bluuebunny/crossref_metadata_2025_split huggingface dataset:
762. Climate Change and the Seroprevalence of Borrelia burgdorferi over 25 Years in Rhode Island
Authors: Espich Scott , Weinberger Daniel , Mancini Diane , Brancato Janna , Lee Giyoung , Akosa Fredua , Warcup Thomas , Krause Peter J 
Published: January 2021

Abstract

Background
The Ixodes scapularis tick (deer tick or black-legged tick) is the primary vector of Borrelia burgdorferi, the causative agent of Lyme disease. Climatic conditions, specifically temperature, relative humidity, and rainfall, have been shown to affect I. scapularis tick densities. We hypothesized that temperature and moisture correlate with the frequency of human Lyme disease.

Methods
We have carried out a biannual B. burgdorferi serosurvey on Block island, Rhode Island over the past 25 years using a standard B. burgdorferi two-tier ELISA and Western blot assay. Residents of the Island were invited to participate and we only used first visit results. We analyzed B. burgdorferi seroprevalence and weather pattern trends (temperature, rainfall, relative humidity) among a cohort of 2,439 Block Island residents over the past 25 years.

Results
During the months in which ticks are active, we found that both temperature and relative humidity increased on Block Island over the past 25 years (p=0.04 and p=0.03, respectively). We also found that the seroprevalence of B. burgdorferi on the Island increased over the course of the study (p&lt; 0.01), and that increased temperature and moisture in a given season is associated with increased B. burgdorferi seroprevalence in the following season. For example, we found that every inch increase in total rainfall in a given season was associated with a 2% (95% CI 1.01-1.03) increase in the odds of B. burgdorferi seropositivity during the following season. Similarly, we found that every degree Fahrenheit increase in temperature in the spring was associated with a 2% (95% CI 1.02-1.03) increase in the odds of seropositivity in the fall.

Conclusion
We conclude that increasing temperature and moisture are associated with increased frequency of B. burgdorferi infection in humans.

Disclosures
All Authors: No reported disclosures
778. Travel-Acquired Tropical Illness in Children Under the Age of 5: A Scoping Review
Authors: Zaman Michele , Willmott Shannon , Bal Chandandeep , Morris Shaun , Morris Shaun 
Published: January 2021

Abstract

Background
International travel, including by children, is increasing. Due to both biologic and behavioral factors, children face different risks for and disease outcomes in travel acquired illness compared to adults. This systematic literature review aims to identify gaps in knowledge about health outcomes in children under the age of 5 related to international travel.

Methods
We used MEDLINE and Embase databases and followed PRISMA guidelines to conduct a systematic literature review of publications that included extractable information on children under the age of 5 who acquired infectious diseases or other morbidities during international travel. Studies were excluded if they were published prior to 1990, reported on fewer than 5 cases in children under the age of 5, or were letters to the editor. Two independent reviewers completed the abstract screen, full text review and data extraction. In this study, we present results for specific important tropical infections (including malaria and typhoid fever), as well as gastrointestinal, respiratory, and dermatologic illnesses
Systematic Review Flow Diagram

Results
Our literature search (completed on July 17th 2019) identified 8664 citations. 35 citations met our inclusion criteria. Information related to tropical diseases, gastrointestinal, dermatological and respiratory conditions were extracted. Young children, especially those visiting friends and relatives in South Asia and Sub-Saharan Africa are at a higher risk for acquiring tropical infections. Additionally, children in this age group appear to have worse outcomes for conditions such as diarrhea and malaria in comparison to other pediatric age groups.
Tropical Disease Outcomes part 1

Tropical Disease Outcomes part 2

Conclusion
In spite of unique biologic and behavioral traits that may affect risk, outcomes in children under the age of 5 years are rarely presented in the literature distinctly from the overall pediatric population. Future pediatric travel-health research should make efforts to report and analyze data by age in order to better understand the risk for tropical diseases infants face while travelling internationally.

