bluuebunny/crossref_metadata_2025 huggingface dataset:
Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety
Authors: Zafeiri Aikaterini , Mitchell Rod T , Hay David C , Fowler Paul A
Published: August 2020

BACKGROUND

Analgesia during pregnancy is often necessary. Due to their widespread availability, many mothers opt to use over-the-counter (OTC) analgesics. Those analgesic compounds and their metabolites can readily cross the placenta and reach the developing foetus. Evidence for safety or associations with adverse health outcomes is conflicting, limiting definitive decision-making for healthcare professionals.

OBJECTIVE AND RATIONALE

This review provides a detailed and objective overview of research in this field. We consider the global prevalence of OTC analgesia during pregnancy, explain the current mechanistic understanding of how analgesic compounds cross the placenta and reach the foetus, and review current research on exposure associations with offspring health outcomes.

SEARCH METHODS

A comprehensive English language literature search was conducted using PubMed and Scopus databases. Different combinations of key search terms were used including ‘over-the-counter/non-prescription analgesics’, ‘pregnancy’, ‘self-medication’, ‘paracetamol’, ‘acetaminophen’, ‘diclofenac’, ‘aspirin’, ‘ibuprofen’, ‘in utero exposure’, ‘placenta drug transport’, ‘placental transporters’, ‘placenta drug metabolism’ and ‘offspring outcomes’.

OUTCOMES

This article examines the evidence of foetal exposure to OTC analgesia, starting from different routes of exposure to evidence, or the lack thereof, linking maternal consumption to offspring ill health. There is a very high prevalence of maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association of in utero exposure at different pregnancy trimesters and the development of neurodevelopmental, cardiovascular, respiratory and reproductive defects. This is in contrast to other studies which report no associations.

WIDER IMPLICATIONS

The high prevalence and the challenges of reporting exact consumption rates make OTC analgesia during pregnancy a pressing reproductive health issue globally. Even though some healthcare policy-making authorities have declared the consumption of some OTC analgesics for most stages of pregnancy to be safe, such decisions are often based on partial review of literature. Our comprehensive review of current evidence highlights that important knowledge gaps still exist. Those areas require further research in order to provide pregnant mothers with clear guidance with regard to OTC analgesic use during pregnancy.
Stock-scale electronic tracking of Atlantic halibut reveals summer site fidelity and winter mixing on common spawning grounds
Authors: Gatti Paul , Robert Dominique , Fisher Jonathan A D , Marshall Rachel C , Le Bris Arnault
Published: August 2020

Knowledge of movement ecology, habitat use, and spatiotemporal distribution is critical to inform sustainable fisheries management and conservation. Atlantic halibut in the Gulf of St. Lawrence (GSL) is of great economic value, although little is known about its spatiotemporal distribution, seasonal migrations, and spawning areas. To investigate these aspects, 114 pop-up satellite archival tags (PSATs) were deployed on halibut from 2013 up to 2018 throughout the GSL. A total of 62 physically recovered PSATs provided complete archived datasets with high temporal resolution. PSAT detachment locations revealed specific summer site fidelity. In contrast, the reconstruction of movement tracks with a geolocation model revealed that all fish converged to the Gulf’s deep channels to overwinter and spawn. This suggests strong mixing during the spawning period and thus one reproductive population within the GSL. These findings illustrate the utility of large-scale PSAT tagging combined with dedicated PSAT-recovery surveys to reveal critical stock-scale information on movements and spawning locations. This information addresses important gaps in the movement ecology of this halibut stock, revealing that reported summer site fidelity, based on years of conventional tagging, also conceals important winter mixing that is only apparent through analyses of movement on the time scale of annual cycles.
‘The Makings of a Success’: The Global Compact on Refugees and the Inaugural Global Refugee Forum
Authors: Triggs Gillian D , Wall Patrick C J
Published: August 2020

The last five years have witnessed a dramatic increase in the number of forcibly displaced people worldwide, and a key part of the international response has been a multilateral and multi-stakeholder effort to develop an architecture to share more equitably and predictably the burden and responsibility for hosting and supporting the world’s refugees. This piece offers a reflective assessment of this regime-strengthening exercise – the key milestones of which have been the New York Declaration, the Global Compact on Refugees, and the first Global Refugee Forum – and assesses what has been achieved and what challenges still lie ahead. The Global Compact on Refugees is presented as the product of a ‘States plus’ approach to multilateralism that brought together a wide range of States, other stakeholders, and – importantly – refugees to fill a crucial gap in the international refugee protection regime. It seeks to do this by bolstering international cooperation with a view to enhancing protection and expanding access to solutions, building on existing and emerging trends, and laying the ground for future cooperation. The first Global Refugee Forum in December 2019 was an important and positive first step in the Compact’s implementation, but much more remains to be done before success can be declared.

