bluuebunny/crossref_metadata_2025 huggingface dataset:
Using grass inflorescence as source material for biomonitoring through environmental DNA metabarcoding
Authors: Coetzer Willem G.
Published: September 2024

Background

Over the last decade, increasing attention has been directed to using different substrates as sources of environmental DNA (eDNA) in ecological research. Reports on the use of environmental DNA located on the surface of plant leaves and flowers have highlighted the utility of this DNA source in studies including, but not limited to, biodiversity, invasive species, and pollination ecology. The current study assesses grass inflorescence as a source of eDNA for detecting invertebrate taxa.

Methods and results

Inflorescences from four common grass species in a central South African grassland were collected for high-throughput sequencing analysis. Universal COI primers were utilised to detect Metazoan diversity. The sequencing results allowed for the detection of three Arthropoda orders, with most OTUs assigned to fungal taxa (Ascomycota and Basidiomycota). Some biases were detected while observing the relative read abundance (RRA) results.

Discussion

The observed biases could be explained by the accidental inclusion of invertebrate specimens during sample collection and DNA extraction. Primer biases towards the amplified taxa could be another reason for the observed RRA results. This study provided insight into the invertebrate community associated with the four sampled grass species. It should be noted that with the lack of negative field controls, it is impossible to rule out the influence of airborne eDNA on the observed diversity associated with each grass species. The lack of the inclusion of PCR and extraction blanks in the sequencing step, as well as the inclusion of negative field controls, including other areas for refinement were highlighted, and suggestions were provided to improve the outcomes of future studies.
Two-Term Asymptotics of the Exchange Energy of the Electron Gas on Symmetric Polytopes in the High-Density Limit
Authors: Corso Thiago Carvalho
Published: September 2024

We derive a two-term asymptotic expansion for the exchange energy of the free electron gas on strictly tessellating polytopes and fundamental domains of lattices in the thermodynamic limit. This expansion comprises a bulk (volume-dependent) term, the celebrated Dirac exchange, and a novel surface correction stemming from a boundary layer and finite-size effects. Furthermore, we derive analogous two-term asymptotic expansions for semi-local density functionals. By matching the coefficients of these asymptotic expansions, we obtain an integral constraint for semi-local approximations of the exchange energy used in density functional theory.
Parenting Profiles in Military Families: Intervention-Related Transitions and Relationships to Child Adjustment
Authors: Lee Sun-Kyung , Gewirtz Abigail H. , Piehler Timothy F.
Published: September 2024

Parenting programs aim to improve parenting quality, which may, in turn, support various aspects of child development, including behavior and mental health. However, parenting interventions show considerable heterogeneity in response patterns across different families, demonstrating that they are not one-size-fits-all programs. This variability points to a need for greater understanding of which families benefit most from these interventions and how to improve response among those who do not. Following this literature gap, this study employed a person-centered approach to identify different parenting profiles associated with heterogeneity in treatment responses to a family-based prevention interventions adapted for military families. This study used data from a randomized controlled trial of the ADAPT intervention for 336 US military families in which at least one parent had deployed to war. Latent profile analyses revealed three unobserved parenting profiles among mothers and fathers, reflecting High positive, Moderate positive, and Coercive parenting styles. Latent transition analysis (LTA) suggested that the ADAPT program led to improvements in parenting, particularly among mothers who began the program with moderate or typical levels of parenting skills, and that these positive changes in parenting may help to decrease child externalizing problems. For fathers, the ADAPT program was most effective in preventing declines in positive parenting among those with initially typical levels of positive parenting. Overall, study findings demonstrate considerable heterogeneity in parenting behavior among a sample of military families that is associated with variability in parent responses to the evidence-based parenting program.
CEO power and firm risk at the onset of the 2007 financial crisis and the COVID-19 health crisis: international evidence
Authors: Aldawsari Hamad , Choudhry Taufiq , Luo Di
Published: September 2024

We investigate the association between CEO power and firm risk at the onset of the global financial crisis in 2007 and the COVID-19 pandemic health crisis in 2020. Examining an international sample of publicly listed firms in the G7 nations between 2006 and 2021, we show that firms led by CEOs with greater power are exposed to higher risk than firms led by CEOs with lesser power. The result is primarily driven by the impact of CEO power on idiosyncratic risk rather than systematic risk. Further, we find that powerful CEOs tend to be more cautious and conservative during crises that they have no reference for or experience of, as in the case of the pandemic, during which the positive power–risk associations are less pronounced. Nevertheless, the power–risk association remains relatively unchanged during the more familiar financial crisis. This study has important implications for firms, investors, regulators, and policymakers.
Influence of Posttraumatic Stress Disorder Severity on Return to Substance Use Immediately Following Residential Substance Use Treatment
Authors: Weiss Nicole H. , Newberger Noam G. , Thomas Emmanuel D. , Goldstein Silvi C. , Ho Diana , Coutu Stephen M. , Avila Alyssa L. , Contractor Ateka A. , Stein Lynda A. R.
Published: September 2024

