bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroligin-3 Regulates Excitatory Synaptic Transmission and EPSP-Spike Coupling in the Dentate Gyrus In Vivo
Authors: Muellerleile Julia , Vnencak Matej , Ippolito Angelo , Krueger-Burg Dilja , Jungenitz Tassilo , Schwarzacher Stephan W. , Jedlicka Peter
Published: November 2021

Neuroligin-3 (Nlgn3), a neuronal adhesion protein implicated in autism spectrum disorder (ASD), is expressed at excitatory and inhibitory postsynapses and hence may regulate neuronal excitation/inhibition balance. To test this hypothesis, we recorded field excitatory postsynaptic potentials (fEPSPs) in the dentate gyrus of Nlgn3 knockout (KO) and wild-type mice. Synaptic transmission evoked by perforant path stimulation was reduced in KO mice, but coupling of the fEPSP to the population spike was increased, suggesting a compensatory change in granule cell excitability. These findings closely resemble those in neuroligin-1 (Nlgn1) KO mice and could be partially explained by the reduction in Nlgn1 levels we observed in hippocampal synaptosomes from Nlgn3 KO mice. However, unlike Nlgn1, Nlgn3 is not necessary for long-term potentiation. We conclude that while Nlgn1 and Nlgn3 have distinct functions, both are required for intact synaptic transmission in the mouse dentate gyrus. Our results indicate that interactions between neuroligins may play an important role in regulating synaptic transmission and that ASD-related neuroligin mutations may also affect the synaptic availability of other neuroligins.
Exploring domestic energy consumption feedback through interactive annotation
Authors: Herrmann Melanie R. , Costanza Enrico , Brumby Duncan P. , Harries Tim , das Graças Brightwell Maria , Ramchurn Sarvapali , Jennings Nicholas R.
Published: November 2021

We report on a three-week field study in which participants from nine households were asked to annotate their domestic electricity consumption data using a prototype interactive visualisation. Through an analysis of the annotations and semi-structured interviews, our findings suggest that the intervention helped participants to develop a detailed and accurate understanding of their electricity consumption data. Our results suggest that energy data visualisations can be improved by having users actively manipulate and annotate their data, as doing so encourages reflection on how energy is being used, facilitating insights on how consumption can be reduced. One of the key findings from our thematic analysis was that participants went beyond the data in their reflections, talking about generational issues, upbringing, financial matters, socio-economic comparisons, environmental concern, mistrust towards utilities, convenience, comfort and self-reported waste. Reading beyond the data illustrates the importance of social practices in the context of energy feedback, embedding eco-feedback research into the relevant context of sociology and psychology research.
Mesenchymal stem cell therapy in decompensated liver cirrhosis: a long-term follow-up analysis of the randomized controlled clinical trial
Authors: Shi Ming , Li Yuan-Yuan , Xu Ruo-Nan , Meng Fan-Ping , Yu Shuang-Jie , Fu Jun-Liang , Hu Jin-Hua , Li Jing-Xin , Wang Li-Feng , Jin Lei , Wang Fu-Sheng
Published: November 2021

Background

Mesenchymal stem cell (MSC) infusion was reported to improve liver function in patients with decompensated liver cirrhosis (DLC); however, whether the medication can improve outcome of these patients is poorly understood.

Methods

This prospective, open-labeled, randomized controlled study enrolled 219 patients with HBV-related DLC who were divided into control group (n = 111) and umbilical cord-derived MSC (UC-MSC)-treated group (n = 108), then all of them received a follow-up check from October 2010 to October 2017. The treated patients received three times of UC-MSC infusions at 4-week intervals plus conventional treatment that was only used for control group. The overall survival rate and HCC-free survival rate were calculated as primary endpoints and the liver function and adverse events associated with the medication were also evaluated.

Results

During the follow-up check period from 13 to 75th months, there was a significantly higher overall survival rate in the treated group than the control group, while the difference of the hepatocellular carcinoma event-free survival rate between the treated and control groups was not observed during the 75-month follow-up. UC-MSC treatment markedly improved liver function, as indicated by the levels of serum albumin, prothrombin activity, cholinesterase, and total bilirubin during 48 weeks of follow-up. No significant side effects or treatment-related complications were observed in the UC-MSC group.

Conclusions

Therapy of UC-MSC is not only well tolerated, but also significantly improves long-term survival rate, as well as the liver function in patients with HBV-related DLC. UC-MSC medication, therefore, might present a novel therapeutic approach for the disease.

