Publications by authors named "Michael Stevens"

438 Publications

Reward Processing in Novelty Seekers: A Transdiagnostic Psychiatric Imaging Biomarker.

Biol Psychiatry 2021 Jan 30. Epub 2021 Jan 30.

Centre for Population Neuroscience and Stratified Medicine, Institute for Science and Technology of Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.

Background: Dysfunctional reward processing is implicated in multiple mental disorders. Novelty seeking (NS) assesses preference for seeking novel experiences, which is linked to sensitivity to reward environmental cues.

Methods: A subset of 14-year-old adolescents (IMAGEN) with the top 20% ranked high-NS scores was used to identify high-NS-associated multimodal components by supervised fusion. These features were then used to longitudinally predict five different risk scales for the same and unseen subjects (an independent dataset of subjects at 19 years of age that was not used in predictive modeling training at 14 years of age) (within IMAGEN, n ≈1100) and even for the corresponding symptom scores of five types of patient cohorts (non-IMAGEN), including drinking (n = 313), smoking (n = 104), attention-deficit/hyperactivity disorder (n = 320), major depressive disorder (n = 81), and schizophrenia (n = 147), as well as to classify different patient groups with diagnostic labels.

Results: Multimodal biomarkers, including the prefrontal cortex, striatum, amygdala, and hippocampus, associated with high NS in 14-year-old adolescents were identified. The prediction models built on these features are able to longitudinally predict five different risk scales, including alcohol drinking, smoking, hyperactivity, depression, and psychosis for the same and unseen 19-year-old adolescents and even predict the corresponding symptom scores of five types of patient cohorts. Furthermore, the identified reward-related multimodal features can classify among attention-deficit/hyperactivity disorder, major depressive disorder, and schizophrenia with an accuracy of 87.2%.

Conclusions: Adolescents with higher NS scores can be used to reveal brain alterations in the reward-related system, implicating potential higher risk for subsequent development of multiple disorders. The identified high-NS-associated multimodal reward-related signatures may serve as a transdiagnostic neuroimaging biomarker to predict disease risks or severity.
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http://dx.doi.org/10.1016/j.biopsych.2021.01.011DOI Listing
January 2021

Pandemic stewardship: reflecting on new roles and contributions of antimicrobial stewardship programs during COVID-19.

Infect Control Hosp Epidemiol 2021 Apr 16:1-5. Epub 2021 Apr 16.

Department of Medicine, Division of Infectious Diseases Virginia Commonwealth University School of Medicine 1300 E. Marshall Street P.O. Box 980019 Richmond, Virginia 23298

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http://dx.doi.org/10.1017/ice.2021.172DOI Listing
April 2021

Impact of cascade reporting of antimicrobial susceptibility on fluoroquinolone and meropenem consumption at a Veterans' Affairs medical center.

Infect Control Hosp Epidemiol 2021 Apr 6:1-6. Epub 2021 Apr 6.

Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia.

Objective: To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption.

Design: A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting.

Setting: A 399-bed, tertiary-care, Veterans' Affairs medical center.

Participants: Antimicrobial consumption data across 8 inpatient units were extracted from the Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) antimicrobial use (AU) module from April 2017 through March 2019, reported as antimicrobial days of therapy (DOT) per 1,000 days present (DP).

Intervention: Cascade reporting is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow-spectrum agents. A multidisciplinary team developed cascade reporting algorithms for gram-negative bacteria based on local antibiogram and infectious diseases practice guidelines, aimed at restricting the use of fluoroquinolones and carbapenems. The algorithms were implemented in March 2018.

Results: Following the implementation of cascade reporting, mean monthly meropenem (P =.005) and piperacillin/tazobactam (P = .002) consumption decreased and cefepime consumption increased (P < .001). Ciprofloxacin consumption decreased by 2.16 DOT per 1,000 DP per month (SE, 0.25; P < .001). Clostridioides difficile rates did not significantly change.

Conclusion: Ciprofloxacin consumption significantly decreased after the implementation of cascade reporting. Mean meropenem consumption decreased after cascade reporting was implemented, but we observed no significant change in the slope of consumption. cascade reporting may be a useful strategy to optimize antimicrobial prescribing.
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http://dx.doi.org/10.1017/ice.2021.83DOI Listing
April 2021

Cloud Formation From a Localized Water Release in the Upper Mesosphere: Indication of Rapid Cooling.

