Background: In March–April 2021, 23 patients at a 906-bed hospital in Delaware had surgical implantation of a bone graft product contaminated with Mycobacterium tuberculosis; 17 patients were rehospitalized for surgical site infections and 6 developed pulmonary tuberculosis. In May 2021, we investigated this tuberculosis outbreak and conducted a large, multidisciplinary, contact investigation among healthcare personnel (HCP) and patients potentially exposed over an extended period in multiple departments. Methods: Exposed HCP were those identified by their managers as present, without the use of airborne precautions, in operating rooms (ORs) during index spine surgeries or subsequent procedures, the postanesthesia care unit (PACU) when patients had draining wounds, inpatient rooms when wound care was performed, and the sterile processing department (SPD) on the days repeated surgeries were performed. We created and assigned an online education module and symptom screening questionnaire to exposed HCP. Employee health services (EHS) instituted a dedicated phlebotomy station to provide interferon-γ release assay (IGRA) testing for HCP at ≥8 weeks after last known exposure. EHS managed all exposed HCP, including nonemployees (eg, private surgeons) via automated e-mail reminders, which were escalated through supervisory chains as needed until follow-up completion. The infection prevention team notified exposed patients, defined as those who shared semiprivate rooms with case patients with transmissible tuberculosis. The Delaware Division of Public Health performed IGRA testing. Results: There were 506 exposed HCP in ORs (n = 100), the PACU (n = 87), inpatient units (n = 140), the SPD (n = 54), and other locations (n = 122); 83% were employed by the health system. Surgical masks and eye protection were routinely used during patient care. All exposed HCP completed screening by December 17, 2021. Furthermore, 2 HCP had positive IGRAs without symptoms or chest radiograph abnormalities, indicating latent tuberculosis infection, but after further review of records and interviews, we discovered that they had previously tested positive and had been treated for latent tuberculosis infection. In addition, 5 exposed patients tested negative and 2 remain pending. Conclusions: This large investigation demonstrated the need for a systematic process that encompassed all exposed HCP including nonemployees and incorporated administrative controls to ensure complete follow-up. We did not identify any conversions related to this outbreak despite high burden of disease in case patients and multiple exposures to contaminated bone-graft material and infectious bodily fluids without respirator use. Transmission risk was likely reduced by baseline surgical mask use and rapid institution of airborne precautions after outbreak recognition.

Funding: None

Disclosures: None

Corn (Zea mays L. ‘Pioneer 3732′) showed little to no injury following the postemergence-directed application of sethoxydim {2-[1-(ethoxyimino)butyl]-5-[2-(ethylthio) propyl]-3-hydroxy-2-cyclohexen-1-one} plus crop oil concentrate (COC) at 56 g/ha plus 1.25% (v/v) at nine locations across Midwestern U.S. in 1984 and 1985. Little corn injury also occurred for the postemergence-directed application of sethoxydim plus COC at 110 g/ha plus 1.25% (v/v) at most locations in both years. Considerable variation in tolerance was seen across locations for over-the-top applications of sethoxydim at all rates tested and for the directed application at 220 g/ha. Although corn at most locations showed no yield reduction with the over-the-top application of sethoxydim plus COC at 56 g/ha plus 1.25% (v/v), a 70% yield reduction occurred in one location in one year. For an over-the-top application of sethoxydim plus COC at 110 g/ha plus 1.25% (v/v), yields ranged from 3 to 95% of the untreated check in 1984, and from 3 to 88% in 1985. Stand reductions from an over-the-top application of sethoxydim plus COC at 220 g/ha plus 1.25% (v/v) ranged from 0 to 99%. A significant negative correlation was found between yield of corn treated over the top with sethoxydim and precipitation on the day of application and in the week following application. Air temperature on the day of application was positively correlated with corn injury from over-the-top and directed sethoxydim applications, but no correlation existed between percent relative humidity and corn injury. Open pan evaporation and solar radiation before and after application were not correlated with corn injury from sethoxydim.

The emergence and persistence of conduct problems (CPs) during early childhood is a robust predictor of behavior problems in school and of future maladaptation. In this study we examined the reciprocal influences between observed coercive interactions between children and caregivers, oppositional and aggressive behavior, and growth in parent report of early childhood (ages 2–5) and school-age CPs (ages 7.5 and 8.5). Participants were drawn from the Early Steps multisite randomized prevention trial that includes an ethnically diverse sample of male and female children and their families (N = 731). A parallel-process growth model combining latent trajectory and cross-lagged approaches revealed the amplifying effect of observed coercive caregiver–child interactions on children's noncompliance, whereas child oppositional and aggressive behaviors did not consistently predict increased coercion. The slope and initial levels of child oppositional and aggressive behaviors and the stability of caregiver–child coercion were predictive of teacher-reported oppositional behavior at school age. Families assigned to the Family Check-Up condition had significantly steeper declines in child oppositional and aggressive behavior and moderate reductions in oppositional behavior in school and in coercion at age 3. Results were not moderated by child gender, race/ethnicity, or assignment to the intervention condition. The implications of these findings are discussed with respect to understanding the early development of CPs and to designing optimal strategies for reducing problem behavior in early childhood with families most in need.

