bluuebunny/crossref_metadata_2025_split huggingface dataset:
LB13. Candida auris in NYC: A Health System’s Experience Treating the Emerging Drug-Resistant Yeast
Authors: Mazo Dana , Gottlieb Lindsey , Schaefer Sarah , Alexander Kinta , Ehni Jordan , Javaid Waleed , Patel Gopi , Aberg Judith , Lorin Scott 
Published: November 2018

Abstract

Background
Candida auris is emerging multidrug-resistant yeast that can cause serious infections with published mortality rates as high as 60%. It was first recognized in 2009 and has been reported in over a dozen countries. The current United States outbreak was identified in 2016 with New York City (NYC) as the epicenter. The aim of this evaluation was to describe the clinical infections and outcomes with C. auris in a large health system in NYC.

Methods
Cases were identified from clinical specimens collected December 2015–June 2018 from the Mount Sinai Hospital Clinical Microbiology Laboratory, the central laboratory for the Mount Sinai Health System, which encompasses seven hospitals across NYC. All C. auris isolates were confirmed by the New York State Department of Health Wadsworth Center. Medical charts were reviewed. A case was included if C. auris grew from a sterile body site, an antifungal treatment was initiated or the patient expired before the yeast was identified on Gram stain.

Results
Twenty-nine possible cases were identified with 23 meeting the case definition. These cases included 19 bloodstream infections (BSI), two intra-abdominal abscesses, one skin soft tissue infection, and one otitis externa. Using the MIC breakpoints recommended by the Centers for Disease Control and Prevention, 100% of isolates tested were susceptible to caspofungin, 29% were susceptible to amphotericin B, and 17% were susceptible to fluconazole. Nineteen patients received antifungal treatment, 13 with caspofungin monotherapy and four with sequential therapy of caspofungin followed by an azole (three with fluconazole, one with posaconazole). Fifteen (65%) patients expired within 90 days of the positive culture. Fourteen of the deaths were in candidemic patients, despite that eight (57%) of these patients had documented microbiologic clearance after appropriate therapy. The 90-day mortality rate was 74% for BSI.

Conclusions
This case series is the largest reported in the United States. Candidemia was the most common site of infection and had a very high 90-day mortality rate, despite sterilization of the blood. These findings highlight the significant morbidity and mortality associated with C. auris and the need to focus efforts on rapid diagnostics and infection prevention.

Disclosures
All authors: No reported disclosures.
LB15. Vaccine Effectiveness of Flucelvax Relative to Inactivated Influenza Vaccine During the 2017–18 Influenza Season in Northern California
Authors: Klein Nicola P , Fireman Bruce , Goddard Kristin , Zerbo Ousseny , Asher Jason , Zhou James , King James , Lewis Ned 
Published: November 2018

Abstract

Background
In June 2018, the CDC reported that influenza vaccine effectiveness (VE) against A(H3N2) influenza virus for the 2017–2018 season was ~24%. This lower than expected VE was hypothesized to be partially related to genetic changes arising in the vaccine virus during passage in eggs. Flucelvax™ (Seqirus) is a cell culture-based inactivated influenza vaccine (ccIIV) which is not manufactured in eggs. We investigated whether the VE of ccIIV against influenza A differed from that of egg-based IIV (ebIIV) during the 2017–2018 influenza season.

Methods
The study included all Kaiser Permanente Northern California members aged 4–64 years. We identified all individuals who were positive for influenza by polymerase chain reaction (PCR). This cohort analysis estimated the relative VE of ccIIV vs. ebIIV by comparing the ccIIV vaccinees vs. the ebIIV vaccinees with respect to the risk of PCR-confirmed influenza. We separately estimated the absolute VE of ccIIV and ebIIV by comparing each group of vaccinees with unvaccinated individuals. We used Cox regression with a calendar timeline, stratified by birth year, and adjusted for facility, race, years of membership, prior season influenza vaccine, co-morbidities, and number of inpatient admits in the prior year. We calculated VE as 1 − hazard ratio (HR).

