bluuebunny/crossref_metadata_2025_split huggingface dataset:
861. Health Disparities in HIV and Pregnancy
Authors: Abbas Anum , Aurit Sarah , Destache Chris , Horne John , Gorby Gary , Vivekanandan Renuga 
Published: November 2018

Abstract

Background
HIV infection in pregnant females confers a higher risk of morbidity and obstetric complications. Widespread use of anti-retroviral therapy (ART) has dramatically decreased vertical HIV transmission. US HIV-infected pregnant females continue to be at higher risk for obstetric complications compared with nonHIV infected females. This study will be conducted with the objective to estimate the current US morbidity and mortality in HIV-infected pregnant females as well as incidence of obstetric complications in this patient population.

Methods
The National Inpatient Sample (NIS) was utilized to identify hospitalizations associated with pregnancy from 2002 to 2014. The aggregation of hospitalizations was stratified into 2 groups based on HIV status to determine whether there were differences in demographic factors, complications, and mortality. All analyses accounted for the NIS sampling design.

Results
There were 39,404,956 pregnancy-related hospitalizations identified; of which, 51,762 were also associated with a positive HIV status. There were differences in complications for those with and without HIV, which included eclampsia (1.27% vs. 0.45%; P &lt; 0.001), preterm labor (11.81% vs. 6.41%; P &lt; 0.001), gestational diabetes (0.92% vs. 0.38%; P &lt; 0.001), group B strep (0.03% vs. &lt;0.01%; P &lt; 0.001), and Gram-negative infection (0.07% vs. 0.03%; P = 0.013). After adjusting for mortality risk, calendar year, age, race and ethnicity, insurance, and zip-code level income, it was found that a positive HIV status was associated with a 91.1% increased odds of mortality (95% CI: 3.9%–351.5%; P = 0.037).

Conclusion
As ART are readily available, we expected better outcomes for our HIV-positive pregnant females. Our results are concerning that there is such an increase rate of mortality and health disparity in HIV-positive pregnant females. As this is a retrospective study, there are limitation and further studies need to be conducted.

Disclosures
All authors: No reported disclosures.
863. Increasing PrEP Uptake: A Diffusion-Based Network Intervention for HIV Prevention Among Young Black Men Who Have Sex With Men
Authors: Ferreira Matthew , Young Lindsay , Schneider John 
Published: November 2018

Abstract

Background
Advances in biomedical prevention strategies provide new opportunities for reducing HIV incidence among young black men who have sex with men (YBMSM). Pre-exposure prophylaxis (PrEP) is for HIV-negative individuals and has been shown to be up to 99% effective in preventing HIV infection when taken as prescribed by CDC clinical practice guidelines. Several studies, however, have documented low rates of PrEP uptake among YBMSM.

Methods
PrEP Chicago is a randomized controlled trial peer leader intervention designed to promote uptake of PrEP for HIV prevention among YBMSM. Participants (n = 423) were recruited using respondent-driven sampling (RDS) and randomized to either an intervention (n = 209) or control (n = 214) condition. Eligibility criteria included: aged 18–35, identifies as a person of color, assigned male sex at birth, had sex with a man in the past 12 months, had an active Facebook profile, and resided in Chicago. The intervention includes a half-day, small group PrEP, and peer leader training workshop followed by monthly check-in booster calls. Approximately 12 months after their initial baseline visit, participants return to complete follow-up data collection and switch conditions, giving year 1 control participants the opportunity to learn about PrEP.

Results
The number of HIV-negative intervention participants on PrEP at baseline vs. 12-month follow-up (PrEP Chicago Study, Chicago, 2016–2018). A total of 341 participants (80.6%) returned at 12 months. Of 209 intervention participants at baseline, 176 (84.2%) completed a follow-up survey at 12 months. At baseline, 13 (13.3%) of 98 HIV-negative intervention participants indicated that they were currently taking PrEP. At 12 months, this number grew to 25 (32.5%) of 77 HIV-negative intervention participants, indicating that they were currently taking PrEP. A total of 21 participants reported initiating PrEP during their time in the intervention.

Conclusion
PrEP is a valuable biomedical intervention for preventing HIV infection in those at risk. PrEP Chicago, a network intervention designed to promote uptake of PrEP among YBMSM, shows promising results for PrEP adoption among this community.

Disclosures
All authors: No reported disclosures.
924. Incidence of Symptomatic and Asymptomatic Influenza Among Healthcare Workers: A Multicenter Prospective Cohort Study
Authors: Bénet Thomas , Valette Martine , Amour Sélilah , Aho-Glélé Serge , Berthelot Philippe , Grando Jacqueline , Landelle Caroline , Lina Bruno , Vanhems Philippe ,   AFP Study Group
Published: November 2018

Abstract

Background
Influenza is an important cause of viral nosocomial infections; however, the incidence of asymptomatic influenza among healthcare workers (HCWs) is poorly known. The objective was to estimate the cumulative incidence of asymptomatic and symptomatic influenza among HCWs.

