bluuebunny/crossref_metadata_2025 huggingface dataset:
Charged Particle Transport in Gaseous Nitrogen at Intermediate E/N using the Voltage Transient Method
Authors: Purdie PH , Fletcher J
Published: November 2018

A pulsed swarm of charged particles crossing an inter-electrode gap under the influence of an applied electric field E will produce a pulsed current in the external circuit which, when integrated over time, will result in a transient voltage pulse, the shape and magnitude of which is characteristic of the number and type of charged particles. This voltage transient technique has been used to investigate a gas discharge in nitrogen gas at values of EIN (the ratio of applied electric field to gas number density), such that ionisation is non-negligible. The voltage transients have been subjected to a theoretical analysis, which has previously been reported, which includes not only cathode and anode image terms but also both electron and ion diffusion terms. Electron transport parameters are reported for EIN ::; 350 Td (1 Td = 10-17 V cm2). Data are also obtained for the drift velocities and diffusion coefficients of the ions operative within the nitrogen discharge. An estimate is obtained for the collisional decay rate of Nt.
Power Spectral Analysis of Enhanced Scintillation of Quasar 3C459 Due to Comet Halley
Authors: Janardhan P , Alurkar SK , Bobra AD , Slee OB , Waldron D
Published: November 2018

The radio source 2314+038 (3C459) showed enhanced scintillations on three days at a solar elongation of about 90� as the plasma tail of Halley's Comet swept across it on six days during 16-21 December 1985. If we assume that the plasma velocities in the tail were not constant everywhere, but increased linearly from about 50 kms-1 at the tail axis to the normal average solar wind velocity of 400 kms-1 at the edges where the tail merged with the solar wind, a power spectral analysis of the scintillations shows two ranges of the rms electron density variation t:..N and scale size a. In particular, these are a fine scale zone near the axis where a is in the range 9 to 27 km and t:..N in the range 2 to 5 cm -3 and a zone near the edges with a and t:..N in the ranges 100 to 265 km and 0�4 to 0�8 cm-3 respectively. The assumption of a single velocity of 100 kms-1 throughout the tail shows similar fine scales near the tail axis and large scales near the edges. The scale sizes in that case range from about 18 km at the axis to about 70 km at the edges, corresponding to t:..N of 3�3 and 0�85 cm-3 respectively. A comparison with the results obtained by Slee et al. (1987) shows that there is no radial variation of t:..N. The tail-lag is seen to playa crucial role in determining the correct occulting geometry and the path of the source through the tail.
Evaluation of Electrostatic Potentials and Madelung Constants in Ionic Crystals by the Method of Spherically Symmetric Equivalent Charges
Authors: Argyriou DN , Howard CJ
Published: November 2018

A simple derivation is given of the electrostatic potential in a periodic three-dimensional array of spherically symmetric charge distributions. By noting the equivalence in electrostatic calculations of point charges and suitably chosen spherical charge distributions, this leads to expressions for electrostatic potentials and (Madelung) interaction energies in ionic crystals. The expressions involve sums in reciprocal space only. The approach is illustrated by the calculation of Madelung constants for NaCl and CaF2, and the electrostatic interaction energy of Ti02 (rutile). A previous controversy is resolved by showing that the two expressions for the electrostatic potential, which are apparently different, under certain conditions give the same result.
Electron Spin Resonance of Ti3+ in Synthetic Beryl
Authors: Hutton DR , Pilbrow JR , Troup GJ , Warne JO
Published: November 2018

Synthetic Australian Biron beryl, coloured pink by titanium, shows an ESR spectrum due to Ti3+ substituted into the trigonally distorted A13+ octahedral site of the crystal structure.
HIV knowledge, sexual health and sexual behaviour among Black and minority ethnic men who have sex with men in the UK: a cross-sectional study
Authors: Jaspal Rusi , Lopes Barbara , Jamal Zahra , Yap Carmen , Paccoud Ivana , Sekhon Parminder
Published: November 2018

Background Black and minority ethnic (BME) men who have sex with men (MSM) face a major burden in relation to HIV infection. Using a cross-sectional correlational survey design, the present study explored the relationships between HIV knowledge and reported sexual health and sexual behaviour in this population. Methods: A convenience sample of 538 BME MSM was recruited in London, Leicester and Leeds: 346 (64%) self-identified as South Asian, 88 (16%) self-identified as Latin American, 76 (14%) self-identified as Black, 13 (2%) self-identified as mixed, and 15 (3%) self-identified as other. Results: HIV knowledge was low across the board, and South Asian MSM manifested the lowest scores. Respondents who perceived their HIV risk to be low possessed the least HIV knowledge. There were interethnic differences in the frequency of gay sauna visits, sex-seeking on mobile applications, drug use and attendance at sex parties. Respondents reported a high frequency of racism and discrimination, with Black MSM reporting highest frequency. Conclusions: There is an urgent need to raise awareness of HIV in BME MSM, and a culturally competent approach to HIV awareness-raising in BME MSM is required. These findings shed light on the contexts in which HIV prevention efforts should be targeted to reach specific ethnic groups, as well as some of the potential syndemics that can increase HIV risk or undermine HIV outcomes in BME MSM patients.
Le sous-titrage et le commentaire au service d’unmythe
Authors: Kourdis Evangelos
Published: November 2018

