bluuebunny/crossref_metadata_2025 huggingface dataset:
Überlegungen zum Beenden von Psychotherapien
Authors: Weilguny Barbara
Published: May 2022

In der einschlägigen Fachliteratur finden sich unzählige Bücher zum Thema Beginn und Verlauf einer Psychotherapie, jedoch gibt es bis heute kein klares Vorgehen beim Beenden von Psychotherapien in den unterschiedlichen Therapiemethoden. In der Ausbildung scheint diese Thematik wenig Aufmerksamkeit zu erhalten, in der Lehr-Literatur findet sich nur wenig darüber. Wesentlich erscheint als Zugang zur Öffnung dieses Themas eine Zusammenschau, um vom gegenseitigen Erkenntnisgewinn zu profitieren und einen Diskurs in Gang zu setzen.

Die Bedeutung der Sprache in der sensiblen Abschlussphase einer Therapie, die Konflikte, die auf Seiten der Therapeut_innen und Klient_innen aufkommen können, die Fragestellung, wann eine Therapie überhaupt zu Ende ist, die Berücksichtigung von bindungstheoretischen Aspekten, all das fordert viel Sensibilität und Reflexionsfähigkeit. Die Kultivierung einer Haltung der Abschiedlichkeit kann dabei dienlich sein.

Jede Psychotherapie ist individuell und jede Beendigung derselben ebenso. Manche Fälle bedürfen einer lebenslangen Therapie. Es erscheint bedeutsam, als Therapeut_in ein Bewusstsein zum Thema Abschied zu erlangen und eigene Trennungskompetenzen zu reflektieren. Die Metapher der Reise bietet sich für diese Thematik an. Der Steuermann (Therapeut_in) weiß um die Schwachstellen des Schiffes, richtet die Segel aus, erkennt Stärken, Potenziale, er ist Korrektiv und Regulativ zugleich, balanciert aus. Der Kapitän (Klient_in) ist Experte_in für das Schiff, gibt die Richtung und das Tempo an. Beide befinden sich auf einer Reise auf Zeit. Irgendwann erreichen sie den Hafen und werden wieder getrennte Wege gehen.
Moringa oleifera alcoholic extract protected stomach from bisphenol A–induced gastric ulcer in rats via its anti-oxidant and anti-inflammatory activities
Authors: Abo-Elsoud Reda Abo Elfath Ahmed , Ahmed Mohamed Abdelaziz Seham , Attia Abd Eldaim Mabrouk , Hazzaa Suzan Moustafa
Published: May 2022

This study evaluated the protective potentials of Moringa oleifera leaf alcoholic extract (MOLE) against bisphenol A (BPA)-induced stomach ulceration and inflammation in rats. Control rats received olive oil. Second group administered MOLE (200 mg/kg bwt) by oral gavage. Third group was given BPA (50 mg/ kg bwt) for 4 weeks. Fourth group administrated BPA and MOLE simultaneously. Fifth group was given MOLE for 4 weeks then administered BPA and MOLE for another 4 weeks. Bisphenol A induced gastric ulceration and decreased the volume of gastric juice, prostaglandin E2 (PGE2), reduced glutathione (GSH) and interleukin 10 (IL-10) contents, superoxide dismutase (SOD) activity, and proliferating cell nuclear antigen (PCNA) protein in stomach tissues, while increased the titratable acidity, malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) contents, and caspase-3 and NF‑κB proteins in stomach tissue. However, MOLE ameliorated BPA-induced gastric ulceration and significantly increased the volume of gastric juice, PGE2, GSH and IL-10 contents, SOD activity, and PCNA protein while significantly decreased titratable acidity, MDA, TNF-α and IL-6 contents, and of NF‑κB and caspase-3 proteins in gastric tissue. This study indicated that MOLE protected stomach against BPA-induced gastric injury via its anti-oxidant, anti-apoptotic, and anti-inflammatory activities.
Task model-specific operator skill assessment in routine fetal ultrasound scanning
Authors: Wang Yipei , Yang Qianye , Drukker Lior , Papageorghiou Aris , Hu Yipeng , Noble J. Alison
Published: May 2022

Purpose

For highly operator-dependent ultrasound scanning, skill assessment approaches evaluate operator competence given available data, such as acquired images and tracked probe movement. Operator skill level can be quantified by the completeness, speed, and precision of performing a clinical task, such as biometry. Such clinical tasks are increasingly becoming assisted or even replaced by automated machine learning models. In addition to measurement, operators need to be competent at the upstream task of acquiring images of sufficient quality. To provide computer assistance for this task requires a new definition of skill.

Methods

This paper focuses on the task of selecting ultrasound frames for biometry, for which operator skill is assessed by quantifying how well the tasks are performed with neural network-based frame classifiers. We first develop a frame classification model for each biometry task, using a novel label-efficient training strategy. Once these task models are trained, we propose a second task model-specific network to predict two skill assessment scores, based on the probability of identifying positive frames and accuracy of model classification.

Results

We present comprehensive results to demonstrate the efficacy of both the frame-classification and skill-assessment networks, using clinically acquired data from two biometry tasks for a total of 139 subjects, and compare the proposed skill assessment with metrics of operator experience.

