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Breaking Through: My Life in Science Katalin Kariko; Crown Publishing Group, New York, NY, USA, 2023; ISBN: 9780593443163; Pages: 330; Price: $21.99 (hardcover), $13.99 (ebook) In Breaking Through: My Life [...]

Background There are no systematic measures of central line–associated bloodstream infections (CLABSIs) in patients maintaining central venous catheters (CVCs) outside acute care hospitals. To clarify the burden of CLABSIs in these patients, we characterized patients with CLABSI present on hospital admission (POA). Methods Retrospective cross-sectional analysis of patients with CLABSI-POA in 3 health systems covering 11 hospitals across Maryland, Washington DC, and Missouri from November 2020 to October 2021. CLABSI-POA was defined using an adaptation of the acute care CLABSI definition. Patient demographics, clinical characteristics, and outcomes were collected via record review. Cox proportional hazard analysis was used to assess factors associated with the all-cause mortality rate within 30 days. Results A total of 461 patients were identified as having CLABSI-POA. CVCs were most commonly maintained in home infusion therapy (32.8%) or oncology clinics (31.2%). Enterobacterales were the most common etiologic agent (29.2%). Recurrent CLABSIs occurred in a quarter of patients (25%). Eleven percent of patients died during the hospital admission. Among patients with CLABSI-POA, mortality risk increased with age (hazard ratio vs age <20 years by age group: 20–44 years, 11.2 [95% confidence interval, 1.46–86.22]; 45–64 years, 20.88 [2.84–153.58]; ≥65 years, 22.50 [2.98–169.93]) and lack of insurance (2.46 [1.08–5.59]), and it decreased with CVC removal (0.57 [.39–.84]). Conclusions CLABSI-POA is associated with significant in-hospital mortality risk. Surveillance is required to understand the burden of CLABSI in the community to identify targets for CLABSI prevention initiatives outside acute care settings. [ABSTRACT FROM AUTHOR]

Background: Skilled home healthcare (HH) provided in‐person care to older adults during the COVID‐19 pandemic, yet little is known about the pandemic's impact on HH care transition patterns. We investigated pandemic impact on (1) HH service volume; (2) population characteristics; and (3) care transition patterns for older adults receiving HH services after hospital or skilled nursing facility (SNF) discharge. Methods: Retrospective, cohort, comparative study of recently hospitalized older adults (≥ 65 years) receiving HH services after hospital or SNF discharge at two large HH agencies in Baltimore and New York City (NYC) 1‐year pre‐ and 1‐year post‐pandemic onset. We used the Outcome and Assessment Information Set (OASIS) and service use records to examine HH utilization, patient characteristics, visit timeliness, medication issues, and 30‐day emergency department (ED) visit and rehospitalization. Results: Across sites, admissions to HH declined by 23% in the pandemic's first year. Compared to the year prior, older adults receiving HH services during the first year of the pandemic were more likely to be younger, have worse mental, respiratory, and functional status in some areas, and be assessed by HH providers as having higher risk of rehospitalization. Thirty‐day rehospitalization rates were lower during the first year of the pandemic. COVID‐positive HH patients had lower odds of 30‐day ED visit or rehospitalization. At the NYC site, extended duration between discharge and first HH visit was associated with reduced 30‐day ED visit or rehospitalization. Conclusions: HH patient characteristics and utilization were distinct in Baltimore versus NYC in the initial year of the COVID‐19 pandemic. Study findings suggest some older adults who needed HH may not have received it, since the decrease in HH services occurred as SNF use decreased nationally. Findings demonstrate the importance of understanding HH agency responsiveness during public health emergencies to ensure older adults' access to care. [ABSTRACT FROM AUTHOR]

Orthopoxvirus-specific T-cell responses were analyzed in 10 patients who had recovered from Mpox including 7 people with human immunodeficiency virus (PWH). Eight participants had detectable virus-specific T-cell responses, including a PWH who was not on antiretroviral therapy and a PWH on immunosuppressive therapy. These 2 participants had robust polyfunctional CD4+ T-cell responses to peptides from the 121L vaccinia virus (VACV) protein. T-cells from 4 of 5 HLA-A2–positive participants targeted at least 1 previously described HLA-A2–restricted VACV epitope, including an epitope targeted in 2 participants. These results advance our understanding of immunity in convalescent Mpox patients. [ABSTRACT FROM AUTHOR]

