Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chronic lower urinary tract symptoms (LUTS), making the diagnosis of UTI challenging. We sought to understand the clinical presentation of patients who receive urine tests in a cohort of diverse hospitals. Methods: This retrospective descriptive cohort study included all adult noncatheterized inpatient and ED encounters with paired urinalysis and urine cultures (24 hours apart) from 5 community and academic hospitals in 3 states (NC, VA, GA) between January 1, 2017, and December 31, 2019. Trained abstractors collected clinical and demographic data using a 60-question REDCap survey. The study group met with multidisciplinary experts (ID, geriatrics, urology) to define the “continuum of UTI” (Table 1), which includes 2 new categories: (1) LUTS to capture patients with chronic lower urinary tract symptoms and (2) bacteriuria of unclear significance (BUS) to capture patients who do not clinically meet criteria for ASB or UTI (eg, older adults who present with delirium and bacteriuria). The newly defined categories were compared to current guideline-based categories. We further compared ASB, BUS, and UTI categories using a lower bacterial threshold of 1,000 colony-forming units. Results: In total, 220,531 encounters met study criteria. After using a random number generator and removing duplicates, 3,392 encounters were included. Based on current IDSA guidelines, the prevalence of ASB was 32.1% (n = 975), and prevalence of patients with “not UTI” was 1,614 (53%). Applying the expert panel’s new “continuum of UTI” definitions, the prevalence of “not UTI” patients decreased to 1,147 (37.7%), due to reassignment of 467 patients (15.3%)to LUTS. The prevalence of ASB decreased by 24% due to reassignment to BUS. Lowering the bacterial threshold had a slight impact on the number of definitive UTIs (14.9 vs 15.9%) (Table 1). Conclusions: Our rigorous review of laboratory and symptom data from a diverse population dataset revealed that diagnostic uncertainty exists when assessing patients with suspicion for UTI. We propose moving away from dichotomous approach of ASB versus UTI and using the “continuum of UTI” for stewardship conversations. This approach will allow us to develop nuanced deprescribing interventions for patients with LUTS or BUS (eg, watchful waiting, shorter course therapy) that account for the unique characteristics of these populations.

Disclosures: None

The development of wearable technology, which enables motion tracking analysis for human movement outside the laboratory, can improve awareness of personal health and performance. This study used a wearable smart sock prototype to track foot–ankle kinematics during gait movement. Multivariable linear regression and two deep learning models, including long short-term memory (LSTM) and convolutional neural networks, were trained to estimate the joint angles in sagittal and frontal planes measured by an optical motion capture system. Participant-specific models were established for ten healthy subjects walking on a treadmill. The prototype was tested at various walking speeds to assess its ability to track movements for multiple speeds and generalize models for estimating joint angles in sagittal and frontal planes. LSTM outperformed other models with lower mean absolute error (MAE), lower root mean squared error, and higher R-squared values. The average MAE score was less than 1.138° and 0.939° in sagittal and frontal planes, respectively, when training models for each speed and 2.15° and 1.14° when trained and evaluated for all speeds. These results indicate wearable smart socks to generalize foot–ankle kinematics over various walking speeds with relatively low error and could consequently be used to measure gait parameters without the need for a lab-constricted motion capture system.

Sixty years have passed since occupiers in England and Wales were placed under a statutory duty to keep visitors to occupied premises reasonably safe. The legislation, however, did not detail the exact operation of this duty of care. The case law, expected to fill in the gaps, has arguably developed without sufficient consistency and/or predictability. This apparent confusion can be remedied through applying a systematic test to the question of whether a breach of duty has occurred. The test follows the verification that the case falls within the field of occupiers’ liability because of the presence of a danger attributable to the state of the premises. It consists of three consecutive stages which ask: (1) whether the risk of injury was foreseeable; (2) whether the occupier could reasonably have been expected to have addressed this very particular risk; and (3) whether any remedial action the occupier actually took was appropriate.

The terms Eem and Eemian have been applied to lithostratigraphic, chronostratigraphic, and biostratigraphic aspects of the last interglacial in western Europe. Eemian vegetational successions show strong uniformity at sites from western France across the North European Plain to Poland, suggesting, by comparison with the Holocene, that major pollen zones are broadly synchronous. South of the Alps and Pyrenees, a different vegetational succession is observed with no evidence for a substage of post-temperate cooling.

