Highly portable and accessible MRI technology will allow researchers to conduct field-based MRI research in community settings. Previous guidance for researchers working with fixed MRI does not address the novel ethical, legal, and societal issues (ELSI) of portable MRI (pMRI). Our interdisciplinary Working Group (WG) previously identified 15 core ELSI challenges associated with pMRI research and recommended solutions. In this article, we distill those detailed recommendations into a Portable MRI Research ELSI Checklist that offers practical operational guidance for researchers contemplating using this technology.

Fast and efficient identification is critical for reducing the likelihood of weed establishment and for appropriately managing established weeds. Traditional identification tools require either knowledge of technical morphological terminology or time-consuming image matching by the user. In recent years, deep learning computer vision models have become mature enough to enable automatic identification. The major remaining bottlenecks are the availability of a sufficient number of high-quality, reliably identified training images and the user-friendly, mobile operationalization of the technology. Here, we present the first weed identification and reporting app and website for all of Australia. It includes an image classification model covering more than 400 species of weeds and some Australian native relatives, with a focus on emerging biosecurity threats and spreading weeds that can still be eradicated or contained. It links the user to additional information provided by state and territory governments, flags species that are locally reportable or notifiable, and allows the creation of observation records in a central database. State and local weed officers can create notification profiles to be alerted of relevant weed observations in their area. We discuss the background of the WeedScan project, the approach taken in design and software development, the photo library used for training the WeedScan image classifier, the model itself and its accuracy, and technical challenges and how these were overcome.

Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.

Background: Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Health Administration (VA) facilities from 2007 to 2019 using active surveillance for facility admissions and contact precautions for patients colonized (CPC) or infected (CPI) with MRSA, but the value of these interventions is controversial. Objective: To determine the impact of active surveillance, CPC, and CPI on prevention MRSA HAIs, we conducted a prospective cohort study between July 2020 and June 2022 in all 123 acute-care VA medical facilities. In April 2020, all facilities were given the option to suspend any combination of active surveillance, CPC, or CPI to free up laboratory resources for COVID-19 testing and conserve personal protective equipment. We measured MRSA HAIs (cases per 1,000 patient days) in intensive care units (ICUs) and non-ICUs by the infection control policy. Results: During the analysis period, there were 917,591 admissions, 5,225,174 patient days, and 568 MRSA HAIs. Only 20% of facilities continued all 3 MRSA infection control measures in July 2020, but this rate increased to 57% by June 2022. The MRSA HAI rate for all infection sites in non-ICUs was 0.07 (95% CI, 0.05–0.08) for facilities practicing active surveillance plus CPC plus CPI compared to 0.12 (95% CI, 0.08–0.19; P = .01) for those not practicing any of these strategies, and in ICUs the MRSA HAI rates were 0.20 (95% CI, 0.15–0.26) and 0.65 (95% CI, 0.41–0.98; P < .001) for the respective policies. Similar differences were seen when the analyses were restricted to MRSA bloodstream HAIs. Accounting for monthly COVID-19 admissions to facilities over the analysis period using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates in the ICUs or non-ICUs. There was no statistically significant difference in monthly facility urinary catheter-associated infection rates, a nonequivalent dependent variable, in the categories during the analysis period in either ICUs or non-ICUs. Conclusions: In Veterans Affairs medical centers, there were fewer MRSA HAIs when facilities practiced active surveillance and contact precautions for colonized or infected patients during the COVID-19 pandemic. The effect was greater in ICUs than non-ICUs.

