We calculated the attributable cost of several healthcare-associated infections in a community hospital network: central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile infections (CDI-HOs) (43 hospitals); surgical site infections (SSIs) (40 hospitals). From 2016 to 2022, the total cost of CLABSIs, CAUTIs, CDI-HOs, and SSIs was $420,012,025.

Bacterial superinfection and antibiotic prescribing in the setting of the current mpox outbreak are not well described in the literature. This retrospective observational study revealed low prevalence (11%) of outpatient antibiotic prescribing for bacterial superinfection of mpox lesions; at least 3 prescriptions (23%) were unnecessary.

The interaction of relativistically intense lasers with opaque targets represents a highly non-linear, multi-dimensional parameter space. This limits the utility of sequential 1D scanning of experimental parameters for the optimization of secondary radiation, although to-date this has been the accepted methodology due to low data acquisition rates. High repetition-rate (HRR) lasers augmented by machine learning present a valuable opportunity for efficient source optimization. Here, an automated, HRR-compatible system produced high-fidelity parameter scans, revealing the influence of laser intensity on target pre-heating and proton generation. A closed-loop Bayesian optimization of maximum proton energy, through control of the laser wavefront and target position, produced proton beams with equivalent maximum energy to manually optimized laser pulses but using only 60% of the laser energy. This demonstration of automated optimization of laser-driven proton beams is a crucial step towards deeper physical insight and the construction of future radiation sources.

We present the development and characterization of a high-stability, multi-material, multi-thickness tape-drive target for laser-driven acceleration at repetition rates of up to 100 Hz. The tape surface position was measured to be stable on the sub-micrometre scale, compatible with the high-numerical aperture focusing geometries required to achieve relativistic intensity interactions with the pulse energy available in current multi-Hz and near-future higher repetition-rate lasers ($>$kHz). Long-term drift was characterized at 100 Hz demonstrating suitability for operation over extended periods. The target was continuously operated at up to 5 Hz in a recent experiment for 70,000 shots without intervention by the experimental team, with the exception of tape replacement, producing the largest data-set of relativistically intense laser–solid foil measurements to date. This tape drive provides robust targetry for the generation and study of high-repetition-rate ion beams using next-generation high-power laser systems, also enabling wider applications of laser-driven proton sources.

A series of measures of calf welfare was developed through a process of expert consultation. A welfare assessment of group-housed calves was carried out on 53 UK dairy farms during the winter of 2000/01. The assessment used animal-based measures including direct observation of the calves and examination of their health history through a review of farm records. The findings from this were compiled into a profile of calf welfare which outlined the range of results for each measure used. The results fell into the three categories of respiratory health, nutrition and general appearance. A broad range of results was found across the farms visited for the measures in each of these categories. Some farms performed well for all measures taken, and no farms performed consistently badly across all aspects of calf welfare. The majority of farms combined aspects of both good and poor welfare performance.

The within-farm prevalence of vulva biting in breeding sows in south-west England was investigated using a postal survey sent to 410 pig farmers in January 1997. The response rate was 65 per cent and there were 83 useable replies. The majority of farms where vulva biting was reported indicated a low within-farm prevalence of 1-9 per cent of sows affected, although prevalences as high as 30-60 per cent were reported. The injuries reported ranged from bleeding to removal of the whole vulva, the most commonly reported injuries being bleeding and superficial damage to the vulva. No long-term effects from this injury to service and dry sows were reported by 70 per cent and 76 per cent of farmers respectively. Competition for food, aggressive sows, closeness to farrowing and mixing of sows were the most common reasons suggested by these farmers as causes of vulva biting.

This paper describes an approach to assessing the overall welfare of cows on dairy farms. Veterinary and behaviour experts were shown results for ten selected welfare parameters for 25 pairs of dairy farms paired for farm assurance status but with similar geographical location and husbandry system. From this information alone they were asked to state which farms had better welfare. Overall, there were no significant differences between the conclusions of veterinary and behaviour experts. There was a significant relationship between the proportion of experts rating a farm as poorer and the measured difference in the number of cows with lameness or rising restrictions between the paired farms. There were no significant relationships between the expert decisions and differences in milk yield, flight distance, swollen hocks, mastitis incidence, dystocia level, conception rates, prevalence of thin cows and proportion of cows with dirty udders. Clearly, experts rate lameness and discomfort as highly important indices of poor welfare in dairy cows.

A Delphi technique was used to gather the opinions of animal welfare experts on the most appropriate measures for welfare assessment of farm animals. The experts were asked to consider measures that were directed towards the animal (animal-based), rather than measurement of their environment. This systematic approach was designed to achieve a degree of consensus of opinion between a large number of experts. Two rounds of postal questionnaires were targeted at people with expertise in one or more of the species of interest. The respondents suggested measures based upon observations of health status, behaviour, and examination of records. These measures reflect the animal's welfare state — in other words, how the animal is coping within the environment and husbandry system in which it lives. The measures for cattle, pigs and laying hens were categorised into 22, 23 and 28 aspects, respectively, with the highest ranking of importance being given to observation of lameness in dairy cattle and pigs and to observation of feather condition in laying hens. This Delphi study was the basis for the development of a series of protocols to assess the welfare state of dairy cattle, pigs and laying hens.