The period immediately following residential substance use disorder (SUD) treatment is characterized by high rates of return to substance use. Posttraumatic stress disorder (PTSD) is highly prevalent among individuals in residential SUD treatment and is a primary motive for substance use among individuals with co-occurring PTSD and SUD. Addressing important gaps in the literature, the current study examined the role of PTSD severity on days of substance use during the 30 days immediately following residential SUD treatment over and above demographic, SUD, and clinical factors associated with return to substance use. Participants (N = 65, Mage = 40.6, 52% women, 79% white) completed semi-structured diagnostic interviews for PTSD and SUD and self-report measures of demographics and depression while in residential SUD treatment (approximately one week before discharge), and then a follow-up assessment (timeline follow-back for substance use) approximately one month after discharge. Greater PTSD severity was associated with more days of substance use in the 30 days immediately following residential SUD treatment over and above demographic (i.e., race/ethnicity, gender, employment, housing insecurity), SUD (i.e., alcohol, stimulant, opioid, cannabis, and sedative/hypnotic/anxiolytic use disorder severity), and clinical (i.e., depression severity) factors. Findings underscore the importance of PTSD assessment and intervention during residential SUD treatment and re-entry planning to assist in mitigating return to substance use during community reintegration.
Dendrite Growth in Single-Grain and Cyclic-Twinned Sn–3Ag–0.5Cu Solder Joints
Authors: Sun S. , Gourlay C. M.
Published: September 2024

The microstructure of electronic solder joints is generated by the solidification of a small volume of bulk undercooled liquid. Here, we study β-Sn dendrite growth in Sn–3Ag–0.5Cu in the specific geometry and nucleation conditions of ball grid array (BGA) solder joints by combining electron backscatter diffraction and imaging of microstructures. It is shown that, while $$\langle 110\rangle$$

⟨
110
⟩

is the preferred dendrite growth direction, out-of-plane branching and growth with $$\langle 11W\rangle$$

⟨
11
W
⟩

directions are important for allowing dendrites to fan out into the spheroidal volume of BGA joints due to the low symmetry of β-Sn. We find that the crystallographic orientation of β-Sn at the nucleation point plays a strong role in subsequent dendrite growth. In single-grain joints, dendrites are often unfavorably oriented for growth, resulting in different types of zig-zag dendrite growth. In cyclic-twinned joints, it is shown how competitive out-of-plane trunk growth between three dendrite orientations produces {101} boundaries and the characteristic beachball microstructure.
Sunlight-driven charge separation for a heterojunction of nano-pyramidal CuWO4-MOF modified TiO2 nanoflakes for photocatalytic degradation of ciprofloxacin
Authors: Mabape Kgaugelo S. , Mishra Shivani B. , Mishra Ajay K. , Moloto Makwena J.
Published: September 2024

The study presents a breakthrough of a balanced charge separation for heterojunction CuWO4-TiO2 cocatalyst to efficiently enhance visible light photocatalytic degradation of ciprofloxacin (CIP). A solvothermal-synthesized nanopyramid-like CuWO4 semiconductor was assembled before sol–gel treatment with TiO2 precursors to generate CuWO4-TiO2 nanocomposites. The optical, structural, and morphological properties of CuWO4-TiO2 were elucidated using UV–Vis DRS, XRD, FTIR, Raman spectroscopy, and TEM/SEM techniques. The UV–Vis DRS spectroscopy of as-synthesized CuWO4-TiO2 cocatalyst demonstrated enhanced visible light absorbance. The XRD patterns of CuWO4-TiO2 revealed a triclinic phase nanocrystal. The O-Ti–O functionality was confirmed by FTIR spectroscopy. The photoactive bands corresponding to anatase redshift were observed from Raman spectroscopy of CuWO4-TiO2 nanocomposite. The PL studies attributed this redshift to the elevated extra energy bands that aid electron/hole pair charge separation in a co-catalyst heterojunction CuWO4-TiO2 nanocomposite afforded by embedding CuWO4-MOF within TiO2 crystalline. The TEM showed that un-sintered CuWO4.MOF mimicked a pyramidal shape and converted to nanoflakes upon sintering, while TiO2 and CuWO4-TiO2 retained a tetragonal shape. The photocatalytic activity of CuWO4-TiO2 cocatalyst was studied using CIP, as a model pollutant. The innovative design of 5CuWO4-TiO2 charge separation nanocomposite completely degraded 10 mg L−1 CIP solution at pH = 6.31 (natural pH) and 9 under 120 min of sunlight irradiation.
Types of Value
Authors: Slote Michael
Published: September 2024

Our values possess a previously unrecognized distinctive kind of underlying unity. Discussion here begins with moral values, and it is argued that recent approaches like Scanlon’s and Parfit’s run together moral and rational values in an unintuitive way. A defense is then briefly given of a more intuitively plausible moral approach that focuses on empathy, and it is argued further that empathy itself can be theoretically grounded in updated versions of yin 陰 and yang 陽, with yin understood as receptivity and yang as directed purpose. The discussion then takes up notions like practical rationality, well-being, the (impersonally) Good, moral approval/disapproval, and nonethical value concepts like “good knife” and “beautiful face.” It is argued that in every one of these spheres of evaluation positive value judgments imply attraction and negative value judgments repulsion but that in all cases these implications can be canceled in a Gricean way. And it also turns out that we can use yin/yang to better understand not only the positive and negative implications of value judgments but also the ways those implications can be contextually canceled.
Long-Term Survivor of Intrahepatic Cholangiocarcinoma for over 18 Years: Case Study with Longitudinal Histo-molecular and Tumor Immune Microenvironment Characterization and Systematic Review of the Literature
Authors: Mattiolo Paola , De Bellis Mario , Mafficini Andrea , Fassan Matteo , Bevere Michele , Ciulla Calogero , Bersani Samantha , Lawlor Rita T. , Milella Michele , Scarpa Aldo , Luchini Claudio , Ruzzenente Andrea
Published: September 2024

