Mixed flora in urine cultures usually occur due to preanalytic contamination. In our outpatient urology clinic, we detected a high prevalence of mixed flora (46.2%), which was associated with female sex and older age. Patient education did not influence the rate of mixed flora. Future efforts should target high-risk patients.

We argue that concentration of power in religious hospitals threatens disestablishment values. When hospitals deny care for religious reasons, they dominate patients’ bodies and convictions. Health law should — and to some extent already does — constrain such religious domination.

Background: West syndrome (WS) is characterized by the onset of epileptic spasms usually within the first year of life. Global developmental delay with/without regression is common. Advances in high-throughput sequencing have supported the genetic heterogeneity of this condition. To better understand the genetic causes of this disorder, we investigated the results of targeted exome sequencing in 29 patients with WS. Methods: Whole exome sequencing (WES) was performed on an Ion ProtonTM and variant reporting was restricted to sequences of 620 known epilepsy genes. Diagnostic yield and treatment impact are described for 29 patients with WS. Results: A definitely/likely diagnosis was made in 10 patients (34%), which included 10 different genes (ALG13, PAFAH1B1, SLC35A2, DYNC1H1, ADSL, DEPDC5, ARX, CDKL5, SCN8A, STXBP1) known to be associated with epilepsy or WS. Most variants were de novo dominant (X-linked/autosomal) except for ARX (X-linked recessive) and ADSL (autosomal recessive). 4 out of 10 (40%) had a genetic diagnosis with potential treatment implications. Conclusions: These results emphasize the genetic heterogeneity of WS. The high diagnostic yield, along with the significant genetic variability, and the potential for treatment impact, supports the early use of this testing in patients with unexplained WS.

Background: We evaluated (1) the predictive accuracy and (2) multi-observer reliability of non-contrast CT markers of hematoma expansion (HE). Methods: In 124 patients with spontaneous intracerebral hemorrhage, two investigators documented the presence of six density (Barras density, hypodensity, black hole, swirl, blend, fluid level) and three shape (Barras shape, island, satellite) expansion markers, with discrepancies resolved by a third rater. We defined HE as any one of (1) >6 mL absolute or >33% relative growth of the intraparenchymal hematoma or (2) an absolute growth of >1 mL or new development of intraventricular hematoma. A subsample of 60 patients was used for the inter-observer reliability study in 13 raters. Seven raters participated in the intra-rater study. Results: The sensitivity of markers for HE varied between 4% (fluid level) and 78% (satellite), while specificity ranged from 37% (swirl) to 97% (black hole). Almost perfect inter-rater agreement was observed for the swirl (0.89) and fluid level (0.83) markers, while hypodensity (0.65) showed substantial agreement. Only the blend and fluid level markers achieved substantial intra-rater agreement (> 0.6) in all raters. Conclusions: Non-contrast CT markers of HE showed lower reliability and predictive accuracy than previously reported. Future studies should address means to improve NCCT-based HE prediction.

The prevalence rates of trypanosomes, including those that require cyclical transmission by tsetse flies, are widely distributed in Africa. Trypanosoma brucei and Trypanosoma congolense are actively maintained in regions where there are no tsetse flies although at low frequencies. Whether this could be due to an independent evolutionary origin or multiple introduction of trypanosomes due to continuous movement of livestock between tsetse-free and -infested areas is not known. Thus, the aim of the study was to carry out microsatellite genotyping to explore intra-specific genetic diversity between T. (Trypanozoon), T. congolense and Trypanosoma vivax from the two regions: tsetse infested and tsetse free. Microsatellite genotyping showed geographical origin-based structuring among T. (Trypanozoon) isolates. There was a clear separation between isolates from the two regions signalling the potential of microsatellite markers as diagnostic markers for T. brucei and Trypanosoma evansi isolates. Trypanosoma vivax isolates also clustered largely based on the sampling location with a significant differentiation between the two locations. However, our results revealed that T. congolense isolates from Northern Kenya are not genetically separated from those from Coastal Kenya. Therefore, these isolates are likely introduced in the region through animal movement. Our results demonstrate the occurrence of both genetic connectivity as well as independent evolutionary origin, depending on the trypanosome species between the two ecologies.

Neuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations.

Every year in Australia over a thousand children who are born with congenital heart disease require surgical intervention. Vocal cord dysfunction (VCD) can be an unavoidable and potentially devastating complication of surgery for congenital heart disease. Structured, multidisciplinary care pathways help to guide clinical care and reduce mortality and morbidity. An implementation study was conducted to embed a novel, multidisciplinary management pathway into practice using the consolidated framework for implementation research (CFIR). The goal of the pathway was to prepare children with postoperative vocal cord dysfunction to safely commence and transition to oral feeding. Education sessions to support pathway rollout were completed with clinical stakeholders. Other implementation strategies used included adaptation of the pre-procedural pathway to obtain consent, improving the process of identifying patients on the VCD pathway, and nominating a small team who were responsible for the ongoing monitoring of patients following recruitment. Implementation success was evaluated according to compliance with pathway defined management. Our study found that while there were several barriers to pathway adoption, implementation of the pathway was feasible despite pathway adaptations that were required in response to COVID-19.

