bluuebunny/crossref_metadata_2025 huggingface dataset:
2015. Challenges in Assessing Blood Stream Infection Clearance in Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Frankford Stone A , Sobieszczyk Michal J , Markelz Ana E , Marcus Joseph E
Published: December 2022

Background

There is a limited published data on the treatment of blood stream infections (BSI) in patients receiving extracorporeal membrane oxygenation (ECMO). Traditionally, the management of only fungal and Gram-positive BSIs require follow-up blood cultures to document clearance. The presence of large retained cannulas in ECMO create concern for persistent bacteremia. This study investigates whether certain variables are predictive of blood stream infections with positive repeat cultures (BSIPRC) and if BSIPRC is associated with increased mortality.

Methods

All positive blood cultures from patients receiving ECMO at Brooke Army Medical Center identified between September 2012 and October 2021 were included in this study. Blood cultures were excluded if they were determined to be contaminants by the primary team. For each positive blood culture, charts were retrospectively reviewed. Date of clearance was defined as the first negative blood culture after a positive. BSIPRC was defined as re-isolation of the same organism on repeat blood cultures following an initial positive blood culture.

Results

A total of 60 patients and 87 BSI were investigated (38.5 BSI per 1000 ECMO days). Gram-positive (GP) organisms caused a majority of BSI (n=52, 60%) followed by Gram-negative (GN) (n=22, 25%) and fungal (n=13, 15%) infections. Of the 80 (92%) BSIs who had repeat blood cultures drawn, patients had BSIPRC in 35 (44%) of cases. There were no clinical features that differentiated patients with positive repeat cultures (Table). There was no difference in survival to discharge for patients with BSIPRC as compared to single day BSI (20 (58%) vs. 28 (63%), p=0.78). In 6 patients with BSIPRC with Gram-negative organisms, two (33%) died before clearance and five (83%) died before decannulation.

Characteristics of patients and all blood stream infections.

Conclusion

There were no clinical findings that differentiated patients with BSIPRC from those who had a single day of positivity. BSIPRC was associated with high mortality in patients with Gram-negative bacteremia. In the absence of clear predicative factors in demonstrating clearance of BSI, repeat blood cultures may be necessary. Future studies are needed to determine why Gram-negative BSIPRC are associated with a high mortality.

Disclosures

All Authors: No reported disclosures.
15. Forecasting the Monkeypox Outbreak: Using a SIR Epidemic Model
Authors: Mendes Neto Nilson N , Maia Marcio R G , Mendes Jessika Maia , Zacarkim Marcelo , Aronoff David M , Forgerini Fabricio L
Published: December 2022

Background

Monkeypox virus person-to-person transmission mostly occurs by personal contact with an infected individual or surface. We used the classical susceptible-infectious-removed (SIR) epidemic model (Figure 1) to forecast the virus spread in a simulated population.

Diagram of the SIR epidemic model

Methods

SIR model equations (ds/dt = −βsi; di/dt = βsi − µi; dr/dt = µi) were applied. We assumed an infection rate β = 9%; recovery rate µ = 100%; incubation period ranged from 4 to 21 days; length of a timestep = 15 days. Initially 150 infected individuals in a N= 10,000 population were organized in a lattice format (Figure 2) in which everyone has the same number of connections.

Schematic infection process: Initial condition with a susceptible population (white circles); we put a few infected individuals (red circles); the infection spreads through the nearest neighbors; then, the previously infected population gets recovered (blue circles) and the virus transmission continues.

Results

Around 45 days after the transmission started, we obtained a maximum incidence of 2.5% (Figure 3) of infection in the population. At this time, 0.5% of the infected cases will be recovered from monkeypox infection. If the fraction of initially infected cases is smaller than 150/10,000, our simulations show that the outbreak would end in the early days.

Numeric simulation of the SIR epidemic model in a lattice format and using β = 9%, µ = 100% and N = 10,000

Conclusion

Applying our results to the US population (335 million), almost 10 million people might be affected by monkeypox. Considering that infected people should be isolated for up to 21 days, this could lead to negative impacts on the economy as people would be out of their work environments. In addition, monkeypox could put even more pressure on the health system already worn out by the COVID-19 pandemic. This study might be used by health agencies to plan coordinated actions to contain the spread of monkeypox virus.

Disclosures

All Authors: No reported disclosures.
116. Potential Clinical Impact of Respiratory Syncytial Virus (RSV) Vaccination in Older Adults in the United States
Authors: Fust Kelly , Kohli Michele , Panozzo Catherine A , Weinstein Milton C , Buck Philip , Ghaswalla Parinaz
Published: December 2022

Background

RSV causes acute respiratory disease (ARD), including severe lower respiratory tract disease (LRTD) in older adults, which can lead to hospitalization and death. Currently, there are no vaccines approved to prevent RSV disease. This study estimated the potential clinical impact of a hypothetical RSV vaccine over a 1-year time horizon in older adults aged ≥ 60 years.

