Background: Infections due to antibiotic resistant bacteria are increasing worldwide and while, the epidemiology of these pathogens is well described in adults, pediatric specific data are lacking. We sought to gain an understanding of the risk factors for multi-drug resistant Gram-negative (MDRGN) infections in our pediatric population. Methods: We performed a retrospective review of pediatric patients seen at a pediatric hospital system in 2022 who had a culture-positive MDRGN, which was defined as a gram-negative bacteria resistant or intermediate to at least 1 antibiotic in ≥ 3 antibiotic groups. Repeat positive cultures for the same MDRGN were considered a single infection episode if occurring within a 14-day period. Demographic, clinical, and microbiologic data was obtained from the electronic medical record. Fisher’s exact was used for analysis. Results: One hundred and seventy-nine children had 237 infection episodes during the study period. Eighty-one patients (45%) were male and the median age was 5.3 years. The most prevalent MDRGNs included: Escherichia coli (154, 65%), Klebsiella spp (52, 22%), and Enterobacter spp (16, 7%). Escherichia coli was significantly more likely than other pathogens to be isolated from the urine (P = 0.008). Compared to multi-drug resistant E. coli, patients with a non-E. coli MDRGN were significantly more likely to have an underlying medical condition, recent hospitalization and antibiotic use (P≤0.001 for each, Table 1). A carbapenem was administered in 32% (75/237) of infection episodes. There were only 6 carbapenem resistant organisms. Conclusions: In our study, E. coli was the most frequent MDRGN. Most patients with a non-E. coli MDRGN infection episode had an underlying medical condition, recent hospitalization and antibiotic use. Carbapenem resistance was infrequent, though surveillance studies are needed to identify changing antibiotic resistance patterns and to direct prevention measures.

Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children’s self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks.

The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of ‘3’ indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were ‘educators not using food to calm or encourage behaviour’ (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and ‘not requiring children to sit at the table until finished’ (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were ‘educator prompts for children to drink water’ (M = 0.78, SD = 0.94) and ‘children self-serving’ (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were ‘enthusiastic role modelling during mealtime’ (M = 0.70, SD = 0.68) and ‘praise of mealtime behaviour unrelated to food intake’ (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.

In this paper, dedicated to Dante Cicchetti’s contributions and enduring influence, we explore the prospective directions of developmental psychopathology. Our focus centers on key domains where Cicchetti’s significant achievements have continually shaped our evolving thinking about psychological development. These domains include (a) the concepts of equifinality and multifinality, along with the challenges in predicting developmental trajectories, (b) the imperative to integrate wider sociocultural viewpoints into developmental psychopathology frameworks, (c) the interplay of genetic and environmental influences in developmental courses, (d) the significance of mental state language, and (e) the progress, or its absence, in the development of prevention and intervention tactics for children, adolescents, and their caregivers. While many of our forecasts regarding the future of developmental psychopathology may not materialize, we maintain optimistic that the essential ideas presented will influence the research agenda in this field and contribute to its growth over the next fifty years.

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

The pubertal transition is characterized by pronounced sex hormone fluctuation, refinement of affective neural circuitry, and an increased risk of depression in female adolescents. Sex hormones, including testosterone, exert modulatory effects on frontal-limbic brain networks and are associated with emotion dysregulation and depressive symptoms. Weekly changes in hormones predict affective symptoms in peripubertal female adolescents, particularly in the context of stress; however, the biobehavioral mechanisms underlying hormone change and mood relationships during the pubertal transition have yet to be determined and was the objective of the present study. Forty-three peripubertal female adolescents (ages 11–14) collected 8-weekly salivary hormone (estrone, testosterone) samples and mood assessments to evaluate hormone-mood relationships, followed by a biobehavioral testing session with psychosocial stress and EEG. Within-person correlations between weekly hormone changes and corresponding mood were performed to determine individual differences in mood sensitivity to weekly hormone change. Increased frontal theta activity indexing emotion reactivity, reduced cortisol reactivity, and reduced vagal efficiency predicted the strength of the relationship between testosterone and mood. Further, testosterone-sensitivity strength was associated with the enhancement of negative affect following stress testing. Results identify divergent frontal theta and stress responses as potential biobehavioral mechanisms underlying mood sensitivity to peripubertal testosterone fluctuation.

