bluuebunny/crossref_metadata_2025_split huggingface dataset:
1127. Utilization of Combination Anti-fungal Therapy in Hospitalized Children and Adverse Events
Authors: Scardina Tonya , Oikonomopoulou Zacharoula , Sun Shan , Patel Sameer 
Published: October 2019

Abstract

Background
Combination antifungal therapy (CAF) is often prescribed to treat invasive fungal infections, despite equivocal data showing benefit. We evaluated number of CAF for treatment of proven, probable and possible invasive fungal infection (IFI) in hospitalized children, associated adverse effects (AE), and use of therapeutic drug monitoring (TDM).

Methods
Medical charts of patients ≤ 18 years old that received CAF for ≥72 hours with normal liver function test between 1/1/13 through December 31/18 were reviewed. Patients could be included for multiple episodes of CAF. Data included primary site of IFI, host risk factors, demonstration of fungal elements in tissue/sterile sites, clinical and mycological criteria for IFI (defined by European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group), CAF regimen, incidence of TDM, and AE.

Results
Overall, 73 episodes of IFI were reviewed [unique patients (n) =60]. The median age was 10 years. Majority (61.6%) of patients were diagnosed with a hematological malignancy (n = 20 acute lymphoblastic leukemia, n = 12 acute myeloid leukemia, n = 5 aplastic anemia). A number of proven, possible, probable IFI were 36, 27 and 20, respectively (Table 1). Most frequent organism isolated in proven IFI was Aspergillus fumigatus (episodes=5, n = 4). Most common primary site of IFI was pulmonary (episodes=32, n = 27). Median days of CAF was 6.8 (range: 3–170). Sixty-six episodes included treatment with a triazole-containing regimen (90%). TDM was conducted in 51 (77%) episodes of triazole-containing regimens. AE were reported in 14 episodes (n = 10) (infusion-related reactions and nephrotoxicity reported in 4 episodes each, electrolyte abnormalities and skin reaction reported in 2 episodes each, and liver dysfunction and hypersensitivity reported in 1 episode each).

Conclusion
Patients diagnosed with proven or probable IFI received a longer duration of CAF in comparison to possible IFI. Voriconazole was frequently prescribed in combination with either micafungin or liposomal amphotericin B for IFI. Antifungal stewardship opportunities exist to improve TDM and reduce the incidence of AE when prescribing CAF.

Disclosures
All authors: No reported disclosures
1131. Prevalence and Characteristics of Non-β-Lactam Allergy Labeling at a Children’s Hospital
Authors: Miceli Amanda , Sun Shan , Scardina Tonya , Bhasin Ajay , Kociolek Larry , Patel Sameer 
Published: October 2019

Abstract

Background
Limited data are available on non-β-lactam (NBL) antibiotic allergy labeling in children. Understanding the incidence and patterns of NBL labeling is important as NBL hypersensitivity testing lacks standardization and false labeling may constrain therapeutic options and compromise antimicrobial stewardship.

Methods
We conducted a retrospective review of patients at our tertiary care pediatric facility and associated clinics who had first reported allergy to NBL antibiotics from January 1, 2015 to December 31, 2015. Demographic data, NBL subclass, severity, description of reaction, and ICD-9/10 diagnostic codes were recorded. In addition, subsequent antibiotic during the following 3 years (2016–2018) was determined. NBL allergy descriptions, when reported, were categorized based on severity and type of reaction.

Results
Of 35,796 patients with first clinical encounters in 2015, 223 patients (0.6%) had at least one NBL allergy reported, 1370 (3.8%) had a β-lactam allergy reported, and 101 (0.3%) patients had both an NBL and β-lactam allergy. There were 16 patients with two NBL allergies. The median age of patients with NBL allergy was 9.0 years. NBL classes and allergic reaction types are listed in the tables. Chronic conditions of patients with NBL allergy included gastrointestinal disease (n = 51), neurological disease (n = 37), malignancy (n = 36), bone marrow or solid-organ transplant (n = 4), and cystic fibrosis (n = 5). In the subsequent 3 years, 28 patients with NBL allergies received 129 systemic courses of antibiotics as inpatients, including 8 patients who received ≥10 courses.