Disclosures
All Authors: No reported disclosures
785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018
Authors: Xu Kerui , Benin Andrea L , Wu Hsiu , Edwards Jonathan R , Li Qunna , O’Leary Erin , Leaptrot Denise , Nkwata Allan 
Published: January 2021

Abstract

Background
Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).

Methods
We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted &lt; 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs.

Results
Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63).
Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018

Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs

Conclusion
The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs.

Disclosures
All Authors: No reported disclosures
793. Expert Panel Consensus Ranking of Comorbid Conditions Causally Related to Clostridioides difficile Infection
Authors: Goodman Katherine E , Pineles Lisa , Fridkin Scott , Kyne Lorraine , Loo Vivian , Lora Alfredo J Mena , Perencevich Eli N , Spivak Emily S , Maragakis Lisa , Leekha Surbhi , Harris Anthony 
Published: January 2021

Abstract

Background
Numerous studies have identified comorbidities that are associated with Clostridioides difficile infection (CDI), but current CDC and CMS models for risk adjusting hospital CDI rates do not include patient comorbid conditions. Incorporating patient-level data could improve CDI risk adjustment, but comorbidities would need to be easily electronically available for widescale implementation. Ideally, they would also be causally related to CDI — i.e., true risk factors, not confounders — to facilitate more unbiased inter-hospital comparisons. The current study aimed to determine which comorbid conditions are causally related to CDI based upon expert consensus.

Methods
We used Delphi methodology to administer an iterative, two-round survey with an intervening teleconference, to eight infectious disease experts. Experts evaluated 40 comorbid conditions included in Charlson and Elixhauser comorbidity indices (and thus validated for electronic capture through administrative data), as well as other comorbidities commonly associated with CDI. Experts rated comorbid conditions from 1 (not at all related) to 5 (strongly related), based upon perceived relatedness with CDI. To assign causal relatedness, the following criteria had to be met at the end of round two: 1) majority (&gt; 50%) of experts rating the condition at 3 (somewhat related) or higher; 2) inter-quartile range (IQR) &lt; = 1; and 3) standard deviation (SD) &lt; = 1.

Results
8/40 (20%) comorbid conditions were ranked as causally related to CDI, including patient age, three malignancy comorbidities, two transplant-related comorbidities, HIV/AIDS, and inflammatory bowel disease. A further 18/40 (45%) qualified as indeterminately related, and 14/40 (35%) were ranked as not causally related to CDI (Table). Three of the eight causally related factors were not components of Elixhauser or Charlson indices.
Table

Conclusion
We identified comorbid conditions that may be appropriate candidates to consider for inclusion in patient-level risk adjustment models. Some causal factors did not originate from established comorbidity indices. Thus, future work to validate electronic capture of these conditions could further reduce barriers to risk-adjustment implementation.

Disclosures
All Authors: No reported disclosures
807. Effect of Inter-Hospital Transfer on Nosocomial Infection Rates in Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Marcus Joseph E , Okulicz Jason , Sams Valerie , Batchinsky Andriy , Barsoumian Alice 
Published: January 2021

Abstract

Background
Extracorporeal Oxygenation (ECMO) has been increasingly used as a life support modality for cardiac and pulmonary failure. Due to improved survival in patients treated in high volume ECMO centers, inter-hospital transport of these critically ill patients is on the rise. These patients may be transported via ambulance locally, or by aircraft over long distances. However, potential risks of nosocomial infectious complications associated with transfers has not been reported. We evaluated the impact of transfers on nosocomial infections for patients who received ECMO at Brooke Army Medical Center (BAMC).

Methods
All patients who received ECMO for ≥48 hours at BAMC between May 2012 and October 2019 were included. Chart review was performed to determine transport status, infectious complications while on ECMO, and antimicrobial susceptibility of isolated organisms. Statistical analyses were performed using Chi-squared, Fisher’s exact, or Mann-Whitney U tests as appropriate. Factors associated with nosocomial infections were evaluated by multivariate logistic regression.

