bluuebunny/crossref_metadata_2025_split huggingface dataset:
1110. Outcomes Following Implementation of a Urine Culture
Authors: Simpson Timothy , Wu Janet , Choudhary Chirag , Shah Sneha 
Published: October 2019

Abstract

Background
Antimicrobials are often inappropriately initiated for asymptomatic bacteriuria (ASB). At our institution, urinalysis (U/A) and urine culture (UCx) are ordered simultaneously, leading to an increased rate of catheter-associated UTI (CAUTI) diagnosis and antimicrobial initiation. A UCx algorithm was implemented in the medical intensive care unit (MICU) to guide the appropriate ordering of UCx in patients with foley catheters. The purpose of this study was to assess the impact of this UCx algorithm paired with nursing and prescriber education on overall patient outcomes.

Methods
This was a single-center, pre- and post-analysis of patients admitted to the MICU with an order for a U/A and/or UCx for suspected UTI. Patients were excluded if they had a suspected co-infection from another source, absence of foley catheter or UCx drawn prior to MICU admission. The pre-implementation phase was November 1, 2017 to April 31, 2018, and the post-phase was May 1, 2018 to October 31, 2018. The primary objective was to compare the incidence of CAUTI between pre- and post-implementation phases. Secondary objectives included rate of adherence to the algorithm, number of UCx ordered, rate and days of antimicrobial therapy for ASB, duration of catheterization and 30-day mortality between pre- and post-implementation phase.

Results
There were 94 patients in the pre-phase and 77 patients in the post-phase. Baseline characteristics were similar between groups, except a greater proportion of patients in the pre-phase had a catheter prior to admission (12.8% vs. 2.6%; P = 0.02). Incidence of CAUTI decreased following algorithm implementation (16% vs. 6.5%; P = 0.05). Complete algorithm adherence was 2.6%, whereas partial adherence was 49.4%. Number of UCx ordered were 126 (comprising 100% of patients) and 76 (comprising 86% of patients) in the pre- and post-phase, respectively. Antimicrobial therapy for ASB was initiated in 55.3% of patients in the pre-phase vs. 37.7% in the post-phase; P = 0.02. There were no differences in duration of ASB treatment, catheterization or 30-day mortality.

Conclusion
Implementation of UCx algorithm paired with educational intervention resulted in a significant decrease in CAUTI and ASB treatment. Additional interventions may be necessary to optimize adherence to the algorithm.

Disclosures
All authors: No reported disclosures.
1117. A Retrospective Analysis of Paediatric Prescribing in British Columbia from 2013 to 2016
Authors: Saatchi Ariana , Patrick David M , McCormack James , Morris Andrew , Marra Fawziah 
Published: October 2019

Abstract

Background
Antibiotic prescribing in pediatric care is highly prevalent. Often children are prescribed antibiotics for conditions that are commonly self-limiting and viral in etiology such as upper respiratory tract infections. The purpose of this study was to examine the scope of pediatric antibiotic prescribing in British Columbia from 2013 to 2016 and identify potential new provincial antimicrobial stewardship targets.

Methods
Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to demographic files in order to obtain patient age, sex and geographic location. Prescription rates were then calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification.

Results
Our cohort included an average of 271,134 children per year and 1,767,652 antibiotic prescriptions. Over the 4 years, rates of antibiotic prescribing increased 4.5% (from 453 to 474 prescriptions per 1,000 population per year). The greatest increase, across all classes of antibiotics, was seen in children aged 0–2 years of age. By 2016, the greatest increase in prescribing, by class, was observed in J01X (e.g., nitrofurantoin, fosfomycin) with a 1360% increase for children aged 3–9. Across all ages, quinolones (J01M) increased 98%. Remaining classes, including β lactams (J01C), and macrolides (J01F), experienced modest reductions in the older age groups.

Conclusion
Past studies have illustrated decreasing or static rates of antibiotic prescribing in British Columbia. However, we have identified a paradoxical (4.5%) increase in pediatric antibiotic prescribing since 2013. Although it appears that provincial efforts have been successful in reducing the use of broad-spectrum penicillins (J01C), marked surges in the use of classes like tetracylines (J01A), quinolones (J01M), and other antibacterials (J01X) identify a new potential target for provincial stewardship.