Conclusion
Although not as common as β-lactam allergies, NBL allergies were noted in a substantial number of new patients. When described, the majority of patients did not have severe reactions, and were most likely nonallergic adverse reactions. As many of the patients have chronic conditions and require subsequent antibiotics, adjudication of true allergy status may be beneficial.

Disclosures
All authors: No reported disclosures.
LB15. Measles Outbreak in New York State (NYS) Outside of New York City, 2018–2019
Authors: Hoefer Dina , Ruppert Patricia S , Rausch-Phung Elizabeth , Dufort Elizabeth , Patel Manisha , Patel Manisha , Johns Dylan , Gastanaduy Paul , Gastanaduy Paul , McDonald Robert , Souto Maria , Bryant Patrick , McKay Kevin T , McNulty Lissette , McGraw Nancy , Huang Ada J , Wester Rachel E , Ahmad Nina , St. George Kirsten , Sommer Jamie N , Southwick Karen L , Carrasco Kimberly , Ostrowski Stephanie , Adams Eleanor , Adams Eleanor , Levin Toby R , Gelman Irina , Hutton Brad , Zucker Howard , Blog Debra 
Published: October 2019

Abstract

Background
The United States is experiencing one of the largest and longest measles outbreaks since elimination was declared in 2000 and is at risk of losing this status. Most cases occurring in NYS were reported in undervaccinated communities.

Methods
We included all confirmed NYS measles cases (excluding NYC) from outbreak counties from October 1, 2018 to July 25, 2019. We used the CSTE measles case definition requiring an acute febrile rash illness and either laboratory confirmation or direct epidemiologic linkage to a lab-confirmed case. For each case, demographic and clinical characteristics were obtained. A medical record review was completed for those reported to have an encounter at a hospital, emergency department, or urgent care center.

Results
There were 371 cases of measles reported, including 11 internationally imported cases. Most occurred in Rockland county (n = 283); followed by Orange (n = 55), Westchester (n = 18), Sullivan (n = 14) and Greene (n = 1) (Figures 1 and 2). The median age was 5.5 years; 79% of all cases occurred among children younger than 18 years of age (Figure 3). Most cases (79%) had not received any doses of measles vaccine. Of the 371 cases, 263 (71%) were children who had received 0 doses of measles, mumps, rubella vaccine (MMR), 218 (83%) of whom were over 1 year of age (Table 1). There have been no deaths or documented cases of encephalitis. Twenty-eight (8%) patients were diagnosed with pneumonia and 25 (7%) patients were hospitalized. Among 17 hospitalized children, 5 (29%) were admitted to the intensive care unit (ICU) (ages 1 day to 7 years). There were two preterm births at 34 and 25 weeks gestation to women with measles while pregnant. During October 1, 2018–July 31, 2019, providers in outbreak counties vaccinated 72,465 individuals with MMR, a 46% increase from the same period the year prior.

Conclusion
Unvaccinated children were identified as the largest group affected and experienced severe complications; nearly 30% of hospitalized children were admitted to an ICU. These data support the critical need for continued education and outreach on the risks of measles and the value of vaccination to prevent continued circulation in undervaccinated communities and potential further cases of severe disease.

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); others, no disclosures reported..
Jasmonate Signaling during Arabidopsis Stamen Maturation
Authors: Acosta Ivan F , Przybyl Marine 
Published: October 2019

