Background: Wastewater surveillance has emerged as a powerful tool for monitoring community pathogen burden. However, its role in hospital infection prevention remains unclear. We evaluated hospital wastewater for detectable multidrug-resistant organisms (MDRO) at an academic tertiary-care center (AH) and a community hospital (CH). Methods: From April-September 2024, wastewater was collected longitudinally from an AH and a CH. Samples were collected from selective plumbing draining intensive care beds at both facilities. After a 24-hour collection, samples were processed using digital droplet PCR to detect and quantify resistance genes and pathogens, including blaCTX-M, blaTEM, blaCMY-2, blaSHV, IMP, VIM, OXA-48, KPC, NDM, and Candida auris. Results were reported as gene copies per swab. Concurrent hospital isolation logs were reviewed to identify unit isolation with corresponding MDROs at the time of sampling. Results: Wastewater from both hospitals consistently contained multiple MDRO genetic markers across all sampling periods (Figures 1-4). Extended-spectrum beta-lactamase (ESBL) genes blaCTX-M, blaTEM, and blaSHV were detected in every sample, often at high copy number. Carbapenemase (CRE) genes IMP, KPC, and VIM were frequently detected, whereas NDM and OXA-48 were present at low and variable levels. C. auris was rarely detected. Across both sites, quantitative gene copy numbers varied over time. AH demonstrated persistently high ESBL and CRE gene burdens with temporal surges (Figure 1-2), while CH showed lower and more episodic detection patterns (Figure 3-4). Isolation needs for ESBL and CRE at both hospitals are reported in Figures 1-4. Conclusion: Hospital wastewater harbors diverse MDRO genetic signatures that do not reliably track with isolation practices, reflecting contributions from both silent patient shedding and environmental sources. ESBL genes often remained high even when no patients required isolation, whereas carbapenemase surges frequently preceded increases in CRE isolation, suggesting wastewater may provide early warning of rising resistance pressure. Differences between hospitals likely reflect both patient populations and environmental persistence. Wastewater surveillance may complement infection prevention efforts but should not be interpreted as a direct surrogate for patient colonization. Figure 1. Temporal trends in ESBL-producing resistance genes in wastewater and isolation needs at an academic center Figure 2. Temporal trends in CRE-producing resistance genes in wastewater and isolation needs at an academic center Figure 3. Temporal trends in ESBL-producing resistance genes in wastewater and isolation needs at a community hospital Figure 4. Temporal trends in CRE-producing resistance genes in wastewater and isolation needs at a community hospital

Background: Community-acquired pneumonia (CAP), a heterogeneous clinical entity with a wide range of inciting pathogens, remains a significant cause of morbidity and mortality worldwide. The recent COVID-19 pandemic and subsequent shifts in clinical and diagnostic practices necessitate an updated understanding of the contemporary epidemiologic and etiologic landscape for non-COVID CAP. Method: This retrospective cohort study included adult patients hospitalized with CAP between January 1, 2017, and December 31, 2024, across 68 hospitals participating in the Michigan Hospital Medicine Safety consortium. Eligible patients included hospitalized adults with a pneumonia discharge code, symptoms and imaging consistent with pneumonia, and receipt of antibiotic treatment on hospital day 1 or 2. Patients admitted to intensive care, those with concomitant infections, positive SARS-CoV-2 tests, or severe immunosuppression were excluded. Diagnostic testing methods and the pathogens detected were reviewed and summarized by year. Result: A total of 62,340 patients were included. Mean age was 69.0 ±15.9 years, and 50.3% (31,359) were male. 94.0% (58,613) received a chest X-ray and 53.1% (33,084) received a CT, with use of CTs increasing over time. Microbiological evaluation was performed in 92.8% (57,820) of patients, with a median 4 [IQR 2-6] etiologic tests per patient. Blood cultures were the most common microbiologic test (74.7%; 46,566) with use slightly decreasing over the study period. In contrast, the use of molecular respiratory pathogen assays increased substantially from 28.2% in 2017 to 77.1% in 2024 (overall performed in 55.6%, 34,655). Over the entire study period, one or more pathogens were detected in 15.9% (9,915) of patients: 10.5% (6,515) had a bacterial pathogen, 6.3% (3,908) had a viral pathogen, and 0.8% (508) had both. The most common pathogens were Streptococcus pneumoniae (2.6%), influenza virus (2.6%), Pseudomonas aeruginosa (1.6%), and human rhinovirus (1.4%). Conclusion: The 2019 CAP guideline recommendations to limit traditional bacterial tests to severe CAP patients appear to have had minimal impact on diagnostic practices. Despite a substantial post-pandemic increase in molecular diagnostic use, pathogen detection rates remained low, revealing an etiology in only a minority of patients. These findings underscore the need for a reassessment of the diagnostic approach to optimize resource allocation and ensure high-value testing in hospitalized CAP patients.

