In Antimicrobial Stewardship and Infection Prevention and Control, programmatic goals often strive to achieve clinical benefit by practice change in the direction of doing less. Practically, this may include reducing the number of tests ordered, encouraging shorter and more narrow courses of antimicrobials, or discontinuing practices that are no longer contextually appropriate. Because promoting practice change in the direction of doing less is a critical aspect of day-to-day operations in Antimicrobial Stewardship and Infection Prevention and Control, the goals of this Society for Healthcare Epidemiology Research Committee White Paper are to provide a roadmap and framework for leveraging principles of implementation and de-implementation science in day-to-day practice. Part II of this series focuses on some practical case studies, including real-world examples of applied de-implementation science to promote discontinuation of practices that are ineffective, overused, or no longer effective.

De-implementation of established practices is a common challenge in infection prevention and antimicrobial stewardship and a necessary part of the life cycle of healthcare quality improvement programs. Promoting de-implementation of ineffective antimicrobial use and increasingly of low-value diagnostic testing are cornerstones of stewardship practice. Principles of de-implementation science and the interplay of implementation and de-implementation are discussed in part I of this Society for Healthcare Epidemiology of America White Paper Series.In this second part of the series, we discuss a process for applying principles of de-implementation science in infection prevention and stewardship and then review some real-world examples and case studies, including a national blood culture shortage, contact precautions, and surgical and dental prophylaxis. We use these examples to demonstrate how barriers and facilitators can be mapped to evidence-informed implementation/de-implementation strategies to promote efforts to reduce low-value, ineffective, or out-of-date practices. These real-world examples highlight the need for infection prevention and stewardship programs to adapt to changing evidence, contexts, and conditions. Although barriers to practice change are often a bit different, de-implementation can sometimes be thought of as the implementation of a new program—but the new program aims to stop rather than start doing something.

As the saying goes, sometimes less really is more. Medicine and public health have a strong action bias and a strong aversion to risk and uncertainty. Although our best intentions may point us to implementing more interventions, often, the best medicine instead dictates that we do less, or nothing at all. Leveraging principles of de-implementation science can help move healthcare in the right direction when interventions are low-value, ineffective, or no longer needed.

The genus Bursaphelenchus has attracted significant attention due to its economically devastating and quarantined species – notably the pine wood nematode B. xylophilus and B. cocophilus. Despite their ecological and agricultural importance, genomic data for this genus remain scarce. In this study, we sequenced and assembled the complete mitochondrial genomes of three Bursaphelenchus species (B. chengi, B. parantoniae, and B. sinensis) using high-throughput sequencing. The circular mitogenomes exhibited size variation, with B. chengi (17,670 bp), B. parantoniae (15,021 bp), and B. sinensis (18,386 bp) each containing the typical nematode mitochondrial gene complement: 12 protein-coding genes (PCGs), 2 ribosomal RNA (rRNA) genes, and 22 transfer RNA (tRNA) genes. Phylogenetic analysis based on the concatenated amino acid sequences of the 12 PCGs revealed that these species form a sister clade to B. xylophilus and B. mucronatus. Comparative mitogenomic analysis demonstrated a conserved gene arrangement shared among Bursaphelenchus, Aphelenchoides, Caenorhabditis, Cruznema tripartitum, and Pristionchus pacificus, suggesting strong evolutionary conservatism across the families Aphelenchoididae, Neodiplogasteridae, and Rhabditidae. Our study enriched the mitochondrial genomic resources for Bursaphelenchus and advanced resolution of their intrageneric phylogenetic relationships.

The impact of the self-sealing band on interior ballistics is investigated during the gun launching, and a high-precision interior ballistics coupling algorithm that takes leakage into account is proposed. This study focuses on a 65 mm short-barrel, equal-caliber balanced cannon, integrating Abaqus finite element software with an interior ballistics calculation programme. It uses a User-defined AMPlication Load (VUAMP) subroutine to achieve real-time coupling calculations of the chamber pressure and self-sealing band deformation, correcting variations in the chamber pressure. Experimental results show that the coupling algorithm offers the higher precision compared to traditional interior ballistics models and can effectively capture the impact of leakage on the interior ballistics performance. Further research reveals that changes in the charge amount and assembly gap significantly affect the sealing performance of the self-sealing band and the leakage of propellant gases, which in turn influence the chamber pressure and projectile velocity. The high-precision coupling algorithm proposed in this paper provides the effective theoretical support for the design of the self-sealing band and the analysis of cannon performance.