Abstract
The last stages of stamen development, collectively called stamen maturation, encompass pollen viability, filament elongation and anther dehiscence or opening. These processes are essential for male fertility in Arabidopsis and require the function of jasmonate signaling. There is a good understanding of jasmonate synthesis, perception and transcriptional outputs in Arabidopsis stamens. In addition, the spatiotemporal localization of jasmonate signaling components at the tissue and cellular levels has started to emerge in recent years. However, the ultimate cellular functions activated by jasmonate to promote stamen maturation remain unknown. The hormones auxin and gibberellin have been proposed to control the activation of jasmonate synthesis to promote stamen maturation, although we hypothesize that this action is rather indirect. In this review, we examine these different areas, attempt to clarify some confusing aspects found in the literature and raise testable hypothesis that may help to further understand how jasmonate controls male fertility in Arabidopsis.
Molecular Basis for Natural Vegetative Propagation via Regeneration in North American Lake Cress, Rorippa aquatica (Brassicaceae)
Authors: Amano Rumi , Nakayama Hokuto , Momoi Risa , Omata Emi , Gunji Shizuka , Takebayashi Yumiko , Kojima Mikiko , Ikematsu Shuka , Ikeuchi Momoko , Iwase Akira , Sakamoto Tomoaki , Kasahara Hiroyuki , Sakakibara Hitoshi , Ferjani Ali , Kimura Seisuke 
Published: October 2019

AbstractSome plant species have a striking capacity for regeneration in nature, including regeneration of the entire individual from explants. However, due to the lack of suitable experimental models, the regulatory mechanisms of spontaneous whole plant regeneration are mostly unknown. In this study, we established a novel model system to study these mechanisms using an amphibious plant within Brassicaceae, Rorippa aquatica, which naturally undergoes vegetative propagation via regeneration from leaf fragments. Morphological and anatomical observation showed that both de novo root and shoot organogenesis occurred from the proximal side of the cut edge transversely with leaf vascular tissue. Time-series RNA-seq analysis revealed that auxin and cytokinin responses were activated after leaf amputation and that regeneration-related genes were upregulated mainly on the proximal side of the leaf explants. Accordingly, we found that both auxin and cytokinin accumulated on the proximal side. Application of a polar auxin transport inhibitor retarded root and shoot regeneration, suggesting that the enhancement of auxin responses caused by polar auxin transport enhanced de novo organogenesis at the proximal wound site. Exogenous phytohormone and inhibitor applications further demonstrated that, in R. aquatica, both auxin and gibberellin are required for root regeneration, whereas cytokinin is important for shoot regeneration. Our results provide a molecular basis for vegetative propagation via de novo organogenesis.
‘No Empty Place for Complementing Doubt’: The Spaces of Religious Toleration in Andrew Marvell’s ‘Flecknoe’
Authors: Koch Jonathan 
Published: October 2019

Abstract
Andrew Marvell’s ‘Flecknoe, an English Priest at Rome’ (1646) is a striking document in early modern debates over toleration and an exemplar of their rhetoric and design. Considering ‘Flecknoe’ together with Upon Appleton House (1651), I argue that Marvell uses spatial terms and satiric forms to present confessional rivalry and complementarity. Satire itself might be thought of as a practice of toleration in these poems, at once mocking the languages and gestures of opposing religious confessions and allowing the poet to draw close to—to contrive a surprising intimacy with—the convictions and practices of others. The result is a brilliant interweaving of the ideas and experiences of religious and erotic toleration: Marvell sets liberty of the spirit alongside liberty of the body in these poems’ scenes of forbearance.
Improving quality of life in vasculitis patients
Authors: Aitken M , Basu N 
Published: October 2019

Abstract
Systemic vasculitis are a complex cluster of diseases with high associated morbidity. As disease-related mortality diminishes, the cumulative impact of poor health-related quality of life becomes more pertinent to patients than the initial pathological insult. In this article we explore health-related quality of life in ANCA-associated vasculitis, large-vessel vasculitis and therapeutic strategies that may enhance this critical outcome.
Family Planning Training at Catholic and Other Faith-Based Obstetrics and Gynecology Programs
Authors: Guiahi Maryam , Teal Stephanie , Kenton Kimberly , DeCesare Julie , Steinauer Jody 
Published: October 2019

PURPOSE:
To evaluate family planning training at obstetrics and gynecology (OB-GYN) residency programs that primarily train at restrictive religious hospitals.