Yellow starthistle is an annual that is dependent on achene production, dispersal, and germination for stand renewal. Our purpose in this study was to determine the temperature relations for germination of achenes of this species. Germination temperature profiles were developed for achenes of yellow starthistle collected from 15 sites in California, Nevada, and Oregon. Each profile consisted of achene germination at 55 constant or alternating temperatures from 0 through 40 C. A total of 85 germination temperature profiles were developed by using the germination data to construct quadratic response surfaces through regression analysis. For most profiles, germination occurred at all the temperature regimes except a constant 40 C. This includes a constant 0 C and 0 alternating with 40 C. Rarely, there was no germination at 35 C and 35 C alternating with 40 C. The only evidence of afterripening requirements for achenes of yellow starthistle that we noted occurred at very cold temperature regimes. At those temperatures, the germination of dark-colored achenes without pappus increased 3 mo after harvest, and decreased for light-colored achenes with a pappus. No single temperature regime always supported optimum germination when all the profiles were combined. The most frequent optima was 2/20 C. Comparing all profiles for the Davis, CA, accession, there were 5 regimes (5 and 10 C cold periods alternating with 15 through 25 C warm periods) that always supported optimum germination. Light-colored achenes with pappus tended to have optimal germination at colder temperatures, and the dark-colored achenes at higher temperatures when seeds were tested immediately after harvest.

The last interglacial, commonly understood as an interval with climate as warm or warmer than today, is represented by marine isotope stage (MIS) 5e, which is a proxy record of low global ice volume and high sea level. It is arbitrarily dated to begin at approximately 130,000 yr B.P. and end at 116,000 yr B.P. with the onset of the early glacial unit MIS 5d. The age of the stage is determined by correlation to uranium–thorium dates of raised coral reefs. The most detailed proxy record of interglacial climate is found in the Vostok ice core where the temperature reached current levels 132,000 yr ago and continued rising for another two millennia. Approximately 127,000 yr ago the Eemian mixed forests were established in Europe. They developed through a characteristic succession of tree species, probably surviving well into the early glacial stage in southern parts of Europe. After ca. 115,000 yr ago, open vegetation replaced forests in northwestern Europe and the proportion of conifers increased significantly farther south. Air temperature at Vostok dropped sharply. Pulses of cold water affected the northern North Atlantic already in late MIS 5e, but the central North Atlantic remained warm throughout most of MIS 5d. Model results show that the sea surface in the eastern tropical Pacific warmed when the ice grew and sea level dropped. The essentially interglacial conditions in southwestern Europe remained unaffected by ice buildup until late MIS 5d when the forests disappeared abruptly and cold water invaded the central North Atlantic ca. 107,000 yr ago.

Suggestions that the duration of the Eemian interglacial was about 11,000 yr, based on annually laminated sediment sequences in Germany, have been challenged in favor of a much longer interval. However, biostratigraphic evidence demonstrates why the Eemian sequences at Grande Pile and Ribains cannot be reliably used for alignment with the marine sequence, as applied by Kukla et al. (2002, this issue) to estimate the duration of this interglacial. The long chronology they propose would imply not just coniferous but, for up to 5000 yr, fully temperate forest in central France coexisting with treeless heath and steppe tundra conditions in northwestern Europe, an unlikely climatic and ecological scenario. The proposal that the Eemian Interglacial in western Europe lasted for 17,000 or even 23,000 yr is rejected. A duration of no more than 13,000 yr is preferred, at least for sites north of the Alps and Pyrenees. The duration of temperate conditions in the Mediterranean region is less certain.

Gusts, says Duchêne, are more frequent when the machine is flying into the wind than with the wind, “for the simple reason that the gusts have a certain speed and the aeroplane therefore meets more of them (in the same space of time).” Elsewhere Duchêne refers to the experience of a pedestrian on a tramway route: in a given time a pedestrian meets more cars than those that overtake him.

I can see no parallel here, however, to meeting or following gusts in an aeroplane. Whether the machine is flying with the wind, or in the opposite direction to the stream of air, it has got to maintain its relative speed to the air: increase or decrease means a lift or a dip. So, as regards gusts in either case, the number met or overtaken would be the same. And it would seem that a following lull should have much the same effect on a machine as a head gust, and vice–versâ.