bluuebunny/crossref_metadata_2025 huggingface dataset:
lncRNA RP11-10A14.5: a potential prognosis biomarker for LUAD through regulation on proliferation and metastasis
Authors: Lin Zhijie , Feng Fenglan , Liang Jiaming , Zeng Haikang , Li Jin
Published: May 2022

Lung cancer is the malignancy most commonly seen worldwide. Emerging evidences indicated that lncRNAs may serve as a prognosis marker and play important role in NSCLC tumor biology. In this work, we analyzed the prognosis value of RP11-10A14.5 using TCGA and GEPIA database and expression profiles using PCR and FISH assay. The biological roles of RP11-10A14.5 in cell growth and invasion were determined by in vitro and in vivo experiments. Expression of RP11-10A14.5 is correlated with increased clinical stage and poor survival prognosis. In vitro experiments revealed that RP11-10A14.5 was widely expressed in lung cancer cell lines and mainly distributed in the cytoplasm and enhanced the growth, invasion and migration ability of NSCLC cell lines. Immunofluorescence assay suggested that RP11-10A14.5 may promote EMT by downregulating E-cadherin and upregulating N-cadherin and Vimentin. Flow cytometry results suggested that RP11-10A14.5 did not significantly affect cell cycle function, but could significantly inhibit apoptosis which may further enhance metastasis cell survival. In conclusion, RP11-10A14.5 is associated with clinical stage and poor survival outcome, may serve as a diagnosis and prognosis predictor for LUAD. Further, RP11-10A14.5 could promote LUAD cell growth and metastasis.
An Ever-Expanding Humanities Knowledge Graph: The Sphaera Corpus at the Intersection of Humanities, Data Management, and Machine Learning
Authors: El-Hajj Hassan , Zamani Maryam , Büttner Jochen , Martinetz Julius , Eberle Oliver , Shlomi Noga , Siebold Anna , Montavon Grégoire , Müller Klaus-Robert , Kantz Holger , Valleriani Matteo
Published: May 2022

The Sphere project stands at the intersection of the humanities and information sciences. The project aims to better understand the evolution of knowledge in the early modern period by studying a collection of 359 textbook editions published between 1472 and 1650 which were used to teach geocentric cosmology and astronomy at European universities. The relatively large size of the corpus at hand presents a challenge for traditional historical approaches, but provides a great opportunity to explore such a large collection of historical data using computational approaches. In this paper, we present a review of the different computational approaches, used in this project over the period of the last three years, that led to a better understanding of the dynamics of knowledge transfer and transformation in the early modern period.
Soil compaction raises nitrous oxide emissions in managed agroecosystems. A review
Authors: Pulido-Moncada Mansonia , Petersen Søren O. , Munkholm Lars J.
Published: May 2022

Nitrous oxide (N2O) is the contributor to agricultural greenhouse gas emissions with the highest warming global potential. It is widely recognised that traffic and animal-induced compaction can lead to an increased potential for N2O emissions by decreasing soil oxygen supply. The extent to which the spatial and temporal variability of N2O emissions can be explained by soil compaction is unclear. This review aims to comprehensively discuss soil compaction effects on N2O emissions, and to understand how compaction may promote N2O emission hotspots and hot moments. An impact factor of N2O emissions due to compaction was calculated for each selected study; compaction effects were evaluated separately for croplands, grasslands and forest lands. Topsoil compaction was found to increase N2O emissions by 1.3 to 42 times across sites and land uses. Large impact factors were especially reported for cropland and grassland soils when topsoil compaction—induced by field traffic and/or grazing—is combined with nitrogen input from fertiliser or urine. Little is known about the contribution of subsoil compaction to N2O emissions. Water-filled pore space is the most common water metric used to explain N2O emission variability, but gas diffusivity is a parameter with higher prediction potential. Microbial community composition may be less critical than the soil environment for N2O emissions, and there is a need for comprehensive studies on association between environmental drivers and soil compaction. Lack of knowledge about the interacting factors causing N2O accumulation in compacted soils, at different degrees of compactness and across different spatial scales, limits the identification of high-risk areas and development of efficient mitigation strategies. Soil compaction mitigation strategies that aim to loosen the soil and recover pore system functionality, in combination with other agricultural management practices to regulate N2O emission, should be evaluated for their effectiveness across different agro-climatic conditions and scales.
Agonisti del recettore del GLP1 e infiammazione: non solo compenso glicemico
Authors: Costanzo Gabriele , Frasca Francesco
Published: May 2022

Sommario

I farmaci agonisti del recettore del Glucagon-like peptide 1 (GLP1) sono ormai da diversi anni protagonisti nella gestione terapeutica del paziente affetto da diabete mellito tipo 2. Oltre alla significativa efficacia sull’omeostasi glicemica, alcuni membri di questa categoria di farmaci trovano inoltre indicazione nel trattamento dell’obesità. Ultimamente, le evidenze in letteratura hanno infine suggerito un ruolo protettivo sulla salute cardiovascolare, tanto che le più recenti linee guida italiane e internazionali promuovono il loro impiego nei soggetti diabetici ad alto rischio. Il possibile ruolo dei farmaci agonisti del GLP1R (GLP1RAs) sui meccanismi alla base dell’infiammazione cronica e la pressoché ubiquitaria distribuzione dei recettori per il GLP1 potrebbero, in realtà, spiegare l’enorme versatilità di questi farmaci.
Co-producing better land management? An ethnographic study of partnership working in the context of agricultural diffuse pollution
Authors: Vetter Thomas
Published: May 2022