Methods

A decision-analytic model was developed (Figure 1). A strategy was used where the entire US population aged ≥ 60 years was given a single dose vaccine with an assumed efficacy of 75% against ARD, LRTD, and LRTD-hospitalizations and compared to a population who did not receive a vaccine. Given the uncertainty around RSV hospitalization rates, 2 base-case scenarios were created: (1) hospitalization rates that used RSV-specific claim codes and (2) hospitalization rates increased by 49% to account for underreporting in claims; Table 1 shows key inputs. One-way sensitivity analyses were used to assess the impact of specific parameter estimates.

Results

The vaccine would prevent 1.8 million and 0.6 million upper respiratory disease and LRTD cases, respectively; Figure 2 shows additional results for both base-case scenarios. The number needed to vaccinate (NNV) to prevent 1 LRTD case is 119; the NNV to prevent 1 LRTD hospitalization or death ranges from 792 to 1180 and 10,452 to 15,574, respectively. Sensitivity analyses indicate that results mainly depend on vaccine efficacy, and incidence of ARD and LRTD.

Conclusion

There is substantial US public health benefit associated with utilization of an effective RSV vaccine in individuals ≥ 60 years of age to reduce RSV-associated morbidity and mortality; however, the magnitude of impact depends on RSV epidemiology, which is still being defined for older adults. Several model parameters were based on assumptions, and robust evidence generation is needed including the efficacy of an RSV vaccine, which is an important consideration in assessing the impact of vaccination in this age group.

Disclosures

Kelly Fust, MS, Quadrant Health Economics Inc: Contractor at Quadrant Health Economics Inc who was funded by Moderna to perform this study Michele Kohli, PhD, Quadrant Health Economics Inc: Shareholder at Quadrant Health Economics Inc who was funded by Moderna to perform this study|Quadrant Health Economics Inc: Stocks/Bonds Catherine A. Panozzo, PhD, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Philip Buck, PhD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Parinaz Ghaswalla, PhD, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds.
218. A Phase 1 Study of the Single-Dose Safety, Tolerability, and Pharmacokinetics of the Beta-lactamase inhibitor Xeruborbactam Administered as the Isobutyryloxymethyl Oral Prodrug to Healthy Adult Subjects
Authors: Griffith David , Roberts Jason , Wallis Steven , Hernandez-Mitre Maria Patricia , Morgan Elizabeth , Dudley Michael , Loutit Jeff
Published: December 2022

Background

Xeruborbactam (XERU) is a member of a new class of cyclic boronic acid β-lactamase inhibitors with inhibitory activity against major members of Class A, B, C, and D beta-lactamases. This report describes the first safety and pharmacokinetic data following oral administration as the isobutyryloxymethyl prodrug in humans.

Methods

Forty-eight healthy subjects were enrolled into one of 6 cohorts of 8 subjects each in the single ascending doses (100, 200, 400, 600, 800, and 1000 mg). Subjects were randomly assigned with each cohort to XERU oral prodrug (n = 6), or placebo capsule (n = 2). Intensive plasma (total drug) and ultrafiltrate (free drug) sampling was obtained after dosing and assayed for QPX7831 and XERU content using validated HPLC/MS methods.

Results

XERU PK parameters following oral administration as the prodrug are shown in the table below. Compared to IV XERU doses (data not shown), XERU bioavailability is 90 - 100% orally bioavailable.

No subjects discontinued due to AEs and no SAEs were observed. There was no evidence of increasing numbers or severity of AEs with increasing dose. All AEs were mild in severity.

Conclusion

Orally administered XERU was safe and well tolerated at all doses tested. Plasma XERU AUC and Cmax increased with increasing dose. XERU exposures (24h free AUC) exceed the predicted PK-PD parameter for stasis with once-daily doses of 400 mg or higher and exceed the PK-PD parameter for 1-log of bacterial killing once daily doses of 800 mg or higher. XERU, administered as an oral prodrug, has plasma PK properties that support once-daily administration.

Disclosures

David Griffith, n/a, Qpex Biopharma: Employee Jason Roberts, BPharm(Hons), PhD, FSHP, FISAC, British Society of Chemotherapy: Grant/Research Support|Cipla: Honoraria|Gilead: Advisor/Consultant|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Board Member|Pfizer: Honoraria|Qpex: Grant/Research Support|Sandoz: Board Member|Summit: Advisor/Consultant|Wolters Kluwer: Advisor/Consultant Elizabeth Morgan, n/a, Qpex Biopharma: Employee Michael Dudley, n/a, ArrePath: Board Member|Qpex Biopharma: Board Member|Qpex Biopharma: Employee Jeff Loutit, MBChB, Qpex Biopharma: Employee.
306. Development a Predictive Score for Severe Coronavirus Disease 2019 (COVID-19) from High Risk Factor of Patient Described by Thai Government Policy
Authors: Noopetch Preudtipong , Benchamanon Rutporn , Kongsuwan Samerjan , Chai-adisaksopha Chatree
Published: December 2022

Background

Thai government had a policy defined population groups that are at risk of severe COVID-19 infection. It is called “608 group” consisting of age more than 60 years old, obesity, diabetes mellitus, cancer, cerebrovascular disease, respiratory disease, chronic kidney disease, HIV infection, and pregnancy. But no study has evaluated performance of this policy. We aimed to develop parameter risk-based scoring system from Thai policy for diagnosis of severe COVID-19 infection.

