bluuebunny/crossref_metadata_2025 huggingface dataset:
Update on advanced semen-processing technologies and their application for in vitro embryo production in horses
Authors: Morris Lee H. , Maclellan Lisa J.
Published: October 2019

The increased commercialisation of intracytoplasmic sperm injection (ICSI) in horses creates more opportunities to incorporate advanced reproductive technologies, such as sex-sorted, refrozen and lyophilised spermatozoa, into a breeding program. This paper reviews the status of these semen-handling technologies in light of their use in equine ICSI programs. Pregnancies have been achieved from each of these advanced technologies when combined with ICSI in horses, but refinements in the semen-handling processes underpinning these technologies are currently being explored to produce more reliable and practical improvements in the results from equine ICSI.
Estimating kangaroo density by aerial survey: a comparison of thermal cameras with human observers
Authors: Lethbridge Mark , Stead Michael , Wells Cameron
Published: October 2019

Abstract
ContextAerial surveys provide valuable information about the population status and distribution of many native and pest vertebrate species. They are vital for evidence-based monitoring, budget planning and setting management targets. Despite aircraft running costs, they remain one of the most cost-effective ways to capture distribution and abundance data over a broad area. In Australia, annual surveys of large macropods are undertaken in several states to inform management, and in some jurisdictions, to help set commercial kangaroo harvest quotas. Improvements in the cost efficiencies of these surveys are continually sought. Aerial thermal imaging techniques are increasingly being tested for wildlife surveys, but to date no studies have directly compared population data derived from thermal imaging with data collected by human observers during the same flight.
AimsDuring an aerial survey of western grey kangaroos (Macropus fuliginosus), eastern grey kangaroos (M. giganteus) and red kangaroos (Osphranter rufus) across the state of Victoria, Australia, the objective was to conduct a direct comparison of the effectiveness of thermal camera technology and human observers for estimating kangaroo populations from aerial surveys.
MethodsA thermal camera was mounted alongside an aerial observer on one side of the aircraft for a total of 1360km of transect lines. All thermal footage was reviewed manually. Population density estimates and distance sampling models were compared with human observer counts.
Key resultsOverall, the kangaroo density estimates obtained from the thermal camera data were around 30% higher than estimates derived from aerial observer counts. This difference was greater in wooded habitats. Conversely, human-derived counts were greater in open habitats, possibly due to interference from sunlight and flushing. It was not possible to distinguish between species of macropod in the thermal imagery.
ConclusionsThermal survey techniques require refining, but the results of the present study suggest that with careful selection of time of day for surveys, more accurate population estimates may be possible than with conventional aerial surveys.
ImplicationsConventional aerial surveys may be underestimating animal populations in some habitats. Further studies that directly compare the performance of aerial observers and thermal imaging are required across a range of species and habitats.
Psychiatric Comorbidity and Co-Occurring Opioid Misuse: Depression Mediates the Relationship between Post-Traumatic Stress Disorder and Opioid Misuse in Community Pharmacy Settings
Authors: Hruschak Valerie , Hildenbrand Aimee K. , Cochran Gerald
Published: October 2019

Background

Individuals who misuse opioids frequently have comorbid psychiatric issues, including post-traumatic stress disorder (PTSD) and depression. However, little is known about the mechanisms by which these disorders are associated with opioid misuse and specifically in community pharmacy settings. The current study examined whether depression mediated the relationship between PTSD and opioid misuse in patients filling opioid prescriptions.

Methods

We administered a health survey in four community pharmacies among patients filling opioid medications in southwestern Pennsylvania. Univariate statistics were used to assess relationships among demographic and clinical characteristics of PTSD, depression, and opioid misuse behaviors. We then examined whether depression mediated the relationship between PTSD and opioid misuse using ordinary least squares path analysis with bootstrapping.

Results

A total of 333 participants completed the health survey. Opioid misuse was reported among 15.9% of all participants, 33.3% among those with a positive PTSD screen, and 29.3% of those who screened positive for depression. Depression significantly mediated the relationship between PTSD and opioid misuse. Specifically, there was a statistically significant indirect effect (ab) of PTSD on opioid misuse through a pathway mediated by depression (ab = .06, SE ab = .02, 95% CI = .02–.10). The direct effect (c’) of PTSD on opioid misuse was also significant (c’ = .12, SE c’ = .05, P = .01, 95% CI = .03–.22), suggesting partial mediation.

Conclusions

Results suggest an indirect pathway by which clinical intervention may help ameliorate outcomes in patients with PTSD. Further, there is an increased need for screening, assessment, and intervention protocols for this patient population in which community pharmacy is a novel setting to expand future efforts within the patient population.
The Lock-In Loophole: Using Mixed Methods to Explain Patient Circumvention of a Medicaid Opioid Restriction Program
Authors: Roberts Andrew W. , Skinner Asheley C. , Lauffenburger Julie C. , Galt Kimberly A.
Published: October 2019

Background

Lock-in programs are proliferating among private and public payers to restrict access to controlled substance prescriptions and enhance care coordination for patients exhibiting high-risk use of, primarily, opioids. Patients enrolled in lock-in programs are required to seek opioids from a designated provider and pharmacy for insurance coverage of their opioid and benzodiazepine prescriptions. Lock-in program restrictions are often circumvented by patients through out-of-pocket cash purchases of opioid prescriptions, undermining the program's intended function. This study sought to construct and explain trajectories of Medicaid-covered and cash pay opioid prescription fills among adults enrolled in an opioid lock-in program.

