bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting land use and climate impacts on water yield ecosystem service in arid and semi-arid areas. A study in Sirvan River Basin-Iran
Authors: Balist Jahanbakhsh , Malekmohammadi Bahram , Jafari Hamid Reza , Nohegar Ahmad , Geneletti Davide
Published: November 2021

This study investigates how land use and climate changes affect water yield ecosystem service (ES) in the Sirvan River basin, located in Iran’s Kurdistan and Kermanshah provinces. By detecting land-use and climatic parameter changes in the past, their future evolution were modeled by scenario making. For this purpose, we developed two land-use scenarios (low and high urbanization) and two climatic scenarios (Representative Concentration Pathway 2.6 and RCP 8.5). The implemented scenarios showed how the amount of water yield in the basin and sub-basins changes in the future based on climate and land-use changes. The results showed that, concerning land use, the forest has decreased from 2013 to 2019, and built-up areas have increased. Also, the results showed that precipitation has been declining in the long term, and the temperature has been rising. Finally, the Water yield in 2019 was higher than in 2013 and lower in the future based on forecast scenarios. This trend will continue until 2040. In addition, it was found that the t effects of these factors on water yield ES are a complex process, and based on the results, the impact of climatic factors is more significant than the one of land-use change. We could conclude that this region will face more environmental problems in the future.
Simulation model for energy consumption and acoustic underwater communication of autonomous underwater vehicles
Authors: Danielis Peter , Parzyjegla Helge , Ali Mostafa Assem Mohamed , Torres Frank Sill
Published: November 2021

Recently, cooperative autonomous underwater vehicles (AUVs) have been deployed in application areas such as surveillance and protection of maritime infrastructures for inspection and monitoring purposes. These cooperative methodologies require wireless transmission of data between the different AUVs operating in the underwater environment. Communication over ranges exceeding 100 m exclusively relies on underwater acoustic communication. However, the propagating acoustic waves suffer from several challenges due to the presence of path loss, multi-path propagation, the slow and variant propagation speed, background noise, and Doppler distortion. Since the power supply of the AUVs is limited, communication must be very energy efficient and energy constraints have to be known to be able to plan the mission of AUVs. Due to the difficulties of real experiments, the modeling and simulation of the energy consumption and underwater acoustic communication play an essential role in studying and developing these systems. We provide a modular simulation model for the energy consumption and acoustic underwater communication of AUVs implemented in the network simulator OMNeT++ using the INET framework. More specifically, we extend several INET modules in such a way as to reflect the characteristics of AUVs and underwater communication. We study and analyze the AUVs’ energy consumption and dependence of the message quality on different properties such as those mentioned above.
Lang–Vojta conjecture over function fields for surfaces dominating $${{\mathbb {G}}}_m^2$$
Authors: Capuano Laura , Turchet Amos
Published: November 2021

We prove the nonsplit case of the Lang–Vojta conjecture over function fields for surfaces of log general type that are ramified covers of $${{\mathbb {G}}}_m^2$$

G
m
2

. This extends the results of Corvaja and Zannier (J Differ Geom 93(3):355–377, 2013), where the conjecture was proved in the split case, and the results of Corvaja and Zannier (J Algebr Geom 17(2):295–333, 2008), Turchet (Trans Amer Math Soc 369(12):8537–8558, 2017) that were obtained in the case of the complement of a degree four and three component divisor in $${{\mathbb {P}}}^2$$

P

2

. We follow the strategy developed by Corvaja and Zannier and make explicit all the constants involved.
Prelog Chow groups of self-products of degenerations of cubic threefolds
Authors: Böhning Christian , von Bothmer Hans-Christian Graf , van Garrel Michel
Published: November 2021

It is unknown whether smooth cubic threefolds have an (integral Chow-theoretic) decomposition of the diagonal, or whether they are stably rational or not in general. As a first step towards making progress on these questions, we compute the (saturated numerical) prelog Chow group of the self-product of a certain degeneration of cubic threefolds.
Compilation of Black Soldier Fly Frass Analyses
Authors: Gärttling Daniel , Schulz Hannes
Published: November 2021

