Commonwealth Computer Research (United States)

This cross-sectional study examines trends in Lyme disease incidence using data from the Massachusetts Department of Public Health's electronic health record–based surveillance platform.

Abstract Background Guidelines recommend de-escalation of broad-spectrum antibiotics initiated for suspected sepsis based on clinical status and microbiological results after 48-72 hours, yet real world patterns of de-escalation remain unknown. We aimed to evaluate the frequency, hospital-level variation, predictors, and clinical outcomes of antibiotic de-escalation in suspected sepsis. Methods We used the PINC AITM Healthcare Database to retrospectively analyze adults admitted to 236 US hospitals between 2017-2021 with suspected sepsis (blood culture and lactate drawn) and minimal 4-day stay who received ≥2 days of empiric anti-MRSA and anti-pseudomonal antibiotics on admission, in the absence of any beta-lactam resistant gram-positive or ceftriaxone-resistant gram-negative organisms in the clinical cultures by day 4.De-escalation was defined as cessation or switching to narrower spectrum intravenous or oral agents by day 4. We utilized a multivariate logistic regression model with 82 covariates to predict the likelihood of de-escalation; the probabilities from this model were then used for propensity-score matching. Results Among 124,577 patients who met inclusion criteria, 36,806 (29.5%) had antibiotics de-escalated (21.8% narrowed, 7.7% stopped) (Figure 1). The median hospital-level de-escalation rate was 29.4% (IQR: 21.3-38.0%) and varied across hospital types (Figure 2). Predictors of de-escalation included clinical indicators of less severe disease (especially on days 3-4), positive cultures, and negative/absent MRSA nasal swabs (Figure 3). De-escalation was also associated with medium, large or teaching hospitals in the Northeast or Midwest region. On propensity-matched analysis (effective sample size of 32,964 and 36,803 in control and treated groups, respectively), de-escalation was associated with lower rates of acute kidney injury (OR 0.91, 95% CI 0.85-0.96), inpatient mortality (OR 0.89, 95% CI 0.83-0.96), and a trend towards fewer C.difficile infections (OR 0.84, 95% CI 0.71-1.01) (Table 1). Conclusion In this large US cohort, antibiotic de-escalation in patients with suspected sepsis was infrequent and variable across hospitals. De-escalation was influenced by clinical and microbiologic factors and associated with lower risk for adverse outcomes. Disclosures Michael Klompas, MD, MPH, AHRQ: Grant/Research Support|CDC: Grant/Research Support|UpToDate: Royalties

This cohort study assessed obesity prevalence before and during the COVID-19 pandemic (2018-2020) in children and adolescents in Massachusetts.

BackgroundGuidelines recommend immediate empiric broad-spectrum antibiotics for all patients with suspected sepsis. Understanding the epidemiology of antibiotic-resistant pathogens and empiric treatment patterns in sepsis could inform improvements in antibiotic utilization and outcomes.MethodsWe identified adults admitted during 2009–2015 to 104 US hospitals in the Cerner HealthFacts dataset who met CDC Adult Sepsis Event criteria and had positive clinical cultures within 2 days of admission. We characterized prevalence and empiric treatment rates for methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococcus (VRE), ceftriaxone-resistant Gram-negative organisms (CRO) (including P. aeruginosa), and extended-spectrum β-lactamase Gram-negative organisms (ESBL). We evaluated associations between in-hospital mortality and either inappropriate empiric therapy (antibiotics inactive against any isolated pathogen) or excessively broad therapy (empiric MRSA or VRE coverage, extended spectrum β-lactam, or carbapenem therapy when targeted organisms were absent), adjusting for baseline characteristics and severity-of-illness.ResultsThe cohort included 17,962 patients with culture-positive sepsis; 2,965 (16.5%) died in-hospital. The most common culture-positive sites were urine (51.2%), blood (41.8%), and respiratory (16.5%). The most common pathogens were E. coli (33.0%), S. aureus (20.9%), and Streptococcus (13.2%) (Figure 1). Most (81.6%) patients received empiric antibiotics active against all isolated pathogens. Empiric therapy was directed at resistant organisms in 67.5% of cases (primarily vancomycin and extended spectrum β-lactams, Figure 2), but resistant organisms were isolated in only 25.2% (MRSA 11.5%, CRO 12.9%, VRE 2.0%, ESBL 0.8%). Both inappropriate empiric therapy and excessively broad empiric therapy were associated with higher mortality on multivariate analysis (OR 1.30, 95% CI 1.14–1.48 and OR 1.20, 95% CI 1.05–1.38, respectively).ConclusionMost patients with community-onset sepsis do not have resistant pathogens, yet empiric broad-spectrum antibiotics are frequently prescribed. Both inappropriate empiric therapy and excessively broad therapy are associated with worse outcomes.DisclosuresAll authors: No reported disclosures.

