The factsheet that follows, prepared by Nan Kim in conjunction with members of the National Campaign to End the Korean War, provides an informative overview of the dangerous military standoff that has been unfolding on the Korean Peninsula ever since South Korea conducted a 4-hour artillery exercise on November 23. The exercise was conducted on Yeonpyeong Island, populated at the time by 1,000 South Korean soldiers and 1,300 civilians, about 12 kilometers from North Korea's coastline. The North – which had demanded that the South cancel the exercise prior to its start, and then according to reports repeatedly called for a halt as the South continued its exercise – responded with direct shelling of the island. This resulted in the killing of two South Korean soldiers and two civilian contractors working on a military base. (Pyongyang later expressed regret for the civilian deaths.). See CSPAN report here.

The Bush administration's approach to North Korea was once quite consistent with its overall foreign policy. There was name calling, a preference for regime change and an emphasis on military solutions. Unsurprisingly, the relationship between the United States and North Korea, like so many other tense standoffs, deteriorated over the last seven years. The U.S. accused the third member of the “axis of evil” of money-laundering, missile sales and a secret program for the production of nuclear material. For its part, North Korea responded tit for tat at the rhetorical level. In October 2006, it upped the ante by exploding a nuclear device. If the United States were not tied up in other military conflicts — and eyeing Iran — a war in Northeast Asia might have been higher on the administration's to-do list.

Objectives/Goals: This study assesses the feasibility of a human-to-swine lung transplant model for the evaluation of bioengineered organs. Given the critical organ shortage, this research explores bioengineered organs as a potential solution by evaluating early lung function, immune responses, and technical aspects to develop a model for bioengineered lungs. Methods/Study Population: The study employs a non-survival human-to-swine left lung transplant model in an immunosuppressed Yorkshire swine. A combination of cobra venom factor pretreated with methylprednisolone and Benadryl with scheduled dosing of tacrolimus and mycophenolate over a 24-hour period will be administered. The transplanted human lung is assessed over a 24-hour post-transplant period, with hourly pulmonary vein gas sampling and lung tissue resections. The proposed model will assess the immunological response of swine to human lung tissue as well as the efficacy of the immunosuppression model. Tissue samples are taken at intervals to evaluate for signs of rejection, cellular damage, and the overall function of the transplanted lung. All tissues are preserved in formaldehyde for subsequent immunohistology evaluation. Results/Anticipated Results: We anticipate a successful non-survival swine transplant model with pulmonary function sustained for the full 24-hour study using our proposed immunosuppression regimen. Initial testing with a standard human lung will lay the groundwork to assess the effectiveness of the human-to-swine transplant model. Hourly pulmonary vein gas analyses and tissue biopsies are expected to show minimal immune rejection, supported by the preoperative immunosuppression regimen. Early data indicate that the swine tolerates both the surgical procedure and immunosuppressive therapy well, with manageable hemodynamic stability. This model is expected to yield critical insights into lung viability and will identify areas for optimization for long-term survival studies to test the efficacy of bioengineered organs. Discussion/Significance of Impact: This non-survival swine model offers valuable insights into the acute-phase immune response and functional viability of human-to-swine lung transplant model. The findings will support the development of long-term survival models that will allow the evaluation of bioengineered organs based solely on their functionality as engineered organs.

There are many ways that an economy can be greened. Building vast new renewable energy manufacturing industries is one pathway – as pioneered by China. Deploying extensive renewable power generation systems is another pathway – as demonstrated by Germany with its Energiewende. Yet another route is pursuing R&D led strategies and strategic initiatives via the military, as shown by the US. Now Korea demonstrates another pathway, one based on liberalization of its power generation system (to promote competition) and development of the IT-enabling of its electric power grid (smart grid) with a characteristic modular approach to smart grid construction, utilizing microgrids.

We experimentally test a model of public good bargaining due to Bowen et al. (Am Econ Rev 104:2941–2974, 2014) and compare two institutions governing bargaining over public good allocations. The setup involves two parties negotiating the distribution of a fixed endowment between a public good and each party’s individual account. Parties attach either high or low weight to the public good and the difference in these weights reflects the degree of polarization. Under discretionary bargaining rules, the status quo default allocation to the group account (in the event of disagreement) is zero while under the mandatory bargaining rule it is equal to the level last agreed upon. The mandatory rule thus creates a dynamic relationship between current decisions and future payoffs, and our experiment tests the theoretical prediction that the efficient level of public good is provided under the mandatory rule while the level of public good funding is at a sub-optimal level under the discretionary rule. Consistent with the theory, we find that proposers (particularly those attaching high weight to the public good) propose significantly greater allocations to the public good under mandatory rules than under discretionary rules and this result is strengthened with an increase in polarization. Still, public good allocations under mandatory rules fall short of steady state predictions, primarily due to fairness concerns that prevent proposers from exercising full proposer power.

