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Life is a cycle as Keats’ poem beautifully illustrates.1 We progress through the seasons of life as we do with our professional lives, intertwining with our more private lives and our personal development. Shakespeare wrote about the seven ages of man  in As You Like It in the famous speech of Jacques when he compares the world to a stage and roles that we occupy as we pass through life. The psychoanalyst Eric Erikson developed his theory of the stages of psychosocial development  where we experience conflicts at each stage of development that need to be negotiated to feel a sense of mastery and develop a strong sense of self.
Here we present stringent low-frequency (185 MHz) limits on coherent radio emission associated with a short-duration gamma-ray burst (SGRB). Our observations of the short gamma-ray burst (GRB) 180805A were taken with the upgraded Murchison Widefield Array (MWA) rapid-response system, which triggered within 20s of receiving the transient alert from the Swift Burst Alert Telescope, corresponding to 83.7 s post-burst. The SGRB was observed for a total of 30 min, resulting in a
persistent flux density upper limit of 40.2 mJy beam–1. Transient searches were conducted at the Swift position of this GRB on 0.5 s, 5 s, 30 s and 2 min timescales, resulting in
limits of 570–1 830, 270–630, 200–420, and 100–200 mJy beam–1, respectively. We also performed a dedispersion search for prompt signals at the position of the SGRB with a temporal and spectral resolution of 0.5 s and 1.28 MHz, respectively, resulting in a
fluence upper-limit range from 570 Jy ms at DM
pc cm–3 (
) to 1 750 Jy ms at DM
pc cm–3 (
, corresponding to the known redshift range of SGRBs. We compare the fluence prompt emission limit and the persistent upper limit to SGRB coherent emission models assuming the merger resulted in a stable magnetar remnant. Our observations were not sensitive enough to detect prompt emission associated with the alignment of magnetic fields of a binary neutron star just prior to the merger, from the interaction between the relativistic jet and the interstellar medium (ISM) or persistent pulsar-like emission from the spin-down of the magnetar. However, in the case of a more powerful SGRB (a gamma-ray fluence an order of magnitude higher than GRB 180805A and/or a brighter X-ray counterpart), our MWA observations may be sensitive enough to detect coherent radio emission from the jet-ISM interaction and/or the magnetar remnant. Finally, we demonstrate that of all current low- frequency radio telescopes, only the MWA has the sensitivity and response times capable of probing prompt emission models associated with the initial SGRB merger event.
Hepatitis C virus (HCV) is an important cause of viral hepatitis in children and the actual number of infected children is clearly underestimated. HCV infection across the pediatric age spectrum differs from perinatal acquisition to infection acquired later in life; the modes of transmission, rates of spontaneous clearance or progression of fibrosis, the potential duration of chronic infection when acquired at birth, and, significantly, available treatment options also vary . The discovery of HCV using molecular cloning techniques in 1989 led directly to an initial reduction in the number of acute HCV infections, and to the establishment of detection and treatment strategies. Mirroring the IV drug abuse epidemic, there has been a significant increase in reported HCV infections across all age groups over the last decade.
The aim of this study was to provide insights learned from disaster research response (DR2) efforts following Hurricane Harvey in 2017 to launch DR2 activities following the Intercontinental Terminals Company (ITC) fire in Deer Park, Texas, in 2019.
A multidisciplinary group of academic, community, and government partners launched a myriad of DR2 activities.
The DR2 response to Hurricane Harvey focused on enhancing environmental health literacy around clean-up efforts, measuring environmental contaminants in soil and water in impacted neighborhoods, and launching studies to evaluate the health impact of the disaster. The lessons learned after Harvey enabled rapid DR2 activities following the ITC fire, including air monitoring and administering surveys and in-depth interviews with affected residents.
