bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring Overweight and Obesity in Persons with Spinal Cord Injury: What Do Health Providers Use and What are the Challenges?
Authors: Pellegrini Christine A , Burkhart Lisa , Ramey Kaitlyn , LaVela Sherri L 
Published: November 2023

ABSTRACT

Introduction
Obesity is a significant health concern for veterans and individuals with spinal cord injury, yet screening for overweight/obesity can be challenging. This study examines how healthcare providers screen for overweight/obesity and the challenges encountered in identifying overweight/obesity in veterans and persons with spinal cord injury.

Materials and Methods
Healthcare providers who provide care for persons with spinal cord injury completed a semi-structured interview. The interview explored their perspectives on measuring overweight/obesity in persons with spinal cord injury and the challenges they faced. Thematic analysis was used to identify themes that emerged from the interviews.

Results
Twenty-five providers (88% female with an average experience of 9.6 ± 7.3 years in providing care for spinal cord injury patients) participated in the interviews. The themes described the health indicators and equipment used to assess overweight/obesity, provider concerns regarding measurement, and criteria for classifying overweight/obesity. Body weight and body mass index were the most commonly used indicators. However, concerns were raised regarding accuracy of these measures for spinal cord injury patients, as well as issues related to the accessibility, calibration, and usability of the equipment. Many providers reported using standard body mass index ranges and categories instead of those specific to spinal cord injury.

Conclusion
This study identified the most commonly used indicators of weight or body composition in veterans and persons with spinal cord injury and highlighted providers’ concerns with these measures. Future research is needed to identify the most feasible, accurate, and appropriate health indicators that could be used in a clinical setting to identify overweight and obesity in this population.
1451. Elizabethkingia spp. Outbreak in a Ventilator-capable Skilled Nursing Facility, Chicago 2023
Authors: Thigpen Sidney , Walblay Kelly , Adil Hira , Zelencik Shane , Zelinski Christy , Nelson Kathryn , Cox Brian , McQuiston John R , Turner Janice , Toews Karrie-Ann , Kim Do Young , Black Stephanie R 
Published: November 2023

Abstract

Background
In July 2022, the Chicago Department of Public Health (CDPH) was notified of four residents with Elizabethkingia (Ek) infections at a ventilator-capable skilled nursing facility (vSNF A). The facility reviewed microbiology records, identified six additional cases and CDPH initiated an investigation.

Methods
A case-patient was defined as a resident at vSNF A with Ek spp. identified from a clinical specimen. Information was collected via case report form regarding risk factors for Ek infection. Site visits were conducted to observe dialysis, wound care practices, and water disruption. Environmental and clinical isolates were sequenced by the CDC to assess genetic relatedness.

Results
January 2021-2023, 14 case-patients were identified with Ek infection: 11 bacteremias, two pneumonias, and one had both. Two case-patients died. Nine case-patients were hemodialyzed, six required ventilator support, and all case-patients had decubitus ulcers. Seven had exposures to tap-water during care. Site visits revealed potential exposure through bathing or healthcare worker hands contaminated by tap-water, personal items on sink-tops, and sterile supplies stored by sinks. Water quality parameters verified chlorine levels above minimum standards by the Illinois Pollution Control Board. Among environmental samples collected, E. anophelis was isolated from first-catch water in the room of a ventilated case-patient. Whole genome sequencing indicated this isolate was closely related to the clinical isolate of the case-patient in the room and a case-patient on a different floor. Both patients were hemodialyzed and exposed to tap-water for bathing.

Conclusion
Infection control recommendations included avoiding tap-water for bathing, not disposing body-fluid in sinks, routine flushing, disinfecting or removing aerators, and disinfecting sink drains with scheduled foaming disinfectant application. This investigation demonstrates a persistent outbreak of Ek in a vSNF population, likely related to contaminated tap-water. We postulate that Elizabethkingia persisted in water system biofilms, despite measurable chlorine levels, leading to patient exposure by contaminated healthcare worker hands or through tap water bathing in the presence of decubitus ulcers.

