Background: Beta-D-glucan (BDG) is a blood test that supports invasive fungal infection diagnoses, but is often over-ordered approximately 50% of the time, particularly in low-risk patients or for fungi not associated with BDG production. High rates of inappropriate use and frequent false positives, often driven by certain clinical scenarios or medication interactions, can lead to repeat testing and unnecessary procedures and treatment. While audit-and-feedback interventions can reduce test misuse, they are not feasible or sustainable for most hospitals. We implemented diagnostic stewardship of BDG through a guideline-based order panel with embedded decision support and interruptive alerts to replace a standalone test (figure 1). This quality improvement (QI) study aimed to reduce the use of BDG in the adult inpatient setting by 20% by 3/2026. Methods: From 3/5 -10/25/25, a multi-disciplinary team implemented this QI project at 8 campuses using iterative Plan-Do-Study-Act cycles. The primary outcome was the number of weekly BDG tests ordered across all campuses. Process measures included the number of interruptive alerts, the rate of duplicate tests, and adherence to order panel recommendations regarding appropriate host factors for BDG testing. Data was collected via the electronic health record. Statistical process charts (SPC) were used to display and analyze data, and Associate Process Improvement rules were applied to detect special cause variation. Results: Across the health system, the average weekly serum BDG orders decreased by 17% (figure 2). The false-positive and repeat-test alerts fired on average 76 and 8 times/week, respectively. Due to frequent false-positive alerts, low-impact factors (e.g., piperacillin-tazobactam) were removed, reducing average weekly false positive alerts from 101 in the first half of the intervention to 52. 77% of the false positive alerts were among patients on internal medicine, critical care, and oncology services. Based on chart review of 50 medicine, critical care, and oncology patients, approximately 51% of false-positive OPAs led to successful test interruption (i.e. delayed BDG ordering by ≥6 hours). The percentage of weekly duplicate tests decreased from 23% pre-intervention to 20% during the intervention. Accurate adherence to the order panel in this subset was 76%. Conclusion: In this study, we successfully implemented scalable BDG diagnostic stewardship, achieving a sustained 17% reduction in weekly BDG orders and nearly reaching the 20% target after 32 weeks. Further optimization of OPAs, along with provider feedback and education, may yield additional improvements.

Background: Rates of Candida auris are rising across the US, particularly in New York. Due to C. auris’ affinity for environmental contamination and prolonged skin colonization, rapid implementation of comprehensive infection prevention & control (IP&C) measures is essential. Given the complexity and multidisciplinary involvement required for these efforts, we developed the C.A.R.E (Candida Auris Response & Engagement) framework in response to an inpatient outbreak to guide multidisciplinary efforts and provide a model for other facilities facing similar challenges with C. auris or other pathogens with extensive contact transmission. Methods: A C. auris cluster was identified in an 862-bed New York City academic medical center between July and October 2025. 23 cases were found involving a medical stepdown unit and adjacent intensive care unit. Baseline IP&C C. auris efforts include isolation precautions (gown and gloves), twice-daily room cleaning/disinfection, dedicated equipment, ATP testing of high touch surfaces (HTS) post terminal room cleaning, observations of personal protective equipment (PPE) use and hand hygiene, and screening of exposed roommates. After an August point prevalence surveillance (PPS) identified additional cases, we expanded interventions across various categories. The C.A.R.E. framework (Fig. 1) summarizes baseline and expanded efforts during this cluster. Figure 1. The C.A.R.E. (Candida Auris Response & Engagement) Framework to approaching a rise in C. auris cases. Results: Of 23 cases, 83% (19/23) were detected through surveillance. Clinical cases included bloodstream (3/4) and respiratory (1/4) sources. Shared rooms, either roommates or subsequent room occupants, were associated with 52% (12/23) of cases. Following implementation of the C.A.R.E. framework, further transmission ceased, confirmed by two negative rounds of PPS on each unit (Fig. 2). Figure 2. A timeline of C.auris cases identified on 2 units with corresponding IP&C effort implementation. To address identified gaps, a C. auris task force was created to improve IP&C processes. Key actions included clarifying equipment cleaning responsibility in collaboration with Environmental Services and Nursing, reevaluating the C. auris isolation category, and expanding screening for high-risk patients. Further, we incorporated fluorescent marker audits alongside ATP testing into routine practices to monitor environmental and equipment cleaning. While not all measures in the C.A.R.E. framework may be needed for every outbreak, facilities can adapt and scale interventions based on feasibility and outbreak severity. Conclusions: Effective prevention of C. auris transmission requires coordinated and multidisciplinary efforts. Establishing a structured response after early case detection can help close gaps in infection prevention that contribute to spread.

