bluuebunny/crossref_metadata_2025_split huggingface dataset:
1125. In with the Out-patient Antimicrobial Stewardship Initiative: A Collaboration between a Children’s Hospital Antimicrobial Stewardship Program and a Nonaffiliated Pediatric Private Practice
Authors: Namtu Katie , Berman David M , Hough-Telford Catherine 
Published: October 2019

Abstract

Background
While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient stewardship in pediatric patients is scarce. To the best of our knowledge, this is the first study describing the impact that an established inpatient pediatric antimicrobial stewardship program (ASP) has had on antimicrobial prescribing practices in a multi-site (14 locations) nonacademic, nonaffiliated pediatric outpatient practice. This study’s main objective was to compare the prescribing patterns for urinary tract infections (UTIs) at baseline (before education was provided on local uropathogen resistance patterns, implications of broad-spectrum antibiotic usage, national practice guidelines, cost, etc.) and after antimicrobial stewardship education and interventions.

Methods
Prescribing patterns for UTIs at baseline were reviewed and assessed for appropriateness by the inpatient ASP the summer of 2018. Following this review, education was provided to the outpatient prescribers that included discussion on local uropathogen resistance patterns, UTI guidelines, antimicrobial properties, risk for adverse effects, appropriate antimicrobial selections and dosing for UTIs. After education was provided prescribing patterns from the various sites and prescribers was reviewed on a quarterly basis. Email reminders were also sent out to providers reminding them to use cephalexin as first-line treatment. Unblinded peer comparison was utilized as a behavioral intervention in which all prescribers received reports comparing their antibiotic prescribing rates for UTIs to their peers.

Results
The rate by which cephalexin was prescribed for UTIs has steadily improved from 4.02% of all prescriptions for UTIs during the reporting period of December 2017 - February 28, 2018 to 67.55% during the reporting period January 1 - March 31, 2019.

Conclusion
Collaboration between an established inpatient pediatric ASP and a nonaffiliate, multi-site private pediatric outpatient practice resulted in decreased utilization of broad-spectrum antibiotics and optimization of empiric treatment of urinary tract infections based on local resistance patterns.

Disclosures
All authors: No reported disclosures
1126. Variability in Antibiotic Use in Children’s Hospitals in the United States
Authors: Griffith Hannah , Dantuluri Keerti , Thurm Cary , Williams Derek , Banerjee Ritu , Banerjee Ritu , Howard Leigh M , Grijalva Carlos G 
Published: October 2019

Abstract

Background
Understanding patterns of inpatient antibiotic use is necessary to enhance appropriate use and minimize preventable harm at hospitals. Few studies have characterized antibiotic use in the inpatient setting in children.

Methods
We conducted a cross-sectional study in children admitted to 51 freestanding US children’s hospitals included in the Pediatric Health Information System (PHIS). Overall and broad-spectrum antibiotic use (see Table) were measured using charge data, and prevalence of use was assessed on a single day of each 2017–2018 season over one year. Comparisons were made based on clinical setting (medical vs. surgical), clinical unit (PICU, NICU, and all others), hospital, and region. We assessed the relationship between antibiotic use and median hospital case-mix index (CMI), a surrogate for clinical complexity.

Results
Of 52769 hospitalized children assessed on a study day, 19174 (36%) received antibiotics, and 6575 (12%) received broad-spectrum antibiotics (table). Overall antibiotic use prevalence varied across hospitals from 22% to 52% (Figure 1). Median hospital CMI had no significant relationship with overall antibiotic use and only a weak correlation (ρ=0.29) with broad-spectrum antibiotic use (Figure 2). Antibiotic use prevalence varied minimally by season, ranging from 36% in fall to 37% in summer. Antibiotic use prevalence was 29% (9470/32436) among medical patients and 48% (9704/20333) among surgical patients. The antibiotics most commonly administered in medical patients were ceftriaxone and ampicillin, while surgical patients most commonly received cefazolin and vancomycin. Regional prevalence ranged from 33% (Midwest) to 40% (West). By unit, PICU patients had the highest prevalence of overall [58% (4006/6874)] and broad-spectrum [27% (1830/6874)] antibiotic use. Children with complex chronic conditions accounted for 63% of hospitalized children but represented 72% of children receiving any antibiotic and 85% of those receiving broad-spectrum antibiotics.