Background: Deviations from expected relative humidity ranges in operating room (OR) sterile cores raise concern for compromise of sterile supply packaging and frequently result in large-scale disposal of supplies. Data guiding salvage versus discard decisions following humidity exposure are limited. Following two humidity events, we performed a two-experiment bench study to evaluate whether elevated ambient humidity or direct moisture exposure results in moisture penetration or microbial contamination of Tyvek-packaged sterile supplies. Methods: Experiment 1 evaluated direct moisture exposure by applying saturated compresses to package exteriors for 0.5, 1, 5, 30, or 60 minutes. Experiment 2 evaluated elevated ambient humidity by incubating packages at 37°C and 70% relative humidity without direct moisture contact. For Experiment 1, ambient temperature and relative humidity were continuously monitored, with humidity documented at swab timepoints (4, 8, 24, and 48 hours). For both experiments, moisture content of package exteriors and interiors was measured at baseline and serial timepoints up to 48 hours. Internal package surfaces were aseptically swabbed at each timepoint, plated onto general culture media, and incubated for 48 hours at 37°C. Negative controls without moisture or humidity exposure were included. Results: In Experiment 1, ten items were evaluated, including five exposed to direct compress application and five controls. External moisture content increased following compress exposure (range: 0.9–2.2) and decreased over time. Internal moisture content remained low across all samples, including controls (range: 0–1.4). No microbial growth was detected from any internal swab across all samples and timepoints (0/10 items; 0 CFU recovered). In Experiment 2, ten items were incubated under elevated ambient humidity. Occasional low-level external moisture readings were observed (maximum: 1.2), while internal moisture content remained 0 throughout the study period. All internal cultures were negative (0/10 items; 0 CFU recovered). Conclusion: Differences in absolute internal moisture measurements between experiments 1 and 2 reflect the use of a moisture meter reporting relative units influenced by ambient conditions and the fact that experiments were not conducted in parallel. Interpretations were therefore within experiments. Tyvek-packaged sterile supplies-maintained barrier integrity under both direct moisture exposure and sustained elevated ambient humidity, with no evidence of internal microbial contamination. These findings suggest that, in the absence of visible package compromise or internal condensation, salvage of Tyvek-packaged sterile supplies following humidity excursions may be reasonable. These findings provide bench-level evidence to support data-informed infection prevention decisions during OR humidity events and may help reduce unnecessary waste and operational disruption.

Despite the increasing adoption of technologies that generate, process, and analyze digital objects, the final stages of the data life cycle—archiving and preservation—remain insufficiently addressed across cultural heritage disciplines. The rapid inclusion of technologies such as Geographic Information Systems (GIS), photogrammetry, 3D scanning, and remote sensing in cultural heritage has exponentially increased the volume and types of data produced. However, many cultural heritage projects lack adequate long-term planning, infrastructure, and institutional support for the proper stewardship of digital objects, leading to significant risks of data degradation, obsolescence, or complete loss. The Digital Curation Crisis refers to a critical challenge in managing, preserving, and ensuring access to the vast and ever-growing body of digital objects generated within cultural heritage. This new type of crisis is occurring adjacent to the already recognized curation crisis, and it is in this line of thinking that we structure this article. We utilize readily recognized terms and concepts associated with physical archaeological curation to convey standardized definitions, benefits, and recommendations for data producers (i.e., museum professionals, historic preservationists, and archaeologists across different sectors) and data preservationists (i.e., curating individuals and institutions) needing guidance for actionable steps toward their own digital curation journey.