Ultrasound-mediated cavitation shows great promise for improving targeted drug delivery across a range of clinical applications. Cavitation nuclei—sound-sensitive constructs that enhance cavitation activity at lower pressures—have become a powerful adjuvant to ultrasound-based treatments, and more recently emerged as a drug delivery vehicle in their own right. The unique combination of physical, biological, and chemical effects that occur around these structures, as well as their varied compositions and morphologies, make cavitation nuclei an attractive platform for creating delivery systems tuned to particular therapeutics. In this review, we describe the structure and function of cavitation nuclei, approaches to their functionalization and customization, various clinical applications, progress toward real-world translation, and future directions for the field. [ABSTRACT FROM AUTHOR]

Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications in 2022. Seventy-five articles were initially identified, with 54 being scored. The top 20 OPAT articles published in 2022 were reviewed by a group of multidisciplinary OPAT clinicians. This article provides a summary of the "top 10" OPAT publications of 2022. [ABSTRACT FROM AUTHOR]

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Bacterial biofilms are a major and ongoing concern for public health, featuring both inherited genetic resistance traits and a conferred innate tolerance to traditional antibiotic therapies. Consequently, there is a growing need for novel methods of drug delivery, to increase the efficacy of antimicrobial agents. This research evaluated the anti-biofilm and bactericidal effects of ultrasound responsive gas-microbubbles (MBs) of either air or nitric oxide, using an in vitro Pseudomonas aeruginosa biofilm model grown in artificial wound medium. The four lipid-based MB formulations evaluated were room-air MBs (RAMBs) and nitric oxide MBs (NOMBs) with no electrical charge, as well as cationic (+) RAMBs+ and NOMBs+. Two principal treatment conditions were used: i) ultrasound stimulated MBs only, and ii) ultrasound stimulated MBs with a sub-inhibitory concentration (4 µg/mL) of the antibiotic gentamicin. The total treatment time was divided into a 60 second passive MB interaction period prior to 40 second ultrasound exposure; each MB formulation was tested in triplicate. Ultrasound stimulated RAMBs and NOMBs without antibiotic achieved reductions in biofilm biomass of 93.3% and 94.0%, respectively. Their bactericidal efficacy however was limited, with a reduction in culturable cells of 26.9% and 65.3%, respectively. NOMBs with sub-inhibitory antibiotic produced the most significant reduction in biofilm biomass, corresponding to a 99.9% (SD ± 5.21%); and a 99.9% (SD ± 0.07%) (3-log) reduction in culturable bacterial cells. Cationic MBs were initially manufactured to promote binding of MBs to negatively charged biofilms, but these formulations also demonstrated intrinsic bactericidal properties. In the absence of antibiotic, the bactericidal efficacy of RAMB+ and NOMB+ was greater that of uncharged counterparts, reducing culturable cells by 84.7% and 86.1% respectively; increasing to 99.8% when combined with antibiotic. This study thus demonstrates the anti-biofilm and bactericidal utility of ultrasound stimulated MBs, and specifically is the first to demonstrate the efficacy of a NOMB for the dispersal and potentiation of antibiotics against bacterial biofilms in vitro. Importantly the biofilm system and complex growth-medium were selected to recapitulate key morphological features of in vivo biofilms. The results us offer new insight for the development of new clinical treatments, for example, in chronic wounds. [ABSTRACT FROM AUTHOR]

As outpatient parenteral antimicrobial therapy (OPAT) becomes more common, it may be difficult to stay current with recent related publications. A group of multidisciplinary OPAT clinicians reviewed and ranked all OPAT publications published in 2021. This article provides a high-level summary of the OPAT manuscripts that were voted the "top 10" publications of 2021. [ABSTRACT FROM AUTHOR]

