bluuebunny/crossref_metadata_2025 huggingface dataset:
Findings from healthcare-associated infections data validation attestation in California general acute-care hospitals
Authors: Barahmani Nadia , Parriott Andrea , Epson Erin , Tang Genie , Kazerouni N. Neely
Published: May 2022

Background: Accurate and complete hospital healthcare-associated infection (HAI) data are essential to inform facility-level HAI prevention efforts and to ensure the validity and reliability of annual public reports. We implemented a validation attestation survey to assess and improve the HAI data reported by California hospitals via NHSN. Methods: The California Department of Public Health (CDPH) HAI Program invited all 401 general acute-care hospitals in California to participate in an annual HAI validation attestation survey in 2021. The survey was designed to be completed by the person with primary responsibility for HAI surveillance and reporting consistent with NHSN protocols and California laws. Survey questions addressed HAI reporting knowledge and practices and surgical procedures performed, and they included 3 hypothetical scenarios evaluating hospital application of HAI surveillance, decision making, and reporting methods. Results: We received responses from 345 hospitals (86%). For the 3 hypothetical scenarios, 171 hospitals (49.6%) correctly answered all 3 questions, 110 hospitals (31.9%) answered 2 questions correctly, 52 (15.1%) hospitals answered 1 question correctly, and 12 hospitals (3.5%) answered zero questions correctly. We did not detect a statistically significant association between facility type (ie, acute-care hospital, critical access hospital, long-term acute-care hospital, or rehabilitation hospital or unit) and the probability of getting all questions correct (Fisher exact P = .42). Of the 303 hospitals (88.0%) that perform at least 1 of the 28 surgical procedures reportable in California, 269 (88.8%) apply CDPH-recommended postoperative ICD-10 diagnosis flag codes to identify records that might indicate a possible surgical site infection (SSI). Moreover, ~289 (84.0%) hospitals confirmed that someone at their facility reviews CDPH quality assurance–quality control reports to verify the accuracy and completeness of their hospital’s reported HAI data. In 321 hospitals (93.0%) decisions about which infections are reported to NHSN are made solely by the infection preventionists or hospital epidemiologists, who are thoroughly familiar and follow NHSN protocol, definitions, and criteria. Conclusions: Most hospitals reported following best practices for evaluating records for SSIs; however, only half responded correctly to all 3 hypothetical scenarios. Our results highlight the need for ongoing education on HAI surveillance, decision making and reporting methods, and external HAI data validation in hospitals. This survey could serve as a model for other states that work with hospitals to improve HAI surveillance data and to ensure the integrity of public reports. Future research will link the results of this survey to NHSN validation audits.

Funding: None

Disclosures: None
SARS-CoV-2 environmental contamination in COVID-19 patient rooms in a VA medical center
Authors: Gibson Kristen , Ridenour Jennifer , Carver Kyle , Mantey Julia , Deng Jane , Mody Lona
Published: May 2022

Background: SARS-CoV-2, the virus causing COVID-19 infection, can significantly contaminate environmental surfaces and can remain viable on surfaces for up to 9 days. Although respiratory route remains the most significant mode of transmission, fomites and environmental sources of infection remain a concern for healthcare personnel who are working in dedicated COVID-19 units. We investigated the extent of detectable SARS-CoV-2 contamination in the environment of COVID-19 patients at a single VA hospital, with the intent of identifying potential high-touch surfaces at risk for viral contamination, which could be used to inform the development of simple COVID-19 prevention strategies. Methods: We conducted a cohort study at 1 VA hospital in a unit housing adult veterans admitted with COVID-19 between October and December 2020. In total, 11 swab specimens were collected for PCR analysis (SARS-CoV-2 env gene) from environmental surfaces inside and just outside the rooms of COVID-19 patients one time. Retrospective chart reviews were conducted to provide the SARS-CoV-2 epidemiologic context for environmental detection. Results: In total, 297 swabs were collected from the unit and environmental areas surrounding 27 hospitalized patients: average age, 72.5 years (range, 34–94); 100% male; 92% non-Hispanic white; average comorbidities, 1.8 (SD, 1.1). Of 297 swabs, 80 (27%) were positive for SARS-CoV-2 and 19 (70%) of 27 patients had at least 1 positive site. The most contaminated site was the floor just outside the patient room (78% positive samples), followed by the patient’s bedrail (37%) and chair handle (37%) (Fig. 1). Traditionally high-touch surfaces, such as the door handle (outside patient room) and the light switch, did not have high positivity rates (<15%). Interestingly, both the personal protective equipment (PPE) cart outside patient’s room (33%) and the double doors leading out of the unit (19%) were positive, which are surfaces often touched with bare hands after handwashing. Analyses of clinical data are underway to examine whether specific care needs, based on activities of daily living disability, comorbidities, and clinical presentation of COVID-19, predict SARS-CoV-2 environmental contamination. Conclusions: The presence of environmental contamination by SARS-CoV-2 highlights the importance of transmission via direct or indirect contact. Studies targeting high-risk populations are needed to better understand the transmission of SARS-CoV-2 between infected patients and their environment. Our findings also suggest that handwashing and attention to using disinfecting wipes may mitigate the risk of transmission of virus from surfaces that one might consider safe to touch.

