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Background: Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years., Methods: We conducted a test-negative design analysis in an electronic health records-based network in eight states in the USA, including hospitalisations and emergency department encounters with respiratory syncytial virus-like illness among adults aged at least 60 years who underwent respiratory syncytial virus testing from Oct 1, 2023, to March 31, 2024. Respiratory syncytial virus vaccination status at the time of the encounter was derived from electronic health record documentation, state and city immunisation registries, and, for some sites, medical claims. Vaccine effectiveness was estimated by immunocompromise status, comparing the odds of vaccination among respiratory syncytial virus-positive case patients and respiratory syncytial virus-negative control patients, and adjusting for age, race and ethnicity, sex, calendar day, social vulnerability index, number of underlying non-respiratory medical conditions, presence of respiratory underlying medical conditions, and geographical region., Findings: Among 28 271 hospitalisations for respiratory syncytial virus-like illness among adults aged at least 60 years without immunocompromising conditions, vaccine effectiveness was 80% (95% CI 71-85) against respiratory syncytial virus-associated hospitalisations, and vaccine effectiveness was 81% (52-92) against respiratory syncytial virus-associated critical illness (ICU admission or death, or both). Among 8435 hospitalisations for respiratory syncytial virus-like illness among adults with immunocompromising conditions, vaccine effectiveness was 73% (48-85) against associated hospitalisation. Among 36 521 emergency department encounters for respiratory syncytial virus-like illness among adults aged at least 60 years without an immunocompromising condition, vaccine effectiveness was 77% (70-83) against respiratory syncytial virus-associated emergency department encounters. Vaccine effectiveness estimates were similar by age group and product type., Interpretation: Respiratory syncytial virus vaccination was effective in preventing respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years in the USA during the 2023-24 respiratory syncytial virus season, which was the first season after respiratory syncytial virus vaccine was approved., Funding: The Centers for Disease Control and Prevention., Competing Interests: Declaration of interests NPK reports support for other work from Sanofi Pasteur, Merck, Pfizer, Seqirus, and GSK, unpaid expert panel membership for a planned hepatitis E phase 2 vaccine clinical trial among pregnant women in Pakistan, and unpaid membership on the Western States COVID-19 Scientific Safety Review Workgroup, Board on Population Health and Public Health Practice, National Academies of Science, Engineering, and Medicine, and National Vaccine Advisory Committee Safety Subcommittee. SJG reports funding from the National Institutes of Health's National Center for Advancing Translation Sciences and National Institute of Mental Health. TCO reports consulting fees from Regenstrief Institute as a domain expert in patient matching in global health informatics, travel support from Regenstrief Institute and Patient-Centered Outcomes Research institute, and holds a patent (patent number PCT/US2018/047961). MBD, BED, and WFF report an additional CDC contract for the Vaccine Safety Datalink. TS reports unpaid participation as a member of the Advisory Committee on the Immunization Practices Influenza Vaccine Work Group, is chief of the Utah Adult Immunization Coalition, and is a member of the Utah Department of Health and Human Services Scientific Advisory Committee on Vaccines. OZ reports funding from the National Institute of Allergy and Infectious Diseases (grant number R01AI168373). NPK, JT, and KG report a CDC contract for VISION (contract number 75D30123C17595). SR reports funding from Biofire and GSK. MB reports speaker bureau participation for Innoviva Specialty Therapeutics. CEM reports funding from AstraZeneca, GSK, National Institutes of Health, US Department of Defense, and Patient-Centered Outcomes Research Institute, payment or honoraria for a lecture from Pri-Med, and leadership on the American Lung Association of Minnesota board, the Minnesota Department of Health Long COVID Advisory Committee, and on the Minnesota Department of Health Asthma Care Advisory Committee. JAW, PKM, SWB, SER, and EAKR report a CDC contract for VISION (contract number 75D30121D12779). KD, SAI, SJG, TCO, MBD, KN, BED, WFF, CR, KSA, and CEM report payments made to their institution by CDC via Westat. All other authors declare no competing interests., (Copyright © 2024 Published by Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Insects collected in dry traps can degrade rapidly, especially in warm, humid environments where many biodiversity and biosecurity surveillance activities are undertaken. Degradation can severely impact diagnostics, as trap catches can become difficult to identify to species level using morphological characters or, of increasing importance, molecular approaches. This is especially problematic for biosecurity surveillance of exotic tephritid fruit flies, where diagnostics are heavily reliant on morphological characters. We tested the effects of differing temperature and humidity conditions on mock samples of tephritid fruit flies in a controlled environment and compared our results to field trap catches. DNA degradation was quantified using real-time PCR assays, including one assay newly developed and tested here. We observed a correlation between increasing DNA degradation and increasing temperature and humidity. The greatest DNA degradation occurred under combined high humidity (90% relative humidity) and constant high temperature (35 °C). Unexpectedly, fluctuating temperature did not have a significant impact on DNA. Other factors, such as trap design, time in the field, and rainfall, did not significantly correlate with DNA quality across the field samples tested. When plotted against mock samples, field samples clustered together, with no clear pattern or predictability regarding the quantity of DNA preserved, indicating other untested environmental variables may be at play. Predictably, increased exposure time was found to have a detrimental effect on DNA quality for all treatments. These findings will improve the delivery of surveillance activities through the implementation of shorter trap clearance timeframes and improved trap designs and procedures., (© The Author(s) 2024. Published by Oxford University Press on behalf of Entomological Society of America.)

In July 2017, an investigation into the cause of neurological signs in a black flying fox (Pteropus alecto, family Pteropodidae) identified a putative novel hantavirus (Robina virus, ROBV, order Bunyavirales, family Hantaviridae, genus Mobatvirus) in its brain. Analysis of the evolutionary relationship between other hantaviruses using maximum-likelihood, a systematic Bayesian clustering approach, and a minimum spanning tree, all suggest that ROBV is most closely related to another Mobatvirus, Quezon virus, previously identified in the lung of a Philippine frugivorous bat (Rousettus amplexicaudatus, also family Pteropodidae). Subsequently, between March 2018 and October 2023, a total of 495 bats were opportunistically screened for ROBV with an experimental qRT-PCR. The total prevalence of ROBV RNA detected in Pteropus spp. was 4.2% (95% CI 2.8-6.4%). Binomial modelling identified that there was substantial evidence supporting an increase (P = 0.033) in the detection of ROBV RNA in bats in 2019 and 2020 suggesting of a possible transient epidemic. There was also moderate evidence to support the effect of season (P = 0.064), with peak detection in the cooler seasons, autumn, and winter, possibly driven by physiological and ecological factors similar to those already identified for other bat-borne viruses. This is Australia's first reported putative hantavirus and its identification could expand the southern known range of hantaviruses in Australasia., (© 2024. Crown.)

