A systematic simulation study of the $n/m=1/1$ instability driven by energetic counter-passing particles in tokamak plasmas has been carried out using the kinetic-MHD (Magnetohydrodynamics) hybrid code M3D-K. The safety factor's radial profile is monotonically increasing with central value $q_0$ less than unity. The linear simulation results show that the instability is either a $m/n=1/1$ energetic particle mode or a $m/n=1/1$ global Alfvén eigenmode depending on the value of the central safety factor. The mode frequencies are close to the tip of Alfvén continuum spectrum at the magnetic axis. The excited modes are radially localized near the magnetic axis well within the safety factor $q=1$ surface. The main wave particle resonance is found to be $\omega _\phi +2\omega _\theta =\omega$, where ω is the mode frequency. The nonlinear simulation results show that there is a long period of quasi-steady-state saturation phase with frequency chirping up after initial saturation. Correspondingly, the energetic particle distribution with low energies is flattened in the core of the plasma. After this quasi-steady phase, the mode amplitude grows again and frequency jumps down to a low value corresponding to a new mode similar to the energetic co-passing particle-driven low-frequency fishbone while the energetic particle distribution is flattened for higher energies in the core of plasma.

Coronavirus disease 2019 (COVID-19) asymptomatic cases are hard to identify, impeding transmissibility estimation. The value of COVID-19 transmissibility is worth further elucidation for key assumptions in further modelling studies. Through a population-based surveillance network, we collected data on 1342 confirmed cases with a 90-days follow-up for all asymptomatic cases. An age-stratified compartmental model containing contact information was built to estimate the transmissibility of symptomatic and asymptomatic COVID-19 cases. The difference in transmissibility of a symptomatic and asymptomatic case depended on age and was most distinct for the middle-age groups. The asymptomatic cases had a 66.7% lower transmissibility rate than symptomatic cases, and 74.1% (95% CI 65.9–80.7) of all asymptomatic cases were missed in detection. The average proportion of asymptomatic cases was 28.2% (95% CI 23.0–34.6). Simulation demonstrated that the burden of asymptomatic transmission increased as the epidemic continued and could potentially dominate total transmission. The transmissibility of asymptomatic COVID-19 cases is high and asymptomatic COVID-19 cases play a significant role in outbreaks.

Lithospheric thinning occurred in the North China Craton (NCC) that resulted in extensive Mesozoic magmatism, which has provided the opportunity to explore the mechanism of the destruction of the NCC. In this study, new zircon U–Pb ages, geochemical and Lu–Hf isotopic data are presented for Early Cretaceous adakitic rocks in the Liaodong Peninsula, with the aim of establishing their origin as well as the thinning mechanism of the NCC. The zircon U–Pb data show that crystallization occurred during 127–120 Ma (i.e. Early Cretaceous). These rocks are characterized by high Sr (294–711 ppm) content and Sr/Y ratio (38.5–108), low Yb (0.54–1.24 ppm) and Y (4.9–16.4 ppm) contents, and with no obvious Eu anomalies, implying that they are adakitic rocks. They are enriched in large-ion lithophile elements (e.g. Ba, K, Pb and Sr) and depleted in high-field-strength elements (e.g. Nb, Ta, P and Ti). These adakitic rocks have negative zircon ϵHf(t) contents (−28.9 to −15.0) with two-stage Hf model ages (TDM2) of 3004–2131 Ma. Based on the geochemical features, such as low TiO2 and MgO contents, and high La/Yb and K2O/Na2O ratios, these adakites originated from the partial melting of thickened eclogitic lower crust. They were in an extensional setting associated with the slab rollback of the Palaeo-Pacific Ocean. In combination with previous studies, as a result of the rapid retracting of the Palaeo-Pacific Ocean during 130–120 Ma, the asthenosphere upwelled and modified the thickened lithospheric mantle, which lost its stability, resulting in the lithospheric delamination and thinning of the NCC.

