bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling methicillin-resistant Staphylococcus aureus (MRSA) acquisitions in the intensive care unit with different staffing levels and finite direct-care tasks
Authors: Johnson Stephanie , Mietchen Matthew , Lofgren Eric 
Published: September 2023

Background: Modeling is a cost-effective way to evaluate interventions pertaining to hospital infection acquisitions, such as staffing levels. Increasing the number of nurses in an intensive care unit affects rates of HAI transmission. The way compartmental models are often formulated assumes that there is a never-ending series of tasks for workers to perform. Our previous models used a baseline of 1:3 nurse:patient ratio, and we kept the number of tasks the same across staffing ratios. We wanted to understand how having a finite number of tasks, using this baseline number, across staffing levels affected HAI acquisitions. Methods: We used a stochastic mathematical model of methicillin-resistant Staphylococcus aureus (MRSA) to study the impact of changes in staffing and a finite pool of tasks on hospital-associated acquisitions. For a 15-bed intensive care unit (ICU), we have 1 intensivist, and we set the nurse:patient ratios at 1:1, 1:1.5, 1:2.5, 1:3, 1:5, and 1:7.5, to represent the extreme ends of staffing levels and more moderate values in line with critical care society guidelines. Each model was run 1,000 times. The outcome of each scenario is the median number of hospital-associated MRSA acquisitions in 1 year from those 1,000 runs. Results: Treating the 1:3 nurse:patient ratio as the baseline, with 45 MRSA acquisitions per year, increasing the number of nurses from 5 to 6 (moving to a 1:2.5 nurse:patient ratio) had a relative risk (RR) of 0.77, suggesting that a small change in nurse staffing levels might have an outsized impact on rates. More dramatic changes had correspondingly larger swings in MRSA acquisition rates, with 1:1 nurse:patient ratio scenarios having an RR of 0.17, and at the other extreme, a 1:7.5 nurse:patient ratio having an RR of 4.66. Comparing the infinite to finite models, the ratios with more nurses had lower acquisition rates, with decreases ranging from 20% to 50%. Ratios with fewer nurses in the ICU showed 100%–400% increases in the number of acquisitions. All results were statistically significant. Conclusions: As nurse:patient ratios go up, the burden of direct-care tasks fall on fewer people, which has a direct impact on HAI rates. Our model demonstrates this hypothesis. Therefore, appropriate staffing should be considered in infection control guidelines, and the cost of staffing should be weighed against its impact on infection prevention as well as other areas of patient care. In this study, we considered only the impact from changes in contact patterns emerging from different staffing levels. Further insights may exist when considering other outcomes that also accompany increased staffing.Disclosures: None
Perioperative cefazolin prescribing rates following suppression of alerts for non-IgE-mediated penicillin allergies
Authors: Bogus Ashley , McGinnis Kelley , May Sara , Stohs Erica , Schooneveld Trevor Van , Bergman Scott 
Published: September 2023