Results
Compared to patients who were cannulated locally (n=33), patients who underwent cannulation at referral facility and inter-hospital transfer (n=76) had no difference in infections per 1000 ECMO days (33.1 vs. 30.5, p=0.74) or in infections with multidrug resistant organisms (MDRO) (50% vs. 55%, p=1). Of transferred patients, those transferred by aircraft (n=11) had no difference in infection rate (22.4 vs. 31.8 per 1000 ECMO days, p= 0.39) or MDRO incidence (52% vs 75%, p=0.61) compared to those only transferred by ambulance (n=65). Multivariate analysis showed the greatest risk factor for nosocomial infection was time on ECMO (OR 12.2 for longest tertile time on ECMO vs. shortest tertile, p=0.0001); transport was not significantly associated with infection (OR 2.1, p=0.06).
Nosocomial infection rate by site of ECMO cannulation

Conclusion
This study did not find a significant difference in nosocomial infection rate or recovery of MDROs between transported and non-transported patients on ECMO, regardless of transport modality. This study suggests that transportation is not the primary driver of nosocomial infections in this cohort.

Disclosures
All Authors: No reported disclosures
LB-6. Increased Diagnoses of Acute HIV Infection through Routine ED Screening and Rapid Linkage to Care and initiation of HAART During the COVID-19 Pandemic
Authors: Stanford Kimberly , Schmitt Jessica , Taylor Michelle M , Eller Dylan , Friedman Eleanor , McNulty Moira , Ridway Jessica , Hazra Aniruddha , Michelle Moore , Beavis Kathleen 
Published: January 2021

Abstract

Background
The COVID-19 pandemic has negatively impacted routine HIV screening in healthcare settings. This has serious implications, especially for patients with acute HIV infection (AHI) presenting with symptoms suggesting COVID-19 infection. This is a high priority population for rapid linkage to care (LTC) and initiation of HAART.

Methods
We reviewed data from our eXpanded HIV Testing and LTC (X-TLC) Program, a collaboration effort between 13 healthcare centers on the South and West Sides of Chicago. Since 2016, most sites had 4th or 5th generation HIV Ag/Ab testing available.

Results
Most sites experienced reductions in HIV screens during the COVID-19 pandemic. Advanced planning by our ED incorporated blood draws for HIV screens as part of COVID-19 evaluations. UCM performed 19,111 HIV screens (11,133 in the ED) between 1/1/20 and 8/17/20, along with 100,635 COVID PCRs (14,754 in ED) between 3/17/20 and 8/17/20. Nine patients were diagnosed with AHI after the first case of COVID-19 in Chicago (1/24/20), and 7 were diagnosed after the first case of community transmission in Cook County (3/8/20). All cases of AHI were diagnosed in the ED. The rate of AHI was significantly higher in 2020 versus the prior 4 years (14.4 vs 6.8 per year, p &lt; 0.05). AHI patients comprised 25.7 % (9/35) of all new diagnoses, the highest percent ever. There were 7 men (6 identified as MSM) and 2 cis-gender women, median age of 25 years (21 to 28 years). The median viral load was 6 million (115,000 to &gt; 6 million) copies/mL. Eight of 9 patients presented with an illness indistinguishable from COVID-19, including 1co-infected patient. All were LTC and started on HAART from time of PCR result within a median of 1 day (0–38), but 3 days (range 1–41) from sample collection as a result of delayed reflex PCR confirmatory testing due to high demands on lab personnel and scarcity of reagents due to COVID-19 PCR volumes (since resolved).
HIV Screening and COVID-19 Testing in the ED During COVID-19

Conclusion
Continued HIV screening in our ED during the COVID-19 pandemic identified an increased number of patients with AHI. These individuals may be more likely to present for care due to fear of COVID-19 infection. We achieved rapid LTC and initiation of HAART without any incremental increases in resources. All HIV screening programs should incorporate blood-based HIV screening into their COVID-19 testing programs.

