This article reviews existing state laws related to autonomous vehicle (AV) safety, equity, and automobile insurance. Thirty states were identified with relevant legislation. Of these, most states had one or two relevant laws in place. Many of these laws were related to safety and insurance requirements. Data are needed to evaluate the effectiveness of these laws in order to guide further policy development.

We conducted a molecular survey on microsporidian diversity in different lineages (operational taxonomic units = OTUs) of Asellus aquaticus from 30 sites throughout Europe. Host body length was determined, and DNA was extracted from host tissue excluding the intestine and amplified by microsporidian-specific primers. In total, 247 A. aquaticus specimens were analysed from which 26.7% were PCR-positive for microsporidians, with significantly more infections in larger individuals. Prevalence ranged between 10 and 90%. At 9 sites, no microsporidians were detected. A significant relationship was found between the frequency of infected individuals and habitat type, as well as host OTU. The lowest proportion of infected individuals was detected in spring-habitats (8.7%, n = 46) and the highest in ponds (37.7%, n = 53). Proportion of infected individuals among host OTUs A, D and J was 31.7, 21.7 and 32.1%, respectively. No infections were detected in OTU F. Our results are, however, accompanied by a partially low sample size, as only a minimum of 5 individuals was available at a few locations. Overall, 17 different microsporidian molecular taxonomic units (MICMOTUs) were distinguished with 5 abundant isolates (found in 4–17 host individuals) while the remaining 12 MICMOTUs were “rare” and found only in 1–3 host individuals. No obvious spatio-genetic pattern could be observed. The MICMOTUs predominantly belonged to Nosematida and Enterocytozoonida. The present study shows that microsporidians in A. aquaticus are abundant and diverse but do not show obvious patterns related to host genetic lineages or geography.

Background: Many urologists continue antibiotics after common urologic procedure beyond the timeframes recommended by professional guidelines. In this study, we sought to evaluate the association between postprocedural antibiotic use and patient outcomes. Methods: We identified all patients who underwent 1 of 3 urologic procedures (transurethral resection of bladder tumor [TURBT], transurethral resection of prostate [TURP], and ureteroscopy) within the Veterans’ Health Administration (VHA) between January 1, 2017, and June 30, 2021. A postprocedural antibiotic was any antibiotic potentially used for a urinary tract–related indication that was prescribed for administration after the day of the procedure. Outcomes were captured within 30 days of the procedure and included (1) return visits, defined as any emergency department or urgent care encounter or hospital readmission, and (2) Clostridium difficile infection (CDI), defined as a positive test for C. difficile and the prescription of an anti-CDI antibiotic. We used log-binomial models with risk adjustment to determine the association between postprocedural antibiotic use and outcomes. We constructed hospital-level observed-to-expected ratios for postprocedural antibiotic use, and we used these models to calculate the probability of each patient receiving postprocedural antibiotics. Results: Overall, we identified 74,629 patients; 98% were male; the mean age was 70 years (SD, 10). Among them, 50% underwent TURBT, 28% underwent TURP, and 23% underwent ureteroscopy. A postprocedural antibiotic was prescribed to 25,738 (35%) cases for a median duration of 3 days (IQR, 3–6). Return visits occurred in 13,489 patients (18%), and CDI occurred in 104 patients (0.1%). Patients exposed to postprocedural antibiotics had 16% more return visits (RR, 1.16; 95% CI, 1.13–1.20) and more than twice as much CDI (RR, 2.22; 95% CI, 1.51–3.26) than patients not exposed to postprocedural antibiotics. In log-binomial risk-adjusted analysis, the risk of return visits did not differ between the 2 groups (RR, 1.00; 95% CI, 0.97–1.04) but the risk of CDI was higher in patients who received post-procedural antibiotics (RR, 1.87; 95% CI, 1.00–3.51). Hospitals (n = 105) varied widely in their observed-to-expected ratios for prescribing postprocedural antibiotics, and the frequency of return visits was similar regardless of the frequency at which postprocedural antibiotics were prescribed (Table 1). Conclusions: Postprocedural antibiotics were prescribed beyond recommended intervals after more than one-third of common urologic procedures, with a large degree of variability across hospitals. The use of postprocedural antibiotics was not associated with fewer return visits but was associated with a nonsignificant increase in CDI risk. Efforts to reduce postprocedural antibiotics are needed.

Funding: Yes

Disclosures: This work was funded, in part, by the Merck Investigator Studies Program. This work was also supported by a Career Development Award (DJL) from the VA Health Services Research and Development Service (CDA 16-204) and by the Iowa City VA Health Care System, Department of Pharmacy Services.