Background

Intrahepatic cholangiocarcinoma is a biliary neoplasm usually showing a dismal prognosis. In early stages, surgical resection is the best treatment option, significantly increasing the overall survival. This approach is also recommended in the case of relapsing disease. In this study, we report the case of a patient affected by intrahepatic cholangiocarcinoma with multiple relapses and still alive for over 18 years. We also provide a systematic review regarding long-survivor (> 60 months) of intrahepatic cholangiocarcinoma.

Case Presentation

A 41-year-old woman with no pathological history was diagnosed with localized intrahepatic cholangiocarcinoma and surgically treated with left hepatectomy. After the first intervention, the patients underwent three further surgical resections because of locoregional recurrences. Histologically, there were some significant similarities among all neoplasms, including the tubule-glandular architecture, but also morphological heterogeneity. The tumor immune microenvironment remained stable across the different lesions. The molecular analysis with next-generation sequencing demonstrated that all neoplasms shared the same genomic profile, including NBN and NOTCH3 mutations and chromosomes 1 and 3 alterations.

Conclusions

This case study highlights the essential role of a stringent follow-up after resection of intrahepatic cholangiocarcinoma for detecting early relapsing tumors. Moreover, it shows the importance of the molecular characterization of multiple tumors for understanding their real nature. The accurate study of long-surviving patients highlights the features that are critical for outcome improvement.
Internalized stigma and its correlates in families of persons with mental illness in Qatar: a cross-sectional study
Authors: Kehyayan Vahe , Omar Hanin , Ghuloum Suhaila , Marji Tamara , Al-Amin Hassen , Abed Alah Muna , Mahfoud Ziyad
Published: September 2024

Persons with mental illness (PWMI) experience rejection, isolation, and discrimination in employment, education, and housing due to the prejudice associated with the illness. Families affiliated with PWMI often internalize the public’s prejudice towards mental illness. Such internalized stigma can further impact the health and quality of life of both PWMI and their families. This study aimed to examine the level and correlates of internalized stigma in family members of PWMI in Qatar. A cross-sectional study of 106 family members was conducted using the Family Internalized Stigma Mental Illness Scale. The mean stigma score was 2.04 suggesting a mild level of stigma overall. Being married was found to be a predictor of higher levels of internalized stigma, while having college education or higher predicted lower levels of stigma. The overall stigma scores among family members were not high, which may reflect the protective stance families take towards about their relatives with mental illness. Some sociodemographic attributes predicted trends in internalized stigma among our surveyed sample. Future research efforts in this area may help increase understanding of internalized stigma in this population to inform stigma reduction efforts.
Bleeding Jejunal Diverticula: Always a Timely Reminder
Authors: Rambarran Pranesh , Singh Juhi Priyam , Kinoo Suman Mewa , Singh Bhugwan
Published: September 2024

Bleeding jejunal diverticula is a rare cause of lower gastrointestinal bleeding. We describe a case of rectal bleeding secondary to jejunal diverticula disease and outline our experience of managing bleeding jejunal diverticula in current practice.
Digital Business as a Field for Research and Education
Authors: Hess Thomas , Riedl René , Becker Luc
Published: September 2024

Digital technologies ignite new businesses and force existing companies to restructure their business models. Various independent academic research streams discuss the potential of digital technologies for business. However, these streams’ research findings are published across outlets in various communities, and an approach to bringing these streams together is missing. In this position paper, we propose to integrate these streams under the concept of Digital Business. We see Digital Innovations as the core of Digital Business and offer a framework for structuring the field. Using this framework, we describe the field’s development to date and provide three ideas for further integrating the field in the future. Altogether, a key aim of this paper is to create a conceptual basis that structures both research and education in the field Digital Business.
Heavy rainfalls in Poland and their hyetographs
Authors: Mikołajewski Karol , Stach Alfred , Ruman Marek , Kosek Klaudia , Kundzewicz Zbigniew W. , Licznar Paweł
Published: September 2024

In the light of observed variability in precipitation patterns, there is a growing need for comprehensive data mining of regularly updated rainfall recording databases. Therefore, an analysis of heavy rainfall and hyetographs was conducted using a 30-year high-resolution dataset from 100 rain gauges across Poland, covering 31 646 rainfall events. Distributions of rainfall depths, durations, and intensities were explored, and maxima were compared to global records. Spatial analysis revealed significant variations in the frequency, depths, and durations of extreme rainfall across different regions. Cluster analysis determined model hyetographs for each station. The likelihood of regions belonging to clusters with three to five model hyetographs was assessed using Indicator Kriging. Findings underscore the importance of using local, characteristics rainfalls in hydrodynamic modelling of drainage systems and future rainfall scenarios. These results provide a foundational step towards understanding and monitoring the impacts of climate change on rainfall characteristics, especially extremes, in future decades.
Assessing the Impact of Data-resolution On Ocean Frontal Characteristics
Authors: Yang Kai , Fischer Andrew M.
Published: September 2024