In postscript, the authors reflect on the emergence of the COVID-19 pandemic, its impact on the international refugee response regime, and the role for the Global Compact on Refugees in the response.
Human factors: the pharmaceutical supply chain as a complex sociotechnical system
Authors: Edwards Brian , Gloor Charles A , Toussaint Franck , Guan Chaofeng , Furniss Dominic
Published: August 2020

Background

The COVID-19 pandemic has exacerbated preexisting weaknesses in the global supply chain. Regional assessments by the Food and Drug Administration (FDA), European Medicines Agency (EMA), and independent consultants, have demonstrated various contributory causal factors requiring changes in policy, relationships, and incentives within the dynamic and developing networks. Human factors and ergonomics (HFE) is an approach that encourages sociotechnical systems thinking to optimize the performance of systems that involve human activity. The global supply chain can be considered such a system. However, it has neither been systematically examined from this perspective.

Methods

In 2015, the UK Chartered Institute of Ergonomics and Human Factors established the Pharmaceutical Sector Group. This unique group is open to all who work in the pharmaceutical sector at any level and in any discipline who share the vision of a pharmaceutical system that places an understanding of HFE at the heart of improving the use of healthcare products throughout their life cycles including their supply chains.

Results

For this complex system to work efficiently, it is paramount that we have effective coordination and integration between the different elements in the supply chain. HFE can give valuable insights and solutions for developing these complex social–technical systems effectively.

Conclusion

By partnering with international groups such as Biophorum and Bio Supply Chain Management Alliance, we wish to stimulate discussion about how sociotechnical thinking about HFE may help develop better monitoring and investigative techniques to strengthen global supply chains.
Use of aspirin to intentionally induce gastrointestinal tract barrier dysfunction in feedlot cattle
Authors: Briggs Nathan G , Brennan Kristen M , Funnell Bethany J , Nicholls Griffin T , Schoonmaker Jon P
Published: August 2020

Stress negatively affects the gastrointestinal tract (GIT) barrier function, resulting in compromised animal health. A deeper understanding of how diet and stress impacts the GIT barrier function in feedlot cattle is needed. Aspirin decreases mucus production and mucosal repair in the GIT and could be used as a model for GIT barrier dysfunction research. The objective of this study was to evaluate the effectiveness of aspirin to induce GIT barrier dysfunction in beef cattle. In experiment 1, sixteen crossbred heifers (425.0 ± 8.6 kg) were allotted to 0, 50, 100, or 200 mg/kg body weight (BW) aspirin doses based on BW. Experiment 1 consisted of two periods separated by 4 wk where four heifers per treatment received the same aspirin dose during each period. Heifers were fed a 49.4% corn silage and 50.6% concentrate diet. The 200 mg/kg BW aspirin treatment was dosed as a 100 mg/kg BW aspirin oral bolus 36 and 24 h prior to Cr-ethylenediaminetetraacetic acid (EDTA) dosing (1 liter; 180 mM). The 50 and 100 mg/kg BW aspirin treatments were dosed as an oral bolus 24 h prior to Cr-EDTA dosing. Urine was collected every 3 h for 48 h and analyzed for Cr. Serum was collected at 0 and 48 h and analyzed for lipopolysaccharide-binding protein (LBP), interleukin-6, serum amyloid A (SAA), haptoglobin, and aspartate aminotransferase. In experiment 2, sixteen crossbred steers (576.0 ± 14.2 kg) fed a similar diet were allotted by BW to the 0 and 200 mg/kg BW aspirin treatments (eight steers/treatment) and were slaughtered 24 h after the last dose. Jejunal tissues were collected, and claudin (CLDN) 1, 2, and 3, occludin, and zonula occludens tight junction messenger ribonucleic acid (mRNA) expression was determined. Data were analyzed using the MIXED procedure of SAS. Urinary Cr excretion increased linearly at hours 3, 6, 9, and 12 (P ≤ 0.04) as aspirin dose increased from 0 to 200 mg/kg. Aspirin linearly increased Cr absorption (P = 0.02) and elimination (P = 0.04) rates and linearly decreased mean retention time of Cr (P = 0.02). Aspirin increased SAA (P = 0.04) and tended to increase LBP (P = 0.09) in serum but did not affect any other serum inflammatory marker (P ≥ 0.19). Aspirin tended to increase jejunal CLDN-1 mRNA expression (P = 0.10) but did not affect the mRNA expression of other genes regulating tight junction function (P ≥ 0.20). Results from this study indicate that aspirin disrupts the GIT barrier function in beef cattle and has a potential as a model in GIT permeability research.
Why Do Policymakers Support Administrative Burdens? The Roles of Deservingness, Political Ideology, and Personal Experience
Authors: Baekgaard Martin , Moynihan Donald P , Thomsen Mette Kjærgaard
Published: August 2020

Administrative burdens affect peoples’ experience of public administration but there is, to date, limited evidence to as why policymakers are willing to accept and impose burdens. To address this gap, we draw from the policy design and administrative burden literatures to develop the concept of burden tolerance—the willingness of policymakers and people more generally to passively allow or actively impose state actions that result in others experiencing administrative burdens. Drawing on a survey experiment and observational data with Danish local politicians in a social welfare setting, we find that more right-wing politicians are more tolerant of burdens, but politicians are less willing to impose burdens on a welfare claimant perceived as being more deserving. Politicians with a personal experience of receiving welfare benefits themselves are less tolerant of burdens, while information about the psychological costs experienced by claimants did not reduce burden tolerance.
Minimally invasive management of a paraduodenal hernia with intestinal malrotation
Authors: Misheva Bojana , Hajjar Roy , Sebajang Herawaty , Schwenter Frank
Published: August 2020

