bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital incidence and mortality of patients treated for AAA in Switzerland
Authors: Meuli L , Menges A-L , Steigmiller K , Kuehnl A , Reutersberg B , Held U , Zimmermann A 
Published: June 2022

Abstract

Objective
To analyse hospital incidence and in hospital mortality of patients treated for abdominal aortic aneurysms (AAA) in Switzerland.

Methods
Secondary data analysis of case-related hospital discharge data of the Swiss Federal Statistical Office for the years 2009–2018. Patients who were hospitalized and surgically treated for non-ruptured AAA (nrAAA) or hospitalized and treated for ruptured AAA (rAAA) were included in the analysis. Standardised incidences rates were calculated using the European standard population 2013. In-hospital mortality rates were calculated as raw values and standardized for age, sex, and the Elixhauser comorbidity score.

Results
A total of 10,728 patients were included in this study, of which 87.1% were male. 22.7% of the patients presented with rAAA, 46% of these patients were surgically treated whereas 54% patients received conservative therapy. The age standardized cumulative hospital incidence for treatment of nrAAA was 2.6 (95%-confidence interval: 2.5–2.8) and 19.7 (19.2–20.1) per 100,000 for women and men, respectively; for rAAA 0.4 (0.3–2.4) per 100,000 in women, and 2.7 (2.6–2.9) in men. The incidence rates were stable in the observed decade. The adjusted mortality rates for treatment of nrAAA decreased from 5.5% (2.6–11.2%) in 2009 to 1.4% (0.5–3.6%) in 2018 in women, and from 2.4% (1.3–4.5%) in 2009 to 0.6% (0.2–1.5%) in 2018 in men. The adjusted mortality rates for treatment of rAAA remained high without relevant improvements for both sexes over time; for women 32.4% (24.1–42.1%), for men 19.7% (16.8–22.8%).

Conclusion
The hospital incidence rates for nrAAA and rAAA remained unchanged in the observed decade. The incidence of rAAA is substantially higher than in comparable populations like Germany. Mortality rates in the elective setting are low and decreased in the last decade but remained high in patients treated for rAAA. Efforts to reduce the incidence of rAAA are needed to reduce aneurysm-related mortality in Switzerland.
Wing morphology covaries with migration distance in a highly aerial insectivorous songbird
Authors: Matyjasiak Piotr , López-Calderón Cosme , Ambrosini Roberto , Balbontín Javier , Costanzo Alessandra , Kiat Yosef , Romano Andrea , Rubolini Diego 
Published: June 2022

AbstractAccording to classical prediction of aerodynamic theory, birds and other powered fliers that migrate over long distances should have longer and more pointed wings than those that migrate less. However, the association between wing morphology and migratory behavior can be masked by contrasting selective pressures related to foraging behavior, habitat selection and predator avoidance, possibly at the cost of lower flight energetic efficiency. We studied the handwing morphology of Eurasian barn swallows Hirundo rustica from four populations representing a migration distance gradient. This species is an aerial insectivore, so it flies extensively while foraging, and may migrate during the day using a ‘fly-and-forage’ migration strategy. Prolonged foraging flights may reinforce the effects of migration distance on flight morphology. We found that two wings’ aerodynamic properties—isometric handwing length and pointedness, both favoring energetically efficient flight, were more pronounced in barn swallows from populations undertaking longer seasonal migrations compared to less migratory populations. Our result contrast with two recent interspecific comparative studies that either reported no relationship or reported a negative relationship between pointedness and the degree of migratory behavior in hirundines. Our results may thus contribute to confirming the universality of the rule that longer migrations are associated with more pointed wings.
Bend relief fenestration might prevent outflow graft obstruction in patients with left ventricular assist device
Authors: Färber Gloria , Kirov Hristo , Schwan Imke , Gräger Stephanie , Diab Mahmoud , Tkebuchava Sophie , Doenst Torsten 
Published: June 2022

Abstract

OBJECTIVES
Patients with left ventricular assist devices may experience external obstruction of the outflow graft through a gelatinous substance within the bend relief (BR; a stiff tube graft guiding the outflow graft). Preventative strategies have been missing. Having faced this problem, we decided to fenestrate the BR to avoid outflow graft obstruction (OGO).

