In a retrospective cohort of 6363 neonates admitted to three NICUs, there was no reduction in Staphylococcus aureus acquisition when comparing pre- and post-pandemic incidence rates. While additional infection prevention practices introduced during the pandemic helped prevent SARS-CoV-2 transmission, these practices may not have reduced S. aureus transmission to infants.

Background: Ventilator associated events (VAE) due to changes in positive end expiratory pressure (PEEP) or fraction of inspired oxygen (FiO2) are associated with adverse outcomes for patients in the intensive care unit (ICU). Accurately identifying VAEs is important to improve the quality of care and outcomes for ICU patients. However, we have identified “false-positive” VAEs that are triggered by stylistic manipulation in ventilator settings, or knobmanship, without “true” VAEs that are preceded by signs of hypoxia. This knobmanship creates an undue burden for Infection Preventionists to differentiate clinically relevant VAEs that impact patient outcomes from “false-positive” VAEs. Methods: We utilized the Center for Disease Control and Prevention’s National Healthcare Safety Network definition to retrospectively identify VAEs in the pre-pandemic and post-pandemic eras. Of the five ICUs monitored for VAEs, the Neurosciences ICU had the greatest number of events in 2022 and 2023. Working with the NSICU, a pilot study using an initial PEEP of 6 millimeters of mercury (mmHg) rather than 5 mmHg for all intubated patients was conducted. We hypothesized that this would reduce the incidence of “false-positive” VAE without causing adverse patient outcomes. Results: Out of 283 reported VAEs from the pre-pandemic period of January 1, 2019, to December 31, 2020, 59 (21%) were due to ventilator changes in PEEP or Fi02 without preceding hypoxia. Post-pandemic evaluation from January 1, 2022, to December 31, 2022, identified “false-positive” VAE in 56 (41%) out of 137 VAE cases. Eighty-two (59%) of the 137 VAE cases were due to changes in PEEP from 5 mmHg to 8 mmHg. After changing the starting PEEP in the NSICU to 6 mmHg from 5 mmHg, from October 1, 2024, to December 1, 2024, only 1 VAE was identified compared to an average of 10 for similar quarters in 2022 and 2023. Despite this change, no adverse events or concerns were noted by the primary ICU team or respiratory therapists. Discussion: With thoughtful changes in knobmanship we reduced the burden of “false-positive” VAE without leading to adverse patient outcomes. Conclusions: Alteration in starting PEEP can reduce the burden of VAE that are not clinically relevant and allow Infection Preventionists the opportunity to critically analyze clinically relevant VAEs to improve ICU patient outcomes.

The study investigated the effects of replacing maize with enzyme-supplemented Dried Date Fruit Pulp (DDFP) in the diets of broiler chickens. 576-day-old commercial broiler chicks (Arbor Acre Plus) were randomly selected and distributed into 8 treatment groups of 72 birds each. Each treatment was divided into six replicates of 12 birds on a weight-equalisation basis. The treatments consisted of 4 levels of DDFP (0, 100, 200 and 300 g/kg) and 2 levels of enzyme supplementation (with or without). The data obtained were subjected to an Analysis of Variance in a 4 × 2 factorial arrangement. Birds fed 300 g/kg DDFP recorded the least weight gain (971 g) and final weight (1013 g) across the treatments at the starter phase, while there were no significant (P > 0.05) differences in the final weight, weight gain, feed intake and feed conversion ratio of birds fed with DDFP and maize-based diets at the finisher phase. DDFP inclusion reduced the experimental birds’ feeding cost (NGN/kg) and cost/kg weight gain (NGN/kg WG). Enzyme supplementation increased serum protein and glucose concentrations. Reduced (P < 0.05) EE and CF digestibility coefficients were seen in birds fed 30% DDFP at the finisher phase. Carcass indices, ileal digesta viscosity and caecal total bacteria were not negatively influenced. It was concluded that DDFP could replace up to 200 g/kg maize in broiler chicken diets at the starter phase and up to 300 g/kg at the finisher phase without any deleterious effects on health and performance.