Conclusion

Task model-specific skill assessment is feasible and can be predicted by the proposed neural networks, which provide objective assessment that is a stronger indicator of task model performance, compared to existing skill assessment methods.
Official Risks and Everyday Disasters: the Interplay of Riskscapes in Two Unplanned Settlements in Monrovia
Authors: Innis Phillip Garjay
Published: May 2022

Monrovia’s unplanned settlements provide a window into the diverse rationales and practices that go into planning and managing urban space. Even though unplanned settlements are economically, spatially, and socially integrated into cities, the desire to eliminate or formalise them persists. In the essay, I examine how everyday risks are addressed in the coexistence and co-evolution of planning and unplanned urbanisation in postwar contexts. As well as showing how expert-recommended risk management approaches cross over into local practices, I explain how and why multiple understandings of ‘risk’ and ‘resilience’ can influence practice. The unequal power dynamic suggests that the practices of state actors influence the residents of unplanned settlements, in a manner that is discernible of governmentality. As riskscapes, and by extension resilience, represent multiple realities to stakeholders, the question of coalescing the mosaic of practices into a common risk governance framework is critical. The essay emphasises that resilience-building should evolve from a thorough understanding of the dynamics of the multiplicity of riskscapes. Finally, the paper argues that an evolutionary approach to risk governance, paying attention to the interacting elements and configurations that link discourse, actors, institutions, power, and knowledge, will provide a platform for negotiating the links between risk perception and risk assessment within the emerging riskscapes. This will be the basis of a deliberative and negotiated resilience pathway that will integrate the priorities and interests of all stakeholders in the planning and decision-making process.
Digital sufficiency: conceptual considerations for ICTs on a finite planet
Authors: Santarius Tilman , Bieser Jan C. T. , Frick Vivian , Höjer Mattias , Gossen Maike , Hilty Lorenz M. , Kern Eva , Pohl Johanna , Rohde Friederike , Lange Steffen
Published: May 2022

ICT hold significant potential to increase resource and energy efficiencies and contribute to a circular economy. Yet unresolved is whether the aggregated net effect of ICT overall mitigates or aggravates environmental burdens. While the savings potentials have been explored, drivers that prevent these and possible counter measures have not been researched thoroughly. The concept digital sufficiency constitutes a basis to understand how ICT can become part of the essential environmental transformation. Digital sufficiency consists of four dimensions, each suggesting a set of strategies and policy proposals: (a) hardware sufficiency, which aims for fewer devices needing to be produced and their absolute energy demand being kept to the lowest level possible to perform the desired tasks; (b) software sufficiency, which covers ensuring that data traffic and hardware utilization during application are kept as low as possible; (c) user sufficiency, which strives for users applying digital devices frugally and using ICT in a way that promotes sustainable lifestyles; and (d) economic sufficiency, which aspires to digitalization supporting a transition to an economy characterized not by economic growth as the primary goal but by sufficient production and consumption within planetary boundaries. The policies for hardware and software sufficiency are relatively easily conceivable and executable. Policies for user and economic sufficiency are politically more difficult to implement and relate strongly to policies for environmental transformation in general. This article argues for comprehensive policies for digital sufficiency, which are indispensible if ICT are to play a beneficial role in overall environmental transformation.
The Volcanic Geoheritage of El Teide National Park (Tenerife, Canary Islands, Spain)
Authors: Martí-Molist Joan , Dorado-García Olaya , López-Saavedra Marta
Published: May 2022

El Teide National Park on the island of Tenerife (Canary Islands) is home to one of the most spectacular volcanic landscapes in the world. Although the conservation of its geodiversity is not a major problem given that it is governed by strict Spanish laws on geoconservation and is, in addition, a UNESCO World Heritage site, the diffusion of its geological values among the general public is more of a challenge due to the lack of any specific program for scientific knowledge transfer to visitors. The volcanological history of this national park needs to be transmitted in a clear and comprehensible fashion. However, the lack of adequate outreach material and of any coherent and consistent narrative regarding the significance of the island’s geological heritage makes it difficult to incorporate its geological history into the minds of visitors. This engenders a perception of its geoheritage that underestimates its importance. To remedy this misconception, the following tasks need to be carried out: (1) a compilation of all current scientific knowledge of the geology and volcanology of the area; (2) the identification of key geosites that offer the best means of understanding the history and evolution of this volcanic area; (3) the production of outreach and diffusion programs specifically designed to transmit this scientific knowledge to the general public; and (4) the establishment of permanent training programs for park and tourist guides that will guarantee the efficacy of this knowledge transmission. This contribution summarizes the main aspects of the geological history of El Teide National Park, identifies the elements that best exhibit its geological heritage, discusses the main problems observed in transmitting these geological values to visitors, and provides some clues as to how to face up to these challenges.
Deconstructing Self-Compassion: How the Continued Use of the Total Score of the Self-Compassion Scale Hinders Studying a Protective Construct Within the Context of Psychopathology and Stress
Authors: Muris Peter , Otgaar Henry
Published: May 2022

In a new commentary in Mindfulness, Neff once again tried to defend the use of the Self-Compassion Scale (SCS) total score by arguing that compassionate and uncompassionate self-responding (CS and UCS) are part of a bipolar continuum. In this brief reaction, we refute this notion and also clarify how the continued use of the SCS total score muddies the water of research on self-compassion as a protective variable. We also illustrate how the SCS—by separating CS and UCS—can provide more valid and valuable information on protection and vulnerability within the context of psychopathology and stress than just relying on the total score of the SCS.
Digital Forensics AI: Evaluating, Standardizing and Optimizing Digital Evidence Mining Techniques
Authors: Solanke Abiodun A. , Biasiotti Maria Angela
Published: May 2022

