bluuebunny/crossref_metadata_2025_split huggingface dataset:
1099. SARS-CoV-2 Positive Pregnant Women Delivering in a Hospital From March 2020 – February 2021 in Three California Counties
Authors: Hall Brenna , Lee Jane E , Kirley Pam Daily , Roland Jeremy L , Hundal Kareena 
Published: December 2022

Abstract

Background
Comparing outcomes of both symptomatic and asymptomatic hospitalized pregnant women with COVID-19 can inform both the prognosis during hospitalization for pregnant women with COVID-19 and the relationship of COVID-19 to pregnancy outcomes.

Methods
Using population-based surveillance data from COVID-19 Associated Hospitalization Surveillance Network (COVID-NET), chart reviews were conducted for SARS-CoV-2 positive pregnant patients, age 15 to 49 years, residing in Alameda, Contra Costa, and San Francisco Counties in California who delivered in a hospital between March 1st 2020 and February 28th 2021. Cases were defined as SARS-CoV-2 positive if they had a positive test during hospitalization or within 14 days prior to admission. Multivariate analysis was used to describe demographic characteristics, underlying medical conditions, vaccination status, and pregnancy outcomes by presence or absence of symptoms upon hospitalization. Chi-square tests assessed significance with p-values &lt; 0.05 considered statistically significant.

Results
Among the 330 SARS-CoV-2 positive women that delivered in a hospital, 60.3% were Hispanic or Latino, 4.9% were White (Non-Hispanic), 6.4% were Black (Non-Hispanic), 6.7% were Asian or Pacific Islander, 0.9% were multiracial, and 20.9% were unknown race or ethnicity. Symptomatic cases spent a median of 3 days in the hospital while asymptomatic cases spent a median of 2 days in the hospital. Symptomatic women were more likely to have a Caesarian-section (OR 2.49, 95% CI: 1.45, 4.28), have preeclampsia (OR 2.19, 95% CI: 1.17, 4.10), and be admitted to the ICU (OR 3.78, 95% CI: 1.08, 13.29) than asymptomatic women. Invasive mechanical ventilation was required for 3 of the 109 symptomatic women and none of the 221 asymptomatic women (P=0.03).

Conclusion
Among hospitalized SARS-CoV-2 positive patients in three California countries from March 1st 2020 to February 28th 2021, symptomatic pregnant women were more likely to have a Caesarian-section, have preeclampsia, and be admitted to the ICU compared to asymptomatic pregnant women. As COVID-19 continues to be prevalent, future studies should examine the associations and potential confounders between COVID-19 symptoms and pregnancy outcomes.

Disclosures
All Authors: No reported disclosures.
1104. A comparison of remdesivir versus remdesivir plus tocilizumab for patients with severe COVID-19 in the Dominican Republic
Authors: Roque Yori A , Luna David De , Mena Lora Alfredo J , De la Nuez Liz , Hernando Ana , Jimenez Cesar , Morel Rommel , Pichardo Maily 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has strained healthcare systems worldwide and is now a leading cause of death. Remdesivir is the first antiviral shown to decrease time to recovery in a randomized placebo-controlled trial. Other studies have conflicting results and the World Helath Organization does not recommend the routine use of Remdesivir in hospitalized patients. The herogeneity of these studies and their populations makes interpretation of the available data difficult, with standard of care in different countries as the main confounding factor. Thus, it is imperative for low and middle income countries to study the role of remdesivir within their healthcare systems. We seek to further understand the impact of COVID-19 in a cohort in the Dominican Republic.

Methods
This is a retrospective review of patients admitted for COVID-19 to a tertiary center in the DR between August 2020 to March. 2021. Patients with clinical findings consistent with COVID-19 pneumonia and a positive molecular test for SARS-CoV-2 were included in the study.

Results
A total of 59 cases were reviewed, of which 40 were treated with remdesivir and 19 with remdesivir plus tocilizumab. Patients were more commonly male (69.5%) and ages ranged from 71-80 years (34.5%), 61-70 (20.7%), 51-60 (20.7%), 41-50 (10%), &gt;81 (8.6%) and 18-30 (1.7%). Hypertension was the most common comorbidity (Figure 1). The average length of stay was 16.5 days, and 2.1 days. Mechanical ventilation was needed in 33.9%. Tocilizumab was administered in 32%. Mortality for the cohort was 29% (Figure 2). Mortality in patients treated with remdesivir alone was 22%, compared to 6.8% in those receiving tocilizumab and remdesivir.
Comorbidities
Mortality by length of stay

Conclusion
In our cohort, the use of remdesivir was associated with higher mortality than remdesivir in combination with tocilizumab. The mortality in our cohort was high (29%) compared to the 11.9% reported in in the placebo group of the ACTT-1 study. Furthermore, studies have consistently shown benefit earlier in the disease course and with lower oxygen needs. Our cohort had high rates of mechanical ventilation. Thus, the modest benefit seen in developed countries may be harder to show in resource limited settings and the number needed to treat is likely much higher. Remdesivir did not appear to have an impact in our cohort.

