OBJECTIVES/GOALS: Craniosynostosis is the premature fusion of one or more cranial sutures that produces brain growth constraints and typically requires surgical treatment. We present an age- and sex-specific method to evaluate surgical outcomes using non-invasive 3D photogrammetry that brings objectivity to the current approach for clinical assessment. METHODS/STUDY POPULATION: First, we created standardized head anatomy representations for 2,020 patients (1,081 males, 939 females, age 3.14 ± 3.05 years) without cranial pathology from their computed tomography (CT) images based on our previous methods. We used principal component regression stratified by sex to establish age-specific normative ranges of anatomical variability and we designed a new metric called cranial shape abnormality (CSA) index that calculates the number of standard deviations from normality of a given patient’s head anatomy. We calculated our CSA index in a group of 56 patients (44 male, 12 female) with sagittal craniosynostosis who underwent sagittal craniectomy from their pre- (22 ± 30 days before surgery) and post-surgical (267 ± 63 days after surgery) 3D photograms to evaluate surgical outcomes. RESULTS/ANTICIPATED RESULTS: We observed a reduction in the CSA index from 1.28 ± 0.26 before surgery to 0.87 ± 0.22 after surgery (p < 0.001 with a paired Wilcoxon test). The CSA index decreased in 53 of 56 patients (94.6%), who consistently showed head shape improvements after corrective surgery during clinical evaluation. Linear temporal regression indicates a CSA index decrease of 0.43 ± 0.05 during the first year after surgery. We found no significant correlation between a patient’s age at surgery and the patient’s CSA index after surgery (Pearson’s correlation coefficient 0.17, p = 0.20) or the patient’s change in CSA index before and after surgery (Pearson’s correlation coefficient 0.22, p = 0.11), suggesting that sagittal craniectomy is equally effective for all patients who are between 85 and 331 days old at the time of surgery. DISCUSSION/SIGNIFICANCE: Our new CSA index is a sex- and age-specific metric of head shape anomalies built upon the observed statistical distributions in the normative pediatric population. Our metric can objectively evaluate pre- and post-surgical head shapes and will allow the investigation of the reported variability in surgical outcomes among patients and procedures.

The trilobite Needmorella new genus, with type species N. simoni new genus new species from the late Emsian to mid-Eifelian Needmore Shale of West Virginia, is a distinctive member of the subfamily Synphoriinae. It also occurs in the same formation in Pennsylvania and Virginia. It is not very similar to other Devonian representatives of the subfamily and is considered to have its origins in a morphologically less-derived ancestor because it shares certain similarities with Silurian genera, including the very short anterior cephalic border unmodified by crenulations or spines, S2 that is not largely reduced to a deep pit adaxially, the relatively low inflation of L3, and the well-defined interpleural furrows on the pygidium. Other particularly distinctive characters of the genus include the very long genal spines and the abaxially inflated and expanded posterior pleural bands on the thorax and pygidium that project slightly distally. The conventional concept of the Devonian synphoriine Anchiopsis Delo, 1935 appears to be incompatible with the holotype of the type species, judging from the early illustrations of the specimen, and the genus could be a synonym of Synphoria Clarke, 1894.

UUID: http://zoobank.org/4a820e27-54ec-4f7b-a408-675e62b75154

Digital psychiatry has become increasingly important and understanding of certain aspects is essential for practising clinicians. This article discusses electronic patient records (EPRs), from their origins to current and future use, the growth and embedding of outcome measurements, the use of social media, and learning and research in virtual arenas.

Spectrum scores measure antimicrobial utilization while also quantifying the spectrum of activity. Accordingly, changes in spectrum score can be used to identify antimicrobial de-escalation. We show that spectrum-score–based de-escalation has a 95.7% positive percentage agreement and 81.6% negative percentage agreement versus de-escalation defined as stopping either antistaphylococcal or antipseudomonal agents.