Embedding DR2 activities at academic institutions can enable rapid deployment of lessons learned from one disaster to enhance the response to subsequent disasters, even when those disasters are different. Our experience demonstrates the importance of academic institutions working with governmental and community partners to support timely disaster response efforts. Efforts enabled by such experience include providing health and safety training and consistent and reliable messaging, collecting time-sensitive and critical data in the wake of the event, and launching research to understand health impacts and improve resiliency.
Fundamental knowledge about the processes that control the functioning of the biophysical workings of ecosystems has expanded exponentially since the late 1960s. Scientists, then, had only primitive knowledge about C, N, P, S, and H2O cycles; plant, animal, and soil microbial interactions and dynamics; and land, atmosphere, and water interactions. With the advent of systems ecology paradigm (SEP) and the explosion of technologies supporting field and laboratory research, scientists throughout the world were able to assemble the knowledge base known today as ecosystem science. This chapter describes, through the eyes of scientists associated with the Natural Resource Ecology Laboratory (NREL) at Colorado State University (CSU), the evolution of the SEP in discovering how biophysical systems at small scales (ecological sites, landscapes) function as systems. The NREL and CSU are epicenters of the development of ecosystem science. Later, that knowledge, including humans as components of ecosystems, has been applied to small regions, regions, and the globe. Many research results that have formed the foundation for ecosystem science and management of natural resources, terrestrial environments, and its waters are described in this chapter. Throughout are direct and implicit references to the vital collaborations with the global network of ecosystem scientists.
The abundance and prevalence of dry-surface biofilms (DSBs) in hospitals constitute an emerging problem, yet studies rarely report the cleaning and disinfection efficacy against DSBs. Here, the combined impact of treatments on viability, transferability, and recovery of bacteria from DSBs has been investigated for the first time.
Staphylococcus aureus DSBs were produced in alternating 48-hour wet–dry cycles for 12 days on AISI 430 stainless steel discs. The efficacy of 11 commercially available disinfectants, 4 detergents, and 2 contactless interventions were tested using a modified standardized product test. Reduction in viability, direct transferability, cross transmission (via glove intermediate), and DSB recovery after treatment were measured.
Of 11 disinfectants, 9 were effective in killing and removing bacteria from S. aureus DSBs with >4 log10 reduction. Only 2 disinfectants, sodium dichloroisocyanurate 1,000 ppm and peracetic acid 3,500 ppm, were able to lower both direct and cross transmission of bacteria (<2 compression contacts positive for bacterial growth). Of 11 disinfectants, 8 could not prevent DSB recovery for >2 days. Treatments not involving mechanical action (vaporized hydrogen peroxide and cold atmospheric plasma) were ineffective, producing <1 log10 reduction in viability, DSB regrowth within 1 day, and 100% transferability of DSB after treatment.
Reduction in bacterial viability alone does not determine product performance against biofilm and might give a false sense of security to consumers, manufacturers and regulators. The ability to prevent bacterial transfer and biofilm recovery after treatment requires a better understanding of the effectiveness of biocidal products.
Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.
We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.
Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).
Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.
ABSTRACT IMPACT: Our may suggest that delta hsTrop could be of prognostic value in patients with sepsis. OBJECTIVES/GOALS: - METHODS/STUDY POPULATION: We analyzed data of those presenting to the ED over an 18-month period with sepsis and at least one episode of hypotension after 1 liter of IV fluids. We performed a retrospective analysis using a cohort derived from modified inclusion and exclusion criteria from the CLOVERS study. The outcomes of patients found to have a delta (at least 6 pg/dL) in high sensitivity troponin T were compared to patients who did not have a delta or have a troponin level measured. We examined demographic and treatment characteristics of this cohort and the incidence of adverse outcomes were determined. We used multivariable logistic regression analysis to test the association of hsTrop and mortality. RESULTS/ANTICIPATED RESULTS: 778 patients met criteria to be included in the cohort. 279 patients had a change in high sensitivity troponins, an incidence of 35.9%. Patients with a delta were more likely to be older, male, and have a higher Charlson index than patients without a delta or those that had no troponin measured. They were also more likely to have a history of chronic lung disease, heart failure and hypertension. Change in high sensitivity troponins were associated with higher in-hospital mortality. When adjusted for age, gender, and Charlson Index, the association between a positive delta troponin and mortality remained statistically significant. DISCUSSION/SIGNIFICANCE OF FINDINGS: In patients with severe sepsis and septic shock, the presence of a positive or negative delta hsTrop at 2 hours is associated with increased mortality. Measurement of high sensitivity troponin early in the patient’s hospital course may have prognostic utility.