This paper presents a new method to reveal the relation between the surface deformation and near-field amplitude of a reflector antenna based on complex geometrical optics, which could be used as an efficient way to estimate the antenna surface verified by simulation results. The measurement process based on this method is envisaged to be realized by a single scanning of the near-field amplitude which would overcome many limitations of radio holography and phase retrieval methods such as the frequency and elevation. The largest source of error in the original deformation-amplitude equation (DAE) has been corrected by considering the Gaussian feed as a complex point source. To track the ray trajectory so that the improved DAE could be solved, an iteration method including a golden section search algorithm is designed to make the solution converge. By solving the modified DAE, simulation result shows that a more accurate solution could be obtained, and the antenna surface could be recovered to a root mean square error of under 30 microns.

Microtubule-severing protein (MTSP) is critical for the survival of both mitotic and postmitotic cells. However, the study of MTSP during meiosis of mammalian oocytes has not been reported. We found that spastin, a member of the MTSP family, was highly expressed in oocytes and aggregated in spindle microtubules. After knocking down spastin by specific siRNA, the spindle microtubule density of meiotic oocytes decreased significantly. When the oocytes were cultured in vitro, the oocytes lacking spastin showed an obvious maturation disorder. Considering the microtubule-severing activity of spastin, we speculate that spastin on spindles may increase the number of microtubule broken ends by severing the microtubules, therefore playing a nucleating role, promoting spindle assembly and ensuring normal meiosis. In addition, we found the colocalization and interaction of collapsin response mediator protein 5 (CRMP5) and spastin in oocytes. CRMP5 can provide structural support and promote microtubule aggregation, creating transportation routes, and can interact with spastin in the microtubule activity of nerve cells (30). Knocking down CRMP5 may lead to spindle abnormalities and developmental disorders in oocytes. Overexpression of spastin may reverse the abnormal phenotype caused by the deletion of CRMP5. In summary, our data support a model in which the interaction between spastin and CRMP5 promotes the assembly of spindle microtubules in oocytes by controlling microtubule dynamics, therefore ensuring normal meiosis.

Spatial profiles of impurity emission measurements in the extreme ultraviolet (EUV) spectroscopic range in radiofrequency (RF)-heated discharges are combined with one-dimensional and three-dimensional transport simulations to study the effects of resonant magnetic perturbations (RMPs) on core impurity accumulation at EAST. The amount of impurity line emission mitigation by RMPs appears to be correlated with the ion Z for lithium, carbon, iron and tungsten monitored, i.e. stronger suppression of accumulation for heavier ions. The targeted effect on the most detrimental high-Z impurities suggests a possible advantage using RMPs for impurity control. Profiles of transport coefficients are calculated with the STRAHL one-dimensional impurity transport code, keeping $\nu /D$ fixed and using the measured spatial profiles of $\textrm{F}{\textrm{e}^{20 + }}$, $\textrm{F}{\textrm{e}^{21 + }}$ and $\textrm{F}{\textrm{e}^{22 + }}$ to disentangle the transport coefficients. The iron diffusion coefficient ${D_{\textrm{Fe}}}$ increases from $1.0- 2.0\;{\textrm{m}^2}\;{\textrm{s}^{ - 1}}$ to $1.5- 3.0\;{\textrm{m}^2}\;{\textrm{s}^{ - 1}}$ from the core region to the edge region $(\rho \gt 0.5)$ after the onset of RMPs. Meanwhile, an inward pinch of iron convective velocity ${\nu _{\textrm{Fe}}}$ decreases in magnitude in the inner core region and increases significantly in the outer confined region, simultaneously contributing to preserving centrally peaked $\textrm{Fe}$ profiles and exhausting the impurities. The ${D_{\textrm{Fe}}}$ and ${\nu _{\textrm{Fe}}}$ variations lead to reduced impurity contents in the plasma. The three-dimensional edge impurity transport code EMC3-EIRENE was also applied for a case of RMP-mitigated high-Z accumulation at EAST and compared to that of low-Z carbon. The exhaust of ${\textrm{C}^{6 + }}$ toward the scrape-off layer accompanying an overall suppression of heavier ${\textrm{W}^{30 + }}$ is observed when using RMPs.