Conclusion
We observed large and apparently unexplained variability in antibiotic use prevalence among children’s hospitals, clinical settings, and regions. This indicates potential opportunities for enhanced antibiotic stewardship activities.

Disclosures
Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant
X-ray properties of high-richness CAMIRA clusters in the Hyper Suprime-Cam Subaru Strategic Program field
Authors: Ota Naomi , Mitsuishi Ikuyuki , Babazaki Yasunori , Akamatsu Hiroki , Ichinohe Yuto , Ueda Shutaro , Okabe Nobuhiro , Oguri Masamune , Fujimoto Ryuichi , Hamana Takashi , Miyaoka Keita , Miyazaki Satoshi , Otani Hanae , Tanaka Keigo , Tsuji Ayumi , Yoshida Atsushi 
Published: October 2019

Abstract
We present the first results of a pilot X-ray study of 37 rich galaxy clusters at 0.1 &lt; z &lt; 1.1 in the Hyper Suprime-Cam Subaru Strategic Program field. Diffuse X-ray emissions from these clusters were serendipitously detected in the XMM-Newton fields of view. We systematically analyze X-ray images of 37 clusters and emission spectra of a subsample of 17 clusters with high photon statistics by using the XMM-Newton archive data. The frequency distribution of the offset between the X-ray centroid or peak and the position of the brightest cluster galaxy was derived for the optical cluster sample. The fraction of relaxed clusters estimated from the X-ray peak offsets in 17 clusters is 29 ± 11(±13)%, which is smaller than that of the X-ray cluster samples such as HIFLUGCS. Since the optical cluster search is immune to the physical state of X-ray-emitting gas, it is likely to cover a larger range of the cluster morphology. We also derive the luminosity–temperature relation and found that the slope is marginally shallower than those of X-ray-selected samples and consistent with the self-similar model prediction of 2. Accordingly, our results show that the X-ray properties of the optical clusters are marginally different from those observed in the X-ray samples. The implication of the results and future prospects are briefly discussed.
Introducing and testing an advanced quantitative methodological approach for the evaluation of research centers: a case study on sustainability science
Authors: Kassab Omar , Mutz Rüdiger , Daniel Hans-Dieter 
Published: October 2019

AbstractWith the growing complexity of societal and scientific problems, research centers have emerged to facilitate the conduct of research beyond disciplinary and institutional boundaries. While they have become firmly established in the global university landscape, research centers raise some critical questions for research evaluation. Existing evaluation approaches designed to assess universities, departments, projects, or individual researchers fail to capture some of the core characteristics of research centers and their participants, including the diversity of the involved researchers, at what point in time they join and leave the research center, or the intensity of their participation. In addressing these aspects, this article introduces an advanced approach for the ex post evaluation of research centers. It builds on a quasi-experimental within-group design, bibliometric analyses, and multilevel statistics to assess average and individual causal effects of research center affiliation on participants along three dimensions of research performance. The evaluation approach is tested with archival data from a center in the field of sustainability science. Against a widely held belief, we find that participation in research centers entails no disadvantages for researchers as far as their research performance is concerned. However, individual trajectories varied strongly.
Picturing the Unusual: Uncertainty in the Historiography of Medical Photography
Authors: Engelmann Lukas 
Published: October 2019

Summary
The article explores and expands the historiography of medical photography. First, it revisits historical scholarship on medical photography to demonstrate the absence of a consensus as to what counts as medical photography and what does not. Secondly, the article illustrates the shortcomings of current analytical perspectives with two examples. The first picture was taken by the board of health in Honolulu in 1900 to visualise bubonic plague but resists recognition as a medical representation. The second, a 1986 picture of a person with AIDS, has been perceived as a medicalised photograph contrary to the artist’s intention. Both pictures, rather than delivering diagnostic inferences sustained notions of uncertainty and unusualness. With these examples, I outline the often overlooked significance of picturing uncertainty in the historiography of medical photography. Finally, I ask if these visualisations might be better addressed as elements of experimental systems rather than as representations of disease.
Interprofessional Substance Use Disorder Education in Health Professions Education Programs: A Scoping Review
Authors: Muzyk Andrew , Smothers Zachary P.W. , Andolsek Kathryn M. , Bradner Melissa , Bratberg Jeffrey P. , Clark Seth A. , Collins Kathryn , Greskovic Gerard A. , Gruppen Larry , MacEachern Mark , Ramsey Susan E. , Ruiz Veve Jennifer , Tetrault Jeanette M. 
Published: October 2019

Purpose
The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research.