Partnership working has become a normative principle within agri-environmental governance. With more and more benefits becoming attributed to closer multi-stakeholder collaboration, more public monies are being directed towards this cause. These benefits have been studied widely and are usually presented in terms of their contributions to environmental, economic and/or social objectives. However, in contrast to these reported outcomes of partnership working, the practical ways towards them have received little attention. What does it mean to work together on a day-to-day basis? More specifically, how do stakeholders become trusted partners, bridge interests and coordinate their actions? What collaborative working culture becomes established within partnerships and how does this in turn affect wider governance outcomes, expectations and aspirations? Answers to these questions are not only important to better understand the factors that contribute to successful ways of partnership working, but also to account for its limitations. This paper responds to this research need by drawing on the example of Farm Herefordshire. This cross-organizational partnership promotes profitable farming, healthy soils and clean water to address the problem of diffuse pollution from agricultural practices within the Wye catchment in the UK. The insights from this case study contribute to the literature in two major ways: firstly, the paper follows prompts to study such modes of collective action holistically and bottom-up to capture all their contributions and implications. It does so by employing an ethnographic research approach to investigate the social interactions and struggles that characterize joint working. This commands attention to the backstories, the actual work meetings, the discussions, the processes of consensus building, and the joint actions undertaken; secondly, the paper connects with wider social science concerns around the underlying processes and practices of governmentality that are essential for establishing social and ecological orders. Thus, the paper explores how everyday practices of partnership working contribute to the co-production of institutions, discourses, identities, and representations—which in this case become strategically deployed to nudge—rather than revolutionise—better land management practices.
Detecting and Assessing the Spatio-Temporal Land Use Land Cover Changes of Bahrain Island During 1986–2020 Using Remote Sensing and GIS
Authors: Aljenaid Sabah S. , Kadhem Ghadeer R. , AlKhuzaei Manaf F. , Alam Jobair B.
Published: May 2022

The Kingdom of Bahrain has experienced accelerated development growth since the 1980s. These rapid land demands increased the pressure on the country area to rebuild urban centers and cities surrounding the coast. The purpose of this research is to detect and investigate changes in land use and land cover (LULC), which is one of the most critical aspects of planning and managing the use of land as a natural resource. The massive growth in land demand, particularly in small-area countries like Bahrain, forces decision-makers to re-plan the main island areas (Bahrain, Muharraq, Sitra, and Nabih Saleh). The study focuses on mapping the LULC changes detection over 1986–2020. It employs an integrated approach of remote sensing and GIS (Geographic Information System) to analyze and evaluate the changes in the LULC area in the main islands using multi-temporal and multispectral Landsat satellite imagery acquired in 1986, 1994, 2000, 2005, 2013, and 2020. In addition, high-resolution satellite images of different dates IKONOS 2000, GeoEye1 2011, 2013, Worldview3 2019, ASTER 2012, 2013, and multiresolution seamless image database-MrSID 1994, 1998 were used to enhance the LULC classification. Furthermore, different ancillary data were utilized to adjust the decision of LULC classes. The images were supervised using Maximum Likelihood Classifier (MLC) algorithms to generate the seven LULC maps. The seven-raster classification maps revealed overall accuracies exceeding 85%, and overall Kappa statistics range between 87 and 95%. The results indicate that the increment in the built-up area was dominant over the last 3 decades.
White matter microstructural integrity and BOLD fluctuation alterations mediated the effects of insulin resistance on cognitive function in patients with type 2 diabetes mellitus
Authors: Wang Xin , Bi Yan , Zhang Zhou , Lu Jiaming , Qing Zhao , Zhang Xin , Zhang Wen , Zhang Bing
Published: May 2022

Aims

To explore the neural mechanism of white matter related cognitive dysfunction in patients with type 2 diabetes mellitus.

Methods

This prospective study between 2016 and 2018 included 55 patients with type 2 diabetes mellitus and 40 participants without type 2 diabetes mellitus. Detailed neuropsychological assessment, clinical and biochemical information, diffusion tensor imaging and resting-state functional MRI were collected. The fractional anisotropy (FA), mean diffusivity (MD) and amplitude of low-frequency fluctuation (ALFF) in white matter were compared between the two groups and then extracted for correlation and mediation analysis with clinical parameters and cognitive assessments.

Results

The current research showed that three parameters changed in several white matter areas of patients with type 2 diabetes mellitus. Meanwhile, FA in the corpus callosum mediated the effect of insulin resistance on executive function in both two groups. In the group without type 2 diabetes mellitus, ALFF moderated the effect of FA on executive function.

