bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting Antimicrobial Stewardship Education Among Pediatricians Through a Maintenance of Certification Part 4 Quality Impro
Authors: Singh Prachi , Lee Brian , Holmen Jenna 
Published: November 2021

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None
Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin
Authors: Gusovsky Amanda , Burgess David , Burgess Donna , Slade Emily , Delcher Chris , Woodworth Alison , Chael Jordan , Osborne Thai 
Published: November 2021

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.Funding: NoDisclosures: None
Evaluating the Prevalence of Leading Practices in Antimicrobial Stewardship
Authors: Braun Barbara , Chitavi Salome , Stenehjem Eddie , Khan Mushira , Baker David , Hyun David 
Published: November 2021

Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.Funding: The Pew Charitable TrustsDisclosures: None
Transmission of COVID-19 on an Inpatient Hospital Prison Unit
Authors: Witherspoon Kelsey , Shah Manisha , Smyer Justin , Colburn Nora , Liscynesky Christina , Hebert Courtney , Day Shandra 
Published: November 2021

Background: Prison populations have been disproportionally affected by COVID-19, partly due to challenges related to social distancing. Data on viral transmission dynamics in inpatient prison units remain limited. The Ohio State University Wexner Medical Center (OSUWMC) has a 24-bed inpatient prison unit in collaboration with the Ohio Department of Rehabilitations and Corrections (ODRC). The unit has 5 shared rooms holding 4 patients each and 4 single-patient rooms. Several cases of inpatient transmission of COVID-19 were identified on the inpatient prison unit. Methods: An IRB-approved retrospective chart review was conducted to evaluate inpatient transmission dynamics of hospital-acquired (HCA) COVID-19. All ODRC patients admitted from March 1 to April 24, 2020, were included. Patients assigned to the prison unit during their hospital stay were evaluated for potential HCA COVID-19, defined as a positive SARS-CoV-2 test ≥4 days after admission. Patient characteristics, testing data, symptoms, aerosol-generating procedures (AGPs), and room assignments were reviewed. Healthcare workers (HCWs) and correction officers (COs) working on the unit who tested positive during this period were identified. Results: In total, 142 ODRC patients were admitted during the study period and 89% had a positive SARS-CoV-2 testing prior to or during admission. Also, 61 patients (43%) were assigned to the prison unit. Moreover, 8 patients on the unit met potential HCA COVID-19 definition with 7 linked to 3 distinct clusters. Also, 7 COs had COVID-19 (outside hospital exposure) and 5 HCWs acquired COVID-19 from patient exposure on the unit. In cluster 1, 4 patients admitted to the same room developed HCA COVID-19. A symptomatic index patient not tested on admission given an atypical presentation required CPAP and frequent nebulizer treatments. In cluster 2, 1 patient from cluster 1 was transferred to another room. The new roommate subsequently developed HCA COVID-19. In cluster 3, a symptomatic correctional officer was assigned to 2 patients in a shared room; the patients later developed HCA COVID-19. Conclusions: Three patient clusters of HCA COVID-19 on a prison unit were identified. Aerosol transmission potentially played a role in cluster 1. Inpatient transmission within the unit prompted updated guidance for ODRC admissions, including universal SARS-CoV-2 admission testing, excluding patients requiring AGPs from shared rooms, and preemptive isolation for patients from an ODRC facility experiencing a COVID-19 surge. Universal testing was quickly expanded to all inpatient admissions. HCWs and COs were also linked to inpatient transmission, highlighting the importance of strict infection control practices for patient populations who cannot socially distance.Funding: NoDisclosures: None
Characteristics of On-Site Infection Prevention and Control Visits for COVID-19—California, February 2020–December 2020
Authors: Stendel Patrick , Karmarkar Ellora , Kennedy Idamae , Bagheri Hosniyeh , Nelson Teresa , Nelson Terry , Epson Erin 
Published: November 2021

