bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Outcomes of Portal Vein Thrombosis in the Clinical Setting of Cirrhosis, Malignancy, and Intra-abdominal Infections with and without Anticoagulation: A Retrospective 5-Year Study
Authors: Joseph Joanne , Chew Samuel , George Julie , Chin Tay , Sule Ashish
Published: October 2017

The aim of this study was to understand the differences in clinical outcomes in portal vein thrombosis (PVT) patients with cirrhosis, malignancy, and abdominal infections, with or without anticoagulation. This study was approved by ethics committee. Data were collected from 2011 to 2016. Patients were classified into three groups: PVT with cirrhosis, malignancy, and infections. Primary outcomes measures collected were clot resolution, bleeding, recurrence, and death. Frequency, means, and percentages were calculated. In total, 30 patients were analyzed in this study. Mean age was 60.8 years (range of 30–91 years). There were 19 (63.3%) males and 11 (36.7%) females with ethnicity: 21 (70.0%) Chinese, 2 (6.7%) Malay, 2 (6.7%) Indian, and 5 (16.7%) other race. Fifteen patients received anticoagulation and 15 did not receive anticoagulation. Of the 15 patients who received anticoagulation, there was complete resolution of thrombus in 5 (33.3%), partial resolution in 1 (6.7%), and no resolution in 9 (60.0%). Of these 15 patients, there was bleeding in 3 (20.0%), there was no recurrence in 9 (60.0%), and 3 (20.0%) died during the period of follow-up. Of the 15 patients who did not receive anticoagulation, there was complete resolution of thrombus in 2 (13.3%), partial resolution in 0 (0.0%), and no resolution in 13 (86.7%). Of these 15 patients, there was bleeding in 0 (0%), there was recurrence in 2 (13.3%), and 6 (40.0%) died during the period of follow-up. Anticoagulation is effective in PVT. It reduces mortality with lower rate of recurrence. However, it is associated with increased risk of bleeding.
Hörrehabilitation durch Cochlea-Implantation nach
Vestibularisschwannom-Entfernung?
Authors: Schipper Jörg , Kristin Julia , Volpert Simone , Klenzner Thomas
Published: October 2017

Ausgewertet wurden in einer Qualitätssicherungsanalyse 10 Patienten mit einem
individuellen Behandlungsversuch nach einer simultanen oder konsekutiven
Cochlea-Implantation nach translabyrinthärer Vestibularisschwannomentfernung im
Kleinhirnbrückenwinkel. Die Ergebnisse zeigen, dass die Mehrzahl der Patienten
mit einseitiger Ertaubung durch die stereophone Hörrehabilitation profitiert.
Durch eine schonende chirurgische Präparationstechnik im Bereich des inneren
Gehörgangs kann die morphologisch-funktionelle Integrität der neurovaskulären
Strukturen gewährleistet werden.
Effect of chain stiffness for semiflexible macromolecules in array of cylindrical nanoposts
Authors: Benková Zuzana , Rišpanová Lucia , Cifra Peter
Published: October 2017

Equilibrium conformation of a semiflexible macromolecule in an array of nanoposts exhibits a non-monotonic behavior both at variation of the chain stiffness and increased crowding imposed by nanoposts. This is a result of the competition between the axial chain extension in channel-like interstitial volumes between nanoposts and the chain partitioning among these volumes. The approximation of a nanopost array as a combination of a quasi-channel and a quasi-slit like geometry semi-qualitatively explains the behavior of a chain in the array. In this approximation, the interstitial spaces are viewed as being of the channel geometry, while the passages between two adjacent posts are viewed as being of the slit geometry. Interestingly, the stiffer chains tend to penetrate more readily through the passage apertures, in the direction perpendicular to the post axes, and thus to occupy more interstitial volumes. This is consistent with the prediction of the free-energy penalty that is lower for a stiffer chain at strong slit-like confinement. These findings can find applications in the control of macromolecular conformations in recent nanotechnological techniques with bio-macromolecules such as a DNA.
Conceptual DFT analysis of the fragility spectra of atoms along the minimum energy reaction coordinate
Authors: Ordon Piotr , Komorowski Ludwik , Jedrzejewski Mateusz
Published: October 2017

Theoretical justification has been provided to the method for monitoring the sequence of chemical bonds’ rearrangement along a reaction path, by tracing the evolution of the diagonal elements of the Hessian matrix. Relations between the divergences of Hellman-Feynman forces and the energy and electron density derivatives have been demonstrated. By the proof presented on the grounds of the conceptual density functional theory formalism, the spectral amplitude observed on the atomic fragility spectra [L. Komorowski et al., Phys. Chem. Chem. Phys. 18, 32658 (2016)] reflects selectively the electron density modifications in bonds of an atom. In fact the spectral peaks for an atom reveal changes of the electron density occurring with bonds creation, breaking, or varying with the reaction progress.
Attractors in complex networks
Authors: Rodrigues Alexandre A. P.
Published: October 2017

In the framework of the generalized Lotka–Volterra model, solutions representing multispecies sequential competition can be predictable with high probability. In this paper, we show that it occurs because the corresponding “heteroclinic channel” forms part of an attractor. We prove that, generically, in an attracting heteroclinic network involving a finite number of hyperbolic and non-resonant saddle-equilibria whose linearization has only real eigenvalues, the connections corresponding to the most positive expanding eigenvalues form part of an attractor (observable in numerical simulations).
Effect of interface voids on electroluminescence colors for ZnO microdisk/p-GaN heterojunction light-emitting diodes
Authors: Mo Ran , Choi Ji Eun , Kim Hyeong Jin , Jeong Junseok , Kim Jong Chan , Kim Yong-Jin , Jeong Hu Young , Hong Young Joon
Published: October 2017

