With an annual growth in travel demand of about 5% globally, managing the environmental impact is a challenge. In 2019, the International Civil Aviation Organisation (ICAO) issued emission reduction targets, including well-to-wake greenhouse gas (GHG) emissions reduced at least 50% from 2005 levels by 2050. This discusses several technologies from an aircraft design perspective that can contribute to achieving these targets. One thing is certain: aircraft will look different in the future. The Transonic Truss-Braced Wing and Flying V configurations are promising significant efficiency improvements over conventional configurations. Electric propulsion, in various architectures, is becoming a feasible option for general aviation and commuter aircraft. It will be a growing field of aviation with zero-emissions flight and opportunities for special missions. Lastly, this paper discusses methods and design processes that include all relevant disciplines to ensure that the aircraft is optimised as a complete system. While empirical methods are essential for initial design, Multidisciplinary Design Optimisation (MDO) incorporates models and simulations integrated in an optimisation environment to capture critical trade-offs. Concurrent design places domain experts in one site to facilitate collaboration, interaction, and joint decision-making, and to ensure all disciplines are equally considered. It is supported by a Collaborative Design Facility (CDF), an information technology facility with connected hardware and software tools for design analysis.

Noonan syndrome is a genetic disorder characteried by short stature, typical facial features, developmental delay, and CHD. In this single-centre retrospective study, we analysed typical Noonan syndrome-related electrocardiographic features in 95 patients with clinically and molecularly confirmed Noonan syndrome. Typical Noonan syndrome-related electrocardiographic features are left axis deviation, small left precordial R-waves, large right precordial S-waves, abnormal Q-wave, and abnormal wide QRS complex. In this representative cohort, CHD was found in 59 patients (62.1%) and typical Noonan syndrome-related electrographic features in 60 patients (63.2%). The typical Noonan syndrome-related electrographic features were also increased over baseline in patients without CHD (41.7%). Of all 95 patients, left axis deviation was seen in 46.3%, small left precordial R-waves in 30.5%, large right precordial S-waves in 5.3%, and abnormal Q-wave and wide QRS complex in 2.1%. There was no significant difference in the frequency of the individual-specific electrographic features between the group with CHD and the group without CHD. However, there were significantly more patients with a small left precordial R-wave in the subgroup with pulmonary stenosis compared to patients without pulmonary stenosis. Conclusion: Specific Noonan syndrome-related electrographic features are frequently present in patients with Noonan syndrome, also in the absence of CHD. These results suggest that there may be a continuum of cardiac anomalies from overt CHD to milder abnormalities that are only seen on electrocardiogram.

Background: In the Erasmus MC University Medical Center, Rotterdam, the Netherlands, patients considered at risk for carrying highly resistant microorganisms (HRMO) are placed in isolation on admission, until tested negative for HRMO (ie, targeted screening). Patients without risk factors are not routinely screened (ie, nontargeted screening). However, nontargeted screening could identify patients colonized with HRMO missed by targeted screening. To determine the additional value of nontargeted screening, we compared the outcomes of the nontargeted screening approach with all available clinical cultures. Objective: We aim to identify patients colonized with HRMO, but missed by targeted screening, and to determine whether non-targeted screening has additional value. Methods: For the MOVE study, nontargeted admission and discharge cultures (nose and perianal) were obtained from randomly selected patients admitted to specific wards, regardless of HRMO risk factors. This study was part of a research initiative to identify the relation of a contaminated environment with the risk of becoming infected or colonized on a patient level. All bacteriological clinical samples positive for at least 1 HRMO from January 1, 2018, until August 31, 2019, were compared with the nontargeted screening samples. Samples were screened for methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) as well as highly resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecium, and Enterobacteriales. Broth enrichment was used for all cultures. Results: During the study period, 50,653 patients were admitted. 706 patients (1%) had a clinical sample positive for at least 1 HRMO during their hospital stay. 936 (1.8%) patients were included in the nontargeted screening for the MOVE study, and 40 patients were found to have at least 1 culture positive for HRMO (4.3%). Among these 40 patients, 28 were positive at admission and 12 were positive at discharge. Extended-spectrum β-lactamase (ESBL)–producing Enterobacteriales were most prevalent (n = 36, 90.0%) both at admission and discharge (n = 26 and n = 10, respectively). At admission, 1 patient was identified with MRSA and 1 patient was positive for vancomycin-resistant E. faecium (VRE). At discharge, 1 patient was identified with VRE and 1 had Verona Integron-encoded Metallo-β-lactamase (VIM)–positive P. aeruginosa. Conclusions: Our results show that the current targeted screening does not identify all HRMO carriers. Furthermore, patients who acquire an HRMO during admission are missed. The nontargeted screening identified 40 unknown carriers (4.3%). The limitations of the study are the restricted number of sample sites and the fact that we were unable to culture all patients. Therefore, it is likely that our study shows an underestimation of the true number of patients with HRMO.