Background: The benefit of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) is controversial because of a lack of high-quality evidence. We aim to evaluate the impact of CTO-PCI on symptoms, quality of life and mortality., Methods: We conducted a retrospective single center study of patients with CTO-PCI in a tertiary center in Austria. The study outcomes were Canadian Cardiovascular Society (CCS) angina score, quality of life measured by Seattle Angina Questionnaire (SAQ), and death at median follow up for patients with successful vs. failed CTO-PCI., Results: A total of 300 patients underwent CTO-PCI for coronary artery disease, of which 252 (84%) were technically successful with median follow up of 3.4 years. There were no significant differences in in-hospital or all-cause mortality, major adverse cardiovascular event, or stent-related complications between the groups of failed and successful CTO-PCI. Among patients with successful CTO-PCI there was a significant improvement in CCS score, which was not found for the group with failed CTO-PCI. Successful reopening was associated with significant benefits of the SAQ domains of angina with stressful activity [3.7 ± 0.9 vs. 3.1 ± 0.5, p  = 0.004, use of nitrates (4.7 ± 0.5 vs. 3.0 ± 1.0) p  = 0.005] and satisfaction from angina relief (4.4 ± 1.1 vs. 3.6 ± 1.4 p  < 0.001)., Conclusion: While there was no significant difference in mortality, successful CTO-PCI was associated with greater reduction in angina and the use of nitrates compared to unsuccessful CTO-PCI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Will, Schwarz, Aufhauser, Leibundgut, Schmidt, Mayer, Vock, Borovac, Kwok, Lamm, Mascherbauer and Weiss.)

Importance: During the COVID-19 pandemic, the effective distribution of limited treatments became a crucial policy goal. Yet, limited research exists using electronic health record data and machine learning techniques, such as policy learning trees (PLTs), to optimize the distribution of scarce therapeutics., Objective: To evaluate whether a machine learning PLT-based method of scarce resource allocation optimizes the treatment benefit of COVID-19 neutralizing monoclonal antibodies (mAbs) during periods of resource constraint., Design, Setting, and Participants: This retrospective cohort study used electronic health record data from October 1, 2021, to December 11, 2021, for the training cohort and data from June 1, 2021, to October 1, 2021, for the testing cohort. The cohorts included patients who had positive test results for SARS-CoV-2 and qualified for COVID-19 mAb therapy based on the US Food and Drug Administration's emergency use authorization criteria, ascertained from the patient electronic health record. Only some of the qualifying candidates received treatment with mAbs. Data were analyzed between from January 2023 to May 2024., Main Outcomes and Measures: The primary outcome was overall expected hospitalization, assessed as the potential reduction in overall expected hospitalization if the PLT-based allocation system was used. This was compared to observed allocation using risk differences., Results: Among 9542 eligible patients in the training cohort (5418 female [56.8%]; age distribution: 18-44 years, 4151 [43.5%]; 45-64 years, 3146 [33.0%]; and ≥65 years, 2245 [23.5%]), a total of 3862 (40.5%) received mAbs. Among 6248 eligible patients in the testing cohort (3416 female [54.7%]; age distribution: 18-44 years, 2827 [45.2%]; 45-64 years, 1927 [30.8%]; and ≥65 years, 1494 [23.9%]), a total of 1329 (21.3%) received mAbs. Treatment allocation using the trained PLT model led to an estimated 1.6% reduction (95% CI, -2.0% to -1.2%) in overall expected hospitalization compared to observed treatment allocation in the testing cohort. The visual assessment showed that the PLT-based point system had a larger reduction in 28-day hospitalization compared with the Monoclonal Antibody Screening Score (maximum overall hospitalization difference, -1.0% [95% CI, -1.3% to -0.7%]) in the testing cohort., Conclusions and Relevance: This retrospective cohort study proposes and tests a PLT method, which can be linked to a electronic health record data platform to improve real-time allocation of scarce treatments. Use of this PLT-based allocation method would have likely resulted in fewer hospitalizations across a population than were observed in usual care, with greater expected reductions than a commonly used point system.

Background: A trial performed among unvaccinated, high-risk outpatients with COVID-19 during the delta period showed remdesivir reduced hospitalization. We used our real-world data platform to determine the effectiveness of remdesivir on reducing 28-day hospitalization among outpatients with mild-moderate COVID-19 during an Omicron period including BQ.1/BQ.1.1/XBB.1.5., Methods: We did a propensity-matched, retrospective cohort study of non-hospitalized adults with SARS-CoV-2 infection between April 7, 2022, and February 7, 2023. Electronic healthcare record data from a large health system in Colorado were linked to statewide vaccination and mortality data. We included patients with a positive SARS-CoV-2 test or outpatient remdesivir administration. Exclusion criteria were other SARS-CoV-2 treatments or positive SARS-CoV-2 test more than seven days before remdesivir. The primary outcome was all-cause hospitalization up to day 28. Secondary outcomes included 28-day COVID-related hospitalization and 28-day all-cause mortality., Results: Among 29,270 patients with SARS-CoV-2 infection, 1,252 remdesivir-treated patients were matched to 2,499 untreated patients. Remdesivir was associated with lower 28-day all-cause hospitalization (1.3% vs. 3.3%, adjusted hazard ratio (aHR) 0.39 [95% CI 0.23-0.67], p < 0.001) than no treatment. All-cause mortality at 28 days was numerically lower among remdesivir-treated patients (0.1% vs. 0.4%; aOR 0.32 [95% CI 0.03-1.40]). Similar benefit of RDV treatment on 28-day all-cause hospitalization was observed across Omicron periods, aOR (95% CI): BA.2/BA2.12.1 (0.77[0.19-2.41]), BA.4/5 (0.50[95% CI 0.50-1.01]), BQ.1/BQ.1.1/XBB.1.5 (0.21[95% CI 0.08-0.57]., Conclusion: Among outpatients with SARS-CoV-2 during recent Omicron surges, remdesivir was associated with lower hospitalization than no treatment, supporting current National Institutes of Health Guidelines., (© 2024. The Author(s).)