Results
Of the 3,015,891 members aged 4–64 years, 1,017,314 were vaccinated. Of these, 932,874 (91.7%) received ebIIV and 84,440 (8.3%) received ccIIV. Most ebIIV (86.2%) was trivalent. Comparing ccIIV with ebIIV, the adjusted relative VE against influenza A was 6.8% (95% CI: 11.2, 21.9; P = 0.43). The adjusted absolute VE vs. unvaccinated of ccIIV was 30.2% (95% CI: 17.1, 41.3; P &lt; 0.0001) and of ebIIV was 17.9% (95% CI: 12.1, 23.3; P &lt; 0.0001).

Conclusion
Both cell-culture and egg-based IIV vaccines showed relatively low effectiveness during the 2017–2018 influenza season in which A(H3N2) predominated. The findings of this study show there was no significant difference in the effectiveness of cell-culture IIV compared with egg-based IIVs. Improvements in influenza vaccines will require ongoing monitoring of vaccine effectiveness.

Disclosures
N. P. Klein, GSK: Investigator, Research support. Sanofi Pasteur: Investigator, Research support. Merck: Investigator, Research support. Pfizer: Investigator, Research support. Protein Science: Investigator, Research support. MedImmune: Investigator, Research support. Dynavax: Investigator, Research support.
The Effect of Body Weight Support on Energy Expenditure in an Individual With High-Level Lower Extremity Amputation
Authors: Miller Carol A , Hayes Dawn M , Brooks Bailey E , Sloan Katie Y , Sloan Phillip G 
Published: November 2018

Abstract

Background
High-level lower extremity amputation (HLLEA) has significant impact on an individual's ability to ambulate and maintain cardiovascular fitness for extended periods of time.

Objective
The purpose of this study was to evaluate whether body weight support (BWS) would improve energy efficiency in an individual with HLLEA to achieve appropriate target cardiovascular intensity for aerobic training.

Design
This was an exploratory single-subject study.

Methods
The participant was a 45-year-old woman, 4.5 years after left hip disarticulation secondary to necrotizing fasciitis with resultant organ failure and cardiomyopathy. She was wearing a well-fitted prosthesis and had a goal of ambulating in the community with less fatigue. Vital signs and expiratory gases were recorded, and oxygen uptake efficiency slope was calculated during treadmill walking at 0%, 20%, and 40% unweighting. An age-matched control completed 0% unweighting baseline testing.

Results
Under all conditions of treadmill walking, the participant's heart rate, blood pressure, and rate of perceived exertion consistently increased as speed and time increased. The participant's oxygen uptake efficiency slope was most efficient at 20% unweighting, and the economy of movement improved as the percentage of BWS increased, bringing values closer to the age-matched control. The participant reported only minimal pain immediately following 20% unweighting.

Limitations
The primary limitation of this study is generalizability of findings because of minimal information for comparing the effects of BWS on aerobic capacity in individuals with HLLEA. Additionally, the percentages of unweighting using BWS were extrapolated based on corollary preexisting research; thus, there were no set parameters defined for this specific population.

Conclusions
BWS allowed the participant to work more efficiently, which suggests that if used during an intervention, BWS might enable individuals with HLLEA to achieve recommended levels of training for aerobic conditioning. In future studies, it is recommended that 20% BWS be used at a speed that results in moderate-intensity exercise for individuals with HLLEA as determined by 50% to 70% of maximum heart rate for 20 to 30 minutes.
Weight-related quality of life and temperament as predictors and moderators of outcomes among treatment-seeking, low-income, ethnically diverse children with obesity
Authors: Frerichs Leah , Smith Natalie R , Lyden Jessica , Gaskin Kiah , Skinner Asheley , Armstrong Sarah 
Published: November 2018