Graphic abstract
CD47 interactions with exportin-1 limit the targeting of m7G-modified RNAs to extracellular vesicles
Authors: Kaur Sukhbir , Saldana Alejandra Cavazos , Elkahloun Abdel G. , Petersen Jennifer D. , Arakelyan Anush , Singh Satya P. , Jenkins Lisa M. , Kuo Bethany , Reginauld Bianca , Jordan David G. , Tran Andy D. , Wu Weiwei , Zimmerberg Joshua , Margolis Leonid , Roberts David D.
Published: November 2021

CD47 is a marker of self and a signaling receptor for thrombospondin-1 that is also a component of extracellular vesicles (EVs) released by various cell types. Previous studies identified CD47-dependent functional effects of T cell EVs on target cells, mediated by delivery of their RNA contents, and enrichment of specific subsets of coding and noncoding RNAs in CD47+ EVs. Mass spectrometry was employed here to identify potential mechanisms by which CD47 regulates the trafficking of specific RNAs to EVs. Specific interactions of CD47 and its cytoplasmic adapter ubiquilin-1 with components of the exportin-1/Ran nuclear export complex were identified and confirmed by coimmunoprecipitation. Exportin-1 is known to regulate nuclear to cytoplasmic trafficking of 5’-7-methylguanosine (m7G)-modified microRNAs and mRNAs that interact with its cargo protein EIF4E. Interaction with CD47 was inhibited following alkylation of exportin-1 at Cys528 by its covalent inhibitor leptomycin B. Leptomycin B increased levels of m7G-modified RNAs, and their association with exportin-1 in EVs released from wild type but not CD47-deficient cells. In addition to perturbing nuclear to cytoplasmic transport, transcriptomic analyses of EVs released by wild type and CD47-deficient Jurkat T cells revealed a global CD47-dependent enrichment of m7G-modified microRNAs and mRNAs in EVs released by CD47-deficient cells. Correspondingly, decreasing CD47 expression in wild type cells or treatment with thrombospondin-1 enhanced levels of specific m7G-modified RNAs released in EVs, and re-expressing CD47 in CD47-deficient T cells decreased their levels. Therefore, CD47 signaling limits the trafficking of m7G-modified RNAs to EVs through physical interactions with the exportin-1/Ran transport complex.
Intergroup Contact as a Potential Path to Neutralize the Detrimental Effect of National Identification on Xenophobia in Germany
Authors: Genkova Petia , Schaefer Christoph Daniel , Karch Simone
Published: November 2021

Proceeding globalization and the increase in global mobility entail that a growing proportion of people in economically developed countries have a migration background, so that cultural diversity has become an integral characteristic of many societies. Consequently, national identifications and attitudes towards immigrants are gaining importance in both international and intra-societal contexts. Previous studies revealed that in some countries, including Germany, national identification is associated with negative attitudes towards outgroups. In the present article, the interplay between national identification and intergroup contact is analyzed, with xenophobia as the criterion. The study is based on a cross-sectional survey amongst members of the majority population in Germany. It was predicted and found that the association between national identification and xenophobia is moderated by intergroup contact. There was only an association between national identification and xenophobia in participants with below-average or average levels of contact, whilst for those with above-average levels of contact, there was no significant association. Thus, the results point to the importance of contact experiences as a path to neutralize the effects of national identification on xenophobia, possibly by assisting in a redefinition of national belonging.
A design of forceps-type coincidence radiation detector for intraoperative LN diagnosis: clinical impact estimated from LNs data of 20 esophageal cancer patients
Authors: Takahashi Miwako , Yoshimura Shuntaro , Takyu Sodai , Aikou Susumu , Okumura Yasuhiro , Yagi Koichi , Fukayama Masashi , Momose Toshimitsu , Seto Yasuyuki , Yamaya Taiga
Published: November 2021

Purpose

To reduce postoperative complications, intraoperative lymph node (LN) diagnosis with 18F-fluoro-2-deoxy-D-glucose (FDG) is expected to optimize the extent of LN dissection, leading to less invasive surgery. However, such a diagnostic device has not yet been realized. We proposed the concept of coincidence detection wherein a pair of scintillation crystals formed the head of the forceps. To estimate the clinical impact of this detector, we determined the cut-off value using FDG as a marker for intraoperative LN diagnosis in patients with esophageal cancer, the specifications needed for the detector, and its feasibility using numerical simulation.

Methods

We investigated the dataset including pathological diagnosis and radioactivity of 1073 LNs resected from 20 patients who underwent FDG-positron emission tomography followed by surgery for esophageal cancer on the same day. The specifications for the detector were determined assuming that it should measure 100 counts (less than 10% statistical error) or more within the intraoperative measurement time of 30 s. The detector sensitivity was estimated using GEANT4 simulation and the expected diagnostic ability was calculated.

Results

The cut-off value was 620 Bq for intraoperative LN diagnosis. The simulation study showed that the detector had a radiation detection sensitivity of 0.96%, which was better than the estimated specification needed for the detector. Among the 1035 non-metastatic LNs, 815 were below the cut-off value.