Disclosures
All authors: No reported disclosures.
LB8. Microarray Patch Delivery of Long-Acting HIV PrEP and Contraception
Authors: Rein-Weston Annie , Tekko Ismaiel , Vora Lalit , Jarrahian Courtney , Spreen Bill , Scott Trevor , Donnelly Ryan , Zehrung Darin 
Published: October 2019

Abstract

Background
The purpose of this research was to develop a microarray patch (MAP; also known as a microneedle patch) for delivery of long-acting cabotegravir (CAB LA) for HIV pre-exposure prophylaxis (PrEP) and co-delivery of long-acting CAB LA and a hormonal contraceptive to enable a future multi-purpose prevention technology. This abstract presents preclinical pharmacokinetic results of MAP delivery of CAB LA.

Methods
MAPs are an alternative delivery technology in clinical development for intradermal delivery of vaccines and pharmaceuticals. A MAP consists of an array of micron-scale projections (<1 mm in height) amassed on a baseplate and applied to the skin like a bandage. MAPs could provide a discreet delivery system that enables self-administration, which could be particularly important for HIV prevention and contraception for young women and girls in low-resource settings. The purpose of this 3-year, USAID-funded project is to develop a MAP for delivery of long-acting HIV PrEP through to the point of Phase I clinical readiness. Key attributes of the MAP for long-acting HIV PrEP, as defined by our target product profile, include patch size similar to commercially available transdermal patches (20 to 140 cm2), wear-time of less than 24 hours (ideally 20 minutes), weekly or monthly administration to achieve therapeutic efficacy, and ideally successful self-administration after reading simple product instructions.

Results
We successfully formulated and optimized MAP projection geometry to accommodate high drug-loading requirements of CAB LA (5.86 mg CAB LA per 1 cm2 MAP), a hydrophobic drug. The MAPs are stable for 6 months under accelerated aging conditions in foil packaging, readily pierce the skin, and rapidly dissolve. In rats, plasma concentration levels of CAB LA were maintained above therapeutic targets of 4xPA-IC90 for 28 days; however, bioavailability was lower than IM or ID injection controls. Photos: QUB. MAPs dissolving over time in phosphate-buffered solution; MAP projections fully dissolved within 25 minutes.

Conclusion
Additional development work is warranted, including optimizing bioavailability, evaluating MAPs as a maintenance dose in vivo, conducting cost of manufacturing and cost of delivery analyses, and assessing potential end-user acceptability.

Disclosures
Bill Spreen, PharmD, ViiV Healthcare (Employee), Trevor Scott, RPh, PhD, ViiV Healthcare (Employee). Others Authors: No reported disclosures.
LB16. The Role of Adults in the Measles Outbreak in New York State Outside of New York City, 2018–2019
Authors: Dufort Elizabeth , Johns Dylan , Patel Manisha , Patel Manisha , Ahmad Nina , Ruppert Patricia S , Rausch-Phung Elizabeth , Gastanaduy Paul , Gastanaduy Paul , McDonald Robert , Souto Maria , Bryant Patrick , McKay Kevin T , McNulty Lissette , McGraw Nancy , Huang Ada J , Wester Rachel E , St. George Kirsten , Sommer Jamie N , Southwick Karen L , Hoefer Dina , Landis Vanessa , Adams Eleanor , Adams Eleanor , Ostrowski Stephanie , Levin Toby R , Gelman Irina , Hutton Brad , Zucker Howard , Blog Debra 
Published: October 2019

Abstract

Background
The United States is experiencing the largest measles outbreak since elimination was declared in 2000, with the majority of cases in NYS reported in undervaccinated communities. The objective of this evaluation was to describe adult measles cases in the NYS measles outbreak outside of New York City (NYC).

Methods
We included all confirmed cases aged ≥18 years in NYS residents (excluding NYC) during October 1, 2018–July 25, 2019 that met the CSTE measles case definition. We defined measles cases attributable to adults as the sum of measles cases among adults and children who contracted disease directly from adults.