Background: vSNFs are known for exceedingly high MDRO prevalence, raising questions about the role of environmental contamination and persistence in this healthcare setting. Methods: Environmental sampling was conducted May-June 2025 in two vSNFs. High-touch objects in common areas (mobile/shower equipment, staff breakrooms, dining rooms, rehabilitation gyms) and resident rooms were swabbed using spongesicles, homogenized in trypticase soy broth, incubated 18-24 hours, and cultured for MRSA, VRE, ESBL, C. auris, CRAB, and CRE. On the same day, resident carriage of the same organisms was assessed at nares, hands, axilla/groin, and peri?rectal sites. All ventilator-capable (vBed) and non-vBed occupied beds were sampled except for one facility’s non-vBeds, which randomly sampled 50 beds due to size. The proportion of positive common area objects was compared with MDRO carriage prevalence using two-sample tests of proportions. Within resident rooms, object contamination was compared among carriers and non-carriers for each pathogen, overall and stratified by vBed status, using Fisher’s exact tests. Results: Sampling included 96 common area objects and 245 objects from 39 resident rooms (20 vBed, 19 non-vBed). MDRO contamination of high-touch objects in common areas was extensive (73.9%), including 77.8% of mobile equipment and 58.3% of common area objects (37.5% staff breakroom, 87.5% rehabilitation gym, 50.0% dining objects). The most frequently detected MDROs on objects were MRSA>CRAB>VRE>ESBL>C. auris>CRE, which differed from the sequence of MDRO carriage among residents: MRSA>ESBL>VRE>C. auris>CRAB>CRE. Object contamination and resident carriage were similar for MRSA (65.6% vs. 60.5%, p=0.43), VRE (19.8% vs. 23.3%, p=0.54), and CRE (1.0% vs. 4.1%, p=0.27). In contrast, contamination was markedly lower than carriage for ESBL (8.3% vs. 43.6%, p<0.001) and C. auris (3.1% vs. 25.6%, p<0.001), while CRAB contamination far exceeded carriage (21.9% vs. 11.0%, p=0.02) (Figure 1). Among bedrooms, all sampled rooms had some MDRO contamination, including all rooms of non-carriers. MRSA contamination was similar in the rooms of carriers and non-carriers; all other pathogens, contamination was substantially greater in rooms of carriers (Figure 2). Conclusions: The relationship between MDRO contamination and resident carriage in vSNFs showed clear pathogen?specific patterns. MRSA and VRE contamination closely mirrored resident carriage, whereas ESBL and C. auris were less frequent on surfaces despite high carriage. Notably, CRAB was disproportionately common in the environment, suggesting environmental persistence. Bedrooms of carriers had higher contamination, yet MDROs were also present in non-carrier rooms, contributing to ongoing transmission risk. Effective containment likely requires universal strategies supplemented by targeted, pathogen-specific efforts.

Background: Sinks in hospital patient rooms are potential reservoirs of hospital acquired infections (HAI) pathogens and outbreaks; sink colonization can occur in new buildings soon after patient occupancy and persist. To control this source, it is important to understand how occurrence and concentrations of organisms in sinks and drains change over time. This study longitudinally measures the occurrence and concentration of Acinetobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae in sinks and drains of new inpatient hospital rooms after patient occupancy. Methods Three inpatient units of a newly constructed cancer hospital were studied. Ten randomly selected rooms per unit were sampled biweekly for seven months for Acinetobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Surface samples were swabbed from a 4x4 cm section of the sink basin around the drain. Water was sampled from the p-trap via the drain. Results Approximately 400 sink and drain samples were taken. Acinetobacter was the most commonly detected organism, and Klebsiella the least. Based on the unit, 90-100% of sink and 50-90% of drain samples by the end of the study period had detectable Acinetobacter, 90-100% of sink and 50-80% of drain had Pseudomonas, and 0-10% of sink and 0-30% of drain had Klebsiella. In samples with detectable organisms, Acinetobacter concentrations ranged from 1.3-8 logCFU in sinks and 1.6-6.7 log CFU/mL in drains. Pseudomonas aeruginosa ranged from 2.8-7.4 log CFU in sinks and 2.2-6.1 log CFU/mL in drains, and Klebsiella from 2.6-4.5 logCFU in sinks and 1.6-4.9 logCFU/mL in drains. There was low to no correlation between occurrence of detectable bacteria in sink basin and drain water samples from the same room; median correlation estimates across ten rooms for the three units were -0.09 (-0.3; 0.46 95% CI), 0.21 (0.02; 0.67 95% CI) and 0.36 (-0.18; 0.52 95% CI) for Acinetobacter, 0.07 (-0.32; 0.45 95% CI), 0.09 (-0.32; 0.53 95% CI), and 0.18 (-0.21; 0.39 95% CI) for Pseudomonas and -0.25 (-0.3; -0.17 95% CI), 0.04 (-0.29; 0.55 95% CI), and 0.25 (-0.4; 0.54 95% CI) for Klebsiella. Conclusions Over 7 months, Acinetobacter and Pseudomonas aeruginosa were common in basins and drains of patient room sinks. Klebsiella was less common but still detected. Concentrations fluctuated over time but could reach levels up to 6-7 login the sink basin. These results suggest that sinks and drains in inpatient rooms are potentially a consistent source of HAI organisms in the hospital environment.