Conclusion

The forceps-type coincidence detector can provide sufficient sensitivity for intraoperative LN diagnosis. Approximately 80% of the prophylactic LN dissections in esophageal cancer can be avoided using this detector.
CSA6D: Channel-Spatial Attention Networks for 6D Object Pose Estimation
Authors: Chen Tao , Gu Dongbing
Published: November 2021

6D object pose estimation plays a crucial role in robotic manipulation and grasping tasks. The aim to estimate the 6D object pose from RGB or RGB-D images is to detect objects and estimate their orientations and translations relative to the given canonical models. RGB-D cameras provide two sensory modalities: RGB and depth images, which could benefit the estimation accuracy. But the exploitation of two different modality sources remains a challenging issue. In this paper, inspired by recent works on attention networks that could focus on important regions and ignore unnecessary information, we propose a novel network: Channel-Spatial Attention Network (CSA6D) to estimate the 6D object pose from RGB-D camera. The proposed CSA6D includes a pre-trained 2D network to segment the interested objects from RGB image. Then it uses two separate networks to extract appearance and geometrical features from RGB and depth images for each segmented object. Two feature vectors for each pixel are stacked together as a fusion vector which is refined by an attention module to generate a aggregated feature vector. The attention module includes a channel attention block and a spatial attention block which can effectively leverage the concatenated embeddings into accurate 6D pose prediction on known objects. We evaluate proposed network on two benchmark datasetsYCB-Videodataset andLineModdataset and the results show it can outperform previous state-of-the-art methods underADDandADD-Smetrics. Also, the attention map demonstrates our proposed network searches for the unique geometry information as the most likely features for pose estimation. From experiments, we conclude that the proposed network can accurately estimate the object pose by effectively leveraging multi-modality features.
A hydrogeochemical approach to evaluate groundwater quality in the vicinity of three tributaries of the Beas River, North-West India
Authors: Singh Jasdeep , Sehgal Simerpreet Kaur , Singh Kuldip , Singh Didar
Published: November 2021

The present study focused on the seasonal investigation of hydro-geochemical characteristics of groundwater samples collected from the vicinity of three tributaries of the Beas River, Punjab, India. Total 45 samples were analyzed during the pre- and post-monsoon season for physico-chemical parameters and heavy metals along with health risk assessment. Results revealed that the majority of samples were below the permissible limits set by the BIS and WHO. The relative abundance of major cations was Ca2+ > Mg2+ > Na+ > K+ and Ca2+ > Na+ > Mg2+ > K+, while that of the major anions was HCO3− > SO42− > Cl− > CO32− in the pre- and post-monsoon season, respectively. Groundwater was alkaline and hard in nature at most of the sites. Bicarbonate content exceeded the desirable limit having an average concentration of 337.26 mg/L and 391.48 mg/L, respectively, during the pre- and post-monsoon season. Tukey’s multiple comparison test was applied for finding significant differences among samples at p < 0.05. The dominant hydrochemical face of water was Ca–Mg–HCO3 type. US salinity (USSL) diagram indicated that during the pre-monsoon, 48.9% samples were C2S1 type and remaining 51.1% were C3S1 type while during the post-monsoon all samples were C3S1 type. It indicates that groundwater of the study area is at risk of salinity hazards in future and is not to be ignored. Such monitoring studies are recommended to design future safety plans to combat soil and human health risks.
Cutting inserts made of glass and glass ceramics
Authors: Breidenstein Bernd , Müller-Cramm Dominik , Vogel Nils
Published: November 2021

Against the background of the increasing cost and scarcity of raw materials that are required for the manufacture of cutting tools, the question of alternative cutting materials arises. Glasses and glass ceramics represent a possibility for this, the use of which has hardly been considered so far. This thesis is devoted to the question of whether cutting tools can be made from glass and glass ceramic materials at all. In addition, the question of how such tools can be used for which purposes is dealt with. First results on both questions are presented. The grinding of indexable inserts from the materials examined was possible without breaking corners and edges. Plastics can be easily machined with the tools produced. When machining aluminum, however, the tools made of glass fail completely, while those made of glass–ceramic show good results here too. These first results are intended to pave the way for further research in this area.
The Role of the Natural Antioxidant Mechanism in Sperm Cells
Authors: Kowalczyk Alicja
Published: November 2021

Molecular studies of the causes of male infertility revealed a significant contribution of oxidative stress. When excessive amounts of reactive oxygen species (ROS) are produced or antioxidant activity fails, the equilibrium between oxidation and reduction is disrupted, causing oxidative stress (OS). High levels of ROS can have an adverse effect on sperm function through the initiation of DNA damage, lipid peroxidation, loss of membrane integrity and increased permeability, inactivation of cellular enzymes, and cell apoptosis. In addition to endogenous factors such as immature sperm, leukocytes, and varicocele, potential causes of excessive ROS can also be found exogenously in males with testicular hyperthermia or exposed to environmental toxicity. To maintain the optimal functioning of sperm cells, it is, therefore, necessary to balance the redox potential, i.e., to balance ROS by antioxidants. The purpose of this review is to present the antioxidant defense systems in semen.
A survey of irrigation water and soil quality that likely impacts paddy rice yields in Kilimanjaro, Tanzania
Authors: Mpanda Fridolin M. , Rwiza Mwemezi J. , Mtei Kelvin M.
Published: November 2021