Results
Among 371 confirmed measles cases, the median age was 5.5 years (range: 1 day to 64 years); 79 (21%) were in adults, 4 (5%) of whom were born before 1957 (3 unvaccinated and 1 with unknown vaccine status). Among the 75 cases born during or after 1957, 65 (87%) were unvaccinated or had unknown vaccine status, while 3 had one dose and 7 had 2 doses of measles vaccine. Notably, 5 of 11 internationally imported measles cases were adults, and all were unvaccinated or had unknown vaccine status. During the first month of the outbreak, 26 of the 51 (51%) cases were attributable to adults; of the 26, 15 (58%) were in adults and 11 (42%) were in children who acquired infection from adults (Figure 3).

Conclusion
The majority of measles cases occurred in unvaccinated children emphasizing the importance of ongoing and focused efforts on pediatric vaccination. However, measles cases in unvaccinated adults played an important role in both importations and disease transmission early in the outbreak. These data strongly support current recommendations of 1 dose of measles, mumps, rubella vaccine (MMR) for most adults and 2 doses of MMR for adults traveling internationally and at high-risk such as those in outbreak areas, as determined by local/state public health.

Disclosures
Kirsten St. George, MAppSc, PhD, Akonni Biosystems (Other Financial or Material Support), ThermoFisher (Grant/Research Support), Zeptometrix (Other Financial or Material Support, royalty generating collaborative agreement). .
Retrieval of an Intracranially Migrated Dental Injection Needle Through the Foramen Ovale: 2-Dimensional Operative Video
Authors: Aoun Salah G , El Ahmadieh Tarek Y , Ban Vin Shen , Patel Vishal J , Vance Awais , Patel Ankur R , Tandon Rahul , Zuniga John R , Batjer H Hunt , Barnett Sam 
Published: October 2019

Abstract
Dental injection needle migration is a rare complication of orthodontal procedures. When these needles fracture, they typically dislodge into the cervical space or the facial musculature. Migration into the cranial vault is difficult because of the obstacle created by the skull base. We report a rare case of intracranial migration of an anesthetic injection needle through the foramen ovale. A 59-yr-old man underwent the extraction of a right maxillary molar. The distal end of a 25-gauge injection needle broke into his pterygoid musculature, causing him pain while chewing. Vascular imaging obtained after a computed tomography scan of his face showed that the needle had migrated, potentially because of his efforts of mastication, and had traversed the foramen ovale into the middle cranial fossa. The patient started experiencing intermittent right facial numbness, likely due to compression or injury to the right trigeminal nerve. Our oral and maxillofacial colleagues did not believe that the needle could be retrieved from its facial end. The patient elected to undergo the recovery of the needle through a craniotomy given the fact that the object was contaminated and because he was becoming increasingly symptomatic. A right pterional craniotomy was planned. Extradural dissection was performed until the dura going into the foramen ovale was revealed. We could feel the metallic needle under the dural sheath of the trigeminal nerve. The dura was opened sharply directly over the needle. We then proceeded to mobilize the needle into the face, and then pulled it out completely through the craniotomy to avoid injury to the temporal lobe. The patient recovered well and was asymptomatic at the time of discharge.
This case report was written in compliance with our institutional ethical review board. Institutional review board (IRB) approval and patient consent were waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas Southwestern (UTSW) IRB.
Sensible Over-Determination
Authors: Sethi Umrao 
Published: October 2019

AbstractI develop a view of perception that does justice to Price's intuition that all sensory experience acquaints us with sensible qualities like colour and shape. Contrary to the received opinion, I argue that we can respect this intuition while insisting that ordinary perception puts us in direct contact with the mind-independent world. In other words, Price's intuition is compatible with naïve realism. Both hallucinations and ordinary perceptions acquaint us with instances of the same kinds of sensible qualities. While the instances in hallucination are mind-dependent, those in veridical perception are not. The latter are ontologically over-determined—they have their existence guaranteed both in virtue of having a material bearer and in virtue of being perceived by a mind. Such over-determined instances are mind-independent—they can continue to exist unperceived, because, in addition to the minds that perceive them, their existence is guaranteed by the material objects that are their bearers.
Association between depression and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort
Authors: Kim So Young , Chanyang Min , Oh Dong Jun , Choi Hyo Geun 
Published: October 2019

Abstract

Objective
To investigate the bidirectional relation between RA and depression.

