bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of the gut microbiota in hemodialysis patients with sarcopenia
Authors: Zhou Qifan , Zhang Hailin , Yin Lixia , Li Guilian , Liang Wenxue , Chen Guanjie
Published: November 2021

Purpose

Maintenance hemodialysis (MHD) patients are at high risk of sarcopenia. Gut microbiota affects host metabolic and may act in the occurrence of sarcopenia importantly. This study aimed to study the characterization of the gut microbiota in MHD patients with sarcopenia, and to further reveal the complex pathophysiology of sarcopenia in MHD patients.

Methods

Fecal samples and clinical data were collected from 30 MHD patients with sarcopenia, and 30 age-and-sex-matched MHD patients without sarcopenia in 1 general hospital of Jiangsu Province from December 2020 to March 2021. 16S rRNA sequencing technology was used to analyze the genetic sequence of the gut microbiota for evaluation of the diversity, species composition, and differential microbiota of the two groups.

Results

Compared to MHD patients without sarcopenia, the ACE index of patients with sarcopenia was lower (P = 0.014), and there was a structural difference in the β-diversity between the two groups (P = 0.001). At the genus level, the relative abundance of Tyzzerella_4 in the sarcopenia group was significantly higher than in the non-sarcopenia group (P = 0.039), and the relative abundance of Megamonas (P = 0.004), Coprococcus_2 (P = 0.038), and uncultured_bacterium_f_Muribaculaceae (P = 0.040) decreased significantly.

Conclusion

The diversity and structure of the gut microbiota of MHD patients with sarcopenia were altered. The occurrence of sarcopenia in MHD patients may be influenced by gut microbiota.
A Cox Process with State-Dependent Exponential Pulses to Model Rainfall
Authors: Ramesh Nadarajah I , Rode Gayatri , Onof Christian
Published: November 2021

A point process model based on a class of Cox processes is developed to analyse precipitation data at a point location. The model is constructed using state-dependent exponential pulses that are governed by an unobserved underlying Markov chain. The mathematical formulation of the model where both the arrival rate of the rain cells and the initial pulse depth are determined by the Markov chain is presented. Second-order properties of the rainfall depth process are derived and utilised in model assessment. A method of moment estimation is employed in model fitting. The proposed model is used to analyse 69 years of sub-hourly rainfall data from Germany and 15 years of English rainfall data. The results of the analysis using variants of the proposed model with fixed pulse lifetime and variable pulse duration are presented. The performance of the proposed model, in reproducing second-moment characteristics of the rainfall, is compared with that of two stochastic models where one has exponential pulses and the other has rectangular pulses. The proposed model is found to capture most of the empirical rainfall properties well and outperform the two alternative models considered in our analysis.
Development of a Systematic Review Protocol and a Scoping Review of Ultrasound-Induced Immune Effects in Peripheral Tumors
Authors: Rix Anne , Girbig Renée , Porte Céline , Lederle Wiltrud , Leenaars Cathalijn , Kiessling Fabian
Published: November 2021

Purpose

Publication numbers reporting that ultrasound can stimulate immune reactions in tumors steadily increase. However, the presented data are partially conflicting, and mechanisms are difficult to identify from single publications. These shortcomings can be addressed by a systematic review and meta-analysis of current literature. As a first step, we here present the methodology and protocol for a systematic review to answer the following research question: Does ultrasound alter the immune reaction of peripheral solid tumors in humans and animals compared to control conditions without ultrasound?

Procedures

We designed a protocol to perform a systematic review and meta-analysis. The suitability of the protocol to detect and sort relevant literature was tested using a subset of publications. We extracted study characteristics, ultrasound parameters, and study outcomes to pre-evaluate the differences between publications and present the data as a scoping review.

Results

From 6532 publications detected by our preliminary literature search, 320 were selected for testing our systematic review protocol. Of the latter, 15 publications were eligible for data extraction. There, we found large differences between study characteristics (e.g., tumor type, age) and ultrasound settings (e.g., wavelength 0.5–9.5 MHz, acoustic pressure 0.0001–15,000 W/cm2). Finally, study outcomes included reports on cells of the innate (e.g., dendritic cells, macrophages) and adaptive immune system (e.g., CD8-/CD4-positive T cells).

Conclusion

We designed a protocol to identify relevant literature and perform a systematic review and meta-analysis. The differences between extracted features between publications show the necessity for a comprehensive search and selection strategy in the systematic review to get a complete overview of the literature. Meta-analyses of the extracted outcomes can then enable evidence-based conclusions.
The influence of values in sustainable consumption among millennials
Authors: Falke Andreas , Schröder Nadine , Hofmann Claudia
Published: November 2021

