bluuebunny/crossref_metadata_2025 huggingface dataset:
Measles, Mumps, and Rubella Antibody: Patterns of Persistence and Rate of Decline Following the Second Dose of the MMR Vaccine
Authors: Seagle Emma , Bednarczyk Robert , Hill Tenisha , Fiebelkorn Amy Parker , Hickman Carole , Icenogle Joseph , Belongia Edward , Mclean Huong Q
Published: October 2017

Background

Antibodies to measles, mumps, and rubella decline an estimated average of 3% per year, and have a high degree of variation among individuals. Yet, this variation and differences in individual-level response to the 3 antigens are not well understood. To better understand potential implications on individual and population-level susceptibility, we reanalyzed existing longitudinal data to identify patterns of seropositivity and antibody persistence.

Methods

Wisconsin children given the second dose of measles, mumps, and rubella vaccine (MMR2) at age 4–6 years were followed up to 12 years postvaccination. The rate of antibody decline and factors associated with the rate of decline were assessed using regression models that accounted for differences between and among subjects.

Results

Most of the 302 participants were seropositive throughout follow-up (96% measles, 88% mumps, 79% rubella). The rate of antibody decline was associated with MMR2 response and baseline titer for measles and age at first dose of MMR (MMR1) for rubella. None of the demographic or clinical factors examined were associated with rate of decline for mumps. One month after MMR2, geometric mean titer (GMT) to measles was high (3892 mIU/mL), but declined on average 9.7% per year among subjects with the same baseline titer and <2-fold increase in antibody titer after MMR2. Subjects with ≥2-fold increase experienced a slower decline (≤7.4%). GMT to rubella was 149 IU/mL one month after MMR2 and declined 2.6% and 5.9% per year among those who received MMR1 at 12–15 months and >15 months, respectively. GMT to mumps one month after MMR2 was 151 and declined 9.2% per year. Only 14% of participants had the same trends in antibody persistence for all 3 antigens.

Conclusion

The rate of antibody decay varied substantially among individuals and among the 3 antigens. Despite waning titers, measles and rubella antibody levels remained high 12 years post MMR2. However, a fast rate of decline and high degree of variation was observed for mumps, yet no predictors of the decline were identified. Future research should focus on better understanding waning antibody titers to mumps and its impact on community protection and individual susceptibility, in light of recent mumps outbreaks in vaccinated populations.

Disclosures

All authors: No reported disclosures.
Differential Gene Expression Elicited by Children in Response to the 2015–2016 Live Attenuated vs. Inactivated Influenza Vaccine
Authors: Zimmerman Richard , Cole Kelly , Martin Judith , Horne William , Lin Chyongchiou J , Nowalk Mary Patricia
Published: October 2017

Background

In recent influenza seasons, the live attenuated influenza vaccine (LAIV) has not demonstrated the same level of vaccine effectiveness as that observed among children who received the inactivated influenza vaccine (IIV). To better understand this difference, this study compared the mRNA sequencing transcription profile (RNA seq) in children who received either IIV or LAIV.

Methods

Children 3–17 years of age receiving quadrivalent influenza vaccine were enrolled. Blood samples were collected on Day 0 prior to vaccination and again on Day 7 (range 6–10 days) following vaccination. Total RNA was isolated from PAXgene tubes and sequenced for a custom panel of 89 transcripts using the TruSeq Targeted RNA Expression method. Fold differences in normalized RNA seq counts from Day 0 to Day 7 were calculated, log2 transformed and compared between the two vaccine groups.

Results

Of 73 children, 47 received IIV and 26 received LAIV. Following IIV vaccination, 12 genes demonstrated significant differential expression at Day 7. In contrast, following LAIV vaccination, seven genes demonstrated significant differential expression at Day 7, five of which were not differentially expressed by IIV. Two genes demonstrated similar patterns of regulation in both IIV and LAIV recipients.

Conclusion

Differential regulation of genes was observed between 2015 and 2016 LAIV and IIV recipients. These results help to elucidate the immune response to influenza vaccines and might help explain the difference in vaccine effectiveness observed in recent years between LAIV and IIV.

Disclosures

R. Zimmerman, sanofi pasteur: Grant Investigator, Research grant Merck & Co, Inc.: Grant Investigator, Research grant Pfizer, Inc.: Grant Investigator, Research grant; C. J. Lin, Sanofi: Grant Investigator, Research grant Merck & Co, Inc.: Grant Investigator, Research grant Pfizer, Inc..: Grant Investigator, Research grant; M. P. Nowalk, Merck & Co, Inc.: Grant Investigator, Research grant Pfizer, Inc.: Grant Investigator, Research grant
Effectiveness of Antimicrobial Use and Diagnostic Testing in the Postoperative Setting for Colectomy, Craniectomy and Knee Arthroplasty
Authors: Saeed Huma , Grant Jennifer , Bhaimia Eric , Parikh Ronak , Lahrman Frances , McNulty Moira C , Robicsek Ari , Padman Rema , Shah Nirav
Published: October 2017

Background

Patients with postoperative fevers tend to receive empiric antibiotics and a diagnostic workup even though postoperative fevers are frequently physiologic. The yield of postoperative workups ranges from 2–24%. Studying the effectiveness of antibiotic use and diagnostic testing across surgeries may provide insight to improve value of care for the postoperative patient.