Methods
Data from the Korean Health Insurance Review and Assessment Service – National Sample Cohort from 2002 to 2013 were analysed. Patients ≥20 years of age were included. Study I was conducted with 38 087 depression patients and 152 348 matched control participants. Study II was conducted with 7385 RA patients and 29 540 matched control participants. Stratified Cox proportional hazards models were used to analyse the hazard ratios (HRs) for depression and RA (study I) and for RA and depression (study II). The data were adjusted by the Charlson comorbidity index; rheumatic disease was excluded. Subgroups were also analysed according to age and sex.

Results
A total of 0.7% (1260/38 087) of the depression group and 0.6% (883/152 348) of the control I group had RA (P = 0.02). The HR for RA in the depression group was not significantly higher than that in control I group. In study II, 5.5% (408/7385) of the RA group and 4.3% (1246/29 540) of the control II group presented with depression (P &lt; 0.001). The RA patients showed an adjusted depression HR that was 1.20 times higher (95% CI 1.07, 1.34; P = 0.002) than that of the control group. The &gt;30-years-old and women subgroups of RA patients showed higher depression HRs than the control subgroups.

Conclusion
RA increased the risk of depression; however, depression did not increase the risk of RA in the Korean adult population.
Involuntary Detention and Treatment: Are We Edging Toward a “Paradigm Shift”?
Authors: Szmukler George 
Published: October 2019

AbstractRecent challenges to conventional mental health laws concerning involuntary detention and treatment of persons with a mental disorder have led to proposals, or indeed an insistence, that fundamental reform is necessary. A key theme has been the need to eliminate unfair discrimination against people with a mental disorder because their human rights are not respected on an equal basis with other people. Some proposals depart radically from conventional assumptions concerning the justification of involuntary detention and treatment. One is a “fusion law,” a generic law applying to all persons lacking the ability to make a treatment decision, whether resulting from a “mental” or “physical” illness. An authoritative interpretation of the UN Convention on the Rights of Persons with Disabilities (2006) goes so far as to maintain that involuntary interventions are a violation of the Convention.
Dietary preferences and diet effects on life-history traits of tardigrades
Authors: Bryndová Michala , Stec Daniel , Schill Ralph O , Michalczyk Łukasz , Devetter Miloslav 
Published: October 2019

AbstractTardigrades may be divided into the following feeding groups: herbivores, carnivores and omnivores. However, little is known about their specific feeding preferences. Here, we used a number of laboratory experiments with 18 potential food sources, representing a wide variety of organisms, to test feeding preferences, survival and fecundity of three tardigrade species, representing different feeding modes. We also tested for differences in preferences between juveniles and adults, and differences in survival between two age groups: one that started the experiment as juveniles and the other as adults. In our experiments, Milnesium inceptum is confirmed to be a carnivore, being able to reproduce only on animal prey. We also show that Hypsibius exemplaris is a herbivore, feeding on cyanobacteria, algae and fungi. Paramacrobiotus fairbanksi, on the other hand, is demonstrated to be an omnivore, feeding on cyanobacteria, algae, fungi and animals. In some cases, juveniles preferred different types of food than adults. Reproduction was strongly affected by food type. Finally, we demonstrate that tardigrades may ingest food types that they are not able to digest. Thus, gut content analysis may be misleading as a method of studying tardigrade feeding habits.
Resident Education in Complex Obstetric Procedures: Are We Adequately Preparing Tomorrow's Obstetricians?
Authors: Dotters-Katz Sarah , Gray Beverly , Heine R. Phillip , Propst Katie 
Published: October 2019

PURPOSE:
Describe resident experience with surgical obstetrics and comfort in performing those procedures after graduation.

BACKGROUND:
ACGME milestones and CREOG objectives for OB/GYN residents include obstetrical technical skills. Data is limited on how often graduating residents meet these.

