bluuebunny/crossref_metadata_2025 huggingface dataset:
Secreted frizzled-related protein 2: a key player in noncanonical Wnt signaling and tumor angiogenesis
Authors: van Loon Karlijn , Huijbers Elisabeth J. M. , Griffioen Arjan W.
Published: November 2020

Secreted frizzled-related proteins (SFRP) are glycoproteins containing a so-called frizzled-like cysteine-rich domain. This domain enables them to bind to Wnt ligands or frizzled (FzD) receptors, making potent regulators of Wnt signaling. As Wnt signaling is often altered in cancer, it is not surprising that Wnt regulators such as SFRP proteins are often differentially expressed in the tumor microenvironment, both in a metastatic and non-metastatic setting. Indeed, SFRP2 is shown to be specifically upregulated in the tumor vasculature of several types of cancer. Several studies investigated the functional role of SFRP2 in the tumor vasculature, showing that SFRP2 binds to FzD receptors on the surface of tumor endothelial cells. This activates downstream Wnt signaling and which is, thereby, stimulating angiogenesis. Interestingly, not the well-known canonical Wnt signaling pathway, but the noncanonical Wnt/Ca2+ pathway seems to be a key player in this event. In tumor models, the pro-angiogenic effect of SFRP2 could be counteracted by antibodies targeting SFRP2, without the occurrence of toxicity. Since tumor angiogenesis is an important process in tumorigenesis and metastasis formation, specific tumor endothelial markers such as SFRP2 show great promise as targets for anti-cancer therapies. This review discusses the role of SFRP2 in noncanonical Wnt signaling and tumor angiogenesis, and highlights its potential as anti-angiogenic therapeutic target in cancer.
COVID-19: US federal accountability for entry, spread, and inequities—lessons for the future
Authors: Hanage William P. , Testa Christian , Chen Jarvis T. , Davis Letitia , Pechter Elise , Seminario Peg , Santillana Mauricio , Krieger Nancy
Published: November 2020

The United States (US) has been among those nations most severely affected by the first—and subsequent—phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortality rate is over 585/million, respectively 2.4 and 5 times higher compared to Canada and Germany. As we enter Fall 2020, the US is enduring ongoing outbreaks across large regions of the country. Moreover, within the US, an early and persistent feature of the pandemic has been the disproportionate impact on populations already made vulnerable by racism and dangerous jobs, inadequate wages, and unaffordable housing, and this is true for both the headline public health threat and the additional disastrous economic impacts. In this article we assess the impact of missteps by the Federal Government in three specific areas: the introduction of the virus to the US and the establishment of community transmission; the lack of national COVID-19 workplace standards and enforcement, and lack of personal protective equipment (PPE) for workplaces as represented by complaints to the Occupational Safety and Health Administration (OSHA) which we find are correlated with deaths 16 days later (ρ = 0.83); and the total excess deaths in 2020 to date already total more than 230,000, while COVID-19 mortality rates exhibit severe—and rising—inequities in race/ethnicity, including among working age adults.
Experience of Spiritual Dryness and Acedia Symptoms in Seventh-Day Adventists
Authors: Büssing Arndt , Starck Lorethy , van Treeck Klaus
Published: November 2020

In a cross-sectional survey among 626 Adventists, we investigated their perception of spiritual dryness, and its association with indicators of Acedia, well-being and emotional exhaustion. Women, younger persons and those without a specific duty within the church had significantly higher spiritual dryness scores. Spiritual dryness was predicted best by perceived Excessive Spiritual Demands (indicating spiritual exhaustion) and low perception of the sacred. Further predictors are Acedia’s Difficulties in Prayer Life, reduced well-being and emotional exhaustion. The underlying causes might be complex and thus to support persons experiencing these phases, a thorough differentiation of the underlying ‘spirits’ is required.
La parola alle cose. Alcuni esempi nella poesia italiana del Novecento
Authors: Sasso Stefano
Published: November 2020

The article discusses the presence of matter (organic as well as inorganic) in twentieth-century Italian poetry. The paper offers a diachronic survey of some exemplary authors and texts (Marinetti, Gozzano, Montale, Giudici, Caproni, and Sereni), highlighting the different utilisations of objects and things within literary texts. Objects and things define spaces and places in subjects’ lives, support their identity, and document various ages and generations. The death of their owners makes things and objects lose their original purpose and find different functions with new subjects. In this context, they appear as miniature eternities always ready for a connection with new subjects.
Third Space of Legal Translation: Between Protean Meanings, Legal Cultures and Communication Stratification
Authors: Matulewska Aleksandra , Wagner Anne
Published: November 2020

Legal translation is a complex transfer of the text formulated in a source language into a target language which needs to take into account a wide array of factors to ensure the equality of parties to the process of interlingual communication. It is an autonomous realm of cross-cultural events within which the system-bound of legal concepts/notions deeply rooted in language, history and societal evolution of one country are transformed and integrated into the language of another, and as a result, stratified over the course of time (Mattila in Comparative legal linguistics, Routledge, Aldershot, 2006). That aspect of legal translation is called the Third Space (Bhabha in: Ashcroft B, Griffiths G, Tiffin H (eds) The post-colonial studies readers. Routledge New York, pp 206–209, 1995). The authors investigate some aspects of the Third Space including (1) Protean meanings and diverging legal cultures which are constantly remodeled, (2) cultural codes, and communication stereotypes as well as (3) communication problems stemming from stratification of communication in legal settings. The research methods applied include the semiotic analysis of legal translation strategies and potential loss of meaning.
Spontaneous Capillary Imbibition of Water and Nonaqueous Liquids into Dry Quarry Limestones
Authors: Hall Christopher , Pugsley Victoria
Published: November 2020