Disclosures
All Authors: No reported disclosures.
1107. A Survey on Remdesivir Use and Antimicrobial Stewardship Restrictions Throughout the COVID-19 Pandemic
Authors: Mena Lora Alfredo J , Herald Fischer , Burgos Rodrigo M , Borgetti Scott , Lindsey Brenna , Chaisson Lelia H , Bleasdale Susan C 
Published: December 2022

Abstract

Background
Remdesivir (RDV) was the first agent with proven clinical benefit against COVID-19, shortening the time to recovery in a randomized placebo-controlled trial (RCT). Based on this trial, the Food and Drug Administration approved RDV via emergency use authorization. Despite its wide use, RDV remains controversial. Early use of RDV in patients requiring low flow nasal canula has robust evidence. However, benefit in mechanical ventilation (MV), high-flow nasal canula (HFNC) and non-invasive positive pressure ventilation (NIPPV) is conflicting. Multiple studies, most notably the SOLIDARITY and DisCoVeRy trial, have conflicting results on who benefits from RDV. Deploying novel therapeutics in this changing landscape is challenging. We seek to understand RDV practices and the role of antimicrobial stewardship (ASP) in hospitals across the US.

Methods
A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, presence of RDV therapeutic restrictions, and RDV use by degree of oxygen needs for each COVID-19 wave.

Results
A total of 78 responses were collected, representing wide geographic reach in the US (Figure 1). RDV was restricted in 53% of facilities. Hospitals without restrictions commonly used RDV for patients on MV, NIPPV and HFNC, with more use on HFNC than on NC during the first winter, Delta and Omicron waves (Figure 2). Use on MV declined with each surge. Hospitals with RDV restrictions had more use of RDV on NC than all other ordinal scales (Figure 3). Use in MV, NIPPV and HFNC compared to NC declined in the restricted group with each COVID-19 surge. Figure 1.Geographic distribution of hospitals represented in the survey
Figure 2. Remdesivir use by oxygen requirements in hospitals without remdesivir therapeutic restrictions.
Figure 3 Remdesivir use by oxygen requirements in hospitals without remdesivir therapeutic restrictions.

Conclusion
A wide gap between evidence-based guidelines and actual practice exists. This gap was wider in hospitals without COVID-19 therapeutic restrictions in place for RDV. In the unrestricted group, RDV was commonly used for MV, HFNC and NIPPV, where robust RCT evidence of benefit is lacking. Though this practice occurred in both groups, the restricted RDV group prioritized RDV use in NC and did so at higher percentages each subsequent COVID-19 surge. ASP restrictions can have an important role in guiding COVID-19 therapy.

Disclosures
All Authors: No reported disclosures.
1120. Descriptive Analysis of Monoclonal Antibody Administration for Pregnant Patients with SARS-CoV-2 Infection
Authors: Vikraman Praveen Kumar , Chang Kai Ming , Doan Thien-Ly , Donaghy Henry 
Published: December 2022

Abstract

Background
We studied the safety and efficacy of the use of monoclonal antibodies (MAB) against SARS-CoV-2 in pregnant women who developed COVID-19 infection.

Methods
We conducted a cross-sectional descriptive multi-center study of pregnant patients who developed SARS-CoV-2 infection from January 2021 to January 2022 and received MAB therapy. Primary outcomes assessed were infusion-related adverse events and pregnancy outcomes within one month of MAB infusion. The secondary outcomes assessed were hospitalization and ICU admission for COVID19 infection and thirty-day all-cause mortality.