Funding: None

Disclosures: None
Clinical factors associated with antibiotic de-escalation after a positive multiplex molecular respiratory panel
Authors: Baghdadi Jonathan , Morgan Daniel , Harris Anthony , Goodman Katherine
Published: May 2022

Background: Under ideal circumstances, multiplex molecular respiratory panels can support early all discontinuation of unnecessary antibiotics by facilitating diagnosis of viral infection. Our goal was to identify clinic situations in which a positive respiratory panel was associated with antibiotic de-escalation. We focused on gram-negative antibiotics in recognition of the urgent threat posed by gram-negative resistance. Methods: The sample included hospitalized adults tested by respiratory panel while receiving gram-negative antibiotics at the University of Maryland Medical Center from 2015 to 2020. Only the first respiratory panel performed during hospitalization was included. The primary outcome was the combination of a positive result on respiratory panel indicating detection of a viral pathogen and de-escalation of gram-negative antibiotics. De-escalation was assessed based on antibiotics administered on day 3 after testing and was defined by discontinuation or switch to an agent with a narrower spectrum of activity. Least absolute shrinkage and selection operator (LASSO) regression was used to construct the multivariable logistic regression model. Classification and regression tree (CART) analysis was used to identify subgroups with a higher likelihood of the primary outcome. Results: Of 8,326 patients, 1,462 (17.6%) tested positive by respiratory panel. The most common pathogen was rhinovirus (7.9% of the sample). Gram-negative–targeted antibiotics were de-escalated in 4,456 cases (53.5% of the sample), including 887 patients with a positive result on respiratory panel indicating a viral pathogen (60.7% of patients with a positive viral result). LASSO regression was used to select 12 variables (Table 1). Admitting diagnosis of pneumonia (OR, 1.42), comorbid substance abuse (OR, 1.39), chronic pulmonary disease (OR, 1.39), and admission from home (OR, 1.34) were associated with antibiotic de-escalation in conjunction with a positive respiratory panel. Leukocytosis (OR, 0.59), hematologic malignancy (OR, 0.64), mechanical ventilation at time of testing (OR, 0.68), and hypotension (OR, 0.77) were associated with decreased likelihood of antibiotic de-escalation in conjunction with a positive respiratory panel. CART analysis identified patients tested within 40 hours of admission as having a higher likelihood of a positive result in conjunction with antibiotic de-escalation. Among patients tested within 40 hours of admission, the probability of a positive result followed by antibiotic de-escalation was 11.9% (95% CI, 11.1%–12.8%). For patients tested >40 hours after admission, the probability was 6.0% (95% CI, 4.8%–7.2%). Conclusions: Targeted use of respiratory panel testing may increase the likelihood of an informative result that can drive decision making related to antibiotic use. Our exploratory analysis suggests that respiratory panel testing in the first 2 days

Funding: None

Disclosures: None
Outpatient antibiotic use for common infectious diagnoses: Patterns in telehealth during the emergence of COVID-19
Authors: Mongilardi Nicole , Wilson Brigid , Bej Taissa , Song Sunah , Jump Federico , Perez Federico , Akpoji Ukwen
Published: May 2022

Background: The Veterans’ Affairs (VA) healthcare system has had established telehealth programs for several years. Even so, the COVID-19 pandemic led to an expansion of and changes in these services. Little is known about the influence of the increased use of telehealth due to the COVID-19 pandemic on antibiotic prescriptions in outpatient settings. Here, we report on changes in visit modality and antibiotic prescribing at primary care clinics at a large VA medical center after the emergence of the COVID-19 pandemic. Methods: Using VA administrative databases, we identified primary care visits from March 2018 to November 2019 (before the COVID-19 pandemic) and March 2020 to November 2021 (during the COVID-19 pandemic), which permitted us to account for seasonality while analyzing visit modality and antibiotic trends. For primary care visits during the pre–COVID-19 and COVID-19 periods, we have described the type of visit (in-person or telehealth), diagnostic codes for any infection, and antibiotic prescriptions. Results: The patient population was primarily men (89%) with a mean age of 62.9 years (SD, ±15.3) at first visit. The most common medical conditions were diabetes mellitus (26%) and chronic lung disease (17%). Comparing visits during the pre–COVID-19 and the COVID-19 periods, the proportions of telehealth visits were 20% (17,708 of 88,565) and 74% (69,891 of 94,937), respectively (Fig. 1). The proportions of visits with an antibiotic prescription were 1.4% (1,212 of 88,565) and 0.8% (798 of 94,396), respectively. When considered by the type of visit, the rates of antibiotics prescribed were consistent during the pre–COVID-19 and COVID-19 periods, with a lower rate for telehealth visits (Fig. 2). In both periods, >50% of antibiotic prescriptions occurred during visits without an associated infectious disease diagnosis. Conclusions: Compared to the pre–COVID-19 period, primary care providers at a large VA medical center prescribed fewer antibiotics during the COVID-19 period, and they saw most of their patients via telehealth. These results suggest that some aspects of telehealth may support clinical practices consistent with antibiotic stewardship. The prescription of an antibiotic without an associated diagnostic code also suggests opportunities to improve implementation of antibiotic stewardship principles in primary care settings.

Funding: This work was supported by the Merck Investigator Studies Program (grant no. MISP 59266 to F.P. and R.J.) and by funds and facilities provided by the Cleveland Geriatric Research.

