bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of indiscriminate fisheries on a group of small data-poor species in Thailand
Authors: Aylesworth Lindsay , Phoonsawat Ratanavaree , Vincent Amanda C J 
Published: October 2017

AbstractAs catches of economically valuable target fishes decline, indiscriminate fisheries are on the rise, where commercial and small-scale fishers retain and sell an increasing number of marine species. Some of these catches are destined for international markets and subject to international trade regulations. Many of these species are considered “data-poor” in that there are limited data on their biology, ecology, and exploitation, which poses a serious management challenge for sustainable fisheries and trade. Our research explores the relative pressure exerted by such indiscriminate fisheries on a data-poor marine fish genus—seahorses (Hippocampus spp.)—whose considerable international trade is regulated globally. Our focus is Thailand, a dominant fishing nation and the world‘s largest exporter of seahorses, where we gathered data by interviewing commercial and small-scale fishers and through port sampling of landed catch. We estimate that annual catches were more than threefold larger than previously documented, approximating 29 million individuals from all gears. Three fishing gears–two commercial (otter and pair trawl) and one small-scale (gillnet)–caught the most individuals. Results from port sampling and our vulnerability analysis confirmed that H. kelloggi, H. kuda, and H. trimaculatus were the three species (of seven found in Thai waters) most susceptible to fishing. Small-scale gillnets captured the majority of specimens under length at maturity, largely due to catches of juvenile H. kuda and H. trimaculatus. This research indicates a role for vulnerability analysis to initiate precautionary management plans while more extensive studies can be conducted.
Étale Fundamental Groups of Strongly $\boldsymbol{F}$-Regular Schemes
Authors: Bhatt Bhargav , Carvajal-Rojas Javier , Graf Patrick , Schwede Karl , Tucker Kevin 
Published: October 2017

Abstract
We prove that a strongly $F$-regular scheme $X$ admits a finite, generically Galois, and étale-in-codimension-one cover $\tilde X \to X$ such that the étale fundamental groups of $\tilde X$ and $\tilde X_{{\mathrm{reg}}}$ agree. Equivalently, every finite étale cover of $\tilde X_{{\mathrm{reg}}}$ extends to a finite étale cover of $\tilde X$. This is analogous to a result for complex klt varieties by Greb, Kebekus, and Peternell.
The Association of Molecular Characteristics, Vancomycin MIC and Clinical Outcomes in Methicillin-susceptible Staphylococcus aureus Osteoarticular Infections in Children
Authors: McNeil Jonathon , Vallejo Jesus G , Rosas Louie , Mason Edward O , Kaplan Sheldon L , Hulten Kristina G 
Published: October 2017

Abstract

Background
Methicillin-resistant Staphylococcus aureus, particularly those belonging to the USA300 pulsotype and bearing Panton–Valentine leucocidin (pvl), have been well described to cause severe osteoarticular infection (OAI). Vancomycin minimum inhibitory concentration (MIC) ≥ 1.5 µg/ml has been demonstrated to contribute to disease severity in MRSA bacteremia. Little data exist to describe the spectrum of outcomes in MSSA OAI in terms of molecular characteristics and vancomycin MIC.

Methods
OAI isolates were identified from 2011 to 2016 and subjected to vancomycin E-tests. MSSA isolates underwent PFGE, PCR for pvl, and a stepwise assay to determine accessory gene regulator (agr) group. A review of the medical record was performed. Orthopedic complications included chronic osteomyelitis, pathologic fracture, and growth arrest.

Results
During the study period, 167 cases of S. aureus OAI were identified; 115 were MSSA (68.9%). 29.1 and 26.1% of MSSA isolates were USA300 and pvl positive, respectively. USA300 isolates were more likely to be pvl-positive (66.7 vs. 13.6%, P &lt; 0.001) and agr I (80% vs. 57.5%, P = 0.001). The presence of pvl was associated with agr I (P = 0.03), larger abscesses (6 vs. 2cm, P = 0.04), ICU admission (16.7 vs. 3.5%, P = 0.03) and a longer length of stay (11 vs. 6 days, P = 0.05). agr III and IV were associated with a higher rate of orthopedic complications (36.4 vs. 13.9%, P = 0.03) and surgical procedures (90.1 vs. 64.5%, P = 0.02) than other agr groups. An increase in the proportion of MSSA isolates with a vancomycin MIC ≥ 1.5 µg/ml occurred in the study period (P = 0.007, Figure 1). In MSSA, vancomycin MIC ≥ 2 µg/ml was associated with agr III (p = 0.07) and higher rates of orthopedic complications (P = 0.08) and venous thrombosis (P = 0.06, Figure 2).