Methods

We evaluated all patients who had elective colectomy, craniectomy and knee arthroplasty (KA) at NorthShore University HealthSystem between October 2009 and December 2013. Inpatient clinical data were extracted from the electronic data warehouse. All complications were confirmed by chart review. Antimicrobial Effectiveness was defined as the use of antibiotics only when patient had a confirmed infectious complication (pneumonia, urinary tract infection, etc) during hospital course. Diagnostic Effectiveness was defined as the use of diagnostic test only when patient had a confirmed complication. Length-of-stay (LOS) and cost were compared using Student’s t-test.

Results

233 patients had a colectomy, 506 had a craniectomy and 4,693 had a knee arthroplasty. Antibiotic and Workup Effectiveness rates were 51% and 45.33% for colectomy, 18% and 22.53% for craniectomy, and 27%and 9.89% for KA, respectively. Effectiveness of antimicrobial use and diagnostic workups are shown in Figure 1. Patients without complications in all 3 surgeries who had a workup, as compared with those patients without a workup, were more likely to have a longer LOS (colectomy: 8.95 days vs. 5.08 days, P < 0.0001; craniectomy: 4.88 days vs. 2.62 days, P < 0.001; KA: 3.22 days vs. 2.95 days, P < 0.0001) and a higher cost of hospitalization (colectomy: $76,034 vs. $42,865, P < 0.001; craniectomy: $83,779 vs. $58,998, P < 0.001; KA: $53,451 vs. $52,159, P < 0.001).

Conclusion

A significant fraction of empiric antibiotics in the postoperative setting are unnecessary across multiple surgeries. Diagnostic testing effectiveness rates are low and have consequences in terms of healthcare utilization.

Disclosures

All authors: No reported disclosures.
Emergency Department Utilization During Self-Administered Outpatient Parenteral Antimicrobial Therapy
Authors: Ganguly Anisha , Brown Larry , Agrawal Deepak , Bhavan Kavita
Published: October 2017

Background

Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment.

Methods

We conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT.

Results

Among our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1).

Conclusion

Our review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home.

Disclosures

All authors: No reported disclosures.
Systematic Review of Professional Liability when Prescribing Β-Lactams for Patients with a Known Penicillin Allergy
Authors: Jeffres Meghan , Hall-Lipsy Elizabeth , King S Travis , Cleary John
Published: October 2017

Background

Patients labeled as penicillin allergic are more likely to receive second line non-β-lactam antibiotics, experience higher rates of treatment failure, and incur higher antibiotic costs. Fear of litigation has been identified as a reason clinicians avoid using β-lactams in a patient with a penicillin allergy. The systematic review objective is to describe medical negligence and malpractice cases in which known penicillin allergy patients received a β-lactam and experienced an adverse reaction.

Methods

Lexis-Nexus and Google Scholar were used to identify relevant legal cases. Variables collected from each case included date of publication, legal jurisdiction, date of injury, plaintiff and defendant demographics, health care setting, plaintiff clinical outcome, and legal outcome.

Results

Twenty-seven unique cases met inclusion criteria. The earliest case was published in 1959 and the most recent in 2013. The highest number of cases filed (n = 7) occurred in the most recent 10 year segment, from 2005 to 2015. Eighteen cases involved the receipt of a penicillin-based antibiotic; of these cases with a known legal outcome, the plaintiff (patient) prevailed or settled in 3 cases and defendants (providers) prevailed in 7 cases. Seven cases involved the receipt of a cephalosporin; of these cases with a known legal outcome, the plaintiff settled with physicians prior to trial in 1 case and defendants prevailed in 3 cases. Two cases involved the receipt of a carbapenem. Defendants prevailed in 1 case and the legal outcome of the other case is unknown. In cases where the defense successfully moved for summary judgment, judges cited a lack of scientific evidence demonstrating that a cephalosporin or carbapenem were contraindicated for a patient with a penicillin allergy.

Conclusion

The cases with published legal outcomes found limited professional liability and identify clear precedence for clinicians who prescribed cephalosporins or carbapenems to a patient with a known penicillin allergy. These results should decrease litigation fears of providers and risk managers within healthcare systems.

Disclosures

All authors: No reported disclosures.
Responses to Fever Overnight: Do Residents Choose Wisely?
Authors: Howard-Anderson Jessica , Schwab Kristin , Chang Sandy , Graber Christopher J , Quinn Roswell
Published: October 2017

Background

Residents at our institution rely heavily on the terminology “Full Fever Work Up” (FFWU) as a cognitive tool for cross-covering patients with a fever. Prior survey data revealed that residents vary considerably in how they respond to fevers and what FFWU means. We sought to determine what tests are included in the FFWU, how often the term is adhered to, and if it significantly changes clinical outcomes.

Methods

For 3 months, study investigators collected FFWU instructions for patients who experienced a fever at night. For each febrile episode, investigators reviewed chart data on patient factors, circumstances surrounding the fever, tests ordered, etiologies of the fever, and outcomes (immediately and 30-days after the fever). The UCLA Institutional Review Board approved this study.

