Background: Infection prevention surveillance for cross transmission is often performed by manual review of microbiologic culture results to identify geotemporally related clusters. However, the sensitivity and specificity of this approach remains uncertain. Whole-genome sequencing (WGS) analysis can help provide a gold-standard for identifying cross-transmission events. Objective: We employed a published WGS program, the Philips IntelliSpace Epidemiology platform, to compare accuracy of two surveillance methods: (i.) a virtual infection practitioner (VIP) with perfect recall and automated analysis of antibiotic susceptibility testing (AST), sample collection timing, and patient location data and (ii) a novel clinical matching (CM) algorithm that provides cluster suggestions based on a nuanced weighted analysis of AST data, timing of sample collection, and shared location stays between patients. Methods: WGS was performed routinely on inpatient and emergency department isolates of Enterobacter cloacae, Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa at an academic medical center. Single-nucleotide variants (SNVs) were compared within core genome regions on a per-species basis to determine cross-transmission clusters. Moreover, one unique strain per patient was included within each analysis, and duplicates were excluded from the final results. Results: Between May 2018 and April 2019, clinical data from 121 patients were paired with WGS data from 28 E. cloacae, 21 E. faecium, 61 K. pneumoniae, and 46 P. aeruginosa isolates. Previously published SNV relatedness thresholds were applied to define genomically related isolates. Mapping of genomic relatedness defined clusters as follows: 4 patients in 2 E. faecium clusters and 2 patients in 1 P. aeruginosa cluster. The VIP method identified 12 potential clusters involving 28 patients, all of which were “pseudoclusters.” Importantly, the CM method identified 7 clusters consisting of 27 patients, which included 1 true E. faecium cluster of 2 patients with genomically related isolates. Conclusions: In light of the WGS data, all of the potential clusters identified by the VIP were pseudoclusters, lacking sufficient genomic relatedness. In contrast, the CM method showed increased sensitivity and specificity: it decreased the percentage of pseudoclusters by 14% and it identified a related genomic cluster of E. faecium. These findings suggest that integrating clinical data analytics and WGS is likely to benefit institutions in limiting expenditure of resources on pseudoclusters. Therefore, WGS combined with more sophisticated surveillance approaches, over standard methods as modeled by the VIP, are needed to better identify and address true cross-transmission events.

Funding: This study was supported by Philips Healthcare.

Disclosures: None

Canadian specialist emergency medicine (EM) residency training is undergoing the most significant transformation in its history. This article describes the rationale, process, and redesign of EM competency-based medical education. The rationale for this evolution in residency education includes 1) improved public trust by increasing transparency of the quality and rigour of residency education, 2) improved fiscal accountability to government and institutions regarding specialist EM training, 3) improved assessment systems to replace poor functioning end-of-rotation assessment reports and overemphasis on high-stakes, end-of-training examinations, and 4) and tailored learning for residents to address individualized needs. A working group with geographic and stakeholder representation convened over a 2-year period. A consensus process for decision-making was used. Four key design features of the new residency education design include 1) specialty EM-specific outcomes to be achieved in residency; 2) designation of four progressive stages of training, linked to required learning experiences and entrustable professional activities to be achieved at each stage; 3) tailored learning that provides residency programs and learner flexibility to adapt to local resources and learner needs; and 4) programmatic assessment that emphasizes systematic, longitudinal assessments from multiple sources, and sampling sentinel abilities. Required future study includes a program evaluation of this complex education intervention to ensure that intended outcomes are achieved and unintended outcomes are identified.

A major goal of Gardner, Ryan, and Snoeyink (2018) was to determine what steps are needed moving forward in examining gender representation in industrial and organizational (I-O) psychology. Specifically, on the topic of pay differences, we highlight that gender differences in pay are in part due to differences in negotiation behaviors and/or experiences. Prior research demonstrates that female negotiators receive greater backlash than male negotiators—a possible explanation to why men tend to negotiate more often and more successfully than women (Bowles, Babcock, & Lai, 2007). Based on this evidence, one next step in moving forward should involve providing resources and knowledge to improve negotiation skills and practices specifically aimed at eliminating differences between women and men in both propensity to negotiate and the evaluation/consequences of negotiating.

Objectives: Studies suggest that impairments in some of the same domains of cognition occur in different neuropsychiatric conditions, including those known to share genetic liability. Yet, direct, multi-disorder cognitive comparisons are limited, and it remains unclear whether overlapping deficits are due to comorbidity. We aimed to extend the literature by examining cognition across different neuropsychiatric conditions and addressing comorbidity. Methods: Subjects were 486 youth consecutively referred for neuropsychiatric evaluation and enrolled in the Longitudinal Study of Genetic Influences on Cognition. First, we assessed general ability, reaction time variability (RTV), and aspects of executive functions (EFs) in youth with non-comorbid forms of attention-deficit/hyperactivity disorder (ADHD), mood disorders and autism spectrum disorder (ASD), as well as in youth with psychosis. Second, we determined the impact of comorbid ADHD on cognition in youth with ASD and mood disorders. Results: For EFs (working memory, inhibition, and shifting/ flexibility), we observed weaknesses in all diagnostic groups when participants’ own ability was the referent. Decrements were subtle in relation to published normative data. For RTV, weaknesses emerged in youth with ADHD and mood disorders, but trend-level results could not rule out decrements in other conditions. Comorbidity with ADHD did not impact the pattern of weaknesses for youth with ASD or mood disorders but increased the magnitude of the decrement in those with mood disorders. Conclusions: Youth with ADHD, mood disorders, ASD, and psychosis show EF weaknesses that are not due to comorbidity. Whether such cognitive difficulties reflect genetic liability shared among these conditions requires further study. (JINS, 2018, 24, 91–103)

Objective: The aim of this study was to determine the rates of osteopenia and osteoporosis and other general health problems in a long-stay male psychiatric unit.

Method: All 15 patients underwent a semi-structured clinical interview and a full physical examination including calculation of Body Mass Index, central obesity (abdominal circumference) and blood pressure measurement. All patients had blood sampling examining FBC, U&E, LFTs, TFTs, PSA, prolactin, lipid profile and glucose. The rates of metabolic syndrome were calculated according to the International Diabetes Federation consensus worldwide definition. Bone mineral density was determined in the lumbar vertebrae and left hip by DEXA scanning.

Results: The prevalence of osteopenia or osteoporosis was 46%, and bone mineral density was inversely correlated with serum prolactin levels (r = -0.595, p = 0.041) and chlorpromazine equivalence (r = -0.645, p = 0.017). The prevalence of obesity was 53%, while central obesity was present in 87% of patients. Metabolic Syndrome was present in 27% of patients.

Conclusions: More attention should be given to diagnosing and treating osteopenia and osteoporosis in patients on long-term antipsychotic agents and preventative measures should form part of any treatment regime in these individuals. Frequent input from dietitians should also be available for long-stay psychiatric inpatients to reduce the prevalence of obesity.

We describe two cases reports, demonstrating an association between clozapine treatment and stuttering. Stuttering in both cases was dose-related and a significant improvement was noted when the dose of clozapine was reduced.

This essay examines the methodological relationship of social doctrines of the Trinity and ecclesiologies of communion. The Theologies of Gisbert Greshake and Leonardo Boff represent theologians arguing that ecclesiology must be based on a doctrine of God which they present from a social (or psychological) perspective. The goal of the essay is to expose some of the methodological assumptions made by ecclesiologists and the value of social approach to the Trinity can have in an ecclesiology of communion.