bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of COVID-19 Serologic Testing in Healthcare Workers with Acute Respiratory Tract Infection
Authors: Ray Amy 
Published: November 2021

Background: Diagnostic tests for COVID-19 are in high demand. Serologic assays are of interest as diagnostic adjuncts to SARS-CoV-2 quantitative polymerase chain reaction (PCR); however, many of the commercially available assays have limited validation data and clinical utility is unknown. We describe the utilization of SARS-CoV-2 IgG enzyme-linked immunosorbent assay (ELISA) for healthcare workers with acute respiratory tract infection (ARTI) who underwent SARS-CoV-2 PCR testing. Methods: The MetroHealth System is the largest public hospital system in Ohio, employing ~8,000 staff. COVID-19 detection began in early March 2020. EDI novel coronavirus COVID-19 IgG ELISA (KT-1032) targeting antibody response to viral nucleocapsid was obtained for diagnostic and seroprevalence analyses. Manufacturer reports of sensitivity and specificity of the assay are 100% and 99%, respectively. A 2-part test strategy for employees with symptoms of ARTI was implemented. Qualifying symptoms for SARS-CoV-2 PCR testing included fever and either cough or shortness of breath. Additional symptoms were included to reflect expanding knowledge of COVID-19. Employees who underwent SARS-CoV-2 PCR testing (Luminex ARIES) were offered serologic testing on day 14 following PCR result. Education accompanied the offer for serologic testing as well as the receipt of test result to aide interpretation. Results: From April 16, 2020, through July 6, 2020, 588 employees underwent PCR testing. Overall, 70 cases of COVID-19 were detected. Of the 197 employees who opted for serologic testing, IgG positivity was 12.6%. The mean time to IgG collection following PCR result was 30 days (range, 10–79). Using PCR results obtained in the clinical setting of ARTI as the diagnostic gold standard, IgG was 84.6% sensitive and 98.2% specific (Figure 1). Conclusions: In a population of symptomatic healthcare workers, SARS-CoV2 IgG testing was specific for COVID-19 diagnosis. Sensitivity was inadequate compared to the positive predictive agreement of 90% or greater required for US Food and Drug Administration emergency use authorization. In a low-prevalence environment for COVID-19 (<5%), a positive SARS-CoV-2 IgG has a low positive predictive value, which may falsely imply immunity and may negatively affect infection prevention practices.Funding: NoDisclosures: None
Stewardship of Remdesivir Use in a Rural Community Hospital During the COVID-19 Pandemic
Authors: Tirupathi Raghavendra , Gross Melissa 
Published: November 2021

Background: Remdesivir was granted EUA followed by full FDA approval for treatment of hospitalized COVID-19 patients on October 22, 2020, based on the results from the ACTT1 trial. Remdesivir use was initially restricted to infectious disease (ID) physicians in our hospital with prescription needing formal ID consultation until complete approval. Due to increasing case counts in our hospital, a decision was made to allow intensivists and hospitalists the authorization to prescribe remdesivir in a phased manner. In this retrospective study, we assessed the impact of phased-in prescribing on remdesivir utilization and days of therapy of antimicrobials. Methods: Remdesivir prescribing was streamlined by real-time institutional guidelines developed by a COVID-19 treatment committee constituting ID and other clinicians. Eligibility for remdesivir included positive SARS-CoV-2 PCR test, severe disease defined as persistent hypoxia (<94% oxygen saturation on room air), requiring supplemental oxygen and/or on mechanical ventilation (MV) for <72 hours, and symptom onset of <10 days. We retrospectively reviewed cohorts of 3 periods during which remdesivir was prescribed. In the first cohort A, between October 23, 2020, and November 12, 2020, remdesivir was restricted to ID physicians with formal ID consultation. Cohort B comprised inpatients between November 13, 2020, and December 6, 2020, when hospitalists and intensivists were allowed to prescribe remdesivir through an EMR order set after prior authorization by an ID physician via curbside or telephonic consultation. Cohort C, from December 7, 2020, to December 26, 2020, comprised inpatients with unrestricted prescribing of remdesivir by hospitalists and intensivists. We also evaluated antibiotic use. Results: In cohort A, SARS CoV-2 positivity was 20.3%; 64 inpatients tested positive and 35 patients (54.7%) who met the criteria were prescribed remdesivir after a formal consultation with an ID physician. In cohort B, requiring prior authorization by an ID physician, SARS-CoV-2 positivity rapidly increased to 34%; 193 patients tested positive and 97 patients (50.3%) received remdesivir. In cohort C, during unrestricted access, positivity further increased to 38%; 235 inpatients tested positive and 123 (52.5%) received remdesivir. Remdesivir use remained steady during the 3 phases of gradual de-escalation of restricted prescribing and safe handoff in the context of clear guidelines, as well as ongoing curbside education provided by ID physicians during the second phase. Cohort B demonstrated the best prescribing rates. Antimicrobial prescribing data were also collected during the 3 cohort phases (Figures 1–3). Conclusions: Remdesivir is an expensive antiviral with limited utility and maximum benefit in COVID-19 inpatients who are hypoxic but do not require mechanical ventilation. Stewardship of remdesivir with safe, gradual handoff to inpatient can be achieved without overuse.Funding: NoDisclosures: None
Comparing Hospital Healthcare-Associated Infection Incidence During Pre-COVID-19 Pandemic and Pandemic Eras
Authors: Parriott Andrea , Kazerouni N. Neely , Epson Erin 
Published: November 2021