Disclosures
Moira McNulty, MD, MS, Gilead Sciences (Grant/Research Support)
LB-10. Rapid Assessments of Non-Pharmaceutical Intervention Uptake and Population Mobility Patterns Elucidate SARS-Cov-2 Transmission Dynamics
Authors: Wesolowski Amy , Gibson Dustin , Agarwal Smisha , Lambrou Anastasia , Kirk Gregory , Labrique Alain , Mehta Shruti , Solomon Sunil 
Published: January 2021

Abstract

Background
Current mitigation strategies for SARS-CoV-2 rely on population-wide adoption of non-pharmaceutical interventions (NPIs). Monitoring NPI adoption, mobility patterns and their association with SARS-CoV-2 infection can provide key information for public health agencies and be used to calibrate transmission models.

Methods
We used an online panel to accrue representative samples from Florida, Illinois, and Maryland (n=3,009, approximately 1,000 per state) from July 15–31, 2020 and capture socio-demographically and geographically resolved information about NPI adoption and mobility in the prior 2 weeks. Logistic regression was used to identify correlates of self-reported SARS-CoV-2 infection in the prior 2 weeks.

Results
Overall, 96% reported traveling outside their home in the prior 2 weeks, the most common reason being to visit a grocery store/pharmacy (92%), followed by visiting friends/family (61%), and visiting a place of worship (23%); 22% reporting public transportation use. In total, 44% of respondents reported always practicing social distancing and 40% reported always using a mask indoors and outdoors. Overall, 74 (2.5%) reported testing positive for SARS-CoV-2 in the prior 2 weeks, with strong dose-response relationships between several forms of movement frequency and SARS-CoV-2 positivity. Variables capturing mobility were all highly correlated with one another, suggesting there are clusters of individuals who engage in multiple activities (Figure); 41% of positive cases engaged in all forms of mobility captured compared to 1% of those who did not test positive within the prior 2 weeks. Patterns of mobility and NPI uptake did not significantly differ by state; however, there were significant relationships with age, race/ethnicity, and gender. In multivariable models including adjustment for NPIs, significant relationships remained with public transportation, visiting a place of worship, and participating in outdoor group fitness activities.
Figure. Heatmap depicting pairwise Spearman correlation coefficients between survey responses. Pairwise correlation coefficients are displayed in the boxes at intersection of any two variables. Questions were asked with respect activities in the prior 2 weeks.

Conclusion
NPI adoption and mobility did not vary across these three states with variable policies and SARS-CoV-2 positivity rates. Rather, associations with recent positivity appear to be driven largely by mobility patterns and engagement in activities where NPI use may be challenging or inconsistent.

Disclosures
Shruti Mehta, PhD, MPH, Gilead Sciences (Other Financial or Material Support, Speaker) Sunil Solomon, MD, PhD, MPH, Abbott Diagnostics (Grant/Research Support)Gilead Sciences (Grant/Research Support, Advisor or Review Panel member)
Intrinsic color diversity of nearby Type Ia supernovae
Authors: Arima Noriaki , Doi Mamoru , Morokuma Tomoki , Takanashi Naohiro 
Published: January 2021

Abstract
It has been reported that the extinction law for Type Ia supernovae (SNe Ia) may be different from the one in the Milky Way, but the intrinsic color of SNe Ia and the dust extinction are observationally mixed. In this study, we examine photometric properties of SNe Ia in the nearby universe (z ≲ 0.04) to investigate the SN Ia intrinsic color and the dust extinction. We focus on the Branch spectroscopic classification of 34 SNe Ia and morphological types of host galaxies. We carefully study the distribution of their peak colors on the B − V, V − R color–color diagram, as well as the color excess and absolute magnitude deviation from the stretch-color relation of the bluest SNe Ia. We find that SNe Ia which show the reddest color occur in early-type spirals and the trend holds when divided into Branch sub-types. The dust extinction becomes close to the Milky Way like extinction if we exclude some peculiar red Broad Line (BL) sub-type SNe Ia. Furthermore, two of these red BLs occur in elliptical galaxies, a less-dusty environment, suggesting intrinsic color diversity in BL sub-type SNe Ia.
Mutations in a Golden2-Like Gene Cause Reduced Seed Weight in Barley albino lemma 1 Mutants
Authors: Taketa Shin , Hattori Momoko , Takami Tsuneaki , Himi Eiko , Sakamoto Wataru 
Published: January 2021