AbstractWithin any childhood obesity treatment program, some children have better outcomes than others. Little is known about predictors or moderators of more positive outcomes. We aimed to identify whether child temperament and weight-related quality of life predict or moderate childhood obesity treatment outcomes at 6 months. From 2015 to 2016, children (n = 97) ages 5–11 years old with obesity were randomized to a clinic–community (Bull City Fit) or a clinic-only treatment program. Linear regression was used to explore whether dimensions of child temperament and weight-related quality of life predicted or moderated 6-month anthropometric and physical activity outcomes. Children who had more social avoidance due to their weight at baseline had significantly better improvements in body fat percent in the clinic–community model compared with the clinic-only model at 6 months. Across programs, better baseline social quality of life predicted greater increases in waist circumference; conversely, better physical quality of life predicted a decrease in percent of the 95th percentile. Also, children with longer attention spans had greater increases in physical activity. Our findings suggest that children who have social avoidance due to their weight may benefit most from comprehensive clinic–community treatment. Weight-related quality of life may influence outcomes across all treatments, and practitioners need to carefully counsel children experiencing weight negatively.
Increasing the impact of randomized controlled trials: an example of a hybrid effectiveness–implementation design in psychotherapy research
Authors: Johnson Adrienne L , Ecker Anthony H , Fletcher Terri L , Hundt Natalie , Kauth Michael R , Martin Lindsey A , Curran Geoffrey M , Cully Jeffrey A 
Published: November 2018

Abstract
Randomized controlled trials (RCTs) are the gold standard for clinical research. However, significant delays between completion of RCTs and adoption of evidence-based practices into clinical settings remain. Engagement of stakeholders and implementation-focused outcomes to augment traditional RCTs hold the potential to increase the impact of RCT outcomes for clinical practice and more rapidly lead to the adoption of evidence-based practices in clinical settings. The purpose of this study is to discuss hybrid effectiveness–implementation designs and use a project example to highlight important methodological considerations to enhance the impact of RCTs. A hybrid effectiveness–implementation study assessed the effectiveness and implementation potential of brief cognitive behavioral therapy (bCBT) for rural Veterans. A patient-randomized trial (bCBT vs. enhanced usual care) explored the impact on depression symptoms. Implementation elements included engagement of stakeholders and a multifaceted provider training and support program to increase bCBT use by providers in Veterans Health Administration (VA) community-based outpatient clinics. Implementation outcomes included the number of providers who adopted bCBT, provider fidelity, and delivery outcomes (e.g., use of measurement-based care, treatment engagement, and completion). Hybrid designs offer opportunities to improve the alignment between research and practice, potentially improving dissemination of evidence-based interventions and reducing known delays in the translation from research to practice. Expansion of traditional RCTs through collaborative stakeholder contributions and stakeholder/consumer-informed implementation approaches is critical to improve adoption postproject. Although hybrid designs offer significant benefits related to generalizability and adoption, these approaches involve complex procedures and processes and often come at the cost of reduced internal study controls.
Radiation Exposure to the Surgeon, Surgical Assistant, and Scrub Nurse During Closed Intramedullary Nailing of Long Bones—Does It Vary Depending on the Experience of the Surgeon?
Authors: Patra Sudipta K. , Shetty Ajoy P. , Jayaramaraju Dheenadhayalan , Rajasekaran Shanmuganathan 
Published: November 2018

Objectives:
To assess radiation exposure (RE) to the surgical team and fluoroscopy time (FT) during closed nailing of long bone fractures performed under fluoroscopic guidance with regard to surgeon's experience.

Design:
Prospective observational study.

Setting:
Level-1 trauma center.

Participants:
Surgical team, comprising a surgeon, a surgical assistant, and a scrub nurse, for closed nailing procedures performed in 202 consecutive closed tibial and femoral diaphyseal fractures.

Intervention:
Dosimeter provided to each member of surgical team. Surgeon experience level (trainee, senior registrar, and consultant).

Main Outcome Measurements:
RE (microsieverts) to the surgical team and FT (minutes) were recorded from the dosimeter and fluoroscopic unit, respectively, and correlated with surgeon's experience.