The impact of AI on numerous sectors of our society and its successes over the years indicate that it can assist in resolving a variety of complex digital forensics investigative problems. Forensics analysis can make use of machine learning models’ pattern detection and recognition capabilities to uncover hidden evidence in digital artifacts that would have been missed if conducted manually. Numerous works have proposed ways for applying AI to digital forensics; nevertheless, scepticism regarding the opacity of AI has impeded the domain’s adequate formalization and standardization. We present three critical instruments necessary for the development of sound machine-driven digital forensics methodologies in this paper. We cover various methods for evaluating, standardizing, and optimizing techniques applicable to artificial intelligence models used in digital forensics. Additionally, we describe several applications of these instruments in digital forensics, emphasizing their strengths and weaknesses that may be critical to the methods’ admissibility in a judicial process.
Synergistic effect of V2O5 and Bi2O3 on the grain boundary structure of high-frequency NiCuZn ferrite ceramics
Authors: Fan Xiuyuan , Bai Guohua , Zhang Zhenhua , Chen Qiming , Jin Jiaying , Xu Jiafeng , Zhang Xuefeng , Yan Mi
Published: May 2022

High-frequency soft magnetic ferrite ceramics are desired in miniaturized and efficient power electronics but remain extremely challenging to deploy on account of the power loss (Pcv) at megahertz frequencies. Here, we prepared NiCuZn ferrite with superior high-frequency properties by V2O5 and Bi2O3 synergistic doping, which proves to be a potent pathway to reduce Pcv of the ferrite at megahertz frequencies. The sample doped with 800 ppm V2O5 and 800 ppm Bi2O3 yielded the most optimized magnetic properties with a Pcv of 113 kW/m3 (10 MHz, 5 mT, 25 °C), an initial permeability (μi) of 89, and a saturation induction (Bs) of 340 mT, which is at the forefront of the reported results. These outstanding properties are closely related to the notable grain boundary structure, which features a new type of nano-Bi2Fe4O9 phase around ferrite grains and a Ca/Si/V/O amorphous layer. Our results indicate great strides in correlating the grain boundary structure with multiple-ion doping and set the scene for the developing high-frequency soft magnet ferrites.
Global Entropy Solutions and Newtonian Limit for the Relativistic Euler Equations
Authors: Chen Gui-Qiang G. , Schrecker Matthew R. I.
Published: May 2022

We analyze the relativistic Euler equations of conservation laws of baryon number and momentum with a general pressure law. The existence of global-in-time bounded entropy solutions for the system is established by developing a compensated compactness framework. The proof relies on a careful analysis of the entropy and entropy-flux functions, which are represented by the fundamental solutions of the entropy and entropy-flux equations for the relativistic Euler equations. Based on a careful entropy analysis, we establish the compactness framework for sequences of both exact solutions and approximate solutions of the relativistic Euler equations. Then we construct approximate solutions via the vanishing viscosity method and employ our compactness framework to deduce the global-in-time existence of entropy solutions. The compactness of the solution operator is also established. Finally, we apply our techniques to establish the convergence of the Newtonian limit from the entropy solutions of the relativistic Euler equations to the classical Euler equations.
Efficient WENO-Based Prolongation Strategies for Divergence-Preserving Vector Fields
Authors: Balsara Dinshaw S. , Samantaray Saurav , Subramanian Sethupathy
Published: May 2022

Adaptive mesh refinement (AMR) is the art of solving PDEs on a mesh hierarchy with increasing mesh refinement at each level of the hierarchy. Accurate treatment on AMR hierarchies requires accurate prolongation of the solution from a coarse mesh to a newly defined finer mesh. For scalar variables, suitably high-order finite volume WENO methods can carry out such a prolongation. However, classes of PDEs, such as computational electrodynamics (CED) and magnetohydrodynamics (MHD), require that vector fields preserve a divergence constraint. The primal variables in such schemes consist of normal components of the vector field that are collocated at the faces of the mesh. As a result, the reconstruction and prolongation strategies for divergence constraint-preserving vector fields are necessarily more intricate. In this paper we present a fourth-order divergence constraint-preserving prolongation strategy that is analytically exact. Extension to higher orders using analytically exact methods is very challenging. To overcome that challenge, a novel WENO-like reconstruction strategy is invented that matches the moments of the vector field in the faces, where the vector field components are collocated. This approach is almost divergence constraint-preserving, therefore, we call it WENO-ADP. To make it exactly divergence constraint-preserving, a touch-up procedure is developed that is based on a constrained least squares (CLSQ) method for restoring the divergence constraint up to machine accuracy. With the touch-up, it is called WENO-ADPT. It is shown that refinement ratios of two and higher can be accommodated. An item of broader interest in this work is that we have also been able to invent very efficientfinite volumeWENO methods, where the coefficients are very easily obtained and the multidimensional smoothness indicators can be expressed as perfect squares. We demonstrate that the divergence constraint-preserving strategy works at several high orders for divergence-free vector fields as well as vector fields, where the divergence of the vector field has to match a charge density and its higher moments. We also show that our methods overcome the late time instability that has been known to plague adaptive computations in CED.
Integrative studies on the taxonomy and molecular phylogeny of four new Pleuronema species (Protozoa, Ciliophora, Scuticociliatia)
Authors: Liu Mingjian , Liu Yujie , Zhang Tengteng , Lu Borong , Gao Feng , Gu Jing , Al-Farraj Saleh A. , Hu Xiaozhong , Song Weibo
Published: May 2022

