bluuebunny/crossref_metadata_2025 huggingface dataset:
14. Issue: International Terrorism
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines an important issues in world politics: International terrorism. The chapter begins with a discussion of what the issue is about in empirical terms, the problems raised by it and why they are claimed to be important, and the relative significance of the issue on the agenda of IR and GP. International terrorism is nothing new, but it was less apparent in the 1990s, only to surge to prominence in the 2000s. This has led to a great expansion of interest in terrorism within IR and GP theories. The chapter explores the nature of the theoretical challenge that the issue of international terrorism presents to IR and GP theories and how classical and contemporary theories handle the analysis of this issue.
15. Issue: Religion in World Politics: A Clash of Civilizations?
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines another important issue: Religion in world politics. Most IR theories are inherently secular; they are based on a distinction between religion and politics. However, in recent decades it has become increasingly clear that many political movements are inspired by religion, and that no neat separation can be made between religion and politics. It has even been claimed that the fault lines between the big world religions are the new conflict zones of world politics. This chapter takes stock of these new debates. It critically reviews Samuel P. Huntington’s much cited claim about a clash of civilizations, and it explores what IR and GP theories say about the role of religion in world politics.
Raviolo Vertex Algebras, Cochains, and Conformal Blocks
Authors: Alfonsi Luigi , Kim Hyungrok , Young Charles A S
Published: January 2025

Raviolo vertex algebras were introduced recently by Garner and Williams in [25]. Working at the level of cochain complexes, in the present paper we construct spaces of conformal blocks, or more precisely their duals, coinvariants, in the raviolo setting. We prove that the raviolo state-field map correctly captures the limiting behaviour of coinvariants as marked points collide.
Bacterial Vaginosis Is Associated With Transcriptomic Changes but Not Higher Concentrations of Cervical Leukocytes in a Study of Women at High Risk for Human Immunodeficiency Virus Acquisition
Authors: Sabo Michelle C , Mustafa Salwa , Saha Aparajita , Oyaro Brenda , Fiedler Tina L , Krueger Melissa , Fuchs Esther , Mureithi Marianne , Mandaliya Kishor , Jaoko Walter , Richardson Barbra A , Gharib Sina A , Fredricks David N , Shah Javeed A , McClelland R Scott
Published: January 2025

Background

The association between bacterial vaginosis (BV) and increased human immunodeficiency virus (HIV) acquisition risk may be related to concentrations of HIV-susceptible immune cells in the cervix.

Methods

Participants (31 with BV and 30 with normal microbiota) underwent cervical biopsy at a single visit. Immune cells were quantified and sorted using flow cytometry (n = 55), localization assessed by immunofluorescence (n = 16), and function determined by bulk RNA sequencing (RNA-seq) of live CD45+ cells (n = 21).

Results

Linear regression analyses demonstrated no differences in mean log2 (cells/mg tissue) between women with BV versus normal microbiota for antigen-presenting cell (APC) subtypes linked to HIV risk (including CD1a+HLA-DR+ Langerhans cells, CD11c+CD14+ dendritic cells [DCs], and CD11c+HLA-DR+ DCs) and CD4+ T cells. Women with BV had a higher median proportion of CD11c+HLA-DR+ APCs (out of total cells) in cervical epithelium (0.1% vs 0.0%; P = .03 using Mann-Whitney test). RNA-seq identified 1032 differentially expressed genes (adjusted P < .05) in CD45+ cells between women with BV versus normal microbiota. Women with BV demonstrated downregulation of pathways linked to translation, metabolism, cell stress, and immune signaling.

Conclusions

BV alters immune cell localization and function; future studies are needed to address how these changes may mediate HIV acquisition risk.
Risk characterization of organic micropollutants in public wastewater treatment plant effluents in Flanders, Belgium
Authors: Leekitratanapisan Warich , De Schamphelaere Karel A C
Published: January 2025

This study investigates the ecological risks posed by organic micropollutants (OMPs) in wastewater treatment plant (WWTP) effluents in Flanders, Belgium, based on single-compound risk characterization. Utilizing a 5-year monitoring dataset from the Flemish Environment Agency (VMM) and seven ecological threshold values types, this research characterizes the risk of 207 OMPs, including pharmaceuticals, pesticides, industrial chemicals, and other pollutants. Several OMPs persist in effluents at concentrations that pose significant ecological risks after secondary and tertiary treatment processes in the region of Flanders (Belgium). This study identified 32 OMPs with regional risk quotients (RQregion) exceeding 1, with 24 of these showing RQregion values over 10, marking them as high-priority pollutants. Notable high-risk substances include chlorpyrifos, benzo(b)fluorene, and several herbicides. The findings highlight the necessity for investment in advanced treatment processes to enable compliance with the updated Urban Wastewater Treatment Directive (UWWTD), which mandates an 80% reduction in a fixed set of micropollutant indicators in relation to their load in WWTP influent by 2045. Based on our prioritization of high-risk OMPs, the fixed set of indicators mandated by the UWWTD does not fully represent the range of harmful contaminants in WWTP effluents, indicating a need for a broader monitoring framework and a more inclusive indicator set. These results underscore the necessity for an expanded approach to monitoring and regulating OMPs to ensure comprehensive protection of aquatic environments.
Comparative assessment of exposure tools to estimate pesticide concentrations in rice paddies: a discussion of the Brazilian context
Authors: Casallanovo Fábio , Souza Santos Gustavo , Cione Ana Paola , de Cirugeda Helle Olivier , Li Zhaoqiang , Simone Daniela Mejias
Published: January 2025

