Background: A comprehensive understanding of antimicrobial prescribing practices, requires antimicrobial stewardship (AMS) clinicians to assess both the quantity and quality of antimicrobial prescribing. In Australia, two national programs collect and analyse such data in the hospital setting; the National Antimicrobial Utilisation Surveillance Program (NAUSP) a continuous, volume-based surveillance program that monitors antimicrobial usage trends; and the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) a standardised auditing program that assesses antimicrobial prescribing appropriateness. This study aims to analyse the 2023 NAUSP and Hospital NAPS data to compare the volume and appropriateness of inpatient antimicrobial use in Australian hospitals. Methods: Data were extracted from hospitals that participated in both programs in 2023, including systemically administered antimicrobials for adult patients. NAUSP data were aggregated and acute inpatient usage rates relative to patient activity were calculated as Defined Daily Doses (DDD) per 1,000 Occupied Bed Days (OBD) for individual antimicrobials.

Hospital NAPS data on appropriateness of prescribing, as assessed by local auditors as a point prevalence survey and using a standardised assessment matrix, were aggregated and calculated for each antimicrobial. Antimicrobials with high-volume use (NAUSP data), high rates of antimicrobial prescribing (NAPS data), or classified as medium to high risk for antimicrobial resistance potential according to the World Health Organization AWaRe classifications were further investigated. Results: There were 192 acute care hospitals that contributed in 2023 to both NAUSP (representing 12, 619, 253 OBDs) and Hospital NAPS (representing 21,017 antimicrobial prescriptions). Figure 1 summarizes the aggregate usage rates and appropriateness for antimicrobials of interest. Antimicrobials with the highest usage rates, including amoxicillin-clavulanic acid and cefazolin (92.2 and 78.8 DDD/1,000 OBD respectively), had moderate levels of appropriateness (67.8% and 69.9% respectively). Similar ‘Access‘ antimicrobials such as doxycycline, amoxicillin and metronidazole, which tend to be unrestricted in hospital formularies, had moderate levels of appropriateness. Cefalexin had the lowest rate of appropriateness (52.2%). In comparison, ‘Watch‘ antimicrobials, including meropenem and vancomycin, which tend to be restricted, had lower usage rates (14.3 and 19.8 DDDs/1,000 OBD respectively) but higher rates of appropriateness (83.5%, 82.8% respectively). Conclusion: This analysis highlights the importance of assessing and analyzing antimicrobial quantity and quality concurrently, providing a holistic view of prescribing practices. Furthermore, AMS efforts should include all antimicrobials, regardless of restriction category, as commonly used, unrestricted antimicrobials may have substantial rates of inappropriate prescribing.

Ocean submesoscales, flows with characteristic size $10\,\text{m}{-}10\,\text{km}$, are transitional between the larger, rotationally constrained mesoscale and three-dimensional turbulence. In this paper, we present simulations of a submesoscale ocean filament. In our case, the filament is strongly sheared in both vertical and cross-filament directions, and is unstable. Instability indeed dominates the early behaviour with a fast extraction of kinetic energy from the vertically sheared thermal wind. However, the instability that emerges does not exhibit characteristics that match the perhaps expected symmetric or Kelvin–Helmholtz instabilities, and appears to be non-normal in nature. The prominence of the transient response depends on the initial noise, and for large initial noise amplitudes, saturates before symmetric instability normal modes are able to develop. The action of the instability is sufficiently rapid – with energy extraction from the mean flow emerging and peaking within the first inertial period ($\sim\! 18\ \text{h}$) – that the filament does not respond in a geostrophically balanced sense. Instead, at all initial noise levels, it later exhibits vertically sheared near-inertial oscillations with higher amplitude as the initial minimum Richardson number decreases. Horizontal gradients strengthen only briefly as the fronts restratify. These unstable filaments can be generated by strong mixing events at pre-existing stable structures; we also caution against inadvertently triggering this response in idealised studies that start in a very unstable state.

The attitudes toward genomics and precision medicine (AGPM) measure examines attitudes toward activities such as genetic testing, gene editing, and biobanking. This is a useful tool for research on the ethical, legal, and social implications of genomics, a major program within the National Institutes of Health. We updated the AGPM to explore controversies over mRNA vaccines. This brief report examines the factor structure of the updated AGPM using a sample of 4939 adults in the USA. The updated AGPM’s seven factors include health benefits, knowledge benefits, and concerns about the sacredness of life, privacy, gene editing, mRNA vaccines, and social justice.