Objectives: To evaluate whether subcutaneous neutralizing monoclonal antibody (mAb) treatment given in the emergency department (ED) setting was associated with reduced hospitalizations, mortality, and severity of disease when compared to nontreatment among mAb-eligible patients with coronavirus disease 2019 (COVID-19)., Methods: This retrospective observational cohort study of ED patients utilized a propensity score-matched analysis to compare patients who received subcutaneous casirivimab and imdevimab mAb to nontreated COVID-19 control patients in November-December 2021. The primary outcome was all-cause hospitalization within 28 days, and secondary outcomes were 90-day hospitalization, 28- and 90-day mortality, and ED length of stay (LOS)., Results: Of 1340 patients included in the analysis, 490 received subcutaneous casirivimab and imdevimab, and 850 did not received them. There was no difference observed for 28-day hospitalization (8.4% vs. 10.6%; adjusted odds ratio [aOR] 0.79, 95% confidence intervals [CI] 0.53-1.17) or 90-day hospitalization (11.6% vs. 12.5%; aOR 0.93, 95% CI 0.65-1.31). However, mortality at both the 28-day and 90-day timepoints was substantially lower in the treated group (28-day 0.6% vs. 3.1%; aOR 0.18, 95% CI 0.08-0.41; 90-day 0.6% vs. 3.9%; aOR 0.14, 95% CI 0.06-0.36). Among hospitalized patients, treated patients had shorter hospital LOS (5.7 vs. 11.4 days; adjusted rate ratio [aRR] 0.47, 95% CI 0.33-0.69), shorter intensive care unit LOS (3.8 vs. 10.2 days; aRR 0.22, 95% CI 0.14-0.35), and the severity of hospitalization was lower (aOR 0.45, 95% CI 0.21-0.97) compared to untreated., Conclusions: Among ED patients who presented for symptomatic COVID-19 during the Delta variant phase, ED subcutaneous casirivimab/imdevimab treatment was not associated with a decrease in hospitalizations. However, treatment was associated with lower mortality at 28 and 90 days, hospital LOS, and overall severity of illness., Competing Interests: All authors attest to meeting the four ICMJE.org authorship criteria., (© 2024 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Background: Ritonavir-boosted Nirmatrelvir (NMV-r), a protease inhibitor with in vitro activity against SARS-CoV-2, can reduce risk of progression to severe COVID-19 among high-risk individuals infected with earlier variants, but less is known about its effectiveness against omicron variants BQ.1/BQ.1.1/XBB.1.5. We sought to evaluate effectiveness of NMV-r in BQ.1/BQ.1.1/XBB.1.5 omicron variants by comparing hospitalisation rates to NMV-r treated patients during a previous omicron phase and to contemporaneous untreated patients., Methods: We conducted a retrospective observational cohort study of non-hospitalised adult patients with SARS-CoV-2 infection using real-world data from three health systems in Colorado and Utah, and compared hospitalisation rates in NMV-r-treated patients in a BA.2/BA.2.12.1/BA.4/BA.5 variant-predominant (first) phase (April 3, 2022-November 12, 2022), with a BQ.1/BQ.1.1/XBB.1.5 variant-predominant (second) phase (November 13, 2022-March 7, 2023). In the primary analysis, we used Firth logistic regression with a two-segment (phase) linear time model, and pre-specified non-inferiority bounds for the mean change between segments. In a pre-specified secondary analysis, we inferred NMV-r effectiveness in a cohort of treated and untreated patients infected during the second phase. For both analyses, the primary outcome was 28-day all-cause hospitalisation. Subgroup analyses assessed treatment effect heterogeneity., Findings: In the primary analysis, 28-day all-cause hospitalisation rates in NMV-r treated patients in the second phase (n = 12,061) were non-inferior compared to the first phase (n = 25,075) (198 [1.6%] vs. 345 [1.4%], adjusted odds ratio (aOR): 0.76 [95% CI 0.54-1.06]), with consistent results among secondary endpoints and key subgroups. Secondary cohort analyses revealed additional evidence for NMV-r effectiveness, with reduced 28-day hospitalisation rates among treated patients compared to untreated patients during a BQ.1/BQ.1.1/XBB.1.5 predominant phase (198/12,061 [1.6%] vs. 376/10,031 [3.7%], aOR 0.34 [95% CI 0.30-0.38), findings robust to additional sensitivity analyses., Interpretation: Real-world evidence from major US healthcare systems suggests ongoing NMV-r effectiveness in preventing hospitalisation during a BQ.1/BQ.1.1/XBB.1.5-predominant phase in the U.S, supporting its continued use in similar patient populations., Funding: U.S. National Institutes of Health., Competing Interests: NRA reports grants from the US National Institutes of Health (NIH), during the conduct of the study. KCM reports grants from the National Center for Advancing Translational Sciences (NCATS), during the conduct of the study, and grants from the National Institute of Child Health and Human Development (NICHD) and the National Heart, Lung, and Blood Institute (NHLBI), outside of the submitted work. TDB reports grants from the NCATS, during the conduct of the study, and grants from the NICHD and NHLBI, outside of the submitted work. NEC reports grants from the US NIH, during the conduct of the study. AAG reports grants from the US NIH during the conduct of the study, grants from the US Centers for Disease Control, the US Department of Defense, AbbVie, and Faron Pharmaceuticals, and participation on an NIH data safety monitoring board, outside of the submitted work. BJW reports institutional grant support for serving as a investigator for COVID clinical trials sponsored by US Administration for Strategic Preparedness and Response (ASPR) Biomedical Advanced Research and Development Authority (BARDA), NHLBI, Gilead, Regeneron, Abbvie, Roche/Genetech for which he received no direct remuneration, All other authors declare no competing interests., (© 2024 The Author(s).)

A multi-stage option to address food-safety can be produced by a clearer understanding of Campylobacter 's persistence through the broiler production chain, its environmental niche and its interaction with bacteriophages. This study addressed Campylobacter levels, species, genotype, bacteriophage composition/ levels in caeca, litter, soil and carcasses across commercial broiler farming practices to inform on-farm management, including interventions. Broilers were sequentially collected as per company slaughter schedules over two-years from 17 farms, which represented four commercially adopted farming practices, prior to the final bird removal (days 39-53). The practices were conventional full clean-out, conventional litter re-use, free-range-full cleanout and free-range-litter re-use. Caeca, litter and soil collected on-farm, and representative carcases collected at the processing plant, were tested for Campylobacter levels, species dominance and Campylobacter bacteriophages. General community profiling via denaturing gradient gel electrophoresis of the flaA gene was used to establish the population relationships between various farming practices on representative Campylobacter isolates. The farming practice choices did not influence the high caeca Campylobacter levels (log 7.5 to log 8.5 CFU/g), the carcass levels (log 2.5 to log 3.2 CFU/carcass), the C. jejuni / C. coli dominance and the on-farm bacteriophage presence/levels. A principal coordinate analysis of the flaA distribution for farm and litter practices showed strong separation but no obvious farming practice related grouping of Campylobacter . Bacteriophages originated from select farms, were not practice-dependent, and were detected in the environment (litter) only if present in the birds (caeca). This multifaceted study showed no influence of farming practices on on-farm Campylobacter dynamics. The significance of this study means that a unified on-farm risk-management could be adopted irrespective of commercial practice choices to collectively address caeca Campylobacter levels, as well as the potential to include Campylobacter bacteriophage biocontrol. The impact of this study means that there are no constraints in re-using bedding or adopting free-range farming, thus contributing to environmentally sustainable (re-use) and emerging (free-range) broiler farming choices., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (© 2024 the Author(s), licensee AIMS Press.)