Paraduodenal hernias (PDHs) are rare entities that may present with acute or subacute symptoms, and which pose challenges to prompt diagnosis and treatment. The minimally invasive management of these hernias is emerging as a new compelling approach to optimize surgical recovery. We present the case of a 42-year-old female patient who presented with acute abdominal pain and symptoms of bowel obstruction. Abdominal imaging suggested the presence of a left PDH. Laparoscopic exploration was performed. Intestinal malrotation was noted with incarceration of a small bowel loop in the Landzert fossa. The incarcerated bowel loop was freed and primary repair of the hernial defect was performed. PDHs are usually congenital and involve a herniation of abdominal content into the left mesocolon, between the mesocolon and the posterior abdominal wall. Minimally invasive treatment, consisting of adhesiolysis and repair of the hernial defect, seems to be a valid and safe option.
Information Entropy and Scale Development
Authors: Friesner Daniel , Bozman Carl , McPherson Matthew , Valente Faith , Zhang Anqing
Published: August 2020

A wide variety of techniques are used to assess the development of survey-based scales. The majority of these techniques focus on the quality of information characterized by the scale. Aside from very rudimentary measures such as response rates and sample sizes, very few empirical techniques are available to measure the quantity of information contained in a scale. This article conducts an exploratory empirical analysis to assess whether information entropy can be useful for measuring the quantity of information in a scale’s development. If the quantity of information in the scale significantly increases (decreases) with the addition of the survey item, researchers may consider retaining (discarding) that item in the scale. The study was conducted within the context of a natural experiment that occurred at a major amateur sporting event in 2018. Customer satisfaction was assessed using a survey whose core questions have been assessed repeatedly over time. The most recent survey contained a previously validated empathy scale, with two items contained in the base measure. Six additional items were added to this base empathy measure. The quantity of information provided (as measured by information entropy) is calculated for each set of scale items. Statistical analysis indicates that, when adding the behavioral, cognitive, and affective scales to the two-item base scale, the quantity of information available increased. However, most of the increase in information quantity was attributable to three survey items, one item from each of the behavioral, cognitive, and affective domains. These findings suggest that information entropy may indeed be a useful quality control tool for survey scale development.
The Political Determinants of China’S New Health Constitution
Authors: Ip Eric C
Published: August 2020

The Basic Healthcare and Health Promotion Law 2019 became the new constitution of China’s health system in June 2020, giving legal effect to ambitious health reform programmes like Healthy China 2030. The concurrent outbreak of coronavirus disease 2019 must not distract us from appreciating the fact that this Law will comprehensively overhaul the health regulatory framework of the world’s most populous country during the coming decade, if not beyond. This article offers an original evaluation of the Law in its political context. The Law commendably promises to safeguard the right to health, assist citizens to live a ‘complete cycle of life’, and promote health using the resources of the public health system. However, it is also deeply politicised, guaranteeing extensive and penetrative political control in health campaigns, digitalised health data, the governance of health institutions, and the resolution of medical disputes. This can be explained by the consequential roles played by epidemics in China’s historical dynastic cycles, but even more so by powerful tendencies of centralisation on the part of the Leninist Party-state. The Law’s potential is thus subject to the overriding caveat that the Party-state’s existence and influence over law and public health must be secured.
Baryonic effects on the matter bispectrum
Authors: Foreman Simon , Coulton William , Villaescusa-Navarro Francisco , Barreira Alexandre
Published: August 2020

The large-scale clustering of matter is impacted by baryonic physics, particularly active galactic nuclei (AGN) feedback. Modelling or mitigating this impact will be essential for making full use of upcoming measurements of cosmic shear and other large-scale structure probes. We study baryonic effects on the matter bispectrum, using measurements from a selection of state-of-the-art hydrodynamical simulations: IllustrisTNG, Illustris, EAGLE, and BAHAMAS. We identify a low-redshift enhancement of the bispectrum, peaking at $k\sim 3\,h\, {\rm Mpc}^{-1}$, which is present in several simulations, and discuss how it can be associated to the evolving nature of AGN feedback at late times. This enhancement does not appear in the matter power spectrum, and therefore represents a new source of degeneracy breaking between two- and three-point statistics. In addition, we provide physical interpretations for other aspects of these measurements, and make initial comparisons to predictions from perturbation theory, empirical fitting formulas, and the response function formalism. We publicly release our measurements (including estimates of their uncertainty due to sample variance) and bispectrum measurement code as resources for the community.
Dynamics of small grains in transitional discs
Authors: Krumholz Mark R , Ireland Michael J , Kratter Kaitlin M
Published: August 2020