Background: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection in the United States. Diagnostic stewardship is a core element of reducing inappropriate CDI testing. Methods: In response to rising rates of hospital onset CDI (HO-CDI), our institution implemented a “hard-stop” clinical practice alert (OPA) in the Electronic Medical Record (EMR) in July 2024, shown in Figure 1. The OPA fired when a CDI test was ordered on patients hospitalized greater than 48 hours who had received laxatives within the previous 48 hours or who had a positive test within the previous 7 days and was active from 7AM-5PM Monday through Friday. OPA completion to order CDI testing required approval from either the Infection Prevention & Control Medical Directors (IPCMD) or a consulting Infectious Disease (ID) physician if patient was followed by ID. To facilitate communication, a dedicated “chat group” was created in the EMR instant messaging to specifically respond to a request for testing by the IPCMDs and a link to the chat was included in the OPA. EMR documentation of the approving IPCMD was required, and logs were regularly reviewed for compliance. Every HO-CDI case at our institution undergoes a multidisciplinary review with the staff and primary providers involved in the care of the patient at time of diagnosis to identify a “driver” for the case. Testing Stewardship, defined as inappropriate testing due to noncompliance with institutional CDI testing guidance, is one of the 5 drivers that can be assigned during this review process. Results: Over the 12.5 months following implementation the OPA was triggered 432 times on 214 unique patients with testing performed 79 times (0.18 tests per trigger). Twenty of 79 tests (25%) were positive for toxigenic C. difficile. In the 12 months prior to the OPA, there were 17 of 88 HO-CDI cases attributed to Testing Stewardship compared to 4 of 58 in the 12 months after the OPA (18/80 vs 4/58 by fiscal year). In the context of multiple interventions, NHSN-defined HO-CDI declined from 68 in FY 2023, 80 in FY 2024 to 58 in FY2025, corresponding to rates of 2.22, 3.13 and 1.7 per 10,000 patient days, respectively. Conclusion: A multicomponent OPA requiring approval for CDI testing for specific parameters was successfully implemented. This intervention contributed to improved diagnostic stewardship and reduction on HO-CDC cases Figure 1: C. difficile Hard Stop OPA example for patient with recent laxative administration