Rates of spontaneous imbibition of water and nonaqueous liquids into dry limestones have been measured at 25 °C. Thirteen English and French limestones were used, with eight liquids (water, decane, dodecane, sec-butanol, iso-propanol, tetrahydrofuran, perfluorodimethylcyclohexane, ethanediol). For the nonaqueous liquids, the measured sorptivity generally scales as (surface-tension/viscosity)$$^{1/2}$$

1
/
2

(here called F-scaling). Water sorptivities deviate from F-scaling, indicating partial wetting. A wetting coefficient (wetting index) is derived. Data show that there is little difference in the Hirschwald saturation coefficient measured with the different liquids, although there is a large variation between stones. Results suggest that physicochemical alteration of exposed pore surfaces strongly (and unpredictably) influences the capillary absorption of water by limestones.
Das Handekzem
Authors: Gorris A. , Kinaciyan T.
Published: November 2020

Obwohl das chronische Handekzem ein weit verbreitetes Problem ist und das Management sowohl für Hautärzte als auch die Betroffenen eine Herausforderung darstellt, sind die therapeutischen Möglichkeiten immer noch begrenzt, um der steigenden Prävalenz und Belastung der Erkrankung gerecht zu werden.
Remote Sensing Based Rapid Assessment of Flood Crop Damage Using Novel Disaster Vegetation Damage Index (DVDI)
Authors: Rahman Md. Shahinoor , Di Liping , Yu Eugene , Lin Li , Yu Zhiqi
Published: November 2020

Accurate crop-specific damage assessment immediately after flood events is crucial for grain pricing, food policy, and agricultural trade. The main goal of this research is to estimate the crop-specific damage that occurs immediately after flood events by using a newly developed Disaster Vegetation Damage Index (DVDI). By incorporating the DVDI along with information on crop types and flood inundation extents, this research assessed crop damage for three case-study events: Iowa Severe Storms and Flooding (DR 4386), Nebraska Severe Storms and Flooding (DR 4387), and Texas Severe Storms and Flooding (DR 4272). Crop damage is assessed on a qualitative scale and reported at the county level for the selected flood cases in Iowa, Nebraska, and Texas. More than half of flooded corn has experienced no damage, whereas 60% of affected soybean has a higher degree of loss in most of the selected counties in Iowa. Similarly, a total of 350 ha of soybean has moderate to severe damage whereas corn has a negligible impact in Cuming, which is the most affected county in Nebraska. A total of 454 ha of corn are severely damaged in Anderson County, Texas. More than 200 ha of alfalfa have moderate to severe damage in Navarro County, Texas. The results of damage assessment are validated through the NDVI profile and yield loss in percentage. A linear relation is found between DVDI values and crop yield loss. An R2 value of 0.54 indicates the potentiality of DVDI for rapid crop damage estimation. The results also indicate the association between DVDI class and crop yield loss.
Equality of graphs up to complementation
Authors: Dammak Jamel , Lopez Gérard , Si Kaddour Hamza
Published: November 2020

We prove the following: Let G and $$G'$$

G
′

be two graphs on the same set V of v vertices, and let k be an integer, $$4\le k\le v-4$$

4
≤
k
≤
v
-
4

. If for all k-element subsets K of V, the induced subgraphs $$G_{\restriction K}$$

G

↾
K

and $$G'_{\restriction K}$$

G

↾
K

′

have the same numbers of 3-homogeneous subsets, the same numbers of $$P_4$$

P
4

’s, and the same numbers of claws or co-claws, then $$G'$$

G
′

is equal to G or to the complement $$\overline{G}$$

G
¯

of G. We give also a similar result whenever the same numbers are modulo a prime.
FCP $$\Delta $$-extensions of rings
Authors: Picavet Gabriel , Picavet-L’Hermitte Martine
Published: November 2020

We consider ring extensions, whose set of all subextensions is stable under the formation of sums, the so-called$$\Delta $$Δ-extensions. An integrally closed extension has the$$\Delta $$Δ-property if and only it is a Prüfer extension. We then give characterizations of FCP$$\Delta $$Δ-extensions, using the fact that for FCP extensions, it is enough to consider integral FCP extensions. We are able to give substantial results. In particular, our work can be applied to extensions of number field orders because they have the FCP property.
Combined effects of interface modification and micro-filler reinforcements on the thermal and tribological performances of fabric composites
Authors: Yuan Junya , Zhang Zhaozhu , Yang Mingming , Zhao Xin , Wu Liangfei , Li Peilong , Jiang Wei , Men Xuehu , Liu Weimin
Published: November 2020

