A clinical decision support system, EvalMpox, was developed to apply person under investigation (PUI) criteria for patients presenting with rash and to recommend testing for PUIs. Of 668 patients evaluated, an EvalMpox recommendation for testing had a positive predictive value of 35% and a negative predictive value of 99% for a positive mpox test.

The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.

Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.

Multifetal pregnancies are at risk of adverse maternal, neonatal and long-term health outcomes, and gestational weight gain (GWG) is a potentially modifiable risk factor for several of these. However, studies assessing the associations of GWG with long-term health in twins are rare, and studies which do assess these associations in twins often do not account for gestational age. Since longer gestations are likely to lead to larger GWG and lower risk of adverse outcomes, adjusting for gestational age is necessary to better understand the association of GWG with twin health outcomes. We aimed to explore long-term associations of GWG-for-gestational-age with twin anthropometric measures. The Peri/Postnatal Epigenetic Twins Study (PETS) is a prospective cohort study, which recruited women pregnant with twins from 2007 to 2009. Twins were followed-up at 18 months and 6 years of age. GWG-for-gestational-age z-scores were calculated from pre-pregnancy weight and weight at delivery. We fitted regression models to assess associations of GWG with twin weight, height and BMI at birth, 18 months, and 6 years. Of the 250 women in the PETS, 172 had GWG measured throughout pregnancy. Overall, higher GWG-for-gestational-age z-scores were associated with higher birthweight (β: 0.32 z-scores, 95% Confidence Interval (95% CI): 0.19, 0.45), BMI (β: 0.29 z-scores, 95% CI: 0.14, 0.43) and length (β: 0.27 z-scores, 95% CI: 0.09, 0.45). However, these associations were not observed at 18 months or 6 years of age. GWG was associated with twin length, weight and BMI at birth but not during childhood. Further research is needed to determine the long-term effects of GWG on twin health outcomes.

Although twins often participate in medical research, few clinical trials are conducted entirely in twin populations. The purpose of this review is to demonstrate the substantial benefits and address the key challenges of conducting clinical trials in twin populations, or ‘twin-only trials’. We consider the unique design, analysis, recruitment and ethical issues that arise in such trials. In particular, we describe the different approaches available for randomizing twin pairs, highlight the similarity or correlation that exists between outcomes of twins, and discuss the impact of this correlation on sample size calculations and statistical analysis methods for estimating treatment effects. We also consider the role of both monozygotic and dizygotic twins for studying variation in outcomes, the factors that may affect recruitment of twins, and the ethics of conducting trials entirely in twin populations. The advantages and disadvantages of conducting twin-only trials are also discussed. Finally, we recommend that twin-only trials should be considered more often.

Background: A penicillin allergy guidance document containing an algorithm for challenging penicillin allergic patients with β-lactams was developed by the antimicrobial stewardship program (ASP). As part of this algorithm, a “graded challenge” order set was created containing antimicrobial orders and safety medications along with monitoring instructions. The process is designed to challenge patients at low risk of reaction with infusions of 1% of the target dose, then 10%, and finally the full dose, each 30 minutes apart. We evaluated outcomes from the order set. Methods: Orders of the graded challenge over 17 months (March 2018 through July 2019) were reviewed retrospectively. Data were collected on ordering and outcomes of the challenges and allergy documentation. Use was evaluated based on ASP-recommended indications: history of IgE-mediated or unknown reaction plus (1) no previous β-lactam tolerance and the reaction occurred >10 years ago, or (2) previous β-lactam tolerance, now requiring a different β-lactam for treatment. Only administered challenges were included and descriptive statistics were utilized. Results: Of 67 orders, 57 graded challenges were administered to 56 patients. The most common allergies were penicillins (87.7%) and cephalosporins (38.6%), with the most common reactions being unknown (41.7%) or hives (22%). The most common antibiotics challenged were ceftriaxone (43.9%), cefepime (21.1%), and cefazolin (5.3%). Antibiotics given prior to challenge included vancomycin (48.2%), fluoroquinolones (35.7%), carbapenems (21.4%), aztreonam (19.6%), and clindamycin (12.5%). The median duration of challenged antibiotic was 6 days. The infectious diseases service was consulted on 59.6% of challenges and 75.4% of challenges were administered in non-ICU settings. There was 1 reaction (1.8%) involving a rash with the second infusion, which was treated with oral diphenhydramine and had no lasting effects. Based on indications, 80.7% of challenges were aligned with ASP guidance criteria. The most common use outside of these criteria was in patients without IgE-mediated reactions (10.5%). Most of these had minor rashes and could have received a full dose of a cephalosporin. Allergy information was updated in the electronic health record after 91.2% of challenges. Conclusions: We demonstrated the utility of a graded challenge process at our academic medical center. It was well tolerated, ordered frequently by noninfectious diseases clinicians, administered primarily in non-ICU settings, and regularly resulted in updated allergy information in the medical record. With many patients initially receiving broad-spectrum antibiotics with high costs or increased rates of adverse effects, graded challenges can potentially prevent the use of suboptimal therapies with minimal time and resource investment.