Estimating pesticide concentrations in paddy rice systems is challenging due to unique cultivation methods and water management practices. Various models, ranging from simple exposure calculators to complex scenario-dependent tools, have been developed globally to address this issue (Pesticide Paddy Field [PADDY], the European Union Mediterranean working group modelling tool [MED-Rice], Rice Water Quality [RICEWQ], and Pesticides in Flooded Applications [PFAM]). In Brazil, pesticides are used in paddy rice production, and there is a potential risk of these compounds reaching waterbodies. Legislative changes in 2023 made environmental risk assessment (ERA) mandatory for pesticide registration in Brazil. However, Brazil has not officially adopted a specific modeling tool for paddy rice systems. This critical review (a) evaluates the strengths and limitations of pesticide exposure models for paddy rice most commonly used in Europe, North America, Asia, and Latin America; (b) reviews the tools used in a regulatory context outside Brazil; (c) discusses exposure tools used in lower tiers and then proceeds to a discussion of more sophisticated tools used in higher tiers; (d) provides an overview of the paddy rice production system in Brazil; (e) performs a comparative analysis of the features of each exposure tool against the characteristics of the Brazilian paddy rice production system, and finally, (f) discusses which exposure tools may be most appropriate for integration into a prospective regulatory ERA framework in Brazil. The goal of this review is to contribute to the ongoing regulatory changes and discussions by identifying appropriate models that can effectively assess the environmental risks associated with pesticide use in Brazilian paddy rice cultivation.
An Introduction to the Complete Blood Count for Clinical Chemists: White Blood Cells
Authors: Osa-Andrews Bremansu , van Wijk Xander M R , Herrera Rivera Normarie , Seifert Robert P , Harris Neil S , Marin Maximo J
Published: January 2025

Background

The most frequently ordered laboratory test worldwide is the complete blood count (CBC). As clinical chemists are increasingly assigned to assist or direct laboratories outside of the traditional clinical chemistry sections, such as the automated hematology section, expertise must be established. This review article is a dedication to that ongoing effort.

Content

In this primer, the white blood cell (WBC) test components of the CBC are introduced, followed by a discussion of the laboratory evaluation of leukopenia and leukocytosis.

The laboratorian's approach to consult cases should be guided by the patient's clinical history and presentation while being able to provide key laboratory-based insights to assist in resolving result discrepancies that may otherwise go unnoticed.
Deaf legal theory: challenging the law’s hearing bias
Authors: Wilks Rob
Published: January 2025

Bryan and Emery introduced a new concept in legal jurisprudence through which a critical examination of how the law deals with deaf people can be undertaken: deaf legal theory (DLT). They define it as “how the law seeks to frame Deaf people” and argue that legal systems should be reoriented to recognise and accommodate the unique perspectives and experiences of deaf people. Current legal systems are biased in favour of hearing people and these bias disadvantage deaf people in a variety of ways, including in their access to justice, employment, and education. The aim of this article is to advance Bryan and Emery’s DLT by expounding its main arguments, situating it within its jurisprudential home of critical legal studies, considering the justification for its existence and providing a framework to apply it. The concept was introduced not within legal discourse but within Deaf Studies discourse and is therefore not yet widely known in legal scholarship. This article aims to bridge the gap between the two disciplines and firmly establish DLT as a legal theory in jurisprudence following which it can be applied to various legal subjects of intellectual enquiry.
Potential of dip treatments to disinfest cuttings of the invasive Thrips parvispinus (Thysanoptera: Thripidae)
Authors: Ataide Livia M S , Velazquez-Hernandez Yisell , Reyes-Arauz Isamar , Villamarin Paola , Canon Maria A , Revynthi Alexandra M
Published: January 2025

Thrips parvispinus (Karny) (Thysanoptera: Thripidae), an invasive thrips species, poses a significant threat to global agriculture due to its polyphagous nature and rapid spread. Its recent arrival in the continental United States raises concerns about potential impacts on ornamental and vegetable crops. Dip treatments might serve as a phytosanitary practice for growers to start with plants free of visible pests. This study aimed to assess the efficacy of dip treatments using 4 biorational and microbial insecticides (mineral oil and Beauveria bassiana-based) in controlling T. parvispinus on bean seedlings. Following gentle agitation of cuttings, artificially infested with 10 second-instar (L2) larvae, for 15 s in each solution, thrips infestation was evaluated at 1, and 24 h postdipping, scoring the numbers of dislodged and dead larvae. Additionally, we tested whether dipping could cause phytotoxicity on bean (Phaseolus vulgaris L.), gardenia (Gardenia jasminoides Ellis), and mandevilla (Mandevilla splendens (Hook.f.) Woodson) cuttings during a 7-day period. Our results demonstrated that dip treatments effectively dislodged and killed T. parvispinus L2 larvae from infested cuttings, with BotaniGard-ES and Suffoil-X exhibiting the highest efficacy and a dislodgment rate of 80%–100%. BotaniGard-ES was the only product causing phytotoxicity on bean seedlings, but not on mandevilla and gardenia. Overall, we demonstrated that dip treatment using biorational insecticides is an additional tool that can be incorporated in the integrated pest management of T. parvispinus. These results hold implications for the broader application in the management of thrips across various plants propagated from cuttings.
Numerical viscosity and resistivity in MHD turbulence simulations
Authors: Shivakumar Lakshmi Malvadi , Federrath Christoph
Published: January 2025