Conclusion

Patients with type 2 diabetes mellitus showed alterations in structural integrity and activation of white matter, which played a mediating and regulating role in the cognitive impairment caused by insulin resistance.
Statistics in the Service of Science: Don’t Let the Tail Wag the Dog
Authors: Singmann Henrik , Kellen David , Cox Gregory E. , Chandramouli Suyog H. , Davis-Stober Clintin P. , Dunn John C. , Gronau Quentin F. , Kalish Michael L. , McMullin Sara D. , Navarro Danielle J. , Shiffrin Richard M.
Published: May 2022

Statistical modeling is generally meant to describe patterns in data in service of the broader scientific goal of developing theories to explain those patterns. Statistical models support meaningful inferences when models are built so as to align parameters of the model with potential causal mechanisms and how they manifest in data. When statistical models are instead based on assumptions chosen by default, attempts to draw inferences can be uninformative or even paradoxical—in essence, the tail is trying to wag the dog. These issues are illustrated by van Doorn et al. (this issue) in the context of using Bayes Factors to identify effects and interactions in linear mixed models. We show that the problems identified in their applications (along with other problems identified here) can be circumvented by using priors over inherently meaningful units instead of default priors on standardized scales. This case study illustrates how researchers must directly engage with a number of substantive issues in order to support meaningful inferences, of which we highlight two: The first is the problem of coordination, which requires a researcher to specify how the theoretical constructs postulated by a model are functionally related to observable variables. The second is the problem of generalization, which requires a researcher to consider how a model may represent theoretical constructs shared across similar but non-identical situations, along with the fact that model comparison metrics like Bayes Factors do not directly address this form of generalization. For statistical modeling to serve the goals of science, models cannot be based on default assumptions, but should instead be based on an understanding of their coordination function and on how they represent causal mechanisms that may be expected to generalize to other related scenarios.
Dimensional crossovers in the Gaussian critical fluctuations above Tc of two-layer and three-layer superconductors
Authors: Viz A. S. , Botana M. M. , Verde J. C. , Ramallo M. V.
Published: May 2022

By using a Ginzburg–Landau functional in the Gaussian approximation, we calculate the energy of superconducting fluctuations above the transition, at zero external magnetic field, of a system composed by a small number N of parallel two-dimensional superconducting planes, each of them Josephson coupled to its first neighbour, with special focus in the N = 2 and 3 cases. This allows us to obtain expressions for the critical contributions to various observables (fluctuation specific heat and magnetic susceptibility and Aslamazov–Larkin paraconductivity). Our results suggest that these systems may display deviations from pure 2D behaviour and interesting crossover effects, with both similitudes and differences to those known to occur in infinite-layers superconductors. Some challenges for future related research are also outlined.
Investigation and control strategy for canine distemper disease on endangered wild dog species: a model-based approach
Authors: Reja Selim , Ghosh Sinchan , Ghosh Indrajit , Paul Ayan , Bhattacharya Sabyasachi
Published: May 2022

The canine distemper virus (CDV) is a major threat to the already endangered wild dogs. We propose an evidence-based mathematical model of canine distemper in the wild to predict the rate and possibility of disease spread in wild dogs under a different scenario. We find the endemic and disease-free equilibrium points and the condition for their stability from the model. The bifurcation analysis of the model shows how the endemic equilibrium can be transformed into the disease-free equilibrium through parameters that represent fundamental ecological properties. The sensitivity of these parameters to the secondary disease spread points out the specific interaction rates and a birth rate that should be targeted to reduce the CDV outbreak. We suggest target parameters for controlling the disease outbreak considering the plausibility of manipulating them in terms of implications besides the sensitivity of the parameters. Finally, this article proposes two specific control strategies based on this modeling framework: isolation and birth-control-reintroduction. Since the isolation strategy may be cost-intensive, we modify our model to quantify the isolation rate necessary to reduce the disease outbreak. We suggest that the birth-control-reintroduction strategy based on the proposed model is cost-effective for a small contaminated area. Overall, the models in this study is applied in the field of conservation biology.
Five Pillars: A Framework for Transforming the Police Response to Rape and Sexual Assault
Authors: Hohl Katrin , Stanko Elizabeth A.
Published: May 2022

The ‘justice gap’ for cases of rape and sexual assault is well-documented. Despite our rich understanding of the problem, its visibility in the public sphere, and state commitments to increasing charge and conviction rates, the justice gap is getting larger in the Western World. On a practical level, police are gatekeepers of outcome justice—arrests, charges, and convictions. As representatives of the state and society, police also wield significant symbolic power in defining the faultline between behaviour that is deemed ‘right’ or ‘wrong’. In this article we propose a theory-based and practice-oriented framework for transforming the police response to rape and sexual assault that draws on the large body of feminist literature on sexual violence and criminal justice responses, in combination with policing literature. This framework comprises five pillars: (1) suspect-focused investigations; (2) disrupting repeat offenders; (3) a procedural justice approach to victim-survivor engagement; (4) officer learning, wellbeing, and organisational change; and (5) the use of data. We conclude with a discussion of its practical implementation and empirical validation.
Community-Scale Composting Initiatives in South-East Queensland and Beyond: a Review of Successes, Challenges and Lessons for a Pilot Project on Karragarra Island, southern Moreton Bay
Authors: Gillespie Ariel , Halog Anthony
Published: May 2022