Funding: None

Disclosures: Scott Bergman reports a research grant from Merck.

The reflectance spectroscopic characteristics of cyanobacteria-dominated microbial mats in the McMurdo Dry Valleys (MDVs) were measured using a hyperspectral point spectrometer aboard an unmanned aerial system (remotely piloted aircraft system, unmanned aerial vehicle or drone) to determine whether mat presence, type and activity could be mapped at a spatial scale sufficient to characterize inter-annual change. Mats near Howard Glacier and Canada Glacier (ASPA 131) were mapped and mat samples were collected for DNA-based microbiome analysis. Although a broadband spectral parameter (a partial normalized difference vegetation index) identified mats, it missed mats in comparatively deep (> 10 cm) water or on bouldery surfaces where mats occupied fringing moats. A hyperspectral parameter (B6) did not have these shortcomings and recorded a larger dynamic range at both sites. When linked with colour orthomosaic data, B6 band strength is shown to be capable of characterizing the presence, type and activity of cyanobacteria-dominated mats in and around MDV streams. 16S rRNA gene polymerase chain reaction amplicon sequencing analysis of the mat samples revealed that dominant cyanobacterial taxa differed between spectrally distinguishable mats, indicating that spectral differences reflect underlying biological distinctiveness. Combined rapid-repeat hyperspectral measurements can be applied in order to monitor the distribution and activity of sentinel microbial ecosystems across the terrestrial Antarctic.

The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

Intermediate wheatgrass (Thinopyrum intermedium; IWG) is a perennial cereal crop undergoing development for grain production; however, grain yield declines of >75% are often observed after year 2 of the perennial stand and may be linked to soil nutrient depletion. Intercropping IWG with a perennial legume such as alfalfa (Medicago sativa) could benefit nutrient cycling while increasing agroecological diversity. Intermediate wheatgrass was established at five environmentally diverse sites in Minnesota, USA in (1) bi-culture with alfalfa, (2) non-fertilized monoculture and (3) monoculture fertilized annually in the spring with 80 kg N/ha. At northern sites where alfalfa growth was favoured, IWG grain yields were reduced in year 2 by growing IWG in bi-culture with alfalfa, relative to the monoculture systems. Across all sites IWG grain yield decreased by 90% in the non-fertilized monoculture, 80% in the fertilized monoculture and 65% in the bi-culture from year 2 to 4 and plant macronutrient concentrations decreased by 25–70%. In year 4, IWG grain yield was similar or greater in the bi-culture than the fertilized monoculture at three of the five sites and alfalfa biomass was correlated positively with grain yield, harvest index and nutrient uptake in the year 4 bi-culture. Chemical-nitrogen fertilization increased grain yields in year 2 but did not mitigate the decline in yields as stands aged. Intermediate wheatgrass in the bi-culture had similar yields and nutrient uptake and lower yield declines than the chemically fertilized stand at sites where alfalfa growth was maintained throughout the life of the stand.