Due to climate change and global warming, sustainable consumption—as one possible solution to these challenges—is becoming more and more relevant. One generation that is affected the most by these developments are the millennials. While more and more baby boomers are retiring, millennials are now transitioning from being in training to being full-time employed, which marks a big change in their lives and makes understanding their values and consumption behaviour more important for marketers. The goal of our study is to clarify which values influence the building of attitude of millennials, if this influence differs according to employment status, and how attitude affects purchase intention concerning sustainable goods. Building to the list of values by Kahle (1983), the theory of planned behaviour, and perceived consumer effectiveness, we construct a framework to understand how values and employment status of millennials interact with their purchasing intention. Our results show that, among others, the values, that play a role during purchase intention forming, differ depending on the employment status. We also find that millennials place high importance on being in control when purchasing sustainable goods. Advertising and product managers can use our results to better understand and target the audience of their products as they construct their marketing efforts with the values of the audience in mind. In particular, messages that comply with the notion of being in control should be considered in every communication channel. This way, they may increase the share of sustainable consumers.
CHRO firm dinosaur versus CHRO role gorilla: the effect of CHRO company and role tenure on firms’ social performance
Authors: Engels Nina , Fischer-Kreer Denise , Brettel Malte
Published: November 2021

Academics and practitioners emphasize the rising importance of Chief Human Resource Officers (CHROs). CHROs act as heads of staff—they motivate the personnel and offer guidance. This study helps clarify the impact of increasingly relevant CHROs and reveals how their company and role tenure influence firms’ social performance. Drawing on a multisource longitudinal dataset of S&P 500 firms, we empirically validate our hypotheses. The sample contains 283 companies with 1944 firm-year observations from 2005 to 2017 and combines manually collected top management team data with data from Thomson Reuters Datastream. Our results show that there is a negative relation between CHROs with long company tenure and firms’ social performance, whereas CHROs with long role tenure positively relate to firms’ social performance. We also investigate the moderating role of CEO prior experience (i.e., HR experience, education, company and role experience) on the effect of CHRO company and role tenure on firms’ social performance. Surprisingly, CEO prior experience negatively moderates the relationship between CHRO role tenure and firms’ social performance. Overall, this article offers novel implications for the CHRO role and uncovers a distinction between two types of CHROs: CHRO firm dinosaurs versus CHRO role gorillas.
Budget-cut: introduction to a budget based cutting-plane algorithm for capacity expansion models
Authors: Singh Bismark , Rehberg Oliver , Groß Theresa , Hoffmann Maximilian , Kotzur Leander , Stolten Detlef
Published: November 2021

We present an algorithm to solve capacity extension problems that frequently occur in energy system optimization models. Such models describe a system where certain components can be installed to reduce future costs and achieve carbon reduction goals; however, the choice of these components requires the solution of a computationally expensive combinatorial problem. In our proposed algorithm, we solve a sequence of linear programs that serve to tighten a budget—the maximum amount we are willing to spend towards reducing overall costs. Our proposal finds application in the general setting where optional investment decisions provide an enhanced portfolio over the original setting that maintains feasibility. We present computational results on two model classes, and demonstrate computational savings up to 96% on certain instances.
Moving Towards Induced Pluripotent Stem Cell-based Therapies with Artificial Intelligence and Machine Learning
Authors: Coronnello Claudia , Francipane Maria Giovanna
Published: November 2021

The advent of induced pluripotent stem cell (iPSC) technology, which allows to transform one cell type into another, holds the promise to produce therapeutic cells and organs on demand. Realization of this objective is contingent on the ability to demonstrate quality and safety of the cellular product for its intended use. Bottlenecks and backlogs to the clinical use of iPSCs have been fully outlined and a need has emerged for safer and standardized protocols to trigger cell reprogramming and functional differentiation. Amidst great challenges, in particular associated with lengthy culture time and laborious cell characterization, a demand for faster and more accurate methods for the validation of cell identity and function at different stages of the iPSC manufacturing process has risen. Artificial intelligence-based methods are proving helpful for these complex tasks and might revolutionize the way iPSCs are managed to create surrogate cells and organs. Here, we briefly review recent progress in artificial intelligence approaches for evaluation of iPSCs and their derivatives in experimental studies.

Graphical Abstract
Hand Washing and Related Cognitions Following a Brief Behavior Change Intervention During the COVID-19 Pandemic: a Pre-Post Analysis
Authors: Keller Jan , Kwasnicka Dominika , Wilhelm Lea O. , Lorbeer Noemi , Pauly Theresa , Domke Antonia , Knoll Nina , Fleig Lena
Published: November 2021

Background

Effective hand washing (for at least 20 s, with water and soap) is one of the health behaviors protecting against infection transmissions. Behavior change interventions supporting the initiation and maintenance of hand washing are crucial to prevent infection transmissions. Based on the Health Action Process Approach, the aim of this research was to conduct a pre-post analysis of hand washing and related cognitions (i.e., intention, self-efficacy, self-monitoring), measured up to 100 days following an intervention.

Methods

A convenience sample of N = 123 participants (age: M = 23.96 years; SD = 5.82; 80% women) received a brief intervention (key behavior change techniques: information about health consequences of hand washing; action planning) and responded to daily diaries and questionnaires up to a 100-day follow-up. Two-level models were used to analyze data of n = 89 participants who provided longitudinal data.

Results

Hand washing and self-monitoring increased, whereas intention and self-efficacy decreased over time. Only self-monitoring was a consistent positive correlate of hand washing on a between-person level.

Conclusions

Hand washing and self-monitoring considerably increased over several weeks following the intervention. Future research testing the intervention against a control condition is needed to rule out that changes in behavior and cognitions might have been prompted by completing the daily diaries.