Transitional discs have central regions characterized by significant depletion of both dust and gas compared to younger, optically thick discs. However, gas and dust are not depleted by equal amounts: gas surface densities are typically reduced by factors of ∼100, but small dust grains are sometimes depleted by far larger factors, to the point of being undetectable. While this extreme dust depletion is often attributed to planet formation, in this paper we show that another physical mechanism is possible: expulsion of grains from the disc by radiation pressure. We explore this mechanism using 2D simulations of dust dynamics, simultaneously solving the equation of radiative transfer with the evolution equations for dust diffusion and advection under the combined effects of stellar radiation and hydrodynamic interaction with a turbulent, accreting background gas disc. We show that, in transition discs that are depleted in both gas and dust fraction by factors of ∼100–1000 compared to minimum mass Solar nebular values, and where the ratio of accretion rate to stellar luminosity is low ($\dot{M}/L \lesssim 10^{-10}\, \mathrm{ M}_\odot$ yr$^{-1}\, \mathrm{ L}_\odot ^{-1}$), radiative clearing of any remaining ${\sim}0.5\, \mu\mathrm{ m}$ and larger grains is both rapid and inevitable. The process is size-dependent, with smaller grains removed fastest and larger ones persisting for longer times. Our proposed mechanism thus naturally explains the extreme depletion of small grains commonly found in transition discs. We further suggest that the dependence of this mechanism on grain size and optical properties may explain some of the unusual grain properties recently discovered in a number of transition discs. The simulation code we develop is freely available.
How much H and He is ‘hidden’ in SNe Ib/c? – II. Intermediate-mass objects: a 22 M⊙ progenitor case study
Authors: Teffs Jacob , Ertl Thomas , Mazzali Paolo , Hachinger Stephan , Janka H-Thomas
Published: August 2020

Stripped envelope supernovae are a sub-class of core-collapse supernovae showing several stages of H/He shell stripping that determines the type: H-free/He-poor SNe are classified as Type Ic, H-poor/He-rich are Type Ib, and H/He-rich are Type IIb. Stripping H/He with only stellar wind requires significantly higher mass-loss rates than observed while binary-involved mass transfer may usually not strip enough to produce H/He free SNe. Type Ib/c SNe are sometimes found to include weak H/He transient lines as a product of a trace amount of H/He left over from stripping processes. The extent and mass of the H/He required to produce these lines is not well known. In this work, a 22 M⊙ progenitor model is stripped of the H/He shells in five steps prior to collapse and then exploded at four explosion energies. Requiring both optical and near-infrared He i lines for helium identification does not allow much He mass to be hidden in SE–SNE. Increasing the mass of He above the CO core delays the visibility of O i 7774 in early spectra. Our SN Ib-like models are capable of reproducing the spectral evolution of a set of observed SNe with reasonable estimated Ek accuracy. Our SN IIb-like models can partially reproduce low energy observed SN IIb, but we find no observed comparison for the SN IIb-like models with high Ek.
Less than the sum of its parts: the dust-corrected H α luminosity of star-forming galaxies explored at different spatial resolutions with MaNGA and MUSE
Authors: Vale Asari N , Wild V , de Amorim A L , Werle A , Zheng Y , Kennicutt R , Johnson B D , Galametz M , Pellegrini E W , Klessen R S , Reissl S , Glover S C O , Rahner D
Published: August 2020

The H α and H β emission-line luminosities measured in a single integrated spectrum are affected in non-trivial ways by point-to-point variations in dust attenuation in a galaxy. This work investigates the impact of this variation when estimating global H α luminosities corrected for the presence of dust by a global Balmer decrement. Analytical arguments show that the dust-corrected H α luminosity is always underestimated when using the global H α/H β flux ratio to correct for dust attenuation. We measure this effect on 156 face-on star-forming galaxies from the Mapping Nearby Galaxies at APO (MaNGA) survey. At 1–2 kpc spatial resolution, the effect is small but systematic, with the integrated dust-corrected H α luminosity underestimated by 2–4 per cent (and typically not more than by 10 per cent), and depends on the specific star formation rate of the galaxy. Given the spatial resolution of MaNGA, these are lower limits for the effect. From Multi Unit Spectroscopic Explorer (MUSE) observations of NGC 628 with a resolution of 36 pc, we find the discrepancy between the globally and the point-by-point dust-corrected H α luminosity to be 14 ± 1 per cent, which may still underestimate the true effect. We use toy models and simulations to show that the true difference depends strongly on the spatial variance of the H α/H β flux ratio, and on the slope of the relation between H αluminosity and dust attenuation within a galaxy. Larger samples of higher spatial resolution observations are required to quantify the dependence of this effect as a function of galaxy properties.
The MOSDEF Survey: calibrating the relationship between H α star formation rate and radio continuum luminosity at 1.4 < z < 2.6
Authors: Duncan Kenneth J , Shivaei Irene , Shapley Alice E , Reddy Naveen A , Mobasher Bahram , Coil Alison L , Kriek Mariska , Siana Brian
Published: August 2020