Conclusion
MSSA accounts for 70% of S. aureus isolates causing OAI at TCH. While pvl-positive strains are associated with worse short-term outcomes, agr III and IV are associated with long-term morbidity. Vancomycin E-test MICs appear to be increasing among MSSA; vancomycin MIC ≥ 2 µg/ml are associated with agr-III and adverse clinical outcomes suggesting that this may be a surrogate for disease severity. Further work is needed to understand the contribution of these factors to invasive MSSA disease.

Disclosures
J. McNeil, NIAID, NIH: Grant Investigator, Grant recipient. &#x2028;S. L. Kaplan, Pfizer: Grant Investigator and Speaker at PCV13 Launch Meeting in China, Research grant and Speaker honorarium
U.S. Combat-related Invasive Fungal Wound Infection (IFI) Epidemiology and Wound Microbiology: Afghanistan Theater 2009–2014
Authors: Ganesan Anuradha , Shaikh Faraz , Peterson Philip , Bradley William P , Blyth Dana M , Lu Dan Z , Bennett Denise , Schnaubelt Elizabeth , Johnson Brian , Merritt Teresa , Flores Nicole , Hawthorne Virginia , Wells Justin , Carson Leigh , Tribble David R 
Published: October 2017

Abstract

Background
Culturing combat-related wounds often yields both fungi and bacteria. It is difficult to differentiate fungal contamination from infection, and objective criteria that identify patients at risk for IFI are needed. This study was designed to characterize IFI among US combat casualties in the Afghanistan Theater.

Methods
This retrospective study includes subjects with any labortory evidence of fungi (either histopathology or cultures). Wounds with ongoing necrosis and labortory evidence of infection were classified as IFI). Wounds with labortory evidence of fungal infection, but without ongoing necrosis were classified as either highly suspicious wounds based on objective clinical criteria (i.e., presence of systemic and local signs of infection and use of antifungals for ≥10 days) or non-IFI wounds if they failed to meet clinical criteria.

Results
Of 1932 subjects, 246 (12.7%) had labortory evidence of fungal infection. There were a total of 143 IFI wounds (n = 94), 157 non-IFI wounds (n = 96), and 113 high suspicion wounds (n = 56). IFI subjects had significantly higher injury severity scores (ISS median: 39.5 vs. 33), Sequential Organ Failure Assessment (SOFA) scores (7 vs. 2) and were more likely to require mechanical ventilation (66 vs. 28%). IFI patients also had higher ISS (93 vs. 84% with ISS &gt;25) and SOFA scores (7 vs. 4) compared with the subjects with high suspicion wounds. IFI wounds often grew molds belonging to the order Mucorales compared with high suspicion (19 vs. 10%, P = 0.04) and non-IFI wounds (19 vs. 7%, P = 0.02). About half of the IF wounds grew fungi of the order Mucorales either isolated alone or in conjunction with other fungi, in comparison, 25% of the high suspicion wounds and 11% of the non-IFI wounds grew fungi of the order Mucorales. Three groups of fungi belonging to the order Mucorales, genus Aspergillus and Fusarium accounted for 83% of the IFI wounds and 74% of the high suspicion wounds.

Conclusion
Labortory evidence of fungal infection is common among combat casualties. Clinical characteristics and wound microbiology allows us to group subjects into groups at low and high risk of IFI. Fungi of the order Mucorales, genus Aspergillus and Fusarium should not be considered contaminants. The presence of these fungi should obligate close clinical follow-up and debridement as needed.

Disclosures
All authors: No reported disclosures.
Current Epidemiology of Serogroup W Meningococcal Disease—United States, 2010–2015
Authors: Soeters Heidi , Blain Amy , Chang How-Yi , Whaley Melissa , Macneil Jessica 
Published: October 2017

Abstract

Background
Serogroup W (NmW) meningococcal disease is a rare but severe infection. Following an NmW outbreak after the Hajj in 2000, NmW disease, predominantly caused by sequence type (ST)-11 clonal complex (cc), rapidly increased in South Africa, South America, and the UK. We describe NmW meningococcal disease epidemiology in the USA during 2010–2015.

Methods
Data were collected from the National Notifiable Diseases Surveillance System, Active Bacterial Core surveillance, and state health departments. Isolates were serogrouped via slide agglutination and real-time polymerase chain reaction. For cases lacking a serogroup result at CDC, the state result was used. Case-fatality ratios (CFR) were calculated using the proportion of cases with known outcomes as the denominator. cc and ST were determined using multilocus sequence typing (MLST).