The Drygalski Ice Tongue presents an ~80 km long floating obstacle to alongshore flows in the Victoria Land coastal ocean region of the Western Ross Sea. Here we use oceanographic data from near to the tongue to explore the interplay between the floating glacier and the local currents and stratification. A vessel-based circuit of the glacier, recording ocean temperature and salinity profiles, reveals the southwest corner to be the coldest and most complex in terms of vertical structure. The southwest corner structure beneath the surface warm, salty layer sustains a block of very cold water extending to 200 m depth. In this same location there was a distinct layer at 370 m not seen anywhere else of water at ~−1.93°C. The new observations broadly, but not directly, support the presence of a coherent Victoria Land Coastal Current. The data suggest the northward moving coastal current turns against the Coriolis force and works its way anticlockwise around the glacier, but with leakage beneath the glacier through the highly ‘rippled’ underside, resulting in a spatially heterogeneous supply to the Terra Nova Bay Polynya region – an important location for the formation of high-salinity shelf water.

Ice patches and the alpine are important elements of the sociocultural landscape of the Greater Yellowstone Area, and they transcend the jurisdictional boundaries that divide the lands on which they occur. The ice patch record complements traditional sources of archaeological knowledge through the addition of well-dated organic artifacts, such as shafts from hunting tools, recovered in a readily recognizable context. This paper examines the types of wood used in the manufacture of hunting implements recovered at Greater Yellowstone Area ice patches through the analysis of nine unique wooden shafts and shaft fragments from five sites. Five shafts are birch (Betula spp.), two are willow (Salix spp.), one is fir (Abies sp.), and one is pine (Pinus sp.). The shafts included in this analysis range in age from 9230 ± 25 B.P. to 215 ± 20 B.P. Diagnostic Oxbow and Pelican Lake chipped stone projectile points recovered in association with ice patches provide additional temporal resolution regarding use of these features. One of the four sites that yielded wooden shafts contains a record of bighorn sheep (Ovis canadensis) hunting between 3885 ± 25 B.P. and 879 ± 23 B.P.

The potential of satellite radar altimetry for high-resolution mapping of Antarctic ice streams is evaluated, using retracked and slope-corrected data from the Lambert Glacier and Amery Ice Shelf area, East Antarctica, acquired by Geosat during the Exact Repeat Mission (ERM), 1986–89. The map area includes lower Lambert Glacier north of 72.18°S, the southern Amery Ice Shelf, and the grounded inland ice sheet on both sides. The Geosat ERM altimetry is found to provide substantially more complete coverage than the 1978 Seasat altimetry, due to improved tracking. Variogram methods are used to estimate the noise levels in the data as a function of position throughout the map area. The spatial structure in the data is quantified by constructing experimental variograms using altimetry from the area of the grounding zone of Lambert Glacier, which is the area chiefly of interest in this topographically complex region. Kriging is employed to invert the along-track height measurements onto a fine-scale 3 km grid. The unsmoothed along-track Geosat ERM altimetry yields spatially continuous maps showing the main topographic features of lower Lambert Glacier, upper Amery Ice Shelf and the adjacent inland ice sheet. The probable position of the grounding line of Lambert Glacier is identified from a break in slope at the grounded ice/floating ice transition. The approximate standard error of the kriged map is inferred from the data noise levels.

The mean rate-of-change of the surface elevation on lower Lambert Glacier is measured with satellite-radar altimetry from the Geosat Exact Repeat Mission (ERM) (1987 89) and Seasat (1978), using orbit cross-over analysis. The measurement region extends 190km in the along-flow direction from 72.1° to 70.4° S, an area that includes the grounding zone of Lambert Glacier. The Geosat ERM and Seasat altimetry are referenced to GEM T2 orbits. The random-noise levels in the data are reduced by low-pass filtering. The orbit bias between the two satellites is estimated from cross-over differences over sea ice seaward of the calving front of the Amery Ice Shelf. The results show a mean rate of increase of the surface height on lower Lambert Glacier of 31±10 mm year-1 during the decade from 1978 to 1987–89. The computation is also carried out independently using data not low-pass filtered but with orbit bias minimized by adjusting the Seasat and Geosat ERM orbits into a common ocean surface. The latter analysis shows a mean rate of increase of the surface height of 83 ± 9 mm year-1 during the same time period. Cross-over analyses carried out using altimetry not low-pass filtered and with orbits not adjusted into a common ocean surface yield intermediate results. Taken together, the cross-over analyses show that the surface height on lower Lambert Glacier increased at a mean rate within the range 20–90 mm year-1 during the decade 1978 to 1987–89.