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Building Quantum Computers
- A Practical Introduction
- Shayan Majidy, Christopher Wilson, Raymond Laflamme
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- September 2024
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- 11 July 2024
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The global race to build the world's first quantum computer has attracted enormous investment from government and industry, and it attracts a growing pool of talent. As with many cutting-edge technologies, the optimal implementation is not yet settled. This important textbook describes four of the most advanced platforms for quantum computing: nuclear magnetic resonance, quantum optics, trapped ions, and superconducting systems. The fundamental physical concepts underpinning the practical implementation of quantum computing are reviewed, followed by a balanced analysis of the strengths and weaknesses inherent to each type of hardware. The text includes more than 80 carefully designed exercises with worked solutions available to instructors, applied problems from key scenarios, and suggestions for further reading, facilitating a practical and expansive learning experience. Suitable for senior undergraduate and graduate students in physics, engineering, and computer science, Building Quantum Computers is an invaluable resource for this emerging field.
Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020–December 2021
- Nora Chea, Taniece Eure, Rebecca Alkis Ramirez, Maria Zlotorzynska, Gregory T. Blazek, Joelle Nadle, Jane Lee, Christopher A. Czaja, Helen Johnston, Devra Barter, Melissa Kellogg, Catherine Emanuel, James Meek, Monica Brackney, Stacy Carswell, Stepy Thomas, Scott K. Fridkin, Lucy E. Wilson, Rebecca Perlmutter, Kaytlynn Marceaux-Galli, Ashley Fell, Sara Lovett, Sarah Lim, Ruth Lynfield, Sarah Shrum Davis, Erin C. Phipps, Marla Sievers, Ghinwa Dumyati, Christopher Myers, Christine Hurley, Erin Licherdell, Rebecca Pierce, Valerie L. S. Ocampo, Eric W. Hall, Christopher Wilson, Cullen Adre, Erika Kirtz, Tiffanie M. Markus, Kathryn Billings, Ian D Plumb, Glen R. Abedi, Jade James-Gist, Shelley S. Magill, Cheri T. Grigg
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- Journal:
- Infection Control & Hospital Epidemiology , First View
- Published online by Cambridge University Press:
- 21 May 2024, pp. 1-9
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Background:
Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021.
Methods:CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively.
Results:Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles.
Conclusions:To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
Potential underreporting of treated patients using a Clostridioides difficile testing algorithm that screens with a nucleic acid amplification test
- Alice Y. Guh, Scott Fridkin, Dana Goodenough, Lisa G. Winston, Helen Johnston, Elizabeth Basiliere, Danyel Olson, Christopher D. Wilson, Jasmine J. Watkins, Lauren Korhonen, Dale N. Gerding
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 5 / May 2024
- Published online by Cambridge University Press:
- 25 January 2024, pp. 590-598
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- May 2024
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Objective:
Patients tested for Clostridioides difficile infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (−). We compared NAAT+/toxin− and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin− patients.
Design:Retrospective observational study.
Setting:The study was conducted across 36 laboratories at 5 Emerging Infections Program sites.
Patients:We defined a CDI case as a positive test detected by this 2-step algorithm during 2018–2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks.
Methods:We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin− and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin− cases.
Results:Of 1,801 cases, 1,252 were NAAT+/toxin−, and 549 were NAAT+/toxin+. CDI treatment was given to 866 (71.5%) of 1,212 NAAT+/toxin− cases versus 510 (95.9%) of 532 NAAT+/toxin+ cases (P < .0001). NAAT+/toxin− status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55–0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87–1.28). Among NAAT+/toxin− cases, white blood cell count ≥15,000/µL (aOR, 1.87; 95% CI, 1.28–2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40–2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23–4.68) were predictors of CDI treatment.
Conclusion:Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin− cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin− cases.