The physical fidelity of turbulence models can benefit from a partial resolution of fluctuations, but doing so often comes with an increase in computational cost. To explore this trade-off in the context of wall-bounded flows, this paper introduces a framework for turbulence-resolving integral simulations (TRIS) with the goal of efficiently resolving the largest motions using a two-dimensional, three-component representation of the flow defined by instantaneous wall-normal integrals of velocity and pressure. Self-sustaining turbulence with qualitatively realistic large-scale structures is demonstrated for TRIS on an open-channel (half-channel) flow configuration using moment-of-momentum integral equations derived from Navier–Stokes with relatively simple closure approximations. Evidence from direct numerical simulations (DNS) suggests that TRIS can theoretically resolve $35\,\%{-}40\,\%$ of the turbulent skin friction enhancement for friction Reynolds numbers between $180$ and $5200$, without a noticeable decrease or increase as a function of Reynolds number. The current implementation of TRIS can match this resolution while simulating one flow through time in ${\sim}1$ minute on a single processor, even for very large Reynolds numbers. The framework facilitates a detailed apples-to-apples comparison of predicted statistics against data from DNS. Comparisons at friction Reynolds numbers of $395$ and $590$ show that TRIS generates a relatively accurate representation of the flow, while highlighting discrepancies that demonstrate a need for improving the closure models. The present results for open-channel flow represent a proof of concept for TRIS as a new approach for wall-bounded turbulence modelling, motivating extension to more general flow configurations such as boundary layers on immersed objects.

Foliar-applied postemergence applications of glufosinate are often applied to glufosinate-resistant crops to provide nonselective weed control without significant crop injury. Rainfall, air temperature, solar radiation, and relative humidity near the time of application have been reported to affect glufosinate efficacy. However, previous research may have not captured the full range of weather variability to which glufosinate may be exposed before or following application. Additionally, climate models suggest more extreme weather will become the norm, further expanding the weather range to which glufosinate can be exposed. The objective of this research was to quantify the probability of successful weed control (efficacy ≥85%) with glufosinate applied to some key weed species across a broad range of weather conditions. A database of >10,000 North American herbicide evaluation trials was used in this study. The database was filtered to include treatments with a single postemergence application of glufosinate applied to waterhemp [Amaranthus tuberculatus (Moq.) Sauer], morningglory species (Ipomoea spp.), and/or giant foxtail (Setaria faberi Herrm.) <15 cm in height. These species were chosen because they are well represented in the database and listed as common and troublesome weed species in both corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] (Van Wychen 2020, 2022). Individual random forest models were created. Low rainfall (≤20 mm) over the 5 d before glufosinate application was detrimental to the probability of successful control of A. tuberculatus and S. faberi. Lower relative humidity (≤70%) and solar radiation (≤23 MJ m−1 d−1) on the day of application reduced the probability of successful weed control in most cases. Additionally, the probability of successful control decreased for all species when average air temperature over the first 5 d after application was ≤25 C. As climate continues to change and become more variable, the risk of unacceptable control of several common species with glufosinate is likely to increase.

Task planning and its effect on the complexity of second language (L2) written production have been studied extensively. However, the results of these studies are inconclusive, and at times contradictory, potentially as a result of variation in metrics of linguistic complexity. This study is an extension of earlier research syntheses and quantitative meta-analyses on the effects of planning on oral and written L2 production. It examines the identification and selection of linguistic complexity metrics in previous research on planning and its subsequent effects on the linguistic complexity of written L2 production. This research-focused synthesis of studies surveys construct definitions and operational definitions of linguistic complexity in the research domain and provides an overview of rationales for metric selection in the included studies. Methodological implications for future research are discussed in light of the findings.

Foliar-applied postemergence herbicides are a critical component of corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] weed management programs in North America. Rainfall and air temperature around the time of application may affect the efficacy of herbicides applied postemergence in corn or soybean production fields. However, previous research utilized a limited number of site-years and may not capture the range of rainfall and air temperatures that these herbicides are exposed to throughout North America. The objective of this research was to model the probability of achieving successful weed control (≥85%) with commonly applied postemergence herbicides across a broad range of environments. A large database of more than 10,000 individual herbicide evaluation field trials conducted throughout North America was used in this study. The database was filtered to include only trials with a single postemergence application of fomesafen, glyphosate, mesotrione, or fomesafen + glyphosate. Waterhemp [Amaranthus tuberculatus (Moq.) Sauer], morningglory species (Ipomoea spp.), and giant foxtail (Setaria faberi Herrm.) were the weeds of focus. Separate random forest models were created for each weed species by herbicide combination. The probability of successful weed control deteriorated when the average air temperature within the first 10 d after application was <19 or >25 C for most of the herbicide by weed species models. Additionally, drier conditions before postemergence herbicide application reduced the probability of successful control for several of the herbicide by weed species models. As air temperatures increase and rainfall becomes more variable, weed control with many of the commonly used postemergence herbicides is likely to become less reliable.