Breeding and housing wild animals in captive environments can pose challenges for their welfare. In South Africa, thousands of lions (Panthera leo) are bred and raised at commercial captive breeding facilities, so called ‘lion farms’, for use in tourism, trophy hunting and traditional medicine. To gain a better understanding of the potential welfare challenges faced by lions on farms we reviewed 91 peer-reviewed articles relating to lion welfare, identified via a systematic review of the scientific literature. Across these studies, we identified 170 different terms relating to negative behaviours and physical health afflictions. The majority of these terms were associated with disease and injury (124; 73%), followed by negative behaviours (19; 11%), negative mental experiences (15; 9%), nutritional concerns (7; 4%), and environmental challenges or discomfort arising from the animal's surroundings (5; 3%). Of the 91 articles, 32 (35%) focused on data concerning captive lions. Only two studies focused specifically on data obtained from lion farms in South Africa, whilst the remainder reported on data collected from zoos, wildlife parks, sanctuaries, game reserves and private ownership. Our preliminary review of the scientific literature draws attention to some of the challenges associated with caring for lions in captivity, and outlines the potential significance of these welfare challenges for commercial lion farms. Our data highlight the apparent lack of scientific research involving captive lion welfare generally, particularly data collected at commercial breeding facilities in South Africa and the consequences this could have for the welfare of thousands of lions within the industry.

Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.

The combination of florpyrauxifen-benzyl + 2,4-D is a new, pre-packaged herbicide mixture for use in pastures and hayfields in the United States. Unlike many other pasture herbicides, florpyrauxifen-benzyl + 2,4-D is reported to preserve white clover. However, limited research exists on the efficacy of florpyrauxifen-benzyl + 2,4-D on common weed species and on the level of tolerance of white clover to it. Field trials were conducted in Virginia in 2018 to 2020 to evaluate control of various broadleaf weeds with florpyrauxifen-benzyl + 2,4-D compared to other commonly used herbicides. Field and greenhouse studies were also carried out to assess white clover tolerance. Weed species evaluated included bulbous buttercup, Canada thistle, horsenettle, and broadleaf plantain. Florpyrauxifen-benzyl + 2,4-D provided 75% to 99% control of all weeds 90 d after application except for horsenettle (56%), while causing the least white clover injury of any herbicide treatment that was evaluated. Spring herbicide applications resulted in greater bulbous buttercup control compared to fall applications, but florpyrauxifen-benzyl + 2,4-D provided greater than 81% control from both application timings. There were no differences in aboveground biomass between white clover varieties; however, all herbicides reduced white clover biomass compared to a nontreated control. This research suggests that florpyrauxifen-benzyl + 2,4-D can improve overall forage quality by controlling broadleaf weeds in mixed grass-legume stands while preserving white clover.

Narrow-windrow burning (NWB) is a form of harvest weed seed control in which crop residues and weed seeds collected by the combine are concentrated into windrows and subsequently burned. The objectives of this study were to determine how NWB will 1) affect seed survival of Italian ryegrass in wheat and Palmer amaranth in soybean and 2) determine whether a relationship exists between NWB heat index (HI; the sum of temperatures above ambient) or effective burn time (EBT; the cumulative number of seconds temperatures exceed 200 C) and the post-NWB seed survival of both species. Average soybean and wheat windrow HI totaled 140,725 ± 14,370 and 66,196 ± 6224 C, and 259 ± 27 and 116 ± 12 s of EBT, respectively. Pre-NWB versus post-NWB germinability testing revealed an estimated seed kill rate of 79.7% for Italian ryegrass, and 86.3% for Palmer amaranth. Non-linear two-parameter exponential regressions between seed kill and HI or EBT indicated NWB at an HI of 146,000 C and 277 s of EBT potentially kills 99% of Palmer amaranth seed. Seventy-six percent of soybean windrow burning events resulted in estimated Palmer amaranth seed kill rates greater than 85%. Predicted Italian ryegrass seed kill was greater than 97% in all but two wheat NWB events; therefore, relationships were not calculated. These results validate the effectiveness of the ability of NWB to reduce seed survival, thereby improving weed management and combating herbicide resistance.

