Changes in abundance and distribution of marine top predators can indicate environmental change or anthropogenic pressure requiring management response. Here, we used an extensive dataset (21 years) to conduct a spatial and temporal analysis of grey seal strandings in Cornwall and the Isles of Scilly, close to the southern edge of the breeding range of the species. A total of 2007 strandings were reported from 2000 to 2020, increasing by 474% from 35 to 201 individuals per year during this period. The continued rise in strandings was consistent across all life stages and timeframes (5, 10 and 20 years), underpinning the suggestion of increasing abundance in the region. The observed seasonality differed by life stage, coinciding with the increased presence of animals near the coast for key life phases such as breeding, moulting and pupping. Strandings are widely distributed across the coast of Cornwall and the Isles of Scilly; however, most strandings were recorded on the north coast of Cornwall (70%) where major pupping and haul out sites are found. Despite hosting several pupping and haul out sites, a small proportion was recorded on the Isles of Scilly (5%) where it is thought that strandings are particularly underreported. Describing baselines in magnitude of strandings and life-stage compositions across space and time allows future deviations in frequency, demographic composition or spatial distribution to be detected and investigated. We demonstrate the utility of long-term citizen science data to provide valuable and cost-effective information on the distribution and abundance of a highly mobile marine mammal.

Since 2017, the Fédération Internationale de Football Association (FIFA) has incorporated human rights risk assessments into its bidding requirements for major events, beginning with the competition to host the 2026 FIFA Men’s World Cup.1 This process began at a time of increased scrutiny on the impact of major events and greater focus on the applicability of the UN Guiding Principles on Business and Human Rights (UNGPs) to sport. In 2014, the Centre for Sport and Human Rights’ founding Chair Mary Robinson, together with John Ruggie (author of the UNGPs), wrote to FIFA in their respective capacities as Patron and Chair of the Institute for Human Rights and Business (IHRB) to stress the need for ‘sustained due diligence […] with respect to decisions about host nations and how major sporting events are planned and implemented’.2 Following recommendations set forth in the letter, expanded upon in Ruggie’s 2016 report ‘For the Game, For the World’, FIFA introduced robust bidding requirements that any country or region wishing to bid to host a World Cup will have to conduct a human rights risk assessment and outline how they intend to mitigate each of the risks identified.3 These requirements are designed to align the World Cup bidding process with the UNGPs.

Background: Nearly one-third of patients on hemodialysis receive intravenous (IV) antibiotics annually, but national data characterizing antibiotic use in this population are limited. Using NHSN surveillance data for outpatient dialysis facilities, we estimated temporal changes in the rate of IV antibiotic starts (IVAS) among hemodialysis patients as well as the proportion of IVAS that were not supported by a reported clinical indication. Methods: IVAS events were obtained from the NHSN Dialysis Event module between 2016 and 2020, excluding patients who were out of network, receiving peritoneal or home dialysis, or with unspecified vascular access. IVAS unsupported by documentation were defined as new IVAS without a collected or positive blood culture, pus, redness or swelling event, or an associated clinical symptom. Pooled mean rates of total and unsupported IVAS were estimated per 100 patient months yearly and stratified by vascular access type. Differences in IVAS rates by year were estimated with negative binomial regression. Results: Between 2016 and 2020, 7,278 facilities reported 648,410 IVAS events; 161,317 (25%) were unsupported by documentation (Table 1). In 2016, 3,340 (54%) facilities with ≥1 IVAS event reported an IVAS unsupported by documentation, which increased to 4,994 (73%) in 2020. Total IVAS rates decreased by an average of 8.2% annually (95% CI, 7.1%–9.3%; P < .001). The average annual percentage decrease did not differ significantly by vascular access site. The total IVAS rate was lowest in 2020 (2.17 per 100 patient months; 95% CI, 2.18–2.17). IVAS rates in 2020 were greatest for patients with catheter access (4.79 per 100 patient months; 95% CI, 4.75–4.83), followed by graft (1.71 per 100 patient months; 95% CI, 1.68–1.73), and lowest for patients with fistulas (1.30 per 100 patient months; 95% CI, 1.29–1.31). The overall pooled mean rate of unsupported IVAS was 0.64 per 100 patient months (95% CI, 0.63–0.64), which did not significantly change by year (Fig. 1). Conclusions: Total IVAS rates among outpatient hemodialysis patients have decreased since 2016, and rates among catheter patients remain highest compared to patients with fistulas or grafts. However, unsupported IVAS rates did not change, and the proportion of facilities reporting an unsupported IVAS increased annually. Targeted efforts to engage facilities with unsupported IVAS may help improve accurate reporting and prescribing practices.

Funding: None

Disclosures: None

This essay argues that a defining characteristic of modern law – the distinctive way in which it judges its addressees – will disappear. After sketching the distinctive nature of modern law's judgment, I show that it is part of a broader regulatory paradigm (rule or East Coast regulation) which is itself being superseded. Technological management is the alternative regulatory paradigm and I examine its rise and salience, showing how it might, in combination with the advent of ubiquitous computing, machine learning and artificial intelligence, cure a range of alleged pathologies that mark contemporary legal systems. The essay also demonstrates why technological management is now our regulatory default, its salience flowing from changes in the nature of our thinking about, and deployment of, power. The essay combines the work of Roger Brownsword, a leading contemporary jurist of technological management, with that of the world-renowned social theorist Michel Foucault.