Background: Diversion of resources from infection prevention activities, personal protective equipment supply shortages, conservation (extended use and reuse) or overuse with multiple gown and glove layers, and antimicrobial prescribing changes during the COVID-19 pandemic might increase healthcare-associated infection (HAI) incidence and antimicrobial resistance. We compared the incidences of Clostridioides difficile infection (CDI), methicillin-resistant Staphyloccocus aureus bloodstream infection (MRSA BSI), and vancomycin-resistant enterococci bloodstream infection (VRE BSI) reported by California hospitals during the COVID-19 pandemic with incidence data collected prior to the pandemic. Methods: Using data reported by hospitals to the California Department of Health via the NHSN, we compared incidences in the second and third quarters of 2020 (pandemic) to the second and third quarters of 2019 (before the pandemic). For CDI and MRSA BSI, we compared the standardized infection ratios (SIRs, based on the 2015 national baseline), and we calculated the P values. No adjustment model is available for VRE BSI; thus, we measured incidence via crude incidence rates (infections per 100,000 patient days). We calculated incidence rate ratio (IRR) with 95% CI for VRE BSI. To examine the possible effect of missing data during the pandemic, we performed a sensitivity analysis by excluding all facilities that had incomplete data reporting at any time during either analysis period. Results: Incidence measures and numbers of facilities contributing data in prepandemic and pandemic periods are shown in Table 1. There were no statistically significant changes in SIRs at P = .05 for either MRSA BSI or CDI between the prepandemic and pandemic periods (MRSA BSI P = .17; CDI P = .08). Crude VRE BSI incidence increased during the pandemic compared to the prepandemic period (IRR, 1.40; 95% CI, 1.16–1.70). Excluding facilities with incomplete data had minimal effect. Conclusions: We found insufficient evidence that MRSA BSI or CDI incidence changed in California hospitals during the pandemic relative to the prepandemic period; however, there was a significant increase in the crude incidence of VRE BSI. Next, we will include interrupted time series analyses to assess departure from long-term trends, including a risk-adjusted model for VRE BSI. Additionally, we will evaluate for changes in central-line–associated bloodstream infection incidence and antimicrobial resistance among HAI pathogens.Funding: NoDisclosures: None
Linking Staff Cases in a Hospital COVID-19 Outbreak Using Electronic Tracking Data
Authors: Dhaubhadel Pragya , Pace Margie , Augustine Trina , Hostetler Seth , Shelly Mark 
Published: November 2021

