bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total cysto-pericystectomy for huge echinococcal cyst located on hepatic segment IVb. Case report and review of the literature
Authors: Pavlidis E T , Symeonidis N G , Psarras K K , Martzivanou E K , Marneri A G , Stavrati K E , Pavlidis T E 
Published: January 2021

Abstract
Hepatic hydatid disease is located mainly in the right liver. It is usually solitary and asymptomatic; however, a large cyst may cause compression symptoms. We report a case of a huge echinococcal cyst located in segment IVb of the liver in a 39-year-old female, 17 x 11 cm in dimensions, causing persistent epigastric pain and discomfort. The diagnosis was made by a computed tomography (CT) scan, which showed the cystic mass with the characteristic daughter cysts and reactive caps (pericystic wall) consisting of fibrous connective tissue and calcifications. The patient underwent radical resection by total cysto-pericystectomy and had an uneventful postoperative course. Follow-up showed no recurrence in CT and normal liver function test. Total cysto-pericystectomy, as an alternative to hepatectomy, is the preferable choice of radical resection operation, nowadays, in the management of liver hydatid disease even in huge cysts.
Intussusception caused by small intestine metastasis of malignant pleural mesothelioma: a case report
Authors: Hamaoka Michinori , Nakagawa Masataka , Nakahara Hideki , Yamamoto Rie , Nishisaka Takashi , Itamoto Toshiyuki 
Published: January 2021

Abstract
Malignant pleural mesothelioma (MPM) is an aggressive form of malignant tumor that originates in the pleural mesothelioma and presents as a local disease in the affected hemithorax. Small intestine metastasis is a rare complication. Herein, the case of a patient with jejunal intussusception caused by small intestine metastasis of MPM has been reported. A 72-year-old man with MPM was admitted to our hospital for abdominal pain. Computed tomography revealed small intestine intussusception. An emergency surgery was performed, and the tumor and intussusception were located in the upper jejunum. Histopathological examination of the resected jejunum revealed that the tumor was a small intestinal metastasis of the MPM from the chest wall. This case showed that MPM may metastasize to the small intestine, and metastatic tumors may cause intussusception.
Kinematic Determinants of Front Kick Dynamics Across Different Loading Conditions
Authors: Vagner Michal , Cleather Daniel , Kubovy Petr , Hojka Vladimir , Stastny Petr 
Published: January 2021

ABSTRACT

Introduction
The efficiency of front kick is related to the kicking technique. Thus, the aim of this study was to find the kinematic determinants of front kick dynamics across different performance and loading levels (no load to 45-kg load).

Materials and Methods
Twenty-four elite and sub-elite professional military personnel (26.8 ± 10.1 years, 84.2 ± 5.4 kg, 181.1 ± 6.4 cm) performed six front kicks into a force plate across five different loading conditions. Three-dimensional kinematics of the kicks was quantified and included velocity of the hip (Vhip), velocity of the knee (Vknee), velocity of the shoulder (Vshoulder), velocity of the foot (Vfoot), angular velocity of the knee (AVknee), and angular velocity of the hip (AVhip).

Results
The main kinematic differences between the two groups were that the sub-elite group had an increased kick time for all loading conditions (P &lt; .001) and a lower Vfoot (P = .05) and a decreased Vhip and Vshoulder (P &lt; .05) in the highest load condition. Vhip and AVhip were the best predictors (up to R2 = 0.58; P = .020) of peak force and impact force during no-load or loaded kicking at the elite level. Typical predictors of impulse in the elite group were AVhip, Vhip, and Vshoulder and those in the sub-elite group were AVknee and Vfoot.

Conclusions
The kinematic variables provide good predictions of kicking dynamics; however, the best predictor varies with the loading conditions and performance levels. Hip motion is the main differentiating factor.
Psychiatric Care in a Novel Federal COVID-19 Treatment Center: Development of a Consultation-Liaison Psychiatry Service at the Javits New York Medical Station
Authors: Kaplan Alexander , Smith Colin M , Toukolehto Olli , van Schalkwyk Gerrit 
Published: January 2021

ABSTRACT
At the outset of the 2019 coronavirus disease (COVID-19) pandemic, New York City faced the highest burden of COVID-19 cases in the United States. In response, the U.S. Federal Government deployed medical providers from various uniformed services to treat patients with COVID-19 at the Jacob Javits Convention Center in New York City. There quickly arose a need for psychiatric services for patients with COVID-19 and psychological support for medical staff. Psychiatrists were tasked with establishing a consult-liaison psychiatry service in this unique environment. The authors detail the establishment of a novel consultation-liaison psychiatry service in a large convention center and explore lessons learned from this experience with the aim to empower uniformed psychiatrists to prepare for and deliver patient-focused care in pandemic settings.
A high-resolution cosmological simulation of a strong gravitational lens
Authors: Richings Jack , Frenk Carlos , Jenkins Adrian , Robertson Andrew , Schaller Matthieu 
Published: January 2021