Disclosures: None
Do hospitalists who prescribe high (risk-adjusted) rates of antibiotics do so repeatedly?
Authors: Onwubiko Udodirim , Mehta Christina , Wiley Zanthia , Jacob Jesse , Jones Ashley , Hassan Shabir , Sexton Marybeth , Suchindran Sujit , Fridkin Scott
Published: May 2022

Background: Provider-specific prescribing metrics can be used for benchmarking and feedback to reduce unnecessary antibiotic use; however, metrics must be credible. To improve credibility of a recently described risk-adjusted antibiotic prescribing metric for hospital medicine service (HMS) providers, we assessed whether providers who initially prescribed excess antibiotics continued to prescribe antibiotics excessively. Methods: We linked administration and billing data among patients at 4 acute-care hospitals (1,571 beds) to calculate days of therapy (DOT) ordered by individual hospitalists for each of 3 NHSN antibiotic groupings: broad-spectrum hospital onset (BS-HO), broad-spectrum community-onset (BS-CO), or anti-MRSA for each patient day billed from January 2020 to June 2021. To incorporate repeated measures by provider, mixed models adjusted for patient-mix characteristics (eg, % encounters with urinary tract infection, etc) were used to calculate serial, bimonthly, provider-specific, observed-to-expected ratios (OERs). An OER of 1.25 indicates that the prescribing rate observed was 25% higher than predicted, adjusting for patient mix. We then used log binomial generalized estimating equations to assess whether a high prescribing rate (defined as an OER ≥ 1.25) for an individual provider in an earlier bimonthly period was associated with a persistent high rate for that provider in the following period. Results: Overall, 975 bimonthly periods were evaluated from 136 hospitalists. Most (58%) contributed data the entire 18-month study period. Median OERs were similar between hospitals: 0.94 (IQR, 0.65–1.28) for BS-HO antibiotic use, 0.99 (IQR, 0.73–1.24) for BS-CO antibiotic use, and 0.95 (IQR, 0.65–1.28) for anti-MRSA antibiotic use. At the individual prescriber level, roughly one-quarter of bimonthly OERs (range varied by group and hospital from 21% to 31%) were categorized as high. At 3 of the 4 hospitals, a provider with a high OER for either BS-HO or BS-CO antibiotic use in any bimonthly period was more likely to have a high OER in the subsequent period (Fig. 1). These observed risk ratios were statistically significant for BS-HO antibiotic use at only 2 hospitals: hospital A risk ratio (RR) was 1.54 (95% CI, 1.10–2.16); hospital B RR was 1.28 (95% CI, 0.90–1.82); hospital C RR was 0.76 (95% CI, 0.39–1.48); and ospital D RR was 1.71 (95% CI, 1.09–2.68). Conclusions: Our findings suggest that hospitalists with a higher than expected 2-month period of antibiotic prescribing are likely to continue to have elevated prescribing rates in the following period, particularly for BS-HO antibiotics. These findings increase the credibility of using a 2-month prescribing metric for BS-HO antibiotic stewardship efforts; further work is needed to evaluate utility for other antibiotic groupings.

Funding: None

Disclosures: None
The effect of a parenteral-to-oral conversion program for high-bioavailability antibiotics use
Authors: Jang Wooyoung , Kim Bongyoung
Published: May 2022

Background: Appropriate conversion of antibiotics from parenteral to the oral route can lower the risk of catheter-associated infections, reduce medical costs, and shorten hospitalization. We investigated the effect of a parenteral-to-oral conversion program on high-bioavailability antibiotics conducted by medical students and the changes in perceptions of oral antibiotics after participating in the program. Methods: The parenteral-to-oral conversion program was implemented as a core clinical practice course for the fifth-year medical students in 2021 at the infectious diseases department in an affiliated hospital of a medical school in Korea. Half of the students in this class participated in the program from January to October 2021. An evaluation of the possibility of oral conversion was performed for parenterally administered, high oral-bioavailability antibiotics including ciprofloxacin, levofloxacin, moxifloxacin, metronidazole, linezolid, and trimethoprim–sulfamethoxazole. These agents are prescribed in the departments of pulmonology, gastroenterology, general surgery, and neurology. The medical students reviewed medical records for the patients treated with those antibiotics and wrote a recommendation for oral conversion for the cases with “possible oral conversion” after an infectious disease specialist confirmed their assessments. The cases without administration of any oral drugs or with the duration of parenteral antibiotic use of <3 days were excluded from the evaluation. The following cases were considered as “impossible oral conversion” and were excluded from the intervention: (1) admitted to the ICUs, (2) admitted to the protected isolation rooms, (3) difficult to take oral medication, (4) risk of insufficient medication absorption, e) bone and joint infections, (5) fever within 24 hours, (6) insufficient response to antibiotic therapy, and (7) recommended to use intravenous antibiotics by consultation with an infectious disease specialist. Furthermore, a survey was conducted on the perception of oral antibiotics in medical students before and after clinical practice to evaluate the educational effect of this program. Results: In total, 923 cases were reviewed, and 190 (20.6%) of 923 antibiotics prescriptions with high oral bioavailability were found to be administered parenterally even though they could be converted oral administration. Among these 190 antibiotics prescriptions, 46 (24.2%) were changed via a written proposal within 48 hours, 83 (43.7%) proposed changes were declined, and 61 (32.1%) antibiotics prescriptions were discontinued within 48 hours. Through this program, students have gained a better perception of oral antibiotics. Conclusions: This parenteral-to-oral conversion program showed a 24.2% acceptance rate of oral antibiotics conversions in the hospital, and it had significant educational effects on medical students regarding an appropriate perception of oral antibiotics.