Disclosures: None

This is the fourth comprehensive assessment of the population status of all wild bird species in Europe. It identifies Species of European Conservation Concern (SPECs) so that action can be taken to improve their status. Species are categorised according to their global extinction risk, the size and trend of their European population and range, and Europe’s global responsibility for them. Of the 546 species assessed, 207 (38%) are SPECs: 74 (14%) of global concern (SPEC 1); 32 (6%) of European concern and concentrated in Europe (SPEC 2); and 101 (18%) of European concern but not concentrated in Europe (SPEC 3). The proportion of SPECs has remained similar (38–43%) across all four assessments since 1994, but the number of SPEC 1 species of global concern has trebled. The 44 species assessed as Non-SPECs in the third assessment (2017) but as SPECs here include multiple waders, raptors and passerines that breed in arctic, boreal or alpine regions, highlighting the growing importance of northern Europe and mountain ecosystems for bird conservation. Conversely, the 62 species assessed as SPECs in 2017 but as Non-SPECs here include various large waterbirds and raptors that are recovering due to conservation action. Since 1994, the number of specially protected species (listed on Annex I of the EU Birds Directive) qualifying as SPECs has fallen by 33%, while the number of huntable (Annex II) species qualifying as SPECs has risen by 56%. The broad patterns identified previously remain evident: 100 species have been classified as SPECs in all four assessments, including numerous farmland and steppe birds, ducks, waders, raptors, seabirds and long-distance migrants. Many of their populations are heavily depleted or continue to decline and/or contract in range. Europe still holds 3.4–5.4 billion breeding birds, but more action to halt and reverse losses is needed.

Melanin pigments are central to colors and patterns in modern vertebrate integuments, which inform upon ecological and behavioral strategies like crypsis, aposematism, and sociosexual selection. Over the last decade, melanin has emerged as a valuable tool for predicting color in exceptionally preserved fossil feathers and subsequent testing of paleobiological hypotheses in long-extinct dinosaurs and birds. Yet much remains to be learned about melanin stability, diagenetic alterations to melanin chemistry, and their implications for “paleocolor reconstruction.” Pressure–temperature maturation experiments with modern feathers offer a way to examine these topics but have mostly been conducted in closed-system capsules or open-system aluminum foil. Both methods have operational limitations and do not consider the filtering effect of porous sediment matrices on thermally labile chemical groups versus stable ones during natural fossilization. We use sediment-encased maturation to resolve this issue and demonstrate replication of organic preservation of melanin highly comparable to compression fossils. Our experiments, coupled with time-of-flight secondary ion mass spectrometry, show predictable volatilization of N/S-bearing molecules and increased melanin cross-linking with elevated temperatures. We also suggest that eumelanin is more stable compared with pheomelanin at higher temperatures, explaining why eumelanic colors (black, dark brown, iridescent) are better preserved in fossils than pheomelanic ones (reddish brown). Furthermore, we propose that proteins preferentially undergo hydrolysis more so than forming N-heterocycles in selectively open systems analogous to natural matrices. Thus, we conclude that melanin pigments and not diagenetically altered protein remnants are the key players in promoting fossilization of soft tissues like feathers.

Optimum nutrition plays a major role in the achievement and maintenance of good health. The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a charity based in Türkiye and focused on improving public health, combined forces to highlight this important subject. A hybrid conference was held in Istanbul, with over 4000 delegates from sixty-two countries joining the proceedings live online in addition to those attending in person. The primary purpose was to inspire healthcare professionals and nutrition policy makers to better consider the role of nutrition in their interactions with patients and the public at large to reduce the prevalence of non-communicable diseases such as obesity and type 2 diabetes. The event provided an opportunity to share and learn from different approaches in the UK, Türkiye and Finland, highlighting initiatives to strengthen research in the nutritional sciences and translation of that research into nutrition policy. The presenters provided evidence of the links between nutrition and disease risk and emphasised the importance of minimising risk and implementing early treatment of diet-related disease. Suggestions were made including improving health literacy and strengthening policies to improve the quality of food production and dietary behaviour. A multidisciplinary approach is needed whereby Governments, the food industry, non-governmental groups and consumer groups collaborate to develop evidence-based recommendations and appropriate joined-up policies that do not widen inequalities. This summary of the proceedings will serve as a gateway for those seeking to access additional information on nutrition and health across the globe.