Results:
In tibial nailing, mean RE (in µSv) per procedure to surgeon, surgical assistant, and scrub nurse was 15.2, 9.2, and 2.0 for trainees, 14.5, 8.1, and 1.6 for senior registrars, and 13.6, 7.4, and 1.5 for consultants, respectively. In femoral nailing, mean RE per procedure to surgeon, surgical assistant, and scrub nurse was 181.6, 113.6, and 37.1 for trainees, 110.1, 66.7, and 20.4 for senior registrars, and 79.9, 30.9, and 12.5 for consultants, respectively. RE to the surgeon was highest followed by surgical assistant and scrub nurse irrespective of operating surgeon's experience in both tibial and femoral nailing (P < 0.001). In tibial nailing, there was a significant difference in FT only for the stage of guide wire passage (P = 0.041), whereas in femoral nailing, total FT (P < 0.001), nail entry verification (P = 0.02), guide wire passage (P = 0.013), nail introduction (P = 0.006), and distal locking (P < 0.001) showed a significant difference.

Conclusions:
RE was maximum for operating surgeon and least for scrub nurse irrespective of operating surgeon's experience in both femoral and tibial nailing. FT and RE to the surgical team decreased with increasing experience of the surgeon in femoral nailing.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
IMMUNE RECOVERY UVEITIS-LIKE SYNDROME MIMICKING RECURRENT T-CELL LYMPHOMA AFTER AUTOLOGOUS BONE MARROW TRANSPLANT
Authors: Lavine Jeremy A. , Singh Arun D. , Baynes Kimberly , Srivastava Sunil K. 
Published: November 2018

Purpose:
To report the multimodal imaging findings of immune recovery uveitis mimicking recurrent T-cell lymphoma after autologous bone marrow transplant therapy.

Methods:
A 71-year-old man presented with posterior uveitis 6 weeks after chemotherapy and autologous bone marrow transplant for angioimmunoblastic T-cell lymphoma. Multimodal imaging included fluorescein angiography, fundus autofluorescence, and optical coherence tomography. Diagnostic testing included ocular polymerase chain reaction and diagnostic vitrectomy.

Results:
Clinical examination demonstrated vitritis and perivascular deep retinal whitening. Imaging of the retinal whitening showed late hyperfluorescence on fluorescein angiography, hyperautofluorescence on fundus autofluorescence, and ellipsoid zone loss on optical coherence tomography without infiltrative lesions. Testing was negative for syphilis, herpes simplex virus, varicella-zoster virus, and cytomegalovirus. After no clinical improvement with valacyclovir and intravitreal foscarnet treatment, diagnostic vitrectomy was performed. Bacterial and fungal cultures were negative, and herpes simplex virus, varicella-zoster virus, and cytomegalovirus were not detected by polymerase chain reaction. Cytopathology showed mature small nonneoplastic lymphocytes, macrophages, and monocytes. Flow cytometry demonstrated a reactive T-cell population. The patient demonstrated clinical improvement over time with spontaneous resolution of all retinal findings.

Conclusion:
This case most likely represents immune recovery uveitis-like syndrome. Diagnostic vitrectomy is highly valuable when the differential includes inflammatory, infectious, and neoplastic processes.
CONVERSION OF FOCAL CHOROIDAL EXCAVATION WITH THE ONSET OF CENTRAL SEROUS CHORIORETINOPATHY: REPORT OF 2 CASES AND REVIEW OF THE LITERATURE
Authors: Docherty Gavin , Sidiqi Ahmad , Martens Rosanna , Akil Handan , Navajas Eduardo V. 
Published: November 2018

Purpose:
To describe two cases of focal choroidal excavation (FCE) conversion in patients with central serous chorioretinopathy.

Methods:
Case report and literature review of cases of FCE conversion.

Results:
A 35-year-old asymptomatic pregnant patient was found to have conforming FCE on spectral domain optical coherence tomography of the right eye during hydroxychloroquine screening. Three months later, she presented with decreased vision in the right eye and subretinal fluid in both eyes secondary to central serous chorioretinopathy. Spectral domain optical coherence tomography revealed that her FCE had changed to nonconforming type. A 40-year-old male patient was found to have nonconforming FCE and subretinal fluid in his right eye on spectral domain optical coherence tomography. On follow-up, spectral domain optical coherence tomography demonstrated resolution of subretinal fluid and conversion of nonconforming FCE to conforming type. Literature review showed that most cases of FCE remain stable over time. Conversion from nonconforming FCE to conforming type has been described after photodynamic therapy or anti–vascular endothelial growth factor therapy. Conversion from conforming to nonconforming type has been described in 2 cases that developed subretinal fluid in the setting of acute central serous chorioretinopathy.