The high specific-strength of glass fibers and exceptional self-lubrication of polytetrafluoroethylene (PTFE) fibers promote the potential application of hybrid PTFE/glass fabric composites in the tribological field, but their weak interfacial adhesion and inferior thermal properties significantly inhibit their tribological performance and reliability. Herein, a hybrid of polydopamine/silicon carbide/polyethyleneimine (PDA/SiC/PEI) functional coating was co-deposited onto the hybrid PTFE/glass fabric surface through a one-step impregnation method, leading to increased surface roughness and abundant amine groups. Tensile and peeling tests showed that this functional coating offered 47.8% enhancement in the fabric/matrix interfacial adhesion without compromising the strength of the pristine fabric. Moreover, the additional incorporation of WS2, and aluminum nitride (AlN) micro-fillers contributed to the development of a high-quality tribofilm and improved the thermal properties of fabric composites. The results of wear tests proved that the hybrid-fabric composites, after the introduction of functional coating and micro-fillers, exhibited outstanding tribological performance, which was attributed to the superior interfacial adhesion as well as the synergistic enhancement effects between WS2 and AlN micro-fillers.
A contingency lens on cloud provider management processes
Authors: Oesterle Severin , Jöhnk Jan , Keller Robert , Urbach Nils , Yu Xin
Published: November 2020

Traditional ways of managing information technology (IT) service providers are no longer applicable as companies use more and more services provisioned in the cloud. Therefore, organizations are looking for new ways to manage their relationship with cloud providers. The shift from IT-as-a-product to IT-as-a-service puts clients in a continued dependency on cloud service providers (CSPs), making provider management a critical factor for companies’ success. In this paper, we (1) identify cloud-specific challenges in managing CSPs, (2) develop a corresponding process framework for CSP management, and (3) discuss and extend this framework. Our final cloud management framework comprises ten processes for effective CSP management based on a literature study and twelve expert interviews. Furthermore, we unpack three major contingency factors, i.e., client–provider ratio, specificity, and service delivery model, which influence the reasonability and configuration of the cloud management processes. Drawing on two specific cases from our interview study, we explicate the contingency factors’ influence. Thus, our paper contributes to cloud sourcing research by deepening the understanding of client–provider relationships and by introducing a viable CSP management instrument contingent on three salient factors of cloud service provisioning.
COVID-19 in HIV: a Review of Published Case Reports
Authors: Morani Zoya , Patel Saumil , Ghosh Sudeshna , Hassan Falah Abu , Doreswamy Shriya , Singh Sandeep , Kothapudi Venkata Neelima , Desai Rupak
Published: November 2020

Patients with COVID-19 present with a myriad of comorbidities. An immunocompromised state like HIV in patients with COVID-19 can be life-threatening. We searched PubMed/Medline, Scopus, and Web of Science for case reports and case series about COVID-19 in HIV patients. We finally reviewed 20 case reports including cases of 43 patients with HIV and COVID-19. The mean age of 43 adult patients was 51.56 ± 27.56 years (range 24–76 years). Of these, 30 were male (69.77%), 11 were female (25.58%), and 2 were transgender (4.65%). A total of 25 patients (58.14%) were above 50 years of age. The most common cardiovascular comorbidities were hypertension and hyperlipidemia (48.8%), diabetes (20.93%), and morbid obesity (11.63%). Out of 43 HIV patients with COVID-19, 6 resulted in death (13.95%). All the patients who died were elderly above 50 years and required mechanical ventilation. HIV patients infected with COVID-19 had a high mortality rate. A high burden of pre-existing comorbidities and an advanced age in these patients make them prone to disease progression and worse outcomes.
Identifying macroscopic features in foreign visitor travel pathways
Authors: Kawamoto Tatsuro , Hashimoto Ryutaro
Published: November 2020

Human travel patterns are commonly studied as networks in which the points of departure and destination are encoded as nodes and the travel frequency between two points is recorded as a weighted edge. However, because travelers often visit multiple destinations, which constitute pathways, an analysis incorporating pathway statistics is expected to be more informative over an approach based solely on pairwise frequencies. Hence, in this study, we apply a higher-order network representation framework to identify characteristic travel patterns from foreign visitor pathways in Japan. We expect that the results herein are mainly useful for marketing research in the tourism industry.
RO analysis software helps to localise interference factors in water treatment applications more easily
Authors: Atkinson Simon
Published: November 2020

German speciality chemicals company Lanxess has developed software for analysing reverse osmosis systems. The company says that it helps to localise interference factors in water treatment applications more easily – producing data that can be used for process optimisation and troubleshooting – as this technology focus article explains.
Editorial
Authors: Barrett Steve
Published: November 2020

Green electrons and green molecules’ is the key theme of the feature article in this issue, which emphasises the importance of renewably produced hydrogen in achieving a climate-neutral energy system. This will require a large amount of renewable electricity and a very large amount of green hydrogen.
Developments in the global hydrogen market: Electrolyser deployment rationale and renewable hydrogen strategies and policies
Authors: Newborough Marcus , Cooley Graham
Published: November 2020