This study investigates the influence of voids on the electroluminescence (EL) emission color of ZnO microdisk/p-GaN heterojunction light-emitting diodes (LEDs). For this study, position-controlled microdisk arrays were fabricated on patterned p-GaN via wet chemical epitaxy of ZnO, and specifically, the use of trisodium citrate dihydrate (TCD) yielded high-density voids at the bottom of the microdisk. Greenish yellow or whitish blue EL was emitted from the microdisk LEDs formed with or without TCD, respectively, at reverse-bias voltages. Such different EL colors were found to be responsible for the relative EL intensity ratio between indigo and yellow emission peaks, which were originated from radiative recombination at p-GaN and ZnO, respectively. The relative EL intensity between dichromatic emissions is discussed in terms of (i) junction edge effect provoked by interfacial voids and (ii) electron tunneling probability depending on the depletion layer geometry.
Heavily doped silicon electrode for dielectrophoresis in high conductivity media
Authors: Zhu Xiongfeng , Tung Kuan-Wen , Chiou Pei-Yu
Published: October 2017

A hemispherically shaped, heavily doped (N++) silicon electrode is proposed to overcome the challenges of dielectrophoretic (DEP) manipulation using a conventional metal electrode operating in high conductivity media. An N++ electrode decouples the strong electric field region from the electrode interface and provides a large interface capacitance to prevent surface charging in high conductivity media, thereby effectively suppressing electrochemical reactions. Compared to a conventional metal electrode, an N++ electrode can provide 3 times higher threshold voltage and a corresponding 9-fold enhancement of maximum DEP force in 1×  phosphate-buffered saline buffer with an electrical conductivity of 1 S/m. Furthermore, an N++ silicon electrode has excellent thermal conductivity and low electrical impedance, ideal for powering massively parallel DEP manipulation in high conductivity media across a large area.
Unique features of parallel whistler instability in a plasma with anisotropic Cairns distribution
Authors: Usman Malik M. , Masood W. , Mirza Arshad M.
Published: October 2017

In this paper, whistler waves propagating parallel to the ambient magnetic field with electron temperature anisotropy are investigated by employing the kinetic theory of plasmas. The electron distribution function is considered to follow the Cairns distribution. The dispersion relation for the whistler waves with Cairns distribution is derived, and the condition for the onset of instability is also obtained. It is found that the Cairns distribution significantly modifies the instability condition for the growth of whistler instability. The comparison of the dispersion characteristics and the growth rate with Maxwellian distribution is also made, and it is observed that Cairns distributed electrons yield a higher growth rate in comparison to their Maxwellian counterparts. It is also shown that unlike the kappa distribution where parallel electron beta was found to play the key role, whistler instability with Cairns distributed electrons shows a greater sensitivity towards electron temperature anisotropy. It is shown that the real frequency of the whistler waves shows a greater dependence on the choice of parallel electron beta. Interestingly, it is found that a particular combination of parallel electron beta and electron temperature anisotropy is deleterious for the whistler instability.
Development of a combined OCT-Raman probe for the prospective in vivo clinical melanoma skin cancer screening
Authors: Mazurenka M. , Behrendt L. , Meinhardt-Wollweber M. , Morgner U. , Roth B.
Published: October 2017

A combined optical coherence tomography (OCT)-Raman probe was designed and built into a spectral domain OCT head, and its performance was evaluated and compared to the most common Raman probe setups, based on a fiber bundle and confocal free space optics. Due to the use of the full field of view of an OCT scanning lens, the combined probe has a superior performance within maximum permissible exposure limits, compared to the other two probes. Skin Raman spectra, recorded in vivo, further prove the feasibility of the OCT-Raman probe for the future in vivo clinical applications in skin cancer screening.
Thermo-economic and multiobjective optimization of saturated and superheated organic Rankine cycle using a low-grade solar heat source
Authors: Tiwari Deepak , Sherwani Ahmad Faizan , Arora Akhilesh , Haleem Abid
Published: October 2017

This paper presents detailed energy and exergy analysis and comparison of low-grade solar heat source powered superheated and saturated organic Rankine cycle (ORC) using zeotropic mixture butane/R1234ze. The required expression to evaluate the power output, first law efficiency exergetic efficiency, exergy destruction, and required heat exchangers area are coded in Matlab 2015a interfaced with REFPROP 9.0. Moreover, saturated and superheated ORCs are further optimized by genetic algorithm by selecting exergetic efficiency and product of overall heat transfer coefficient and heat exchanger area. It is observed that superheated ORC exhibits better net power output, first law, and exergetic efficiency, lower exergy destruction, and poorer economy than saturated ORC. Further, the performance of saturated ORC is increased by 34.02% and that of superheated ORC by 17.06% by the multiobjective genetic algorithm.
Observation of thick toroidal filaments during the disruptive phase of Aditya tokamak plasma
Authors: Banerjee Santanu , Bisai N. , Chandra D. , Dhyani P. , Manchanda R. , Chowdhuri M. B. , Ramaiya N. , Sangwan D. , Ghosh J. , Tanna R. L. , Chattopadhyay P. K. , Raju D. , Atrey P. K. , Shankar Joisa Y. , Sen A. , Kaw P. K. ,   Aditya Team
Published: October 2017