METHODS:
Anonymous 27-question e-survey sent to all US OB/GYN residents in 3/2018 via CREOG coordinator-listserv. Complex obstetric procedures included: forceps (FAVD), vacuum (VAVD), cerclage, breech second twin (B2T), breech delivery (BVD), perineal repairs, and cesarean hysterectomy. Technical skills questions included experience as primary surgeon (PS), comfort performing procedures independently (CPI), and for 4th year residents only-comfort performing procedures post-residency (CPPR). Descriptive statistics used to analyze responses.

RESULTS:
417 residents completed the survey. Respondents were 88% female, 75% from academic programs, and nearly 50% were post-graduate year (PGY) 3&4.
Among residents of all levels, many had been primary surgeon in operative vaginal deliveries (51%-FAVD,72%-VAVD) and cerclage (62%), fewer for BVD (21%) and B2T (34%), cesarean hysterectomy (21%), and 4th degree repairs (37%). For PGY 3&4, 85% were CPI VAVD, while only 34% were CPI FAVD. 14% and 37% were CPI BVD and 4th degree repairs respectively. Of the 95 PGY4 respondents, all felt CPPR either VAVD or FAVD. Nearly all felt CPPR a 3rd degree repair (97%), but almost 20% did not feel CPPR a 4th degree repair. 33% did not feel CPPR a cesarean hysterectomy, 28% and 74% did not feel CPPR with B2T and BVD respectively.

DISCUSSION:
Though ACGME and CREOG recommend that graduating residents are able to perform complex obstetric procedures, data suggest that for many graduating chief residents, this is not the case.
Providing Veterans With Innovative Nursing Educational Opportunities
Authors: Wittmann-Price Ruth , Orrico Suzan , Brogdon Rhonda , Morgan Robyn D. 
Published: October 2019

Abstract
This funded project assisted veteran students to obtain a baccalaureate in nursing by aligning the skills learned through military training with concepts and skills valued by professional nursing and taught to nursing students. Nine concepts or skills were identified by nursing faculty that validated for course credit. The identified concepts and skills were incorporated into four simulation scenarios. Veteran students’ skills were validated through simulation experiences in place of taking a three-credit nursing course. Anecdotal data from the debriefing process were rich with students’ experiences and gratitude for being recognized for their military knowledge and service.
Outcomes Associated With Insertion of Indwelling Urinary Catheters by Medical Students in the Operating Room Following Implementation of a Simulation-Based Curriculum
Authors: Barnum Trevor , Tatebe Leah C. , Halverson Amy L. , Helenowski Irene B. , Yang Anthony D. , Odell David D. 
Published: October 2019

Purpose
Catheter-associated urinary tract infection (CAUTI) is a priority quality metric for hospitals. The impact of placement of indwelling urinary catheter (IUC) by medical students on CAUTI rates is not well known. This study examined the impact of a simulation-based medical student education curriculum on CAUTI rates at an academic medical center.

Method
Patient characteristics, procedural data, and outcome data from all operating room IUC insertions from June 2011 through December 2016 at the Northwestern University Feinberg School of Medicine were analyzed using a multivariable model to evaluate associations between CAUTI and inserting provider. Infection data before and after implementation of a simulation-based IUC competency course for medical students were compared.

Results
A total of 57,328 IUC insertions were recorded during the study period. Medical students inserted 12.6% (7,239) of IUCs. Medical students had the lowest overall rate of CAUTI among all providers during the study period (medical students: 0.05%, resident/fellows: 0.2%, attending physicians: 0.3%, advanced practice clinicians: 0.1%, nurses: 0.2%; P = .003). Further, medical student IUC placement was not associated with increased odds of CAUTI in multivariable analysis (odds ratio, 0.411; 95% confidence interval: 0.122, 1.382; P = .15). Implementation of a simulation-based curriculum for IUC insertion resulted in complete elimination of CAUTI in patients catheterized by medical students (0 in 3,471).

Conclusions
IUC insertion can be safely performed by medical students in the operating room. Simulation-based skills curricula for medical students can be effectively implemented and achieve clinically relevant improvements in patient outcomes.