The occurrence of nonlocal objects, raw materials, and ideas in the southwestern United States (U.S. SW) has long been recognized as evidence of interaction between prehispanic peoples of this region and those of greater Mesoamerica. Although many archaeologists have analyzed the directionality and potential means by which these objects and concepts moved across the landscape, few have assessed the degree to which Mesoamerican practices and traditional assemblages remained intact as the artifacts and ideas moved farther from their places of origin. The current study analyzes the distribution and deposition of blue-green stone mosaics, a craft technology that was well established in Mesoamerica by the Late Preclassic period (300 BC–AD 250) and spread to the U.S. SW by the start of the Hohokam Pioneer period (AD 475). We assess the spatial distribution, contextual deposition, and morphology of mosaics at sites within Hohokam Canal System 2, located in the Phoenix Basin of Arizona. We use these data to infer mosaics’ social value and function within Hohokam social structure. Analyses suggest that, although the technology of mosaic making may have originated in Mesoamerica, the contexts and ways in which mosaics were used in the Hohokam regional system were decidedly Hohokam.

ABSTRACT IMPACT: Our research focuses on determining rural-urban disparities in chronic obstructive pulmonary disease (COPD) management to improve COPD health outcomes in rural areas. OBJECTIVES/GOALS: Several methods exist to distinguish rural from urban areas, but it is not clear which method relates most directly to rural-urban health care disparities. To address this, we compared different measures of rurality to measures of chronic obstructive pulmonary disease (COPD) processes of care among a national sample of veterans. METHODS/STUDY POPULATION: Retrospective analysis of patients with COPD (2016-2019 by ICD-10 codes) using national Veterans Affairs (VA) data. We assessed rurality by: 1) patient’s residential address, 2) assigned primary care clinic address, and 3) drive time from the patient’s residence to closest primary care clinic. Rurality designations of the residential address and primary care clinic address into urban, rural, and highly rural areas are based on the Rural Urban Commuting Area (RUCA) codes. The dependent variables were binary outcomes of: 1) documentation of a pulmonary clinic encounter and 2) evidence of spirometry to confirm the diagnosis of COPD. RESULTS/ANTICIPATED RESULTS: Of 6,765,951 veterans, 1,157,002 (17%) had COPD (Table 1). Although approximately 40% of patients with COPD reside in addresses that are rural and highly rural, a large majority are assigned to primary care clinics in urban areas (82.8%) and reside within 30 minutes to the closest primary care clinic (76.7%) (Table 2). Compared to defining rurality based on patient’s residential address or drive time to closest primary care, defining rurality based on the assigned primary care clinic address was associated with a larger disparity in rates of pulmonary encounter. In contrast, the drive time from the patient’s residence to the closest primary care was the strongest predictor of receipt of spirometry (Figure 1 and Table 3). DISCUSSION/SIGNIFICANCE OF FINDINGS: Estimates of the severity of rural-urban disparities varied based on the definition of rurality used. For two process measures, definitions of rurality based on where the patient received primary care generated more evidence of disparities than definitions based solely on the patient’s residential address.

This paper investigates the distributions of triangle counts per vertex and edge, as a means for network description, analysis, model building, and other tasks. The main interest is in estimating these distributions through sampling, especially for large networks. A novel sampling method tailored for the estimation analysis is proposed, with three sampling designs motivated by several network access scenarios. An estimation method based on inversion and an asymptotic method are developed to recover the entire distribution. A single method to estimate the distribution using multiple samples is also considered. Algorithms are presented to sample the network under the various access scenarios. Finally, the estimation methods on synthetic and real-world networks are evaluated in a data study.

The recently discovered massive and stockwork sulphide mineralization of Semblana-Rosa Magra and Monte Branco, situated ESE of the Neves–Corvo volcanogenic massive sulphide (VMS) deposit in the Iberian Pyrite Belt (IPB) is presented. Geological setting and tectonic model is discussed based on proxies such as palynostratigraphy and U–Pb zircon geochronology. The mineralization is found within the IPB Volcano-Sedimentary Complex (VSC) Lower sequence, which includes felsic volcanic rocks (rhyolites) with U–Pb ages in zircons of 359.6 ± 1.6 Ma, and black shales of the Neves Formation of late Strunian age. Massive sulphides are enveloped by these shales, implying that felsic volcanism, mineralization and shale sedimentation are essentially coeval. This circumstance is considered highly prospective, as it represents an important exploration vector to target VMS mineralization across the IPB, in areas where the Lower VSC sequence is present. The Upper VSC sequence, with siliciclastic and volcanogenic sedimentary rocks of middle–late Visean age, shows no massive mineralization but a late Tournaisian (350.9 ± 2.3 Ma) volcanism with disseminated sulphides was also identified. Nevertheless, stratigraphic palynological gaps were found within the Strunian and in the Tournaisian sediments, between the Lower and Upper VSC sequences, reflecting probable erosion and uplift mechanisms linked with extensional tectonics. The Semblana and Monte Branco deposits and the Rosa Magra stockwork are enclosed by tectonic sheets that dismembered the VSC sequence in a fold-and-thrust tectonic complex, characteristic of the NE Neves–Corvo region. The methodologies used allow a geological comparison between Neves–Corvo and other IPB mine regions such as Lousal–Caveira, Herrerias, Tharsis and Aznalcollar.