A systematic literature review was conducted on decentralised, community-scale composting and organics recycling initiatives in South-East Queensland, and other regions in Australia and globally. The results found were compared with the results of a pilot project on Karragarra Island, off the coast of southern Queensland. No relevant literature found in the review was from Australia and projects in south-east Queensland were investigated via personal communication. Overall, the results showed community-scale composting to be viable with the right partnerships, community awareness, project design and financial support. The pilot project implemented on Karragarra Island may be modified and replicated in South-East Queensland and beyond.
Technical pathways of dual carbon control in China’s buildings sector
Authors: Xu Wei , Sun Deyu , Dong Jiankai , Huang Shuai , Yang Shuo
Published: May 2022

Reducing carbon emissions in the buildings sector is of great significance to the realization of China’s carbon peak and neutrality goals. By analyzing factors influencing buildings carbon emissions at the operational stage, this paper applies the China Building Carbon Emission Model (CBCEM) to make medium and long-term forecasts of China’s building operation carbon emissions, discussing the goals and realization paths of China’s dual carbon goals in the buildings sector. The results show that building operation carbon emissions, according to the current development model in the buildings sector, will peak in 2038–2040 with a peak carbon emission of about 3.15 billion tons of CO2; however, by 2060, carbon emissions will still be 2.72 billion tons of CO2, falling short of China’s dual carbon goals. The carbon saving effects of three scenarios, namely clean grid priority, building photovoltaic priority and energy efficiency enhancement priority, were measured and shown to be significant in all three scenarios, but the building photovoltaic priority and energy efficiency enhancement priority scenarios were superior in comparison.
Implementing Leading antimicrobial stewardship practices in United States hospitals – A qualitative study
Authors: Chitavi Salome , Kohut Mike , Braun Barbara , Adams Meghann , Hyun David
Published: May 2022

Background: In May 2018, The Joint Commission, The Pew Charitable Trusts, and the CDC cosponsored a meeting of experts who identified 6 evidence-based leading practices that antimicrobial stewardship programs (ASPs) should be doing beyond having basic infrastructure for improving antibiotic prescribing. The Joint Commission Department of Research working with external experts in 2020 conducted a prevalence study to assess what proportion of Joint Commission-accredited hospitals had implemented the 6 leading practices identified (results presented at SHEA Spring 2021). In this qualitative study, we collected information about how hospitals implemented ASP leading practices to identify facilitators and barriers to implementation among diverse hospitals. Methods: We conducted in-depth telephone interviews with a subset of ASP leaders from hospitals that participated in the 2020 prevalence study. We used purposive sampling to select 30 hospitals from 288 hospitals based on leading practices implemented, hospital size, and system membership. An experienced qualitative researcher (M.K.) not previously affiliated with the Joint Commission interviewed all participants using a semistructured interview guide. The framework method of analysis was used to review and organize data. We used the constant comparative approach to ensure that factors were not missed. Each transcript was reviewed by at least 2 researchers who compared coded findings in group discussion sessions. Two researchers independently identified key factors and combined findings following discussion and review. We focused on super factors that are relevant to implementing multiple leading practices. Results: ASP leaders from 30 hospitals were interviewed. Participating hospitals were evenly distributed across hospital size (10 small, 10 medium, 10 large) and membership in a health system (16 system, 14 nonsystem). At least 14, (46.7%) interviewees had pharmacist in their title; 11 (36.7%) had pharmacist-antimicrobial stewardship; and 5 (16.6%) had other titles (eg, infection preventionist). Super factors included ASP team capacity, ID expertise, having a physician champion, relationships with clinicians and relevant departments, structure of electronic health records, adequate software, and information technology resources. Small and rural nonsystem hospitals often lacked resources related to ID expertise, dedicated staff, and software tools, whereas hospitals that belong to a system benefit from centralized ID expertise and technical infrastructure provided. Conclusions: Specific factors related to personnel, relationships and IT resources have an outsized impact on implementing multiple leading antimicrobial stewardship practices in hospitals. Hospital ASPs could benefit by targeting resources toward these areas.

Funding: None

Disclosures: None
In veteran outpatients, antibiotics remain significant risk factor for community-acquired Clostridiodes difficile infection
Authors: Akpoji Ukwen , Wilson Brigid , Chengsupanimit Tayoot , Song Sunah , Bej Taissa , Jump Robin , Perez Federico
Published: May 2022

Background: An estimated 30% of antibiotic prescriptions in outpatient settings may be inappropriate. Antibiotic exposure increases an individual’s risk of Clostridioides difficile infection (CDI). To assess the prevalence of community-acquired CDI (CA-CDI) among patients without recent hospitalization and to examine the influence of outpatient antibiotic exposure on the risk of acquiring CA-CDI in this population, we examined a 2-year cohort of patients seen in primary care clinics at VA community-based outpatient clinics (CBOCs) associated with a large VA medical center. Methods: All primary care visits and nonvisit antibiotic prescriptions were identified in calendar years 2018–2019 as encounters of interest. Encounters occurring Results: We identified 84,787 patients with visits meeting our criteria. In this cohort, 3,533 patients were prescribed antibiotics at their encounter of whom 5 (0.14%) developed CA-CDI. Among the 81,254 patients who were not prescribed antibiotics, 15 (0.02%) developed CA-CDI, yielding an unadjusted CA-CDI odds ratio of 7.68 (95% CI, 2.50–19.82). p Conclusions: Although CA-CDI episodes were infrequent among VA outpatients with a CBOC visit in 2018–2019, the odds of CA-CDI were 7-fold greater in outpatients with antibiotic exposure than outpatients without antibiotic exposure. Antibiotic stewardship interventions that emphasize adverse events as a result of care provided in the outpatient setting, rather than as events limited to acute-care settings, may mitigate CDI risk.