J Geophys Res Space Phys 2021 Feb 22;126(2):e2019JA027285. Epub 2021 Feb 22.

Johns Hopkins University Applied Physics Laboratory Laurel MD USA.

Polar mesospheric clouds (PMCs) occur in the summer near 82 -85km altitude due to seasonal changes of temperature and humidity. However, water vapor and associated PMCs have also been observed associated with rocket exhaust. The effects of this rocket exhaust on the temperature of the upper mesosphere are not well understood. To investigate these effects, 220 kg of pure water was explosively released at 85 km as part of the Super Soaker sounding rocket experiment on the night of January 25-26, 2018 at Poker Flat Research Range (65°N, 147°W). A cloud formed within 18 s and was measured by a ground-based Rayleigh lidar. The peak altitude of the cloud appeared to descend from 92 to 78 km over 3 min. Temperatures leading up to the release were between 197 and 232 K, about 50 K above the summertime water frost point when PMCs typically occur. The apparent motion of the cloud is interpreted in terms of the expansion of the explosive release. Analysis using a water vapor radiative cooling code coupled to a microphysical model indicates that the cloud formed due to the combined effects of rapid radiative cooling (∼25 K) by meter-scale filaments of nearly pure water vapor (∼1 ppv) and an increase in the frost point temperature (from 150 to 200 K) due to the high concentration of water vapor. These results indicate that water exhaust not only acts as a reservoir for mesospheric cloud production but also actively cools the mesosphere to induce cloud formation.
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http://dx.doi.org/10.1029/2019JA027285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988588PMC
February 2021

An Examination of the Association Between Subjective Distress and Functional Connectivity During Discarding Decisions in Hoarding Disorder.

Biol Psychiatry Cogn Neurosci Neuroimaging 2021 Jan 12. Epub 2021 Jan 12.

Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.

Background: Individuals with hoarding disorder (HD) demonstrate exaggerated subjective distress and hyperactivation of cingulate and insular cortex regions when discarding personal possessions. No prior study has sought to determine whether this subjective distress is associated with specific profiles of abnormal brain function in individuals with HD.

Methods: We used multimodal canonical correlation analysis plus joint independent component analysis to test whether five hoarding-relevant domains of subjective distress when deciding to discard possessions (anxiety, sadness, monetary value, importance, and sentimental attachment) are associated with functional magnetic resonance imaging-measured whole-brain functional connectivity in 72 participants with HD and 44 healthy controls.

Results: Three extracted components differed between HD participants and healthy control subjects. Each of these components depicted an abnormal profile of functional connectivity in HD participants relative to control subjects during discarding decisions, and a specific distress response profile. One component pair showed a relationship between anxiety ratings during discarding decisions and connectivity among the pallidum, perirhinal ectorhinal cortex, and dorsolateral prefrontal cortex. Another component comprised sadness ratings during discarding decisions and connectivity in the pallidum, nucleus accumbens, amygdala, and dorsolateral prefrontal cortex. The third component linked HD brain connectivity in several dorsolateral prefrontal cortex regions with perceived importance ratings during discarding decisions.

Conclusions: The findings indicate that in patients with HD, the subjective intensity of anxiety, sadness, and perceived possession importance is related to abnormal functional connectivity in key frontal and emotional processing brain regions. The findings are discussed in terms of emerging neurobiological models of HD.
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http://dx.doi.org/10.1016/j.bpsc.2020.12.014DOI Listing
January 2021

Effects of weather and season on human brain volume.

PLoS One 2021 24;16(3):e0236303. Epub 2021 Mar 24.

Olin Neuropsychiatry Research Center, Hartford Hospital, Hartford, CT, United States of America.