Dans cette étude nous mettrons en valeur la dimension sémiotique du sous-titrage en grec et du commentaire de spots publicitaires français qui traitent des soins corporels. Il s’agit de spots publicitaires qui lancent sur le marché grec des produits de soins corporels de la marqueLe petit Marseillais.L’étude se fait tant au niveau interlingual qu’au niveau intersémiotique. Nous allons voir que le choix sémiotique du sous-titrage est lié aux connotations positives de la société grecque concernant la langue française lorsqu’ elle est utilisée dans la publicité de produits cosmétiques et de soins corporels. Par ailleurs les sous-titres traduisent parfois intersémiotiquement les dialogues du spot et le contenu de l’image ce qui facilite le transfert culturel de la valeur de laméditerranéitéavec laquelle les Grecs sont familiarisés. Les constatations principales tirées sont que le sous-titrage ne s’éloigne pas de la langue source, préservant ainsi les mêmes isotopies sémantiques, et que la traduction intersémiotique est une caractéristique commune des spots publicitaire qui se fait entre les énoncés verbaux français ou les sous-titres grecs et le contenu de l’image. Enfin, les commentaires grecs reproduisent les informations essentielles du texte français effacé, ce qui dote les spots d’une valeur supplémentaire grâce à leur caractère médiatique et narratif.
Bickering
Authors: Boxer Diana , Radice Joseph
Published: November 2018

This paper studies a speech behavior commonly referred to as “bickering,” which occurs primarily among interlocutors of close
social distance (e.g. partners, spouses, siblings, roommates). Using ethnographic methodology, the study analyzes 100 naturally
occurring sequences of familial conflict conversation supplemented by ten open-ended interviews. These data enable the
disambiguation of “bickering” from other speech behaviors such as “complaining” and “nagging.” The analysis offers conclusions on
the typical topics, interlocutor relationships and speech behaviors inherent in the bickering event.
The role of verbal irony in conflict talk among relatives and friends in an Argentinian community
Authors: Kalbermatten María Isabel
Published: November 2018

This article shows the role of verbal irony in conflict talk among relatives and friends. Excerpts from ten naturally occurring multiparty conversations among relatives and friends were analyzed. The analysis shows that the introduction of verbal irony in the conversation by one of the participants can: (1) end the conflict between two other participants by switching the topic of the interaction; (2) extend the conflict; (3) fail to alter the trajectory of the conflict sequence because one of the participants does not acknowledge the irony; (4) defuse a dispute about an unpleasant topic for one or two of the participants; or (5) initiate a dispute among relatives and/or friends whose relationship is not a friendly one. The analysis in this article is qualitative rather than quantitative; the tendencies presented are not based on frequency.
Linguistic landscapes as pornoheterotopias
Authors: Vasconcelos Barboza Rafael de , Borba Rodrigo
Published: November 2018

Drawing on multimodal analysis of graffiti in male public restrooms at the Faculdade de Letras of the Universidade Federal do Rio
de Janeiro, this paper investigates how notions of place and gendered/sexualized subjects are discursively (re)constructed in
interactions with the materiality and historicity of the public realm. The analysis focuses on the indexicalities of public
signage and the ways they (in)form understandings of and access to certain spaces. By investigating the fragmented history of
entextualizations of these toilet graffiti as well as the indexicalities of their lexical, graphic, and co(n)textual aspects, we
argue that places can be queered since they are semiotically constructed and discursively
performed. The paper illustrates how static assumptions about place, gender, and sexuality can be disrupted and
ressignified which highlights the pornoheterotopic character of these public restrooms in which semiotic processes that
(de)regulate gender and sexual dissidence are emplaced.
Mothering Brooklyn
Authors: Trinch Shonna , Snajdr Edward
Published: November 2018

This paper examines how Brooklyn retail signage represents how gentrifying women struggle for claiming space in public and the way in which different intersectional identity formations are used and implicated in transforming urban space. In exploring different ethnographic dimensions to retail storefronts, we show how women, many of whom are college-educated, married, and new mothers, play a significant role in redefining Brooklyn and cultural norms of motherhood more broadly. Yet, as newly arriving women emerge as key players in the gentrification project, they experience backlash against their public roles. We explore how women also employ race, inequality, and patriarchal notions of heteronormative sexuality as a cover for their public challenges to patriarchal power. Drawing on visual ethnography, interviews, and digital archival material we argue that the ambiguity of word play accomplishes both the pushing of normative boundaries as well as the protective cover of public meanings.
Attempting international normative change in gender and the law: a reply to DeLaet, Baldez and Bunting
Authors: Matt Darby
Published: November 2018

This reply responds to contributions by DeLaet, Baldez and Bunting to the issue's sub-theme on ‘The Role of International and Domestic Law in Attaining Gender and Sexual Equality’. While each paper allocates different degrees of importance to the role of international actors in international normative change, all agree that domestic attempts are more important to sustainable change than international attempts. This reply attempts to determine the reasons for divergence on the attribution of importance to international actors, while examining means by which these international actors can better service domestic actors rather than merely replicating neo-colonialist policies.
Mothers do not make good workers: the role of work/life balance policies in reinforcing gendered stereotypes
Authors: Hampson Sarah Cote
Published: November 2018