In the context of black soldier fly (BSF) rearing, often the residues from production — mainly faeces but also undigested substrate — are addressed as frass in a broader sense. As BSF production is expanding, the valorization of BSF frass as organic fertilizer is gaining importance. However, in contrast to established organic fertilizers, little is known on the properties and variation of this by-product, which is essential for assessing possible application purposes. To elaborate a first overview on this relatively new waste stream, BSF frass analyses from the literature and anonymized frass analyses enquired from BSF producers were compiled. For a possible agricultural use as a fertilizer, their nutrient patterns were assessed. With a balanced nitrogen:phosphorous pentoxide:potassium oxide (N:P2O5:K2O) ratio of 1:0.9:1.1, BSF frass can be characterized as a slightly alkaline (pH 7.5), nutrient-rich compound fertilizer, with the nutrient and especially the micronutrient contents showing high variation. The comparably high carbon-to-nitrogen ratio and low shares of ammonium nitrogen indicate a limited immediate nutrient release and point to possible applications of frass as a long-term fertilizer. The use of frass as an organic fertilizer as one element in a fertilization strategy is promising. By improving nutrient cycling back to the field, BSF frass can represent an important element of sustainable circular agriculture. However, more information on BSF feed and production systems needs to be combined with the nutrient analyses to better understand the variation in frass nutrient contents.
Upregulation of circRNA hsa_circ_0008726 in Pre-eclampsia Inhibits Trophoblast Migration, Invasion, and EMT by Regulating miR-345-3p/RYBP Axis
Authors: Shu Chang , Xu Peng , Han Jun , Han Shumei , He Jin
Published: November 2021

Accumulating evidence shows that impaired spiral artery remodeling, placental dysfunction, and insufficient trophoblast infiltration contribute to the etiology and pathogenesis of pre-eclampsia (PE). circRNAs are a class of endogenous non-coding RNAs implicated in the pathogenesis of many diseases, including PE. This study aims to investigate the role of circRNA hsa_circ_0008726 in regulating the migration and invasion of extravillous trophoblast cells. RNase R assay was performed to confirm that circ_0008726 was a circular transcript. The expression of circ_0008726, RYBP, and miR-345-3p was examined by qRT-PCR. The functional interaction between miR-345-3p and circ_0008726 or RYBP was confirmed using dual-luciferase reporter assay and RNA immunoprecipitation (RIP). Cell migration and invasion ability was analyzed by Transwell assays. Western blot was used for the quantification of RYBP protein level. Circ_0008726 expression was significantly increased in PE placenta tissues as compared with normal placenta tissues. Circ_0008726 was resistant to RNase R digestion and was predominately located in the cytoplasm of HTR-8/SVneo cells. Silencing circ_0008726 promoted cell migration and EMT (epithelial-mesenchymal transition), while circ_0008726 overexpression suppressed these processes. Mechanistically, circ_0008726 sponged miR-345-3p to negatively regulate its expression, and miR-345-3p negatively modulated the expression of RYBP. In PE samples, the expression level of circ_0008726 was negatively correlated with miR-345-3p level, but was positively correlated with RYBP expression. Transfection of miR-345-3p mimic or RYBP knockdown counteracted the effects of circ_0008726 overexpression on cell migration and EMT. Our data demonstrate the upregulation of circ_0008726 in PE placenta, which inhibits the migration, invasion, and EMT of HTR-8/SVneo cells by targeting miR-345-3p/RYBP axis. These data suggest that circ_0008726 could be a potential biomarker and therapeutic target for PE.
Ivacaftor in Omani children with cystic fibrosis caused by p.Ser549Arg CFTR mutation
Authors: Al Oraimi Sumaya , Mohsin Hussain , Al Musawi Zainab , Al Balushi Younis , Al Shidhani Khoula , Al Salmi Qasem
Published: November 2021

Background:

Cystic fibrosis (CF) is a multisystemic chronic disease caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein. These mutations are classified in to six classes. Ivacaftor is a CFTR potentiator which partially restores the CFTR function for class III mutations. In Oman, p.Ser549Arg (class III) is the most common mutation (65% of cases). Our study prospectively evaluated the tolerance and clinical efficacy of ivacaftor.

Methods:

A prospective observational study was conducted at the Royal Hospital, Oman. All children aged 6–18 years who are followed and carry at least one copy of the p.Ser549Arg mutation were started on Ivacaftor and included in the study. Data collected included weight, height, forced expiratory volume in first second (FEV1), sweat chloride concentration, stool elastase level and liver enzymes at baseline and at 12, 24, 36, and 48 weeks after initiation of treatment. The number of CF pulmonary exacerbations one year before and during treatment were compared.

Results:

Twenty one children were started on Ivacaftor (90% homozygous for p.Ser549Arg). The mean age was 10.8 (SD ±3.5) years. When compared to baseline, FEV1 significantly improved by a mean of 10.8 (SD ±13.5) percentage points (pp) and 14.3 (SD ±7.5) pp at 12 and 48 weeks respectively. The sweat chloride level significantly dropped from a mean of 107 (SD ±8.5) mmol/l to 38.5 (SD ±22.3) mmol/l at 12 weeks and remained low. The Body Mass Index (BMI) improved by a mean of 1.37 (SD ±1.3) kg/m 2 and 1.9 (SD ±1.35) kg/m 2 at 24 and 48 weeks of treatment respectively. The number of admissions the year before and during treatment reduced significantly from a mean of 2.2 (SD± 1.9) to 0.7 (SD ±1) admission per year. Two children developed transaminitis.