We present an exploratory cross-sectional analysis of the effect of season and weather on Freesurfer-derived brain volumes from a sample of 3,279 healthy individuals collected on two MRI scanners in Hartford, CT, USA over a 15 year period. Weather and seasonal effects were analyzed using a single linear regression model with age, sex, motion, scan sequence, time-of-day, month of the year, and the deviation from average barometric pressure, air temperature, and humidity, as covariates. FDR correction for multiple comparisons was applied to groups of non-overlapping ROIs. Significant negative relationships were found between the left- and right- cerebellum cortex and pressure (t = -2.25, p = 0.049; t = -2.771, p = 0.017). Significant positive relationships were found between left- and right- cerebellum cortex and white matter between the comparisons of January/June and January/September. Significant negative relationships were found between several subcortical ROIs for the summer months compared to January. An opposing effect was observed between the supra- and infra-tentorium, with opposite effect directions in winter and summer. Cohen's d effect sizes from monthly comparisons were similar to those reported in recent psychiatric big-data publications, raising the possibility that seasonal changes and weather may be confounds in large cohort studies. Additionally, changes in brain volume due to natural environmental variation have not been reported before and may have implications for weather-related and seasonal ailments.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236303PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990212PMC
March 2021

Spatially clustered count data provide more efficient search strategies in invasion biology and disease control.

Ecol Appl 2021 Mar 22:e02329. Epub 2021 Mar 22.

School of Biological and Chemical Sciences, Queen Mary University of London, London, E1 4NS, UK.

Geographic profiling, a mathematical model originally developed in criminology, is increasingly being used in ecology and epidemiology. Geographic profiling boasts a wide range of applications, such as finding source populations of invasive species or breeding sites of vectors of infectious disease. The model provides a cost-effective approach for prioritizing search strategies for source locations and does so via simple data in the form of the positions of each observation, such as individual sightings of invasive species or cases of a disease. In doing so, however, classic geographic profiling approaches fail to make the distinction between those areas containing observed absences and those areas where no data were recorded. Absence data are generated via spatial sampling protocols but are often discarded during the inference process. Here we construct a geographic profiling model that resolves these issues by making inferences via count data, analyzing a set of discrete sentinel locations at which the number of encounters has been recorded. Crucially, in our model this number can be zero. We verify the ability of this new model to estimate source locations and other parameters of practical interest via a Bayesian power analysis. We also measure model performance via real-world data in which the model infers breeding locations of mosquitoes in bromeliads in Miami-Dade County, Florida, USA. In both cases, our novel model produces more efficient search strategies by shifting focus from those areas containing observed absences to those with no data, an improvement over existing models that treat these areas equally. Our model makes important improvements upon classic geographic profiling methods, which will significantly enhance real-world efforts to develop conservation management plans and targeted interventions.
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http://dx.doi.org/10.1002/eap.2329DOI Listing
March 2021

Analysis of structural brain asymmetries in attention-deficit/hyperactivity disorder in 39 datasets.

J Child Psychol Psychiatry 2021 Mar 22. Epub 2021 Mar 22.

Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA.

Objective: Some studies have suggested alterations of structural brain asymmetry in attention-deficit/hyperactivity disorder (ADHD), but findings have been contradictory and based on small samples. Here, we performed the largest ever analysis of brain left-right asymmetry in ADHD, using 39 datasets of the ENIGMA consortium.

Methods: We analyzed asymmetry of subcortical and cerebral cortical structures in up to 1,933 people with ADHD and 1,829 unaffected controls. Asymmetry Indexes (AIs) were calculated per participant for each bilaterally paired measure, and linear mixed effects modeling was applied separately in children, adolescents, adults, and the total sample, to test exhaustively for potential associations of ADHD with structural brain asymmetries.

Results: There was no evidence for altered caudate nucleus asymmetry in ADHD, in contrast to prior literature. In children, there was less rightward asymmetry of the total hemispheric surface area compared to controls (t = 2.1, p = .04). Lower rightward asymmetry of medial orbitofrontal cortex surface area in ADHD (t = 2.7, p = .01) was similar to a recent finding for autism spectrum disorder. There were also some differences in cortical thickness asymmetry across age groups. In adults with ADHD, globus pallidus asymmetry was altered compared to those without ADHD. However, all effects were small (Cohen's d from -0.18 to 0.18) and would not survive study-wide correction for multiple testing.

Conclusion: Prior studies of altered structural brain asymmetry in ADHD were likely underpowered to detect the small effects reported here. Altered structural asymmetry is unlikely to provide a useful biomarker for ADHD, but may provide neurobiological insights into the trait.
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http://dx.doi.org/10.1111/jcpp.13396DOI Listing
March 2021

Impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections: An update and perspective.