The observed empirical relation between the star formation rates (SFR) of low-redshift galaxies and their radio continuum luminosity offers a potential means of measuring SFR in high-redshift galaxies that is unaffected by dust obscuration. In this study, we make the first test for redshift evolution in the SFR-radio continuum relation at high redshift using dust-corrected H α SFR. Our sample consists of 178 galaxies from the MOSFIRE Deep Evolution Field (MOSDEF) Survey at 1.4 < z < 2.6 with rest-frame optical spectroscopy and deep 1.5 GHz radio continuum observations from the Karl G. Jansky Very Large Array (VLA) GOODS North field. Using a stacking analysis, we compare the observed radio continuum luminosities with those predicted from the dust-corrected H α SFR assuming a range of z ∼ 0 relations. We find no evidence for a systematic evolution with redshift, when stacking the radio continuum as a function of dust-corrected H α SFR and when stacking both optical spectroscopy and radio continuum as a function of stellar mass. We conclude that locally calibrated relations between SFR and radio continuum luminosity remain valid out to z ∼ 2.
Some ASOs that bind in the coding region of mRNAs and induce RNase H1 cleavage can cause increases in the pre-mRNAs that may blunt total activity
Authors: Liang Xue-hai , Nichols Joshua G , De Hoyos Cheryl L , Crooke Stanley T
Published: August 2020

Antisense oligonucleotide (ASO) drugs that trigger RNase H1 cleavage of target RNAs have been developed to treat various diseases. Basic pharmacological principles suggest that the development of tolerance is a common response to pharmacological interventions. In this manuscript, for the first time we report a molecular mechanism of tolerance that occurs with some ASOs. Two observations stimulated our interest: some RNA targets are difficult to reduce with RNase H1 activating ASOs and some ASOs display a shorter duration of activity than the prolonged target reduction typically observed. We found that certain ASOs targeting the coding region of some mRNAs that initially reduce target mRNAs can surprisingly increase the levels of the corresponding pre-mRNAs. The increase in pre-mRNA is delayed and due to enhanced transcription and likely also slower processing. This process requires that the ASOs bind in the coding region and reduce the target mRNA by RNase H1 while the mRNA resides in the ribosomes. The pre-mRNA increase is dependent on UPF3A and independent of the NMD pathway or the XRN1-CNOT pathway. The response is consistent in multiple cell lines and independent of the methods used to introduce ASOs into cells.
Prostate cancer heterogeneity assessment with multi-regional sampling and alignment-free methods
Authors: Murphy Ross G , Roddy Aideen C , Srivastava Shambhavi , Baena Esther , Waugh David J , M. O’Sullivan Joe , McArt Darragh G , Jain Suneil , LaBonte Melissa J
Published: August 2020

Combining alignment-free methods for phylogenetic analysis with multi-regional sampling using next-generation sequencing can provide an assessment of intra-patient tumour heterogeneity. From multi-regional sampling divergent branching, we validated two different lesions within a patient’s prostate. Where multi-regional sampling has not been used, a single sample from one of these areas could misguide as to which drugs or therapies would best benefit this patient, due to the fact these tumours appear to be genetically different. This application has the power to render, in a fraction of the time used by other approaches, intra-patient heterogeneity and decipher aberrant biomarkers. Another alignment-free method for calling single-nucleotide variants from raw next-generation sequencing samples has determined possible variants and genomic locations that may be able to characterize the differences between the two main branching patterns. Alignment-free approaches have been applied to relevant clinical multi-regional samples and may be considered as a valuable option for comparing and determining heterogeneity to help deliver personalized medicine through more robust efforts in identifying targetable pathways and therapeutic strategies. Our study highlights the application these tools could have on patient-aligned treatment indications.
Subcutaneous Suppressive Antibiotic Therapy for Bone and Joints Infections: Safety and Outcome in a Cohort of 10 Patients
Authors: Ferry Tristan , Pouderoux Cecile , Goutelle Sylvain , Lustig Sébastien , Triffault-Fillit Claire , Daoud Fatiha , Fessy Michel-Henri , Cohen Sabine , Laurent Frederic , Chidiac Christian , Valour Florent ,   Lyon BJI Study group
Published: August 2020

Background

Optimal surgical therapy could be sometimes non-feasible, especially in the elderly population. Therefore, a medical therapy with oral prolonged suppressive antibiotic therapy (PSAT) seems to be an option to prevent recurrence and prosthesis loosening. Subcutaneous (SC) administration of injectable intravenous antibiotics as PSAT could be a convenient way when oral treatment is not available to facilitate ambulatory care, even if this practice is considered as an “off-label” practice.

Methods

All patients receiving SC PSAT since 2010 were prospectively enrolled in a cohort study evaluating treatment modalities, efficacy, and safety. Success was defined by the absence of clinical signs of infection at the time of last follow-up.

Results

We included 10 patients (median age of 79 years): seven had PJI and three chronic osteomyelitis. Six had plurimicrobial infections and four had infections due to multidrug-resistant Gram-negative pathogens. Suboptimal surgery was performed in seven patients, and three received only antibiotics. All patients received an induction-phase therapy with conventional antibiotic treatment before SC PSAT. For nine patients, SC injections were delivered by a 50 mlml 30 minute gravity infusion of the antibiotic, using butterfly disposable needle. One patient received direct flash SC administration. The most frequent drug used was ertapenem (n = 7; 1–2 g/day), followed by ceftriaxone (n = 2; 1 g/day), and ceftazidime (n = 1; 2 g/day). The dose was adjusted depending on the results of trough residual blood concentration. Median duration of treatment was 6 months (from 1 to 58 months), corresponding to a total of about 5,000 SC injections. SC PSAT had to be discontinued for side effects in only two patients, including skin necrosis in the patient receiving direct SC infusion (lost to follow-up after treatment discontinuation) and epilepsy under ertapenem therapy (with relapse of the BJI after the treatment discontinuation). One other patient experienced a relapse despite the SC PSAT. Finally, SC PSAT was still ongoing in seven patients with a favorable outcome at the last follow-up.