Disclosures
All Authors: No reported disclosures
161. Impact of Committee-Based Diagnostic Stewardship on Performance of metagenomic Next-Generation Sequence Testing for Suspected Infections in Children
Authors: Allen Brian S , Sue Paul K , Filkins Laura , Teherani Mehgan 
Published: November 2023

Abstract

Background
Metagenomic next generation sequencing (mNGS) is a novel, unbiased approach to identify clinically relevant microorganisms. While an increasing body of lliterature suggests the potential positive impact of mNGS testing, best–use cases remain unclear, with rates of clinically significant outcomes as low as 10%. We implemented a restrictive testing model requiring pre-approval for mNGS testing via an ad-hoc committee of infectious disease specialists and pathologists, to optimize utilization of mNGS testing and aid in interpretation of results. We hypothesized that implementation of this diagnostic stewardship model would lead to higher rates of clinically actionable results.

Methods
We performed a retrospective review of mNGS requests at our institution from August 1, 2018 – April 30, 2021. Cases were evaluated by the mNGS committee within 24 hours, and following committee-provider discussion, either approved, denied as inappropriate, or denied in favor of additional conventional evaluation. Charts were subsequently reviewed and mNGS testing adjudicated as having either positive, negative, or no impact .

Results
12 mNGS requests were adjudicated, with 9 subjects approved for testing. Median age of participants was 8 years, with a large proportion (67%) of immunocompromised individuals. The most common indication for mNGS testing was persistent fever (58%). All samples were collected within 24 hours of request, with a median result time of 4 days. Among the 9 approved tests, seven (67%) were deemed to be clinically significant and directly impacted care, while three (33%) resulted in no impact. In total, mNGS testing led to 7 changes in management, 3 clinically relevant organisms identified, and 2 invasive procedures avoided. No adverse outcomes were observed among the denied requests. .

Conclusion
Plasma cell-free DNA mNGS is a promising albeit limited diagnostic tool for clinically relevant infectious diseases, and in the absence of diagnostic stewardship, may lead to unnecessary treatment and excess costs. Implementation of committee-based pre-approval and testing restriction led to high rates of clinically actionable results, and may improve the utility of mNGS testing, while neither delaying care nor negatively impacting outcomes.

Disclosures
Paul K. Sue, MDCM, Allovir, Inc: Participant in Industry Sponsored Trial|Gilead Sciences, Inc: Participant in Industry Sponsored Trial|Merck & Co.: Participant in Industry Sponsored Trial Laura Filkins, PhD, Avsana Labs: Board Member|Avsana Labs: Stocks/Bonds|Biofire Diagnostics: Grant/Research Support
532. Nirmatrelvir/Ritonavir Versus Placebo in Unvaccinated and Vaccinated High Risk Patients
Authors: Leister-Tebbe Heidi , Bao Weihang , Fountaine Robert , Baniecki Mary Lynn , Hendrick Victoria , Wisemandle Wayne , Hammond Jennifer , Rusnak James 
Published: November 2023

Abstract

Background
Nirmatrelvir with ritonavir (nirmatrelvir/r) is an oral antiviral treatment for COVID-19. EPIC-high risk (HR) was a Ph 2/3 double-blind, randomized, placebo (PBO)-controlled trial to evaluate nirmatrelvir/r in symptomatic, unvaccinated, nonhospitalized patients (pts) with ≥ 1 risk factor for progression to severe COVID-19. EPIC-standard risk (SR), a similarly designed trial enrolled pts with no risk factors, and fully vaccinated pts with ≥ 1 risk factor. An integrated analysis of treated pts with risk factors, including unvaccinated pts from EPIC-HR and vaccinated pts from EPIC-SR has been conducted.

Methods
Eligible adults from EPIC-HR and EPIC-SR with confirmed SARS-CoV-2 were randomized 1:1 within 5 days (d) of symptom onset to receive nirmatrelvir/r 300 mg/100 mg or PBO every 12 hrs for 5 d. Efficacy of nirmatrelvir/r was compared with PBO for COVID-19-related hospitalization or death from any cause through day 28. Other endpoints, including number of medical visits/hospital days and quantification of SARS-CoV-2 viral RNA load in nasopharyngeal swabs, and TEAEs through day 35 were evaluated.

Results
Nirmatrelvir/r reduced COVID-19-related hospitalization or death due to any cause by 83% (Relative Risk Reduction, RRR) compared to the PBO (0.94% vs 5.52%, p&lt; 0.0001). The rate of hospitalization or death was lower among sero+ or vaccinated pts, however, nirmatrelvir/r treatment was associated with a substantial risk reduction among sero+ EPIC-HR pts (87.9% RRR), vaccinated EPIC-SR pts (57.6% RRR), or pts who were either vaccinated or sero+ (73.8% RRR) (Figure 1). These observations were regardless of age, gender, BMI, coexisting conditions, baseline serology status, viral RNA load and vaccination status (Figure 2). On average, pts treated with nirmatrelvir/r spent significantly fewer days in hospital and had significantly fewer medical visits compared with PBO. Nirmatrelvir/r treated pts had significantly greater reductions in viral RNA load from baseline to day 5 than PBO. Rates of all-causality TEAEs were similar between treatment groups and most were mild to moderate in severity.