Infect Control Hosp Epidemiol 2021 Mar 12:1-2. Epub 2021 Mar 12.

Hospital Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, Virginia.

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http://dx.doi.org/10.1017/ice.2021.92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985904PMC
March 2021

Syndromic Multiplex Polymerase Chain Reaction (mPCR) Testing and Antimicrobial Stewardship: Current Practice and Future Directions.

Curr Infect Dis Rep 2021 26;23(4). Epub 2021 Feb 26.

Division of Infectious Diseases, Virginia Commonwealth University Health System, Richmond, VA USA.

Purpose Of Review: Syndromic multiplex polymerase chain reaction (mPCR) panels offer the antimicrobial steward a rapid tool for optimizing and de-escalating antimicrobials. In this review, we analyze the role of syndromic mPCR in respiratory, gastrointestinal, and central nervous system infections within the context of antimicrobial stewardship efforts.

Recent Findings: For all mPCR syndromic panels, multiple studies analyzed the pre-and-post implementation impact of mPCR on antimicrobial utilization. Prospective studies and trials of respiratory mPCR stewardship interventions, including diagnostic algorithms, educational efforts, co-testing with procalcitonin, and targeted provider feedback currently exist. For gastrointestinal and cerebrospinal fluid mPCR, fewer peer-reviewed reports exist for the use of mPCR in antimicrobial stewardship. These studies demonstrated an inconsistent trend towards decreasing antibiotic use with mPCR. This is further limited by a lack of statistical significance, the absence of controlled, prospective trials, and issues with data generalizability.

Summary: Antibiotic overuse may improve when mPCR is coupled with electronic medical record algorithm-based approaches and direct provider feedback by an antimicrobial stewardship professional. mPCR may prove a useful tool for antimicrobial stewardship but future studies are needed to define the best practice for its utilization.
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http://dx.doi.org/10.1007/s11908-021-00748-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909367PMC
February 2021

In Reference to Beethoven's Deafness.

Laryngoscope 2021 Feb 26. Epub 2021 Feb 26.

Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.

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http://dx.doi.org/10.1002/lary.29493DOI Listing
February 2021

Resistors and constipators: Financial impact in an academic medical center, a mathematical model.

Infect Control Hosp Epidemiol 2021 Feb 24:1-3. Epub 2021 Feb 24.

Virginia Commonwealth University, Richmond, Virginia.

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http://dx.doi.org/10.1017/ice.2021.34DOI Listing
February 2021

A Sensorless Control System for an Implantable Heart Pump using a Real-time Deep Convolutional Neural Network.

IEEE Trans Biomed Eng 2021 Feb 23;PP. Epub 2021 Feb 23.

Left ventricular assist devices (LVADs) are implantable mechanical pumps, which can be used to support heart failure (HF) patients as bridge to transplant and destination therapy. To automatically adjust the LVAD speed, a physiological control system needs to be designed to respond to variations of patient hemodynamics across a variety of clinical scenarios. These control systems require pressure feedback signals from the cardiovascular system. However, there are no suitable long-term implantable sensors available. In this study, a novel real-time deep convolutional neural network (CNN) for estimation of preload based on the LVAD flow was proposed. A new sensorless adaptive physiological control system for an LVAD pump was developed using the full dynamic form of model free adaptive control (FFDL-MFAC) and the proposed preload estimator to maintain the patient conditions in safe physiological ranges. The CNN model for preload estimation was trained and evaluated through 10-fold cross validation on 100 different patient conditions and the proposed sensorless control system was assessed on a new testing set of 30 different patient conditions across six different patient scenarios. The proposed preload estimator was extremely accurate with a correlation coefficient of 0.97, root mean squared error of 0.84 mmHg, reproducibility coefficient of 1.56 mmHg, coefficient of variation of 14.44 %, and bias of 0.29 mmHg for the testing dataset. The results also indicate that the proposed sensorless physiological controller works similarly to the preload-based physiological control system for LVAD using measured preload to prevent ventricular suction and pulmonary congestion. This study shows that the LVADs can respond appropriately to changing patient states and physiological demands without the need for additional pressure or flow measurements.
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http://dx.doi.org/10.1109/TBME.2021.3061405DOI Listing
February 2021

Be still, my beating heart: reading pulselessness from Shakespeare to the artificial heart.