Easy access to and advances in satellite remote sensing data has enabled enhanced analysis of ocean fronts, physical and ecologically important areas where water masses converge. Recent development of higher-resolution satellite imagery to detect ocean fronts provides the potential to better capture patterns and trends of ocean change and improve modelling and prediction efforts. This study examines the relationship between satellite data spatial resolution and its influence on the quantification of frontal characteristics, frontal quantity, length, strength and density. We also examine the relationship between Finite-Size Lyapunov Exponents and image resolution. We found higher spatial resolution leads to increased frontal quantity and decreased frontal length. Also, both strength and spatial density of fronts differ at various resolutions. The Finite-Size Lyapunov Exponent value does not change significantly with resolution. Knowledge of the impact of resolution on the quantification of frontal characteristics is crucial as it enables the exploration of novel experimental design to further facilitate the development of improved parameterization and uncertainties in ocean modelling/studies.
Can a Surgical Vulnerability Score Predict Outcomes of Hip Reconstruction in Children with Severe Neuromuscular Disability?
Authors: Bevan Alistair , Buchan Stephanie , Aarvold Alexander , Bennet Simon , Rad Darius , Le Prevost Nick , Edwards Caroline
Published: September 2024

Background

Hip surgery is often necessary for children with severe neuromuscular disabilities to avoid chronic pain resulting from hip migration. This study correlated the Surgical Vulnerability Score (SVS), a novel measure of physiological reserve, with reconstructive hip surgery outcomes to improve shared surgical decision-making.

Materials and methods

Sixty-eight cases performed by a single surgeon were retrospectively evaluated. Cases were graded according to physiological vulnerability using the SVS, which was then correlated with two outcomes: length of hospital stay (LOS) and severity of postoperative complications. The Gross Motor Function Classification System (GMFCS) level was used as a baseline comparison. Sub-analysis compared results for patients who underwent only a femoral varus derotation osteotomy (VDRO) (n = 48) with those who underwent a combined VDRO and Dega Pelvic Osteotomy (Dega PO) (n = 20).

Results

Results showed that a higher SVS was associated with increased LOS (p = 0.001) and severity of postoperative complications (p = 0.0008). A greater GMFCS level was not associated with either LOS (p = 0.246) or the severity of postoperative complications (p = 0.282). For patients who underwent only a VDRO, an increase in SVS had no association with LOS (p = 0.483) or severity of complications (p = 0.981). However, for patients who underwent both a VDRO and Dega PO, a higher SVS was associated with increased LOS (p = 0.0002) and severity of complications (p = 0.0001).

Conclusions

The SVS can aid surgical decision-making and prepare the child’s family for surgery. Early intervention and fixation using only a VDRO may lead to better outcomes, underscoring the importance of hip surveillance programs in the early identification of migrating hips.
Uncovering labeler bias in machine learning annotation tasks
Authors: Haliburton Luke , Leusmann Jan , Welsch Robin , Ghebremedhin Sinksar , Isaakidis Petros , Schmidt Albrecht , Mayer Sven
Published: September 2024

As artificial intelligence becomes increasingly pervasive, it is essential that we understand the implications of bias in machine learning. Many developers rely on crowd workers to generate and annotate datasets for machine learning applications. However, this step risks embedding training data with labeler bias, leading to biased decision-making in systems trained on these datasets. To characterize labeler bias, we created a face dataset and conducted two studies where labelers of different ethnicity and sex completed annotation tasks. In the first study, labelers annotated subjective characteristics of faces. In the second, they annotated images using bounding boxes. Our results demonstrate that labeler demographics significantly impact both subjective and accuracy-based annotations, indicating that collecting a diverse set of labelers may not be enough to solve the problem. We discuss the consequences of these findings for current machine learning practices to create fair and unbiased systems.
Cosymplectic Geometry, Reductions, and Energy-Momentum Methods with Applications
Authors: Lucas J. de , Maskalaniec A. , Zawora B. M.
Published: September 2024

Classical energy-momentum methods study the existence and stability properties of solutions of t-dependent Hamilton equations on symplectic manifolds whose evolution is given by their Hamiltonian Lie symmetries. The points of such solutions are called relative equilibrium points. This work devises a new cosymplectic energy-momentum method providing a new and more general framework to study t-dependent Hamilton equations. In fact, cosymplectic geometry allows for using more types of distinguished Lie symmetries (given by Hamiltonian, gradient, or evolution vector fields), relative equilibrium points, and reduction methods, than symplectic techniques. To make our work more self-contained and to fill some gaps in the literature, a review of the cosymplectic formalism and the cosymplectic Marsden–Weinstein reduction is included. Known and new types of relative equilibrium points are characterised and studied. Our methods remove technical conditions used in previous energy-momentum methods, like the

$$\textrm{Ad}^*$$

Ad
∗

-equivariance of momentum maps. Eigenfunctions of t-dependent Schrödinger equations are interpreted in terms of relative equilibrium points in cosymplectic manifolds. A new cosymplectic-to-symplectic reduction is developed and a new associated type of relative equilibrium points, the so-called gradient relative equilibrium points, are introduced and applied to study the Lagrange points and Hill spheres of a restricted circular three-body system by means of a not Hamiltonian Lie symmetry of the system.
Runway assignment optimisation model for Istanbul Airport considering multiple parallel runway operations
Authors: Güven A. , Aybek Cetek F. , Cecen R.K.
Published: September 2024

