We assessed patterns of enteric infections caused by 14 pathogens, in a longitudinal cohort study of sequelae in British Columbia (BC) Canada, 2005–2014. Our population cohort of 5.8 million individuals was followed for an average of 7.5 years/person; during this time, 40 523 individuals experienced 42 308 incident laboratory-confirmed, provincially reported enteric infections (96.4 incident infections per 100 000 person-years). Most individuals (38 882/40 523; 96%) had only one, but 4% had multiple concurrent infections or more than one infection across the study. Among individuals with more than one infection, the pathogens and combinations occurring most frequently per individual matched the pathogens occurring most frequently in the BC population. An additional 298 557 new fee-for-service physician visits and hospitalisations for enteric infections, that did not coincide with a reported enteric infection, also occurred, and some may be potentially unreported enteric infections. Our findings demonstrate that sequelae risk analyses should explore the possible impacts of multiple infections, and that estimating risk for individuals who may have had a potentially unreported enteric infection is warranted.

MeerTime is a five-year Large Survey Project to time pulsars with MeerKAT, the 64-dish South African precursor to the Square Kilometre Array. The science goals for the programme include timing millisecond pulsar (MSPs) to high precision ( ${<} 1 \unicode{x03BC} \mathrm{s}$ ) to study the Galactic MSP population and to contribute to global efforts to detect nanohertz gravitational waves with the International Pulsar Timing Array (IPTA). In order to plan for the remainder of the programme and to use the allocated time most efficiently, we have conducted an initial census with the MeerKAT ‘L-band’ receiver of 189 MSPs visible to MeerKAT and here present their dispersion measures, polarisation profiles, polarisation fractions, rotation measures, flux density measurements, spectral indices, and timing potential. As all of these observations are taken with the same instrument (which uses coherent dedispersion, interferometric polarisation calibration techniques, and a uniform flux scale), they present an excellent resource for population studies. We used wideband pulse portraits as timing standards for each MSP and demonstrated that the MeerTime Pulsar Timing Array (MPTA) can already contribute significantly to the IPTA as it currently achieves better than $1\,\unicode{x03BC}\mathrm{s}$ timing accuracy on 89 MSPs (observed with fortnightly cadence). By the conclusion of the initial five-year MeerTime programme in 2024 July, the MPTA will be extremely significant in global efforts to detect the gravitational wave background with a contribution to the detection statistic comparable to other long-standing timing programmes.

Given the importance of angiostrongyliasis as an emerging infectious disease of humans, companion animals, and wildlife, the current study focused on the transmission dynamics of first- and third-stage larvae of the parasitic nematode, Angiostrongylus cantonensis. The migration of infective larvae and their subsequent distribution within the Lymnaeidae snail, Bullastra lessoni, were investigated over time using microscopic examination of histological sections and fresh tissue. Snails were divided into four anatomical regions: (i) anterior and (ii) posterior cephalopedal masses, (iii) mantle skirt and (iv) visceral mass. The viability of free-swimming third-stage larvae, after their release from snail tissues, was evaluated in vitro by propidium iodide staining and infectivity by in vivo infection of Wistar rats. Snails were sequentially dissected over time to assess the number and anatomical distribution of larvae within each snail and hence infer their migration pathway. Herein, ongoing larval migratory activity was detected over 28 days post-infection. A comparison of infection rates and the larval distribution within the four designated snail regions demonstrated a significant relationship between anatomical region and density of infective larvae, with larvae mostly distributed in the anterior cephalopedal mass (43.6 ± 10.8%) and the mantle skirt (33.0 ± 8.8%). Propidium iodide staining showed that free-swimming third-stage larvae retained viability for between 4 and 8 weeks when stored under laboratory conditions. In contrast to viability, larval infectivity in rats remained for up to 2 weeks only. Knowledge gained from the current work could provide information on the development of new approaches to controlling the transmission of this parasite.

Irritability is a transdiagnostic symptom dimension in developmental psychopathology, closely related to the Research Domain Criteria (RDoC) construct of frustrative nonreward. Consistent with the RDoC framework and calls for transdiagnostic, developmentally-sensitive assessment methods, we report data from a smartphone-based, naturalistic ecological momentary assessment (EMA) study of irritability. We assessed 109 children and adolescents (Mage = 12.55 years; 75.20% male) encompassing several diagnostic groups – disruptive mood dysregulation disorder (DMDD), attention-deficit/hyperactivity disorder (ADHD), anxiety disorders (ANX), healthy volunteers (HV). The participants rated symptoms three times per day for 1 week. Compliance with the EMA protocol was high. As tested using multilevel modeling, EMA ratings of irritability were strongly and consistently associated with in-clinic, gold-standard measures of irritability. Further, EMA ratings of irritability were significantly related to subjective frustration during a laboratory task eliciting frustrative nonreward. Irritability levels exhibited an expected graduated pattern across diagnostic groups, and the different EMA items measuring irritability were significantly associated with one another within all groups, supporting the transdiagnostic phenomenology of irritability. Additional analyses utilized EMA ratings of anxiety as a comparison with respect to convergent validity and transdiagnostic phenomenology. The results support new measurement tools that can be used in future studies of irritability and frustrative nonreward.