Methods
The AFP (Asymptomatic Influenza Project, NCT02868658) multicenter prospective cohort study was conducted in 5 French university hospitals in Lyon (2 sites), Grenoble, Saint-Etienne, and Dijon. Each voluntary HCW was followed-up during the entire 2016–2017 influenza season with 3 visits for influenza diagnostic by PCR from nasal swabs and serology. The outcome was laboratory confirmed influenza (LCI) defined by an influenza detection by PCR, and/or influenza A seroconversion/significant increase in the anti-A antibodies titer against A/Hong-Kong/4801/2014, with the absence of seroconversion/significant increase in the level of anti-B/Brisbane/60/2008 antibodies; influenza A was indeed the only strain circulating this winter in the Lyon area. Asymptomatic cases presented no general or respiratory sign/symptom, paucisymptomatic LCI cases had those symptoms/signs but not conforming to clinical influenza, symptomatic LCI cases had temperature ≥37.8°C and cough or sore throat. Cumulative incidence was expressed per 100 HCWs.

Results
Overall 278 HCWs were analyzed, 84.2% were female, the mean age was 38 years, and influenza vaccination coverage in 2016–2017 was 45.3%. Globally, 62 HCWs had evidence of LCI. Among laboratory confirmed influenza cases, 67.7% (95% CI: 55.8%–79.7%, n = 42) were asymptomatic, 21.0% (95% CI: 10.5%–31.4%, n = 13) were paucisymptomatic, and 11.3% (95% CI: 3.2%–19.4%, n = 7) were symptomatic. Among HCWs, global cumulative influenza incidence was 22.3% (95% CI: 17.7%–27.5%). Cumulative incidence of asymptomatic influenza was 15.1% (95% CI: 10.9%–19.3%), it was 4.7% (95% CI: 2.2%–7.2%) for paucisymptomatic influenza, and 2.5% (95% CI: 0.1%–4.4%) for symptomatic influenza.

Conclusion
Asymptomatic influenza is frequent among HCWs, representing two-third of the influenza burden in this population. This highlights the importance of infection control measures among HCWs no presenting influenza symptoms.

Disclosures
All authors: No reported disclosures.
926. Outbreak of Invasive Nontuberculous Mycobacterium (NTM) Infections Associated With a Pediatric Dental Practice
Authors: Singh Jasjit , O’Donnell Kathleen , Ashouri Negar , Adler-Shohet Felice C , Nieves Delma , Tran M Tuan , Arrieta Antonio , Tran Lisa , Cheung Michele , Zahn Matthew 
Published: November 2018

Abstract

Background
In 2016, an Orange County, California, pediatric dental clinic’s contaminated water system led to the largest outbreak of odontogenic NTM infections yet described.

Methods
Mandatory reporting and active case finding directed by County Public Health were conducted in collaboration with community Pediatric Infectious Disease physicians for patients who underwent pulpotomy at Dental Clinic A from January 1 to September 6, 2016. Confirmed cases were those with positive NTM culture. Probable cases were those with multiple pulmonary nodules on computed tomography (CT), necrotic bone or osteomyelitis seen at surgery, or pathology with positive acid-fast bacilli stain, granulomatous inflammation or chronic osteomyelitis. Clinical data was collected from medical records.

Results
Of 1,089 patients at risk, 71 cases (22 (31%) confirmed and 49 (69%) probable) (Figure 1) had been identified as of March 19, 2018 (Figure 2). Median case age was 6 years (range 2–11 years). Symptoms began a median of 85 days (range 1–409 days) after pulpotomy (Figure 3). Pain and/or swelling on admission were reported in 79%; 21% were asymptomatic. CT findings included 49/70 with abnormalities of the mandible or maxilla, 13/70 with lymphadenopathy, and 19/68 with pulmonary nodules. Only 6/60 had erythrocyte sedimentation rate &gt;40 mm/hour. Of 71 cases, 70 were hospitalized and underwent surgical debridement, for an average of 8.5 inpatient days (range 1–60 days); 23 had &gt;1 hospitalization and 26 required &gt;1 inpatient surgery. Permanent teeth were lost in 45/65 (range of 1–6 teeth lost). Intravenous antibiotics were administered to 32 cases for a median length of 137 days (range 113–282 days). Clofazimine was obtained for 29/32 cases as part of the regimen. Medical therapy was complicated by peripherally inserted central catheter malfunction/replacement/infection (18/27), rash (2/27), neutropenia (12/27), and elevated creatinine (7/27). All treated children showed evidence of jaw healing with resolved or improving lung nodules at 1-year follow-up.

