bluuebunny/crossref_metadata_2025_split huggingface dataset:
1118. Trends of Paediatric Prescribing for Common Infections in British Columbia
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, and quite often children are prescribed for conditions which are commonly self-limiting and viral in etiology. The purpose of this study was to examine the scope of pediatric antibiotic prescribing by indication, from 2013 to 2016, and identify potential new targets for provincial antimicrobial stewardship efforts.

Methods
Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to physician billing data in order to obtain diagnostic information. Prescription rates were then calculated, and trends were examined by indication. Major categories included: upper respiratory tract infection, acute otitis media, lower respiratory tract, skin and soft tissue, and urinary tract infections.

Results
Our database included an average of 244,763 children per year, and 5,896,173 total antibiotic prescriptions. Increased indication-specific rates of prescribing were observed in children aged 0–2 years, for every category. Children aged 3–18 years experienced decreased prescribing across all indications, with the exception of urinary tract infections for those aged between 10–18 years. Urinary tract infections increased by 134% for children aged 0–2 years, and 75% for those aged 10–18 years, from 2013 to 2016. Although antibiotic use for upper respiratory tract infections decreased by 11% for all ages, these diagnoses continue to be prescribed for at rates 2 – 5 times higher than other conditions.

Conclusion
Although this study found a decrease in prescribing over time across all indications, antibiotic use continues to be a concern for upper respiratory tract infections in pediatric care. These diagnoses generally do not require antibiotics, and inappropriate prescribing is a major factor in antimicrobial resistance. The increased prescribing rates in the youngest age group (0–2 years) offers a new target for provincial stewardship efforts.

Disclosures
All authors: No reported disclosures.
1135. The 2018 Global Point Prevalence Survey of Antimicrobial Consumption and Resistance: Pediatric Results from 26 Canadian Hospitals
Authors: Lefebvre Marie-Astrid , Versporten Ann , Carrier Marie , Chang Sandra , Comeau Jeannette L , Emond Yannick , Frenette Charles , Khan Sarah , Landry Daniel L , MacLaggan Timothy D , Tien Nguyen Trong , Nguyen Tuyen , Valiquette Louis , Mertz Dominik , Pauwels Ines , Goossens Herman 
Published: October 2019

Abstract

Background
Inappropriate antimicrobial use (AMU) is strongly associated with antimicrobial resistance. The Global Point Prevalence Survey (Global-PPS) is a standardized tool that is used worldwide to characterize inpatient AMU. We report pediatric results from 26 Canadian hospitals that participated in the Global-PPS in 2018.

Methods
The survey was completed by each site on the Global-PPS website for all patients aged 0–17 years hospitalized in a neonatal or pediatric ward on a chosen day between January and December 2018. Data collected included ward type, demographics, antimicrobials prescribed, diagnosis, type of indication (community-acquired [CA] vs. healthcare-associated [HA]) and type of therapy (empiric vs. targeted). Quality indicators included guideline compliance, medical record documentation of diagnosis, antimicrobial stop/review date, and surgical prophylaxis (SP) duration.

Results
Of the 26 sites, 23 were mixed and 3 were pediatric hospitals, with data on 767 inpatients. Overall, 25.8% (n = 198) of patients received at least one antimicrobial, and 21.9% (n = 168) were on at least one antibiotic. The highest AMU was found in Hematology-Oncology (84%), Pediatric Intensive Care (55.3%) and surgical (42.1%) units. Of the 330 antimicrobial prescriptions, 40.9% were for CA infections, 23% for medical prophylaxis, 20% for HA infections and 2.7% for SP. The most commonly treated infections were sepsis (16%) and lower respiratory tract infection (12.1%). The top five prescribed antibiotics were aminopenicillins (20.4%), aminoglycosides (16.1%), third-generation cephalosporins (15.4%), piperacillin–tazobactam (7.5%) and trimethoprim-sulfamethoxazole (7.5%). Diagnosis and stop/review date were documented for 88.1% and 65.1% of prescriptions, respectively. Compliance to local guidelines was found in 91.5% of therapies. SP exceeded 24 hours in 88.9% of courses.