Funding: None

Disclosures: None

Background: Studies have shown that patients colonized with highly resistant microorganisms (HRMO) contaminate the hospital environment, and that transmission from contaminated environments to patients occurs. In May 2018, the Erasmus MC University Medical Center, Rotterdam, moved from a hospital with mostly multiple-occupancy rooms to a new hospital with 100% single-patient rooms with private bathrooms. This move provided the unique opportunity to determine environmental contamination before the new hospital was open for admissions and thereafter and to compare the environmental contamination to the number of patients colonized with HRMO. Method: Environmental sampling took place twice in the old building and 12 times in the new building, from 2 weeks before to 15 months after relocating patients. At each moment, ~306 samples were taken from 13 locations (eg, nightstands, sinks) in 40 patient rooms. Samples were screened for Staphylococcus aureus (methicillin-susceptible [MSSA] and methicillin resistant [MRSA]) and highly resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecium, and Enterobacteriales. During the study period, January 1, 2018, until August 31, 2019, all clinical samples positive for HRMO were included. Results: Environmental sampling revealed that 29 of 724 (4.0%) locations were positive for HRMO in the old building, whereas 4 of 3,358 (0.1%) samples in the new building were positive for HRMO (P < .001). In the old building, 14 of 29 locations were positive for extended-spectrum β-lactamase (ESBL)–producing bacteria and 15 were positive for carbapenemase-producing bacteria. In the new building, 3 of 4 positive samples were positive for vancomycin-resistant E. faecium (VRE), 1 was positive for ESBL-producing K. pneumoniae. For both HRMO, no carriers were detected. In the old building, 145 of 12,256 adult patients (1.2%) had clinical samples positive for HRMO, compared to 561 of 38,397 (1.5%) in the new building, a small but significant increase (P = .02). Conclusions: The transition from mainly 2- and 4-person rooms to 100% single-patient rooms resulted in a significant decrease in environmental contamination, even though the number of patients colonized with HRMO slightly increased. No molecular typing to determine transfer from environment to patients and vice versa has yet been performed. Future sampling is needed to determine whether the low environmental contamination is a long-term effect of the transition to single rooms.

Funding: None

Disclosures: None

Background: Isolation precautions are recommended when caring for patients identified with highly resistant microorganisms (HRMOs). However, the direct costs of isolating patients are largely unknown. Therefore, we aimed to obtain detailed information on the daily direct costs associated with isolating patients identified with HRMO. Methods: This study was performed from November until December 2017 on a 12-bed surgical ward. This ward contained solely isolation rooms with an anteroom. The daily direct costs of isolation were based on three cost items: (1) additional personal protective equipment (PPE); measured by counting the consumption of empty packaging materials, (2) cleaning and disinfection of the isolation room; based on the costs of an outsourced cleaning company, and (3) additional workload for healthcare workers; based on literature and multiplied by the average gross hourly salary of nurses. A distinction was made between the costs for strict isolation, contact-plus isolation, and contact isolation. Results: During the study period, 26 patients were nursed in isolation because of HRMO carriage, resulting in a total of 304 isolation days (median 7 isolation days; range 1-44). Gloves were consumed the most and hair caps the least. The average daily direct costs of isolation were the least expensive for contact isolation, €28/$31, and the most expensive for strict isolation, €41/$47. Conclusions: By using a novel, easy method to estimate consumption of PPE, we conclude that the daily direct costs of isolating a patient, differs per type of isolation. Insight into the direct costs of isolation is of utmost importance when developing or revising policies.