This article explores the importance of renewable hydrogen in achieving a ‘climate neutral’ energy system, which will require a large amount of renewable electricity and a very large amount of renewable hydrogen. Because of the fundamental need for energy storage to match supply and demand, a two-carrier approach needs to be adopted, where both electricity and hydrogen are derived from renewable energy. National hydrogen strategies, electrolyser deployment plans and the actions required by governments to overcome the current policy vacuum are discussed. It is recommended that a cross-sector ‘green electrons and green molecules’ strategy is taken, and that policies are developed urgently for advancing the adoption of renewable hydrogen.
Analyzing Child Rape in Bangladesh: A Socio-Legal Perspective
Authors: Jahan Monira Nazmi
Published: November 2020

Bangladesh is experiencing an epidemic of child rape. Discrimination based on patriarchal philosophies, inadequate rape laws, inadequate policies to address child rape, a conservative criminal justice system, and a conventional judicial environment has culminated in injustice for victims. Laws exist that require severe punishments; however, child rape has not been satisfactorily prevented. Societal norms, stigma, political pressure, money, power, and the critical process of the justice system make it extraordinarily difficult for victims to receive justice. This article describes the reasons why men rape children, including offenders’ psychological conditions and the advantages that men have over the weaker in the criminal justice system, enjoying impunity. While attempting to understand the reasons broadly, statistical data show that the reporting of such crimes has been increasing, but this does not genuinely represent the actual number of crimes committed. The article focuses on social phenomena associated with child rape culture and identifies reasons why crimes are not reported. An in-depth discussion of inappropriate laws for child rape and of the loopholes in these laws demonstrates the hardship that victims face in their fight for justice. Finally, social and legal recommendations for the prevention of child rape are highlighted.
Regional Supervision of Healthcare Institutions With a Focus on Antimicrobial Resistance
Authors: Westerhof Robbin , Boer Lisanne de
Published: November 2020

Background: Resistance to antibiotic drugs, also called antimicrobial resistance (AMR) is a serious threat to (public) health. Surveillance reports throughout the world show that formation and spread of highly resistant microorganisms (HRMOs) continues to be substantial. In The Netherlands, 10 regional collaborative networks on AMR have been established among healthcare institutions to mitigate the existing risks concerning HRMO by collaborative actions in antibiotic stewardship and infection prevention. Objective: We sought to determine whether the healthcare institutions in one of the regional collaborative networks in The Netherlands contribute adequately to reducing the risks of formation and/or spread of HRMO. Methods: The Health and Youth Care Inspectorate in The Netherlands visited 37 institutions in the region of Limburg (the southern province). The following healthcare sectors were included: hospitals (n = 5), rehabilitation clinics (n = 2), long-term care facilities (n = 5), homecare institutions (n = 4), mental healthcare institutions (n = 2), dental care clinics (n = 4), general practitioners (GPs; n = 10), municipal health services (n = 2) and healthcare facilities for mentally disabled people (n = 3). In each visit, 5 topics were addressed: antibiotic policy, infection prevention, information transfer, governance and collaboration in the region. Results and Conclusions: In general, the healthcare institutions had an adequate to good score. Good results were seen in antibiotic policy (ie, the use of diagnostic tools to avoid the use of antibiotics); information transfer among GPs and in homecare institutions; and infection prevention in homecare institutions and dental care clinics. Exceptions with inadequate scores were observed in several areas: absence of prescription guidance specifically for antibiotics in various sectors; infection prevention among GPs, and dental care clinics. In 4 cases (ie, 3 GPs and 1 dental care clinic), we stopped using the autoclave because of lack of proof of proper maintenance.

Funding: None

Disclosures: None
Resource Constraint Hindering Infection Prevention and Control: Evidence From Tertiary-Care Public Hospitals in Bangladesh
Authors: Babar Md. Reaj Khan , Parveen Shahana , Hassan Md. Zakiul , Sumon Md Shariful Amin , Chanda Kanij Fatima , Rahman Mahmudur
Published: November 2020

Background: Despite gradual economic growth in Bangladesh, healthcare facilities are still resource limited and do not measure up to the standard to practice for infection prevention and control (IPC) in reducing the risk of hospital-acquired infections. We assessed the existing resources and facilities in tertiary-care public hospitals to guide a context-specific low-resource IPC intervention for routine use in Hospital wards. Methods: We conducted the study in 3 tertiary-care hospitals from November 2017 to January 2018. The study team collected data on existing facilities and resources associated with IPC strategy from hospital records, semi-structured interviews with different level healthcare staff (n = 176) and spot checks (n = 30). Results: The mean bed occupancy rates for study hospitals were 165%, 200%, and 150%, respectively, on admission days. Among study wards, medicine ward (230%) had the highest bed occupancy rate. Different types of patients were placed together in the wards, and there were no isolation areas for highly infectious patients. Moreover, 22%–58% posts of physicians, 15%–20% of nurses and 38%–42% of support staff were vacant against the authorized posts in these hospitals. There were no usable handwashing facilities for support staff, patients, and family caregivers; however, all the allocated handwashing facilities for physicians and nurses were functional. On average, 50% fewer surgical gloves were provided than were actually required. Although supplies of masks were available in the surgery theater, no supplies in general wards were recorded. Disposable nasal cannula for oxygen and nebulizer masks was unavailable; hence, providers had to reuse this equipment for multiple patients. Most of the autoclave machines (20 of 30) were nonfunctional; therefore, one-third of the surgical instruments could not be sterilized by autoclaving. None of the hospital wards followed the 3 steps of surface cleaning, and no segregation of hazardous wastes was observed. All kind of wastes were dumped in the selected open area within the hospital premises. Healthcare workers (n = 110) directly involved in patient care reported that hand hygiene is usually not possible between patient visits. High turnover of patients and shortage of healthcare staff were reported as major barriers to IPC practices, specifically hand hygiene and environmental cleaning. There was no active committee nor specific training program on IPC for healthcare staff. Conclusions: Existing resources and facilities of these hospitals did not support a standard IPC strategy. Coordination from policy level to implementation with proper allocation of resources is required to ensure a practical IPC strategy.