Med Humanit 2021 Feb 4. Epub 2021 Feb 4.

Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia.

Today, patients with heart failure can be kept alive by an artificial heart while they await a heart transplant. These modern artificial hearts, or left ventricular assist devices (LVADs), remove the patient's discernible pulse while still maintaining life. This technology contradicts physiological, historical and sociocultural understandings of the pulse as central to human life. In this essay, we consider the ramifications of this contrast between the historical and cultural importance placed on the pulse (especially in relation to our sense of self) and living with a pulseless LVAD. We argue that the pulse's relationship to individual identity can be rescripted by examining its representation in formative cultural texts like the works of William Shakespeare. Through an integration of historical, literary and biomedical engineering perspectives on the pulse, this paper expands interpretations of pulselessness and advocates for the importance of cultural-as well as biomedical-knowledge to support patients with LVADs and those around them. In reconsidering figurative and literal representations of the heartbeat in the context of technology which removes the need for a pulse, this essay argues that narrative and metaphor can be used to reconceptualise the relationship between the heartbeat and identity.
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http://dx.doi.org/10.1136/medhum-2020-011962DOI Listing
February 2021

bacteraemia in a patient with heart failure: case report and literature review.

Eur Heart J Case Rep 2020 Dec 12;4(6):1-6. Epub 2020 Nov 12.

Division of Infectious Diseases, Department of Internal Medicine, VCU Health System, VMI Building, Suite 205, 1000 East Marshall Street, Richmond, VA 23298, USA.

Background: A 29-year-old male with recently diagnosed biventricular failure from myopericarditis and subsequent constrictive pericarditis on home milrinone presented to the Emergency Department with fevers/chills.

Case Summary: On arrival to the Emergency Department, he was found to have septic shock and required vasopressor therapy. grew on his admission blood cultures, and he was treated with ciprofloxacin and piperacillin/tazobactam. He quickly improved, allowing for a successful pericardiectomy, was weaned off inotropes and discharged from the hospital.

Discussion: is an environmental Gram-negative rod found in groundwater. It is rarely associated with human infection, but is associated with indwelling lines and has been documented in immunocompromised patients. Treatment typically involves line removal and a fluoroquinolone or piperacillin/tazobactam; the most optimal antimicrobial regimen and duration of treatment are unknown.
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http://dx.doi.org/10.1093/ehjcr/ytaa338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793199PMC
December 2020

Rational allocation of coronavirus disease 2019 (COVID-19) vaccines to healthcare personnel and patients: A role for antimicrobial stewardship programs?

Infect Control Hosp Epidemiol 2020 Dec 16:1-3. Epub 2020 Dec 16.

Healthcare Infection Prevention Department, Virginia Commonwealth University Health System, Richmond, Virginia.

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http://dx.doi.org/10.1017/ice.2020.1393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082121PMC
December 2020

Healthcare-associated COVID-19: The experience of an academic medical center.

Infect Control Hosp Epidemiol 2020 Dec 7:1-3. Epub 2020 Dec 7.

Hospital Infection Prevention Program, Virginia Commonwealth University, Richmond, Virginia.

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http://dx.doi.org/10.1017/ice.2020.1357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750652PMC
December 2020

A descriptive analysis of outpatient antibiotic use for urinary tract infections in Virginia.

Infect Control Hosp Epidemiol 2021 Mar 24;42(3):361-362. Epub 2020 Nov 24.

Virginia Commonwealth University School of Medicine, Richmond, Virginia.

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http://dx.doi.org/10.1017/ice.2020.1301DOI Listing
March 2021

Fungal superinfection in patients with COVID-19: Role of antifungal stewardship?

Am J Infect Control 2021 02 19;49(2):279-280. Epub 2020 Nov 19.

Virginia Commonwealth University School of Medicine, Richmond, VA; Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2020.11.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674015PMC
February 2021

The impact of coronavirus disease 2019 (COVID-19) on provider use of electronic hand hygiene monitoring technology.

Infect Control Hosp Epidemiol 2020 Nov 20:1-3. Epub 2020 Nov 20.

Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, Virginia.

