robot with all of the necessary behaviors to produce running and climbing multimodality. This design methodology proves robust enough to determine advantageous legs for a diverse range of dynamic requirements, leg morphologies, and cost functions, therefore demonstrating its possible application to many legged robotic platforms.
Effect of Material Distribution in the Unit Cell on Effective Thermal Conductivity and Young's Modulus of Cellular Structure
Authors: Wagh Akshay , Deshmukh Sagar , Ramamoorthy Sripriya , Krishnan Shankar 
Published: October 2022

Abstract
Effective thermal conductivity and Young's modulus of periodic unit cell geometries are widely studied in the literature. This paper compares and contrasts strut-based unit cells against surface-based unit cells obtained by subtracting spheres from a solid cube. In order to understand the reason for the difference in the behavior of effective thermal conductivity of surface-based and strut-based unit cell geometries and the difference in the behavior of Young's modulus of surface-based and strut-based unit cell geometries, the effect of material distribution on effective thermal conductivity and Young's modulus is studied here. The material in the unit cell is varied in two ways, i.e., by changing the material distribution on the cell wall (partially closed unit cell) and changing the material distribution across the strut of unit cell geometry. It is found that the distribution of material on the wall of the unit cell improves the effective thermal conductivity and Young's modulus. In contrast, a narrow cross-section area in the unit cell reduces the effective thermal conductivity and Young's modulus. Using the studied effect of material distribution on effective thermal conductivity and Young's modulus, the reason for the difference in properties of surface-based and strut-based unit cell geometry is qualitatively explained. Partially closed unit cell geometries introduced here for studying the effect of material distribution on cell walls give a wide range of effective thermal conductivity and Young's modulus for the same porosity with a change in pore opening ratio.
Coupling of a Magnetic Field With Instability for Multimodal and Multistep Deformations of a Curved Beam With Asymmetric Magnetic Torque
Authors: Zou Bihui , Liang Zihe , Ju Jaehyung 
Published: October 2022

Abstract
A bistable curved beam with magnetic-torque-driven actuation has the potential for fast and untethered reconfiguration of metamaterials. However, there is currently no modeling method for a bistable curved beam for which the instability is coupled with an external magnetic field for the design of active metamaterials. The second-mode (S-shape) generation of a bistable curved beam is essential for a multimodal and multistep reconfiguration of metamaterials and has not yet been explored. Herein, we aim to construct an analytical model of the deformation of a bistable curved beam triggered by an external magnetic field, providing magnetic-torque-driven multimodal and multistep deformations. We also implement symmetric and asymmetric magnet arrangements to the model to enable variation of the external magnetic fields to identify the range of the magnetic field’s direction on the bistable and doubly curved transformations. Our instability model coupled with a magnetic field predicts multimodal and multistep deformations of bistable curved beams with magnetic torques triggered by the orientation and magnitude of the magnetic field. Our model reveals that (i) a bistable curved beam without prestressing and (ii) the asymmetric magnet arrangement design are favorable for generating an extensive range of the S-shape, which is significant for the design of multimodal transformation of metamaterials.