Saponite, hectorite, and laponite have been pillared with cationic Al clusters, and special attention has been given to the solution chemistry or Al. Pillared saponite is obtained after exchange with refluxed Al solutions; while for hectorite, Al solutions treated with ammonium acetate give a pillared product with 1.8–1.9 nm spacing and thermal stability up to 873 K. In both types of solutions, the Keggin ion Al cluster is a minority species or totally absent. The typical 1.8–1.9 nm spacing is only obtained after washing. The quality of the pillared material can be judged from its thermal stability, its surface area, and the width of the d001 line before and after pillaring. The width should not exceed 0.3 nm before calcination and 0.5 nm after calcination. The latter criterion reflects the importance of the crystallinity of the parent clay for successful pillaring. Pillaring in concentrated conditions occurs by a combination of ion exchange and precipitation of Al and gives materials that exhibit poor thermal stability.

Modified teeth and jaws have long been recognized as important ceremonial objects during the Middle Woodland period of eastern North America. Direct evidence for the manufacture of the objects is exceedingly rare because they are typically recovered from mortuary contexts or ceremonial caches. Here, we present multiple lines of evidence pointing to the manufacture of modified teeth and jaws at the Moorehead Circle post enclosure within the Fort Ancient Earthworks. The convergence of protein residue, lithic use-wear, and faunal data indicate that bear and likely canid bones were modified by artisans working within the Moorehead Circle. These findings add an important new layer of understanding to our knowledge of these objects, human–animal relations, and craft production in the Middle Woodland.

Early adolescents (ages 10–14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40–62%), Emotional Problems (14–29%), Behavioral Problems (15–22%; not present in China), and Maladjusted (4–15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings.

There are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of psychiatric researchers who currently sit on the Academic Faculty of the Royal College of Psychiatrists and represent the breadth of research in mental health from across the UK discuss the challenges faced in academic mental health research. They reflect on the need for additional investment in the specialty and ask whether this is a turning point for the future of mental health research.

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.

Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)

Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).

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.

The surface radiation budget of the polar regions strongly influences ice growth and melt. Thermodynamic sea-ice models therefore require accurate yet computationally efficient methods of computing radiative fluxes. In this paper a new parameterization of the downwelling shortwave radiation flux at the Arctic surface is developed and compared to a variety of existing schemes. Parameterized llnxes are compared to in situ measurements using data for one year at Barrow, Alaska. Our results show that the new parameterization can estimate the downwelling shortwave flux with mean and root mean square errors of 1 and 5%, respectively, for clear conditions and 5 and 20% for cloudy conditions. The new parameterization offers a unified approach to estimating downwelling shortwave fluxes under clear and cloudy conditions, and is more accurate than existing schemes.

Response tests are widely used in ground-water studies to assess the hydraulic properties of sub-surface water-flow systems. The simplicity of such tests also makes them attractive for investigation of subglacial hydraulic conditions. This paper describes a systematic, quantitative approach to the analysis of borehole-response test data. The approach uses the theoretical model of Stone and Clarke (1993), which describes water motion in a coupled borehole—subglacial flow system; this framework provides the basis for an inversion scheme that is focused on quantifying physical properties of the basal-flow system, as it is characterized in the theoretical model. The inversion procedure was applied to response-test data from Trapridge Glacier, Yukon Territory, Canada. Results of the inversions suggest that the subglacial drainage network can be described as a confined layer comprising coarse-sand-to fine-gravel-sized sediments, having a thickness of 0.1 – 0.3 m, and a hydraulic conductivity of about 5 × 10−4ms−1. Based on the water-drainage rates from boreholes, as they connect with the subglacial water-flow system, specific storage of the sediment layer was estimated to be approximately 1 × 10−4m−1. Further consideration of subglacial water-flow conditions suggests that connection drainage test results may tend to underestimate specific storage of the overall glacier substrate.

Forty-six specimens of Nautilus pompilius Linnaeus were captured in depths varying between 100 and 500 m outside of the fringing reef near Suva, Fiji Islands. Thirty-eight of the specimens were male. Air weight per individual varied between 347 and 630 g. Sexual dimorphism in size is indicated, since mature shell modifications (approximated septa, blackened aperture) were present in two females weighing about 350 g (soft parts plus shell) and one weighing slightly over 400 g; the smallest male showing mature shell modifications weighed 496 g. All newly captured specimens were heavier than seawater, with mean weight in seawater of 1.87 g determined for twenty-five specimens. Total volumes of cameral liquid ranged between 13.5 and 0 ml. Thirteen of twenty-five sampled specimens showed less than 1.0 ml of cameral liquid from all chambers. Average cameral liquid osmolarity was lower than that observed in sampled populations of N. macromphalus from New Caledonia and N. pompilius from the Philippine Islands. Maximum swimming rates were 0.25 m/sec. N. pompilius exhibits two common color polymorphs.

We examine the degree of consensus in quality ratings of prominent U.S. wine publications. For the purposes of wine consumption and research, are ratings on the ubiquitous 100-point scale reliable measures of quality? The value of expert judgment has been called into question by a number of studies, especially in the context of wine competitions and tasting events. Using data on 853 wines, we find a moderately high level of consensus, measured by the correlation coefficient, between most pairs of publications, similar to the level found by Ashton (2013). Rank and intraclass correlations are similar. Consensus is not found to be related to the blinding policies (or lack thereof) of the critical publications. (JEL Classifications: C93, D46)

Two new demosponges, Megaciella pituitosa and Cladocroce toxifera, are described from the Aleutian Islands, fostering our contention that the region is a hotspot of poriferan biodiversity. Seven of the thirteen species of Megaciella now known worldwide occur in the Sea of Okhotsk or around the Aleutian Islands. Similarly, five of the sixteen species of Cladocroce known worldwide occur in Alaska. Megaciella pituitosa sp. nov. possesses two categories of choanosomal styles and spicules of different sizes that differentiate it from all known congeners. Cladocroce toxifera sp. nov. differs from all known congeners by possessing toxa and an ectosomal tangential arrangement of oxeas.