bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pilot of a Home Telehealth Platform in a Pediatric OPAT Program
Authors: Vaz Louise , Wagner Tamara , Cochran Bryan , Lovgren Mark 
Published: October 2017

Abstract

Background
Patients discharged with outpatient parenteral or prolonged oral antibiotic (OPAT) require monitoring to ensure optimal clinical outcomes. Advances in technology have allowed novel approaches for clinical interactions. We sought to develop a new home telehealth platform for a subsection of pediatric OPAT patients.

Methods
We used an existing infrastructure developed by our hospital telemedicine program to pilot the electronic home visit. A process was established to create a virtual connection at a pre-designated time using a HIPPA-secured web-based platform. Clinic staff performed a pre-visit technology check. Electronic Medical Record (EMR) scheduling platforms were created and the parent was coached on how to download and execute the necessary software. A virtual clinic was established between provider and family. Documentation occurred in the EMR with specific language and modifier codes for billing accuracy identified by the telemedicine team. Patients were selected based on medical complexity and travel time greater than 2 hours to our institution.

Results
Two pediatric OPAT patients completed the pilot in Spring 2017 for treatment of 1) CLABSI with retained line and 2) chronic ulcer with osteomyelitis. Three visits between the OPAT ID provider, located in her office, and the patient, located at home, were successfully piloted with video and voice. A routine clinic visit was conducted with a parent-driven physical exam. A clinical note was documented in the EMR with specific telemedicine templates. This platform also allowed for multi-disciplinary visits with a hospitalist and home health nurse to address a central line related issue with ID provider present. Total time for each visit was under 20 minutes.

Conclusion
We were able to demonstrate feasibility and functionality of this novel platform to conduct a billable OPAT clinic visit in a patient’s home. Health system infrastructure was a necessary and vital component to execution of the virtual clinic. Specific patient groups may benefit from this provider-patient interface. The use of telemedicine in OPAT may serve as a new platform for improving provider efficiency, lowering health system costs, and achieving greater patient satisfaction.

Disclosures
All authors: No reported disclosures.
Classical Fever of Unknown Origin: Retrospective Study in Infectious Clinical Hospital №2
Authors: Lunchenkov Nikolay , Filippov Eugene , Prihodko Olga , Volchkova Elena 
Published: October 2017

Abstract

Background
Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. The etiological structure of FUO is determined by many factors, including the one where a person lived and where has been hospitalized. The aim of this study is to investigate the etiology and clinical characteristics of adult classical FUO with more diagnostics available and to analyze the factors for certain disease categories.

Methods
The clinical data were retrospectively analyzed from 80 patients with cFUO hospitalized at the Infectious Clinical Hospital №2 between October 2015 and October 2016 the patients who met the D.Durack criteria (1) An axillary temperature of &gt;38.0 which corresponds oral temperature of &gt;38.3; (2) illness duration is more than 3 weeks; (3) there is no definite diagnosis after three outpatient visits or 3 days in the hospital with intensive investigations; (4) the fever is not related to FUO of other groups: nosocomial FUO, FUO in patients with AIDS, neutropenia were included.

Results
Of the 80 FUO cases, 70 were positively diagnosed with a diagnosis rate of 87,5%. Infectious diseases were still the primary causes of FUO 63% (n = 50). Among them the most frequent diagnoses were bacterial infection of unspecified site 12.5%&#x2028;(n = 10), infective endocarditis 11% (n = 9), as well as pneumonia 7.5% (n = 6) and viral infections of unspecified site 7.5% (n=6). Connective tissue diseases and other noninfectious inflammatory diseases accounted for 17.5% of the FUO cases among which SLE and autoimmune thyroiditis were the most common etiologies and made up 5% (n = 4) and 3,75% (n = 3), respectively. Neoplasms were 8% (n = 6) in our sample. Also ten patients (12,5%) could not be confirmed until they were discharged from hospital.

Conclusion
Infectious diseases are the major causes of FUO, and the most common cause is bacterial infection of unspecified site. To determine the etiology was difficult due to the limited conditions of the clinical hospital. Infectious endocarditis was found on the second place. The most common causative agents of infective endocarditis were MRSA (3/9) и streptococcus viridans (4/9). The frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.