Funding: None

Disclosures: None
Review of Candida dubliniensis at a Pediatric Hospital
Authors: Diaz Alejandro , Danino Dana , Leber Amy , Wang s Hospital Huanyu , Klamet Emily , Stack-Simone Stephanie , Washam Matthew
Published: November 2020

Background:Candida dubliniensis is a worldwide fungal opportunistic pathogen, closely related to C. albicans. Originally identified in patients infected with HIV in Dublin, Ireland, C. dubliniensis has emerged as a pathogen in other immunocompromised individuals, including patients receiving chemotherapy and transplant recipients. Pediatric epidemiological data for this organism are limited. Methods: We report a descriptive review of C. dubliniensis isolates recovered between January 2018 and June 2019 at a large tertiary-care pediatric institution in Columbus, Ohio. Results:C. dubliniensis was identified in 48 patients in the 18-month review period. In total, 67 positive cultures were collected in these patients with the following distribution of sources: 44 sputum (66%), 11 bronchoalveloar lavage fluid (16%), 4 blood (6%), 3 wounds (4%), 2 esophageal (3%), 2 peritoneal fluid (3%), and 1 vaginal (1%). Of the 48 patients in whom C. dubliniensis was identified, 35 (73%) were patients with cystic fibrosis. Also, 8 patients (17%) were considered to have clinical infections and received antifungal therapy: 3 patients with pneumonia, 2 patients with esophagitis, 1 patient with peritonitis, 1 patient with catheter-related bloodstream infection, and 1 patient with disseminated candidiasis. The remaining 40 patients (83%) were considered colonized. Conclusions: We report a descriptive series over 18 months of clinical isolates with C. dubliniensis recovery at a pediatric institution. Most isolates were identified as colonizing strains in patients with cystic fibrosis. C. dubliniensis was a rare cause of invasive disease in our institution, with only 8 cases identified.

Funding: None

Disclosures: None
Risk Factors Associated with Acute Hepatitis C in Mongolia
Authors: Chunt Munkhtsetseg , Luvsansharav Ulzii-Oshikh , Dugersuren tgon , Gombojamts Narantuya , Biedron Caitlin , Ganbold Sarangua , Dorjdamba Dorjpagma , Ganbaatar Khorolgarav , Jadambaa zarantuya , Jinnai Yuka , Drobeniuc Jan , Baggs James , Beckett Geoff , Bira Tsatsralt-Od , Smith Rachel
Published: November 2020

Background: Hepatitis C virus (HCV) infection is endemic in Mongolia, with reported prevalence of HCV antibody (anti-HCV) positivity of 11%–16% in the adult population. Healthcare-related risk factors associated with development of acute HCV infection have not been evaluated in this population. Methods:We conducted a prospective, matched case-control study to identify risk factors associated with acute HCV infection in Ulaanbaatar, Mongolia. Cases were aged 18 years with discrete onset of symptoms consistent with acute viral hepatitis as well as jaundice or elevated serum alanine aminotransferase (ALT) levels who were admitted to the National Center for Communicable Diseases during January–October, 2019. Cases were both anti-HCV and HCV RNA positive and tested negative for acute hepatitis A, B, and E. Controls were randomly selected from the Population and Household Database, a national registry of all citizens, and were matched by age and gender. Data collection covered healthcare-associated and other risk factors in the 6 months before symptom onset (cases) or interview date (controls). Adjusted measures of association comparing cases and their matched controls were obtained using a multivariate conditional logistic regression model. Results: We enrolled 35 case patients and 104 controls. Median age of all participants was 44 (range, 23–63) years and 19% (27 of 139) were men. All case patients reported jaundice and loss of appetite; most cases reported nausea, malaise, and abdominal pain (97%, 91%, and 83%, respectively). The median ALT level among case patients was 1,185 IU/L (range, 212–3,349). Case patients were more likely than controls to have been admitted as inpatients (matched odds ratio [mOR], 4.3; 95% CI, 1.5–11.9), to have visited an outpatient clinic (mOR, 3.6; 95% CI, 1.3–10.2), to have had phlebotomy (mOR, 3.3; 95% CI, 1.5–7.5) or endoscopy (mOR, 10.7; 95% CI, 2.2–51.2) as an outpatient procedure, and to have received an injection outside of healthcare settings (mOR, 2.2; 95% CI, 1.0–5.1). Cases were also more likely to have lived in a yurt (mOR, 2.3; 95% CI, 1.0–5.0) and to have lived with persons diagnosed with HCV infection (mOR, 3.0; 95% CI, 1.1–7.9). In a multivariate model, only outpatient endoscopy (adjusted OR, 10.8; 95% CI, 1.7–69.6) was significantly associated with case status. Conclusions: This is the first study to evaluate risk factors for acute HCV infection among adults in Ulaanbaatar, Mongolia. Outpatient endoscopy was associated with new HCV infections in this population; evaluation of gaps in infection control practices at settings providing these services are needed to prevent transmission of communicable diseases, including hepatitis C.