Major disruptions in Aditya tokamak are initiated by the growth and subsequent locking of m/n = 2/1 and 3/1 tearing modes, which leads to the thermal quench of the plasma. Thick filaments are seen to evolve at the low field side (LFS) of the plasma column following the thermal quench, and during the current quench. The number of filaments and inter filament spacing are observed to be related with the plasma stored energy just prior to the disruption. Rapid enhancement of the outward particle flux is seen during the thermal quench phase and the plasma conductivity reduces considerably. Interchange modes, with low poloidal wavenumber, are inferred to grow due to the reduced plasma conductivity and enhanced effective diffusivity. This may be a plausible explanation for the visualization of the thick filaments at the LFS.
Reform and counter-reform in Kenya's land governance
Authors: Klopp Jacqueline M. , Lumumba Odenda
Published: October 2017

Fashioned within conquest, Kenya’s current system of land governance was designed to facilitate land expropriation for the few and powerful. Post-colonial elites never fundamentally reformed this system of concentrated legal and administrative power over land and continue to benefit from it. This article explores both recent efforts at land governance reform and the numerous ways that counter-reform resistance is occurring and currently gaining the upper hand. The authors argue that powerful networks of beneficiaries create a strong system of control and exclusion around land, producing a path dependency against reform. The challenge for reformers is to overcome these powerful forces arrayed against change with creative mobilisation strategies, leveraging not only the 2010 Constitution and the courts but also public outrage and stronger civil society organisation. Overall, an important reform struggle in Kenya is just beginning, the outcome uncertain and the stakes for the country’s future very high.
Selective aggregation of the splicing factor Hsh155 suppresses splicing upon genotoxic stress
Authors: Mathew Veena , Tam Annie S. , Milbury Karissa L. , Hofmann Analise K. , Hughes Christopher S. , Morin Gregg B. , Loewen Christopher J.R. , Stirling Peter C.
Published: October 2017

Upon genotoxic stress, dynamic relocalization events control DNA repair as well as alterations of the transcriptome and proteome, enabling stress recovery. How these events may influence one another is only partly known. Beginning with a cytological screen of genome stability proteins, we find that the splicing factor Hsh155 disassembles from its partners and localizes to both intranuclear and cytoplasmic protein quality control (PQC) aggregates under alkylation stress. Aggregate sequestration of Hsh155 occurs at nuclear and then cytoplasmic sites in a manner that is regulated by molecular chaperones and requires TORC1 activity signaling through the Sfp1 transcription factor. This dynamic behavior is associated with intron retention in ribosomal protein gene transcripts, a decrease in splicing efficiency, and more rapid recovery from stress. Collectively, our analyses suggest a model in which some proteins evicted from chromatin and undergoing transcriptional remodeling during stress are targeted to PQC sites to influence gene expression changes and facilitate stress recovery.
EURAMET project No. 1225: intercomparsion of very low air speed standard facilities (0.05 m/s to 1 m/s)
Authors: Pachinger Dietmar , Huu Marc De , Mueller Harald , Care Isabelle , Frederiksen John , Piccato Aline , Bertasiene Agne
Published: October 2017

For the first time a EURAMET comparison of standard facilities in the field of low air speed is presented. The air velocities range from 0.05 m/s up to 1 m/s. Two different thermal anemometers are used as Transfer Standards (TS), namely a ball-type and a planar-type anemometer. Due to their construction it is possible to analyze different components of the flow vector. Orientation-dependent measurements which are investigated in addition might also deliver information concerning the components of the flow vector. A Comparison Reference Value (CRV) is calculated with the help of the chi-squared test according to the procedure A presented by Cox [1] [2] and the degree of equivalence of the laboratory data to the CRV is determined. Both TS show reasonable results and a high degree of equivalence. Furthermore the degree of equivalence of the laboratory data to each other is investigated in detail.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Uniqueness of solutions of mean field equations in 𝑅²
Authors: Gui Changfeng , Moradifam Amir
Published: October 2017

In this paper, we prove uniqueness of solutions of mean field equations with general boundary conditions for the critical and subcritical total mass regime, extending the earlier results for null Dirichlet boundary condition. The proof is based on new Bol’s inequalities for weak radial solutions obtained from rearrangement of the solutions.
Sweet SIGNs: IgG glycosylation leads the way in IVIG-mediated resolution of inflammation
Authors: Brückner Christin , Lehmann Christian , Dudziak Diana , Nimmerjahn Falk
Published: October 2017

A hallmark of many chronic inflammatory and autoimmune diseases is that there is an impaired resolution of inflammation and return to the steady state. The infusion of high doses of pooled serum IgG preparations from thousands of donors [intravenous immunoglobulin (IVIG) therapy] has been shown to induce resolution of inflammation in a variety of chronic inflammatory and autoimmune diseases, suggesting that IgG molecules can instruct the immune system to stop inflammatory processes and initiate the return to the steady state. The aim of this review is to discuss how insights into the mechanism of IVIG activity may help to understand the molecular and cellular pathways underlying resolution of inflammation. We will put a special emphasis on pathways dependent on the IgG FC domain and IgG sialylation, as several recent studies have provided new insights into how this glycosylation-dependent pathway modulates innate and adaptive immune responses through different sets of C-type or I-type lectins.
Halo abundance and assembly history with extreme-axion wave dark matter at z ≥ 4
Authors: Schive Hsi-Yu , Chiueh Tzihong
Published: September 2017