Trial Registration

German Clinical Trials Register; https://www.drks.de; registration number: DRKS00022067.
The Effectiveness of Mindfulness-Based Cognitive Therapy in Primary Care and the Role of Depression Severity and Treatment Attendance
Authors: Elices Matilde , Pérez-Sola Víctor , Pérez-Aranda Adrián , Colom Francesc , Polo Maria , Martín-López Luis Miguel , Gárriz Miguel
Published: November 2021

Objectives

Evidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants’ characteristics on symptom improvement.

Methods

Data were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment.

Results

Sixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms was associated with outcomes. Most individuals who lacked depressive symptoms at baseline remained in the non-clinical range after the treatment. Those in the severe group benefited the most from the intervention, since 35.6% were considered recovered. Rates of deterioration ranged from 2.1 to 2.7%, depending on the depression-baseline scores. Depression severity at the entrance, attendance, and age, but not personality traits, appear to be related to symptom improvement.

Conclusions

According to our results, MBCT can be effectively and safely delivered in primary care.
Primary studies on the effect of coal bio-gasification in situ in the Qinshui basin
Authors: Xiao Dong , Zhang Cong , Wu Junyong , Wang Enyuan , He Hailun , Zhang Yidong , Díaz Norberto Daniel , Deng Liuping , Wang Meng
Published: November 2021

Coal bio-gasification is one in situ coal gasification technology that utilizes the digestion of organic components in coal by methanogenic bacteria. It is not only an effective technology to enhance the recoverable reserves of coalbed methane, but also an important technical method to promote clean coal utilization. Relevant laboratory researches have confirmed the technical feasibility of anthracite bio-gasification. However, in the complex environment of coal bed, whether in situ gas can be yield with methanogenic bacteria needs to be verified by in situ experiments. In this study, a vertical well and a horizontal well were used in Qinshui basin to perform field experiments to confirm the technical industrial feasibility. The concentration of Cl− ion and number changes of Methanogen spp. were used to trace nutrition diffusion. Gas production changes and coalbed biome evolution were used to analyze technical implementation results. The trace data and biome evolution identified that: (1) The development of Methanoculleus spp. has a significant positive correlation with culture medium diffusion; (2) the structure of coalbed microbial community was significantly changed with the injection of nutrition, and the newly constructed methanogenic community was more suitable for fermentation of coal; and (3) the evolution of dominant microflora has further enhanced bio-gasification of coal. Gas production data showed that the gasification of coal lasted 635 and 799 days and yielded 74,817 m3 and 251,754 m3 coalbed methane in Z-159 and Z-7H wells, respectively. One nutrition injection in coalbed achieved an average of 717 days of continuous gas production in experimental wells. Results confirmed that coalbed methane enhancement with bio-gasification of coal is a potential technology to achieve the productivity improvement of coalbed methane wells. And the findings of this study can help to further understand the mechanism of in situ coal bio-gasification and provide theoretical support for the development of biomining of coal.
In vivo evaluation of nanostructured lipid carrier systems (NLCs) in mice bearing prostate cancer tumours
Authors: Akanda Mushfiq , Getti Giulia , Douroumis Dennis
Published: November 2021

Nanostructure lipid carriers (NLCs) were developed for the delivery of curmumin (CRN), a potent anticancer agent with low bioavailability, for the treatment of prostate cancer. NLCs prepared using high pressure homogenization (HPH) with around 150 nm particle size, − 40 V ζ-potential and excellent long-term stability. Cellular uptake of CRN-SLN showed nanoparticle localization in the cytoplasm around the nucleus. CRN-NLCs were assessed using flow cytometry and found to cause early and late apoptotic events at 100 μg/ml CRN concentrations. CRN-NLC nanoparticles were administrated to nude mice with LNCaP prostate cancer xenografts and demonstrated substantial tumour volume suppression (40%) with no weight loss compared to pure CRN (ethanolic solution). Overall, NLCs were proved a suitable carrier for passive drug delivery and cancer treatment.

Graphical abstract
Developing the EQ-5D-5L Value Set for Uganda Using the ‘Lite’ Protocol
Authors: Yang Fan , Katumba Kenneth R. , Roudijk Bram , Yang Zhihao , Revill Paul , Griffin Susan , Ochanda Perez N. , Lamorde Mohammed , Greco Giulia , Seeley Janet , Sculpher Mark
Published: November 2021

Objective

A ‘lite’ version of the EQ-5D-5L valuation protocol, which requires a smaller sample by collecting more data from each participant, was proposed and used to develop an EQ-5D-5L value set for Uganda.

Methods

Adult respondents from the general Ugandan population were quota sampled based on age and sex. Eligible participants were asked to complete 20 composite time trade-off tasks in the tablet-assisted personal interviews using the offline EuroQol Portable Valuation Technology software under routine quality control. No discrete choice experiment task was administered.

The composite time trade-off data were modelled using four additive and two multiplicative regression models. Model performance was evaluated based on face validity, prediction accuracy in cross-validation and in predicting mild health states. The final value set was generated using the best-performing model.