Variations in implementation of antimicrobial stewardship via telehealth at select Veterans Affairs medical centers
- Geneva Wilson, Amanda Vivo, Daniel Livorsi, Rabeeya Sabzwari, Christopher Crnich, Robin Jump, Charlesnika Evans
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s38
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Background: Antimicrobial stewardship programs (ASPs) seek to reduce the prevalence of antimicrobial-resistant and healthcare-associated infections. There are limited infectious disease (ID) physicians and pharmacists to support these ASPs, particularly in rural areas. The Veterans Health Administration has a robust telehealth program in place. Our previous work has demonstrated the feasibility of using telehealth modalities to support ASPs at rural Veterans Affairs medical centers (VAMCs) by pairing them with an ID expert from a larger, geographically distant, VAMC. This program, dubbed the Videoconference Antimicrobial Stewardship Team (VAST), emphasizes discussion of patients undergoing treatment for an active infection and additional relevant clinical topics with a multidisciplinary team at the rural VA. VAST implementation is ongoing at VAMCs. To understand and compare the qualitative differences in implementation, we used process maps to describe the VAST at 3 VAMC dyads. Methods: Team members from each dyad participated in interviews at 3, 6, and 9 months after beginning their VAST sessions. Questions addressed several aspects of VAST implementation and included identifying cases and topics to discuss; advance preparation for meetings; the frequency and general structure of VAST meetings; and documentation including workload capture. The research team used the responses to develop process maps to permit visual display and comparison of VAST implementation. Results: The first dyad began in January 2022 and the third in March 2022. The sessions had 3 phases: preparation, team meeting, and documentation of experts’ recommendations. Tasks were shared between VAST champions at the rural VAMC and the ID experts (Fig. 1). The preparation phase showed the most variation among the 3 dyads. In general, champions at the rural VA identified cases and topics for discussion that were sent to the ID expert for review. The approaches used to find cases and the type of preparatory work by the ID expert differed. Team meetings differed in both frequency and participation by professionals from the rural site. Documentation of expert recommendations processes appeared similar among the dyads. Discussion: Each of the 3 dyads implemented VAST differently. These results suggest that the overall structure of the VAST is readily adaptable and that each site tailored VAST to suit the clinical needs, workflow, and culture of their partner facility. Future work will seek to determine which aspects in the preparation, team meeting, or documentation phases are associated with successful ASPs, including assessment of quantitative and qualitative outcomes.
Disclosures: None
Evaluating racial disparities in central-line–associated bloodstream infections for Tennessee hospitals, 2018–2021
- Simone Godwin, Erika Kirtz, Christopher Wilson
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s48
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Background: Central-line–associated bloodstream infections (CLABSIs) significantly burden the US population and healthcare system. Reporting facilities in Tennessee consistently omit race and ethnicity data in the NHSN despite having the option to enter. Racial and ethnic disparities are well documented across many health outcomes, including patient safety. CLABSIs were compared among 3 racial groups to better understand the impact of race on CLABSI incidence in Tennessee. Methods: CLABSI data from NHSN were linked with records from the TN Hospital Discharge Data System (HDDS) for 2018–2021. A multivariable linear regression model was used to determine relative risk (RR) between racial groups for contracting a CLABSI after controlling for confounding variables including Charlson comorbidity index (CCI) and social vulnerability index (SVI) scores. Statistical significance was set at P < .05. Data linkage and statistical analyses were performed in SAS version 9.4 software. Results: In Tennessee between 2018 and 2021, 342 (17.2%) of the 1,980 CLABSI events had race documented, and no ethnicity variables exist in the NHSN. The data linkage process yielded a 72% match (1,426 CLABSIs). The remaining 28% were excluded from the analysis. Per 1,000 central-line days (CL days) for all races, white patients had the highest CLABSI rate (17.5), followed by Black patients (1.36), and Native American or Alaskan Native patients (0.68). Per 1,000 admissions by race, Black patients had a higher CLABSI rate (1.26) than Native American/Alaskan Native patients (0.85) and white patients (0.75). The risk of contracting a CLABSI was 79% higher in Black patients than in white patients (RR, 1.79; 95% CI, 1.55–2.07; P < .0001) when controlling for CCI, age group, and SVI. Conclusions: These results suggest that racial disparities between Black and white patients are present in Tennessee hospitals regarding CLABSIs. Although most CLABSI events were linked to HDDS patients, there were limitations in the ability to match all cases and calculate CL days by race. This study highlights the need for complete race and ethnicity data in the NHSN. Further studies should examine infection types at the regional and facility levels to target interventions for reducing HAI inequities in Tennessee.
Disclosures: None
Factors associated with high influenza vaccination among healthcare workers in Tennessee acute-care hospitals, 2014–2022
- Ashley Gambrell, Raquel Villegas, Christopher Wilson, Simone Godwin
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s73
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Background: Healthcare workers (HCWs) are at increased risk of influenza exposure and represent a potential transmission source. The Department of Health and Human Services (HHS) set a goal for 2020 to have 90% of all HCWs in acute-care hospitals (ACHs) vaccinated. Vaccination against influenza decreases symptomatic illness and absenteeism and protects HCWs and their contacts. We assessed characteristics of facility intervention programs based on their success in meeting this benchmark. Methods: Data from the NHSN were utilized, including answers to the Annual Flu Survey for 2014–2022 and the rate of vaccine compliance by facility. Flu surveys detail facility-specific programs implemented for each influenza season, from October to March. We used SAS version 9.4 software for univariate analyses to determine factors significantly associated with meeting the HHS benchmark target of ≥90% vaccination among all HCWs, split into categories for employees, students or volunteers, and licensed independent practitioners. Facilities were excluded if they were not ACHs or Critical Access Hospitals (CAH), did not complete the Annual Flu Survey for at least 1 year, or required vaccination as a condition of employment. Results: From 2014 to 2022, 745 surveys were completed. Overall, 48.58% of respondents succeeded in meeting the HHS benchmark. Also, 306 surveys completed noted that their facility did not require influenza vaccination. Among those, only 19.93% respondents succeeded. Moreover, 80.33% of successful respondents for all HCWs required personal protective equipment (PPE) upon vaccination refusal compared to 34.29% of unsuccessful respondents (P < .0001). Furthermore, 98.36% successful respondents required documentation of offsite vaccination, compared to 89.39% of unsuccessful respondents (P = .027). For employees, 64.56% of successful respondents tracked vaccination rates in some or all units compared to 45.81% of unsuccessful respondents (P = .004). Also, 63.29% successful respondents had visible vaccination of leadership, compared to 43.61% of unsuccessful respondents (P = .003). Furthermore, 86.08% of successful respondents had mobile vaccination carts, compared to 73.57% unsuccessful respondents (P = .023). For the student- or volunteer-specific benchmark, 24.59% of successful respondents provided vaccination incentives compared to 14.63% of unsuccessful respondents (P = .035). Conclusions: Facilities with ≥90% vaccination among HCWs were more likely to require PPE after vaccination refusal and documentation for offsite vaccination. Other strategies for vaccination were differentially associated by employee type for Tennessee facilities. For future outreach, a multipronged approach is more likely to be successful in addressing vaccine uptake among employees with lagging rates. Strategies for influenza vaccine uptake could also improve other occupational vaccinations. More research is needed on the barriers to vaccination among HCWs specifically.