In this study, the impacts of irrigation water quality and soil characteristics on paddy rice yields were investigated. Standard spectroscopy and spectrometry methods were used to analyze irrigation water and irrigated soil samples. The irrigation water had sodium adsorption ratio (SAR) values ranging from 0 to 3. The corresponding electrical conductivity (EC) values were between 0.2 and 0.7 dS/m and accounted for 14% of all samples—posing slight to moderate infiltration problem. Neither Na+ nor Cl− levels were high enough to cause toxicity problems in the irrigation water. For B, 54% of the samples were found to have moderate toxicity whereas ~ 14% of the samples indicated severe B toxicity in the irrigation water. For bicarbonate, about 86 and 14% of the irrigation water indicated slight-to-moderate and severe potential detrimental effect to plant growth, respectively. All trace elements in the irrigation water were too low to cause any harmful effect. Although soil EC, organic carbon (OC), and pH indicated favorable level, there were high standard deviation (SD) values in soil Fe and Zn. The mean value of Fe in soils was 19.8 mg/kg, indicating signs of Fe-deficiency. High SD values were also found in the total N (TN) content of the studied soils. Furthermore, a low soil K content was observed in the analyzed soil samples. Appropriate fertilizer application for improving nutrient deficiencies in the study area is highly recommended. Furthermore, on-farm management practices need to be guided by scientific findings from the present as well as other studies.
CircR2Disease v2.0: An Updated Web Server for Experimentally Validated circRNA–Disease Associations and Its Application
Authors: Fan Chunyan , Lei Xiujuan , Tie Jiaojiao , Zhang Yuchen , Wu Fang-Xiang , Pan Yi
Published: November 2021

With accumulating dysregulated circular RNAs (circRNAs) in pathological processes, the regulatory functions of circRNAs, especially circRNAs as microRNA (miRNA) sponges and their interactions with RNA-binding proteins (RBPs), have been widely validated. However, the collected information on experimentally validated circRNA–disease associations is only preliminary. Therefore, an updated CircR2Disease database providing a comprehensive resource and web tool to clarify the relationships between circRNAs and diseases in diverse species is necessary. Here, we present an updated CircR2Disease v2.0 with the increased number of circRNA–disease associations and novel characteristics. CircR2Disease v2.0 provides more than 5-fold experimentally validated circRNA–disease associations compared to its previous version. This version includes 4201 entries between 3077 circRNAs and 312 disease subtypes. Secondly, the information of circRNA–miRNA, circRNA–miRNA–target, and circRNA–RBP interactions has been manually collected for various diseases. Thirdly, the gene symbols of circRNAs and disease name IDs can be linked with various nomenclature databases. Detailed descriptions such as samples and journals have also been integrated into the updated version. Thus, CircR2Disease v2.0 can serve as a platform for users to systematically investigate the roles of dysregulated circRNAs in various diseases and further explore the posttranscriptional regulatory function in diseases. Finally, we propose a computational method named circDis based on the graph convolutional network (GCN) and gradient boosting decision tree (GBDT) to illustrate the applications of the CircR2Disease v2.0 database. CircR2Disease v2.0 is available at http://bioinfo.snnu.edu.cn/CircR2Disease_v2.0 and https://github.com/bioinforlab/CircR2Disease-v2.0.
Becoming-with fire and rainforest: Emergent curriculum and pedagogies for planetary wellbeing
Authors: Somerville Margaret J. , Powell Sarah J.
Published: November 2021

In this paper we propose the concept of ‘becoming-with’ in relation to the experience of the catastrophic fires in the summer of 2019–2020 in Australia, and their implications for research into young children’s response to bushfires, and their learning about bushfire recovery, which resulted in the development of an arts-based project to explore emergent curriculum and pedagogies for planetary wellbeing. We draw on Deleuze and Guattari’s theorising that ‘the self is only a threshold, a door, a becoming between two multiplicities’; and ‘Spatio-temporal relations’ as ‘not predicates of the thing but dimensions of multiplicities of events as encounters’ to theorise how ‘becoming-with’ fires enabled the development of emergent curriculum and pedagogies in an early learning centre, which can ultimately contribute to planetary wellbeing.
COVID-19 Vaccine Superstations as a Model to Rapidly Achieve Herd Immunity
Authors: Keehner Jocelyn , Torriani Francesca , Abeles Shira , Horton Lucy
Published: November 2021

Background: The County of San Diego Health and Human Services (SDHHSA) established a goal to vaccinate 1.9 million residents as quickly as possible to attain vaccine induced herd immunity. This strategy would minimize the emergence of more transmissible variants, to which some vaccines may be less effective. With this strategy in mind, UC San Diego Health (UCSDH) collaborated with the local health authorities and the San Diego Padres to build a superstation in downtown San Diego in the parking lot of a baseball stadium. Methods: Building on the experience of rapidly vaccinating the UCSDH workforce in mid-December 2020, UCSDH and SDHHSA partnered to more efficiently distribute SARS-CoV-2 vaccine in San Diego County by building a vaccine superstation. The San Diego Padres offered their parking lot as the site; it was centrally located, easily accessible, quick to set up, and semipermanent. They also provided infrastructure support, event coordination, and internet capability. Occupying a space of ~6.5 acres, the superstation included 12 lanes serving 12 cars each, with ~3 cycles every hour, as well as a pedestrian walk-up station. Altogether, the site had the capacity for >5,000 vaccinations daily. This effort required coordination among administration, healthcare providers, IT specialists, and support staff—a daily workforce of >300 persons. The workforce needs were met using a multipronged approach, including flexible staffing, coordination of volunteers, and recruitment of previously retired providers. The private–public partnership enabled the superstation to be up and running in 5 days. Results: The operation was quickly ramped up to provide >6,000 vaccines daily. Initially only open to healthcare workers, on January 17 the superstation was expanded to persons aged >75 years, with further expansion to those aged ≥65 years on January 23. From January 11 to February 5, >100,000 individuals received their first dose of vaccine at the superstation, corresponding to ~31% of all San Diego county vaccinations. Conclusions: Vaccination of as many people as quickly as possible is essential to controlling the pandemic. Unchecked replication of SARS-CoV-2 allows increases the chance that the virus may develop mutations that render vaccines and therapeutics less effective. Our model vaccine superstation was replicated at 3 more sites around the county, the limited allocation of vaccine has been the only barrier to further expansion. A force of 10 superstations could administer a first dose to the remaining 1.6 million county residents within 32 days.