Pre-existing health conditions may exacerbate the severity of coronavirus disease 2019 (COVID-19). We aimed to estimate the case-fatality rate (CFR) and rate ratios (RR) for patients with hypertension (HBP) and diabetes mellitus (DM) in the New York state. We obtained the age-specific number of COVID-19 confirmed cases and deaths from public reports provided by the New York State Department of Health, and age-specific prevalence of HBP and DM from the Behavioral Risk Factor Surveillance System 2017. We calculated CFR and RR for COVID-19 patients with HBP and DM based on the reported number of deaths with the comorbidity divided by the expected number of COVID-19 cases with the comorbidity. We performed subgroup analysis by age and calculated the CFR and RR for ages of 18–44, 45–64 and 65+ years, respectively. We found that the older population had a higher CFR, but the elevated RRs associated with comorbidities are more pronounced among the younger population. Our findings suggest that besides the elderly, the young population with comorbidity should also be considered as a vulnerable group.

Background: In Alberta, Canada, surgical site infections (SSIs) following total hip (THR) and knee replacements (TKR) are reported using 2 data sources: infection prevention and control (IPC), which surveys all THR and TKR using NHSN definitions and the Canadian International Classification of Disease, Tenth Revision (ICD-10-CA) codes, and the National Surgical Quality Improvement Program (NSQIP), which uses a systematic sampling process that involves an 8-day cycle schedule, modified NHSN definitions and current procedural terminology (CPT) codes. We compared the similarities and discrepancies in THR/TKR SSI reporting. Methods: A retrospective multisite cohort study of IPC and NSQIP THR/TKR SSI data at 4 hospitals was performed. SSI data were collected between September 1, 2015, and March 31, 2018. Demographic information and complex and total SSIs reported by IPC and NSQIP were compared for both THR and TKR surgeries. To determine whether both data sources reported similar trends over time, total SSIs by quarter were compared. Univariate analyses using a t test for age and the χ2 test for gender for complex SSIs and total SSIs was performed. The Pearson correlation and the Shapiro-Wilk test were used to assess the THR and TKR trends between the 2 data sources. A P value of <.05 was considered significant. Results: Following the removal of duplicates and missing data, 7,549 IPC and 2,037 NSQIP patients, respectively, were compared. Age, gender, and other demographic parameters were not significantly different. Total THR and TKR SSIs per 100 procedures using NSQIP data were significantly higher than the same rates using IPC data: THR, 2.25 versus 0.92 (P < .05) and TKR, 3.43 versus 1.26 (P < .05). Both IPC and NSQIP data indicated increasing total THR SSI rates over time, but with different magnitudes (r = 0.658). For total TKR SSI, the IPC rate decreased, whereas the NSQIP rate increased over the same period (r = 0.374). When superficial SSIs were excluded, the rates reported between IPC and NSQIP data by hospital and by procedure type were more comparable, with trends toward higher rates reported by NSQIP for THR than for TKR: THR, 1.19 versus 0.68 (P = 0.15) and TKR, 0.92 versus 0.80 (P = .68). Conclusions: Different approaches used to monitor SSIs following surgeries may lead to different results and trend patterns. NSQIP reports total SSI rates that are significantly higher than the IPC Alberta orthopedic population predominantly as a result of increased identification of superficial SSIs. Because the diagnosis of superficial SSIs may be less reliable, SSI reporting should focus on complex infections.