‘Family friendly’ policies such as maternity leave allow millions of women in the United States to take some time off when they give birth or adopt a child in order to spend time physically recuperating and/or initiating a bond with their children. However, many working mothers report facing stereotypes that either negatively impact their decision-making about claiming their rights under work/life balance policies, or cause them to be the specific targets of discrimination in their workplaces. This article, which draws upon in-depth interviews with 48 women from 2 types of work environments (the U.S. military and academia), identifies stereotypes that have developed in these institutions. These stereotypes establish the identity of a working mother as the antithesis of an ‘ideal worker’. I argue that the very policies that are aimed at easing the tension between work and family help to create and reinforce these stereotypes through discursive institutional processes.
The intention to adopt a green product (a study on a green fuel product (pertalite))
Authors: Haryanto H , Purnomo H , Wiyono W
Published: November 2018

Indonesia Government through Pertamina Co. Ltd has launched a new fuel product, namely Pertalite that is more environmentally friendly than the previous one (premium). Premium is 88 octanes gasoline that is less environmentally friendly than Pertalite (90-octanes). Low-octane gasoline causes the inefficiency in usage so that more carbon will be released into the environment which contributes to global warming. Unfortunately, the premium consumption is still relatively high, which became the background of this research. The purpose of this study is to examine the influence of variables affecting the intention of adoption of environmentally friendly fuel product. This study is a survey that was conducted in Surakarta City, Indonesia by purposive sampling method. The criteria of respondents are the people who know the difference between premium and pertalite gasoline. Testing instruments and testing data used Structural Equation Modelling-Partial Least Square (SEM-PLS) method. The result showed the t-score of SEM-PLS analysis for the price fairness, relative advantage and product knowledge were 3.057, 9.134, and 4.668, respectively, hence influenced the attitude toward adoption. That scores are more than cut off 1.96 in T table with significance level 5%. Furthermore, attitude toward adoption influenced the intention of adoption with t-value 17.903.
Unique Effects of Perceived Neighborhood Physical Disorder and Social Cohesion on Episodic Memory and Semantic Fluency
Authors: Zaheed Afsara B , Sharifian Neika , Kraal A Zarina , Sol Ketlyne , Hence Alyssia , Zahodne Laura B
Published: November 2018

Objective

Objective measures of neighborhood quality are associated with physical and mental health outcomes for older adults, but the relationship between perceived neighborhood quality and cognitive health has not been fully explored. Furthermore, positive and negative neighborhood characteristics may influence cognition through different mechanisms. The present study aimed to determine whether perceptions of neighborhood quality predict cognitive functioning in two domains, above and beyond individual-level risk factors, in a nationally representative sample of older adults.

Method

Using cross-sectional weighted data from 13,919 participants aged 51 and older from the Health and Retirement Study, linear regression models tested independent associations between perceived neighborhood quality (physical disorder and social cohesion) and cognition (episodic memory and semantic verbal fluency), controlling for sociodemographic characteristics, chronic disease burden, and depressive symptoms. Interaction terms tested whether neighborhood social cohesion moderated the relationship between neighborhood physical disorder and each cognitive outcome.

Results

Perception of greater neighborhood physical disorder was significantly associated with worse episodic memory, while perception of lower neighborhood social cohesion was significantly associated with worse semantic fluency. There were no significant interactions between physical disorder and social cohesion.

Conclusions

Results provide preliminary evidence for different mechanisms underlying associations between aspects of neighborhood quality and cognition (e.g., stress vs. social interaction). Additional intervention work is needed to determine whether improving neighborhood physical conditions and promoting social cohesion at the neighborhood level could reduce cognitive morbidity among older adults.
“The Place is Gone!”: Policing Black Women to Redevelop Downtown Boston
Authors: Fischer Anne Gray
Published: November 2018

In the late 1960s and early 1970s, Boston politicians and urban managers sought to reverse the city’s postwar capital drain by luring white consumer dollars and private investment. Their recovery plan featured the Adult Entertainment District (AED), which was established to contain burgeoning sexual commerce while demonstrating the vibrancy and economic viability of the city’s downtown core. At the same time, the changing spatial dynamics of interracial sexual commerce, Black economic isolation, and discriminatory practices citywide drew increasing numbers of Black women onto downtown streets. The presence of Black women in formerly white downtown spaces ignited a powerful law-and-order narrative linking race, sex, and violence. Black women became oversignified with sexual deviance and violent criminality amid the urban crisis. The development of the AED experiment and the raced and gendered crime panic posed unique challenges and opportunities for the Boston Police Department (BPD). Like urban police departments nationwide in the early 1970s, the BPD was embroiled in a battle for its authority. But the deeper motivations of economic turnaround guiding the AED ultimately served to strengthen the BPD’s legitimacy. As the separate goals of political officials and law enforcement authorities converged—to redevelop downtown Boston, and to secure urban authority, respectively—the intensifying policing and spatial banishment of Black women in downtown Boston became central to urban recovery strategies. This history demonstrates that aggressive, racially charged morals policing was deployed to prepare the city for an influx of white capital.
113. Accuracy of the NHSN Central Line-Associated Bloodstream Infection (CLABSI) Definition
Authors: Hammadi Ahmed Al , Ostrosky-Zeichner Luis , Boston Kelley , McInnis-Cole Tawanna , Butler John
Published: November 2018

Background

CLABSIs are serious infections that cause prolonged hospital length of stay, increased cost, and mortality. Acute care hospitals must report CLABSIs to NHSN to participate in CMS programs. NHSN definitions must be met to attribute a secondary BSI (SBSI), or bacteremia is defaulted to CLABSI if a central line is present. The lack of CDC/NHSN definitions for certain secondary sites of infections or problems in the definitions may lead to over-labeling CLABSIs. We reviewed the accuracy of NHSN definitions in a large healthcare system.