Background: Cefazolin is the preferred antimicrobial for prevention of surgical-site infections in most procedures at our institution. Our first alternative is vancomycin which is associated with higher adverse events and infection rates. The presence of penicillin allergies can influence prescribing of vancomycin despite a low risk of cross-reactivity between penicillin and cephalosporins. Nebraska Medicine implemented a systemwide change in April 2022 that suppressed alerts for non–IgE-mediated penicillin allergies in the electronic medical record (EMR, Epic Systems) upon cephalosporin prescribing. We evaluated changes in perioperative antimicrobial surgical infection prophylaxis after this change. Methods: We conducted a quasi-experimental study of all patients undergoing procedures for which cefazolin is considered preferred per institutional guidance. Preintervention data were from April 1, 2021, to March 31, 2022, and postintervention data included patients from April 11, 2022, to October 31, 2022, after guidance was distributed to surgeons, operating room staff, and pharmacists. Patients were excluded if they were aged <19 years, had a hospital length of stay <24 hours, underwent procedures after their first throughout the time frame, or received both vancomycin and cefazolin. Statistical significance was set at P < .05, determined using the Fisher exact test. Results: The study included 6,676 patients: 4,147 in the preintervention group and 2,529 in the postintervention group. We identified 15 procedure categories, with no significant differences between periods (Table 1). The average age was 61 years. Penicillin allergy was reported in 508 patients (12.3%) in the preintervention group and in 319 patients (12.6%) in the postintervention group. In individuals with penicillin allergy, cefazolin prescribing increased from 49.6% to 74.3% (P < .01) and vancomycin prescribing decreased from 50.4% to 25.7% (P < .01). The largest changes occurred in patients undergoing cardiac, spinal, neurological, and vascular procedures. For patients without penicillin allergy, prescribing remained unchanged. Overall, cefazolin prescribing increased from 92.0% to 95.0% (P < .01), and the rate of vancomycin prescribing decreased from 8.0% to 5.0% (P < .01) in procedures for which cefazolin was preferred. Conclusions: Following the suppression of EMR alerts for non–IgE-mediated allergies when ordering cephalosporins, penicillin prescribing rates of cefazolin for surgical infection prophylaxis improved significantly in procedures for which it was the preferred agent. Further research on infection rates and adverse events with these and other alternative agents are needed.Disclosures: None
Candida auris screening practices at healthcare facilities in the United States: A survey of the Emerging Infections Network
Authors: Hennessee Ian , Forsberg Kaitlin , Beekmann Susan E. , Polgreen Philip , Gold Jeremy , Lyman Meghan 
Published: September 2023

Background:Candida auris, an emerging fungal pathogen, is frequently drug resistant and spreads rapidly in healthcare facilities. Screening to identify patients colonized with C. auris can prevent further spread by prompting aggressive infection prevention and control measures. The CDC recommends C. auris screening based on local epidemiological conditions, patient characteristics, and facility-level risk factors; such screening might help facilities in higher burden areas to mitigate transmission and those in lower-burden areas to detect new introductions before spread begins. To describe US screening practices and challenges, we surveyed a network of infection disease practitioners, comparing responses by local C. auris case burdens. Methods: In August 2022, we emailed a survey about C. auris screening practices to ~3,000 members of the IDSA Emerging Infection Network. We describe survey results, stratifying findings by whether the healthcare facility was in a region where C. auris is frequently identified (tier 3 facility) or not frequently identified (tier 2 facility), based on CDC assessment using existing multidrug-resistant organism containment guidance (https://www.cdc.gov/hai/containment/guidelines.html). Results: We received 253 responses (tier 3 facilities: 119, tier 2 facilities: 134); overall, 37% performed screening. Tier 3 facilities more frequently performed screening than tier 2 facilities (59% vs 17%). Among facilities that performed screening, tier 3 facilities, compared with tier 2 facilities, more frequently screened patients on admission (84% vs 55%) and used an in-house laboratory for testing (68% vs 29%), most often with culture-based methods. Tier 2 facilities more frequently screened patients already admitted in the facility (eg, in response to cases or as part of point-prevalence surveys) compared with tier 3 facilities (59% vs 49%). Among facilities performing screening, 72% had identified ≥1 case in the previous year (tier 3 facilities, 85%; tier 2 facilities, 33%). Barriers to screening included limited laboratory capacity, long testing turnaround times, and the perception that screening was not useful. Conclusions: Most facilities surveyed did not perform C. auris screening. However, most facilities that performed screening, including those in regions of higher and lower C. auris burden, detected cases during the previous year. Admission screening, which might help detect new introductions before spread begins, was uncommon in facilities in lower-burden areas. Improving ease of C. auris screening through access to in-house laboratory testing with rapid turnaround times might increase the adoption of C. auris screening by facilities, thereby increasing detection and preventing spread.Disclosures: None
Trends and duration of antibacterial drug supply chain issues in the United States, January 2017–June 2022
Authors: Suda Katie , Kim Katherine Callaway , Hernandez Inma , Tadrous Mina 
Published: September 2023