Background: central line–associated bloodstream infections (clabsis) remain a leading cause of preventable morbidity and mortality in hospitalized patients. although evidence-based guidelines for central venous catheter (cvc) insertion and maintenance are well established, variability in knowledge, procedural practice, and access to essential equipment persists across hospitals and clinical settings. Methods: between january 2019 and march 2020, a mobile classroom simulation-based training (sbt) program was implemented in 26 of 30 public acute-care hospitals in israel, representing a nationwide large-scale initiative. the program combined standardized curricula, hands-on simulation, and structured feedback for cvc insertion (physicians and nurses) and maintenance (nurses). for physicians undergoing cvc insertion training, the program also included a dedicated hands-on workshop focused on ultrasound-guided central venous catheter insertion. training sessions were video-recorded using a closed internal system, allowing participants to review their performance. each trainee completed two standardized simulation scenarios, enabling real-time feedback, iterative improvement, and experiential learning. of approximately 1,700 healthcare workers who participated in the program, 1,551 (91.2%) completed both pre- and post-training questionnaires. questionnaires assessed procedural knowledge, satisfaction, and availability of cvc-related equipment. knowledge outcomes were compared using paired t-tests, and associations between hospital characteristics, equipment availability, and knowledge improvement were evaluated using chi-square analyses. Result: knowledge scores improved significantly across all participant groups (p<0.001). mean knowledge gains were 18.6% for physician cvc insertion, 26.5% for nurse insertion, and 16.4% for nurse maintenance. the largest improvements were observed in sterile technique, minimal barrier precautions, and maintenance-related clinical decision-making. higher baseline knowledge was associated with icu settings, larger hospitals, and availability of full personal protective equipment (ppe) kits and disinfectant wipes (p<0.05). knowledge improvement was independently associated with refresher training, structured feedback during simulation, and access to full ppe kits, whereas hospital size and professional seniority were not consistently associated with learning gains. substantial variability in availability of essential cvc equipment was observed across departments. Conclusion: a nationally coordinated simulation-based training program significantly improved cvc insertion and maintenance knowledge among physicians and nurses across diverse hospital settings. structured feedback and reliable access to essential equipment emerged as key drivers of learning gains. these findings support simulation-based training as a scalable, policy-relevant strategy for strengthening clabsi prevention and standardizing practice at the national level, particularly in smaller hospitals and non-icu settings. background: central line–associated bloodstream infections (clabsis) remain a leading cause of preventable morbidity and mortality in hospitalized patients. although evidence-based guidelines for central venous catheter (cvc) insertion

Background Enhanced Barrier Precautions (EBP) aim to reduce multidrug-resistant organism transmission in long-term care settings. Infection preventionists play a critical role in implementing EBP, yet their experiences navigating operational challenges, staff adherence, and resident safety remain underexplored. Understanding these perspectives informs strategies for effective infection control and policy development. Methods A 42-item electronic survey was distributed via Qualtrics to 578 Florida nursing homes between May and September 2024, addressed to “Infection Control.” Ninety valid responses were received. Thirty-seven respondents provided 58 comments across seven prompts—six linked to specific survey questions and one to an open-ended prompt to share questions or thoughts about EBP. Comments were coded into nine categories and analyzed using MAXQDA Analytics Pro. Results The coding categories were: 1) Citation or Feedback, 2) Clarity and Scope of Criteria, 3) Cost and Resource Burden, 4) Effect on Infection Control Practice, 5) Effectiveness of EBP, 6) Resident Experience, 7) Staff Confusion, 8) Staffing, Workload, and Compliance, and 9) Support for EBP. Fourteen coded comments fell under Citation or Feedback, mostly related to corrective feedback or citations during F880 survey experiences, including, “Facility interpreted an action to be low contact and therefore not needing EBP while surveyor considered action to be high contact requiring full EBP”. Staffing, Workload, and Compliance had 13 coded comments, including six responses to a survey prompt asking about challenges in implementing EBP. One respondent wrote, “Non compliance in donning. No one wants to take the time to don when they are strapped for time.” Clarity and Scope of Criteria had ten coded comments, with four specifically mentioning wounds. One wrote, “I think that small skin tears should not be included into the EBP, so there is such a gray area on who should be on EBH [sic] and who doesn’t need to be. So maybe clarify skin tears.” Seven comments addressed Resident Experience, with mixed views on resident reactions. Cost and Resource Burden, Support for EBP, and Effectiveness of EBP each had four comments; Staff Confusion had two, and Effect on Infection Control Practices had one. Conclusions Infection preventionists reported significant challenges in implementing EBP, particularly staffing limitations, unclear criteria, and resource constraints. While many supported EBP’s intent, concerns about feasibility and resident impact persist. Addressing these barriers through clearer guidance, staff education, and resource allocation is essential for successful adoption and sustained infection control in long-term care settings.