Funding: This work was supported by the Merck Investigator Studies Program (MISP 59266 to F.P. and R.J.), and funds and facilities were provided by the Cleveland Geriatric Research Education and Clinical Center (GRECC) at the VA Northeast Ohio Healthcare System. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclosures:. All authors report no conflicts of interest relevant to this article. R.J. has received research funding from Pfizer; she has also participated in advisory boards for Pfizer and Merck.
Prospective audit and feedback of Clostridioides difficile PCR at the time of ordering increases appropriateness of testing
Authors: Tassone Daniel , Hitchcock Matthew , Markley John , Stevens Michael
Published: May 2022

Background: Over-testing for Clostridioides difficile infection outside acute diarrheal illness without a clear alternative cause can lead to inappropriate diagnosis and treatment with antibiotic therapy. Preanalytical interventions such as education, order restriction, and electronic order assistance are common but are limited in effectiveness. As an alternative approach, our antibiotic stewardship program (ASP) implemented prospective audit and feedback (PAF) on C. difficile PCR orders to reduce inappropriate testing.

Methods: The study was conducted at a 399-bed, tertiary-care, Veterans’ Affairs Medical Center and included adult inpatients and outpatients for whom C. difficile PCR testing was ordered. In the preintervention period from June through September 2019, the ASP was alerted to C. difficile PCR tests and collected data but did not intervene. From October 2019 to January 2020, the ASP performed real-time PAF at the time of ordering. Appropriateness of testing was determined based on whether there was a negative result in the prior 7 days and a 3-step review of clinical factors (Fig. 1). When possible, a direct conversation took place with the ordering provider. If not possible, a general note delineating appropriate clinical criteria for testing was generated. No PAF was done outside standard hours. The ASP recommended cancelling tests deemed inappropriate. Monthly test rates during the pre- and postintervention periods were compared using the Student t test with α = .05, and test appropriateness was compared using the χ2 test. All analyses were conducted using Microsoft Excel software. Results: During the preintervention period, a total of 418 tests were ordered (104.5 per month). This number decreased to 276 (69 per month) during the intervention period. (p Conclusions: Direct PAF at the time of C. difficile PCR ordering may increase test appropriateness and is associated with a reduction in overall testing, primarily by reducing the number of tests that are considered not appropriate on clinical grounds. PAF is effective but requires significant time investment by ASP staff and may not be a sustainable intervention over time.

Funding: None

Disclosures: None
Blood-culture ordering practices in patients with a central line at an academic medical center–Iowa, 2020
Authors: Kovoor Elias , Kobayashi Takaaki , Sheeler Lorinda , Trannel Alexandra , Etienne William , Abosi Oluchi , Holley Stephanie , Kukla Mary , Dains Angie , Jenn Kyle , Meacham Holly , Hanna Beth , Marra Alexandre , Parsons Meredith , Ford Bradley , Wellington Melanie , Diekema Daniel , Salinas Jorge
Published: May 2022

Background: The IDSA has a clinical definition for catheter-related bloodstream infection (CRBSI) that requires ≥1 set of blood cultures from the catheter and ≥1 set from a peripheral vein. However, because blood cultures obtained from a central line may represent contamination rather than true infection, many institutions discourage blood cultures from central lines. We describe blood culture ordering practices in patients with a central line. Methods: The University of Iowa Hospitals & Clinics is an academic medical center with 860 hospital beds. We retrospectively collected data for blood cultures obtained from adult patients (aged ≥18 years) in the emergency department or an inpatient unit during 2020. We focused on the first blood cultures obtained during each admission because they are usually obtained before antibiotic initiation and are the most important opportunity to diagnose bacteremia. We classified blood-culture orders as follows: CRBSI workup, non-CRBSI sepsis workup, or incomplete workup. We defined CRBSI workup as ≥1 blood culture from a central line and ≥1 peripheral blood culture (IDSA guidelines). We defined non-CRBSI sepsis workup as ≥2 peripheral blood cultures without cultures from a central line because providers might have suspected secondary bacteremia rather than CRBSI. We defined incomplete workup as any order that did not meet the CRBSI or non-CRBSI sepsis workup. This occurred when only 1 peripheral culture was obtained or when ≥1 central-line culture was obtained without peripheral cultures. Results: We included 1,150 patient admissions with 4,071 blood cultures. In total, 349 patient admissions with blood culture orders (30.4%) met CRBSI workup. 62.8% were deemed non-CRBSI sepsis workup, and 6.9% were deemed an incomplete workup. Stratified by location, ICUs had the highest percentage of orders with incomplete workups (8.8%), followed by wards (7.2%) and the emergency department (5.1%). In total, 204 patient admissions had ≥1 positive blood culture (17.7%). The most frequently isolated organisms were Staphylococcus epidermidis (n = 33, 16.2%), Staphylococcus aureus (n = 16, 7.8%), and Escherichia coli (n = 15, 7.4%) Conclusions: Analysis of blood culture data allowed us to identify units at our institute that were underperforming in terms of ordering the necessary blood cultures to diagnose CRBSI. Being familiar with CRBSI guidelines as well as decreasing inappropriate ordering will help lead to early and proper diagnosis of CRBSI which can reduce its morbidity, mortality, and cost.