The ciliate genus Pleuronema comprises approximately 30 nominal species and has been reported in freshwater, brackish water, and marine habitats. Nevertheless, recent studies have indicated that there might be a large undiscovered species diversity. In the present work, four new Pleuronema species, namely P. foissneri sp. nov., P. parasmalli sp. nov., P. parasalmastra sp. nov., and P. paraorientale sp. nov., collected from Shenzhen, southern China, was investigated using taxonomic methods. The diagnosis, description, comparisons with morphologically related species and detailed morphometric data are supplied for each. The small subunit ribosomal RNA (SSU rRNA) gene of the four new species is sequenced and their molecular phylogeny is analyzed. The SSU rRNA gene tree shows that Pleuronema is polyphyletic comprising several separate clades. All four new species cluster consistently with P. orientale KF206429, P. puytoraci KF840520 and P. setigerum FJ848874 within the core Pleuronematidae + Peniculistomatidae clade. Phylogenies of Pleuronematidae-related taxa are also discussed.
Introduction to Medical Software
Authors: Papademetris Xenophon , Quraishi Ayesha N. , Licholai Gregory P.
Published: May 2022

Providing a concise and accessible overview of the design, implementation and management of medical software, this textbook will equip students with a solid understanding of critical considerations for both standalone medical software (software as a medical device/SaMD) and software that is integrated into hardware devices. It includes: practical discussion of key regulatory documents and industry standards, and how these translate into concrete considerations for medical software design; detailed coverage of the medical software lifecycle process ; accessible introduction to quality and risk management systems in the context of medical software; succinct coverage of essential topics in data science, machine learning, statistics, cybersecurity, software engineering and healthcare bring readers up-to-speed; six cautionary real-world case studies illustrate the dangers of improper or careless software processes. Accompanied by online resources for instructors, this is the ideal introduction for undergraduate students in biomedical engineering, electrical engineering and computer science, junior software engineers, and digital health entrepreneurs.
Evaluation of the genomic epidemiology and transmission of Clostridioides difficile infection across a community
Authors: Tesini Brenda , Taffner Samantha , Hatwar Trupti , Gill Steven , Dumyati Ghinwa , Pecora Nicole
Published: May 2022

Background:Clostridioides difficile infection (CDI) is a major cause of morbidity and healthcare costs in the United States. The epidemiology of CDI has recently shifted, with healthcare-associated (HCA) CDI trending downward and community-associated (CA)-CDI becoming more prominent. The cause of this shift is not well understood but may be related to changing genomic epidemiology. We assessed C. difficile strains across a CDC Emerging Infections Program (EIP) site in Western New York, including strains from both HCA-CDI and CA-CDI cases to characterize predominating strains and putative transmission across epidemiological classifications and between index and recurrent cases. Methods: In total, 535 isolates of C. difficile were collected over a 6-month period in 2018 from the Monroe Country, New York, EIP site and were analyzed using whole-genome sequencing (WGS). Standard epidemiological definitions were used to classify cases as hospital onset (HO-CDI); community associated (CA-CDI); community onset, healthcare associated (CO-HCFA-CDI); or long-term care onset (LTCO-CDI). Recurrent cases were defined as those diagnosed within 8 weeks of an initial positive test. Multilocus sequence types (MLSTs) were assigned according to PUBMLST and single-nucleotide polymorphisms (SNPs) were determined using a modified CFSAN analytical pipeline. Cases resulting from putative transmission were defined as those separated by 0–1 core SNPs. Results: Of 535 isolates, 454 were from index and 81 were from recurrent cases. The index cases were comprised of CA-CDI (47.4%), CO-HCFA-CDI (24%), LTCO-CDI (8.1%), and HO-CDI (19.3%). Cases with recurrent disease mirrored the epidemiological distribution of the larger set. Common MLSTs included ST2 (12.3%), ST8 (10.5%), ST42 (7.9%), ST58 (4.9%), ST43 (4.5%), and ST11 (4.3%). The previously widespread epidemic strain, NAP1/ST1/RT027 accounted for Conclusions: The genomic epidemiology of C. difficile across this large community cohort demonstrated a diverse group of strain types that was similarly distributed across epidemiological classifications and between index and recurrent cases. SNP analysis indicated that direct transmission between cases was uncommon.

Funding: None

Disclosures: None
Central-line associated bloodstream infection (CLABSI) in patients hospitalized with COVID-19
Authors: Kang Minji , Conrad Zane , Thomas Elizabeth , Arocha Doramarie , Trivedi Julie
Published: May 2022

