Digital Commons Network^™

Core Warming Of Coronavirus Disease 2019 (Covid-19) Patients Undergoing Mechanical Ventilation-A Protocol For A Randomized Controlled Pilot Study, Nathaniel Bonfanti, Emily Gundert, Anne M. Drewry, Kristina Goff, Roger Bedimo, Erik Kulstad

Open Access Publications

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, is spreading rapidly across the globe, with little proven effective therapy. Fever is seen in most cases of COVID-19, at least at the initial stages of illness. Although fever is typically treated (with antipyretics or directly with ice or other mechanical means), increasing data suggest that fever is a protective adaptive response that facilitates recovery from infectious illness.

OBJECTIVE: To describe a randomized controlled pilot study of core warming patients with COVID-19 undergoing mechanical ventilation.

METHODS: This prospective single-site randomized controlled pilot study will enroll 20 patients undergoing mechanical ventilation …

Prevention And Management Of Dermatologic Adverse Events Associated With Tumor Treating Fields In Patients With Glioblastoma, Mario E Lacouture, Milan J Anadkat, Matthew T Ballo, Fabio Iwamoto, Suriya A Jeyapalan, Renato V La Rocca, Margaret Schwartz, Jennifer N Serventi, Martin Glas

Open Access Publications

No abstract provided.

Inappropriate Antibiotic Surgical Prophylaxis In Pediatric Patients: A National Point-Prevalence Study, Brian R Lee, Alison C Tribble, Jeffrey S Gerber, Adam L Hersh, Matthew P Kronman, Jason G Newland

Open Access Publications

No abstract provided.

Neural Networks To Predict Radiographic Brain Injury In Pediatric Patients Treated With Extracorporeal Membrane Oxygenation, Neel Shah, Abdelaziz Farhat, Jefferson Tweed, Ziheng Wang, Jeon Lee, Rafe Mcbeth, Michael Skinner, Fenghua Tian, Ravi Thiagarajan, Lakshmi Raman

Open Access Publications

Brain injury is a significant source of morbidity and mortality for pediatric patients treated with Extracorporeal Membrane Oxygenation (ECMO). Our objective was to utilize neural networks to predict radiographic evidence of brain injury in pediatric ECMO-supported patients and identify specific variables that can be explored for future research. Data from 174 ECMO-supported patients were collected up to 24 h prior to, and for the duration of, the ECMO course. Thirty-five variables were collected, including physiological data, markers of end-organ perfusion, acid-base homeostasis, vasoactive infusions, markers of coagulation, and ECMO-machine factors. The primary outcome was the presence of radiologic evidence of …

Survival Following Allogeneic Transplant In Patients With Myelofibrosis, Krisstina Gowin, Kierstin Luber, Et Al.

Open Access Publications

No abstract provided.

The Current State Of Antifungal Stewardship Among Pediatric Antimicrobial Stewardship Programs, Lourdes Eguiguren, Jason G Newland, Matthew P Kronman, Adam L Hersh, Jeffrey S Gerber, Grace M Lee, Hayden T Schwenk

Open Access Publications

OBJECTIVE: To characterize the current state of antifungal stewardship practices and perceptions of antifungal use among pediatric antimicrobial stewardship programs (ASPs).

DESIGN: We developed and distributed an electronic survey, which included 17 closed-ended questions about institutional antifungal stewardship practices and perceptions, among pediatric ASPs.

PARTICIPANTS: ASP physicians and pharmacists of 74 hospitals participating in the multicenter Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative.

RESULTS: We sent surveys to 74 hospitals and received 68 unique responses, for a response rate of 92%. Overall, 63 of 68 the respondent ASPs (93%) reported that they conduct 1 or more antifungal stewardship activities. …

Exposure To Covid-19 Patients Increases Physician Trainee Stress And Burnout, Thomas G. Kannampallil, Charles W. Goss, Bradley A. Evanoff, Jaime R. Strickland, Rebecca P. Mcalister, Jennifer Duncan