The use of an electronic hand hygiene monitoring system (EHHMS) decreased due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed dispenser use, hand hygiene (HH) badge use, and HH compliance to determine the effect of COVID-19 on EHHMS use and HH compliance. HH product shortages and other pandemic-induced challenges influenced EHHMS use.
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http://dx.doi.org/10.1017/ice.2020.1336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711352PMC
November 2020

Antimicrobial stewardship and bamlanivimab: Opportunities for outpatient preauthorization?

Infect Control Hosp Epidemiol 2020 Nov 20:1-3. Epub 2020 Nov 20.

Healthcare Infection Prevention Department, Virginia Commonwealth University Health System, North Hospital, Richmond, Virginia.

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http://dx.doi.org/10.1017/ice.2020.1343DOI Listing
November 2020

Combined resistance and aerobic exercise intervention improves fitness, insulin resistance and quality of life in survivors of childhood haemopoietic stem cell transplantation with total body irradiation.

Pediatr Blood Cancer 2020 12 12;67(12):e28687. Epub 2020 Oct 12.

Department of Paediatric Endocrinology and Diabetes, Level 6 UHBristol Education Centre, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK.

Purpose: To investigate the effects of a supervised combined resistance and aerobic training programme on cardiorespiratory fitness, body composition, insulin resistance and quality of life (QoL) in survivors of childhood haematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI).

Participants: HSCT/TBI survivors (n = 20; 8 females). Mean (range) for age at study and time since HSCT/TBI was 16.7 (10.9-24.5) and 8.4 (2.3-16.0) years, respectively.

Methods: After a 6-month run-in, participants undertook supervised 45- to 60-minute resistance and aerobic training twice weekly for 6 months, with a 6-month follow-up. The following assessments were made at 0, 6 (start of exercise programme), 12 (end of exercise programme) and 18 months: Body composition via dual energy X-ray absorptiometry, homeostatic model assessment of insulin resistance (HOMA-IR), cardiorespiratory fitness (treadmill-based peak rate of oxygen uptake (VO peak) test), QoL questionnaires (36-Item Short Form Health Survey (SF-36) and Minneapolis-Manchester Quality of Life Instrument (MMQL).

Results: Results expressed as mean (standard deviation) or geometric mean (range). There were significant improvements in VO peak (35.7 (8.9) vs 41.7 (16.1) mL/min/kg, P = 0.05), fasted plasma insulin (16.56 (1.48-72.8) vs 12.62 (1.04-54.97) mIU/L, P = 0.03) and HOMA-IR (3.65 (0.30-17.26) vs 2.72 (0.22-12.89), P = 0.02) after the exercise intervention. There were also significant improvements in the SF-36 QoL general health domain (69.7 (14.3) vs 72.7 (16.0), P = 0.001) and the MMQL school domain (69.1 (25.2) vs (79.3 (21.6), P = 0.03) during the exercise intervention. No significant changes were observed in percentage body fat, fat mass or lean mass.

Conclusion: The supervised 6-month combined resistance and aerobic exercise programme significantly improved cardiorespiratory fitness, insulin resistance and QoL in childhood HSCT/TBI survivors, with no change in body composition, suggesting a metabolic training effect on muscle. These data support a role for targeted physical rehabilitation services in this group at high risk of diabetes and cardiovascular disease.
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http://dx.doi.org/10.1002/pbc.28687DOI Listing
December 2020

Levofloxacin for Antibacterial Prophylaxis in Pediatric Patients With Acute Myeloid Leukemia or Undergoing Hematopoietic Stem Cell Transplantation.

J Pediatr Pharmacol Ther 2020 ;25(7):629-635

Objective: This study aimed to evaluate the use of levofloxacin for the prevention of bacterial infections in pediatric patients with acute myeloid leukemia or those undergoing hematopoietic stem cell transplantation.

Methods: This study was a single-center, retrospective review designed to assess the frequency of bacteremia with levofloxacin prophylaxis compared with historical controls that used other, clinician-directed antibacterial prophylaxis. The primary outcome of the study was microbiologically documented bacteremia. Secondary outcomes included febrile neutropenia, clinically documented infection, duration of neutropenia, treatment antibiotic exposure days, infection, and infection-related mortality.

