Adolescent anterior cruciate ligament reconstruction: a decade of rising surgical cost.

Objectives: The number of anterior cruciate ligament reconstruction (ACL-R) surgeries for adolescent patients has been increasing, and so are the costs for medical care services and the general cost of living. We proposed a novel economic model assessing the cost associated with adolescent ACL-R over time and how this compared with price measures in the US economy.

Study Design: Economic analysis.

Plasma cell-free DNA hydroxymethylation profiling reveals anti-PD-1 treatment response and resistance biology in non-small cell lung cancer.

Background: Treatment with immune checkpoint inhibitors (ICIs) targeting programmed death-1 (PD-1) can yield durable antitumor responses, yet not all patients respond to ICIs. Current approaches to select patients who may benefit from anti-PD-1 treatment are insufficient. 5-hydroxymethylation (5hmC) analysis of plasma-derived cell-free DNA (cfDNA) presents a novel non-invasive approach for identification of therapy response biomarkers which can tackle challenges associated with tumor biopsies such as tumor heterogeneity and serial sample collection.

Epigenomic Blood-Based Early Detection of Pancreatic Cancer Employing Cell-Free DNA.

Background & Aims: Early detection of pancreatic cancer (PaC) can drastically improve survival rates. Approximately 25% of subjects with PaC have type 2 diabetes diagnosed within 3 years prior to the PaC diagnosis, suggesting that subjects with type 2 diabetes are at high risk of occult PaC. We have developed an early-detection PaC test, based on changes in 5-hydroxymethylcytosine (5hmC) signals in cell-free DNA from plasma.

Identifying and Unpacking the Role of Social Identity in Moderating Evaluations of Police-Civilian Interactions.

Scholars and policy makers rely on the theory of procedural justice (PJ) to further the twin goals of improving police-civilian relations and reducing crime. Substantial PJ research demonstrates that civilians evaluate fairness in police-civilian interactions based on voice, neutrality, trust, and respect. Although social identity is an important predictor and outcome of PJ, little research has examined how police officers, who have a unique social identity and sub-culture, evaluate fairness.

Prevalence of Postoperative Micronutrient Deficiencies in Bariatric Surgery Patients Who Use Transdermal Patches for Supplementation: A Pilot Study.

Background Patients require vitamin and mineral supplementation after bariatric surgery to prevent the development of micronutrient deficiencies. Consuming oral supplements is challenging due to gastric volume restriction. A transdermal patch dosage form may provide adequate micronutrient supplementation without pill burden.

Exhibition of antifungal resistance by sterol-auxotrophic strains of with intact virulence.

Background: is an emerging fungal pathogen in immune-compromised hosts. Previously undetected isolates were successfully recovered from clinical specimens by adding sterols to the growth medium. The clinical isolates are unable to synthesize ergosterol but can take up exogenous sterols under aerobic conditions.

Chinese-English bilinguals show linguistic-perceptual links in the brain associating short spoken phrases with corresponding real-world natural action sounds by semantic category.

Higher cognitive functions such as linguistic comprehension must ultimately relate to perceptual systems in the brain, though how and why this forms remains unclear. Different brain networks that mediate perception when hearing real-world natural sounds has recently been proposed to respect a taxonomic model of acoustic-semantic categories. Using functional magnetic resonance imaging (fMRI) with Chinese/English bilingual listeners, the present study explored whether reception of short spoken phrases, in both Chinese (Mandarin) and English, describing corresponding sound-producing events would engage overlapping brain regions at a semantic category level.

Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017).

Background: Bloodstream infections (BSIs) occur frequently after hematopoietic stem cell transplantation (HSCT). We examined the microbiology of BSI in pediatric HSCT recipients over a 2-decade period at our institution to inform empirical antimicrobial prescribing and infection prevention strategies.

Methods: We conducted a retrospective cohort study of children (<18 years) who underwent HSCT at Duke University between 1997 and 2015.

Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients.

Background: Children undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for hospital-associated bloodstream infections (HA-BSIs). This study aimed to describe the incidence, microbiology, and risk factors for HA-BSI in pediatric HSCT recipients.

Methods: We performed a single-center retrospective cohort study of children and adolescents (<18 years of age) who underwent HSCT over a 20-year period (1997-2016).

Performance of the Accelerate Diagnostics Pheno system with resin-containing BacT/ALERT® Plus blood culture bottles.

Bacteremia and septicemia require rapid identification (ID) and antimicrobial susceptibility testing (AST) to start targeted, appropriate therapy. To answer this need, Accelerate Diagnostics, Inc., developed the Accelerate Pheno™ system (AXDX), a fast ID and phenotypic AST platform.

Multicenter Clinical Evaluation of BacT/Alert Virtuo Blood Culture System.