Among 353 healthcare personnel in a longitudinal cohort in 4 hospitals in Atlanta, Georgia (May–June 2020), 23 (6.5%) had severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. Spending >50% of a typical shift at the bedside (OR, 3.4; 95% CI, 1.2–10.5) and black race (OR, 8.4; 95% CI, 2.7–27.4) were associated with SARS-CoV-2 seropositivity.
The devastating impact of Franz Schubert’s Winterreise arises from our identification with its primary persona. We walk with the wanderer, privy to his thoughts, and imagine ourselves in his shoes, psychologically associating ourselves with the authorial creation. Schubert’s Die schöne Müllerin also inspires identification, but our rapport with its central character gradually grows tenuous. We witness the journeyman’s enthusiasm, but become troubled by his choices and perceptions, wondering why common sense or rationality doesn’t intervene. Both cycles set Wilhelm Müller’s poetry, feature rejected unfortunates, and address mortality. Yet we regard and respond to their focal figures differently. Die schöne Müllerin solicits sympathy for its greenhorn, encouraging us to understand his feelings and regret his unhappiness.
Why did Britain withdraw from its military bases in the Arabian Peninsula and Southeast Asia midway through the Cold War? Existing accounts tend to focus on Britain's weak economic position, as well as the domestic political incentives of retrenchment for the ruling Labour Party. This article offers an alternative explanation: the strategic rationale for retaining a permanent presence East of Suez dissolved during the 1960s, as policymakers realised that these military bases were consuming more security than they could generate. These findings have resonance for British officials charting a return East of Suez today under the banner of ‘Global Britain’.
The vacuum-exhausted isolation locker (VEIL) provides a safety barrier during the care of COVID-19 patients. The VEIL is a 175-L enclosure with exhaust ports to continuously extract air through viral particle filters connected to hospital suction. Our experiments show that the VEIL contains and exhausts exhaled aerosols and droplets.
Although Ainslie dismisses the hot/cool framework as pertaining only to suppression, it actually also has interesting implications for resolve. Resolve focally involves access to our future selves. This access is a cool system function linked to episodic memory. Thus, factors negatively affecting the cool system, such as stress, are predicted to impact two seemingly unrelated capabilities: willpower and episodic memory.
In this article I press four different objections on Forst’s theory of the ‘Right to Justification’. These are (i) that the principle of justification is not well-formulated; (ii) that ‘reasonableness and reciprocity’, as these notions are used by Rawls, are not apt to support a Kantian conception of morality; (iii) that the principle of justification, as Forst understands it, gives an inadequate account of what makes actions wrong; and (iv) that, in spite of his protestations to the contrary, Forst’s account veers towards a version of moral realism that is prima facie incompatible with Kantian constructivism. I then evaluate Forst’s theory in the light of a distinction made by Sharon Street between restricted and unrestricted constructivism. I show that Forst has reason to deny that it is either the one or the other, but he is not able to show that it is both or neither. I conclude that the arguments Forst advances in support of his constructivist theory of the right to justification entail that it is a metaphysical and comprehensive conception in the relevant, Rawlsian sense. Forst’s theory of the right to justification therefore fails to fulfil one of the main stated aims.
