Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.

Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)

Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).

Depression is a major cause of disability in adolescents. Higher dietary fibre intake has been associated with lower depressive symptoms in adults, but there is a lack of research in adolescents. We examined the association between dietary fibre intake (Commonwealth Scientific and Industrial Research Organisation (CSIRO) FFQ) and depressive symptoms (Beck Depression Inventory for Youth) in adolescents with prospective data from the Raine Study Gen2 14- and 17-year follow-ups (n 1260 and 653). Odds of moderate/extreme (clinically relevant) depressive symptoms by quartile of fibre intake were calculated using mixed-effects logistic regression for all participants, in a paired sample without moderate/extreme depressive symptoms at 14 years and in a sub-sample of participants with available inflammatory data at the ages of 14 and 17 years (n 718 and 547). Odds of moderate/extreme depressive symptoms were lower in the fourth (highest) quartile of overall fibre intake (OR 0·273, 95 % CI 0·09, 0·81) compared with the first (lowest) quartile, adjusting for sex, age, energy intake, adiposity, and family and lifestyle factors. However, further adjustment for dietary patterns attenuated the results. Associations of depressive symptoms with cereal or fruit and vegetable fibre intake were not significant in the final model. Adjustment for inflammation had no effect on OR. The association between a higher dietary fibre intake and lower odds of clinically relevant depressive symptoms may be more reflective of a high-fibre diet with all its accompanying nutrients than of an independent effect of fibre.

We prove that sums of length about $q^{3/2}$ of Hecke eigenvalues of automorphic forms on $\operatorname{SL}_{3}(\mathbf{Z})$ do not correlate with $q$-periodic functions with bounded Fourier transform. This generalizes the earlier results of Munshi and Holowinsky–Nelson, corresponding to multiplicative Dirichlet characters, and applies, in particular, to trace functions of small conductor modulo primes.

Integration of photonic devices on silicon (Si) substrates is a key method in enabling large scale manufacturing of Si-based photonic–electronic circuits for next generation systems with high performance, small form factor, low power consumption, and low cost. Germanium (Ge) is a promising material due to its pseudo-direct bandgap and its compatibility with Si-CMOS processing. In this article, we present our recent progress on achieving high quality germanium-on-silicon (Ge/Si) materials. Subsequently, the performance of various functional devices such as photodetectors, lasers, waveguides, and sensors that are fabricated on the Ge/Si platform are discussed. Some possible future works such as the incorporation of tin (Sn) into Ge will be proposed. Finally, some applications based on a fully monolithic integrated photonic–electronic chip on an Si platform will be highlighted at the end of this article.

We demonstrate that the second-Stokes output from a diamond Raman laser, pumped by a femtosecond Ti:Sapphire laser, can be used to efficiently excite red-emitting dyes by two-photon excitation at 1,080 nm and beyond. We image HeLa cells expressing red fluorescent protein, as well as dyes such as Texas Red and Mitotracker Red. We demonstrate the potential for simultaneous two-color, two-photon imaging with this laser by using the residual pump beam for excitation of a green-emitting dye. We demonstrate this for the combination of Alexa Fluor 488 and Alexa Fluor 568. Because the Raman laser extends the wavelength range of the Ti:Sapphire laser, resulting in a laser system tunable to 680–1,200 nm, it can be used for two-photon excitation of a large variety and combination of dyes.

