bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duboisian Leadership through Standpoint Epistemology
Authors: Bright Liam Kofi 
Published: November 2023

Abstract
I outline a defence of a naive group-level standpoint epistemology. According to this view then under conditions often met in real situations of oppression, it is the majority view on questions of import to those marginalised by oppression that ought to be treated as deference worthy. I further argue that this view is inspired by and coheres well with various doctrines laid out and defended by W.E.B. Du Bois, making this a recognisably Duboisian vision of standpoint epistemology. The central conceptual move is to relate principles of social epistemology under conditions of oppression that were of great interest to Du Bois with the conditions for group accuracy that have been studied by social-choice theorists working on Condorcet’s Jury Theorem, as well as contemporary epistemological work on group polarisation. I argue that once these elements are brought together a surprisingly cogent case for deference to the simple majority view of the marginalised can often be made.
Nicotine Formulation Influences the Autonomic and Arrhythmogenic Effects of Electronic Cigarettes
Authors: Kucera Cory , Ramalingam Anand , Srivastava Shweta , Bhatnagar Aruni , Carll Alex P 
Published: November 2023

Abstract

Introduction
Evidence is mounting that electronic cigarette (e-cig) use induces cardiac sympathetic dominance and electrical dysfunction conducive to arrhythmias and dependent upon nicotine. A variety of nicotine types and concentrations are available in e-cigs, but their relative cardiovascular effects remain unclear. Here we examine how different nicotine forms (racemic, free base, and salt) and concentrations influence e-cig-evoked cardiac dysfunction and arrhythmogenesis and provide a mechanism for nicotine-salt-induced autonomic imbalance.

Methods
ECG-telemetered C57BL/6J mice were exposed to filtered air (FA) or e-cig aerosols from propylene glycol and vegetable glycerin solvents either without nicotine (vehicle) or with increasing nicotine concentrations (1%, 2.5%, and 5%) for three 9-minute puff sessions per concentration. Spontaneous ventricular premature beat (VPB) incidence rates, heart rate, and heart rate variability (HRV) were compared between treatments. Subsequently, to test the role of β1-adrenergic activation in e-cig-induced cardiac effects, mice were pretreated with atenolol and exposed to either FA or 2.5% nicotine salt.

Results
During puffing and washout phases, ≥2.5% racemic nicotine reduced heart rate and increased HRV relative to FA and vehicle controls, indicating parasympathetic dominance. Relative to both controls, 5% nicotine salt elevated heart rate and decreased HRV during washout, suggesting sympathetic dominance, and also increased VPB frequency. Atenolol abolished e-cig-induced elevations in heart rate and declines in HRV during washout, indicating e-cig-evoked sympathetic dominance is mediated by β1-adrenergic stimulation.

Conclusions
Our findings suggest that inhalation of e-cig aerosols from nicotine-salt-containing e-liquids could increase the cardiovascular risks of vaping by inducing sympathetic dominance and cardiac arrhythmias.

Implications
Exposure to e-cig aerosols containing commercially relevant concentrations of nicotine salts may increase nicotine delivery and impair cardiac function by eliciting β1-adrenoceptor-mediated sympathoexcitation and provoking ventricular arrhythmias. If confirmed in humans, our work suggests that regulatory targeting of nicotine salts through minimum pH standards or limits on acid additives in e-liquids may mitigate the public health risks of vaping.
1026. Hepatitis B Reactivation in Persons with HIV with Positive Hepatitis B Core Antibody after Switching to Antiretroviral Therapy without Hepatitis B Activity
Authors: Denyer Rachel V , Tate Janet P , Benator Debra A , Lim Joseph K , Weintrob Amy 
Published: November 2023

Abstract

Background
One in three persons with HIV (PWH) without active hepatitis B virus (HBV) coinfection have a positive hepatitis B core antibody (cAb) suggesting prior HBV exposure. This group is at risk for HBV reactivation (HBVr) when changes to antiretrovirals (ARV) result in cessation of nucleos(t)ide reverse transcriptase inhibitors (NRTIs) with dual activity against HIV and HBV, e.g. tenofovir. Case reports of HBVr in PWH with positive cAb after NRTI cessation have been published, but the frequency of reactivation is unknown. Since FDA approval of dolutegravir-rilpivirine in 2017 and long-acting injectable cabotegravir-rilpivirine in 2021, increasing numbers of PWH are switching to ARV without HBV activity. We describe HBV reactivation in cAb positive PWH following switch to ARV without HBV activity (AHB-) from ARV with HBV activity (AHB+).