Disclosures: None
Susceptibility results discrepancy analysis between NHSN antimicrobial resistance (AR) Option and NEDSS Base System in Tennessee, July 2020–December 2021
- Carol Davis, Youssoufou Ouedraogo, Christopher Evans, Christopher Wilson
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s104
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Background: The NHSN Antimicrobial Resistance (AR) Option is an important avenue for acute-care hospitals to electronically report facilitywide antibiogram data. The NEDSS Base System (NBS) is the statewide surveillance system for mandatory reporting of all carbapenem-resistant Enterobacteriaceae (CRE) cases. The state health department (SHD) validated CRE case data reported through the AR Option to assess completeness and accuracy. Methods: NHSN AR Option data from July 2020–December 2021 for 24 facilities were validated by comparing reported CRE and susceptibility results to CRE isolates reported via the NBS. Isolates were matched based on specimen date, sex, birth month and day, pathogen, and specimen source. NHSN susceptibility results were dichotomized as “not resistant” and “resistant” to match the NBS results. Susceptibility discordance (differing proportions of resistant isolates) of matched pairs were evaluated using the McNemar exact test in SAS version 9.4 software. Results: The SHD identified 270 CRE cases from the NHSN and 1,254 unique CRE isolates from the NBS. Of the NHSN events, 72 (26.67%) were matched to the NBS. Among matched isolates, discordance was significant for doripenem (0 resistant isolates in the NHSN vs 13 in the NBS; P < .001) and imipenem (5 resistant isolates in the NHSN vs 23 in the NBS; P < .0001). Discordance was not significant for ertapenem nor meropenem. Sensitivity analyses maximized the match rate at 30.74% (83 matches) when NBS isolates from unknown sources were included and matching factors were specimen date and date of birth ± 1 day, and pathogen. Among all 6,325 CRE isolates in NBS, 290 (4.58%) did not have a specimen source provided. Of all 47,348 NHSN events, 7,624 (16.10%) had impossible patient birthdays. Conclusions: Many NHSN isolates could not be matched to NBS due to either isolates being missing from NBS or to data differences across the systems. This mismatch highlights the need for data validation and standardization at the point of entry for both systems. Discordant susceptibility outcomes raise concerns about using the NHSN as a method for facility and regional antibiogram data.
Disclosures: None
Characterization of negative health outcomes for dialysis events by vascular access type—Tennessee, 2015–2019
- Tara Suhs, Alex Kurutz, Christopher Wilson
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
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- 29 September 2023, p. s64
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Background: The dialysis patient population is at a higher risk for nosocomial infections as well as related negative consequences including hospitalization and death. The CMS and the state of Tennessee mandate reporting of 3 types of dialysis events: positive blood culture, intravenous antimicrobial starts, and pus, redness, or increased swelling at the access site. We explored hospitalization and death outcomes by vascular access types for dialysis events reported to the NHSN for licensed outpatient hemodialysis clinics in Tennessee from 2015 to 2019. Methods: We looked at the frequency of hospitalization and death among those who experienced a dialysis event for 3 types of vascular access: arteriovenous fistula, arteriovenous graft, and tunneled central venous catheter (CVC). Other vascular-access types were excluded due to low usage rates. Odds ratios and confidence intervals were used to quantify the relationship between access type and hospitalization, and access type and death. Pooled analysis was used due to the stable rates of death and hospitalization among access types from 2015 to 2019. Results: From 2015 to 2019, 16,742 dialysis events were reported for the 3 access types: 8,055 dialysis events (48.1%) occurred among those with tunneled CVCs, 7,107 (42.5%) occurred among those with fistulas, and 1,580 (9.4%) occurred among those with grafts. Of the 16,742 dialysis events, 3,420 patients (20.4%) were hospitalized either due or related to their dialysis event; 220 (1.3%) deaths occurred either due to or related to the patient’s dialysis event. The odds of being hospitalized was 1.47 (95% CI, 1.29–1.67) times greater in those with grafts compared to those with fistulas. Patients with tunneled CVCs were 1.30 (95% CI, 1.20–1.41) times greater to be hospitalized compared to those with fistulas. The odds of death was 1.09 (95% CI, 0.9–2.5) times greater in those patient with tunneled CVCs compared to those with fistulas, whereas the odds of death among patients with grafts was 0.73 (95% CI, 0.82–1.43) times the odds of death compared to patients with fistulas. Conclusions: Overall, our findings conclude hemodialysis patients with tunneled CVCs have an increased risk for the negative health outcomes of hospitalization and death when compared to the other access types, supporting previous studies. Additionally, grafts had a higher risk of hospitalization compared to fistulas, but patients with grafts had lower odds of death than those with fistulas. Further investigation is needed to study how the COVID-19 pandemic may have affected the trends of negative health outcomes related to dialysis events.