Methods

A study was carried out in 11,677 patients with confirmed COVID-19 infection were admitted to Hatyai hospital, Songkhla, Thailand from 1 April 2021 to 31 December 2021. Patients were categorized to severe COVID-19 infection if their oxygen saturation less than 94% or need oxygen supplement. Multivariable logistic regression was used to explore for predictors. The logistic coefficients were transformed to risk-based scoring system.

Results

A total of 11,677 patients were included in analysis and predictive model development, 1036 (8.88%) patients were severe COVID-19 infection, and 10,631 (91.12%) patients were non-severe COVID-19 infection. Age more than 60 years old, obesity, diabetes, cancer, cerebrovascular disease, respiratory disease, chronic kidney disease, HIV infection, and pregnancy were used for derivation of the scoring system. The score-based model showed area under ROC of 0.81 (95%CI 0.79 – 0.82). The scoring system ranged from 0 to 40 was classified into 3 subcategories for clinical practicability. The sensitivity and specificity for predictive of severe COVID-19 were 81.18% and 69.83% for low risk patient, 70.56% and 80.79% in moderate risk patient, and 54.92% and 89.81% in high risk patient.

Conclusion

This simplified risk-based scoring system for prediction severe COVID-19 disease could aid general physicians or internist in evaluation and triage of patients who present with COVID-19 infection and help physicians in management and prioritization of patients in outbreak situation.

Disclosures

All Authors: No reported disclosures.
489. Bile Acid Concentrations in Healthy Volunteers Receiving Oral Omadacycline or Vancomycin
Authors: Jo Jinhee , Hu Chenlin , Wang Weiqun , Gonzales-Luna Anne J , Lancaster Chris , Garey Kevin W
Published: December 2022

Background

Microbiome disruption associated with Clostridioides difficile infection (CDI) includes reduced metabolism of primary to secondary bile acids leading to increased likelihood of C. difficile germination and CDI recurrence. Omadacycline has potent in vitro activity against C. difficile but its effect on the microbiome is unknown. The purpose of this study was to assess changes in bile acid concentrations in healthy volunteers given omadacycline compared to vancomycin, the most common antibiotic used to treat CDI.

Methods

As part of an ongoing healthy volunteer study of adults between 18 and 40 years, subjects received a 10-day course of oral omadacycline or vancomycin. Stool samples were collected and bile acids were extracted and quantified via targeted liquid chromatography-mass spectrometry (LC-MS). For this analysis, samples collected at the end of antibiotic therapy (day 9-10) were analyzed for primary and secondary bile acids. Results were compared and visualized using R (ggplot2).

Results

Between October 2020 and December 2021, 16 healthy volunteers aged 26 ± 5 years (male: 69%; Caucasian: 31%; mean body mass index: 23.6 ± 3.8 kg/m2) were enrolled. Concentrations of primary bile acids (cholic acid and chenodeoxycholic acid) were higher in patients receiving oral vancomycin than those receiving omadacycline (Table 1). Secondary bile acids were higher in the omadacycline arm compared to vancomycin. Secondary:primary bile ratio was higher for omadacycline (0.43) than vancomycin (0.03).

Conclusion

Omadacycline preserved bile acid homeostasis in the gut to a higher extent that vancomycin, suggesting reduced microbiome dysbiosis. With potent in vitro C. difficile activity, availability as an oral and IV formulations, and favorable microbiome properties, further development of omadacycline for the treatment of CDI is warranted.

Disclosures

Kevin W. Garey, PharmD, MS, Acurx Pharmaceuticals: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support|Summit Pharmaceuticals: Grant/Research Support.
500. Impact of an iron chelator on in vitro and in vivo growth of A. baumannii
Authors: Eales Brianna , Bai Bing , Tam Vincent
Published: December 2022

Background

Acinetobacter baumannii (AB) has become multidrug-resistant in recent years and currently there is no consensus on the optimal treatment for these infections. To combat this urgent threat, novel treatment options are needed to minimize spread and lower mortality rates. Nutrient metals (e.g., iron) are essential to the metabolic functions of AB. If the bioavailability of essential nutrients is restricted, this can cause a bacterial stress response and alter their ability to multiply.

Methods

The objective of the study was to examine the impact of iron chelation on the growth of AB in vitro and in vivo. MDR AB bloodstream isolates (n=4) were recovered from unique patients between 2011 and 2018. Clonal diversity was ascertained by Fourier Transform Infrared Spectroscopy. In vitro bacterial densities were measured longitudinally over 20-hours to determine the growth profile. Isolates were started at a baseline concentration of approximately 5.5 log CFU/mL in tryptic soy broth. Variable amounts of an iron chelating agent (deferiprone, 0.2-2mM) were added to create a concentration gradient. Galleria mellonella larvae (100-150mg) were inoculated with approximately 5 log CFU of an isolate, with and without deferiprone (10mM). Quantitative culture was used to ascertain the bacterial burden of aggregate larvae (n=10) immediately and 4h post infection. Additional infected larvae (n=20 in each group) were incubated at 35°C and monitored hourly for 24h.