Conclusion

SC PSAT appears to be a safe and effective alternative therapy when optimal surgical strategy is not feasible and when oral treatment is not available.

Disclosures

T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee
Pressure Ulcer-Related Pelvic Osteomyelitis: Evaluation of a Two-Stage Surgical Strategy (Debridement, Negative Pressure Therapy and Flap Coverage) with Prolonged Antimicrobial Therapy
Authors: Ferry Tristan , Boucher Fabien , Chateau Joseph , Shipkov Hristo , Daoud Fatiha , Braun Evelyne , Triffault-Fillit Claire , Perpoint Thomas , Laurent Frederic , Mojallal Alain-Ali , Chidiac Christian , Valour Florent , Andrianasolo Johan ,   Lyon BJI Study group
Published: August 2020

Background

A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated.

Methods

Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e.,, additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan–Meier curve analysis.

Results

Sixty-four pressure ulcer-related pelvic osteomyelitis in 61 patients (age, 47 [IQR 36–63]) were included. Osteomyelitis was mostly plurimicrobial (73%), with a predominance of S. aureus (47%), Enterobacteriaceae (44%), and anaerobes (44%). Flap coverage was performed after 7 (IQR 5–10) weeks of NPT, with 43 (68%) positive bone samples among which 39 (91%) were superinfections, associated with a high ASA score (OR, 5.8; P = 0.022). An increased prevalence of coagulase negative Staphylococci (P = 0.017) and Candida (P = 0.003) was observed at time of flap coverage. An ESBL Enterobacteriaceae was found in one (12%) patients, associated with fluoroquinolone consumption (OR, 32.4; P = 0.005). Treatment duration was as 20 (IQR 14–27) weeks, including 11 (IQR 8–15) after reconstruction. After a follow-up of 54 (IQR 27–102) weeks, 15 (23%) failures were observed, associated with previous pressure ulcer (OR, 5.7; P = 0.025) and Actinomyces infection (OR, 9.5; P = 0.027).

Conclusion

Pressure ulcer-related pelvic osteomyelitis is a difficult-to-treat clinical condition, generating an important consumption of broad-spectrum antibiotics. Carbapenem should be reserved for ESBL at-risk patients only, including those with previous fluoroquinolone use. The uncorrelation between outcome and the debridement-to-reconstruction interval argue for a short sequence to limit the total duration of treatment.

Disclosures

T. Ferry, HERAEUS: Consultant, Speaker honorarium
Effect of Rectal Hygiene on Sexually Transmitted Infections Among HIV-Negative Men Who Have Sex with Men (MSM)
Authors: Hassan Adiba , Blumenthal Jill , Dube Michael , Ellorin Eric , Corado Katya , Moore David , Morris Sheldon ,   California Collaborative Treatment Group (CCTG) 595 Team
Published: August 2020

Background

Rectal gonorrhea (NG) and chlamydia (Connecticut) infections are common among men who have sex with men (MSM). Rectal douching/enema (RDE) is a common practice among MSM that can affect the rectal microbiome. It is unclear if this practice is associated with acquiring rectal infections (RI) with either NG or CT.

Methods

From 2013–2015, 398 adult HIV-negative MSM and transwomen were enrolled in a randomized controlled study on text messaging for adherence to pre-exposure prophylaxis (PrEP). Participants were surveyed on sexual behavior, frequency of RDE, drug use, and nutritional habits in conjunction with routine sexually transmitted infection testing. Pearson’s χ 2 and two sample t-tests were used to measure significance of RDE and other risk factors with RI. Multivariable logistic regression model was used to control for confounding and assess the association of RDE with RIs. Confounders (i.e., age, number anal receptive sex, number sex partners) were selected a priori for inclusion in the final model based on a causal model and statistical significance.

Results

Of 397 participants, 262 (67%) performed RDE and 132 (33%) had at least one NG or CT rectal infection over 48 weeks. Number of condomless anal receptive sex acts (mean = 19, P < 0.001), condom use for anal receptive sex (P = 0.017), number of male sex partners in past 3 months (mean = 14, P = 0.001), and the use of poppers (P < 0.001) were associated with RI. There was no significant association between nutritional habits, probiotic foods or supplements and RI, with the exception of energy bars (P = 0.029). Controlling for confounders, RI was associated with RDE less than weekly with OR = 1.02 (95% CI 0.52–1.99) while RDE weekly or more had OR = 2.08 (95% CI 1.03–4.17). Stratified by number of partners, MSMs with more than the median (>6) number of partners had OR = 4.96 (95% CI 1.29–19.03) if performing RDE less than weekly, and OR = 6.03 (95% CI 1.55–23.49) if weekly or more.

Conclusion

Rectal hygiene with douching/enemas is a common practice among MSMs on PrEP, which increases the odds of acquiring rectal NG and/or CT. This finding is suggestive for the use of rectal hygiene products/practices as potential targets for sexually transmitted infection prevention.