Disclosures: None
Epidemiology of carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacterales in US children, 2016–2020
- Heather Grome, Julian Grass, Nadezhda Duffy, Sandra Bulens, Jesse Jacob, Gillian Smith, Lucy Wilson, Elisabeth Vaeth, Bailey Evenson, Ghinwa Dumyati, Rebecca Tsay, Erin C. Phipps, Kristina Flores, Christopher Wilson, Christopher Czaja, Helen Johnston, Ruth Lynfield, Sean O’Malley, Meghan Maloney, Nicole Stabach, Joelle Nadle, Alice Guh
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s16
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Background: The Centers for Disease Control and Prevention’s Emerging Infections Program conducts active laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE) and extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E). To better understand the U.S. epidemiology of these organisms among children, we determined the incidence of pediatric CRE and ESBL-E cases and described their clinical characteristics. Methods: Surveillance was conducted among children <18 years of age for CRE from 2016–2020 in 10 sites, and for ESBL-E from 2019–2020 in 6 sites. Among catchment-area residents, an incident CRE case was defined as the first isolation of Escherichia coli, Enterobacter cloacae complex, Klebsiella aerogenes, K. oxytoca, or K. pneumoniae in a 30-day period resistant to ≥1 carbapenem from a normally sterile site or urine. An incident ESBL-E case was defined as the first isolation of E. coli, K. pneumoniae, or K. oxytoca in a 30-day period resistant to any third-generation cephalosporin and non-resistant to all carbapenems from a normally sterile site or urine. Case records were reviewed. Results: Among 159 CRE cases, 131 (82.9%) were isolated from urine and 19 (12.0%) from blood; median age was 5 years (IQR 1–10) and 94 (59.1%) were female. Combined CRE incidence rate per 100,000 population by year ranged from 0.47 to 0.87. Among 207 ESBL-E cases, 160 (94.7%) were isolated from urine and 6 (3.6%) from blood; median age was 6 years (IQR 2–15) and 165 (79.7%) were female. Annual ESBL incidence rate per 100,000 population was 26.5 in 2019 and 19.63 in 2020. Incidence rates of CRE and ESBL-E were >2-fold higher in infants (children <1 year) than other age groups. Among those with data available, CRE cases were more likely than ESBL-E cases to have underlying conditions (99/158 [62.7%] versus 59/169 [34.9%], P<0.0001), prior healthcare exposures (74/158 [46.8%] versus 38/169 [22.5%], P<0.0001), and be hospitalized for any reason around time of their culture collection (75/158 [47.5%] versus 38/169 [22.5%], P<0.0001); median duration of admission was 18 days [IQR 3–103] for CRE versus 10 days [IQR 4–43] for ESBL-E. Urinary tract infection was the most frequent infection for CRE (89/158 [56.3%]) and ESBL-E (125/169 [74.0%]) cases. Conclusion: CRE infections occurred less frequently than ESBL-infections in U.S. children but were more often associated with healthcare risk factors and hospitalization. Infants had highest incidence of CRE and ESBL-E. Continued surveillance, infection prevention and control efforts, and antibiotic stewardship outside and within pediatric care are needed
Disclosure: None
Using telehealth to support antimicrobial stewardship at four rural VA medical centers: Interim analysis
- Alexandria Nguyen, Mayyadah Alabdely, Taissa Bej, Tola Ewers, Tammy Walkner Amanda Vivo, Christopher Crnich, Daniel Livorsi, Rabeeya Sabzwari, Geneva Wilson, Brigid Wilson, Corinne Kowal, Oteshia Hicks, Charlesnika Evans, Robin Jump
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s110
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Background: Healthcare settings without access to infectious diseases experts may struggle to implement effective antibiotic stewardship programs. We previously described a successful pilot project using the Veterans Affairs (VA) telehealth system to form a Videoconference Antimicrobial Stewardship Team (VAST) that connected multidisciplinary teams from rural VA medical centers (VAMCs) with infectious diseases experts at geographically distant locations. VASTs discussed patients from the rural VAMC, with the overarching goal of supporting antibiotic stewardship. This project is currently ongoing. Here, we describe preliminary outcomes describing the cases discussed, recommendations made, and acceptance of those recommendations among 4 VASTs. Methods: Cases discussed at any of the 4 participating intervention sites were independently reviewed by study staff, noting the infectious disease diagnoses, recommendations made by infectious diseases experts and, when applicable, acceptance of those recommendations at the rural VAMC within 1 week. Discrepancies between independent reviewers were discussed and, when consensus could