Results: Of the 60 patients included, 24 patients with 32 hospital admissions received levofloxacin and 36 patients with 48 hospital admissions received clinician-directed prophylaxis. There was no difference found in the frequency of bacteremia between levofloxacin and clinician-directed prophylaxis (15.6% vs 10.4%, p = 0.49). There was no difference in the incidence of febrile neutropenia, clinically documented infection, treatment antibiotic exposure days, or 30-day infection-related mortality between the 2 groups. The levofloxacin group had a longer mean duration of neutropenia compared with clinician-directed prophylaxis (26.8 days vs 16.4 days, p = 0.01).

Conclusions: There was no difference in bacteremia between levofloxacin prophylaxis and clinician-directed prophylaxis in pediatric patients with acute myeloid leukemia or those undergoing hematopoietic stem cell transplantation. Levofloxacin prophylaxis is an appropriate alternative for the prevention of serious bacterial infections in this patient population, although further studies are needed to confirm these results.
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http://dx.doi.org/10.5863/1551-6776-25.7.629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541028PMC
January 2020

Structural neuroimaging biomarkers for obsessive-compulsive disorder in the ENIGMA-OCD consortium: medication matters.

Transl Psychiatry 2020 10 8;10(1):342. Epub 2020 Oct 8.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA.

No diagnostic biomarkers are available for obsessive-compulsive disorder (OCD). Here, we aimed to identify magnetic resonance imaging (MRI) biomarkers for OCD, using 46 data sets with 2304 OCD patients and 2068 healthy controls from the ENIGMA consortium. We performed machine learning analysis of regional measures of cortical thickness, surface area and subcortical volume and tested classification performance using cross-validation. Classification performance for OCD vs. controls using the complete sample with different classifiers and cross-validation strategies was poor. When models were validated on data from other sites, model performance did not exceed chance-level. In contrast, fair classification performance was achieved when patients were grouped according to their medication status. These results indicate that medication use is associated with substantial differences in brain anatomy that are widely distributed, and indicate that clinical heterogeneity contributes to the poor performance of structural MRI as a disease marker.
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http://dx.doi.org/10.1038/s41398-020-01013-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598942PMC
October 2020

Antimicrobial stewardship programs and convalescent plasma for COVID-19: A new paradigm for preauthorization?

Infect Control Hosp Epidemiol 2020 Sep 9:1-2. Epub 2020 Sep 9.

Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

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http://dx.doi.org/10.1017/ice.2020.459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588712PMC
September 2020

The Fibrosis-4 Index Is Associated With Need for Mechanical Ventilation and 30-Day Mortality in Patients Admitted With Coronavirus Disease 2019.

J Infect Dis 2020 11;222(11):1794-1797

Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA.

The Fibrosis-4 Index (FIB-4), developed to predict fibrosis in liver disease, was used to identify patients with coronavirus disease 2019 who will require ventilator support as well as those associated with 30-day mortality. Multivariate analysis found obesity (odds ratio [OR], 4.5), diabetes mellitus (OR, 2.55), and FIB-4 ≥2.67 (OR, 3.09) independently associated with need for mechanical ventilation. When controlling for ventilator use, sex, and comorbid conditions, FIB-4 ≥2.67 was also associated with increased 30-day mortality (OR, 8.4 [95% confidence interval, 2.23-31.7]). Although it may not be measuring hepatic fibrosis, its components suggest that increases in FIB-4 may be reflecting systemic inflammation associated with poor outcomes.
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http://dx.doi.org/10.1093/infdis/jiaa550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499595PMC
November 2020

Antimicrobial Stewardship at the Core of COVID-19 Response Efforts: Implications for Sustaining and Building Programs.

Curr Infect Dis Rep 2020 3;22(9):23. Epub 2020 Jul 3.

Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA.