Methods

We used sequential explanatory mixed methods, which involved a quantitative retrospective cohort analysis of opioid fill trajectories using North Carolina Medicaid administrative claims data linked with state prescription drug monitoring program data, followed by qualitative semi-structured interviews with North Carolina pharmacists. The quantitative component included adults enrolled in the North Carolina Medicaid lock-in program between 10/1/2010-3/31/2012. The qualitative component included a maximum variation sample of community pharmacists in North Carolina delivering care to lock-in patients. Quantitative outcomes included group-based trajectories of monthly Medicaid-covered and cash pay opioid prescription fills six months before and after LIP enrollment, and qualitative analyses generated themes explaining observed trajectories.

Results

Two-thirds of subjects exhibited reduced Medicaid-covered opioid prescription fills and no increase in cash pay fills after lock-in enrollment, with one-third exhibiting increased cash pay fills after lock-in. Pharmacists attributed increases in cash pay fills primarily to illicit behaviors, while some cash pay behavior likely reflected new unintended barriers to care.

Conclusions

Lock-in programs appear to reduce prescription opioid use for most enrolled patients. However, lock-in programs may have limited capacity to deter illicit behaviors among patients intent on abusing, misusing, or diverting these medications and may introduce new access barriers to necessary care for some.
Juhász’s topological generalization of Neumer’s theorem may fail in 𝖹𝖥
Authors: Tachtsis Eleftherios
Published: October 2019

In set theory without the Axiom of Choice (

A
C

\mathsf {AC}

), we investigate the open problem of the deductive strength of Juhász’s topological generalization of Neumer’s Theorem from his paper On Neumer’s Theorem [Proc. Amer. Math. Soc. 54 (1976), 453–454].

Among other results, we show that Juhász’s Theorem is deducible from the Principle of Dependent Choices and (when restricted to the class of

T

1

T_{1}

spaces) implies the Axiom of Countable Multiple Choice, and hence implies van Douwen’s Countable Choice Principle, but does not imply either the full van Douwen’s Choice Principle or the axiom of choice for linearly ordered families of nonempty finite sets. Furthermore, we prove that Juhász’s Theorem (for

T

1

T_{1}

spaces) implies each of the following principles: “

ℵ

1

\aleph _{1}

is a regular cardinal”, “every infinite set is weakly Dedekind-infinite”, and “every infinite linearly ordered set is Dedekind-infinite”. We also establish that Juhász’s Theorem for

T

2

T_{2}

spaces is not provable in

Z
F

\mathsf {ZF}

.

In contrast to the above results, we show that Neumer’s Theorem and Juhász’s Theorem for compact

T

1

T_{1}

spaces are both provable in

Z
F

\mathsf {ZF}

.
Specht modules decompose as alternating sums of restrictions of Schur modules
Authors: Assaf Sami , Speyer David
Published: October 2019

Schur modules give the irreducible polynomial representations of the general linear groupGLt\mathrm {GL}_t. Viewing the symmetric groupSt\mathfrak {S}_tas a subgroup ofGLt\mathrm {GL}_t, we may restrict Schur modules toSt\mathfrak {S}_tand decompose the result into a direct sum of Specht modules, the irreducible representations ofSt\mathfrak {S}_t. We give an equivariant Möbius inversion formula that we use to invert this expansion in the representation ring forSt\mathfrak {S}_tforttlarge. In addition to explicit formulas in terms of plethysms, we show the coefficients that appear alternate in sign by degree. In particular, this allows us to define a new basis of symmetric functions whose structure constants are stable Kronecker coefficients and which expand with signs alternating by degree into the Schur basis.
Limit operator theory for groupoids
Authors: Austin Kyle , Zhang Jiawen
Published: October 2019

We extend the symbol calculus and study the limit operator theory for

σ
\sigma

-compact, étale, and amenable groupoids, in the Hilbert space case. This approach not only unifies various existing results which include the cases of exact groups and discrete metric spaces with Property A, but also establish new limit operator theories for group/groupoid actions and uniform Roe algebras of groupoids. In the process, we extend a monumental result by Exel, Nistor, and Prudhon, showing that the invertibility of an element in the groupoid

C
∗

C^*

-algebra of a

σ
\sigma

-compact amenable groupoid with a Haar system is equivalent to the invertibility of its images under regular representations.
A mechanism for how Cdr1/Nim1 kinase promotes mitotic entry by inhibiting Wee1
Authors: Opalko Hannah E. , Nasa Isha , Kettenbach Arminja N. , Moseley James B.
Published: October 2019

To enter into mitosis, cells must shut off the cell cycle inhibitor Wee1. SAD family protein kinases regulate Wee1 signaling in yeast and humans. In Schizosaccharomyces pombe, two SAD kinases (Cdr1/Nim1 and Cdr2) act as upstream inhibitors of Wee1. Previous studies found that S. pombe Cdr1/Nim1 directly phosphorylates and inhibits Wee1 in vitro, but different results were obtained for budding yeast and human SAD kinases. Without a full understanding of Cdr1 action on Wee1, it has been difficult to assess the in vivo relevance and conservation of this mechanism. Here, we show that both Cdr1 and Cdr2 promote Wee1 phosphorylation in cells, but only Cdr1 inhibits Wee1 kinase activity. Inhibition occurs when Cdr1 phosphorylates a cluster of serine residues linking α-helices G and H of the Wee1 kinase domain. This region is highly divergent among different Wee1 proteins, consistent with distinct regulatory mechanisms. A wee(4A) mutant that impairs phosphorylation by Cdr1 delays mitotic entry and causes elongated cells. By disrupting and retargeting Cdr1 localization, we show that Cdr1 inhibition of Wee1 occurs in cells at cortical nodes formed by Cdr2. On the basis of our results, we propose a two-step model for inhibition of Wee1 by Cdr1 and Cdr2 at nodes.
The focal adhesion scaffold protein Hic-5 regulates vimentin organization in fibroblasts
Authors: Vohnoutka Rishel B. , Gulvady Anushree C. , Goreczny Gregory , Alpha Kyle , Handelman Samuel K. , Sexton Jonathan Z. , Turner Christopher E.
Published: October 2019