Funding: No

Disclosures: None
The Impact of COVID-19 on Patient Safety: A Survey of Acute-Care Registered Nurses in New Jersey
Authors: Pogorzelska-Maziarz Monika , Lou Manning Mary , Gerolamo Angela , Johansen Mary , Grafova Irina , Crincoli Suzie , de Cordova Pamela
Published: November 2021

Background: As the world grapples with the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is important to consider the full impact of coronavirus disease 2019 (COVID-19) on healthcare delivery. Evidence from outbreaks of novel H1N1 and Ebola indicates that response to these types of outbreaks requires extraordinary resources, which are diverted from routine infection prevention and control activities. However, little is known about the impact of COVID-19 on adherence to patient safety protocols in hospitals, including infection prevention and control activities. We have described the reports of acute-care registered nurses (RNs) in adhering to patient safety protocols while delivering care to COVID-19 patients. Methods: In October 2020, we conducted a cross-sectional electronic survey of all active RNs in the state of New Jersey who provided direct patient care in a New Jersey hospital in an emergency or adult inpatient unit during the onset of the COVID-19 pandemic. Results: More than 3,027 RNs participated in the survey, for a 15% response rate based on number of eligible RNs. Moreover, 15% of respondents reported that they tested positive for COVID-19 during the initial peak of COVID-19 in New Jersey (March–June 2020). Most RNs reported that the number of patients they were assigned during the first peak of the pandemic affected their ability to adhere to patient safety protocols (eg, deep-vein thrombosis screening, central-line bundles, pressure ulcer prevention). In open-ended responses, they shared that being understaffed, the extra time it took for downing and doffing of PPE, the lack of access to ancillary staff (ie nursing assistants, runners), and the need to cluster care affected the quality of care. A nurse working in the intensive care unit (ICU) lamented, “We were sometimes given 4–5 ICU patients who were very sick and required a lot of care. Shortcuts had to be taken to prioritize the most important needs. Sometimes IVs remained longer than desired. Foleys remained in longer. To avoid PPE shortages, we didn’t go into the rooms nearly as much as we normally would, [and] things got missed.” Feelings of being overwhelmed and helpless permeated the nurses’ comments. Conclusions: When caring for COVID-19 patients, frontline nurses struggled with adherence to necessary patient safety protocols, which ultimately disrupted care delivery. Future research should quantify the extent to which the COVID-19 pandemic affected care delivery, including adherence to patient safety protocols among frontline providers.

Funding: No

Disclosures: None
Predictors of COVID-19 Mortality in Residents of Flint, Michigan: Effect of Age, Gender, Smoking, and Health Plan
Authors: Younas Mariam , Osterholzer Danielle , McDonald Philip , Rios-Bedoya Carlos , Bachuwa Ghassan , Demian Sherry , Deliwala Smit , Kunaprayoon Lalida , Lakshman Harini , Beere Thulasi , Omaduvie Uyoyo
Published: November 2021

Background: Current literature suggests that older age, hypertension, and diabetes mellitus confer a significant increased risk of mortality among patients with COVID-19. The purpose of this study is to further characterize the predictors of mortality in patients with COVID-19 in residents of Flint, Michigan, based on variables such as gender, age, smoking status, health insurance plan, and comorbidities. Methods: Hurley Medical Center, is a 443-bed public, nonprofit, teaching medical center located in Flint, Michigan. In total, 289 consecutive adult patients (aged ≥18 years) with confirmed SARS-CoV-2 infection by nasal polymerase chain reaction (PCR), admitted and discharged from our facility from March 2020 through June 2020, were retrospectively analyzed. Results: During the 4-month study period, the overall in-hospital case fatality rate (CFR) was 18% (51 of 289), with highest CFR in the age group aged 60–69 years (36%; P = .06). Nonsurvivors tended to be older with mean age of 67 years (95% CI, 61.6–71.8) versus survivors with mean age of 60 years (95% CI, 57.7–62.4). Highest mortality was seen in patients with Medicare or Medicaid as their sole health plan (39%, P = .59). Men comprised 51% (148 of 289) of the cohort with CFR of 21% versus 14% in females. Females tended to be younger with a higher body mass index (BMI) than their male counterparts (mean age of 58 years, mean BMI of 35 in women vs a mean age of 62 and BMI of 29 in men). A higher proportion of deceased were active smokers (51%; P = .02). CFR was highest in patients with hypertension (92%,; P = .15), followed by diabetes (44%; P = .85), chronic kidney disease (CKD) (31%; P = .10), obstructive sleep apnea (OSA) (28%; P = .25), asthma (22%; P = .64), and coronary artery disease (22%; P = .34). It was lowest in patients with end-stage renal disease (3%; P = .69). Conclusions: Our study suggests trends towards higher mortality with male sex, hypertension and diabetes, along with other comorbidities. Smoking seems to be a strong predictor of mortality in this cohort. Further studies are needed to ascertain the relationship between possible risk factors with COVID-19 mortality in residents of Flint, Michigan. Describing and understanding the potential risk factors is the key to improving outcomes in this population.