Method
The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies’ quality.

Results
The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5–15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students’ educational outcomes related to SUDs and/or interprofessionalism.

Conclusions
Interprofessional SUD educational interventions improved health professions students’ knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students’ behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.
The Rise of Nontenured Faculty in Obstetrics and Gynecology by Sex and Underrepresented in Medicine Status
Authors: Esters Danielle , Xierali Imam M. , Nivet Marc A. , Rayburn William F. 
Published: October 2019

OBJECTIVE:
To assess the changing landscape in nontenured faculty, stratified by sex and underrepresented in medicine status, for obstetrician–gynecologists at all U.S. medical schools.

METHODS:
In this retrospective observational study, we used data from the Association of American Medical Colleges Faculty Roster to identify trends in career pathways of full-time faculty at all U.S. MD-granting medical schools from 1978 to 2017. Proportions of nontenured faculty were compared with other clinical departments, according to sex and race–ethnicity. Two-sample t-testing and simple linear regression were used for statistical comparisons.

RESULTS:
The number of full-time obstetrics and gynecology faculty increased from 1,688 to 6,347, with most being nontenured (from 535 to 4,951; 9.3-fold increase) rather than tenured (from 457 to 587; 1.3-fold increase) or tenure-eligible (from 397 to 514; 1.3-fold increase). The proportions of all faculty who were nontenured increased from 29.6% to 72.5% (a 2.5-fold increase; P<.010) for men and from 43.4% to 81.4% (a 1.9-fold increase; P<.01) for women. The proportion who were nontenured increased similarly for faculty who were underrepresented in medicine (from 27.4% to 83.5%; a 3.0-fold increase; P<.01) and for those who were not underrepresented in medicine (from 32.0% to 77.1%; a 2.4-fold increase; P<.01). Trends in the increased proportions of nontenured obstetrics and gynecology faculty were similar with those in other major clinical departments.

CONCLUSIONS:
The substantial rise in the number of obstetrics and gynecology faculty was largely among those who were nontenured, regardless of sex or underrepresented in medicine status. This finding signals the essential need for examining career development and academic accomplishment for promoting nontenured faculty.
Minimally Invasive Subscapularis Release: A Novel Technique and Results
Authors: Shah Maulin M. , Naik Nischal , Patel Tejas , Gupta Gaurav , Makadia Akash 
Published: October 2019

Background:
Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered as the prime element of internal rotation contracture and various methods have been described for subscapularis lengthening. It includes open subscapularis slide or lengthening and arthroscopic release. We hypothesized that subscapularis can be released through minimally invasive approach from the medial border of scapula and thus avoiding formal open procedures and risk of weakening the internal rotation strength.

Methods:
Safety zones to avoid injury to important neurovascular structures while performing minimally invasive subscapularis release (MISR) were determined through cadaveric dissection. Between 2014 and 2016, 45 patients underwent MISR. A concomitant conjoined Latissimus Dorsi and Teres Major transfer was performed. Twenty patients with minimum 2-year follow-up were included in this study. Average age of patients was 6.4 years. A 5-point modified Mallet Score, degrees of active and passive rotations and abduction were used as outcome measures. Axial MRI imaging were available to classify the gleno-humeral deformity.

Results:
Mean improvement in passive external rotation was 80 degrees and in active external rotation was 43 degrees (P <0.001) at 3 months, which was maintained at final follow-up. Average shoulder abduction improved from preoperative—101 degrees to postoperative—142 degrees. Aggregate 5-point Mallet Score improved from 12.8 points (range, 11 to 16) preoperatively to 18.5 points (range, 16 to 21) postoperatively. None of the patients developed external rotation contracture. The results were comparable with other existing techniques of subscapularis release with conjoint tendon transfer.

Conclusions:
MISR with conjoined tendon transfer is an effective way of treating internal rotation contracture in children with congruent glenohumeral joints. This procedure has shown beneficial outcomes even in patients with noncongruous glenohumeral joints, when performed in children younger than 4 years. Advantages of MISR include less risk to neurovascular structures, minimal soft tissue trauma, directly addressing the medial tight subscapularis fibers, significantly less surgical time and minimum learning curve.

Levels of Evidence:
Level III—retrospective comparative study.
Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease
Authors: Carrwik Christian , Olerud Claes , Robinson Yohan 
Published: October 2019

Study Design.
Retrospective cohort study.

