Distinguished Oral

Background: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.

Funding: None

Disclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

Research on presidential power delineates between a modern era of relative autonomy and an earlier period of congressional dominance. What drove this change? Unlike prior arguments about presidential entrepreneurship and the rise of the United States as a global power, we attribute the emergence of the modern presidency partially to an institutional change—the adoption of direct election of senators that culminated in the 17th Amendment. With direct election, senators were selected by individual voters rather than state legislators. These senators answered to a new principal—the general public—that was (in the aggregate) less informed and less interested in foreign policy. As a result, senators had less incentive to constrain presidential foreign policy preferences. We find evidence for this shift in the relationship between the piecemeal adoption of direct election and senate votes to delegate foreign policy authority to the executive. The implication is that the direct election of senators played an underappreciated role in the emergence of the modern presidency.

Prebiotics are considered beneficial to health owing to positive effects upon the gut microbiota (GM). These effects on the GM include stimulating the growth of beneficial species and increasing short chain fatty acid (SCFA) production (1). Accumulating evidence suggests that the putative health benefits associated with seaweed consumption may be, in part, owing to their effects on the GM(2). The red seaweed Palmaria palmata is a source of xylan, a β(1–3) and β(1–4) D-xylose polysaccharide. Given that xylo-oligosaccharides are a recently accepted prebiotic (3), the aim of this investigation was to assess the prebiotic potential of xylan from Palmaria palmata using an in-vitro fermentation gut model. Fibres were subjected to an in-vitro digestion and underwent in-vitro batch culture fermentation (MicroMatrix) over 24 hours. Fermentation vessels were inoculated using a pooled faecal slurry (5% v/v), prepared from six healthy volunteers. Xylan fibre (n = 4) was compared to Cellulose (negative control, n = 8) and Synergy 1 (positive control, n = 8). Changes to GM composition was determined using qPCR (total bacteria, Lactobacilli, and Bifidobacteria), and MiSeq 16S rRNA sequencing. Short chain fatty acid analysis was conducted using gas chromatography-mass spectrometry. The differential abundance of taxa between fermentation substrates was determined using linear discriminant analysis (LDA) effect size (LEfSe). A permutational multivariate analysis of variance (PerMANOVA) was used to determine statistical differences of beta diversity whilst treatment associated differences of short chain fatty acids were determined using an unpaired Mann-Whitney U Test. Xylan altered GM composition at Phylum, Family and Genus taxonomic levels, notably a significant reduction in the Firmicutes/Bacteroides ratio (p = 0.004). Both 16S sequencing data and qPCR analysis revealed a significant increase in Bifidobacteria relative to cellulose, where the effect was comparable to Synergy 1. No significant differences in microbiota diversity were noted for either Xylan or Synergy 1 in comparison to the cellulose control. Xylan was shown to significantly modulate GM activity through increased short chain fatty acid production with increased acetate, propionate and butyrate. The evidence gained from this study suggests that Xylan from Palmaria palmata is a fermentable fibre with potential prebiotic characteristics, and therefore warrants further investigation in humans.

This research was funded under the National Development Plan, through the Food Institutional Research Measure, administered by the Department of Agriculture, Food and the Marine, Ireland (13/F/511) and a Northern Ireland Department of Education and Learning PhD scholarship to Paul Cherry.

This paper provides an up-to-date review of the problems related to the generation, detection and mitigation of strong electromagnetic pulses created in the interaction of high-power, high-energy laser pulses with different types of solid targets. It includes new experimental data obtained independently at several international laboratories. The mechanisms of electromagnetic field generation are analyzed and considered as a function of the intensity and the spectral range of emissions they produce. The major emphasis is put on the GHz frequency domain, which is the most damaging for electronics and may have important applications. The physics of electromagnetic emissions in other spectral domains, in particular THz and MHz, is also discussed. The theoretical models and numerical simulations are compared with the results of experimental measurements, with special attention to the methodology of measurements and complementary diagnostics. Understanding the underlying physical processes is the basis for developing techniques to mitigate the electromagnetic threat and to harness electromagnetic emissions, which may have promising applications.

The impact of mechanical ventilation on the daily costs of intensive care unit (ICU) care is largely unknown. We thus conducted a systematic search for studies measuring the daily costs of ICU stays for general populations of adults (age ≥18 years) and the added costs of mechanical ventilation. The relative increase in the daily costs was estimated using random effects meta regression. The results of the analyses were applied to a recent study calculating the excess length-of-stay associated with ICU-acquired (ventilator-associated) pneumonia, a major complication of mechanical ventilation. The search identified five eligible studies including a total of 54 766 patients and ~238 037 patient days in the ICU. Overall, mechanical ventilation was associated with a 25.8% (95% CI 4.7%–51.2%) increase in the daily costs of ICU care. A combination of these estimates with standardised unit costs results in approximate daily costs of a single ventilated ICU day of €1654 and €1580 in France and Germany, respectively. Mechanical ventilation is a major driver of ICU costs and should be taken into account when measuring the financial burden of adverse events in ICU settings.

The Twins Early Development Study (TEDS) is a longitudinal twin study that recruited over 16,000 twin-pairs born between 1994 and 1996 in England and Wales through national birth records. More than 10,000 of these families are still engaged in the study. TEDS was and still is a representative sample of the population in England and Wales. Rich cognitive and emotional/behavioral data have been collected from the twins from infancy to emerging adulthood, with data collection at first contact and at ages 2, 3, 4, 7, 8, 9, 10, 12, 14, 16, 18 and 21, enabling longitudinal genetically sensitive analyses. Data have been collected from the twins themselves, from their parents and teachers, and from the UK National Pupil Database. Genotyped DNA data are available for 10,346 individuals (who are unrelated except for 3320 dizygotic co-twins). TEDS data have contributed to over 400 scientific papers involving more than 140 researchers in 50 research institutions. TEDS offers an outstanding resource for investigating cognitive and behavioral development across childhood and early adulthood and actively fosters scientific collaborations.

Glyphosate-resistant (GR) kochia has been reported across the western and midwestern United States. From 2011 to 2014, kochia seed was collected from agronomic regions across Colorado to evaluate the frequency and distribution of glyphosate-, dicamba-, and fluroxypyr-resistant kochia, and to assess the frequency of multiple resistance. Here we report resistance frequency as percent resistance within a population, and resistance distribution as the percentage and locations of accessions classified as resistant to a discriminating herbicide dose. In 2011, kochia accessions were screened with glyphosate only, whereas from 2012 to 2014 kochia accessions were screened with glyphosate, dicamba, and fluroxypyr. From 2011 to 2014, the percentages of GR kochia accessions were 60%, 45%, 39%, and 52%, respectively. The percentages of dicamba-resistant kochia accessions from 2012 to 2014 were 33%, 45%, and 28%, respectively. No fluroxypyr-resistant accessions were identified. Multiple-resistant accessions (low resistance or resistant to both glyphosate and dicamba) from 2012 to 2014 were identified in 14%, 15%, and 20% of total sampled accessions, respectively. This confirmation of multiple glyphosate and dicamba resistance in kochia accessions emphasizes the importance of diversity in herbicide site of action as critical to extend the usefulness of remaining effective herbicides such as fluroxypyr for management of this weed.