Results

We reviewed 253 fever episodes. For 204 episodes, written sign-out by the primary team was available. 59% of the fevers were in male patients and the mean age was 59 years. 12% had an organ transplant and 45% qualified as highly immunocompromised. 79% met SIRS criteria, whereas only 3% met qSOFA criteria and 2% required escalation of care.

The cross-covering physician wrote a note in 4% of the cases and evaluated the patient in-person in 12% of the cases per chart review. Residents most often ordered bacterial blood cultures (48%), followed by urinary tests (34%) and chest X-rays (30%). These tests, as well as fungal blood cultures, lactate and CBC, were significantly more likely to be ordered by the cross-covering resident if the sign-out instructed to perform a FFWU. The mean number of diagnostic tests ordered was 2 and residents started or changed antibiotics in 14% of cases. 88% of the time patients were alive 30 days after their fever. 11% had an antibiotic-related complication and 8% of blood cultures drawn were positive.

Conclusion

Ordering practices overnight were significantly influenced by the FFWU sign-out instructions, yet evaluating the patient in-person was rare. We hypothesize that the FFWU standardization has replaced a more individualized evaluation overnight. Fortunately, poor outcomes including death, bacteremia, escalation of care, or antibiotic-related complications were low in this population.

Disclosures

All authors: No reported disclosures.
Epidemiology, Microbiology and Outcomes of Catheter-Associated Urinary Tract Infection and Complicated Urinary Tract Infection in the USA
Authors: Merchant Sanjay , Sarpong Eric M , Magee Glenn , Lapointe Nancy , Gundrum Jake , Zilberberg Marya
Published: October 2017

Background

An estimated 93,300 cases of healthcare-associated urinary tract infection (UTI) were recorded in US acute care hospitals in 2011. Many are classified as catheter-associated UTI (CAUTI) or complicated UTI (cUTI). Although CAUTI and cUTI share some commonalities, strategies differ for their prevention and treatment. We examined the epidemiology, microbiology and outcome of patients with CAUTI and cUTI in a large multicenter US database.

Methods

This was a retrospective cohort study using the 2013–2015 Premier Healthcare Database. ICD-9-CM codes were used to identify hospitalized adults (≥18 years) with CAUTI or cUTI. The demographics, clinical characteristics, microbiology, and hospital outcomes of all identified patients were compared. Differences between groups were examined using χ2 test for categorical variables and Student’s t-test for continuous variables. Statistical significance was set at P ≤ 0.05.

Results

Of 120,332 identified patients, 50,034 (41.6%) had CAUTI (87.0% present on admission [POA]) and the remainder had cUTI [95.3% POA]. Patients with CAUTI were older (71.3 ± 16.1 vs. 56.3 ± 19.5 years) and more likely to be male (62.5% vs. 30.6%) and white (71.6% vs. 66.7%) (all P < 0.001). They also had greater comorbidity burden (Charlson Comorbidity Index of 2.8 ± 2.4 vs. 1.7 ± 2.2) and a higher ICU care rate (23.2% vs. 17.8%) than cUTI patients (all P < 0.001). Although Escherichia coli was the most common pathogen in both (69.8% cUTI vs. 39.5% CAUTI), Pseudomonas aeruginosa accounted for one quarter of all CAUTIs and only 5.0% of cUTIs. Compared with cUTI, CAUTI carried a >2-fold increase in unadjusted mortality (3.6% vs. 1.6%) and a higher rate of 30-day readmission (3.9% vs. 2.5%) (all P < 0.001). Additionally, CAUTI was associated with a greater unadjusted ICU length of stay (LOS, 6.0 ± 8.8 vs. 5.5 ± 5.5 days), hospital LOS (8.4 ± 12.9 vs. 5.5 ± 6.4 days) and cost ($16,871+$29,513 vs. $11,915 ± $19,657) (all P < 0.001).

Conclusion

The volume of CAUTI and cUTI hospitalizations in the US is high, and a majority of infections were present on admission. CAUTI is associated with greater mortality and resource use than cUTI. The high rate of P aeruginosa portends a greater potential for antimicrobial resistance in CAUTI, which may require different prevention and treatment approaches from cUTI.

Disclosures

S. Merchant, 1Merck & Co., Inc.: Employee and Shareholder, Salary E. M. Sarpong, Merck & Co., Inc.: Employee and Shareholder, Salary M. Zilberberg, EviMed Research Group, LLC,; Universtiy of Massachusetts: Shareholder, Research grant
Analytical and Clinical Performance of a Real-time Screening PCR Assay Identifying Congenital CMV Infection
Authors: Rohde Benjamin , Carillo-Marquez Maria , Tomlinson Ryan , Blanch Jacqueline , Kim-Hoehamer Young-In , Patel Hema , Patel Chirag , Zanalian Gita , Osborne Gertrude , Davis Joseph , Patel Anami , Devincenzo John P
Published: October 2017

Background

Congenital CMV infection (cCMV) is the most common identifiable cause of mental retardation in the United States but requires early diagnosis to define the infection and to institute effective antiviral therapy. Traditional identification strategies including hearing screens and physical exams likely miss many patients with cCMV. We therefore developed and evaluated the performance of a PCR assay optimized for low cost, specimen collection at time of dried blood spot collection, and detection thresholds below the salivary CMV concentrations known to occur in cCMV patients.