Objective.
To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.

Summary of Background Data.
Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.

Methods.
Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.

Results.
The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6–14.2) and median 5.9 months (confidence interval 4.5–7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.

Conclusion.
Predictive scores underestimate survival for the patients which might affect important clinical decisions.

Level of Evidence: 3
Anterior Sacral Meningocele: A New Classification and Treatment Using the Dorsal Transsacral Approach
Authors: Cheng Cheng , Tao Benzhang , Bai Shaocong , Gao Gan , Li Shiqiang , Shang Aijia 
Published: October 2019

Study Design.
Retrospective case series.

Objective.
Anterior sacral meningocele (ASM) is a rare disorder. We reviewed 11 cases of congenital ASM and classified them into three types based on the anatomy and relationship between the cyst and sacral nerve roots.

Summary of Background Data.
The cohort with ASM is relatively large; the classification is novel and has not been previously reported.

Methods.
Eleven consecutive patients with ASM who underwent surgery between February 2014 and January 2019 were retrospectively analyzed. They included four males and seven females. The dorsal transsacral approach was adopted in all cases. The follow-up time was at least 3 months.

Results.
We attempted to classify ASM into three types. Of the 11 cases, six were caudal type, two were paraneural type, and three were nerve-root type. The meningocele was ligated after exploring no nerve involvement, in Type I and II. For Type III, the herniating sac and involved nerve roots were ligated when the nerve roots were indicated as nonfunctional on neurophysiological monitoring; otherwise, the sacral nerve roots were protected and imbricated on the residual sac like a hand-in-glove, and sutured to reconstruct the nerves sleeve. Eight cases were accompanied by tethered cord syndrome (TCS); spinal cord detethering was done with one-stage operation. Ten patients’ presenting symptoms improved at 3 to 6 months’ follow-up; notably, constipation significantly improved. Only one case accompanied by an epidermoid cyst had a second laparoscopic surgery by a general surgeon.

Conclusion.
Aim of surgical treatment is to obliterate the communication between the subarachnoid space and herniated sac, detether the spinal cord, and resect the congenital tumor. The new classification helps to recognize the relationship between the meningocele and sacral nerve roots, and subsequently adopt different surgical strategies. We consider the dorsal transsacral approach relatively feasible, safe, and with lower complication.

Level of Evidence: 4
The Impact of Preoperative Chronic Opioid Therapy in Patients Undergoing Decompression Laminectomy of the Lumbar Spine
Authors: Kha Stephanie T. , Scheman Judith , Davin Sara , Benzel Edward C. 
Published: October 2019

Study Design.
Retrospective review of electronic medical records (EMR).

Objective.
This study aims to (1) characterize the pattern of opioid utilization in patients undergoing spine surgery and (2) compare the postoperative course between patients with and without chronic preoperative opioid prescriptions.

Summary of Background Data.
Postoperative pain management for patients with a history of opioid usage remains a challenge for spine surgeons. Opioids are controversial in this setting due to side effects and potential for abuse and addiction. Given the increasing rate of opioid prescriptions for spine-related pain, more studies are needed to evaluate patterns and risks of preoperative opioid usage in surgical patients.

Methods.
EMR were reviewed for patients (age > 18) with lumbar spinal stenosis undergoing lumbar laminectomy in 2011 at our institution. Data regarding patient demographics, levels operated, pre/postoperative medications, and in-hospital length of stay were collected. Primary outcomes were length of stay and duration of postoperative opioid usage.

Results.
One hundred patients were reviewed. Fifty-five patients had a chronic opioid prescription documented at least 3 months before surgery. Forty-five patients were not on chronic opioid therapy preoperatively. The preoperative opioid group compared with the non-opioid group had a greater proportion of females (53% vs. 40%), younger mean age (63 yrs vs. 65 yrs), higher frequency of preoperative benzodiazepine prescription (20% vs. 11%), longer average in-hospital length of stay (3.7 d vs. 3.2 d), and longer duration on postoperative opioids (211 d vs. 79 d).

Conclusion.
Patients on chronic opioids prior to spine surgery are more likely to have a longer hospital stay and continue on opioids for a longer time after surgery, compared with patients not on chronic opioid therapy. Spine surgeons and pain specialists should seek to identify patients on chronic opioids before surgery and evaluate strategies to optimize pain management in the pre- and postoperative course.

Level of Evidence: 3