Disclosures
All authors: No reported disclosures.
Clinical Characteristics of Diarrheal Illness with Enteropathogenic E. coli (EPEC) Diagnosed with FilmArray (BioFire Diagnostics, Salt Lake City, UT) Multiplex PCR (MPCR) Testing. Maria Georgen BS, Paul Schreckenberger, PhD, Paul O’Keefe MD. Loyola University Medical Center, Maywood, Illinois, USA
Authors: Georgen Maria 
Published: October 2017

Abstract

Background
EPEC is a known cause of diarrhea, predominately in children, which has not been identified with conventional stool culture in most medical centers. MPCR testing assesses stool samples in which DNA targets for 20 or more pathogens are tested with rapid turnaround. This method has become the standard for diagnostic testing in many clinical laboratories. MPCR testing has identified EPEC as among the most frequent pathogens in published studies.

Methods
We have completed a retrospective review of medical records of patients who tested positive for EPEC in our medical center.

Results
EPEC was found in 56 of 332 MPCR samples analyzed between February 1, 2016 and July 31, 2016. EPEC was the only pathogen in 25 while co-infecting pathogens were found in 31. Co-infections included other diarrhea-causing E. coli (ETEC, EAEC and EIEC but none with STEC) in 17, C. difficile in 7, viruses (astrovirus 3, sapovirus 2, norovirus 2, rotavirus 2), Campylobacter 3, Giardia 2, Salmonella 2, Pleisiomonas 1 and Yersinia 1.
Patients ages ranged from &lt;1 to 100 with 37 over age 19. Half were female. 7/46 had received antibiotic prior to sample collection. 10 reported recent travel. 51/52 presented to the emergency department, urgent care centers or ambulatory clinics. Symptoms included fever in 15/54, nausea 16/54, vomiting 14/54 and abdominal pain in 17/56. Diarrhea was described as watery in 23/32 and bloody in only 3. Antibiotic treatment was prescribed for 6/24 with EPEC only and for 22/31 with coinfection. A follow-up encounter was documented for 24 patients with EPEC only: 13 resolved, 3 remained ill and 8 could not be assessed.

Conclusion
EPEC is frequently found in stools from persons with diarrhea when MPCR is employed. Symptoms cannot be attributed to EPEC alone when other pathogens are found, but our analysis does suggest that EPEC is a common cause of diarrheal illness in adults as well as children. Prospective studies on natural history and treatment are necessary.

Disclosures
All authors: No reported disclosures.
Pharmacological Therapies for Hepatorenal Syndrome
Authors: Nanda Arjun , Reddy Rewanth , Safraz Humaira , Salameh Habeeb , Singal Ashwani K. 
Published: October 2017

Background:
Hepatorenal syndrome (HRS) is a serious complication of advanced chronic liver disease. Different pharmacological therapies have variable efficacy. We performed a systematic review and meta-analysis to compare the efficacy of various drugs in the treatment of HRS.

Study:
Randomized controlled trials comparing active drug with placebo or comparing 2 different drugs were included in this analysis. Primary study outcome was reversal of HRS. Secondary outcomes were HRS relapse and patient survival. Subgroup analysis was performed on patients with type 1 HRS.

Results:
Thirteen randomized controlled trial were eligible for analysis. Terlipressin plus albumin was more efficacious than placebo plus albumin (odds ratio=4.72; 95% confidence interval, 1.72-12.93; P=0.003) or midodrine plus albumin and octreotide (odds ratio=5.94; 95% confidence interval, 1.69-20.85; P=0.005), for HRS reversal. However, no significant difference was noted comparing terlipressin plus albumin versus noradrenaline plus albumin, octreotide plus albumin versus placebo plus albumin or noradrenaline plus albumin versus midodrine plus albumin and octreotide. None of the comparisons showed difference on HRS relapse or patient survival. Subgroup analysis revealed that terlipressin was more effective than placebo for type 1 HRS reversal, but no significant differences were noted between any other comparisons, and none of the comparisons showed difference on HRS relapse or patient survival.

Conclusions:
Intravenous infusion of terlipressin is the most effective medical therapy for reversing HRS. Intravenous infusion of noradrenaline is an acceptable alternative. Studies are needed as basis for developing pharmacological strategies to reduce relapse of HRS and improve patient survival.
Viral infections in solid organ transplant recipients: novel updates and a review of the classics
Authors: Haidar Ghady , Singh Nina 
Published: October 2017

Purpose of review
To summarize new discoveries in viral pathogenesis and novel therapeutic and prophylactic strategies in organ transplant recipients.