This manuscript introduces a new Bayesian finite mixture methodology for the joint clustering of row and column stimuli/objects associated with two-mode asymmetric proximity, dominance, or profile data. That is, common clusters are derived which partition both the row and column stimuli/objects simultaneously into the same derived set of clusters. In this manner, interrelationships between both sets of entities (rows and columns) are easily ascertained. We describe the technical details of the proposed two-mode clustering methodology including its Bayesian mixture formulation and a Bayes factor heuristic for model selection. We present a modest Monte Carlo analysis to investigate the performance of the proposed Bayesian two-mode clustering procedure with respect to synthetically created data whose structure and parameters are known. Next, a consumer psychology application is provided examining physician pharmaceutical prescription behavior for various brands of prescription drugs in the neuroscience health market. We conclude by discussing several fertile areas for future research.

Given multivariate multiblock data (e.g., subjects nested in groups are measured on multiple variables), one may be interested in the nature and number of dimensions that underlie the variables, and in differences in dimensional structure across data blocks. To this end, clusterwise simultaneous component analysis (SCA) was proposed which simultaneously clusters blocks with a similar structure and performs an SCA per cluster. However, the number of components was restricted to be the same across clusters, which is often unrealistic. In this paper, this restriction is removed. The resulting challenges with respect to model estimation and selection are resolved.

Background: Multiplex molecular tests for infectious diseases can provide highly sensitive results rapidly; however, these tests may more readily detect asymptomatic colonization. There are reports of non-FDA approved laboratory-developed multiplex tests for the diagnosis of urinary tract infections (UTI). Differentiating UTI from asymptomatic bacteriuria is challenging, especially in older adults. The increased sensitivity of multiplex tests may exacerbate this challenge. We sought to describe the use of multiplex testing for UTIs in Medicare claims. Methods: Multiplex testing was identified using carrier claims submitted by non-institutional providers using the Chronic Conditions Warehouse for 2016 – 2022. Because there are no CPT-4 codes specifying UTI multiplex testing, we included claims as described in Figure 1 and categorized claims based on the primary ICD-10-CM diagnosis. The payment amounts for line items related to testing for infectious agents were summed. Laboratories were counted using CLIA numbers listed on corresponding claims. Beneficiaries residing in a nursing home at the time of their claim were identified using stay information derived from the Minimum Dataset 3.0. For comparison, similar characteristics among carrier claims with a CPT-4 code indicating urine culture were also described. Results: Claims for unspecified multiplex molecular tests overall have increased, driven by increases in claims with a primary UTI diagnosis (from 8,521 in 2016 to 386,943 in 2022), while urine cultures have not (Figure 1). In 2022, 65% of all unspecified multiplex tests were linked to a diagnosis of UTI; UTI multiplex claims were associated with 647 laboratories. For UTI claims, the median cost per claim for line items related to multiplex testing was $589 compared to $13 for urine culture-related line items. Overall, 8% of UTI multiplex claims were for beneficiaries residing in a nursing home. Conclusions: Claims for non-FDA approved unspecified multiplex tests associated with a primary diagnosis of UTI have increased >45-times between 2016-2021 and have >45-times higher median costs than urine cultures. The use of this testing in the Medicare population, including nursing home residents, is of potential concern given that inappropriate treatment of asymptomatic bacteriuria has been described to be common in older adults. Research is needed to outline use cases where UTI multiplex testing may be beneficial. Appropriate use of diagnostic testing is important to minimize diagnostic errors and avoid unnecessary antibiotic use.

We analyzed invasive group A streptococcal puerperal sepsis cases in a large health zone in Alberta, Canada between 2013 and 2022. Of the 21 cases, 85.7% were adjudicated as hospital/delivery-acquired, with 2 clusters having identical isolates found through whole genome sequencing. We implemented policy interventions across Alberta aimed at preventing future infections.

Structured processes to improve the quality and impact of clinical and translational research are a required element of the Clinical and Translational Sciences Awards (CTSA) program and are central to awardees’ strategic management efforts. Quality improvement is often assumed to be an ordinary consequence of evaluation programs, in which standardized metrics are tabulated and reported externally. Yet evaluation programs may not actually be very effective at driving quality improvement: required metrics may lack direct relevance; they lack incentive to improve on areas of relative strength; and the validity of inter-site comparability may be limited. In this article, we describe how we convened leaders at our CTSA hub in an iterative planning process to improve the quality of our CTSA program by intentionally focusing on how data collection activities can primarily advance continuous quality improvement (CQI) rather than strictly serve as evaluative tools. We describe our CQI process, which consists of three key components: (1) Logic models outlining goals and associated mechanisms; (2) relevant metrics to evaluate performance improvement opportunities; and (3) an interconnected and collaborative CQI framework that defines actions and timelines to enhance performance.