Funding: None

Disclosures: None
Risk to Hospitals During a Community Hepatitis A Outbreak: Flipping the Perspective
Authors: Kressel Amy Beth , Swafford Katie
Published: November 2020

Background: In February 2019, in the context of a nationwide community-based hepatitis A (HAV) outbreak, Eskenazi Health (EH), an acute-care hospital in Indianapolis, Indiana, identified a healthcare worker (HCW) with HAV who had potentially exposed patients via medicine administration. Objective: We began an investigation and mitigation plan to determine the source of the HAV and the risk to patients. Methods: The investigation and mitigation consisted of 6 measures. (1) We searched the electronic medical record (EMR) tracer report to determine whether any of the HCW’s patients had HAV during the incubation period (15–50 days prior to diagnosis) or were potentially exposed during the infectious period (0–14 days prior to diagnosis). 2. We searched the EMR and CHIRP (Indiana’s electronic vaccine database) for potentially exposed patients to determine HAV immunity or HAV vaccination (HAVx). (3) We contacted potentially exposed patients. (4) We communicated with public health partners. (5) We investiged other potential exposures. (6) We communicated with employees regarding free HAVx and the community HAV outbreak via e-mail newsletters (reaching almost 6,000 unique addresses) and posts on our internal website. Results: The HCW had not provided care for a patient with diagnosed HAV during the incubation period. The HCW had provided care for 14 patients during the infectious period. No potentially exposed patient had evidence of HAV immunity or HAVx in EMR or CHIRP. We initiated communication to all 14 patients or their surrogates regarding the potential exposure, symptoms of HAV, testing, and HAVx. We could confirm HAV testing for only 1 of 14 patients, and the result was negative. None of the 14 patients developed HAV. Public health partners confirmed notification of the HCW case. No further information about the HCW’s HAV source was determined. The HCW did not share community food at work. No workplace source of HAV was identified. HAVx dispensed at the pharmacy increased after communication about availability: December 2018–February 2019, 4 HAVx dispensed and March–May 2019, 82 HAVx dispensed. Conclusions: Traditionally, hospitals view infection risk in terms of HCWs acquiring infections from or spreading infections among patients. Viewed this way, the Indiana HAV community outbreak, although serious for the community, did not appear to be a threat to the hospital: HAV acquisition in hospitals has been rare, which is supported by our results. However, this episode demonstrates that the traditional view needs to be flipped: HCWs can bring community-acquired HAV into the hospital. Nudges can quickly increase HAVx uptake among HCWs.

Funding: None

Disclosures: None
Rotavirus Vaccination in the NICU: Where Are We? A Rapid Review of Recent Evidence
Authors: Sicard lanie , Bryant Kristina , Muller Martha , Quach Caroline
Published: November 2020

Background: Rotavirus is a leading cause of viral acute gastroenteritis (AGE) in infants. Neonates hospitalized in neonatal intensive care units (NICUs) are at risk of rotavirus infections with severe outcomes. The administration of rotavirus vaccines is only recommended, in the United States and Canada, upon discharge from the NICU despite rotavirus vaccine being proven safe and effective in these populations, due to risks of live-attenuated vaccine administration in immunocompromised patients and theoretical risks of rotavirus vaccines strains shedding and transmission. We summarized recent evidence regarding rotavirus vaccines administration in the NICU setting and safety of rotavirus vaccines in preterm infants. Methods: We conducted a rapid review of the literature from the past 10 years, searching Medline and Embase, including all study types except reviews, reporting on rotavirus vaccine 1 and rotavirus vaccine 5; NICU setting; shedding or transmission; and/or safety in preterm. One reviewer performed data extraction and quality assessment. Results: In total, 31 articles were analyzed. Vaccine-derived virus shedding following rotavirus vaccination existed for nearly all infants, mostly during the first week after dose 1, with rare transmission described only in the household setting. No case of transmission in the NICU was reported. Adverse events were mild to moderate, occurring in 10%–60% of vaccinated infants. Extreme premature infants or with underlying gastrointestinal failure requiring surgery presented more severe adverse events. Conclusions: Recommendations regarding rotavirus vaccine administration in the NICU should be reassessed in light of the relative safety and absence of transmission of rotavirus vaccine strains in the NICU.