Recent findings
For decades, prophylaxis of cytomegalovirus (CMV) has been the standard preventive strategy, but new clinical trials are expected to determine the advantages of preemptive therapy over prophylaxis. Novel anti-CMV agents, such as maribavir and letermovir, are being studied for the treatment of resistant/refractory CMV as alternatives to foscarnet and cidofovir. CMV immune monitoring may offer individualized management plans. Epstein–Barr virus infections in transplant recipients are difficult to prevent and treat, though recent data suggest possible merit to pretransplant rituximab among high-risk transplant recipients. We review the groundbreaking HIV-to-HIV organ transplant trials, which are expected to revolutionize the care of HIV-infected individuals. Finally, we review topical developments in human herpesvirus 8, Zika virus, RNA respiratory viruses, adenovirus, norovirus, and polyoma viruses in organ transplantation.

Summary
Ongoing trials to optimize CMV prophylaxis and treatment, and outcomes of HIV-to-HIV organ transplantation in the United States, have significant implications to optimize management of these viruses in transplant recipients. Assessment of new antivirals and antiviral strategies, such as adoptive immunotherapy, is warranted for refractory viral infections.
Advances in understanding and management of lymphoedema (cancer, primary)
Authors: Keeley Vaughan 
Published: October 2017

Purpose of review
Despite being neglected both clinically and in research in the past, primary lymphoedema, and lymphoedema secondary to cancer treatment have been the subject of an increasing number of studies in recent years. This review will focus on new developments relevant to clinical practice.

Recent findings
The main themes covered by the review include the incidence and prevalence of lymphoedema, early detection and intervention in cancer-related lymphoedema, risk reduction for the development of cancer-related lymphoedema, surgical treatment, palliative care for lymphoedema in advanced cancer and developments in the genetics of primary lymphoedema.

Summary
Evidence suggests that lymphoedema is more common than has been previously recognized. It continues to be a significant problem for people following cancer treatment. Developments in the early detection and treatment of cancer-related lymphoedema should reduce the future impact for patients. Advice on how to reduce the risk of developing lymphoedema may need to be modified in light of recent research. New treatments such as surgical procedures are still in their infancy but the results seem encouraging for selected patients.
Exposing the bidirectional effects of alcohol on coagulation in trauma: Impaired clot formation and decreased fibrinolysis in rotational thromboelastometry
Authors: Howard Benjamin Michael , Kornblith Lucy Z. , Redick Brittney J. , Conroy Amanda S. , Nelson Mary F. , Calfee Carolyn S. , Callcut Rachael A. , Cohen Mitchell Jay 
Published: October 2017

BACKGROUND
Alcohol has been associated with altered viscoelastic testing in trauma, indicative of impaired coagulation. Such alterations, however, show no correlation to coagulopathy-related outcomes. Other data suggest that alcohol may inhibit fibrinolysis. We sought to clarify these mechanisms after traumatic injury using thromboelastometry (ROTEM), hypothesizing that alcohol-related clot formation impairment may be counter-balanced by inhibited fibrinolysis.

METHODS
Laboratory, demographic, clinical, and outcome data were prospectively collected from 406 critically injured trauma patients at a Level I trauma center. ROTEM and standard coagulation measures were conducted in parallel. Univariate comparisons were performed by alcohol level (EtOH), with subsequent regression analysis.

RESULTS
Among 274 (58%) patients with detectable EtOH, median EtOH was 229 mg/dL. These patients were primarily bluntly injured and had lower GCS (p < 0.05) than EtOH-negative patients, but had similar admission pH and injury severity (p = NS). EtOH-positive patients had prolonged ROTEM clotting time and rate of clot formation time (CFT/α); they also had decreased fibrinolysis (max lysis %; all p < 0.05). In linear regression, for every 100 mg/dL increase in EtOH, clotting time increased by 13 seconds and fibrinolysis decreased by 1.5% (both p < 0.05). However, EtOH was not an independent predictor of transfusion requirements or mortality. In high-EtOH patients with coagulopathic ROTEM tracings, transfusion rates were significantly lower than expected, relative to EtOH-negative patients with similar ROTEM findings.