Conclusion:

Ivacaftor is well tolerated and resulted in a significant improvement in FEV1, BMI and sweat chloride level in children with p.Ser549Arg CFTR mutation.
Efficacy and Safety of Investigational Microbiome Drug SER-109 for Treatment of Recurrent Clostridioides difficile Infection
Authors: McGovern Barbara , Sims Mathew , Kraft Colleen , Wang Elaine , Brady Kelly , Ford Christopher , Edward O’Brien , Lombardo Mary-Jane , Wortman Jennifer , Litcofsky Kevin , Mahoney Jennifer , McChalicher Christopher , Winkler Jonathan , Garant Sarah , Aunins John , Henn Matthew , von Moltke Lisa
Published: November 2021

Background: Antibiotics targeted against Clostridioides difficile bacteria are necessary, but insufficient, to achieve a durable clinical response because they have no effect on C. difficile spores that germinate within a disrupted microbiome. ECOSPOR-III evaluated SER-109, an investigational, biologically derived microbiome therapeutic of purified Firmicute spores for treatment of rCDI. Herein, we present the interim analysis in the ITT population at 8 and 12 weeks. Methods: Adults ≥18 years with rCDI (≥3 episodes in 12 months) were screened at 75 US and CAN sites. CDI was defined as ≥3 unformed stools per day for <48 hours with a positive C. difficile assay. After completion of 10–21 days of vancomycin or fidaxomicin, adults with symptom resolution were randomized 1:1 to SER-109 (4 capsules × 3 days) or matching placebo and stratified by age (≥ or <65 years) and antibiotic received. Primary objectives were safety and efficacy at 8 weeks. Primary efficacy endpoint was rCDI (recurrent toxin+ diarrhea requiring treatment); secondary endpoints included efficacy at 12 weeks after dosing. Results: Overall, 287 participants were screened and 182 were randomized (59.9% female; mean age, 65.5 years). The most common reason for screen failure was a negative C. difficile toxin assay. A significantly lower proportion of SER-109 participants had rCDI after dosing compared to placebo at week 8 (11.1% vs 41.3%, respectively; relative risk [RR], 0.27; 95% confidence interval [CI], 0.15–0.51; p-value <0.001). Efficacy rates were significantly higher with SER-109 vs placebo in both stratified age groups (Figure 1). SER-109 was well-tolerated with a safety profile similar to placebo. The most common treatment-emergent adverse events (TEAEs) were gastrointestinal and were mainly mild to moderate. No serious TEAEs, infections, deaths, or drug discontinuations were deemed related to study drug. Conclusions: SER-109, an oral live microbiome therapeutic, achieved high rates of sustained clinical response with a favorable safety profile. By enriching for Firmicute spores, SER-109 achieves high efficacy while mitigating risk of transmitting infectious agents, beyond donor screening alone. SER-109 represents a major paradigm shift in the clinical management of patients with recurrent CDI. Clinicaltrials.gov Identifier NCT03183128. These data were previously presented as a late breaker at American College of Gastroenterology 2020.

Funding: Seres Therapeutics

Disclosures: None
COVID-19 Vaccine Readiness Among Acute-Care Registered Nurses in New Jersey: Results of a Statewide Survey
Authors: Pogorzelska-Maziarz Monika , Lou Manning Mary , Gerolamo Angela , Johansen Mary , Grafova Irina , Crincoli Suzie , de Cordova Pamela
Published: November 2021

Background: The coronavirus disease 2019 (COVID-19) vaccine is an important intervention to control the COVID-19 pandemic. As the most trusted profession integral to providing care to patients across all care settings, nurses play a critical role in educating patients regarding the SARS-CoV-2 vaccine. However, little is known about the readiness of registered nurses (RNs) to receive the vaccine. Methods: In October 2020, prior to FDA approval of vaccines, we conducted a cross-sectional electronic survey of all active registered nurses in the state of New Jersey. The eligibility criteria included providing direct patient care in a New Jersey hospital in an emergency or an adult inpatient unit during the emergence of COVID-19 (March 2020). Results: In total, 3,027 RNs completed the survey (15% response rate). When asked whether they plan to get vaccinated, 27% of RNs responded yes, 30% responded no, and 43% were undecided. Among those RNs who reported that they were planning to get vaccinated, their main reasons for their willingness to receive the vaccine included (1) wanting to protect themselves and their families (95%), (2) wanting to protect the community at large (76%), wanting to protect their patients (75%), the belief that life won’t get back to normal until most people are vaccinated (72%), and the belief that getting vaccinated is the best way to avoid getting seriously ill from COVID-19 (67%). The main reasons reported for not planning to or being undecided about getting vaccinated included the belief that the vaccine will likely be developed too quickly to be safe (81%) and concern about the side effects from the vaccine (74%). RNs also reported being in a low-risk group for becoming seriously ill (12%) and having had COVID-19 (8%) as reasons for planning not to get vaccinated. In open-ended responses, participants also discussed several additional issues driving vaccine hesitancy: their lack of trust in the political process, planning to become pregnant or currently pregnant or breastfeeding, questions about effectiveness of the vaccine and long-term side effects, and the need for more information before making a decision. Conclusions: This cross-sectional study of all acute-care RNs in the State of New Jersey was conducted prior to the FDA approval of COVID-19 vaccines. The results outline factors driving vaccine hesitancy among RNs. Although vaccine efficacy data and approval by the FDA may have alleviated some of these fears, immunization programs for healthcare workers and the public should focus on dispelling myths about vaccine development and side effects.

