Background: Nucleic acid amplification tests (NAAT) do not distinguish between colonization and Clostridioides difficile (C.diff) associated diarrhea. On April 5th 2023 our laboratory introduced a new C. diff testing methodology. Previously, if a C. diff screen result was negative for toxin and positive for glutamate dehydrogenase (GDH), a second confirmatory test was conducted with NAAT. This confirmatory test was removed from our testing algorithm. NAAT testing may be ordered ad hoc when clinically relevant diarrhea persists, and alternative etiologies have been excluded. We wanted to evaluate the impact of change with testing methods. Method: Retrospective review of all inpatient hospital-acquired C.diff infections reported to NHSN database from Ascension Michigan Market which comprises 14 acute care hospitals from June 2019 to August 2023. Data for C diff was analyzed every quarter. The risk adjustments used to calculate the Standardized Infection Ratios (SIRs) for C. diff infections was set at 0.48 based on CDC mean SIR established for acute care hospitals in 2022. Results: A total of 14 acute care hospitals were included from which 866 C.diff cases were reported during this period. Overall, the SIR dropped from 0.59 from June-August 2019 to 0.32 reported from March-May 2023; 45.7 % decrease. The maximum reduction in SIR was seen post intervention at 0.21 from June-August 2023 which was 78.3% below the benchmark of 0.48. (Figure) Conclusions: Strategies to optimize current laboratory tests are critical to differentiate C. diff infection from colonization. The current strategy by changing the testing method led to substantial reduction in C-diff. Diagnostic stewardship studies should ideally include outcome measures targeted to post-intervention patients to determine clinical relevance and patient safety. Optimizing test utilization remains a critical component of quality healthcare delivery. Future NHSN updated surveillance definition will require incorporating clinical decision-making into the metric; that is including a combination of any positive C-diff test plus initiation of antibiotic therapy for C-diff.

Disclosure: Reese Cosimi: Advisory Board - Abbvie

Academic discovery in biomedicine is a growing enterprise with tens of billions of dollars in research funding available to universities and hospitals. Protecting and optimizing the resultant intellectual property is required in order for the discoveries to have an impact on society. To achieve that, institutions must create a multidisciplinary, collaborative system of review and support, and utilize connections to industry partners. In this study, we outline the efforts of Case Western Reserve University, coordinated through its Clinical and Translational Science Collaborative (CTSC), to promote entrepreneurial culture, and achieve goals of product development and startup formation for biomedical and population health discoveries arising from the academic ecosystem in Cleveland. The CTSC Office of Translation and Innovation, with the university’s Technology Transfer Office (TTO), helps identify and derisk promising IP while building interdisciplinary project teams to optimize the assets through key preclinical derisking steps. The benefits of coordinating funding across multiple programs, assuring dedicated project management to oversee optimizing the IP, and ensuring training to help improve proposals and encourage an entrepreneurial culture, are discussed in the context of a case study of therapeutic assets, the Council to Advance Human Health. This case study highlights best practices in academic innovation.

Music composition is traditionally regarded as an act of individual creation and expression, but can be approached, through the aid of digital platforms, as an activity that encourages learning through social participation. This article describes the development of a tablet-based app, Paynter, intended as a digital graphic interface for group collaborative composition and its experimental use in a primary school in Salford, UK, alongside musicians from the BBC Philharmonic orchestra. The app created a framework for a negotiated language of symbols used by two groups of students at Key Stage 1 and Key Stage 2 to tell stories through sound and music. Its functionality enabled compositional thinking to emerge collectively from groups with relatively little exposure to the idea of composing and little knowledge of traditional notational or digital sequencing technologies. The research is grounded in a theoretical context of constructivist approaches to education.

Emerson and colleagues (2020) provide new isotopic evidence on directly dated human bone from the Greater Cahokia region. They conclude that maize was not adopted in the region prior to AD 900. Placing this result within the larger context of maize histories in northeastern North America, they suggest that evidence from the lower Great Lakes and St. Lawrence River valley for earlier maize is “enigmatic” and “perplexing.” Here, we review that evidence, accumulated over the course of several decades, and question why Emerson and colleagues felt the need to offer opinions on that evidence without providing any new contradictory empirical evidence for the region.