Background: Nipocalimab (a fully human, effectorless anti-neonatal Fc receptor (FcRn) monoclonal antibody) may ameliorate gMG disease manifestations by selectively targeting FcRn IgG recycling and lowering IgG, including pathogenic autoantibodies in generalized myasthenia gravis (gMG). The objective was to evaluate the effectiveness and safety of intravenous nipocalimab added to background standard-of-care therapy in adolescents with gMG. Methods: Seropositive patients (12-<18 years) with gMG (MGFA Class II-IV) on stable therapy but inadequately controlled, were enrolled in a 24-week open label study. Nipocalimab was administered as a 30 mg/kg IV loading dose followed by 15 mg/kg IV every 2 Weeks. Results: Seven adolescents were enrolled; 5 completed 24-weeks of dosing. The mean(SD) age was 14.1(1.86) years; seven were anti-AChR+, six were female. Mean(SD) baseline MG-ADL/QMG scores were 4.29(2.430)/12.50(3.708). Nipocalimab showed a significant reduction in total serum IgG at week-24; the mean(SD) change from baseline to week-24 for total serum IgG was -68.98%(7.561). The mean(SD) change in MG-ADL/QMG scores at week-24 was -2.40(0.418)/-3.80(2.683); 4 of 5 patients achieved minimum symptom expression (MG-ADL score 0-1) by week-24. Nipocalimab was well-tolerated; there were no serious adverse events. There were no clinically meaningful laboratory changes. Conclusions: Nipocalimab demonstrated efficacy and safety in this 6-month trial in seropositive adolescents with gMG.

Background: Artificial intelligence (AI) holds promise to predict outcomes for patients sustaining moderate to severe traumatic brain injury (msTBI). This systematic review sought to identify studies utilizing AI-based methods to predict mortality and functional outcomes after msTBI, where prognostic uncertainty is highest. Methods: The APPRAISE-AI quantitative evidence appraisal tool was used to evaluate methodological quality of included studies by determining overall scores and domain-specific scores. We constructed a multivariable linear regression model using study sample size, country of data collection, publication year and journal impact factor to quantify associations with overall APPRAISE-AI scores. Results: We identified 38 studies comprising 591,234 patients with msTBI. Median APPRAISE-AI score was 45.5 (/100 points), corresponding to moderate study quality. There were 13 low-quality studies (34%) and only 5 high-quality studies (13%). Weakest domains were methodological conduct, robustness of results and reproducibility. Multivariable linear regression highlighted that higher journal impact factor, larger sample size, more recent publication year and use of data that were collected in a high-income country were associated with higher APPRAISE-AI overall scores. Conclusions: We identified several study weaknesses of existing AI-based prediction models for msTBI; this work highlights methodological domains that require quality improvement to ultimately ensure safety and effiicacy of clinical AI models.

With numerous applications of coilable masts in high-precision space application scenarios, there are also greater demands on the accuracy of their dynamic modelling and analysis. The modelling of hinges is a critical issue in the dynamic modelling of coilable masts, which significantly affects the accuracy of the dynamic response analysis. For coilable masts, the rotational effect is the most important problem in hinge modelling. However, few studies have focused on this topic. To address this problem, the concept of hinge equivalent rotational stiffness is proposed in this paper to describe the rotational effect of the coilable mast hinges. After that, a new coilable mast dynamic model containing the undetermined hinge equivalent rotational stiffness is introduced, and an identification method for the hinge equivalent rotational stiffness based on the hammer test is proposed. Finally, the dynamic modelling method is validated through an actual coilable mast example, and the analysis and test results show that the accuracy of the dynamic model established by the proposed method in this paper is greater than that of the traditional model.

Metabolic enzymes are the catalysts that drive the biochemical reactions essential for sustaining life. Many of these enzymes are tightly regulated by feedback mechanisms. To fully understand their roles and modulation, it is crucial to investigate the relationship between their structure, catalytic mechanism, and function. In this perspective, by using three examples from our studies on Mycobacterium tuberculosis (Mtb) isocitrate lyase and related proteins, we highlight how an integrated approach combining structural, activity, and biophysical data provides insights into their biological functions. These examples underscore the importance of employing fast-fail experiments at the early stages of a research project, emphasise the value of complementary techniques in validating findings, and demonstrate how in vitro data combined with chemical, biochemical, and physiological knowledge can lead to a broader understanding of metabolic adaptations in pathogenic bacteria. Finally, we address the unexplored questions in Mtb metabolism and discuss how we expand our approach to include microbiological and bioanalytical techniques to further our understanding. Such an integrated and interdisciplinary strategy has the potential to uncover novel regulatory mechanisms and identify new therapeutic opportunities for the eradication of tuberculosis. The approach can also be broadly applied to investigate other biochemical networks and complex biological systems.

