Faculty Bibliography

It is time for action by leaders across higher education to strengthen quality improvement (QI) in college health, in pursuit of better care, better health, and increased value - goals closely linked to students' learning and success. The size and importance of the college student population; the connections between wellbeing, and therefore QI, and student success; the need for improved standards and greater accountability; and the positive contributions of QI to employee satisfaction and professionalism all warrant a widespread commitment to building greater capacity and capability for QI in college health. This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring QI to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.

Our patient with primary biliary cholangitis, previously termed as primary biliary cirrhosis, presented with an unexpected and unusual cause of hematemesis in the form of multiple esophageal ulcers in-between variceal columns. Given that upon endoscopic examination, the esophageal ulcers were found to bleeding instead of the varices; they should be considered in the differential in the etiology of hematemesis in primary biliary cholangitis and thoroughly searched for during an endoscopic procedure for early treatment and subsequent secondary prevention.

Here we describe the first report of a clinical colistin-resistant ST84 Enterobacter cloacae isolate co-harboring mcr-4.6 (previously named mcr-4.2) and bla_NDM-1 from a patient in China. The bla_NDM-1-harboring IncX3 plasmid and the novel mcr-4.6-harboring ColE plasmid were completely sequenced. Although this isolate showed high level resistance to colistin, mcr-4.6 plasmid transformation, gene subcloning, susceptibility testing and lipid A matrix-assisted laser desorption ionization mass spectrometry analysis indicate that mcr-4.6 itself doesn't confer resistance to colistin.

Background/UNASSIGNED:Urgent-start peritoneal dialysis (USPD) was designed to avoid temporary hemodialysis initiation with a hemodialysis catheter. In these patients, PD is initiated within 2 weeks of catheter placement, but typically these prescriptions utilize automated peritoneal dialysis (APD) with a cycler. Manual exchanges have not been reported previously for USPD. We hypothesize that using multiple, low-volume manual exchanges, patients will have similar rates of peritonitis, exit-site infection (ESI), pericatheter leaks and discontinuation of PD in the first 3 months after initiation. Methods/UNASSIGNED:used 1000 mL dwell volumes during the first 7 days. Dwell times were 2-2.5 h for two to three exchanges per day. After 7 days of successful therapy, the dwell volumes were doubled. All patients were maintained on furosemide 160 mg twice daily. Results/UNASSIGNED:There were 20 patients enrolled in our USPD program. Our rates of peritonitis, ESI, pericatheter leak and discontinuation of PD were 5%, 0%, 5% and 5%, respectively. Conclusions/UNASSIGNED:Manual exchange during USPD is a viable modality with similar results as APD. Using manual exchanges allows patients to be more ambulatory during the day when they are not dwelling, allows nurses to evaluate the amount of ultrafiltration and effluent characteristics and allows for training in manual exchanges as well.

Aim of this review is to inform major clinical trials in peripheral vascular interventions in the year of 2017.

Heart failure affects nearly 26 million people worldwide. Patients with heart failure are frequently affected with atrial fibrillation, and the interrelation between these pathologies is complex. Atrial fibrillation shares the same risk factors as heart failure. Moreover, it is associated with a higher-risk baseline clinical status and higher mortality rates in patients with heart failure. The mechanisms by which atrial fibrillation occurs in a failing heart are incompletely understood, but animal studies suggest they differ from those that occur in a healthy heart. Data suggest that heart failure-induced atrial fibrosis and atrial ionic remodeling are the underlying abnormalities that facilitate atrial fibrillation. Therapeutic considerations for atrial fibrillation in patients with heart failure include risk factor modification and guideline-directed medical therapy, anticoagulation, rate control, and rhythm control. As recommended for atrial fibrillation in the non-failing heart, anticoagulation in patients with heart failure should be guided by a careful estimation of the risk of embolic events versus the risk of hemorrhagic episodes. The decision whether to target a rate-control or rhythm-control strategy is an evolving aspect of management. Currently, both approaches are good medical practice, but recent data suggest that rhythm control, particularly when achieved through catheter ablation, is associated with improved outcomes. A promising field of research is the application of neurohormonal modulation to prevent the creation of the "structural substrate" for atrial fibrillation in the failing heart.

Background: Mother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B (CHB) infections worldwide. Identification and evaluation of pregnant women with CHB are key steps to reducing MTCT. We aimed to assess demographic and clinical characteristics and MTCT risk in Asian American women with CHB receiving prenatal care at two community health center sites in New York City. Methods: We performed a retrospective cross-sectional study of all women with CHB evaluated with HBV DNA during prenatal care from 2007 to 2017. Clinical and demographic data were extracted from medical records and analyzed. We measured the percentage of pregnant women not on antiviral treatment at high-risk for MTCT, defined by highly viremic levels (HBV DNA >=200,000 IU/mL), then further analyzed by HBeAg status, alanine aminotransferase (ALT) levels, age, birth region, and other demographic variables to measure association with MTCT risk using logistic regression analysis. Results: There were a total of 978 unique pregnancies in 804 HBsAg-positive women included in this study. All 804 women were born in Asia with 786 (97.8%) born in China, and 589 (73.3%) from China's Fujian province. Of 978 unique pregnancies, the women's mean (range) age and gestational age at the time of initial HBV DNA levels were 29.2 (18-55) years and 16.9 (1.0-38.4) weeks, respectively. The distribution of initial HBV DNA and ALT level during each unique pregnancy is presented in Figure 1. Of 933 unique pregnancies of women not on HBV antiviral treatment at initial evaluation, 203 (21.8%) had a HBV DNA level >=200,000 IU/mL of which 185 (91.1%) were HBeAg-positive, 15 (7.4%) were HBeAg negative, and 3 (1.5%) were unknown. HBeAg-positive status (aOR 204.2, CI 104.0-400.8, p<0.01) and elevated ALT (aOR 1.02, CI 1.01-1.03, p<0.01) were associated with increased odds for high levels of viremia. Conclusion: At two community health sites providing perinatal HBV care to primarily Asian American patients, 21.8% of pregnant women were high risk for MTCT. While HBeAg-positive status was associated with high viremia, it is a limited predictor of MTCT alone as 7.4% of high risk patients were HBeAg-negative. Full assessment of CHB pregnant women and early coordinated care is needed to offer and deliver interventions to prevent MTCT during critical windows of time including antiviral therapy for highly viremic women. (Figure Presented)