Background: Significant increases in healthcare-associated infections (HAIs) including central-line associated blood stream infections (CLABSIs) have been reported during the COVID-19 pandemic. Acute-care hospitals have faced staffing and personal protective equipment shortages, increased critical care capacity, and diversion of resources from traditional HAI surveillance and prevention efforts. In this study, we characterized CLABSIs among patients with COVID-19 and compared demographics, comorbidities, and outcomes between patients diagnosed with CLABSI with and without COVID-19. Methods: This is an observational retrospective cohort study of all patients diagnosed with CLABSI as defined by NHSN at William P. Clements Jr. University Hospital from April 1, 2020, through September 30, 2021. A retrospective chart review was conducted to identify demographics, comorbidities, and outcomes of hospitalized patients diagnosed with CLABSI. Patients hospitalized with and without COVID-19 were compared using the independent-sample t test for means and the χ2 test for proportions. Results: Overall, 82 patients diagnosed with CLABSI between April 1, 2020, to September 30, 2021, among whom 31 (38%) were hospitalized with COVID-19 and 51 (62%) were not hospitalized with COVID-19. Patients hospitalized with COVID-19 were significantly more likely to be obese (58% for COVID-19 positive vs 26% for COVID-19 negative; P = .01) and to require extracorporeal membrane oxygenation (19% vs 4%; P = .04). However, COVID-19 patients were significantly less likely to have hematologic malignancy (7% vs 28%; P = .03), undergone bone marrow transplantation (0% vs 18%; P = .01), or have neutropenia (3% vs 22%; P = .03). There were no significant differences in line type or organism identified. Gram-positive pathogens were identified in 16 patients (52%) hospitalized with COVID-19. Gram-negative pathogens were identified in 3 patients (10%); fungal organisms were identified in 10 patients (32%), and 2 cases (7%) were polymicrobial. Patients with COVID-19 were significantly more likely to require an ICU stay (84% vs 43%). p Conclusions: High device utilization as well as prolonged hospitalization and line days among patients with COVID-19 along are contributing risk factors for CLABSI among patients hospitalized with COVID-19. This finding highlights the need for ongoing HAI surveillance and prevention efforts in patients hospitalized with COVID-19 given their characteristics and increased risk for CLABSI. Reinforcing infection prevention efforts by accentuating the importance of optimal line care and regular feedback are crucial, especially among patients hospitalized with COVID-19.

Funding: None

Disclosures: None
Challenges in IPC training for non–healthcare workers
Authors: Abdul Majid Faridah Binte , Lee Lai Chee , Yuen Tan Kwee , Ling Moi Lin
Published: May 2022

Background: In the last 2 years of the COVID-19 pandemic, Singapore has been forced to explore alternative sites to quarantine persons or manage infected cases during surge periods in a national effort not to overwhelm the public healthcare facilities. External quarantine facilities were created at the EXPO and further extended to D’Resort and other hotels in May 2020. Infection prevention (IP) practices were implemented at these external facilities, where training non–healthcare staff to quickly learn and understand these required practices has been challenging. A team of staff from different clinical disciplines was formed to manage the COVID-19 patients at these facilities. The Infection Prevention and Epidemiology (IPE) department was invited to train all staff, including the clinical team, management agency, and security staff, regarding IP measures. We have described the system and approach used in the rapid training of all staff in IP measures where the goal is zero transmission while providing care to COVID-19 patients. Methods: Training materials were developed to facilitate rapid learning by all staff; medical jargon was avoided. Curriculum included precautions to be taken while performing terminal cleaning of patient rooms, serving meals, disinfecting phones and thermometers, as well as donning and doffing personal protective equipment (PPE). “Green” and “red” zones were created to assist staff in remembering appropriate PPE to be used. PPE training was provided using slides and video. Posters were created as a guide for staff at donning and doffing stations. Additionally, the IPE training team utilized an online data collection tool to capture staff completion on IP training and PPE competency for record keeping. We used a ‘soft’ approach because staff members were fearful of the unknown when caring for COVID-19 patients. Daily audits were conducted with immediate concurrent feedback to engage the relevant stakeholders. Infection prevention liaison officers (IPLOs) were appointed to assist in the daily audits. An electronic audit tool was used to facilitate audit and quick analysis. Conclusions: The experience gained in the last 2 years has been useful and may provide a template if new external sites are needed in the future because of the potential surge associated with the ο (omicron) variant.

Funding: None

Disclosures: None
Care innovations and health disparities: An exploration of COVID-19 outcomes in inpatient and hospital-at-home care settings
Authors: Priem Jennifer , Krinner Lisa , Murphy Stephanie , Monahan Sveta , Hole Colleen
Published: May 2022

Background: Hospital at home (HaH) programs have been a critical resource for providing inpatient care to acutely ill patients throughout the COVID-19 pandemic. Given that this innovative care delivery model relies on technology and environmental concerns, questions have been raised about the effectiveness of HaH for vulnerable groups. However, evidence is extremely limited regarding equity issues in the HaH context. Thus, we explored COVID-19 outcomes within vulnerable groups. Methods: We conducted a matched, retrospective study of 116 acutely ill patients with COVID-19, aged ≥18 years, who presented to an AH emergency department (ED) and were admitted for inpatient care. Treatment patients were admitted to AH HaH between July 15 and September 31, 2020, and control patients were hospitalized between May 8 and June 25, 2020. Patients were matched based on oxygen requirement and DS CRB-65 (DEFINE) score. Race or ethnicity and area deprivation index (ADI) were chosen as predictors of health disparities. The ADI incorporates 17 indicators of poverty, educational attainment, and housing quality at the census tract level. Outcomes included 30-day (from discharge) severe illness or death composite, IP readmission, and ED visit. Results: The frequency of 30-day severe illness or death and ED visits were equivalent between the groups (n = 11; ED n = 5); the proportion of severe illness was higher for White patients in AH-HaH (n = 9 vs n = 5), and for Hispanic patients treated in the hospital (n = 5 vs n = 0; Fig. 1). There were no 30-day inpatient readmissions in the AH-HaH group, but 8 readmissions occurred with inpatients. The distribution of severe illness among the ADI quintiles varied. For traditional inpatients, disease progression was limited to ADI Q3–5 (Q3 = 3, Q4 = 6, Q5 = 2); for AH-HaH patients, disease progression was not influenced by ADI. The effect of ADI on 30-day ED readmission was nonsignificant. Conclusions: Although exploratory in nature, the results suggest that HaH may help combat sources of health disparities that have dominated the pandemic. Although inpatient care resulted in inpatient readmissions, mainly among Black and Hispanic patients, AH-HaH stays were not associated with any inpatient readmissions. The equivalent distribution among ADI quintiles of patients who became severely ill within 30 days of their AH-HaH stay suggests that HaH may be able to leverage innovation to reach vulnerable populations and reduce the impact of factors that contribute to inequity.