Members of the genus Scaphanocephalus mature in accipitrids, particularly osprey, Pandion haliaetus, with metacercaria causing Black Spot Syndrome in reef fishes. In most of the world, only the type species, Scaphanocephalus expansus (Creplin, 1842) has been reported. Recent molecular studies in the Western Atlantic, Mediterranean and Persian Gulf reveal multiple species of Scaphanocephalus, but have relied on 28S rDNA, mainly from metacercariae, which limits both morphological identification and resolution of closely related species. Here we combine nuclear rDNA with mitochondrial sequences from adult worms collected in osprey across North America and the Caribbean to describe species and elucidate life cycles in Scaphanocephalus. A new species described herein can be distinguished from S. expansus based on overall body shape and size. Phylogenetic analysis of the whole mitochondrial genome of Scaphanocephalus indicates a close relationship with Cryptocotyle. We conclude that at least 3 species of Scaphanocephalus are present in the Americas and 2 others are in the Old World. Specimens in the Americas have similar or identical 28S to those in the Mediterranean and Persian Gulf, but amphi-Atlantic species are unlikely in light of divergence in cytochrome c oxidase I and the lack of amphi-Atlantic avian and fish hosts. Our results provide insight into the geographic distribution and taxonomy of a little-studied trematode recently linked to an emerging pathology in ecologically important reef fishes.

We report a 14-month-old male with hypoplastic left heart syndrome, mitral stenosis, and aortic stenosis with native aortic root thrombus. He developed a wide complex ventricular tachycardia and ST-segment elevation myocardial infarction with troponin I levels peaking at 388 ng/mL. He was treated safely with systemic alteplase with a resolution of his regional wall motion abnormality 18 hours later.

The Buffalo National River in northwest Arkansas preserves an extensive Quaternary record of fluvial bedrock incision and aggradation across lithologies of variable resistance. In this work, we apply optically stimulated luminescence (OSL) dating to strath and fill terraces along the Buffalo River to elucidate the role of lithology and climate on the development of the two youngest terrace units (Qtm and Qty). Our OSL ages suggest a minimum strath planation age of ca. 250 ka for the Qtm terraces followed by a ca. 200 ka record of aggradation. Qtm incision likely occurred near the last glacial maximum (LGM), prior to the onset of Qty fill terrace aggradation ca. 14 ka. Our terrace ages are broadly consistent with other regional terrace records, and comparison with available paleoclimatic archives suggests that terrace aggradation and incision occurred during drier and wetter hydrological conditions, respectively. Vertical bedrock incision rates were also calculated using OSL-derived estimates of Qtm strath planation and displayed statistically significant spatial variability with bedrock lithology, ranging from ~35 mm/ka in the higher resistance reaches and ~16 mm/ka in the lower resistance reaches. In combination with observations of valley width and terrace distribution, these results suggest that vertical processes outpace lateral ones in lithologic reaches with higher resistance.

Three-dimensional (3D) food printing is a rapidly emerging technology offering unprecedented potential for customised food design and personalised nutrition. Here, we evaluate the technological advances in extrusion-based 3D food printing and its possibilities to promote healthy and sustainable eating. We consider the challenges in implementing the technology in real-world applications. We propose viable applications for 3D food printing in health care, health promotion and food waste upcycling. Finally, we outline future work on 3D food printing in food safety, acceptability and economics, ethics and regulations.