Precision medicine initiatives across the globe have led to a revolution of repositories linking large-scale genomic data with electronic health records, enabling genomic analyses across the entire phenome. Many of these initiatives focus solely on research insights, leading to limited direct benefit to patients. We describe the biobank at the Colorado Center for Personalized Medicine (CCPM Biobank) that was jointly developed by the University of Colorado Anschutz Medical Campus and UCHealth to serve as a unique, dual-purpose research and clinical resource accelerating personalized medicine. This living resource currently has more than 200,000 participants with ongoing recruitment. We highlight the clinical, laboratory, regulatory, and HIPAA-compliant informatics infrastructure along with our stakeholder engagement, consent, recontact, and participant engagement strategies. We characterize aspects of genetic and geographic diversity unique to the Rocky Mountain region, the primary catchment area for CCPM Biobank participants. We leverage linked health and demographic information of the CCPM Biobank participant population to demonstrate the utility of the CCPM Biobank to replicate complex trait associations in the first 33,674 genotyped individuals across multiple disease domains. Finally, we describe our current efforts toward return of clinical genetic test results, including high-impact pathogenic variants and pharmacogenetic information, and our broader goals as the CCPM Biobank continues to grow. Bringing clinical and research interests together fosters unique clinical and translational questions that can be addressed from the large EHR-linked CCPM Biobank resource within a HIPAA- and CLIA-certified environment., Competing Interests: Declaration of interests K.C.B. owns stock in Tempus and Galatea Bio and is an employee of Oxford Nanopore Technologies. C.R.G. owns stock in 23andMe, Inc., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Trading partners often require phytosanitary or quarantine treatments for fresh horticultural produce to ensure no economically important pest species are moved with the imported product. When developing such treatments, it is essential that the level of treatment efficacy can be determined. This is often based on the mortality of the total number of target pests exposed to treatment, but in naturally infested products this number is not always known. In such cases, the infestation rate and subsequently an estimate of the number of pests are obtained directly from a set of untreated control samples of the host product. The International Plant Protection Convention (IPPC) Secretariat has provided 2 formulas for these situations that place an interval around the point estimate obtained from the control samples to obtain an estimate of the infestation rate. However, these formulas do not allow a confidence level to be assigned to the estimate, and there are concerns with the assumptions regarding the distribution and the measure of variability used in the formulas. In this article, we propose 2 alternative formulas. We propose that the lower one-sided confidence limit should be applied to all infestation datasets that are approximately normally distributed. As infestation data are sometimes skewed, it is proposed the lower one-sided modified Cox confidence limit is applied to data approximately log-normal distributed. These well-recognized formulas are compared to the formulas recommended by the IPPC and applied to 3 datasets involving natural infestation., (© The Author(s) 2023. Published by Oxford University Press on behalf of Entomological Society of America.)

Objectives: Bebtelovimab is an anti-SARS-CoV-2 monoclonal antibody active against Omicron lineage variants authorized to treat high-risk outpatients with COVID-19. We sought to determine the real-world effectiveness of bebtelovimab during the Omicron phases BA.2/BA2.12.1/BA4/BA5., Methods: We conducted a retrospective cohort study of adults with SARS-CoV-2 infection between April 6 and October 11, 2022, using health records linked to vaccine and mortality data. We used propensity scores to match of bebtelovimab-treated with untreated outpatients. The primary outcome was 28-day all-cause hospitalization. The secondary outcomes were 28-day COVID-19-related hospitalization, 28-day all-cause mortality, 28-day emergency department visits, maximum respiratory support level, intensive care unit admission, and in-hospital mortality among hospitalized patients. We used logistic regression to determine bebtelovimab treatment effectiveness., Results: Among 22,720 patients with SARS-COV-2 infection, 3739 bebtelovimab-treated patients were matched to 5423 untreated patients. Compared with no treatment, bebtelovimab was associated with lower odds of 28-day all-cause hospitalization (1.3% vs 2.1%, adjusted odds ratio: 0.53; 95% confidence interval: 0.37-0.74, P <0.001), as well as COVID-19-related hospitalization (1.0% vs 2.0%, adjusted odds ratio: 0.44 [95% confidence interval: 0.30-0.64], P <0.001). Bebtelovimab appeared to be more beneficial in lowering the odds of hospitalization among patients with two or more comorbidities (interaction P = 0.03)., Conclusion: During the Omicron BA.2/BA.2.12.1/BA.4/BA.5 variant phase, bebtelovimab was associated with lower hospitalization., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Nirmatrelvir is a protease inhibitor with in-vitro activity against SARS-CoV-2, and ritonavir-boosted nirmatrelvir can reduce the risk of progression to severe COVID-19 among individuals at high risk infected with delta and early omicron variants. However, less is known about the effectiveness of nirmatrelvir-ritonavir during more recent BA.2, BA2.12.1, BA.4, and BA.5 omicron variant surges. We used our real-world data platform to evaluate the effect of nirmatrelvir-ritonavir treatment on 28-day hospitalisation, mortality, and emergency department visits among outpatients with early symptomatic COVID-19 during a SARS-CoV-2 omicron (BA.2, BA2.12.1, BA.4, and BA.5) predominant period in Colorado, USA., Methods: We did a propensity-matched, retrospective, observational cohort study of non-hospitalised adult patients infected with SARS-CoV-2 between March 26 and Aug 25, 2022, using records from a statewide health system in Colorado. We obtained data from the electronic health records of University of Colorado Health, the largest health system in Colorado, with 13 hospitals and 141 000 annual hospital admissions, and with numerous ambulatory sites and affiliated pharmacies around the state. Included patients had a positive SARS-CoV-2 test or nirmatrelvir-ritonavir medication order. Exclusion criteria were an order for or administration of other SARS-CoV-2 treatments within 10 days of a positive SARS-CoV-2 test, hospitalisation at the time of positive SARS-CoV-2 test, and positive SARS-CoV-2 test more than 10 days before a nirmatrelvir-ritonavir order. We propensity score matched patients treated with nirmatrelvir-ritonavir with untreated patients. The primary outcome was 28-day all-cause hospitalisation., Findings: Among 28 167 patients infected with SARS-CoV-2 between March 26 and Aug 25, 2022, 21 493 met the study inclusion criteria. 9881 patients received treatment with nirmatrelvir-ritonavir and 11 612 were untreated. Nirmatrelvir-ritonavir treatment was associated with reduced 28-day all-cause hospitalisation compared with no antiviral treatment (61 [0·9%] of 7168 patients vs 135 [1·4%] of 9361 patients, adjusted odds ratio (OR) 0·45 [95% CI 0·33-0·62]; p<0·0001). Nirmatrelvir-ritonavir treatment was also associated with reduced 28-day all-cause mortality (two [<0·1%] of 7168 patients vs 15 [0·2%] of 9361 patients; adjusted OR 0·15 [95% CI 0·03-0·50]; p=0·0010). Using subsequent emergency department visits as a surrogate for clinically significant relapse, we observed a decrease after nirmatrelvir-ritonavir treatment (283 [3·9%] of 7168 patients vs 437 [4·7%] of 9361 patients; adjusted OR 0·74 [95% CI 0·63-0·87]; p=0·0002)., Interpretation: Real-world evidence reported during a BA.2, BA2.12.1, BA.4, and BA.5 omicron surge showed an association between nirmatrelvir-ritonavir treatment and reduced 28-day all-cause hospitalisation, all-cause mortality, and visits to the emergency department. With results that are among the first to suggest effectiveness of nirmatrelvir-ritonavir for non-hospitalised patients during an omicron period inclusive of BA.4 and BA.5 subvariants, these data support nirmatrelvir-ritonavir as an ongoing first-line treatment for adults acutely infected with SARS-CoV-2., Funding: US National Institutes of Health., Competing Interests: Declaration of interests NRA reports grants from the US National Institutes of Health (NIH), during the conduct of the study. KCM reports grants from the National Center for Advancing Translational Sciences (NCATS), during the conduct of the study, and grants from the National Institute of Child Health and Human Development (NICHD) and the National Heart, Lung, and Blood Institute (NHLBI), outside of the submitted work. TDB reports grants from the NCATS, during the conduct of the study, and grants from the NICHD and NHLBI, outside of the submitted work. NEC reports grants from the US NIH, during the conduct of the study. AAG reports grants from the US NIH during the conduct of the study, grants from the US Centers for Disease Control, the US Department of Defense, AbbVie, and Faron Pharmaceuticals, and participation on an NIH data safety monitoring board, outside of the submitted work. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Neutralizing monoclonal antibodies (mAbs) were authorized for the treatment of COVID-19 outpatients based on clinical trials completed early in the pandemic, which were underpowered for mortality and subgroup analyses. Real-world data studies are promising for further assessing rapidly deployed therapeutics., Research Question: Did mAb treatment prevent progression to severe disease and death across pandemic phases and based on risk factors, including prior vaccination status?, Study Design and Methods: This observational cohort study included nonhospitalized adult patients with SARS-CoV-2 infection from November 2020 to October 2021 using electronic health records from a statewide health system plus state-level vaccine and mortality data. Using propensity matching, we selected approximately 2.5 patients not receiving mAbs for each patient who received mAb treatment under emergency use authorization. The primary outcome was 28-day hospitalization; secondary outcomes included mortality and hospitalization severity., Results: Of 36,077 patients with SARS-CoV-2 infection, 2,675 receiving mAbs were matched to 6,677 patients not receiving mAbs. Compared with mAb-untreated patients, mAb-treated patients had lower all-cause hospitalization (4.0% vs 7.7%; adjusted OR, 0.48; 95% CI, 0.38-0.60) and all-cause mortality (0.1% vs 0.9%; adjusted OR, 0.11; 95% CI, 0.03-0.29) to day 28; differences persisted to day 90. Among hospitalized patients, mAb-treated patients had shorter hospital length of stay (5.8 vs 8.5 days) and lower risk of mechanical ventilation (4.6% vs 16.6%). Results were similar for preventing hospitalizations during the Delta variant phase (adjusted OR, 0.35; 95% CI, 0.25-0.50) and across subgroups. Number-needed-to-treat (NNT) to prevent hospitalization was lower for subgroups with higher baseline risk of hospitalization; for example, multiple comorbidities (NNT = 17) and not fully vaccinated (NNT = 24) vs no comorbidities (NNT = 88) and fully vaccinated (NNT = 81)., Interpretation: Real-world data revealed a strong association between receipt of mAbs and reduced hospitalization and deaths among COVID-19 outpatients across pandemic phases. Real-world data studies should be used to guide practice and policy decisions, including allocation of scarce resources., (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objectives: Sotrovimab effectively prevented progression to severe disease and mortality following infection with pre-Omicron SARS-CoV-2 variants. We sought to determine whether sotrovimab is similarly effective against SARS-CoV-2 Omicron variant infection., Methods: Observational cohort study of non-hospitalized adult patients with SARS-CoV-2 infection from December 26, 2021, to March 10, 2022, using electronic health records from a statewide health system. We propensity-matched patients not receiving authorized treatment for each patient treated with sotrovimab. The primary outcome was 28-day hospitalization; secondary outcomes included mortality. We also propensity-matched sotrovimab-treated patients from the Omicron and Delta phases. Logistic regression was used to determine sotrovimab effectiveness during Omicron and between variant phases., Results: Of 30,247 SARS-CoV-2 Omicron variant infected outpatients, we matched 1542 receiving sotrovimab to 3663 not receiving treatment. Sotrovimab treatment was not associated with reduced odds of 28-day hospitalization (2.5% vs 3.2%; adjusted odds ratio [OR] 0.82, 95% CI 0.55, 1.19) or mortality (0.1% vs 0.2%; adjusted OR 0.62, 95% CI 0.07, 2.78). Between phases, the observed treatment OR was higher during Omicron than during Delta (OR 0.85 vs 0.39, respectively; interaction P-value = 0.053)., Conclusion: Real-world evidence demonstrated that sotrovimab was not associated with reduced 28-day hospitalization or mortality among COVID-19 outpatients during the Omicron BA.1 phase., Competing Interests: Declaration of competing interest The authors do not have a commercial or other association that might pose a conflict of interest (e.g., pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding)., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Over 6.37 million people have died from COVID-19 worldwide, but factors influencing COVID-19-related mortality remain understudied. We aimed to describe and identify risk factors for COVID-19 mortality in the Colorado Center for Personalized Medicine (CCPM) Biobank using integrated data sources, including Electronic Health Records (EHRs). We calculated cause-specific mortality and case-fatality rates for COVID-19 and common pre-existing health conditions defined by diagnostic phecodes and encounters in EHRs. We performed multivariable logistic regression analyses of the association between each pre-existing condition and COVID-19 mortality. Of the 155,859 Biobank participants enrolled as of July 2022, 20,797 had been diagnosed with COVID-19. Of 5334 Biobank participants who had died, 190 were attributed to COVID-19. The case-fatality rate was 0.91% and the COVID-19 mortality rate was 122 per 100,000 persons. The odds of dying from COVID-19 were significantly increased among older men, and those with 14 of the 61 pre-existing conditions tested, including hypertensive chronic kidney disease (OR: 10.14, 95% CI: 5.48, 19.16) and type 2 diabetes with renal manifestations (OR: 5.59, 95% CI: 3.42, 8.97). Male patients who are older and have pre-existing kidney diseases may be at higher risk for death from COVID-19 and may require special care.