The aviation industry has rapidly developed in recent years. Due to the increased number of flight operations, managing air traffic has become essential. The air traffic management system aims to reduce the air traffic control workload and use existing resources more efficiently. This study proposed a new mixed integer linear programming model to minimise the total fuel consumption during taxi operations for the runway assignment problem, comparing the actual Istanbul Airport runway assignment data. The average taxi times are calculated using the 30,000-flight operations data for each arrival and departure taxi route. Also, 47 different aircraft types are obtained using the data for the fuel consumption calculation. The International Civil. Aviation Organisation (IACO) aircraft engine emissions databank provides the fuel consumption values for each aircraft according to engine type. This approach allows our model to calculate more realistic fuel consumption for taxi operations, as each aircraft engine type has a different fuel consumption value. The proposed model is implemented at Istanbul Airport, the busiest airport in Turkey, where multiple parallel runway operations are applied. The results showed that the proposed model reduced total fuel consumption for taxi operations between 6.6% and 14.4% compared to the actual Istanbul Airport runway assignment data.
Model compensation control of composite vertical take-off and landing UAV
Authors: Qi G.Y. , Zhang X.R. , Xu L.
Published: September 2024

The unmanned aerial vehicle (UAV) system for composite vertical take-off and landing (VTOL) is a complex, highly coupled, and nonlinear system which is sensitive to external disturbances and model uncertainties. The composite VTOL UAV system consists of a multi-rotor section and a fixed-wing section. To improve observation accuracy, the compensation function observer (CFO) uses a new structure that includes velocity information. The CFO is utilised to estimate the uncertainty and the external disturbances of the system model, which performs superior estimation accuracy compared to the extended state observer (ESO). In the modeling process of the VTOL UAV, the aerodynamic moment is calculated by means of the cross-product operation of force and force arm, which solves the problem of over-reliance on aerodynamic parameters in the traditional modeling approach. The controlled object is refined by CFO, and model compensation control (MCC) is used to realise the velocity and attitude control of the composite VTOL. The numerical simulation of MATLAB/Simulink and hardware-in-loop simulation (HIL) of Rflysim were implemented, and which were used to compare the MCC, active disturbance rejection control (ADRC), and proportion integration differentiation (PID). The simulation results confirm the superiority of MCC in controlling composite VTOL UAVs in terms of anti-disturbance and tracking speed.
The Uncharted Patterns of Antibiotic Prescribing in Urology Ambulatory Practices: A Four-Year Analysis
Authors: Munsiff Sonal , Holt Kathleen , Ghosh Sucharu , Dumyati Ghinwa
Published: September 2024

Background: Urinary tract infections (UTIs) represent a prevalent indication for outpatient antibiotic usage, yet limited data exist regarding antibiotic prescriptions within urology specialties. This study aimed to assess antibiotic prescribing patterns in urology offices over a four-year period, providing insights for potential stewardship interventions. Methods: The analysis focused on antibiotic prescribing trends in adults between 2018 and 2021 during both visit and non-visit (e.g. telephone and chart messages) encounters across 15 ambulatory Urology clinics in an academic medical center in Western New York. Exclusions were made for antivirals, antiparasitics, antifungals, oral suspensions, selected non-UTI antibiotics, duplicate orders on the same day or week, and prescriptions exceeding 28 days. Prescriptions were categorized into single doses administered in the clinic and those prescribed for 2-28 days, with descriptive statistics and trend analyses conducted using SAS v9.14. Results: Over the four-year period, 54,282 prescriptions were analyzed. Of these, 26,944 (49.7%) were single doses administered in the clinic, predominantly for pre-procedure prophylaxis. The most commonly prescribed antibiotics for prophylaxis were fluoroquinolones (FQ) (47.5%), followed by ceftriaxone (19.2%), nitrofurantoin (13.2%), trimethoprim/sulfamethoxazole (8.6%), and gentamicin (4.2%). Among the 27,288 prescriptions for 2-28 days, 72.3% were from non-visit encounters, with 61.6% prescribed by advanced practice providers (APPs) (Figure 1). The mean number of prescriptions per patient was 2.07, with women receiving more prescriptions than men (2.39 vs. 1.88, P < 0.001). FQ remained the most commonly prescribed antibiotics during all encounters (23.7%), followed by nitrofurantoin (23.0%) (Figure 2). The antibiotic duration was longer for visit-based compared to non-visit-based prescriptions (mean 10 vs. 7 days, P < 0.001). Notably, there was a significant decrease in fluoroquinolone use between Q1 2018 and Q4 2019 for both male and female patients, followed by insignificant changes thereafter. Conclusions: Antibiotic use in urology outpatient settings is substantially underestimated if only prescriptions made during visit encounters are considered. More than two-thirds of prescriptions for 2-28 days were from non-visit encounters, with the majority originating from APPs. The average therapy duration exceeded guideline recommendations. Moreover, approximately half of the antibiotics were administered in the office for pre-procedure prophylaxis. To enhance antibiotic prescribing in these specialized clinics, interventions should focus on non-visit prescriptions and provide education for APPs, alongside adjustments to default durations in electronic orders. Further evaluation is essential to assess the appropriateness of single doses for pre-procedure prophylaxis.
Infectious Diseases Consultation Reduces Antibiotic Duration for Uncomplicated Gram-Negative Bacteremia
Authors: Acree Mary , Naegele Sandra , Baik Bianca , Ravichandran Urmila , Shah Nirav
Published: September 2024

