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.

The provision of formal childcare services holds significant potential benefits in addressing challenges posed by population ageing, labour shortages and welfare dependency. However, existing literature indicates persistent differentials in formal childcare uptake by migration background, with limited understanding of underlying demand-side factors. This study addresses this gap by comprehensively examining demographic, socio-economic, employment-related and attitudinal characteristics as potential explanations for these disparities. Utilising data from the Generations and Gender Survey across seven high-income countries, our findings reveal that whereas differentials for migrants’ descendants are limited and insignificant even without controlling for background variables, the negative differential for migrants disappears almost completely. Socio-economic status and particularly employment potential emerge as a key explanatory factors alongside differential attitudes towards maternal employment, which seem to play a role in some contexts, yet not in others. Cross-country differences in the results are discussed in the face of socio-economic gradients in formal childcare uptake, migrant-native gaps in the labour market and below-demand supply of formal childcare, yet also plead for future research interacting demand- and supply-side factors for a larger set of countries. In conclusion, this study reveals the intricate interplay of demographic, socio-economic and attitudinal factors underlying migrant–native disparities in formal childcare uptake.

Objectives/Goals: This project aims to inform and develop a clinician-centered educational tool evidence-based and stakeholder-informed that fosters healthcare professionals’ (HCPs) adaptive expertise (AE) in cannabinoid-based therapies (CBT) for chronic pain management (CPM), addressing existing knowledge gaps, improving patient care and clinical decision-making. Methods/Study Population: To achieve this, the project will use a mixed-methods approach divided into three phases to evaluate existing educational resources, identify gaps, and inform the design of a curriculum to transform clinician education in CBT for CPM. It includes stakeholder mapping to engage and consult key experts for real-world insights and an environmental scan to assess and compare current educational resources qualitatively. A rigorous curriculum will be informed to be designed through an adaptive expertise and reflective practice framework, emphasizing case and problem-based learning, clinical simulations, and other pedagogical techniques. The educational tool will be pilot-tested with clinicians, measuring its impact on knowledge and decision-making flexibility through pre- and post-assessments, ensuring it fosters AE on CBT. Results/Anticipated Results: The project is expected to identify key gaps in existing educational resources, particularly AE in HCPs specializing in CPM. Through pilot testing, we anticipate improved knowledge of CBT among clinicians and enhanced ability to apply this knowledge flexibly in clinical practice. We also expect to establish core curriculum components that better support routine and adaptive expertise in chronic pain management. The pilot evaluations will guide further curriculum refinement and inform broader educational implementation. Discussion/Significance of Impact: This project addresses critical gaps in CbT education by informing the development of a curriculum that enhances clinicians’ ability to manage chronic pain with cannabinoid-based therapies. The resulting educational tool could significantly impact clinical practice, empowering patients, and HCPs to make informed decisions and improve patient outcomes.

Objectives/Goals: This Weill Cornell Clinical and Translational Science Collaborative (CTSC) project evaluates whether large language models (LLMs) can generate accurate summaries of translational science benefits using the Translational Science Benefits Model (TSBM) framework, aiming to identify optimal LLMs and prompting strategies via expert review. Methods/Study Population: We are using prompt engineering to train multiple LLMs to generate one-page impact profiles based on the TSBM framework. LLMs will be selected via benchmarks, focusing on models excelling in information extraction. Leading LLMs (e.g., Llama 3.2, ChatGPT 4.0, Gemini 1.5 Pro, and Claude) and other high-performing models will be considered. Initial work has utilized Gemini 1.5 Pro. Models use data from CTSC-supported projects in WebCAMP, our local instantiation of a translational research activity tracking system used by >20 CTSA hubs, and manuscripts from the Overton database cited in policy documents. Human experts will evaluate the quality and accuracy of LLM-generated profiles. Results/Anticipated Results: Preliminary results using Gemini 1.5 Pro indicate that LLMs can generate coherent and informative impact profiles encompassing diverse areas within the TSBM. Face validity appears satisfactory, suggesting the outputs align with expectations. We anticipate that further exploration with other LLMs and expert validation will reveal strengths and weaknesses of the LLM approach, including the potential for naccuracies (“hallucinations”), informing further refinement of models and prompting strategies. Analysis of manuscripts cited in policy will provide valuable insights into communicating policy-relevant benefits effectively, and benchmark comparisons will identify optimal LLMs for this use case. Discussion/Significance of Impact: This project demonstrates LLMs’ potential for streamlining and enhancing impact reporting in translational science, enabling broader dissemination of research outcomes and promoting better understanding among stakeholders. Future work will integrate LLM-based reporting into research infrastructure.