Wave dark matter (ψDM) composed of extremely light bosons (mψ ∼ 10 − 22 eV), with quantum pressure suppressing structures below a kpc-scale de Broglie wavelength, has become a viable dark matter candidate. Compared to the conventional free-particle ψDM (FPψDM), the extreme-axion ψDM model (EAψDM) proposed by Zhang & Chiueh features a larger cut-off wavenumber and a broad spectral bump in the matter transfer function. Here, we conduct cosmological simulations to compare the halo abundances and assembly histories at z = 4–11 between three different scenarios: FPψDM, EAψDM and cold dark matter (CDM). We show that EAψDM produces significantly more abundant low-mass haloes than FPψDM with the same mψ, and therefore could alleviate the tension in mψ required by the Lyα forest data and by the kpc-scale dwarf galaxy cores. We also find that, compared to the CDM counterparts, massive EAψDM haloes are, on average, 3–4 times more massive at z = 10–11 due to their earlier formation, undergo a slower mass accretion at 7 ≲ z ≲ 11, and then show a rapidly rising major merger rate exceeding CDM by ∼ 50 per cent at 4 ≲ z ≲ 7. This fact suggests that EAψDM haloes may exhibit more prominent starbursts at z ≲ 7.
Classification of extremely metal-poor stars: absent region in A(C)–[Fe/H] plane and the role of dust cooling
Authors: Chiaki Gen , Tominaga Nozomu , Nozawa Takaya
Published: October 2017

Extremely metal-poor (EMP) stars are the living fossils with records of chemical enrichment history at the early epoch of galaxy formation. By the recent large observation campaigns, statistical samples of EMP stars have been obtained. This motivates us to reconsider their classification and formation conditions. From the observed lower limits of carbon and iron abundances of Acr(C) ∼ 6 and [Fe/H]cr ∼ −5 for C-enhanced EMP (CE-EMP) and C-normal EMP (CN-EMP) stars, we confirm that gas cooling by dust thermal emission is indispensable for the fragmentation of their parent clouds to form such low mass, i.e. long-lived stars, and that the dominant grain species are carbon and silicate, respectively. We constrain the grain radius $r_i^{\rm cool}$ of a species i and condensation efficiency fij of a key element j as $r_{\rm C}^{\rm cool} / f_{\rm C,C} = 10 \ {\rm \mu m}$ and $r_{\rm Sil}^{\rm cool} / f_{\rm Sil,Mg} = 0.1 \ {\rm \mu m}$ to reproduce Acr(C) and [Fe/H]cr, which give a universal condition 10[C/H] − 2.30 + 10[Fe/H] > 10−5.07 for the formation of every EMP star. Instead of the conventional boundary [C/Fe] = 0.7 between CE-EMP and CN-EMP stars, this condition suggests a physically meaningful boundary [C/Fe]b = 2.30 above and below which carbon and silicate grains are dominant coolants, respectively.
Implementing Antimicrobial Stewardship in Two Community Nepali Hospitals
Authors: Veve Michael P , Kaljee Linda M , Prentiss Tyler , Joshi Rajesh Dhoj , Rai Shankar Man , Shrestha Basudha , Bajracharya Deepak Chandra , Zervos Marcus J
Published: October 2017

Background

Antimicrobial stewardship programs (ASP) are crucial to improving patient outcomes and decreasing resistance, but the effectiveness and the presence of ASP in low-income countries, like Nepal, are unknown. Nepal has no formal ASP efforts or antimicrobial regulations, which has lead to an increased prevalence of resistance in the community. We developed and implemented an educational ASP training program to identify areas for ASP in two community hospitals in Kathmandu. With a multidisciplinary team of clinicians and Nepal stakeholders, we developed an ASP toolkit aimed to improve patient outcomes through antimicrobial optimization.

Methods

A 1-day conference on ASP and resistance was held at a community hospital in Kathmandu, with subsequent field observations, microbiologic hospital surveillance, and 2,016 antibiogram review. Eleven physician champions (PC) from the two hospitals were selected for formal ASP instruction. ASP protocols were developed with stakeholders and included (i) empiric and definitive antibiotic selection recommendations, (ii) renal dose-adjustment guidelines, (iii) evidence-based duration of therapy recommendations, and (iv) an intravenous-to-oral antimicrobial conversion policy. Two days of fieldwork and stakeholder feedback occurred. A post-test PC evaluation was performed with the intent to gather feedback for implementation of a post-prescription review and feedback (PPRF) system incorporating AMS protocols related to antimicrobial optimization.

Results

The most prevalent infectious organism isolated was Escherichia coli (51%). Most E. coli isolates were commonly resistant to first-line or broad-spectrum antibiotics: 49% ceftriaxone, 46% ciprofloxacin, 22% piperacillin/tazobactam, and 32% meropenem. The overall PC response to ASP toolkit was positive: 73% of PC felt the guidelines would be useful in making decisions about antimicrobials. Cost and availability of antimicrobials were identified as barriers to successful implementation.

Conclusion

Development of a simple ASP toolkit can be an effective means to bring awareness appropriate antimicrobial use, and may be extrapolated to other low-income countries. Stakeholder buy-in is necessary for a successful international interventional program.

