In recognition of an increasing number of high-consequence infectious disease events, a group of subject-matter experts identified core safety principles that can be applied across all donning and doffing protocols for personal protective equipment.

We provide an overview of diagnostic stewardship with key concepts that include the diagnostic pathway and the multiple points where interventions can be implemented, strategies for interventions, the importance of multidisciplinary collaboration, and key microbiologic diagnostic tests that should be considered for diagnostic stewardship. The document focuses on microbiologic laboratory testing for adult and pediatric patients and is intended for a target audience of healthcare workers involved in diagnostic stewardship interventions and all workers affected by any step of the diagnostic pathway (ie, ordering, collecting, processing, reporting, and interpreting results of a diagnostic test). This document was developed by the Society for Healthcare Epidemiology of America Diagnostic Stewardship Taskforce.

Over a 4-year period, the antimicrobial stewardship team reviewed all positive (PCR+/Tox+) and indeterminate (PCR+/Tox−) cases with the most responsible physician for classification of patients as infection or colonization. Among 501 indeterminate samples, 213 (43%) were considered to be clinical infection, suggesting the need for ongoing clinical assessment of indeterminates.

Oxyurid nematodes (Syphacia spp.) from bank (Myodes glareolus) and field/common (Microtus spp.) voles, from disparate geographical sites in the British Isles, were examined morphologically and genetically. The genetic signatures of 118 new isolates are provided, based primarily on the rDNA internal transcribed spacers (ITS1-5.8S-ITS2) region and for representative isolates also on the small subunit 18S rDNA region and cytochrome c oxidase subunit 1 (cox-1) gene locus. Genetic data on worms recovered from Microtus spp. from the European mainland and from other rodent genera from the Palaearctic, North America and West Africa are also included. We test historical hypotheses indicating that S. nigeriana is a generalist species, infecting a range of different rodent genera. Our results establish that S. nigeriana is a parasite of both bank and field voles in the British Isles. An identical genotype was also recorded from Hubert's multimammate mouse (Mastomys huberti) from Senegal, but Mastomys spp. from West Africa were additionally parasitized by a related, although genetically distinct Syphacia species. We found no evidence for S. petrusewiczi in voles from the British Isles but isolates from Russia and North America were genetically distinct and formed their own separate deep branch in maximum likelihood molecular phylogenetic trees.

Ichthyosporean parasites (order Dermocystida) can cause morbidity and mortality in amphibians, but their ecology and epidemiology remain understudied. We investigated the prevalence, gross and histologic appearance, and molecular phylogeny of a novel dermocystid in the state-endangered silvery salamander (Ambystoma platineum) and the co-occurring, non-threatened small-mouthed salamander (Ambystoma texanum) from Illinois. Silvery salamanders (N = 610) were sampled at six ephemeral wetlands from 2016 to 2018. Beginning in 2017, 1–3 mm raised, white skin nodules were identified in 24 silvery salamanders and two small-mouthed salamanders from five wetlands (prevalence = 0–11.1%). Skin biopsy histology (N = 4) was consistent with dermocystid sporangia, and necropsies (N = 3) identified infrequent hepatic sporangia. Parasitic 18S rRNA sequences (N = 5) from both salamander species were identical, and phylogenetic analysis revealed a close relationship to Dermotheca viridescens. Dermocystids were not identified in museum specimens from the same wetlands (N = 125) dating back to 1973. This is the first report of Dermotheca sp. affecting caudates in the Midwestern United States. Future research is needed to determine the effects of this pathogen on individual and population health, and to assess whether this organism poses a threat to the conservation of ambystomatid salamanders.

Widely different views have been held concerning the structure of Plautus’ Menaechmi. On the one hand, the sequence of misunderstandings arising from the presence in the same city of a pair of identical twins with the same name has been likened to clockwork and attributed in essentials to an unknown Greek dramatist. On the other hand, E. Stärk has stressed features of the play which are typical of improvised comedy and put forward the bold theory that it was constructed by Plautus himself, following traditions of pre-literary Italic drama but using stock motifs of Greek New Comedy. I wish to suggest that the truth lies between these extreme positions.

We compared elastic moduli in polar firn derived from diving wave refraction seismic velocity analysis, firn-core density measurements and microstructure modelling based on firn-core data. The seismic data were obtained with a small electrodynamic vibrator source near Kohnen Station, East Antarctica. The analysis of diving waves resulted in velocity–depth profiles for different wave types (P-, SH- and SV-waves). Dynamic elastic moduli of firn were derived by combining P- and S-wave velocities and densities obtained from firn-core measurements. The structural finite-element method (FEM) was used to calculate the components of the elastic tensor from firn microstructure derived from X-ray tomography of firn-core samples at depths of 10, 42, 71 and 99 m, providing static elastic moduli. Shear and bulk moduli range from 0.39 to 2.42 GPa and 0.68 to 2.42 GPa, respectively. The elastic moduli from seismic observations and the structural FEM agree within 8.5% for the deepest achieved values at a depth of 71 m, and are within the uncertainty range. Our observations demonstrate that the elastic moduli of the firn can be consistently obtained from two independent methods which are based on dynamic (seismic) and static (tomography and FEM) observations, respectively, for deeper layers in the firn below ~10 m depth.

Acute flank pain from suspected urolithiasis is a common presenting complaint in the Emergency Department. Multiple computed tomography (CT) has traditionally been the standard imaging modality used to diagnose obstructive kidney stones, however point of care ultrasound (PoCUS) can play an important role in the diagnostic algorithm and risk stratification of acute flank pain. Here, we present the case of a 29-year-old female with suspected urolithiasis, who underwent PoCUS that revealed right-sided hydronephrosis and normal left kidney, bladder, and aorta. A subsequent KUB was negative. As the clinical course failed to improve with therapy, an abdominal and pelvic CT was ordered revealing a 5 mm distal obstructing ureteric calculus at the right vesico-ureteric junction and another 5 mm left mid ureteric calculus. To the best of our knowledge, this is the first case in which a patient presenting with acute right-sided flank pain demonstrated unilateral hydronephrosis on PoCUS, but had clinically significant bilateral ureteric stones on CT. Emergency physicians who employ PoCUS for evaluation of flank pain must be aware of its benefits and drawbacks and how they apply to each patient. As such, we have developed a script emergency physicians can use for shared decision-making with renal colic patients when deciding on the appropriate imaging modality.

The provisioning of potable water was a microcosm of the Ottoman state's incomplete projects of technopolitical modernization on the Arab frontier. Water questions sat at the intersection between international pressures surrounding cholera, drought, Wahhabi and Bedouin disorder, and the inability of the state to impose its will on the semi-autonomous Amirate of Mecca. To be sure, Ottoman public health reforms and increased attention to water infrastructure were partly a product of the intense international attention generated by the hajj's role in the globalization of cholera. However, like other projects with more overt military and strategic implications, most notably the Hijaz telegraph and railway, the Ottoman state also saw an opportunity to harness the increasing medicalization of the hajj to serve a broader set of efforts to consolidate the empire's most vulnerable frontier provinces. Through the lens of the technopolitical frontier this essay seeks to tell a larger story about the evolution of state building and development in Arabia, one that would otherwise be obscured without reference to both its late Ottoman and Saudi histories. By viewing the evolution of hydraulic management in the Hijaz as a continuous process unfolding across the long nineteenth century, we gain a new perspective on the role that Ottoman technopolitics played in shaping the Saudi state that eventually succeeded it. We find that the quest for water security in the Hijaz, particularly in Jidda, played a critical role in setting the stage for the discovery of the Saudi Arabia's massive petroleum reserves.