Background: Unlike Staphylococcus aureus bacteremia, the impact of ID consultation for gram negative bacteremia (GNB) has not been well studied. Recent literature has supported shorter courses of antibiotics in adults with uncomplicated GNB. We examined duration of therapy for adult patients with uncomplicated GNB over a period of time during which ID consultation for GNB was made mandatory. Method: NorthShore University HealthSystem is a 4 hospital, 828 bed hospital system located in the northern suburbs of Chicago. Data were collected retrospectively from 1/1/2018 through 12/31/2021 for patients 18 years or older hospitalized with an uncomplicated bloodstream infection due to Escherichia coli, Klebsiella species or Proteus species. This study was approved by the Institutional Review Board. All sources of infection were included. Days of effective antibiotic therapy were extracted manually by two pharmacists and an infectious diseases physician. During the study period, two major changes occurred: 1) the Physician Practice Council of NorthShore University Healthsystem voted in favor of a mandatory ID consultation for GNB and 2) the ID division developed a treatment algorithm for GNB management with an emphasis on shorter antibiotic duration in uncomplicated cases. This study was divided into three time periods: Pre-ID consultation – 1/1/2018 – 8/31/2019; Transition – 9/1/2019 – 5/31/2020 (after mandatory ID consultation, before ID division consensus achieved); Post-ID Consensus – 6/1/2020 – 12/31/21. Primary outcome was duration of antibiotic therapy. Secondary outcomes included in-hospital all-cause mortality and 30 day readmission. Continuous variables were described using median and interquartile range, and categorical data using frequency and prevalence. Kruskal-Wallis rank sum test for continuous and χ2 for categorical variables was used to verify similarity among the pre-ID consultation, transition and post-ID consensus periods. The analysis was performed using Python. Result: 1026 patients were included in the study. Pathogens included 773 E. coli (75.4%), 193 Klebsiella species (18.8%) and 60 Proteus species (5.9%). Length of stay, 30 day readmission and in-hospital mortality were not statistically significantly different when comparing pre-ID consultation and post-ID consensus time periods. Total duration of therapy was statistically significantly shorter in the post-ID consensus period (p < 0.001). Conclusion: Mandatory ID consultation and development of an ID consensus approach can shorten antibiotic duration in uncomplicated GNB. Further analysis will explore timing of transition to oral therapy and syndromic differences.
Impact of Vascular Access Teams on Central Line Associated Bloodstream Infections
Authors: Kester Shelley , Passaretti Katie , Sampson Mindy , Neelakanta Anupama , Rose Robert , Tincopa David , Parsons Johnna , Weaver Audrey , Avery Abby , Mills Barbi , Dickerson Candice
Published: September 2024

Background: During the COVID-19 pandemic, rates of central line bloodstream infections (CLABSI) increased nationally. Studies pre-pandemic showed improved CLABSI rates with implementation of a standardized vascular access team (VAT).[PL1] [PL2] [mi3] Varying VAT resources and coverage existed in our 10 acute care facilities (ACF) prior to and during the pandemic. VAT scope also varied in 1) process for line selection during initial placement, 2) ability to place a peripherally inserted central catheter (PICC), midline or ultrasound-guided peripheral IV in patients with difficult vascular access, 3) ownership of daily assessment of central line (CL) necessity, and 4) routine CL dressing changes. We aimed to define and implement the ideal VAT structure and evaluate the impact on CLABSI standardized infection ratios (SIR) and rates prior to and during the pandemic. Methods: A multidisciplinary workgroup including representatives from nursing, infection prevention, and vascular access was formed to understand the current state of VAT responsibilities across all ACFs. The group identified key responsibilities a VAT should conduct to aid in CLABSI prevention. Complete VAT coverage[mi4] was defined as the ability to conduct the identified responsibilities daily. We compared the SIR and CLABSI rates between hospitals who had complete VAT (CVAT) coverage to hospitals with incomplete VAT (IVAT) coverage. Given this work occurred during the pandemic, we further stratified our analysis based on a time frame prior to the pandemic (1/2015 – 12/2019) and intra-pandemic (1/2020 - 12/2022). Results: The multidisciplinary team identified 6 key components of complete VAT coverage: Assessment for appropriate line selection prior to insertion, ability to insert PICC and midlines, daily CL and midline care and maintenance assessments, daily assessment of necessity for CL, and weekly dressing changes for CL and midlines[NA5] . A cross walk of VAT scope (Figure 1) was performed in October 2022 which revealed two facilities (A and E) which met CVAT criteria. Pre-pandemic, while IVAT CLABSI rates and SIR were higher than in CVAT units, the difference was not statistically significant. During the pandemic, however, CLABSI rates and SIR were 40-50% higher in IVAT compared to CVAT facilities (Incident Rate Ratio 1.5, 95% CI 1.1-2.0 and SIR Relative Ratio 1.4, 95% CI1.1-1.9 respectively) (Table 1). Conclusions: CLABSI rates were lower in facilities with complete VAT coverage prior to and during the COVID-19 pandemic suggesting a highly functioning VAT can aid in preventing CLABSIs, especially when a healthcare system is stressed and resources are limited.
The Impact of COVID-19 on Healthcare-Associated Infections: A Survey of Acute Care Hospitals
Authors: Pogorzelska-Maziarz Monika , Kay Julia , Schmidt Tara , Patel Anika , De Cordova Pamela
Published: September 2024

