Background: To provide a standardized, risk-adjusted method for summarizing antimicrobial use (AU), the Centers for Disease Control and Prevention developed the standardized antimicrobial administration ratio, an observed-to-predicted use ratio in which predicted use is estimated from a statistical model accounting for patient locations and hospital characteristics. The infection burden, which could drive AU, was not available for assessment. To inform AU risk adjustment, we evaluated the relationship between the burden of drug-resistant gram-positive infections and the use of anti-MRSA agents. Methods: We analyzed data from acute-care hospitals that reported ≥10 months of hospital-wide AU and microbiologic data to the National Healthcare Safety Network (NHSN) from January 2018 through June 2019. Hospital infection burden was estimated using the prevalence of deduplicated positive cultures per 1,000 admissions. Eligible cultures included blood and lower respiratory specimens that yielded oxacillin/cefoxitin–resistant Staphylococcus aureus (SA) and ampicillin-nonsusceptible enterococci, and cerebrospinal fluid that yielded SA. The anti-MRSA use rate is the total antimicrobial days of ceftaroline, dalbavancin, daptomycin, linezolid, oritavancin, quinupristin/dalfopristin, tedizolid, telavancin, and intravenous vancomycin per 1,000 days patients were present. AU rates were modeled using negative binomial regression assessing its association with infection burden and hospital characteristics. Results: Among 182 hospitals, the median (interquartile range, IQR) of anti-MRSA use rate was 86.3 (59.9–105.0), and the median (IQR) prevalence of drug-resistant gram-positive infections was 3.4 (2.1–4.8). Higher prevalence of drug-resistant gram-positive infections was associated with higher use of anti-MRSA agents after adjusting for facility type and percentage of beds in intensive care units (Table 1). Number of hospital beds, average length of stay, and medical school affiliation were nonsignificant. Conclusions: Prevalence of drug-resistant gram-positive infections was independently associated with the use of anti-MRSA agents. Infection burden should be used for risk adjustment in predicting the use of anti-MRSA agents. To make this possible, we recommend that hospitals reporting to NHSN’s AU Option also report microbiologic culture results.

Funding: None

Disclosures: None

We show that there exists a cubic threefold defined by an invertible polynomial that, when quotiented by the maximal diagonal symmetry group, has a derived category that does not have a full exceptional collection consisting of line bundles. This provides a counterexample to a conjecture of Lekili and Ueda.

This study evaluated the efficacy of a family-centered preventive intervention, the Family Check-Up (FCU), delivered as an online, eHealth model to middle school families. To increase accessibility of family-centered prevention in schools, we adapted the evidence-based FCU to an online format, with the goal of providing a model of service delivery that is feasible, given limited staffing and resources in many schools. Building on prior research, we randomly assigned participants to waitlist control (n = 105), FCU Online as a web-based intervention (n = 109), and FCU Online with coaching support (n = 108). We tested the effects of the intervention on multiple outcomes, including parental self-efficacy, child self-regulation, and child behavior, in this registered clinical trial (NCT03060291). Families engaged in the intervention at a high rate (72% completed the FCU assessment) and completed 3-month posttest assessments with good retention (94% retained). Random assignment to the FCU Online with coaching support was associated with reduced emotional problems for children (p = .003, d = −0.32) and improved parental confidence and self-efficacy (p = .018, d = 0.25) when compared with waitlist controls. Risk moderated effects: at-risk youth showed stronger effects than did those with minimal risk. The results have implications for online delivery of family-centered interventions in schools.

Lentic freshwater habitats are important centres of biodiversity within the infrequent ice-free oases across Antarctica. Given imminent climate changes, it is crucial to catalogue these habitats in order to provide baseline data for future monitoring and biological surveys. The lacustrine systems of Clearwater Mesa, a previously unexplored part of James Ross Island, north-eastern Antarctic Peninsula, are described here. We conducted basic geomorphological and limnological surveys over three Antarctic summers (2009–16) to characterize landscape evolution, infer the origin of lake basins and assess the variability in their water chemistry. Stable shallow lakes, formed in depressions between lava tumuli following the last deglaciation, were found to dominate the volcanic mesa, although several peripheral lakes in ice-proximal settings appear to have formed recently as a result of post-Neoglacial ice recession. We found large heterogeneity in conductivity (~10–7000 μS cm−1), despite the lithologically uniform substrate. This variability was shown to be related to lake type, basin type (open vs closed), meltwater source and proximity to the coast. Inter-annual differences were attributed to changes in sea spray influx and snow accumulation driven by variable weather conditions. Overall, the ion composition of lakes suggested that sea spray was the dominant source of ions, followed by the weathering of bedrock.

Scaling laws for the propulsive performance of rigid foils undergoing oscillatory heaving and pitching motions are presented. Water tunnel experiments on a nominally two-dimensional flow validate the scaling laws, with the scaled data for thrust, power and efficiency all showing excellent collapse. The analysis indicates that the behaviour of the foils depends on both Strouhal number and reduced frequency, but for motions where the viscous drag is small the thrust closely follows a linear dependence on reduced frequency. The scaling laws are also shown to be consistent with biological data on swimming aquatic animals.

The effect of changing environment on the evolution of Homo sapiens is heavily debated, but few data are available from equatorial Africa prior to the last glacial maximum. The Karungu deposits on the northeast coast of Lake Victoria are ideal for paleoenvironmental reconstructions and are best studied at the Kisaaka site near Karunga in Kenya (94 to > 33 ka) where paleosols, fluvial deposits, tufa, and volcaniclastic deposits (tuffs) are exposed over a ~ 2 km transect. Three well-exposed and laterally continuous paleosols with intercalated tuffs allow for reconstruction of a succession of paleocatenas. The oldest paleosol is a smectitic paleo-Vertisol with saline and sodic properties. Higher in the section, the paleosols are tuffaceous paleo-Inceptisols with Alfisol-like soil characteristics (illuviated clay). Mean annual precipitation (MAP) proxies indicate little change through time, with an average of 764 ± 108 mm yr− 1 for Vertisols (CALMAG) and 813 ± 182 to 963 ± 182 mm yr− 1 for all paleosols (CIA-K). Field observations and MAP proxies suggest that Karungu was significantly drier than today, consistent with the associated faunal assemblage, and likely resulted in a significantly smaller Lake Victoria during the late Pleistocene. Rainfall reduction and associated grassland expansion may have facilitated human and faunal dispersals across equatorial East Africa.

Let n be any positive integer and p be any prime. Also, let X be any spectrum and let K(n) denote the nth Morava K-theory spectrum. Then we construct a descent spectral sequence with abutment π∗(LK(n)(X)) and E2-term equal to the continuous cohomology of Gn, the extended Morava stabilizer group, with coefficients in a certain discrete Gn-module that is built from various homotopy fixed point spectra of the Morava module of X. This spectral sequence can be contrasted with the K(n)-local En-Adams spectral sequence for π∗(LK(n)(X)), whose E2-term is not known to always be equal to a continuous cohomology group.