For magnetohydrodynamical (MHD) turbulence simulations to accurately capture the underlying physics, we must understand numerical dissipation. Here, we quantify numerical viscosity and resistivity in the subsonic and supersonic turbulence regimes, with Mach numbers $\mathcal {M}= 0.1$ and 10, respectively. We find that the hydrodynamic (${\mathrm{Re}}$) and magnetic Reynolds numbers (${\mathrm{Rm}}$) on the turbulence driving scale $\ell _{\mathrm{turb}}$ in a cubic domain of side length L with a total of $N^3$ resolution elements are well described by ${\mathrm{Re}}=[2(N/N_{\mathrm{Re}})(\ell _{\mathrm{turb}}/L)]^{p_{\mathrm{Re}}}$ and ${\mathrm{Rm}}=[2(N/N_{\mathrm{Rm}})(\ell _{\mathrm{turb}}/L)]^{p_{\mathrm{Rm}}}$. We provide two sets of fit values of $(N_{\mathrm{Re}}, p_{\mathrm{Re}}, N_{\mathrm{Rm}}, p_{\mathrm{Rm}})$: one with $p_{\mathrm{Re}}$ and $p_{\mathrm{Rm}}$ fixed at their theoretical values, and the other one allowing all four parameters to vary. The sets for $\mathcal {M}=0.1$ are $(1.57_{-0.12}^{+0.10},4/3,1.55_{-0.14}^{+0.45},4/3)$ and $(0.83_{-0.08}^{+0.09},1.20_{-0.02}^{+0.02},4.19_{-4.05}^{+2.95},1.60_{-0.33}^{+0.18})$, respectively. For $\mathcal {M}=10$, they are $(3.55_{-0.56}^{+0.78},3/2,1.03_{-0.11}^{+0.12},3/2)$ and $(10.46_{-0.85}^{+0.96},1.90_{-0.04}^{+0.04},0.44_{-0.23}^{+0.61},1.32_{-0.09}^{+0.17})$. The resulting magnetic Prandtl numbers (${\mathrm{Pm}}={\mathrm{Rm}}/{\mathrm{Re}}$) are consistent with constant values of $1.0_{-0.2}^{+0.3}$ for $\mathcal {M}= 0.1$, and $6.2_{-4.8}^{+5.6}$ for $\mathcal {M}= 10$. These results apply when the magnetic energy ($E_{\mathrm{mag}}$) is $\lesssim 10{{\ \rm per\ cent}}$ of the turbulent kinetic energy ($E_{\mathrm{kin}}$). When $E_{\mathrm{mag}}/E_{\mathrm{kin}}\sim 0.1-1$, ${\mathrm{Rm}}$ is reduced by a factor $\sim 3$ (implying an increase in $N_{\mathrm{Rm}}$ by a factor $\sim 2$) for $\mathcal {M}=0.1$, while ${\mathrm{Rm}}$ for $\mathcal {M}=10$ and ${\mathrm{Re}}$ (for any $\mathcal {M}$) remain largely unaffected. We compare our ${\mathrm{Re}}- N$ relation with 14 other simulations from the literature, which use a large range of different numerical methods (with and without Riemann solvers, different reconstruction schemes and orders, and smoothed particle hydrodynamics), and find that they all agree with the ${\mathrm{Re}}- N$ relations above to within a factor of three. We further compare these results to target ${\mathrm{Re}}$ and ${\mathrm{Rm}}$ values in simulations using explicit dissipation from the literature. These literature comparisons and our relations allow users to assess what value of ${\mathrm{Re}}$ and ${\mathrm{Rm}}$ can be reached at a given N, ensuring that physical dissipation dominates over numerical dissipation.
Viscous circumbinary protoplanetary discs – II. Disc effects on the binary orbit
Authors: Penzlin Anna B T , Booth Richard A , Nelson Richard P , Schäfer Christoph M , Kley Wilhelm
Published: January 2025

More than half of all stars are part of binaries, and many form in a common circumbinary disc. The interaction with the binary shapes the disc to feature a large eccentric inner cavity and spirals in the inner disc. The shape of the cavities is linked to binary and disc properties such as viscosity and scale height, and the disc and cavity shape influence the orbital evolution of the binary stars. This is the second part of the study in which we use 2D hydrodynamic long-term simulations for a range of viscous parameters relevant to protoplanetary discs to understand the interaction between young stars and the circumbinary disc. The long-term simulations allow us to study how disc shape and exchange of mass, momentum, and energy between binary and disc depend on the precession angle between disc and binary orbit on time-scales of thousands of binary orbits. We find a considerable, periodic interaction between the precession of the disc and the binary eccentricity that can significantly exceed the precession-averaged change in eccentricity. We further confirm that thin discs ($H/R\lt 0.05$) lead to shrinking binary orbits, also in the regime of low viscosity, $\alpha =10^{-3}$. In general, the disc can excite eccentricity in binaries with initial eccentricities in the range of $e_\mathrm{bin}=0.05\!\!-\!\!0.4$. In most cases, the terms aiding shrinking or expansion and circularization or excitation are nearly balanced, and the evolution of the binary semimajor axis and eccentricity will be sensitive to the ratio of mass accretion between the secondary and primary components.
Therapy enhancing chromosome instability may be advantageous for IDH1R132H/WT gliomas
Authors: Goncharov Nikolay V , Baklanov Ivan N , Gulaia Valeriia S , Shuliak Anastasiia P , Lanskikh Daria V , Zhmenia Valeriia M , Shmelev Mikhail E , Shved Nikita A , Wu Jing , Liskovykh Mikhail , Larionov Vladimir , Kouprina Natalay , Kumeiko Vadim V
Published: January 2025