In US government courses, simulations have been shown to increase students’ engagement and knowledge retention. We present an original simulation that focuses on both the interactions between political institutions that contribute to policy making and the normative ideas underlying politics. By exploring a civil rights or liberties policy area, students learn about the importance of both political institutions and foundational political ideas such as liberty and equality. Students role-play members of Congress, lobbyists for a pro- or anti-natural gas pipeline group, and Supreme Court justices. Although the goal of simulations in many US government courses is to teach students about the ways that institutions shape policy, this is the first (to our knowledge) that also integrates normative reflection on the ideas behind political arguments. Assessment indicates that the simulation was effective in increasing students’ knowledge of and/or interest in American political institutions and eminent domain.

Background: Certain nursing home (NH) resident care tasks have a higher risk for multidrug-resistant organisms (MDRO) transfer to healthcare personnel (HCP), which can result in transmission to residents if HCPs fail to perform recommended infection prevention practices. However, data on HCP-resident interactions are limited and do not account for intrafacility practice variation. Understanding differences in interactions, by HCP role and unit, is important for informing MDRO prevention strategies in NHs. Methods: In 2019, we conducted serial intercept interviews; each HCP was interviewed 6–7 times for the duration of a unit’s dayshift at 20 NHs in 7 states. The next day, staff on a second unit within the facility were interviewed during the dayshift. HCP on 38 units were interviewed to identify healthcare personnel (HCP)–resident care patterns. All unit staff were eligible for interviews, including certified nursing assistants (CNAs), nurses, physical or occupational therapists, physicians, midlevel practitioners, and respiratory therapists. HCP were asked to list which residents they had cared for (within resident rooms or common areas) since the prior interview. Respondents selected from 14 care tasks. We classified units into 1 of 4 types: long-term, mixed, short stay or rehabilitation, or ventilator or skilled nursing. Interactions were classified based on the risk of HCP contamination after task performance. We compared proportions of interactions associated with each HCP role and performed clustered linear regression to determine the effect of unit type and HCP role on the number of unique task types performed per interaction. Results: Intercept-interviews described 7,050 interactions and 13,843 care tasks. Except in ventilator or skilled nursing units, CNAs have the greatest proportion of care interactions (interfacility range, 50%–60%) (Fig. 1). In ventilator and skilled nursing units, interactions are evenly shared between CNAs and nurses (43% and 47%, respectively). On average, CNAs in ventilator and skilled nursing units perform the most unique task types (2.5 task types per interaction, Fig. 2) compared to other unit types (P < .05). Compared to CNAs, most other HCP types had significantly fewer task types (0.6–1.4 task types per interaction, P < .001). Across all facilities, 45.6% of interactions included tasks that were higher-risk for HCP contamination (eg, transferring, wound and device care, Fig. 3). Conclusions: Focusing infection prevention education efforts on CNAs may be most efficient for preventing MDRO transmission within NH because CNAs have the most HCP–resident interactions and complete more tasks per visit. Studies of HCP-resident interactions are critical to improving understanding of transmission mechanisms as well as target MDRO prevention interventions.

Funding: Centers for Disease Control and Prevention (grant no. U01CK000555-01-00)

Disclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)

In benefit-cost analysis, fatality risk reductions are usually valued based on estimates of adults’ willingness to pay for changes in their own risks, regardless of whether the risk reduction accrues to adults or children. This approach reflects the relatively large number of valuation studies that address adults; however, the literature on children is growing. We review these studies, focusing on those that estimate values for both adults and children using a consistent approach to limit the effects of between-study variability. We rely on explicit selection criteria to identify studies that measure reasonably comparable outcomes and are candidates for application to analyses of U.S. policies. The ratio of values for children to values for adults ranges from 0.6 to 2.9; however, most estimates are greater than 1.5. Although some studies suggest that the divergence between child and adult values decreases as the child ages, this finding is not universal. We conclude that analysts should test the sensitivity of their results to the use of higher values for children than adults. Additional empirical research is needed to support more precise estimates of the variation in values by age that can be featured in the primary analysis.

Early life stress (ELS) is a significant risk factor for the emergence of internalizing problems in adolescence. Beginning in adolescence, females are twice as likely as males to experience internalizing disorders. The present study was designed to examine sex differences in the association between ELS and internalizing problems in early pubertal adolescents, and whether and how corticolimbic function and connectivity may underlie these associations. Fifty-nine early pubertal males and 78 early pubertal females, ages 9–13 years (all Tanner Stage 3 or below) underwent functional magnetic resonance imaging as they performed an emotion label task that robustly interrogates corticolimbic function. Participants were also interviewed about their experience of ELS. Females exhibited a positive association between ELS and internalizing problems, whereas males exhibited no such association. Whole-brain and amygdala region of interest analyses indicated that whereas females exhibited a positive association between ELS and the ventrolateral prefrontal cortex during implicit emotion regulation, males showed no such association. Activation in these regions was positively associated with internalizing problems in females but not males; however, activation in these regions did not mediate the association between ELS and internalizing problems. Finally, both boys and girls exhibited an association between ELS and increased negative connectivity between the right ventrolateral prefrontal cortex and bilateral amygdala. Using a carefully characterized sample of early pubertal adolescents, the current study highlights important sex differences in the development of corticolimbic circuitry during a critical period of brain development. These sex differences may play a significant role in subsequent risk for internalizing problems.

Two female snapper-choking isopods Cymothoa excisa (body length 11 and 14 mm) were in the buccal cavity of two invasive lionfish Pterois volitans (total length 294 and 301 mm) collected in Alacranes Reef, southern Gulf of Mexico. This is the first record of C. excisa parasitizing invasive lionfish P. volitans in coral reefs of the Western Atlantic, where these isopods appear to have infected the host through adult prey-predator transfer.