The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

ABSTRACT IMPACT: Our results reveal a limited amount of breast cancer survivorship print materials as both understandable and actionable, and indicate a need to supplement material with personalized teaching. OBJECTIVES/GOALS: Using educational print material for young women breast cancer survivors (YBCS) is considered a best practice in patient teaching. Little is known about how well YBCS understand or act upon the material. The purpose of this study was to assess the understandability and actionability of commonly distributed breast cancer survivorship print materials. METHODS/STUDY POPULATION: We used an environmental scan approach to obtain breast cancer survivorship print materials available in eight outpatient oncology clinics and one electronic medical record used in a Midwestern state. Print materials were included if they were freely available to patients, were specific to breast cancer, provided detailed information about survivorship, and were directly given to patients by physicians or nurses. Print materials were excluded if topics were related to treatment, diagnosis, or prevention. All brochures, drug advertisements, and advertisements for support services were excluded. The understandability and actionability analyses of the breast cancer survivorship print materials were analyzed using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). RESULTS/ANTICIPATED RESULTS: The environmental scan resulted in 82 individual print materials. After applying the inclusion and exclusion criteria, eight breast cancer survivorship print materials were included in the final sample. The final sample included two books, two patient education handouts from the electronic medical record, two multi-page booklets, and two pamphlets. The overall mean understandability score of the print materials was 68.9% ? 11.3 with a range of 47% to 80%. Five materials scored above the recommended 70% in understandability. The overall mean actionability score of the print materials was much higher at 81.3% ? 21.6 with a range of 67% to 100%. Five materials scored above 70% in actionability. However, only three of the eight materials scored above the recommended 70% in both understandability and actionability. DISCUSSION/SIGNIFICANCE OF FINDINGS: Limited breast cancer survivorship print materials exist as both understandable and actionable. Personalized instruction provided by oncology team members may be indicated to supplement the material. This additional teaching may help ensure survivors comprehend messages and act upon specific tasks as indicated in survivorship print material.

OBJECTIVES/GOALS: Young women (18 – 45 years of age) with breast cancer have complex medical and psychosocial needs. Educational materials are often used as tools in patient-centered communication. However, these materials disseminate complex health information in print-heavy formats and can be difficult to understand for women with varying health literacy levels. METHODS/STUDY POPULATION: In the first phase of this study, the principal investigator (PI) will recruit 40 diverse women to participate in four focus groups (FG) to explore the perceived usefulness of the most frequently used cancer educational materials. The PI will also obtain demographics and heath literacy levels of the FG participants using the Newest Vital Sign. In the second phase, the PI will assess the literacy demands of the ten most frequently used cancer educational print materials and five most frequently used websites described by the FG participants. The perceptions of the usefulness of materials and the literacy demands will then be used to appraise the effectiveness of materials within patient-centered cancer communication. RESULTS/ANTICIPATED RESULTS: Results from this study will provide a patient-centered blueprint that will be used to design more effective educational materials that treatment centers can incorporate into their patient-centered cancer communication process. The next step of this research will be to determine providers’ perceptions of cancer education materials used to exchange information within the patient-centered communication process. This will complement the patient findings and inform the development of the provider aspect of a communication intervention centered on designing educational materials for women with various health literacy levels within the patient-centered cancer communication process. DISCUSSION/SIGNIFICANCE OF IMPACT: Detecting the usefulness of cancer educational materials, as perceived by young women with breast cancer, is foundational to developing communication interventions that improve cancer outcomes. This study will identify how materials can be improved in the critical informational-exchange component of the patient-communication process.

Introduction: Overcrowding in the Emergency Department (ED) results in delays in care, and increased patient morbidity and mortality. Innovative departmental approaches have the potential to make patient flow through the ED more efficient and reduce overcrowding by improving patient throughput. The Calgary zone ED recently piloted a new physician role, the Emergency Physician Lead (EPL), a senior physician working closely with the charge nurse and consulting services to provide physician leadership, and to troubleshoot flow issues and safety breeches such as EMS offload delays and long emergency inpatient (EIP) stays. The objective of this study was to evaluate the efficacy of the EPL by determining its effect on key metrics of patient flow, and by identifying which specific EPL interventions were most effective at improving patient throughput. Methods: A retrospective cohort design was used to compare Foothills Medical Centre (FMC) ED patients seen by the EPL from March-June 2019 (n = 1343 patients) with a control group from the same period in 2018 (n = 5530). An EMR search was used to collect patient data and generate descriptive statistics, which were compared between groups by Mann-Whitney U-test. Patient handover notes left by the EPL were also collected and analyzed by two independent assessors to develop a list of actions taken by the EPL. Each patient was then coded based on the actions in the handover note, and means for each coded group were compared to control to find correlations between action and changes in key flow metrics. Results: Patients whose care involved the EPL had a 40% shorter average ED length of stay (ELOS) compared to control (515 vs 865 min, p < 0.001). The EPL was especially effective for patients with ELOS above the 90th percentile, with a 58% relative reduction. EPL patients also had lower average times from first contact with the department to first order being placed (79 vs 143 min, p < 0.001), and spent less time as EIPs after being admitted (390 vs 515 mins, p < 0.001). EPL actions aimed at early ordering of investigations or early management showed the largest relative reductions in ELOS, followed by actions related to resolving issues with consulting services (56% and 48% respectively, p < 0.001). Conclusion: The EPL role appears to be associated with improvements in several key metrics of patient flow. Specific EPL actions were correlated with marked decreases in length of stay. The EPL may be an effective strategy to improve patient throughput and combat ED overcrowding.