SHEA, in partnership with ASGE, APIC, AAMI, AORN, HSPA, IDSA, SGNA, and The Joint Commission, developed this multisociety infection prevention guidance document for individuals and organizations that engage in sterilization or high-level disinfection (HLD). This document follows the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities. This guidance is based on a synthesis of published scientific evidence, theoretical rationale, current practices, practical considerations, writing group consensus, and consideration of potential harm when applicable. The supplementary material includes a summary of recommendations. The guidance provides an overview of the Spaulding Classification and considerations around manufacturers’ instructions for use (MIFUs). Its recommendations address: point-of-use treatment prior to sterilization or HLD, preparation of reusable medical devices at the location of processing, sterilization, and immediate use steam sterilization (IUSS), HLD of lumened and non-lumened devices, processing of reusable medical devices used with lubricating or defoaming agents, monitoring for effectiveness of processing, handling of devices after HLD, augments and alternatives to HLD, processing of investigational devices, tracking of reusable medical devices, and approaches to implementation.

Experimental stone tool replication is an important method for understanding the context and production of prehistoric technologies. Experimental control is valuable for restricting the influence of confounding variables. Researchers can exert control in studies related to cognition and behavior by standardizing the type, form, and size of raw materials. Although standardization measures are already part of archaeological practice, specific protocols—let alone comparisons between standardization techniques—are rarely openly reported. Consequently, independent laboratories often repeat the costly trial-and-error process for selecting usable raw material types or forms. Here, we investigated various techniques and raw materials (such as hand-knapped flint, machine-cut basalt, manufactured glass, and porcelain) and evaluated them for validity, reliability, and standardizability. We describe the tests we performed, providing information on the individual approaches, as well as comparisons between the techniques and materials according to validity and reliability, along with relative costs. We end by providing recommendations. This is intended as a serviceable guide on raw material standardization for knapping experiments, including existing strategies and ones so far undescribed in the experimental archaeology literature. The future of this field would benefit from developments in the relevant technologies and methodologies, especially for those that are not yet widely available or affordable.

Objectives/Goals: To identify clinician and researcher barriers, facilitators and learning preferences for patient partner engagement in research. In addition, to describe the strategies, our Patient Partners Program has planned for building clinician and researcher capacity to engage patient partners in clinical research. Methods/Study Population: Our program to promote authentic patient–researcher partnerships to advance clinical and translational research is grounded in participatory approaches to maximize meaningful engagement. We utilized small group listening sessions with health care providers involved in clinical research at the University of Michigan, Michigan Medicine healthcare system. Insights from these sessions are informing the development of learning models and curriculum content. We used purposive sampling to recruit individuals (n = 12) with a wide array of patient engagement experiences across diverse clinical departments. The study materials and interview guide were co-created with a patient research partner who also participated in co-facilitating the listening sessions. Results/Anticipated Results: The interview guide included questions about the benefits, challenges, and supports to engagement and capacity building training programs for researchers. The listening sessions were recorded, transcribed, and analyzed for common themes. Preliminary findings have identified the following themes related to barriers: (1) identifying and onboarding patient partners, (2) communication challenges, and (3) institutional and structural challenges (e.g., time constraints and difficulty offering compensation) and facilitators: (1) institutional and administrative support, (2) flexibility, and (3) respect, trust, and partnership. Improved knowledge about how and when to engage patient partners was identified as a key component to build researcher capacity in patient partnered research. Discussion/Significance of Impact: Integrating patient partners into study teams accelerates innovation and translational science, increases the relevance of research findings, improves health outcomes and patient empowerment, and elevates the value of the patient perspective allowing researchers to gain a new point of view from an individual with lived experience.

Vascular rings represent a heterogeneous set of aberrant great vessel anatomic configurations which can cause respiratory symptoms or dysphagia due to tracheal or oesophageal compression. These symptoms can be subtle and may present at varied ages. More recently, many have been identified in patients without symptoms, including fetal echocardiogram, resulting in a conundrum for practitioners when attempting to determine who will benefit from surgical correction. Here, we provide a review of vascular rings and a guide to the practitioner on when to consider additional imaging or referral. Additionally, we discuss the changing landscape regarding asymptomatic patients and fetal echocardiogram.