Funding: None

Disclosures: None
The impact of GenMark Dx ePlex blood-culture identification on the treatment and outcomes of gram-positive bacteremia
Authors: Kiszla B. Matthew , McCarty Todd , White Cameron , Moates Derek , Leal Sixto , Lee Rachael
Published: May 2022

Background: In the treatment of bloodstream infections, the identification of the causal pathogen, and the evaluation of its susceptibility to antibiotics, often serve as the rate-limiting steps of the patient’s hospital stay. The GenMark Dx ePlex blood culture identification gram-positive (BCID-GP) panel aims to alleviate this bottleneck, thereby reducing the risk of severe complications and the spread of resistance, using electrowetting technology to detect the most common causes of GP bacteremia (20 targets) and 4 antimicrobial resistance (AMR) genes. We hypothesized that implementation of the ePlex BCID-GP panel would improve antimicrobial choice and de-escalation where appropriate. Methods: A mixed blinded and unblinded study was conducted to assess the effect of the BCID-GP panel on the outcomes and antibiotic stewardship of GP bacteremic patients before ePlex results were made clinically available (before implementation, N = 73) and once they accompanied the standard-of-care work-up (after implementation, N = 82). Differences in time to different benchmarks between the 2 modalities and the effect on patient outcomes were analyzed using null-hypothesis significance testing. Results: During the study, the BCID-GP panel identified 63 (42%) Staphylococcus epidermidis isolates, 31 (21%) Staphylococcus spp, 24 (16%) Staphylococcus aureus isolates, 12 (8%) Streptococcus spp, and 7 (5%) Enterococcus spp, and results were similar in the pre- and postimplementation groups (P = .13). The panel saved an average of 32.0 ± 24.2 hours in pathogen identification over standard-of-care methods, with no statistical difference made by the clinical availability of the data (Table 1). In terms of susceptibility testing, the panel saved an average of 70.1 ± 58.2 hours but with less unity between the 2 cohorts (P = .005). Of the 66 cases with follow-up, identification via ePlex indicated an escalation of therapy in 20 (30%) and a narrowing of coverage in 31 (47%). In patients identified to have Staphylococcus aureus, BCID-GP could change antimicrobial therapy in 79%; the need for escalation of antibiotics was identified in 58% of cases. In patients with Staphylococcus epidermidis bacteremia, implementation of BCID-GP panel could have resulted in de-escalation of antimicrobial therapy in 67% of patients. The implementation of the BCID-GP panel was correlated with no significant change of in-hospital mortality (P = .72) but was correlated with a significantly decreased death-censored total length of stay (LOS) (P < .001) and LOS after culture (P = .001). Conclusions: Our study has demonstrated that nonculture identification of bacteria and susceptibility can result in major improvements in antimicrobial therapy in patients, particularly those with contaminants identified.

Funding: GenMark DX

Disclosures: None
Compliance and constraints of hand hygiene among healthcare workers in Bangladesh
Authors: Harun Md. Golam Dostogir , Sumon Shariful Amin , Mohona Tahrima Mohsin , Hassan Md. Zakiul , Rahman Aninda , Abdullah Syed Abul Hassan Md , Islam Md. Saiful , Styczynski Ashley
Published: May 2022