OBJECTIVES/GOALS: Chronic low back pain (cLBP) is associated with gait impairments. Gait may serve as an important biomarker for improvement following therapy interventions; however, gait has not been sufficiently studied in relationship to pain and function in cLBP. METHODS/STUDY POPULATION: Adults with cLBP completed a two-minute-walk-test around a 37.5 m oval track while wearing an inertial measurement unit (IMU—Lifeware LLC, Pittsburgh, PA) over the L5 spinous process. Step time average, step time variability, step length, and symmetry (harmonic ratio) were calculated based on linear trunk accelerations, and gait speed was calculated based on distance walked. Participants completed the PEG tool (Pain, Enjoyment, General activity; scores closer to 10 indicate worse pain) to quantify pain intensity/interference and the PROMIS Physical Function SF-6b tool (mean t-scores=50 +/- 10; higher scores indicate better function) to quantify physical function. Pearson correlation coefficient (r) was used to determine strength of associations between gait and pain/physical function. RESULTS/ANTICIPATED RESULTS: Eleven adults (8 female, age 40 +/- 17, pain duration≥3 months) with cLPB participated in this study after completing an informed consent process approved by the University of Pittsburgh Institutional Review Board. Participants with a history of cancer, spinal cord compression, discitis, or activity restrictions prohibiting them from protocol completion were excluded. The mean PEG scores and PROMIS Physical Function t-scores were 2.8 +/- 1.8 and 47.8 +/- 8.2 respectively. There was a moderate-strong correlation between step time average and PEG (r=0.67, p=0.02), and a moderate-strong correlation between gait speed and PROMIS Physical Function (r=0.62, p=0.04). There were no other significant associations. DISCUSSION/SIGNIFICANCE: Gait speed and step time may be important movement biomarkers to consider when evaluating patients with cLBP. Generalizability of results are limited by the small study cohort and this cohort's relatively low pain burden and high level of physical function.

There has recently been an increased interest in studying the language development of non-western languages. This is not new - it began in 1960’s and continued into the 1980’s and 1990’s. The current renewed interest is much welcomed, and will benefit from many of the experimental methods and theoretical insights developed over the past decades.

Archaeologists tend to produce slow data that is contextually rich but often difficult to generalize. An example is the analysis of lithic microdebitage, or knapping debris, that is smaller than 6.3 mm (0.25 in.). So far, scholars have relied on manual approaches that are prone to intra- and interobserver errors. In the following, we present a machine learning–based alternative together with experimental archaeology and dynamic image analysis. We use a dynamic image particle analyzer to measure each particle in experimentally produced lithic microdebitage (N = 5,299) as well as an archaeological soil sample (N = 73,313). We have developed four machine learning models based on Naïve Bayes, glmnet (generalized linear regression), random forest, and XGBoost (“Extreme Gradient Boost[ing]”) algorithms. Hyperparameter tuning optimized each model. A random forest model performed best with a sensitivity of 83.5%. It misclassified only 28 or 0.9% of lithic microdebitage. XGBoost models reached a sensitivity of 67.3%, whereas Naïve Bayes and glmnet models stayed below 50%. Except for glmnet models, transparency proved to be the most critical variable to distinguish microdebitage. Our approach objectifies and standardizes microdebitage analysis. Machine learning allows studying much larger sample sizes. Algorithms differ, though, and a random forest model offers the best performance so far.

Objective. The efficacy of individualized, community-based physical activity as an adjunctive smoking cessation treatment to enhance long-term smoking cessation rates was evaluated for the Lifestyle Enhancement Program (LEAP). Methods. The study was a two-arm, parallel-group, randomized controlled trial. All participants (n = 392) received cessation counseling and a nicotine patch and were randomized to physical activity (n = 199; YMCA membership and personalized exercise programming from a health coach) or an equal contact frequency wellness curriculum (n = 193). Physical activity treatment was individualized and flexible (with each participant selecting types of activities and intensity levels and being encouraged to exercise at the YMCA and at home, as well as to use “lifestyle” activity). The primary outcome (biochemically verified prolonged abstinence at 7-weeks (end of treatment) and 6- and 12-months postcessation) and secondary outcomes (7-day point prevalent tobacco abstinence (PPA), total minutes per week of leisure time physical activity and strength training) were assessed at baseline, 7 weeks, 6 months, and 12 months. Results. Prolonged abstinence in the physical activity and wellness groups was 19.6% and 25.4%, respectively, at 7-weeks, 15.1% and 16.6% at 6-months, and 14.1% and 17.1% at 12 months (all between-group P values >0.18). Similarly, PPA rates did not differ significantly between groups at any follow-up. Change from baseline leisure-time activity plus strength training increased significantly in the physical activity group at 7 weeks (P = 0.04). Across treatment groups, an increase in the number of minutes per week in strength training from baseline to 7 weeks predicted prolonged abstinence at 12 months (P ≤ 0.001). Further analyses revealed that social support, fewer years smoked, and less temptation to smoke were associated with prolonged abstinence over 12 months in both groups. Conclusions. Community-based physical activity programming, delivered as adjunctive treatment with behavioral/pharmacological cessation treatment, did not improve long-term quit rates compared to adjunctive wellness counseling plus behavioral/pharmacological cessation treatment. This trial is registered with https://beta.clinicaltrials.gov/study/NCT00403312, registration no. NCT00403312.

South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.