Funding: None

Disclosures: None
The evaluation of central-line–associated bloodstream infection (CLABSI) preventability at an academic institution
Authors: Hsueh Leon , Uslan Daniel , De St. Maurice Annabelle
Published: May 2022

Background: In 2008, the hospital-acquired conditions (HACs) initiative labeled central-line–associated bloodstream infections (CLABSIs) as preventable “never events” that could no longer be reimbursed by Medicare. However, some patients have inherent unpreventable etiologies for bacteremia, such as obstructive biliary malignancies. We assessed the number of CLABSIs that were reasonably preventable. Methods: We examined all CLABSI cases at 2 academic medical centers over a 2-year period (2019–2021). We established 3 categories of CLABSIs: (1) preventable CLABSI (pCLABSI); (2) end-of-life CLABSI (EOL-CLABSI), which were CLABSIs that were caused by underlying disease processes in patients who were nearing the end of their lives due to a debilitating comorbidity; and (3) definition-based (dCLABSI), which met NHSN criteria for a CLABSI but, based on the pathogen and the clinical situation, likely occurred as a consequence of a patient’s comorbidities. Two experienced infectious diseases physicians (D.U. and A.S.M.) reviewed the charts of each patient with a CLABSI and, based on expert opinion, determined the category for each CLABSI. Results: Over the 2-year period, 147 CLABSIs were identified among the 2 hospitals, 66 (44.9%) of which occurred in an ICU. Most CLABSIs were pCLABSIs, making up 99 CLABSIs (67.3%). In comparison, 20 cases were categorized EOL-CLABSIs (13.6%), although 26 cases were dCLABSIs (17.7%), and 2 cases could not be classified. There was no difference in the distribution of CLABSI types in an ICU versus a non-ICU setting (χ2P = .265). However, we detected microbiologic differences between pCLABSIs, EOL-CLABSIs, and dCLABSIs (χ2P < .001), with gram-positive cocci making up the large majority of pCLABSIs (62.6%), followed by Candida spp (24.2%). Gram-negative bacilli (GNR) made up 11.1% of pCLABSIs. In comparison, GNRs were more prevalent in EOL-CLABSIs and dCLABSIs, making up 30.0% and 38.5% of each CLABSI type, respectively. Conclusions: Two-thirds of CLABSIs were deemed preventable. Central lines are important for managing critically ill patients, many of whom have inherent risk factors for bloodstream infections. EOL-CLABSIs highlight the potential for early care discussions to avoid CLABSIs at the end of a patient’s life and to avoid unnecessary blood cultures for patients on comfort care. Additionally, the pCLABSI distinction allows hospital epidemiology teams to focus on the CLABSI cases that can realistically be prevented with appropriate central-line care, techniques, and hand hygiene. Creating these categories allows hospital systems to use more targeted approaches for improving CLABSI rates.

Funding: None

Disclosures: None
CDC COVID-19 healthcare infection prevention and control assistance to health departments, January 2020–December 2021
Authors: Hart Ayana , Schrodt Caroline A. , Hunter Jennifer C. , Ham David , Soda Elizabeth , Perz Joseph , Perkins Kiran
Published: May 2022

Background: Throughout the COVID-19 pandemic, CDC Division of Healthcare Quality Promotion (DHQP) has provided technical assistance in support of state, tribal, local, and territorial health departments for COVID-19 healthcare outbreak management and infection prevention and control (IPC). We characterized the volume and trends of technical assistance provided during the pandemic to inform the future needs of health departments for COVID-19 healthcare IPC and DHQP resources required to meet these needs. Methods: In January 2020, DHQP began receiving COVID-19 IPC TA requests directly from health departments for remote assistance or from CDC staff on field deployments providing onsite support. DHQP subject-matter experts provided responses via e-mail or, for more complex inquiries, outbreaks, or field deployments, via phone consultations. Records of e-mail communications and phone consultations were entered into an inquiry database for tracking. We calculated the number, mean, and range of technical-assistance responses by jurisdiction and by month from January 2020 through December 2021. We designated months as high-volume periods for technical assistance if inquiries surpassed the 75th percentile. Results: In total, 1,869 IPC technical-assistance responses were provided. Of all technical-assistance responses, 1,725 (92%) were to state or local health departments, 115 (6%) were tribal nations, and 28 (2%) were US territories. IPC technical assistance was provided to all 50 states and the District of Columbia, 16 tribal nations, and 5 US territories. The average total number of technical assistance responses per site during the 24-month period was 34 to state and local HDs (range, 2–111), 6 to tribal nations (when tribal nation was specified; range, 1–17), and 6 to US territories (range, 1–15). E-mail communications comprised 1,164 responses (62%); phone consultations made up the remaining 705 responses (38%). Of phone consultations, 350 (50%) were with CDC field deployers providing onsite support to health departments. The average number of technical-assistance responses provided each month across all jurisdictions was 78 (range, 0–334); months with high volumes included April–August 2020 and January 2021. Conclusions: These findings highlight the high-level collaboration between federal and state, tribal, local, and territorial health department partners in remote and onsite support of COVID-19 prevention and response efforts in healthcare settings. Variations in monthly volumes of health-department COVID-19 healthcare IPC technical assistance requests may reflect factors such as fluctuations in community infection rates and changes in CDC IPC guidance. The ability to provide effective technical assistance during pandemic response depends on the CDC maintaining sufficient healthcare IPC staffing and expertise.