Open Access Publications

The coronavirus disease 2019 (COVID-19) pandemic has put considerable physical and emotional strain on frontline healthcare workers. Among frontline healthcare workers, physician trainees represent a unique group-functioning simultaneously as both learners and caregivers and experiencing considerable challenges during the pandemic. However, we have a limited understanding regarding the emotional effects and vulnerability experienced by trainees during the pandemic. We investigated the effects of trainee exposure to patients being tested for COVID-19 on their depression, anxiety, stress, burnout and professional fulfillment. All physician trainees at an academic medical center (n = 1375) were invited to participate in an online survey. We …

The Impact Of Sars-Cov-2 In Dementia Across Latin America: A Call For An Urgent Regional Plan And Coordinated Response, Agustin Ibanez, Jorge Llibre-Guerra, Et Al

Open Access Publications

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently …

Clinical Implications Of Restrictions In Criteria For Defining Surgical Site Infections After Mastectomy, Antoinette A A Bediako-Bowan, David K Warren, Katelin B Nickel, Victoria J Fraser, Margaret A Olsen

Open Access Publications

More than 50% of women with clinically apparent infection after mastectomy did not meet the 2020 National Healthcare Safety Network (NHSN) definition for surgical site infection (SSI). Implant loss was similar whether the 2020 NHSN SSI definition was met or not, suggesting equivalent adverse outcomes regardless of restriction to the surveillance definition.

Pediatric Research Priorities In Healthcare-Associated Infections And Antimicrobial Stewardship, Susan E Coffin, Stephanie Fritz, Jason Newland, Et Al

Open Access Publications

OBJECTIVE: To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.

PARTICIPANTS: The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).

METHODS: Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and …

A Multi-Mrna Host-Response Molecular Blood Test For The Diagnosis And Prognosis Of Acute Infections And Sepsis: Proceedings From A Clinical Advisory Panel, James Ducharme, Wesley H Self, Tiffany M Osborn, Nathan A Ledeboer, Jonathan Romanowsky, Timothy E Sweeney, Oliver Liesenfeld, Richard E Rothman

Open Access Publications

Current diagnostics are insufficient for diagnosis and prognosis of acute infections and sepsis. Clinical decisions including prescription and timing of antibiotics, ordering of additional diagnostics and level-of-care decisions rely on understanding etiology and implications of a clinical presentation. Host mRNA signatures can differentiate infectious from noninfectious etiologies, bacterial from viral infections, and predict 30-day mortality. The 29-host-mRNA blood-based InSep

Co-Occurrence Of Campylobacter Species In Children From Eastern Ethiopia, And Their Association With Environmental Enteric Dysfunction, Diarrhea, And Host Microbiome, Yitagele Terefe, Mark J Manary, Maria Isabel Ordiz, Et Al

Open Access Publications

High

Postdischarge Antibiotic Use For Prophylaxis Following Spinal Fusion, David K Warren, Katelin B Nickel, Jennifer H Han, Pam Tolomeo, Christopher J Hostler, Katherine Foy, Ian R Banks, Victoria J Fraser, Margaret A Olsen, Cdc Prevention Epicenter Program

Open Access Publications

OBJECTIVE: Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion.

DESIGN: Multicenter retrospective cohort study.

PATIENTS: This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded.

METHODS: Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models.

RESULTS: In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). …

Use Of Neuroimaging To Inform Optimal Neurocognitive Criteria For Detecting Hiv-Associated Brain Abnormalities, Laura M Campbell, David B Clifford, Et Al, Charter Group

Open Access Publications

OBJECTIVE: Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV.

METHOD: Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive …

Hematopoietic Cell Transplantation In Patients With Primary Immune Regulatory Disorders (Pird): A Primary Immune Deficiency Treatment Consortium (Pidtc) Survey, Alice Y. Chan, Jeffrey J. Bednarski, Megan A. Cooper, Shalini Shenoy, Et Al

Open Access Publications

No abstract provided.

Cryptococcus Neoformans Evades Pulmonary Immunity By Modulating Xylose Precursor Transport, Lucy X. Li, Camaron R. Hole, Javier Rangel-Moreno, Shabaana A. Khader, Tamara L. Doering

Open Access Publications

No abstract provided.

