Hospital and Regional Variations in S. aureus Infection Prevalence and Outcomes in the US

Many countries have passed their first COVID-19 epidemic peak. Traditional epidemiological models describe this as a result of non-pharmaceutical interventions that pushed the growth rate below the recovery rate. In this new phase of the pandemic many countries show an almost linear growth of confirmed cases for extended time-periods. This new containment regime is hard to explain by traditional models where infection numbers either grow explosively until herd immunity is reached, or the epidemic is completely suppressed (zero new cases). Here we offer an explanation of this puzzling observation based on the structure of contact networks. We show that for any given transmission rate there exists a critical number of social contacts, Dc, below which linear growth and low infection prevalence must occur. Above Dc traditional epidemiological dynamics takes place, as e.g. in SIR-type models. When calibrating our corresponding model to empirical estimates of the transmission rate and the number of days being contagious, we find Dc ~ 7.2. Assuming realistic contact networks with a degree of about 5, and assuming that lockdown measures would reduce that to household-size (about 2.5), we reproduce actual infection curves with a remarkable precision, without fitting or fine-tuning of parameters. In particular we compare the US and Austria, as examples for one country that initially did not impose measures and one that responded with a severe lockdown early on. Our findings question the applicability of standard compartmental models to describe the COVID-19 containment phase. The probability to observe linear growth in these is practically zero.

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Impact of prophylactic human papillomavirus (HPV) vaccination on oral HPV infections among young adults in the U.S.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6003 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6003-6003 ◽

Cited By ~ 9

Author(s):

Maura L. Gillison ◽

Tatevik Broutian ◽

Barry Graubard ◽

Robert Pickard ◽

Zhen-Yue Tong ◽

...

Keyword(s):

Young Adults ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Vaccine Dose ◽

Population Level ◽

Hpv Infection ◽

Vaccine Uptake ◽

Infection Prevalence ◽

The Us ◽

Oral Hpv

6003 Background: The incidence of HPV-positive oropharyngeal cancers has risen in recent decades among US men. The potential impact of HPV vaccines on oral HPV infections has yet to be evaluated in efficacy-trials or surveillance studies. Methods: To evaluate the impact of prophylactic HPV vaccination on oral HPV infections in the US population, we conducted a cross-sectional study among men and women aged 18-33 years (n = 2,627) in the National Health and Nutrition Examination Survey, 2011-2014. We examined the effect of self-reported receipt of ≥1 vaccine dose on oral HPV infection (vaccine-types 16/18/6/11) prevalence among vaccinated vs. unvaccinated individuals. Additional outcomes included percent reduction in infection-prevalence among vaccinated individuals and population-level effectiveness of vaccination. Analyses accounted for the complex sampling design. Comparisons between vaccinated and unvaccinated individuals were conducted using binary logistic regression, with adjustment for age, gender, and race. Statistical significance was assessed using a quasi-score test. Results: During 2011-2014, 18.3% of the US population aged 18-33 years reported receipt of ≥1 HPV vaccine-dose prior to age 26 (29.2% in women and 6.9% in men; P< 0.001). The prevalence (population-weighted) of oral HPV16/18/6/11 infections was significantly reduced in vaccinated vs. unvaccinated individuals (0.11% vs. 1.61%; P= 0.008), corresponding to an estimated 88.2% (95%CI = 5.7%-98.5%) reduction in prevalence. Notably, oral HPV16/18/6/11 prevalence was significantly reduced in vaccinated vs. unvaccinated men (0.0% vs. 2.13%; P= 0.007). In contrast, prevalence for 33 non-vaccine HPV types was similar (3.98% vs. 4.74%; P= 0.24). Accounting for HPV vaccine-uptake, the population-level effectiveness of HPV vaccination on the burden of oral HPV16/18/6/11 infections was 17.0% overall, 25.0% in women and 6.9% in men. Conclusions: HPV vaccination substantially reduced vaccine-type oral HPV infection prevalence among young adults (ages 18-33 years) in the US population during 2011-2014. However, due to low vaccine uptake, population-level effectiveness was modest overall and particularly low in men.

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Regional variations in online education test performance for prostate cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.317 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 317-317

Author(s):

Hamsa Jaganathan ◽

Anne Roc ◽

Wendy Turell ◽

Daniel J. George

Keyword(s):