Results
From 2010 to 2015, 3,504 meningococcal disease cases were reported to CDC; 2,976 (85%) had a serogroup result, of which 290 (10%) were NmW. Although the number of NmW cases reported annually remained fairly stable (range: 40–57), the total number of reported meningococcal disease cases decreased by 60%, and the proportion of cases due to NmW increased from 6% (42/830) in 2010 to 12% (40/332) in 2015. The majority of NmW cases were reported from five states: Florida (n = 106), California (n = 31), New York (n = 25), Georgia (n = 19), and Oregon (n = 11). Half of people with NmW disease were male, 185 (64%) were white, and 84 (29%) were Hispanic. The median age was 51 years (interquartile range: 26–70). Overall, 20% (52/259) of NmW cases were fatal, compared with CFRs for serogroups B (15%), Y (18%), or C (24%). NmW CFR was highest among adults aged 50–59 years (38%). MLST results were available for 119 (41%) of NmW cases: 76 (64%) were cc11, 40 (34%) were cc22, and 1 each were cc23, cc32, and an unassigned cc. cc appeared to be geographically associated: cc11 was concentrated in Florida and Georgia, while cc22 predominated on the West coast. Within cc11, the majority of isolates (86%) were ST-11, and within cc22 the majority (73%) were ST-22.

Conclusion
A rapid increase in NmW disease has not been observed in the USA. Most NmW cases were reported in a limited number of states, with geographic differences in clonal complex.

Disclosures
All authors: No reported disclosures.
Detection of Respiratory Pathogens in Parapneumonic Effusions by Hypothesis-free, Next-Generation Sequencing (NGS)
Authors: Ampofo Krow , Pavia Andrew , Blaschke Anne J , Schlaberg Robert 
Published: October 2017

Abstract

Background
Species-specific polymerase chain reaction (PCR) testing of pleural fluid (PF) from children with parapneumonic effusion (PPE) has increased pathogen identification in pediatric PPE. However, a pathogen is not detected in 25–35% of cases. Hypothesis-free, next-generation sequencing (NGS) provides a more comprehensive alternative and has led to pathogen detection in PCR-negative samples. However, the utility of NGS in the evaluation of PF from children with PPE is unknown.

Methods
Archived PF (n = 20) from children younger than 18 years with PPE and hospitalized at Primary Children’s Hospital, Utah, in 2015 and previously tested by PCR were evaluated. Ten PCR-negative and 10 PCR-positive PF specimens were tested using RNA-seq at an average depth of 7.7×106 sequencing reads per sample. NGS data were analyzed with Taxonomer. We compared pathogens detected by blood and PF culture, PCR, and NGS.

Results
Overall, compared with blood/PF culture, PF PCR and PF NGS testing of PF increased bacterial identification from 15% to 50% (P &lt; 0.05) and 65% (P = 0.003), respectively. Pathogen detection in PF by PCR and NGS were comparable (50 vs. 65%, p = NS) (Table). However, compared with PF PCR, NGS significantly increased detection of S. pyogenes (20% vs. 55%; P &lt; 0.05), with 100% concordance when detected by PCR and culture. Detection of Fusobacterium spp. (10 vs. 10%) by PF NGS and PF PCR were comparable. In contrast, there was no detection of S. pneumoniae (15 vs. 0%) by PF NGS compared with PF PCR.

Conclusion
PF NGS testing significantly improves bacterial identification and comparable to PF PCR testing, which can help inform antimicrobial selection. However there were differences in detection of S. pneumoniae and S. pyogenes. Further studies of NGS testing of PF of children with PPE are needed to assess its potential in the evaluation of PPE in children.

Disclosures
A. J. Blaschke, BioFire Diagnostics LLC: Collaborator, Have intellectual property in BioFire Diagnostics through the University of Utah and Investigator, Licensing agreement or royalty and Research support; R. Schlaberg, IDbyDNA: Co-founder, Consultant and Shareholder, Stock
Trends and Associations with PrEP Prescription Among 602 New York City (NYC) Ambulatory Care Practices, 2014–2016
Authors: Salcuni Paul , Smolen Jenny , Jain Sachin , Myers Julie , Edelstein Zoe 
Published: October 2017

Abstract

Background
Concern over equitable access to HIV preexposure prophylaxis (PrEP) informs comprehensive scale-up efforts in New York City (NYC). We examined trends plus patient and practice factors associated with PrEP prescribing by NYC ambulatory care practices.