Objectives/Goals: The human coronavirus OC43 is a Betacoronavirus, like SARS-CoV-2, but causes limited disease. Current clinical OC43 strains replicate in airway epithelial cultures while the lab-adapted strains only replicate in immortalized cells. We will identify the host and viral factors causing this difference. Methods/Study Population: To observe the effects of specific mutations present in clinical isolates of OC43, we will construct infectious clones of clinical and lab-adapted strains. Through targeted mutagenesis, we will characterize structural differences present in the Spike protein of clinical strains and identify the tropism-determining genome regions. By manipulating expression levels of enzymes involved in sialic acid production including SIAE and CasD1 and using a carbohydrate microarray to further evaluate carbohydrate binding, we will evaluate whether clinical OC43 isolates use the same 9-O-acetylated sialic acid identified as a receptor for the lab-adapted OC43 strain (VR-1558). Results/Anticipated Results: In primary human lung epithelial cell cultures, clinical strains of OC43 persistently replicate through 30 days post-infection. In contrast, the lab-adapted strain did not replicate. Growth on standard immortalized cells demonstrated the reverse phenotype with extensive replication of VR-1558 but no replication by the clinical isolates. Using AlphaFold to predict the 3D structure of Spike from a clinical isolate of OC43, we identified differences at a region previously identified as the binding site for its 9-O-acetylated sialic acid receptor. Further testing will determine whether these structural differences in Spike are responsible for the observed differences in viral tropism. Discussion/Significance of Impact: This project will deepen knowledge of coronavirus biology and the drivers of respiratory cell tropism. It will also develop novel tools for the study of OC43 and particularly of clinically relevant circulating strains which are better models for developing broad-spectrum therapies.

The Radio Neutrino Observatory-Greenland (RNO-G, at Summit Station) experiment comprises an extensive fat-dipole antenna array deployed into ice boreholes over an eventual area of approximately 35 km2. Since the RNO-G experimental sensitivity depends on the radio-frequency properties of the firn, which are known to vary laterally on sub-km distance scales and vertically on sub-meter distance scales, a technique for quickly extracting information on firn ice properties with depth ($n(z)$) during drilling and deployment is desirable. Given that a dipole’s resonant wavelength is fixed by geometry, the resonant frequency $f_{res}$ (measured as an S-parameter reflection coefficient [‘$S_{11}$’] minimum) scales inversely with the local refractive index, allowing a translation of a depth-dependent $S_{11}$(z) profile into $n(z)$. $S_{11}$(z) data were initially taken in August 2024 using a dipole lowered into a newly drilled 98 ± 1 mm diameter, 350 m deep borehole at Summit Station, Greenland, approximately 1 km from the site of the original GISP-2 core; improved measurements were subsequently made in May 2025. We conclude that $S_{11}$(z) data can be used to estimate $n(z)$, on 50 cm vertical scales, at the per cent level of accuracy required by experiments such as RN0-G.

We present a Late Pleistocene paleoecological record from King Island in western Bass Strait, Tasmania, and compare this to existing records from the eastern Bass Strait islands to improve our understanding of the region’s paleoecology and paleoclimatology. Vegetation change across the region followed similar trajectories during the late glacial–Middle Holocene, characterized by homogeneous warming and wetting trends. Spatial divergence occurred during the Middle Holocene when sea level rose, and different drivers began influencing western and eastern Bass Strait islands. In eastern Bass Strait, Middle Holocene sea-level rise caused replacement of woodland by coastal heathland, while in the west, a drier period accompanied by fires transformed forests to forest–scrub. The comparative analysis suggests that Westerly driven climatic anti-phasing was pronounced at higher latitudes of Tasmania during the late glacial–Early Holocene. A combination of weak Leeuwin Current, positive Indian Ocean Dipole (IOD), and El Niño–Southern Oscillation (ENSO) intensification contributed to Middle Holocene aridity across Bass Strait. Strong Westerlies and negative IOD phases led to greater regionalization of rainfall across western Bass Strait during the Late Holocene, while ENSO intensification drove rainfall declines in eastern Bass Strait. These findings provide new insights into the complexity of Late Pleistocene environmental dynamics across southeast Australia.