Results

Time to mortality was compared using Kaplan-Meier survival analysis and log-rank test. Increasing concentrations of the chelating agent caused a transient and concentration-dependent hindrance of in vitro bacterial growth, compared to the no-treatment group. Bacterial burden immediately post-infection of the control and treatment group were comparable at 6.4 log CFU/g. After 4 hours the bacterial burden was much higher in the control group than the treatment group, 8.7 and 6.7 log CFU/g respectively. A trend of delayed mortality was shown in the iron chelator group (median survival 6.5 vs 10 hours, p=0.15).

Conclusion

These results support that micro-nutrient limitation has the potential to be a novel approach for treating high-risk infections due to MDR AB. Future studies are warranted to further define its optimal place in therapy.

Disclosures

All Authors: No reported disclosures.
559. Inpatient Allergy Delabeling of Pediatric Patients with Low-Risk Penicillin Allergy Status through Direct Graded Oral Amoxicillin Challenge
Authors: Lim Peter Paul , Desai Ankita P , Wessell Kathryn Ruda , Moore LeAnne , Minich Nori M
Published: December 2022

Background

Only 1% of patients with penicillin allergy are truly allergic but it remains the most common drug allergy reported. Studies show that direct oral challenge is a safe method to delabel low-risk patients using institutional screening stratification tools. There is no verified universal screening tool to perform this function, underscoring the need to address this clinical gap. This study aims to assess the efficacy of our institutional screening questionnaire at correctly stratifying penicillin allergy risk status and determine whether direct graded oral amoxicillin challenge can be safely used to delabel patients with low-risk penicillin allergy status. Figure 1Flow chart showing patient categorization based on penicillin allergy risk status and subsequent disposition following screening.

Methods

This was a pilot prospective study to verify penicillin allergy status among patients 3-18 years old in our institution from September 2021-March 2022. Patients were stratified using institutional screening questionnaire to no-risk, low-risk and high-risk penicillin allergy status. Low-risk patients underwent direct graded oral amoxicillin challenge using an institutional algorithm and delabeled based on their response to the testing. No-risk patients were delabeled without challenge testing. High-risk patients were referred to allergy.

Results

Ninety-two patients were identified with penicillin allergy. Forty (43.5%) of the 92 patients were screened using our institutional screening questionnaire. Of the 40 screened patients, 6 (15%) were identified as no-risk, 28 (70%) were identified as low-risk, and 6 (15%) were identified as high-risk. Twenty-four (86%) of the 28 low-risk patients were eligible for direct amoxicillin oral challenge. Seventeen (71%) of the 24 consented to the challenge testing but only 12 (70%) underwent direct amoxicillin oral challenge. Eleven (92%) of the 12 who underwent oral challenge were successfully delabeled. Five (83%) of the 6 no-risk patients were successfully delabeled. Three (50%) of 6 high-risk patients were referred to allergy. Overall, 16 (40%) of the 40 patients who were screened were successfully delabeled.

Conclusion

Our institutional risk stratification screening tool is effective at identifying penicillin allergy risk status and direct graded oral amoxicillin challenge is a safe initiative to delabel patients with low-risk penicillin allergy status.

Disclosures

All Authors: No reported disclosures.
666. Outcomes Using Cefiderocol for the Treatment of Acinetobacter baumannii Infections from the PROVE (Real-World Evidence) Study
Authors: Marcella Stephen , Kobic Emir , Carr Amy L , Georgiades Benjamin , Margiotta Caroline
Published: December 2022

Background

PROVE is an ongoing international, retrospective study assessing cefiderocol (CFDC) for Gram-negative (GN) infections. Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are difficult-to-treat with limited treatment options. CFDC is a novel sidero cephalosporin with activity against CRAB. This analysis describes the outcomes and treatment patterns of CFDC treatment in CRAB infections from this study.

Methods

Patients were eligible if they received ≥ 72 hours of CFDC. Key patient characteristics, infecting pathogen susceptibility, illness severity, and treatment patterns were assessed. Fourteen and 30-day all-cause mortality (ACM) and clinical cure were examined as outcomes. Susceptibility testing was performed locally. Serious adverse drug reactions (SADR) were recorded.

Results

To date,123 patients treated with CFDC at 12 sites were included. Forty-one had monomicrobial (n=29) or polymicrobial (n=12) Acinetobacter baumannii (AB) infection. All but one were CRAB. The median age was 53 years; 71% were male. The most prevalent comorbidity was severe burns (N=9, 22%). Sixty-one percent of patients received CFDC in the ICU, 51% required mechanical ventilation, and 34% required vasopressor support. The median time from positive culture to CFDC initiation was 5 days. CFDC monotherapy was used in 61%. Tetracyclines were the most common concurrent GN antibiotics used with CFDC (N = 8, 19.5%). Targeted therapy with or without prior GN antibiotics was used in 76%, salvage in 20%, and empirical in 2%. Susceptibility results were available for 28 AB cultures from 28 patients of which 82% were susceptible to CFDC. Post-CFDC 14- and 30-day ACM was 12% (95% CI: 4%-26%) and 22% (95% CI: 11%-38%), respectively. Clinical resolution was achieved in 59% (95% CI: 42% -74%). Thirty-day ACM varied by susceptibility to CFDC: 26% for susceptible, 40% for resistant. One SADR (interstitial nephritis) was reported.

