Background: Candida auris and methicillin-resistant Staphylococcus aureus (MRSA) are prevalent in nursing homes, and both are known to shed profusely from the skin. We evaluated the degree of differential shedding during caregiving activities versus at rest in nursing home residents. Methods: Residents at two nursing homes were screened for C. auris and MRSA using nares, axilla/groin, and peri-rectal swabs. Carriers of C. auris, some of whom also carried MRSA, were evaluated for proximal shed around their bed during rest and caregiving activities using chromogenic settle plates. Morning caregiving activities (e.g. hygiene care, linen/clothing change) were noted to generally take 12 minutes. For rest, settle plates were placed for a 12-minute period prior to the resident awakening in the morning. For caregiving, settle plates were placed for the 12-minute period of morning activity shortly after awakening. Twin rest-caregiving measurements were taken on three separate days per C. auris carrier. In addition, prior to caregiving, bilateral nares, hands, axilla, groin, and perirectal swabs were taken for C. auris and MRSA culture, along with an axilla/groin swab for measuring chlorhexidine concentration (CHG used for routine bathing). Logistic regression with person-level clustering analyzed associations between positive settle plates (“shedding”) and activity (caregiving versus rest), along with other adjusters. Results: The study included 23 C. auris carriers, 15 of whom carried MRSA. 65% were male, 91% had an indwelling device, 39% had wounds. Mean number of positive body sites was 2.3 for C. auris and 1.2 for MRSA. Median CHG concentration was 156 µg/mL (IQR=39-1250). Shedding occurred more frequently during caregiving versus rest for both C. auris (8/69 vs 1/69, P=0.02) and MRSA (15/69 vs 3/69, p=0.002). In multivariable models (Table), caregiving was associated with increased odds of shedding for both C. auris (OR: 9.25 (95% CI: 1.07-80.35), P=0.04) and MRSA (OR: 6.52 (95% CI: 1.72-24.78), P =0.01). Higher CHG concentrations were non-significantly associated with reduced shedding of both pathogens. Conclusion: C. auris and MRSA shedding increased significantly during caregiving activities, supporting CDC’s current recommendations for enhanced barrier precautions in nursing homes, which involve gown and glove use during high-contact care for carriers of multidrug-resistant organisms. Remarkably, shedding was readily detected within 12 minutes of morning caregiving, highlighting a rapid “plume effect” during resident care.

Almost 12 % of the human population have insufficient access to food and hence are at risk from nutrient deficiencies and related conditions, such as anaemia and stunting. Ruminant meat and milk are rich in protein and micronutrients, making them a highly nutritious food source for human consumption. Conversely, ruminant production contributes to methane (CH4) emissions, a greenhouse gas (GHG) with a global warming potential (GWP) 27–30 times greater than that of carbon dioxide (CO2). Nonetheless, ruminant production plays a crucial role in the circular bioeconomy in terms of upcycling agricultural products that cannot be consumed by humans, into valuable and nutritional food, whilst delivering important ecosystem services. Taking on board the complexities of ruminant production and the need to improve both human and planetary health, there is increasing emphasis on developing innovative solutions to achieve sustainable ruminant production within the ‘One Health’ framework. Specifically, research and innovation will undoubtedly continue to focus on (1) Genetics and Breeding; (2) Animal nutrition and (3) Animal Health, to achieve food security and human health, whilst limiting environmental impact. Implementation of resultant innovations within the agri-food sector will require several enablers, including large-scale investment, multi-actor partnerships, scaling, regulatory approval and importantly social acceptability. This review outlines the grand challenges of achieving sustainable ruminant production and likely research and innovation landscape over the next 15 years and beyond, specifically outlining the pathways and enablers required to achieve sustainable ruminant production within the One Health framework.

Objectives/Goals: Lung transplant is a life-saving surgery for patients with advanced lung diseases yet long-term survival remains poor. The clinical features and lung injury patterns of lung transplant recipients who die early versus those who survive longer term remain undefined. Here, we use cell-free DNA and rejection parameters to help elucidate this further. Methods/Study Population: Lung transplant candidacy prioritizes patients who have a high mortality risk within 2 years and will likely survive beyond 5 years. We stratified patients who died within 2 years of transplant as early death (n = 50) and those who survived past 5 years as long-term survivors (n = 53). Lung transplant recipients had serial blood collected as part of two prospective cohort studies. Cell-free DNA (cfDNA) was quantified using relative (% donor-derived cfDNA {%ddcfDNA}) and absolute (nuclear-derived {n-cfDNA}, mitochondrial-derived {mt-cfDNA}) measurements. As part of routine posttransplant clinical care, all patients underwent pulmonary function testing (PFT), surveillance bronchoscopy with bronchoalveolar lavage (BAL), transbronchial biopsy (TBBx), and donor-specific antibody testing (DSA). Results/Anticipated Results: Over the first 2 years after transplant, the number of episodes of antibody-mediated rejection (p) Discussion/Significance of Impact: Clinically, early-death patients perform worse on routine surveillance PFTs and experience a worse degree of CLAD. These patients also have higher levels of cfDNA as quantified by n-cfDNA and mt-cfDNA. These results provide preliminary evidence that early-death patients have worse allograft rejection, dysfunction, and molecular injury.