Background: It is not known whether sotrovimab, a neutralizing monoclonal antibody (mAb) treatment authorized for early symptomatic coronavirus disease 2019 (COVID-19) patients, is also effective in preventing the progression of severe disease and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection., Methods: In an observational cohort study of nonhospitalized adult patients with SARS-CoV-2 infection, 1 October 2021-11 December 2021, using electronic health records from a statewide health system plus state-level vaccine and mortality data, we used propensity matching to select 3 patients not receiving mAbs for each patient who received outpatient sotrovimab treatment. The primary outcome was 28-day hospitalization; secondary outcomes included mortality and severity of hospitalization., Results: Of 10 036 patients with SARS-CoV-2 infection, 522 receiving sotrovimab were matched to 1563 not receiving mAbs. Compared to mAb-untreated patients, sotrovimab treatment was associated with a 63% decrease in the odds of all-cause hospitalization (raw rate 2.1% vs 5.7%; adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], .19-.66) and an 89% decrease in the odds of all-cause 28-day mortality (raw rate 0% vs 1.0%; aOR, 0.11; 95% CI, .0-.79), and may reduce respiratory disease severity among those hospitalized., Conclusions: Real-world evidence demonstrated sotrovimab effectiveness in reducing hospitalization and all-cause 28-day mortality among COVID-19 outpatients during the Delta variant phase., Competing Interests: Potential conflicts of interest . All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Neutralizing monoclonal antibodies (mAbs) are highly effective in reducing hospitalization and mortality among early symptomatic COVID-19 patients in clinical trials and real-world data. While resistance to some mAbs has since emerged among new variants, characteristics associated with treatment failure of mAbs remain unknown., Methods: This multicenter, observational cohort study included patients with COVID-19 who received mAb treatment between November 20, 2020, and December 9, 2021. We utilized electronic health records from a statewide health system plus state-level vaccine and mortality data. The primary outcome was mAb treatment failure, defined as hospitalization or death within 28 days of a positive SARS-CoV-2 test., Results: COVID-19 mAb was administered to 7406 patients. Hospitalization within 28 days of positive SARS-CoV-2 test occurred in 258 (3.5%) of all patients who received mAb treatment. Ten patients (0.1%) died within 28 days, and all but one were hospitalized prior to death. Characteristics associated with treatment failure included having two or more comorbidities excluding obesity and immunocompromised status (adjusted odds ratio [OR] 3.71, 95% confidence interval [CI] 2.52-5.56), lack of SARS-CoV-2 vaccination (OR 2.73, 95% CI 2.01-3.77), non-Hispanic black race/ethnicity (OR 2.21, 95% CI 1.20-3.82), obesity (OR 1.79, 95% CI 1.36-2.34), one comorbidity (OR 1.68, 95% CI 1.11-2.57), age ≥ 65 years (OR 1.62, 95% CI 1.13-2.35), and male sex (OR 1.56, 95% CI 1.21-2.02). Immunocompromised status (none, mild, or moderate/severe), pandemic phase, and type of mAb received were not associated with treatment failure (all p > 0.05)., Conclusions: Comorbidities, lack of prior SARS-CoV-2 vaccination, non-Hispanic black race/ethnicity, obesity, age ≥ 65 years, and male sex are associated with treatment failure of mAbs., (© 2022. The Author(s).)