Methods
We queried electronic health records (EHR) from Q1 2014 to Q2 2016 using the NYC Health Department’s “Hub.” Data from 602 practices were aggregated quarterly by patient factors, including age (18–29, 30–100); sex (male, female); and race/ethnicity (Asian, Black, Hispanic, White, other, missing). Practice factors included location (Manhattan, other); type (community health center [CHC], hospital, independent); number of infectious disease (ID) specialists; and proportion of patients (ranked by quartile) from high poverty neighborhoods (ZIP codes in which ≥20% of residents live below the federal poverty level). PrEP prescription was defined as tenofovir/emtricitabine prescription without other antiretrovirals or diagnoses of HIV, HIV-related opportunistic infections or hepatitis B. Rates were calculated per 105 patients seen. We used generalized estimating equations clustered by practice to examine trends overall and by sex, as well as associations among males. Factors and time interactions that were significant (P &lt; 0.05) in bivariate analysis were assessed for inclusion in the final model.

Results
Overall, PrEP prescription rose from 38.9 per 105 in Q1 2014 to 418.5 per 105 in Q2 2016, a 976% increase. Increases were significant for both sexes (P &lt; .0001; Figure 1). In multivariate analysis (Table 1), PrEP prescription was associated with both patient (younger age, white race/ethnicity) and practice factors (Manhattan location, CHCs, and on-site ID specialists). While practices with a greater proportion of patients from high poverty neighborhoods were less likely to prescribe PrEP initially, this association weakened over time (Table 2).

Conclusion
PrEP prescription increased over 9-fold from 2014 to 2016 among NYC ambulatory care practices, but disparities persisted. While efforts to promote PrEP may have helped attenuate the disparity by neighborhood poverty of the patient population, continued work may be needed to facilitate PrEP access for women, persons of color and for those in care at non-CHCs or practices outside of Manhattan.

Disclosures
All authors: No reported disclosures.
Estimating Risk to Humans Exposed to Highly Pathogenic Avian Influenza Outbreaks in the United States, 2014–2017
Authors: Olsen Sonja , Havers Fiona , Rolfes Melissa , Blanton Lenee , Rooney Jane , Gomez Thomas , Nelson Deborah , Karli Steven , Trock Susan C , Fry Alicia M 
Published: October 2017

Abstract

Background
In the USA, poultry outbreaks of highly pathogenic avian influenza viruses (AI) caused by H5 and H7 viruses have raised concern about the risk of infections in humans. Based on data from Asian lineage H5 and H7 AI, which sporadically transmit from poultry to humans, CDC currently recommends active daily monitoring of persons exposed to H5 and H7 AI viruses, including those who wear personal protective equipment (PPE).

Methods
Persons exposed to HPAI-infected birds or contaminated environments in the USA were actively monitored during exposure and for 10 days post-exposure for illness, during 2014–2017. Some exposed persons were monitored on-site by USDA or contract safety officers, company staff, or state health officials. State health department staff monitored people during the 10-day post-exposure period. Persons reporting any respiratory illness or conjunctivitis were swabbed for molecular influenza testing. Preliminary results are presented.

Results
From 2014 to 2017, 270 detections in poultry/wild birds were reported and at least 606 persons were potentially exposed to AI virus by exposure to birds, carcasses, or environment. Most exposed persons wore PPE. No human infections with AI viruses were detected.

Conclusion
The risk of transmission of these H5 and H7 AI viruses to humans was low. These preliminary data offer evidence to change the recommendations for monitoring in persons exposed to these viruses. If final data support these findings, self-monitoring by workers with reporting to health departments if symptoms develop, rather than active monitoring by public health personnel, could be considered. However, it will be important to reconsider and update recommendations as the viruses evolve. Furthermore, risk of infection likely varies by exposure and those without PPE should be actively monitored.

Disclosures
All authors: No reported disclosures.
Interdisciplinary Public Health Intervention in a Multigenerational Tuberculosis (TB) Outbreak in Harris County, Texas: A Case Study with Implications for Disease Control Process Improvement and Transmission Cycle Interruption
Authors: Haynie Aisha , Plasencia Carlos , Fields Kimberly , Nesbitt Elna , Lovings-Clark Audrey , Scott Mary , Wiltz-Beckham Dana , Reed Brian , Shah Umair A 
Published: October 2017