Infection prevention and surveillance training approaches for home infusion therapy have not been well defined. We interviewed home infusion staff who perform surveillance activities about barriers to and facilitators for central line-associated bloodstream infection (CLABSI) surveillance and identified barriers to training in CLABSI surveillance. Our findings show a lack of formal surveillance training for staff. This gap can be addressed by adapting existing training resources to the home infusion setting. [ABSTRACT FROM AUTHOR]

• Observational study assessed appropriateness of antibiotic therapy. • Over 50% of patients were prescribed excess antibiotics at discharge. • Choice of antibiotic was appropriate in 70% of cases. Antibiotic resistance is increasing worldwide and can be largely attributed to excess antibiotic use. At our institution, 75% of patients were prescribed excess antibiotic days and total duration of therapy was appropriate in only 24.5% of cases per the reviewers. Choice of antibiotic was appropriate in 70.4% of cases. [ABSTRACT FROM AUTHOR]

• We identified 8 major steps to perform home infusion CLABSI surveillance. • Barriers included the lack of training, definition, time, and IT support. • Poor hospital communication and front-line and leadership support were common. • Those performing home infusion CLABSI surveillance require significant support. Barriers for home infusion therapy central line associated bloodstream infection (CLABSI) surveillance have not been elucidated and are needed to identify how to support home infusion CLABSI surveillance. We aimed to (1) perform a goal-directed task analysis of home infusion CLABSI surveillance, and (2) describe barriers to, facilitators for, and suggested strategies for successful home infusion CLABSI surveillance. We conducted semi-structured interviews with team members involved in CLABSI surveillance at 5 large home infusion agencies to explore work systems used by members of the agency for home infusion CLABSI surveillance. We analyzed the transcribed interviews qualitatively for themes. Twenty-one interviews revealed 8 steps for performing CLABSI surveillance in home infusion therapy. Major barriers identified included the need for training of the surveillance staff, lack of a standardized definition, inadequate information technology support, struggles communicating with hospitals, inadequate time, and insufficient clinician engagement and leadership support. Staff performing home infusion CLABSI surveillance need health system resources, particularly leadership and front-line engagement, access to data, information technology support, training, dedicated time, and reports to perform tasks. Building home infusion CLABSI surveillance programs will require support from home infusion leadership [ABSTRACT FROM AUTHOR]

Contrast-enhanced ultrasound (CEUS) imaging relies on distinguishing between microbubble and tissue echoes. Amplitude modulation (AM), a nonlinear pulsing scheme, has been developed to take advantage of the amplitude-dependent nonlinearity of microbubble echoes. However, with AM, tissue nonlinear propagation can also degrade the image contrast. Segmentation of CEUS images based on amplitude-dependent phase difference in the echoes, defined in this article as ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ , has been proposed as an additional method of enhancing contrast-to-tissue ratio as tissue is not expected to create the same degree of ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ ; however, this has not been robustly investigated. In this work, we evaluate the source of ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ through simulations of unshelled versus shelled microbubble oscillation and simulations of nonlinear propagation in tissue. We then validate the simulated ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ results with experimental ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ measurements during in vitro scattering and imaging in a flow phantom. We show that shelled and unshelled microbubbles resulted in a ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ with similar overall magnitude with some differences in trends, and that tissue echoes have a small yet detectable degree of ${\sf \varDelta } {\sf \varPhi }_{\textit {AM}}$ due to nonlinear propagation. The results from this work can help inform optimal parameter selection for phase segmentation and implementation on a clinical scanner. [ABSTRACT FROM AUTHOR]