Conclusion
The Global-PPS generated Canada-wide data on inpatient pediatric AMU, which will allow hospitals to benchmark and develop local quality improvement interventions to enhance appropriate AMU. Targets for improvement include suboptimal antimicrobial stop/review date documentation and prolonged SP.

Disclosures
All authors: No reported disclosures.
LB14. Cerebrospinal Fluid Profiling of the Human Host Response Reveals Species-Specific Enterovirus Biosignatures in Acute Flaccid Myelitis Cases
Authors: Briggs Benjamin J , Santos Yale , Ramesh Akshaya , Grabherr Manfred , Achari Asmeeta , Yu Guixia , Miller Steve , Miller Steve , Federman Scot , Arevalo Shaun , Sample Hannah , Zorn Kelsey , Harriman Kathleen , Messenger Sharon , Domingue Samuel , Dominguez Samuel , Glaser Carol , Wadford Debra , Messacar Kevin , Messacar Kevin , Wilson Michael , Chiu Charles , Chiu Charles 
Published: October 2019

Abstract

Background
Since 2014 there have been global biennial outbreaks of acute flaccid myelitis (AFM), a rare but severe “polio-like” illness of as yet-unknown etiology primarily affecting children. Enteroviruses (EVs),, especially EV-D68 and EV-A71, have been implicated in association with AFM cases, but proving causality has been difficult as EVs are rarely isolated from cerebrospinal fluid. In addition, early identification of EV-associated AFM is challenging given that the diagnosis is reliant on potentially subjective clinical and radiological criteria with no specific biomarkers described to date.

Methods
We leveraged existing and newly generated data from a clinical CSF metagenomic assay for pathogen identification at University of California, San Francisco (UCSF) to interrogate the host response at the transcriptome level by RNA sequencing (RNA-Seq). These transcriptome RNA-Seq data were used to create statistical classification models to discriminate among viral infections that have been linked to AFM, including EV-D68, EV-A71, West Nile virus, and Powassan virus. The dynamic range of CSF cellularity (0 to >106 cells/mL), resulting in varying trancriptome coverage, as well as technical variation across samples required the development and validation of novel normalization techniques. In total, we analyzed ~50 CSF samples split into independent training and test sets.

Results
We were able to demonstrate a distinct signature of AFM that was able to predict the virus associated with AFM in blinded test samples with >80% accuracy. The key transcriptional features that best discriminated EV-A71 from EV-D68-associated AFM involved protein targeting, viral transcription, viral gene expression, and translation initiation pathways.

Conclusion
Here we demonstrate a novel approach to diagnosis of AFM that relies on host transcriptional biomarkers from cerebrospinal fluid. In the future, this method might allow earlier diagnosis of AFM to drive appropriate therapies and vaccines and predict patient outcomes, as well as guide research studies on the pathophysiology of EV-associated AFM.

Disclosures
All authors: No reported disclosures.
Addressing the disease burden of vertically-acquired hepatitis C virus (HCV) infection among opioid-exposed infants
Authors: Protopapas Stella , Murrison Liza Bronner , Wexelblatt Scott L , Blackard Jason T , Hall Eric S 
Published: October 2019

Abstract

Purpose
This study aims to estimate the disease burden of vertically-acquired hepatitis C virus (HCV) in a large Midwestern hospital; and to identify factors associated with HCV diagnostic testing among high-risk infants.

Methods
Retrospective analysis of an infant cohort (n=58,427) born from 2014-2016 in the Greater Cincinnati region, where universal maternal urine testing is conducted at delivery to assess for intrauterine drug exposure (IUDE). Demographics and birth characteristics were analyzed among high-risk infants to identify factors associated with receiving HCV testing. A nested matched case-control analysis examined the association of pediatric HCV infection and IUDE.

Results
The HCV prevalence rate among high-risk infants who received testing was 3.6-5.2% of births. Approximately 66.7% of maternally-acquired HCV infections may be missed using current testing recommendations. Prenatal care had no significant effect (aOR 1.2 [95%CI 0.4-3.5]) on the odds of a high-risk infant receiving HCV testing. Opioid-exposed cases had an over 6-fold increase in the odds of HCV infection (aOR 6.2 [95%CI 2.3-16.6]) compared to non-opioid exposed infants.