Cefiderocol Use Patterns in Acinetobacter baumannii

Conclusion

Real-world use of CFDC for AB demonstrates that most patients were complex with multiple comorbidities and severe illness prior to treatment. It was used mostly as targeted therapy. CFDC may be a treatment option in these difficult-to-treat infections.

Disclosures

Stephen Marcella, MD, MPH, Shionogi: Shionogi employee|Shionogi, Inc: Employee Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board Benjamin Georgiades, PharmD, Shionogi, Inc: Employee Caroline Margiotta, MA, Shionogi, Inc: contracting work for Shionogi, Inc.
1093. Multiparametric Investigation Of Spike-Protein Specific T-cell Cytokine Expression Profile In Children With Symptomatic COVID-19 Or Multisystem Inflammatory Syndrome
Authors: Filippatos Filippos , Tzanoudaki Marianna , Tatsi Elizabeth-Barbara , Efthymiou Vasiliki , Liatsis Manolis , Syriopoulou Vasiliki , Michos Athanasios
Published: December 2022

Background

Data regarding cell-mediated immunological differences in children across COVID-19 clinical spectrum are limited. We prospectively investigated Spike-protein specific cellular immunity in children with symptomatic COVID-19 or MIS-C, by single cell cytokine expression profiling.

Methods

PBMCs from children with MIS-C, symptomatic COVID-19 (one month after hospitalization) and healthy controls were isolated prospectively. Cell suspensions were divided into two quantitatively equal samples (a negative control-unstimulated and a positive-stimulated). Cells stimulation was performed using SARS-CoV-2 Spike antigenic peptides mix (Peptivator SARS-CoV-2 Prot_S). Cells of each sample were stained with fluorochrome monoclonal antibodies against 8 surface markers (CD3, CD4, CD8, CD14, CD19, CD137, CD197, CD45RA) and 6 intracellular markers (IL-4, IL-2, IL-17, IFN-γ, TNF-α, Granzyme B). Viability was assessed by 7AAD. Stained cell preparations were analysed using 13 colour Flow Cytometry (DX Flex, Beckman Coulter). Flow cytometric analysis was performed using Kaluza 2.1 Software.

Results

Sixteen children (4 MIS-C, 8 post-COVID-19 and 4 healthy controls) were included in the study. The mean age (±SD) of the participants was 11.22 years (±3.48). Children with MIS-C had significantly higher mean (±SD) values of CD8+IFN-γ/million CD3+ [226.68 (134.92) vs 45.43 (57.28); P: 0.033] and median (IQR) of CD8+IFN-γ/ml [156.38 (184.13) vs 26.34 (82.36);P: 0.033] compared to symptomatic COVID-19 children. Compared to healthy controls, MIS-C patients had significantly higher median (IQR) values of CD4+IL-2/million CD3+ [923.12 (3777.95) vs 97.59 (71.71); P: 0.042] and CD4+IL-2/ml median (IQR) [626.33 (2744.98) vs 169.3 (173.91); P: 0.042]. No other significant differences were observed regarding other immunological markers in 3 study groups.

Conclusion

IFN-γ production by CD8+ T cells is highly expressed in children with MIS-C compared to hospitalized children one month after acute COVID-19 and could consist possible immunological biomarker. Further studies are needed in order to elucidate the pathophysiological basis of these findings.

Disclosures

All Authors: No reported disclosures.
Cabotegravir—Global Access to Long-Acting Pre-exposure Prophylaxis for HIV
Authors: Pepperrell Toby , Cross Samuel , Hill Andrew
Published: December 2022

A novel injectable pre-exposure prophylaxis, cabotegravir, has greater efficacy and acceptability than oral tenofovir/emtricitabine for prevention of HIV infection. Cabotegravir is currently priced at $22 200 per year, >185 times higher than the $60–$119 estimated cost-effectiveness threshold for middle-income countries (MICs). Following civil society pressure, ViiV provided access to generic versions in 90 countries with the Medicines Patent Pool (MPP), including all African nations. However, several MICs outside Africa have rapidly growing HIV epidemics. We analyzed the ViiV-MPP deal to assess population covered and gross domestic product (GDP) per capita. There were 38 countries excluded from the ViiV-MPP deal despite having a GDP per capita lower than the highest-earning African country. These countries include 2.4 billion people (30% global population), with an incidence of 122 000 (8%). For cabotegravir to have a significant impact on HIV infections, millions will need to be treated at affordable prices in a wide range of countries.
Self-Injury
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A.
Published: December 2022

About one in five middle and high school students has engaged in nonsuicidal self-injury within the last year. These behaviors, and their severity, can vary greatly, with the most common types being cutting, burning, punching, throwing oneself down the stairs, and headbanging. Identifying the students who engage in self-injury, contacting parents, and getting the students to appropriate care—all without encouraging contagion—is the appropriate role of school mental health professionals. The motivations for self-injury differ by student, and the link between self-injury and suicide is unclear and differs by student. Following a set, predetermined, and evidence-based protocol for working with these students is the best approach.
Building the Foundation of a School-Based Suicide Prevention Program
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A.
Published: December 2022