Background: Significant outbreaks of SARS-CoV-2 infections have occurred in healthcare personnel (HCP). We used an electronic tracking system (ETS) as a tool to link staff cases of COVID-19 in place and time during a COVID-19 outbreak in a community hospital. Methods: We identified SARS-CoV-2 infection cases through surveillance, case investigation and contact tracing, and voluntary testing. For those wearing ETS badges (Centrak), data were reviewed for places occupied by the personnel during their incubation and infectious windows. Contacts beyond 15 minutes in the same location were considered close contacts. Results: Over 6 weeks (August 10–September 14, 2020), 35 HCPs tested positive for SARS-CoV-2 by NAAT testing. In total, 18 nurses and aides were clustered on 1 hospital unit, 7 cases occurred among respiratory therapists that visited that unit, and 10 occurred in other departments. Overall, 17 individuals wore ETS badges as part of hand hygiene monitoring. ETS data established potential transmission opportunities in 17 instances, all but 2 before symptom onset or positive test result. Contacts were most often (10 of 17) in common work areas (nursing stations), with a median time of 45 minutes (IQR, 21–137). Contacts occurred within and between departments. A few COVID-19 patients were cared for in this location at the time of the outbreak. However, we did not detect HCP-to-patient nor patient-to-HCP transmission. Conclusions: Significant HCP-to-HCP transmission occurred during this outbreak based on ETS location. These events often occurred in shared work areas such as the nursing station in addition to break areas noted in other reports. ETS systems, installed for other purposes, can serve to reinforce standard epidemiology.Funding: NoDisclosures: None
Constituting and Regulating Democracy: Kenya's Electoral Commission and the Courts in the 2010s
Authors: Stacey Richard , Miyandazi Victoria 
Published: November 2021

AbstractIn August 2017, responding to a petition from the losing candidate in the presidential election held days before, the Supreme Court of Kenya declared the results of the election null and void. Dramatic in itself, the decision stands in surprising contrast to the same Court's decision to uphold the 2013 election results following a similar petition. Beyond the different outcomes in 2013 and 2017, the Court's jurisprudential approach to the two petitions was markedly different. The Court showed significant deference to the Independent Elections and Boundaries Commission (IEBC) in 2013, and did not seriously interrogate its conclusion that the election had been free and fair. In 2017, however, the Court scrutinised the IEBC's process and paid close attention to the reasons it gave for declaring the result free and fair. This article considers the difference in the Court's approach in two ways. First, from a prescriptive perspective, it suggests when it is appropriate for courts to closely scrutinise the work of elections management boards and other ‘fourth branch’ institutions protecting democracy (IPDs). The article argues that where an IPD performs a function that is constitutive of rights, courts should be prepared to intervene. By contrast, where an IPD performs a function that is regulative of already constituted rights, courts of review should act with deference. On this basis, the article concludes that the Court should have engaged in a deeper review of the IEBC's 2013 decision. Second, from a descriptive perspective, the article suggests that the difference between the Court's 2013 and 2017 approaches can be explained by waning levels of public trust in the IEBC alongside growing levels of public confidence in the judiciary.
Topology of random -dimensional cubical complexes
Authors: Kahle Matthew , Paquette Elliot , Roldán Érika 
Published: November 2021

Abstract
We study a natural model of a random

$2$

-dimensional cubical complex which is a subcomplex of an n-dimensional cube, and where every possible square

$2$

-face is included independently with probability p. Our main result exhibits a sharp threshold

$p=1/2$

for homology vanishing as

$n \to \infty $

. This is a

$2$

-dimensional analogue of the Burtin and Erdoős–Spencer theorems characterising the connectivity threshold for random graphs on the

$1$

-skeleton of the n-dimensional cube.
Our main result can also be seen as a cubical counterpart to the Linial–Meshulam theorem for random

$2$

-dimensional simplicial complexes. However, the models exhibit strikingly different behaviours. We show that if

$p> 1 - \sqrt {1/2} \approx 0.2929$

, then with high probability the fundamental group is a free group with one generator for every maximal