Conclusions
IUDE was significantly associated with increased odds of pediatric HCV infection in this population. The gaps in pediatric HCV testing identified in this study, despite known risk level and maternal infection, suggest the need for increased focus on HCV identification in the pediatric population.
Corticosteroids for Posttransplant Immune Reconstitution Syndrome in Cryptococcus gattii Meningoencephalitis: Case Report and Literature Review
Authors: Canfield Gregory S , Henao-Martínez Andrés F , Franco-Paredes Carlos , Zhelnin Kristen , Wilson Michael L , Shihadeh Katherine C , Wyles David , Gardner Edward M 
Published: October 2019

Abstract
Cryptococcus gattii represents an emerging fungal pathogen of immunocompromised and immunocompetent hosts in the United States. To our knowledge, this is the first case of posttransplant immune reconstitution syndrome due to C. gattii meningoencephalitis successfully treated with corticosteroids. We also report successful maintenance phase treatment with isavuconazole, a novel triazole, following fluconazole-induced prolonged QT syndrome.
Teen vaping: There is no vapour without fire
Authors: Chadi Nicholas , Belanger Richard E 
Published: October 2019

Abstract
E-cigarettes have become the most important source of nicotine exposure among adolescents. While e-cigarettes may have the potential to help some adults quit smoking, there is a lack of reliable evidence that this would apply to adolescents. On the contrary, e-cigarette use is associated with subsequent use of cigarettes and other tobacco products in teens and is also associated with increased use of alcohol, marijuana, and other drugs. Research on the health effects of e-cigarettes is rapidly emerging suggesting that they carry several acute and long-term risks, particularly for adolescents’ still-developing bodies and brains. While several strategies to help youth quit smoking exist, much less is known about effective clinical interventions for adolescents presenting with an addiction to nicotine consumed through e-cigarettes. We discuss the latest research on e-cigarettes with a focus on health effects in youth and propose potential avenues for concerted action among paediatric providers and decision makers.
Obesity reduces the real-world effectiveness of cytokine-targeted but not cell-targeted disease-modifying agents in rheumatoid arthritis
Authors: Schäfer Martin , Meißner Yvette , Kekow Jörn , Berger Sylvia , Remstedt Sven , Manger Bernhard , Listing Joachim , Strangfeld Anja , Zink Angela 
Published: October 2019

Abstract

Objectives
The effectiveness of TNF inhibitors in RA has been shown to be affected by obesity. No such effect has been found for abatacept and rituximab, while for tocilizumab results are ambiguous. Additionally, it remains unresolved whether sex is an effect modifier for obesity. We investigated the impact of obesity on the drug effectiveness of conventional synthetic or biologic DMARDs, taking into account potential sex-specific differences.

Methods
Data from 10 593 RA patients included in the German observational cohort study Rheumatoid Arthritis: oBservation of BIologic Therapy (RABBIT) since 2009 were analysed. Patients had to have a BMI ≥18.5 kg/m2, at least one follow-up and 6 months of observation time. The influence of obesity on drug effectiveness was investigated by regression analysis, adjusting for potential confounders.

Results
Obesity had a negative impact on improvement in the DAS with 28 joints using ESR as an inflammation marker of –0.15 (95% CI: –0.26; –0.04) units for women receiving conventional synthetic DMARDs, –0.22 (95% CI: –0.31; –0.12) units for women receiving TNF inhibitors, –0.22 (95% CI: –0.42; –0.03) units for women receiving tocilizumab and –0.41 (95% CI: –0.74; –0.07) units for men receiving tocilizumab. Overall, no negative obesity effects on the effectiveness of rituximab and abatacept were found.

Conclusion
Obesity has a negative impact on the effectiveness of cytokine-targeted but not cell-targeted therapies in daily practice, affecting more outcomes and therapies in women than in men. Overall, no effects of obesity on treatment effectiveness were found for rituximab and abatacept.
Wearable technologies for developing sleep and circadian biomarkers: a summary of workshop discussions
Authors: Depner Christopher M , Cheng Philip C , Devine Jaime K , Khosla Seema , de Zambotti Massimiliano , Robillard Rébecca , Vakulin Andrew , Drummond Sean P A 
Published: October 2019