Methods

We utilized a real-time CMV PCR assay (SimplexaTM CMV)(DiaSorin, Cypress CA) amplifying the UL83 gene and the 3M Integrated Cycler. Saliva was collected from volunteers (Copan swab), and spiked with known concentrations of CMV culture supernatant quantified by COBAS AmpliprepTM. (Roche Diagnostics). Additionally, saliva was collected by copan swab from all births within a single multi-hospital system from 3/21/16 – 5/4/17. Newborns who were initial screen PCR positive were subsequently evaluated by urine CMV PCR by an outside laboratory for confirmation of cCMV.

Results

Analytical threshold of detection was well below 4 log copies/ML, with 100% of samples testing positive at 3.5 log copies/ML (Fig 1). 6127 newborn saliva samples were evaluated and 61 were PCR positive (£40 CT). 47 of these tests were confirmed by urine PCR (Fig 2) (PPV 0.9792, NPV 0.9988, Sens 0.8704, Spec 0.9998). Screen positive tests which were not confirmed by urine PCR had CT values £36. Adjusting the definition of a positive to CT £36 further improved the performance (PPV >0.9999, NPV 0.9997, Sens 0.9592, Spec >0.9999).

Conclusion

We demonstrate good performance of a congenital CMV methodology thus facilitating an effective universal newborn screening program

Disclosures

J. P. Devincenzo, AstraZeneca/MedImmune: Investigator, Research support
Molecular Investigation of an Ontario Mumps Outbreak using Whole Genome Sequencing
Authors: Stapleton Patrick , Eshaghi Alireza , Chong-King Eddie , Cardona Mark , Masney Steve , Li Aimin , Gubbay Jonathan , Patel Samir
Published: October 2017

Background

In early 2017 an outbreak of Mumps virus affected over 100 individuals in the province of Ontario, concurrent with multiple mumps virus outbreaks across North America. Traditional genotyping of mumps outbreaks relies on sequencing a portion of the small hydrophobic (SH) gene, but has limited capability to distinguish between strains of the same genotype. Most mumps cases in Ontario in recent years are of genotype G. We used a novel whole genome sequencing (WGS) protocol to perform a molecular epidemiological investigation of the outbreak.

Methods

Throat (n = 5) and buccal (n = 15) swabs positive by RT-PCR for SH or Fusion (F) gene targets were cultured in primary Rhesus monkey kidney cells. Cell free viral extract underwent RT-PCR and subsequent PCR amplification using overlapping primer pairs to cover the entire 15 kilobase (kb) genome. The first 8 samples were amplified with 18 pairs of overlapping primers, which was reduced to 9 sets (average fragment size 1.9 kb, range 1.6–2.8 kb) for the final 12 samples. Mumps cDNA libraries were prepared with Nextera XT kit and WGS of the indexed fragments was performed with V2 reagent kits on the Illumina MiSeq instrument. Reference based genome assembly was performed using samtools version 1.4. Phylogenetic analysis was performed by maximum likelihood method in MEGA7.

Results

We identified two distinct genotype G lineages comprised of 9 patients each and closely related to a 2009–2010 outbreak in Ontario and New York (Figure 1). Inter-lineage single nucleotide polymorphism (SNP) differences ranged from 25 to 31, whereas intra-lineage SNPs ranged from 0 to 8 SNPs. Two outlying sequences, of genotype C and G respectively, may represent sporadic introduction of virus from other areas. Time from virus isolation to SNP based analysis was approximately 4 days.

Conclusion

WGS of Mumps virus culture isolates using the PCR fragment method identified two distinct genotype G lineages in a large provincial outbreak. This method may aid public health authorities identify separate transmission chains in the case of large outbreaks.

Disclosures

All authors: No reported disclosures.
Comparison of Antibiotic Regimens in Intra-abdominal Infections
Authors: Hasanoglu Imran , Guner Rahmet , Bilmez Ruveyda , Kayaaslan Bircan , Buzgan Turan , Tasyaran Mehmet A
Published: October 2017

Background

Appropriate antimicrobial therapy and sometimes urgent surgery are life-saving in intra-abdominal infections (IAI).

Methods

We performed a retrospective case control study to evaluate the efficacy of ceftriaxone, ceftriaxone plus metronidazole, tigecycline, and ertapenem regimens in IAI. Patients aged >18 years and diagnosed with IAI between 2015 and 2017 are included in the study. Definitions are based on IDSA IAI guideline. Significant resolution of all signs and symptoms of IAI with no further need for antimicrobial therapy or surgical intervention for infection is accepted as clinical response (CR). Microbiological response (MR) is assessed among patients with positive culture and defined as documented or presumptive microbiological eradication of pathogen.

Results

659 patients are included in the study. Mean age was 56 years. Source control was maintained in 45.5% of patients. Among 54 patients with available culture specimen, E.coli was the most isolated pathogen (81% ESBL +). Comparisons of antibiotics in all patients and in complicated IAI are shown in Table 1 and 2, respectively.