Schools have an important role to play in suicide prevention. Universal prevention models are based on a public health approach. They help limit stigma, increase help seeking, and promote strategies to reach out to those at risk. A Comprehensive School-Based Suicide Prevention Program, with 10 component pieces, includes developing a Core Team, universal prevention (training staff, teaching students, helping parents, engaging peers, lowering stigma through advocacy and anti-stigma campaigns, screening students); selective and intensive prevention (refer and consult, reintegration); and Postvention. Although the research on these types of programming varies significantly, all of these types of interventions have initial empirical support as methods to reduce suicide risk in schools.
School-Based Suicide Prevention Programming
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A.
Published: December 2022

Once schools have developed a comprehensive suicide prevention plan, the next step is implementation. In most schools, school mental health professionals will require some advanced preparation and training in suicide assessment and intervention first. Once there are members of the school who are prepared to assist with suicidal students, the next step involves training the staff and teachers. All adults who interact with students should be confident, competent, and willing to interact with suicidal students and to refer them to the appropriate staff in the school building. To do this, everyone will require training that enhances their knowledge, beliefs, attitudes, skills, and self-efficacy. Schools should also prepare parents so they know how to speak with their children who either express suicidal ideation themselves or voice concerns about their friends. Students will require developmentally appropriate education. Other strategies should align with the comprehensive plan.
Assessing Suicide Risk in Schools
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A.
Published: December 2022

Students who are at risk for suicide need special attention in schools. Selective interventions are for students who have certain risk factors that require remediation and support. When these students are identified, helping them connect to selective interventions means they can receive school-based interventions that help them develop positive social and emotional skills. Indicated interventions are for those students who have been identified as at risk for suicide. These students must first be identified through a prompt and accurate school-based suicide risk assessment. School-based risk assessments are not the same as comprehensive suicide risk assessments, but they typically are conducted with a semistructured interview that guides the assessor and student through major areas of risk so that information can be shared with parents and treating professionals.
After a Suicide
Authors: Granello Darcy Haag , Granello Paul F. , Juhnke Gerald A.
Published: December 2022

Suicide postvention is a critical component of school-based suicide prevention. A comprehensive protocol that is in place prior to any crises and clearly defines the decisions and responsibilities of all staff and personnel is essential. Importantly, all staff must know and understand the protocol and be ready to implement it on a moment’s notice. The sad reality is that many schools and districts make decisions in the aftermath of a student suicide that are well intentioned but made in the moment of grieving. These decisions can have the unintended consequence of escalating suicide risk among vulnerable members of the student population. The essential take-home message from this chapter is to develop evidence-based policies that have the potential to limit suicide contagion.
Problem Mothers
Authors: Chettiar Teri
Published: December 2022

Chapter 3 investigates new rehabilitative programs designed to tackle the increasingly visible problems of child neglect and post-partum mental illness in post-1945 Britain, focusing on the joint admission of mothers and their young children at the Cassel Hospital for Functional Nervous Disorders in London. Although Cassel medical and nursing staff sought to humanize “bad” mothers and establish greater empathy for severe cases of emotional distress, they ultimately reinforced post-WWII expectations that childcare was the “natural” central preoccupation of female adults. Treatment at the hospital focused on helping mostly young married female patients resolve their “emotional immaturity” through an intensive around-the-clock therapeutic regime that centered on patients’ appropriately loving relationships with their children. This chapter argues that new post-WWII visibility surrounding the emotional burdens of motherhood ended up further reifying, rather than undermining, the presumption that women were, by nature, relational “experts” and better suited to childcare than men.
An Art School Education
Authors: Quin Jack
Published: December 2022

The first chapter constructs an unfamiliar portrait of Yeats—the famous autodidact—as a fledgling poet who was educated at art school in Dublin. The opening section documents Yeats’s art school years at the Dublin Metropolitan School of Art and later the Royal Hibernian Academy. It outlines how Yeats’s art school training in the mid-1880s put him in contact with John Hughes and Oliver Sheppard who would become the foremost Irish sculptors of the early twentieth century. By tracing his time at art school, the chapter recovers Yeats’s earliest exposure to the visual arts; sketching from casts of classical statues, and comparing antique and modern artworks. Subsequent sections compare Yeats’s earliest poems, The Island of Statues, ekphrastic verses, and verse fragments, with his later recollections of the Metropolitan School of Art and Royal Hibernian Academy in Reveries over Childhood and Youth, a 1906 committee deposition, and his draft Memoirs, arguing that a poetics of sculpture offered Yeats a creative escape from the dry, academic neoclassicism of his art schooling. The art writing of Yeats and George Russell (Æ)—another art school student—in the Daily Express promoted the sculpture of Sheppard and Hughes in the 1890s to early 1900s. The later sections propose a reciprocal relationship between Irish sculpture and poetry of the Revival, tracing Yeats and Russell’s reinterpretation of Matthew Arnold and his critique of the Celtic plastic arts, and closing with an examination of Sheppard’s unpublished essay on public sculpture in Ireland.
Yeats’s Late Sculptural Poetics
Authors: Quin Jack
Published: December 2022