Abstract
The “International Biomarkers Workshop on Wearables in Sleep and Circadian Science” was held at the 2018 SLEEP Meeting of the Associated Professional Sleep Societies. The workshop brought together experts in consumer sleep technologies and medical devices, sleep and circadian physiology, clinical translational research, and clinical practice. The goals of the workshop were: (1) characterize the term “wearable” for use in sleep and circadian science and identify relevant sleep and circadian metrics for wearables to measure; (2) assess the current use of wearables in sleep and circadian science; (3) identify current barriers for applying wearables to sleep and circadian science; and (4) identify goals and opportunities for wearables to advance sleep and circadian science. For the purposes of biomarker development in the sleep and circadian fields, the workshop included the terms “wearables,” “nearables,” and “ingestibles.” Given the state of the current science and technology, the limited validation of wearable devices against gold standard measurements is the primary factor limiting large-scale use of wearable technologies for sleep and circadian research. As such, the workshop committee proposed a set of best practices for validation studies and guidelines regarding how to choose a wearable device for research and clinical use. To complement validation studies, the workshop committee recommends the development of a public data repository for wearable data. Finally, sleep and circadian scientists must actively engage in the development and use of wearable devices to maintain the rigor of scientific findings and public health messages based on wearable technology.
Sleep in children with Smith–Magenis syndrome: a case–control actigraphy study
Authors: Trickett Jayne , Oliver Chris , Heald Mary , Denyer Hayley , Surtees Andrew , Clarkson Emma , Gringras Paul , Richards Caroline 
Published: October 2019

Abstract

Study Objectives
The objectives of the study were (1) to compare both actigraphy and questionnaire-assessed sleep quality and timing in children with Smith–Magenis syndrome (SMS) to a chronologically age-matched typically developing (TD) group and (2) to explore associations between age, nocturnal and diurnal sleep quality, and daytime behavior.

Methods
Seven nights of actigraphy data were collected from 20 children with SMS (mean age 8.70; SD 2.70) and 20 TD children. Daily parent/teacher ratings of behavior and sleepiness were obtained. Mixed linear modeling was used to explore associations between total sleep time and daytime naps and behavior.

Results
Sleep in children with SMS was characterized by shorter total sleep time (TST), extended night waking, shorter sleep onset, more daytime naps, and earlier morning waking compared to the TD group. Considerable inter-daily and inter-individual variability in sleep quality was found in the SMS group, so caution in generalizing results is required. An expected inverse association between age and TST was found in the TD group, but no significant association was found for the SMS group. No between-group differences in sleep hygiene practices were identified. A bidirectional negative association between TST and nap duration was found for the SMS group. In the SMS group, increased afternoon sleepiness was associated with increased irritability (p = .007) and overactivity (p = .005).

Conclusion
These findings evidence poor sleep quality in SMS and the need to implement evidence-based interventions in this population.
Parenthood and Medical Careers: The Challenges and Experiences of Physician Moms in the US
Authors: Gray Beverly , Weber Jeremy , Pieper Carl , Dotters-Katz Sarah 
Published: October 2019

PURPOSE:
This survey study sought to gain a better understanding of the experiences and challenges physician moms face during training and as junior faculty.

BACKGROUND:
Balancing the demands of medical training and a career along with those of parenthood is challenging. Currently 46% of residents and fellows in training are women, with a rate as high as 83% in Obstetrics and Gynecology.

METHODS:
We surveyed 897 physician moms from January 2018-February 2018 about their experiences with child-bearing, breastfeeding and maternity leave. Participants completed an open-ended question “What is your biggest challenge as a physician mom?”, these answers were qualitatively coded.

RESULTS:
The majority of participants (40%) had their first child between 31 and 34 years old; 36% of participants had their first child as a resident, while 28% did as junior faculty. For those who had a child during residency, 38% breastfed for 1 year or more, 26% breastfed for 6 months or less. For women who delayed child-bearing, 55% delayed to complete training, 21% delayed for financial reasons, 20% delayed for infertility, 12% of participants delayed due to pressure from their training program. For women who had a child during training 44% described having inadequate leave, but 53% report support from program administration. The themes for biggest challenges for physician moms were coded as: time/hours (37%), balance (26%); over-expectation/guilt/shame (21%), work/working at home (21%), missing out (18%); logistics/child-care (11%).