The Amazon River dolphin Inia geoffrensis occurs throughout the basins of the Amazon and Orinoco Rivers and is categorized as Endangered on the IUCN Red List. Using satellite tracking data from eight dolphins (one female and seven males) in the Peruvian Amazon, we demonstrate that these dolphins inhabit a variety of habitat types and have core areas and home range areas of variable magnitudes. To gain a better understanding of how threats affect these dolphins, we examined the distance of dolphin records to locations of current and potential future anthropogenic threats. On average, dolphin home ranges overlapped with fisheries by 89%. Dolphins were found at an average distance of 252 km from the nearest proposed dam and 125 km from the nearest proposed dredging site. Given that many of these threats are still in the planning stage, we advise the government to consider the negative effects these activities have already had on other riverine species before proceeding. Additionally, efforts should be made to expand river dolphin tracking programmes to span multiple seasons, to track more females at our study sites and to increase the numbers tracked overall in other areas to improve our knowledge of the species' movement patterns.

Objectives: COVID-19 has highlighted the importance of the hierarchy of controls and early implementation of transmission-based precautions during outbreaks in residential aged-care facilities (RACFs). The RACF outreach team is a service provided by the Sydney Local Health District (SLHD) that provides RACFs with expert clinical care and advice, along with outbreak management and infection control and prevention education. Methods: The RACF outreach team developed 2 unique IPC management tools designed to assist RACFs during the COVID-19 pandemic: (1) the comprehensive initial review and (2) first-responder assessment tool designed to assist the team in identifying high-risk issues during afterhours shifts. The tool reviews 5 key components in outbreak management: screening, PPE usage, resident care, communication and signage, and infection control and prevention. The outreach team provides an IPC report of the comprehensive initial review, which provides site-specific advice regarding zoning, cohorting, implementation of donning and doffing stations, safe staffing and workflows, ventilation, personal protective equipment (PPE) use, and PPE safety. The recommendations supplied in the SLHD IPC report are provided to facilities and are implemented at the facility level. These reviews are followed up in meetings of the outbreak management team conducted virtually via Zoom videoconferencing. These meetings include an RACF senior manager and a representative from the local PHU, the outreach service, the Australian Commonwealth, the Aged Care Commission, an SLHD executive manager, and an infectious diseases practitioner. Results: Since the outbreak of the SARS-CoV-2 ο (omicron) variant began in Sydney, Australia, in November 2021, 58 facilities with >2,500 residents have been reviewed, and 57 of these facilities had a COVID-19 outbreak at some point during the pandemic. Conclusions: The RACFs in SLHD continue to report death rates <5% among all SARS-COV-2–positive residents.

Democracy is premised on the ability of individuals, often working with others, to influence policies affecting them. However, existing theory cannot always explain why some organized efforts are more influential than others. We introduce the concept of civic feedbacks, arguing that the ways organizations engage individuals in collective action have feedback effects that shape the strategic position of organizations, the options available to leaders, and the likelihood of policy influence. The mechanisms through which civic feedbacks operate include the depth of accountability to the constituency, the network of elite relationships to which leaders subsequently have access, and their ongoing ability to recruit a committed and flexible constituency willing to engage new issues. Analyzing how these feedbacks redound to organizations over time enhances our ability to explain civic organizations’ differential rates of political influence. The concept of civic feedbacks returns organizations and organizational strategy to the center of the study of political influence.

In recent years, the work of the American Monuments Men has been celebrated in popular histories and culture, such as bestselling books by Robert Edsel and a feature film directed by George Clooney (The Monuments Men, 2014). While public awareness of Nazi art looting and the courageous work of American cultural officers is long overdue, these popular narratives elide the role played by women and other Western Allies and fail to address the corps’ greatest failure: the incomplete restitution of Jewish assets. This article explores these factors through a case study of British Major Anne Olivier Popham (1916–2018), who served the Monuments, Fine Arts, and Archives (MFA&A) division in Bünde from November 1945 to October 1947. Drawing on Popham’s diaries held at the Imperial War Museum in London, the author’s interview with her, and British and American archives, the case study yields important insight into personnel recruited by the MFA&A, gender relations among the officers, methodological dilemmas presented by the use of first-hand accounts, and the ongoing need for transnational restitution efforts.