A growing percentage of international aid is distributed through local nongovernmental organizations (NGOs). Scholarship is divided on how that aid affects domestic politics. One side argues that aid to NGOs reinforces the status quo. As NGOs become dependent on external funding, they lose sight of their original goals. The other side contends that channeling funds to NGOs generates associational activity; producing political change by empowering previously marginalized groups. We test these competing hypotheses in Rondonia, Brazil, measuring the impact of internationally funded NGO activity on voting behavior. We find that the impact of aid varies with the institutional environment. At the state level, more votes for the conservative governor came from municipalities whose NGOs received project money. In contrast, the same municipalities registered a significant shift to leftist candidates at the presidential level. The findings have broad implications for the impact international aid has on political competition, political change, and democracy.

Police, like other bureaucratic agencies, are responsible for collecting and disseminating policy-relevant data. Nonetheless, critical data, including killings by police, often go unreported. We argue that this is due in part to the limited oversight capacity of legislative bodies to whom police are accountable. Although many local assemblies lack the means for effective oversight, well-resourced state legislatures may induce transparency from state and substate agencies. This argument is evaluated in two studies of police transparency in the United States. First, we examine the compliance of 19,095 state, county, and municipal police agencies with official data requests over five decades, finding strong positive effects of state legislative capacity on transparency. Second, we examine the accuracy of transmitted data on killings by police, finding that lethality is systematically underreported in states with lower-capacity legislatures. Collectively, our study has implications for research on policing, legislatures, agency control, and analyses of government data.

The clustered chromatic number of a class of graphs is the minimum integer $k$ such that for some integer $c$ every graph in the class is $k$ -colourable with monochromatic components of size at most $c$ . We determine the clustered chromatic number of any minor-closed class with bounded treedepth, and prove a best possible upper bound on the clustered chromatic number of any minor-closed class with bounded pathwidth. As a consequence, we determine the fractional clustered chromatic number of every minor-closed class.

Background: Antibiotics are frequently prescribed–and overprescribed–at hospital discharge, leading to adverse-events and patient harm. Our understanding of how to optimize prescribing at discharge is limited. Recently, we published the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework, which identified potential strategies to improve antibiotic prescribing at discharge across 3 tiers: Tier 1–Critical infrastructure, Tier 2–Broad inpatient interventions, Tier 3–Discharge-specific strategies. Here, we used the ROAD Home Framework to assess the association of stewardship strategies with antibiotic overuse at discharge and to describe pathways toward improved discharge prescribing. Methods: In fall 2019, we surveyed 39 Michigan hospitals on their antibiotic stewardship strategies. For patients hospitalized at participating hospitals July 1, 2017, through July 30, 2019, and treated for community-acquired pneumonia (CAP) and urinary tract infection (UTI), we assessed the association of reported strategies with days of antibiotic overuse at discharge. Days of antibiotic overuse at discharge were defined based on national guidelines and included unnecessary therapy, excess duration, and suboptimal fluoroquinolone use. We evaluated the association of stewardship strategies with days of discharge antibiotic overuse 2 ways: (1) all stewardship strategies were assumed to have equal weight, and (2) strategies weighted using the ROAD Home Framework with tier 3 (discharge-specific) strategies had the highest weight. Results: Overall, 39 hospitals with 20,444 patients (56.5% CAP; 43.5% UTI) were included. The survey response rate was 100% (39 of 39). Hospitals reported a median of 12 (IQR, 9–14) of 33 possible stewardship strategies (Fig. 1). On bivariable analyses, review of antibiotics prior to discharge was the only strategy consistently associated with lower antibiotic overuse at discharge (aIRR, 0.543; 95% CI, 0.335–0.878). On multivariable analysis, weighting by ROAD Home tier predicted antibiotic overuse at discharge for both CAP and UTI. For diseases combined, having more weighted strategies was associated with lower antibiotic overuse at discharge (aIRR per weighted intervention, 0.957; 95% CI, 0.927–0.987). Discharge-specific stewardship strategies were associated with a 12.4% relative decrease in antibiotic overuse days at discharge. Based on these findings, 3 pathways emerged to improve antibiotic use at discharge (Fig. 2): inpatient-focused strategies, “doing it all,” and discharge-focused strategies. Conclusions: The more stewardship strategies reported, the lower a hospitals’ antibiotic overuse at discharge. However, different pathways to improve discharge antibiotic use exist. Thus, discharge stewardship strategies should be tailored. Specifically, hospitals with limited stewardship resources and infrastructure should consider implementing a discharge-specific strategy straightaway. In contrast, hospitals that already have substantial inpatient infrastructure may benefit from proactively incorporating discharge into their existing strategies.