Objectives: Manual record review is a crucial step for electronic health record (EHR)-based research, but it has poor workflows and is error prone. We sought to build a tool that provides a unified environment for data review and chart abstraction data entry., Materials and Methods: ReviewR is an open-source R Shiny application that can be deployed on a single machine or made available to multiple users. It supports multiple data models and database systems, and integrates with the REDCap API for storing abstraction results., Results: We describe 2 real-world uses and extensions of ReviewR. Since its release in April 2021 as a package on CRAN it has been downloaded 2204 times., Discussion and Conclusion: ReviewR provides an easily accessible review interface for clinical data warehouses. Its modular, extensible, and open source nature afford future expansion by other researchers., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys., Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources., Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a "confirmed case" of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses., Results: Of the 25,063 (13.9%) survey respondents, 10,661 (42.5%) had been tested for COVID-19, and of those, 1366 (12.8%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6%) and family life (n=12,233, 48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic., Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic., (©Randi K Johnson, Katie M Marker, David Mayer, Jonathan Shortt, David Kao, Kathleen C Barnes, Jan T Lowery, Christopher R Gignoux. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 13.06.2022.)

Background: Nitrous oxide (N2O) has been used nationally as an analgesic in many clinical settings. While neuraxial analgesia is still the most commonly used labor analgesic in the United States, there is increasing use of N2O in labor. Given the reduction in the partial pressure of gases at a higher altitude, N2O has been reported to have reduced analgesic properties. However, there is no study to date evaluating the impact of altitude on labor analgesia and N2O., Methods: We conducted a multicenter retrospective data analysis of a N2O registry collected from 4 institutions over a 3-year period. We compared the impact of altitude on 50% N2O administration for labor analgesia, conversion rates to another analgesic modality, as well as collected side effect frequencies and conversion predictors. Multivariable regression models were used to compare clinical characteristics and outcomes between parturients at high and low altitudes, while adjusting for race, ethnicity, education, and age (logistic and linear regressions for categorical and quantitative outcomes, respectively)., Results: A total of 1856 laboring parturients (age 18-50) were included in the analysis. The odds of converting from 50% N2O to another analgesic modality had no statistically significant difference between high- versus low-altitude institutions (adjusted odds ratio [aOR], 1.13; 95% confidence interval [CI], 0.90-1.42; P = .3). Yet, when parturients at low altitude converted from N2O, they were more likely (aOR, 3.03; 95% CI, 1.59-5.88) to choose neuraxial analgesia instead of another analgesic modality when compared to high-altitude parturients. This is possibly due to higher epidural rates at the low-altitude institutions. When parturients at high altitude did convert into another modality, they were more likely (aOR, 2.19; 95% CI, 1.14-4.21) to convert due to inadequate pain relief compared to low-altitude parturients; however, missing data may have affected this finding. Laboring individuals at low altitude were significantly more likely to experience side effects (aOR, 2.13; 95% CI, 1.45-3.12). Those requiring labor augmentation, assisted vaginal, or cesarean delivery converted to neuraxial analgesia significantly more often than those that delivered via spontaneous vaginal delivery (P < .05) in both high- and low-altitude groups., Conclusions: This is the first study evaluating 50% N2O as a labor analgesic at high altitude. As expected, we found lower side effects at high altitude, likely due to the lower partial pressure of N2O. However, there was not a statistically significant increase in conversion from N2O to another analgesic modality at high altitude and no clinically significant differences in neonatal outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 International Anesthesia Research Society.)

Benzene-1,3,5-tri(dithiocarboxylate) (BTDTC 3- ), the sulfur-donor analogue of trimesate (BTC 3- , benzene-1,3,5-tricarboxylate), is introduced, and its potential as a multidentate, electronically bridging ligand in coordination chemistry is evaluated. For this, the sodium salt Na 3 BTDTC has been synthesized, characterized, and compared with the sodium salt of the related ditopic benzene-1,4-di(dithiocarboxylate) (Na 2 BDDTC). Single-crystal X-ray diffraction of the respective tetrahydrofuran (THF) solvates reveals that such multitopic aromatic dithiocarboxylate linkers can form both discrete metal complexes (Na 3 BTDTC·9THF) and (two-dimensional) coordination polymers (Na 2 BDDTC·4THF). Additionally, the versatile coordination behavior of the novel BTDTC 3- ligand is demonstrated by successful synthesis and characterization of trinuclear Cu(I) and hexanuclear Mo(II) 2 paddlewheel complexes. The electronic structure and molecular orbitals of both dithiocarboxylate ligands as well as their carboxylate counterparts are investigated by density functional theory computational methods. Electrochemical investigations suggest that BTDTC 3- enables electronic communication between the coordinated metal ions, rendering it a promising tritopic linker for functional coordination polymers.

A new solvatomorph of [Au 3 (1-Methylimidazolate) 3 ] (Au 3 (MeIm) 3 )-the simplest congener of imidazolate-based Au(I) cyclic trinuclear complexes (CTCs)-has been identified and structurally characterized. Single-crystal X-ray diffraction revealed a dichloromethane solvate exhibiting remarkably short intermolecular Au⋯Au distances (3.2190(7) Å). This goes along with a dimer formation in the solid state, which is not observed in a previously reported solvent-free crystal structure. Hirshfeld analysis, in combination with density functional theory (DFT) calculations, indicates that the dimerization is generally driven by attractive aurophilic interactions, which are commonly associated with the luminescence properties of CTCs. Since Au 3 (MeIm) 3 has previously been reported to be emissive in the solid-state, we conducted a thorough photophysical study combined with phase analysis by means of powder X-ray diffraction (PXRD), to correctly attribute the photophysically active phase of the bulk material. Interestingly, all investigated powder samples accessed via different preparation methods can be assigned to the pristine solvent-free crystal structure, showing no aurophilic interactions. Finally, the observed strong thermochromism of the solid-state material was investigated by means of variable-temperature PXRD, ruling out a significant phase transition being responsible for the drastic change of the emission properties (hypsochromic shift from 710 nm to 510 nm) when lowering the temperature down to 77 K.