The recent increase in well-localised fast radio bursts (FRBs) has facilitated in-depth studies of global FRB host properties, the source circumburst medium, and the potential impacts of these environments on the burst properties. The Australian Square Kilometre Array Pathfinder (ASKAP) has localised 11 FRBs with sub-arcsecond to arcsecond precision, leading to sub-galaxy localisation regions in some cases and those covering much of the host galaxy in others. The method used to astrometrically register the FRB image frame for ASKAP, in order to align it with images taken at other wavelengths, is currently limited by the brightness of continuum sources detected in the short-duration (‘snapshot’) voltage data captured by the Commensal Real-Time ASKAP Fast Transients (CRAFT) software correlator, which are used to correct for any frame offsets due to imperfect calibration solutions and estimate the accuracy of any required correction. In this paper, we use dedicated observations of bright, compact radio sources in the low- and mid-frequency bands observable by ASKAP to investigate the typical astrometric accuracy of the positions obtained using this so-called ‘snapshot’ technique. Having captured these data with both the CRAFT software and ASKAP hardware correlators, we also compare the offset distributions obtained from both data products to estimate a typical offset between the image frames resulting from the differing processing paths, laying the groundwork for future use of the longer duration, higher signal-to-noise ratio (S/N) data recorded by the hardware correlator. We find typical offsets between the two frames of ${\sim}0.6$ and ${\sim}0.3$ arcsec in the low- and mid-band data, respectively, for both RA and Dec. We also find reasonable agreement between our offset distributions and those of the published FRBs. We detect only a weak dependence in positional offset on the relative separation in time and elevation between target and calibrator scans, with the trends being more pronounced in the low-band data and in Dec. Conversely, the offsets show a clear dependence on frequency in the low band, which we compare to the frequency-dependent Dec. offsets found in FRB 200430. In addition, we present a refined methodology for estimating the overall astrometric accuracy of CRAFT FRBs.

Background: US healthcare facilities experienced significant personal protective equipment (PPE) shortages, including N95 masks, in the spring and summer of 2020. The Centers for Disease Control and Prevention issued guidance for extended use, reprocessing, and reuse of N95s. Eskenazi Health (EH) implemented a program to reprocess N95s and other PPE on-site using low-heat decontamination (LHD). EH considered large-scale and small-scale ultraviolet (UV), hydrogen peroxide vapor, and LHD for on-site reprocessing of N95s. All of these methods allowed up to 3 reprocessing cycles according to most literature available at the time. However, each method differed in feasibility and acceptability to staff. EH chose to implement LHD based on both considerations. Methods: Numerous small-group meetings were held in April 2020 to determine the feasibility and acceptability of N95 reprocessing methods. Staff wanted a method that was easy for the end user, had quick turnaround, and allowed them to retrieve their own N95s. They favored a method that could be used for all PPE. EH had deployed numerous small UV machines that individuals could use for N95s. The UV machines could not be scaled up easily. To scale up, a multidisciplinary team comprising infection prevention, biomedical engineering, and sterile processing representatives reviewed available methods and implemented LHD. Biomedical engineers determined that existing blanket warmers could be reprogrammed and repurposed for low-heat decontamination. Food warmers were also available but were not needed. Biomedical engineers reprogrammed the blanket warmers to 70°C and developed a wicking system using a towel and water tray to maintain humidity; decontamination took 30 minutes. Testing runs determined that both N95s and eye protection tolerated LHD without apparent damage. Infection prevention staff developed a workflow in which staff deposited all PPE in a paper bag; the PPE bag was centrally reprocessed, marked (Figure 1), and returned to designated locations (Figure 2) for staff to retrieve their original PPE. Sterile processing staff facilitated the reprocessing workflow, and elective surgeries were canceled during the COVID-19 surge. Results: From April 20, 2020, to July 19, 2020, 7,512 units were decontaminated with LHD. If each N95 was sterilized thrice (4 uses per N95), then LHD reduced the need to purchase 22,536 N95s. Restarting elective surgeries decreased staff and support from sterile processing; the space was needed for other purposes; and N95 availability increased. All of these factors led to the discontinuation of LHD. Conclusions: LHD enables reprocessing of N95s and other PPE using existing assets. LHD is advantageous because of scalability and the capacity to provide staff with their own reprocessed PPE.

Funding: No

Disclosures: None

Figure 1.

Figure 2.