ABSTRACT
We present a cosmological hydrodynamical simulation of a 1013 M⊙ galaxy group and its environment (out to 10 times the virial radius) carried out using the eagle model of galaxy formation. Exploiting a novel technique to increase the resolution of the dark matter calculation independently of that of the gas, the simulation resolves dark matter haloes and subhaloes of mass 5 × 106 M⊙. It is therefore useful for studying the abundance and properties of the haloes and subhaloes targeted in strong lensing tests of the cold dark matter model. We estimate the halo and subhalo mass functions and discuss how they are affected both by the inclusion of baryons in the simulation and by the environment. We find that the halo and subhalo mass functions have lower amplitude in the hydrodynamical simulation than in its dark-matter-only counterpart. This reflects the reduced growth of haloes in the hydrodynamical simulation due to the early loss of gas by reionization and galactic winds and, additionally, in the case of subhaloes, disruption by enhanced tidal effects within the host halo due to the presence of a massive central galaxy. The distribution of haloes is highly anisotropic reflecting the filamentary character of mass accretion on to the cluster. As a result, there is significant variation in the number of structures with viewing direction. The median number of structures near the centre of the halo, when viewed in projection, is reduced by a factor of 2 when baryons are included.
National Estimates of Prevalence, Time-Trend, and Correlates of Smoking in US People Living with HIV (NHANES 1999–2016)
Authors: Asfar Taghrid , Perez Amanda , Shipman Patrick , Carrico Adam W , Lee David J , Alcaide Maria Luisa , Jones Deborah L , Brewer Judson , Koru-Sengul Tulay 
Published: January 2021

Abstract

Objective
Approximately one in four deaths among people living with HIV (PLWH) in the United States can be attributed to cigarette smoking. Using a nationally representative sample of PLWH, this study examines the prevalence, time-trends, and correlates of current cigarette smoking among PLWH compared to people without HIV.

Design
Secondary analysis of population-based cross-sectional biobehavioral survey.

Methods
Data were pooled from the 1999–2016 National Health and Nutrition Examination Survey (NHANES). All adults (20–59 years) who self-reported their smoking status and were tested for HIV (HIV+ = 152; HIV− = 26 305) were included in the analysis. Prevalence with 95% confidence interval (95% CI), trend analysis by year and group (HIV+/HIV−), and multivariable logistic regression analyses were performed with the complex survey design adjustments.

Results
Overall, 47.0% of PLWH were current smokers compared to 25.5% of those without HIV. From 1999 to 2016, the decline in smoking in PLWH was comparable to those without HIV (10.7% vs. 8.0%). PLWH smokers were more likely than PLWH nonsmokers to be substance users (adjusted odds ratio [aOR] = 17.52; 95% CI = 2.04 to 27.8). Compared to smokers without HIV, PLWH smokers were more likely to be older (1.10; 1.06 to 1.14), males (7.96; 2.50 to 25.40), non-Hispanic Black (10.45; 4.13 to 26.45), with depression (Patient Health Questionnaire-9 sum score ≥5) (3.79; 1.22 to 11.79), and less likely to be gay (0.02; 0.00 to 0.07).

Conclusion
Cigarette smoking among PLWH is a major public health problem in the United States. Targeted and tailored smoking cessation interventions that incorporate assessment and treatment of depression and co-occurring substance use are critical for PLWH, especially among those who are disproportionately affected by smoking and HIV (sexual minority).

Implications
This study offers important research implications in four areas:
1. The decline in smoking among PLWH over 18 years has been modest, and half of PLWH are still smokers.
2. More resources and efforts should be allocated to reduce cigarette smoking among PLWH.
3. There is a critical need to develop and test culturally tailored smoking cessation interventions for minority subgroups who are most impacted by HIV infection and smoking (non-Hispanic Blacks and men who have sex with men)
4. Smoking cessation interventions designed for PLWH should incorporate assessment and treatment of depression and substance use.
11. Evaluation of the Bact/alert® VIRTUO™ in Terms of Time to Detection, Performance, Workflow Efficiency and Impact on Patient Management, Compared to the BACTEC™ FX Automated Blood Culture System
Authors: Halperin Ana V , Cuevas José Luis Cortés , Del Castillo Polo Juan Antonio , Cuesta Miriam , Talens Sergio , Birch Robert , Sánchez Díaz Ana María , Cantón Rafael 
Published: January 2021

Abstract

Background
Bloodstream infections are associated with high rates of morbidity and mortality, therefore prompt identification and antimicrobial susceptibility testing of the causative organism(s) are critical. We compared the microbiological/clinical performance of BacT/ALERT®-VIRTUO™-(BioMerieux) to that of the BACTEC™FX-(BD) instrument, with time-to-detection (TTD, from loading into system until positivity) as the primary outcome. Secondary microbiological outcomes were positivity and contamination rates, hands-on-time, turn-around-time (TAT) and time-to-identification.