Disclosures

L. M. Kaljee, Merck: Grant Investigator, Grant recipient; T. Prentiss, Merck, Inc.: Investigator, Research grant; R. D. Joshi, Merck: Grant Investigator, Grant recipient; B. Shrestha, Merck: Grant Investigator, Research grant; D. C. Bajracharya, Merck: Grant Investigator, Grant recipient; M. J. Zervos, Merck: Grant Investigator, Grant recipient; Genentech: Grant Investigator, Grant recipient; Cempra: Grant Investigator, Grant recipient; Medicines Company: Consultant, Consulting fee
The Ontario Program To Improve AntiMIcrobial USE (OPTIMISE): A Descriptive Analysis of Dispensed Antibiotics
Authors: Schwartz Kevin , Achonu Camille , Brown Kevin , Garber Gary , Johnstone Jennie , Langford Bradley , Leung Valerie , Daneman Nick
Published: October 2017

Background

Antimicrobial resistant infections are an emerging global public health crisis. Antibiotic use is the largest modifiable risk factor for antimicrobial resistance. Greater than 90% of antibiotic use in Canada occurs outside of the hospital setting; however, there is a lack of data describing the patterns of community antibiotic use. Our objective was to describe outpatient antibiotic prescriptions for all of Ontario, Canada and to examine variability in antibiotic prescribing across physicians.

Methods

We conducted a cross-sectional study of antibiotics dispensed from community pharmacies in Ontario, Canada, between March 1, 2016 and February 28, 2017. Ontario has a population of 13.9 million people and over 30,000 physicians. We analyzed data from the Xponent™ database by QuintilesIMS. Xponent™ is based on data from 79% of retail pharmacies in Ontario. QuintilesIMS uses a geospatial extrapolation algorithm to project antibiotic utilization on 100% of the population. This analysis describes physician antibiotic prescribing patterns stratified by patient age and sex.

Results

There were 6,995,416 antibiotics dispensed or 501/1,000 population. The highest prescribing rate was for patients aged 65 and older at 702 antibiotic scripts/1,000 population, children 0–17 years received 477 antibiotic scripts/1,000 population and adults 18–64 years 446 antibiotics/1,000 population. Females aged 65 years and older received the highest number of antibiotics. Narrow spectrum penicillins, macrolides, first-generation cephalosporins, and second-generation fluoroquinolones (ciprofloxacin and norfloxacin) were the most common classes of antibiotics overall; however, the urinary antibiotics including ciprofloxacin, norfloxacin, and nitrofurantoin were the most common in older females (Figure 1). There was significant prescriber variability with 25% of all antibiotics being prescribed by 2.2% of physicians. Family physicians comprised 91% of these high prescribers.

Conclusion

This population-based study quantified community antibiotic utilization and demonstrated marked prescriber variability. Future antibiotic stewardship interventions should target the minority of family physicians that prescribe the majority of antibiotics.

Disclosures

All authors: No reported disclosures.
“Big data” and Gram-negative Resistance: A Multiple Logistic Regression Model Using EMR Data to Predict Carbapenem Resistance in Patients with Klebsiella pneumoniae Bloodstream Infection
Authors: Sullivan Timothy , Aberg Judith
Published: October 2017

Background

The timely identification of carbapenem resistance is essential in the management of patients with Klebsiella pneumoniae bloodstream infection (BSI). An algorithm using electronic medical record (EMR) data to quickly predict resistance could potentially help guide therapy until more definitive resistance testing results are available.

Methods

All cases of K. pneumoniae BSI at Mount Sinai Hospital from September 2012 through September 2016 were identified. Cases of persistent BSI or recurrent BSI within 2 weeks were included only once. Patients with recurrent BSI after more than 2 weeks of negative blood cultures were considered distinct cases and included more than once. Carbapenem resistance was defined as an imipenem minimum inhibitory concentration of ≥2 μg/ml. Extensive EMR data for each patient were compiled into a relational database using SQLite. Possible risk factors for carbapenem resistance were queried from the database and analyzed via univariate methods. Significant factors were then entered into a multiple logistic regression model in a forward stepwise approach using SPSS.

Results

A total of 613 cases of K. pneumoniae BSI were identified in 540 unique patients. The overall incidence of imipenem resistance was 10% (61 cases). Significant markers of resistance included in the final model were (1) prior colonization with imipenem-resistant Klebsiella pneumoniae; (2) hospital unit (defined as high-risk unit, low-risk unit, and emergency department); (3) total inpatient days in the previous 5 years; (4) total days of oral or parenteral antibiotics in the past 2 years; and (5) age >60 years old (Figure 1). The model generated a receiver operating characteristic curve with an area under the curve of 0.75 (Figure 2). At a cut point of 0.083, the model correctly predicted 72% of imipenem-resistant cases while incorrectly labeling 32% of susceptible cases as resistant (Sn = 72%, Sp = 63%, Figure 3).

Conclusion

A multiple logistic regression model using EMR data can generate immediate, clinically useful predictions of carbapenem resistance in patients with K. pneumoniae BSI. Larger data sets are needed to improve and validate these findings.

Disclosures

All authors: No reported disclosures.
Treatment as Prevention for Hepatitis C (TraP HepC). A Real-world Experience from the First 12 Months of a Nationwide Elimination Program in Iceland
Authors: Gottfredsson Magnus , Tyrfingsson Thorarinn , Runarsdottir Valgerdur , Bergmann Ottar M , Bjornsson Einar S , Johannsson Birgir , Sigurdardottir Bryndis , Fridriksdottir Ragnheidur H , Löve Arthur , Löve Thorvardur J , Sigmundsdottir Gudrun , Heimisdottir Maria , Olafsson Sigurdur
Published: October 2017

Background

Hepatitis C virus (HCV) infection is associated with significant morbidity and mortality. Iceland, an island with a population of 330,000 has a HCV seroprevalence of 0.3% and an estimated total of 800–1000 patients. There is good access to health care among people who inject drugs (PWID) and Iceland thus serves as an ideal setting for a proof of concept intervention, aiming for elimination of the disease as a public health threat. If elimination is to be achieved PWID, who are key drivers of transmission, need to be a focus of treatment scale up.