Prostate Cancer ◽

Online Education ◽

Test Performance ◽

Quality Care ◽

Healthcare Providers ◽

Regional Variations ◽

Significant Difference ◽

The Us ◽

Post Test ◽

Retention Of Knowledge

317 Background: Regional variations in prostate cancer (PC) care in the US remain an issue with inconsistent clinician adherence to quality measures endorsed by national health services. To assess potential disparities in PC care among US-based healthcare providers (HCPs), we compared test performance of clinician participants in PC continuing medical education (CME) activities across 4 US regions. This would enable targeted education with region-specific strategies to effectively manage PC and promote consistent, high-quality care for all patients. Methods: PlatformQ Health developed and executed 3 online CME activities in PC (live broadcast and on-demand). The 1st 2 activities attracted 448 learners July 2016-2017. The 3rd activity attracted 319 learners to date May-Nov 2018. Self-reported US-based practicing HCPs (294) were included in this study. The percent of correct answers to CME tests pre-activity, post-activity, and at 8-weeks were collected and tested for significance (using 1 and 2 factor ANOVA tests) among 4 US regions: Northeast, Midwest, South, and West. CME test questions included case studies, new data on castration-resistant PC, and managing adverse events. Results: No significant difference was observed among the 4 regions in the pretest scores (p = 0.080, α = 0.05). While there was a significant improvement in performance among learners between pretest and posttest (p = 0.001), no significant regional variations were observed. There was also a significant improvement in performance from pretest to the follow-up test, which validates retention of knowledge 8 weeks after the education (p = 0.0016). However, learners from the South region performed significantly better than learners from the other regions (p < 0.05) when it came to 8-week retention. Conclusions: Education can improve knowledge and competence in PC management among US-based HCPs. Future studies, including post- test surveys regarding practice integration, should identify reasons for regional discrepancies in test performances among providers specializing in PC. A broader understanding towards PC care variations can help tailor CME activities specific to regional issues and identify region-specific best practices and learning gaps.

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Incidence of Staphylococcus aureus Infections After Elective Surgeries in US Hospitals

Clinical Infectious Diseases ◽

10.1093/cid/ciaa913 ◽

2020 ◽

Author(s):

Jill Dreyfus ◽

Holly Yu ◽

Elizabeth Begier ◽

Julie Gayle ◽

Margaret A Olsen

Keyword(s):

Staphylococcus Aureus ◽

Infection Prevention ◽

Elective Surgery ◽

Methicillin Resistance ◽

Healthcare Database ◽

Aureus Infection ◽

National Healthcare ◽

National Healthcare Safety Network ◽

The Us ◽

National Estimates

Abstract Background Although Staphylococcus aureus is a leading cause of postsurgical infections, national estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed cumulative 180-day postsurgical S. aureus incidence in real-world hospital settings. Methods A retrospective study of adults (≥18 years) undergoing inpatient or hospital-based outpatient elective surgeries from 1/7/2010–30/6/2015 at hospitals (N = 181) reporting microbiology results in the Premier Healthcare Database (PHD). 86 surgical categories were identified from the National Healthcare Safety Network procedures. We classified positive S. aureus cultures using a hierarchy (bloodstream [BSI], surgical site [SSI], and all other types [urinary tract, respiratory, other/unknown site]) and calculated incidence (number of infections divided by the number of elective surgery discharges). We estimated national infection case volumes by multiplying incidence by national inpatient elective surgical discharge estimates using the entire PHD and weights based on hospital characteristics. Results Following 884 803 inpatient elective surgical discharges, 180-day S. aureus infection incidence was 1.35% (0.30% BSI, 0.74% SSI no BSI, 0.32% all other types only). Among 1 116 994 hospital-based outpatient elective surgical discharges, 180-day S. aureus incidence was 1.19% (0.25% BSI, 0.75% SSI no BSI, 0.19% all other types only). Methicillin resistance was observed in ~45% of the S. aureus infections. We estimated 55 764 S. aureus postsurgical infections occurred annually in the US following 4.2 million elective inpatient surgical discharges. Conclusions The high burden of S. aureus infections after both inpatient and outpatient elective surgeries highlights the continued need for surveillance and novel infection prevention efforts.

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Demographic and spatial disparity in HIV prevalence among incarcerated population in the US: A state-level analysis

International Journal of STD & AIDS ◽

10.1177/0956462417724586 ◽

2017 ◽

Vol 29 (3) ◽

pp. 278-286 ◽

Cited By ~ 4

Author(s):

Srimoyee Bose

Keyword(s):

Hiv Infection ◽

Infection Rate ◽

Pearson Correlation ◽

State Level ◽

Hiv Prevalence ◽

The State ◽

Infection Prevalence ◽

Spatial Disparity ◽

Female Prisoners ◽

The Us

The purpose of this study was to explore empirically the presence of any spatial and demographic disparity in the Human Immunodeficiency Virus (HIV) infection rate among the prison inmates across 48 states in the US and compare the results for 2000 and 2010. HIV infection is a severe health issue for incarcerated populations in the US. In 2010, the rate of diagnosed HIV infection among inmates in state and federal prisons was five times more than the nonincarcerated population. The National Prisoner Statistics database was used to find the demographic disparities in HIV prevalence rate based on incarceration rate, gender, race/ethnicity, the proportion of non-US citizens, and proportion of population below 18 years. State-level spatial mapping, Pearson correlation coefficient, and Moran’s I statistic (univariate and bivariate) were computed based on these demographic characteristics using QGIS and Geoda software. There was a statistically significant pattern of spatial disparity in overall, male and female HIV infection rates across the state prisoners, with South and South-Eastern states facing a higher risk of infection. There was also statistically significant bivariate spatial association of HIV infection rate with the covariates: whites (negative), blacks (positive), non-US citizen (positive), and prisoners under age 18 years (positive) for both 2000 and 2010. There was a statistically significant higher HIV infection rate among the female prisoners in comparison to the male prisoners. It is of prime importance to examine the state-level disparities in HIV infection rate based on place and demographics. This is because evaluating the spatial pattern will help in accessing the relevant local information and provide federal agencies with better knowledge to target interventions and prevention programs toward the subgroup of the population at higher risk and help in controlling and reducing HIV infection prevalence.