Funding: None

Disclosures: None

Background: Hospital-acquired Clostridioides difficile infection (HA-CDI) rates are highly variable over time, posing problems for research assessing interventions that might improve rates. By understanding seasonality in HA-CDI rates and the impacts that other factors such as influenza admissions might have on these rates, we can account for them when establishing the relationship between interventions and infection rates. We assessed whether there were seasonal trends in HA-CDI and whether they could be accounted for by influenza rates. Methods: We assessed HA-CDI rates per 10,000 patient days, and the rate of hospitalized patients with influenza per 1,000 admissions in 4 acute-care facilities (n = 2,490 beds) in Calgary, Alberta, from January 2016 to December 2018. We used 4 statistical approaches in R (version 3.5.1 software): (1) autoregressive integrated moving average (ARIMA) to assess dependencies and trends in each of the monthly HA-CDI and influenza series; (2) cross correlation to assess dependencies between the HA-CDI and influenza series lagged over time; (3) Poisson harmonic regression models (with sine and cosine components) to assess the seasonality of the rates; and (4) Poisson regression to determine whether influenza rates accounted for seasonality in the HA-CDI rates. Results: Conventional ARIMA approaches did not detect seasonality in the HA-CDI rates, but we found strong seasonality in the influenza rates. A cross-correlation analysis revealed evidence of correlation between the series at a lag of zero (R = 0.41; 95% CI, 0.10–0.65) and provided an indication of a seasonal relationship between the series (Fig. 1). Poisson regression suggested that influenza rates predicted CDI rates (P < .01). Using harmonic regression, there was evidence of seasonality in HA-CDI rates (2 [2 df] = 6.62; P < .05) and influenza rates (2 [2 df] = 1,796.6; P < .001). In a Poisson model of HA-CDI rates with both the harmonic components and influenza admission rates, the harmonic components were no longer predictive of HA-CDI rates. Conclusions: Harmonic regression provided a sensitive means of identifying seasonality in HA-CDI rates, but the seasonality effect was accounted for by influenza admission rates. The relationship between HA-CDI and influenza rates is likely mediated by antibiotic prescriptions, which needs to be assessed. To improve precision and reduce bias, research on interventions to reduce HA-CDI rates should assess historic seasonality in HA-CDI rates and should account for influenza admissions.

Funding: None

Disclosures: None

Background: This review describes the epidemiology of carbapenemase-producing organisms (CPO) in both the community and hospitalized populations in the province of Alberta. Methods: Newly identified CPO-positive individuals from April 1, 2013, to March 31, 2018, were retrospectively reviewed from 3 data sources, which shared a common provincial CPO case definition: (1) positive CPO results from the Provincial Laboratory for Public Health, which provides all referral and confirmatory CPO testing, (2) CPO cases reported to Alberta Health, and (3) CPO surveillance from Alberta Health Services Infection Prevention and Control (IPC). The 3 data sources were collated, and initial CPO cases were classified according to their likely location of acquisition: hospital-acquired, hospital-identified, on admission, and community-identified. Risk factors and adverse outcomes were obtained from linkage to administrative data. Results: In total, 171 unique individuals were newly identified with a first-time CPO case. Also, 15% (25 of 171) were hospital-acquired (HA), 21% (36 of 171) were hospital-identified (HI), 33% (57 of 171) were on admission, and 31% (53 of 171) were community identified. Overall, 9% (5 of 171) resided in long-term care facilities. Of all patients in acute-care facilities, 30% (35 of 118) had infections and 70% were colonized. Overall, 38% (65 of 171) had an acute-care admission in the 1 year prior to CPO identification; 59% (63 of 106) of those who did not have a previous admission had received healthcare outside Alberta. A large proportion of on-admission cases (81%, 46 of 57) and community-identified (66%, 33 of 53) cases did not have any acute-care admissions in Alberta in the previous year. Overall, 10% (14 of 171) had ICU admissions in Alberta within 30 days of CPO identification, and 5% (8 of 171) died within 30 days. The most common carbapenemase gene identified was NDM-1 (53%, 90 of 171). Conclusions: These findings highlight the robust nature of Alberta’s provincial CPO surveillance network. We reviewed 3 different databases (laboratory, health ministry, IPC) to obtain comprehensive data to better understand the epidemiology of CPO in both the community and hospital settings. More than half of the individuals with CPO were initially identified in the community or on admission. Most had received healthcare outside Alberta, and no acute-care admissions occurred in Alberta in the previous year. It is important to be aware of the growing reservoir of CPO outside the hospital setting because it could impact future screening and management practices.