Methods

We retrospectively reviewed medical records of 279 patients with positive blood cultures on or after hospital day 3 and a central line from 15 hospitals belonging to a large healthcare system from January 1 to November 27, 2017. A team of centralized infection preventionists (IPs) adjudicated each case as a CLABSI or as SBSI through routine surveillance following NHSN methodology. A clinical review was performed by a PGY6 infectious diseases fellow. Descriptive statistics are presented.

Results

A total of 279 bacteremia cases were analyzed. Of those 279 patients, 237 (85%) were ≥18 years old, 162 (58%) were males, 92 (33%) were white, 62 (22.2%) were black, 5 (1.8%) were Asian, and 12 (4.3%) were “other.” Ninety-seven (34.8%) were from the reference hospital. IPs classified 171 CLABSIs and 108 as SBSI. Of the 171 CLABSIs classified by IPs, in 62 patients (36.3%), a primary site infection clinically explaining the BSI, but which did not meet the NHSN infection criteria, could be attributed as follows during the clinical review: 30 pneumonia, 6 urinary tract infections, 4 surgical site infections, 2 vascular infections, 2 mucosal barrier injury associated blood stream infections, 7 gastrointestinal infections, 1 decubitus ulcer infection, 4 skin and soft-tissue infections, 2 left ventricular-assisted device infections, 2 endocarditis, and 2 infected thrombi. Misclassification most often occurred due to missing elements of the definitions or infections not defined by NHSN.

Conclusion

Current NHSN definitions may overestimate CLABSIs by nearly 30%. As hospitals continue to work in CLABSI reduction, accurate and precise definitions/methodology will be key in focusing efforts and attention of the engaged parties and avoiding penalties.

Disclosures

L. Ostrosky-Zeichner, Cidara Therapeutics: Grant Investigator, Research grant.
124. Microbiological Outcomes With Plazomicin (PLZ) Versus Meropenem (MEM) in Patients With Complicated Urinary Tract Infections (cUTI), Including Acute Pyelonephritis (AP) in the EPIC Study
Authors: Keepers Tiffany R , Cebrik Deborah S , Cloutier Daniel J , Komirenko Allison , Connolly Lynn , Krause Kevin
Published: November 2018

Background

PLZ is a next-generation aminoglycoside (AG) that is structurally protected from common AG-modifying enzymes (AMEs) in Enterobacteriaceae and with in vitro activity against multidrug-resistant Enterobacteriaceae, including ESBL-producing, AG-resistant, and carbapenem-resistant isolates. We report microbiological outcomes in the EPIC study, including outcomes for resistant pathogens and by the PLZ MIC.

Methods

EPIC was a multinational, randomized, double-blind study in hospitalized patients with cUTI or AP. Patients received IV PLZ (15 mg/kg q24h) or IV MEM (1 g q8h) for 4–7 days, followed by optional oral therapy, for a total of 7–10 days of therapy. The extended mMITT population included patients with ≥1 qualifying baseline pathogen (≥105 CFU/mL urine) who received study drug. Microbiological outcomes were assessed at TOC (day 15–19). Isolate identification and susceptibility testing were conducted by a central laboratory. Whole-genome sequencing was used to identify AME and β-lactamase genes.

Results

Of 609 patients enrolled, 407 (66.8%) were included in the extended mMITT population. The most common uropathogen was Escherichia coli (63.4%) followed by Klebsiella pneumoniae (19.7%). PLZ and MEM MIC50/90 for Enterobacteriaceae were 0.5/2 μg/mL (range: ≤0.06–>128 mg/mL) and 0.015/0.06 mg/mL (range: ≤0.004–128 mg/mL), respectively. ESBL and AG-NS phenotypes were found in 29% and 27% of isolates, respectively. Genotyping detected β-lactamase and AME genes in 32.5% and 36.8% of isolates, respectively, most commonly blaCTX-M-15 (n = 98), blaOXA-1/OXA-30 (n = 82), aac(6′)Ib-cr (n = 79), and aac(3)-IIa (n = 56). Rates of microbiological eradication are shown in Table 1. All Enterobacteriaceae in the PLZ group with a PLZ MIC of 4 µg/mL (6/6) were eradicated at TOC (Table 2). Across 49 patients with concurrent bacteremia, 100% (27/27) and 96% (24/25) of Enterobacteriaceae were cleared from the blood at TOC in the PLZ and MEM groups, respectively.

Conclusion

PLZ demonstrated comparable or higher microbiological eradication rates compared with MEM for common Gram-negative uropathogens, including resistant pathogens. The results support PLZ as a potential treatment option for cUTI, including AP, caused by Enterobacteriaceae with PLZ MICs of ≤4 mg/mL.