Methods
We performed a prospective cross-over study using blood cultures from patients (&gt;18 years) suspected of bacteremia/fungemia, localized in different wards into two strata (Stratum-1: Emergency Department-ED-; Stratum-2: in-hospital patients). Testing was performed in BACTEC™-PlusAerobic/F and BACTEC-Lytic/10-Anaerobic/F bottles and incubated in BACTEC™FX, or BacT/ALERT®FA-Plus and FN-Plus bottles and incubated in VIRTUO™. Initially, each strata was randomly assigned to one of the incubators and then alternated every 2-weeks for 6 months (October-16th-2018 to April-16th-2019). All samples were processed in parallel with the same work-flow from the moment they were flagged positive. Maximum incubation time was 5 days.

Results
We included a total of 4782 extractions (9510 bottles) in VIRTUO and 5139 (10193 bottles) in BACTEC. The median age was 67 years for both groups and the samples were equally distributed for each ward (ED: VIRTUO 80.9%, BD 76.4%). The number of blood cultures with at least one positive extraction was 873(18.3%) for VIRTUO and 802(15.6%) for BACTEC (p=0.0003). TTD and proportion of aerobic/anaerobic bottles is shown in Table.
Hands-on-time was reduced by 15 minutes/day when using VIRTUO.
Table

Conclusion
We have compared on a large scale and in a “real world” setting the performance of two automatic blood culture incubators. TTD was significantly lower for the VIRTUO incubated samples, with differences in both systems depending on the type of bottle (aerobic vs. anaerobic). The number of positive results was significantly higher for the VIRTUO incubated samples, which might impact antimicrobial prescription and clinical outcomes.

Disclosures
Ana V. Halperin, MD, Biomérieux (Grant/Research Support) José Luis Cortés Cuevas, MD, biomerieux (Research Grant or Support)biomerieux (Research Grant or Support) Juan Antonio Del Castillo Polo, MD, Biomérieux (Research Grant or Support) Sergio Talens, n/a, Biomerieux (Research Grant or Support) Robert Birch, n/a, bioMerieux Inc. (Employee) Rafael Cantón, PharmD PhD, Biomérieux (Grant/Research Support)
14. Outcomes from the AHRQ Safety Program for Improving Antibiotic Use Across 439 Long-term Care Facilities
Authors: Katz Morgan , Rowe Theresa A , Cosgrove Sara E , Tamma Pranita D , Miller Melissa A , Dullabh Prashila , Speck Kathleen , Ahn Roy , Gao Yue , Scherpf Erik , Jump Robin , Jump Robin 
Published: January 2021

Abstract

Background
Implementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) settings is challenging. We present the results of an intervention intended to change the culture of antibiotic prescribing in 439 United States LTC facilities (LTCF).

Methods
The LTC Safety Program assisted LTCFs with establishing and implementing ASPs from 12/2018 to 11/2019. Through webinars held 1–2 times per month and other educational content, the Safety Program emphasized 1) the science of safety to improve teamwork and identify antibiotic-associated harm and 2) clinical best practices in making antibiotic treatment decisions. Content was organized using the Four Moments of Antibiotic Decision Making Framework (Figure 1). All staff (e.g., physicians, nurses, nurse assistants) were encouraged to participate. LTCFs submitted monthly antibiotic days of therapy (DOT), numbers of new antibiotic starts, urine cultures (UCX) ordered, Clostridioides difficile LabID events, and census data. Generalized linear mixed effects models were used to calculate pre-post intervention changes at bi-monthly intervals for antibiotic DOT, antibiotic starts and UCX, each per 1,000 resident-days (RD), and C. difficile LabID events per 10,000 RD, comparing the beginning (1/2019 and 2/2019) and end (11/2019 and 12/2019) of the Safety Program.
Figure 1. Four Moments of Antibiotic Decision Making in the Long-Term Care Setting

Results
Of 439 LTCFs who completed the Safety program, the majority were mid-sized (75–149 beds; 229, 52.2%), most were non-hospital based and owned by a larger system (246, 56.0%), with similar distributions between urban and rural settings. Of these, 348 (79%) submitted both baseline and end-of-intervention data. Antibiotic starts decreased from 7.89 to 7.48 starts/1000 RD; P = 0.02). Days of therapy for all antibiotics decreased from 64.1 to 61.0 DOT/1,000 RD; P = 0.068) and for fluoroquinolones (an antibiotic targeted in the Safety Program) from 1.49 to 1.28 DOT/1,000RD; P=0.002. UCX decreased from 3.01 to 2.63 orders/1000 RD; P = 0.001). There were no significant differences in C. difficile LabID events Table 1.