Abstract

Background
Harris County Public Health (HCPH) is the health department for Harris County, Texas jurisdiction. Harris County as a whole is the nation’s third most populous county, with 4.3 million residents, and a TB case rate more than double that of the USA. (7.6 cases per 100,000 pop). A total, 327 individuals were diagnosed with TB in Harris County during 2015, over two-thirds occurring in foreign-born individuals. In 2016, HCPH treated an immigrant female with active TB. Initial contact investigation (CI) yielded five household contacts (HHC). Two tested positive, but refused subsequent clinical evaluation by HCPH. Two months later, HCPH was notified of a HHC hospitalized with TB. After hospital discharge, the sick HHC moved into a motel in attempts to self-isolate, but refused evaluation of additional HHC in the home, and banned home access, precluding adequate CI. After numerous phone calls, visits to motel and home, and multiple rescheduled appointments, legal action appeared inevitable. Days later, HCPH was notified of another HHC diagnosed with active TB.

Methods
With alarm regarding the family’s adherence to control orders, TB staff implemented an innovative multidisciplinary team-based intervention in hopes of avoiding legal action. A site visit was paid to the motel by a local health authority, two TB staff, a county public investigator, and a refugee clinic outreach worker fluent in the family’s language. Patients were presented with letters requesting immediate cooperation to avoid court filings. Questions were answered, misinformation corrected, and education provided.

Results
Intermediary on-site intervention using a compassionate, firm multidisciplinary team approach resulted in 16 additional family members tested, yielding an infant with active TB (Case 4) and 8 with TB Infection (TBI). Isolation breaches were also discovered. Most importantly, TB transmission cycle was interrupted. Cultural and economic barriers hindering successful interaction with family were addressed, TB misconceptions corrected, and trusting relationship developed.

Conclusion
This innovative multidisciplinary intervention avoided court proceedings and curtailed the TB transmission cycle. HCPH improved its non-adherence intervention process, and modified TB control orders for infectious patients residing in congregate settings.

Disclosures
All authors: No reported disclosures.
Getting it Right the First Time: Relating Pharmacokinetic-Pharmacodynamic Target Attainment and Patient Outcomes
Authors: Bulik Catharine C , Bader Justin C , Lakota Elizabeth A , Bhavnani Sujata M , Rubino Christopher M , Sweeney Kim L , Ambrose Paul G , Owens Robert C 
Published: October 2017

Abstract

Background
The importance of delivering appropriate therapy to patients at the onset of treatment is well established. However, this goal is easier said than done given the complexity and uniqueness of each patient case. Nonetheless, treatment decisions driven by pharmacokinetic-pharmacodynamic (PK-PD) can account for patient variability and assist in selecting patient-specific therapies. Using data obtained from electronic decision support software (EDSS), we evaluated the relationship between the probability of PK-PD target attainment (PTA) and patient outcomes.

Methods
Data obtained over a 20-month period from an EDSS were evaluated and included: (1) patient demographics; (2) infection type; (3) pathogen; (4) clinician-selected antimicrobials; (4) pathogen susceptibility; (5) clinician-provided early and late outcomes. Data calculated by the EDSS included the PTA for all evaluated antimicrobial regimens. Using logistic regression, relationships between the probability of PTA and clinical improvement and clinical success at 48 hours and Days 7–10, respectively, were assessed.

Results
Data for 121 patient cases with various infection types were available. The most common pathogens reported were MRSA (14.9%) and K. pneumoniae (14.9%). Overall, 76.3% of patients demonstrated clinical improvement at 48 hours while 70.3% of patients demonstrated clinical success at Days 7–10. Based on the relationship between the probability of PTA and clinical improvement at 48 hours (Figure 1), for every 10% increase in PTA, patients were 1.74 times more likely to demonstrate clinical improvement (OR [95% CI] 1.74 [1.28–2.37], P &lt; 0.001). At Days 7–10 (Figure 2), patients were 1.82 times more likely to have a successful response (OR [95% CI] 1.82 [1.29–2.58], p &lt; 0.001). Based on these relationships, the predicted percent probability of a positive outcome at 48 hours and Days 7–10 for an initial treatment regimen with PTA of 90% was 77.2% and 76.1%, respectively.

Conclusion
Statistically significant positive relationships between PTA and clinical outcomes at 48 hours and Days 7–10 were identified. These data demonstrate the value of PK-PD in dosing regimen selection and provide a path toward delivering appropriate initial therapy to optimize patient outcomes.

Disclosures
S. M. Bhavnani, ICPD Technologies: Shareholder, stock options; C. M. Rubino, ICPD Technologies: Shareholder, stock options; P. G. Ambrose, ICPD Technologies: Shareholder, stock options