Conclusion

Ertapenem, and especially tigecycline are good options in IAI in the era of high antimicrobial resistance.

Disclosures

All authors: No reported disclosures.
Comparative in vitro Activities of Ceftazidime–Avibactam and Ceftolozane-tazobactam Against Characterized β-Lactamase-producing Pseudomonas aeruginosa
Authors: Lin Lynn-Yao , Vail McClain , Debabov Dmitri , Critchley Ian
Published: October 2017

Background

Ceftazidime-avibactam (CAZ-AVI) and ceftolozane-tazobactam (TOL-TAZ) are cephalosporin/β-lactamase inhibitor combinations recently approved for the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI). Both agents are reported to have antibacterial activity against P. aeruginosa including multi-drug-resistant strains, but few studies have directly compared the activities of both agents against the same strains in a single study. This study evaluated the activities of both agents against characterized β-lactamase-producing P. aeruginosa using broth microdilution (BMD) and disk diffusion (DD) methods.

Methods

A total of 98 clinical isolates of P. aeruginosa, including characterized β-lactamase-producing strains were tested for susceptibility to CAZ-AVI and TOL-TAZ using BMD and DD and results were interpreted using FDA/CLSI breakpoints. The isolates tested included CTX-M (ESBL), AmpC, KPC, OXA and metallo-β-lactamase (MBL) producing organisms. The results from both BMD and DD were analyzed to assess the correlation between the testing methods and ability to differentiate isolates susceptible and resistant to both agents.

Results

CAZ-AVI and TOL-TAZ exhibited similar MIC values against all isolates with MIC50/90 values of 2 and 16 µg/mL, respectively. When results were interpreted using FDA/CLSI breakpoints, the susceptibility rates for CAZ-AVI and TOL-TAZ were 82.7% and 62.2%, respectively. Isolates resistant to CAZ-AVI were predominantly MBL-producers whereas isolates resistant to TOL-TAZ included both MBL and KPC-producing P. aeruginosa. Both agents were active against AmpC-producing P. aeruginosa and both agents showed good correlation between BMD and DD methods.

Conclusion

CAZ-AVI and TOL-TAZ were active against β-lactamase-producing subsets of P. aeruginosa isolates in this challenge set. Both AmpC and KPC-producing P. aeruginosa were susceptible to CAZ-AVI whereas TOL-TAZ activity was limited to AmpC-producing organisms. Neither agent was active against MBL-producing organisms.

Disclosures

L. Y. Lin, Allergan plc: Employee, Salary; M. Vail, Allergan plc: Employee and Intern during study conduct and analysis, Educational support; D. Debabov, Allergan plc: Employee, Salary; I. Critchley, Allergan plc: Employee, Salary
CD4+ T Cells Specific for C. difficile Toxins are a Marker of Patients with Active Relapsing Disease
Authors: Cook Laura , Wong May , Rees William , Lau Torey , Levings Megan , Steiner Theodore
Published: October 2017

Background

The bacterial pathogen Clostridium difficile is the leading cause of nosocomial infectious diarrhea. Although C. difficile infection (CDI) can be treated with antibiotics, approximately 25% of patients relapse after treatment. The pathogenicity of CDI requires the activities of its toxins, TcdA and TcdB, but T cell-mediated responses to these toxins remain uncharacterized.

Methods

We enrolled two cohorts of patients, one with newly acquired CDI (n = 14) and the other with relapsing CDI (n = 25); and healthy volunteers with no history of CDI (n = 12). We measured peripheral blood CD4+ T cell responses to the toxins using a whole blood flow cytometry assay that identifies antigen-specific CD4+ T cells by co-expression of CD25 and OX40 following 44h incubation with antigen (Fig 1).

Results

We found that in patients with recurring CDI, T cell responses to TcdB were significantly higher than in healthy controls (median 1.04% vs. 0.18%; P = 0.003, Fig 2). In contrast, TcdA T cell responses and anti-TcdA/TcdB IgG titres were not different between recurring patients and controls. TcdB, but not TcdA, T cell responses were significantly higher in recurring CDI compared with newly acquired CDI (median 1.04% vs. 0.44%; P = 0.032). In both patient cohorts TcdB-specific CD4+ T cells were functionally heterogeneous, on average: 25% expressed the gut homing marker integrin β7; there was a 1:1 ratio of Tregs to T effectors; and T effectors contained Th1, Th2 and Th17 cells at a 1.5:1:3 ratio. The proportion of Th1 and Th17 cells within TcdB-specific CD4+ T cells was also significantly reduced in recurring, compared with newly acquired, CDI (Fig 3). Analysis of sorted TcdB-specific CD25+OX40+ cells confirmed specificity for TcdB and polarization towards Th17 cells, which are important for intestinal anti-pathogen immunity.

Conclusion

This is the first investigation of T cell immunity to C. difficile toxins. Our data show that anti-TcdB CD4+ T cell responses are a more specific marker of disease than IgG titres. Tracking how toxin-specific CD4+ T cell responses change following treatment and/or vaccination not only has the potential to predict relapse, but also to deliver insight into how CD4+ T cell memory develops in response to this prevalent pathogen.