Conclusion
This is the largest outbreak of invasive NTM infections seen associated with a pediatric dental practice. While infections were indolent, patients suffered medical and surgical consequences of treatment. Enhanced national dental water quality standards are needed to prevent future outbreaks.

Disclosures
A. Arrieta, Melinta Therapeutics: Investigator, Research support
930. HCV Treatment Is Associated With a Reduced Risk of Cardiovascular Disease Events: Results From ERCHIVES
Authors: Butt Adeel Ajwad , Yan Peng , Shuaib Ashfaq , Abou-Samra Abdul-Badi , Saikh Obaid , Freiberg Matthew 
Published: November 2018

Abstract

Background
Studies reporting on the association between HCV and cardiovascular disease (CVD), and effect of HCV treatment upon future risk of CVD have shown mixed results.

Methods
Within ERCHIVES (Electronically Retrieved Cohort of HCV Infected Veterans), we identified all persons treated for ≥7 weeks and propensity-score-matched group who never received HCV treatment. We excluded those with HIV, HBV, or previously diagnosed CVD. Incidence rate (per 1,000 person-years) and risk factors for CVD events (Cox proportional hazards analysis) were determined for various treatment groups. CVD events were identified using ICD-9CM/ICD-10 codes. Kaplan–Meier plots were generated to show and compare CVD-free survival by treatment status and attainment of SVR.

Results
Among 32,575 treated and same number of untreated persons in the final dataset, median age was 58 years, 27% were Black race, and 96% were male. The incidence rate for CVD events/1,000 person-years (95% CI) among the treated was 19.10 (17.79, 20.50) vs. 32.37 (30.51, 34.33) among the untreated (P &lt; 0.01). Treatment with a DAA regimen (vs. PEG/RBV; HR [95% CI] 0.68 [0.53,0.88]) and achieving SVR (HR [95% CI] 0.76 [0.63,0.92]) were associated with a lower risk of incidence CVD event (table). Kaplan–Meier curves demonstrated that untreated persons had a shorter CVD event-free survival during 30 months of follow-up compared with the treated persons. (figure; log-rank P &lt; 0.0001)

Conclusion
HCV treatment is associated with a reduction in incident CVD events. Directly acting antiviral regimens (vs. PEG/RBV) and attainment of SVR (vs. no SVR) are associated with a lower risk of incident CVD events.

Disclosures
A. Ajwad Butt, Gilead: Grant Investigator, Research grant.
972. Asymptomatic Carriage of Clostridiodes difficile and Risk of Subsequent Infection
Authors: Espiritu Katrina , Vernon Michael , Schora Donna , Peterson Lance , Singh Kamaljit 
Published: November 2018

Abstract

Background
C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI.

Methods
Adult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats.

Results
There were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05).

Conclusion
We found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers.

Disclosures
All authors: No reported disclosures.
978. Assessing the Impact of a Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload
Authors: Richardson Katherine , Fouquet Sarah , Kerns Ellen , Mcculloh Russell 
Published: November 2018

Abstract

Background
Fever in infants &lt;90 days old can indicate a serious bacterial infection (SBI) such as urinary tract infection, bacteremia, or meningitis. Clinical management of febrile infants varies widely. Implementing clinical practice guidelines (CPGs) can help standardize care, and electronic clinical decision support (eCDS) tools are a potential means of distributing CPGs. Little is known regarding the individual-level impact of eCDS tool use on medical decision-making. Children’s Mercy Kansas City developed a mobile eCDS tool (CMPeDS: Pediatric Decision Support) that was used internationally in a practice standardization project focused on the management of febrile infants.

Methods
We conducted a prospective cross-over simulation study amongst pediatric healthcare providers. Attending and resident physicians performed simulated patient scenarios using either CMPeDS or a standard text reference (the Harriet Lane Handbook). Participants’ responses in the simulation were evaluated based on adherence to evidence-based guidelines. Participants’ mental workload was assessed using the NASA Task Load Index survey (NASA-TLX, in which lower scores are optimal) to assesses mental, physical, and temporal demand, as well as performance, effort, and frustration when completing a series of tasks. Paired t-test and ANOVA were used to determine significance for case performance scores and NASA-TLX scores, respectively. A System Usability Scale (SUS) was used to determine usability of the CMPeDS app.

Results
A total 28 of 32 planned participants have completed trial procedures to date. Mean performance scores on the cases were significantly higher with CMPeDS vs. standard reference, (87.7% vs. 72.4% [t(27) 3.22, P = 0.003]). Participants reported lower scores on the NASA-TLX when using CMPeDS compared with standard reference tool (Figure 1). Mean score on SUS was 88.2 (scale 0–100) indicating excellent tool usability (Figure 2).