Conclusion:
Our cases and literature review suggest that nonconforming FCE is the result of persistent subretinal fluid. Further studies are necessary to determine whether symptomatic nonconforming SRF needs treatment to reduce subretinal fluid.
Using Group-based Trajectory Models and Propensity Score Weighting to Detect Heterogeneous Treatment Effects
Authors: Winn Aaron N. , Fergestrom Nicole M. , Neuner Joan M. 
Published: November 2018

Background:
We extend an interrupted time series study design to identify heterogenous treatment effects using group-based trajectory models (GBTMs) to identify groups before a new policy and then examine if the effects of the policy has consistent impacts across groups using propensity score weighting to balance individuals within trajectory groups who are and are not exposed to the policy change. We explore this by examining how adherence to endocrine therapy (ET) for women with breast cancer was impacted by reducing copayments for medications by the introduction of generic ETs among women who do not receive a subsidy (the “treatment” group) to those that do receive a subsidy and are not exposed to any changes in copayments (the “control” group).

Methods:
We examined monthly adherence to ET using the proportion of days covered for women diagnosed with breast cancer between 2008 and 2009 using SEER-Medicare data. To account for baseline trends, we characterize adherence for 1 year before generic approval of ET using GBTMs, within each groups we generate inverse probability treatment weights of not receiving a subsidy. We compared adherence after generic entry within each GBTM using a modified Poisson model.

Results:
GBTMs for adherence in the 1-year pregeneric identified 6 groups. When comparing patients who did and did not receive a subsidy we found no overall effect of generic introduction. However, 1 of the 6 identified adherence groups postgeneric adherence increased [the “consistently low” (risk ratio=1.91; 95% confidence interval=1.34–2.72)].

Conclusions:
This study describes a new approach to identify heterogenous effects when using an interrupted time series research design.
Palliative Care in Adolescents and Young Adults With Cancer—Why Do Adolescents Need Special Attention?
Authors: Pinkerton Ross , Donovan Leigh , Herbert Anthony 
Published: November 2018

AbstractMeeting shortfalls in the provision of care to adolescents and young adults with cancer has focused largely on improving outcomes and psychosocial support. A significant percentage of adolescents and young adults with cancer will die of disease because of initial poor prognosis conditions or disease relapse. In adults, progress has been made in the concept of an integrated cancer/palliative care service. In pediatric oncology, the application of this philosophy of care has lagged behind somewhat. In the case of adolescents, particularly those with advanced cancer, the palliative care needs, in a broader sense than only end-of-life care, are often not adequately met, irrespective of whether treatment is delivered in a pediatric or adult cancer service. There are a number of age-specific aspects to palliative and supportive care for adolescents. Complex interactions between clinicians, parents, and patients potentially limit the young person's ability to influence care planning. The wide variation in real or perceived competency at this age, the developmental challenges in relation to behavior, communication, and coping strategy all require particular professional expertise that is not always available.
Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference
Authors: Anastas Tracy , Colpitts Kelsey , Ziadni Maisa , Darnall Beth D. , Wilson Anna C. 
Published: November 2018

Abstract

Introduction:
Chronic pain in late adolescence and young adults is understudied and poorly characterized.

Objectives:
We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity.

Methods:
Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference.

Results:
Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference.

Conclusion:
Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.
Neonatal Teratoma: Craniofacial Treatment
Authors: Oommen John , Mohammed Hafiz , Ayyappan Kutty Shanker , Mammen Abraham , Kalathingal Kader , Vellani Thamunni Chandrabose , Sivadasan Anand , Nair Santhy 
Published: November 2018

Abstract
Teratomas are rare congenital neoplasms. Head and neck locations of the tumor are uncommon with combined intracranial and extracranial extensions being even more rare. The authors present a case of teratoma involving the temporal, buccal, maxillary, orbital and extending to the intracranial regions, which was successfully managed by surgical resection.