Abstract
The albino lemma 1 (alm1) mutants of barley (Hordeum vulgare L.) exhibit obvious chlorophyll-deficient hulls. Hulls are seed-enclosing tissues on the spike, consisting of the lemma and palea. The alm1 phenotype is also expressed in the pericarp, culm nodes and basal leaf sheaths, but leaf blades and awns are normal green. A single recessive nuclear gene controls tissue-specific alm1 phenotypic expression. Positional cloning revealed that the ALM1 gene encodes a Golden 2-like (GLK) transcription factor, HvGLK2, belonging to the GARP subfamily of Myb transcription factors. This finding was validated by genetic evidence indicating that all 10 alm1 mutants studied had a lesion in functionally important regions of HvGLK2, including the three alpha-helix domains, an AREAEAA motif and the GCT box. Transmission electron microscopy revealed that, in lemmas of the alm1.g mutant, the chloroplasts lacked thylakoid membranes, instead of stacked thylakoid grana in wild-type chloroplasts. Compared with wild type, alm1.g plants showed similar levels of leaf photosynthesis but reduced spike photosynthesis by 34%. The alm1.g mutant and the alm1.a mutant showed a reduction in 100-grain weight by 15.8% and 23.1%, respectively. As in other plants, barley has HvGLK2 and a paralog, HvGLK1. In flag leaves and awns, HvGLK2 and HvGLK1 are expressed at moderate levels, but in hulls, HvGLK1 expression was barely detectable compared with HvGLK2. Barley alm1/Hvglk2 mutants exhibit more severe phenotypes than glk2 mutants of other plant species reported to date. The severe alm1 phenotypic expression in multiple tissues indicates that HvGLK2 plays some roles that are nonredundant with HvGLK1.
Randomized Controlled Trial Comparing Silver-Impregnated Fibrous Hydrocolloid Dressings With Silver Sulfadiazine Cream Dressings for the Treatment of Fracture Blisters to Determine Time to Surgical Readiness
Authors: Wiese Karin R. , van Heukelum Marcus , Lombard Carl J. , Ferreira Nando , Burger Marilize C. 
Published: January 2021

Objectives:To investigate, in patients with fracture blisters, the time to surgical readiness in those treated with silver-impregnated fibrous hydrocolloid (SFH) dressings compared with those treated with topical silver sulfadiazine (SS) cream and to determine the direct costs associated with both treatments.Design:A single-blind, randomized controlled trial.Setting:The study was conducted at Tygerberg Hospital, a tertiary care facility, and Worcester Provincial Hospital, a secondary care facility, Western Cape, South Africa.Patients:Patients >18 years of age with one or more fracture blisters overlying fractures requiring surgical fixation were considered for inclusion.Main Outcome Measurements:The main outcome was the time to surgical readiness, after complete re-epithelialization of the affected site, in both groups. The direct cost associated with each treatment and the daily cost associated with hospital stay per day were recorded.Results:At an interim analysis, 70 patients had been enrolled and completed the study protocol with 35 patients per group. Groups were balanced across patient and clinical demographic characteristics. A significant difference of 4 days (95% confidence interval: 2.9–5.1 days,P< 0.001) in the mean time to surgical readiness (SFH group, 5.3 days vs. SS group, 9.3 days) was observed. No difference between the time to surgical procedure as well as the total length of hospital stay between the 2 groups was observed.Conclusion:This study reports that SFH dressings are a cost-effective treatment option for the management of fracture blisters evidenced by a significant accelerated time to blister re-epithelialization compared with a commonly described method of SS cream dressings.Level of evidence:Therapeutic Level 1. See Instructions for Authors for a complete description of levels of evidence.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.