Burden of bacteraemia is rising due to increased average life expectancy in developed countries. This study aimed to compare the epidemiology and outcomes of bacteraemia in two similarly ageing populations with different ethnicities in Singapore and Denmark. Historical cohorts from the second largest acute-care hospital in Singapore and in the hospitals of two Danish regions included patients aged 15 and above who were admitted from 1 January 2006 to 31 December 2016 with at least 1 day of hospital stay and a pathogenic organism identified. Among 13 144 and 39 073 bacteraemia patients from Singapore and Denmark, similar 30-day mortality rates (16.5%; 20.3%), length of hospital stay (median 14 (IQR: 9–28) days; 11 (6–21)), and admission rate to ICU (15.5%; 15.6%) were observed, respectively. Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus ranked among the top four in both countries. However, Singaporeans had a higher proportion of patients with diabetes (46.8%) and renal disease (29.5%) than the Danes (28.0% and 13.7%, respectively), whilst the Danes had a higher proportion of patients with chronic pulmonary disease (18.0%) and malignancy (35.3%) than Singaporeans (9.7% and 16.2%, respectively). Our study showed that top four causative organisms and clinical outcomes were similar between the two cohorts despite pre-existing comorbidities differed.

The network theory of psychological disorders posits that systems of symptoms cause, or are associated with, the expression of other symptoms. Substantial literature on symptom networks has been published to date, although no systematic review has been conducted exclusively on symptom networks of schizophrenia, schizoaffective disorder, and schizophreniform (people diagnosed with schizophrenia; PDS). This study aims to compare statistics of the symptom network publications on PDS in the last 21 years and identify congruences and discrepancies in the literature. More specifically, we will focus on centrality statistics. Thirty-two studies met the inclusion criteria. The results suggest that cognition, and social, and occupational functioning are central to the network of symptoms. Positive symptoms, particularly delusions were central among participants in many studies that did not include cognitive assessment. Nodes representing cognition were most central in those studies that did. Nodes representing negative symptoms were not as central as items measuring positive symptoms. Some studies that included measures of mood and affect found items or subscales measuring depression were central nodes in the networks. Cognition, and social, and occupational functioning appear to be core symptoms of schizophrenia as they are more central in the networks, compared to variables assessing positive symptoms. This seems consistent despite heterogeneity in the design of the studies.

Clay particle aggregation affects a number of environmental processes, such as contaminant sorption/desorption, particle movement/deposition, and sediment structure and stability, yet factors that control clay aggregation are not well understood. This study was designed to investigate how microbial reduction of Fe(III) in clay structure, a common process in soils and sediments, affects clay-particle aggregation. Microbial Fe(III) reduction experiments were conducted with Shewanella putrefaciens CN32 in bicarbonate buffer with structural Fe (III) in nontronite as the sole electron acceptor, lactate as the sole electron donor, and AQDS as an electron shuttle. Four size fractions of nontronite (D5–D95 of 0.12–0.22 µm, 0.41–0.69 µm, 0.73–0.96 µm and 1.42–1.78 µm) were used to evaluate size-dependent aggregation kinetics. The extent of Fe(III) bioreduction and the amount of exopolysaccharide (EPS), a major biopolymer secreted by CN32 cells during Fe(III) bioreduction, were measured with chemical methods. Nontronite particle aggregation was determined by photon correlation spectroscopy and scanning electron microscopy. The maximum extent of Fe(III) bioreduction reached 36% and 24% for the smallest and the largest size fractions, respectively. Within the same time duration, the effective diameter, measured at 95% percentile (D95), increased by a factor of 43.7 and 7.7 for these two fractions, respectively. Because there was production of EPS by CN32 cells during Fe(III) reduction, it was difficult to assess the relative role of Fe(III) bioreduction and EPS bridging in particle aggregation. Thus, additional experiments were performed. Reduction of Fe(III) by dithionite was designed to examine the effect of Fe(III) reduction, and pure EPS isolated from CN32 cells was used to examine the effect of EPS. The data showed that both Fe(III) reduction and EPS were important in promoting clay mineral aggregation. In natural environments, the relative importance of these two factors may be dependent on local conditions. These results have important implications for understanding factors in controlling clay particle aggregation in natural environments.