Background: The COVID-19 pandemic has placed an enormous strain on the healthcare system, including infection prevention and control. The response to the COVID-19 pandemic required extraordinary resources, which were often diverted from routine infection prevention and control activities and may have contributed to increased rates of HAI in the acute care setting. However, the impact of the COVID-19 pandemic on infection prevention and control departments, including staffing and resources, and on routine infection prevention and control activities is not well-described. The objective of this study was to describe the impact of the COVID-19 pandemic on IPC departments and department response to the pandemic. Methods: Between August and December of 2023, we conducted an electronic survey of all acute care facilities participating in the National Healthcare Safety Network. Survey data were analyzed using descriptive statistics. Results: Over 594 infection control departments participated in the survey, representing 1,400 NHSN facilities (20% response rate based on number of eligible NHSN facilities). Half of the respondents reported that their hospital experienced increases in the following HAI rates during the first two years of the pandemic: central-line associated bloodstream infections (54%), catheter-associated urinary tract infections (46%) and ventilator associated pneumonia (45%). When asked to identify the top three contributors to increased HAI rates in their facility, respondents cited the following factors: staffing shortages (70%), patient acuity (69%), use of travel nurses (48%), increased device utilization (37%), and reduced bedside acuity (31%). Respondents reported that their department utilized the following actions to decrease these HAI rates: increased rounding and monitoring of IPC procedures (81%), reeducation of frontline staff on IPC policies and procedures (77%), environmental care rounds (69%), monitoring of isolation compliance (66%), HAI Task Force/Committee (57%), nurse-driven catheter removal protocols (53%), and insertion prevention protocols (53%). When asked if the department experienced applied pressure or attempts to influence HAI reporting due to the increase in HAI rates in the facility experienced in the wake of the pandemic, 19% of respondents reported increased pressure from management/C-suite and 7% reported increased pressure from providers. Conclusion: The COVID-19 pandemic had a substantial impact on IPC departments in acute care hospitals and had a profound effect on IPC staffing, resources and routine IPC activities. Future work needs to identify best practices and lessons learned from the pandemic to inform future pandemic preparedness.
Candida auris Response in a Tennessee Dialysis Facility, 2023
Authors: Kurutz Alex , Key Joshua , Edwards Autumn , Godwin Simone
Published: September 2024

Background: Candida auris, a multi-drug resistant fungal pathogen, was introduced to Tennessee in 2021. There are limited studies on the spread of C. auris in highly specialized care settings including outpatient dialysis facilities. Facilities are concerned that C. auris transmission is difficult to prevent in this setting due to patient vulnerability, treatment frequency and length, and isolation challenges. As a result, these facilities may reject patients based on their positive colonization status. In 2023, the Tennessee Department of Health (TDH) conducted two containment-driven colonization screenings in response to a colonized patient receiving dialysis treatment for one month without their status being known to the facility. Methods: An initial point prevalence survey (PPS) was conducted to assess for ongoing transmission among dialysis patients. Patient screening was prioritized for the cohort of patients who received dialysis at the same time as the index patient (Cohort A). The screening was broadened to include patients dialyzed directly before Cohort A (Cohort B) by request of the Cohort B patients. A second PPS was conducted 7 weeks later, targeting the same cohorts. Specimens were collected through supervised patient self-collection of a skin swab from the axilla and groin. Flocked Eswabs were used for collection and transferred in Amies transport media to the Tennessee State Public Health Lab. The presence of C. auris was detected via Polymerase Chain Reaction (PCR). Results: Twenty-three patients (12 from Cohort A; 11 from Cohort B) were screened in the first PPS. One patient from Cohort A tested positive. This colonized patient was determined to be a known C. auris case first detected four months prior, but the patient’s status was never communicated to the dialysis facility from the discharging acute care facility. Eleven patients, excluding the previously identified positives, participated (9 from Cohort A; 2 from Cohort B) in the second PPS; no positives were identified. Discussion: The index patient and an additional patient identified by the PPS both received dialysis at this facility for up to 4 months without facility knowledge. These results suggest that the standard infection control practices at this dialysis facility were adequate to prevent the transmission of C. auris among dialysis patients on multiple shifts. Additionally, patient self-collection identified a known C. auris patient. Future TDH work includes further evaluating the risk of C. auris transmission and developing targeted infection prevention and control practices for the outpatient dialysis setting.
Large-Scale S. aureus Screening with Molecular Epidemiology; the Role of MSSA and Community MRSA in Hospital Transmissions
Authors: Takats Courtney , Putzel Gregory , Siskin Drew , Pironti Alejandro , Shopsin Bo , Hochman Sarah
Published: September 2024