$1$

-dimensional face. As a corollary, homology vanishing and simple connectivity have the same threshold, even in the strong ‘hitting time’ sense. This is in contrast with the simplicial case, where the thresholds are far apart. The proof depends on an iterative algorithm for contracting cycles – we show that with high probability, the algorithm rapidly and dramatically simplifies the fundamental group, converging after only a few steps.
Mapping non-laminar proton acceleration in laser-driven target normal sheath field
Authors: Qin C. Y. , Zhang H. , Li S. , Zhai S. H. , Li A. X. , Qian J. Y. , Gui J. Y. , Wu F. X. , Zhang Z. X. , Xu Y. , Liang X. Y. , Leng Y. X. , Shen B. F. , Ji L. L. , Li R. X. 
Published: November 2021

Abstract
We report on experimental observation of non-laminar proton acceleration modulated by a strong magnetic field in laser irradiating micrometer aluminum targets. The results illustrate the coexistence of ring-like and filamentation structures. We implement the knife edge method into the radiochromic film detector to map the accelerated beams, measuring a source size of 30–110 μm for protons of more than 5 MeV. The diagnosis reveals that the ring-like profile originates from low-energy protons far off the axis whereas the filamentation is from the near-axis high-energy protons, exhibiting non-laminar features. Particle-in-cell simulations reproduced the experimental results, showing that the short-term magnetic turbulence via Weibel instability and the long-term quasi-static annular magnetic field by the streaming electric current account for the measured beam profile. Our work provides direct mapping of laser-driven proton sources in the space-energy domain and reveals the non-laminar beam evolution at featured time scales.
Examination of dietary intake of UK preschool children by varying carers: evidence from the 2008–2016 UK National Diet and Nutrition Survey
Authors: Marr Colette , Breeze Penny , Caton Samantha J. 
Published: November 2021

AbstractEarly years caregivers can play a key role in young children’s eating and the prevention of childhood obesity. The UK National Diet and Nutrition Survey (NDNS) is a large representative survey collecting detailed food and nutrition consumption data. Using these data, the aim of this study was to investigate the relationship between dietary intake of preschool children in the UK aged 2 to 4 years and accompanying adult/s. Nutrition consumption data from 1218 preschool children from years 1 to 8 of the 2008–2016 NDNS were accessed. Dietary data were captured using 3 or 4 day estimated food diaries. Regression analyses revealed significant differences in consumption when children were not accompanied by their parents. Compared with when children were with parents, children consumed significantly more energy dense meals (0·32 kJ/g, 95% CI 0·1–0·6 kJ/g), energy (62 kJ/g, (95% CI 27–97 kJ)) Na (19 mg, (95 % CI 6, 32)), added sugars (0·6 g, (95 % CI 0·1, 1·1)), vegetables (3 g, (95 % CI 1, 4)), total grams (12 g, (95 % CI 3, 21)) and saturated fat (0·2 g, (95 % CI 0·1, 0·4)) per eating occasion when accompanied by wider family. When children were accompanied by a formal childcare provider, they consumed significantly lower energy dense meals (−0·9 kJ/g, (95% CI −1·4 – −0·3 kJ/g)), less added sugars (−1·6 g, (95 % CI −2·4, −0·8)) and more fruit (12 g, (95 % CI 3, 21)) per eating occasion than when they were with their parents. The results demonstrate that non-parental caregivers might be an important target to promote healthy eating in young children. Further research is needed to establish which caregivers would benefit most.
The Frucht property in the quantum group setting
Authors: Banica T. , McCarthy J.P. 
Published: November 2021

AbstractA classical theorem of Frucht states that any finite group appears as the automorphism group of a finite graph. In the quantum setting, the problem is to understand the structure of the compact quantum groups which can appear as quantum automorphism groups of finite graphs. We discuss here this question, notably with a number of negative results.
Management of obstructive pathology of the salivary glands in elderly patients: a preliminary study
Authors: Familiari M , Ferrario F , Giordano L , Di Santo D , Indelicato P , Battista R A , Bussi M 
Published: November 2021