Results

A representative sample (N = 545) participated in this study. Responses to composite time trade-off tasks from 492 participants were included in the primary analysis. All models showed face validity and generated comparable prediction accuracy. The Tobit model with constrained intercepts and corrected for heteroscedasticity was considered the preferred model for the value set on the basis of better performance. The value set ranges from − 1.116 (state 55555) to 1 (state 11111) with ‘pain/discomfort’ as the most important dimension.

Conclusions

This is the first EQ-5D-5L valuation study using a ‘lite’ protocol involving composite time trade-off data only. Our results suggest its feasibility in resource-constrained settings. The established EQ-5D-5L value set for Uganda is expected to be used for economic evaluations and decision making in Uganda and the East Africa region.
Cumulative Risk of Immigration Prison Conditions on Health Outcomes Among Detained Immigrants in California
Authors: Saadi Altaf , Patler Caitlin , De Trinidad Young Maria-Elena
Published: November 2021

Objectives

The USA maintains the world’s largest immigration detention system. This study examines the mechanisms by which detention serves as a catalyst for worsening health.

Methods

Using data from detained immigrants in California (n = 493) from 2013 to 2014, we assessed the prevalence of exposure to conditions of confinement hypothesized to negatively influence health; the extent to which conditions of confinement are associated with psychological stress, diagnosed mental health conditions, and/or declines in general health; and the cumulative impact of confinement conditions on these outcomes.

Results

We found that each condition increased the likelihood of one or more negative health conditions, but there was also a cumulative effect: for each additional confinement condition, the odds of worsening general health rose by 39% and reporting good health decreased by 24%.

Conclusions

Confinement conditions are associated with poor physical and mental health outcomes among immigrants detained in immigration prisons. Policies that seek to improve specific conditions in detention centers may remove some risks of harm, but alternatives to detention are likely to be most effective.
The Impact of Racial and Non-racial Discrimination on Health Behavior Change Among Visible Minority Adults During the COVID-19 Pandemic
Authors: Currie Cheryl L. , Higa Erin K.
Published: November 2021

Introduction

Pre-pandemic health behavior has been put forward as a reason for excess COVID-19 infection and death in some racialized groups. At the same time, scholars have labeled racism the other pandemic and argued for its role in the adverse COVID-19 outcomes observed. The purpose of this study was to examine the impact of discrimination on health behavior change among racialized adults in the early stages of the pandemic.

Methods

Data were collected from 210 adults who identified as a visible minority in Alberta, Canada, in June 2020. The Everyday Discrimination Scale (Short Version) was adapted to examine past-month experiences. Four questions asked if alcohol/cannabis use and stress eating had significantly increased, and if sleep and exercise had significantly decreased in the past month. Logistic regression models examined associations between discrimination attributed to racial and non-racial causes and health behavior change adjusted for covariates.

Results

The majority of adults (56.2%) reported past-month discrimination including 26.7% who attributed it to their race. Asian adults reported more racial discrimination and discrimination due to people believing they had COVID-19 than other visible minorities. Racial discrimination during the pandemic was strongly associated with increased substance use (OR: 4.0, 95% CI 1.2, 13.4) and decreased sleep (OR: 7.0, 95% CI 2.7, 18.4), and weakly associated with decreased exercise (OR: 2.2, 95% CI 1.1, 4.5). Non-racial discrimination was strongly associated with decreased sleep (OR: 4.8, 95% CI 1.8, 12.5).

Conclusion

Racial discrimination may have a particularly important effect on intensifying adverse health behavior changes among racialized adults during a time of global crisis.
Prior Prognostic Expectations as a Potential Predictor in Neurofeedback Training
Authors: Damanskyy Yevhen , Olsen Alexander , Hollup Stig
Published: November 2021

The present study evaluated whether subjects’ expectations and neurofeedback training performance predict neurofeedback efficacy in cognitive training by controlling both factors as statistical variables. Twenty-two psychology students underwent neurofeedback training, employing beta/theta protocol to enhance beta1 power (13–21 Hz) and suppress theta (4–7 Hz) power. Neurofeedback efficacy was evaluated by behavioral components measured on pre-tests and post-tests employing a visual continuous performance task. The results revealed a significant interaction term between change in reaction time from pre-test to post-test and expectancy effect, indicating that participants with high prognostic expectations showed better improvement in reaction time scores. The data did not reveal that actual neurofeedback performance influenced the post-test measurements of the visual continuous performance task. No significant differences were found for reaction time variability, omission, or commission errors. Possible factors contributing to the results are discussed, and directions for future research are suggested.
Juveniler Typ-2-Diabetes mellitus – eine unterschätzte Hochrisikoerkrankung
Authors: Hörtenhuber Thomas
Published: November 2021

Der Typ-2-Diabetes mellitus (T2DM) des Kindes- und Jugendalters ist historisch gesehen die jüngste Entität der Diabetologie mit ersten Fallberichten in den USA in den frühen 1980ern. Er wird bzw. wurde lange Zeit eher wenig intensiv klinisch und akademisch betrachtet und als eher „benigne“ im Vergleich zum Typ-1-Diabetes mellitus (T1DM) von Gleichaltrigen eingestuft.