Background: Drug manufacturing and distribution is a complex, global process. The global drug supply chain is prone to disruptions associated with geopolitical issues, trade, civil unrest, severe weather, and pandemics, all of which have the potential to affect medication supply and result in drug shortages. To our knowledge, the extent to which the supply of antimicrobials is threated due to disruptions in the drug supply chain in the United States is unknown. We examined trends and duration of disruptions to the drug supply chain for antimicrobials. Methods: Manufacturer reports of supply disruptions were extracted from the Food and Drug Administration (FDA) and the American Society for Health-Systems Pharmacists (ASHP) websites and merged on the agent-formulation level. For each month of the study period, a drug was considered to have an active supply chain issue if an FDA or ASHP shortage or recall report overlapped with that month for ≥15 days, or if a discontinuation had occurred within the previous 3 months. Total months of supply chain issues were summed for antimicrobials overall, at the agent formulation , and class levels. A Mann-Kendall test was used to determine the significance of trends in supply-chain issues. Results: Of 105 antimicrobials purchased in the United States, 74 (70%) had a supply-chain issue for ≥1 month from January 15, 2017, to June 30, 2022. Combined, the 74 agents had 1,611 total months of supply-chain issues over the 66-month study period. Agents from the penicillin class were most frequently affected (ie, 80% of penicillins had supply-chain issues for 206 months), but cephalosporins had supply-chain issues for the longest duration (66% of cephalosporins for 653 months). From 2017–2021, supply-chain issues decreased significantly for penicillins and quinolones (tests of trend, P = .01 and .02, respectively). No trend was identified for the other classes or antimicrobials overall. Interestingly, supply-chain issues for most classes did not increase with seasonal increases in antimicrobial use. Also, supply-chain issues affected 33 antimicrobial agents for at least half of the study period, and supply-chain issues affected ampicillin-sulbactam, cefotaxime, ceftazidime, cefotetan, cefepime, clindamycin, vancomycin for 100% of the study period. Conclusions: Drug supply-chain issues commonly affect antimicrobials and are not improving for most classes. Drug supply-chain issues cause significant strain on healthcare, including drug procurement, access to optimal therapy, and poses challenges to prescribing and antimicrobial stewardship. To decrease the threat to the antibacterial drug supply, action should be taken to strengthen the drug supply chain to ensure access to these essential medicines.Disclosures: None
The Untapped Potential of the Systemic Criterion in the ECJ’s Case Law on Judicial Independence
Authors: Leloup Mathieu 
Published: September 2023

AbstractThis article explores the use of the systemic criterion in the European Court of Justice’s (ECJ) case law on judicial independence under Article 19(1)(2) Treaty on European Union (TEU). It starts from the observation that ever since the Portuguese Judges judgment, the case law has moved towards a more abstract and general assessment of issues of judicial independence. Yet, despite that evolution, the Court—perhaps surprisingly—only rarely uses the systemic criterion in its judgments. There are only two strands of case law to be found, neither of which tell us much about how the Court understands the notion of “systemic” in this field. This article argues that this criterion nevertheless has an important role to play in the case law on judicial independence and that the Court should explicitly limit the finding of a violation of Article 19(1)(2) TEU to those issues that have a systemic impact on the functioning of the domestic judiciary. By limiting the effects of Article 19(1)(2) TEU in such a way, the Court would strike a balance between the protection of the independence of the domestic judiciary, which is crucial for the proper functioning of the European Union (EU), and respect for the autonomy of the Member States as to the organization of their judiciary.
LEA—A NOVEL LOW ENERGY ACCELERATOR FOR 14C DATING
Authors: Ramsperger Urs , De Maria Daniele , Gautschi Philip , Maxeiner Sascha , Müller Arnold Milenko , Synal Hans-Arno , Wacker Lukas 
Published: September 2023