Focal adhesion (FA)-stimulated reorganization of the F-actin cytoskeleton regulates cellular size, shape, and mechanical properties. However, FA cross-talk with the intermediate filament cytoskeleton is poorly understood. Genetic ablation of the FA-associated scaffold protein Hic-5 in mouse cancer-associated fibroblasts (CAFs) promoted a dramatic collapse of the vimentin network, which was rescued following EGFP-Hic-5 expression. Vimentin collapse correlated with a loss of detergent-soluble vimentin filament precursors and decreased vimentin S72/S82 phosphorylation. Additionally, fluorescence recovery after photobleaching analysis indicated impaired vimentin dynamics. Microtubule (MT)-associated EB1 tracking and Western blotting of MT posttranslational modifications indicated no change in MT dynamics that could explain the vimentin collapse. However, pharmacological inhibition of the RhoGTPase Cdc42 in Hic-5 knockout CAFs rescued the vimentin collapse, while pan-formin inhibition with SMIFH2 promoted vimentin collapse in Hic-5 heterozygous CAFs. Our results reveal novel regulation of vimentin organization/dynamics by the FA scaffold protein Hic-5 via modulation of RhoGTPases and downstream formin activity.
Genetic Epidemiology Reveals 3 Chronic Reservoir Areas With Recurrent Population Mobility Challenging Poliovirus Eradication in Pakistan
Authors: Akhtar Ribqa , Mahmood Nayab , Alam Muhammad Masroor , Naeem Muhammad , Zaidi Syed Sohail Zahoor , Sharif Salmaan , Khattak Zainab , Arshad Yasir , Khurshid Adnan , Mujtaba Ghulam , Rehman Lubna , Angez Mehar , Shaukat Shehzad , Mushtaq Nighat , Umair Massab , Ikram Aamer , Salman Muhammad
Published: October 2019

Background

Pakistan is among 3 countries endemic for wild poliovirus type 1 (WPV1) circulation that are still struggling for eradication of poliomyelitis. Active clinical and environmental surveillance with meticulous laboratory investigations provide insights into poliovirus transmission patterns and genomic diversity to inform decisions for strategic operations required to achieve eradication.

Methods

We analyzed epidemiological and virological data to comprehend the current epidemiological status of WPV1 in Pakistan during 2015–2017. Stool specimens of patients with acute flaccid paralysis (AFP) and sewage samples collected from 60 environmental sites were tested. Viral culturing, intratypic differentiation by real-time polymerase chain reaction, and nucleic acid sequencing of the VP1 region of the poliovirus genome to determine genetic relatedness among WPV1 strains were applied.

Results

Poliovirus isolates were grouped into 11 distinct clusters, which had ≥95% nucleotide homology in the VP1 coding region. Most of the poliovirus burden was shared by 3 major reservoirs: Karachi, Peshawar, and Quetta block (64.2% in 2015, 75.4% in 2016, and 76.7% in 2017).

Conclusions

Environmental surveillance reveals importations and pockets of unimmunized children that dictate intensive target mop-up campaigns to contain poliovirus transmission. A decrease in the number of orphan isolates reflects effective combination of AFP and environmental surveillance in Pakistan. The genetic data reflect sustained transmission within reservoir areas, further expanded by periodic importations to areas of high immunity reflected by immediate termination of imported viruses. Improved immunization coverage with high-quality surveillance is vital for global certification of polio eradication.
Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama
Authors: Ara�z-Ledezma Ana B , Massar Karlijn , Kok Gerjo
Published: October 2019

Adolescents in Panama face multiple challenges to their sexual health, rights and well-being such as high rates of teenage pregnancy (∼30% of all pregnancies), increased HIV infections and sexual violence. In the absence of sufficient evidence-based data and an ongoing debate in Panamanian society about how to approach adolescents’ health problems, the aim of this qualitative study was to explore the perceptions and attitudes of different societal actors, namely governmental employees, NGO employees, academics, members from religious groups, teachers and parents. We conducted in-depth interviews (N = 34) which focused on the behavioural and environmental factors considered to influence adolescents’ decision making with regard to love, friendships and family relations. Furthermore, we explored how these stakeholders viewed the role of the education system, and the potential of including social–emotional learning (SEL) in the curriculum to provide skills and capacities, which could encourage adolescents to make better decisions and improve their well-being, in general but also in the context of sexual behaviours. Analysis revealed five central themes, i.e. perceptions towards gender roles and equality, adolescents’ love (sexual) relationships, capacity needs regarding prevention of risk behaviours and the role of education, comprehensive sexuality education in schools and the potentiality of SEL in the education system. The findings of the study can enhance understanding on the views of stakeholders regarding the factors influencing adolescents’ decision making, as well as regarding the possibilities of introducing SEL in the Panamanian educational curriculum.
Kinetic and solvent isotope effects in oxidation of halogen derivatives of tyramine catalyzed by monoamine oxidase A
Authors: Pająk Małgorzata
Published: October 2019

