Background: Group A Streptococcus (GAS; Streptococcus pyogenes) is an important human pathogen that can cause life-threatening invasive disease, ranging from skin/soft tissue infections to infective endocarditis. In the fall of 2022, the Center for Disease Control & Prevention (CDC) issued an alert due to a global increase in invasive GAS infections, particularly among children and adults with co-morbidities. An increase in invasive disease was observed at our five-hospital healthcare system in Southeast Michigan. The objective of this study was to describe characteristics of patients with invasive GAS and characterize treatment and outcomes of disease. Methods: This was a retrospective cross-sectional study of patients from June 2013 to August 2023 with positive blood cultures for GAS. Patients were identified using a data query for positive blood cultures for GAS through Microsoft SQL Server. Patients with age < 1 8 years, polymicrobial bacteremia, incomplete data, or who were enrolled in hospice and/or died within 48-hours of admission were excluded. Collected variables included: demographics, infection characteristics (syndrome, duration of bacteremia), microbiological characteristics (antimicrobial susceptibility testing; AST), antimicrobial treatment (empiric and final, antitoxin therapy), and clinical outcomes (length of hospital stay [LOS], treatment-associated adverse events, 30-day mortality and infection-related readmission). Results: 250 patients were included (Table 1). More than half were male with median age of 57.5 years. Diabetes mellitus (38%) and chronic kidney disease (23%) were common comorbidities [Table 1]. Persons experiencing homelessness and persons who use injection drugs accounted for 9% and 13% of the cases, respectively. The most common infective syndrome accompanying bacteremia was cellulitis (57%). The majority of patients received vancomycin for empiric therapy (81%) and penicillin (38%) or cephalosporin (36%) for final regimen [Table 2]. A total of 79 GAS isolates (32%) were clindamycin resistant. Clindamycin was included in the empiric regimen of 20 (8%) patients, the final regimen in 44 (18%) of patients, and as antitoxin adjunct therapy in 135 (54%) of patients. A third (33%) of patients received no antitoxin. The average duration of antitoxin therapy was 3.6 days and antimicrobial therapy 19.9 days. The mean LOS was 11.4 days (Table 3). Thirty nine (16%) patients had treatment failure and 8 (3%) experienced C. difficile infection within 30 days of antimicrobial treatment. Thirty-day mortality was 11%; of these, 9% had in-hospital mortality. Conclusions: Invasive GAS infection confers significant morbidity and mortality, and ongoing research is needed to determine the best treatment regimens in the era of increasing clindamycin resistance.

Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.

Boduch-Grabka and Lev-Ari (2021) showed that so-called “native” British-English speakers judged statements produced by Polish-accented English speakers as less likely to be true than statements produced by “native” speakers and that prior exposure to Polish-accented English speech modulates this effect. Given the real-world consequences of this study, as well as our commitment to assessing and mitigating linguistic biases, we conducted a close replication, extending the work by collecting additional information about participants’ explicit biases towards Polish migrants in the UK. We did not reproduce the original pattern of results, observing no effect of speaker accent or exposure on comprehension or veracity. In addition, the measure of explicit bias did not predict differential veracity ratings for Polish- and British-accented speech. Although the current pattern of results differs from that of the original study, our finding that neither comprehension nor veracity were impacted by accent or exposure condition is not inconsistent with the Boduch-Grabka and Lev-Ari (2021) processing difficulty account of the accent-based veracity judgment effect. We explore possible explanations for the lack of replication and future directions for this work.

Background: Blood cultures are commonly ordered for patients with low risk of bacteremia. Liberal blood-culture ordering increases the risk of false-positive results, which can lead to increased length of stay, excess antibiotics, and unnecessary diagnostic procedures. We implemented a blood-culture indication algorithm with data feedback and assessed the impact on ordering volume and percent positivity. Methods: We performed a prospective cohort study from February 2022 to November 2022 using historical controls from February 2020 to January 2022. We introduced the blood-culture algorithm (Fig. 1) in 2 adult surgical intensive care units (ICUs). Clinicians reviewed charts of eligible patients with blood cultures weekly to determine whether the blood-culture algorithm was followed. They provided feedback to the unit medical directors weekly. We defined a blood-culture event as ≥1 blood culture within 24 hours. We excluded patients aged <18 years, absolute neutrophil count <500, and heart and lung transplant recipients at the time of blood-culture review. Results: In total, 7,315 blood-culture events in the preintervention group and 2,506 blood-culture events in the postintervention group met eligibility criteria. The average monthly blood-culture rate decreased from 190 blood cultures per 1,000 patient days to 142 blood cultures per 1,000 patient days (P < .01) after the algorithm was implemented. (Fig. 2) The average monthly blood-culture positivity increased from 11.7% to 14.2% (P = .13). Average monthly days of antibiotic therapy (DOT) was lower in the postintervention period than in the preintervention period (2,200 vs 1,940; P < .01). (Fig. 3) The ICU length of stay did not change before the intervention compared to after the intervention: 10 days (IQR, 5–18) versus 10 days (IQR, 5–17; P = .63). The in-hospital mortality rate was lower during the postintervention period, but the difference was not statistically significant: 9.24% versus 8.34% (P = .17). The all-cause 30-day mortality was significantly lower during the intervention period: 11.9% versus 9.7% (P < .01). The unplanned 30-day readmission percentage was significantly lower during the intervention period (10.6% vs 7.6%; P < .01). Over the 9-month intervention, we reviewed 916 blood-culture events in 452 unique patients. Overall, 74.6% of blood cultures followed the algorithm. The most common reasons overall for ordering blood cultures were severe sepsis or septic shock (37%), isolated fever and/or leukocytosis (19%), and documenting clearance of bacteremia (15%) (Table 1). The most common indications for inappropriate blood cultures were isolated fever and/or leukocytosis (53%). Conclusions: We introduced a blood-culture algorithm with data feedback in 2 surgical ICUs and observed decreases in blood-culture volume without a negative impact on ICU LOS or mortality rate.