CONCLUSION
As assayed by ROTEM, alcohol appears to have a bidirectional effect on coagulation in trauma, both impairing initial clot formation and inhibiting fibrinolysis. This balancing of mechanisms may explain lack of correlation between altered ROTEM and coagulopathy-related outcomes. Viscoelastic testing should be used with caution in intoxicated trauma patients.

Level of Evidence
Epidemiological study, level III.
The vascular facet of late-onset Alzheimer's disease: an essential factor in a complex multifactorial disorder
Authors: Iturria-Medina Yasser , Hachinski Vladimir , Evans Alan C. 
Published: October 2017

Purpose of review
This article provides a brief overview of relevant cerebrovascular mechanisms implicated in late-onset Alzheimer's disease (LOAD) development, and highlights the main reasons for incorporating novel cerebrovascular biomarkers to the models defining a multifactorial LOAD pathogenesis. We also discuss how novel brain mapping techniques and multifactorial data-driven models are having a critical role on understanding LOAD and may be particularly useful for identifying effective therapeutic agents for this disorder.

Recent findings
A growing body of evidence supports that LOAD is a complex disorder, causally associated to a high multiplicity of pathologic mechanisms. New experimental and neuroimaging data, in combination with the recent use of integrative multifactorial data-driven models, support the early role of vascular factors in LOAD genesis and development. Among other relevant roles, the cerebrovascular system has a key modulatory effect on prion-like propagation, deposition and toxicity (e.g. Aβ, tau proteins). The early signs of vascular dysregulation during LOAD progression are notable both at the microscopic and the macroscopic scales.

Summary
We emphasize that LOAD should be studied as a complex multifactorial disorder, not dominated by a dominant biological factor (e.g. Aβ), and without disregarding any relevant pathologic factor, such as vascular dysregulation. Cerebrovascular biomarkers are invaluable for defining multifactorial disease progression models as well as for evaluating the effectiveness of different therapeutic strategies.
Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community
Authors: Yan Jing , Grantham Michael , Pantelic Jovan , Bueno de Mesquita P. Jacob , Albert Barbara , Liu Fengjie , Ehrman Sheryl , Milton Donald K. ,   for the EMIT Consortium
Published: September 2017

AbstractLittle is known about the amount and infectiousness of influenza virus shed into exhaled breath. This contributes to uncertainty about the importance of airborne influenza transmission. We screened 355 symptomatic volunteers with acute respiratory illness and report 142 cases with confirmed influenza infection who provided 218 paired nasopharyngeal (NP) and 30-minute breath samples (coarse >5 μm and fine <5 μm fractions) on days 1 to 3 post symptom onset. We assessed viral RNA copy number for all samples and cultured NP swabs and fine aerosols. We recovered infectious virus from 52 (39%) of the fine aerosols and 150 (89%) of the NP swabs with valid cultures. The geometric mean RNA copy numbers were 3.8×104/30-min fine, 1.2×104/30-min coarse aerosol sample, and 8.2×108per NP swab. Fine and coarse aerosol viral RNA was positively associated with body mass index (fine p<0.05, coarse p<0.10) and number of coughs (fine p<0.001, coarse p<0.01) and negatively associated with increasing days since symptom onset (fine p<0.05 to p<0.01, coarse p<0.10) in adjusted models. Fine aerosol viral RNA was also positively associated with having influenza vaccination for both the current and prior season (p<0.01). NP swab viral RNA was positively associated with upper respiratory symptoms (p<0.01) and negatively associated with age (p<0.01) but was not significantly associated with fine or coarse aerosol viral RNA or their predictors. Sneezing was rare, and sneezing and coughing were not necessary for infectious aerosol generation. Our observations suggest that influenza infection in the upper and lower airways are compartmentalized and independent.SignificanceLack of human data on influenza virus aerosol shedding fuels debate over the importance of airborne transmission. We provide overwhelming evidence that humans generate infectious aerosols and quantitative data to improve mathematical models of transmission and public health interventions. We show that sneezing is rare and not important for, and that coughing is not required for influenza virus aerosolization. Our findings, that upper and lower airway infection are independent and that fine particle exhaled aerosols reflect infection in the lung, open a new pathway for understanding the human biology of influenza infection and transmission. Our observation of an association between repeated vaccination and increased viral aerosol generation demonstrated the power of our method, but needs confirmation.
Spatial Correlation as an Early Warning Signal of Regime Shifts in a Multiplex Disease-Behaviour Network
Authors: Jentsch Peter C. , Anand Madhur , Bauch Chris T. 
Published: September 2017