Disclosures

T. R. Keepers, Achaogen, Inc.: Employee, Salary. D. S. Cebrik, Achaogen, Inc.: Employee, Salary. D. J. Cloutier, Achaogen, Inc.: Employee and Shareholder, Salary. A. Komirenko, Achaogen, Inc.: Employee and Shareholder, Salary. L. Connolly, Achaogen, Inc.: Consultant, Consulting fee. K. Krause, Achaogen, Inc.: Employee, Salary.
153. The Effect of Timing of Tetanus–Diphtheria and Pertussis Vaccine Administration in Pregnancy on The Avidity of Pertussis Antibodies
Authors: Raya Bahaa Abu , Giles Michelle , Kollmann Tobias , Sadarangani Manish
Published: November 2018

Background

Tetanus–diphtheria–pertussis (Tdap) vaccination in pregnancy is currently recommended in many countries. The optimal timing of pertussis immunization in pregnancy is not well established, leading to different recommendations. We aimed to determine the effect of timing of vaccination with Tdap in pregnancy on the umbilical cord avidity of antipertussis toxin (PT) immunoglobulin G (IgG).

Methods

Avidity of anti-PTIgG was assessed using ammonium thiocyanate (NH4SCN) at concentrations between 0.25 M (to measure low avidity antibodies) and 3 M (to measure high avidity antibodies). Anti-PT IgG levels achieved at each NH4SCN concentration were calculated. T-tests were used to compare anti-PT IgG levels between newborns of women vaccinated in early (28–32 weeks gestation) and late (33–36 weeks gestation) third trimester. Pearson correlation assessed the relationship between the timing of vaccination and anti-PT IgG levels.

Results

Newborns of women vaccinated with Tdap in early third trimester (n = 43) had higher anti-PT IgG levels at 1 M and 2 M NH4SCN concentrations compared with newborns of women vaccinated in late third trimester (n = 47), 2.4 international units (IU)/mL vs. 1.9 IU/mL (P = 0.0073) and 2.3 IU/mL vs. 1.7 IU/mL (P = 0.0354), respectively, after adjustment for gestational age at birth. There was a negative association between later timing of vaccination in third trimester and anti-PT IgG levels achieved at 0.5 M, 1 M, 1.5 M, and 2 M NH4SCN (all P ≤ 0.02). There was a positive association between increasing time between vaccination and delivery and anti-PT IgG levels achieved at 0.5 M, 1 M, 1.5 M, and 2 M NH4SCN (all P ≤ 0.02).

Conclusion

Vaccination against pertussis during early third trimester results in higher levels of high avidity antibodies compared with vaccination in late third trimester. High avidity antibodies may confer greater protection to the neonate supporting recommendations for vaccination at 28–32 WG vs. 33–36 WG.

Disclosures

All authors: No reported disclosures.
154. Diagnosis and Genotyping of Coxiella burnetii Causing Endocarditis in a Patient With Prosthetic Pulmonary Valve Replacement (PVR) Using Next-Generation Sequencing (NGS) of Plasma
Authors: Kondo Maiko , Dalai Sudeb , Westblade Lars , Venkatasubrahmanyam Shivkumar , Eisenberg Nell , Marks Kristen M
Published: November 2018

Background

Identification of Coxiella burnetii, the etiologic agent of Q Fever, in culture-negative endocarditis (CNE) remains challenging, and strain-level information is typically unavailable through conventional testing. We used a novel next-generation sequencing (NGS) assay on plasma cell-free DNA to facilitate rapid diagnosis and genotyping in a patient with C. burnetii CNE.

Methods

NGS was performed on plasma by Karius, Inc. (Redwood City, California). Human reads were removed and remaining sequences were aligned to a curated database of over 1,000 pathogens. Organisms present above a predefined significance threshold were reported. For C. burnetti strain-typing, alignments to different Coxiella strains in the pathogen database were compared by BLAST bit-score to determine the most closely related strain to the infecting organism. C. burnetii genotype group was also determined by in silico analysis of polymorphic ORF deletion markers known to distinguish groups I–VI.

Results

Twenty-nine-year-old male with history of Tetralogy of Fallot, multiple pulmonary valve replacement (PVR), and 18 months of intermittent fever and night sweats were admitted. Relevant history included travel in South and South East Asia, the use of a LivaNova 3T Heater-Cooler device during surgery (i.e., at risk for Mycobacterium chimaera), and drinking unpasteurized milk. Cardiac CT showed 2 pulmonary opacities concerning for septic emboli and echocardiography showed echodensity on pulmonic valve. Blood cultures were negative. NGS detected C. burnetii within 48 hours of sample receipt. On the basis of these results, hydroxychloroquine and doxycycline were initiated with symptomatic improvement. Strain-typing demonstrated highest relatedness to the CbuK_Q154 (group IV) strain typically seen in North America. Genotype group was independently confirmed by inference of a pattern of ORF deletion most similar to group IV (and highly related group VII). Serologic testing for C. burnetii confirmed the diagnosis. After 4 weeks of antibiotics, the patient underwent successful PVR with graft exchange.

Conclusion

NGS testing aided in diagnosis of C. burnetii CNE, enabling early targeted antimicrobial therapy. It also allowed inference of strain-level information, supporting further investigations regarding epidemiologic origins of this pathogen.

Disclosures

S. Dalai, Karius, Inc.: Consultant, Consulting fee. S. Venkatasubrahmanyam, Karius, Inc.: Employee, Salary.
155. Infective Endocarditis and Cardiac Valve Surgery During the Opioid Epidemic in North Carolina, 2007 to 2017
Authors: Schranz Asher , Fleischauer Aaron , Chu Vivian H , Rosen David
Published: November 2018

Background

Infective endocarditis (IE) associated with drug use (DA-IE) is rising nationally. North Carolina (NC), a state hard-hit by the opioid epidemic, saw an over 12-fold increase in DA-IE from 2010 to 2015. Concerns about surgery exist due to the risk of ongoing drug use and reinfection after valvuloplasty. We evaluated trends, characteristics, and outcomes of valve surgery for DA-IE, compared with IE not associated with drug use (non-DA-IE), in NC.