Methods

All patients in the country infected with HCV were offered direct-acting antiviral agents (DAAs) starting in 01/2016. The regimens are chosen according to national guidelines; SOF/LDV +/−RBV through October 2016 and SOF/VEL +/− RBV thereafter. People with recent injection drug use (IDU), prisoners and patients with advanced liver disease are prioritized. PWID receive additional support to facilitate compliance. Various strategies are employed to enhance case detection and harm reduction. The goal is to initiate treatment for every patient in Iceland within 36 months (end-2018), aiming for elimination of domestic transmission of HCV.

Results

Twelve months after launching the nationwide program 527 patients had been evaluated, 53–66% of the estimated total patient population. The mean age is 42 years (range, 17–70 years, 2 males to every female). The reported main route of infection was IDU (90%). At the time of evaluation, 33% reported recent (within 6 months) IDU, 6% were homeless, and 5% in prison. Stimulants were the preferred IV drug among 84% of PWID but opiates by only 14%; overall 15% were receiving opiate substitution therapy (OST). During the first 12 months of the study period treatment with DAAs was initiated in 480 patients and 322 were scheduled to complete protocol. Drop-out rate is 6.5%. Sustained virological response at 12 weeks (SVR12) for the entire group, including patients who dropped out or are lost to follow-up is 90%. It is significantly lower among the homeless (60%) and active IDU (83% vs. 93%, P = 0.007).

Conclusion

A relatively large proportion of HCV infected patients in the community, including people actively injecting drugs, can be initiated on treatment in a short period of time. Current drug use does not preclude treatment success.

Disclosures

M. Gottfredsson, Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Research support; Astellas: Consultant, Speaker honorarium
Impact of Infectious Diseases Consultation on Mortality in Patients with Candidemia
Authors: Mejia Carlos , Kronen Ryan , Lin Charlotte , Hsueh Kevin , Powderly William , Spec Andrej
Published: October 2017

Background

An infectious diseases (ID) consultation is often, but not always, obtained to help guide treatment of patients with candidemia. We examined if ID consultation affected patient outcome in patients with culture positive candidemia.

Methods

We assembled a retrospective cohort of 1,873 cases of candidemia in patients hospitalized in our academic tertiary care hospital from 2002 to 2015. We collected data on comorbidities, predisposing factors; antifungal therapy, survival and ID consult. Patients who died within 24 hours of diagnosis were excluded, under the presumption that they did not have an opportunity to receive an ID consult. Survival analysis was performed via univariate and multivariate Cox Regression with censoring at 90 days, as subsequent mortality was less likely to be related to candidemia.

Results

913 (49%) of the candidemic patients received an ID consult; 960 (51%) did not. Underlying comorbidities were evenly distributed between patients with and without an ID consult, except that patients with an ID consult more frequently had a central line (39% vs. 26%, p < 0.001), were on mechanical ventilation (4% vs. 2%, P = 0.003) or were receiving extracorporeal membrane oxygenation (2.2% vs. 0.5%, p = 0.002). The ID consult group had lower 90-day mortality compared with patients without an ID consult (34% vs. 49%, P < 0.001), with an adjusted hazard ratio of mortality for those patients receiving an ID consult of 0.55 (95% CI: 0.48, 0.64, P < 0.001) (Fig 1). Patient management differed significantly: the ID consult group was more likely to receive an echinocandin (29% vs. 21%, P < 0.001) or amphotericin B (AmB) (3.4% vs. 1.4%, P = 0.006).

Conclusion

Candidemic patients who received an ID consult were significantly less likely to die, and were more likely to receive therapy with amphotericin or an echinocandin. These data suggest that an ID consult should be an integral part of clinical care of patients with candidemia.

Disclosures

W. Powderly, Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Gilead: Scientific Advisor, Consulting fee; Astellas: Grant Investigator, Research grant; A. Spec, Astellas Pharma US, Inc.: Grant Investigator, Research grant
Arboviral Infections Following the 2016 Olympic and Paralympic Games in a Cohort of US Athletes and Support Staff
Authors: Byington Carrie L , Ampofo Krow , Lewis Tammi , Mathie Taylor , Nanayakkara Dholani , Pavia Andrew , Hanson Kim , Couturier Marc Roger , Moreau Bill
Published: October 2017

Background

The 2016 Olympic and Paralympic games were held in Brazil after the peak of an explosive Zika virus (ZIKV) outbreak. The risk to US athletes and support staff of travel-associated ZIKV and other arboviral infections was unknown but concern was high.

Methods

Individuals traveling with the US Olympic Committee (USOC), including Olympic and Paralympic athletes and support staff were enrolled. Participants provided a pre- and post-travel (2–12 weeks) blood samples, and were also counseled about mosquito avoidance. Participants completed pre- and post-travel surveys detailing demographics, health history, vaccination, mosquito protection, and symptoms during and up to 2 weeks after travel to Brazil. Blood samples were tested at ARUP Laboratories, Utah, for ZIKV IgM and for Chikungunya (CHKV), Dengue (DENV), and West Nile (WNV) viruses IgM and IgG. Recent infection was defined as the presence of IgM in a post-travel blood sample and or IgG seroconversion.