Smoking pipes discovered in archaeological contexts demonstrate that Indigenous peoples of the Pacific Northwest of North America have practiced smoking for over 4,500 years. Archaeometry and ancient residue metabolomics provide evidence for the association of particular plants with these artifacts. In this article, we synthesize recent research on ancient smoking and present current knowledge on the spatiotemporal distribution of smoking in the past. The presence of stone smoking pipes in the archaeological record is paired with our understanding of past plant use based on chemical residue analyses to create a picture of precontact smoking practices. Archaeological pipe data demonstrate that smoking was a widely distributed practice in the inland Northwest over the past several thousand years, but not on the coast. Distributional data—including positive and negative evidence from chemical residue studies—show that tobacco was an important smoke plant in the region as early as around 1,410 years ago and as far north as the mid-Columbia region. Ancient residue metabolomics contributes to a richer understanding of past use of specific plants through the identification of tobacco species and other indigenous plants, including Rhus glabra, Cornus sericia, and Salvia sp., as contributing to the chemical residues in ancient pipes.

Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.

Background: Peritoneal dialysis is a type of dialysis performed by patients in their homes; patients receive training from dialysis clinic staff. Peritonitis is a serious complication of peritoneal dialysis, most commonly caused by gram-positive organisms. During March‒April 2019, a dialysis provider organization transitioned ~400 patients to a different manufacturer of peritoneal dialysis equipment and supplies (from product A to B). Shortly thereafter, patients experienced an increase in peritonitis episodes, caused predominantly by gram-negative organisms. In May 2019, we initiated an investigation to determine the source. Methods: We conducted case finding, reviewed medical records, observed peritoneal dialysis procedures and trainings, and performed patient home visits and interviews. A 1:1 matched case–control study was performed in 1 state. A case had ≥2 of the following: (1) positive peritoneal fluid culture, (2) high peritoneal fluid white cell count with ≥50% polymorphonuclear cells, or (3) cloudy peritoneal fluid and/or abdominal pain. Controls were matched to cases by week of clinic visit. Conditional logistic regression was used to estimate univariate matched odds ratios (mOR) and 95% confidence intervals (CIs). We conducted microbiological testing of peritoneal dialysis fluid bags to rule out product contamination. Results: During March‒September 2019, we identified 157 cases of peritonitis across 15 clinics in 2 states (attack rate≍39%). Staphylococcus spp (14%), Serratia spp (12%) and Klebsiella spp (6.3%) were the most common pathogens. Steps to perform peritoneal dialysis using product B differed from product A in several key areas; however, no common errors in practice were identified to explain the outbreak. Patient training on transitioning products was not standardized. Outcomes of the 73 cases in the case–control study included hospitalization (77%), peritoneal dialysis failure (40%), and death (7%). The median duration of training prior to product transition was 1 day for cases and controls (P = .86). Transitioning to product B (mOR, 18.00; 95% CI, 2.40‒134.83), using product B (mOR, 18.26; 95% CI, 3.86‒∞), drain-line reuse (mOR, 4.67; 95% CI, 1.34‒16.24) and performing daytime exchanges (mOR, 3.63; 95% CI, 1.71‒8.45) were associated with peritonitis. After several interventions, including transition of patients back to product A (Fig. 1), overall cases declined. Sterility testing of samples from 23 unopened product B peritoneal dialysis solution bags showed no contamination. Conclusions: Multiple factors may have contributed to this large outbreak, including a rapid transition in peritoneal dialysis products and potentially inadequate patient training. Efforts are needed to identify and incorporate best training practices, and product advances are desired to improve the safety of patient transitions between different types of peritoneal dialysis equipment.

Funding: None

Disclosures: None

Indaziflam, a PRE herbicide option for weed management on rangeland and natural areas, provides long-term control of invasive winter annual grasses (IWAGs). Because indaziflam only provides PRE control of IWAGs, POST herbicides such as glyphosate can be mixed with indaziflam to control germinated IWAG seedlings. Field trials were conducted at three sites on the Colorado Front Range to evaluate glyphosate dose required to provide adequate POST IWAG control and compare long-term downy brome (Bromus tectorum L.), Japanese brome (Bromus arvensis L.), and feral rye (Secale cereale L.) control with indaziflam and imazapic. Two of the three sites were void of desirable species, so species establishment through drill seeding was assessed, while the remnant native plant response was assessed at the third site. Herbicide applications were made March 2014 through April 2015, and two sites were drill seeded with native species 9 mo after herbicide application. Yearly visual control evaluations, biomass of all plant species, and drilled species stand counts were collected. Glyphosate at 474 g ae ha−1 reduced B. tectorum biomass to zero, while glyphosate at 631 g ae ha−1 was needed to reduce biomass to near zero at the S. cereale site. At all three sites, only indaziflam treatments had significant reductions in IWAG biomass compared with the nontreated check at 3 yr after treatment (YAT). By 3 YAT in the drill-seeded sites, cool-season grass frequency ranged from 37% to 69% within indaziflam treatments (73 and 102 g ai ha−1), while imazapic treatments ranged from 0% to 26% cool-season grass frequency. In the site with a remnant native plant community, indaziflam treatments resulted in a 3- to 4-fold increase in native grass biomass. These results indicate that the multiyear IWAG control provided by indaziflam can aid in desirable species reestablishment through drill seeding or response of the remnant plant community.