Conclusion
The efficacy and safety of nirmatrelvir/r was demonstrated in vaccinated and unvaccinated pts at high risk as well as in pts with serologic evidence of prior exposure to COVID-19.

Disclosures
Heidi Leister-Tebbe, BSN, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Weihang Bao, PhD, Pfizer, Inc.: Employee of Pfizer|Pfizer, Inc.: Stocks/Bonds Robert Fountaine, PharmD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Mary Lynn Baniecki, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Victoria Hendrick, BSc, Pfizer: Employee|Pfizer: Stocks/Bonds Wayne Wisemandle, MA, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Jennifer Hammond, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds James Rusnak, MD, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds
866. A new protocol for bacterial identification and carbapenemases by MALDI-TOF and lateral flow assay directly from positive blood culture: MALDI-FAST
Authors: Josa D I E G O , Silva Edwin , Osorio Juan Pablo , Hernandez Paula , Torres Isabel , Quiroga Blanca , martinez Deisy , Pescador Luz , Hurtado Lydy , Trujillo Paola , Cortes Fabian 
Published: November 2023

Abstract

Background
Infectious diseases are a global public health problem, accounting for more than 20% of the mortality burden. Klebsiella pneumoniae and Pseudomonas aeruginosa caused more than 1.3 million deaths globally in 2019. Antimicrobial resistance (AMR) is a major factor in this mortality. Rapid molecular test for the detection of the blaKPC gene improves treatment time and mortality in patients with bacteremia caused by carbapenem-resistant Enterobacterales, however, the use of molecular biology techniques may not be optimal in multiple resourced care settings limited. Our goal is to perform rapid identification of Gram-negative bacilli and detection of carbapenemases directly from blood cultures using the combination of mass spectrometry (MALDI-TOF) and the lateral flow immunochromatography test.4

Methods
We analyzed 97 bottles of positive blood cultures detected by the BACT/Alert 3D system (BioMérieux®). Our new method (MALDI-FAST) uses 0.5ml of blood obtained from the positive blood culture bottle for Gram-negative bacilli, from which a pellet is obtained by rapid centrifugation in 3 minutes. This material is processed both for bacterial identification by MALDI-TOF mass spectrophotometry (Bruker®), and rapid detection of carbapenemases by NG Test Carba 5 lateral flow immunochromatography (NG Biotech®). The results obtained were compared with the gold standard RT-PCR FilmArray Panel BCID 2.0 (BioMérieux®)

Results
Of the 97 blood culture bottles, 94/97 (96.9%) were correctly identified to the species level and 3/97 (3.1%) were polymicrobial blood cultures. Klebsiella pneumoniae was detected in 39 samples, E. coli in 24, and 34 other microorganisms including non-fermenting bacteria. Excellent concordance (kappa index 1,000) was achieved in 31/97 blood cultures (31.9%) that presented carbapenemases, 18/31 KPC (18.6%) and 13/31 with KPC and NDM coproduction (13.4%). 66/97(68.15%) bottles did not present carbapenemase.

Conclusion
Our protocol presents very good results for bacterial identification by mass spectrometry and carbapenemase detection by lateral flow immunoassay in a few minutes directly from the positive blood culture, becoming a fast and cost-effective tool to contribute to patient management.

Disclosures
All Authors: No reported disclosures
Health Care Costs and Corporate Investment
Authors: Tong Joy Tianjiao 
Published: November 2023

Abstract
Health care costs for U.S. employers have tripled over the past 20 years. Using firm-specific health expense data, I show that firms negatively adjust capital expenditures and R&D expenses in response to increases in health care costs. The effects are more pronounced for firms that are financially constrained, employ more high-skilled workers, and have less bargaining power relative to insurers. Furthermore, policy uncertainty surrounding health care costs is substantial and discourages capital investment. These findings suggest that an elevated level of health care costs and the associated uncertainty limit a firm’s ability to expand physically or through innovation.
Aripiprazole and Other Third-Generation Antipsychotics as a Risk Factor for Impulse Control Disorders
Authors: Williams Benjamin David , Lee Kenn , Ewah Silas Okey , Neelam Kishen 
Published: November 2023

Abstract

Background
Increasing evidence suggests an association between third-generation antipsychotics (TGAs) and impulse control disorders (ICDs). This is thought to be due to their partial agonism of dopamine receptors. However, neither the relative nor absolute risks of ICDs in those prescribed TGAs are well established. To inform clinical practice, this systematic review and meta-analysis summarizes and quantifies the current evidence for an association.