Disclosure: None

The deleterious effects of adversity are likely intergenerational, such that one generation’s adverse experiences can affect the next. Epidemiological studies link maternal adversity to offspring depression and anxiety, possibly via transmission mechanisms that influence offspring fronto-limbic connectivity. However, studies have not thoroughly disassociated postnatal exposure effects nor considered the role of offspring sex. We utilized infant neuroimaging to test the hypothesis that maternal childhood maltreatment (CM) would be associated with increased fronto-limbic connectivity in infancy and tested brain-behavior associations in childhood. Ninety-two dyads participated (32 mothers with CM, 60 without; 52 infant females, 40 infant males). Women reported on their experiences of CM and non-sedated sleeping infants underwent MRIs at 2.44 ± 2.74 weeks. Brain volumes were estimated via structural MRI and white matter structural connectivity (fiber counts) via diffusion MRI with probabilistic tractography. A subset of parents (n = 36) reported on children’s behaviors at age 5.17 ± 1.73 years. Males in the maltreatment group demonstrated greater intra-hemispheric fronto-limbic connectivity (b = 0.96, p= 0.008, [95%CI 0.25, 1.66]), no differences emerged for females. Fronto-limbic connectivity was related to somatic complaints in childhood only for males (r = 0.673, p = 0.006). Our findings suggest that CM could have intergenerational associations to offspring brain development, yet mechanistic studies are needed.

Precise instrumental calibration is of crucial importance to 21-cm cosmology experiments. The Murchison Widefield Array’s (MWA) Phase II compact configuration offers us opportunities for both redundant calibration and sky-based calibration algorithms; using the two in tandem is a potential approach to mitigate calibration errors caused by inaccurate sky models. The MWA Epoch of Reionization (EoR) experiment targets three patches of the sky (dubbed EoR0, EoR1, and EoR2) with deep observations. Previous work in Li et al. (2018) and (2019) studied the effect of tandem calibration on the EoR0 field and found that it yielded no significant improvement in the power spectrum (PS) over sky-based calibration alone. In this work, we apply similar techniques to the EoR1 field and find a distinct result: the improvements in the PS from tandem calibration are significant. To understand this result, we analyse both the calibration solutions themselves and the effects on the PS over three nights of EoR1 observations. We conclude that the presence of the bright radio galaxy Fornax A in EoR1 degrades the performance of sky-based calibration, which in turn enables redundant calibration to have a larger impact. These results suggest that redundant calibration can indeed mitigate some level of model incompleteness error.

Trainees were encouraged to tell a mythological story to the class, lasting about ten minutes. They could use props and other visual aids if they wished, but the emphasis was for them to practise speaking before the class, using prompt cards if necessary, and employing all the techniques of a professional oral ‘poet’ – such as gesture, eye contact, tone of voice and so on. There is obviously considerable general interest among younger students about mythology. Locally, interest is captured by the Cambridge School Classics project which puts on an annual Ovid Mythology competition and the website War with Troy is used by several of the schools where trainees are placed. Its use as a stimulus for learning has been well-documented by its author and past PGCE subject lecturer Bob Lister (2005, 2007) and by Walker (2018), a former teacher trainee from the faculty. Some of the Latin textbooks such as Minimus (Bell, 1999) and Suburani (Hands-Up Education, 2020) contain myth episodes and are familiar to the teacher trainees. The GCSE and A Level qualifications often contain mythological subject matter. Khan-Evans (2018) has shown how older students of Classics have retained deep-rooted affection for mythological stories in their earlier schooldays. Research into the power of mythological storytelling as a stimulus for learning, creative arts and even therapy is current, as the Our Mythical Childhood project (2020) has demonstrated. A book of the project's work is eagerly anticipated next year. The recent Troy exhibition at the British Museum has also awoken considerable interest.