Funding: None

Disclosures: None
Procalcitonin as marker for bacterial coinfection among adult COVID-19 patients in a tertiary-care hospital in the Philippines
Authors: Pesebre Angelie Lorraine , Abad Cybele Lara , Francisco Jan Jorge , Ong Justin Allister
Published: May 2022

Background: Antimicrobials are often given to patients with COVID-19 despite the absence of a bacterial coinfection. Procalcitonin (PCT), when elevated, often indicates the presence of a bacterial infection and is used to guide empiric antibiotic therapy. We sought to determine the utility of PCT and the optimal cutoff value of PCT among patients with COVID-19. Methods: We retrospectively reviewed all COVID-19 confirmed ca-ses hospitalized in our institution from March to December 2020. Of 729 cases, we included 403 (55.3%) who had baseline PCT and blood or respiratory tract specimens (eg, sputum, endotracheal aspirate) within 48 hours of admission. Participants were classified according to PCT levels and COVID-19 severity. A receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) obtained was used to compute the possible optimal cutoff value using the Youden index. A χ2 test was used to define association between groups according to the characteristics of variables. Results: Of a total cohort of 403, 245 (57%) were male, with an overall median age of 60 years (range, 22–94). Overall, 28 presented with mild COVID-19, 194 presented with moderate COVID-19, and 181 presented with severe or critical COVID-19. Moreover, 363 (90%) were given antibiotics. Of 28 with mild COVID-19, 22 (79%) received empiric antibiotics. The rate of bacterial coinfection was high at 28% (113 of 403). Klebsiella pneumoniae was the most commonly identified microorganism: 52 (19.5%) of 266 patients. Based on the ROC curve, the optimal cutoff for PCT was 4.72 ng/mL, with 97% specificity and only 6% sensitivity. Only 17 participants had PCT > 4.72 ng/mL. Of these, 1 was mild, 5 were moderate COVID-19, 8 had severe COVID-19, and 3 had critical COVID-19; all received antibiotic therapy. Conclusions: In our cohort, the rate of bacterial coinfection was high. A PCT of >4.72 ng/mL increased the likelihood of a coinfection. However, PCT had poor sensitivity and may not detect the presence of bacterial coinfection, especially when used alone. Serial PCT monitoring, its use in conjunction with other markers, or as a prognostic tool, need to be explored further.

Funding: None

Disclosures: None
The Strike Team as an implementation strategy for surgical infection prevention
Authors: Hatharaliyadda Buddhi , Schmitz Michelle , Osman Fauzia , Van Dyke Kenneth , Safdar Nasia , Pop-Vicas Aurora , Heise Charles , Mork Anne
Published: May 2022

Background: Surgical site infections (SSIs) incur up to $10 billion annually due to their excessive morbidity. SSI prevention bundles have had variable success in colorectal surgery. For example, at the University of Wisconsin Hospital, a 505-bed regional referral center, SSI rates have remained high despite the introduction of a 14-element SSI prevention bundle in 2016. To aid in the implementation of this complex bundle, the hospital started Strike Teams in 2019. We have described the impact of Strike Teams on colorectal SSI rates in our tertiary-care hospital. Methods: A Strike Team with key stakeholders from colorectal surgery (ie, surgeon, OR director, nurses, surgical technicians), anesthesia, pharmacy, infection prevention, and infectious disease was formed, supported by the hospital’s executive leadership. The Strike Team met monthly throughout 2019 to review each SSI case, discussed barriers to adherence for the SSI prevention bundle elements with implementation difficulties (Table 1), and proposed actionable feedback to increase adherence. The latter was disseminated to frontline clinicians by the teams’ surgical leaders during everyday clinical practice. The Strike Team was paused in 2020 due to resource reallocation in response to the COVID-19 pandemic. Monthly and quarterly SSI surveillance was conducted according to CDC guidance. Results: Colorectal SSI rates before, after, and during Strike Team activity are shown in Fig. 1. Adherence rates to the bundle elements targeted by the Strike Team are shown in Fig. 2. Conclusions: Adherence to the preferred antibiotic prophylaxis increased, although adherence to other bundle elements of focus did not change significantly. SSI rates decreased below our expectation while the Strike Team was active in our hospital, although SSI reduction was not sustained. Further research should study the effectiveness of Strike Teams as a long-term implementation strategy for SSI prevention in colorectal surgery.

Funding: None

Disclosures: None
A qualitative study of parent and childcare leadership perspectives on attendance policies at childcare centers
Authors: Poole Nicole , Dorsey-Holliman Brooke , Anderson Leisha , O’Leary Sean , Glaros Chloe
Published: May 2022