Funding: None

Disclosures: Sicard Mélanie: I reference the use of rotavirus vaccines in the NICU setting, which is not recommended; I discuss possible reassessment of these recommendations.
Scenario-Based, Interactive Infection Prevention and Control and Bloodborne Pathogen Education
Authors: Faller Rebecca , Sampathkumar Priya , Lande Lisa , Clarenbach Seth
Published: November 2020

Background: Infection prevention and control (IPAC) and bloodborne pathogen (BBP) education are required for all healthcare workers at least annually by the Occupational Safety and Health Administration and The Joint Commission. An inventory in 2016 at a large health system with >60,000 employees identified 46 different training modules used to fulfill this regulatory mandate. Objective: Using quality improvement tools and management, we sought to reduce duplication of effort, to enhance education, and to improve employee engagement. Methods: A multidisciplinary team that included IPAC, physician, nursing, educational designn and occupational safety was formed. The team reviewed regulatory standards, cross checked site-specific practices, and identified gaps in the current training structure. The goal was to create a module with multiple pathways that tailored regulatory content and delivery to the employee’s job responsibilities (Figs. 1 and 2). Results: The 46 individual training modules were replaced with 1 module that averaged 24.46 minutes to complete. Branching was incorporated that customized education to the employee’s role. The employee completion rate was 99% (n = 61,456). The scenario-based interactive approach engaged learners by challenging them to respond to real-life activities tailored to their level of risk. Most responders (87.4%) rated the learning activity as “good” or “excellent,” and 92.4% of responders agreed or strongly agreed that the activities in the course aided their learning. Conclusions: We leveraged adult learning principles and industry-proven instructional design activities to deliver interactive and relevant infection control training that met regulatory requirements and engaged employees through action-driven tasks. In 2018, the work group created fast paths for employees who had previously completed this module whereby they could revisit the original content and/or focus only on updates and targeted areas of interest. A pathway for laboratory workers involved in specimen handling and processing is planned next.

Funding: None

Disclosures: None
Screening for Multidrug-Resistant Organisms in a Tertiary-Care University Hospital in the North West Bank: A Descriptive Study
Authors: Belkebir Souad , Kanaan Alaa , Jeetawi Rawan
Published: November 2020

Background: The prevalence of multidrug-resistant organisms (MDROs) in acute healthcare settings is increasing worldwide. Active screening for MDROs carriers on admission permits the prompt implementation of the appropriate precautions to decrease the probability of cross transmission to other inpatients. Objective: To report the spectrum of bacterial nasal, axilla, and perianal colonization among in patients at Najah National University Hospital (NNUH) during 2018. Methods: A retrospective observational study was performed at NNUH, a tertiary-care referral university hospital in Nablus, north of Palestine, that includes medical and surgical ICUs for both adults and children from January to August 2018. Nasal, axilla, and perianal swabs were collected within the first 24 hours of admission according to hospital policy. Patients who were referred from another hospital, who were admitted to a hospital for at least 2 nights during the previous 8 months, and who are known to have an MDROs in the past were included. Swab samples were processed for isolation and identification of these multidrug-resistant strains. Transmission-based precautions were implemented if positive results were reported (ie, contact isolation) and decolonization regimens were applied according to the CDC recommendations (muporocin ointment for nasal MRSA, daily bathing with chlorhexidine 2% soap for the rest). A daily isolation list was circulated among bed managers and senior nurses and head of departments for appropriate management of beds and reallocation of patients. The antibiotic susceptibility pattern was assessed using the disc-diffusion method on Mueller–Hinton agar and a Vitek-2 system. Results: During the period of the study, 1,425 nasal swabs, 1,245 axilla swabs, and 300 perianal swabs were collected according to the inclusion criteria. Positive results were reportedin 7%, 4%, and 44% for nasal, axilla, and perianal specimens, respectively. Regarding the distribution of bacterial colonization in the nasal swab, 73% were MRSA; for the axial, 29% were Pseudomonas; and from the perianal swab, the most prevalent pathogen was ESBL (56%) (Figs. 1–3). A discrepancy between the number of nasal or axilla and perianal swabs was observed, which was mainly due to the refusal of many patients to have the sample collected by the nurse. Conclusions: Colonization of the skin and mucous membranes of inpatients with MDROs is considered a risk factor for developing future infections. Therefore, active screening for those pathogens is critical for infection prevention and control programs and patient safety in acute-care settings.

Funding: None

Disclosures: None
Secular Trends in Nosocomial Carbapenem-Resistant Enterobacteriaceae (CRE): Twenty-Five Years of Surveillance in Brazilian Hospitals
Authors: Ferreira Jose Antonio , Couto Braulio , Starling Carlos
Published: November 2020

Background:
Enterobacteriaceae that develop resistance to carbapenems are a family of different types of bacteria that cause hospital-acquired infections. We evaluated the incidence of nosocomial infections caused by carbapenem-resistant Enterobacteriaceae (CRE) in 13 Brazilian hospitals over 25 years from 1995 to 2019. Methods: CRE was defined as Enterobacteriaceae that is nonsusceptible to any of the a carbapenem (doripenem, meropenem, or imipenem) AND is resistant to all of the following third-generation cephalosporins: ceftriaxone, cefotaxime, and ceftazidime. Hospital-acquired infections (HAIs) were diagnosed according to the CDC NHSN protocols in 13 hospitals from Belo Horizonte, Brazil, between January 1995 to June 2019. Results: In total, 33,922 HAIs caused by Enterobacteriaceae were diagnosed in 25 years across all 13 hospitals. The percentage of CRE varied among hospitals from a minimum of 3% in hospital to a maximum of 30% in hospital E (Fig. 2). The percentage of CRE varied along time as well: for 1995–1999, 0.1% (2 of 1,414) were CRE; for 2000–2004, 0.5% (28 of 5,160) were CRE; for 2005–2009, 2.0% (160 of 8,068) were CRE; for 2010–2014, 11.1% (971 of 8,771) were CRE; and for 2015–2019, 20.2% (2,127 of 10,509) were CRE (Fig. 1). ICU patients and elderly were the most affected by CRE, which has increased lethality, compared to non-CRE Enterobacteriaceae. Conclusions: Over 25 years, CRE percentage increase from almost zero in 1995–1999, to >20% in 2015–2019.