Rezente Outcome-Analysen bzw. Ergebnisse aus Interventionsstudien zeigen jedoch ein gänzlich anderes Bild: Der juvenile T2DM scheint die aggressivste und riskanteste Diabetesentität unter allen zu sein, mit einem massiv erhöhten Mortalitäts- und Morbiditätsrisiko im Vergleich zu gleich alten bzw. gleich lang erkrankten Typ-1-Diabetikern und aktuell ohne wirksame pharmakologische Intervention.
The Uncertain Structure of Process Review in the EU: Beyond the Debate on the CJEU’s Weiss Ruling and the German Federal Constitutional Court’s PSPP Ruling
Authors: Gerstenberg Oliver
Published: November 2021

The obligation to provide reasons (e.g. in Art. 296 TFEU) may appear rather a simple and straightforward, but in actual practice—as the mutually antagonistic Weiss rulings of the CJEU and the German Bundesverfassungsgericht (“BVG”) amply demonstrate—is fraught with constitutional complication. On the one side, there lies the concern with a deeply intrusive form of judicial review which substitutes judicially determined “good” reasons for those of the reviewee decisionmaker—legislatures, administrative agencies, or, as in Weiss, the European Central Bank (ECB). On the other side lies the concern with judicial abdication in the face of technical expertise, uncertainty and complexity, turning the reason-giving requirement into a mere façade thereby placing democratic accountability in the modern administrative state beyond law’s remit. Either way, normatively and conceptually, we seem left with a half-way house only. Drawing on the recent US administrative law discourse—the neo-Fullerian concept of an “internal morality of law” (Sunstein / Vermeule) and democratic experimentalism (Sabel / Kessler)—this paper explores the concept of process review as tertium datur. Process review responds to concerns over the rule of law and administrative discretion through indirect, procedural safeguards, by imposing requirements of reasoned justification, rather than through wholesale invalidation or aggressive substantive review.
Detail-preserving depth estimation from a single image based on modified fully convolutional residual network and gradient network
Authors: Xu Huihui , Liu Nan
Published: November 2021

Predicting a convincing depth map from a monocular single image is a daunting task in the field of computer vision. In this paper, we propose a novel detail-preserving depth estimation (DPDE) algorithm based on a modified fully convolutional residual network and gradient network. Specifically, we first introduce a new deep network that combines the fully convolutional residual network (FCRN) and a U-shaped architecture to generate the global depth map. Meanwhile, an efficient feature similarity-based loss term is introduced for training this network better. Then, we devise a gradient network to generate the local details of the scene based on gradient information. Finally, an optimization-based fusion scheme is proposed to integrate the depth and depth gradients to generate a reliable depth map with better details. Three benchmark RGBD datasets are evaluated from the perspective of qualitative and quantitative, the experimental results show that the designed depth prediction algorithm is superior to several classic depth prediction approaches and can reconstruct plausible depth maps.
Regulating artificial-intelligence applications to achieve the sustainable development goals
Authors: Goh Hoe-Han , Vinuesa Ricardo
Published: November 2021

Artificial intelligence is producing a revolution with increasing impacts on the people, planet, and prosperity. This perspective illustrates some of the AI applications that can accelerate the achievement of the United Nations Sustainable Development Goals (SDGs) and highlights some of the considerations that could hinder the efforts towards them. In this context, we strongly support the development of an 18thSDG on digital technologies. This emphasizes the importance of establishing standard AI guidelines and regulations for the beneficial applications of AI. Such regulations should focus on concrete applications of AI, rather than generally on AI technology, to facilitate both AI development and enforceability of legal implications.
No-boundary thinking: a viable solution to ethical data-driven AI in precision medicine
Authors: Obafemi-Ajayi Tayo , Perkins Andy , Nanduri Bindu , Wunsch II Donald C. , Foster James A. , Peckham Joan
Published: November 2021

Today Artificial Intelligence (AI) supports difficult decisions about policy, health, and our personal lives. The AI algorithms we develop and deploy to make sense of information, are informed by data, and based on models that capture and use pertinent details of the population or phenomenon being analyzed. For any application area, more importantly in precision medicine which directly impacts human lives, the data upon which algorithms are run must be procured, cleaned, and organized well to assure reliable and interpretable results, and to assure that they do not perpetrate or amplify human prejudices. This must be done without violating basic assumptions of the algorithms in use. Algorithmic results need to be clearly communicated to stakeholders and domain experts to enable sound conclusions. Our position is that AI holds great promise for supporting precision medicine, but we need to move forward with great care, with consideration for possible ethical implications. We make the case that a no-boundary or convergent approach is essential to support sound and ethical decisions. No-boundary thinking supports problem definition and solving with teams of experts possessing diverse perspectives. When dealing with AI and the data needed to use AI, there is a spectrum of activities that needs the attention of a no-boundary team. This is necessary if we are to draw viable conclusions and develop actions and policies based on the AI, the data, and the scientific foundations of the domain in question.
Comparative genomic analysis of clinicalCandida glabrataisolates identifies multiple polymorphic loci that can improve existing multilocus sequence typing strategy
Authors: Arastehfar A. , Marcet-Houben M. , Daneshnia F. , Taj-Aldeen S.J. , Batra D. , Lockhart S.R. , Shor E. , Gabaldón T. , Perlin D.S.
Published: November 2021