Methods

We analyzed the NC Discharge Database, which includes administrative data from all hospital discharges in NC. Using International Classification of Diseases codes, we identified all persons ≥18 years of age with IE from July 1, 2007 to June 30, 2017. Hospitalizations were deemed DA-IE by a diagnosis code related to illicit drug use, dependence, poisoning or withdrawal (excepting marijuana), or Hepatitis C in a person born after 1965. All others were labeled non-DA-IE. Procedure codes were queried to identify cardiac valve surgery. Year-to-year trends in surgery for IE by drug-associated status were reported. Demographics, length of stay (LOS), charges, and disposition were compared among DA-IE and non-DA-IE.

Results

A total of 22,809 hospitalizations were coded for IE. Valve surgery occurred in 1,652. Of surgical hospitalizations, 17% overall and 42% in the final study year were DA-IE. Hospitalizations for DA-IE where surgery was done increased from <10 through 2012–2013 to 109 in 2016–2017 (figure). Compared with non-DA-IE, those undergoing surgery for DA-IE were younger (median age 33 vs. 56), female (47% vs. 33%), White (89% vs. 64%), uninsured (34% vs. 11%), insured by Medicaid (39% vs. 13%), and had tricuspid valve surgery (38% vs. 11%). DA-IE had longer median LOS (27 vs. 17 days) and were less often discharged home (51% vs. 59%). For the 287 DA-IE admissions with surgery, median hospital charges were $247,524, totaling over $79,000,000. All comparisons were significant at P < 0.0001.

Conclusion

From 2007 to 2017, valve surgeries for DA-IE in NC rose over tenfold and are approaching half of all surgeries for IE. This phenomenon is an underappreciated and morbid component of the opioid epidemic that burdens hospital and state resources. Research into best practices for managing patients with DA-IE and addressing addiction in this setting is critically needed.

Disclosures

All authors: No reported disclosures.
161. Prevalence and Risk Factors for Candida auris Colonization Among Patients in a Long-term Acute Care Hospital—New Jersey, 2017
Authors: Rozwadowski Faye , McAteer Jarred , Chow Nancy A , Skrobarcek Kimberly , Forsberg Kaitlin , Barrett Patricia M , Greeley Rebecca , Fulton Tara , Wells Julia , Welsh Rory M , Dietz Stephanie , Derado Gordana , Jackson Brendan R , Vallabhaneni Snigdha
Published: November 2018

Background

Candida auris can be transmitted in healthcare settings, and patients can become asymptomatically colonized, increasing risk for invasive infection and transmission. We investigated an ongoing C. auris outbreak at a 30-bed long-term acute care hospital to identify colonization for C. auris prevalence and risk factors.

Methods

During February–June 2017, we conducted point prevalence surveys every 2 weeks among admitted patients. We abstracted clinical information from medical records and collected axillary and groin swabs. Swabs were tested for C. auris. Data were analyzed to identify risk factors for colonization with C. auris by evaluating differences between colonized and noncolonized patients.

Results

All 101 hospitalized patients were surveyed, and 33 (33%) were colonized with C. auris. Prevalence of colonization ranged from 8% to 38%; incidence ranged from 5% to 20% (figure). Among colonized patients with available data, 19/27 (70%) had a tracheostomy, 20/31 (65%) had gastrostomy tubes, 24/33 (73%) ventilator use, and 12/27 (44%) had hemodialysis. Also, 31/33 (94%) had antibiotics and 13/33 (34%) antifungals during hospitalization. BMI for colonized patients (mean = 30.3, standard deviation (SD) = 10) was higher than for noncolonized patients (mean = 26.5, SD = 7.9); t = −2.1; P = 0.04). Odds of colonization were higher among Black patients (33%) vs. White patients (16%) (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.3–9.8), and those colonized with other multidrug-resistant organism (MDRO) (72%) vs. noncolonized (44%) (OR 3.2; CI 1.3–8.0). Odds of death were higher among colonized patients (OR 4.6; CI 1.6—13.6).

Conclusion

Patients in long-term acute care facilities and having high prevalences of MDROs might be at risk for C. auris. Such patients with these risk factors could be targeted for enhanced surveillance to facilitate early detection of C. auris. Infection control measures to reduce MDROs’ spread, including hand hygiene, contact precautions, and judicious use of antimicrobials, could prevent further C. auris transmission.

Acknowledgements

The authors thank Janet Glowicz and Kathleen Ross.

Disclosures

All authors: No reported disclosures.
162. Association Between Antibiotic Use and Multidrug-Resistant Organism Detection in Advanced Cancer Patients on Palliative Chemotherapy
Authors: Datta Rupak , McManus Dayna , Topal Jeffrey , Quagliarello Vincent , Juthani-Mehta Manisha
Published: November 2018

Background

Data suggest end-of-life antibiotics predispose to multidrug-resistant organism (MDRO) acquisition in intensive care units (ICUs). Less is known regarding antibiotics and MDRO acquisition in other palliative care populations.