Recently revised brain tumor classification suggested a glioma treatment strategy that takes into consideration molecular variants in IDH1 and TP53 marker genes. While pathogenic variants of IDH1 and TP53 can be accompanied by chromosomal instability (CIN), the impact of IDH1 and TP53 mutations on genome stability remains unstudied. Elevated CIN might provide therapeutic targets, based on synergistic effects of chemotherapy with CIN-inducing drugs. Using an assay based on human artificial chromosomes, we investigated the impact of common glioma missense mutations in IDH1 and TP53 on chromosome transmission and demonstrated that IDH1R132H and TP53R248Q variants elevate CIN. We next found enhanced CIN levels and the sensitivity of IDH1R132H/WT and TP53R248Q/R248Q genotypes, introduced into U87 MG glioma cells by CRISPR/Cas9, to different drugs, including conventional temozolomide. It was found that U87 MG cells carrying IDH1R132H/WT exhibit dramatic sensitivity to paclitaxel, which was independently confirmed on cell cultures derived from patients with naturally occurring IDH1R132H/WT. Overall, our results suggest that the development of CIN-enhancing therapy for glioma tumors with the IDH1R132H/WT genotype could be advantageous for adjuvant treatment.
Effect of Vitamin D Supplementation on Lipid Profile in Overweight or Obese Women: A Meta-analysis and Systematic Review of Randomized Controlled Trials
Authors: Hu Li , Velu Periyannan , Prabahar Kousalya , Hernández-Wolters Benjamin , Kord-Varkaneh Hamed , Xu Yan
Published: January 2025

Context

Previous studies have explored the relationship between vitamin D and lipid profile in individuals with obesity or overweight women, but the results have been inconsistent.

Objective

This meta-analysis and systematic review of randomized controlled trials (RCTs) was conducted to assess the effect of vitamin D on lipid profile in women who are overweight or obese.

Data Sources

A meticulous search strategy was used across the Scopus, PubMed/Medline, Web of Science, and Embase databases up to June 2024.

Data Extraction

RCT studies administering vitamin D to overweight or obese women were extracted. A random-effects model was applied to compute the weighted mean difference (WMD) and 95% CIs of the intervention on each variable.

Data Analyses

Thirteen eligible publications with 16 arms focused on low-density-lipoprotein cholesterol (LDL-C), 16 arms on high-density-lipoprotein cholesterol (HDL-C), 18 arms on total cholesterol (TC), and 18 arms on triglycerides (TG) were included in the final quantitative analysis. Vitamin D supplementation resulted in significant reductions in TG (WMD: −6.13 mg/dL; 95% CI: −8.99 to −3.28; P = .000) and TC (WMD: −4.45 mg/dL; 95% CI: −7.06 to −1.83; P = .001), as well as a significant increase in HDL-C concentrations (WMD: 1.54 mg/dL; 95% CI: 0.57 to 2.52; P = .002). Stratified analysis indicated a greater reduction in TG levels in studies with a mean baseline TG concentration ≥150 mg/dL (WMD: −23.58 mg/dL) and when vitamin D was administered for ≤26 weeks (WMD: −11.44 mg/dL).

Conclusion

According to our findings, vitamin D has a significant effect on hypertriglyceridemia in individuals who are overweight or obese. However, vitamin D has no significant effect on LDL-C concentrations in this population.
213. Electronic Visit (E-visit) Use for Sexually Transmitted Infection (STI) Testing in a Large Integrated Healthcare System
Authors: Clutter Dana S , Thornton Amanda , Ni Yuching , Hsiao Crystal , Volk Jonathan E , Silverberg Michael , Lee-Rodriguez Christian , Luu Mitchell N , Bruno Christine B , Vinson David R , Srisuro Anne , Nugent Joshua , Skarbinski Jacek
Published: January 2025

Background

To improve access to sexually transmitted infection (STI) and HIV prevention services, Kaiser Permanente Northern California (KPNC), an integrated healthcare system, launched a sexual health electronic visit (E-visit) in February 2022. This E-visit allows users to self-order STI testing and other sexual health services through the healthcare patient portal.

Methods

We conducted a retrospective cohort study to characterize E-visit use for STI testing among all persons who had STI testing within KPNC from February 13, 2022 to December 31, 2023. We compared demographic factors of persons requesting STI testing via the E-visit with those who accessed STI services via conventional pathways. We used log-binomial regression to assess factors associated with E-visit use and compared STI test positivity among persons who used the E-visit versus those who used conventional pathways.

Results

Of the 773,884 persons who underwent STI testing, 120,064 (16%) used the sexual health E-visit and 653,820 (84%) used conventional pathways. Younger persons were more likely to use the E-visit, with persons aged 18-24 years being the most likely to use the E-visit (adjusted prevalence ratio [aPR] 1.61 [95% CI 1.58, 1.64] compared with persons aged 35-44 years) (Table 1). Compared with white persons, black persons were more likely to use the E-visit (aPR 1.48 [95% CI 1.45, 1.5]). Men were more likely than women to use the E-visit (aPR 1.12 [95% CI 1.11, 1.14). Use was similar across socioeconomic status. Persons with HIV were less likely to use the E-visit (aPR 0.51 [95% CI 0.48-0.55]), whereas those with prior or current HIV pre-exposure prophylaxis use were more likely (aPRs 1.48 [95% CI 1.37, 1.6] and 2.0 [95% CI 1.94, 2.05], respectively). Test positivity was higher for E-visit testing compared with conventional pathways for urogenital chlamydia (4.6% vs. 2.1%; p < 0.0001), urogenital gonorrhea (0.9% vs. 0.5%; p < 0.0001), rectal chlamydia (5.6% vs 4.0% p < 0.0001), and pharyngeal chlamydia (2.0% vs 1.3%, p < 0.0001) (Table 2).