Background: Respiratory viral infections cause substantial acute morbidity among older adults; however, their impact on short-term health-related quality of life (HRQoL) and functional recovery remains incompletely characterized. Methods: We conducted a prospective observational analysis among adults aged ?65 years enrolled in the U.S. Flu Vaccine Effectiveness Network. Multivariable linear regression was used to examine associations between respiratory virus test positivity (influenza, COVID-19, and respiratory syncytial virus [RSV]) and follow-up HRQoL. Outcomes included EQ-5D utility scores and self-rated health measured using a visual analog scale (VAS). Models adjusted for baseline HRQoL, demographics, household characteristics, and comorbidities. Bias-reduced CR2 cluster-robust standard errors were used to account for heteroskedasticity and within-site clustering. Multicollinearity was assessed using variance inflation factors, all of which were <2. EQ-5D coefficients were rescaled to a 0–100 metric to improve interpretability. Results: After multivariable adjustment, respiratory virus test positivity was not consistently associated with worse follow-up HRQoL. Influenza test positivity was not associated with follow-up EQ-5D scores (? = ?0.4 points on a 100-point EQ-5D scale, 95% CI ?12.5 to 11.6) and showed a positive but non-significant association with follow-up VAS scores (? = 5.9, 95% CI ?2.0 to 13.8). COVID-19 test positivity was associated with higher follow-up EQ-5D scores (? = 21.6, 95% CI 6.0–37.2), but not with follow-up VAS scores. RSV test positivity was not associated with follow-up EQ-5D (? = ?2.1, 95% CI ?16.6 to 12.4) or VAS scores (? = 13.6, 95% CI ?23.4 to 50.6). Across all EQ-5D models, baseline EQ-5D was the strongest predictor of follow-up EQ-5D. In contrast, baseline self-rated health demonstrated weaker and less consistent associations with follow-up VAS scores. Household and social factors showed stronger and more consistent associations with VAS outcomes than infection status, including a significant association between comorbidities and lower follow-up VAS scores in the COVID-19 model. Conclusions: Among adults aged ?65 years with acute respiratory illness, respiratory virus test positivity was not associated with worse short-term HRQoL after adjustment for baseline health and social factors. Baseline health status and social context were more strongly associated with subsequent HRQoL and functional recovery than viral etiology.

Background Central-line–associated bloodstream infections (CLABSIs) are healthcare-associated infections occurring in critically-ill patients where central veins are accessed using central venous catheters (CVCs). Use of antimicrobial CVCs has been recommended to reduce CLABSI rates in acute care settings. 1 Reducing CLABSI rates in community hospitals remains a challenge due to variability in the type of CVC used, CVC bundle compliance, interdisciplinary collaboration, and overall culture related to central line (CL) use. Methods A quality improvement project (QIP) conducted at two acute care community hospitals evaluated the impact of standardized CL insertion bundle, interdisciplinary collaboration, and shared accountability on CLABSI rates. The QIP was conducted at facilities, A and B, within the same hospital system, from October 2018–September 2025, where both facilities used a CVC kit containing a silver-platinum-carbon (SPC)-impregnated CVC for vascular access. From January 2020–June 2024, in addition to the CL kit, key interventions implemented sequentially included daily infection prevention (IP) emails regarding CL status; multidisciplinary CLABSI rounds to discuss CL indications/culturing practices; chlorhexidine gluconate (CHG) bathing documentation transition to medical administration records; optimization of CVC device maintenance order placement in an electronic health record system; initiation of CHG/isopropyl alcohol device swab for hub scrubbing for all CL access; and blood cultures ordered through a care pathway incorporating blood culturing stewardship. CLABSI rates were calculated in terms of events per 1,000 CL days to assess the impact of these interventions on CLABSI prevention. Results The post-intervention CLABSI rate for Facility A was significantly lower than the pre-intervention rate (0.100 vs 0.728; P = 0.0409). The post- and pre-intervention CLABSI rates for Facility B were 0.494 and 0, respectively; although clinically significant, no statistical difference in rates was observed (P = 1). For both facilities, the observed monthly CLABSI rates exhibited a gradual long-term decline without significant impact of specific interventions. The decline was statistically significant for Facility A (P = 0.00992) whereas for Facility B the decline was non-significant (P = 0.152). Conclusions Continuous implementation of the SPC-impregnated CVC-containing kit likely established a stable baseline for infection prevention. Subsequent interventions did not result in statistically significant changes in monthly CLABSI rates, suggesting gradual improvements attributable to ongoing process maturation rather than discrete intervention effects. References

This paper investigates variation in the realization of the happy vowel in Manchester, England, that is, the final vowel in happy, baby, etc., which is often described as extremely lax. It is based on the acoustic analysis of 109 speakers, stratified for age, gender, social class, and ethnicity. The vowel is a rarely reported case of a stable vocalic variable, with no change in apparent time but with clear conditioning by social class (with higher social classes having tenser vowels) and by ethnicity. Style-shifting is minimal, statistically insignificant, and appears to result from durational effects; we conclude that the variable lies largely below speakers’ conscious awareness within the speech community. We explore the long-standing Labovian hypothesis that internal linguistic constraints operate independently of social factors and find that the results largely support this hypothesis for the happy vowel. This suggests a shared underlying system despite social differentiation in overall vowel realization.