Disclosures

All authors: No reported disclosures.
C. difficile Screening for Colonization among Surgical Ward Admissions Is Feasible and Useful
Authors: Linsenmeyer Katherine , Brecher Stephen , Strymish Judith , O’Brien William , Rochman Alexandra , Itani Kamal , Gupta Kalpana ,   VA Boston Healthcare System Infection Prevention Nurses
Published: August 2020

Background

Identification of patients colonized with C. difficile (CDcol) upon admission and initiation of precautions has been shown to decrease hospital-acquired C. difficileinfection (HA-CDI) in a recent study. We implemented a quality improvement program screening new admissions to a surgical service and evaluated risk factors and outcomes associated with CDcol.

Methods

Prospective cohort of all patients admitted to the surgical wards including ICU over a 6 month period 10/16–4/17. Upon admission, a perirectal swab was sent for C diff PCR. Patients with positive screens were placed on contact precautions. CDcol patients were not treated. Testing for CDI was done as usual practice only in patients with diarrhea. Main outcome was prevalence of CDcol and relationship to HA-CDI.

Results

Of 708 surgical admissions, 585 (82.6%) patients were screened, 543 were eligible based on first admission; 19 (3.5%) were colonized. Recent surgical hospitalization (OR 13.2, 95% CI 3.4;52.1) and prior CDI (OR 19.5, 95% CI 2.9;127.7) were independent risk factors for CDcol. Antibiotic and PPI use were not associated. Of those with CDcol, 7 developed CDI (36.8%) compared with 5/524 (0.9%) screen negative patients (adj OR 60, 95% CI 12.6;286). CDcol combined with a prior h/o CDI allowed for detection of 8/12 (75%) cases of HA-CDI compared with 3/12 (25%) if only prior history was available. HA-CDI rates on surgical wards after one month post-implementation were 9.3/10,000 bed days of care compared with 12.2 in 2016 and 12.8 in 2015. No delays in bed flow were identified.

Conclusion

Admission CDcol prevalence was low in our surgical VA population but was strongly associated with development of HA-CDI. Prior CDI was the strongest risk factor for CDcol and HA-CDI. Knowledge of prior CDI and CDcol status identified 75% of patients who developed CDI, 3 times more than knowledge of prior CDI alone. In certain settings, CDcol screening could improve detection and early isolation of potential CDiff spreaders. Implementation required significant support from administration, nursing and the laboratory, and was successful based on screening percentage without impact on bed flow. Impact on facility CDI rates remains to be fully demonstrated.

Disclosures

All authors: No reported disclosures.
The Impact of Drugs, Infants, Single Mothers, and Relatives on Reunification
Authors: Wittenstrom Kim , Baumann Donald J. , Fluke John D. , Graham J. Christopher , James Joyce
Published: August 2020

Using a Decision-Making Ecology (DME) approach and proportional hazards models, the study reviewed in this chapter isolated four case factor profiles that interacted strongly with race and resulted in disparate reunification outcomes for African American children compared with Anglos. The four interrelated factors were drug involvement, a solo infant case, single mothers, and relative placements. A cohort of 21,763 children from the Texas Department of Family and Protective Services who were placed for the first time in care, who were under 13, and were either Anglo or African American were followed for 20 months or more post entry into care. Starting with an initial model consisting of main effects only and consistent with other studies, African American children had a 12% lower hazard rate of reunification compared to Anglo children. However, when a set of case profiles involving combinations of single parents, single infants, drug involvements, and kinship placements were crossed with race, the magnitude of the effect of race on hazard rates fanned out from no difference to as much as 68% that of Anglo children. The results show that racial disparities in outcomes resulting from complex, contextual decision-making cannot be modeled well with simple main effects models.
Exploring Alternate Explanations for Agency-Level Effects in Placement Decisions Regarding Aboriginal Children
Authors: Fallon Barbara A. , Fluke John D. , Chabot Martin , Blackstock Cindy , Sinha Vandna , Allan Kate , MacLaurin Bruce
Published: August 2020

This chapter summarizes a series of published papers that used data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) to explore the influence of case and organizational characteristics on decisions to place Aboriginal children in out-of-home placements. The premise of the analyses was that these influences were consistent with the framework of the Decision-Making Ecology. In Canada, Aboriginal children are overrepresented at all points of child welfare decision-making: investigation, substantiation, and placement in out-of-home care. Case factors accounting for the overrepresentation of Aboriginal children at all service points in the child welfare system include poverty, poor housing, and substance misuse, and these factors, when coupled with inequitable resources for First Nations children residing on reserves, result in the overrepresentation of Aboriginal children in the Canadian child welfare system. For this study, the authors examine case characteristics and organizational factors in a multilevel context, hypothesizing that children are more likely to be placed out of home in agencies that serve a relatively high proportion of Aboriginal children. According to the statistical models presented, the most important of these factors is whether the provincial government operates the child welfare agency. As with the proportion of Aboriginal children on the caseload, the risk of a child being placed is greater in government-run agencies compared to agencies operated by private funders. Further analysis needs to be conducted to fully understand individual- and organizational-level variables that may influence /decisions regarding placement of Aboriginal children.
The Use and Usability of Decision-Making Theory in Child Welfare Policy and Practice
Authors: Bartelink Cora , van Yperen Tom A. , Ten Berge Ingrid J. , Knorth Erik J.
Published: August 2020