One of the challenges of teaching applied data science courses is managing individual students' local computing environment. This is especially challenging when teaching massively open online courses (MOOCs) where students come from across the globe and have a variety of access to and types of computing systems. There are additional challenges with using sensitive health information for clinical data science education. Here we describe the development and performance of a computing platform developed to support a series of MOOCs in clinical data science. This platform was designed to restrict and log all access to health datasets while also being scalable, accessible, secure, privacy preserving, and easy to access. Over the 19 months the platform has been live it has supported the computation of more than 2300 students from 101 countries., (©2021 AMIA - All rights reserved.)

The precious group metal (PGM) analogues of the iconic metal-organic framework [Cu3(BTC)2] (HKUST-1; BTC = 1,3,5 benzenetricarboxylate) still represent a synthetic challenge, especially if targeting the univalent and ideally defect-free RuII,II variant. Herein we present a systematic study employing the controlled secondary building unit approach (CSA) by using a variety of diruthenium tetracarboxylate complexes [Ru2(RCO2)4] as precursors in the synthesis of univalent Ru-HKUST-1 samples. Carboxylate ligand exchange test reactions suggest the importance of a pKa match between precursor ligand and BTC linker. For example, l-mandelate substituted precursors resulted in the most "perfect" samples of the investigated series with a fourfold increase in crystalline domain sizes compared to the established acetate route (according to PXRD and HR-TEM), high compositional purity (FT-IR, Raman, TGA and elemental analysis) and feature a so far unprecedentedly high BET surface area of 1789 m2 g-1 with the expected pore size distribution and total pore volume all similar to the ideal HKUST-1 parent structure.

Background: The 10th revision of International Classification of Disease, Clinical Modification (ICD10-CM) increased the number of codes to identify non-traumatic subarachnoid hemorrhage from 1 to 22. ICD10-CM codes are able to specify the location of aneurysms causing subarachnoid hemorrhage (aSAH); however, it is not clear how frequently or accurately these codes are being used in practice., Objective: To systematically evaluate the usage and accuracy of location-specific ICD10-CM codes for aSAH., Methods: We extracted all uses of ICD10-CM codes for non-traumatic subarachnoid hemorrhage (I60.x) during the first 3 years following the implementation of ICD10-CM from the billing module of the electronic health record (EHR) for UCHealth. For those codes that specified aSAH location (I60.0-I60.6), EHR documentation was reviewed to determine whether there was an active aSAH, any patient history of aSAH, or unruptured intracranial aneurysm/s and the locations of those outcomes., Results: Between 1 October 2015 and 30 September 2018, there were 3119 instances of non-traumatic subarachnoid hemorrhage ICD10-CM codes (I60.00-I60.9), of which 297 (9.5%) code instances identified aSAH location (I60.0-I60.6). The usage of location-specific codes increased from 5.7% in 2015 to 11.2% in 2018. These codes accurately identified current aSAH (64%), any patient history of aSAH (84%), and any patient history of intracranial aneurysm (87%). The accuracy of identified outcome location was 53% in current aSAH, 72% for any history of aSAH, and 76% for any history of an intracranial aneurysm., Conclusions: Researchers should use ICD10-CM codes with caution when attempting to detect active aSAH and/or aneurysm location., Competing Interests: None., (© 2021 The Authors. Learning Health Systems published by Wiley Periodicals LLC on behalf of the University of Michigan.)

The lesser grain borer, Rhyzopertha dominica , and the rust red flour beetle, Tribolium castaneum , are two major beetle pests commonly found infesting stored products worldwide. Both species can cause severe economic damage and their management is complicated by their potential to develop resistance to several of the limited chemical options available. However, pest management strategies can be improved by understanding the ecology of the pest insect. To determine the spatiotemporal activity of R. dominica and T. castaneum, we conducted a trapping study over two years in a temperate region of south-eastern Australia, with traps located near grain storages and fields. We captured higher numbers of R. dominica than T. castaneum , and both species were more prevalent in traps located close to grain storages. Similar and consistent seasonal patterns were displayed by both species with activity ceasing during the winter (June-August) months. We found linear correlations between maximum daily temperatures and trap catches, and minimum threshold temperatures for flight activity were 14.5 °C and 15.6 °C for R. dominica and T. castaneum , respectively. The results are discussed in relation to the ecology of these pests along with their implications for pest management.

Background: There is a high incidence of preventable error in health care. Many of these errors are the result of poor teamwork between different health professionals and not listening to the patient voice. We describe changes in attitudes to patient safety from potential future health care leaders who participated in an interactive programme focusing on these attributes., Methods: A total of 87 scholars from medicine, nursing and pharmacy participated in an annual 4-day intensive programme, repeated over 3 years. Their attitudes about patient safety were measured before and after the programme using the Attitudes to Patients Safety Questionnaire (APSQ3) and qualitative data about their experiences during the course. Data were analysed using descriptive statistics and qualitative measures., Results: The majority showed shifts in attitudes, particularly about the value of teamwork, patients being more involved in their own care, the importance of learning about patient safety and the value of self-care as ways of reducing error. Qualitative data showed that the course was valuable in networking with like-minded people, having faculty members on site with a flattened hierarchy and being encouraged to promote change in their own workplaces., Discussion: We showed that an interprofessional immersive course can change the thinking of young clinicians in a way that may be able contribute to improved health care., (© 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

The male fruit fly attractants, cue-lure (CL) and raspberry ketone (RK), are important in pest management. These volatile phenylbutanoids occur in daciniphilous Bulbophyllum Thouar (Orchidaceae: Asparagales) orchids, along with zingerone (ZN) and anisyl acetone (AA). While these four compounds attract a similar range of species, their relative attractiveness to multiple species is unknown. We field tested these compounds in two fruit fly speciose locations in north Queensland, Australia (Lockhart and Cairns) for 8 wk. Of 16 species trapped in significant numbers, 14 were trapped with CL and RK, all in significantly greater numbers with CL traps than RK traps (at least in higher population locations). This included the pest species Bactrocera tryoni (Froggatt) (Diptera: Tephritidae) (CL catches ca. 5× > RK), Bactrocera neohumeralis (Hardy) (Diptera: Tephritidae) and Bactrocera bryoniae (Tryon) (Diptera: Tephritidae) (CL catches ca. 3× > RK), and Bactrocera frauenfeldi (Schiner) (Diptera: Tephritidae) (in Cairns-CL catches ca. 1.6× > RK). Seven species were trapped with AA, and all were also caught in CL and RK traps in significantly greater numbers, with the exception of B. frauenfeldi. For this species, catches were not statistically different with CL, RK, and AA in Lockhart, and RK and AA in Cairns. Seven species were trapped with ZN, two at this lure only, and the remainder also with CL or RK but in significantly greater numbers. This is the first quantitative comparison of the relative attractiveness of CL, RK, AA, and ZN against multiple species, and supports the long-held but untested assumption that CL is broadly more attractive lure than RK., (© The Author(s) 2020. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The effects of lucerne ( Medicago sativa ) post-grazing residual pasture height on pasture utilisation (vertical and horizontal), pasture intake and animal production were investigated in a sub-tropical partial mixed ration dairy system. The study took place at the Gatton Research Dairy, Southeast Queensland (-27.552, 152.333), with a 26-day adaptation period followed by two 8-day measurement periods during August and September 2018. A quantity of 30 multiparous Holstein-Friesian dairy cows were offered two levels of mixed ration, 7 and 14 kg dry matter (DM)/cow/day for low and high levels respectively, and five levels of pasture allocation, to achieve decreasing residual pasture heights. Pasture allocations measured from 5 cm above ground level for the low mixed ration groups averaged 12.7, 15.9, 19.8, 35.3 and 49.2 kg DM/cow/day, and for the high mixed ration groups averaged 5.0, 8.3, 10.3, 18.6, and 25.2 kg DM/cow/day, respectively. As pasture allocation decreased, cows were forced to graze further down into the pasture sward, and therefore residual pasture height declined. Total intake (kg DM/cow/day) declined as residual pasture height (expressed as % of the initial height) declined, irrespective of mixed ration level, decreasing by 0.5 kg DM/cow/day for every 10% decrease in residual pasture height. Low total intakes were associated with high non-esterified fatty acid (NEFA) levels in plasma, indicating mobilisation of fat tissue to maintain milk production. In the high allocation treatments, an area of pasture remained ungrazed and cows were only grazing the top leafy stratum where pasture intake rate and intake were highest. Therefore, to maximise intake in sub-tropical partial mixed ration (PMR) systems, lucerne pasture should be allocated so that cows are always grazing the top leafy stratum. This can be achieved by ensuring the pasture around faecal patches remains ungrazed., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