Funding: None

Disclosures: None

A critical barrier to generating cumulative knowledge in political science and related disciplines is the inability of researchers to observe the results from the full set of research designs that scholars have conceptualized, implemented, and analyzed. For a variety of reasons, studies that produce null findings are especially likely to be unobserved, creating biases in publicly accessible research. While several approaches have been suggested to overcome this problem, none have yet proven adequate. We call for the establishment of a new discipline-wide norm in which scholars post short “null results reports” online that summarize their research designs, findings, and interpretations. To address the inevitable incentive problems that earlier proposals for reform were unable to overcome, we argue that decentralized research communities can spur the broader disciplinary norm change that would bring advantage to scientific advance. To facilitate our contribution, we offer a template for these reports that incorporates evaluation of the possible explanations for the null findings, including statistical power, measurement strategy, implementation issues, spillover/contamination, and flaws in theoretical priors. We illustrate the template’s utility with two experimental studies focused on the naturalization of immigrants in the United States and attitudes toward Syrian refugees in Jordan.

Despite extensive paleoenvironmental research on the postglacial history of the Kenai Peninsula, Alaska, uncertainties remain regarding the region's deglaciation, vegetation development, and past hydroclimate. To elucidate this complex environmental history, we present new proxy datasets from Hidden and Kelly lakes, located in the eastern Kenai lowlands at the foot of the Kenai Mountains, including sedimentological properties (magnetic susceptibility, organic matter, grain size, and biogenic silica), pollen and macrofossils, diatom assemblages, and diatom oxygen isotopes. We use a simple hydrologic and isotope mass balance model to constrain interpretations of the diatom oxygen isotope data. Results reveal that glacier ice retreated from Hidden Lake's headwaters by ca. 13.1 cal ka BP, and that groundwater was an important component of Kelly Lake's hydrologic budget in the Early Holocene. As the forest developed and the climate became wetter in the Middle to Late Holocene, Kelly Lake reached or exceeded its modern level. In the last ca. 75 years, rising temperature caused rapid changes in biogenic silica content and diatom oxygen isotope values. Our findings demonstrate the utility of mass balance modeling to constrain interpretations of paleolimnologic oxygen isotope data, and that groundwater can exert a strong influence on lake water isotopes, potentially confounding interpretations of regional climate.

Acetolactate synthase (ALS) inhibitors provide postemergence control of green kyllinga (Kyllinga brevifolia Rottb.) in turfgrass and other cropping systems. A suspected resistant (R) biotype of K. brevifolia was collected from a golf course and evaluated for resistance to ALS inhibitors. In greenhouse experiments, the sulfosulfuron rates required to cause 50% shoot biomass reduction from the nontreated at 4 wk after treatment (WAT) were 10 and 792 g ai ha−1 for the susceptible (S) and R biotypes, respectively. The rates required to cause 50% injury at 4 WAT were 189 and >3,360 g ai ha−1, respectively. In other experiments, shoot mass of the R biotype was not reduced by imazaquin, trifloxysulfuron-sodium, pyrimisulfan, thiencarbazone + foramsulfuron + halosulfuron, florasulam + halauxifen-methyl, and bentazon compared with the nontreated, while sulfentrazone reduced biomass similarly for both R and S biotypes. Gene sequencing of the R biotype revealed a mutation at Asp-376-Glu that has previously conferred resistance to five families of ALS inhibitors. This is the first report of ALS-inhibitor resistance in K. brevifolia.

Political borders profoundly influence outcomes central to international politics. Accordingly, a growing literature shows that historical boundaries affect important macro-outcomes such as patterns of interstate disputes and trade. To explain these findings, existing theories posit that borders have persistent effects on individual-level behavior, but the literature lacks empirical evidence of such effects. Combining spatial data on centuries of border changes in Europe with a wide range of contemporary survey evidence, we show that historical border changes have persistent effects on two of the most politically significant aspects of behavior: individuals’ political and social trust. We demonstrate that in areas where borders frequently changed, individuals are, on average, less trusting of others as well as their governments. We argue that this occurs because border changes disrupt historical state-building processes and limit the formation of interpersonal social networks, which leads to lower levels of trust.

From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.