Methods
An electronic search of Medline, PsychINFO, EMBASE, and the Cochrane Clinical Trials Database was undertaken from database inception to November 2022. Three reviewers screened abstracts and reviewed full texts for inclusion. A random-effects meta-analysis was conducted with eligible studies.

Results
A total of 392 abstracts were retrieved, 214 remained after duplicates were removed. Fifteen full texts were reviewed, of which 8 were included. All 8 studies found that TGAs were associated with increased probability of ICDs. Risk of bias was high or critical in 7 of 8 studies. Three studies were included in the pooled analysis for the primary outcome, 2 with data on each of aripiprazole, cariprazine, and brexpiprazole. Exposure to TGAs versus other antipsychotics was associated with an increase in ICDs (pooled odds ratio, 5.54; 2.24–13.68). Cariprazine and brexpiprazole were significantly associated with ICDs when analyzed individually. Aripiprazole trended toward increased risk, but very wide confidence intervals included no effect.

Conclusions
Third-generation antipsychotics were associated with increased risk of ICDs in all studies included and pooled analysis. However, the risk of bias is high, confidence intervals are wide, and the quality of evidence is very low for all TGAs examined.
Workplace Harassment and Health
Authors: Abdulla Ahmad M. , Lin Tracy W. , Rospenda Kathleen M. 
Published: November 2023

ObjectiveWe examine relationships between workplace harassment (WH) and onset of health conditions over a 23-year period.MethodsParticipants were surveyed at seven points between 1997–2006 and again in 2020. Regression analyses (n= 921) assessed effects of chronic WH exposure on onset or recent health conditions by 2020.ResultsGrowth mixture modeling revealed infrequent and chronic classes of generalized workplace harassment (GWH; 33.39% chronic) and sexual harassment (SH; 32.32% chronic). Prevalence of health conditions ranged from 3.71% for myocardial infarction to 43.06% for hypertension. Analysis via propensity score matching showed chronic WH class membership increased odds of coronary heart disease (GWH, odds ratio [OR] = 3.42,P< 0.05), arthritic/rheumatic conditions (SH, OR = 1.56,P< 0.05), and recent migraine (SH, OR = 1.68,P< 0.05).ConclusionsWorkplace harassment is associated with coronary heart disease, arthritic/rheumatic conditions, and migraine. Worker health can be protected through strengthening and enforcing organizational and social antiharassment policies and laws.
Yanghe Pingchuan granules mitigates oxidative stress and inflammation in a bronchial asthma rat model: role of the IKK/IκB/NF-κB signalling pathway
Authors: Pan Lingyu , Gong Chunxia , Chen Yan , Jiang Yeke , Sun Yehong , He Bangfu , Duan Xianchun , Han Yanquan , Wang Yongzhong 
Published: November 2023

Background:
Bronchial asthma (BA) is a chronic inflammatory airway disease. Previous research has shown that Yanghe Pingchuan granules (YPG), among the granules formulated by the First Affiliated Hospital of the Anhui University of Chinese Medicine, exerts a precise therapeutic effect on BA. We previously showed that YPG improves airway inflammation in BA rats. Other studies have shown that the inhibitor of kappa-B kinase (IKK)/inhibitor of NF-κB (IκB)/nuclear factor kappa-B (NF-κB) signalling pathway plays a key role in inflammation mediation. Therefore, this study explored whether YPG could intervene in BA through the IKK/IκB/NF-κB signalling pathway.

Methods:
Ovalbumin-induced method was used to established BA rat model. After successful modelling, the authors used YPG to intervene the rats in BA rats. Hematoxylin-eosin (HE) staining was used to detect the bronchial pathological changes in BA rats, enzyme-linked immunosorbent assay (ELISA) was used to detect the changes of inflammatory factors (IL-1β and IL-6) and oxidative stress indexes malondialdehyde (MDA), superoxide dismutase (SOD) and nitrogen monoxide (NO), Quantitative real-time polymerase chain reactionCR and western blot were used to detect the expression of IKK/IκB/NF-κB signalling pathway.

