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To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.
The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).
Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings.
A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level “harm index” for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.
We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.
This research aims to enhance our understanding of the relationship between racial prejudice and White Americans’ views on cannabis legalization. The recent legalization of recreational cannabis in a handful of states, along with many other states legalizing medical cannabis in recent years, has catapulted the flowering plant back into the spotlight and nightly news cycles. Given the historically racist propaganda used to criminalize the plant, it follows that Whites’ support for legalization may be associated with racial prejudice. Using data from the General Social Survey data from 1972–2018, we find that different forms of racial prejudice have a negative effect on Whites’ support for cannabis legalization generally. Additionally, as the negative effect of overt, old-fashioned racism diminishes over time and across birth cohorts it is supplanted by the more subtle laissez-faire racism. In conclusion, we discuss the implication of the relationship between racial prejudice and views on marijuana for the increasingly complicated racial dynamics surrounding cannabis legalization.
Background: UV-C light reduces contamination of high-touch clinical surfaces. Few studies have tested the relative efficacy of UV-C devices in real-world clinical environments. Methods: We assessed the efficacy of the Tru-D (SmartUVC) and Moonbeam-3 UV-C (Diversey) devices at eradicating important clinical pathogens in 2 hyperbaric chambers at a tertiary-care hospital. Formica sheets were inoculated with 106–107 CFU of MRSA (USA300) or 104–105 CFU of C. difficile (NAP1). Sheets were placed in 6 predetermined locations throughout the chambers. Two Moonbeam-3 UV-C devices were positioned in the center of each chamber and were run for 3-minute (per manufacturer’s instructions) and 5-minute cycles. One Tru-D was positioned in the center of the chamber and was run on the vegetative cycle for MRSA and the spore cycle for C. difficile. UV-C dosage was measured for both machines. Quantitative cultures were collected using Rodac plates with DE neutralizing agar and were incubated at 37C for 48 hours. C. difficile was likewise plated onto sheep’s blood agar. Results: We ran each combination of chamber, microbe, and UV-C device in triplicate for In total, 108 samples per species.
For MRSA, the Tru-D vegetative cycle, the 5-minute Moonbeam cycle, and the 3-minute Moonbeam cycle resulted in average CFU log10 reductions of 7.02 (95% CI, 7.02–7.02), 6.99 (95% CI, 6.95–7.02), and 6.58 (95% CI, 6.37–6.79), respectively (Fig. 1). The Tru-D vegetative and 5-minute Moonbeam cycles were similarly effective (P > .99), and both were more effective than the 3-minute Moonbeam cycle (P < .001 and P < .001, respectively). MRSA samples receiving direct UV-C exposure had significantly greater log10 reductions (6.95; 95% CI, 6.89–7.01) than did indirect exposure (6.67; 95% CI, 6.46–6.87; P < .05) (Fig. 2). For C. difficile, the Tru-D sporicidal, the 5-, and 3-minute Moonbeam cycles resulted in average CFU log10 reductions of 1.78 (95% CI, 1.43–2.12), 0.57 (95% CI, 0.33–0.81) and 0.64 (95% CI, 0.42–0.86), respectively (Fig. 1). Tru-D was significantly more effective than either the 3- or 5-minute Moonbeam cycles (P < .00). C. difficile samples receiving direct UV-C exposure had higher dosage and significantly greater log10 reductions (1.34; 95% CI, 1.10–1.58) than did indirect exposure (0.58; 95% CI, 0.31–0.86; P < .01) (Fig. 2). Conclusions: Use of the Tru-D vegetative cycle and the Moonbeam 3- and 5-minute cycles resulted in similar reductions in MRSA; both resulted in significantly greater reductions than the manufacturer’s recommended 3-minute Moonbeam cycle. Therefore, healthcare facilities should carefully evaluate manufacturer-recommended run times in their specific clinical setting. For C. difficile, the Tru-D sporicidal cycle was significantly more effective than either of the Moonbeam cycles, likely due to higher irradiation levels. As such, direct UV-C exposure resulted in greater average reductions than indirect exposure.
