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During the 2022 mpox outbreak, tecovirimat was accessed through an expanded access investigational new drug (EA-IND) protocol. We leveraged a unique public/private hospital partnership in New York City to create a novel infrastructure to navigate the EA-IND’s regulatory requirements and rapidly provide tecovirimat to patients.
To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication.
Retrospective cohort study.
Four hospitals within NYU Langone Health (NYULH).
All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission.
Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001).
Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.
Background: Outpatient parenteral antimicrobial therapy (OPAT) is used in the outpatient setting to treat infectious conditions that require a prolonged course of antimicrobials. OPAT has been shown to decrease length of hospital stay and healthcare costs without compromising patient care and has become a widely accepted practice nationally. Due to this trend, the study of OPAT is of vital importance and will continue to be relevant moving forward. Currently, few studies have explored risk factors associated with OPAT complications, and most are limited in their analysis by indication. Further work should be performed to expand upon what is currently known. We characterized factors associated with increased OPAT complication risk. Methods: We conducted a retrospective cohort study at 4 sites across NYU Langone Health in patients admitted from 2017 to 2020. We applied the following inclusion criteria: aged ≥18 years and discharged with OPAT. Complications were defined as follows: vascular-access-related (line occlusion, thrombosis, dislodgement, central-line associated bloodstream infection or CLABSI) and antimicrobial-related (laboratory derangement, drug reaction, Clostridioides difficile infection), all-cause 30-day readmission, and OPAT-related readmission. Data were obtained from electronic medical records and the OPAT database. This study was granted a waiver from informed consent by the NYU Institutional Review Board. Multivariate logistic regression was performed, adjusting for confounding variables (sex, age, hospital of admission, history of chronic medical conditions, line type, and line duration). Results: Overall, 1,846 patient encounters of 5,951 reviewed met inclusion criteria. The median age was 66 (IQR, 26), 42.2% were female. Moreover, 810 (44%) received a peripherally inserted central catheter (PICC) and 1,036 (56%) received a midline cathether. Also, 563 (30.5%) were discharged to subacute rehabilitation (SAR). The most frequent complications were line dislodgement (4.2% of all patients), laboratory derangement (3.0%), and drug reaction (2.4%). Furthermore, 27 patients (1.5%) developed CLABSI. Patients discharged to SAR were more likely to develop CLABSI (OR, 4.1l; P = .005), and they had higher rates of OPAT-related 30-day readmissions (OR, 2.675; P = .004) compared to those who were discharged home, after adjusting for key confounders. Conclusions: Discharge to SAR is strongly associated with increased risk of readmission for OPAT-related complications and CLABSI, after adjusting for key confounders. CLABSI prevention during SAR admission is a critically needed public health intervention.
The Câmara dos Deputados, the lower house of Brazil’s National Congress, is a leader in the digitization and online dissemination of audiovisual recordings of legislative sessions. Its website hosts the Arquivo Sonoro, an initiative of the Câmara’s audiovisual department, which contains over 120,000 hours of recordings of speeches, votes, and committee meetings spanning over half a century. The Câmara also makes available online complete video of sessions dating back three years. This research note explores the methodological, historical, and pedagogical opportunities that these audiovisual sources offer scholars and educators. It employs as examples the research of a faculty member, a doctoral candidate, and three undergraduate students, all of whom are among the contributors to a digital humanities project that showcases this remarkable resource. By highlighting ambient noise, volume, emotion, body language, grammatical errors, regional or ethnic accents, and discrepancies with the written record, the authors demonstrate some of the ways that aurality and visuality can enrich and complicate humanities and social science research. They also reveal the multifaceted benefits of institutional support for the digitization of archival material and its free dissemination online to scholars and the public.
The rediscovery of Athens by Western travelers from the fifteenth century onwards led to an international fascination with the ruins of the city and their relationship with descriptions in ancient literature. The publications and manuscripts of these journeys preserve crucial documentation for the remains of Athens, its temples, topography, and inscriptions, much of which has been lost over the subsequent centuries.
