Dynamics of Anti-influenza Mucosal IgA Over a Season in a Cohort of Individuals Living or Working in a Long-term Care Facility.

BACKGROUND: Serological surveys are used to ascertain influenza infection and immunity, but evidence for the utility of mucosal immunoglobulin A (IgA) as a correlate of infection or protection is limited. METHODS: We performed influenza-like illness (ILI) surveillance on 220 individuals living or working in a retirement community in Gainesville, Florida from January to May 2018, and took pre- and postseason nasal samples of 11 individuals with polymerase chain reaction (PCR)-confirmed influenza infection and 60 randomly selected controls. Mucosal IgA against 10 strains of influenza was measured from nasal samples. RESULTS: Overall, 28.2% and 11.3% of individuals experienced a 2-fold and 4-fold rise, respectively, in mucosal IgA to at least 1 influenza strain. Individuals with PCR-confirmed influenza A had significantly lower levels of preseason IgA to influenza A. Influenza-associated respiratory illness was associated with a higher rise in mucosal IgA to influenza strains of the same subtype, and H3N2-associated respiratory illness was associated with a higher rise in mucosal IgA to other influenza A strains. CONCLUSIONS: By comparing individuals with and without influenza illness, we demonstrated that mucosal IgA is a correlate of influenza infection. There was evidence for cross-reactivity in mucosal IgA across influenza A subtypes.

Disclosure of Conflicts of Interest Among Speakers, Moderators, Presenters, and Discussants at National Trauma Meetings.

BACKGROUND: Official conference participants (OCPs) consisting of speakers, moderators, discussants, and presenters) with conflicts of interest (COI) could negatively influence the audience's ability to fairly evaluate information if their COI is not properly disclosed. We aim to examine the patterns of COI disclosures by OCPs and the nature and extent of financial compensation at 3 annual trauma conferences. METHODS: A retrospective cohort analysis of COI disclosures of OCPs, in the EAST, WTA, and AAST Annual Meetings from 2016 to 2019. The Open Payments Database (OPD) was used to describe the nature and extent of financial compensation. Descriptive statistics and independent sample t-tests were performed with significance defined as P < .05. RESULTS: Eastern Association for the Surgery of Trauma: conflicts of interest ranged from 3.8 to 6.0% of OCPs. Moderators, discussants, and presenters comprised decreasing proportions disclosing COIs, whereas speakers comprised an increasing proportion. Western Trauma Association: conflicts of interest ranged from 1.3 to 6.8% of OCPs. Moderators comprised an increasing proportion whereas speakers comprised a decreasing proportion. American Association for the Surgery of Trauma: conflicts of interest ranged from 3.6 to 5.4% of OCPs. Speakers, moderators, and presenters comprised progressively decreasing proportions, whereas discussants comprised an increasing proportion. Participants who did not disclose a COI comprised the majority of payment recipients in the OPD. CONCLUSION: Official conference participants who disclosed a COI varied between EAST, WTA, and AAST Annual Meetings from 2016 to 2019. Implementation of standardized COI disclosure policies with explicitly communicated definitions/categories can maximize the participants' understanding of the disclosure process, translate into improved COI reporting, and preserve an evidence-based environment that is free from commercial influence for physicians to teach and learn.

Blood Culture Results and Overtreatment Associated With the Use of a 1-Hour Sepsis Bundle.

BACKGROUND: Some experts recommend using a 1-h sepsis bundle, but clinical data supporting this strategy are lacking. OBJECTIVES: We aimed to determine the rate of, and clinical predictors for, bacteremia for patients undergoing a 1-h sepsis bundle, and to determine the percentage of "code sepsis" patients who are ultimately diagnosed with sepsis or a bacterial infection. METHODS: This retrospective chart review evaluated code sepsis patients from three emergency departments (EDs) that utilize a 1-h sepsis bundle. The primary outcome was the rate of true-positive blood cultures. Secondarily, we analyzed various clinical factors using logistic regression analysis to determine which are associated with bacteremia. RESULTS: Of the 544 code sepsis patients analyzed, 33.8% (95% confidence interval [CI] 29.9-38.0%) were ultimately diagnosed with sepsis, and 54.6% (95% CI 50.3-58.8%) were diagnosed with a bacterial infection. Exactly 7.0% (95% CI 5.0-9.5%) of the blood cultures performed were true positives. On multivariate logistic regression analysis, temperature > 38°C (100.4°F) or < 36°C (96.8°F), lactate > 4 mmol/L, and indwelling line/device were found to be positively associated with true-positive blood cultures. CONCLUSION: In a group of code sepsis patients from facilities that use a 1-h sepsis bundle, the majority were ultimately not diagnosed with sepsis, and nearly half did not have a bacterial infection. A small minority of patients had bacteremia. Restricting blood culture ordering in patients with possible sepsis to only those who have increased risk for bacteremia could lead to a more judicious use of blood cultures.

Variations in surgical peer-reviewed publications among editorial board members, associate editors and their respective journal: Towards maintaining academic integrity.

BACKGROUND: Physician scientists who are also Editorial Board members or Associate Editors may prefer publishing in their own journal and therefore create an environment for conflicts of interest to arise. OBJECTIVES: To assess the relationship between the number of peer-reviewed publications in surgical journals in which authors serve as Editorial Board Members and Associate Editors and their total number of annual publications. MATERIALS AND METHODS: A cross-sectional study utilizing PubMed was performed regarding the total annual number of peer-reviewed publications by Editorial Board Members/Associate Editors and the number published in their respective affiliated journals from 2016 to 2019. Significance defined as p < 0.05. RESULTS: 80 Associate Editors and 721 Editorial Board Members (n = 801 total) were analyzed from 10 surgical journals. The mean number of total annual peer-reviewed publications varied from 5.19 to 17.18. The mean number of annual peer-reviewed publications in affiliated journals varied from 0.06 to 2.53. Multiple significant associations were discovered between the total number of annual peer-reviewed publications and number of peer-reviewed publications in affiliated journals for all authors/surgical journals evaluated, except for the International Journal of Surgery (p > 0.05). CONCLUSIONS: We found significant associations between the total number of annual peer-reviewed publications by Editorial Board Members/Associate Editors and number of annual peer-reviewed publications by their affiliated surgical journals. The implementation and enforcement of a standardized double-blind review process and mandatory reporting of any potential conflicts of interest can reduce possible bias and promote a fair and high-quality peer-review process.