Results

A total of 950 individual subjects provided pre-travel samples and surveys. Of these, 457 (48%) also provided post-travel samples. No ZIKV infections were detected by IgM. However, 48 (11%) participants had antibody evidence of other arboviral infections; 4 (0.9% tested) with CHKV, 6 (1.3%) with DENV, and 39 (9%) with WNV. Of these, new travel-associated infection was confirmed in 32 (7%); 3 of 4 CHKV, 2 of 6 DENV, and 27 of 39 WNV. Twelve (38%) of the subjects with travel associated arbovirus infection submitted post-travel surveys; 3 (25%) respondents had symptoms of arboviral infection during or within 2 weeks after travel; 2 (16%) CHKV, and 1 (8%) WNV. Those with travel-associated arboviral infections had similar demographics, and exposure whilst in Brazil, but were less likely to use mosquito repellent than athletes without arboviral infection (7/12 (58%) vs. 130/154 (84%), OR 0.26, P = 0.04).

Conclusion

ZIKV was not detected in the USOC athletes or staff traveling to Brazil. Other arboviral infections were detected in 7% of travelers, with WNV being most common. The use of mosquito repellent was associated with decreased risk of infection. This study demonstrates multiple arboviruses in addition to ZIKV were circulating simultaneously in Brazil and has implications for pre- and post-travel counseling.

Disclosures

C. L. Byington, BioFire: Collaborator and Grant Investigator, Licensing agreement or royalty and Research grant
Pharmacodynamic Optimization for the Treatment of Invasive Candida auris Infection
Authors: Lepak Alexander J , Zhao Miao , Berkow Elizabeth , Lockhart Shawn , Andes David R
Published: October 2017

Background

Candida auris is an emerging, nosocomial multidrug-resistant threat with high treatment failure rate and mortality. The optimal antifungal agent to use and susceptibility breakpoints are based on limited clinical data.

Methods

Nine clinical C. auris strains were used. MICs were determined by CLSI standards. Drug treatment studies consisted of: fluconazole (FLC) dose range 0.78–200 mg/kg/12 h, micafungin (MFG) dose range 0.3125–80 mg/kg/24 h, or amphotericin B deoxycholate (AMB) dose range 0.0.78–20 mg/kg/24 hours. Plasma PK was previously determined in the murine model for all three drugs. A 96 h neutropenic murine model of invasive candidiasis (IC) was used for all studies. The Emax Hill equation was used to model the dose–response data to PK/PD index AUC/MIC (FLC and MFG) and Cmax/MIC (AMB). The static and 1 log kill doses (when achieved) and the associated PK/PD targets (AUC/MIC or Cmax/MIC) were determined and compared with previous murine IC studies with C. albicans, C. glabrata, and C. parapsilosis.

Results

MIC range: FLC 2–256 mg/l, MFG 0.125–4 mg/l, and AMB 0.38–6 mg/l. Dose-dependent activity was observed with all three drugs. Net stasis was achieved against seven strains for FLC, eight strains for MFG, and eight strains for AMB. However, MFG performed significantly better than comparators for cidal endpoints. A 1 log kill endpoint was achieved in eight strains for MFG, whereas this endpoint was only achieved in one strain for FLC and three strains for AMB. PK/PD analyses demonstrated a strong relationship between AUC/MIC and treatment outcome for FLC (R2 0.61) and MFG (R2 0.77); and Cmax/MIC and treatment outcome for AMB (R2 0.64). The median static dose and 1 log kill dose (MFG only) and associated AUC/MIC or Cmax/MIC values are shown (Table).

Conclusion

MFG was the most potent drug over the dose range achieving up to 2 log kill against eight of nine strains. PK/PD targets for C. auris against FLC and AMB were similar to other Candida species; however, MFG targets were ≥20-fold lower than C. albicans, C. glabrata, and C. parapsilosis. Using the median stasis targets and human PK for each drug, resistance thresholds could be 16 mg/l for FLC, 2–4 mg/l for MFG, and 1–2 mg/l for AMB.

Disclosures

All authors: No reported disclosures.
Increasing Incidence of Blastomycosis Infection in Vermont
Authors: Kiatsimkul Porntip
Published: October 2017

Background

Blastomycosis is an invasive infection caused by the ubiquitous fungus Blastomyces. The clinical presentation ranges from limited cutanenous infections to pneumonia and disseminated disease. Endemic areas in the United States include: midwestern, south-central, and southeastern states; yearly incidence is <0.3 cases per 100,000. Diagnosis is based on recovery of the organism on fungal culture. A urine antigen test is available for the detection of blastomycosis which has a sensitivity of 92.9% and specificity of 79.3%. Anecdotally, an increasing number of patients are presenting to the University of Vermont Medical Center (UVMMC) with disseminated blastomycosis – an area in which the fungus is rare. We hoped to determine the incidence of blastomycosis in Vermont over a 10-year period and examine the sensitivity of the urine antigen in our patient population.

Methods

After IRB approval, medical record numbers of all patients who had BD-glucan, blastomyces urine antigen, culture, or pathology positive for blastomyces during a 10-year period (2006–2016) were obtained. Chart review completed for all patients with diagnosis of blastomycosis. Data collected on demographic characteristics: zip code, comorbidities, site of infection, HIV, BD-glucan, blastomyces urine antigen, fungal culture, and treatment duration.

Results

Forty-one blastomycosis cases were found; 39 cases in Vermont residents. The incidence rate Vermont was 0.7 cases per 100,000. Mean age was 49 years, 60% of patients were male. Most patients had pulmonary (37%) or disseminated infection (37%). 17% of patients had localized cutaneous disease, bone and joint infection (7%) or CNS disease (2%). Urine antigen was positive in 78% overall, and in 90% with disseminated infection. Three deaths, none attributed to blastomycosis.