Archimedes screw generators are a small-scale, eco-friendly hydropower technology. Despite their promise as a sustainable energy technology, the design specifics of the technology are not well documented in the published literature. Existing performance prediction models often fail to accurately forecast power loss, particularly as it relates to the outlet of the screw generator. To address this, a comprehensive computational fluid dynamic model was developed and evaluated using both laboratory-scale experiments and real-world data. This yielded an extensive dataset that covered wide variations in design parameters. The dataset was then used to inform the development and evaluation of an outlet power loss prediction model. The resulting model significantly improved the accuracy of overall performance predictions, reducing average error to 13.68 % compared with nominal experimental data – a substantial improvement over previous models, which averaged around 42.55 % error for the same test cases. Notably, the new model achieved an absolute error of 5 % or less in over 26 % of comparison points, marking a remarkable advancement by predicting outlet power loss by more than 28.8 %.

On the upper reaches of the Tigris and Euphrates, archaeologists encounter evidence that challenges conventional understandings of early state formation as a transition from ‘small-scale, egalitarian’ to ‘large-scale, stratified’ societies. One such location is the Early Bronze Age cemetery of Başur Höyük, which presents evidence of grand funerary rituals—including ‘retainer burials’ and spectacular deposits of metallic wealth—in an otherwise small-scale, egalitarian setting. A further, puzzling feature of this cemetery is the preponderance of teenagers in the richest tombs. Here we describe the combined results of archaeological and anthropological analysis at Başur Höyük, including ancient DNA, and consider the challenges they pose to traditional accounts of early state formation.

The Diene Report of 2005 represents an instance in which an international organization investigated Japanese official treatment of minority communities in Japan in relation to international standards, and their findings strongly supported the Ainu activists. The United Nations sent Doudou Diene, their Special Rapporteur, to Japan to look into discrimination and racism. Diene's report harshly criticized the racism that exists in Japan and suggested that improved measures are necessary to protect the Ainu and other minorities there. This article is a response to his report by five Japanese individuals who have long been committed to countering discrimination and racism in the country. Four of the five contributors agree with the overall content of the Diene report and provide further information. They see the report as a small but positive impetus that will help the 21st century activism that further counters discrimination and racism in Japan. On the other hand, William Wetherall criticizes the report as seriously flawed, because he thinks it misunderstands the main aspects of the issue.

Williams v Commonwealth of Australia is a landmark decision of the High Court on the scope of federal executive power in s 61 of the Constitution. The decision is also important for the interpretive methodology adopted by the Court. Notably, each judge based their understanding of s 61 upon federal readings of the Constitution. This methodology raises fresh questions about how the Constitution is to be interpreted, and whether Williams marks a break from orthodox understandings of that task. This article assesses the significance of Williams for constitutional interpretation in Australia, and whether it lays the foundation for a more robust protection of state interests by the High Court.

Confidence intervals are ubiquitous in the presentation of social science models, data, and effects. When several intervals are plotted together, one natural inclination is to ask whether the estimates represented by those intervals are significantly different from each other. Unfortunately, there is no general rule or procedure that would allow us to answer this question from the confidence intervals alone. It is well known that using the overlaps in 95% confidence intervals to perform significance tests at the 0.05 level does not work. Recent scholarship has developed and refined a set of tools for inferential confidence intervals that permit inference on confidence intervals with the appropriate type I error rate in many different bivariate contexts. These are all based on the same underlying idea of identifying the multiple of the standard error (i.e., a new confidence level) such that the overlap in confidence intervals matches the desired type I error rate. These procedures remain stymied by multiple simultaneous comparisons. We propose an entirely new procedure for developing inferential confidence intervals that decouples the testing and visualization that can overcome many of these problems in any visual testing scenario. We provide software in R and Stata to accomplish this goal.

A reflective analysis is presented on the potential added value that actuarial science can contribute to the field of health technology assessment. This topic is discussed based on the experience of several experts in health actuarial science and health economics. Different points are addressed, such as the role of actuarial science in health, actuarial judgment, data inputs and their quality, modeling methodologies and the use of decision-analytic models in the age of artificial intelligence, and the development of innovative pricing and payment models.