The fifth chapter traces the prominence of sculpture in Yeats’s late poems. It begins with close readings of poems about Maud Gonne and Iseult Gonne, where statues or busts are invoked to address concerns with aging, loneliness, and a thwarted or unreciprocated desire. A comparative study of these sculptural love poems with the poems of Eva Gore-Booth and H.D. underscore the gender dynamics of Yeats’s use of statues in verse. Subsequent sections connect Yeats’s esoteric ideas about ancient statues in A Vision and a Rapallo Notebook to New Poems and Last Poems, where statues are nonstatic, seemingly organic, and consequently subject to aging or material degrading. The chapter concludes that Yeats’s late “sculptural poetics” brings him into dialogue with Pound and T.S. Eliot. In his last poems he returns to and reanimates his early fantasies—as well as the material realities—of the art of sculpture.
Original Common Possession of the Earth
Authors: Huber Jakob
Published: December 2022

This chapter unpacks the relation between earth dwellers further by focusing on the idea of original common possession of the earth. It argues against the widespread attempt to liken Kant’s notion to that prevalent in the natural law tradition, that is, as constituting a community of proto-ownership. For Kant, the notion does not provide a distributive standard for carving up the world. Instead, it spells out our shared task of coming to terms with the fact that embodied agents who jointly inhabit a bounded territory can affect and constrain each other with their choices; a challenge that normatively transcends any division of the earth’s surface into slices of property and territory. A detour into the Critique of Pure Reason helps to illuminate that Kant’s disjunctive community of original common possession describes a system of mutual exclusion in which a plurality of different persons stand in a relation of ‘possible physical interaction’. To act from the ‘global standpoint’ is to respect distant strangers as justificatory equals in the process of coming to terms with the fact that we have to share the earth in common.
The Jurisprudence of Constitutional Conflict in the European Union
Authors: Bobić Ana
Published: December 2022

A comparative and comprehensive account of the jurisprudence of constitutional conflict between the Court of Justice and national courts with the power of constitutional review, this book addresses the incidences of, and the reasons for, constitutional clashes in the application and enforcement of EU law. Its aim is to determine how the principle of primacy of EU law works in reality and whether the jurisprudence of the courts under analysis supports this concept. To this end, the book explores the three areas of constitutional conflict: ultra vires review, identity review, and fundamental rights review. The book substantiates the descriptive, and strengthens the normative contributions of the theory of constitutional pluralism in relation to the web of relations in the European judicial space. By examining the influence that the jurisprudence of constitutional conflict has on the balance of powers between the Court of Justice and constitutional courts, the book uses the judicial triangle as an analytical tool that depicts the consequences for the horizontal (constitutional courts vis-à-vis the Court of Justice) and vertical judicial relationships (Court of Justice vis-à-vis ordinary national courts; constitutional courts vis-à-vis ordinary national courts). By offering a thorough compilation of the jurisprudence of constitutional conflict in the EU, this book thus improves our understanding of the principle of primacy of EU law and its limits; as well as reinforces the theory of constitutional pluralism in explaining and guiding judicial interactions and power relations in the EU.
Trade wars and economic warfare in history
Authors: Oermann Nils Ole , Wolff Hans-Jürgen
Published: December 2022

The chapter describes the many, mostly violent, trade wars and instances of economic warfare from around 1500 to 1956, the year of the Suez Crisis. It shows the predatory European expansion into the Americas, Asia, and Africa, and the attending introduction of mass slavery. It deals with the East India Company and its Dutch equivalent. It shows that China and Russia expanded their empires, too. It concentrates, though, on the experience and example of Great Britain, because that country proved exceptionally successful in trade and economic warfare, and formed the entire international system during the nineteenth century. It shows how geography, institutional reforms like the rule of law and reliable finance, naval mastery and the fortunes of war, progress in ideas about trade, and the industrial revolution, all helped Britain to achieve its towering position, and how in the twentieth century the United States took over most of Britain’s former role.
The Developer’s Dilemma
Authors: Alisjahbana Armida Salsiah , Sen Kunal , Sumner Andy , Yusuf Arief
Published: December 2022

The developer’s dilemma is this: developing countries seek inclusive economic development—that is, structural transformation—sufficiently broad-based to raise the income of the poor. Inclusive economic growth requires falling income inequality to maximize income growth at the lower end of the distribution. Yet, this is at odds with Kuznets hypothesis that economic development puts upward pressure on income inequality—at least in the absence of countervailing policies. Our book explores the developer’s dilemma between structural transformation and income inequality. The core questions of our book are: (i) What are the varieties of structural transformation experienced in developing countries? (ii) What inequality dynamics are associated with each variety? (iii) Which policies have been utilized to manage trade-offs between structural transformation, income inequality, and inclusive growth? We answer using a comparative case-study approach, contrasting nine developing countries, while employing a common analytical framework and a set of common data sets across the studies.
Getting Rich and Unequal?
Authors: Li Yanan , Xing Chunbing
Published: December 2022