Table 1. Changes from baseline (Jan-Feb, 2019) to the end (Nov-Dec, 2019) of the AHRQ Safety Program

Conclusion
By targeting both antibiotic prescribing culture and knowledge of best practices, the AHRQ Safety Program led to significant reductions in antibiotic use across a large cohort of LTCFs.

Disclosures
Morgan Katz, MD, MHS, AHRQ (Research Grant or Support)FutureCare Health Systems (Consultant)Roche (Advisor or Review Panel member) Robin Jump, MD, PhD, Accelerate (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)
16. SCORE-UC: Antibiotic Stewardship in Urgent Care
Authors: Hersh Adam , Stenehjem Eddie , Fino Nora , Willis Park , Srivastava Rajendu , Buckel Whitney R , Brunisholz Kim , Wallin Anthony , Kumar Naresh , Samore Matthew H 
Published: January 2021

Abstract

Background
Urgent care (UC) is a rapidly growing site of healthcare delivery. The CDC developed Core Elements for Outpatient Antibiotic Stewardship to guide development of outpatient stewardship but little experience exists in applying Core Elements to UC settings. Our objective was to evaluate the effectiveness of a UC stewardship program in a health system.
Figure

Methods
We designed a UC stewardship program for Intermountain Healthcare’s 39 UC sites based on CDC Core Elements. The pre-intervention period was Aug 2017-June 2019. The intervention period was 12 months from Jul 2019 -June 2020. The program consisted of education for patients/providers about appropriate diagnosis and prescribing for respiratory conditions; media campaigns; EHR tools; and a prescribing dashboard for clinicians. The primary outcome was the percentage of respiratory visits where an antibiotic was prescribed. Secondary outcomes included the percentage of encounters receiving antibiotics for conditions where no antibiotics are indicated (e.g. bronchitis) and the percentage of encounters receiving first-line recommended therapy for conditions in which antibiotics may be warrented (otitis media, sinusitis, and pharyngitis). We used a binomial mixed effects hierarchical model to calculate the odds of antibiotic prescribing associated with the intervention period accounting for pre-intervention trends. Models account for clustering within providers and clinics. We present the results of an interim analysis after 7 months of the intervention.

Results
The overall number of UC encounters during the study period was 1,559,403 and 41.5% were for respiratory conditions. The percentage of patients with respiratory conditions that received an antibiotic prescription declined from 49.9% pre-intervention to 35.3% during the intervention (OR 0.73, 95% CI: 0.71, 0.76), reaching a low of 30% during February 2020 (Figure). Prescribing for conditions where antibiotics are not indicated decreased (OR 0.31, 95% CI 0.26–0.36) and first line recommended therapy increased (OR 1.28, 95% CI 1.20–1.26) during the intervention.

Conclusion
After 7 months of a planned 12 month intervention, the UC stewardship program was associated with improved antibiotic prescribing.

Disclosures
Rajendu Srivastava, MD, AHRQ, NIH, CDC (Grant/Research Support, I hold grants from AHRQ, NIH and CDC for a variety of clinical research and implementation studies)IPASS Patient Safety Institute (Other Financial or Material Support, I am a physician founder of this company to spread handoff best practices and reduce adverse events. My employer holds my equity in this company.)
20. Fluoroquinolone and Overall Outpatient Antibiotic Prescribing Trends in Adults, 2011 to 2018
Authors: Gouin Katryna A , King Laura M , Bartoces Monina , Roberts Sarah Kabbani; Rebecca M , Tsay Sharon , Hicks Lauri 
Published: January 2021

Abstract

Background
Fluoroquinolones (FQs) are the third most commonly prescribed antibiotics among U.S. outpatients, and the second most commonly prescribed class among adults ≥ 65 years of age. However, FQ use has been associated with severe adverse events, especially among older adults. As a result, in 2016 the U.S. Food and Drug Administration (FDA) issued warnings against FQ use when other agents may be effective. We assessed changes in outpatient FQ prescribing relative to overall antibiotic prescribing from 2011 to 2018.