BacT/Alert Virtuo is an advanced, automated blood culture system incorporating improved automation and an enhanced detection algorithm to shorten time to detection. A multicenter study of the investigational Virtuo system (bioMérieux, Inc., Durham, NC) compared to BacT/Alert 3D (BTA3D) for detection of bacteremia/fungemia in four bottle types, SA and FA Plus (aerobic) and SN and FN Plus (anaerobic), was performed in a clinical setting with patient samples in a matched system design clinical trial.

Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation.

Background: Nontuberculous mycobacteria (NTM) commonly colonize municipal water supplies and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital.

Methods: Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M.

RALB provides critical survival signals downstream of Ras in acute myeloid leukemia.

Mutations that activate RAS proto-oncogenes and their effectors are common in acute myeloid leukemia (AML); however, efforts to therapeutically target Ras or its effectors have been unsuccessful, and have been hampered by an incomplete understanding of which effectors are required for AML proliferation and survival. We investigated the role of Ras effector pathways in AML using murine and human AML models. Whereas genetic disruption of NRAS(V12) expression in an NRAS(V12) and Mll-AF9-driven murine AML induced apoptosis of leukemic cells, inhibition of phosphatidylinositol-3-kinase (PI3K) and/or mitogen-activated protein kinase (MAPK) signaling did not reproduce this effect.

Evaluation of a Fully Automated Research Prototype for the Immediate Identification of Microorganisms from Positive Blood Cultures under Clinical Conditions.

Unlabelled: A clinical laboratory evaluation of an intrinsic fluorescence spectroscopy (IFS)-based identification system paired to a BacT/Alert Virtuo microbial detection system (bioMérieux, Inc., Durham, NC) was performed to assess the potential for fully automated identification of positive blood cultures. The prototype IFS system incorporates a novel method combining a simple microbial purification procedure with rapid in situ identification via spectroscopy.

Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals.

Knowledge of local antimicrobial resistance is critical for management of infectious diseases. Community hospitals' compliance with Clinical and Laboratory Standards Institute (CLSI) guidance for creation of cumulative antibiograms is uncertain. This descriptive cohort study of antibiogram reporting practices included community hospitals enrolled in the Duke Infection Control Outreach Network.

The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study.

Background: Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty. There is limited evidence to suggest how frequently false-positive cultures occur. The purpose of this prospective controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery.

Rising rates of carbapenem-resistant enterobacteriaceae in community hospitals: a mixed-methods review of epidemiology and microbiology practices in a network of community hospitals in the southeastern United States.

Objective: Describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and examine the effect of lower carbapenem breakpoints on CRE detection.

Design: Retrospective cohort.

Setting: Inpatient care at community hospitals.

Control of simultaneous outbreaks of carbapenemase-producing enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase-resistant Enterobacteriaceae Toolkit.

Objective: We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention's 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).

Design: Before-after intervention study.

Setting: Fifteen-bed surgical trauma intensive care unit (ICU).

Respiratory fungal infections: molecular diagnostic tests.

Fungal infection of the respiratory tract can take several forms, the most common of which is pneumonia. Fungal infection can occur in the immunocompetent typically as a result of inhalation of a large inoculum of fungal elements. However, the number of etiologic agents attacking immunocompetent individuals and causing significant infection is limited.

More serious infectious morbidity and mortality associated with simultaneous candidemia and coagulase-negative staphylococcal bacteremia in neonates and in vitro adherence studies between Candida albicans and Staphylococcus epidermidis.

Background: Candida species and coagulase-negative staphylococci (CoNS) are common etiologies of hospital acquired bloodstream infection in the neonatal intensive care unit (NICU). Sepsis with either organism may result in serious infectious sequelae and along with other staphylococci are the most common causes of abscess formation in preterm infants. This increased incidence of abscess formation may be in part due to adherence factors of both pathogens.

Successful treatment of osseous blastomycosis without pulmonary or disseminated disease and review of the literature.

Blastomycosis commonly occurs following inhalation of Blastomyces dermatitidis conidia causing a pulmonary infection and can disseminate to extrapulmonary sites. Osseous involvement primarily results from hematogenous spread, but in rare cases, direct inoculation can occur. We describe a case of osseous blastomycosis without pulmonary or disseminated disease successfully treated with posaconazole.

Clinical microbiology costs for methods of active surveillance for Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae.

Objective: To compare direct laboratory costs of different methods for perirectal screening for carbapenemase-producing Enterobacteriaceae (CPE) colonization.

Design: Cost-benefit analysis.

Setting: A university hospital and affiliated long-term acute care hospital (LTACH).

Outbreak of bacteremia due to Burkholderia contaminans linked to intravenous fentanyl from an institutional compounding pharmacy.

IMPORTANCE Many health care facilities compound medications on site to fulfill local demands when customized formulations are needed, national supply is critically low, or costs for manufactured pharmaceuticals are excessive. Small, institutional compounding facilities may perform the same high-risk procedures as large distributors of compounded medications. OBJECTIVES To investigate an outbreak related to contamination of compounded sterile preparations and to determine processes to prevent future outbreaks.