Although recognized as one of the most significant cultural transformations in North America, the reintroduction of the horse to the continent after AD 1492 has been rarely addressed by archaeological science. A key contributing factor behind this limited study is the apparent absence of equine skeletal remains from early historic archaeological contexts. Here, we present a multidisciplinary analysis of a horse skeleton recovered in Lehi, Utah, originally attributed to the Pleistocene. Reanalysis of stratigraphic context and radiocarbon dating indicates a historic age for this horse (cal AD 1681–1939), linking it with Ute or other Indigenous groups, whereas osteological features demonstrate its use for mounted horseback riding—perhaps with a nonframe saddle. DNA analysis indicates that the animal was a female domestic horse, which was likely cared for as part of a breeding herd despite outliving its usefulness in transport. Finally, sequentially sampled stable carbon, oxygen, and strontium isotope values from tooth enamel (δ13C, δ18O, and 87Sr/86Sr) suggest that the horse was raised locally. These results show the utility of archaeological science as applied to horse remains in understanding Indigenous horse pastoralism, whereas consideration of the broader archaeological record suggests a pattern of misidentification of horse bones from early historic contexts.

The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother–child interactions as well as inform interventions for women and their families.

TwinsUK is the largest cohort of community-dwelling adult twins in the UK. The registry comprises over 14,000 volunteer twins (14,838 including mixed, single and triplets); it is predominantly female (82%) and middle-aged (mean age 59). In addition, over 1800 parents and siblings of twins are registered volunteers. During the last 27 years, TwinsUK has collected numerous questionnaire responses, physical/cognitive measures and biological measures on over 8500 subjects. Data were collected alongside four comprehensive phenotyping clinical visits to the Department of Twin Research and Genetic Epidemiology, King’s College London. Such collection methods have resulted in very detailed longitudinal clinical, biochemical, behavioral, dietary and socioeconomic cohort characterization; it provides a multidisciplinary platform for the study of complex disease during the adult life course, including the process of healthy aging. The major strength of TwinsUK is the availability of several ‘omic’ technologies for a range of sample types from participants, which includes genomewide scans of single-nucleotide variants, next-generation sequencing, metabolomic profiles, microbiomics, exome sequencing, epigenetic markers, gene expression arrays, RNA sequencing and telomere length measures. TwinsUK facilitates and actively encourages sharing the ‘TwinsUK’ resource with the scientific community — interested researchers may request data via the TwinsUK website (http://twinsuk.ac.uk/resources-for-researchers/access-our-data/) for their own use or future collaboration with the study team. In addition, further cohort data collection is planned via the Wellcome Open Research gateway (https://wellcomeopenresearch.org/gateways). The current article presents an up-to-date report on the application of technological advances, new study procedures in the cohort and future direction of TwinsUK.

In the late fifteenth and early sixteenth centuries, artists in West Africa made sophisticated ivory carvings specifically for the early Portuguese navigators and their patrons. In researching the history of the ivories, the records of eighteenth-century English antiquarians are a neglected yet important source of information. Such sources help to bridge the gap between the earliest references to Afro-Portuguese ivories in Portuguese customs records (as well as the inventories of royal and princely treasuries of the late Renaissance) and their re-appearance in nineteenth-century museum registers and the collections of private individuals.

Especially valuable in this regard are the eighteenth-century minutes of the Society of Antiquaries of London, which enable us to trace the history of several African ivories associated with Fellows of the Society – in particular, Richard Rawlinson, Martin Folkes, Sir Hans Sloane, George Vertue and George Allan. In this article, the author reassesses two African ivories, an oliphant and a saltcellar, with specific reference to the Minutes of the Society of Antiquaries of London, shedding new light on the history of these beautiful objects.

Twenty accessions within 11 perennial Glycine species plus soybean were tested for tolerance to 2,4-D. Soybean was severely injured by 2,4-D, but 13 of the Glycine accessions had 15% or less injury 4 weeks after 2,4-D application. Greatest 2,4-D tolerance occurred with accessions of G. latifolia and G. microphylla. There was no difference among tolerant accessions of G. latifolia and G. microphylla and susceptible accessions of G. canescens in recovery or absorption of 14C-2,4-D 1, 3, 7, or 14 days after treatment (DAT). Distribution of 14C from 14C-2,4-D in various plant parts was similar among accessions. Metabolism of 2,4-D in the tolerant accessions (81 to 89% 1 DAT) was higher and more rapid than in susceptible accessions (approximately 50%, 1 DAT). The same five metabolites plus parent 2,4-D were extracted from the treated leaf of all accessions at all sampling dates. However, relative distribution between metabolites differed between tolerant and susceptible accessions. More rapid metabolism of 2,4-D in treated leaves of tolerant Glycine accessions can explain differential 2,4-D responses.