Candida glabratais the second leading cause of candidemia in many countries and is one of the most concerning yeast species of nosocomial importance due to its increasing rate of antifungal drug resistance and emerging multidrug-resistant isolates. Application of multilocus sequence typing (MLST) to clinicalC. glabrataisolates revealed an association of certain sequence types (STs) with drug resistance and mortality. The currentC. glabrataMLST scheme is based on single nucleotide polymorphisms (SNPs) at six loci and is therefore relatively laborious and costly. Furthermore, only a few high-qualityC. glabratareference genomes are available, limiting rapid analysis of clinical isolates by whole genome sequencing. In this study we provide long-read based assemblies for seven additional clinical strains belonging to three different STs and use this information to simplify theC. glabrataMLST scheme. Specifically, a comparison of these genomes identified highly polymorphic loci (HPL) defined by frequent insertions and deletions (indels), two of which proved to be highly resolutive for ST. When challenged with 53 additional isolates, a combination ofTRP1(a component of the current MLST scheme) with either of the two HPL fully recapitulated ST identification. Therefore, our comparative genomic analysis identified a new typing approach combining SNPs and indels and based on only two loci, thus significantly simplifying ST identification inC. glabrata. Because typing tools are instrumental in addressing numerous clinical and biological questions, our new MLST scheme can be used for high throughput typing ofC. glabratain clinical and research settings.
Investigation on Occupational Protection and Exposure of Medical Staff in the Diagnosis and Treatment of COVID-19 in Sichuan
Authors: Huang Wenzhi , Zong Zhiyong , Qiao Fu , Lin Ji
Published: November 2021

Background: We investigated the contact status of medical staff with confirmed or suspected patients with COVID-19 in Sichuan Province, China, as well as the use of personal protective equipment at the time of contact, and we explored the factors affecting the effective use of personal protective equipment. Methods: We performed a cross-sectional study by distributing a questionnaire on occupational protection and exposure of medical staff in the diagnosis and treatment of COVID-19 using a convenience sampling method for online surveys from February 23 to February 29, 2020. Results: In total, 13,829 valid questionnaires from 644 hospitals in Sichuan Province were retrieved, and 802 people were exposed to confirmed or suspected patients with COVID-19, accounting for 5.80%. 688 (85.79%) of 802 people who reported that they had taken effective personal protection measures for each exposure. Sex, work department, and length of service were the independent factors influencing the effective use of personal protective equipment in multivariate analysis (P < .05). Conclusions: Medical institutions need to continue to strengthen the training regarding standard precautions and personal protection, especially for general departments other than fever clinics and isolation wards, as well as medical staff with few working years, to ensure the occupational safety of medical staff.

Funding: No

Disclosures: None
Mortality Among Veterans’ Affairs Community Living Center (CLC) Residents with COVID-19
Authors: Bej Taissa , Wilson Brigid , Song Sunah , Briggs Janet M , Banks Richard , Kothadia Sonya , Perez Federico , Jump Robin , Mongilardi Nicole
Published: November 2021

Background: Outcomes among nursing home residents with asymptomatic compared to symptomatic COVID-19 are not well characterized. We assessed all-cause mortality among Veterans’ Affairs (VA) community living center (CLC) residents; we compared those residents with a negative SARS-CoV-2 test to residents with symptomatic, presymptomatic, and asymptomatic SARS-CoV-2 infections. Methods: We conducted a national retrospective cohort study of CLC residents tested for COVID-19 between March 1 and July 31, 2020, based on data compiled through the VA COVID-19 shared data resource. Among those with a positive SARS-CoV-2 test, residents were considered symptomatic if they had experienced COVID-19 symptoms in the 30 days prior to the test. Residents were considered presymptomatic if they did not experience symptoms in the 30 days prior to testing and developed a fever (>38°C) or required supplemental oxygen within 14 and 60 days, respectively, following the test. Residents were considered asymptomatic in the absence of these pre- and posttest symptoms. Results: From March 1 to July 31, 2020, of 9,052 CLC residents screened for COVID-19, 8,325 (92%) tested negative (Table 1). Among 727 residents with positive tests, 467 (64%) were symptomatic, 88 (12%) were presymptomatic, and 172 (24%) remained asymptomatic. We observed significant differences in the racial makeup of these disease groups. Among CLC residents who were symptomatic or presymptomatic, 176 (32%) of 555 were black compared to 39 (23%) of 172 who were asymptomatic and 1,810 (22%) of 8,325 who tested negative for SAR-CoV-2. All-cause 30-day mortality rates for symptomatic and presymptomatic residents were 25% and 34%, respectively, which exceeded the all-cause 30-day mortality of asymptomatic residents (12%) and residents with a negative test (6%) (Figure 1). Conclusions: More than one-third of CLC residents with COVID-19 were asymptomatic at the time of testing. This finding highlights the importance of vigilant infection prevention and control measures. Our finding that mortality among presymptomatic residents exceeded that of symptomatic residents raises consideration for enhancing supportive care measures, such as supplemental oxygen and mitigation of inflammatory reactions, as a means to reduce mortality among nursing home residents with presymptomatic SARS-CoV-2 infections.