Many snow models have been developed for various applications such as hydrology, global atmospheric circulation models and avalanche forecasting. The degree of complexity of these models is highly variable, ranging from simple index methods to multi-layer models that simulate snow-cover stratigraphy and texture. In the framework of the Snow Model Intercomparison Project (SnowMIP), 23 models were compared using observed meteorological parameters from two mountainous alpine sites. The analysis here focuses on validation of snow energy-budget simulations. Albedo and snow surface temperature observations allow identification of the more realistic simulations and quantification of errors for two components of the energy budget: the net short- and longwave radiation. In particular, the different albedo parameterizations are evaluated for different snowpack states (in winter and spring). Analysis of results during the melting period allows an investigation of the different ways of partitioning the energy fluxes and reveals the complex feedbacks which occur when simulating the snow energy budget. Particular attention is paid to the impact of model complexity on the energy-budget components. The model complexity has a major role for the net longwave radiation calculation, whereas the albedo parameterization is the most significant factor explaining the accuracy of the net shortwave radiation simulation.

This study links two models, one that simulates changes in snow microstructure and one that recovers microstructure properties from measurements of snow reflectance. An energy and mass transfer model, SNTHERM.89, was used to calculate snow grain growth. Grain-sizes from the model and measurements of grain bond areas provided estimates of the surface-to-volume ratio of the bulk snow, which were transformed to geometrically-equivalent sphere sizes. An inversion technique based on a discrete-ordinate model of the directional reflectance recovered optically-equivalent sphere sizes from reflectance measurements at 1.075 μm. The predictions of equivalent sphere sizes from the snow model and the recovered optical sphere sizes from the inversion method were compared with stereological measurements from snow sections. The geometrically-equivalent and optically-equivalent grain-sizes showed good agreement with each other and with stereological measurements from snow a few days old. The predictions of the reflectance inversion method also compared favorably with geometrically-equivalent grain-sizes measured from a melt-freeze surface crust. This investigation showed the potential for fully coupling snow property simulations with models to predict the spectral reflectance of snow.

The ability of solar radiation to penetrate into a snow cover combined with the low thermal conductivity of snow can lead to a sub-surface temperature maximum. This elevated sub-surface temperature allows a layer of wet snow to form below the surface even on days when the air temperature remains sub-freezing. A high-resolution frequency-modulated continuous wave (FMCW) radar has been used to detect the onset of sub-surface melting in a seasonal snow cover. The experimental observation of sub-surface melting is shown to be in good agreement with the predictions of a one-dimensional mass- and energy-balance model. The effects of varying snow characteristics and solar extinction parameters on the sub-surface melt characteristics are investigated using model simulations.

The von Kármán constant $k$ relates the flow speed profile in a wall-bounded shear flow to the stress at the surface. Recent laboratory studies in aerodynamically smooth flow report $k$ values that cluster around 0.42–0.43 and around 0.37–0.39. Recent data from the atmospheric boundary layer, where the flow is usually aerodynamically rough, are similarly ambiguous: $k$ is often reported to be significantly smaller than the canonical value 0.40, and two recent data sets suggest that $k$ decreases with increasing roughness Reynolds number $Re_{\ast}$. To this discussion, we bring two large atmospheric data sets that suggest $k$ is constant, 0.387$\,{\pm}\,$0.003, for $2\, {\le}\,\hbox{\it Re}_\ast \,{\le} \,100$.

The data come from our yearlong deployment on Arctic sea ice during SHEBA, the experiment to study the Surface Heat Budget of the Arctic Ocean, and from over 800 h of observations over Antarctic sea ice on Ice Station Weddell (ISW). These were superb sites for atmospheric boundary-layer research; they were horizontally homogeneous, uncomplicated by topography, and unobstructed and uniform for hundreds of kilometres in all directions.

During SHEBA, we instrumented a 20 m tower at five levels between 2 and 18 m with identical sonic anemometer/thermometers and, with these, measured hourly averaged values of the wind speed $U(z)$ and the stress $\tau (z)$ at each tower level $z$. On ISW, we measured the wind-speed profile with propeller anemometers at four heights between 0.5 and 4 m and measured $\tau $ with a sonic anemometer/thermometer at one height. On invoking strict quality controls, we gleaned 453 hourly $U(z)$ profiles from the SHEBA set and 100 from the ISW set. All of these profiles reflect near-neutral stratification, and each exhibits a logarithmic layer that extends over all sampling heights. By combining these profiles and our measurements of $\tau $, we made 553 independent determinations of $k$. This is, thus, the largest, most comprehensive atmospheric data set ever used to evaluate the von Kármán constant.