Funding: No

Disclosures: None
Medical Tape Contamination Study: Effect of Packaging on the Reduction of Cross Contamination
Authors: Vang Kheng , Smith Graham , Pastoor Sara J
Published: November 2021

Background: Medical tape is used routinely for a variety of tasks across healthcare settings. The literature contains numerous publications in which common practices around medical tapes have been suspected to lead to infection transmission. Healthcare providers can turn to individually packaged single-patient-use medical tape rolls to help reduce cross-contamination risk by limiting exposure to environmental contaminants, minimizing contact with hospital surfaces and equipment, and minimizing exposure to healthcare workers’ hands and other patients. Methods: We evaluated the effect of individually packaged tape on cross contamination using a controlled laboratory assay. Ceramic tiles were inoculated with microorganisms evenly spread across the surface and allowed to air dry. Using gloves, packaged and unpackaged tapes were rolled over their entire outside circumference onto the contaminated tiles to simulate cross contamination. Using new gloves, the packaged tapes were then removed from their package with minimum contact. All cross-contaminated tape rolls were placed in phosphate-buffered water and mixed in a vortexer for bacterial recovery procedures. Serial dilutions were plated on appropriate media for bacterial enumeration. The average log10 colony-forming unit (CFU) recovery was measured for comparison. We used 4 types of tapes in this study (3M Micropore S Surgical Tape, 3M Medipore H Soft Cloth Surgical Tape, 3M Durapore Surgical Tape, and 3M Transpore White Surgical Tape). We used 4 different microorganisms as inoculates: Staphylococcus aureus (methicillin-resistant), Enterococcus faecium (vancomycin-resistant), Klebsiella pneumoniae (carbapenem-resistant), and Clostridium difficile (spore). Each test (tape and bacteria combination) was done in 3 or 6 replicates; each bacterial enumeration was the average of duplicate plates. The detection limit for this method is 8 CFU per sample, which is equivalent to 0.9 log10. Results: The results for all tapes tested showed a statistically significant lower mean log10 recovery of each of the microorganisms tested for packaged versus unpackaged tape (Figure 1). The mean differences of log10 recoveries from a packaged and unpackaged tape ranged from 2.51 log10 (for S. aureus on Micropore S) to 4.64 log10 (for K. pneumoniae on Medipore H). This is equivalent to 99%–99.99% cross-contamination protection from the 4 organisms tested. Conclusions: Individual packaging of medical tape rolls protects them from external contaminants. Even if the packaging becomes contaminated, the tape retrieved from the package will be significantly less contaminated than it would have been from exposure to the same contaminants without packaging.

Funding: 3M Company

Disclosures: None
Cluster of Invasive Pseudomonas aeruginosa Infections in a Neonatal Intensive Care Unit
Authors: Spencer Hillary , Banerjee Ritu , Wilson Gregory , Boswell Tanya
Published: November 2021