Malnutrition and sarcopenia are prevalent in patients with head and neck squamous cell carcinoma (HNSCC). Pre-treatment sarcopenia and adverse oncological outcomes in this population are well described. The impact of myosteatosis and post-treatment sarcopenia is less well known. Patients with HNSCC (n = 125) undergoing chemoradiotherapy, radiotherapy alone and/or surgery were assessed for sarcopenia and myosteatosis, using cross-sectional computed tomography (CT) imaging at the third lumbar (L3) vertebra, at baseline and 3 months post-treatment. Outcomes were overall survival (OS) at 12 months and 5 years post-treatment. One hundred and one participants had a CT scan evaluable at one or two time points, of which sixty-seven (66 %) participants were sarcopenic on at least one time point. Reduced muscle attenuation affected 93 % (n = 92) pre-treatment compared with 97 % (n = 90) post-treatment. Five-year OS favoured those without post-treatment sarcopenia (hazard ratio, HR 0·37, 95 % CI 0·16, 0·88, P = 0·06) and those without both post-treatment myosteatosis and sarcopenia (HR 0·33, 95 % CI 0·13, 0·83, P = 0·06). Overall, rates of myosteatosis were high at both pre- and post-treatment time points. Post-treatment sarcopenia was associated with worse 5-year OS, as was post-treatment sarcopenia in those who had myosteatosis. Post-treatment sarcopenia should be evaluated as an independent risk factor for decreased long-term survival post-treatment containing radiotherapy (RT) for HNSCC.

The obsidian mirror associated with the Elizabethan polymath and magus John Dee (1527–1608/1609) has been an object of fascination for centuries. The mirror, however, has a deeper history as an Aztec artefact brought to Europe soon after the Spanish conquest. The authors present the results of new geochemical analysis, and explore its history and changing cultural context to provide insights into its meaning during a period in which entirely new world views were emerging. The biography of the mirror demonstrates how a complex cultural history underpins an iconic object. The study highlights the value of new compositional analyses of museum objects for the reinterpretation of historically significant material culture.

This paper proposes a model for developmental psychopathology that is informed by recent research suggestive of a single model of mental health disorder (the p factor) and seeks to integrate the role of the wider social and cultural environment into our model, which has previously been more narrowly focused on the role of the immediate caregiving context. Informed by recently emerging thinking on the social and culturally driven nature of human cognitive development, the ways in which humans are primed to learn and communicate culture, and a mentalizing perspective on the highly intersubjective nature of our capacity for affect regulation and social functioning, we set out a cultural-developmental approach to psychopathology.

Background: Extended-spectrum β-lactamase–producing (ESBL) Escherichia coli infection incidence is increasing in the United States. This increase may be due to the rapid expansion of ST131, which is now the predominant ESBL strain globally, often multidrug resistant, and has been shown to establish longer-term human colonization than other E. coli strains. We assessed potential risk factors that distinguish ST131 from other ESBL E. coli. Methods: From October 1 through December 31, 2017, 5 CDC Emerging Infections Program (EIP) sites pilot tested active, laboratory-based surveillance in selected counties in Colorado, Georgia, New Mexico, New York, and Tennessee. An E. coli case was defined as the first isolation from a normally sterile body site or urine in a surveillance area resident in a 30-day period resistant to 1 extended-spectrum cephalosporin antibiotic and susceptible or intermediate to all carbapenem antibiotics tested. Epidemiologic data were collected from case patients’ medical records. A convenience sample of 117 E. coli isolates from case patients was collected. All isolates underwent whole-genome sequencing to determine sequence type and the presence of ESBL genes. We compared ST131 E. coli epidemiology to other ESBL E. coli. Results: Among 117 E. coli isolates, 97 (83%) were ESBL producers. Of the 97 ESBL E. coli, 52 (54%) were ST131 (range, for 4 EIP sites submitting >10 isolates: 25%–88%; P < .001). Other common STs were ST38 (12%) and ST10 (5%). ST131 infections were more likely to be healthcare-associated than non-ST131 (56% vs 36%; P = .05) (Table 1). Among specific prior healthcare exposures, only residence in long-term care facilities (LTCFs) in the year before culture was more common among ST131 case patients (29% vs 11%; P = .03). Notably, 85% of ESBL E. coli collected from LTCF residents were ST131. ST131 E. coli were more common among patients with underlying medical conditions (81% vs 60%; P = .02). No statistically significant difference by sex, race, age, culture source, location of culture collection, and frequency of antibiotic use in the prior 30 days was observed. Conclusions:The prevalence of ST131 E. coli varies regionally. The association between ST131 and LTCFs suggests that these may be particularly important settings for ST131 acquisition. Improving infection control measures that limit ESBL transmission in these settings and preventing dissemination in facilities receiving patients from LTCFs may be necessary to contain ST131 spread.

Funding: None

Disclosures: None