Background: Attendance policies for common pediatric illnesses vary widely across childcare centers despite nationally published guidelines from the American Academy of Pediatrics. The COVID-19 pandemic has exacerbated this problem, leading to economic loss from parental work absenteeism and excess medicalization of children with common illnesses. We sought to understand barriers to and recommendations for adopting best practices on attendance policies at Early Head Start and Head Start (EHS/HS) childcare centers. Methods: We conducted 19 semistructured qualitative interviews: 9 with childcare leadership and 10 with parents from EHS/HS childcare centers across Colorado. Interviews took place between April and December 2021. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti using a priori and emergent coding strategies. Descriptive content analysis was used to identify central themes, which were iteratively revised by 2 authors. Results: We derived 7 convergent and 4 divergent themes from leadership and parents addressing attendance decisions. Overlapping themes on barriers to adopting best practices included difficulty assessing symptom severity, limited medical provider understanding of childcare requirements, parent employment pressures, and the impact of the COVID-19 pandemic on exclusion durations. Leadership and parent perspectives differed on resources utilized, understanding of exclusionary symptoms, and role of medical providers in making attendance decisions. Overlapping themes on recommendations for best practices included access to registered nursing, concrete guidance on symptoms, and partnering with health departments. Leadership and parents agree that the COVID-19 pandemic led to increased guideline use in making attendance decisions and increased rates of excluding children from class for minor illness compared to prepandemic times. Both leadership and parents recommended consistency in exclusion practices, but leadership and parents identified medical providers and childcare leadership, respectively, as current sources of inconsistency. Salient findings showed variability in defining a fever by age from both leadership and parents. Conclusions: Coordination is needed between childcare centers, medical facilities, and health departments to improve attendance decisions for common pediatric illnesses. Future work should (1) develop concrete symptom guidance for parents with specific exclusion criteria (eg, via a decision aid), (2) assess the utility and feasibility of regular classroom access to registered nursing, and (3) advocate for employee protections to care for sick children at home.

Funding: None

Disclosures: None
Hospital-level variation in the utilization of antipseudomonal antibiotics: A nationwide cross-sectional study at the VHA
Authors: Hasegawa Shinya , Kakiuchi Satoshi , Livorsi Daniel , Perencevich Eli , Goto Michihiko
Published: May 2022

Background: Avoiding unnecessary antipseudomonal coverage is 1 of the most common targets for antibiotic stewardship programs (ASPs), but little is known about the magnitude of facility-level variation in antipseudomonal agent utilization. We aimed to describe the variability in the use of antipseudomonal agents across inpatient settings within a nationwide integrated healthcare system. Method: We analyzed the data from a retrospective cohort of patients who were admitted to acute-care hospitals within the VHA system in 2019. We defined antipseudomonal agents as systemic antibiotics with activity against wild-type Pseudomonas aeruginosa, and we evaluated overall and antipseudomonal antibiotic use among 129 hospitals, according to the agents described in the NHSN Antimicrobial Usage and Resistance Module. We calculated each hospital’s overall and antipseudomonal days of therapy (DOT) per 1,000 days present and the proportion of antipseudomonal agent usage among all antibiotics based on DOT at each hospital. Hospital-level variation was assessed by comparing the proportion of total antibiotic consumption accounted for by antipseudomonal agents. Associations between antipseudomonal proportions and overall antibiotic consumption were also assessed. Results: Among 129 VHA hospitals, the median DOT per 1,000 days present for all antibiotics was 434.4 (IQR, 371.9–487.1), and the median antipseudomonal DOT per 1,000 days present was 127.7 (IQR, 99.8–159.6). The median proportion of total antibiotic consumption accounted for by antipseudomonal agents was 30.0% (range, 14.9%–40.7%; IQR, 26.4%–34.4%) (Fig. 1). We detected only a weak correlation between overall antibiotic consumption and antipseudomonal proportion (Pearson correlation coefficient, 0.396), which suggests that hospitals with higher total antibiotic consumption were not necessarily using more antipseudomonal agents. In a stratified analysis, there was more prominent hospital-level variability in surgical specialties than medical specialties (Fig. 2). Conclusions: We detected high hospital-level variability in the consumption and proportion of antipseudomonal antibiotics among an integrated healthcare system. Although it is plausible that these variabilities originated from case-mix differences among hospitals, including differing rates of P. aeruginosa infections, it may also highlight opportunities for reducing antipseudomonal antibiotic utilization, especially among surgical specialties. Further studies are needed to evaluate the contribution of modifiable patient- and facility-level factors to this variability.

Funding: None

Disclosures: None
Antimicrobial use patterns during the COVID-19 pandemic at an academic medical center
Authors: Pierce Jacob , Deja Erin , Lee Kimberly , Doll Michelle , Stevens Michael
Published: May 2022

Background: The COVID-19 pandemic has made a significant impact on antimicrobial use patterns across health systems. We have described antibiotic use patterns at an academic medical center in Richmond, Virginia, before and after the onset of COVID-19. We also examined the impact on the proportional consumption of carbapenems (PoCC) metric. PoCC represents meropenem utilization relative to the narrower-spectrum antipseudomonal agents cefepime and piperacillin-tazobactam. Our institution practices antimicrobial restriction for meropenem. All other antibiotics included in the study data can be freely ordered by any provider. Methods: We evaluated antimicrobial use data from September 2018 through August 2021 using days of therapy (DOT) per 1,000 patient days. We included 18 months of data before and after the first recorded COVID-19 admission at our institution in March 2020. Mean comparisons were performed using the Welch 2-sample t test. The Bonferonni correction for multiple comparisons was utilized to determine significance with an initial baseline α of 0.05. All data analyses were performed using R software (R Foundation for Statistical Computing, Vienna, Austria, 2021). Results: Normality was evaluated with QQ-plots and all data demonstrated normality. Bonferroni correction produced an adjusted α value of 0.007. We detected significant increases in the use of cefepime, piperacillin-tazobactam, ceftriaxone, and azithromycin following the onset of the COVID-19 pandemic. We noted a significant decrease in the PoCC metric during this period. No significant change was noted for levofloxacin or meropenem. Conclusions: The COVID-19 pandemic produced significant changes in antimicrobial use patterns at our institution. We noted statistically significant increases in bacterial community-acquired pneumonia-focused antibiotics (ceftriaxone and azithromycin). We observed significant increases for cefepime and piperacillin-tazobactam. Interestingly, relative utilization of carbapenems as measured by the PoCC metric continued to decrease during this time. This trend was primarily driven by increases in cefepime and piperacillin-tazobactam utilization while meropenem utilization remained relatively constant. This study highlights the importance of looking at normalized antibiotic consumption data and not relative-use data alone.