METHODS
Since December 2010, 167 patients underwent left ventricular assist device implantation using HeartMate II or 3. BR fenestration was introduced on July 2018 (108 patients before, 59 after the introduction of BR fenestration). Follow-up computed tomography scans were obtained from all patients and were screened for OGO by 3 independent investigators. Results were correlated with log file history, echocardiographic and clinical outcomes.

RESULTS
Demographic data were comparable between groups, with mostly male patients. Patients with BR fenestration were older [63 (standard deviation (SD):10.6) vs 58 (SD: 10.7) years] and had shorter support duration [494 (SD: 383) vs 951 (SD: 875) days]. OGO was observed in 5 patients and occurred only in patients without fenestration. Importantly, it occurred late on postoperative Days 412, 462, 1043, 1184 and 1506. Three patients are still asymptomatic. Surgical revision was required in the other 2 patients for pump thrombosis or continuous low flow. One of them died 36 days after revision due to right heart failure.

CONCLUSIONS
Our results suggest that fenestration of the BR may be a preventative strategy to avoid external OGO. OGO occurred late, which suggests a careful long-term follow-up.
Heterotopic lung transplant: a feasible approach to compensate for organ shortages
Authors: Zhao Jin , Ye ShuGao , Liu Feng , Huang Man , Xu Yongshan , Chen Yuan , Chen JingYu 
Published: June 2022

Abstract
Lung transplants are still limited by the shortage of suitable donor lungs, especially during the coronavirus disease 2019 pandemic. A heterotopic lung transplant (HLTx), as a flexible surgical procedure, can maximize the potential of donor lungs in an emergency, but its widespread use is hindered by difficulties in anastomosis and paucity of outcome data. We performed a retrospective review of 4 patients, each of whom received an HLTxs over 1 year, including 1 left-to-right single HLTx, 2 right-to-left single HLTxs and 1 lobar HLTx (right upper lobe-to-left). The median recipient age was 58.5 years (46–68); 3 patients were male. The postoperative hospital stay was 33 days (30–42). One recipient lived for 10 years and died of bronchiolitis obliterans syndrome; the others were alive with no major morbidity at 12 to 31 months after the operation with a 1-year survival of 100%. The follow-up chest images showed that transplanted lungs could be inflated well and adapted morphologically to fill the thoracic cavity in the short and long term. This study demonstrates that an HLTx is a feasible alternative to a conventional lung transplant in emergency cases and could be considered in selected patients at advanced medical centres.
Estimating the swelling potential of non-carbon–based binder (NCBB)-treated clayey soil for sustainable green subgrade using AI (GP, ANN and EPR) techniques
Authors: Onyelowe Kennedy C , Ebid Ahmed M , Onyia Michael E , Amanamba Ezenwa C 
Published: June 2022

AbstractA zero carbon footprint stabilization approach has been adopted in this research to improve the swelling potential (SP) of clayey soils for a greener construction approach. Construction activities like earthworks during the cement stabilization of unstable soils utilized as reconstituted subgrade materials is responsible for the emission of unhealthy amount of carbon oxides into the atmosphere contributing to ozone layer depletion and eventual global warming. This has been substituted by using eco-friendly cementing materials, quicklime activated rice husk ash (QARHA), formulated in this research work. The SP of clayey soil treated with QARHA has been predicted using the learning abilities of genetic programming (GP), artificial neural network (ANN) and the evolutionary polynomial regression (EPR). This was aimed at reducing the over dependence on repeated laboratory visits and experiments prior to infrastructure (pavement) designs, construction and future monitoring of the performance of the facility. Multiple data were collected from multiple experiments based on the tested emergent material (QARHA) treatment proportions used in this work. The data were subjected to statistical analysis and predictive model exercises. At the end, the predicted models were validated on the basis of performance and accuracy. The performance indices showed that EPR and GP with R2 of 0.997 outclassed ANN with R2 of 0.994, but EPR outclassed the two, GP and ANN with a minimal error of 6.1%. The performances of GP, ANN and EPR were compared with a previously conducted model, which utilized the learning techniques of the adaptive neuro-fuzzy interface system (ANFIS) and it was observed that EPR and GP performed better than ANFIS but ANN performed at par with it. Generally, the predictive models can predict the SP of subgrade soil treated with QARHA, a non-carbon–based binder with accuracy above 90%, which is a very good outcome.
Stochastic optimal control of pre-exposure prophylaxis for HIV infection
Authors: Ðorđević Jasmina , Rognlien Dahl Kristina 
Published: June 2022