The isotope effects approach was used to elucidate the mechanism of oxidative deamination of 3′-halotyramines, catalyzed by monoamine oxidase A (EC 1.4.3.4). The numerical values of kinetic isotope effect (KIE) and solvent isotope effect (SIE) were established using a non-competitive spectrophotometric technique. Based upon KIE and SIE values, some of the mechanistic details of investigated reaction were discussed.
Pollination interactions reveal direct costs and indirect benefits of plant–plant facilitation for ecosystem engineers
Authors: Losapio Gianalberto , Schöb Christian
Published: October 2019

Aims

Ecosystem engineers substantially modify the environment via their impact on abiotic conditions and the biota, resulting in facilitation of associated species that would not otherwise grow. Yet, reciprocal effects are poorly understood as studies of plant–plant interactions usually estimate only benefits for associated species, while how another trophic level may mediate direct and indirect feedback effects for ecosystem engineers is hardly considered.

Methods

We ran a field experiment with two ecosystem engineers (Arenaria tetraquetra and Hormathophylla spinosa) blooming either alone or with associated plants to decompose net effects and to test the hypothesis that pollinator-mediated interactions provide benefits that balance costs of facilitation by ecosystem engineers.

Important Findings

We found that net costs of facilitation are accompanied by pollinator-mediated benefits. Despite ecosystem engineers producing fewer flowers per plant, they were visited by more and more diverse pollinators per flower when blooming with associated plants than when blooming alone. Although seed production per plant was higher when ecosystem engineers bloomed alone, fruit set and seed set varied between species. In one case (A. tetraquetra), fruit and seed sets were negatively affected by the presence of associated plants, whereas, in another case (H. spinosa), fruit set and seed set were higher and unaffected when ecosystem engineers bloomed with associated plants, respectively. Our findings suggest that besides experiencing direct costs, ecosystem engineers can also benefit from facilitating other species via increasing their own visibility to pollinators. Thus, we highlight that pollination interactions can compensate for costs of facilitation depending on ecosystem engineer species. This study illuminates how the outcome of direct plant–plant interactions might be mediated by indirect interactions including third players.
Money, Death, and Agency in Catholic Ireland, 1850–1921
Authors: Doyle Patrick , Roddy Sarah
Published: October 2019

Between the end of the Great Famine and the end of the union with Britain, the Irish Catholic Church was almost exclusively funded by ordinary lay people. This article examines the financial relationship between clergy and laity, focusing on payments related to death. In doing so, it argues three main points. First, it suggests that previous conceptions of lay people coerced into giving their money to the church are too simplistic and deny the complex agency of the people of many social classes who gave the money. Second, it argues that using the financial transactions of ordinary people gives historians a much-needed methodology for recovering lives about which the archives are otherwise silent. Third, it posits that the mediation of faith through money, specifically, must be added to the growing body of work on “material religion.”
Amyotrophic Lateral Sclerosis Among Veterans Deployed in Support of Post-9/11 U.S. Conflicts
Authors: Sagiraju Hari Krishna Raju , Živković Sasa , VanCott Anne C , Patwa Huned , Gimeno Ruiz de Porras David , Amuan Megan E , Pugh Mary Jo V
Published: October 2019

Introduction

Amyotrophic lateral sclerosis (ALS) is a recognized military service-connected condition. Prior prevalence studies of ALS among U.S. war Veterans were not able to address concerns related to neurodegenerative sequelae of traumatic brain injury (TBI) and disregarded risk heterogeneity from occupational categories within service branches.

Materials and Methods

We identified the prevalence of definite and possible ALS and cumulative incidence of definite ALS among Post-9/11 U.S. Veterans deployed in support of Post-9/11 conflicts (mean age 36.3) who received care in the Veterans Health Administration during fiscal years 2002–2015. Using a case-control study design, we also evaluated the association of TBI and major military occupation groups with ALS adjusting for demographics and comorbidities.

Results

The prevalence of ALS was 19.7 per 100,000 over 14 years. Both prevalence and cumulative incidence of definite ALS were significantly higher among Air Force personnel compared to other service branches and among tactical operation officers and health care workers compared to general and administrative officers. Neither TBI nor younger age (<45 years) was associated with ALS. Depression, cardiac disease, cerebrovascular disease, high blood pressure, and obstructive sleep apnea were clinical comorbidities significantly associated with ALS in this population of Veterans.

Conclusion

This study among a cohort of relatively young Veterans showed a high ALS prevalence, suggesting an early onset of ALS among deployed military service members. The higher prevalence among some military specific occupations highlights the need to determine which occupational exposures specific to these occupations (particularly, Air Force personnel, tactical operations officers, and health care workers) might be associated with early onset ALS.
83. During A Million Patient-Days of Surveillance, Low Levels of Infection Prevention Staff Correlated with Higher Rates of Some Healthcare-Associated Infections
Authors: Lesho Emil P , Clifford Robert , Bronstein Melissa , Sosa Carlos , Laguio-Vila Maryrose
Published: October 2019

Background

Reports regarding the correlations between infection preventionist (IP) staffing levels and healthcare-associated infections (HAI) are scarce, conflicting, and crucial for resource allocation and effort prioritization. We evaluated such correlations from January 1, 2012 to March 1, 2019 at a 528-bed teaching hospital in Rochester, NY; a period when IP staffing levels fluctuated between the recommended ratio of 1 IP: 80 patients and a critically low of 1 IP: >375.