BACKGROUND:
Catholic and other religious hospitals face institutional family planning care restrictions, which are in conflict with the training requirements set forth by the Accreditation Council for Graduate Medical Education (ACGME).

METHODS:
We identified 30 ACGME accredited OB-GYN residency programs in which at least 70% of resident time is in restrictive, faith-based hospitals. We queried program representatives about training using an online survey and follow-up telephone interview.

RESULTS:
We had an 80% survey response rate. The majorities were program directors (83%), represented Catholic hospitals (75%), and completed telephone interviews (71%). Programs often relied on other sites to accomplish contraceptive (33%), sterilization (71%), and abortion (88%) training. All programs reported adequate training in reversible contraception. 58% reported inadequate sterilization training, most commonly in postpartum and hysteroscopic sterilizations. 67% reported inadequate abortion training, most commonly in D&E. Approximately half (54%) offered “routine” and 13% did not offer any abortion training. Eight programs (33%) received a total of ten Residency Review Committee citations due to insufficient family planning training, and most of these programs (71%) reported using these citations to gain institutional support for off-site training.

DISCUSSION:
While Catholic and other faith-based OB-GYN residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies and half remain noncompliant with abortion training requirements. Residency Review Committee citations, however, provided an opportunity for programs to leverage support for comprehensive training.
The “Clerkship Passport” Increases Student Participation in the Third-Year Medical Student Obstetrics Clerkship
Authors: Melber Dora , LaCoursiere Daphne 
Published: October 2019

PURPOSE:
To develop and implement a clinical activity checklist to improve third-year medical student participation, satisfaction, and resident satisfaction on the Obstetrics Clerkship.

BACKGROUND:
The “Clerkship Passport” is a checklist of core clinical experiences that students should master. We hypothesized that its implementation would increase student participation and overall Obstetric Clerkship satisfaction.

METHODS:
The Passport was based on milestones 1 from the Ob/Gyn Milestones Project. Two student cohorts were studied before and after implementation (2/2017–3/2018). Overall participation was the primary outcome, secondary measures included task-specific participation and student and resident satisfaction. Chi-square, ANOVA, linear regression and qualitative coding were used for analysis.

RESULTS:
79 of 84 (94%) third-year medical students participated. Overall participation rates increased from 68% to 87% on nine pre-determined tasks (p < 0.001). Participation rates were higher on the Passport (96%) than on anonymous survey (p < 0.001). Academic quarter and interest were associated with participation (p=0.011 and 0.002). After controlling for both, the passport still increased participation aOR 1.7 [1.1, 2.3]. Lactation counseling, knot tying and performing sterile speculum exams increased the most. Despite increased participation, satisfaction with “amount of hands-on experience” decreased (p = 0.03). The remainder of clerkship satisfaction scores were unchanged. Residents reported the Passport defined expectations, increased teaching, encouraged feedback and was not burdensome.

DISCUSSION:
This study supports the use of a clinical activity checklist, which improves student participation. Overall clerkship satisfaction is not improved, but students report satisfaction with the Passport itself. Residents also support the use of this checklist.
Jazz up the Clinical Learning Environment in the Operating Room: The Impact of Operative Skills Checklist
Authors: Yu Pauline , Chelliah Jerome , Nelson Ashleigh 
Published: October 2019

PURPOSE:
To evaluate the impact of utilizing a standardized operative skills checklist on medical student and physician-educator experience.

BACKGROUND:
As gynecological surgeries become more minimally invasive, medical students are left watching surgeries on operating room screen and may not be actively engaged in the surgery. To re-engage the medical student in the operating room, a gynecological operative skills checklist was created. The checklist outlined expectations for students on how to engage in the pre-operative, intra-operative, and post-operative setting based on our educational goals. We sought to understand the impact of utilizing the checklist on surgical engagement, clarity of expectations, and informal feedback for medical students and physician-educators.

METHODS:
Anonymous data were collected via an online survey from medical students who completed their OB/GYN clerkship in the year prior to implementation of the operative skills checklist and compared to surveys from students collected following the implementation. Similarly, physician-educators involved in surgical teaching were surveyed regarding their impression of medical student experience pre-implementation and six months post-implementation of the checklist.