Methods
We used data from 60,290 PWH enrolled in the Veterans Aging Cohort Study to identify 7,860 who switched to AHB- prior to 12/31/2022 with prior positive cAb and negative pre-switch hepatitis B surface Ag (sAg). We excluded 779 due to active HBV (positive sAg or hepatitis B DNA [HBDNA] on nearest result pre-switch), leaving 7,081 eligible for analysis. We included PWH with remote prior positive sAg not meeting active HBV criteria. We defined HBVr as detection of HBDNA or sAg. AHB+ included lamivudine, emtricitabine, and/or tenofovir.

Results
HBVr occurred in 1.6% of PWH with positive cAb (n = 115) after switch to AHB-, with demographics summarized in Table 1. Table 2 shows prespecified subgroup analyses by prior sAg and hepatitis B surface antibody (sAb). Reactivation risk was 1.0% in those with no prior positive sAg and 20.2% in those with remote prior positive sAg (p &lt; 0.0001). Among those with no prior positive sAg, HBVr risk in those with positive sAb was 0.4%, compared with 1.1% in those without positive sAb (p = 0.065); among those with remote prior positive sAg, no difference in risk by sAb status was found (p = 0.64).

Conclusion
Overall risk of HBVr is low after AHB+ to AHB- switch among cAb positive PWH with no prior positive sAg. Our results will inform provider-patient discussion about risks of HBVr when considering switching to newer NRTI-sparing AHB- and also highlight the importance of pre-switch review of all prior hepatitis serology results.

Disclosures
All Authors: No reported disclosures
1099. CMV PCR Agreement between Blood and Dried Blood Spots in Infants with Congenital Cytomegalovirus Infection
Authors: Kim Juhyeong , Wang Huanyu , Katherine Medoro Alexandra , Pifer Traci , Crisan Rachelle , Leber Amy , Flint Kaitlyn , Powell Sebastian , Sanchez Pablo J , Shimamura Masako 
Published: November 2023

Abstract

Background
Dried blood spot (DBS) PCR sensitivity for congenital cytomegalovirus (cCMV) screening ranges from 34% to 86%, but it is unclear whether a negative DBS PCR reflects an absence of CMV DNAemia or a technical limitation in viral detection by DBS PCR. The objective of this study was to determine the agreement between CMV DNA PCR tests in plasma and DBS among cCMV infected infants.

Methods
This single center retrospective cohort study evaluated infants diagnosed with cCMV infection by urine CMV PCR at age ≤ 21 days due to clinical symptoms, failed newborn hearing screen, or NICU admission screening. Subjects with a plasma CMV PCR test performed within the first month after birth and a newborn CMV DBS PCR test were included in the study. Agreement between the plasma and DBS PCR tests was calculated using Cohen’s kappa coefficient. Clinical characteristics and viral loads were compared between groups with concordant and discordant DBS and plasma PCR tests using the Kruskal-Wallis or Mann-Whitney U test.

Results
70 cCMV infected infants were included in the study. 30 (43%) were female, 51 (73%) were white, 13 (19%) were black, 6 (8%) were other/multiracial, 3 (4%) were Hispanic, and 54 (77%) had symptomatic cCMV infection. 49 (70%) had DBS+/plasma+ PCR; 1 (1.4%) had DBS+/plasma- PCR; 14 (20%) had DBS-/plasma+ PCR; and 6 (9%) had DBS-/plasma- PCR. Groups had similar distributions of sex, race, ethnicity, gestational age, birthweight, birth length, birth head circumference, and symptomatic infection. DBS sensitivity was 71%. Agreement between the tests was fair (κ = 0.348, 95% confidence interval = 0.115-0.581). Of the 20 subjects with DBS- tests, 70% had plasma+ PCR and 30% had undetectable CMV DNA in plasma. Infants with DBS+/plasma+ PCR had significantly higher plasma viral loads compared to those with DBS-/plasma+ PCR (2245 IU/ml [761-5773] vs. 321 IU/ml [165-464], median [interquartile range]) (p &lt; 0.0001).