Methods

Standardized National Health Safety Network (NHSN) definitions, along with laboratory events, re-admissions, interactions with surgical teams, and an independent data management company were used for case finding of catheter-associated urinary tract infection (CAUTI), Clostridiodes difficile (CDI), central line-associated bloodstream infection (CLABSI), carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus (MRSA). Colon, prosthetic knee and hip joint, hysterectomies, and coronary artery bypass graft surgical site infections (SSI) were also studied. Standardized infection ratios (SIR) were extracted from NHSN. Staffing levels were grouped into low (/ = 7 FTE). Correlations between HAI rates, SIR, and staffing levels were examined using Poisson and T-tests with the R statistical package.

Results

The average daily census of 451 resulted in 1.18 million total patient-days of surveillance. Periods of low and recommended IP levels occurred at similar seasons and for similar durations. There were fewer CDI, CAUTI, CLABSI, and MRSA infections when IP staff were at recommended levels than when IP staff were at the lowest level, but only CDI and CLABSI rates were significantly lower (P = 0.003 and 0.005, respectively). CLABSI SIR was 1.07 and 0.64 during periods of low and recommended staffing levels, respectively (P = 0.004). No significant differences occurred in SSI, either by type or by combined.

Conclusion

Hospitals often cannot achieve or maintain recommended IP staffing levels. Our findings suggest that, during critical personnel shortages, IP may have more impact by focusing on the types of HAI that correlated with preventionist staffing levels. This is among the largest such study to date, and uniquely includes the most types of HAI.

Disclosures

All Authors: No reported Disclosures.
851. Validation of Quick Pitt Bacteremia Score in Patients with Staphylococcus aureus Bloodstream Infection
Authors: Elizabeth. Battle Sarah , Ann Justo Julie , Bookstaver P Brandon , Kohn Joseph , Al-hasan Majdi
Published: October 2019

Background

A quick version of the Pitt Bacteremia Score (qPitt) was recently derived based on five binary variables each assigned one point (Table 1). The qPitt broadened respiratory failure definition, simplified mental status, and eliminated fever from the original Pitt bacteremia score. The qPitt had high discrimination in predicting mortality in patients with Gram-negative bloodstream infection (BSI) and outperformed other acute severity of illness scores. This retrospective cohort study aims to evaluate the qPitt performance in patients with Staphylococcus aureus BSI and compare its discrimination to quick Sepsis Related Organ Failure Assessment (qSOFA).

Methods

Hospitalized adult patients with S. aureus BSI at Prisma Health-Midlands hospitals in South Carolina from January 1, 2015 to December 31, 2017 were identified. Multivariate logistic regression was used to examine risk factors for 28-day all-cause mortality. The area under receiver operating characteristic curve (AUROC) was used to evaluate discrimination of qPitt and qSOFA in predicting 28-day mortality (primary outcome). In-hospital and 90-day mortality were examined as secondary outcomes.

Results

Among the 398 patients with S. aureus BSI, the median age was 63 years, 241 (61%) were men, 173 (43%) had methicillin-resistant S. aureus (MRSA) BSI, and 95 (24%) died within 28 days of BSI. After adjustments for age, clinical and microbiological characteristics in the multivariate model, all five individual components of qPitt were independently associated with 28-day mortality (Table 1). There was a 3-fold increase in 28-day mortality for each point increase in qPitt (odds ratio 3.11, 95% confidence intervals: 2.40–4.02, P < 0.001). Mortality was 2% in patients with qPitt of 0 and increased to 14%, 24%, 50%, and 82% in patients with qPitt of 1, 2, 3, and ≥4, respectively. The qPitt had higher discrimination in predicting 28-day mortality than qSOFA (AUROC 0.82 vs. 0.77, P = 0.001). The qPitt also performed well in predicting in-hospital and 90-day mortality (AUROC 0.80 and 0.76, respectively).

Conclusion

The qPitt has good discrimination in predicting mortality in patients with S. aureus BSI. These results support using the qPitt as an acute severity of illness score in future studies.

Disclosures

All Authors: No reported Disclosures.
853. Epidemiology of Groups A, C, and G β-Hemolytic Streptococcal Pharyngitis
Authors: Lim James Ray Mata , Boyanton Bobby L , George Julie , Sims Matthew
Published: October 2019

Background

Treatment of Group A Streptococcus (GAS) pharyngitis is imperative to mitigate sequelae such as rheumatic heart disease. The need for treatment of Group C Streptococcus (GCS) and Group G Streptococcus (GGS) pharyngitis is unclear, as rheumatogenic sequelae have not been well documented. Our institution switched from culture to molecular confirmation testing for a negative rapid streptococcal antigen detection test. Cultures reported GAS whereas molecular testing reported GAS, GCS, and GGS. We performed a retrospective chart review to examine the epidemiological differences of GAS, GCS, and GGS pharyngitis.

Methods

Records were obtained of pharyngeal samples from patients sent for testing at Beaumont Health Laboratory. In all, 92,369 records were analyzed. There were 47,106 records of cultures from May 2012 through December 2014 and 45,263 records of molecular testing from May 2015 to December 2017. Samples positive for either GCS or GGS were reported as positive for Group CG Streptococcus (GCGS). Epidemiological factors were evaluated. If available, electronic records from GCGS positive samples were evaluated for clinical features, antibiotics used, and sequelae or complications reported.

Results

Molecular testing showed GAS positivity of 9.3% (n = 4,189) and GCGS positivity of 1.5% (n = 687). GCGS pharyngitis was more likely during the summer months and in young adults 13 years and older than children under 13 years. GAS pharyngitis was more likely during spring months and in children aged 4–9 years. Mean age of GCGS pharyngitis was 13 vs. 8.6 years for GAS pharyngitis. Similar results were obtained for GAS between culture and molecular testing records. Amoxicillin was most often prescribed for treatment of GCGS. There were few instances of severe GCGS exudative or recurrent pharyngitis that required hospitalization or tonsillectomy. There were no cases of rheumatic fever or rheumatic heart disease associated with GCGS.