Disclosures

All authors: No reported disclosures.
Comparison of Fidaxomicin and Vancomycin for Recurrent Clostridium difficile Colitis
Authors: Khoo Teresa , Fleischner Zachary , Chow Robert , Monteforte Melinda , Marcos Luis A
Published: October 2017

Background

Fidaxomicin is a narrow spectrum macrocyclic antibiotic used for the treatment of Clostridium difficileinfection (CDI). The objective of this study is to compare the recurrence and mortality rates of patients with CDI who received either vancomycin or fidaxomicin at Stony Brook University Hospital.

Methods

A retrospective chart review was performed to identify all hospitalized patients who received fidaxomicin and vancomycin for CDI for the period 2011–2015. Inclusion criteria included patient age ≥18 years, stool positive PCR test for C. difficile and being treated ≥10 days of either fidaxomicin or vancomycin orally. Clinical recurrence was defined as a return of diarrhea, a positive test for C. difficiletoxin B and a need for retreatment for CDI within 90 days of cessation of therapy.

Results

A total of 55 (52.7% male) and 74 (51.4% male) cases met inclusion criteria in the fidaxomicin (F) and vancomycin (V) groups, respectively. The mean age was 65.9 ± 1.88 and 63.7 ± 1.86 years in group F and V respectively (P = 0.4). Median length of hospitalization was 14 and 9 days for F and V respectively (P = 0.6). Both groups had similar proportions on the following variables: immunosuppression (V 36.5% vs. F 36.4%; P = 0.9), ≥ 1 prior episode of CDI (V 59.5% vs. F 61.8%; P = 0.8), sepsis on admission (V 29.7%, F 36.4%; P = 0.4), the use of any antibiotic during the last 30 days (V 74.3%, 71%, P = 0.7), and treatment with additional anti-CDI therapy (V 24.3%, F 29.1%; P = 0.5). CDI recurrence rate was 24% (V) and 40% (F, P = 0.057). The 90-day mortality rate was 4.1% in the vancomycin group and 10.9% in the fidaxomicin group (P = 0.13).

Conclusion

Fidaxomicin had a higher recurrent CDI than vancomycin in this tertiary medical center.

Disclosures

All authors: No reported disclosures.
Distinguishing Proactivity From Citizenship Behavior: Similarities and Differences
Authors: Li Wen-Dong , Frese Michael , Haidar Sarah
Published: October 2017

Organizational citizenship behavior (OCB) and proactivity have garnered a great deal of research attention recently. Some scholars have subsumed proactivity under the concept of OCB because both concepts are based on discretionary behaviors. In this chapter, we want to summarize reasons to differentiate OCB from proactivity. We do this by showing that their functions are different even when they may be correlated, that there are different evolutionary paths for the development of OCB and proactivity, and that there are different biological components. At the same time, we argue that both OCB and proactivity have important evolutionary functions for humans, allowing humans to become a dominate animal in the world. We hope this chapter can spur more research on the intersection between the two constructs.
Self-Compassion and Psychological Well-being
Authors: Neff Kristin , Germer Christopher
Published: October 2017

Self-compassion involves being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness. Self-compassion also involves offering nonjudgmental understanding to one’s pain, inadequacies, and failures, so that one’s experience is seen as part of the larger human experience. This chapter will provide an overview of theory and research on self-compassion and its link to psychological well-being, which is the goal of clinical practice. It will discuss what self-compassion is and what it is not (e.g., a form of weakness, selfishness, etc.), and provide empirical evidence to support these distinctions. Finally, it will discuss methods that have been developed to teach individuals how to be more self-compassionate in their daily lives, some clinical implications of self-compassion training, and future directions for research.
Organizational Compassion
Authors: Cameron Kim S.
Published: October 2017

In this chapter, we discuss compassion as experienced and expressed at the organization level of analysis. Shifting to this collective level suggests that the definition of compassion needs to be expanded to include two additional attributes: (1) the active demonstration of compassion through the organization and its members; and (2) actions motivated by inherent virtuousness rather than the acquisition of a reward. The chapter describes empirical studies in organizational settings in which the relationship between virtuousness and desired organizational outcomes is examined. Compassion by itself is seldom a singular predictor of organizational performance, but in combination with other virtues, it has profound effects. The chapter provides a theoretical rationale for why compassion has a significant impact on organizational performance. Three explanatory mechanisms are identified for why compassion predicts effectiveness. The chapter concludes by highlighting some fundamental principles that are needed to expand our understanding of compassion and its effects in organizations.
Parental Brain: The Crucible of Compassion
Authors: Swain James E. , Ho Shao-Hsuan Shaun
Published: October 2017