not be reached, discrepancies were discussed with an infectious diseases clinician. Results: The VASTs serving 4 different rural VAMCs discussed 96 cases involving 92 patients. Overall, infection of the respiratory tract was the most common syndrome discussed by VASTs (Fig. 1). The most common specific diagnoses among discussed cases were cellulitis (n = 11), acute cystitis (n = 11), wounds (n = 11), and osteomyelitis (n = 10). Of 172 recommendations, 41 (24%) related to diagnostic imaging or laboratory results and 38 (22%) were to change the antibiotic agent, dose, or duration (Fig. 2). Of the 151 recommendations that could be assessed via chart review, 122 (81%) were accepted within 1 week. Conclusions: These findings indicate successful implementation of telehealth to connect clinicians at rural VAMCs with an offsite infectious diseases expert. The cases represented an array of common infectious syndromes. The most frequent recommendations pertained to getting additional diagnostic information and to adjusting, but not stopping, antibiotic therapy. These results suggest that many of the cases discussed warrant antibiotics and that VASTs may use the results of diagnostic studies to tailor that therapy. The high rate of acceptance suggests that the VASTs are affecting patient care. Future work will describe VAST implementation at 4 additional VAMCs, and we will assess whether using telehealth to disseminate infectious diseases expertise to rural VAMCs supports changes in antibiotic use that align with principles of antimicrobial stewardship.
Disclosures: None
Determining trends of respiratory tract infections in a long-term care facility pilot surveillance project
- Cullen Adre, Dipen Patel, Vicky Reed, Srilakshmi Velrajan, Christopher Evans, Christopher Wilson
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s24
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Background: Respiratory tract infections (RTIs) in long-term care facilities (LTCFs) are particularly burdensome among residents, the COVID-19 pandemic highlighted the devastating consequences of RTIs in LTCFs. This situation has prompted the need for LTCFs to have a robust, active surveillance system to assist LTCFs with RTI identification. Such a system could assist with faster implementation of appropriate antimicrobial therapy and critical infection prevention and control. The TN Emerging Infections Program worked with CDC EIP to implement a pilot project to test the feasibility of performing RTI surveillance to inform future changes to NHSN. Methods: We recruited 6 LTCFs to collect prospective RTI surveillance for 6 consecutive months from October 2021 through March 2022. Data were collected for all residents meeting the RTI surveillance definitions: pneumonia, lower respiratory tract infection, influenza-like illness (including influenza), and COVID-19. These data were entered by facility workers into a REDCap database with a prospective RTI LTCF event form. Monthly data collection summaries were submitted using a designated denominator form. Descriptive statistics were used to analyze RTI data, and analyses were performed using SAS version 9.4 software. Results: In total, 6 facilities participated in the pilot project during the capture period. The total number of RTI cases across all facilities was 195. December had the most cases (n = 50). The most common first triggers were new RTI signs or symptoms (67.69%), laboratory results (17.44%), imaging findings (6.67%), and clinician-diagnosed RTI (8.21%). The most reported symptom was new or increased cough (57.44%). Chest radiographs were performed for 50.77% of patients. Positive viral laboratory test results were documented 29.74% of the time. Antibiotic treatments were given to 70.77% of residents. The most commonly prescribed antibiotics were cephalosporins (22.56%), macrolides (17.95%), fluoroquinolones (12.31%), and doxycycline (9.23%). Also, 17.4% of cases with antibiotic regimens had cephalosporins as monotherapy. Vaccine documentation was as follows: influenza 2020–2021 (40.51%), influenza 2021–2022 (64.1%), complete COVID-19 vaccine series (82.56%), PPSV-23 vaccine (33.85%), and PCV-13 (23.59%). Conclusions: RTI surveillance was incorporated smoothly into the daily workflow for facilities; the biggest barrier to effective implementation was staff turnover. A scheduled weekly time to collect data and fill out forms proved most effective. A high percentage of cases was treated with cephalosporins as monotherapy, which, based on the latest guidelines, may be suboptimal. Individual reports were sent back to facilities with a comparison to the aggregated data. These data will be used to evaluate antibiotic appropriateness and to guide future RTI surveillance efforts in the LTCF setting.