To evaluate changes in Clostridioides difficile incidence rates for Maryland hospitals that participated in the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative. Pre-post, difference-indifference analysis of non-randomised intervention using four quarters of preintervention and six quarters of postintervention National Healthcare Safety Network data for SPARC hospitals (April 2017 to March 2020) and 10 quarters for control hospitals (October 2017 to March 2020). Mixed-effects negative binomial models were used to assess changes over time. Process evaluation using hospital intervention implementation plans, assessments and interviews with staff at eight SPARC hospitals. Maryland, USA. All Maryland acute care hospitals; 12 intervention and 36 control hospitals. Participation in SPARC, a public health-academic collaborative made available to Maryland hospitals, with staggered enrolment between June 2018 and August 2019. Hospitals with higher C. difficile rates were recruited via email and phone. SPARC included assessments, feedback reports and ongoing technical assistance. Primary outcomes were C. difficile incidence rate measured as the quarterly number of C. difficile infections per 10 000 patient-days (outcome measure) and SPARC intervention hospitals' experiences participating in the collaborative (process measures). SPARC invited 13 hospitals to participate in the intervention, with 92% (n=12) participating. The 36 hospitals that did not participate served as control hospitals. SPARC hospitals were associated with 45% greater C. difficile reduction as compared with control hospitals (incidence rate ratio=0.55, 95% CI 0.35 to 0.88, p=0.012). Key SPARC activities, including access to trusted external experts, technical assistance, multidisciplinary collaboration, an accountability structure, peer-to-peer learning opportunities and educational resources, were associated with hospitals reporting positive experiences with SPARC. SPARC intervention hospitals experienced 45% greater reduction in C. difficile rates than control hospitals. A public health-academic collaborative might help reduce C. difficile and other hospital-acquired infections in individual hospitals and at state or regional levels. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Inappropriate use of telemetry frequently occurs in the inpatient, non‐intensive care unit setting. Telemetry practice standards have attempted to guide appropriate use and limit the overuse of this important resource with limited success. Clinical‐effectiveness studies have thus far not included care settings in which resident‐physicians are the primary caregivers. Methods: We implemented two interventions on general internal medicine units of an academic hospital. The first intervention, or nurse‐discontinuation protocol, allowed nurses to trigger the discontinuation of telemetry once the appropriate duration had passed according to practice standards. The second intervention, or physician‐discontinuation protocol, instituted a best‐practice advisory that notified the resident‐physician via the electronic medical record when the appropriate telemetry duration for each patient had elapsed and suggested termination of telemetry. Data collection spanned 8 months following the implementation of the nurse‐discontinuation protocol and 12 months following the physician‐discontinuation protocol. Results: During the control period, the average time spent on telemetry was 86.29 hours/patient/month. During the nurse‐discontinuation protocol, patients spent, on average, 70.86 hours/patient/month on telemetry. During the physician‐discontinuation protocol, patients spent, on average, 81.6 hours/patient/month on telemetry. During the nurse‐discontinuation protocol, there was no significant change in the likelihood that a patient was placed on telemetry throughout their admission when compared with the control period. During the physician‐discontinuation protocol, there was a significant decrease of 56.1% in the likelihood that a patient would be put on telemetry when compared with the control time period. Conclusions: These findings expand our understanding of telemetry use in the academic care setting in which trainees serve as the primary caregivers. Furthermore, these findings represent an important addition to the telemetry and patient monitoring literature by demonstrating the impact that nurse‐managed protocols can have on telemetry use and by highlighting effective strategies to improve telemetry use by physicians in training. [ABSTRACT FROM AUTHOR]

The introduction of the underground cistern in South Asia, through Western India, offers a fascinating case study of knowledge migration and technological transfers between West and South Asia. It addresses the question of past hydraulic technologies used in the Western Indian cities and the modalities of a fundamental shift in the relationship to water during the 16th century. The present paper is based on my surveys and architectural studies of underground cisterns (tānkā) in Ahmedabad, urbs prima of Gujarat from 1411 onwards. It describes the tānkā system and its archaeological characteristics, with a special focus on the early reservoir of the Shāh Vajihudin Alvi khānqāh. This study, compared with evidences in other urban centres of Western India, brings to light the emergence of underground cisterns in the urban context from the late 16th century onwards. It also shows the pioneering role played by the large cistern built in the Shāh Vajihudin Alvi khānqāh. Beyond this archaeological work, the paper discusses the causes of this radical technological change, and addresses the issue of cultural and religious continuity. [ABSTRACT FROM AUTHOR]