Background: The U.S. is on track to lose measles elimination status after experiencing the highest number of cases in <30 years. With ongoing transmission and falling vaccination rates, health systems must prepare for measles, focusing on minimizing secondary cases and maximizing prevention. We describe a taskforce approach for comprehensive measles (with a lens towards all-hazard)preparedness across our enterprise. Methods: Our mitigation and preparedness taskforce included four workstreams (Figure 1): Early MMR vaccination for children with international travel: Consistently offer and administer initial or second MMR vaccine, as appropriate, for infants and children travelling abroad. Optimize exposure and testing management: Develop tools to expedite the identification of exposed non-immune patients and optimize processes for high volume testing and result tracking. Optimize screening processes at points of entry (POE): Develop streamlined processes for reliable travel and exposure screening at all enterprise wide POEs. Contingency planning for larger scale exposure events/community spread: Develop post-exposure prophylaxis (PEP) delivery procedures to respond to large-scale community exposure events and establish partnerships with local public health (PH) departments. Results: Increase in vaccination for non-immune travelers in primary care: We built an EMR (electronic medical record) prompt into all child visits to screen for travel, which interfaced with vaccine clinical decision support to offer/administer vaccines. From May through 12/28/25 we administered 1325 early MMRs to travelling children (Figure 2). EMR-based report to identify exposed individuals and their immune status: This report allows all sites to rapidly identify patients needing PEP after exposure. We also developed processes for pre-emptive approval for large scale testing, result tracking, and high-volume patient notification. Optimization of Screening and POE with EMR upgrades, PPE kits: We are upgrading our EMR to better integrate travel & exposure screening. We developed additional resources including screening supports for non-English languages and PPE kits for immediate use at POE when patients screen positive. Development of PEP clinics and PH Collaboration: We developed processes to stand up PEP clinics at our hospitals to expedite large volume PEP administration. We worked with PH to outline roles, capabilities and resources for response to community outbreaks, optimized staff fit testing and developed drills across all care settings. Conclusions: Preparedness for highly contagious infectious diseases and emerging PH threats is critical. A taskforce approach provides a structured framework for collaboration and mobilization of resources. By utilizing an all-hazards lens, this framework is broadly applicable for vaccine preventable infections and other infectious threats.

Background: Carbapenemase-producing organisms (CPOs) can cause serious, difficult-to-treat infections and spread rapidly in healthcare settings. Although pediatric CPO cases are uncommon, they may be increasing in the United States. We describe CPO surveillance practices and patient and specimen characteristics among patients admitted to a California pediatric specialty hospital that regularly receives high-acuity patients referred from healthcare facilities outside the US. Methods: Carbapenem-resistant organisms identified from clinical specimens underwent molecular testing to identify the “big-5” carbapenemases (i.e., KPC, NDM, OXA-48 like, VIM, IMP); carbapenem-resistant Acinetobacter baumannii (CRAB) isolates were also tested for additional oxacillinase (OXA) variant carbapenemases at a public health laboratory. In August 2024, the hospital began screening patients upon admission from non-US healthcare facilities by collecting rectal swabs for molecular testing for big-5 carbapenemases, and culture-based screening for CRAB with molecular testing to identify the big-5 and additional OXA variant carbapenemases. We collected patient and specimen data from the hospital and public health case reports. We defined a case as carbapenemase(s) detected in a clinical or screening specimen from a pediatric patient (ages 1–18 years), either during admission or within 3 days of transfer from the hospital from January 2022 to August 2025. Result: Among 28 total cases, 17 (61%) were in clinical specimens (10 wound, 3 blood, 3 respiratory, and 1 tissue) and 11 (39%) in 34 rectal swab specimens (32% positivity) collected through admission screening starting in August 2024 (Figure 1). The most common carbapenemases were OXA-23-like (32%) and OXA-24/40-like (32%) and the most common organism was A. baumannii (79%). Of the 27 patients (one had two cases), the median age was 11 years; 20 (74%) were Hispanic and 21 (78%) were non-US residents. Twenty-two (82%) were admitted for burn injuries and 24 (89%) had international healthcare exposure. Conclusion: Admission screening based on international healthcare exposures had a high (32%) yield and identified more than half of all CPO cases since implementation. The majority of CPO cases were OXA variant-producing CRAB, highlighting the role of culture-based screening to identify carbapenemase-producing CRAB that otherwise would not be detected by screening with molecular testing for big-5 carbapenemases only. Risk-based admission screening is a key component of a comprehensive CPO prevention strategy by facilitating rapid detection of cases and timely implementation of focused infection prevention and control measures to prevent further spread among a vulnerable population.