Ultrafast optical probing is a widely used method of underdense plasma diagnostic. In relativistic plasma, the motion blur limits spatial resolution in the direction of motion. For many high-power lasers the initial pulse duration of 30–50 fs results in a 10–15 μm motion blur, which can be reduced by probe pulse post-compression. Here we used the compression after compressor approach [Phys.-Usp. 62, 1096 (2019); JINST 17 P07035 (2022)], where spectral broadening is performed in thin optical plates and is followed by reflections from negative-dispersion mirrors. Our initially low-intensity probe beam was down-collimated for a more efficient spectral broadening and higher probe-to-self-emission intensity ratio. The setup is compact, fits in a vacuum chamber and can be implemented within a short experimental time slot. We proved that the compressed pulse retained the high quality necessary for plasma probing.

Eighteen of 56 (32.1%) wild Rana limnocharis from central and south Taiwan were found to contain plerocercoids of Spirometra erinaceieuropaei. This is the first report of S. erinaceieuropaei infections in frogs in Taiwan, with the plerocercoids being recovered from the thigh and back muscles or under the skin. Other species of frogs examined, including nine wild R. latouchii, one wild Buergeria robustus and 110 cultured R. rugulosa were free of infection. The plerocercoids were orally inoculated into four cats; three of which were each given a single plerocercoid and one a dose of three plerocercoids. Daily faecal examination showed that two cats started shedding eggs of S. erinaceieuropaei on day 8 postinfection (PI) and the other two on day 10 PI. The highest eggs per gram and eggs per day for a single worm was found to be 428,000 and 14,416,000 respectively. Only the cat inoculated with three plerocercoids shed proglottids in its faeces during the 2 month observation period.

Echinococcosis poses a significant threat to public health. The Chinese government has implemented prevention and control measures to mitigate the impact of the disease. By analyzing data from the Chinese Center for Disease Control and Prevention and the State Council of the People’s Republic of China, we found that implementation of these measures has reduced the infection rate by nearly 50% between 2004 to 2022 (from 0.3975 to 0.1944 per 100,000 person-years). Nonetheless, some regions still bear a significant disease burden, and lack of detailed information limites further evaluation of the effects on both alveolar and cystic echinococcosis. Our analysis supports the continuing implementation of these measures and suggests that enhanced wildlife management, case-based strategies, and surveillance systems will facilitate disease control.

The chemistry of Al transformation has been well documented, though little is known about the mechanisms of structural perturbation of Al precipitates by carbonates at a molecular level. The purpose of the present study was to investigate the structural perturbation of Al precipitates formed under the influence of carbonates. Initial carbonate/Al molar ratios (MRs) used were 0, 0.1, and 0.5 after aging for 32 days, then the samples were analyzed by X-ray absorption near edge structure spectroscopy (XANES), X-ray diffraction (XRD), Fourier-transform infrared absorption spectroscopy (FTIR), and chemical analysis. The XRD data were in accord with the FTIR results, which revealed that as the carbonate/Al MR was increased from 0 to 0.1, carbonate preferentially retarded the formation of gibbsite and had relatively little effect on the formation of bayerite. As the carbonate/Al MR was increased to 0.5, however, the crystallization of both gibbsite and bayerite was completely inhibited. The impact of carbonate on the nature of Al precipitates was also evident in the increase of adsorbed water and inorganic C contents with increasing carbonate/Al MR. The Al K- and L- edge XANES data provide the first evidence illustrating the change in the coordination number of Al from 6-fold to mixed 6- and 4-fold coordination in the structural network of short-range ordered (SRO) Al precipitates formed under the increasing perturbation of carbonate. The fluorescence yield spectra of the O K-edge show that the intensity of the peak at 534.5 eV assigned to σ* transitions of Al-O and O-H bonding decreased with increasing carbonate/Al MR. The XANES data, along with the evidence from XRD, FTIR, and chemical analysis showed clearly that carbonate caused the alteration of the coordination nature of the Al-O bonding through perturbation of the atomic bonding and structural configuration of Al hydroxides by complexation with Al in the SRO network of Al precipitates. The surface reactivity of an Al-O bond is related to its covalency and coordination geometry. The present findings were, therefore, of fundamental significance in understanding the low-temperature geochemistry of Al and its impacts on the transformation, transport, and fate of nutrients and pollutants in the ecosystem.