DISCUSSION:
Based on our results, there are clear ways residency programs and departments can support physician moms with the challenges they face.
How to optimize neuromuscular blockade in ambulatory setting?
Authors: Meistelman Claude , Plaud Benoit , Debaene Bertrand 
Published: October 2019

Purpose of review
The purpose of this review is to discuss the optimal use of neuromuscular blocking agents (NMBA) during ambulatory surgery, and to provide an update on the routine use of neuromuscular monitoring and the prevention of residual paralysis.

Recent findings
The number of major surgical procedures performed in ambulatory patients is likely to increase in the coming years, following the development of laparoscopic and thoracoscopic procedures. To successfully complete these procedures, the proper use of NMBA is mandatory. The use of NMBA not only improves intubating conditions but also ventilation. Recent studies demonstrate that NMBA are much more the solution rather than the cause of airway problems. There is growing evidence that the paralysis of the diaphragm and the abdominal wall muscles, which are resistant to NMBA is of importance during laparoscopic surgery. Further studies are still required to determine when deep neuromuscular block [posttetanic count (PTC) < 5] is required perioperatively. There is now a consensus to use perioperatively neuromuscular monitoring and particularly objective neuromuscular monitoring in combination with reversal agents to avoid residual paralysis and its related morbidity (e.g. respiratory complications in the PACU).

Summary
Recent data suggest that it is now possible to obtain a tight control of neuromuscular block to maintain optimal relaxation tailored to the surgical requirements and to obtain a rapid and reliable recovery at the end of the procedure.
Resuscitation with Hydroxyethyl Starch Maintains Hemodynamic Coherence in Ovine Hemorrhagic Shock
Authors: Arnemann Philip-Helge , Hessler Michael , Kampmeier Tim , Seidel Laura , Malek Youssef , Van Aken Hugo , Morelli Andrea , Rehberg Sebastian , Ince Can , Ertmer Christian 
Published: October 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Fluid resuscitation in hemorrhagic shock aims to restore hemodynamics and repair altered microcirculation. Hemodynamic coherence is the concordant performance of macro- and microcirculation. The present study on fluid therapy in hemorrhagic shock hypothesized that the choice of fluid (0.9% sodium chloride [saline group] or balanced 6% hydroxyethyl starch 130/0.4 [hydroxyethyl starch group]) impacts on hemodynamic coherence.

Methods
After instrumentation, 10 sheep were bled up to 30 ml/kg body weight of blood stopping at a mean arterial pressure of 30 mmHg to establish hemorrhagic shock. To reestablish baseline mean arterial pressure, they received either saline or hydroxyethyl starch (each n = 5). Hemodynamic coherence was assessed by comparison of changes in mean arterial pressure and both perfused vessel density and microvascular flow index.

Results
Bleeding of 23 ml/kg blood [21; 30] (median [25th; 75th percentile]) in the saline group and 24 ml/kg [22; 25] (P = 0.916) in the hydroxyethyl starch group led to hemorrhagic shock. Fluid resuscitation reestablished baseline mean arterial pressure in all sheep of the hydroxyethyl starch group and in one sheep of the saline group. In the saline group 4,980 ml [3,312; 5,700] and in the hydroxyethyl starch group 610 ml [489; 615] of fluid were needed (P = 0.009). In hemorrhagic shock perfused vessel density (saline from 100% to 83% [49; 86]; hydroxyethyl starch from 100% to 74% [61; 80]) and microvascular flow index (saline from 3.1 [2.5; 3.3] to 2.0 [1.6; 2.3]; hydroxyethyl starch from 2.9 [2.9; 3.1] to 2.5 [2.3; 2.7]) decreased in both groups. After resuscitation both variables improved in the hydroxyethyl starch group (perfused vessel density: 125% [120; 147]; microvascular flow index: 3.4 [3.2; 3.5]), whereas in the saline group perfused vessel density further decreased (64% [62; 79]) and microvascular flow index increased less than in the hydroxyethyl starch group (2.7 [2.4; 2.8]; both P < 0.001 for saline vs. hydroxyethyl starch).

Conclusions
Resuscitation with hydroxyethyl starch maintained coherence in hemorrhagic shock. In contrast, saline only improved macro- but not microcirculation. Hemodynamic coherence might be influenced by the choice of resuscitation fluid.