Conclusion
In this predominantly symptomatic cohort, DBS PCR identified the majority (71%) of infants with cCMV infection. A negative DBS PCR was associated with either low-level plasma CMV DNAemia that was seen in 20% of cCMV infected infants, or no plasma DNAemia in 9% of infants. These findings may impact the use of DBS as a screening test for cCMV infection.

Disclosures
Alexandra Katherine Medoro, MD, Merck: Grant/Research Support Amy Leber, PhD, Biomeriux: Grant/Research Support|BioRad: Advisor/Consultant|Cephied: Grant/Research Support|Diasorin: Grant/Research Support
1173. Risk of Pneumococcal Disease and Rate of Pneumococcal Vaccination Among Medicare Beneficiaries Aged 65 Years and Older Residing in Long-Term Care Facilities — United States, September 1, 2014 – December 31, 2019
Authors: Kobyashi Miwako , Andrejko Kristin , Zielinski Lindsay , Lindaas Arnstein , Cha Hyejeong , Lufkin Bradley , Chillarige Yoganand 
Published: November 2023

Abstract

Background
Adults living in long-term care (LTC) facilities are at increased risk of respiratory infectious diseases, including pneumococcal disease. On August 13, 2014, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in addition to 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults aged ≥65 years based on data that showed PCV13 vaccination confers protection against all-cause community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD). We assessed PCV13 vaccination coverage and incidence of CAP and IPD among Medicare beneficiaries with ≥1 LTC stay.

Methods
We identified Medicare Fee-for-Service beneficiaries aged ≥65 years with no prior PCV13 receipt and ≥1 LTC facility stay during September 1, 2014 through December 31, 2019 through Minimum Data Set assessments and skilled nursing facility claims. PCV13 and PPSV23 vaccination history was determined through Medicare claims using Healthcare Common Procedure Coding System and Current Procedural Terminology codes. Incident IPD and CAP outcomes were identified through inpatient Medicare claims using International Classification of Diseases diagnosis codes (ICD-9-CM/ICD-10-CM). Outcome incidence was calculated based on time during and outside LTC stays. PCV13 coverage was assessed by LTC residency status on December 31, 2019.

Results
There were 3,643,248 beneficiaries with ≥1 LTC facility stay during the observation period. Beneficiaries were majority white (89.9%), female (62.1%), aged ≥75 years (67.7%), and had ≥1 chronic medical condition (55.7%); 25.6% had received PPSV23 vaccination at the study start date. By December 31, 2019, PCV13 coverage was 55.3%; coverage among those residing in and outside a LTC facility was 47.5% and 57.3%, respectively. Incidence of CAP and IPD were higher during LTC compared with time outside LTC stay (incidence rate ratio 3.17 [95% CI: 3.15, 3.19] and 1.90 [95% CI: 1.80, 2.00] for CAP and IPD, respectively) (Table).

Conclusion
Incidence of IPD and CAP were higher during an LTC stay compared with time residing outside of a LTC facility. PCV13 coverage was lower among those in LTC. Improving pneumococcal vaccination coverage may help mitigate the risk of IPD and CAP in this population.

Disclosures
All Authors: No reported disclosures
1184. Investigating the Relationship Between Beta-Lactam Antibiotics and Thrombocytopenia: A Propensity Score-Matched Cohort Study
Authors: Chen Alyssa Y , Hanna John J , Basit Mujeeb , Monogue Marguerite 
Published: November 2023

Abstract

Background
Cases of beta-lactam (BL) induced thrombocytopenia (TCP) have been reported, but the evidence on whether BLs pose an increased risk for TCP remains inconclusive. This large-scale study examines the association of TCP with BLs when compared to alternative non-beta-lactams (nBL).

Methods
This retrospective study included adult inpatients who received at least one antibiotic administration at The University of Texas Southwestern Medical Center between 2008 and 2021. We excluded surgical patients, patients with baseline TCP, noncontinuous antibiotic therapy, no recorded platelet count value following antibiotic administration, and those who received more than one class of antibiotic therapy. Antibiotics were grouped into classes and subclasses (Table 1). BL as well as each BL subclass were compared to nBL. For each comparison group, propensity score matching was performed to control for age, sex, baseline PLT, days of antibiotic therapy, immunosuppression, exposure to other thrombocytopenic medications, hematologic cancer, and transplant status. The primary outcome was TCP defined as 1)&lt; 150×109/L or 2) &gt; 50% decrease from baseline in the 30 days following the first antibiotic administration. Secondary outcomes included TCP in 3 and 7 days, and clinically significant TCP(&lt; 50×109/L).

