Over the past fifteen years, a narrative has developed that IR scholars have become a “cult of the irrelevant,” with declining influence on and engagement with policy debates. Despite these assertions, the evidence for limited policy engagement has been anecdotal. We investigate the extent of policy engagement—the ways in which IR scholars participate in policy-making processes and/or attempt to shape those processes—by surveying IR scholars directly about their engagement activities. We find policy engagement is pervasive among IR scholars. We draw on theories of credit-claiming to motivate expectations about how and when scholars are likely to engage with practitioners. Consistent with our expectations, much of this engagement comes in forms that involve small time commitments and provide opportunities for credit-claiming, such as media appearances and short-form, bylined op-eds and blog posts. However, sizable minorities report engaging in consulting activities not for attribution/publication and writing policy briefs, and a majority of respondents indicate they engaged in these activities several times a year or more. We find only small differences in engagement across gender and rank. Our results demonstrate that, for IR scholars, some form of policy engagement is the norm.

The Ending the HIV Epidemic initiative aims to decrease new HIV infections and promote test-and-treat strategies. Our aims were to establish a baseline of HIV outcomes among newly diagnosed PWH in Washington, DC (DC), a ‘hotspot’ for the HIV epidemic. We also examined sociodemographic and clinical factors associated with retention in care (RIC), antiretroviral therapy (ART) initiation and viral suppression (VS) among newly diagnosed PWH in the DC Cohort from 2011–2016. Among 455 newly diagnosed participants, 92% were RIC at 12 months, ART was initiated in 65% at 3 months and 91% at 12 months, VS in at least 17% at 3 months and 82% at 12 months and 55% of those with VS at 12 months had sustained VS for an additional 12 months. AIDS diagnosis was associated with RIC (aOR 2.99; 1.13–2.28), ART initiation by 3 months (aOR 2.58; 1.61–4.12) and VS by 12 months (aOR4.87; 1.69–14.03). This analysis contributes to our understanding of the HIV treatment dynamics of persons with recently diagnosed HIV infection in a city with a severe HIV epidemic.

Background: Delayed or in vitro inactive empiric antibiotic therapy may be detrimental to survival in patients with bloodstream infections (BSIs). Understanding the landscape of delayed or discordant empiric antibiotic therapy (DDEAT) across different patient, pathogen, and hospital types, as well as by their baseline resistance milieu, may enable providers, antimicrobial stewardship programs, and policy makers to optimize empiric prescribing. Methods: Inpatients with clinically suspected serious infection (based on sampling of blood cultures and receiving systemic antibiotic therapy on the same or next day) found to have BSI were identified in the Cerner Healthfacts EHR database. Patients were considered to have received DDEAT when, on culture sampling day, they received either no antibiotic(s) or none that displayed in vitro activity against the pathogenic bloodstream isolate. Antibiotic-resistant phenotypes were defined by in vitro resistance to taxon-specific prototype antibiotics (eg, methicillin/oxacillin resistance in S. aureus) and were used to estimate baseline resistance prevalence encountered by the hospital. The probability of DDEAT was examined by bacterial taxon, by time of BSI onset, and by presence versus absence of antibiotic-resistance phenotypes, sepsis or septic shock, hospital type, and baseline resistance. Results: Of 26,036 assessable patients with a BSI at 131 US hospitals between 2005 and 2014, 14,658 (56%) had sepsis, 3,623 (14%) had septic shock, 5,084 (20%) had antibiotic-resistant phenotypes, and 8,593 (33%) received DDEAT. Also, 4,428 (52%) recipients of DDEAT received no antibiotics on culture sampling day, whereas the remaining 4,165 (48%) received in vitro discordant therapy. DDEAT occurred most often in S. maltophilia (87%) and E. faecium (80%) BSIs; however, 75% of DDEAT cases and 76% of deaths among recipients of DDEAT collectively occurred among patients with S. aureus and Enterobacteriales BSIs. For every 8 bacteremic patients presenting with septic shock, 1 patient did not receive any antibiotics on culture day (Fig. 1A). Patients with BSIs of hospital (vs community) onset were twice as likely to receive no antibiotics on culture day, whereas those with bloodstream pathogens displaying antibiotic-resistant (vs susceptible) phenotypes were 3 times as likely to receive in vitro discordant therapy (Fig. 1B). The median proportion of DDEAT ranged between 25% (14, 37%) in eight <300-bed teaching hospitals in the lowest baseline resistance quartile and 40% (31, 50%) at five ≥300-bed teaching hospitals in the third baseline resistance quartile (Fig. 2). Conclusions: Delayed or in vitro discordant empiric antibiotic therapy is common among patients with BSI in US hospitals regardless of hospital size, teaching status, or local resistance patterns. Prompt empiric antibiotic therapy in septic shock and hospital-onset BSI needs more support. Reliable detection of S. aureus and Enterobacteriales bloodstream pathogens and their resistance patterns earlier with rapid point-of-care diagnostics may mitigate the population-level impact of DDEAT in BSI.