The White River Badlands (WRB) of South Dakota record eolian activity spanning the late Pleistocene through the latest Holocene (21 ka to modern), reflecting the effects of the last glacial period and Holocene climate fluctuations (Holocene Thermal Maximum, Medieval Climate Anomaly, and Little Ice Age). The WRB dune fields are important paleoclimate indicators in an area of the Great Plains with few climate proxies. The goal of this study is to use 1 m/pixel-resolution digital elevation models from drone imagery to distinguish Early to Middle Holocene parabolic dunes from Late Holocene parabolic dunes. Results indicate that relative ages of dunes are distinguished by slope and roughness (terrain ruggedness index). Morphological differences are attributed to postdepositional wind erosion, soil formation, and mass wasting. Early to Middle Holocene and Late Holocene paleowind directions, 324°± 13.1° (N = 7) and 323° ± 3.0° (N = 19), respectively, are similar to the modern wind regime. Results suggest significant landscape resilience to wind erosion, which resulted in preservation of a mosaic of Early and Late Holocene parabolic dunes. Quantification of dune characteristics will help refine the chronology of eolian activity in the WRB, provide insight into drought-driven landscape evolution, and integrate WRB eolian activity in a regional paleoenvironmental context.

Motivated by near-identical graphs of two increasing continuous functions—one related to Zaremba’s conjecture and the other due to Salem—we provide an explicit connection between fractals and regular sequences by showing that the graphs of ghost distributions, the distribution functions of measures associated to regular sequences, are sections of self-affine sets. Additionally, we provide a sufficient condition for such measures to be purely singular continuous. As a corollary, and analogous to Salem’s strictly increasing singular continuous function, we show that the ghost distributions of the Zaremba sequences are singular continuous.

Randomized prospective studies represent the gold standard for experimental design. In this paper, we present a randomized prospective study to validate the benefits of combining rule-based and data-driven natural language understanding methods in a virtual patient dialogue system. The system uses a rule-based pattern matching approach together with a machine learning (ML) approach in the form of a text-based convolutional neural network, combining the two methods with a simple logistic regression model to choose between their predictions for each dialogue turn. In an earlier, retrospective study, the hybrid system yielded a nearly 50% error reduction on our initial data, in part due to the differential performance between the two methods as a function of label frequency. Given these gains, and considering that our hybrid approach is unique among virtual patient systems, we compare the hybrid system to the rule-based system by itself in a randomized prospective study. We evaluate 110 unique medical student subjects interacting with the system over 5,296 conversation turns, to verify whether similar gains are observed in a deployed system. This prospective study broadly confirms the findings from the earlier one but also highlights important deficits in our training data. The hybrid approach still improves over either rule-based or ML approaches individually, even handling unseen classes with some success. However, we observe that live subjects ask more out-of-scope questions than expected. To better handle such questions, we investigate several modifications to the system combination component. These show significant overall accuracy improvements and modest F1 improvements on out-of-scope queries in an offline evaluation. We provide further analysis to characterize the difficulty of the out-of-scope problem that we have identified, as well as to suggest future improvements over the baseline we establish here.

Background: Although many infectious conditions can be safely treated with oral antimicrobials, select circumstances require parenteral antimicrobial therapy. Benefits of OPAT include prevention of hospital-associated conditions and significant cost savings. However, risks of OPAT include adverse drug events (ADEs) and vascular access device (VAD) complications. We analyzed the safety of OPAT regimens as part of implementing a collaborative OPAT program. Methods: We reviewed adult patients discharged home from an academic hospital between January 2019 and June 2021. Patients with cystic fibrosis were excluded. Data on OPAT agents, ADEs, and VAD complications were collected from electronic medical records by 2 reviewers using a standardized REDCap instrument. The institutional review board approved this study. Results: The cohort comprised 265 unique patients; 212 (80%) received single-drug therapy and 53 (20%) received multidrug therapy. In total, 81 patients (31%), who received a total of 110 antimicrobials, experienced an ADE. In total, 55 patients (21%), who received a total of 72 antimicrobials, experienced a VAD complication. Patients who received >1 antimicrobial were more likely to experience an ADE (53% vs 25%; P = .0002) or a VAD complication (32% vs 18%; P = .04). Cephalosporins were the most frequently prescribed antimicrobial class (Table 1). Conclusions: ADEs and VAD complications were frequent in patients on OPAT. Local data should inform (1) the selection of OPAT therapy and (2) the standardized monitoring of patients who receive OPAT going forward in the implementation of this collaborative OPAT program.

Funding: None

Disclosures: None