Field studies were conducted at Dekalb, Urbana, and Brownstown, IL, in 1996 and 1997 to evaluate corn (Zea mays) injury and weed control from preemergence applications of RPA 201772 alone and tank-mixed with metolachlor, atrazine, or both. No significant corn injury from RPA 201772 was observed at any time for all experiments. Giant foxtail (Setaria faberi) control at 60 days after treatment (DAT) was variable and ranged from 47 to 93% for RPA 201772 applied alone at 105 g ai/ ha. Giant foxtail control of at least 90% was observed by applying metolachlor at 1,120 g ai/ha with 105 g/ha RPA 201772. The addition of atrazine at either 1,120 or 1,680 g ai/ha improved control of giant foxtail compared with RPA 201772 applied alone at 105 g/ha in two of the six studies. RPA 201772 applied at 105 g/ha controlled at least 88% of velvetleaf (Abutilon theophrasti), Pennsylvania smartweed (Polygonum pensylvanicum), and smooth pigweed (Amaranthus hybridus). RPA 201772 controlled 88% or less of common waterhemp (Amaranthus rudis), common ragweed (Ambrosia artemisiifolia), and common cocklebur (Xanthium strumarium). Control of these three species was 92% or greater with RPA 201772 plus atrazine. Control of common lambsquarters (Chenopodium album) was at least 96% with RPA 201772 applied alone at any rate in four of the six studies. However, common lambsquarters control was 68 and 77% for RPA 201772 applied alone at 105 g/ha at Urbana and Brownstown in 1997, respectively, where high common lambsquarters densities were prevalent. Under these conditions, the addition of atrazine to RPA 201772 at 105 g/ha improved control of common lambsquarters. RPA 201772 has excellent potential to provide consistent control of velvetleaf compared with atrazine. In contrast, these studies indicate RPA 201772 may provide inconsistent control of certain weed species in different environments. In order to achieve consistent control of a broad spectrum of weed species, RPA 201772 must be combined with other herbicides.

Field studies were conducted near Knoxville, TN, from 2003 to 2005 to evaluate the response of ‘Thermal Blue’, a new interspecific hybrid Kentucky bluegrass to commonly applied PRE and POST herbicides for weed management. Dithiopyr, oryzalin, oxadiazon, pendimethalin, prodiamine, quinclorac, and trifluralin applied at seeding injured hybrid bluegrass greater than 81% and reduced hybrid bluegrass cover greater than 57%. In a second study, established hybrid bluegrass was treated POST with acetolactate synthase–inhibiting herbicides including bispyribac-sodium, chlorosulfuron, foramsulfuron, halosulfuron, imazapic, imazaquin, metsulfuron, rimsulfuron, sulfosulfuron, and trifloxysulfuron at low and high rates (one and two times the suggested use rates in Kentucky bluegrass or other turfgrasses). By 5 wk after treatment (WAT), foramsulfuron at 88 g ai/ha and trifloxysulfuron at 35 g ai/ha injured hybrid bluegrass greater than 26% and reduced visually estimated quality and chlorophyll meter indices. However, hybrid bluegrass injury was no longer evident at 10 WAT. In a third study, established hybrid bluegrass was treated with clethodim, diclofop-methyl, fluazifop-p-butyl, and sethoxydim applied at low, medium, and high rates (0.5, 1, and 2 times the registered Kentucky bluegrass or other turfgrass use rates). Clethodim applied at 280 and 560 g ai/ha, fluazifop at 420 g ai/ha, and sethoxydim at 630 g ai/ha injured hybrid bluegrass 5 WAT. These treatments also reduced quality (to less than 5 on a scale of 1 to 9) and chlorophyll meter indices (24 to 37%) when compared to the untreated control. By 10 WAT, only clethodim at 560 g ai/ha caused injury (14%). By 10 WAT, hybrid bluegrass had recovered and injury was only observed in plots treated with clethodim at 560 g ai/ha. No differences in chlorophyll indices or quality were observed at 10 WAT for any POST graminicides.