Results:
In BA model rats, YPG significantly improved the inflammatory response in bronchial tissues, reduced inflammatory factors IL-1β and IL-6, alleviated oxidative stress, reduced MDA and NO, and increased SOD. Quantitative real-time polymerase chain reaction and western blot results showed that YPG could block the IKK/IκB/NF-κB signalling pathway.

Conclusion:
These findings showed that YPG had a definite therapeutic effect on BA, which may be related to blocking the IKK/IκB/NF-κB signalling pathway and improving inflammation and oxidative stress.
Jumping Trends In Trampoline-Related Craniofacial Injuries
Authors: Gompels Matthew T. , Treger Dylan , Mangal Rohan , Prasad Soumil , Thaller Seth R. 
Published: November 2023

Introduction:
In 1990, the American Academy of Pediatrics recommended the sale of trampolines cease in the United States. The risk of traumatic injury is well-documented, yet trampolines remain a growing source of recreation. Trampoline parks, in particular, are becoming a common entertainment attraction that can result in serious injury. There is currently a paucity of literature characterizing craniofacial injuries from trampoline use and plans to prevent these injuries.

Methods and Materials:
A retrospective review of the National Electronic Injury Surveillance System was conducted to analyze emergency department visits for trampoline-related craniofacial injuries in 1 to 20 year olds between 2013 and 2022.

Results:
An estimated 206,866 trampoline-related craniofacial injuries occurred. Males suffered injuries 1.67 times more frequently than females. Injured sites included the head (41.0%), face (23.2%), neck (20.4%), mouth (11.9%), eyeball (2.0%), and ear (1.4%). The most common diagnoses were lacerations (28.9%), internal injuries (23.2%), strain/sprains (14.8%), contusions/abrasions (13.0%), and concussions (8.7%). Head internal injuries and facial lacerations significantly increased over the observed time period.

Discussion:
Trampolines are a rising source of craniofacial trauma for America’s youth. Children between 3 and 11 years old were disproportionately affected. Regulation over trampoline safety features remains limited in the United States. Future studies should aim to characterize the mechanisms of these injuries for the development of targeted safety measures.
ALTERED PROFILES OF EXTRACELLULAR MITOCHONDRIAL DNA IN IMMUNOPARALYZED PEDIATRIC PATIENTS AFTER THERMAL INJURY
Authors: Tetri Laura H. , Penatzer Julia A , Tsegay Kaleb B , Tawfik Daniel S. , Burk Shelby , Lopez Ivan , Thakkar Rajan K. , Haileselassie Bereketeab 
Published: November 2023

ABSTRACTBackground:Thermal injury is a major cause of morbidity and mortality in the pediatric population worldwide with secondary infection being the most common acute complication. Suppression of innate and adaptive immune function is predictive of infection in pediatric burn patients, but little is known about the mechanisms causing these effects. Circulating mitochondrial DNA (mtDNA), which induces a proinflammatory signal, has been described in multiple disease states but has not been studied in pediatric burn injuries. This study examined the quantity of circulating mtDNA and mtDNA mutations in immunocompetent (IC) and immunoparalyzed (IP) pediatric burn patients.Methods:Circulating DNA was isolated from plasma of pediatric burn patients treated at Nationwide Children’s Hospital Burn Center at early (1–3 days) and late (4–7 days) time points postinjury. These patients were categorized as IP or IC based on previously established immune function testing and secondary infection. Three mitochondrial genes, D loop, ND1, and ND4, were quantified by multiplexed qPCR to assess both mtDNA quantity and mutation load.Results:At the early time point, there were no differences in plasma mtDNA quantity; however, IC patients had a progressive increase in mtDNA over time when compared with IP patients (change in ND1 copy number over time 3,880 vs. 87 copies/day,P= 0.0004). Conversely, the IP group had an increase in mtDNA mutation burden over time.Conclusion:IC patients experienced a significant increase in circulating mtDNA quantity over time, demonstrating an association between increased mtDNA release and proinflammatory phenotype in the burn patients. IP patients had significant increases in mtDNA mutation load likely representative of degree of oxidative damage. Together, these data provide further insight into the inflammatory and immunological mechanisms after pediatric thermal injury.