Funding: None

Disclosures: None
Monoclonal antibody therapy for prevention of severe disease in nosocomial COVID-19
Authors: Zimilover Adam , Doan Thien-Ly , Jain Sumeet , Malhotra Prashant
Published: May 2022

Background: In November 2020, the FDA issued an emergency use authorization (EUA) for monoclonal antibodies (mAbs) to be used in outpatients with COVID-19 infections who are at a high risk of progressing to severe disease. However, becuase the EUA had limited indications for inpatients, data on their use in hospitalized patients are limited. In this study, we have described the use of mAbs among hospitalized patients with nosocomial COVID-19. Methods: We retrospectively analyzed cases of nosocomial COVID-19 in 2 tertiary-care hospitals from November 1, 2020, to October 11, 2021, and we identified patients who received mAbs. The study period was prior to the ο (omicron) variant (B.1.1.529) being detected in the United States, and infections in the patients were likely primarily with the α alpha variant (B.1.1.7) and the δ (delta) variant (B.1.617.2) of SARS-CoV-2, which responded well to treatment with bamlanivimab and casirivimab–imdevimab. All patients had a negative SARS-CoV-2 PCR on admission. Data on clinical outcomes, including administration of medications for COVID-19, increases in oxygen requirements, ICU admission, mechanical ventilation, and death were collected by a review of the electronic medical record. The study was approved by the institutional review board with expedited approval. Descriptive statistics, such as means and standard deviations of continuous variables and proportions of categorical events or variables, were tabulated to describe patient characteristics and outcomes. Results: The 71 patients included in the study (age range, 39–89 years; median age, 70 years; 51% female) received either bamlanivimab (n = 31) or casirivimab–imdevimab (n = 40). The length of stay ranged from 6 to 242 days (median, 26 days). The comorbidities present included cardiovascular disease (56%), diabetes (45%), obesity (31%), autoimmune disease or immunosuppression (27%), kidney disease (23%), and pulmonary disease (20%). Most of the patients included in the study were incompletely vaccinated or unvaccinated (94%) and were negative for SARS-CoV-2 antibodies (81%). Prior to receiving the mAbs, 23% of patients required supplemental oxygen, including 3 patients who required mechanical ventilation. These patients required oxygen support due to non–COVID-19–related conditions. After mAb infusion, 72% of patients had no increase in their oxygen requirements, and 93% did not progress to mechanical ventilation. Overall, 7 deaths were attributed to COVID-19 among the studied patients (10%). Conclusions: Our study describes the use of mAbs in hospitalized patients with nosocomial COVID-19. Most of the patients who received mAbs had no progression to severe COVID-19, despite having significant comorbidities. The use of mAbs in nosocomial COVID-19 may be associated with beneficial outcomes.

Funding: None

Disclosures: None
Risk factors associated with SARS-CoV-2 transmission, outbreak duration, and mortality in Fraser Health acute-care settings
Authors: Duncombe Tamara , Garrod Matthew , Xuetao Wang , Ng Joyce , Lee Eunsun , Short Katy , Tan Kennard
Published: May 2022

Background: Transmission of SARS-CoV-2 in acute-care settings affects patients, healthcare workers, and the already-burdened healthcare system. An analysis of risk factors associated with outbreak severity was conducted to inform prevention strategies. Methods: This study was a cross-sectional analysis of COVID-19 outbreaks at Fraser Health (FH) acute-care sites between March 2020 and March 2021. Outbreak severity measures included COVID-19 attack rate, outbreak duration, and 30-day case mortality. Covariates at patient, outbreak, unit level, and facility level were included (Table 1). Generalized linear models with generalized estimation equations were used for all outcome measures, with outbreak duration and 30-day case mortality using multivariate negative binomial distributions, and attack rate using Gaussian distribution. A P value of .05 indicated statistical significance. Analyses

were performed using SAS version 3.8 software, R version 4.1.0 software, and Stata version 16.0 software. Results: Between March 2020 and March 2021, 54 COVID-19 outbreaks were declared in FH acute-care sites involving 455 SARS-CoV-2–positive patients. The average outbreak duration was 23 days, the average attack rate was 28%, and the average 30-day all-cause mortality per outbreak was 2 deaths. The results of the full models are shown in Table 1. Discussion: We identified an inverse relationship between increased hand hygiene compliance during outbreaks and all 3 severity measures. Paradoxically, hand hygiene rates in the year prior to the pandemic were positively associated with duration and mortality. Increased unit age was also associated with increases in each of the severity measures. Comorbidity total factor was correlated with outbreak attack rate and duration, demonstrating the importance of individual patient characteristics in an outbreak. Conclusions: Our findings highlight the importance of hand hygiene practices during an outbreak. Additionally, it is important to understand the difficulties faced by older facilities, many of which face infrastructural challenges. This study reinforces the need to incorporate infection control standards into healthcare planning and construction.