Objectives/Goals: Acute myeloid leukemia (AML) is the second most common leukemia among pediatric populations. Approximately 15% of pediatric AML cases have KMT2A gene rearrangements (KMT2A-r), which confers a worse prognosis. Our goal is to better characterize the biologic landscape of KMT2A-r pediatric AML. Methods/Study Population: This study utilizes deidentified peripheral blood and/or bone marrow samples banked in the Children’s Mercy Tumor Bank Biorepository. We investigated four KMT2A-r pediatric AML patients and six patients with other AML subtypes using samples collected at diagnosis and remission that were stored in the “tumor bank.” In addition, we assessed 47 tumor bank samples from patients with other leukemia subtypes. We performed differential expression (DE) analysis on bulk RNA sequencing comparing KMT2A-r and all other AML subtypes, as well as single-cell RNA sequencing and proteomic analysis on the larger cohort. We then coalesced these data to better identify processes and pathways that are dysregulated in KMT2A-r AML, specifically aiming to find those that were contributing to leukemogenesis. Results/Anticipated Results: Transcriptomic analysis showed that HOXA10 and MEIS1, two genes associated with immature myeloid populations and KMT2A-r leukemias, were more highly transcribed in AMLs than other leukemias. In addition, our DE analysis showed significantly higher transcription of ITGA7, a gene shown to correlate with poorer prognosis in AML, in our KMT2A-r samples when compared to other AML subtypes. FAM46C, a tumor suppressor gene contributing to mRNA stabilization, was less highly expressed in KMT2A-r AML when compared to other AML subtypes. Of note, low expression of FAM46C is associated with poorer survival and treatment response in multiple myeloma, and our findings suggest it may also be relevant to AML. Proteomic analysis is currently in process. Discussion/Significance of Impact: Transcriptomic analysis identifies unique molecular features of pediatric KMT2A-r AML. We anticipate that our proteomic data will do the same and will also corroborate our RNA findings. Taken in combination, these results will provide a more complete picture of the specific mechanisms contributing to this aggressive leukemic subtype.

Restrictions on family presence during the COVID-19 pandemic negatively impacted the health of patients and their families. Although there was an expressed need for family involvement in care, guidelines for integrating family members as care partners were lacking. To facilitate family members’ involvement, the Designated Care Partner (DCP) program was implemented at a community hospital. This paper describes the development, implementation, and evaluation of this program. Findings aim to inform healthcare organizations that are seeking ways to integrate family members as care partners.

Despite advances in the development of systemic anticoagulants, there remain few agents approved for utilisation in patients with mechanical heart valves. Currently, recommendations for periprocedural and long-term anticoagulation in mechanical heart valves include unfractionated heparin or vitamin K antagonists, and there are some reports for off-label use of low-molecular-weight heparins. Emerging data on parenteral direct thrombin inhibitors, such as bivalirudin, have led to increased utilisation in both extracorporeal membrane oxygenation and ventricular assist devices. We present the case of a paediatric patient with rheumatic heart disease who had significant bleeding on unfractionated heparin who successfully received prolonged bivalirudin therapy in the setting of mechanical aortic and mitral heart valves.

How do people distribute defenses over a directed network attack graph, where they must defend a critical node? This question is of interest to computer scientists, information technology and security professionals. Decision-makers are often subject to behavioral biases that cause them to make sub-optimal defense decisions, which can prove especially costly if the critical node is an essential infrastructure. We posit that non-linear probability weighting is one bias that may lead to sub-optimal decision-making in this environment, and provide an experimental test. We find support for this conjecture, and also identify other empirically important forms of biases such as naive diversification and preferences over the spatial timing of the revelation of an overall successful defense. The latter preference is related to the concept of anticipatory feelings induced by the timing of the resolution of uncertainty.