Results
141 patients were included in the study (median age 33 +/- 5.3 SD, median BMI 28.9 +/- 8.42 SD). In terms of COVID vaccination status, 49.6% received one dose, 36.1% were fully vaccinated, and 7% received the booster dose. Most patients received casirivimab/imdevimab (105, 74.5%) followed by sotrovimab (33, 23.4%). Four patients developed adverse reactions to MAB infusion (two grade-2 reactions and two grade-1 reactions as per the National cancer institute infusion reaction grading criteria). Only one patient (0.7%) was hospitalized for COVID-19 infection, however, she was not hypoxic nor required ICU admission. Five patients delivered within four weeks of MAB administration, however, four of those patients were of gestational age &gt; 37 weeks. Data for 30-day all-cause mortality was available on 88.7% (125) of the patients and data for 30-day pregnancy adverse outcomes was available on 86.5% (122) of the patients due to lack of follow-up within the Health System. There was no reported 30-Day all-cause mortality within the cohort. Two patients (1.4%) had premature rupture of the membrane and one patient (0.7%) had premature delivery within 30 days of receiving MAB. Two patients had preeclampsia (1.4%) and one patient (0.7%) was admitted for evaluations of decreased fetal movements.

Conclusion
Administration of monoclonal antibodies against SARS-CoV-2 was well tolerated during pregnancy. Only 4 out of 141 (2.8%) had mild to moderate infusion-related reactions. The 30-day pregnancy adverse outcomes observed were well below the mean background rate. There was no reported mortality among MAB recipients and only one patient was hospitalized for mild COVID19 infection.

Disclosures
All Authors: No reported disclosures.
1125. Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalized adults with severe COVID-19 pneumonia: an open-label randomized trial.
Authors: Gutierrez Carlos Dueñas , Abadia-Otero Jesica , Cusacovich Ivan , Martín-González Jose Ignacio , Muela-Molinero Alberto , Corral-Gudino Luis , González-Fuentes Roberto , de Temiño Ängela Ruíz , Moral Elena Tapia , Cuadrado-Medina Francisca , Martín-Asenjo Miguel , Gonzalez Pablo Miramontes , Delgado Morales Jose Luis , Ines Sandra , Abad-Manteca Laura , Usategui-Martín Iciar , Ruíz-Albí Tomás , Miranda-Riaño Sara , Rodríguez-Fortúnez Patricia , Rodríguez-Jiménez Consuelo , López-Franco Esperanza , Marcos Miguel 
Published: December 2022

Abstract

Background
Pulse glucocorticoid therapy is used in COVID-19 infection. We evaluated the
effectiveness of methylprednisolone 250 mg/d for 3 days vs. dexamethasone 6 mg/d for 10 days in patients with severe but not critical COVID-19 pneumonia.

Methods
A multicentre, randomized, open-label, controlled trial was conducted between February 2021 and August 2021 at 4 hospitals in Spain and included 128 hospitalized adults with confirmed COVID-19 pneumonia needing oxygen therapy but not critically ill. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 once daily for 10 days or methylprednisolone 250 mg once daily for 3 days. The primary outcome was 28-day mortality.

Results
Of the 128 randomized patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group vs. 4.8 % in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; P=0.98). The post-hoc added composite outcome of mortality at 90 days or intubation was 15.9% in the 250 mg methylprednisolone group vs. 15% in the 6 mg dexamethasone group (absolute risk difference, -0.9% [95% CI, -13.8 to 12.3%];P=0.83). Hyperglycaemia was more frequent in the methylprednisolone group, at 27.0 vs. 8.1 % (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; P=0.007).

Conclusion
Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.

Disclosures
Carlos Dueñas Gutierrez, MD, ViIV, GILEAD, Jannsen, MSD: Lecture fees.
1129. Efficacy of a Polyclonal Ovine Fab (PR020) Against SARS-CoV-2 Infection
Authors: Bascal Zainab , Griffiths Aled , Dentten Ellen , Hill Christon , Ward Suzanne 
Published: December 2022

Abstract

Background
Passive immune therapies may be useful in mitigating severe COVID-19. The hamster model has been successfully used to study efficacy of COVID-19 treatments. Our objective with this research is to demonstrate initial efficacy of a new polyclonal ovine Fab raised against the SARS-CoV-2 spike protein (PR020) as a treatment for COVID-19.

Methods
Hamsters were treated with PR020 via intraperitoneal route at a dose of 120 mg/kg or a vehicle control once every 24 hours for 8 days, starting 1 day prior to viral challenge with Victoria/1/2020 SARS-CoV-2. Sampling to detect viral RNA and clinical observations were taken throughout the challenge phase. Necropsy occurred 1 day following the last dose of PR020, and tissues were assessed for histopathology and viral RNA.