Funding: No

Disclosures: None
Decrease in MRSA Bacteremia After Implementation of Intranasal Mupirocin Decolonization Protocol
Authors: Beatriz Cruz Angela , LeRose Jennifer , Chopra Teena , Cranis Mara , Cullen Lori , Evans Kenisha , Meyer Monica , Jabbo Lavina , Moshos Judy , Valentini Rudolph
Published: November 2021

Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a key pathogen in burn patients and is associated with increased morbidity and mortality. Disruption of skin barrier exposes these individuals to a myriad of infections. Various decolonization approaches, including chlorhexidine baths and intranasal mupirocin, have shown favorable outcomes in preventing MRSA infections in this cohort. Methods: In August 2020, a mupirocin decolonization protocol was implemented in Michigan’s largest trauma-level 1 burn intensive care unit. All patients admitted to the burn unit received daily intranasal mupirocin for the initial 5 days of hospitalization. We compared MRSA bacteremia rates per 1,000 patient days from January–July 2020 to those after August 2020. A hospital-acquired MRSA bacteremia infection was defined as a positive blood culture after hospital day 3. Patient characteristics and hospital course were collected through medical chart review. A 2-tailed t test was used for analysis. Results: We identified 5 cases of hospital-onset MRSA bacteremia and no cases of community-onset MRSA bacteremia. On average, there were 2.6 cases per 1,000 patient days before mupirocin implementation and 1.0 cases per 1,000 patient days after mupirocin implementation (P = .26) (Figure 1). In this patient cohort, the average total body surface area burned was 45.6% (range, 18%–90%), and 60% (n = 3) of patients had sputum culture positive for MRSA prior to developing bacteremia (Table 1). Also, 2 patients (40%) with MRSA bacteremia died. Notably, the patient in the postintervention cohort was admitted in July, prior to implementation. Conclusions: Implementation of a decolonization protocol with intranasal mupirocin in burn-surgery patients markedly decreased the incidence of MRSA bacteremia in this cohort. This is the first study to evaluate the use of mupirocin as a decolonizing agent in burn victims. Continued long-term surveillance is recommended, and this strategy has potential for application to other high-risk cohorts.

Funding: No

Disclosures: None
Time Above All Else: Pharmacodynamic Analysis of Β-Lactams in Critically Ill Patients
Authors: Landmesser Katherine , Burgess David , Clark Justin
Published: November 2021

Background: Despite the development of new β-lactam agents, gram-negative resistance continues to be an increasing concern in the healthcare setting. The understanding and optimizing antimicrobial pharmacokinetics and pharmacodynamics are essential to enhance activity of appropriate therapy, improve clinical outcomes, and reduce the development of resistance. Methods: A pharmacodynamic analysis was performed for 4 β-lactams (aztreonam, cefepime, piperacillin/tazobactam, and meropenem) and 14 dosage regimens as either intermittent bolus (IB) or prolonged infusion (PI) against 7 gram-negative pathogens: Klebsiella pneumoniae, K. oxytoca, Escherichia coli, Enterobacter cloacae, E. aerogenes, Acinetobacter baumannii, and Pseudomonas aeruginosa. Unit-specific minimum inhibitory concentration (MIC) distribution data were generated using antibiogram data over a decade for 4 intensive care units within our institution: medical ICU, cardiovascular ICU, surgical ICU, and neurosurgical ICU. Published pharmacokinetic parameter estimates in critically ill patients, combined with this MIC distribution data, were utilized to perform Monte Carlo simulations for each antimicrobial regimen. The percentage of time for which the unbound concentration of antibiotic remained above the MIC (ƒT>MIC) was utilized as the pharmacodynamic target for each agent: 40% ƒT>MIC for meropenem, 50% ƒT>MIC for piperacillin/tazobactam, 60% ƒT>MIC for aztreonam, and 70% ƒT>MIC for cefepime. Regimens were modeled using Oracle Crystal Ball software to determine the likelihood of achieving >90% probability of target attainment (PTA). Because resistance rates were significantly higher for P. aeruginosa and A. baumannii, cumulative PTAs for K. pneumoniae, K. oxytoca, E. coli, E. cloacae, and E. aerogenes were analyzed separately to determine the relative PTA for Enterobacterales in each ICU. Results: No intermittent infusion regimens of piperacillin/tazobactam, aztreonam, or cefepime achieved >90% PTA for any organism. Piperacillin/tazobactam 4.5 g infused over 4 hours (PI q6h) and aztreonam 2 g PI q6h failed to achieve adequate PTA for Enterobacterales with only 84% and 85% PTA, respectively. For Enterobacterales, the only regimens to achieve >90% PTA included cefepime 2 g infused over 3 hours (PI q8h) and meropenem 1g IB q8h with 95% and 99% PTA, respectively. Meropenem 2 g PI q8h was the only regimen capable of achieving >90% PTA for both A. baumannii and P. aeruginosa with 97% and 92% PTA, respectively. Conclusions: Although utilization of high doses and prolonged infusions dramatically improve the pharmacodynamics of β-lactam therapy, the only regimen capable of achieving adequate PTA for all organisms analyzed was meropenem 2g PI q8h. To reduce carbapenem use, combination therapy may be considered for critically ill patients receiving aztreonam, cefepime, or piperacillin/tazobactam for empiric treatment of gram-negative infections.