Funding: None

Disclosures: None

Co-ingestion of almonds with carbohydrate prevents excessive increase in plasma glucose level (PGL), but information about the functional fraction is limited. Identifying the functional fraction is necessary to use almonds more efficiently in terms of controlling postprandial glycaemia after a high-carbohydrate meal. In the present study, we evaluated the effects of almond skin, oil, water-soluble fraction and water-insoluble fraction on both postprandial glycaemia and insulinaemia. The effect of almond skin was tested by comparing the effect of whole almonds with the effect of skinless almonds. Male ICR mice were administered dextrin and 4 g/kg body weight test samples. After the administration, 2-h postprandial changes in glycaemia and insulinaemia were measured. Oil was the only fraction being able to blunt postprandial glycaemia. Interestingly, when co-ingesting with dextrin, almond oil did not change the insulin level compared with the control but whole almonds or skinless almonds triggered a 4-fold increase in insulin level. The co-ingestion of whole almonds or skinless almonds similarly suppressed the PGL at 15 and 30 min (P < 0·05), which means almond skin has no effect on postprandial glycaemia. Neither soluble nor insoluble fractions lead to any significant changes in postprandial glycaemia and insulinaemia. In conclusion, oil is the main functional component accounting for the glycaemia-lowering effect without altering insulin level.

The incidence of rabies in livestock is an important factor for estimating the economic impact of the disease, but obtaining reliable data is hindered by inadequate surveillance. In order to understand the contribution of livestock rabies to the overall burden of disease, the rabies incidence in cattle was investigated in detail for Turkey between 2008 and 2011. Data were compiled on cattle numbers, samples submitted for rabies diagnosis, vaccinated animals and positive rabies cases in animals for seven regions in Turkey. Rabies incidence in cattle fluctuated annually and differed between regions from 0·10 to 3·87 cases/100 000 animals. The positive influence of compensation schemes was observed. Livestock losses were conservatively estimated at around $250 000 international dollars per annum, although in areas where compensation schemes are not operating this could be an underestimate of the economic burden. Vaccination of cattle remains an option for disease prevention, although oral rabies vaccination through aerially distributed baits should be implemented to prevent the further spread of fox-mediated rabies, which could result in much greater economic costs.

We reviewed photographic images of fishes from depths of 381–2282 m in Marguerite Bay and 405–2007 m in the Amundsen Sea. Marguerite Bay fishes were 33% notothenioids and 67% non-notothenioids. Channichthyids (47%) and nototheniids (44%) were the most abundant notothenioids. The deep-living channichthyid Chionobathyscus dewitti (74%) and the nototheniid genus Trematomus (66%) were the most abundant taxa within these two families. The most abundant non-notothenioids were the macrourid Macrourus whitsoni (72%) and zoarcids (18%). Amundsen Sea fishes were 87% notothenioids and 13% non-notothenioids, the latter exclusively Macrourus whitsoni. Bathydraconids (38%) and artedidraconids (30%) were the most abundant notothenioids. We observed that Macrourus whitsoni was benthopelagic and benthic and infested by large ectoparasitic copepods. Juvenile (42 cm) Dissostichus mawsoni was not neutrally buoyant and resided on the substrate at 1277 m. Lepidonotothen squamifrons was seen near and on nests of eggs in early December. A Pogonophryne sp. from 2127 m was not a member of the deep-living unspotted P. albipinna group. Chionobathyscus dewitti inhabited the water column as well as the substrate. The pelagic zoarcid Melanostigma gelatinosum was documented in the water column a few metres above the substrate. The zoogeographic character of the Marguerite Bay fauna was West Antarctic or low-Antarctic and the Amundsen Sea was East Antarctic or high-Antarctic.