Background:Pseudomonas aeruginosa uncommonly causes illness in neonatal intensive care units (NICU). A cluster of 4 infections was appreciated over 6 weeks in our inborn–delivery NICU, prompting an investigation. Methods: Upon recognition of a cluster of infections, we retrospectively audited all cultures positive for P. aeruginosa from all sites (sterile and nonsterile) over the prior year in the index NICU (NICU 1, inborn) and for comparison in the adjacent NICU (NICU 2, larger, outborn–surgical). We performed multilocus sequence testing (MLST) of available clinical isolates to identify clonality. We initiated quarterly prospective surveillance of P. aeruginosa colonization of infants through nares, perirectal swabs, and tracheal aspirates of intubated infants or oropharyngeal swabs of nonintubated infants. We also swabbed incubators, ventilatory equipment, and sinks for selective P. aeruginosa culturing. Results: We identified 7 invasive P. aeruginosa infections in the inborn NICU (5 bloodstream and 2 pneumonia) over an 11-month period (Figure 1). Over the same period, there were no P. aeruginosa bloodstream infections in the adjacent NICU. Affected neonates were high risk: gestational age ranged from 22 weeks and 4 days to 26 weeks and 3 days; day of life at infection ranged from 6 to 37; 6 infants were on a jet ventilator; and all infants were receiving enteral nutrition (6 of 7 with donor human milk and 7 of 7 with expressed mother’s milk). Two infants died from their infection, and 5 infants survived to hospital discharge. All 7 isolates were pansusceptible to routine antimicrobials. MLST of the first 4 available isolates demonstrated 4 different sequence types; however, the first 2 were from the same clonal complex, indicating relatedness (Figure 1). For environmental samples, 8 obtained 8 cultures (swabs) of incubators and ventilatory equipment, and 24 cultures of faucets and drains of all sinks. Only sink cultures were positive, yielding 3 isolates identified as P. aeruginosa and 4 isolates identified as P. aeruginosa–like. Whole-genome sequencing (WGS) is underway to identify relatedness to the clinical isolates. We initiated quarterly infant surveillance by swab culture for P. aeruginosa nasal colonization then escalated to perirectal and oropharyngeal swab or tracheal aspirate cultures (intubated infants) in subsequent quarters. We did not detect any infants colonized with P. aeruginosa. Conclusions: We identified a cluster of P. aeruginosa in high-risk neonates with no point source. Molecular typing indicated a multiclonal cluster. This finding poses a management dilemma. A colonized water system is suspected and WGS of environmental samples is underway.

Funding: No

Disclosures: None
Impact of a Black Physician Panel Discussion on Coronavirus Disease 2019 (COVID-19) Health Education
Authors: Evans Kenisha , Lee-Allen Jannel , Chinemelu Okoye Donald , Uroda Lauren , Chopra Teena , Ikwuezunma Gini , Nnodim Opara Ijeoma , Thompson Hayley
Published: November 2021

Background: Coronavirus disease 19 (COVID-19) has infected >26 million Americans with >400,000 deaths. Both Pfizer and Moderna vaccines against severe acute respiratory coronavirus 2 (SARS-CoV-2) have demonstrated 95% efficacy; yet there has been growing vaccination hesitancy, especially within communities of color. To achieve herd immunity and quell the spread of SARS-CoV-2, several strategies need to be deployed. This community-based demonstration project highlights the impact of a panel of black physicians’ ability to increase vaccination intent within a social media campaign targeted toward a black audience, namely a live question-and-answer (Q&A) event on SARS-CoV-2 vaccines. Methods: The social media campaign included a flyer featuring the head shots and titles of 11 black physicians. The flyer showcased a live Q&A event via Zoom video conference software. Attendees were requested to preregister with their name, e-mail address, and country of origin. Results: The live Q&A event was attended by 251 viewers. Geographic distribution was predominantly within the United States (~88%), but a few attendees were from the United Kingdom (~11%) and Canada (<1%), Puerto Rico (<1%), and Paraguay (<1%). One hundred twenty eight questions and comments were received from attendees. Audience questions were categorized, with predominant topics as follows: Vaccine Safety, Medical Mistrust, Vaccine Safety in Pregnancy, Vaccine Efficacy, and Vaccine Development. The top five poll results revealed: 31% of audience members were not planning to vaccinate or were not sure about vaccination, but after the event are now planning to vaccinate; 93% believed their knowledge of the C19 vaccines had increased; 95% believed it was important that the information was presented by Black health experts; 90% reported that they trusted the information presented; and 96% rated the session as “good or excellent”. Conclusion: Our social media project is an example of one strategy healthcare professionals can utilize to positively influence local and global communities in the mitigation of the COVID-19 pandemic. Results of this project evaluation showed that viewers responded favorably, reporting increases in vaccine acceptance and knowledge. Most respondents also affirmed the importance of having black experts involved in communicating this information. COVID-19 has disproportionately affected black communities as a result of health inequities and institutionalized racism.1 The event amplifies the importance of utilizing social-media–based interventions and increasing black healthcare representation to aid infection control. 1. Jones C. Why Racism, Not Race, Is a Risk Factor for Dying of COVID-19. Scientific American June 12, 2020.