Current wound closure methods have drawbacks when used in minimally invasive surgery. Traditional sutures are complicated and time-consuming to apply in this context, and synthetic adhesives can be toxic when used internally. The class of bioadhesives address these challenges, however their independent use in practice is limited due to their low tensile strength. In this work, we develop Kelserra, a novel bioadhesive derived from brown algae with maximized tensile strength and biocompatibility to address a current unmet need in the surgical field. Kelserra’s uniaxial yield stress peaked at 7.19 ± 0.47 kPa when the formulation contained 50 mg/mL alginate, 5 mg/mL phloroglucinol, 10 mg/mL xanthan gum and 2.09 mg/mL Ca-EDTA and was pre-cured using saturated aqueous gluconic acid for 45 minutes. Kelserra’s uniaxial strength was higher than its lap shear strength when pre-cured. Additionally, the type of curing medium (air or PBS) did not significantly influence adhesive strength. This study is intended as a preliminary work inquiring into the possibility of the exploration of internal bioadhesives such as Kelserra, and further validation is required for translational applications. Internal bioadhesives like Kelserra could decrease surgery times, aid in the prevention of postoperative complications and reduce the burden on the healthcare system.

Background: Previous studies demonstrated that the addition of anterior nares to axilla/groin skin testing substantially improved the detection of Candidozyma auris colonization (Proctor et al., Nature Medicine, 2021; Sansom et al., CID, 2024), but these observations were limited by small sample sizes and reflected mostly nursing home residents. We aimed to assess the benefit of adding nares testing to axilla/groin testing among hospitalized patients participating in C. auris point prevalence surveys (PPSs). Methods We conducted a prospective observational study at three long-term acute care hospitals (LTACHs) in the Chicago region, one of which also included distinct inpatient rehabilitation floors. Facilities participated in quarterly public health-led C. auris PPSs from May 2024 to October 2025. Patients underwent swab sampling at two sites: composite bilateral axillae/groin (swab 1) and bilateral anterior nares (swab 2). Samples were processed at a central laboratory for C. auris detection by PCR using a validated assay with enzymatic preprocessing and automated DNA extraction. Primary analyses were restricted to patients with results available from both sampling sites; a positive C. auris test from either body site was considered the reference standard. Analyses were performed using R v4.5.2 (www.r-project.org) and Stata/SE v18.0 (Stata Corp., College Station, TX). Results Across 18 PPSs, 769 of 867 (89%) eligible patients participated. The overall C. auris prevalence was 46% (317/685) among LTACH patients and 15% (13/84) among rehabilitation patients. Among all patients who tested positive for C. auris, 64% were in Contact Precautions for any reason at time of PPS and 34% were previously known to be C. auris colonized. After excluding 16 patients who were missing a body site specimen, 753 patients were eligible for analysis (670 LTACH, 83 rehabilitation). Among 320 patients with C. auris detected at any body site, 301 were detected by axilla/groin screening (94% sensitivity; 95% confidence interval 91% to 96%) and 234 (73%) tested positive at the anterior nares for C. auris. Inclusion of nares swabbing identified 19 additional patients who would have been missed by axilla/groin screening alone, corresponding to an incremental increase of 6%. Conclusion Among LTACH and rehabilitation patients, C. auris colonization was common and PPSs identified a substantial number of patients not previously known to be colonized. The incremental benefit of adding nares screening was modest compared to axilla/groin screening alone. Testing more body sites can identify more C. auris colonized patients, but facilities should balance benefit versus cost of expanded screening approaches.