Since the 1950s, the United Nations (UN) has designated days (e.g., World Wetland Day), years (e.g., Year of the Gorilla) and decades (e.g., Decade on Biodiversity) with a commonly stated goal to raise awareness and funding for conservation-oriented initiatives, and these Days, Years and Decades of ‘…’ (hereafter ‘DYDOs’) continue. However, the effectiveness of these initiatives to achieve their stated objectives and to contribute to positive conservation outcomes is unclear. Here we used a binary analysis change model to evaluate the effectiveness of UN conservation-oriented DYDOs observed between 1974 and 2020. We also examined four case studies to understand the different strategies employed to meet specified conservation goals. We found that DYDOs apparently contributed to positive conservation outcomes when they were tied to social media campaigns and/or when they were strategically situated in current events or global discourse. Although the outcomes of DYDOs were varied, those with longer timescales and those that engaged local communities were more likely to be successful. We suggest that DYDO organizers should identify all possible paths of action through the lens of the change model outlined in this paper to strengthen the value and effectiveness of these initiatives in the future. Using this approach could help ensure that resources are used efficiently and effectively, and that initiatives yield positive conservation outcomes that benefit people and nature.

Each day a venous catheter is retained poses unnecessary safety risks. In a retrospective evaluation of central/peripheral lines in nursing home residents receiving antibiotics, 80% were retained beyond antibiotic treatment end and nearly one third were retained longer than a week. Interventions for timely catheter removal are urgently needed.

Fast glacier motion is facilitated by slip at the ice-bed interface. For slip over rigid beds, areas of ice-bed separation (cavities) can exert significant control on slip dynamics. Analytic models of these systems assume that cavities instantaneously adjust to changes in slip and effective pressure forcings, but recent studies indicate transient forcings violate this—and other—underlying assumptions. To assess these incongruities, we conducted novel experiments emulating hard-bedded slip with ice-bed separation under periodic effective pressure transients. We slid an ice-ring over a sinusoidal bed while varying the applied overburden stress to emulate subglacial effective pressure cycles observed in nature and continuously recorded mechanical and geometric system responses. We observed characteristic lags and nonlinearities in system responses that were sensitive to forcing periodicity and trajectory. This gave rise to hysteresis not predicted in analytic theory, which we ascribed to a combination of geometric, thermal and rheologic processes. This framework corroborates other studies of transient glacier slip and we used it to place new constraints on transient phenomena observed in the field. Despite these divergences, average system responses converged toward model predictions, suggesting that analytic theory remains applicable for modeling longer-term behaviors of transiently forced slip with ice-bed separation.

The reliable change index has been used to evaluate the significance of individual change in health-related quality of life. We estimate reliable change for two measures (physical function and emotional distress) in the Patient-Reported Outcomes Measurement Information System (PROMIS®) 29-item health-related quality of life measure (PROMIS-29 v2.1). Using two waves of data collected 3 months apart in a longitudinal observational study of chronic low back pain and chronic neck pain patients receiving chiropractic care, and simulations, we compare estimates of reliable change from classical test theory fixed standard errors with item response theory standard errors from the graded response model. We find that unless true change in the PROMIS physical function and emotional distress scales is substantial, classical test theory estimates of significant individual change are much more optimistic than estimates of change based on item response theory.

The new software package OpenMx 2.0 for structural equation and other statistical modeling is introduced and its features are described. OpenMx is evolving in a modular direction and now allows a mix-and-match computational approach that separates model expectations from fit functions and optimizers. Major backend architectural improvements include a move to swappable open-source optimizers such as the newly written CSOLNP. Entire new methodologies such as item factor analysis and state space modeling have been implemented. New model expectation functions including support for the expression of models in LISREL syntax and a simplified multigroup expectation function are available. Ease-of-use improvements include helper functions to standardize model parameters and compute their Jacobian-based standard errors, access to model components through standard R $ mechanisms, and improved tab completion from within the R Graphical User Interface.

What are the origins and effects of legal ambiguity in authoritarian regimes? Using a detailed case study of nationality rights in Jordan – which draws from interviews with 210 Jordanian political officials, judges, lawyers, activists, and citizens/residents – we develop a framework for understanding how legal ambiguity emerges, and how it matters, under authoritarianism. We first conceptualize four discrete forms in which legal ambiguity manifests: lexical ambiguity (in legal texts); substantive ambiguity (in status as law); conflictual ambiguity (between contradictory legal rules); and operational ambiguity (in enforcement processes). We then scrutinize the emergence and effects of legal ambiguity in Jordanian nationality policy by integrating historical process tracing, detailed interview evidence, and a content analysis of archival documents, laws, and court verdicts pertaining to nationality rights. Our findings contribute to scholarship on legal ambiguity, authoritarian legality, and discretionary state authority by showing that (1) crisis junctures make the emergence of legal ambiguity more likely; (2) legal ambiguity takes a variety of different forms that warrant conceptual disaggregation; and (3) different forms of legal ambiguity often have disparate effects on how authoritarian state power is organized and experienced in public life.