The Hector Galaxy Survey is a new optical integral field spectroscopy (IFS) survey currently using the Anglo-Australian Telescope to observe up to 15 000 galaxies at low redshift ($z \lt 0.1$). The Hector instrument employs 21 optical fibre bundles feeding into two double-beam spectrographs, AAOmega and the new Spector spectrograph, to enable wide-field multi-object IFS observations of galaxies. To efficiently process the survey data, we adopt the data reduction pipeline developed for the SAMI Galaxy Survey, with significant updates to accommodate Hector’s dual-spectrograph system. These enhancements address key differences in spectral resolution and other instrumental characteristics relative to SAMI and are specifically optimised for Hector’s unique configuration. We introduce a two-dimensional arc fitting approach that reduces the root-mean-square (RMS) velocity scatter by a factor of 1.2–3.4 compared to fitting arc lines independently for each fibre. The pipeline also incorporates detailed modelling of chromatic optical distortion in the wide-field corrector, to account for wavelength-dependent spatial shifts across the focal plane. We assess data quality through a series of validation tests, including wavelength solution accuracy (1.2–2.7 km s$^{-1}$ RMS), spectral resolution (FWHM of 1.2–1.4 Å for Spector), throughput characterisation, astrometric precision ($\lesssim$ 0.03 arcsec median offset), sky subtraction residuals (1–1.6% median continuum residual), and flux calibration stability (4% systematic offset when compared to Legacy Survey fluxes). We demonstrate that Hector delivers high-fidelity, science-ready datasets, supporting robust measurements of galaxy kinematics, stellar populations, and emission-line properties and provide examples. Additionally, we address systematic uncertainties identified during the data processing and propose future improvements to enhance the precision and reliability of upcoming data releases. This work establishes a robust data reduction framework for Hector, delivering high-quality data products that support a broad range of extragalactic studies.

Heath forests, or known locally as kerangas, in Indonesia and Malaysia form a distinct and understudied ecoregion. We document the distribution and ecological significance of the largest extent of kerangas in Kalimantan, Indonesian Borneo. We mapped 16,586 km2 of kerangas to the nearest one square kilometre across Kalimantan, showing a significant reduction from previous estimates. About 19% of this area exists as a poorly documented mosaic landscape in Central Kalimantan’s Rungan-Kahayan region. Here, peat-based forests transition to heath and dipterocarp forests, making it difficult to reliably classify these forests for conservation planning. Using remote sensing and tree plot data, we identified three forest types—kerangas, low pole, and mixed swamp. Vegetation structure is influenced by soil, topography, and hydrology, while peat depth and elevation affect species diversity. Our findings indicate that these forests are dynamic ecosystems with diverse vegetation communities adapted to peat as well as sandy soils. Lowland heath forests in Rungan-Kahayan exhibits higher tree densities compared to other Bornean heath forests, reflecting unique ecological adaptations to challenging environments. Despite covering just 3% of Kalimantan’s forest area, these ecosystems remain largely unprotected, facing threats from land conversion and fire. Our study highlights the ecological complexity of kerangas and underscores the urgent need for targeted conservation and further research on these forests.

Comprehend, Cope and Connect (CCC) is a trauma-informed, transdiagnostic and evidence-based psychological intervention for mental health crises that can be applied cross-culturally. CCC has been implemented in acute and crisis mental health settings across the South of England and in services elsewhere in the UK. More recently, it has been taken up and adapted for specialist community settings, including perinatal services, addiction services and primary care settings. A continuously growing evidence base indicates that CCC could be the next step towards solving the national problem of mental health crises. It is now time for CCC to be piloted and researched nationally.

The First Large Absorption Survey in H i (FLASH) is a large-area radio survey for neutral hydrogen in and around galaxies in the intermediate redshift range $0.4\lt z\lt1.0$, using the 21-cm H i absorption line as a probe of cold neutral gas. The survey uses the ASKAP radio telescope and will cover 24,000 deg$^2$ of sky over the next five years. FLASH breaks new ground in two ways – it is the first large H i absorption survey to be carried out without any optical preselection of targets, and we use an automated Bayesian line-finding tool to search through large datasets and assign a statistical significance to potential line detections. Two Pilot Surveys, covering around 3000 deg$^2$ of sky, were carried out in 2019-22 to test and verify the strategy for the full FLASH survey. The processed data products from these Pilot Surveys (spectral-line cubes, continuum images, and catalogues) are public and available online. In this paper, we describe the FLASH spectral-line and continuum data products and discuss the quality of the H i spectra and the completeness of our automated line search. Finally, we present a set of 30 new H i absorption lines that were robustly detected in the Pilot Surveys, almost doubling the number of known H i absorption systems at $0.4\lt z\lt1$. The detected lines span a wide range in H i optical depth, including three lines with a peak optical depth $\tau\gt1$, and appear to be a mixture of intervening and associated systems. Interestingly, around two-thirds of the lines found in this untargeted sample are detected against sources with a peaked-spectrum radio continuum, which are only a minor (5–20%) fraction of the overall radio-source population. The detection rate for H i absorption lines in the Pilot Surveys (0.3 to 0.5 lines per 40 deg$^2$ ASKAP field) is a factor of two below the expected value. One possible reason for this is the presence of a range of spectral-line artefacts in the Pilot Survey data that have now been mitigated and are not expected to recur in the full FLASH survey. A future paper in this series will discuss the host galaxies of the H i absorption systems identified here.