Disclosures: None
Increasing Registration for a VA Multidrug-Resistant Organism Alert Tool
- Cara Ray, Cassie Cunningham Goedken, Ashley Hughes, Katie Suda, Marylou Guihan, Geneva Wilson, Natalie Hicks, Martin Evans, Makoto Jones, Christopher Pfeiffer, Margaret Fitzpatrick, Stacey Klutts, Charlesnika Evans
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s124-s125
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Objectives: To address the importation of multi-drug-resistant organisms (MDROs) when a colonized or infected patient is transferred from another VA facility, the Veterans Health Administration (VHA) launched the Inpatient Pathogen Tracker (IPT) in 2020. IPT tracks MDRO-infected/colonized patients and alerts MDRO Program Coordinators (MPCs) and Infection Preventionists (IPs) when such patients are admitted to their facility to facilitate rapid identification and isolation of infected/colonized patients. IPT usage has been low during initial rollout (32.5%). The VHA and the CARRIAGE QUERI Program developed targeted implementation strategies to increase utilization of IPT’s second iteration, VA Bug Alert (VABA). Methods: Familiarity with IPT was assessed via pre-education survey (3/2022). All sites received standard VABA implementation including: 1) adaptation of VABA features based on end-user feedback (completed 4/2022), 2) development and delivery of an educational module regarding the revised tool (completed 4/2022), and 3) internal facilitation from the VHA MDRO Program Office (ongoing) (see Figure for all key timepoints). Intent to register for VABA was assessed via post-education survey (4-5/2022). Sites (125 eligible) not registered for VABA by 6/1/2022 were randomly assigned to receive one of two conditions from 6/2022–8/2022: continued standard implementation alone or enhanced implementation. Enhanced implementation added the following to standard implementation: 1) audit and feedback reports and 2) external facilitation, including interviews and education about VABA. We compared the number of sites with ≥1 MPC/IP registered for VABA to-date between implementation conditions. Results: Pre-education survey. 168 MPC/IPs across 117 sites responded (94% of eligible sites). Among respondents, 25% had used IPT, 35.1% were familiar with but had not used IPT, and 39.9% were unfamiliar with IPT. Post-education survey. 93 MPC/IPs across 80 sites responded (59% of eligible sites). Of these, 81.7% said they planned to register for VABA, 4.3% said they would not register, and 14.0% said they were unsure. Post-6/1/2022 Registrations. By 6/1/2022, 71% of sites had ≥1 registered VABA user. Of the 28 unregistered sites eligible for enhanced implementation, thirteen were assigned to receive enhanced implementation, and fifteen were assigned to receive continued standard implementation. Eight sites in the enhanced implementation condition (61.5%) registered for VABA. Seven standard-implementation-only sites (46.7%) registered. The number of registered sites did not significantly differ by implementation condition (Fisher’s exact p=0.476). Conclusions: Standard and enhanced implementation were equally effective at encouraging VABA registration, suggesting that allocating resources to enhanced implementation may not be necessary.
Disclosures: None.
Chapter 12 - How kings went about accumulating wealth and adding to it
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
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- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
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- 20 June 2023, pp 92-94
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Summary
You have already heard about how much was done by former kings to cut back on both their own outlays and on those of the realm, establishing rules for themselves and their subjects in order to accumulate wealth and become rich. They maintained that, if the people were wealthy, then the king was wealthy also, and that a king who had wealth in his treasury was always able to defend his country and make war, whenever that were deemed necessary, and without causing any harm or detriment to his people. They considered that nobody could be so certain of remaining at peace as to be immune from unexpected adverse events.
To accumulate great wealth they all acted in the following way: every year the kings were informed by their comptrollers of finance of all the expenditure that they had incurred, not only in embassies but also in all other actions that it was necessary to accomplish. The comptrollers told them of what, over and above that amount, still remained from their revenues and the levying of duties, both in money and in other forms of income. The order was then issued for the purchase, from these sources, of quantities of gold and silver to be placed in the castle in Lisbon in a tower built for the purpose and known as the Torre Albarrã or Outer Tower. This tower was greatly fortified, though its construction was never completed. It was located over the main gate of the castle, and in it was stored most of the wealth which the kings had amassed in gold, silver and coins. The keys to the tower were held, one by a custodian of the Monastery of São Francisco, another by a prior of the Monastery of São Domingos, and the third by a member of the chapter of the city's cathedral.
The kings had the following method of amassing gold and silver. In all the large and small towns of the realm that were suitable for this purpose, the kings had their money-changers who bought silver and gold from anyone wanting to sell: they alone were authorized to make such purchases. At the end of the year each one took what he had bought to the designated place where it was to be deposited in the treasury.