Methods

We conducted a nested case–control study of advanced cancer patients aged ≥65 years started on palliative chemotherapy from January 2016 to September 2017 at Yale New Haven Hospital. We identified patients with (cases) and without (controls) new MDRO detected from clinical or surveillance cultures from the first hospitalization after starting palliative chemotherapy. All patients had no history of MDRO, and 3 controls were randomly selected per case. Antibiotic use was defined as exposure on or prior to the MDRO culture collection date in cases or during the entire hospitalization in controls. The association between antibiotics and MDRO detection was assessed with χ2 and multivariable logistic regression testing. Length of stay (LOS) was compared between groups.

Results

Of 1,181 advanced cancer patients started on palliative chemotherapy and subsequently admitted, we identified 45 cases and 135 controls (figure). Overall, median age was 75 years (range 65–95) and 48% (N = 87/180) were female. Antibiotic exposure was more likely in cases (91%, N = 41/45) vs. controls (75%, N = 101/135; P = 0.02). In regression testing adjusted for gender, LOS, and ICU stay, antibiotic use was associated with MDRO detection (OR = 3.23, 95% CI 1.1, 9.8; P = 0.04). Mean LOS was higher in those with (8.7 days, 95% CI 7.5, 10.0) vs. without (3.5 days, 95% CI 3.8, 6.1) MDRO detection (P = 0.002)

Conclusion

In older advanced cancer patients on palliative chemotherapy, antibiotic use is predictive of new MDRO detection, and patients with new MDRO detection have significantly longer LOS. These results suggest antibiotics should be used cautiously in palliative care patients in whom the burdens of MDRO detection, such as longer LOS and potential room isolation with contact precautions, may conflict with goals of care.

Disclosures

M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee.
163. Development of an Electronic Flagging Tool for Identifying Cardiac Device Infections: Insights from the VA CART Program
Authors: Asundi Archana , Stanislawski Maggie , Mehta Payal , Mull Hillary , Schweizer Marin , Ho P Michael , Gupta Kalpana , Branch-Elliman Westyn
Published: November 2018

Background

Surveillance is an essential aspect of infection prevention. Despite the high morbidity and mortality associated with procedure-related Cardiac Implantable Electronic Device (CIED) infections, methods for identifying them are limited. The objective of this study was to develop an algorithm with electronic flags to facilitate detection of CIED infections in a large, multi-center cohort.

Methods

A sample of patients who underwent CIED procedures entered into the VA Clinical Assessment Reporting and Tracking Electrophysiology (CART-EP) program from FY 2007 to 2015 were included in the nested case–control study. After cohort creation, data from this review process were combined with electronic variables (e.g., microbiology orders, ICD 9/10 codes) to develop a preliminary algorithm that categorized patients as high, intermediate, or low risk of CIED infection.

Results

A total of 1,014 unique patients out of a cohort of 5,955 procedures underwent manual review. Among these cases, 59 CIED infections and 955 controls were identified. Electronic variables predictive of CIED infection included ICD 9/10 infection codes and microbiology orders (table). ICD 9/10 codes had excellent PPV for flagging infections but sensitivity was limited (47.5%, see figure). Adding microbiology order flags increased sensitivity but lowered specificity. Specificity in patients without either flag was outstanding (99%).

Conclusion

Absence of ICD 9/10 and microbiology orders is highly specific for ruling out CIED infections. The discriminatory abilities of the algorithm for intermediate probability flags (+microbiology/−ICD9/10) need improvement. In patients without ICD codes, at least microbiology orders should be used as a flag to streamline review of possible device infections. Refinement of this tool using other clinical flags may improve operating characteristics and clinical utility.

Disclosures

W. Branch-Elliman, Veterans’ Integrated Service Network Career Development Award: Investigator, Research grant. American Heart Association: Investigator, Research grant.
854. The Impact of the CMS SEP-1 Core Measure on Antimicrobial Utilization: a Multicenter Interrupted Time-Series (ITS) Analysis
Authors: Anderson Deverick J , Ashley Elizabeth Dodds , Parish Alice , Lokhnygina Yuliya , David Michael Z , Hsueh Kevin , Ryan Matthew , Cressman Leigh , Tolomeo Pam , Habrock-Bach Tracey , Hill Cherie , Moehring Rebekah W ,   CDC Prevention Epicenters Program
Published: November 2018

Background

Hospitals began reporting the SEP-1 Core Measure to CMS in October 1, 2015, to promote the use of best practices for patients with sepsis. The impact of SEP-1 on overall antimicrobial utilization (AU), a potential unintended consequence, is unclear.

Methods

We performed an ITS analysis to evaluate changes in antimicrobial utilization after SEP-1 implementation. AU was measured as days of therapy (DOT)/1,000 days present (dp) for all adult inpatients who spent more than 24 hours in 18 hospitals in the southeastern United States. The 12-month period from October 1, 2014 to September 30, 2015 was defined as the “pre” period. After a 1-month wash-in, the 12-month period from November 1, 2015 to October 31, 2016 was defined as the “post” period. AU was aggregated by hospital by month for inpatient units. Total AU and NHSN AU categories were analyzed separately. ITS was modeled using a segmented regression analysis through a GEE model with negative binomial distribution and log link.

Results

A total of 362,460 patients had 688,583 DOT pre-SEP1 (mean 1.9 DOT/admission), and 291,884 patients had 530,382 DOT post-SEP1 (mean 1.8 DOT/admission). The diagnosis of sepsis (3.1%) and median length of stay (3, IQR 2–4) were unchanged after SEP-1. Utilization of combined vancomycin and piperacillin–tazobactam (P-T) increased 17% at SEP-1 implementation but this increase was not statistically significant (Table). Overall AU, anti-MRSA agents, and anti-pseudomonal agents were unchanged after SEP-1 (figure, table).