AbstractBackgroundObstructive pathology is a benign condition of the salivary glands that can affect elderly and co-morbid people. Sialoendoscopy is a minimally invasive surgical procedure with a success rate comparable to standard sialoadenectomy and has the advantage that it can be performed under local anaesthesia.MethodsThis study aimed to assess sialoendoscopy benefits in elderly patients unfit for general anaesthesia. A group of elderly patients (aged 65 years or more) undergoing sialoendoscopy under local anaesthesia were evaluated. Age, co-morbidities, surgical time, hospital stay, and complication and recurrence rates were assessed.ResultsNineteen sialoendoscopies were performed in 18 elderly patients with a mean age of 69.7 ± 5.6 years, with some of them suffering from multiple co-morbidities. Surgery was successful in 16 patients, while surgery was unsuccessful in 2 patients because of intraglandular stones. The average surgical duration was 54.5 ± 30.1 minutes, and all patients were discharged 2–3 hours after surgery. No post-operative complications were found and only one patient had recurrence during follow up.ConclusionSialoendoscopy under local anaesthesia is a safe and effective procedure in elderly patients who are more prone to complications.
Changes in the provision of undergraduate ENT clinical placements across the UK in response to the coronavirus disease 2019 pandemic
Authors: Patel B , Parmar D , Gera R , Hannan S A , Saeed S R 
Published: November 2021

AbstractObjectiveThis study aimed to report the changes made to ENT placements across the UK in response to the pandemic and their impact on student experience.MethodsA questionnaire eliciting how ENT placements were provided before and after coronavirus disease 2019 was disseminated amongst Student and Foundation Doctors in Otolaryngology representatives.ResultsThirty-eight respondents from 27 medical schools across the UK completed the survey (response rate of 90 per cent). Twenty-nine of the 38 respondents (76 per cent) reported a change in ENT placements in response to the pandemic. Six of the 38 students (16 per cent) remained satisfied with their ENT placements, as compared to 12 students prior to the pandemic (32 per cent).ConclusionThere is considerable variability in how medical schools responded to the pandemic. Most medical schools placed students into smaller groups, with less direct contact in the hospital. These changes resulted in lower student satisfaction. The increased emphasis on e-learning underscores the need for high quality e-learning materials to promote learning throughout the pandemic and in the future.
Can we improve our day-case rate in functional endoscopic sinus surgery?
Authors: Edafe O , Sargeant T , Morsy M , Oluwole M K , Mirza S 
Published: November 2021

AbstractObjectiveDay-case functional endoscopic sinus surgery is associated with increased patient satisfaction and reduced costs. This study aimed to identify reasons for overnight admission with a view to improving same-day discharge.MethodsThis was a retrospective observation study over a one-year period. All consecutive patients who underwent elective functional endoscopic sinus surgery were included.ResultsA total of 172 patients were included in this study. Functional endoscopic sinus surgery was planned as a day-case procedure in 152 patients (88 per cent), with a planned overnight stay in 20 (12 per cent). The rate of same-day discharge in patients who underwent elective functional endoscopic sinus surgery was 80.2 per cent (n = 138). Reasons for an unplanned overnight admission were: bleeding (n = 8), urinary retention (n = 3), medical co-morbidities (n = 1), post-operative pain (n = 1) and social reasons (n = 1).ConclusionThere is scope to further improve the functional endoscopic sinus surgery day-case rate by utilising techniques to minimise post-operative bleeding. This has the potential to improve both patient satisfaction and service efficiency.
School Teachers and Soft Decolonisation in Dutch–Indonesian Relations, 1945–1949
Authors: Suwignyo Agus 
Published: November 2021

AbstractThe emergence of two states in Indonesia in the aftermath of the Second World War, namely the Republic of Indonesia and the Netherlands Indies Civil Administration, instigated a war that imposed citizenship, which schoolteachers had to choose carefully. By examining the quest for professional trajectories of Dutch and Indonesian schoolteachers during the 1945–1949 period, this paper argues that expanding citizenship fostered decolonisation through the teachers’ detachment from a shared dream of social mobility. The post–World War II reconstruction project, which is largely depicted as narratives of state building in many of the existing bibliographies, reflected a growing discontent in teachers’ expectations for economic reestablishment at the personal levels. The teachers’ detachment from a shared dream of social mobility reflected the dissolution of an imagined community where transnational cultural identities had met and melded in the early twentieth century. In contrast to the emerging historiography that emphasises atrocities and violence, this paper offers a perspective on the soft process of decolonisation.