Results
Hamsters receiving vehicle alone lost weight more rapidly than the PR020 group (Figure 1, p&lt; 0.05 day 4 onward). Clinical illness scores for the PR020 group were lower compared to control animals (Figure 2, p&lt; 0.05 day 3 onward). While viral shedding assessed by throat swab did not differ between groups, viral RNA levels in lung tissue was significantly lower in PR020-treated animals (Figure 3, p&lt; 0.05). PR020-treated animals also showed significantly less pathological changes in the lung compared to controls (Figure 4, p=0.0022). FIGURE 1.Weight of Hamsters Receiving PR020 Compared to Controls.FIGURE 2.Clinical Scores of Hamsters Receiving PR020 Compared to Controls.FIGURE 3.Viral RNA Levels in Lungs of Hamsters Receiving PR020 Compared to Control.

Conclusion
Treatment with PR020 resulted in a positive clinical outcome (e.g. less weight loss and lower clinical signs). While treatment appeared to have little effect in the nasopharynx, there was a positive effect in the lower respiratory tract, with substantially less viral RNA in the lungs of the group given PR020 and a decrease in the lung histopathology, including consolidation. FIGURE 4.Histopathology Results: Lung Consolidation Scores and Total Histopathology Scores for Lung and Nasal Cavity.

Disclosures
Zainab Bascal, PhD, BTG International Inc: Employee Aled Griffiths, BSc, BTG International Inc: Employee of BTG Ellen Dentten, PhD, BTG International Inc: Employee of BTG Christon Hill, BSc, MBA, BTG International Inc: Employee of BTG Suzanne Ward, PharmD, BTG International Inc: Employee of BTG.
1146. Real-World Experience Highlighting Tocilizumab Use in the Treatment of COVID-19
Authors: Maguire Christina , Terico Adrienne , Patel Hinal , Anesi George L , Degnan Kathleen , Dutcher Lauren , Hamilton Keith W , Meyer Nuala J , Talati Naasha J , Saw Steve 
Published: December 2022

Abstract

Background
Tocilizumab (TCZ) was approved by the Food and Drug Administration under emergency use authorization for treatment of COVID-19 in patients requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation. Despite multiple clinical trials, there remain unanswered questions surrounding TCZ use.

Methods
This multi-hospital retrospective cohort study included patients who received TCZ for COVID-19 between January 29th, 2021 and June 30th, 2021 at five University of Pennsylvania Health System (UPHS) hospitals. Patients were eligible for TCZ per UPHS criteria if they scored ≥ 5 on the World Health Organization (WHO) ordinal scale for ≤ 24 hours and experienced &lt; 14 days of acute COVID-19 symptoms. Descriptive statistics were performed to characterize usage within the health system.

Results
This study evaluated 134 patients who received TCZ for the treatment of COVID-19. TCZ was ordered a median of 22 hours (interquartile range [IQR], 13.2 – 41.5) after hospital admission. A majority of patients (76.1%) were admitted to the intensive care unit and a small portion (12.7%) had a WHO ordinal scale that was &gt;5 at time of TCZ order entry. All patients received concomitant dexamethasone therapy at a total prednisone equivalent of 400 mg (IQR, 335.6 – 480). Overall 33.6% of patients experienced an adverse event (ADE) within 30 days of TCZ administration (Table 1). Most common ADEs included bacterial infection (29.9%), hepatitis (6.7%), and fungal infection (3%); other etiologies of ADEs were not accounted for. All-cause mortality (Table 2) at day 30 occurred in 20.9% of patients and median time from TCZ administration to mortality was 12.5 days (IQR 5 – 18.3). Ninety-six patients in the cohort (71.6%) were discharged by day 30. Of the subgroup discharged by day 30, the majority (70.8%) were discharged to home.

Conclusion
Patients who received TCZ for severe COVID-19 experienced 20.9% mortality; mortality was higher among those with higher ordinal scale at the time of TCZ dosing. A large portion of patients (70.8%) were discharged to home within 30 days. One third of patients experienced an adverse event, primarily bacterial or fungal infection. Our experience may be useful in counseling patients about anticipated effects of TCZ.