Direct numerical simulations (DNS) are used to systematically investigate the applicability of the minimal-channel approach (Chung et al., J. Fluid Mech., vol. 773, 2015, pp. 418–431) for the characterization of roughness-induced drag on irregular rough surfaces. Roughness is generated mathematically using a random algorithm, in which the power spectrum (PS) and probability density function (p.d.f.) of the surface height can be prescribed. Twelve different combinations of PS and p.d.f. are examined, and both transitionally and fully rough regimes are investigated (roughness height varies in the range $k^+ = 25$–100). It is demonstrated that both the roughness function (${\rm \Delta} U^+$) and the zero-plane displacement can be predicted with ${\pm }5\,\%$ accuracy using DNS in properly sized minimal channels. Notably, when reducing the domain size, the predictions remain accurate as long as 90 % of the roughness height variance is retained. Additionally, examining the results obtained from different random realizations of roughness shows that a fixed combination of p.d.f. and PS leads to a nearly unique ${\rm \Delta} U^+$ for deterministically different surface topographies. In addition to the global flow properties, the distribution of time-averaged surface force exerted by the roughness onto the fluid is calculated. It is shown that patterns of surface force distribution over irregular roughness can be well captured when the sheltering effect is taken into account. This is made possible by applying the sheltering model of Yang et al. (J. Fluid Mech., vol. 789, 2016, pp. 127–165) to each specific roughness topography. Furthermore, an analysis of the coherence function between the roughness height and the surface force distributions reveals that the coherence drops at larger streamwise wavelengths, which can be an indication that very large horizontal scales contribute less to the skin-friction drag.

Does temporal thought extend asymmetrically into the past and the future? Do asymmetries depend on cultural differences in temporal focus? Some studies suggest that people in Western (arguably future-focused) cultures perceive the future as being closer, more valued, and deeper than the past (a future asymmetry), while the opposite is shown in East Asian (arguably past-focused) cultures. The proposed explanations of these findings predict a negative relationship between past and future: the more we delve into the future, the less we delve into the past. Here, we report findings that pose a significant challenge to this view. We presented several tasks previously used to measure temporal asymmetry (self-continuity, time discounting, temporal distance, and temporal depth) and two measures of temporal focus to American, Spanish, Serbian, Bosniak, Croatian, Moroccan, Turkish, and Chinese participants (total N = 1,075). There was an overall future asymmetry in all tasks except for temporal distance, but the asymmetry only varied with cultural temporal focus in time discounting. Past and future held a positive (instead of negative) relation in the mind: the more we delve into the future, the more we delve into the past. Finally, the findings suggest that temporal thought has a complex underlying structure.

We evaluated antibiotic-prescribing across 111 mental health units in the Veterans’ Health Administration. We found that accurate diagnosis of urinary tract infections is a major area for improvement. Because non–mental-health clinicians were involved in most antibiotic-prescribing decisions, stewardship interventions for mental health patients should have a broad target audience to be effective.

We present a theoretical stability analysis for an expanding accretion shock that does not involve a rarefaction wave behind it. The dispersion equation that determines the eigenvalues of the problem and the explicit formulae for the corresponding eigenfunction profiles are presented for an arbitrary equation of state and finite-strength shocks. For spherically and cylindrically expanding steady shock waves, we demonstrate the possibility of instability in a literal sense, a power-law growth of shock-front perturbations with time, in the range of $h_c< h<1+2 {\mathcal {M}}_2$, where $h$ is the D'yakov-Kontorovich parameter, $h_c$ is its critical value corresponding to the onset of the instability and ${\mathcal {M}}_2$ is the downstream Mach number. Shock divergence is a stabilizing factor and, therefore, instability is found for high angular mode numbers. As the parameter $h$ increases from $h_c$ to $1+2 {\mathcal {M}}_2$, the instability power index grows from zero to infinity. This result contrasts with the classic theory applicable to planar isolated shocks, which predicts spontaneous acoustic emission associated with constant-amplitude oscillations of the perturbed shock in the range $h_c< h<1+2 {\mathcal {M}}_2$. Examples are given for three different equations of state: ideal gas, van der Waals gas and three-terms constitutive equation for simple metals.

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.

Funding: No

Disclosures: None

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Researchers, clinicians and patients are increasingly using real-time monitoring methods to understand and predict suicidal thoughts and behaviours. These methods involve frequently assessing suicidal thoughts, but it is not known whether asking about suicide repeatedly is iatrogenic. We tested two questions about this approach: (a) does repeatedly assessing suicidal thinking over short periods of time increase suicidal thinking, and (b) is more frequent assessment of suicidal thinking associated with more severe suicidal thinking? In a real-time monitoring study (n = 101 participants, n = 12 793 surveys), we found no evidence to support the notion that repeated assessment of suicidal thoughts is iatrogenic.