Chapter 15 - The pacts that the King of Castile and King Pedro of Portugal signed and how the King of Portugal promised to support him against Aragon
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
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- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
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- 20 June 2023, pp 97-99
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Summary
A number of historians have written in praise of King Pedro [of Portugal], relating that he reigned in peace throughout his lifetime and that it was not in vain that fortune saw fit to guide his reign, at its beginning, middle, and end, through peace and unbroken calm. When he came to power on the death of his father, King Afonso, he found the kingdom free of any dissension likely to lead to conflict with any king, whether of Spain or of some more distant land. In addition, when he became king, he immediately sent Aires Gomes da Silva and Gonçalo Eanes de Beja to his nephew, the King of Castile, with a message, and a nobleman by the name of Fernán López de Estúñiga, representing the king, travelled from Castile to see King Pedro. It was duly agreed that the two kings would be true and loyal friends, and their mutual friendship was signed and sealed at that time.
A year later, when King Pedro was in Évora, a group of messengers arrived from the King of Castile, namely Don Samuel Leví, his chief treasurer, along with García Gutiérrez Tello, the chief magistrate of Seville, and Gómez Fernández de Soria, the governor of that city; these men negotiated a more binding truce between the two kings than the previous one.
On this occasion it was also decided that Prince Fernando, the eldest son of the King of Portugal and heir to the throne, was to marry Princess Beatriz, the daughter of the King of Castile, and that their betrothal should be carried out by their proctors between the middle of the coming February and the last day of March; then the marriage would take place on the last day of April. Moreover, as his daughter's dowry, the King of Castile should give the same amount of money as King Afonso of Portugal had given his daughter Maria when she married his father, King Alfonso. The King of Portugal was to give Princess Beatriz, as dowry and bond, the same amount of money that his father, King Afonso, had given Princess Constanza when she was married to him.
Chapter 40 - How King Pedro arrived in Galicia, killed the Archbishop of Santiago and departed for England
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
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- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
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- 20 June 2023, pp 152-153
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Summary
The King of Castile left Lamego, quite defenceless and with very few followers, for there were no more than about 200 horsemen riding with him. He arrived in Monterrey, a town in Galicia, and from there he wrote messages to Logroño, to Soria and to Zamora, all of which were on his side, urging them to hold on, for he would bring them help. He informed the King of Navarre and the Prince of Wales that he was in Galicia and wished to know what support he could expect from them. There he waited for the Archbishop of Santiago and for Don Fernando de Castro, his standard-bearer and Provincial Governor of the provinces of León and Asturias, who prior to this had come to Galicia in answer to his command. He spoke with all the prelates, knights and squires, as well as with representatives of the cities, towns and fortresses, with the result that all of them took his side.
For three weeks they remained in council, deliberating whether it was better to go on to Zamora and from there to Logroño, since King Enrique and his forces were in Seville, or to go to Bayonne in England to make a personal plea for aid from the Prince of Wales. The king preferred the advice to go to England rather than to return once more to his kingdom, for he trusted as little in those who had expressed their support for him as in those others who were not on his side. He left Monterrey and went to spend the Feast of Saint John in Santiago [de Compostela] in Galicia; there he agreed with his followers to kill the archbishop and seize his strongholds.
Don Suero [the Archbishop] came trustingly on his command on the Feast of Saint Peter, for the king had sent to summon him to the council. However, as he was coming in through the city he was slain at the door of the Cathedral of Santiago by Fernán Pérez Turrichao and Gonzalo Gómez Gallinato, two knights who hated him and whom the king had ordered to kill him. They also killed Pero Álvarez, the Dean of Santiago, a man of great learning and wisdom. The king was watching from the top of the church while all this was done.
Chapter 22 - How the year-long truce between the kings came to be broken, and how King Pedro assembled a fleet to wage war on Aragon
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
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- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
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- 20 June 2023, pp 116-117
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Summary
We have told you about the deaths of the Master Don Fadrique and Prince Joan, which you have just heard about, not because we take any pleasure in relating cruel deeds. Rather, we have presented them at some length and in greater detail than the deaths of others, because they were very important people, and in order to enable you to see exactly how the king had them killed.
For this reason, although the year's truce that the cardinal had brought about between King Pedro [of Castile] and the King of Aragon was still in force, when Count Enrique heard about the death of his brother, Don Fadrique, and when Prince Ferran, the Marquis of Tortosa, was told of the death of his brother, Prince Joan, they decided to join forces and entered Castile.
The count entered via Soria and arrived at the town of Serón, which he plundered; he then made an assault on the castle of Alcázar, with a view to seizing it. Then he returned to Aragon. As for Prince Ferran, he entered via the kingdom of Murcia and caused severe damage there. The king learnt of this while he was in Valladolid and immediately sent troops to protect the borders with Aragon. Then he went to Seville where he ordered twelve galleys to be built post-haste for war. While this was being done, six Genoese galleys arrived (the Genoese were at the time at war against the Catalans). The king was delighted to see these and commissioned them for 1,000 crossed doblas each per month.