The aim of this chapter is to clarify how decision-making processes within the context of child welfare and child protection could be improved by decision-making theories (i.e., Decision-Making Ecology [DME] and decisional conflict model), with specific interest in methods intended to support practitioners based on these theories, in particular methods of structured decision-making and actuarial methods. Existing studies indicate that structured decision-making methods have a limited effect on the decision-making process, as well as on the reliability and validity of the judgments and choices made by professionals in cases of suspected child abuse and neglect. Actuarial methods may be more precise in making valid judgments but may ignore factors relevant to decisions concerning treatment and intervention. The DME framework reveals that other factors—in addition to rationally weighing information and arguing—influence the decision-making process and outcomes. Especially the influence of decision-maker factors seems to be ignored in structured decision-making methods. Although systematic methods and instruments do have some value, several additional options are available that take decision-maker factors more into account. This chapter discusses the potentials of critical thinking, team decision-making, systematic feedback, and shared decision-making.
The Best of the Chinese and of the Western
Authors: Xu Xiaoqun
Published: August 2020

Chapter 4 introduces the conflicts arising in the eighteenth and nineteenth centuries between the Qing dynasty and Western powers over Chinese law and justice that contributed to the Opium Wars and the resultant unequal treaties. It explains how, compelled by Western pressure and modeled after Western systems, the Qing dynasty, not foreseeing its own demise in ten years, began a far-reaching legal-judicial reform to modernize law codes and judicial institutions and practices. Guided by the principles of the rule of law, judicial independence, and due process, the reformers set out ambitious reform goals that would result in some concrete changes in laws and institutions, and more importantly, the goals would outlive the Qing dynasty to be pursued and implemented in the Republican era (1912–1949).
“Contradictions between the People and the Enemy”
Authors: Xu Xiaoqun
Published: August 2020

Chapter 7 presents the Maoist theory of class struggle and its manifestation in dealing with common crimes and political offenses by legal (and extralegal) and judicial (and extrajudicial) means. Such practices originated in the pre-1949 revolutionary experiences and culminated in the disastrous Cultural Revolution (1966–1976). The chapter explains the reasons why the CCP did not find it necessary to have a criminal code and a criminal procedural law, and how the mechanisms of social engineering that the CCP designed and developed helped social control and crime prevention. It traces the rationales and practices of “reform through labor” and “reeducation through labor” during the Mao era and after. It describes the political campaigns of the 1950s and 1960s that reached the point of lawlessness in the Cultural Revolution.
“Naked Officials” and “Heavenly Net”
Authors: Xu Xiaoqun
Published: August 2020

Chapter 10 continues the survey of criminal justice in 1997–2018. It notes important changes in the Criminal Code and the Criminal Procedural Law, including the abolition of class struggle as the guide to criminal justice and “counterrevolutionary” as a criminal category, and the introduction of “harming national security” as a criminal category in the 1997 Criminal Code. Other changes include a series of amendments in recent years to the 1997 Criminal Code and the 1996 Criminal Procedural Law, providing more safeguards of the rights of the accused and reducing the number of capital offenses, and the abolition of the “reeducation through labor” (laojiao) system in 2013. Another area of legal responses to societal changes in the period is prosecution of corrupt party-state officials at high levels. A law-enforcement program called Heavenly Net was launched in early 2015 to capture corrupt officials and white-collar criminals who fled to other countries.
The Future of Christian Marriage
Authors: Regnerus Mark
Published: August 2020

The foundational vision of marriage as a load-bearing structure has receded, but the core and key expectations of marriage have not changed. As a result, marriage rates have declined. Fewer Christians will marry in the future, but given their elevated commitment to matrimony, they will comprise an increasing share of the world’s marriages over time. The recession in marriage highlights the collapse of familism and the rise of atomism. The data supports one particular theory about how religion influences marital behavior—the moral communities thesis, which concludes that Christian marriage is tightly linked to wider trends, suggesting marriage is a public matter. Religious efforts to “get the government out of the marriage business” are shortsighted. How central is marriage to Christian faith and practice? Very. Given its public nature, cohabitation threatens Christianity more than does premarital sex. The book concludes with five predictions for what to expect next.
The Broader Old Hispanic Tradition
Authors: Maloy Rebecca
Published: August 2020

This chapter compares the sacrificium melodies throughout the corpus of the Old Hispanic manuscripts. The author examines the Old Hispanic melodies through the lens of questions that have shaped scholarly thought on Franco-Roman chant, such as the nature of their oral and written transmission and their formative roles in the existing tradition. A comparison of the melodies in existing manuscripts suggests a multilayered melodic transmission, with both oral and written elements. Certain music writing habits are common to all early manuscripts, indicating their basis in a shared culture of musical literacy and, in some cases, descent from common exemplars. The tradition was nonetheless variant and flexible at certain points. The late manuscripts from Toledo associated with liturgical tradition B are far more distantly related to the early sources, with no evidence of connection through writing. The manuscripts thus lie at different points along continuums of aural-written and fixed-flexible.