Funding: No

Disclosures: None
Using Ultraviolet C (UVC) in Operating Rooms: A Hygiene Improvement
Authors: Bosco Roberta , Messina Gabriele , Amodeo Davide , Cevenini Gabriele , Gambelli Simona
Published: November 2021

Background: Disinfection procedures are an essential aspect of preventing cross contamination, especially in situations where the risk of infection is higher, such as in operating rooms (ORs). Disinfection procedures in ORs at the end of each surgery session are not the same as final cleaning procedures. We assessed the difference in microbial contamination between different levels of disinfection, before T(0) and after T(1) the use of an ultraviolet C device (UVC-D). Methods: A cross-sectional study was conducted between December 2019 and August 2020 in a private clinic. Three sanitation levels (SL1–SL3) were compared for the reduction in colony-forming units (CFU) between T(0) and T(1): (1) no disinfection after surgery (SL1);, (2) after in-between cleaning (SL2), and (3) after terminal cleaning (SL3). UVC-D was used for 6 minutes, 3 minutes per bed side. Overall, 260 Petri dishes were used in 3 ORs, incubated at 36°C, and CFU were counted after 48 hours. Descriptive statistics, Wilcoxon test, and MANOVA for repeated measures were performed to verify the 95% statistical difference between T(0) and T(1), both on the whole sample and combined with the different SLs. Results: The unstratified analysis showed statistically significant differences (Wilcoxon test, p < 0.05) between T(0) and T(1), with means and standard deviations of 11.42 ± SD 41.19 CFU/PD and 5.91 ± SD 30.89, respectively. The Manova test for repeated measures, applied to 54 pairs of measurements, showed no significant difference between SLs in T(0)-T(1) CFU reduction. Overall, the mean percent reduction in CFU was 93.48% (CI95% = 86.97-99.99%). Conclusions: The results showed significant improvements in disinfection under any condition tested with UVC-D. Using the device immediately after surgery (SL1), before standard cleaning procedures, reduced CFUs by 97.3%. In some situations, UVC light was sufficient to reduce CFU to zero, even without chemical and mechanical cleaning. However, we do not recommend this approach; UVC light disinfection should be applied only after sanitization procedures because it does not remove dirt.

Funding: UltraViolet Device, Inc

Disclosures: None
Effectiveness of a Multidisciplinary Team-Approach on Central-Line–Associated Bloodstream Infections
Authors: Suleyman Geehan , Ahrens Melissa , Keegan Ann
Published: November 2021

Background: Although there has been a significant reduction in central-line–associated bloodstream infection (CLABSI) rates in the past decade with the implementation of evidence-based practices, an estimated 30,100 CLABSI occur each year in acute-care facilities. CLABSIs are associated with increased length of stay, cost, morbidity, and mortality, and they are preventable. In this study, we assessed the impact of a multidisciplinary team approach on CLABSI rates at a 319-bed teaching hospital in northwestern Ohio. Methods: In this before-and-after retrospective study, we compared the CLABSI rate per 1,000 central-line days, standardized infection ratio (SIR), and standardized utilization ratio (SUR) in the preintervention period (January 1, 2016, to December 31, 2018) to those of the intervention period (January 1, 2019, to December 31, 2020). Despite hospital-wide nursing education focusing on central-line maintenance in 2017, our SIR and SUR remained above the national benchmark. Starting in August 2018, we began to focus on insertion practices and physician education. An infection preventionist observed resident central-line insertion training and noted that there was no emphasis on infection prevention measures. There was a best practice knowledge gap. Thus, the indications for central-line use were updated, the insertion checklist was standardized, and the vascular access policy was revised to limit femoral and internal jugular vein use. Infection prevention training was provided to all providers involved in central-line insertions. Nurses were tasked with observing insertion of every central line and stopping the procedure if there is was an observed break in sterile technique. A central-line report listing indications and duration was developed and was sent to the nursing directors who assessed daily need with providers and prompted removal of unnecessary lines. The infection prevention medical director provided CLABSI prevention education to providers. Results: The CLABSI rate per 1,000 central-line days decreased from 0.90 in the preintervention period to 0.34 in the postintervention period, resulting in a 62% reduction in CLABSI rate. The SIR decreased from 0.886 to 0.323 (p-value <0.05), yielding a 64% reduction. The SUR also decreased from 1.156 to 0.874 (p-value <0.001) with a 24% reduction. Conclusion: A multidisciplinary team-approach with emphasis on standardized insertion checklist to ensure adherence to sterile technique and prompt removal of unnecessary central lines, and physician insertion training focusing on IP practices may potentially reduce CLABSI rates.