International Classification of Diseases, Tenth Revision (ICD-10) billing data used in outpatient stewardship metrics is under-described for acute and chronic sinusitis. We found that different sinusitis ICD-10 definitions impacted antibiotic prescribing rates (APRs). Chronic sinusitis ICD-10s dilute overall sinusitis APR, particularly in primary care settings and should be examined separately.

Even amidst a decline in religious affiliation, nearly half of the U.S. population still attends religious services at least once a month, and congregations remain the single largest non-profit organizational type across the nation. Therefore, congregational influence on political attitudes and behavior is a crucial line of inquiry. We analyze interviews of 94 congregational leaders to better understand why they address or avoid political issues when preaching. Our research reveals that clergy use theological and pragmatic reasoning to determine whether they explicitly include political discourse in their sermons. Our findings are noteworthy in that clergy from a wide range of religious traditions use similar reasoning, and the same rationale can lead different clergy to adopt contrasting approaches to political content in sermons. Thus, this paper provides nuanced insight into the relationship between religion and politics and may help foster greater mutual understanding in a deeply divided political and social climate.

Galaxy Zoo is an online project to classify morphological features in extra-galactic imaging surveys with public voting. In this paper, we compare the classifications made for two different surveys, the Dark Energy Spectroscopic Instrument (DESI) imaging survey and a part of the Kilo-Degree Survey (KiDS), in the equatorial fields of the Galaxy And Mass Assembly (GAMA) survey. Our aim is to cross-validate and compare the classifications based on different imaging quality and depth. We find that generally the voting agrees globally but with substantial scatter, that is, substantial differences for individual galaxies. There is a notable higher voting fraction in favour of ‘smooth’ galaxies in the DESI+zoobot classifications, most likely due to the difference between imaging depth. DESI imaging is shallower and slightly lower resolution than KiDS and the Galaxy Zoo images do not reveal details such as disc features and thus are missed in the zoobot training sample. We check against expert visual classifications and find good agreement with KiDS-based Galaxy Zoo voting. We reproduce the results from Porter-Temple+ (2022), on the dependence of stellar mass, star formation, and specific star formation on the number of spiral arms. This shows that once corrected for redshift, the DESI Galaxy Zoo and KiDS Galaxy Zoo classifications agree well on population properties. The zoobot cross-validation increases confidence in its ability to compliment Galaxy Zoo classifications and its ability for transfer learning across surveys.

Young stellar objects (YSOs) are protostars that exhibit bipolar outflows fed by accretion disks. Theories of the transition between disk and outflow often involve a complex magnetic field structure thought to be created by the disk coiling field lines at the jet base; however, due to limited resolution, these theories cannot be confirmed with observation and thus may benefit from laboratory astrophysics studies. We create a dynamically similar laboratory system by driving a $\sim$1 MA current pulse with a 200 ns rise through a $\approx$2 mm-tall Al cylindrical wire array mounted to a three-dimensional (3-D)-printed, stainless steel scaffolding. This system creates a plasma that converges on the centre axis and ejects cm-scale bipolar outflows. Depending on the chosen 3-D-printed load path, the system may be designed to push the ablated plasma flow radially inwards or off-axis to make rotation. In this paper, we present results from the simplest iteration of the load which generates radially converging streams that launch non-rotating jets. The temperature, velocity and density of the radial inflows and axial outflows are characterized using interferometry, gated optical and ultraviolet imaging, and Thomson scattering diagnostics. We show that experimental measurements of the Reynolds number and sonic Mach number in three different stages of the experiment scale favourably to the observed properties of YSO jets with $Re\sim 10^5\unicode{x2013}10^9$ and $M\sim 1\unicode{x2013}10$, while our magnetic Reynolds number of $Re_M\sim 1\unicode{x2013}15$ indicates that the magnetic field diffuses out of our plasma over multiple hydrodynamical time scales. We compare our results with 3-D numerical simulations in the PERSEUS extended magnetohydrodynamics code.