Conclusion

The KPNC sexual health E-visit is used by individuals at risk for STIs, including younger and black persons, with higher test positivity for urogenital gonorrhea and chlamydia, rectal chlamydia, and pharyngeal chlamydia.

Disclosures

All Authors: No reported disclosures
294. Assessment of Disinfectants for Reducing Candida auris Burden on Needleless Connectors: an In Vitro Study
Authors: Cecilia Tran Truc , Adelman Max W , Murali Shiva , Jimenez Adriana , Arias Cesar A , Shukla Bhavarth S
Published: January 2025

Background

Candida auris, an emerging fungal pathogen, has triggered outbreaks in healthcare settings. It frequently colonizes patient skin, surfaces in their immediate clinical environment, and medical devices, including central venous catheters and connectors. Effective disinfection is vital for patient safety. However, many commonly used disinfectants may have limited efficacy against C. auris and their ability to clean contaminated connects remain uncertain. This study assesses the effectiveness of commonly used disinfectants in reducing C. auris contamination in needleless connectors.

Changes in C. auris and C. albicans catheter contamination after disinfecting with several commonly used products.

Methods

Needleless connectors of Arrowg+ard Blue Plus® Four-Lumen Catheters were contaminated with C. auris and C. albicans over a 24-hour period. Disinfection procedures involved using single-use disinfecting cap protectors containing 70% isopropyl alcohol (IPA), wipes with 70% IPA, and wipes containing 3.15% chlorhexidine gluconate plus 70% IPA (CHG + IPA). The disinfection process included mechanically rotating the wipes and caps in both clockwise and counterclockwise directions for 15 seconds, followed by allowing the connectors to dry for an additional 15 seconds. Treated and control connectors were then immersed in 1 ml of 0.9% NaCl solution, placed in an ultrasonic bath for 1 minute, and subsequently enumerated on Sabouraud dextrose agar.

Results

Two strains of C. auris and one strain of C. albicans were used. Under untreated conditions, C. auris exhibited colonization ranging from 4.4 to 5.0 log10 CFU/ml. Disinfection procedures resulted in a reduction of C. auris fungal load by 1.43 to 2.90 log10 CFU/ml, indicating a 91.2% to 99.9% reduction in CFU/ml across all products. However, efficacy was lower with IPA alone (refer to Table 1). Against C. albicans, disinfecting products reduced the fungal load from 3.66 log10 CFU/ml to 0.82 to 1.52 log10 CFU/ml, representing >99.2% reduction in all conditions, with the most significant reduction observed with the IPA cap and CHG + IPA wipe.

Conclusion

Our findings indicate that commonly used disinfectants have limited efficacy against C. auris colonization in needleless connectors compared to C. abicans. Further research is warranted to assess optimal methods and products for decontaminating devices from this emerging pathogen.

Disclosures

Cesar A. Arias, MD, MSc, PhD, UpToDate, Inc.: Royalties
308. Development and Validation of a LASSO-based Score to Predict 1-year Mortality After Discharge in Patients with Severe Pneumonia Admitted to the Intensive Care Unit
Authors: Garcia-Gallo Esteban , Duque-Vallejo Sara , Sanabria-Herrera Natalia , Viñán Garcés André Emilio , Narváez - Ramírez Oriana , Ramirez Valbuena Paula Camila , Reyes Luis Felipe F
Published: January 2025

Background

Severe community acquired pneumonia(sCAP) is the leading cause of ICU admission around the globe and is responsible for more than 3.5 million deaths yearly. Up to 40% require ICU admission and present a mortality rate up to 50%. Many risk factors for long-term mortality have been previously identified; however, current CAP severity scores do not discriminate patients at higher risk to die 1-year after the sCAP episode.

Figure 1. Comparative Analysis of Severity Score AUCs: Evaluating Discriminatory Power Across Metrics. A) Training B) Validation C) SAPS II D) Charlson Comorbidity Index E) SOFA F) CURB-65

Methods

In this retrospective cohort study, data of 4748 adult patients with sCAP were obtained from the Medical Information Mart for Intensive Care IV(MIMIC-IV) 2001-2012 database. Univariate logistic regression analysis was used to identify those variables that tend to have a significant impact on 1-year mortality. Then a multivariate analysis was carried out to identify variables associated with one-year mortality in SCAP patients. Finally, a predictive model was developed and compared with the widely used severity of disease classification system SAPS-II. 10-fold cross-validation method was used to assess the performance metrics. The data were divided into training and validation sets in a 4:1 ratio. The least absolute shrinkage and selection operator (LASSO) regression method was used to screen the variables and to test the accuracy of the risk prediction model.

Results

17 key factors were used as independent risk factors for 1-year mortality to construct the prediction model, including age, heart rate, temperature, Glasgow coma scale, malignant cancer, severe liver disease, ARDS, BUN, INR, Prothrombin Time, bilirubin, hemoglobin, urine output, supplementary oxygen, vasopressors, piperacillin tazobactam and ceftriaxone prescription. The AUC values of the prediction training and validating model were superior to the SAPS II, Charlson Comorbiditiy index, the SOFA, and CURB-65 scores [0.79, 0.80, 0.71, 0.69, 0.62, and 0.64, respectively] (Figure 1).