Trends In Diagnosis Related Groups For Inpatient Admissions And Associated Changes In Payment From 2012 To 2016, Ty J. Gluckman, Kateri J. Spinelli, Mansen Wang, Amir Yazdani, Gary Grunkemeier, Steven M. Bradley, Jason H. Wasfy, Abhinav Goyal, Andrew Oseran, Karen E. Joynt Maddox

Open Access Publications

Importance: Hospitals are reimbursed based on Diagnosis Related Groups (DRGs), which are defined, in part, by patients having 1 or more complications or comorbidities within a given DRG family. Hospitals have made substantial investment in efforts to document these complications and comorbidities.

Objective: To examine temporal trends in DRGs with a major complication or comorbidity, compare these findings with 2 alternative measures of disease severity, and estimate associated changes in payment.

Design, Setting, and Participants: This retrospective cohort study used data from the all-payer National Inpatient Sample for admissions assigned to 1 of the top 20 reimbursed DRG families at …

Impact Of Cytogenetic Abnormalities On Outcomes Of Adult Philadelphia-Negative Acute Lymphoblastic Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation: A Study By The Acute Leukemia Working Committee Of The Center For International Blood And Marrow Transplant Research, Aleksandr Lazaryan, Ravi Vij, Et Al.

Open Access Publications

No abstract provided.

Wikidata As A Knowledge Graph For The Life Sciences, Andra Waagmeester, Malachi Griffith, Obi L. Griffith, Et Al.

Open Access Publications

No abstract provided.

Activating Immunity To Fight A Foe — A New Path, Richard S. Hotchkiss, Steven M. Opal

Open Access Publications

No abstract provided.

Frequency And Clinical Significance Of Localized Adverse Events Following Mass Drug Administration For Lymphatic Filariasis In An Endemic Area In South India, Vijesh Sreedhar Kuttiatt, Roopali K Somani, Subramanian Swaminathan, Kaliannagounder Krishnamoorthy, Gary J Weil, Jambulingam Purushothaman

Open Access Publications

Fear of adverse events (AEs) negatively affects compliance to mass drug administration (MDA) for lymphatic filariasis (LF) elimination program. Systemic AEs are believed to occur because of killing of microfilariae, whereas localized soft tissue reactions might be due to the death of adult worms following therapy. Most AEs are mild and self-limited. However, localized AEs are sometimes more significant and of concern to participants. Here, we describe localized AEs that were noted during a large community study that evaluated the safety of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) for the treatment of LF in India. We have also discussed …

Tetracycline-Inactivating Enzymes From Environmental, Human Commensal, And Pathogenic Bacteria Cause Broad-Spectrum Tetracycline Resistance, Andrew J. Gasparrini, Jana L. Markley, Hirdesh Kumar, Bin Wang, Luting Fang, Sidra Irum, Chanez T. Symister, Meghan Wallace, Carey-Ann D. Burnham, Saadia Andleeb, Niraj H. Tolia, Timothy A. Wencewicz, Gautam Dantas

Open Access Publications

No abstract provided.

Myd88-Dependent Influx Of Monocytes And Neutrophils Impairs Lymph Node B Cell Responses To Chikungunya Virus Infection Via Irf5, Nos2 And Nox2, Mary K. Mccarthy, Glennys V. Reynoso, Emma S. Winkler, Matthias Mack, Michael S. Diamond, Heather D. Hickman, Thomas E. Morrison

Open Access Publications

Humoral immune responses initiate in the lymph node draining the site of viral infection (dLN). Some viruses subvert LN B cell activation; however, our knowledge of viral hindrance of B cell responses of important human pathogens is lacking. Here, we define mechanisms whereby chikungunya virus (CHIKV), a mosquito-transmitted RNA virus that causes outbreaks of acute and chronic arthritis in humans, hinders dLN antiviral B cell responses. Infection of WT mice with pathogenic, but not acutely cleared CHIKV, induced MyD88-dependent recruitment of monocytes and neutrophils to the dLN. Blocking this influx improved lymphocyte accumulation, dLN organization, and CHIKV-specific B cell responses. …

Gardnerella Vaginalis As A Cause Of Bacterial Vaginosis: Appraisal Of The Evidence From In Vivo Models, Sydney Morrill, Nicole M Gilbert, Amanda L Lewis