Funding: No

Disclosures: None
Bat Intrusions at a Tertiary Care Center, Iowa 2018–2020
Authors: Alsuhaibani Mohammed , Kobayashi Takaaki , Sheeler Lorinda , Trannel Alexandra , Holley Stephanie , Abosi Oluchi , Jenn Kyle , Meacham Holly , Etienne William , Dains Angie , Kukla Mary , Millard Bill , Marra Alexandre , Wellington Melanie , Diekema Daniel , Salinas Jorge
Published: November 2021

Background: Bats are recognized as important vectors in disease transmission. Frequently, bats intrude into homes and buildings, increasing the risk to human health. We describe bat intrusions and exposure incidents in our hospital over a 3-year period. Methods: The University of Iowa Hospitals and Clinics (UIHC) is an 811-bed academic medical center in Iowa City, Iowa. Established in 1928, UIHC currently covers 209,031.84 m2 (~2,250,000 ft2) and contains 6 pavilions built between 1928 and 2017. We retrospectively obtained bat intrusion calls from the infection prevention and control program call database at UIHC during 2018–2020. We have also described the event management for intrusions potentially associated with patient exposures. Results: In total, 67 bat intrusions occurred during 2018–2020. The most frequent locations were hallways or lounges 28 (42%), nonclinical office spaces 19 (14%), and stairwells 8 (12%). Most bat intrusions (65%) occurred during the summer and fall (June–November). The number of events were 15 in 2018, 28 in 2019, and 24 in 2020. We observed that the number of intrusions increased with the age of each pavilion (Figure 1). Of 67 intrusions, 2 incidents (3%) were associated with potential exposure to patients. In the first incident, reported in 2019, the bat was captured in a patient care area and released before an investigation of exposures was completed and no rabies testing was available. Also, 10 patients were identified as having had potential exposure to the bat. Among them, 9 patients (90%) received rabies postexposure prophylaxis. In response to this serious event, we provided facility-wide education on our bat control policy, which includes the capture and safe handling of the bat, assessment of potential exposures, and potential need for rabies testing. We also implemented a bat exclusion project focused on the exterior of the oldest hospital buildings. The second event, 1 patient was identified to have potential exposure to the bat. The bat was captured, tested negative for rabies, no further action was needed. Conclusions: Bat intrusions can be an infection prevention and control challenge in facilities with older buildings. Hospitals may need animal intrusion surveillance systems, management protocols, and remediation efforts.

Funding: No

Disclosures: None
Laboratory-Confirmed SARS-CoV-2 Following One or More Doses of mRNA Vaccine Among Care Team Members at an Academic Health System
Authors: Curry Scott , Salgado Cassandra , Kuppalli Krutika , Nickerson Patricia , Schrader Morgan , Scheurer Danielle , Hirschhorn Julie
Published: November 2021

Background: Medical University of South Carolina Health began vaccinating care team members December 15, 2020, with the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine. We report surveillance data for cases diagnosed following vaccination. Methods: Care team members (CTMs) diagnosed with COVID-19 following SARS-CoV-2 vaccination were self-identified during online electronic contact-tracing surveys. Demographic data, symptoms, and dates of symptoms were recorded. CTMs testing positive at MUSC were linked to viral burden data from nasopharyngeal swabs tested on Abbott PCR platforms. Results: As of January 31, 2021, 111 CTMs tested positive for SARS-CoV-2 following vaccination: 99 and 12 after 1 and 2 doses, respectively, at medians of 10 days (range, 1–22) and 5 days (range, 1–16), respectively, from vaccination to testing. Of 2 cases that tested positive >14 days from dose 2, CTMs had symptom onset at 4 and 12 days from dose 2. Among CTMs reporting symptoms, 104 did so after a median of 7 days (mean 6.3, range −23 to +22) from vaccination to symptom onset, with 8 reporting symptoms before vaccination, 9 on the day of vaccination, and 3 CTMs at 1 day after vaccination, 6 CTMs at 2 days after vaccination, and 11 CTMs at 3 days after vaccination. Overall, 86 (78%) of 111 were female and 95 (86%) of 111 were white. The median age was 44 years (range, 22–71). Clinical job roles were most frequently nurses (n = 31, 28%), physicians or physician extenders (n = 19, 17%), and CTMs with no patient contact (n = 21, 19%). Assessment by the contact-tracing team assigned sources as household clusters (n = 22, 23%), local transmission (n = 21, 22%), occupational acquisition from coworkers (n = 11, 12%), travel related (n = 9, 10%), and unknown (n = 32, 34%). Only 32 (32%) CTMs were compliant with physical distancing. Among 104 CTMs reporting symptoms, cough (75%), headache (71%), rhinorrhea (63%), myalgia (60%), sore throat (48%), anosmia (44%), and subjective fever (40%) were the most commonly reported symptoms. Among 54 symptomatic CTMs with available viral-load data, the median and mean cycle numbers (Cn) were 19.98 and 21.91, respectively, for samples tested a median 3 days from symptom onset. Asymptomatic and symptomatic CTMs had a median Cn of 30.1 vs 20.9, respectively (p <0.001) and overall 50% of vaccinated CTMs had Cn >20, with no significant effect seen by vaccine dose (Figure 1). Conclusions: Most COVID-19 cases following vaccination occurred in CTMs with infection incubating prior to vaccination. No significant attenuation of viral load is apparent among vaccinated CTMs with COVID-19, but asymptomatic CTMs diagnosed with COVID-19 following vaccination appear to have resolved infections. Our data reinforce the need to adhere to public health measures by people who have been vaccinated.