Background: The frequency of Staphylococcus aureus transmission in hospitals is unknown: symptomatic infection may occur months after transmission and colonization, and infection prevention efforts rely on indirect measurements, rather than direct detection of transmission events. We implemented a hospital-based S. aureus screening program, combined with whole genome sequencing of S. aureus surveillance and clinical cultures and data extracted from the electronic health record, to identify S. aureus clonal complex-, patient- and location-specific factors associated with S. aureus transmission in our health system. Methods: Screening S. aureus cultures were obtained at admission by nasal swab for adults admitted to Medicine, Transplant, Oncology and intensive care, and weekly by swab of nares, axilla and groin for children admitted to intensive care and Oncology at NYU Langone Health in New York City. All methicillin-resistant S. aureus (MRSA) from screening and clinical (blood, wound, sputum) cultures and all methicillin-susceptible S. aureus (MSSA) from screening and blood cultures underwent whole genome sequencing. Isolates from distinct patients with < 2 0 single nucleotide pair differences were considered genetically related. Electronic health data was extracted for descriptive statistics and for spatiotemporal plots to assess plausible transmissions. We used REDCap electronic data capture tools hosted at NYU Grossman School of Medicine and SAS software for data analysis to evaluate S. aureus transmissions between November 2022 and November 2023. Results: We analyzed 8,567 S. aureus isolates: including 6,552 screening cultures, 1,008 blood cultures, and 1,007 clinical cultures. We found 424 plausible S. aureus hospital transmissions using sequencing and electronic health data. Screening cultures identified 75% of transmissions that would have otherwise been missed with blood and clinical cultures alone. The majority of positive screening cultures isolated MSSA, but the proportion of transmissions due to MSSA differed by age. In children, MSSA colonization accounted for 62% of transmissions. In adults, only 15% of transmissions were due to MSSA colonization, whereas MRSA colonization accounted for 56% of transmissions. Analysis of adult MRSA isolates by clonal complex found that 45% of transmissions were due to CC8, higher than the 17% among isolates agnostic of transmissions. Emergency departments and the neonatal intensive care unit had the highest number of transmissions. Patients involved in transmissions had longer lengths of stay and frequent hospitalizations. Conclusions: A S. aureus screening program, coupled with genome sequencing and electronic health data, can identify patient group, hospital locations and clonal complexes that are at high risk for S. aureus transmissions.
Public Health Applications of Patient Transfer Networks—Colorado, 2022–2023
Authors: Marshall Kristen , Hoetzer Karlie , Driscoll Jennifer , Bardach Braden , Nichols Janell , Baird Samuel , Panicker Vishnu , Williford Devon , Czaja Christopher
Published: September 2024

Background: During 2021–2023, an increase in Klebsiella pneumoniae carbapenemase producing Enterobacterales species (KPC-CRE) cases occurred among patients admitted to several overlapping healthcare facilities, prompting an investigation by the Colorado Department of Public Health and Environment (CDPHE). We applied social network analysis (SNA) to identify KPC-CRE networks and other multidrug-resistant organism (MDRO) transmission, created a tool for public health prevention planning and for facilities to examine their own patient transfer connectivity, and explored additional public health and emergency preparedness applications. Methods: A statewide patient transfer network was created using 2021–2022 Medicare beneficiary data. Sub-networks were isolated from the larger network to examine a cluster of facilities involved in a KPC-CRE outbreak, defined as ≥2 KPC-CRE cases related by whole genome sequencing (WGS). WGS was conducted at the CDPHE State Lab. Highly connected facilities were determined by patient transfers between at least two KPC-CRE testing facilities. Individual patient journeys were constructed using admissions and culture date. SNA was conducted in RStudio; visualizations, network metric calculations, and clustering analysis were conducted using Gephi and ArcGIS software. Results: SNA yielded 4,864 direct patient transfers between 326 healthcare facilities (220 skilled nursing facilities, 50 acute care hospitals, 32 critical access hospitals, six long term acute care hospitals, and 18 facilities not previously classified; Figure 1). WGS identified five separate KPC-CRE outbreaks among 14 patients during February 2022–January 2023; 14 patient specimens were collected at four testing facilities. We identified five highly connected facilities in addition to the four testing facilities. Patient journeys allowed us to identify possible locations of KPC-CRE transmission in four of the five outbreaks (Figure 2). CDPHE provided guidance to all involved facilities on admission screening, routine point prevalence surveys, and interfacility communication as part of an MDRO prevention plan. CDPHE then developed the transfer network into an interactive ArcGIS dashboard enabling facilities to examine their own patient transfer patterns. Conclusions: SNA enabled CDPHE to identify at-risk facilities for KPC-CRE transmission and create an interactive tool for facility and public health use. Future applications of patient transfer networks can include geographical grouping of facilities based on transfers to zone healthcare coalitions and conduct preparedness activities, and creating medical operations preparedness plans for emergencies or disasters.