In this chapter, we analyse the relationship between China’s structural transformation and the inclusiveness of its economic growth. In the past four decades, China’s economic activities have shifted from the low-productivity agricultural sector to the high-productivity industrial sector and, more recently, the tertiary sector, with a large portion of the labour force moving from rural to urban areas, from inland to coastal regions, and from the public to the private sectors. These changes have only happened because of major reforms to the land system, the Hukou system, the ownership of state-owned enterprises, trade policies, and the education system. Despite its great success in poverty reduction, China has witnessed rapidly increasing income inequality which only began to decline in the late 2000s. We analyse the political economy that determined the inclusiveness of the structural transformation.
Leapfrogging into the Unknown
Authors: Schlogl Lukas
Published: December 2022

This chapter traces a set of major trends and future scenarios in global structural change. It argues that across multiple domains of change, developing economies face novel constellations of lateness and prematurity in technological and economic development. The chapter explores these novel constellations in employment and value added, global trade, and technological upgrading. It argues that an expansion of service-sector work in lockstep with rising economic development will likely continue to shape the medium-term future of structural transformation, albeit with trends of convergence and a hybridization of sectors. New employment challenges may be emerging for participants in a global value chain due to the debated threat of ‘reshoring’ of offshored production. The chapter finally discusses automation in the non-tradable sector and the ramifications of technological leapfrogging or ‘technology creep’ for the future of structural change.
The Effects of (De)Legitimation on Citizens’ Legitimacy Beliefs about Global Governance
Authors: Ghassim Farsan
Published: December 2022

This chapter examines the potential effects of (de)legitimation on citizens’ legitimacy beliefs about global governance institutions (GGIs) through original survey experiments among the general public in ten countries worldwide: Australia, Canada, Colombia, Egypt, France, Hungary, Indonesia, Kenya, Turkey, and South Korea. Building on cueing theory, several hypotheses about the expected effects of (de)legitimation by different agents are tested. Survey respondents are exposed to different treatments of (de)legitimation by foreign ministries, citizen protests, and GGIs themselves. Focusing on the United Nations, the World Bank, and the WHO, the chapter finds that the delegitimation of GGIs by governments and citizen protests has some limited effectiveness, depending on the GGI in question. While GGI self-legitimation in itself does not boost public belief in GGIs’ legitimacy, self-legitimation is generally effective at counteracting delegitimation attempts by governments and citizen protests. Hence, GGIs are vulnerable to delegitimation by agents and actions such as hostile governments and citizen protests. Still, the experimental results demonstrate that GGIs can effectively defend themselves against such attacks and neutralize them through self-legitimation efforts. The results carry significant implications for academic research and agents in GGI legitimacy debates.
Coda
Authors: Ross Kelly
Published: December 2022

While surveillance theorists often focus on the technologies and pervasiveness of twenty-first-century surveillance, this book redirects our attention to the human costs of sousveillance. The book’s examination of sousveillance as a set of tactics to resist, escape, or merely survive racial subjugation restores a measure of agency to the surveilled, even as it also demonstrates that the watcher from below is profoundly vulnerable if sousveillance becomes visible. The protective function of invisibility for sousveillants is critical for analyzing contemporary visual documentation of state-sanctioned violence. The antebellum literary roots of racialized surveillance that Slavery, Surveillance, and Genre examines can teach us about what it means to be seen and why people make this choice despite the harm it brings.
Same As It Ever Was? Race, Capital, and Privatised Immigration Enforcement
Authors: Chacón Jennifer
Published: December 2022

This chapter situates contemporary efforts to privatise various aspects of immigration enforcement in the United States—including immigration surveillance and detention—against the backdrop of a long-lived public–private partnership in racialised migration management. Following a brief introduction, the chapter proceeds in four main sections. Section II provides a descriptive account of privatised immigration enforcement practices in the US, with a particular focus on immigration surveillance. Section III presents critiques of the resulting hybrid public–private immigration enforcement system, with attention to the district contexts of immigration detention and immigration surveillance. Section IV identifies the ways that this hybrid enforcement system frustrates two purported normative goals of good democratic governance: transparency and accountability. Finally, section V argues that the features mapped in the earlier parts of the chapter are not at all new, and that the apparent pathologies of privatisation might properly be understood and assessed as the latest iteration of a deeply entrenched, extractive system of racial capitalism.
Roles and Offices at the Border
Authors: Thorburn Malcolm
Published: December 2022

This chapter argues that border control is an intrinsically public function and should not be carried out by private actors. In doing so, it also develops a robust account of public office more generally. The chapter’s argument challenges both the moral individualism of Jeff McMahan, John Gardner, or Ashwini Vasanthakumar, and the influential anti-privatisation argument of Alon Harel and Avihay Dorfman. Against the moral individualists, it is shown that the legitimacy of border security requires that it be carried out in the name of the whole people of the host country and only public officials can do that. Against Dorfman and Harel, it is argued that their conception of public office is too thin. Although they insist that only public officials can speak in the name of the public (because of their place within a ‘community of practice’ through ‘fidelity by deference’), they neglect other crucial features of public office, such as constraints on entry and exit, limits on conflicts of interest, training, and more.