All infants rely on parenting behaviors that provide what they need to be healthy. As “compassion” can be defined as feelings that are elicited by perceiving someone else’s suffering with a desire to help (Goetz, Keltner, & Simon-Thomas, 2010), parenting behavior in concert with compassion towards a child can be defined as “compassionate parenting.” A child who has received compassionate parenting will tend to provide compassionate parenting to his or her own offspring, and possibly to unrelated others. We postulate that compassionate parenting should have the following characteristics: (1) effective care-giving behaviors (behavioral contingency), (2) parental emotions that are coherent and connected with child’s emotions (emotional connection), and (3) awareness of own and other’s cognitions and emotions and other environmental factors (reflective awareness). In this chapter, a body of literature in neurobiological mechanisms underlying parenting is selectively reviewed in reference to the behavioral, emotional, and cognitive aspects of compassionate parenting.
Compassion-Focused Parenting
Authors: Kirby James N.
Published: October 2017

The parenting a child receives has profound long-term impacts on that child’s life. The rates of child maltreatment globally are high. Evidence-based parenting programs have been demonstrated to have positive impacts on improving parenting style, whilst reducing childhood social, emotional, and behavioral problems. However, uptake in parenting interventions remains low, and governments have been reluctant to provide evidence-based parenting on a wide scale. This chapter aims, first, to show how the adoption of a public health approach to parenting can be considered wide-scale compassionate action, one that will reduce rates of child maltreatment (suffering), which is also cost-effective. Second, I argue that the next generation of evidence-based parenting programs need to be grounded in evolved, caring motivational systems and affiliative emotion processing, which requires an understanding of the evolved processes involved in parent–offspring caring and brain functioning. This new approach to parenting, “compassion-focused parenting,” will be described.
Human Capital Resource Complementarities
Authors: Ployhart Robert E. , Cragun Ormonde R.
Published: October 2017

Firms must increasingly innovate to gain a competitive advantage. One method of innovation is by designing work or grouping individuals in ways that create unique relationships between their knowledge, skills, abilities, and other characteristics, and by designing these relationships to be accessible by the firm (i.e., creating human capital resources). Synergistic relationships between two or more human capital resources are therefore human capital resource complementarities. In the chapter we discuss how talent-management practices relate to the formation, maintenance, and bundling of human capital resource complementarities. We start by briefly summarizing the key features of resource complementarities observed within the broader strategy literature. We then consider the nature of complementarities specifically for human capital resources, and consider numerous types of complementarities that may exist. We conclude by proposing a research agenda to understand how talent-management practices are related to human capital resource complementarities and competitive advantage.
Integrating Talent and Diversity Management
Authors: Baker Darren T. , Kelan Elisabeth
Published: October 2017

In globalized economies, organizations invest significant resources in managing talent in their diverse workforce. Presumably, talent and diversity management are complementary and interrelated, sharing the similar aim to nurture the skills, attributes, and career progression of the workforce. However, the two practices are also at odds. Talent management has been defined by an exclusionary paradigm focused on developing an elite segment of the workforce. We explore the problematic effect of talent management on equality. Talent management could foreclose how perceptions of “talent” are deeply inflected in gendered, classist, and racialized ways. The complex experiences of minority groups in gaining access to and progression within organizations should be considered. We discuss how talent management could be used to catalyze equality in organizations and suggest future research on the intersection between equality, diversity, and talent management.
Within-Person Variability in Performance
Authors: Minbashian Amirali
Published: October 2017

Understanding individual performance at work is an important element in developing effective talent-management systems. Although research on individual performance has largely addressed between-person differences in performance, more recently, focus has been on within-person variability in performance. This chapter reviews the literature on within-person variability. A model of individual performance is presented that incorporates short-term and long-term within-person performance variability and individual differences. The benefits of the model as a framework for explaining individual performance are outlined, as are its implications for the conceptualization of talent and the development of talent-management systems. Specific talent-management practices with respect to employee assessment and employee motivation are discussed.
Talent Management of Nonstandard Employees
Authors: Cascio Wayne F. , Boudreau John W.
Published: October 2017

A growing number of workers everywhere are choosing to work outside the boundaries of regular, full-time employment. Such “nonstandard” work has advantages and disadvantages. It takes a variety of forms. In this chapter, we begin by examining why and when organizations choose to use nonstandard workers, and we describe the stages and objectives of the talent lifecycle. We then map the talent-lifecycle stages and objectives against categories of nonstandard work, to develop a distribution of research attention across that map. We found large areas of sparse research, as well as two significant clusters of research. One focuses on more traditional arrangements (contractors, temporary, and outsourced work), and the other on less traditional arrangements (freelance platforms and crowdsourcing). We revealed striking differences in the theoretical frameworks and disciplinary foundations within each cluster. We close by considering questions and opportunities for future research to deepen our understanding of this budding phenomenon.
Talent Intermediaries in Talent Acquisition
Authors: Bonet Rocio , Hamori Monika
Published: October 2017

Talent intermediaries are entities that stand between the individual worker and the organization that needs work done. They include online intermediaries such as job boards or social networking sites, and search and placement firms such as executive search firms and temporary-help service firms. Talent intermediaries have an increasingly important role in the contemporary employment landscape: they influence not only how and which individuals are matched to organizations but also how tasks are performed or conflicts are resolved once talent is hired by the organization. This chapter reviews the already extensive literature on talent intermediaries, focusing on their role in the identification, assessment, and hiring of talent. The chapter shows the advantages that talent intermediaries present to the talent-acquisition process compared with hiring organizations and the ways in which their intermediation changes traditional talent-acquisition processes that involved only two parties: the job seeker and the hiring organization.
Talent and Turnover
Authors: Hausknecht John P.
Published: October 2017