On Hawai‘i Island, an increase in human neuroangiostrongyliasis cases has been primarily associated with the accidental ingestion of Angiostrongylus cantonensis L3 in snails or slugs, or potentially, from larvae left behind in the slug's slime or feces. We evaluated more than 40 different treatments in vitro for their ability to kill A. cantonensis larvae with the goal of identifying a safe and effective fruit and vegetable wash in order to reduce the risk of exposure. Our evaluation of treatment lethality was carried out in two phases; initially using motility as an indicator of larval survival after treatment, followed by the development and application of a propidium iodide staining assay to document larval mortality. Treatments tested included common household products, consumer vegetable washes and agricultural crop washes. We found minimal larvicidal efficacy among consumer-grade fruit and vegetable washes, nor among botanical extracts such as those from ginger or garlic, nor acid solutions such as vinegar. Alkaline solutions, on the other hand, as well as oxidizers such as bleach and chlorine dioxide, did show larvicidal potential. Surfactants, a frequent ingredient in detergents that lowers surface tension, had variable results, but dodecylbenzene sulfonic acid as a 70% w/w solution in 2-propanol was very effective, both in terms of the speed and the thoroughness with which it killed A. cantonensis L3 nematodes. Thus, our results suggest promising directions for future investigation.
The nonlinear and weakly dispersive Serre equations contain higher-order dispersive terms. These include mixed spatial and temporal derivative flux terms which are difficult to handle numerically. These terms can be replaced by an alternative combination of equivalent temporal and spatial terms, so that the Serre equations can be written in conservation law form. The water depth and new conserved quantities are evolved using a second-order finite-volume scheme. The remaining primitive variable, the depth-averaged horizontal velocity, is obtained by solving a second-order elliptic equation using simple finite differences. Using an analytical solution and simulating the dam-break problem, the proposed scheme is shown to be accurate, simple to implement and stable for a range of problems, including flows with steep gradients. It is only slightly more computationally expensive than solving the shallow water wave equations.
Archaeology in Greece has a long history of reporting epigraphic discoveries, and in recent years the print versions have highlighted a number of finds which have added little by little to our understanding of the history and topography of ancient Athens, including many of the reports now available online (see, for example, inscriptions helping to identify the Sanctuary of Apollo Pythios [ID4053] and of Zeus Meilichios [Map 3, no. 1; ID4557], or new voting sherds from the Athenian procedure of ostracism [Map 3, no. 5; ID1877]). Archaeology in Greece Online tags epigraphic material within its reports, allowing the reader to search for inscriptions as a keyword and also by region (such as Attica). This review of recent Athenian epigraphic developments focuses on major finds of the last decade, in particular focusing on discoveries reported in periodicals and publications from Greece, which some may find difficult to access, and is of course a personal and only a small selection of the voluminous literature on the subject (for more thorough coverage readers are pointed to SEG, the superb annual review of all epigraphy-related publications).
Archaeological data from the city of Athens entered into Archaeology in Greece Online this year are derived from recent work announced in the press or unpublished field reports and from the latest Archaiologikon Deltion, covering work in 2005. The difficulty of bridging this gap of almost a decade is eased greatly by the publication of a series of lectures held at the Museum of Cycladic Art in Athens by members of the Ephoreias of Athens and Attica, covering in a much more detailed way than ADelt allows many important excavations and research projects. The support of the Goulandris and Latsis Foundations, both in organizing the lectures and in publishing them in timely fashion and at very low cost (€10 per volume), is to be applauded (M. Dogka-Toli and S. Oikonomidou (eds), Αρχαιολογικές συμβολές. A: Αττική – ΚΣΤ’ και Β’Εφορείες Προïστορικών & Κλασικών Αρχαιοτήτων and Β: Αττική – Α’ και Γ’ Εφορείες Προïστορικών & Κλασικών Αρχαιοτήτων, Athens 2013). Further information, images and bibliography for the following summary can be found by searching the given ID numbers at AGOnline:www.chronique.efa.gr.