This systematic review evaluates the use of Normothermic Machine Perfusion (NMP) as a testbed for developing peripheral nerve and muscle interfaces for bionic prostheses. Our findings suggest that NMP offers a viable alternative to traditional models, with significant implications for future research and clinical applications. A literature search was performed using Ovid MEDLINE (1946 to October 2023), revealing 559 abstracts.

No studies using nerve and/or muscle electrodes for the testing or development of bionic interface technologies were identified, except for one conference abstract. NMP could serve as a test bed for future development of interface biocompatibility, selectivity, stability and data transfer, whilst complying with ethical practices and potentially offering greater relevance for human translation. Implemention of machine perfusion requires experienced personnel. Encompassing artificial intelligence alongside machine learning will provide a significant contribution to advancing interface technologies for multiple neurological disorders.

In this retrospective cohort study of military trainees, symptomatic-only coronavirus disease 2019 (COVID-19) arrival antigen testing decreased isolation requirements without increasing secondary cases compared to universal antigen testing. Symptomatic-only arrival antigen testing is a feasible alternative for individuals entering a congregant setting with a high risk of COVID-19 transmission.

The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.

We conducted an online survey of weed scientists in the United States and Canada to (1) identify research topics perceived to be important for advancing weed science in the next 5 to 10 years and (2) gain insight into potential gaps in current expertise and funding sources needed to address those priorities. Respondents were asked to prioritize nine broad research areas, as well as 5 to 10 subcategories within each of the broad areas. We received 475 responses, with the majority affiliated with academic institutions (55%) and working in cash crop (agronomic or horticultural) study systems (69%). Results from this survey provide valuable discussion points for policy makers, funding agencies, and academic institutions when allocating resources for weed science research. Notably, our survey reveals a strong prioritization of Cultural and Preventative Weed Management (CPWM) as well as the emerging area of Precision Weed Management and Robotics (PWMR). Although Herbicides remain a high-priority research area, continuing challenges necessitating integrated, nonchemical tactics (e.g., herbicide resistance) and emerging opportunities (e.g., robotics) are reflected in our survey results. Despite previous calls for greater understanding and application of weed biology and ecology in weed research, as well as recent calls for greater integration of social science perspectives to address weed management challenges, these areas were ranked considerably lower than those focused more directly on weed management. Our survey also identified a potential mismatch between research priorities and expertise in several areas, including CPWM, PWMR, and Weed Genomics, suggesting that these topics should be prime targets for expanded training and collaboration. Finally, our survey suggests an increasing reliance on private sector funding for research, raising concerns about our discipline’s capacity to address important research priority areas that lack clear private sector incentives for investment.

Research on proactive and reactive aggression has identified covariates unique to each function of aggression, but hypothesized correlates have often not been tested with consideration of developmental changes in or the overlap between the types of aggression. The present study examines the unique developmental trajectories of proactive and reactive aggression over adolescence and young adulthood and tests these trajectories’ associations with key covariates: callous–unemotional (CU) traits, impulsivity, and internalizing emotions. In a sample of 1,211 justice-involved males (ages 15–22), quadratic growth models (i.e., intercepts, linear slopes, and quadratic slopes) of each type of aggression were regressed onto quadratic growth models of the covariates while controlling for the other type of aggression. After accounting for the level of reactive aggression, the level of proactive aggression was predicted by the level of CU traits. However, change in proactive aggression over time was not related to the change in any covariates. After accounting for proactive aggression, reactive aggression was predicted by impulsivity, both at the initial level and in change over time. Results support that proactive and reactive aggression are unique constructs with separate developmental trajectories and distinct covariates.

Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.

Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.

Funding: None

Disclosures: None

Electronic platforms provide an opportunity to improve the informed consent (IC) process by permitting elements shown to increase research participant understanding and satisfaction, such as graphics, self-pacing, meaningful engagement, and access to additional information on demand. However, including these elements can pose operational and regulatory challenges for study teams and institutional review boards (IRBs) responsible for the ethical conduct and oversight of research. We examined the experience of two study teams at Alzheimer’s Disease Research Centers who chose to move from a paper-based IC process to an electronic informed consent (eIC) process to highlight some of these complexities and explore how IRBs and study teams can navigate them. Here, we identify the key regulations that should be considered when developing and using an eIC process as well as some of the operational considerations eIC presents related to IRB review and how they can be addressed.