Kadri, Sameer; Strich, Jeffrey; Lai, Yi Ling; Mathew, Lauren; Fram, David; Chen, Huai-Chun; Swihart, Bruce; Follmann, Dean; Gouel-Cheron, Aurelie Author Information

ObjectiveTo evaluate current rates and temporal trends in adherence with national guidelines recommending chlamydia test-of-cure for pregnant females and test-of-reinfection for all patients.IntroductionSexually transmitted disease treatment guidelines have incrementally added repeat testing recommendations for Chlamydia trachomatis infections over time, including test-of-cure 3 to 4 weeks following completion of treatment for pregnant women and test-of-reinfection for all patients approximately 3 months after infection. However, few studies have investigated adherence to these recommendations and whether the evolution of guidelines have led to changes in repeat testing patterns over time.MethodsThe Electronic medical record Support for Public Health surveillance network (ESPnet) was leveraged to analyze electronic health record data for three independent practice groups serving approximately 20% of the Massachusetts population. We identified all cases with laboratory-confirmed Chlamydia trachomatis infections between 2010 and 2015 and evaluated the frequency, timing, and results of subsequent chlamydia tests in the following year.ResultsBetween 2010 and 2015, 972 pregnant female cases, 10,309 non-pregnant female cases, and 4,973 male cases had a positive C. trachomatis laboratory result. Test-of-cure within 3-5 weeks following an index positive test occurred in 36.8% of pregnant females. Test-of-reinfection within 2-4 months of an index test occurred in 39.2% of pregnant females, 17.9% of non-pregnant females, and 9.0% of males. There were no significant increases in test-of-cure or test-of-reinfection rates over the study period for any groups. Among cases with repeat tests, 15.9% of pregnant females, 14.6% of non-pregnant females, and 16.3% of males had at least one repeat positive result within one year of the index positive result.ConclusionsChlamydia test-of-cure and test-of-reinfection rates are low, with no evidence of improvement over time. There are substantial opportunities to improve adherence to chlamydia repeat testing recommendations.

The average Total Kinetic Energy (TKE ) release and fission-fragment yields in neutron-induced fission of 235 U and 238 U was measured using a Frisch-gridded ionization chamber. These observables are important nuclear data quantites that are relevant to applications and for informing the next generation of fission models. The measurements were performed a the Los Alamos Neutron Science Center and cover E n = 200 keV – 30 MeV. The double-energy (2E) method was used to determine the fission-fragment yields and two methods of correcting for prompt-neutron emission were explored. The results of this study are correlated mass and TKE data.

With the rise of location-aware IoT devices, there is an increased desire to process data streams in a real-time manner. Responding to such streams may require processing data from multiple streams to inform decisions. There are many uses cases for putting the location data from the sensors or an analytic derivative on a map for a live view of sensors or other assets. Here we describe an architecture which relies solely on free and open-source components to provide streaming spatio-temporal event processing, analysis, and near-real-time visualization.

SpiceyPy 1.0.0 SpiceyPy is a python wrapper for the NAIF C-SPICE toolkit. The library currently supports python 2.7.x and 3.X on 32bit and 64bit platforms for OS X, Linux, and Windows operating systems. SpiceyPy utilizes python idioms for error handling and vectorization with convenience functions to support a variety of python collections including NumPy arrays. The library currently supports ninety eight percent of the documented functions in C-SPICE v65. Thanks go to all the users who wrote in with questions and feature requests!