Conclusion

Our prediction model could effectively predict 1-year mortality in patients with sCAP; additionally, it exhibits commendable classification accuracy within the ICU patient population underscoring its potential utility as a valuable prognostic tool for clinical decision-making in critically ill individuals.

Disclosures

All Authors: No reported disclosures
P-840. Is Staphylococcus lugdunensis just another coagulase-negative Staphylococcus? A Comparative Study of community-acquired Staphylococcus lugdunensis and methicillin-susceptible Staphylococcus aureus Bacteremia
Authors: Chung Jessica , Wathan Khin , Aung Aye Honey , Maung Aye Cherry Maung , Liu Franklin , Ghitan Monica , Chapnick Edward , Shia Lin Yu
Published: January 2025

Background

Staphylococcus lugdunensis (SL), a coagulase-negative staphylococcus (CoNS), usually a skin commensal, has demonstrated similar virulence to Staphylococcus aureus. Current studies have compared SL bacteremia (SLB) to S. aureus bacteremia, primarily hospital-onset methicillin-resistant Staphylococcus aureus bacteremia. Our study is the first to compare the clinical characteristics and outcomes between community-acquired SL bacteremia (SLB) and MSSA bacteremia (SAB).Table 1:Patient Demographics

Methods

This retrospective cohort study evaluated hospitalized adults with SLB and SAB at an urban tertiary care center from January 1, 2017 to December 31, 2022. CA-BSI was defined as at least one positive blood culture with SL or methicillin-susceptible Staphylococcus aureus (MSSA) within 72 hours of admission. Patients previously hospitalized within 30 days, on chemotherapy, or transferred from another facility were excluded. The primary outcome was in-hospital mortality rate with a secondary outcome of hospital length of stay (LOS). The Whitney Mann U test and chi-square test were used for the analysis.

Figure 2

Results

33 SLB patients and 66 SLB patients were included. The demographics of both groups are seen in Table 1. The SLB group was older and had a higher Charlson Comorbidity Index score compared to the SAB group. The incidence of SLB increased during the study period while the incidence of SAB remained the same (Figure 1). Two-thirds of the patients in both groups met sepsis criteria on presentation. 33% of SLB and 18% of SAB had a Pitt bacteremia score of ≥4 points. Endocarditis, skin and soft tissue infections, osteoarticular, line-related, and pneumonia are the primary sources of infections in SLB and SAB. There was no statistical difference in rates of ICU admission, need for ventilator support, need for renal replacement therapy, and length of stay between the two groups. In-hospital mortality was 15% for both groups.

Conclusion

SL is a CoNS recognized as an emerging pathogen. The incidence of CA-SLB is increasing, particularly in older individuals with underlying comorbid conditions. The in-hospital mortality rate associated with SLB is as high as CA-SAB. Clinicians must recognize the high pathogenicity of SLB and implement comprehensive strategies to prevent morbidity and mortality.

Disclosures

All Authors: No reported disclosures
P-848. Proactive Pharmacy-led Transition of Care Protocol to Increase Appropriate Oral Antibiotic Use in Uncomplicated Gram-Negative Bacteremia
Authors: Kufel Julia , McFadden Cadhan , Avery Lisa
Published: January 2025

Background

Limited data are available to describe a pharmacist-driven Gram-negative bacteremia (GNB) protocol on treatment optimization and outcomes. The primary outcome was a composite of the percentage of patients on a pharmacist-driven antibiotic protocol. Secondary outcomes evaluated 30-day all-cause mortality and infection-related readmission.

Methods

This was a single-center, quasi-experimental study conducted in a 451-bed community teaching hospital. The pre- and post-intervention cohorts included patients from 8/1/22-9/30/23 and 10/1/23-4/31/24, respectively. Patients aged >18 years with GNB were included. Patients who are immunocompromised, had a non-functional gastrointestinal tract, were enrolled in hospice, expired during hospitalization, pregnant, left against medical advice, had a polymicrobial infection, bacteria resistant to all PO agents, inadequate source control, or those with infectious disease consultations were excluded. For the intervention, a pharmacist-driven GNB protocol was developed to include the definition of uncomplicated GNB, clinical improvement criteria, ranked order of preferred PO antibiotics with appropriate dosing and duration of therapy. These recommendations were communicated to providers by pharmacists. The Chi-square test and student t-test were used for nominal and continuous data, respectively. A p-value of < 0.05 was considered statistically significant.

Results

There were 61 and 41 patients in the pre- and post-intervention cohorts, respectively. Demographics were similar. The primary outcome was achieved in 59% and 81% of patients, respectively (p=0.02). Urinary source was most common, including 75% in the pre and 85% in the post-intervention group (p=0.22). Trimethoprim-sulfamethoxazole use increased from 6% to 29% (p=0.002). No difference in 30-day all-cause (p=0.51) and infection related readmission (p=0.82) was identified.

Conclusion

Implementation of a proactive pharmacy-led GNB protocol increased the use of appropriate PO transition regimens in uncomplicated GNB.

Disclosures

All Authors: No reported disclosures
P-853. Prevalence, Clinical Data and Associated Risk Factors of Third Generation Cephalosporin Resistance in Salmonella spp. Septicemia in Northeast of Thailand
Authors: Thivakorakot Kunakorn , Meesing Atibordee , Phanthanawiboon Supranee
Published: January 2025

Background

The increase of antimicrobial resistance bacteria among foodborne pathogens including Salmonella spp. has been associated with poor outcomes. The studies of prevalence and risk factors of Salmonella spp. resistance in Thailand is limited. Hence, this study was conducted to study the prevalence and risk factors of third-generation cephalosporin resistance in Salmonella septicemic patients.