Conclusion

Implementation of the CMS SEP-1 measure did not lead to higher rates of AU in our cohort of hospitals, although this study did not assess adherence to SEP-1. Further research is needed to improve the use of antimicrobial therapy in hospitalized patients with suspected sepsis.

Disclosures

All authors: No reported disclosures.
857. A Tele-Antibiotic Stewardship Program Influences Antibiotic Use at 2 Rural Veterans Affairs Medical Centers
Authors: Wilson Brigid , Banks Richard , Crnich Christopher , Ide Emma , Viau Roberto , El Chakhtoura Nadim G , Jones Yvonne , Cherry Jason , Anderson Brett , Urban Andrew , Jump Robin
Published: November 2018

Background

Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people with infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used the Veterans Affairs (VA) telehealth system to facilitate a Videoconference Antimicrobial Stewardship Team (VAST) which connected a multidisciplinary team from a rural VA medical center (VAMC) with ID physicians at a remote site to support antibiotic stewardship. Here, we present 3 distinct metrics to assess the influence of the VAST on antibiotic use at 2 intervention sites.

Methods

Outcomes assessed antibiotic use in the hospital and long-term care units of 2 rural VAMCs in the year before and after VAST implementation, allowing for a 1-month wash-in period in the first month of the VAST. Using VA databases, we determined 3 metrics: the rate of antibiotic use (days of therapy per 1,000 bed days of care); the mean length of therapy (days); and the mean patient antibiotic spectrum index (ASI), a measure of antibiotic spectrum increasing from narrow to broad. Using segmented regression on monthly measures of each metric with a knot at the wash-in month (gray square), we calculated predicted values (solid lines), and confidence intervals (dashed lines) to examine trends before (black squares) and after (white squares) implementing the VAST.

Results

The rate of antibiotic use, mean length of therapy, and ASI decreased at Site A. As indicated in the figure, the effect was more pronounced in long-term care compared with the hospital, where the VAST sustained but did not accelerate downward trends. At Site B, the most notable influence of the VAST was on the ASI for the hospital and long-term care units.

Conclusion

The VAST is a feasible, sustainable program that is effective at inducing change in antibiotic use at 2 VAMCs. The influence of the VAST differed between the 2 sites and, at Site A had a more pronounced effect on the long-term care compared with hospital units. These distinct metrics capture changes in overall antibiotic use, length of therapy, and agent selection. Tele-antibiotic stewardship programs hold potential to improve antibiotic use at facilities with limited access to people with antibiotic stewardship expertise.

Disclosures

All authors: No reported disclosures.
858. Preoperative “Dirty” Urinalysis Leads to Antibiotic Use Without Benefit
Authors: Gallegos Jaime , Obrien William , Strymish Judith , Itani Kamal , Branch-Elliman Westyn , Gupta Kalpana
Published: November 2018

Background

Pyuria is often used as a surrogate for bacteriuria and may trigger antibiotic use even in the setting of negative cultures. The impact of preoperative pyuria on empirical antibiotic use and on postoperative outcomes has not been evaluated in large multisite studies. Thus, we investigated rates and outcomes associated with treated versus untreated preoperative pyuria in a national cohort of surgical patients.

Methods

All patients who underwent standardized Surgical Quality review after cardiac, orthopedic implant, or vascular surgery within the national VA health care system from October 1, 2008 to September 30, 2013 and had a urinalysis performed in the 30 days before surgery were eligible. Rates of preoperative pyuria (≥5 WBCs and/or positive leukocyte esterase) and antibiotics were measured. Adjusted rates of 30-day postoperative surgical (SSI) and urinary tract (UTI) infections were determined by a trained nurse reviewer using CDC definitions and compared between pyuria patients who did or did not receive antibiotics before surgery.

Results

Among 17,749 preoperative urinalyses, 755 were culture-positive and 16,994 were culture-negative. Among culture negative patients, 1,812/16,994 (10.7%) had urinalyses diagnostic of pyuria. Antibiotics were prescribed to 574 (32%) of pyuria-positive, culture-negative patients. After adjusting for diabetes, smoking, age, and ASA score, the rate of post-op SSI was similar among antibiotic-treated pyuria patients (13/574, 2.3%) compared with those not treated (21/1,238, 1.7%), aOR 1.33, 95% (0.66–2.69, P = 0.41). Post-op UTI was also not reduced among pyuria treated (17/351, 4.8%) vs. untreated (39/893, 4.4%), aOR 1.09, 95% (0.60–1.96, P = 0.76).

Conclusion

In this large national study cohort, almost 1/3 of pyuria-positive preoperative patients received antibiotics despite negative cultures. Antibiotic treatment was not associated with clinical benefits, including no reduction in post-operative SSI or UTI. There is an opportunity for diagnostic stewardship to reduce preoperative urinalysis testing and unnecessary antibiotic exposure.

Disclosures

K. Itani, Pfizer: Grant Investigator, Research grant. Sanofi: Grant Investigator, Research grant. K. Gupta, Iterum Therapeutics: Consultant, Consulting fee. Paratek Pharmaceutical: Consultant, Consulting fee. Tetraphase: Consultant, Consulting fee.