Background: The perceived control of intrusive thoughts is important in our understanding of a variety of psychological disorders, but particularly in Obsessive Compulsive Disorder (OCD). Little research has explored thought control strategies in younger populations, despite the frequent onset of OCD in childhood. Aims: This study examined thought control strategies and meta-cognitive beliefs in relation to Obsessive Compulsive (OC) interference scores in an adolescent sample. Method: A non-referred sample of 151 adolescents aged 13–16 completed the Thought Control Questionnaire, the Meta-Cognitions Questionnaire – Adolescent version, and the Leyton Obsessional Inventory – Child Version. Results: Adolescents reported using distraction and worry as thought control strategies as much as adults, but social control and reappraisal less frequently, with adolescent males also reporting less use of punishment as a strategy. The strategies of worry and punishment, and positive beliefs about worry, uncontrollability and danger beliefs (UCD) and superstition punishment and responsibility beliefs (SPR) predicted OC interference scores. Furthermore, these meta-cognitive beliefs mediated the relationships between punishment and worry and OC interference scores. Conclusions: Given the similarities between our results and those from research exploring these variables in adults, it is proposed that cognitive behavioural models of OCD that have been developed in adult populations may be relevant to adolescents, but that meta-cognitive beliefs about superstition, punishment and responsibility may be important in adolescence.

Background: Childhood worry is common, and yet little is known about why some children develop pathological worry and others do not. Two theories of adult worry that are particularly relevant to children are Davey's problem-solving model in which perseverative worry occurs as a result of thwarted problem-solving attempts, and Wells’ metacognitive model, in which positive and negative beliefs about worry interact to produce pathological worry. Aims: The present study aimed to test hypotheses that levels of worry in young children are associated with poor or avoidant solution generation for social problems, and poor problem-solving confidence. It also aimed to explore beliefs about worry in this age group, and to examine their relationships with worry, anxiety and age. Method: Fifty-seven young children (6–10 years) responded to open ended questions about social problem-solving situations and beliefs about worry, and completed measures of worry, anxiety and problem-solving confidence. Results: Children with higher levels of worry and anxiety reported using more avoidant solutions in social problem situations and children's low confidence in problem solving was associated with high levels of worry. Children as young as 6 years old reported both positive and negative beliefs about worry, but neither were associated with age, gender, or level of anxiety or worry. Conclusions: Results indicate similarities between adults and children in the relationships between problem-solving variables and worry, but not in relationships between beliefs about worry and worry. This may be due to developmental factors, or may be the result of measurement issues.

High cereal fibre intake is associated with reduced risk for type 2 diabetes, but wheat fibre had little or no effect on glycaemic control or oral glucose tolerance in clinical trials lasting 4–12 weeks. To explain this discrepancy, we hypothesised that colonic adaptation to increased wheat fibre intake takes many months but eventually results in increased SCFA production and glucagon-like peptide-1 (GLP-1) secretion. Thus, the primary objective was to determine the time-course of the effects of increased wheat fibre intake on plasma acetate, butyrate and GLP-1 concentrations in hyperinsulinaemic human subjects over 1 year. Subjects with fasting plasma insulin ≥ 40 pmol/l were randomly assigned by computer to receive either a high-wheat fibre cereal (fibre group; 24 g fibre/d; twenty assigned; six dropped out, fourteen included) or a low-fibre cereal (control group; twenty assigned; six dropped-out, fourteen included) daily for 1 year. Acetate, butyrate and GLP-1 were measured during 8 h metabolic profiles performed every 3 months. There were no differences in body weight in the fibre group compared with the control group. After 9 months baseline-adjusted mean 8 h acetate and butyrate concentrations were higher on the high-fibre than the control cereal (P < 0·05). After 12 months on the high-fibre cereal, baseline-adjusted mean plasma GLP-1 was 1·3 (95 % CI 0·4, 2·2) pmol/l (P < 0·05) higher than at baseline (about 25 % increase) and 1·4 (95 % CI 0·1, 2·7) pmol/l (P < 0·05) higher than after 12 months on control. It is concluded that wheat fibre increased SCFA production and GLP-1 secretion in hyperinsulinaemic humans, but these effects took 9–12 months to develop. Since GLP-1 may increase insulin sensitivity and secretion, these results may provide a mechanism for the epidemiological association between high cereal fibre intake and reduced risk for diabetes.