Funding: No

Disclosures: None
New COVID-19 Transmission after the First Vaccine Dose at Skilled Nursing Facilities in Nebraska
Authors: Kamal-Ahmed Ishrat , Kanishka FNU , Stover Derry , Donahue Matthew , Du Yi , Julian Derek , German Dan
Published: November 2021

Group Name: DHHS Epi

Background: The inoculation with SARS-CoV-2 vaccine at long-term care facilities (LTCFs) in Nebraska began on December 28, 2020, as part of the Centers for Disease Control and Prevention (CDC) Pharmacy Partnership for Long-Term Care Program.1 As of February 5, 2021, 159 skilled nursing facilities (SNFs) had completed their first vaccine clinic, and 7,271 residents and 6,768 staff had received the first dose of the 2-dose series. Surveillance data before vaccination (December 21–27, 2020) and after the first vaccination dose (January 25–31, 2021) indicate that the weekly SARS-CoV-2 positivity rate at SNFs decreased from 1.18% to 0.42% for residents and 0.54% to 0.11% for staff.2,3,4 In this study, we examined the perceived decrease in new transmission initiated by the first dose of vaccine at SNFs. Methods: We analyzed the data with separate logistic regressions for residents and staff. We included 145 SNFs that completed their first vaccine clinic, and we used the Federal and Pharmacy Partnership database for the number of residents and staff that received the first dose of vaccine at the first vaccine clinic. We followed the SNFs for 21 days after the first vaccine clinic from December 28, 2020, through February 5, 2021, for any first-time SARS-CoV-2–positive cases. The National Healthcare Safety Network (NHSN) database was used to collect the information on the number of residents present at the facility on the day of the first vaccine clinic, if available, or days before in the same week as the first vaccine clinic. The staff count for each facility was extracted from Nebraska Licensure for LTCFs. We collected new case information from the state surveillance, the NHSN, and the Test-Nebraska platform. Results: The mean resident vaccine coverage was 80% and the median staff vaccine coverage was 43%. We found a reverse association between staff vaccine coverage and new positive staff cases. For each percentage increase in staff vaccine coverage, the odds of having a new staff positive case 7 days and 14 days after the first vaccine clinic decrease by 26% and 48%, respectively. No association between coverage and new resident transmission was detected. Possible confounding exists when infected residents might have tested positive 7–14 days after the first vaccine clinic who were not affected by the vaccine. Conclusions: Although we observed the association between lower case count with increased facility-level vaccine coverage, we would need to wait for the administration of the second dose of vaccine before assessing the level of association between coverage and new transmission. Further initiatives are warranted to increase the suboptimal vaccine coverage for staff.

Funding: No

Disclosures: None
Promoting Antimicrobial Stewardship Education Among Pediatricians Through a Maintenance of Certification Part 4 Quality Impro
Authors: Singh Prachi , Lee Brian , Holmen Jenna
Published: November 2021

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.

Funding: No

Disclosures: None
Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin
Authors: Gusovsky Amanda , Burgess David , Burgess Donna , Slade Emily , Delcher Chris , Woodworth Alison , Chael Jordan , Osborne Thai
Published: November 2021

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.

Funding: No

Disclosures: None
Evaluating the Prevalence of Leading Practices in Antimicrobial Stewardship
Authors: Braun Barbara , Chitavi Salome , Stenehjem Eddie , Khan Mushira , Baker David , Hyun David
Published: November 2021

Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.

Funding: The Pew Charitable Trusts

Disclosures: None
Transmission of COVID-19 on an Inpatient Hospital Prison Unit
Authors: Witherspoon Kelsey , Shah Manisha , Smyer Justin , Colburn Nora , Liscynesky Christina , Hebert Courtney , Day Shandra
Published: November 2021