Conclusion
Using the eCDS tool CMPeDS was associated with significantly increased adherence to evidence-based guidelines for febrile infant management and decreased mental workload in simulation. Our findings highlight the potential value of eCDS deployment as part of CPG implementation projects.

Disclosures
All authors: No reported disclosures.
980. Using Videoconferencing with the Clinical Microbiology Lab to Enhance Medical Student Learning During Clinical Rotations
Authors: Chin-Hong Peter , Schwartz Brian 
Published: November 2018

Abstract

Background
Preclinical medical student learning in the microbiology laboratory traditionally focuses on enhancing understanding of microbiology but less on understanding clinical workflow. During a novel course that revisited foundational sciences during clerkships, we designed a virtual microbiology laboratory session to enhance understanding and familiarity with clinical workflow on testing of patient samples.

Methods
The virtual microbiology laboratory sessions were conducted twice in 2018, each including 80 third-year medical students. Clinical cases were used to build upon foundational knowledge. We live-streamed video and audio content from the clinical microbiology laboratory to a remote classroom via the Zoom videoconferencing platform. We conducted the session as a tour and lively interview with microbiology staff who explained the processing as well as diagnostic testing Methods. Students were able to ask questions. To evaluate the sessions we (1) distributed a quantitative survey using a 5-point Likert scale (5 = strongly agree) and (2) conducted focus groups with learners. Qualitative data were analyzed using open and axial coding.

Results
In a questionnaire administered to 160 students, 74% of respondents agreed that the technical aspects and faculty in the session provided the feeling on a “hands-on” tour. Of the respondents, 58% reported that they would be more likely to contact the microbiology laboratory team for help in ordering or interpreting various laboratory tests. In focus groups, learner reflections reinforced the ability of this format to ensure standardization with each student getting to clearly see the demonstration and hear instructor perspectives. Students also appreciated the linear approach of following a specimen from arrival to the laboratory, a better understanding of the laboratory staff and their roles in performing and interpreting laboratory tests. The live feed could be enhanced further by better audio and video synchronization and by reducing ambient noise.

Conclusion
Videoconferencing with the clinical microbiology laboratory can be used to effectively teach microbiology and infectious diseases content to advanced medical students. Whether this exposure to the microbiology laboratory can enhance patient care outcomes requires further study.

Disclosures
All authors: No reported disclosures.
981. A Comprehensive Survey of Infectious Diseases Curriculum Among US Pharmacy Schools
Authors: Jeffres Meghan , Kufel Wesley , Biehle Lauren , Cho Jonathan , Narayanan Navaneeth , Macdougall Conan 
Published: November 2018

Abstract

Background
Pharmacists are key partners in institutional antimicrobial stewardship and require adequate knowledge and skills in antimicrobial pharmacotherapy to fulfill this role, whether or not they have specialized postgraduate training in infectious diseases (ID). The objective of this study was to describe ID topics and teaching strategies across US schools of pharmacy.

Methods
A 23-question electronic survey was sent to ID faculty or curricular deans at all 137 US pharmacy schools.

Results
Surveys were collected from 106 schools (77% response rate). ID curriculum was allotted 60 (IQR 40–80) hours of classroom time and primarily taught in the third year. Respondents dedicated 33% of curriculum hours to ID fundamentals and 66% to disease states. Content was primarily delivered through traditional lectures compared with active learning (75% and 25%, respectively). Greater than 94% of schools taught all tier 1 ID topics from the 2016 American College of Clinical Pharmacy Pharmacotherapy Didactic Curriculum Toolkit. Utilization of active learning methods and time allocated to ID fundamentals differed across schools. Public schools dedicated more time to antimicrobial fundamentals than private schools (40 vs. 30 hours, P = 0.023). Schools using a block schedule allotted more classroom hours to ID content than schools using semester or quarter schedules (77.5 vs. 60 vs. 50 hours, P = 0.001). Schools established less than 5 years ago devoted more classroom hours to active learning than schools established 5 to 10, 11 to 20, and greater than 20 years ago (65 vs. 25 vs. 25 vs. 20, P = 0.012). Private schools were more likely to consistently or frequently use audience response systems (86% vs. 68%, P = 0.037) and concept maps (27% vs. 6%, P = 0.005) compared with public schools. Public schools were more likely to use debates (18% vs. 2%, P = 0.006). Schools established 10 or less years ago were more likely to use concept maps (28% vs. 12%, P = 0.050), games (38% vs. 19%, P = 0.050), and simulation (41% vs. 18%, P = 0.015).

Conclusion
Increased communication and collaboration between ID pharmacotherapy educators is warranted to increase consistency of ID education and distribution of educational innovations.

Disclosures
All authors: No reported disclosures.