Open Access Publications

Koch's postulates dictate the use of experimental models to illustrate features of human disease and provide evidence for a singular organism as the cause. The underlying cause(s) of bacterial vaginosis (BV) has been debated in the literature for over half a century. In 1955, it was first reported that a bacterium now known as

Use Of Icd-10 Codes For Identification Of Injection Drug Use-Associated Infective Endocarditis Is Nonspecific And Obscures Critical Findings On Impact Of Medications For Opioid Use Disorder, Laura R. Marks, Nathanial S. Nolan, Linda Jiang, Dharushana Muthulingam, Stephen Y. Liang, Michael J. Durkin

Open Access Publications

Background: No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use-associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated.

Methods: We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research.

Results: ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. …

Neutrophil L-Plastin Controls Ocular Paucibacteriality And Susceptibility To Keratitis, Xiaoxiao Lu, Abirami Kugadas, Kirsten Smith-Page, Jeffrey Lamb, Tiffany Lin, Yusha Ru, Sharon Celeste Morley, Raina Fichorova, Sharad K Mittal, Sunil K Chauhan, Sejiro Littleton, Daniel Saban, Mihaela Gadjeva

Open Access Publications

Why ocular mucosa is paucibacterial is unknown. Many different mechanisms have been suggested but the comprehensive experimental studies are sparse. We found that a deficiency in L-plastin (LCP1), an actin bundling protein, resulted in an ocular commensal overgrowth, characterized with increased presence of conjunctival

Lipin-1 Contributes To Il-4 Mediated Macrophage Polarization, Sunitha Chandran, Robert M Schilke, Cassidy M R Blackburn, Aila Yurochko, Rusella Mirza, Rona S Scott, Brian N Finck, Matthew D Woolard

Open Access Publications

Macrophage responses contribute to a diverse array of pathologies ranging from infectious disease to sterile inflammation. Polarization of macrophages determines their cellular function within biological processes. Lipin-1 is a phosphatidic acid phosphatase in which its enzymatic activity contributes to macrophage pro-inflammatory responses. Lipin-1 also possesses transcriptional co-regulator activity and whether this activity is required for macrophage polarization is unknown. Using mice that lack only lipin-1 enzymatic activity or both enzymatic and transcriptional coregulator activities from myeloid cells, we investigated the contribution of lipin-1 transcriptional co-regulator function toward macrophage wound healing polarization. Macrophages lacking both lipin-1 activities did not elicit IL-4 …

Quantitative Definition Of Neurobehavior, Vision, Hearing And Brain Volumes In Macaques Congenitally Exposed To Zika Virus, Michelle R. Koenig, Kevin Noguchi, Et Al.

Open Access Publications

Congenital Zika virus (ZIKV) exposure results in a spectrum of disease ranging from severe birth defects to delayed onset neurodevelopmental deficits. ZIKV-related neuropathogenesis, predictors of birth defects, and neurodevelopmental deficits are not well defined in people. Here we assess the methodological and statistical feasibility of a congenital ZIKV exposure macaque model for identifying infant neurobehavior and brain abnormalities that may underlie neurodevelopmental deficits. We inoculated five pregnant macaques with ZIKV and mock-inoculated one macaque in the first trimester. Following birth, growth, ocular structure/function, brain structure, hearing, histopathology, and neurobehavior were quantitatively assessed during the first week of life. We identified …

Mapping Of The Language Network With Deep Learning, Patrick Luckett, John J Lee, Ki Yun Park, Donna Dierker, Andy G S Daniel, Benjamin A Seitzman, Carl D Hacker, Beau M Ances, Eric C Leuthardt, Abraham Z Snyder, Joshua S Shimony

Open Access Publications

No abstract provided.

Targeting Unconventional Host Components For Vaccination-Induced Protection Against Tb, Elisa Nemes, Shabaana A Khader, Rosemary V Swanson, Willem A Hanekom

Open Access Publications

The current tuberculosis (TB) vaccine, Bacille Calmette-Guerin (BCG), is effective in preventing TB in young children but was developed without a basic understanding of human immunology. Most modern TB vaccine candidates have targeted CD4