Methods
We estimated annual antibiotic prescription rates in adults ≥ 20 years of age for all classes and FQs using national prescription dispensing count data from IQVIA Xponent (numerator) and census estimates (denominator) for 2011 to 2018. We used Poisson models to estimate prevalence rate ratios (PRR) and 95% confidence intervals (CIs) comparing antibiotic prescription rates overall and stratified by age group from 2011 to 2018. The Chi-square test was used to compare the percent decrease in rates between age groups.

Results
From 2011 to 2018, prescription rates in adults for all antibiotics decreased by 2% (PRR 0.98, 95% CI: 0.98-0.98); FQ prescription rates decreased by 30% (PRR 0.70, 95% CI: 0.69–0.70), with the largest decline from 2015–2018 (Figure 1). Adults ≥ 65 years had the highest FQ prescription rates for 2011 to 2018, at a rate 2.37 (95% CI: 2.32,2.42) times that of adults 20–64 years (Figure 2). The FQ prescribing rate in adults 20–64 experienced a greater decrease from 2011 to 2018 than the rate in adults ≥ 65 years (p&lt; 0.0001), with a 35% decrease (PRR 0.65, 95% CI: 0.65, 0.65) in adults 20–64 years compared to a 29% (PRR 0.71, 95% CI: 0.71-0.71) decrease in adults ≥ 65 years (Figure 2).
Decreases in total outpatient antibiotic and fluoroquinolone prescribing rates among adults in the United States from 2011 to 2018

Decreases in outpatient fluoroquinolone prescriptions per 1,000 persons by age group in the United States from 2011 to 2018

Conclusion
FQ prescribing decreased markedly compared to overall antibiotic prescribing from 2011 to 2018, which was likely due in part to FDA warnings on FQ-associated adverse events. However, FQ prescribing among older adults remained high during this period and did not decrease as much as in younger adults. Further evaluation of the diagnoses associated with prescribing may provide additional opportunities to optimize FQ prescribing practices, especially among older adults.

Disclosures
All Authors: No reported disclosures
21. Association of MRSA Prevalence and Hospital-level Antibiotic Use: A Retrospective Study Across 122 Acute-care Hospitals
Authors: Livorsi Daniel J , Nair Rajeshwari , Lund Brian , Alexander Bruce , Beck Brice , Goto Michihiko , Perencevich Eli N 
Published: January 2021

Abstract

Background
The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), varies across geographic regions, which could contribute to regional variation in antibiotic use. In this study, we evaluated whether local MRSA prevalence rates were associated with hospital-level antibiotic use across the Veterans Health Administration (VHA).

Methods
This retrospective cohort included all acute-care patients admitted in VHA hospitals during 2016. Anti-MRSA antibiotics were identified per National Healthcare Safety Network definitions and use was quantified as days-of-therapy (DOT) per 1000 days-present. Hospital-level MRSA prevalence (colonization and/or infection) was determined by calculating the proportion of admissions with a positive MRSA nasal swab and/or a MRSA-positive clinical culture obtained ≤1 day before or ≤2 days after admission. Negative binomial regression models were used to determine the association between a hospital’s MRSA prevalence and its antibiotic use, after accounting for intra-hospital clustering, patient case-mix, month of admission, and use of hospital-based stewardship strategies.

Results
There were 548,476 admissions across 122 hospitals. The median rate of MRSA prevalence at admission was 8.0% (IQR 6.7–9.7%). Hospital level median use of anti-MRSA and total antibiotics was 96.5 (interquartile range [IQR] 81.1–116.9) and 562.1 (IQR 505.9–631.6) DOT per 1,000 days-present, respectively. In a hospital-level risk adjusted analysis, a hospital’s MRSA prevalance was significantly associated with its monthly use of both anti-MRSA and total antibiotics (IRR=1.05, 95% 1.02–1.07; IRR=1.02, 95% CI, 1.01–1.03). A 5% increase in the hospital’s MRSA prevalence was associated with an increase in the monthly use of anti-MRSA antibiotics and total antibiotics by 23.6 and 8.3 DOT per 1,000 days-present, respectively.

Conclusion
Higher hospital-level MRSA prevalence was associated with significantly higher rates of antibiotic utilization, even after adjusting for case-mix and reported antibiotic stewardship strategies. Future benchmarking of anti-MRSA antibiotic use across hospitals may need to risk-adjust using baseline rates of MRSA prevalence.

Disclosures
Daniel J. Livorsi, MD, MSc, Merck and Company, Inc (Research Grant or Support) Rajeshwari Nair, PhD, Merck and Company, Inc. (Research Grant or Support)