Background: The novel coronavirus (COVID-19) pandemic has caused significant morbidity and mortality in California: 2,218,000 cases and 24,598 deaths had occurred by December 31, 2020. Deaths at skilled nursing facilities (SNFs) and assisted living facilities (ALFs) comprise 26.2% of deaths in California; the fatality rate (299 per 10,000 SNF and ALF residents) in such facilities is nearly 50 times the statewide COVID-19 mortality rate (6.4 per 10,000 California residents). For healthcare facility (SNF, ALF, acute-care hospitals) and correctional facility outbreak management, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program deployed trained infection preventionists (IPs) to perform on-site infection prevention and control (IPC) assessments and to provide recommendations to staff and local health departments (LHDs). We describe the number and distribution of visits across the state and common IPC challenges identified. Methods: From February 1, 2020, to December 31, 2020, CDPH IP visits were requested directly by facilities, coordinated through LHDs and other state agencies, or prompted by a facility’s increasing case count on twice weekly review of the daily California healthcare facility data survey (Survey 123). Deployed IPs evaluated facility COVID-19 IPC protocols, assessed facility staff adherence using a standardized assessment tool, and provided verbal feedback followed by written summary reports and recommendations. We categorized visits geographically into 5 California Health Officer Association regions and by month, and we reviewed visit reports for common findings. Results: In total, 623 visits were performed for 489 outbreaks at 465 distinct facilities across 46 LHDs; 71 facilities received ≥2 visits. Southern California facilities received 292 visits (46.9%), San Joaquin region facilities received 138 visits (22.2%), Bay Area facilities received 131 visits (21%), Greater Sacramento facilities received 54 visits (8.7%), and Rural North facilities received 8 visits (1.3%) (Figure 1). The highest number of visits per month occurred in December (n = 143, 22.9%), followed by July (n = 87, 13.9%), and April (n = 83, 13.3%). Common IPC challenges included inappropriate resident cohorting practices, improper use of personal protective equipment, and lapses in physical distancing, and source control in breakrooms. Conclusions: On-site visits by CDPH IPs during the COVID-19 pandemic in California, though resource-intensive, provided substantial technical support for healthcare facilities during outbreaks and identified key areas for IPC improvement. Ongoing CDPH HAI guidance and training materials for facility-based IP staff are now being informed by these IPC challenges.Funding: NoDisclosures: None
Predicting SARS-CoV-2 Asymptomatic Infection Rate of Inpatients: A Time Series Analysis
Authors: Rivera Frida , Woo Ahn Kwang , Silvia Munoz-Price L. 
Published: November 2021

Background: Asymptomatic SARS-CoV-2 infections play a crucial role in viral transmission. However, they are often difficult to identify given that widespread surveillance has not been the norm. We sought to determine whether COVID-19 rates reported at the county level could predict the positivity rates for SARS-CoV-2 among asymptomatic patients tested in a large academic health system. Methods: This observational study was conducted from April 23, 2020, to December 10, 2020, at Froedtert Health (FH) system, the largest academic health system in Wisconsin. On April 23, 2020, FH implemented SARS-CoV-2 surveillance among all consecutive admissions not suspected of COVID-19, all patients scheduled for elective procedures and deliveries, and all asymptomatic patients with known exposures. Samples were processed by the FH laboratory using molecular methods (RT-PCR). To obtain the daily number of newly confirmed COVID-19 cases in Milwaukee County, we accessed the Wisconsin Department of Health Services publicly available COVID-19 database. For the purpose of this study, COVID-19 rates were defined as the percentage of positive tests among all daily tests performed at the county level, while SARS-CoV-2 positivity rates were the percentage of positive tests among all daily surveillance tests performed at FH among asymptomatic patients. The association between COVID-19 rates in Milwaukee County and asymptomatic rates at FH were assessed using an autoregressive moving average time series analysis. To examine the association between these rates, we fitted a seventh-order autoregression for the residuals based on autocorrelation function and partial autocorrelation function plots of the residuals from linear regression. Results: From April 23, 2020, to December 10, 2020, there were 2,347 new asymptomatic infections detected at FH and 75,196 new COVID-19 cases reported in Milwaukee County. Figure 1 shows the time-series plot of asymptomatic SARS-CoV-2 positivity rates at FH and Figure 2 shows COVID-19 rates in Milwaukee County. As the COVID-19 rate in Milwaukee County increased by 1 unit, the asymptomatic infection rate in FH decreased by 0.024 unit (95% CI, −0.053 to 0.004; P = .095) after accounting for autocorrelation over time. Thus, there was no association between these rates. Conclusions: The positivity rates among asymptomatic patients at a large medical center were not predicted by the positivity rate at the county level. This finding suggests that the epidemiology at a county level may be determined by pockets in the population who may not interact, and thus not affect, the positivity rates among asymptomatic patients served by a hospital system within the county.Funding: NoDisclosures: None
Compact and robust supercontinuum generation and post-compression using multiple thin plates
Authors: Xie Xinhua , Deng Yunpei , Johnson Steven L. 
Published: November 2021