Abstract
The aim of the paper is to apply the stochastic optimal control problem in order to optimize the number of individual which will have the pre-exposure prophylaxis (PReP) treatment in the stochastic model for HIV/AIDS with PReP. By using the stochastic maximum principle, we derive the stochastic optimal control of PReP for the unconstrained control problem. Furthermore, by combining the stochastic maximum principle with a version of the Lagrange multiplier method, we solve the PReP problem for two different types of budget constrains with a given constrain for the costs (possible of different kind, transportation, price of the treatment, etc.). Obtained results for the different percentage of the individuals who got the vaccine, as well as results for unconstrained and constrained problems, are illustrated by a numerical example.
The Embodiment of Hegemony: Diplomatic Practices in the Ecuadorian Foreign Ministry
Authors: Aguas Lourdes , Pampinella Stephen 
Published: June 2022

AbstractIn this article, we explain Ecuador's foreign policy shift away from the counter-hegemonic project of the Pink Tide and toward the US-led international order. Current scholarship assumes that small states pursue moral recognition from great powers by reproducing the normative principles of the hegemonic order. However, the dynamics of small-state status seeking remain underexplored. How does domestic elite competition, including their preferred strategic narratives and histories of elite socialization, shape policymakers’ preferences for status within alternative international orders? Bourdieu's practice theory enables us to demonstrate how senior Ecuadorian diplomats embody the principles of the US-led hegemonic order. By analyzing documents, speeches, and the results of semistructured interviews, we show how diplomats’ tacit background knowledge led them to reject former president Rafael Correa's initiatives and replace them with a “professional” diplomacy and “pragmatic” foreign policy. Diplomats pursue moral authority not only for its own sake but also as a means of alleviating stigmas associated with Ecuador's intense subordination. In this way, diplomats legitimated the restoration of the pre-Correa liberal state. Their experience of hysteresis, or a mismatch between their habitus and field position, drove them to assert their taken-for-granted truths as a new orthodoxy once Correa departed.
P01 Urinary tract infections caused by ESBL-producing Escherichia coli in outpatients from Sarajevo, Bosnia and Herzegovina
Authors: Keser Sejla Kotoric , Balihodzic Amina Obradovic 
Published: June 2022

Abstract

Background
Urinary tract infections (UTIs) are common infections acquired in the community. Knowledge of local antibiotic susceptibility profile is important in decision-making of the optimal choice for empirical antimicrobial therapy and its duration. ESBL-producing strains of Enterobacterales are considered to be emerging pathogens. Recurrent UTI is one of the risk factors for infection with ESBL-producing bacteria.

Objectives
To report the prevalence of Escherichia coli uropathogens and the frequency of ESBL-producing E. coli strains isolated from urine of outpatients in Sarajevo Canton in Bosnia and Herzegovina.

Materials and methods
In this retrospective study, we collected antibiotic susceptibility data from urine samples analysed in the Microbiology Laboratory of the Institute for Public Health of Canton Sarajevo from 1 January to 31 December 2021. Urine samples were inoculated on CUA III Liofilchem® medium and incubated at 37°C for 24–48 h. A count of ≥ 100 000 cfu/mL of urine was considered positive after incubation, and these isolates were identified. The antimicrobial susceptibility testing was performed using the disc diffusion method, according to EUCAST guidelines and results interpreted following EUCAST breakpoint tables v.10.

Results
There were 34 087 urine samples from outpatients analysed in 2021. Out of this number, 23.72% (n = 8085) were positive. E. coli was identified in 70.27% (n = 5682) samples. ESBL E. coli was identified in 3.36% (n = 191) of all E. coli positive samples.