Heat map showing the proportion of antimicrobial resistance in Salmonella spp.

Methods

A retrospective study was conducted between January 1st, 2016, to June 30th, 2023, in Srinagarind Hospital Khon Kaen, Thailand. All patients with hemoculture positive for Salmonella spp. who aged ≥ 18 years were included for analysis.

Subgroup analysis

Results

A total of 139 patients with Salmonella septicemia were included in this study, The mean age was 56.54 years and males were 51.8%. The prevalence of third-generation cephalosporin resistance Salmonella spp. was 8.8%. The most common primary infection site was primary bacteremia (66.9%), gastrointestinal tract (12.9%), Urinary tract (7.2%), bone and joint (3.6%), and arteritis (3.6%) respectively. Mortality was 7.1% (1 patient died from resistant strain). Carbapenem, piperacillin/tazobactam, and ciprofloxacin were an alternative treatment in the resistant group. There are no statistically significant among previously known factors associated with third-generation cephalosporin resistance in Salmonella septicemic patients.

Vital signs and laboratory investigations

Conclusion

The prevalence of third-generation cephalosporin resistance in Salmonella septicemic patients in this study was higher than overall in Thailand but lower than in tertiary care hospitals in Bangkok. Mortality was not higher in the resistant group. The mortality rate is not associated with ceftriaxone resistance in Salmonella spp. septicemia.

Empirical antibiotic of choice

Disclosures

All Authors: No reported disclosures
P-859. Shorter versus Longer Duration of Antibiotic Therapy for Gram-Negative Bacteremia (GNB) in Immunocompromised Patients
Authors: Slain Nicole , Randazza Olivia , Taylor Alex D , Williamson John C , Hartis Charles , DeWitt Michael E , Palavecino Elizabeth , Ohl Christopher , Luther Vera P , Maves Ryan C , Banoub Mary
Published: January 2025

Background

Although there is no standard duration of therapy for GNB, 14 days has been commonly used. In recent years, studies have evaluated shorter durations of antibiotics (abxs) specifically for uncomplicated GNB in immunocompetent patients. The purpose of this study was to determine whether a shorter duration of abx therapy for GNB in immunocompromised patients had an impact on clinical outcomes compared to a longer abx duration.

Methods

This was a single-center, retrospective, matched pairs study from July 2021 to August 2023. Patients were included if they were ≥ 18 years old, hospitalized with GNB, and met immunocompromising criteria. A blood culture report was obtained and cross referenced with ICD-10 codes to identify patients. Short durations of abxs were considered ≤ 8 days, while a long duration was ≥ 10 days. The primary outcomes were all-cause mortality and abx failure at 90 days (defined as a relapsed blood stream infection, new local suppurative complication, or a new distant complication). Secondary outcomes consisted of 30 day infection related hospital readmission, length of stay, Clostridioides difficile infections, total active days of therapy, and development of resistance. Patients were matched in a 1:1 ratio based on type of GNB (Enterobacterales vs non-Enterobacterales), age (+/- 10 years) and Pitt Bacteremia Score (+/- 1).

Results

29 matched pairs were included (Figure 1). The majority of matched pairs (96.6%) had Enterobacterales infections. The most common immunocompromising conditions were diabetes (21/29 and 19/29) and solid tumors (12/29 and 8/29) in the short and long groups, respectively. Most infections originated from the urinary tract, 16 (55.2%) in the short group and 20 (69.0%) in long group (Table 1). All-cause mortality within 90 days occurred in 2 (6.9%) patients in both the short and long groups (P value >0.9). Abx failure occurred in 1 (3.4%) patient in the short group and 2 (6.9%) in the long group (P value >0.9) (Table 2).

Conclusion

Shorter durations of abx therapy for GNB in immunocompromised patients showed similar clinical outcomes compared to longer durations of therapy. These findings support further investigation with an appropriately powered randomized prospective trial.

Disclosures

John C. Williamson, PharmD, Armata Pharmaceuticals: Grant/Research Support|Blue Collar Vaccines and Therapeutics: Board Member|Blue Collar Vaccines and Therapeutics: Ownership Interest|Paratek Pharmaceuticals: Grant/Research Support|ST Pharm Co, Ltd: Grant/Research Support Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support
P-906. Diagnosis, Treatment, and Outcomes in Patients with Central Nervous System Blastomycosis
Authors: Biggs Megan
Published: January 2025

Background

Blastomyces is a dimorphic fungus found in the soil and is endemic to regions of the Ohio River basin and Southeastern United States. It can cause both local and systemic infections in several organs regardless of immunity status. Infection occurs through inhalation of aerosolized conidia. Blastomycoses most commonly affects the lungs and infection of the central nervous system (CNS) is rarely found representing approximately 5-10% of individuals with extra-pulmonary blastomycosis.

Demographics of Patients with CNS Blastomycosis

Methods

Given the limited information on this rare form of blastomycoses, a retrospective review was conducted at a major tertiary center in Minnesota of adult inpatients diagnosed with proven or probable CNS blastomycoses between 2005 and 2020. Institutional Review Board approval at the Mayo Clinic was obtained. Data pertaining to diagnostic evaluation, treatment and outcomes were collected from eight medical charts found to meet criteria for proven or probable CNS Blastomycosis.