Background: The NHSN methods for central-line–associated bloodstream infection (CLABSI) surveillance do not account for additive CLABSI risk of concurrent central lines. Past studies were small and modestly risk adjusted but quantified the risk to be ~2-fold. If the attributable risk is this high, facilities that serve high-acuity patients with medically indicated concurrent central-line use may disproportionally incur CMS payment penalties for having high CLABSI rates. We aimed to build evidence through analysis using improved risk adjustment of a multihospital CLABSI experience to influence NHSN CLABSI protocols to account for risks attributed to concurrent central lines. Methods: In a retrospective cohort of adult patients at 4 hospitals (range, 110–733 beds) from 2012 to 2017, we linked central-line data to patient encounter data (age, comorbidities, total parenteral nutrition, chemotherapy, CLABSI). Analysis was limited to patients with >2 central-line days, with either a single central line or concurrence of no more than 2 central lines where insertion and removal dates overlapped by >1 day. Propensity-score matching for likelihood of concurrence and conditional logistic regression modeling estimated the risk of CLABSI attributed to concurrence of >1 day. To evaluate in Cox proportional hazards regression of time to CLABSIs, we also analyzed patients as unique central-line episodes: low risk (ie, ports, dialysis central lines, or PICC) or high risk (ie, temporary or nontunneled) and single versus concurrent. Results: In total, 64,575 central lines were used in 50,254 encounters. Among these patients, 517 developed a CLABSI; 438 (85%) with a single central line and 74 (15%) with concurrence. Moreover, 4,657 (9%) patients had concurrence (range, 6%–14% by hospital); of these, 74 (2%) had CLABSI, compared to 71 of 7,864 propensity-matched controls (1%). Concurrence patients had a median of 17 NHSN central-line days and 21 total central-line days. In multivariate modeling, patients with more concurrence (>2 of 3 of concurrent central-line days) had an higher risk for CLABSI (adjusted risk ratio, 1.62; 95% CI, 1.1–2.3) compared to controls. In survival analysis, 14,610 concurrent central-line episodes were compared to 31,126 single low-risk central-line episodes; adjusting for comorbidity, total parenteral nutrition, and chemotherapy, the daily excess risk of CLABSI attributable to the concurrent central line was ~80% (hazard ratio 1.78 for 2 high-risk or 2 low-risk central lines; hazard ratio 1.80 for a mix of high- and low-risk central lines) (Fig. 1). Notably, the hazard ratio attributed to a single high-risk line compared to a low-risk line was 1.44 (95% CI, 1.13–1.84). Conclusions: Since a concurrent central line nearly doubles the risk for CLABSI compared to a single low-risk line, the CDC should modify NHSN methodology to better account for this risk.
Disclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.
Background: Well-designed infection prevention programs include basic elements aimed at reducing the risk of transmission of infectious agents in healthcare settings. Although most acute-care facilities have robust infection prevention programs, data are sporadic and often lacking in other healthcare settings. Infection control assessment tools were developed by the CDC to assist health departments in assessing infection prevention preparedness across a wide spectrum of health care including acute care, long-term care, outpatient care, and hemodialysis. Methods: The North Carolina Division of Public Health collaborated with the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) to conduct a targeted number of on-site assessments for each healthcare setting. Three experienced infection preventionists recruited facilities, conducted on-site assessments, provided detailed assessment findings, and developed educational resources. Results: The goal of 250 assessments was exceeded, with 277 on-site assessments completed across 75% of North Carolina counties (Table 1). Compliance with key observations varied by domain and type of care setting (Table 2). Conclusions: Comprehensive on-site assessments of infection prevention programs are an effective way to identify gaps or breaches in infection prevention practices. Gaps identified in acute care primarily related to competency validation: however, gaps presenting a threat to patient safety (ie, reuse of single dose vials, noncompliance with sterilization and/or high-level disinfection processes) were identified in other care settings. Infection control assessment and response findings underscore the need for ongoing assessment, education, and collaboration among all healthcare settings.