Pollen-mediated gene flow (PMGF) refers to the transfer of genetic information (alleles) from one plant to another compatible plant. With the evolution of herbicide-resistant (HR) weeds, PMGF plays an important role in the transfer of resistance alleles from HR to susceptible weeds; however, little attention is given to this topic. The objective of this work was to review reproductive biology, PMGF studies, and interspecific hybridization, as well as potential for herbicide resistance alleles to transfer in the economically important broadleaf weeds including common lambsquarters, giant ragweed, horseweed, kochia, Palmer amaranth, and waterhemp. The PMGF studies involving these species reveal that transfer of herbicide resistance alleles routinely occurs under field conditions and is influenced by several factors, such as reproductive biology, environment, and production practices. Interspecific hybridization studies within Amaranthus and Ambrosia spp. show that herbicide resistance allele transfer is possible between species of the same genus but at relatively low levels. The widespread occurrence of HR weed populations and high genetic diversity is at least partly due to PMGF, particularly in dioecious species such as Palmer amaranth and waterhemp compared with monoecious species such as common lambsquarters and horseweed. Prolific pollen production in giant ragweed contributes to PMGF. Kochia, a wind-pollinated species can efficiently disseminate herbicide resistance alleles via both PMGF and tumbleweed seed dispersal, resulting in widespread occurrence of multiple HR kochia populations. The findings from this review verify that intra- and interspecific gene flow can occur and, even at a low rate, could contribute to the rapid spread of herbicide resistance alleles. More research is needed to determine the role of PMGF in transferring multiple herbicide resistance alleles at the landscape level.
Ultraviolet C (UV-C) light reduces contamination on high-touch clinical surfaces. We assessed the efficacy of 2 UV-C devices at eradicating important clinical pathogens in hyperbaric chambers. Both devices were similarly efficacious against MRSA but differed significantly against C. difficile. Additionally, direct UV-C exposure was more efficacious against both species than indirect exposure.
OBJECTIVES/GOALS: To characterize the various social and health trajectories of women released from jail, and how these trajectories influence women’s risky sexual and drug behaviors. To identify areas in which prevention programs and community interventions can be implemented to improve social and health outcomes. METHODS/STUDY POPULATION: The present study analyzes data collected as part of the sexual health empowerment (SHE Project) health literacy intervention. Participants were recruited from three county jails in the greater Kansas City area. At baseline, participants completed a survey that assessed participants’ sociodemographic characteristics and social histories prior to incarceration. Women were recruited between 2014-2016 and followed up annually after program completion to complete follow-up surveys to assess long-term health and social circumstances. The present study is a secondary analysis of baseline and follow-up data. Final analyses will include survey data from 126 women. RESULTS/ANTICIPATED RESULTS: In this study, we use Hobfoll’s Conservation of Resources (COR) Theory to conceptualize the impacts of stress on the social and health behaviors of justice-involved women in the years following release from jail. We hypothesize that “loss spirals”, a term coined by Stevan Hobfoll, creates psychological stress that drive justice-involved women to assume behaviors that will generate more resources and help to cope with the stress. We expect to find that women struggle to maintain ties to stable housing, employment, and support, which we believe to be central to “loss spirals.” Additionally, we expect to find that these “loss spirals” are associated with sexual and drug health risks. DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to define a succinct longitudinal timeline assessing biopsychosocial outcomes of women released from jail in order to improve prevention and intervention techniques for the improvement in social and health circumstances of women leaving jail and their reduction in recidivism.
The use of statistical/machine learning (ML) approaches to materials science is experiencing explosive growth. Here, we review recent work focusing on the generation and application of libraries from both experiment and theoretical tools. The library data enables classical correlative ML and also opens the pathway for exploration of underlying causative physical behaviors. We highlight key advances facilitated by this approach and illustrate how modeling, macroscopic experiments, and imaging can be combined to accelerate the understanding and development of new materials systems. These developments point toward a data-driven future wherein knowledge can be aggregated and synthesized, accelerating the advancement of materials science.
We present new results on the Galactic bar/bulge transverse velocity structure using Gaia and the VISTA Variables in Via Lactea (VVV) survey. Gaia is complemented in high extinction regions by the multi-epoch infrared VVV observations for which derived relative proper motions can be tied to Gaia’s absolute frame. We extract kinematic maps (both 2D and 3D) of the Galactic bar/bulge, from which we measure the pattern speed of the bar using a novel technique. We focus on the evidence of an X-shaped bulge from the kinematic maps.
We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.
Climate change will pose a serious and intractable threat to the health of populations. The ability of the public health system to address this problem and to preserve and protect the health of the public depends on a robust surveillance system. While public health has a long history of surveillance, the current system is not prepared to respond to the health effects of climate change. In order to develop a robust surveillance system, the public health infrastructure must address several issues, including coordination problems, conflicting legal authorities, jurisdictional issues, an overemphasis on preparedness, and complex issues of management and long-term planning.
