These guidelines update the 2013 “Updated US Public Health Service (PHS) Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis,” hereafter referred to as the 2013 PHS Guidelines.1,2 The availability of new medication options, new information on the window of detection for different human immunodeficiency virus (HIV) tests, and the risk of transmission from people with undetectable viral loads prompted this update. The primary intended audience for these recommendations remains anyone involved in the provision of HIV post-exposure management to healthcare personnel (HCP).

The U.S. Centers for Disease Control and Prevention assembled a working group of representatives from federal agencies in the U.S. Department of Health and Human Services (HHS) who identified the priority topics for update and conducted systematic literature reviews to formulate recommendations (see Appendix). All recommendations were reviewed by the Healthcare Infection Control Practices Advisory Committee (HICPAC) at public meetings, and by a non-consensus forming panel of external experts. New evidence-based recommendations are developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and classified according to the HICPAC recommendation scheme when evidence supported recommendation development.3,4 Other recommendations in this document are classified as good practice statements according to the criteria set forth by GRADE.5 The working group solicited additional feedback on recommendations from relevant agencies, subject-matter experts, and the public.

Recommendations that have changed since the 2013 PHS guidelines include:

• new antiretroviral drug regimens for post-exposure prophylaxis (PEP);

• a shortened duration of post-exposure follow-up HIV testing;

• elimination of routine laboratory tests for antiretroviral drug toxicity; and

• considerations for PEP for HCP with exposures to source patients with undetectable viral loads.

Important strategies in the principles of exposure management remain: primary prevention strategies; the prompt reporting and management of occupational exposures; adherence to recommended HIV PEP regimens when indicated; the role of expert consultation in management of exposures; and follow-up of exposed HCP.

Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

Housing is an environmental social determinant of health that is linked to mortality and clinical outcomes. We developed a lexicon of housing-related concepts and rule-based natural language processing methods for identifying these housing-related concepts within clinical text. We piloted our methods on several test cohorts: a synthetic cohort generated by ChatGPT for initial infrastructure testing, a cohort with substance use disorders (SUD), and a cohort diagnosed with problems related to housing and economic circumstances (HEC). Our methods successfully identified housing concepts in our ChatGPT notes (recall = 1.0, precision = 1.0), our SUD population (recall = 0.9798, precision = 0.9898), and our HEC population (recall = N/A, precision = 0.9160).

This paper describes the implementation of curricula for Liberia's first-ever psychiatry training programme in 2019 and the actions of the only two Liberian psychiatrists in the country at the time in developing and executing a first-year postgraduate psychiatry training programme (i.e. residency) with support from international collaborators. It explores cultural differences in training models among collaborators and strategies to synergise them best. It highlights the assessment of trainees’ (residents’) basic knowledge on entry into the programme and how it guided immediate and short-term priority teaching objectives, including integrated training in neuroscience and neurology. The paper describes the strengths and challenges of this approach as well as opportunities for continued growth.

In situ elemental imaging of planetary surface regolith at a spatial resolution of 100s to 1000s of microns can provide evidence of the provenance of rocks or sediments and their habitability, and can identify post-depositional diagenetic alteration affecting preservation. We use high-resolution elemental maps and XRF spectra from MapX, a flight prototype in situ X-ray imaging instrument, to demonstrate this technology in rock types relevant to astrobiology. Examples are given for various petrologies and depositional/diagenetic environments, including ultramafic/mafic rocks, serpentinites, hydrothermal carbonates, evaporites, stromatolitic cherts and diagenetic concretions.

We examined the association between multidrug resistance and socioeconomic status (SES), analyzing microbiological and ZIP-code–level socioeconomic data. Using generalized linear models, we determined that multidrug resistance is significantly and persistently more prevalent in samples taken from patients residing in low-income ZIP codes versus high-income ZIP codes in North Carolina.

In total, 50 healthcare facilities completed a survey in 2021 to characterize changes in infection prevention and control and antibiotic stewardship practices. Notable findings include sustained surveillance for multidrug-resistant organisms but decreased use of human resource-intensive interventions compared to previous surveys in 2013 and 2018 conducted prior to the COVID-19 pandemic.

Despite recent guidance from the Centers for Disease Control and Prevention (CDC) allowing institutions to relax in-facility masking strategies and due to our evolving understanding of respiratory pathogen transmission during the coronavirus disease 2019 (COVID-19) pandemic, we propose an updated standard for universal precautions in healthcare settings: permanently including universal masking in routine patient-care interactions. Such a practice prioritizes safety for patients, healthcare providers (HCPs), and visitors.

Conodonts were a highly diverse and abundant vertebrate group whose fossils are found in marine Paleozoic and Triassic strata around the world. They inhabited environments ranging from lagoons to open oceans and are represented by a wide variety of dental morphologies. Conodonts may have filled many different ecological niches and represent a significant proportion of nekton before the Devonian. Despite this, very little is known about trophic ecology of conodonts. While morphological diversity suggests a complex trophic structure within conodont communities, there is little evidence to support dietary niche partitioning among conodonts.

We tested the hypothesis that individual conodont taxa occupied different trophic niches, using Sr/Ca and Ba/Ca ratios preserved in the dental elements of assemblages from Silurian strata of Gotland, Sweden. Sr/Ca and Ba/Ca have been shown to vary in vertebrate skeletal tissues depending on trophic positioning, although biological and environmental conditions can affect these ratios. Environmental influences were minimized by examining entire conodont communities from a tropical epeiric sea and by measuring strontium isotope ratios using thermal ionization mass spectrometry in the most metropolitan taxon (Ozarkodina confluens). Composition of white matter, a tissue unique to conodonts, was also analyzed using microprobe analysis, revealing significantly lower Sr concentrations than in surrounding lamellar tissue, suggesting taxon-specific histology should be considered when analyzing conodonts for geochemical data. Excluding taxa with highly variable quantities of white matter, the results show that each taxon preserves different Sr/Ca and Ba/Ca ratios with limited overlap, indicating variation in trophic positioning.

Despite extensive paleoenvironmental research on the postglacial history of the Kenai Peninsula, Alaska, uncertainties remain regarding the region's deglaciation, vegetation development, and past hydroclimate. To elucidate this complex environmental history, we present new proxy datasets from Hidden and Kelly lakes, located in the eastern Kenai lowlands at the foot of the Kenai Mountains, including sedimentological properties (magnetic susceptibility, organic matter, grain size, and biogenic silica), pollen and macrofossils, diatom assemblages, and diatom oxygen isotopes. We use a simple hydrologic and isotope mass balance model to constrain interpretations of the diatom oxygen isotope data. Results reveal that glacier ice retreated from Hidden Lake's headwaters by ca. 13.1 cal ka BP, and that groundwater was an important component of Kelly Lake's hydrologic budget in the Early Holocene. As the forest developed and the climate became wetter in the Middle to Late Holocene, Kelly Lake reached or exceeded its modern level. In the last ca. 75 years, rising temperature caused rapid changes in biogenic silica content and diatom oxygen isotope values. Our findings demonstrate the utility of mass balance modeling to constrain interpretations of paleolimnologic oxygen isotope data, and that groundwater can exert a strong influence on lake water isotopes, potentially confounding interpretations of regional climate.