Background: Current NHSN denominator reporting for central-line–associated bloodstream infection (CLABSI) counts each patient day with n central lines as 1 central-line day. The NHSN does not directly adjust for potential increased risk of CLABSI from concurrent central lines, but the current NHSN standardized infection ratio (SIR) methods may account for differences in concurrence by adjusting for location type. Objective: We examined differences in central-line concurrence by NHSN location type among CLABSI patients. Methods: In a retrospective cohort of adults with CLABSI at 4 hospitals from 2012 to 2017, we linked central-line data to encounter and CLABSI data. Central lines were considered concurrent if they overlapped for >1 day. We calculated proportion of patients with concurrence at both NHSN location and SIR group levels; risk ratios for concurrence between NHSN location types within each SIR group (ie,, locations defined by SIR models as equal “risk”) were determined. Results: In total, 930 CLABIs were identified from 19 NHSN-defined locations that map to 7 SIR groups. Most CLABSIs occurred in locations mapped to either of 2 SIR groups: wards (227, 16% concurrence) and ICUs (294, 33% concurrence). The ward group had 3 NHSN locations (median, 78 CLABSIs) with concurrence range 8% (medical-surgical ward) to 20% (surgical ward). The ICU group had 6 NHSN locations (median, 47.5 CLABSIs) and concurrence ranged from 20% (neurosurgical ICU) to 39% (medical ICU). Despite the noted variations, no risk ratio was statistically different within each SIR group (Table 1). Conclusions: In patients with CLABSIs, the frequency of concurrence varied up to 2-fold between location types within the current NHSN SIR groups, though not statistically significantly. Assessing whether this difference in magnitude persists in all patients with central lines is an important next step in refining risk adjustment methods to account for concurrent central-line use.
Disclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.
Background: Alcohol-based hand rubs (ABHRs) are the primary form of hand hygiene in healthcare settings globally. Many developed countries, and most US hospitals utilize wall-mounted ABHR dispensers throughout the facility. The adoption of automated touch-free dispensers is increasing. However, data on the efficacy of ABHRs when used at dispensed amounts are limited. The evidence is strong, showing that formulation matters (not just alcohol concentration) and that agent volume impacts efficacy. Objective: We evaluated the efficacy of ABHR foams on human hands using 2 controlled test methods at variable volumes (ie, typical doses and realistic volumes that healthcare personnel could use in patient care practice). Methods: We tested 8 commercially available ABHR products, the WHO hand-rub formulation, (P1–P9) and a nonantibacterial foam handwash control (P10) on human participants at 2 different application frequencies (“1 application” and “10 applications”) using 2 different ASTM test methods (E1174 and E2755). Studies using ASTM-E1174 evaluated 3 different application volumes (0.7 mL, 1.1 mL, and 2.0 mL) of the 10 products, each tested on 12–13 subjects. Studies using ASTM-E2755 evaluated a single 1.1 mL volume for the 9 ABHR products (P1–P9), each on 2–12 subjects. A linear mixed-effects model was fit separately to log reductions with random effects for subject and date, and a fixed effect for product. Results: Four different foam formulations (P1–P4) consistently outperformed all other formulations by the E1174 method, especially with increasing volumes and after 10 product applications (Fig. 1). When tested with E2755, all formulations performed similarly, with only P1 and P2 differentiating after 10 applications (Fig. 2). ABHR efficacy consistently increased with larger application volumes, whereas the handwash control (P10) achieved a similar efficacy (∼2 log reduction) at all volumes. Efficacy for some ABHR formulations increased, whereas others decreased with repeated applications. Alcohol concentration did not correlate with log reduction. Conclusions: Formulation and the product application volume affect the antimicrobial efficacy of ABHR; therefore, those data should be critically assessed by healthcare personnel assessing ABHR product performance. Test methods matter: when E1174 was used, greater differentiation between formulations was observed. This may be due to the larger contamination volume and greater soil load used in E1174.
Funding: GOJO Industries, Inc., provided Funding: for this study.
Disclosures: James W. Arbogast and David R. Macinga report salary from GOJO Industries.