Vegetable and grain amaranths represent a vital source of micronutrients and protein in Asia and Africa. However, various foliar lepidopteran pests and stem-mining weevils hinder amaranth production. Insect-resistant cultivars can enhance the productivity of this crop. Here, we report on the performances of amaranth varieties screened for their resistance to insect pests under the field conditions at The World Vegetable Center stations in Asia and sub-Saharan Africa. We conducted two preliminary screening trials with a total of 263 entries from around the world in Taiwan and a third preliminary screening trial with 49 African-indigenous entries in Tanzania. Promising entries from these preliminary trials were collectively evaluated in an advanced screening trial in Tanzania, to identify lines resistant to foliar and stem-boring pests in East Africa. Four entries exhibited moderate resistance to foliar pests: TZ51 and TZ53 (Amaranthus cruentus), TZ34 (A. dubius) and TZ39 (Amaranthus sp.). Five entries showed moderate resistance to stem weevils: TZ06 and TZ27 (A. cruentus), TZ52 (A. graecizans), TZ59 (A. palmeri) and TZ07 (Amaranthus sp.). Lepidopteran pests affecting leaves were reared to adulthood and identified as Spoladea recurvalis (Crambidae), Spodoptera exigua (Noctuidae) and Spodoptera littoralis (Noctuidae). Stem weevil larvae were also reared and identified as: Neocleonus sannio Herbst, Gasteroclisus pr. rhomboidalis Boheman, Hypolixus pr. haerens Boheman and Baradine sp. (Curculionidae). These results highlight key amaranth pests in East Africa and identify insect-resistant entries that will be useful in breeding programmes and resistance studies.
This paper summarises developments in understanding sea level change during the Quaternary in Scotland since the publication of the Quaternary of Scotland Geological Conservation Review volume in 1993. We present a review of progress in methodology, particularly in the study of sediments in isolation basins and estuaries as well as in techniques in the field and laboratory, which have together disclosed greater detail in the record of relative sea level (RSL) change than was available in 1993. However, progress in determining the record of RSL change varies in different areas. Studies of sediments and stratigraphy offshore on the continental shelf have increased greatly, but the record of RSL change there remains patchy. Studies onshore have resulted in improvements in the knowledge of rock shorelines, including the processes by which they are formed, but much remains to be understood. Studies of Late Devensian and Holocene RSLs around present coasts have improved knowledge of both the extent and age range of the evidence. The record of RSL change on the W and NW coasts has disclosed a much longer dated RSL record than was available before 1993, possibly with evidence of Meltwater Pulse 1A, while studies in estuaries on the E and SW coasts have disclosed widespread and consistent fluctuations in Holocene RSLs. Evidence for the meltwater pulse associated with the Early Holocene discharge of Lakes Agassiz–Ojibway in N America has been found on both E and W coasts. The effects of the impact of storminess, in particular in cliff-top storm deposits, have been widely identified. Further information on the Holocene Storegga Slide tsunami has enabled a better understanding of the event, but evidence for other tsunami events on Scottish coasts remains uncertain. Methodological developments have led to new reconstructions of RSL change for the last 2000 years, utilising state-of-the-art GIA models and alongside coastal biostratigraphy to determine trends to compare with modern tide gauge and documentary evidence. Developments in GIA modelling have provided valuable information on patterns of land uplift during and following deglaciation. The studies undertaken raise a number of research questions which will require addressing in future work.
Public health law has focused primarily on combatting stigma through laws targeting discrimination based on attributes (de jure), when the reach of stigma extends far beyond mere appearances. By exploring the lived experience of stigmatized individuals, policy makers might more deeply understand public health problems, more appropriately create health policies, and more effectively promote positive health behaviors. Efforts to address stigma must focus on all aspects of stigma to be effective.
The Ottawa Ankle Rules (OAR) are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The OAR are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Limited data support its use by other health care workers in children. Our objective was to determine the accuracy of the OAR when applied by non-physician providers (NPP).
Children aged 5 to 17 years presenting with an acute ankle or foot injury were enrolled. Phase 1 captured baseline data on x-ray use in 106 patients. NPPs were then educated on the usage of the OAR and completed an OAR learning module. In phase 2, NPPs applied the OAR to 184 included patients.
The sensitivity of the foot rule, as applied by NPP’s, was 100% (56-100% CI) and the specificity was 17% (9-29% CI) for clinically significant fractures. The sensitivity of the ankle portion of the rule, as applied by NPP’s, was 88% (47-99 CI) and the specificity was 31% (23-40% CI) for clinically significant fractures. The only clinically significant fracture missed by NPP’s was detected on physician assessment. Inter-observer agreement was κ=0.24 for the ankle rule and κ=0.49 for the foot rule.
The sensitivity of the OAR when applied by NPP’s was very good. More training and practice using the OAR would likely improve NPP’s inter-observer reliability. Our data suggest the OAR may be a useful tool for NPP’s to apply prior to physician assessment.