Funding: None

Disclosures: None
Laughing through the Virus the Zimbabwean Way: WhatsApp Humor and the Twenty-one-day COVID-19 Lockdown
Authors: Chibuwe Albert , Munoriyarwa Allen
Published: May 2022

In many African countries, jokes represent one of the many means used by citizens to cope with a crisis. Chibuwe and Munoriyarwa explore how Zimbabweans utilize WhatsApp jokes, which are anchored in the concept of the “everyday,” to cope with pandemic-induced lockdowns. COVID-19 jokes provide citizens momentary relief from fear and function as a defense mechanism against COVID-19 and its effects, enabling citizens to confront and rationalize fear, death, and suffering. Chibuwe and Munoriyarwa argue that jokes are also a means of speaking truth to power by disgruntled citizens attempting to cope with a health crisis, in a context characterized by corruption, state repression, and bad governance.
Enhancing GP care of mental health disorders post-COVID-19: a scoping review of interventions and outcomes
Authors: Keyes Bláthnaid , McCombe Geoff , Broughan John , Frawley Timothy , Guerandel Allys , Gulati Gautam , Kelly Brendan D. , Osborne Brian , O’Connor Karen , Cullen Walter
Published: May 2022

Objectives:

Considerable literature has examined the COVID-19 pandemic’s negative mental health sequelae. It is recognised that most people experiencing mental health problems present to primary care and the development of interventions to support GPs in the care of patients with mental health problems is a priority. This review examines interventions to enhance GP care of mental health disorders, with a view to reviewing how mental health needs might be addressed in the post-COVID-19 era.

Methods:

Five electronic databases (PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO ‘Global Research on COVID-19’) were searched from May – July 2021 for papers published in English following Arksey and O’Malley’s six-stage scoping review process.

Results:

The initial search identified 148 articles and a total of 29 were included in the review. These studies adopted a range of methodologies, most commonly randomised control trials, qualitative interviews and surveys. Results from included studies were divided into themes: Interventions to improve identification of mental health disorders, Interventions to support GPs, Therapeutic interventions, Telemedicine Interventions and Barriers and Facilitators to Intervention Implementation. Outcome measures reported included the Seven-item Generalised Anxiety Disorder Scale (GAD-7), the Nine-item Patient Health Questionnaire (PHQ-9) and the ‘The Patient Global Impression of Change Scale’.

Conclusion:

With increasing recognition of the mental health sequelae of COVID-19, there is a lack of large scale trials researching the acceptability or effectiveness of general practice interventions. Furthermore there is a lack of research regarding possible biological interventions (psychiatric medications) for mental health problems arising from the pandemic.
Decomposition of fluid forcing and phase synchronisation for in-line vortex-induced vibration of a circular cylinder
Authors: Zhao Jisheng , Thompson Mark C. , Hourigan Kerry
Published: May 2022

We present a decomposition of the streamwise fluid force for in-line vortex-induced vibration (VIV) to provide insight into how the wake drag acts as a driving force in fluid–structure interaction. This force decomposition is an extension of that proposed in the recent work of Konstantinidis et al. (J. Fluid Mech., vol. 907, 2021, p. A34), and is applied to and validated by our experiments examining a circular cylinder freely vibrating in line with the free stream. It is revealed from the decomposition and linear analysis that two regimes of significant vibration are in phase synchronisation, while they are separated by a desynchronised regime marked by competition between non-stationary frequency responses of the cylinder vibration and the vortex shedding. Of interest, such a near-resonance desynchronisation regime is not seen in the transverse vibration case.
Recent mass-balance changes of Agua Negra glacier (30°S) in the Desert Andes of Argentina
Authors: Pitte Pierre , Masiokas Mariano , Gargantini Hernán , Ruiz Lucas , Berthier Etienne , Ferri Hidalgo Lidia , Zalazar Laura , Dussaillant Inés , Viale Maximiliano , Zorzut Valentina , Corvalán Ernesto , Scarpa Juan Pablo , Costa Gustavo , Villalba Ricardo
Published: May 2022