Funding: None

Disclosures: None
Rapid identification and isolation of patients with COVID-19 reduces the odds of transmission to hospital roommates
Authors: Alban Jessica , Burke Patrick , Sitaras Joanne , Fraser Thomas
Published: May 2022

Background: The Cleveland Clinic Main Campus is a multispecialty academic medical center with 1,200 adult patient beds, 58% of which are double occupancy. Our facility relies on double-occupancy rooms to provide needed care during the COVID-19 pandemic. Inherently, double occupancy poses a greater risk of exposure to SARS-CoV-2 despite mitigation efforts. We investigated the incidence of postexposure SARS-CoV-2 infection in double-occupancy rooms and evaluated risk factors for viral transmission. Methods: Early in the observation period patients were tested for SARS-CoV-2 based on clinical suspicion. By June 2020, all admitted patients were tested. Symptomatic patients were admitted with pending tests under transmission-based precautions. Asymptomatic patients were managed with standard precautions including patients admitted to double-occupancy rooms. A double-occupancy exposure event was defined as an uninfected patient sharing a room with a patient positive for SARS-CoV-2. All patient exposures were tracked and evaluated by the infection prevention (IP) team. The IP prospective review of source patients included determination of lowest cycle threshold (Ct) value of first COVID-19 test, and whether their infection was hospital or community onset. Review of exposed patients included sex, age, and exposure time (in hours) to the source patient. Postexposure infection was defined as a positive test for SARS-CoV-2 in the exposed population within 14 days of the defined exposure event. We fit a multivariable logistic regression model to estimate the effect of exposure time on the odds of postexposure infection in susceptible roommates. Results: From March 15 to December 15, 2020, 172 susceptible patients were exposed to a roommate with COVID-19. Also, 28 exposed patients met our definition for postexposure infection (attack rate, 16%). The frequency of postexposure infection was higher in patients for whom the source was hospital-onset versus community-onset disease (25% vs 10%; P = .01) and when the source patient’s Ct value was below the median value of 21.1 (26% vs 11% p Conclusions: We identified a postexposure infection attack rate of 16% for double-occupancy patients in the first 9 months of the pandemic. Time exposed to source patient was significantly associated with infection. Our experience demonstrates the potential benefit of asymptomatic admission testing with expedited turnaround time to mitigate viral transmission between patients in double-occupancy rooms.

Funding: None

Disclosures: None
COVID-19 postvaccination adverse events and vaccine hesitancy among hospital employees: Is there a link?
Authors: Weiland Anastasiia , Vallapureddy Rangit , Boaitey Sarah , Ravakhah Keyvan
Published: May 2022

Background: Vaccination against COVID-19 has demonstrated high efficacy in preventing illness severe enough to result in hospitalization. Despite these data, universal vaccine adoption by different population groups, including hospital employees, has been a challenging public health task. Vaccine-associated adverse events, the novelty of the vaccines, and the absence of long-term follow-up data have been reported as major contributors to COVID-19 vaccines mistrust. We sought to quantify postvaccination adverse events, to assess their correlation with unvaccinated status, and to evaluate other factors contributing to COVID-19 vaccination hesitancy. Methods: In a 240-bed community hospital located in a metropolitan area in the United States, we conducted a voluntary and anonymous online survey among contracted employees between September and November 2021. The study protocol was approved by the institutional review board at our facility. Results: Of all 185 responders, 143 (77%) were female, 95 (51%) were aged <51 years, and 146 were White (79%). Most (n = 100, 54%) reported no past medical history. Most common comorbidities included heart disease (n = 45, 24%), diabetes (n = 20, 11%), and chronic lung disease (n = 17, 9%). Among those surveyed, 178 were vaccinated either fully (n = 172, 93%) or partially (n = 6, 3%), and 7 (4%) were unvaccinated. Moderna was the most common vaccine received (n = 152, 85%). Those who received a 2-dose series reported experiencing more adverse events after the second dose than after the first dose (710 vs 451) of either Moderna or Pfizer vaccine. Adverse events included pain at the injection site (n = 257, 22%), fatigue (n = 178, 15%), chills (n = 133, 11%), muscle pain (n = 120, 10%), and headache (n = 117, 10%). Also, 2 responders reported omitting the second dose due to the severity of symptoms after the first dose of both Moderna and Pfizer vaccines. Concern for safety (n = 5, 71%) was the leading reason for vaccine refusal among unvaccinated followed by concern for efficacy (n = 3, 43%), lack of trust in government promoting vaccination (n = 3, 43%), religious reasons (n = 2, 28%), and immunity due to prior COVID-19 (n = 2, 28%). In addition, 3 responders reported intent to be vaccinated in the future. Conclusions: Most of the responders reported at least 1 adverse event related to COVID-19 vaccination. No severe adverse events were reported; however, a high prevalence of self-limited postvaccination adverse events might be misinterpreted as a concern for vaccine safety, as seen among surveyed unvaccinated individuals in our cohort. Targeted education is needed to limit knowledge gaps and address existing cognitive biases in COVID-19 vaccination among hospital employees.

Funding: None

Disclosures: None