AbstractWe report on compact and robust supercontinuum generation and post-compression using transmission of light through multiple thin solid plates at the SwissFEL X-ray free-electron laser facility. A single stage consisting of three thin plates followed by a chirped mirror compressor achieves compression of initially 30-fs pulses with 800-nm center wavelength to sub-10-fs duration. We also demonstrate a two-stage implementation to compress the pulses further to sub-5-fs duration. With the two-stage setup, the generated supercontinuum includes wavelengths ranging from 500 to 1100 nm. The multi-plate setup is compact, robust, and stable, which makes it ideal for applications at free-electron laser facilities such as pump-probe experiments and laser-arrival timing tools.
Law and Order, the Rule of Law, and the Legitimation of the Colonial Presence in Late British Burma
Authors: Brown Ian 
Published: November 2021

AbstractIn Britain's empire across Asia and Africa from the mid-nineteenth century, two political-legal principles were central to colonial modernity, law and order, and the rule of law. These two principles secured the legitimation of colonial rule, in the eyes of those who ruled. It is striking then to see that in late colonial Burma, in the 1920s and 1930s, the colonial government struggled to maintain law and order and to embed the rule of law. Violent crime soared while the criminal justice system failed hopelessly for serious offences. This article seeks to explore the ways in which senior British officials in Burma navigated the disjuncture between the imperial principles that were central to colonial justification and Burma's reality. Perhaps most notably, they did so by putting blame for the soaring crime rates and the failures of the criminal justice system firmly on the Burmese. In the early 1940s, however, with the end of colonial rule clearly imminent, the legitimation of the colonial presence became of less pressing importance, and the failure of colonial practice to live up to its ideological rhetoric could now be more openly faced.
Globalizing the History of the First World War: Economic Approaches
Authors: Martin Jamie 
Published: November 2021

AbstractThis historiographical review offers an overview of new approaches to the global history of the First World War. It first considers how, over the last decade, there has been a move to emphasize the war's imperial dimensions: in reconsiderations of the war in Africa, the experience of soldiers and workers from across Europe's colonial empires, and the German ‘global strategy’ of fomenting unrest within the Allied empires. It then suggests that new global histories of the First World War give further attention to its economic aspects, particularly in two ways: first, by recovering understudied global financial aspects of the war, including the effects of the 1914 financial crisis and wartime inflation on economies and societies far outside of Europe; and second, by investigating wartime histories of primary production, both in colonial territories and sovereign states in Latin America, Africa, and Southeast Asia. It argues that these approaches can offer an important corrective to common assumptions that the First World War led to a dramatic break with pre-war globalizing trends.
Sustainable Tourism in Svalbard: Balancing economic growth, sustainability, and environmental governance
Authors: Hovelsrud Grete K. , Veland Siri , Kaltenborn Bjørn , Olsen Julia , Dannevig Halvor 
Published: November 2021

AbstractThis commentary introduces a methodology and theoretical framework for studying how the tourism industry might balance the competing demands of economic growth and environmental governance. We focus on the “balancing act” Svalbard tourism industry must play among sometimes competing demands of climate change mitigation and emissions from tourism, and of strict Norwegian environmental management policy and demands for increased tourism. While these are specific to Svalbard, the balancing act of competing needs is the core challenge of the UN Sustainability Goals giving this research global and pan-Arctic relevance. Through collaboration between two tourism organisations, the Association of Arctic Expedition Cruise Operators (AECO) and Visit Svalbard and an interdisciplinary team of scientists, we will co-produce knowledge about how to innovate new opportunities while protecting the wilderness, the very backbone of tourism. This collaboration considers how policy, climate change, and local attitudes together may affect the tourism industry and helps to define and develop sustainable tourism operations and products. For instance, tourists may participate in environmental and community-related activities or “micro safaris” rather than a sole focus on charismatic megafauna. Policy discussions about tourism growth need to consider how local and national governments anticipate and navigate rapid social, political, and environmental changes.