Despite longstanding research interest in understanding causes and consequences of employee turnover, much less is known about the turnover of top talent such as high performers or “stars.” Star employees are disproportionately productive, highly visible, and often maintain strong social networks, all of which makes them desirable to organizations. In this chapter, I review theory and research related to the retention of talented employees including stars, high performers, high potentials, critical roles, and core employees. I structure the review around five key questions: (1) How is talent defined and measured? (2) Are talented employees more likely to quit? (3) What frameworks help us understand star performers? (4) What are the drawbacks of attempting to retain top talent? (5) What additional research is needed?
Charismatic Signaling
Authors: Shaver John , Fraser Gloria , Bulbulia Joseph
Published: October 2017

This chapter describes an evolutionary model of religion called “charismatic signaling.” The theory focuses on features of religion that express automated within-group cooperation—that is, cooperation that does not rely on strategic reasoning or explicit social prediction. The model is interesting because it explains otherwise puzzling features of religious systems. Such puzzles range from intrinsic religious motivations to ritual human sacrifice as evolved adaptations for social coordination. An additional virtue of the model is that it explains the reliability of cooperation with strangers who cannot observe or assess cooperative intentions directly or by reputation. The chapter describes the intellectual motivations for charismatic signaling theory and outlines ethnographic and historical puzzles the theory solves.
Historians and Public History in the UN System
Authors: Singleton Lisa
Published: October 2017

This chapter provides a guide for history and heritage professionals in navigating the United Nations. The chapter is divided in two parts. The first section examines the history and heritage policy work of the United Nations Educational, Scientific, and Cultural Organization’s (UNESCO). UNESCO is the main UN body to set standards for history and heritage professions. The second section turns the focus back onto the United Nations as an object of historical study. This section discusses major examples of historical projects about the United Nations. Overall, the chapter explains the origins of UN involvement in heritage and history, describes the relevant structures and functions in the United Nations and UNESCO, and discusses some of the outcomes of history and heritage activities with which it has been involved. The chapter argues for the importance of studying UN history, as well as engaging more closely with its policy work.
Complexity and Collaboration
Authors: Leon Sharon
Published: October 2017

Since the popular emergence of the World Wide Web in the early 1990s, nothing has been clearer about the digital environment than that it changes at a breakneck pace, making it a constant challenge of adaptation for content providers. Public historians who may have come of age in the context of writing either concise wall labels for the public or extended scholarly articles and conference papers for their fellow historians might find the pace and the level of flexibility and interactivity of the Web disconcerting, but in the end, the advantages for the practice of public history are extensive. Breaking the constraints of a physical site by effectively using the Web leaves public historians constrained only by their time, resources, and imagination. This chapter deals specifically with the various modes of communication that are available to public historians through the use of new media.
The Magna Carta
Authors: Smith Graham , Green Anna
Published: October 2017

This chapter explores a range of representations of Magna Carta in the public sphere, and the authors argue that the significance of the Great Charter lies less in constitutional history and more in the different political uses to which the Charter has been put over time. Plans for the 800th commemoration of the Charter in 2015, proposed by both national and local organizations, are examined through oral history interviews with some of the leading participants. These plans ranged from the ideologically conservative and international collaborations of elite national organizations to the more inclusive commemorative activities of the local community. However, the tensions within both local and national projects of commemoration, the absence of broad public involvement, and the financial recession reduced what was intended as high-profile celebration to a more muted and elitist form.
A Review of CBT Treatments for Substance Use Disorders
Authors: Morin Jean-François G. , Harris Maggie , Conrod Patricia J.
Published: October 2017

This review article presents a summary of the existing literature on well-established CBT treatments for substance use disorder. It provides an overview of the origins, procedure, and evidence for six CBT treatment models: relapse prevention (RP) and mindful-based relapse prevention (MBRP), guided self-change (GSC), community reinforcement approach (CRA), behavioral couples therapy (BCT), and personality-targeted brief interventions. Common intervention components include orienting clients towards a meaningful goal, teaching necessary skills to reduce substance use and successfully achieve the goal, and establishing plans to face potential relapses, which generally appear to produce moderate to large effects across contexts and substance-related outcomes.
Social Psychology and Social Justice: Dilemmas, Dynamics, and Destinies
Authors: Gergen Kenneth J.
Published: October 2017

The emergence of this handbook on social justice represents a groundbreaking event in the history of social psychology. In this summary discussion, I outline significant limits to social justice work embedded in the empiricist tradition of inquiry and point to ways in which the current work transcends these limits. However, I also view the present endeavors as in a fledgling state. In the service of enriching and rendering these pursuits more effective, I discuss five domains in which tensions currently prevail and suggest directions for future undertakings. Challenges are discussed in terms of epistemological schisms, presumed ontologies, value pluralism, explanatory paradigms, and the limits of representationalism. A final invitation is made to shift from a mirroring orientation to research to world-making.