Funding: No

Disclosures: None
Working with Respiratory Illness: Presenteeism Among Healthcare Personnel at Tertiary-Care Hospitals in Bangladesh, 2008–2016
Authors: Mah-E-Muneer Syeda , Hassan Md. Zakiul , Uddin Bhuiyan Mejbah , Hussain Kamal , Akhtar Zubair , Rahman Mustafizur , Iuliano A. Danielle , Azziz-Baumgartner Eduardo , Chowdhury Fahmida
Published: November 2021

Background: Healthcare personnel (HCP) in crowded and resource-poor countries (eg Bangladesh), might be at risk of exposure to and transmission of respiratory illnesses to coworkers, patients, and caregivers. The infection control practices in public hospitals are inadequate in Bangladesh. We estimated the incidence of respiratory illness episodes among HCP, and proportion of HCP who worked during respiratory illnesses, including influenza virus infection, at 2 tertiary-care public hospitals in Bangladesh. Methods: From May 2008 to February 2016, HCP (defined as physicians, nurses, interns, patient care assistant, cleaners, and administrative staff working in adult and pediatric medicine wards) were asked to self-report to study physicians when they experienced new onset of cough, rhinorrhea, difficulty breathing, or fever during the April–September influenza epidemic period each year. Study physicians followed HCP throughout their respiratory illness episodes and recorded respiratory symptoms, onset dates, duration of illness, and days of presenteeism and absenteeism during illness. Nasopharyngeal and oropharyngeal swabs were collected after informed written consent and were tested for influenza by rRT-PCR. We used hospital records to enumerate total HCP working in the study wards during influenza season and multiplied by 6-months follow-up per year to calculate person-time contribution for estimating respiratory illness incidence. Results: HCP self-reported 107 episodes of respiratory illness during 656 person years of follow-up, for an estimated incidence of 16.3 per 100 person years (95% CI, 13–20). Of 107 episodes, 33 (31%) included fever and cough. The mean illness length was 3.9 days (SD, ±1.8). HCP worked an average of 3.4 days (SD, ±1.4) while ill. HCP missed work for a median of 1 day (IQR, 1–2) during 29 (27%) of 107 illness episodes. HCP consented to collect swabs during 56 (52%) episodes, and among them 8 (14%) of 56 tested positive for influenza (flu-A, n = 5; flu-B, n = 3). Also, 63% of HCP with influenza reported fever and cough. HCP experiencing either respiratory illness or influenza worked for similar periods of days while ill: mean, 4 (SD, ±2.2) versus mean, 3.3 (SD, ±1.4) (P = .257). HCP worked during 105 (98%) of 107 respiratory illness and 7 (88%) of 8 influenza episodes. Conclusions: Most HCP in Bangladesh, including those with influenza, worked during respiratory illnesses. The potential value of stay-at-home policies, compensation for sick days, and influenza vaccination in reducing HCP-associated respiratory pathogen transmission could be assessed in Bangladesh and similar settings.

Funding: No

Disclosures: None
Knobmanship: Dialing Up Understanding of VAE Triggers
Authors: Cawcutt Kelly , Rupp Mark , Musil Lauren
Published: November 2021

Background: Mechanical ventilation is a lifesaving therapy for critically ill patients. Hospitals perform surveillance for the NHSN for ventilator-associated events (VAE) by monitoring mechanically ventilated patients for metrics that are generally thought to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner; initially, a ventilator-associated condition (VAC) is triggered with an increase in positive end-expiratory pressure (PEEP, >3 cm H2O) or fraction of inspired oxygen (FIO2, 0.20 or 20 points) after a period of stability or improvement on the ventilator. We believe that many reported VAEs could be avoided by provider and respiratory therapy attention to “knobmanship.” We define knobmanship as knowledge of the VAE definition and trigger points combined with appropriate clinical care for mechanically ventilated patients while avoiding unnecessary triggering of the VAE definition by avoiding small unneeded changes in PEEP or FIO2. Methods: We performed a chart review of 283 patients who had a reported VAE to the NHSN between January 1, 2019, and December 31, 2020. We collected data including type of VAE, VAE triggering criteria, and clinical course. Results: Of the 283 VAEs, 59 were triggered by a PEEP increase from 5 to 8 with stable or decreasing FIO2. Of the 59 VAEs, 33 were VACs, 18 were infection-related ventilator- associated complications (IVACs), and 8 were possible ventilator-associated pneumonia (PVAP). Most of these transient changes in PEEP were deemed clinically unnecessary. A 21% reduction of VAEs reported to the NSHN over the 2-year review period could have been avoided by knobmanship. Conclusions: The VAE definition may often be triggered by provider bias to the ventilator settings rather than what the patient’s clinical-condition requires. Attention to knobmanship may result in substantial decrease in reported VAE.

Funding: No

Disclosures: None