Conclusions
Geographic variations in pathogen occurrence and susceptibility profiles require continuous monitoring to provide information to guide the empirical therapeutic options.
P05 The impact of COVID-19 on antifungal stewardship in a UK tertiary teaching hospital: a review of prescribing practices and therapeutic drug monitoring of posaconazole
Authors: Andreani Adam , Tyler Netta , Micallef Christiane , Enoch David , Wong Vanessa 
Published: June 2022

Abstract

Background
Posaconazole is a triazole antifungal licensed for the prevention of invasive fungal infections (IFI) in haemato-oncology patients and treatment of IFI where first-line therapy has failed. In January 2020 COVID-19 hit the UK, with many NHS services reduced to meet the unprecedented challenges of the pandemic. We audited prescriptions and therapeutic drug monitoring (TDM) of posaconazole and compared the results with an audit conducted pre-COVID-19 to assess the impact of the pandemic on antifungal stewardship (AFS).

Methods
Inpatients prescribed posaconazole over two 3 month periods (1 October to 31 December 2019 and 2020) at Addenbrooke's Hospital, Cambridge, were identified using an electronic computer system and their records reviewed for demographic, diagnostic and therapeutic data. Posaconazole levels were performed at the national Mycology Reference Laboratory, Bristol, using guide levels of 0.7–3.75 mg/L (prophylaxis) and 1–3.75 mg/L (treatment). The first pre-dose level for each patient was used in analyses. Audit standards included (i) all inpatients on posaconazole to have an indication in local guidelines; (ii) to have the correct loading dose prescribed; (iii) to have a pre-dose level taken (iv) at the correct time (i.e. between Day 3–8) after commencing therapy or a dose change; (v) to have a turnaround time of ≤5 days; and (vi) to stop posaconazole appropriately.

Results
Forty-two 42 inpatients received posaconazole in 2020 (49, 2019). In total, 39/42 (93%) patients had an appropriate indication [46/49, (94%), 2019]: 38/40 (95%) for prophylaxis [45/45, (100%) 2019]; 1/2 (50%) for treatment [1/1, (100%) 2019]. In 2020, 34/42 (81%) of patients received the correct loading dose [41/46 (89%), 2019). TDM was performed on 33/42 (79%) patients [46/46 (100%), 2019], 18/42 (43%) 3–8 days after starting [25/46 (54%), 2019] and 3/13 (23%) after a dose change [9/10 (90%), 2019]; 32/33 (97%) of TDM results were reported in ≤5 days [32/46 (70%), 2019]. Posaconazole was stopped in 24/26 (92%) patients who were no longer receiving immunosuppression and/or neutropenia had resolved [23/23 (100%), 2019].

Conclusions
Despite the pressures of COVID-19, there were good standards of care with only slight reductions in compliance, with the exception of TDM. This may have reflected the change from face-to-face to virtual meetings with haemato-oncology, as well as representing issues of staff shortages and changes in hospital priorities. Such data have highlighted the usefulness of technology to facilitate AFS, e.g. electronic prescribing order sets, which would provide us with quality assurance in a system that will be facing ongoing pressures from the pandemic for years to come.
P11 Evaluation of in vitro activity of double β-lactam therapy and relationship with PBP activity in Escherichia coli isolates
Authors: Suich J , Van der Woude M , Wearmouth D , Burns P , Barlow G 
Published: June 2022

Abstract

Background
PBPs are involved in the construction of peptidoglycan, which is the major constituent of bacterial cell walls and the target of β-lactam antibiotics. There is little published research analysing the relationship between β-lactams with differing bacterial PBP targets and how they can be manipulated in combinations with respect to clinical or microbiological (e.g. resistance) outcomes (i.e. does expanded PBP activity via a combination lead to better in vitro/in vivo outcomes).

Objectives
To systematically explore the relationship between double β-lactam therapy (with and without at least one partner being a β-lactamase inhibitor antibiotic such as co-amoxiclav) and in vitro activity against susceptible Escherichia coli strains.