Wellbeing (WB) is a major topic of research across several scientific disciplines, partly driven by its strong association with psychological and mental health. Twin-family studies have found that both genotype and environment play an important role in explaining the variance in WB. Epigenetic mechanisms, such as DNA methylation, regulate gene expression, and may mediate genetic and environmental effects on WB. Here, for the first time, we apply an epigenome-wide association study (EWAS) approach to identify differentially methylated sites associated with individual differences in WB. Subjects were part of the longitudinal survey studies of the Netherlands Twin Register (NTR) and participated in the NTR biobank project between 2002 and 2011. WB was assessed by a short inventory that measures satisfaction with life (SAT). DNA methylation was measured in whole blood by the Illumina Infinium HumanMethylation450 BeadChip (HM450k array) and the association between WB and DNA methylation level was tested at 411,169 autosomal sites. Two sites (cg10845147, p = 1.51 * 10−8 and cg01940273, p = 2.34 * 10−8) reached genome-wide significance following Bonferonni correction. Four more sites (cg03329539, p = 2.76* 10−7; cg09716613, p = 3.23 * 10−7; cg04387347, p = 3.95 * 10−7; and cg02290168, p = 5.23 * 10−7) were considered to be genome-wide significant when applying the widely used criterion of a FDR q value < 0.05. Gene ontology (GO) analysis highlighted enrichment of several central nervous system categories among higher-ranking methylation sites. Overall, these results provide a first insight into the epigenetic mechanisms associated with WB and lay the foundations for future work aiming to unravel the biological mechanisms underlying a complex trait like WB.

Emergency physicians are leaders in the ‘‘free open-access meducation’’ (FOAM) movement. The mandate of FOAM is to create open-access education and knowledge translation resources for trainees and practicing physicians (e.g., blogs, podcasts, and vodcasts). Critics of FOAM have suggested that because such resources can be easily published online without quality control mechanisms, unreviewed FOAM resources may be erroneous or biased. We present a new initiative to incorporate open, expert, peer review into an established academic medical blog. Experts provided either pre- or postpublication reviews that were visible to blog readers. This article outlines the details of this initiative and discusses the potentially transformative impact of this educational innovation.

The minimum roman dominating problem (denoted by γR(G), the weight of minimum roman dominating function of graph G) is a variant of the very well known minimum dominating set problem (denoted by γ(G), the cardinality of minimum dominating set of graph G). Both problems remain NP-Complete when restricted to P5-free graph class [A.A. Bertossi, Inf. Process. Lett. 19 (1984) 37–40; E.J. Cockayne, et al. Discret. Math. 278 (2004) 11–22]. In this paper we study both problems restricted to some subclasses of P5-free graphs. We describe robust algorithms that solve both problems restricted to (P5,(s,t)-net)-free graphs in polynomial time. This result generalizes previous works for both problems, and improves existing algorithms when restricted to certain families such as (P5,bull)-free graphs. It turns out that the same approach also serves to solve problems for general graphs in polynomial time whenever γ(G) and γR(G) are fixed (more efficiently than naive algorithms). Moreover, the algorithms described are extremely simple which makes them useful for practical purposes, and as we show in the last section it allows to simplify algorithms for significant classes such as cographs.

Several Gigantopithecus faunas associated with taxonomically undetermined hominoid fossils and/or stone artifacts are known from southern China. These faunas are particularly important for the study of the evolution of humans and other mammals in Asia. However, the geochronology of the Gigantopithecus faunas remains uncertain. In order to solve this problem, a program of geochronological studies of Gigantopithecus faunas in Guangxi Province was recently initiated. Chuifeng Cave is the first studied site, which yielded 92 Gigantopithecus blacki teeth associated with numerous other mammalian fossils. We carried out combined ESR/U-series dating of fossil teeth and sediment paleomagnetic studies. Our ESR results suggest that the lower layers at this cave can be dated to 1.92 ± 0.14 Ma and the upper layers can be dated to older than 1.38 ± 0.17 Ma. Correlation of the recognized magnetozones to the geomagnetic polarity timescale was achieved by combining magnetostratigraphic, biostratigraphic and ESR data. The combined chronologies establish an Olduvai subchron (1.945–1.778 Ma) for the lowermost Chuifeng Cave sediments. We also analyzed the enamel δ13C values of the Gigantopithecus faunas. Our results show that southern China was dominated by C3 plants during the early Pleistocene and that the Gigantopithecus faunas lived in a woodland-forest ecosystem.