Studies were conducted in New Jersey and Virginia to evaluate the response of ‘Aurora Gold’ hard fescue, which had undergone five cycles of phenotypic recurrent selection for increased glyphosate tolerance, to direct applications of glyphosate. ‘Discovery’ hard fescue, which had not undergone recurrent selection, was also included in the study. Glyphosate treatments were initiated in early/mid-May and applied once, twice, or three times at 4- to 5-wk intervals at rates ranging from 0.1 to 1.6 kg ae/ha. Aurora Gold was more tolerant to glyphosate than Discovery in all experiments, indicating that recurrent selection was successful in increasing glyphosate tolerance in hard fescue. Single applications of glyphosate at rates ranging from 0.6 to 0.8 kg/ha could be applied to Aurora Gold with minimal injury or stand thinning (<20%), whereas multiple applications of glyphosate could be applied at rates ranging from 0.4 to 0.6 kg/ha. The use of Aurora Gold in areas planted to hard fescue, such as golf course roughs, vineyards, orchards, and landscapes, would allow the integration of direct glyphosate applications into an overall weed management program providing potential economic and environmental benefits.

Site-specific weed management can increase crop production efficiency by minimizing herbicide input costs without compromising crop yields. A reduction in herbicide inputs resulting from site-specific weed management may also decrease the probability level of nonpoint pollution compared with conventional herbicide applications. A 4.5-ha field was selected to compare site-specific and conventional weed management techniques in 1997 and 1998 at Knoxville, TN. Variable rate applications (VRAs) of atrazine preemergence (PRE) followed by dicamba postemergence (POST) were investigated for the reduction of herbicide inputs and their resulting impact on weed control and corn yield. VRAs of atrazine were on the basis of weed density data collected in 1996. VRAs of dicamba were according to common cocklebur density evaluations within the field. Compared with conventional applications, atrazine usage was decreased by 43 and 32% in the site-specific application treatments in 1997 and 1998, respectively. VRAs of dicamba reduced herbicide inputs by greater than 45% for 1997 and 1998. Corn yields were similar for the conventional and site-specific treatments in both years. On the basis of these data, site-specific herbicide applications have the greatest potential and least risk for managing weeds when POST or PRE + POST variable rate herbicide applications are used.

Field studies were conducted to compare venturi-type nozzles to a fan nozzle with respect to the efficacy of postemergence herbicides applied to common cocklebur and broadleaf signalgrass. Spray solutions of glufosinate, glyphosate, and paraquat were applied through all combinations of three nozzles and two application volumes. Venturi nozzles were a Delavan Raindrop Ultra (RU) and a Spraying Systems AI Teejet (AI). A Spraying Systems XR Teejet (XR) fan nozzle was included as a standard. Previous work indicated droplet size spectra differed among these nozzles. There was a difference in common cocklebur control among nozzles (AI = XR > RU), although control was at least 90% for all nozzles. Herbicide choice had a greater effect on broadleaf signalgrass control than nozzle type. Broadleaf signalgrass control differed among herbicides (glufosinate = paraquat > glyphosate) and among nozzles (AI = XR > RU). Herbicide performance varied between nozzles (AI > RU), but the AI nozzle was as effective as the XR fan nozzle.

Field experiments were conducted near DeKalb and Urbana, IL, and Columbia, MO, in 1997 and 1998 to evaluate weed management systems in glyphosate- and glufosinate-resistant soybean planted in 18-cm rows. Overall weed control was improved to a greater extent when the rate of glufosinate was increased from 300 to 400 g ai/ha than when the rate of glyphosate increased from 630 to 840 g ae/ha. Sequential applications of glufosinate improved control over single applications, whereas sequential treatments of glyphosate generally provided no advantages over single applications. When averaged across all weed species in these trials, the systems that provided 95% or higher average control were sequential applications of glufosinate, sequential applications of glyphosate, and clomazone followed by (fb) glyphosate. Single applications of glufosinate provided somewhat variable control of giant foxtail, common lambsquarters, ragweed, and common cocklebur similar to that observed with pendimethalin fb imazethapyr. The addition of fomesafen to glufosinate did not improve control of any of the weeds in this study with the exception of velvetleaf at DeKalb. The addition of clomazone to glufosinate treatments resulted in slightly better giant foxtail and velvetleaf control. Single applications of glyphosate provided somewhat variable control of giant ragweed at DeKalb in 1997 and ivyleaf morningglory and common cocklebur control at Columbia. The addition of fomesafen to glyphosate provided an increase in ivyleaf morningglory and common cocklebur control at Columbia but did not improve control of any other species. The addition of clomazone to glyphosate-based programs resulted in slightly higher velvetleaf, common cocklebur, and ivyleaf morningglory control. In the glyphosate-based herbicide programs there were no substantial differences in relative yield, with all programs protecting over 95% of soybean yield. Glufosinate-based programs were effective in protecting 85 to 92% of soybean yield.