We describe traditional antimicrobial stewardship program (ASP) activities with a discussion of how these activities can be refocused in the setting of the COVID-19 pandemic. Additionally, we discuss possible adverse consequences of ASP attention diversion on COVID-19 response efforts and overall implications for future pandemic planning. We also discuss ASP in collaboration with other groups within health systems and how COVID-19 may affect these relationships long term. Despite the paucity of literature on Antimicrobial Stewardship and COVID-19, the potential contributions of ASPs during a pandemic are numerous. ASPs can develop strategies to identify patients with COVID-19-like-illness; this is particularly useful when these patients are missed at the time of health system entry. ASPs can also play a critical role in the management of potential drug shortages, developing local treatment guidelines, optimizing the use of antibiotics, and in the diagnostic stewardship of COVID-19 testing, among other roles. Importantly, it is often difficult to ascertain whether critically ill patients who are hospitalized with COVID-19 have concurrent or secondary bacterial infections-ASPs are ideally situated to help optimize antimicrobial use for these patients via a variety of mechanisms. ASPs are uniquely positioned to aid in pandemic response planning and relief efforts. ASPs are already integrated into health systems and play a key role in optimizing antimicrobial prescribing. As ASPs assist in COVID-19 response, understanding the role of ASPs in pandemic relief efforts may mitigate damage from future outbreaks.
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http://dx.doi.org/10.1007/s11908-020-00734-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332741PMC
July 2020

Impact of the Centers for Medicare and Medicaid Services Sepsis Core Measure on Antibiotic Use.

Clin Infect Dis 2021 02;72(4):556-565

Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University Health System, Richmond, Virginia, USA.

Background: The Centers for Medicare and Medicaid Services (CMS) implemented a core measure sepsis (SEP-1) bundle in 2015. One element was initiation of broad-spectrum antibiotics within 3 hours of diagnosis. The policy has the potential to increase antibiotic use and Clostridioides difficile infection (CDI). We evaluated the impact of SEP-1 implementation on broad-spectrum antibiotic use and CDI occurrence rates.

Methods: Monthly adult antibiotic data for 4 antibiotic categories (surgical prophylaxis, broad-spectrum for community-acquired infections, broad-spectrum for hospital-onset/multidrug-resistant [MDR] organisms, and anti-methicillin-resistant Staphylococcus aureus [MRSA]) from 111 hospitals participating in the Clinical Data Base Resource Manager were evaluated in periods before (October 2014-September 2015) and after (October 2015-June 2017) policy implementation. Interrupted time series analyses, using negative binomial regression, evaluated changes in antibiotic category use and CDI rates.

Results: At the hospital level, there was an immediate increase in the level of broad-spectrum agents for hospital-onset/MDR organisms (+2.3%, P = .0375) as well as a long-term increase in trend (+0.4% per month, P = .0273). There was also an immediate increase in level of overall antibiotic use (+1.4%, P = .0293). CDI rates unexpectedly decreased at the time of SEP-1 implementation. When analyses were limited to patients with sepsis, there was a significant level increase in use of all antibiotic categories at the time of SEP-1 implementation.

Conclusions: SEP-1 implementation was associated with immediate and long-term increases in broad-spectrum hospital-onset/MDR organism antibiotics. Antimicrobial stewardship programs should evaluate sepsis treatment for opportunities to de-escalate broad therapy as indicated.
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http://dx.doi.org/10.1093/cid/ciaa456DOI Listing
February 2021

Perceived emotion regulation and emotional distress tolerance in patients with hoarding disorder.

J Obsessive Compuls Relat Disord 2019 Jul 11;22. Epub 2019 May 11.

Institute of Living, Hartford, CT.

Emotional distress tolerance (EDT) and emotion regulation (ER) appear to be highly relevant to hoarding pathology, as excessive saving and/or acquiring may be motivated by emotional avoidance or other attempts to regulate negative affect. While findings with nonclinical samples have suggested and EDT/ER predicts hoarding symptoms, there is little data on clinical samples. The aim of the current study was to examine several self-report measures of EDT and ER in individuals with HD ( = 87) and age-matched nonclinical controls ( = 46), and to explore whether this was predictive of treatment compliance and/or outcome in group CBT for HD. Results suggested that, the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) total score, DERS goals and awareness subscales, and Intolerance of Uncertainty Scale (IUS; Buhr & Dugas, 2002) were predictive of hoarding severity. However, EDT/ER did not change with treatment, did not mediate treatment outcome, and did not predicted treatment retention, compliance, or outcome. Results suggest that some EDT/ER constructs, such as uncertainty intolerance, difficulty persisting in goal behaviors when upset, and low emotional awareness, may explain significant variance in HD symptoms, although they did not appear to be mechanisms of change in CBT for HD.
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http://dx.doi.org/10.1016/j.jocrd.2019.100441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430655PMC
July 2019