AbstractEarly warning signals of sudden regime shifts are a widely studied phenomenon for their ability to quantify a system’s proximity to a tipping point to a new and contrasting dynamical regime. However, this effect has been little studied in the context of the complex interactions between disease dynamics and vaccinating behaviour. Our objective was to determine whether critical slowing down (CSD) occurs in a multiplex network that captures opinion propagation on one network layer and disease spread on a second network layer. We parameterized a network simulation model to represent a hypothetical self-limiting, acute, vaccine-preventable infection with shortlived natural immunity. We tested five different network types: random, lattice, small-world, scale-free, and an empirically derived network. For the first four network types, the model exhibits a regime shift as perceived vaccine risk moves beyond a tipping point from full vaccine acceptance and disease elimination to full vaccine refusal and disease endemicity. This regime shift is preceded by an increase in the spatial correlation in non-vaccinator opinions beginning well before the bifurcation point, indicating CSD. The early warning signals occur across a wide range of parameter values. However, the more gradual transition exhibited in the empirically-derived network underscores the need for further research before it can be determined whether trends in spatial correlation in real-world social networks represent critical slowing down. The potential upside of having this monitoring ability suggests that this is a worthwhile area for further research.
Structural network maturation of the preterm human brain
Authors: Zhao Tengda , Mishra Virendra , Jeon Tina , Ouyang Minhui , Peng Qinmu , Chalak Lina , Wisnowski Jessica Lee , Heyne Roy , Rollins Nancy , Shu Ni , Huang Hao 
Published: September 2017

AbstractDuring the 3rdtrimester, large-scale of neural circuits are formed in the human brain, resulting in the adult-like brain networks at birth. However, how the brain circuits develop into a highly efficient and segregated connectome during this period is unknown. We hypothesized that faster increases of connectivity efficiency and strength at the brain hubs and rich-club are critical for emergence of an efficient and segregated brain connectome. Here, using high resolution diffusion MRI of 77 preterm-born and term-born neonates scanned at 31-42 postmenstrual weeks (PMW), we constructed the structural connectivity matrices and performed graph-theory-based analyses. We found faster increases of nodal efficiency mainly at the brain hubs, distributed in primary sensorimotor regions, superior-middle frontal and posterior cingulate gyrus during 31-42PMW. The rich-club and within-module connections were characterized by higher rates of edge strength increases. Edge strength of short-range connections increased faster than that of long-range connections. The nodal efficiencies of the hubs predicted individual postmenstrual ages more accurately than those of non-hubs. Collectively, these findings revealed regionally differentiated maturation in the baby brain structural connectome and more rapid increases of the hub and rich-club connections, which underlie network segregation and differentiated brain function emergence.
Green microalga Trebouxia sp. produces strigolactone-related compounds
Authors: Smýkalová I. , Ludvίková M. , Ondráčková E. , Klejdus B. , Bonhomme S. , Kronusová O. , Soukup A. , Rozmoš M. , Guzow-Krzemińska B. , Matúšová R. 
Published: September 2017

AbstractDifferent algal species that may have germination inducing activity of holoparasitic broomrape weeds Phelipanche aegyptiaca and P. ramosa seeds were screened through germination bioassay. Green alga produce SL-related compounds. Applied extracts of biomass obtained from the culture of green alga Trebouxia arboricola increased seeds germination of both parasites. An optimatization of the alga extraction led to an increase of P. aegyptiaca germination. Exhausted medium also contained SL-related compounds. The crude extract stimulated the roots length of Arabidopsis thaliana tested in vitro. A similar effect had the algae and GR24 aplications on expression levels of the SL-related genes in Physcomitrella patens. The novel analytical method DESI-MSI detected production of carlactone in the algae. The Trebouxia sp. culture applications in pot experiments had positive effect on growth characteristics of pea plants.