Funding: None

Disclosures: None

Background: Infection Prevention and Control (IPC) for Alberta Health Services and Covenant Health in the province of Alberta, Canada conducts surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) on all individuals admitted to acute-care and acute tertiary-care rehabilitation care facilities. Objective: The objective of this study was to determine the consistency and accuracy of infection decisions for MRSA and VRE. Methods: Surveillance cases of antibiotic-resistant organisms (AROs) collected using the provincial data entry surveillance platform between April 1, 2015, and March 31, 2017, across the province were reabstracted by infection control professionals and physicians using the NHSN infection definitions and compared to the original case severity decisions. Interrater agreement (Cohen’s ) and validity (sensitivity, specificity and predictive values) were calculated to compare the original and reabstracted infection decisions. Results: Collectively, 97% (87 of 90) of the IPC program staff and physicians who were initially invited re-abstracted 264 MRSA cases and 103 VRE cases within the review period. Provincially, 20% of the ARO cases reviewed (74 of 367) differed from the original infection decision. Among these 74 cases, 46 cases (34 MRSA and 12 VRE cases) changed from infection (original decision) to colonization (reabstracted decision) and 28 cases (21 MRSA and 7 VRE cases) changed from colonization to infection. The Cohen values for MRSA and VRE were 0.55 and 0.56, respectively, suggesting a moderate level of agreement for decisions made among IPC program staff. The sensitivity of the infection decision was higher with MRSA (86.5%) than for VRE (74.1%), meaning that there were more MRSA cases than VRE cases classified as infection in the original decision that remained infection following the review. Conclusions: Observed discordances on infection decisions were identified and may be attributed (1) to variations in the interpretation of the NHSN definitions, (2) to additional information that may have been available in the re-abstracted review compared to the original review, or (3) a difference in the information that was accessed to perform the original review compared to the reabstraction. This data-quality review provided an opportunity for IPC staff and physicians to become more familiar with infection definitions and such reviews will continue to be a regular process used to assess data quality within the IPC department.

Funding: None

Disclosures: None

Background: Antibiotic-resistant organisms (AROs) are associated with greater disease severity and poor outcomes. Previous studies have investigated AROs and healthcare-associated infections (HAIs) within larger urban acute-care settings, but similar data for rural settings are scarce. In this stud, we aimed to fill this gap. Methods: Data on antimicrobial resistance (AMR), additional precautions and HAI were collected from 8 rural Alberta acute-care facilities over a 24-hour period from February 4–28, 2019. Data were gathered as part of the national Canadian, Rural, and Northern Acute Care Point Prevalence (CNAPP) survey. All inpatients on included units were reviewed. CNAPP protocol surveillance definitions were used. Results: In total, 961 patients were surveyed, of whom 94 of 961 (9.8%) were on additional precautions. Contact precautions only were most common (54 of 94, 57.4%) and were predominantly in place for MRSA (30 of 94, 31.9%). Of 961 patients, 100 (~10%) met the surveillance definitions for any infection. The most common infections were skin and soft-tissue infections (29 of 100, 29.0%) and bloodstream infections (28 of 100, 28.0%). An HAI occurred in 30 of 961 patients (3.1%); the most common HAIs were surgical site infections (8 of 30, 26.7%) and urinary tract infections (8 of 30, 26.7%). An antimicrobial was prescribed to 333 of 961 patients (34.6%) at the time of the survey, with ceftriaxone the most commonly prescribed (68 of 333, 20.4%). Most patients receiving an antimicrobial (237 of 333, 71.2%) did not meet the surveillance definition for any infection. The most common reason for any antimicrobial administration was empiric therapy (167 of 333, 50.1%). Conclusions: Investigations into antimicrobial use and the burden of HAIs in rural acute-care settings have been limited. In this study, we (1) established provincial baseline data for burden of disease in these facilities due to HAIs and (2) demonstrated that antimicrobial use is common, though most patients who were prescribed an antimicrobial did not meet study definitions for infection. It will be important to continue this type of surveillance in this understudied population to monitor the burden of HAIs over time, to establish antimicrobial utilization trends, and to continue to identify potential antimicrobial stewardship initiatives.

Funding: None

Disclosures: None

Background:Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.

Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: Award

Disclosures: None

Background: In Alberta, Canada, surgical site infections (SSIs) following total hip and knee replacements (THRs and TKRs) are reported using the infection prevention and control (IPC) surveillance system, which surveys all THRs and TKRs using the NHSN definitions; and the National Surgical Quality Improvement Program (NSQIP), which uses different definitions and sampling strategies. Deterministic matching of patient data from these sources was used to examine the overlap and discrepancies in SSI reporting. Methods: A retrospective multisite cohort study of IPC and NSQIP superficial, deep, and organ-space THR/TKR SSI data collected 30 days postoperatively from September 1, 2015, to March 31, 2018 was undertaken. To identify patients with procedures captured by both IPC and NSQIP, data were cleaned, duplicates removed, and patients matched 1:1 using year of birth, procedure facility, type, side, date, and time. Positive and negative agreement were assessed, and the Cohen κ values were calculated. The definitions and data capture methods used by both IPC and NSQIP were also compared. Results: There were 7,549 IPC and 2,037 NSQIP patients, respectively, with 1,798 matched patients: IPC (23.8%) and NSQIP (88.3%). Moreover, 17 SSIs were identified by both IPC and NSQIP, including 9 superficial and 8 complex by IPC and 6 superficial and 11 complex by NSQIP. Also, 7 SSIs were identified only by IPC, of which 5 were superficial, and 36 SSIs were identified only by NSQIP, of which 28 were superficial (positive agreement, 0.44; negative agreement, 0.99; κ = .43). Excluding superficial SSIs, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC; and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.00; κ = 0.48). Conclusions: THR/TKR SSI rates reported by IPC and NSQIP were not comparable in this matched dataset. NSQIP identifies more superficial SSIs. Variations in data capture methods and definitions accounted for most of the discordance. Both surveillance systems are critically involved with improving patient outcomes following surgery. However, stakeholders need to be aware of these variations, and education should be provided to facilitate an understanding of the differences and their interpretation. Future work should explore other surgical procedures and larger data sets.

Funding: None

Disclosures: None

Toxigenic Clostridium difficile (C. difficile) carriers represent an important source in the transmission of C. difficile infection (CDI) during hospitalisation, but its prevalence and mode in patients with hepatic cirrhosis are not well established. We investigated longitudinal changes in carriage rates and strain types of toxigenic C. difficile from admission to discharge among hepatic cirrhosis patients. Toxigenic C. difficile was detected in 104 (19.8%) of 526 hepatic cirrhosis patients on admission, and the carriage status changed in a portion of patients during hospitalisation. Approximately 56% (58/104) of patients lost the colonisation during their hospital stay. Among the remaining 48 patients who remained positive for toxigenic C. difficile, the numbers of patients who were positive at one, two, three and four isolations were 10 (55.6%), three (16.7%), two (11.1%) and three (16.7%), respectively. Twenty-eight patients retained a particular monophyletic strain at multiple isolations. The genotype most frequently identified was the same as that frequently identified in symptomatic CDI patients. A total of 25% (26/104) of patients were diagnosed with CDI during their hospital stay. Conclusions: Colonisation with toxigenic C. difficile strains occurs frequently in cirrhosis patients and is a risk factor for CDI.

This study aims to investigate the prevalence and genotype distribution of anal human papillomavirus (HPV) infection among men with different sexual orientations with or without human immunodeficiency virus (HIV) in China. A cross-sectional study was conducted during 2016–2017 in Taizhou City, Zhejiang Province. Convenient sampling was used to recruit male participants from HIV voluntary counselling and testing clinics and Center for Disease Control and Prevention. A face-to-face questionnaire interview was administered and an anal-canal swab was collected for HPV genotyping. A total of 160 HIV-positive and 113 HIV-negative men participated in the study. The prevalence of any type HPV was 30.6% for heterosexual men, 74.1% for homosexual and 63.6% for bisexual men among HIV-positive participants, while the prevalence was 8.3%, 29.2% and 23.8% respectively among HIV-negatives. The most prevalent genotypes were HPV-58 (16.9%), HPV-6 (15.6%) and HPV-11 (15.0%) among HIV-positive men, and were HPV-16 (4.4%), HPV-52 (4.4%) and HPV-6 (3.5%) among HIV-negative men. Having ever had haemorrhoids and having ever seen blood on tissue after defaecation was associated with HPV infection. One-fourth of the HPV infections in this study population can be covered by the quadrivalent vaccine in market. The highly prevalent anal HPV infection among men especially HIV-infected men calls for close observation and further investigation for anal cancer prevention.