Conclusion

This is the largest study based on our literature review to evaluate the epidemiology of GAS, GCS, and GGS pharyngitis in children and adults. We found a seasonal and age difference between GAS and GCGS. Complications were rare, and no rheumatogenic sequelae were noted from GCGS infections.

Disclosures

All Authors: No reported Disclosures.
854. Impact of Antimicrobial Stewardship and Rapid Diagnostics in Children with Staphylococcus aureus Bacteremia
Authors: Welch Stephanie N , Patel Rupal , Morris Lee , Dassner Aimee , Rozario Nigel L , Forrester Jeanne
Published: October 2019

Background

Rapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB). Data in children are lacking. In January 2017, Atrium Health implemented a pediatric ASP with blood culture RDT. The objective of this study was to determine the impact of those interventions.

Methods

This was a retrospective, multicenter, quasi-experimental study of children ≤18 years with monomicrobial SAB from March 2015 to August 2016 (pre-intervention; PRE) and March 2017 to August 2018 (post-intervention; POST). The primary outcome was time to an optimal antibiotic. Secondary outcomes included time to effective antibiotic, total antibiotic exposure in the first 5 days, duration of bacteremia, infectious diseases (ID) consultation, time to central line removal, hospital and pediatric ICU length of stay (LOS), need for vasopressors or intubation, recurrence of SAB within 90 days, and inpatient mortality.

Results

Of 101 patients with SAB, 32 and 36 met inclusion criteria for the PRE and POST groups, respectively. The median time to optimal antimicrobial therapy decreased by 23 hours (PRE 44.3 hours vs. POST 21.3 hours; P = 0.008). Duration of bacteremia (65h vs. 40.9 hours; P = 0.028) and mortality (12.5% vs. 0%; P = 0.044) was also significantly reduced. Differences in median time to effective therapy (7 hours vs. 5.1 hours; P = 0.74), total antibiotic exposure in the first 5 days (160.4 hours vs. 152 hours; P = 0.4), hospital LOS (9.9 vs. 8.5 days; P = 0.25), and pediatric ICU LOS (7 vs. 4 days; P = 0.11) did not meet statistical significance, but trended downward. The POST group had more patients with ID consultation (78% vs. 89%, P = 0.23) and shorter time to central line removal (68 hours vs. 20 hours; P = 0.037). There was no difference in the need for vasopressors (3 vs. 3 patients; P = 0.99) or intubation (2 vs. 4 patients; P = 0.68). Throughout the study period, recurrence of SAB only occurred in one patient (PRE).

Conclusion

Concurrent implementation of RDT and an ASP in pediatric patients with SAB decreased time to optimal antimicrobial therapy, duration of bacteremia, and mortality. RDT coupled with timely feedback from an ASP contributed to improved SAB management and clinical outcomes in children.

Disclosures

All Authors: No reported Disclosures.
898. Influenza Vaccination Reduces Risk of Severe Outcomes among Adults Hospitalized with Influenza A(H1N1)pdm09, FluSurv-NET, 2013–2018
Authors: Garg Shikha , Beacham Lauren , Arriola Carmen S , O’Halloran Alissa , Cummings Charisse N , Reingold Art , Alden Nisha B , Yousey-Hindes Kim , Anderson Evan J , Monroe Maya , Kim Sue , Lynfield Ruth , Irizarry Lourdes , Muse Alison , Bennett Nancy M , Billing Laurie M , Thomas Ann , Talbot Keipp , McCaffrey Keegan , Fry Alicia M , Reed Carrie
Published: October 2019

Background

Influenza vaccination may reduce illness severity among those with influenza; however, data are limited. We determined whether outcomes were less severe among vaccinated compared with unvaccinated adults hospitalized with influenza over 5 seasons.

Methods

We included adults (≥18 years) hospitalized with laboratory-confirmed influenza during seasons 2013–2014 through 2017–2018 and identified through the US Influenza Hospitalization Surveillance Network (FluSurv-NET). Vaccination status was obtained through medical records, vaccine registries, and interviews. We excluded patients who were institutionalized, did not receive antivirals, or had unknown vaccine status or vaccine receipt <14 days before positive influenza test. We used inverse propensity score weighting to balance differences between vaccinated and unvaccinated groups and multivariable logistic and competing risk regression to evaluate the association between vaccination and outcomes including pneumonia, intensive care unit (ICU) admission, mechanical ventilation (MV), death, and ICU and hospital length of stay (LOS) in days. Models were adjusted for season and admission timing in relation to timing of antiviral treatment, symptom onset and season peak.

Results

Among 67,452 adults hospitalized with influenza, 43,608 were included; 47% were 18–64 years (38% vaccinated) and 53% were ≥65 years (65% vaccinated). Among patients with influenza A(H1N1)pdm09, vaccination was associated with decreased odds of ICU admission (odds ratio (OR) 0.81; OR 0.72) and MV (OR 0.66; OR 0.54) in adults 18–64 and ≥65 years, respectively; decreased odds of pneumonia (OR 0.83), death (OR 0.64) and shortened ICU LOS (relative hazard (RH) 0.82) in adults 18–64 years; and shortened hospital LOS (RH 0.91) in adults ≥65 years (figure). Vaccination was not associated with attenuation of severe outcomes in patients with influenza A(H3N2) and B.