Background: Hand hygiene (HH) is a core element of patient safety and the single most essential strategy for preventing healthcare-associated infections (HAIs). Adherence to HH among healthcare workers (HCWs) varies greatly depending on a range of factors, including risk perceptions, institutional culture, auditing mechanisms, and availability of HH supplies. We observed HH compliance among HCWs to determine the factors influencing practices in tertiary healthcare facilities in Bangladesh. Methods: During September 2020–February 2021, we conducted nonparticipatory observations at 11 tertiary-care hospitals in Bangladesh using the WHO “Five Moments for Hand Hygiene” tool to record compliance among physicians, nurses, and cleaning staff. We also performed semistructured interviews to determine the key barriers to complying with hand hygiene. Furthermore, we noted the presence, location, and functionality of existing HH stations within each hospital ward. Results: We observed 14,668 HH opportunities among HCWs. The overall HH compliance was 25.3%, and compliance differed significantly by professional category (P < .001). Physicians had the highest HH compliance at 28.5% (2,264 of 7,930), followed by nurses at 25.4% (1,272 of 5,008). Cleaning staff had the lowest rates of HH at 9.9% (171 of 3,221). HCWs of public hospitals had significantly higher odds of complying with HH practices than those in private hospitals (27.4% vs 17.9%; aOR, 1.73; 95% CI, 1.55–1.93; P < .001). HH compliance also varied by WHO Five Moments indicators. HCWs were 3 times more likely to perform HH ‘after touching a patient’ than ‘before touching patient’ (aOR, 3.36; 95% CI, 2.90–3.90; P < .001). Common barriers to using hand sanitizer were insufficient supply (57.9%), skin reaction (26.3%), shortage of time (14.5%), and lack of awareness (11.9%). Regarding handwashing with soap, inadequate supplies (27.0%), high workload (26.3%), and lack of facilities (22.7%) were the key factors for low adherence. The HH infrastructure observation in 82 wards showed that running water and soap were available in 168 (86.2%) of 195 HCW-designated basins, compared to 51 (35.9%) of 142 for the patient- and attendant-assigned basins. Handwashing posters were found in only 44 (13.1%) of 337 basin surroundings, and no hand drying supplies were observed for patients or attendants. Conclusions: Hand hygiene compliance among HCWs fall significantly short of the standard for safe patient care. Inadequate HH supplies in a resource-constrained setting like Bangladesh demonstrates a lack of leadership in prioritizing, promoting, and investing in infection prevention and control. The findings of this study might help to motivate and design interventions for HH compliance, which will help reduce HAIs in the hospital setting.

Funding: None

Disclosures: None
Virtual assessments of infection prevention and control practices in African neonatal facilities: A pilot study
Authors: Frantzis Irene , Huebner Jack , Levasseur Stephanie , Sidiki Nabé Aboubacar , Mahida Maitry , Larussa Philip , James Wilmot G. , Stanberry Lawrence , Saiman Lisa
Published: May 2022

Background: Evidence-based infection prevention and control (IPC) practices to reduce healthcare-associated infections in low- and middle-income countries may be difficult to implement due to lack of resources. We pilot-tested the feasibility of virtual assessments of IPC practices in African facilities caring for small and/or sick neonates for opportunities to improve IPC. Methods: We created a checklist (in English and French) to assess IPC practices in African facilities caring for small and/or sick neonates Results: In total, 10 sites participated in this pilot study. Among them, 3 sites had unreliable Internet connections, and all checklist items could be observed and scored in these videos and photos. The lowest scores occurred for kangaroo mother care (KMC) spacing and presence of screens (Table 1). Conclusions: This pilot study demonstrated the feasibility of using virtual assessments of IPC practices. We identified several potentially low-cost opportunities to improve IPC. We are recruiting additional sites to confirm the findings of this pilot study.

Funding: Bill and Melinda Gates Foundation

Disclosures: None
Experiences of nurses responding to the COVID-19 outbreak at a long-term care hospital in Korea: A qualitative study
Authors: Kim EunJo , Kang JaHyun
Published: May 2022

Background: The COVID-19 pandemic revealed the fundamental vulnerability of long-term care hospitals (LTCHs) related to infection control and prevention (ICP). We examined the experiences of nurses who worked at a hospital where a COVID-19 outbreak occurred from February 24 to March 16, 2021. Method: This qualitative research was performed with 9 nurses who were engaged during the COVID-19 outbreak. We prepared a semistructured questionnaire based on the main question, “How was the experience among the nurses during the outbreak, and what difficulties did they encounter while resolving the situation?” The data were collected through in-depth, individual interviews from May to August 2021 after the approval of the institutional review board, and the results were analyzed thematically. Results: The average age of the participants was 52.1 years, and they had an average of 15.2 years of clinical experience. We extracted 4 themes and 16 subthemes from the results. The first theme, “sudden onset of the outbreak,” included the following subthemes: (1) found myself accustomed to COVID-19 and desensitized; (2) unavoidable occurrence despite compliance with ICP guidelines; (3) LTCHs are gradually recognized as a breeding ground for COVID-19 by the public; and (4) fear of spreading the infection in the hospital and of becoming a spreader. The second theme, “heavier workload,” included (1) daily overtime and extra shifts in violation of self-quarantine recommendations due to the shortage of nurses; (2) a barrage of phone calls from family members, other departments, public health centers, and hospitals where confirmed cases were transferred; (3) nursing assistants and private caregivers who do not have ICP knowledge as well as patients who do not cooperate due to cognitive impairment; and (4) accomplishing additional tasks while wearing personal protective equipment with some suffocation. The third theme, “emotions and lessons,” included (1) unsatisfied with the initial responses; (2) awareness of the entire infectious disease; (3) increased compassion and attachment for patients; and (4) take pride in the job and the profession as a nurse. The fourth theme, “necessary support and attention,” included (1) need to install isolation rooms and replenish infection control supplies; (2) need for ICP specialists in LTCHs; (3) need for continuous national-based monitoring on ICP for LTCHs; and (4) need to improve working environment and acknowledge nurses in LTCHs. Conclusions: Overall, participants expressed their experiences with the insufficient infection control and response system toward COVID-19 in the LTCH. To enhance ICP in LTCHs, customized policies, regulations, and financial support for infection control activities and ICP professionals must be established.