Methods
We systematically explored the relationship between double β-lactam therapy combinations against seven E. coli strains of variable resistance in vitro. This included fully susceptible isolates, ESBL producers and carbapenemase producers (CPEs). For each of 10 antibiotics, the MIC was determined individually, and subsequently in combination with 9 further antibiotics, using the MTS™ ‘cross’ synergy method (Liofilchem, 2012).

Results
Overall, 86/630 (13.6%) of all combinations tested showed synergy and 408/630 (64.8%) were additive; 136/630 (21.6%) combinations showed indifference. Of the 86 ‘bug–drug’ combinations that showed synergy, 42/86 (49%) included ceftazidime/avibactam, representing 42/126 (33%) of all ceftazidime/avibactam-based combinations tested, and 56/86 (65%) of synergistic combinations covered PBP2. Synergy was most commonly detected in ESBL producers (58/86; 67% of combinations) and less frequently seen in CPEs (2/86; 2% of combinations) and fully susceptible isolates (8/86; 9% of combinations). Additive effects were seen in 92/180 (51%) combinations versus ESBLs, compared with 18/90 (20%) in CPEs, versus 154/180 (86%) in fully susceptible isolates. No antagonism was identified with any antibiotic combination.

Conclusions
In the combinations tested, synergy or additive effects were common (78%); similar to our previous work with fosfomycin/β-lactam combinations (89%), but higher than we found with fosfomycin/non-β-lactam combinations (28%). Many of the synergistic bug–drug combinations identified contained a β-lactam inhibitor as a partner and/or provided PBP2 activity. This provisionally suggests a role for PBP2 (also targeted by avibactam) in synergy, although the presence of a β-lactamase inhibitor may also be important. Confirmation using an alternative method and mechanistic elucidation is required. The clinical/microbiological importance of such effects remains unclear.
P16 Strengthening surveillance systems for antimicrobial resistance in urinary tract infections in Kenya
Authors: Bartonjo G , Ngata E , Revathi G , Aiken A 
Published: June 2022

Abstract

Background
Urinary tract infections (UTIs) are amongst the most common conditions leading to outpatient visits and are also one of the most common causes of inappropriate antibiotic usage. Addressing antimicrobial resistance (AMR) requires strengthening surveillance system in Kenya where UTI is a problem with health systems having limited capacity for accurate laboratory identification of UTI pathogens. Empirical treatment to manage UTIs is the most common problem due to limited microbiology capacity. These include shortages of suitable training, equipment, quality control procedures and professional expertise to make an accurate clinical interpretation of urine cultures. This leads to reporting normal flora as pathogens.

Objectives
To deliver training on the identification and antibiotic susceptibility testing of bacterial isolates from urine infections at participating hospitals in the Kenyan AMR surveillance network and measure competency levels in staff participating in the training with the aim of strengthening the Kenyan surveillance system.

Methods
A 1 day baseline visit to the five sites was made between October and November 2021 using a standardized checklist to assess laboratory capacity. This was followed by urine processing training conducted between November 2021 and January 2022 in Malindi, Jaramogi, Kitale, Nakuru and Nyeri County Hospitals. Training materials were developed with the input of Aga Khan University Hospital. A 5 day in-person training course was delivered at each of the five hospitals, which targeted an average of 2–3 laboratory staff per hospital. The competencies of the laboratory staff were assessed by written pre-assessment and post-assessment tests. A standardized practical assessment was achieved by use of five different control organisms. The scores were done by doing an average performance score at each hospital laboratory.

Results
Out of 13 trainees, 8 were male and 5 were female. The median number of years since qualification for these staff was 6 (IQR 2–9). The median number of total months of microbiology training time was 2.3 (IQR 1–7). The median pre-training and post-training scores were 46% and 90%, respectively; non-parametric Wilcoxon rank test showed statistical difference (P &lt; 0.0001) between pre-training and post-training. All participants improved from pre-to post- training assessment from the 5 day training with marked improvement amongst from staff with lowest previous level of laboratory training.

Conclusions
Training microbiology staff in the accurate processing of urine sample will be an important activity for a Kenyan AMR surveillance system. These training materials, if delivered by an experienced trainer, can achieve a clear improvement in knowledge levels and practical competence for real-life microbiology identifications.