Funding: No

Disclosures: None
Implementation of a Quality Improvement Role for Unlicensed Assistive Personnel and Effects on Infection Prevention
Authors: Schnell Natalie , DiBiase Lauren , Selimos Amy , Stancill Lisa , Summerlin-Long Shelley , Sickbert-Bennett Emily
Published: November 2021

Background: Care bundles comprise evidence-based practices and interventions that are easily and consistently implemented while improving patient outcomes. As patient acuity and task overload continue to increase, infection prevention bundle and process measure compliance and data collection may become a lower priority for registered nurses (RNs). In early 2019, a certified nursing assistant (CNA) began full-time quality liaison work on a 53-bed inpatient adult oncology unit at UNC Medical Center to provide targeted compliance data collection and to correct deficits in real time when possible and within the appropriate scope of practice. Methods: The quality liaison CNA is highly motivated, with a relevant clinical background and effective communication skills. After conducting a gap analysis, the unit developed specific responsibilities for several areas of quality improvement, including infection prevention. In addition to rounding on all patients daily, the quality liaison (1) performs direct patient care tasks like Foley catheter care, (2) conducts patient education on topics such as chlorhexidine gluconate treatments, (3) performs all relevant process measure audits, and (4) easily relays missed or needed care to RNs with a door sign created as part of this initiative. High-risk findings, such as a loose central-line dressing, prompt immediate communication to the RN, with follow-up and escalation when necessary. Results: Patients and staff received the quality liaison well, and the increased attention to care bundle components and auditing ensured consistent, evidence-based care along with accurate and reliable data collection. Compared to the previous calendar year, the number of central-line audits on the unit increased by >1,400 by the end of 2019. Patient outcomes improved, and during 1 fiscal year, the unit achieved rate reductions between 40% and 55% for central-line–associated bloodstream infections, catheter-associated urinary tract infections, and healthcare-associated C. difficile infections. Staffing and logistical challenges imposed by the COVID-19 global pandemic have hampered this work because the quality liaison was redeployed to direct patient care intermittently. Correspondingly, from July to October 2020, the same infection rates increased between 30% and 353%. Conclusions: Having a designated quality liaison is an effective means to achieving quality improvements while remaining an integral member of the patient care team. As staffing has improved on this unit, the quality liaison has refocused efforts, and infection rates are beginning to improve. Given the success of the quality liaison role in improving quality outcomes on this unit, the hospital is exploring expansion of this model to additional units.

Funding: No

Disclosures: None
Evaluation of Procalcitonin Use in Patients Discharged from the Emergency Department with Acute Respiratory Infection
Authors: Fontaine Garrett , Banach David , Aeschlimann Jeffrey
Published: November 2021

Background: Acute respiratory infections (ARIs) contribute significantly to inappropriate antimicrobial prescription. The rate of such prescriptions in US emergency departments (EDs) has remained stable over time. The use of procalcitonin (PCT) testing has been shown to lower risk of mortality and to reduce antibiotic consumption. It also has the potential to aid ED physicians in stratifying ARI patients who may require antibiotics but do not require hospital admission. In this study, we described the characteristics and proportion of antibiotic prescription in patients evaluated in and discharged from the ED with ARI. Methods: We performed a retrospective chart review of patients diagnosed with ARI and discharged from a single academic ED between January 2018 and January 2020. We compared those for whom a PCT test was ordered to those without a PCT test ordered at ARI diagnosis. Charts were reviewed until there were 110 subjects in each of the 2 study groups. The main outcome variable was receipt of an antibiotic prescription. The χ2 test was used to compare the proportion of patients who received an antibiotic prescription, demographics, and clinical characteristics between the 2 groups. The Mann-Whitney U test was used to compare the distribution of ages between the 2 groups. Results: Among patients in the PCT group, 87 (79.0%) received antibiotics versus 69 (62.7%) in the non-PCT group (P ± 18.8 vs 52.7 years ± 17.6; P = .0002); more likely to have preexisting heart and lung disease (28.2% vs 15.5%; P = .02); more often male (58.2% vs 40%; p < 0.01); had more subjective fevers (47.3% vs 33.6%, p=0.04), sputum production (49.1% vs 28.2%, p < 0.01), and nausea (17.3% vs 8.2%, p=0.04). PCT results were low (≤0.25) in 82.7% (91) of patients, of whom 70.3% (64) received antibiotics. Conclusions: Patients for whom PCT testing was ordered were older, had more underlying conditions and increased severity of illness. This finding may reflect that PCT testing was more likely to be ordered in patients at risk of severe infection but not requiring admission. The proportion of antibiotics prescriptions was higher for patients who had a PCT test. For patients with a low PCT result, the proportion of patients prescribed antibiotics was high. This finding may suggest that clinical characteristics were more influential than PCT result in the decision to prescribe antibiotics. More research is needed on the role of PCT testing in antibiotic prescription decisions for patients presenting to the ED with ARI.