Results
A total of 13,887 unique patients were included, with 6,127 received exclusively BL and 7,760 nBL (Figure 1). Covariate balance was achieved following matching for each comparison. After matching, 931/5047 patients in the BL group developed TCP compared to 875/ 5047 matched patients in the nBL group. There was no statistically significant difference in the odds of TCP between both groups (OR, 1.08; 95 CI%, 0.97-1.19). Of the BL subclasses, only 1st generation cephalosporins and extended combination penicillins were found to carry statistically significant greater odds of TCP compared to nBL (Table 2). However, these differences disappeared for clinically significant TCP levels. There was no statistically significant difference in time to TCP for BL compared to nBL (Figure 2).Figure 1.Cohort flow diagramFigure 2.Kaplan Meier curve for thrombocytopenia by antibiotic class

Conclusion
The study found no statistically significant increase in TCP risk for BL when compared to nBL. Therefore, the risks and benefits should be considered before switching off preferred BL therapy.

Disclosures
Alyssa Y. Chen, MD, MPH, Advanced Clinical: Medical Specialist
1214. Short versus long antibiotic treatment duration for febrile urinary tract infection and acute pyelonephritis: A systematic review and meta-analysis
Authors: Schneider-Smith Erika , Bacher Bailey , Morgan-Gillard Xavier , Yaeger Lauren , Durkin Michael J , Marschall Jonas 
Published: November 2023

Abstract

Background
The optimal treatment duration for febrile UTI and pyelonephritis is unknown; however, multiple randomized trials have compared shorter versus longer duration. The most recent systematic review and meta-analysis was published 10 years ago.

Methods
With the support of a medical librarian (LY), we conducted a systematic review of the pertinent literature up to December 14, 2021. We used key terms for febrile urinary tract infection and acute pyelonephritis, treatment duration, and possible antimicrobial agents in the search. Using the evaluation tool Covidence, the identified abstracts were reviewed by the research team and potentially eligible studies were subject to full-text review. We also reviewed the references of eligible articles and scrutinized meeting abstracts. For the meta-analysis, we used SPSS version 28. For quality assessment, we used the Cochrane risk-of-bias tool.

Results
We screened 6732 abstracts, reviewed 21 full-text articles, and included 12 articles in this systematic review. We conducted a meta-analysis of these 12 articles (Figure 1). The Odds Ratio (OR) for clinical failure between short versus long treatment duration was 0.81 (95% CI 0.55-1.19). We also conducted a subgroup analysis for the more recent trials (#9-12 in Fig 1), with an OR 1.09 (95% CI 0.64-1.87), and the older trials (#1-8 in Fig 1), with an OR 0.68 (95% CI 0.36-1.31). The OR of experiencing an adverse event was 0.88 (95% CI 0.63-1.22) between short and long duration groups (Fig 2).Figure 1:Odds ratio of treatment failure with short versus long antibiotic course for febrile UTI and acute pyelonephritis
This figure represents the odds ratio of treatment failure in short versus long duration treatment. Therefore, an odds ratio &lt;1 favors short duration (i.e. lower odds of treatment failure), whereas an odds ratio &gt;1 favors long duration.Figure 2:Odds ratio of adverse events with short versus long antibiotic course for febrile UTI and acute pyelonephritis
This figure represents the odds ratio of a patient experiencing at least one adverse event in the short versus long duration treatment groups. Therefore, an odds ratio &lt;1 favors short duration (i.e. lower odds of adverse events), whereas an odds ratio &gt;1 favors long duration.

Conclusion
In this systematic review and meta-analysis of the evidence comparing shorter versus longer treatment durations for febrile UTI and pyelonephritis, 7 days of treatment were non-inferior to 14 days. There was no difference in adverse events between the two groups. Our findings confirm those of an earlier meta-analysis and serve as a reminder that shorter treatment durations for febrile UTI and pyelonephritis are sufficient.

Disclosures
All Authors: No reported disclosures
1215. The Impact of MRSA Nasal PCR on Antibiotic De-escalation
Authors: Silverman Adam , Gautam-Goyal Pranisha , Saunders-Hao Patricia , Kline Myriam , Jain Sumeet 
Published: November 2023

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) of the nares is effective in the screening and detection of MRSA colonization. Prior studies have shown that MRSA PCR has an overall negative predictive value (NPV) of more than 90% for ruling out MRSA infection of various anatomic sites.