Background: Prison populations have been disproportionally affected by COVID-19, partly due to challenges related to social distancing. Data on viral transmission dynamics in inpatient prison units remain limited. The Ohio State University Wexner Medical Center (OSUWMC) has a 24-bed inpatient prison unit in collaboration with the Ohio Department of Rehabilitations and Corrections (ODRC). The unit has 5 shared rooms holding 4 patients each and 4 single-patient rooms. Several cases of inpatient transmission of COVID-19 were identified on the inpatient prison unit. Methods: An IRB-approved retrospective chart review was conducted to evaluate inpatient transmission dynamics of hospital-acquired (HCA) COVID-19. All ODRC patients admitted from March 1 to April 24, 2020, were included. Patients assigned to the prison unit during their hospital stay were evaluated for potential HCA COVID-19, defined as a positive SARS-CoV-2 test ≥4 days after admission. Patient characteristics, testing data, symptoms, aerosol-generating procedures (AGPs), and room assignments were reviewed. Healthcare workers (HCWs) and correction officers (COs) working on the unit who tested positive during this period were identified. Results: In total, 142 ODRC patients were admitted during the study period and 89% had a positive SARS-CoV-2 testing prior to or during admission. Also, 61 patients (43%) were assigned to the prison unit. Moreover, 8 patients on the unit met potential HCA COVID-19 definition with 7 linked to 3 distinct clusters. Also, 7 COs had COVID-19 (outside hospital exposure) and 5 HCWs acquired COVID-19 from patient exposure on the unit. In cluster 1, 4 patients admitted to the same room developed HCA COVID-19. A symptomatic index patient not tested on admission given an atypical presentation required CPAP and frequent nebulizer treatments. In cluster 2, 1 patient from cluster 1 was transferred to another room. The new roommate subsequently developed HCA COVID-19. In cluster 3, a symptomatic correctional officer was assigned to 2 patients in a shared room; the patients later developed HCA COVID-19. Conclusions: Three patient clusters of HCA COVID-19 on a prison unit were identified. Aerosol transmission potentially played a role in cluster 1. Inpatient transmission within the unit prompted updated guidance for ODRC admissions, including universal SARS-CoV-2 admission testing, excluding patients requiring AGPs from shared rooms, and preemptive isolation for patients from an ODRC facility experiencing a COVID-19 surge. Universal testing was quickly expanded to all inpatient admissions. HCWs and COs were also linked to inpatient transmission, highlighting the importance of strict infection control practices for patient populations who cannot socially distance.

Funding: No

Disclosures: None
Characteristics of On-Site Infection Prevention and Control Visits for COVID-19—California, February 2020–December 2020
Authors: Stendel Patrick , Karmarkar Ellora , Kennedy Idamae , Bagheri Hosniyeh , Nelson Teresa , Nelson Terry , Epson Erin
Published: November 2021

Background: The novel coronavirus (COVID-19) pandemic has caused significant morbidity and mortality in California: 2,218,000 cases and 24,598 deaths had occurred by December 31, 2020. Deaths at skilled nursing facilities (SNFs) and assisted living facilities (ALFs) comprise 26.2% of deaths in California; the fatality rate (299 per 10,000 SNF and ALF residents) in such facilities is nearly 50 times the statewide COVID-19 mortality rate (6.4 per 10,000 California residents). For healthcare facility (SNF, ALF, acute-care hospitals) and correctional facility outbreak management, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program deployed trained infection preventionists (IPs) to perform on-site infection prevention and control (IPC) assessments and to provide recommendations to staff and local health departments (LHDs). We describe the number and distribution of visits across the state and common IPC challenges identified. Methods: From February 1, 2020, to December 31, 2020, CDPH IP visits were requested directly by facilities, coordinated through LHDs and other state agencies, or prompted by a facility’s increasing case count on twice weekly review of the daily California healthcare facility data survey (Survey 123). Deployed IPs evaluated facility COVID-19 IPC protocols, assessed facility staff adherence using a standardized assessment tool, and provided verbal feedback followed by written summary reports and recommendations. We categorized visits geographically into 5 California Health Officer Association regions and by month, and we reviewed visit reports for common findings. Results: In total, 623 visits were performed for 489 outbreaks at 465 distinct facilities across 46 LHDs; 71 facilities received ≥2 visits. Southern California facilities received 292 visits (46.9%), San Joaquin region facilities received 138 visits (22.2%), Bay Area facilities received 131 visits (21%), Greater Sacramento facilities received 54 visits (8.7%), and Rural North facilities received 8 visits (1.3%) (Figure 1). The highest number of visits per month occurred in December (n = 143, 22.9%), followed by July (n = 87, 13.9%), and April (n = 83, 13.3%). Common IPC challenges included inappropriate resident cohorting practices, improper use of personal protective equipment, and lapses in physical distancing, and source control in breakrooms. Conclusions: On-site visits by CDPH IPs during the COVID-19 pandemic in California, though resource-intensive, provided substantial technical support for healthcare facilities during outbreaks and identified key areas for IPC improvement. Ongoing CDPH HAI guidance and training materials for facility-based IP staff are now being informed by these IPC challenges.

Funding: No

Disclosures: None