ABSTRACTA newly developed compact AMS, LEA (Low Energy Accelerator), is tested and compared with a state-of-the-art AMS system MICADAS (Mini Carbon Dating System), which has a precision performance of better than 1‰ for modern 14C. The main difference between these two systems is the acceleration voltage, which has been reduced from 200 kV with the MICADAS system to 50 kV with the LEA system. In order to execute the final performance tests, exactly same samples (2 sets consisting of 7 standards, 4 blanks, 26 wood samples) are measured on both systems successively. The results show that the LEA system is fully operational, and the performance is entirely comparable with that of the MICADAS system.
Fat-free mass may play a dominant role in the association between systolic blood pressure and body composition in children and adolescents
Authors: Yu Shikai , Zhao Song , Tang Jiamin , Zhao Yifan , Xu Chong , Li Moran , Xu Yawei , Zhang Yi 
Published: September 2023

AbstractSystolic blood pressure (SBP) is significantly associated with body composition in children and adolescents. However, which one of the components of body composition is the dominant contributor to SBP in children and adolescents remains unclear. We, therefore, aimed to determine the dominant contributor to SBP among components of body composition in a large cohort of American children and adolescents derived from the National Health and Nutrition Examination Survey with cross-sectional analysis. In total, 13 618 children and adolescents (median age 13 years; 6107 girls) with available data on whole-body dual-emission X-ray absorptiometry measurements were included. Multiple linear regression showed that SBP was associated with higher total fat-free mass in boys (β = 0·49, P < 0·001) and girls (β = 0·47, P < 0·001) and with higher total fat mass only in boys (β = 0·12, P < 0·001) after adjustment for covariates. When taking fat distribution into consideration, SBP was associated with higher trunk fat mass (boys: β = 0·28, P < 0·001; girls: β = 0·15, P < 0·001) but negatively associated with leg fat mass (Boys: β = −0·14, P < 0·001; Girls: β = −0·11, P < 0·001), in both boys and girls. Dominance analysis showed that total fat-free mass was the dominant contributor to SBP (boys: 49 %; girls: 55·3 %), followed by trunk fat mass (boys: 32·1 %; girls: 26·9 %); leg fat mass contributed the least to SBP in boys (18·9 %) and girls (17·8 %). Our findings indicated that total fat-free mass was not only associated with SBP but also the most dominant contributor to SBP variation in American children and adolescents.
Attitudes toward and experiences of clinical and non-clinical services among individuals who self-harm or attempt suicide: a systematic review
Authors: Uddin Tasnim , Pitman Alexandra , Benson Gemma , Kamal Zeast , Hawton Keith , Rowe Sarah 
Published: September 2023

AbstractThe prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services among patients who self-harm. This systematic review summarized the literature published since then to July 2022 to examine contemporary attitudes toward and experience of clinical and non-clinical services among individuals who self-harm and their relatives. We systematically searched for literature using seven databases. Quality of studies was assessed using the Mixed-Methods Appraisal Tool and findings were summarized using a narrative synthesis. We identified 29 studies that met our inclusion criteria, all of which were from high- or middle-income countries and were generally of high methodological quality. Our narrative synthesis identified negative attitudes toward clinical management and organizational barriers across services. Generally, more positive attitudes were found toward non-clinical services providing therapeutic contact, such as voluntary sector organizations and social services, than clinical services, such as emergency departments and inpatient units. Views suggested that negative experiences of service provision may perpetuate a cycle of self-harm. Our review suggests that in recent years there has been little improvement in attitudes toward and experiences of services for patients who self-harm. These findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centered and compassionate care and deliver more effective, acceptable and accessible services.
Scattering characteristics of a perfect electromagnetic conducting cylindrical object covered with a general Bi-isotropic layer
Authors: Awan Zeeshan Akbar , Raqeeb Abdul , Hussain Arshad 
Published: September 2023