Funding: None

Disclosures: None
Self-Contamination and Failure Modes During PPE Doffing: A Comparison of Two Powered Air-Purifying Respirator Hoods
Authors: Erukunuakpor Kimberly , Kraft Colleen , Casanova Lisa
Published: November 2020

Background: High-level personal protective equipment (PPE) protects healthcare workers (HCWs) during the care of patients with serious communicable diseases. Doffing body fluid–contaminated PPE presents a risk of self-contamination. A study assessing HCW failure modes and self-contamination with viruses during PPE doffing found that, of all PPE items, the highest number of doffing failure modes and highest self-contamination risk occurred during removal of the 1-layer powered air-purifying respirator (PAPR) hood. Hood type may affect contamination risk; however, no experimental evidence exists comparing hood types. Objective: We quantified and compared the risk of self-contamination with viruses during doffing of a 1e-layer versus a 2-layer PAPR hood. Methods: In this study, 8 HCWs with experience using high-level PPE donned PPE contaminated on 4 prespecified areas with 2 surrogate human viruses, bacteriophage MS2 (a nonenvelope virus) and Φ6 (an enveloped virus). They completed a clinical task then doffed PPE according to a standard protocol. Following doffing, inner gloves, hands, face, and scrubs were sampled for viral contamination using infectivity assays. HCWs performed the entire sequence twice, first with a 1-layer hood with 1 shroud then with a 2-layer hood with 2 shrouds. The Wilcoxon rank-sum test was used to compare viral contamination between the 2 hood types. HCWs were video-recorded to identify failure modes in their doffing process using a failure modes and effects analysis to identify ways that individual actions deviated from optimal behavior. Results: Φ6 transfer to hands, inner gloves, and scrubs were observed for 1 HCW using the 1-layer hood versus scrubs only for 1 HCW using the 2-layer hood. MS2 transfer to hands was observed for 2 HCWs using the 1-layer hood versus none using the 2-layer hood. Inner glove contamination was observed for 6 of 8 HCWs using the 1-layer hood versus 2 of 8 using the 2-layer hood. Conclusions: A significantly higher number of MS2 virus was recovered on the inner gloves of HCWs using the 1-layer versus the 2-layer hood (median difference, 2.27×104; P = .03). In addition, 31 failure modes were identified during removal of the 2-layer hood versus 13 failure modes for the 1-layer hood. The magnitude of self-contamination depends on the type of PAPR hood used. The 2-layer hood resulted in significantly less inner glove contamination than the 1-layer hood. However, more failure modes were identified during the doffing process for the 2-layer hood. In conclusion, the failure modes identified during the use of the 2-layer hood were less likely to result in self-contamination compared to the failure modes identified during use of the 1-layer hood.

Funding: None

Disclosures: None
Seroprevalence of Measles in Healthcare Workers in South Korea
Authors: Kim Sun Kyung , Jung Jiwon , Kwak Sun Hee , Hong Min Jee , Kim Eun Ok , Kim Sung-Han
Published: November 2020

Background: Measles is a highly contagious disease that is transmissible by airborne particles but is preventable by vaccination. South Korea has maintained a highly immunized adult population; however, small local outbreaks of measles continued to occur, and there have been some reports of pockets of underimmunity among the young adult population. It is important to know the seroepidemiology of healthcare workers (HCWs) for policy-making process, but data on the seroprevalence of measles in HCWs in South Korea are limited. Methods: We investigated the seroprevalence of HCWs at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2014, after an outbreak of measles occurred in a university in Seoul, Asan Medical Center required measles IgG tests for all HCWs born in and after 1967 for point-prevalence surveillance. In addition, we have routinely performed measles antibody test for new HCWs since 2014. In 2018, antibody tests were administered to HCWs who were born before 1967 or who had taken a leave of absence in 2014. We provided MMR vaccination to all HCWs whose antibody tests yielded negative results. Results: In total, 7,411 HCWs (89%) underwent measles antibody tests from 2014 to 2018. The overall seropositivity was 73% (95% CI, 72%–74%); seroprevalence was 73% in HCWs born in of after 1967, whereas the seroprevalence in HCWs born before 1967 was 98%. The seroprevalence sharply decreased from 85% in the 1986 birth cohort to 42% in the 1995 birth cohort. Conclusions: In conclusion, the proportion of measles-susceptible individuals was substantially high in HCWs, especially in young adults. Because the impact of measles outbreak in healthcare facilities would be critical, a policy regarding routine serologic screening followed by measles vaccination or routine measles vaccination in healthcare facilities should be considered, especially for young Korean HCWs.

Funding: None

Disclosures: None