The Desert Andes contain >4500 ice masses, but only a handful are currently being monitored. We present the mass changes of the small mountain glacier Agua Negra (1 km2) and of the rest of glaciers in the Jáchal river basin. Remote-sensing data show Agua Negra glacier lost 23% of its area during 1959–2019. Glaciological measurements during 2014–2021 indicate an average annual mass balance of −0.52 m w.e. a−1, with mean winter and summer balances of 0.80 and −1.33 m w.e. a−1, respectively. The Equilibrium Line Altitude (ELA) is estimated to be 5100 ± 100 m a.s.l., which corresponds to an Accumulation Area Ratio (AAR) of 0.28 ± 0.21. Geodetic data from SRTM X and Pléiades show a doubling of the loss rate from −0.32 ± 0.03 m w.e. a−1in 2000–2013, to −0.66 ± 0.06 m w.e. a−1in 2013–2019. Comparatively, the ice losses for the entire Jáchal river basin (25 500 km2) derived from ASTER show less negative values, −0.11 ± 16 m w.e. a−1for 2000–2012 and −0.23 ± 14 m w.e. a−1for 2012–2018. The regional warming trend since 1979 and a recent decline in snow accumulation are probably driving the observed glacier mass balance.
Analysis of the Thematic Structure and Discursive Framing in Articles about Trianon and the Holocaust in the Online Hungarian Press Using LDA Topic Modelling
Authors: Barna Ildikó , Knap Árpád
Published: May 2022

In our research, we examined the discursive framing of Trianon and the Holocaust in today’s Hungarian online media. Our corpus contained 26,519 articles connected to these two historical events published between September 2017 and September 2020. We used a mixed-method approach by combining computational text analysis, namely, LDA (Latent Dirichlet Allocation) topic models and qualitative methods. Our aim was not only to map the latent thematic structure and the discourses about Trianon and the Holocaust but also to identify the main differences in the rhetoric of the different sides of the political spectrum. Using Bull and Hansen’s categories, we found that the far-right and government media use the antagonistic, while the left-liberal media use the cosmopolitan mode of remembering. We identified many discursive differences between the rhetoric of the different political sides. Yet, the different relationship to emotions has the most far-reaching consequences. On the one hand, in antagonistic remembering, thus in the far-right and progovernment media, emotions play an essential role. On the other hand, cosmopolitan remembering, thus the rhetoric featured in the nongovernment media, detaches itself from emotions. This difference contributes significantly to the success of antagonistic remembering in Hungary. At the same time, the left-liberal side loses the opportunity to shape memory and identity politics.
Fractional interpolation inequality and radially symmetric ground states
Authors: Ma Li , Dong Fangyuan
Published: May 2022

In this paper, we establish a new fractional interpolation inequality for radially symmetric measurable functions on the whole space $R^{N}$ and a new compact imbedding result about radially symmetric measurable functions. We show that the best constant in the new interpolation inequality can be achieved by a radially symmetric function. As applications of this compactness result, we study the existence of ground states of the nonlinear fractional Schrödinger equation on the whole space $R^{N}$. We also prove an existence result of standing waves and prove their orbital stability.
Hydroclimatic changes in south-central China during the 4.2 ka event and their potential impacts on the development of Neolithic culture
Authors: Wang Tianli , Li Dong , Cheng Xing , Lan Jianghu , Edwards R. Lawrence , Cheng Hai , Liu Xingxing , Xue Gang , Xu Hai , Ma Le , Zang Jingjie , Wang Yaqin , Gao Yongli , Sinha Ashish , Tan Liangcheng
Published: May 2022

The 4.2 ka event is widely presumed to be a globally widespread aridity event and has been linked to several episodes of societal changes across the globe. Whether this climate event impacted the cultural development in south-central China remains uncertain due to a lack of regional paleorainfall records. We present here stalagmite stable carbon isotope and trace element–based reconstruction of hydroclimatic conditions from south-central China. Our data reveal a sub–millennial scale (~5.6 to 4.3 ka) drying trend in the region followed by a gradual transition to wetter conditions during the 4.2 ka event (4.3–3.9 ka). Together with the existing archaeological evidence, our data suggest that the drier climate before 4.3 ka may have promoted the Shijiahe culture, while the pluvial conditions during the 4.2 ka event may have adversely affected its settlements in low-lying areas. While military conflicts with the Wangwan III culture may have accelerated the collapse of Shijiahe culture, we suggest that the joint effects of climate and the region's topography also played important causal roles in its demise.
REGULARITY OF THE SZEGÖ PROJECTION ON THE SYMMETRISED POLYDISC
Authors: HAN KAIKAI , TANG YANYAN
Published: May 2022

We consider the
$L^{p}$
-regularity of the Szegö projection on the symmetrised polydisc
$\mathbb {G}_{n}$
. In the setting of the Hardy space corresponding to the distinguished boundary of the symmetrised polydisc, it is shown that this operator is
$L^{p}$
-bounded for
$p\in (2-{1}/{n}, 2+{1}/{(n-1)})$
.
Erasing Minds: Behavioral Modification, the Prison Rights Movement, and Psychological Experimentation in America's Prisons, 1962–1983
Authors: COLLEY ZOE
Published: May 2022

This article explores the development of behavioral modification programs inside penitentiaries during the 1960s and 1970s, with a focus upon how such tactics were used to crush dissent and silence incarcerated people who challenged the prison regime. First, it explores how psychology became an influential force in the operation of many penitentiaries from the 1950s. Second, it considers the role that psychologists and psychiatrists played in developing brainwashing techniques to punish those prison activists who sought to expose the dehumanizing and brutal treatment of incarcerated people. Finally, it uses the example of the behavioral modification unit at Marion Federal Penitentiary to show how the federal government was complicit in the use of psychological torture to silence prisoners’ complaints.
Drivers of predator-proof boma disrepair in the Amboseli Ecosystem, Kenya
Authors: Manoa David Owino , Melubo Stephen , Kasaine Simon , Banham Penny , Willie Jacob , Oloo Tim , Greengrass Elizabeth , Tagg Nikki
Published: May 2022