Reciprocity has been shown to be sensitive to perceived intentions, however, not much is known about the intensity of reciprocal responses to the precise nature of those intentions. For example, a person can strategically appear to be kind while being self-serving or can be selflessly (genuinely) kind. Do these two intentions elicit different reciprocal reactions? We propose a conjecture that self-serving but generous actions diminish the positively reciprocal response, compared to selfless generous actions. We classify actions that increase a recipient’s maximum payoff, but by less than the giver’s maximum payoff, as being self-serving generous actions, while classifying actions that increase a recipient’s maximum payoff by more than the giver’s as selfless generous actions. We hypothesize that selfless generous actions are considered more generous than self-serving generous actions, and that self-serving generous actions will therefore result in a diminished reciprocal response. We test this conjecture using two novel experimental designs. We find some evidence that subjects perceive self-serving generous actions as being less generous than selfless generous actions, but no empirical support for our conjecture on the diminished reciprocal response.

We review some of the processes leading to dispersion and mixing in porous media, exploring the differences between the travel time distribution of fluid particles within a pore throat and between pore throats of different size within the porous layer. A recent paper of Liu et al. has combined a model of these travel time distributions with a continuous time random walk to quantify the dispersion as a function of the Peclet number. We describe some further problems relating to dispersive mixing of tracer which may be amenable to this approach, including dispersion caused by macroscopic lenses of different permeability, dispersion of tracer which partitions between the fluid and matrix and the effects of buoyancy on mixing.

Limited evidence on relative effectiveness is common in Health Technology Assessment (HTA), often due to sparse evidence on the population of interest or study-design constraints. When evidence directly relating to the policy decision is limited, the evidence base could be extended to incorporate indirectly related evidence. For instance, a sparse evidence base in children could borrow strength from evidence in adults to improve estimation and reduce uncertainty. In HTA, indirect evidence has typically been either disregarded (‘splitting’; no information-sharing) or included without considering any differences (‘lumping’; full information-sharing). However, sophisticated methods that impose moderate degrees of information-sharing have been proposed. We describe and implement multiple information-sharing methods in a case-study evaluating the effectiveness, cost-effectiveness and value of further research of intravenous immunoglobulin for severe sepsis and septic shock. We also provide metrics to determine the degree of information-sharing. Results indicate that method choice can have significant impact. Across information-sharing models, odds ratio estimates ranged between 0.55 and 0.90 and incremental cost-effectiveness ratios between £16,000–52,000 per quality-adjusted life year gained. The need for a future trial also differed by information-sharing model. Heterogeneity in the indirect evidence should also be carefully considered, as it may significantly impact estimates. We conclude that when indirect evidence is relevant to an assessment of effectiveness, the full range of information-sharing methods should be considered. The final selection should be based on a deliberative process that considers not only the plausibility of the methods’ assumptions but also the imposed degree of information-sharing.

Serious superficial incisional surgical site infections (SSISSIs) are a critical subset of SSIs that require surgical intervention or lead to hospital readmission. Analyzing 11,617 SSIs from 47 community hospitals, the inclusion of SSISSIs changed 30/47 hospital rankings (p = 0.02), highlighting the need for inclusion in standardized infection surveillance models.

This paper is a review of existing sources across disciplines focusing on the topic of female farm ownership. Throughout the centuries, females have been explicitly excluded from owning and prevented from inheriting land. The purpose of this paper is to examine historical customs and rules governing female land ownership in Ireland and to demonstrate how the ‘old’ laws and customs have contributed significantly to the patriarchal system of farm ownership that is still in existence today even though the gender-based laws have disappeared. This paper argues that a contributing factor to the current male-dominated farm ownership figures is the normalisation of patriarchy by way of the old, gendered laws and practices. Although gender discrimination is no longer acceptable in such a direct legal form, the tradition and culture that established and supported such customs can still be seen today, as males account for 87% of Irish farmholders. This research addresses a lacuna in our understanding of women’s unequal position when it comes to the ownership of farms in Ireland.