RESULTS:
Ongoing data collection shows improvement of medical student rating of “above-average” and/or “excellent” in post-implementation surveys in the following categories: surgical engagement (83.3% vs 100%), clarity of expectations (62.5% vs 100%), and informal feedback (62.5% vs 80%). Physician-educator scores in these measures have shown similar improvement.

DISCUSSION:
Operative skills checklist digest educational goals into smaller action items. Implementation of such checklists in gynecology can improve medical student engagement, clarify student expectations, and improve informal feedback, thereby jazzing up the learning environment.
Bringing Basic Science to the Ob/Gyn Clerkship: Perspective from Our Learners
Authors: Liang Angela , Hammoud Maya 
Published: October 2019

PURPOSE:
To evaluate medical student perceptions on whether basic science concepts were taught during patient care delivery in an Obstetrics-Gynecology clinical clerkship.

BACKGROUND:
Medical school curriculums are moving towards competency-based curricula, with an emphasis on early introduction to clinical training. These changes condense the traditional basic science curriculum, yet basic science remains critical to clinical medicine. Students who learn basic science explanations for clinical correlates have improved retention. The goal is to embed basic sciences within the clerkship.

METHODS:
At the end of each required clinical clerkship at the University of Michigan, students on their rotations were asked to evaluate their overall clerkship experiences from December 2017 to July 2018. The survey included the statement “Basic science concepts were taught during patient care delivery” with a too-little to too-much five level scale, with a score of three being “just right.” Descriptive statistics were used to analyze the results.

RESULTS:
For the OB/gyn clerkship, 102 students completed the survey. The mean score was 2.37 with a standard deviation of 0.7. Other clerkships were blinded. The same statement in other clerkships resulted in a score of 2.39 (0.69), 2.73 (0.68), 2.88 (0.56), 2.68 (0.64), 2.65 (0.63), 2.45 (0.73), and 2.66 (0.59).

DISCUSSION:
While basic science concepts are taught in the OB/gyn clerkship, there is significant room for improvement. All clerkships fell below what students considered optimal basic science teaching. Teaching scripts, basic science videos, and didactics with purposeful integration of basic science principles could be an effective, efficient method of integrating basic science content within the clerkship.
Impact of Electronic Health Records on Resident Physicians’ Off-Duty Time: A Multi-Specialty Resident Survey at a Large ACGME Accredited Institution
Authors: Grady Cynthia , Ward Sion , Lockhart Krystal , Hagan Joseph , Polite Florencia 
Published: October 2019

PURPOSE:
The purpose of this study is to evaluate off-duty electronic health records (EHR) use among residents at a large multispecialty institution.

BACKGROUND:
Studies have shown that EHRs have greatly impacted the amount of time allocated to documentation of patient care. Little research has been done to investigate the extent to which residents access EHRs remotely while off-duty to complete daily clinical activities.

METHODS:
A voluntary survey was administered to LSUHSC residents to subjectively quantify EHR use in their various settings while on and off duty. Spearman’s correlation analysis was performed to assess associations between ordinal variables while the Kruskal-Wallis test was used to compare residents’ perceptions about EHR access among the top 4 largest specialties and all “other” specialties combined.

RESULTS:
A total of 200 residents (30%) completed the survey. Most residents on their inpatient rotation (60%) reported working 61-80 hours per week and nearly half of the residents accessed EHR outside of work less than 5 hours per week (49%). Among the top 4 specialties and all “other” specialties combined there were significant differences (p=0.027) in the extent of agreement regarding whether “having to access EHRs in your off-duty time negatively impacts your quality of life,” with Ob/Gyn residents having the highest agreement.

DISCUSSION:
Some residents perceive that having off-duty access to EHR negatively impacts their quality of life and this perception varies significantly across specialties. Further understanding of the impact of EHR access as a factor that affects educational and wellness implications is essential.