AbstractAn analytic theory has been developed for the scattering of electromagnetic plane wave from a perfect electromagnetic conducting (PEMC) cylindrical object coated with a general bi-isotropic (BI) material. The proposed problem has been solved using cylindrical vector wave function expansion approach along with the application of tangential boundary conditions. Analytic expressions of the scattering coefficients have been derived in their simplest forms. It is seen that by proper selection of admittance of PEMC core, electromagnetic parameters of BI coating, and coating thickness, one can optimize the scattering characteristics for specific applications. It is shown that the specific types of BI and strong chiral-coated PEMC cylinders having certain coating thicknesses can be used to significantly enhance the co-polarized forward scattering while keeping the cross-polarized forward scattering very small. Such types of enhanced co-polarized forward scattering are preferred in point-to-point communication. Some interesting features have been discussed where co-polarized and cross-polarized backscattering may be suppressed, which find applications in radar engineering problems and stealth technology.
Spanish adaptation of the Gender-Related Variables for Health Research (GVHR): Factorial Structure and Relationship with Health Variables
Authors: Díaz-Morales Juan F. , Esteban-Gonzalo Sara , Martín-María Natalia , Puig-Navarro Yaiza 
Published: September 2023

Abstract
The aim of the present study was to conduct a preliminary study of the Stanford Gender-Related Variables for Health Research (GVHR) adapted to the Spanish population, testing its factor structure, sex factorial invariance and relationship with health variables. Participants were 438 adults between 19–73 years old (M = 31.90, SD = 12.12) who completed the GVHR and measures of health-related quality of life, psychological health, and health-risk behaviors. The confirmatory factorial analysis of the GVHR indicated an acceptable fit to the 7-factor structure as proposed for the North American population. Emotional intelligence and independence factors had low internal consistency, therefore, a five-factor model was tenable in the Spanish population. Sex scalar invariance was tenable, indicating that the factors latent means can be meaningfully compared across sex. Univariate logistic regressions indicated that women reported worse mental and physical health and more health limitations, but this effect dissipated when gender variables were considered. Caregiver and work strain stood out as the variables related to gender that predicted worse health-related quality of life, psychological health, and health-risk behaviors. In conclusion, factorial structure of the GVHR may differ from one culture to another. Additionally, the variables related to gender in the GVHR give a better account of the differences in health compared to biological sex.
Evaluation of chemical control and seasonal application options for smutgrass (Sporobolus indicus)
Authors: Howard Zachary S. , Nolte Scott A. , Hussey Mark , Treadwell Morgan L. , Sellers Brent 
Published: September 2023

AbstractSmutgrass is a non-native perennial weed that is problematic because of its poor palatability to cattle and its difficulty to control once established. Limited literature exists to explain the effectiveness of herbicides other than hexazinone for smutgrass control and forage injury. This study aimed to evaluate seasonal applications of labeled herbicides used on forage for maximum smutgrass control. The second objective was to evaluate preemergent herbicides and hexazinone for their ability to control smutgrass germinating from seed. Hexazinone, nicosulfuron + metsulfuron-methyl, and glyphosate + imazapic were the most effective postemergence treatments, while quinclorac exhibited little activity on smutgrass. Common bermudagrass forage fully recovered from all treatments by 3 mo after treatment. Hexazinone, nicosulfuron + metsulfuron methyl, glyphosate, and imazapic were applied postemergence to smutgrass in spring, summer, and fall. Summer applications of hexazinone resulted in the greatest level of control, while spring treatments provided the least control. Applications of hexazinone or glyphosate resulted in the most effective smutgrass control. However, fall applications resulted in the least forage injury. Results of the study of preemergence herbicides indicate that treatments with indaziflam and hexazinone provide adequate control of germinating smutgrass seedlings in the greenhouse at 0.25×, 0.5×, and 0.75× of the lowest recommended labeled rate for seedling grass control. Indaziflam treatments prevented the emergence of any visible smutgrass seedling tissue, compared to hexazinone, which fully controlled the germinating seedlings by 21 d after treatment, whereas pendimethalin significantly reduced seedling numbers at the 0.5× and 0.75× rates.