Conclusion

Vermont appears to have a higher incidence than what has been reported in the US overall. This increase may have to do with better reporting and testing rather than a true increase in disease. Most common disease presentation was localized pulmonary or disseminated disease. Urine antigen sensitivity ranged from 78% (overall) to 90% (disseminated disease). This appears consistent with what has been reported in other studies, but is lower than the overall reported sensitivity.

Disclosures

All authors: No reported disclosures.
Clinical Characteristics and Outcomes in Hospitalized Patients with Proven and Probable Coccidioidomycosis at the National Institute of Respiratory Diseases in Mexico City
Authors: Martinez-Orozco Jose Arturo , Contreras-Cortez Angelina , Morales-Villareal Fernando , Vargas Eduardo Becerril
Published: October 2017

Background

Coccidioides spp. an endemic dimorphic fungi is present in the north and south of Mexico. The Ministry of Health report in Mexico between 1988 and 1994 0.5 to 1.3 cases per 100,000 habitants. The clinical picture ranges from asymptomatic to disseminated disease. They should be classified according to the EORTC/MSG criteria in proven and probable disease, in Mexico there is no study about clinical characteristics and outcomes in hospitalized patients according to this classification.

Objective

Evaluate the clinical characteristics and outcomes in hospitalized patients with proven and probable coccidioidomycosis according to EORTC/MSG criteria.

Methods

The National Institute of Respiratory Diseases in Mexico City is the national referral center for complicated pulmonary infectious diseases. This retrospective cohort from 2010 to 2016 included proven and probable Coccidioidomycosis hospitalized patients classified according to EORTC/MSG 2008 criteria. We collected data about clinical characteristics on admission and outcomes.

Results

Fifty-seven patients were evaluated, 26 proven and 31 probable, mean age was 43 years. The proven group was associated with DM2 OR 2.8 (IC95% 1.1–7, P = 0.014) and hemoptysis OR 3.2 (IC95% 1.1–9, P = 0.013), the probable group with dyspnea OR 3.5 (IC 95% 1.08–11, P = 0.024), high respiratory rate 27.2 ± 13 vs. 22 ± 3.3 (P = 0.05), and low O2 saturation 83.97% ± 11.1 vs. 91.8% ± 4.31 (P < 0.001). In the proven group, multiple cavities in CT scan were more frequent. The probable had association with severe ARDS (P 0.011), use of invasive mechanical ventilation (P 0.025), and increase in mortality 14% vs. 1.8% OR 1.2 (IC95% 1.03–1.6 P = 0.025) with lower survival in Kaplan–Meier (P < 0.02). In the proven group, there was more disseminated disease (P <0.001), HIV was associated with lower survival (P <0.001) and they received more days of antifungal treatment 109.5 ± 127 vs. 59.8 ± 93 days. Amphotericin B was the most prescribed in both groups.

Conclusion

At present, we do not use the EORTC/MSG criteria due to lack of tests in our country, in this study the probable group referred usually from community centers had worse outcome and clinical characteristics, that is why we cannot underestimate this group of patients. We need to have better diagnostic tests in order to identify promptly these patients and avoid a late disease presentation.

Disclosures

All authors: No reported disclosures.
Review of Treatment Regimens for Mucormycosis in a Las Vegas County Hospital Between 2013 and 2017
Authors: Villamagna Angela , Frani Ian Adrian , Leuthner Kimberly D , Asad Shadaba
Published: October 2017

Background

Mucormycosis (MC) is a group of invasive fungal infections with a mortality rate approaching 100% in disseminated disease. The incidence of MC is low, with one study estimating 500 cases/year in the United States, making optimal treatment difficult to identify. Liposomal amphotericin B (L-ampho), along with aggressive surgical intervention, is the first-line treatment for MC. Isavuconazole (ISA) and posaconazole (POSA) are newer azoles used as salvage therapy in patients not improving with L-ampho. Limited data are available about the use of L-ampho in combination with ISA or POSA as an initial treatment regimen, but aggressive treatment empirically may increase favorable outcomes.

Methods

We performed a retrospective review of patients diagnosed with MC from 2013 to2017 at University Medical Center of Southern Nevada in Las Vegas, Nevada. Data collected included patient demographics, comorbidities, and predisposing risk factors as well as treatment regimens. Patients were evaluated for outcome after treatment therapy with monotherapy (L-ampho, POSA or ISA) or combination therapy (L-ampho with ISA).

Results

From 2013 to 2017, seven cases of MC were identified – five rhinocerebral (RC), one cutaneous (CT), and 1onepulmonary (PM). The most common risk factor was uncontrolled diabetes (5/7), followed by HIV (2/7) and non-Hodgkin lymphoma (1/7). Fifty-seven percent of patients received monotherapy and 43% received combination therapy (L-ampho/ISA). All the patients receiving combination therapy had RC. Seventy-one percent of patients survived to discharge regardless of treatment regimen. One hundred percent of combination therapy patients survived to discharge, whereas 50% of monotherapy patients survived to discharge. The two mortalities were patients with PM and CT MC.

Conclusion

MC is a rare infection with high mortality. For this reason, we are using ISA in combination with L-ampho as initial treatment to improve clinical outcomes. With our limited experience, combination therapy showed better rates of survival to discharge, without increasing adverse events. Our data suggest the use of combination therapy may improve outcomes in MC, but a larger sample of patients treated with initial combination therapy is required to strengthen conclusions about patient outcomes.

Disclosures

All authors: No reported disclosures.