This study aims to explore the impact of different captions on second language (L2) learning in a computer-assisted multimedia context. A quasi-experimental design was adopted, and a total of thirty-two eighth graders selected from a junior high school joined the study. They were systematically assigned into four groups based on their proficiency in English; these groups were shown animations with English narration and one of the following types of caption: no captions (M1), Chinese captions (M2), English captions (M3), and Chinese plus English captions (M4). A multimedia English learning program was conducted; the learning content involved two scientific articles presented on a computer. To track the learning process, data on oral repetition were collected after each sentence or scene was played. A post-test evaluation and a semi-structured interview were conducted immediately after viewing. The results show that the effect of different captions in multimedia L2 learning with respect to vocabulary acquisition and reading comprehension depend on students’ L2 proficiency. With English and Chinese + English captions, learners with low proficiency performed better in learning English relative to those who did not have such captions. Students relied on graphics and animation as an important tool for understanding English sentences.

Probability Density Function (PDF) is often selected to couple chemistry with turbulence for complex reactive flows since complex reactions can be treated without modeling assumptions. This paper describes an investigation into the use of the particles approximation of this transport equation approach applied to Homogeneous Charge Compression Ignition (HCCI) combustion. The model used here is an IEM (Interaction by Exchange with the Mean) model to describe the micromixing. Therefore, the fluid within the combustion chamber is represented by a number of computational particles. Each particle evolves function of the rate of change due to the chemical reaction term and the mixing term. The chemical reaction term is calculated using a reduced mechanism of n-heptane oxidation with 25 species and 25 reactions developed previously. The parametric study with a variation of the number of particles from 50 up to 104 has been investigated for three initial distributions. The numerical experiments have shown that the hat distribution is not appropriate and the normal and lognormal distributions give the same trends. As expected when the number of particles increases for homogenous mixture (i.e. high turbulence intensity), the in-cylinder pressure evolution tends towards the homogeneous curve. For both homogeneous and inhomogeneous (i.e. low turbulence intensity) cases, we have found that 200 particles are sufficient to model correctly the system, with a CPU time of a few minutes when a restriction of initial distribution is adopted.

Two dimensional Er3+-TeO2 thin film photonics crystals (PhCs) are fabricated. These PhCs demonstrate broadband enhancement of PL emission at near Infrared (NIR). The PhC structures are written by dual beam focused ion beam (FIB). Highly uniformed patterns with smooth surfaces are observed. A pattern resolution better than hundred nanometers is achieved. PhCs arrays with photonic lattice constants from 350 nm to 1700 nm are examined in order to optimize the PL extraction efficiency. Strong photoluminescence around 1530 nm is observed by 488-532 nm lasers pumping. A confocal microscopy with spectrometer is used to capture the broadband PL signals from individual PhC array.

The emission enhancement factor and spectral dependent extraction ratio are analyzed to find the interaction between PL lightwave and PhC structures. By optimize the PhC structures, 1500 um-1560 um broadband PL is successfully converted between the PL emission layer and the external cavity. A 60 % enhancement of surface extraction efficiency is achieved when PhC with periodicity a=800 nm is applied. When photonic lattice constants a are smaller than the critical periodicity 600 nm, the PL light becomes confined inside the thin film layer. Simulation is also performed by two dimensional finite difference time domain (FDTD) calculation in order to explain the experimental observed anisotropic PL enhancements.

The broadband PL enhancement enables Er3+-TeO2 PhCs thin film as a potential light source for three dimensional integrated photonic circuits.

While health warnings are present on cigarette packs around the world, the nature of the warnings varies considerably between countries. In the United States, a small text warning citing the dangers of cigarette smoking is found on the side of all packs. This pilot study sought to determine whether graphic cigarette warning images, like those found in the United Kingdom and Canada, were better at decreasing cravings to smoke than existing text warnings found on cigarette packs in the United States. Twenty-five smokers seeking treatment to quit at a specialty tobacco treatment program were administered the Brief Questionnaire of Smoking Urges (QSU — BRIEF), a validated measure of craving, prior to and following exposure to cigarette pack warning images. The graphic cigarette warning images reduced cravings to smoke (6.20 point decrease) more than neutral images (3.36 point decrease) and current text warnings used in the United States (5.75 point decrease), although this difference was not statistically significant. Based on these pilot data, a larger study could further examine the effectiveness of graphic warning images and whether such warnings hold an advantage over the currently used text warnings.