The health benefits of the long-chain omega-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been known for over 50 years and underpin the UK population recommendation to consume >450 mg EPA + DHA per day. These recommendations, last revised in 2004, are based mainly on epidemiological evidence. Much research has been conducted in the interim. Most randomised controlled trials (RCT) use doses of EPA + DHA of 840 mg/d or more. For anti-inflammatory, triacylglycerol-lowering and anti-hypertensive effects, >1.5 g EPA + DHA per day is needed. Cognitive benefits are also likely to require these higher intakes. Farmed salmon now contains considerably less EPA + DHA relative to farmed fish of 20 years ago, meaning one portion per week will no longer provide the equivalent of 450 mg EPA + DHA per day. Oily fish alone can only provide a fraction of the EPA + DHA required to meet global needs. Furthermore, there is low global oily fish consumption, with typical intakes of <200 mg EPA + DHA per day, and limited intakes in vegans and vegetarians. Therefore, there is an urgent need for affordable, acceptable, alternative EPA + DHA sources, including vegan/vegetarian friendly options, such as bio-enriched poultry, red meat and milk products; fortified foods; enriched oilseeds (for example, genetically modified Camelina sativa); algae and algal oils; and approaches which enhance endogenous EPA/DHA synthesis. In this narrative review, we suggest that current EPA + DHA intake recommendations are too low, consider EPA/DHA from a holistic health-sustainability perspective and identify research, policy and knowledge mobilisation areas which need attention.

The savannah–forest mosaic of the Rupununi region of Guyana is a dispersal corridor between large tracts of intact Guiana Shield forests and a subsistence hunting ground for Indigenous Makushi and Wapichan communities. We conducted a camera-trap survey at 199 sites across four major forested habitat types and used multi-species occupancy modelling to determine regional-scale drivers of mammalian occupancy at both species and community levels, accounting for imperfect detection. We detected 47 savannah- and forest-dwelling mammal species, with the occupancy of medium- and large-bodied terrestrial mammal species (community occupancy) positively related to per cent forest cover and negatively to the presence of gallery forest habitat. The occupancy of 15 of 30 species was positively related to forest cover, suggesting the importance of maintaining forested habitat within the broader mosaic comprising savannahs and intermediate habitats for sustaining maximum mammal diversity. Jaguar Panthera onca occupancy was associated with the presence of livestock, and giant anteater Myrmecophaga tridactyla occupancy was negatively associated with distance to the nearest road, both results of concern in relation to potential human–wildlife conflict. The probability of detecting terrestrial mammal species (community detectability) increased away from villages, as did the detectability of two large-bodied, hunted species, the lowland tapir Tapirus terrestris and collared peccary Pecari tajacu, potentially indicating the negative effects of subsistence and commercial hunting in this savannah mosaic habitat. We use our findings to discuss how management strategies for hunting, fire, timber harvest and agriculture within Indigenous titled lands could help ensure the sustainability of these traditional livelihood activities.

The authors report on ancient DNA data from two human skeletons buried within the chancel of the 1608–1616 church at the North American colonial settlement of Jamestown, Virginia. Available archaeological, osteological and documentary evidence suggest that these individuals are Sir Ferdinando Wenman and Captain William West, kinsmen of the colony's first Governor, Thomas West, Third Baron De La Warr. Genomic analyses of the skeletons identify unexpected maternal relatedness as both carried the mitochondrial haplogroup H10e. In this unusual case, aDNA prompted further historical research that led to the discovery of illegitimacy in the West family, an aspect of identity omitted, likely intentionally, from genealogical records.

A quaternary ammonium and alcohol-based disinfectant with reported continuous activity demonstrated reduced microbial buildup on surfaces over time compared to routine disinfectants without continuous activity in in vitro and hospital studies. We compared these disinfectants in ambulatory settings and found no difference in bioburden on high-touch surfaces over time.