With these eighteen galleys the king duly arrived at a town called Guardamar, which belonged to Prince Ferran, and on the morning of 17 August he ordered a substantial number of troops to leave the galleys and attack the town. He took it by force, even though it was well protected by its ramparts, and many of the townspeople took refuge in the castle.
Then, about midday, amidst all the fighting, as frequently happens in this region, a mighty onshore wind began to rage. As the galleys were unmanned the wind blew them all ashore. Only two escaped this fate because they were further out to sea, one belonging to the king and one to the Genoese.
Chapter 2 - How the King of Castile sent for the body of Queen Maria, his mother, and concerning the letter he sent to the King of Portugal, his uncle
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
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- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
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- 20 June 2023, pp 73-74
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Summary
As mentioned elsewhere in this book, at the beginning of King Pedro's reign, the King of Castile gave orders in which he sent for the body of Queen Maria, his mother. She had passed away in Portugal whilst King Afonso [IV], her father, was still alive. He let it be known through a letter to King Pedro, his uncle, that it was his wish to transfer her body and lay it to rest in Seville, in the Royal Chapel, alongside King Alfonso [XI], his father. Accordingly, he ordered the Archbishop of Seville and other prelates from his kingdom to accompany the body of the queen. In addition, he commanded that Gómez Pérez, his Purveyor of the Royal Household, to whom the body was to be entrusted, should travel ahead to make all appropriate preparations for the body to be transferred in an honourable manner and to organize everything necessary for the transfer, so that when the prelates arrived they could find everything ready and leave immediately.
This greatly pleased King Pedro, who wrote asking the King of Castile to send for the body whenever he saw fit. The King of Castile immediately sent his purveyor, who was entrusted with the body in the town of Évora, where it lay, so that he could organize the preparations in accordance with the orders he had been given. When the archbishop and the other prelates and people came for the queen's body, a letter was brought to King Pedro from his nephew, the King of Castile, which read as follows:
Dear king and uncle, we the King of Castile and León, send you our salutations as to one whom we greatly admire and for whom we would desire a long life and health with honour, just as we would wish the same for ourself. We wish to inform Your Grace that we have seen a letter of credence that you sent to us through your vassals Martim Vasques and Gonçalo Eanes de Beja, who have presented on your behalf the credentials with which you invested them. Furthermore, dear king and uncle, our wish is to love you, to maintain at all times the good relations afforded by our kinship, and to act in your honour as we do in our own.
Translators’ Note
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
-
- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
- Print publication:
- 20 June 2023, pp xxv-xxviii
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Bibliography of Works Cited
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
-
- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
- Print publication:
- 20 June 2023, pp 162-166
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Chapter 37 - How the King of Castile sent a daughter of his to Portugal, and how he left Seville out of fear of the people of the city
- Edited by Amélia P. Hutchinson, University of Georgia, Teresa Amado, Juliet Perkins, King's College London, Philip Krummrich, Morehead State University, Kentucky
- Translated by Clive Willis, Iona McCleery, Francisco Fernandes, Shirley Clarke
- Introduction by Christopher Given-Wilson, Nicholas G. Round, David Green
-
- Book:
- The Chronicles of Fernão Lopes
- Published by:
- Boydell & Brewer
- Published online:
- 28 December 2023
- Print publication:
- 20 June 2023, pp 147-148
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Summary
While King Pedro was in Seville, he heard news of all these events, and after much thought he agreed with his followers to ask for help from the King of Portugal, his uncle. To give the latter weightier reasons to be moved to grant him this help, he sent word to remind him that he was well aware that a marriage had been arranged between his own daughter, Princess Beatriz, and Prince Fernando, the first-born son of the King of Portugal; therefore he was sending him the princess and all the dowry that had been agreed she would receive at the time of the marriage. Moreover, he declared that Princess Beatriz would inherit the kingdoms of Castile and León. He sent her immediately away from Seville, and with her Martín López de Trujillo, a man in whom he had a great deal of trust, and also a certain quantity of doblas that had been left to the princess by her mother, María de Padilla, along with jewels, seed-pearls and other things.
After Princess Beatriz had left Seville for Portugal, King Pedro had news that King Enrique was heading towards Seville from Toledo. Consequently, he decided to send for the treasure that he kept in the castle of Almodóvar, which was all in gold and silver coins. He ordered a galley to be fitted out and in it he placed this treasure, as well as all the wealth he had in the city. He gave command of the galley to his treasurer Martín Yáñez, ordering him to go to Tavira, a town in Portugal in the kingdom of the Algarve, and to watch over the galley until he arrived there. He also had many pack-mules loaded with all his wealth, and took with him a very great amount of gold and precious stones and pearls, both those he had taken from the Red Emir and his people and much other wealth that he had gathered, along with as much of the silver as he could take along.
When the king was thus prepared to leave Seville, he was told that the citizens were rising up against him and meant to rob him there where he was. Fear-stricken, he left at once for Portugal.