Funding: This study was funded in part by the National Institutes of Health Clinical Center, National Institutes of Allergy and Infectious Diseases, National Cancer Institute (NCI contract no. HHSN261200800001E) and the Agency for Healthcare Research and Quality.

Disclosures: None

New ideas for diagnostics in clinical parasitology are needed to overcome some of the difficulties experienced in the widespread adoption of detection methods for gastrointestinal parasites in livestock. Here we provide an initial evaluation of the performance of a newly developed automated device (Telenostic) to identify and quantify parasitic elements in fecal samples. This study compared the Telenostic device with the McMaster and Mini-FLOTAC for counting of strongyle eggs in a fecal sample. Three bovine fecal samples were examined, in triplicate, on each of the three fecal egg-counting devices. In addition, both manual (laboratory technician) and automated analysis (image analysis algorithm) were performed on the Telenostic device to calculate fecal egg counts (FEC). Overall, there were consistent egg counts reported across the three devices and calculation methods. The Telenostic device compared very favourably to the Mini-FLOTAC and McMaster. Only in sample C, a significant difference (P < 0.05) was observed between the egg counts obtained by Mini-FLOTAC and by the other methods. From this limited dataset it can be concluded that the Telenostic-automated test is comparable to currently used benchmark FEC methods, while improving the workflow, test turn-around time and not requiring trained laboratory personnel to operate or interpret the results.

This article describes the recent requirement for UK universities to account for the social and economic impact of their research, and asks whether this impact agenda may change the conduct of research itself. Three critical issues are highlighted: the epistemology of impact; the problem of quantifying qualities; and the likelihood of impact growing in significance and changing the landscape of research – so-called ‘impact creep’. Overall, the article identifies some features of the research impact agenda that pose risks to creativity and risk-taking by academics.

Interactions between Antarctic sea ice and synoptic activity in the circumpolar trough have been investigated using meteorological data from European Centre for Medium-Range Weather Forecasts (ECMWF) Interim Re-analysis and sea-ice data from passive-microwave measurements. Total Antarctic sea-ice extent does not show large interannual variations. However, large differences are observed on a regional/monthly scale, depending on prevailing winds and currents, and thus on the prevailing synoptic situations. the sea-ice edge is also a preferred region for cyclogenesis due to the strong meridional temperature gradient (high baroclinicity) in that area. the motivation for this study was to gain a better understanding of the interaction between sea-ice extent and the general atmospheric flow, particularly the frequency of warm-air intrusions into the interior of the Antarctic continent, since this influences precipitation seasonality and must be taken into account for a correct climatic interpretation of ice cores. Two case studies of extraordinary sea-ice concentration anomalies in relation to the prevailing atmospheric conditions are presented. However, both strong positive and negative anomalies can be related to warm biases in ice cores (indicated by stable-isotope ratios), especially in connection with the negative phase of the Southern Annular Mode.

Analyses of shallow cores obtained at the European Project for Ice Coring in Antarctica (EPICA) drilling site Kohnen station (75°00′ S, 00°04′ E; 2892 m a.s.l.) on the plateau of Dronning Maud Land reveal the presence of conserved snow dunes in the firn. In situ observations during three dune formation events in the 2005/06 austral summer at Kohnen station show that these periods were characterized by a phase of 2 or 3 days with snowdrift prior to dune formation which only occurred during high wind speeds of >10 m s-1 at 2 m height caused by the influence of a low-pressure system. The dune surface coverage after a formation event varied between 5% and 15%, with a typical dune size of (4 ± 2) m × (8 ± 3) m, a maximum height of 0.2 ± 0.1 m and a periodicity length of about 30 m. The mean density within a snow dune varied between 380 and 500 kg m-3, whereas the mean density at the surrounding surface was 330 ± 5 kgm-3. The firn cores covering a time-span of 22 ± 2 years reveal that approximately three to eight events per year occurred, during which snow dunes had been formed and were preserved in the firn.

Despite ample evidence of the efficacy of cognitive-behavioral therapy (CBT) for the treatment of patients with panic disorder (PD), dissemination of this evidence is proceeding slowly. This article highlights some of the issues surrounding the dissemination of CBT for PD and suggests strategies for integrating CBT with pharmacotherapy. Treatment principles, with attention to the modification of CBT protocols for use in a brief-contact format, are reviewed. The principles and application of exposure interventions are discussed for both in vivo (situational) and interoceptive (feared anxiety sensations) exposure, with emphasis on the learning of safety in the context of feared sensations of anxiety. Contextual factors that may affect the success of exposure interventions and cognitive and informational interventions are also discussed.