Conclusion

Vaccination was associated with reduced odds of severe outcomes, including death, by up to 36% in adults hospitalized with influenza A(H1N1)pdm09. All adults without contraindications should receive annual influenza vaccination as there is evidence that it can improve outcomes among those who develop influenza despite vaccination.

Disclosures

All Authors: No reported Disclosures.
965. The Efficacy of Oral Β-lactam Antibiotics as Step-down Therapy for Acute Pyelonephritis
Authors: Hobbs Athena L V , Hemmige Vagish , Jaso Theresa , Lutat Katie , Shea Katherine M
Published: October 2019

Background

Often, oral β-lactams have been avoided for the treatment of pyelonephritis due to data suggesting lower efficacy vs. currently recommended therapy. However, increasing resistance and concerns for collateral damage of primarily recommended oral agents have increased interest in the use of oral β-lactams for the treatment of pyelonephritis. Authors sought to assess the impact of oral step-down β-lactam therapy compared with an alternative oral agent (fluoroquinolone or trimethoprim-sulfamethoxazole) in patients with acute pyelonephritis requiring hospitalization.

Methods

This is an IRB-approved, multicenter, retrospective study of hospitalized patients with acute pyelonephritis in six hospitals within two healthcare systems who received an IV cephalosporin followed by step-down therapy with either a β-lactam or an alternative agent (i.e., fluoroquinolone or trimethoprim-sulfamethoxazole). We theorize that oral β-lactams are noninferior to alternative oral agents for step-down therapy for pyelonephritis requiring hospitalization. Treatment success was defined as lack of 30-day urinary system-related re-admission. We calculated that 89 patients were required in each group to achieve 80% power with a noninferiority margin of 15% and assuming a cure rate of 85% as reported in previous literature.

Results

A total of 188 patients were included in the study; 115 and 73 who received an oral β-lactam and an alternative oral agent, respectively. There was no difference in treatment success when comparing the two groups (113 [98%] vs. 70 [96%]; P = 0.38). The mean length of hospital stay, number of patients treated with ceftriaxone inpatient, and the duration of IV therapy was the same in both groups, though mean duration of oral therapy was longer in the oral alternative group compared with the oral β-lactam group (9.5 [+ 3.7] vs. 8.2 [+ 2.7] days, respectively; P = 0.02). Baseline characteristics other than mean age were the same, as reported in Table 1.

Conclusion

When using 30-day urinary system-related readmission as a surrogate for treatment success, we found no difference between β-lactams vs. alternative agents for oral step down therapy for pyelonephritis requiring hospitalization.

Disclosures

All Authors: No reported Disclosures.
980. Effects of Integrase Strand-Transfer Inhibitor Use on Lipids, Glycemic Control, and Insulin Resistance in the Women’s Interagency HIV Study (WIHS)
Authors: Aldredge Amalia , Lahiri Cecile D , Summers Nathan A , Mehta C Christina , Angert Christine D , Kerchberger Anne Marie , Weiser Sheri , Konkle-Parker Deborah , Sharma Anjali , Adimora Adaora A , Bolivar Hector , French Audrey L , Golub Elizabeth T , Kassaye Seble , Gustafson Deborah , Ofotokun Igho , Sheth Anandi N
Published: October 2019

Background

Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended first-line HIV treatment. We recently demonstrated increased weight gain associated with INSTI use among women living with HIV (WLH) enrolled in the Women’s Interagency HIV Study (WIHS), raising concern for cardiometabolic consequences. We, therefore, evaluated the effects of INSTI use on lipids, insulin resistance, and glycemic control in WLH.

Methods

Data from 2008 to 2017 were analyzed from WLH enrolled in WIHS. Women who switched to or added an INSTI to ART (SWAD group) were compared with women who remained on non-INSTI ART (STAY group). Outcomes included changes in fasting total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose; hemoglobin A1c; and incident insulin resistance (defined as homeostatic model assessment of insulin resistance [HOMA] score ≥2). Outcomes were measured 6–12 months before and 6–18 months after INSTI switch/add in the SWAD group with comparable time points in the STAY group. Linear regression models compared change over time in each outcome by SWAD/STAY group, adjusted for age, race, WIHS site, income, smoking status, statin use, and ART regimen at baseline.

Results

In total, 881 WIHS participants (182 SWAD and 699 STAY) were followed for a mean 1.8 (±1.1) years. Mean age was 49 (±8.8) years, BMI was 31 (±8.2) kg/m2, and 49% were Black. At baseline, SWAD vs. STAY was more likely to report NNRTI (vs. PI)-based ART and statin use (both P < 0.0001), but all baseline lipid and glucose variables were similar. Compared with STAY, the SWAD group experienced significantly greater decreases in HDL (−2.4 vs. +0.09 mg/dL, P = 0.03) and trended toward greater decreases in TC (−2.6 vs. −2.4 mg/dL, P = 0.07) at follow-up, without significant differences in TG or LDL. The SWAD group had significantly greater increases in A1c (+0.08% vs. −0.05%, P = 0.01) but trended toward lower incidence of insulin resistance (19% vs. 32%, P = 0.05).

Conclusion

Despite reported increases in weight, INSTI use was associated with only modest changes in lipid measurements and glycemic control during short-term follow-up of WLH compared with non-INSTI ART. Research is needed to elucidate long-term cardiometabolic effects.