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Epidemiological and Clinical Evidence for the Role of Toxins in S. aureus Human Disease

Toxins ◽

10.3390/toxins12060408 ◽

2020 ◽

Vol 12 (6) ◽

pp. 408 ◽

Cited By ~ 1

Author(s):

Monique R. Bennett ◽

Isaac P. Thomsen

Keyword(s):

Human Disease ◽

Clinical Evidence ◽

Treatment Options ◽

Skin Infections ◽

Current Role ◽

Aureus Infection ◽

Joint Infections ◽

The Us ◽

Public Health Threat

Staphylococcus aureus asymptomatically colonizes approximately 30–50% of the population and is a leading cause of bacteremia, bone/joint infections, and skin infections in the US. S. aureus has become a major public health threat due to antibiotic resistance and an increasing number of failed vaccine attempts. To develop new anti-staphylococcal preventive therapies, it will take a more thorough understanding of the current role S. aureus virulence factors play in contributing to human disease. This review focuses on the clinical association of individual toxins with S. aureus infection as well as attempted treatment options. Further understanding of these associations will increase understanding of toxins and their importance to S. aureus pathogenesis.

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A climate migrant escapes its parasites

Marine Ecology Progress Series ◽

10.3354/meps13278 ◽

2020 ◽

Vol 641 ◽

pp. 111-121 ◽

Cited By ~ 1

Author(s):

DS Johnson ◽

JD Shields ◽

D Doucette ◽

R Heard

Keyword(s):

Salt Marshes ◽

Fiddler Crab ◽

Gulf Of Maine ◽

Infection Prevalence ◽

Parasite Richness ◽

The Us ◽

Gill Lamellae ◽

Enemy Escape ◽

First Time ◽

Historical Range

When a species colonizes a new range, it can escape enemies found in its original range. Examples of enemy escape abound for invasive species, but are rare for climate migrants, which are populations of a species that colonize a new range due to climate-driven range shifts or expansions. The fiddler crab Minuca (=Uca) pugnax is found in the intertidal salt marshes of the US east coast. It recently expanded its range north into the Gulf of Maine as a result of ocean warming. We tested the hypothesis that M. pugnax had escaped its parasite enemies. Parasite richness and trematode intensity were lower in populations in the expanded range than in populations in the historical range, but infection prevalence did not differ. Although M. pugnax escaped most of its historical parasites when it migrated northward, it was infected with black-gill lamellae (indicative of Synophrya hypertrophica), which was found in the historical range, and with the trematode Odhneria cf. odhneri, which was not found in the historical range. To our knowledge, this is the first time that O. cf. odhneri has been reported in fiddler crabs. These results demonstrate that although M. pugnax escaped some of its historical parasites when it expanded its range, it appears to have gained a new parasite (O. cf. odhneri) in the expanded range. Overall, our results demonstrate that climate migrants can escape their enemies despite colonizing habitats adjacent to their enemy-filled historical range.

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The Eleventh Circuit Holds that Agreements in which Pharmaceutical Companies Pay Generic Companies Not to Compete May be Valid

The Journal of Law Medicine & Ethics ◽

10.1017/s107311050000749x ◽

2004 ◽

Vol 32 (1) ◽

pp. 181-184

Author(s):

Amy Garrigues

Keyword(s):

Pharmaceutical Companies ◽

Court Decisions ◽

Patent Holder ◽

Trial Court ◽

Court Of Appeals ◽

The Us ◽

Antitrust Laws ◽

Per Se ◽

Appeals Court ◽

Two Sides

On September 15, 2003, the US. Court of Appeals for the Eleventh Circuit held that agreements between pharmaceutical and generic companies not to compete are not per se unlawful if these agreements do not expand the existing exclusionary right of a patent. The Valley DrugCo.v.Geneva Pharmaceuticals decision emphasizes that the nature of a patent gives the patent holder exclusive rights, and if an agreement merely confirms that exclusivity, then it is not per se unlawful. With this holding, the appeals court reversed the decision of the trial court, which held that agreements under which competitors are paid to stay out of the market are per se violations of the antitrust laws. An examination of the Valley Drugtrial and appeals court decisions sheds light on the two sides of an emerging legal debate concerning the validity of pay-not-to-compete agreements, and more broadly, on the appropriate balance between the seemingly competing interests of patent and antitrust laws.

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