Funding: No

Disclosures: None
Evaluation of Penicillin Allergy Prevalence and Antibiotic Prescribing Patterns for Patients within the Emergency Department
Authors: Norris Ashlyn , Daniels Lindsay , Mavrogiorgos Nikolaos , Northam Kalynn , Kwan Mildred , Burke Gary , Boerneke Renae
Published: November 2021

As the point of entry into healthcare for many patients, the emergency department (ED) is an ideal setting in which to assess penicillin (PCN) allergies. An estimated 10% of the United States population has a reported PCN allergy; however, few studies have evaluated the prevalence and impact of PCN allergies on antibiotic selection within the ED. Patients with a documented PCN allergy are more likely to be exposed to costly alternative broad-spectrum antibiotics that have higher rates of adverse events, including C. difficile infections. We sought to determine the prevalence of PCN allergies within the UNC Medical Center ED. Key secondary outcomes included the percentage of patients with a documented PCN allergy who (1) received alternative antibiotics (carbapenems, aztreonam, fluoroquinolones, clindamycin, vancomycin), (2) received β-lactam antibiotics and experienced an allergic reaction during their ED visit, and/or (3) had received a β-lactam antibiotic during a past hospitalization or ED visit without their chart being appropriately updated. A retrospective evaluation included patients aged >18 years with a documented PCN allergy who were discharged from the ED between January 1, 2017, and December 31, 2019. Over the study period, there were 14,635 patient encounters with a documented PCN allergy that comprised 8,573 unique patients. The prevalence of PCN allergies was 14.3% for all ED encounters. PCN allergy–labeled patients received alternative antibiotics in 59.4% of ED encounters in which antibiotics were prescribed. Of the 454 β-lactam antibiotics (62 penicillins, 380 cephalosporins, 12 carbapenems) administered to PCN allergy-labeled patients within the ED, there were zero allergic reactions. Also, 18.6% of PCN allergy-labeled patients had received and tolerated a β-lactam antibiotic during prior hospitalizations or ED visits (1.7% penicillins, 14.4% cephalosporins, 2.6% carbapenems) without appropriate updated documentation to reflect β-lactam antibiotic tolerance. These findings confirm the utilization of non–β-lactam antibiotics in PCN allergy-labeled patients, highlighting the importance of accurate and updated allergy documentation in the electronic medical record. These findings also demonstrate the need for improved allergy documentation and protocols to proactively assess penicillin allergy labels while in the ED.

Funding: No

Disclosures: None
Associations Between Patient Neighborhood Characteristics and Inappropriate Antimicrobial Use
Authors: Engeda Joseph , Kriengkauykiat Jane , Epson Erin
Published: November 2021

Background: Antimicrobials are among the most commonly prescribed medications in US hospitals; an estimated 50% of hospitalized patients receive an antimicrobial. Research has shown that antimicrobial prescriptions to vary by patient- and hospital-level factors; however, disparities by patient neighborhood characteristics have not been examined. We evaluated associations between hospital and neighborhood indicators of socioeconomic status (SES) and antimicrobial use (AU) for gram-positive bacterial infections (GPBs), and broad-spectrum use for community-acquired infections (BSCAs) and hospital-onset infections (BSHOs). Methods: This analysis was conducted among 86 acute-care hospitals in California that submitted AU data via the NHSN in 2019. Hospital-level AU was measured as standardized antimicrobial administration ratios (SAARs) calculated by dividing observed antimicrobial use by risk-adjusted predicted antimicrobial use for GPB, BSCA, and BSHO antimicrobial groupings and categorized as binary (>1 or <1); SAARs >1 indicate potential inappropriate prescribing. California Office of Statewide Health Planning and Development 2018 data were used to obtain hospital characteristics and patient age, race or ethnicity, insurance, and comorbidities (defined by Charlson comorbidity index) for hospitalizations where AU may have been indicated, based on International Classification of Diseases Tenth Revision (ICD-10) diagnosis codes. The California Healthy Places Index (HPI) was used to obtain composite neighborhood SES indicators for each patient at the ZIP code level, measured as tertiles. Covariates were aggregated to the hospital level. Poisson regressions were used to evaluate the association between hospital and neighborhood SES indicators and SAAR scores, controlling for potential hospital-level confounders. Results: Among 86 hospitals included in the analysis, the mean patient age for hospitalizations where AU may have been indicated was 66 years, the proportion of white patients was 55%, and the mean proportion of Medi-Cal users was 19%. After adjusting for confounders including age, race or ethnicity, insurance status, comorbidities, and number of hospital beds; higher median values of patient SES had a protective effect against hospitals having GP SAAR scores > 1 (relative risk [RR], 0.68; 95% CI, 0.50–0.93) but was not significantly associated with hospitals having BSCA SAAR scores >1 (RR, 0.79; 95% CI, 0.62–1.02) or BSHO SAAR scores >1 (RR, 0.80; 95% CI, 0.61–1.04). Conclusions: Considering SES in addition to summary antimicrobial use scores such as SAARs may help identify populations potentially at risk for inappropriate AU; however, patient-level information is still necessary to evaluate appropriateness of antimicrobial prescribing.

Funding: No

Disclosures: None