Disclosures
George L Anesi, MD, MSCE, AHRQ, NHLBI, UpToDate: Advisor/Consultant|AHRQ, NHLBI, UpToDate: Grant/Research Support Kathleen Degnan, MD, Gilead: Grant/Research Support.
1157. The Clinical Impact of Casirivimab–Imdevimab Monoclonal Antibody Therapy (CIMAT) in COVID-19 patients: A real-world insight from India.
Authors: Kochuparambil Jose J , Issac Aleena 
Published: December 2022

Abstract

Background
Various clinical studies from developed countries support the use of Casirivimab–Imdevimab Monoclonal Antibody Therapy (CIMAT) to treat outpatients with mild to moderate coronavirus disease-19 (COVID-19). However, the real-world clinical data from India, owing to the portrayed benefits, are limited. Moreover, the choice of CIMAT depends upon the willingness of the patient or his bystanders for this therapy. The study aimed to assess the impact of Casirivimab–Imdevimab Monoclonal Antibody Therapy (CIMAT) for mild to moderate COVID-19 in India.

Methods
A single-center, retrospective comparative study was conducted to evaluate the impact of the CIMAT in symptomatic adult COVID-19 patients admitted to a secondary care hospital in South India, categorized as mild or moderate, and who are at high risk for progression to severe COVID-19. The data for the study were retrieved from the Electronic Health Records (EHR) of the hospital from April 2021 to March 2022, a period of 12 months. The primary outcome of the study was the length of hospitalization, and the secondary outcomes were mechanical ventilation post-infusion, readmissions after discharge, and mortality rate. Outcomes in the CIMAT cohort were compared to those of a control group of patients admitted with a diagnosis of SARS-CoV-2 during the same period who were qualified for CIMAT but were unwilling to administer it.

Results
This study included 474 patients, 48 in the CIMAT cohort and 426 in the control group. In the CIMAT cohort, the median age was 65 years (IQR: 50–73); 56.2% were ≥65 years old; 54.3% were males. Patients on CIMAT compared to the control group had a lower length of hospitalization(median: 4 [IQR 1–8]), lesser requisite for mechanical ventilation (4.3% vs 20.8%, p &lt; 0.001) and less frequent readmissions within 10 days post-discharge (6.5% vs 9.3%, p &lt; 0.001). Mortality was more among the control group, i.e., 22 (5.1%), and only one patient in the CIMAT cohort died during hospitalization (p = 0.23). The majority of the patients in the CIMAT cohort (41[89.1%]) were symptom-free within seven days of antibody cocktail administration.

Conclusion
Patients treated with CIMAT for COVID-19 were more clinically benefitted than those treated without the antibody cocktail.

Disclosures
All Authors: No reported disclosures.
Spatial Dimensions of Structural Change
Authors: Dore Poornima , Narayanan K. 
Published: December 2022

AbstractThis Chapter provides the conceptual and analytical framework for the book by outlining the spatial dimensions of structural change and drawing from various theoretical paradigms. These are closely linked with the phenomenon of specialization and division of labour along with empirical studies which help trace the pattern of agglomeration and regional development. Sectoral diversification is found to be a significant factor in the Indian experience and various studies point towards the need for greater empirical evidence on agglomeration in the context of developing countries.
The Man behind the Curtain
Authors: Bunch Ryan 
Published: December 2022

Abstract
The life and times of L. Frank Baum are the context for the theatrical humbug and American performances of the novel The Wonderful Wizard of Oz (1900) and the musical extravaganza The Wizard of Oz (1903). Baum’s book has fairy tale qualities and American traits that accommodate its adaptation as a musical. The extravaganza stages carnivalesque performances of American identity using the musical theater conventions of the turn of the twentieth century. These performances reflect attitudes about race, gender, and the performance of self in the theatrical cultures of the immigrant “melting pot” and family entertainment in the Progressive Era. The humbug of fairy tales and theater in these literary and theatrical texts establish the theatrical orientation of Oz and its American utopianism continued in subsequent musicals based on The Wizard of Oz.
Introduction
Authors: Quin Jack 
Published: December 2022

Abstract
The introduction begins by offering a brief vignette about the centrality of sculpture to Yeats’s writing and thinking by recounting the unveiling of Henry Moore’s Standing Figure: Knife Edge sculpture in the Yeats memorial garden, St. Stephen’s Green, Dublin in 1967. The second section provides an outline of the monograph chapters; the third and final section surveys the relevant criticism and recent reassessments of Yeats’s ekphrastic poetry and inter-art collaborations in order to show the importance of a holistic re-evaluation of Yeats’s work. The introduction argues that the conflation of art forms in literary criticism under the aegis of “visual culture” or “the visual arts” risks marginalizing the art of sculpture. While documenting how poetic form draws analogies to sculptural form in a selection of poems, Yeats’s understanding of sculptural practice and his sustained conversations, at times collaborations, with particular sculptors, attest to a more complicated and less metaphorical use of the art of sculpture in his writings.