As natural habitats continue to shrink in Kenya's Amboseli Ecosystem, livestock depredation by lions Panthera leo threatens both the livelihoods of pastoralist communities and the lion populations affected by retaliatory killings. Finding ways for people and carnivores to coexist at the landscape scale is crucial to the long-term persistence of many threatened animal populations. The fortification of existing traditional bomas to make them predator-proof reduces night-time depredation of livestock. However, the sustainability and cost-effectiveness of such an initiative rely on boma owners taking responsibility for the upkeep and repair of their bomas. In August 2018 we surveyed 88 predator-proof bomas constructed during 2012–2018 and recorded their characteristics and levels of damage. We examined which variables influence disrepair, using a series of statistical analyses, including generalized linear mixed models. Our results reveal there was more disrepair in bomas constructed with wooden posts, confirming the benefit of using recycled plastic posts; in bomas with lower livestock density, suggesting that fewer animals could cause more damage or that such damage is not repaired; and in bomas located further away from a neighbouring predator-proof boma, suggesting a social element in encouraging or enabling boma owners to carry out maintenance. We recommend the consideration and further investigation of this social influence in guiding and improving the sustainability of conservation programmes that use predator-proof bomas, with a view to reducing negative interactions between pastoralists and lions.
Plasma glucose levels and diabetes are independent predictors for mortality in patients with COVID-19
Authors: Long Hui , Li Jiachen , Li Rui , Zhang Haiyang , Ge Honghan , Zeng Hui , Chen Xi , Lu Qingbin , Jiang Wanli , Zeng Haolong , Che Tianle , Ye Xiaolei , Fang Liqun , Qin Ying , Wang Qiang , Wu Qingming , Li Hao , Liu Wei
Published: May 2022

This study is performed to figure out how the presence of diabetes affects the infection, progression and prognosis of 2019 novel coronavirus disease (COVID-19), and the effective therapy that can treat the diabetes-complicated patients with COVID-19. A multicentre study was performed in four hospitals. COVID-19 patients with diabetes mellitus (DM) or hyperglycaemia were compared with those without these conditions and matched by propensity score matching for their clinical progress and outcome. Totally, 2444 confirmed COVID-19 patients were recruited, from whom 336 had DM. Compared to 1344 non-DM patients with age and sex matched, DM-COVID-19 patients had significantly higher rates of intensive care unit entrance (12.43% vs. 6.58%, P = 0.014), kidney failure (9.20% vs. 4.05%, P = 0.027) and mortality (25.00% vs. 18.15%, P < 0.001). Age and sex-stratified comparison revealed increased susceptibility to COVID-19 only from females with DM. For either non-DM or DM group, hyperglycaemia was associated with adverse outcomes, featured by higher rates of severe pneumonia and mortality, in comparison with non-hyperglycaemia. This was accompanied by significantly altered laboratory indicators including lymphocyte and neutrophil percentage, C-reactive protein and urea nitrogen level, all with correlation coefficients >0.35. Both diabetes and hyperglycaemia were independently associated with adverse prognosis of COVID-19, with hazard ratios of 10.41 and 3.58, respectively.
Paediatric inflammatory multisystem syndrome – temporally associated with SARS-CoV-2 (PIMS-TS) – a German single centre real-life evaluation of the Swiss and UK consensus statements
Authors: Jenke Andreas , Steinmetz Michael
Published: May 2022

Background:

In the absence of randomised trials for paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV2 (PIMS-TS), optimal management of PIMS-TS-patients remains somewhat uncertain. We aimed to evaluate the practicability of consensus diagnostic/therapeutic pathways in a real-life German hospital setting.

Methods:

All children treated for PIMS-TS (February to November, 2021) at the Childrens’ Hospital Kassel were analysed retrospectively. Patients were treated according to local PIMS-TS standardised operating procedure based on the Swiss and UK consensus statements

Results:

Eleven patients treated for PIMS-TS were included in this study (female:male = 2.1:1). According to the categories of the Swiss and UK consensus statements, 36% were uncomplicated hyperinflammation, 36% Kawasaki-like and 27% shock-like disease. Local estimated incidence was 0.92/1000 Covid-19 cases in children aged 4–15 years. Significant inter-group differences in laboratory parameters were found: BNP was highest in shock-like presentation compared to Kawasaki-like and uncomplicated hyperinflammation (median 954 (668–1491) versus 213 (173–934) versus 80 (5–257) ng/l, p = 0.02), whereas troponin was highest in Kawasaki-like, followed by shock-like presentation and uncomplicated hyperinflammation (median 34.7 (27.5–58.4) versus 19.1 (14.1–23.4) versus 1.9 (1.9–16.4) ng/l, p = 0.02). Patients with shock-like presentation needed circulatory resuscitation in the paediatric ICU. All patients received standardised operating procedure-based therapy and were discharged home after a medium of 7.4 days.

Conclusion:

The Swiss and UK consensus statements on the management of PIMS-TS proved very valuable in a real-life clinical setting, facilitated early categorisation, and initiation of specific therapy, possibly improving the outcome. Additional randomised trials are necessary to further improve the management of PIMS-TS