Funding: None

Disclosures: None
Inpatient point-prevalence screening of New Delhi Metallo-β-lactamase (NDM)–producing Enterobacaterales and Candida auris
Authors: Greco Christian , Smith Heather , Fearon Candice , Flaherty Jennifer , Kendrick Simona , Malcolm Kimberly , McGinnis Marcy , Shah Manisha , Banjoko Kadiatu , Zedek Anjali , Smyer Justin , Day Shandra , Colburn Nora , Liscynesky Christina , Haden Michael
Published: May 2022

Background: Carbapenem-resistant Enterobacterales (CRE) are an increasing threat to patient safety but only a small percentage of CRE identified are NDMs. Since 2018, clinical CRE isolates have been submitted to the Ohio Department of Health for sequencing and NDM cases have notably increased since that time. Candida auris is an emerging pathogen with similar risk factors for colonization as CRE. Methods: A point-prevalence study was initiated after an index patient was identified with NDM CRE infection or colonization during their inpatient admission. Two patient populations were included in the study: current patients on the same unit as the index patient and currently hospitalized patients who overlapped on any unit with the index patient for at least 72 hours. Patients had perirectal screening for CRE (via PCR) and axilla or groin screening for C. auris (via Xpert Carba-R Assay). Patients were excluded if they had been discharged, expired, or refused testing. Results: We completed 5 point-prevalence studies from March 21, 2021, to October 15, 2021. The index patients were admitted at different times and across 2 campuses including medical, cardiac, and surgical ICUs as well as medical-surgical and inpatient rehabilitation units. Moreover, 3 species of NDM were identified from urine and 2 species were identified from bronchoalveolar lavage: Enterobacter hormaechei, Citrobacter freundii, and Enterobacter cloacae complex. C. freundii and E. cloacae complex both had dual mechanisms of NDM and KPC. Although some of the index patients overlapped temporally within the health system, none overlapped in the same unit or building. None of the patients had recently received health care outside the United States, although 1 patient had emigrated from Togo >5 years prior and 4 had had prior local healthcare exposure within 12 months of admission. Also, 147 patients were identified for screening; 105 consented, 32 declined, and 10 were excluded due to being discharged, deceased, or unable to consent. Inpatient point-prevalence screening tests for all patients tested (n = 105) were negative for NDM CRE and C. auris. Conclusions: Despite an increase of inpatients with NDM CRE, evidence of patient-to-patient transmission was not identified, likely resulting from adherence to standard precautions. The diversity of species and lack of international travel suggests that these patients likely acquired NDM CRE from a local reservoir in the community or healthcare settings. Given the continued increase in NDM CRE without traditional risk factors, it is critical for hospitals and public health agencies to collaborate to identify these organisms and that they develop surveillance programs to clarify risk factors for colonization.

Funding: None

Disclosures: None
Increases in methicillin-sensitive Staphylococcus aureus bloodstream infection incidence, 2016–2019
Authors: Jackson Kelly , Nadle Joelle , Ray Susan , Lynfield Ruth , Dumyati Ghinwa , Tracy Marissa , Schaffner William , Ham David , See Isaac
Published: May 2022

Background: Incidence of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in the United States during 2012–2017 has been reported to have been stable for hospital-onset BSIs and to have increased 3.9% per year for community-onset BSIs. We sought to determine whether these trends continued in more recent years and whether there were further differences within subgroups of community-onset BSIs. Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based surveillance data during 2016–2019 for MSSA BSIs from 8 counties in 5 states. BSI cases were defined as isolation of MSSA from blood in a surveillance area resident. Cases were considered hospital onset (HO) if culture was obtained >3 days after hospital admission and healthcare-associated community-onset (HACO) if culture was obtained on or after day 3 of hospitalization and was associated with dialysis, hospitalization, surgery, or long-term care facility residence within 1 year prior or if a central venous catheter was present ≤2 days prior. Cases were otherwise considered community-associated (CA). Annual rates per 100,000 census population were calculated for each epidemiologic classification; rates of HACO cases among chronic dialysis patients per 100,000 dialysis patients were calculated using US Renal Data System data. Annual increases were modeled using negative binomial or Poisson regression and accounting for changes in the overall population age group, and sex. Descriptive analyses were performed. Results: Overall, 8,344 MSSA BSI cases were reported. From 2016–2019 total MSSA BSI rates increased from 23.9 per 100,000 to 28.5 per 100,000 (6.6% per year; P < .01). MSSA BSI rates also increased significantly among all epidemiologic classes. HO cases increased from 2.5 per 100,000 to 3.2 per 100,000 (7.9% per year; P = .01). HACO cases increased from 12.7 per 100,000 to 14.7 per 100,000 (7.0% per year; P = .01). CA cases increased from 8.4 per 100,000 to 10.4 per 100,000 (6.7% per year; P < .01) (Fig. 1). Significant increases in MSSA BSI rates were also observed for nondialysis HACO cases (9.3 per 100,000 to 11.1 per 100,000; 7.8% per year; P < .01) but not dialysis HACO cases (1,823.2 per 100,000 to 1,857.4 per 100,000; 1.4% per year; P = .59). Healthcare risk factors for HACO cases were hospitalization in the previous year (82%), surgery (31%), dialysis (27%), and long-term care facility residence (19%). Conclusions: MSSA BSI rates increased from 2016–2019 overall, among all epidemiologic classes, and among nondialysis HACO cases. Efforts to prevent MSSA BSIs among individuals with healthcare risk factors, particularly those related to hospitalization, might have an impact on MSSA BSI rates.

Funding: None

Disclosures: None