Methods
We conducted a retrospective, single-center cohort study to determine if concomitant collection of an MRSA PCR nares swab among patients receiving IV vancomycin in the emergency department (ED) for suspected or known infection alters vancomycin days of therapy (DOT). We educated ED providers to collect MRSA PCR on all patients receiving a dose of vancomycin, however ordering and collection was left at the discretion of the provider. Patients who received at least one dose of IV vancomycin in the ED were identified through a medication usage report and were retrospectively reviewed through their hospital admissions to compare vancomycin DOT in patients who did and did not have an MRSA PCR collected. PCR collection was required to be done by the ED.

Results
Before education, collection of MRSA PCR by ED providers was 0%. Afterwards, there was an observed sustained MRSA PCR collection rate of approximately 25-30%. Of the 236 patients included, 98 had MRSA PCR collected and 138 did not. Both groups showed similar outcomes. There was no statistically significant difference between median vancomycin DOT in the PCR group vs. non-PCR group (3 vs. 2 days, p=0.2638). There was also no statistically significant difference in vancomycin-associated nephrotoxicity (5.10% vs. 5.80%, p=0.9731), hospital length of stay (median 7 days for both groups, p=0.5638), and mortality (10.20% vs. 11.59%, p=0.7368).

Conclusion
Despite the use of MRSA PCR in admitted patients undergoing treatment for suspected infection, there was no significant difference seen in vancomycin DOT or associated secondary outcomes. The utility of MRSA PCR at our institution was likely undermined by shorter vancomycin DOT at baseline, leading to difficulty detecting its impact on vancomycin de-escalation. Given the test’s high NPV, it is likely being underutilized and should be studied further as a tool in the de-escalation of vancomycin.

Disclosures
All Authors: No reported disclosures
1250. Association Between Antimicrobial Stewardship Resources and Practices Reported by California Hospitals in the National Healthcare Safety Network Annual Survey and California Department of Public Health Antimicrobial Stewardship Program Honor Roll Designation
Authors: Brenes Lizette , Czerny Becca , Mitsunaga Tisha , Epson Erin , Kriengkauykiat Jane 
Published: November 2023

Abstract

Background
California hospitals report information on antimicrobial stewardship (AS) Core Elements, resources, and practices through the National Healthcare Safety Network Annual Survey. The California Department of Public Health has an AS Program (ASP) Honor Roll to recognize and promote hospital AS. We explored associations between AS-related responses in the Annual Survey with Honor Roll designation, which ranks increasingly comprehensive ASP as Bronze, Silver, or Gold.

Methods
We linked 2020–2021 Annual Survey data to Honor Roll designations for acute care and critical access hospitals by year. We included 59 AS-related survey questions based on completeness and consistency between survey years. We compared survey responses by designations with chi-square and Fisher’s exact tests. We used a multivariable proportional odds regression model to evaluate the association of survey responses with the likelihood of ordinal designations. We used a stepwise approach and compared goodness-of-fit statistics at each iteration of model variable selection.

Results
Of 179 Honor Roll hospital designations with linked survey data, 21% were Gold, 41% Silver, and 38% Bronze in 2020, and 21% were Gold, 53% Silver, and 26% Bronze in 2021. The final ordinal model included 29 survey covariates related to leadership oversight, ASP lead, AS practices, and education. Hospitals significantly associated with higher designation included those that: performed prospective audit and feedback (PAF) of vancomycin (OR:4.09, 95%CI 1.27-13.83) and azoles (OR:3.37, 95%CI 1.07-11.31); and required prior authorization of newer beta-lactam/-lactamase inhibitors (OR:3.31, 95%CI 1.18-9.49) and echinocandins (OR:2.78, 95%CI 1.02-7.77), holding constant all other variables. Odds for higher designations were reduced if facilities performed PAF of echinocandins (OR:0.17, 95%CI 0.05-0.53).

Conclusion
Higher Honor Roll designation is a marker for a more effective ASP; thus, AS practices, especially prospective audit and feedback, in conjunction with resources related to ASP lead(s) and leadership oversight, should be prioritized by ASPs. Further exploration of practices, such as prior authorization of select antimicrobials, would be warranted as there were varying associations with designations.

Disclosures
All Authors: No reported disclosures