Disclosures

Anandi N. Sheth, MD, MS, Gilead Sciences, Inc.: Research Grant.
1889. Clinical Features Distinguishing Enterovirus A71 and Enterovirus D68-Associated Acute Flaccid Myelitis in Colorado, 2013–2018
Authors: Messacar Kevin , Messacar Kevin , Spence-Davizon Emily , Osborne Christina , Press Craig , Schreiner Teri , Martin Jan , Messer Ricka , Maloney John , Burakoff Alexis , Barnes Meghan , Abzug Mark , Tyler Ken , Dominguez Samuel
Published: October 2019

Background

Several enteroviruses (EVs), including EV-A71 and EV-D68, have been associated with acute flaccid myelitis (AFM). Clinical features distinguishing AFM presentations associated with specific EV types are not well described.

Methods

EV-associated AFM was defined as any child presenting to Children’s Hospital Colorado in 2013–2018 who met the Council of State and Territorial Epidemiologists definition for confirmed AFM (flaccid limb weakness with longitudinal gray-matter-predominant spinal cord lesion on MRI) and had EV-A71 or EV-D68 identified in any biologic specimen (cerebrospinal fluid [CSF], nasopharyngeal [NP], oropharyngeal [OP], rectal) by VP1-specific RT-PCR and sequencing. Summative limb strength scores (SLSS) were calculated by adding Medical Research Council strength scores (1–5) for all limbs.

Results

Ten cases of EV-A71-associated AFM were identified, all from 2018; 8 cases of EV-D68-associated AFM were identified from 2013 (1), 2014 (4), 2016 (1), and 2018 (2) [Table 1]. Viral detection rates were higher in rectal and OP swabs in EV-A71 cases and NP specimens in EV-D68 cases. Virus was not detected in CSF of EV-D68 cases and in 1 EV-A71 case. EV-A71 cases were younger (median 19 vs. 100 months) and had neurologic onset earlier after prodromal symptom onset (median 1 vs. 5.5 days) than EV-D68 cases. Hand, foot, and/or mouth lesions distinguished EV-A71 cases, whereas respiratory symptoms were uniformly noted in EV-D68 cases. Associated neurologic findings more commonly associated with EV-A71 cases than EV-D68 cases included irritability, myoclonus, and ataxia. Weakness was more generalized with EV-A71 and more asymmetric with EV-D68, though patterns of brainstem and spinal cord involvement on MRI were similar. Compared with EV-D68, EV-A71 cases had milder weakness at onset and improved strength at 1- to 2-month follow-up (Figure 1), shorter length of stay (median 5.5 vs. 32 days) and a greater rate of full neurologic recovery (90% vs. 13%).

Conclusion

EV-D68 and EV-A71 are both associated with AFM with similar MRI findings, but cases can be distinguished by associated prodromal symptoms, neurologic findings, and outcomes. Timely collection and testing of nonsterile site specimens, particularly NP for EV-D68 and OP and rectal for EV-A71, are key to case identification.

Disclosures

All Authors: No reported Disclosures.
2849. Gut Microbiota Differences at the Time of Medical Intensive Care Unit (MICU) Admission Are Associated with Acquisition of Multi-drug-Resistant Organisms (MDROs) Among Patients Not Already Colonized with an MDRO
Authors: Bassis Christine , Seekatz Anna , Dangana Thelma E , Shimasaki Teppei , Yelin Rachel D , Schoeny Michael , Rhee Yoona , Ariston Michelle , Lolans Karen , Cornejo Cisneros Enrique , Aboushaala Khaled , Thabit Lina , Murray John , Sheng Jianrong , Ollison Stefanie , Bell Pamela B , Fogg Louis , Weinstein Robert A , Lin Michael Y , Young Vincent B , Hayden Mary K
Published: October 2019

Background

Among hospitalized patients, underlying variation in gut microbiota may confer differential risk for gut MDRO acquisition.

Methods

Rectal swab samples were collected from patients ≤2 days of MICU admission and then daily in the 27-bed MICU of an acute care hospital in Chicago, IL over 1 year. Patients were screened for MDRO colonization by selective culture (see Figure 1 for MDRO types); those with ≥2 swabs and MICU stays ≥3 days were studied. Bacterial 16S rRNA gene amplicon sequences were used for microbiota analysis. Medical records were reviewed.

Results

In preliminary analysis, 2,480 samples were collected from 627 patients who acquired 170 MDROs (Figure 1). Debilitation, co-morbidities, and certain medical devices were associated with MDRO acquisition, though admission MDRO status was not (table). While no interactions were detected between admission MDRO status and clinical predictors of MDRO acquisition, there were significant differences in gut microbiota composition at the time of MICU admission between patients colonized with an MDRO on admission and those not colonized (P < 0.001, using analysis of molecular variance (AMOVA) on distances). Therefore, we stratified our analysis by admission MDRO colonization status. For patients MDRO-colonized at admission, there were no significant differences in microbiota of patients who later did or did not acquire a new MDRO (AMOVA P-value = 0.32). For patients not MDRO-colonized on admission, there was a significant difference in microbiota of patients who later acquired an MDRO and those who did not (AMOVA P-value: 0.026). Differentially abundant operational taxonomic units (OTUs, based on 3% sequence difference) included OTUs classified as Anaerococcus and as other Clostridiales (higher in patients who remained uncolonized) and as Enterococcus (higher in patients who acquired an MDRO) (Figure 2). Diversity was also higher in patients who remained uncolonized (Wilcoxon test P-value: 0.035) (Figure 3).

Conclusion

Among patients not already colonized with an MDRO on admission, we identified gut microbiota differences associated with MDRO acquisition that could help explain patient-level variation in MDRO colonization resistance.

Disclosures

All Authors: No reported Disclosures.