Water use by saltcedar, an invasive phreatophyte, is of significant concern in many riparian zones in the western United States. Diurnal groundwater fluctuations were analyzed to estimate evapotranspiration and water salvage (water available for other ecological functions) in saltcedar stands over a 6-yr period on a site along the Pecos River in Texas. Seasonal stand-level saltcedar water loss at an untreated control site ranged from 0.42 to 1.18 m/yr. Seasonal water salvage following application of imazapyr ranged from 31% 4 yr after treatment to 82% 2 yr after treatment. Significant water savings may be achieved by chemical saltcedar control, dependent upon water use by replacement vegetation and saltcedar regrowth. A regrowth management strategy is essential to maintain long-term water salvage.

Field experiments were conducted in 1997 and 1998 near Columbia and Novelty, MO, and at Urbana, IL, to evaluate corn injury, weed control, corn yield, and estimated economic returns with weed management programs in glufosinate-resistant corn. Herbicide programs included acetochlor preemergence (PRE) followed by glufosinate alone or with atrazine postemergence (POST) and total POST programs consisting of single and sequential applications of glufosinate alone or tank mixed with acetochlor, atrazine, or acetochlor plus atrazine. Metolachlor PRE followed by dicamba plus atrazine early POST (EPOST) and metolachlor plus atrazine PRE were included for comparison. In the total POST treatments, mid-POST applications controlled shattercane and common cocklebur better than EPOST applications. However, yield reductions as high as 23% occurred because of early-season weed interference, although weeds were controlled later in the season. Applying atrazine with glufosinate generally increased control of giant foxtail, common cocklebur, morningglory species, and common waterhemp compared to glufosinate alone, but did not increase control of common lambsquarters, velvetleaf, or Pennsylvania smartweed. Corn yield was positively correlated with weed control (r = 0.88) and more strongly dependent on grass (r = 0.82) than broadleaf (r = 0.70) weed control. Net incomes were positively correlated to corn yield (r = 0.73). Four of the top six net income-producing treatments included two herbicide applications. Three of the treatments were PRE followed by POST programs, and the fourth was a sequential POST treatment of glufosinate.

Field experiments were conducted in 1997 and 1998 near Columbia and Novelty, MO, and Urbana, IL, to evaluate crop injury, weed control, corn yield, and net economic returns provided by weed control programs in glyphosate-resistant corn. The herbicide programs evaluated included acetochlor preemergence (PRE) followed by (fb) glyphosate with or without atrazine postemergence (POST) and total POST programs consisting of single and sequential applications of glyphosate alone and tank-mixed with actochlor, atrazine, or both. Metolachlor PRE fb dicamba plus atrazine POST and metolachlor plus atrazine PRE were included for comparison. In the total POST treatments, mid-post (MPOST) applications provided better control than early-post (EPOST) applications on weeds that germinated throughout the growing season such as shattercane and common cocklebur, but also resulted in yield reductions of up to 23% caused by early-season weed competition. The addition of atrazine to glyphosate POST generally increased control of common cocklebur, morningglory species, and common waterhemp. EPOST or PRE fb EPOST applications generally provided higher yields than MPOST treatments, although MPOST treatments often provided equal or greater weed control at midseason. Treatments including two herbicide applications tended to provide greater weed control, yield, and profit than those with a single application. Input costs for glyphosate-resistant corn are slightly higher than nontransgenic hybrids. However, net economic returns are similar and the use of glyphosate POST allows greater flexibility in POST weed management decisions.