Diagnosis, Treatment, and Outcomes in Patients with CNS Blastomycosis

Results

As seen in prior studies, most patients were male. The most common CNS related symptom on presentation was headache. Frequent comorbidities included diabetes, COPD, and alcohol use. Findings on MRI varied greatly. Blastomyces serum antibody was positive in only half of patients and urine antigen was frequently negative, however this test was not performed in one patient in this study. All but one patient survived to at least one year post diagnosis. All patients were treated with liposomal amphotericin B ranging from nine days to six weeks and voriconazole was the most frequently used azole. All patients treated with voriconazole survived at least one year following completion of treatment.

Diagnosis, Treatment, and Outcomes in Patients with CNS Blastomycosis (continued)

Conclusion

This study emphasizes the importance of having a high suspicion when CNS symptoms are present in a patient with evidence of Blastomyces. Additionally, patients can have proven CNS blastomycoses without Blastomyces positive antibodies and/or antigen in blood or urine as well as variable MRI findings.

Laboratory and Culture Results in Patients Found to Have CNS Blastomyces

Disclosures

All Authors: No reported disclosures
P-918. Rabies encephalitis: Spectrum of MRI findings and predicted probability of abnormality detection based on symptom duration
Authors: Mohata Madhav , Suri Vikas , Singh Paramjeet
Published: January 2025

Background

Rabies is a highly lethal infectious disease and is equivalent to a death sentence for the patient. With currently available tests, the ante-mortem diagnostic sensitivity is only ∼40%. Currently, there are only isolated case reports or small case series exploring the MRI features in rabies encephalitis.

T2 TSE showing hyperintensities in bilateral basal ganglia (caudate nucleus, putamen and globus pallidus) and thalamus and corresponding DWI and ADC images showing true diffusion restriction

Methods

A prospective observational study was designed to explore the patterns of MRI abnormalities in rabies patients. A total of 31 patients were enrolled in the study, out of which 21 underwent Contrast-Enhanced Magnetic Resonance Imaging of Brain and spinal cord.

FLAIR/T2 images showing hyperintensities in dorsal brainstem, cervical spinal cord

Results

Overall, MRI was normal in 10(47.6%) patients, whereas 11(52.4%) patients showed abnormalities. Abnormalities were detected in various brain regions with brainstem, spinal cord and basal ganglia being the most commonly affected regions. Other regions such as the cortex, sub-cortical white matter, limbic system, internal capsule, corona radiata, thalamus, and sub-thalamic region were also involved to varying degrees. Diffusion-weighted-imaging showed typical pattern of diffusion restriction in 6 cases (28.5%). No gadolinium contrast enhancement was observed in any patient. Overall, no significant difference in neuroimaging findings were observed between encephalitic and paralytic forms of rabies. In addition, univariate logistic regression analysis revealed that the likelihood of detecting abnormalities on MRI increases with the duration from the symptom onset.

T2 hyperintensity in conus medullaris with contrast enhancing cauda equina nerve roots

Conclusion

Till date this is the largest prospective study (21 cases) exploring the MRI findings in the patients of rabies encephalitis. The study demonstrated certain patterns of brain imaging in rabies which in the appropriate clinical context could significantly aid in establishing the ante-mortem diagnosis of rabies encephalitis. At the same time, the study also highlights the fact that a normal MRI brain does not rule out the diagnosis and that the probability of finding specific abnormalities on MRI increases as the disease progresses.

Univariable logistic regression to estimate predicted probability of appearance of MRI abnormality after appearance of 1st cardinal symptom

Disclosures

All Authors: No reported disclosures
P-949. The Success of Rapid-Fire Journal Club in Achieving Doctor of Pharmacy Educational Outcomes
Authors: Bradley Nicole , Lee Yuman
Published: January 2025

Background

Rapid-fire journal club is an activity in the infectious diseases elective for pharmacy students in their third professional year. In small groups, students were tasked with completing a journal club on an assigned study evaluating new antibiotics for treatment of resistant gram-negative infections. Students were given 1 week to prepare their presentation, and 10 minutes deliver their presentation. The goal of rapid-fire journal club was to engage pharmacy students in primary literature relating to new antibiotic agents and differentiate how each of the agents is best used in practice. The purpose of this study was to assess the impact of rapid-fire journal club on achieving Curriculum Outcomes and Entrustable Professional Activities (COEPA) within a Doctor of Pharmacy Program.

Methods

Student feedback was anonymously collected via an electronic survey. Students evaluated the impact of rapid-fire journal club across the 3 domains of the American Association of Colleges of Pharmacy (AACP) COEPA educational outcomes (Knowledge, Skills, and Attitudes) on a Likert scale from strongly disagree (1) to strongly agree (5). Student perceptions and feedback on the activity were also collected.

Results

29 of the 38 students who participated responded. Majority strongly agreed or agreed that rapid-fire journal club allowed them to build foundational knowledge of antibiotics for resistant gram-negative infections (27/29, 93.1%), solve problems (21/29, 72.4%), improve communication among colleagues (24/29, 82.7%), understand the role of primary literature in improving antibiotic use (26/29, 89.7%), support shared goals on a team (25/29, 86.2%), and build and maintain trust among colleagues (25/29, 86.2%).

Majority of students rated the activity a 3 out of 5 in difficulty, found the activity engaging, and enjoyed participating.

Conclusion

Rapid-fire journal allowed pharmacy students to achieve key Doctor of Pharmacy educational outcomes across the 3 COEPA domains. The activity was positively received by students and provided them with a unique activity within the classroom.

Disclosures

All Authors: No reported disclosures