The effect of lucerne ( Medicago sativa L . ) pre-grazing pasture height on pasture intake and milk production was investigated in a sub-tropical partial mixed ration (PMR) dairy system in south-east Queensland, Australia. The experiment involved a 26-day adaptation period followed by an eight-day measurement period during April and May 2018. Twenty-four multiparous Holstein-Friesian dairy cows were offered a mixed ration at either 7 (low) or 14 (high) kg dry matter (DM)/cow/day and allocated pastures at pre-grazing heights ranging from 23 to 39 cm. The targeted pasture intake was 14 and 7 kg DM/cow/day for cows offered the low and high mixed ration allowances respectively, with a total intake target of 21 kg DM/cow/day. Pasture structure did not limit pasture intake as the all groups left at least 12% of the allocated area ungrazed, and therefore could selectively graze pasture. There was no significant difference in intake between mixed ration levels, however intake had a positive linear relationship with pre-grazing pasture height. For every one cm increase in pasture height, intake increased by 0.3 kg DM/cow/day. Using a grazing strategy that ensures the some pasture remains ungrazed and the pre-grazing height of lucerne is approximately 39 cm above ground level will maximise pasture intake in sub-tropical PMR dairy systems., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Introduction: Women desire safe and effective choices for pain management during labor. Currently, neuraxial and opioid analgesia are the most common methods used in the United States. The purpose of this study was to investigate demographic characteristics, safety, and satisfaction in a cohort of parturients who used inhaled nitrous oxide (N 2 O) analgesia and to determine predictors of conversion from N 2 O to neuraxial analgesia., Methods: This was a prospective chart review study. Individuals aged at least 18 years who used inhaled N 2 O during the first or second stage of labor between March 1, 2016, and July 23, 2017, on the labor and delivery unit of one academic medical center (N = 463) and their neonates were included. Data describing maternal and neonatal factors are reported. Logistic regression and chi-square tests were used to model the effects of oxytocin augmentation, labor induction, parity, prior cesarean birth, pre-N 2 O cervical dilatation, and post-N 2 O cervical dilatation on the odds of conversion from N 2 O to neuraxial analgesia., Results: In this cohort, 31% who chose N 2 O for analgesia did not convert to any other analgesic method. Significant positive predictors for conversion from N 2 O to neuraxial analgesia included labor induction (odds ratio [OR], 2.9; 95% CI, 1.7-5.0), oxytocin augmentation (OR, 3.1; 95% CI, 1.6-6.0), and labor after cesarean (OR, 6.4; 95% CI, 2.5-16.5). Multiparity (OR, 0.4; 95% CI, 0.2-0.6) and post-N 2 O cervical dilatation (OR, 0.8; 95% CI, 0.7-0.9) were negative predictors. Adverse effects related to N 2 O use during labor were rare (8%) and were not a significant reason for conversion to neuraxial analgesia. Parturients had moderately high satisfaction with N 2 O for pain management (11-point scale, mean [SD], 7.4 [2.9]). Five-minute Apgar scores were 7 or greater in 97.8% of the newborns., Discussion: Understanding predictors of conversion from inhaled N 2 O to neuraxial analgesia may assist perinatal care providers in their discussions with women about analgesia options during labor. N 2 O is a useful, safe option for labor analgesia in the United States., (© 2020 by the American College of Nurse-Midwives.)

This study describes the development and use of bacteriophage cocktails to control Campylobacter in broiler chickens, in a commercial setting, in Queensland Australia, following the birds from farm to the processing plant. The components of the bacteriophage cocktails were selected to be effective against the maximum number of Campylobacter jejuni and Campylobacter coli isolates encountered on SE Queensland farms. Farms were identified that had suitable Campylobacter target populations and phage were undetectable 1 week prior to the intended treatment. Cocktails of phages were administered at 47 days of age. Groups of study birds were slaughtered the following day, on-farm, at the end of flock transport to the plant, and at processing (approximately 28 h post-treatment). On Farm A, the phage treatment significantly reduced Campylobacter levels in the ceca at the farm in the range of 1-3 log 10 CFU/g ( p = 0.007), compared to mock treated controls. However, individual birds sampled on farm (1/10) or following transport (2/10) exhibited high cecal Campylobacter counts with low phage titers, suggesting that treatment periods > 24 h may be required to ensure phage replication for effective biocontrol in vivo . At the time of the trial the control birds in Farm B were phage positive despite having been negative one week earlier. There was no significant difference in the cecal Campylobacter counts between the treatment and control groups following treatment but a fall of 1.7 log 10 CFU/g was observed from that determined from birds collected the previous week ( p = 0.0004). Campylobacter isolates from both farms retained sensitivity to the treatment phages. These trials demonstrated bacteriophages sourced from Queensland farms have the potential to reduce intestinal Campylobacter levels in market ready broiler chickens., (Copyright © 2020 The State of Queensland (through the Department Agriculture and Fisheries).)

Background: Effective patient- and family-centered care requires a dedication to engaging patients and family members in health system redesign to improve the quality, safety, and experience of care. Provided here are lessons learned six years after establishing an infrastructure of patient and family advisory councils (PFACs) focused on improving health care quality and safety., Context: A large regional health care system with multiple hospitals and ambulatory care delivery sites in the eastern United States adopted a systemwide approach to Patient and Family Advisory Councils on Quality and Safety (PFACQS Ⓡ ) in 2012., Approach: This conceptual article describes the barriers and facilitators of adopting, implementing, and sustaining the PFACQS model across a large, geographically diffuse health system. Successful strategies that emerged include active board engagement, co-creation and mentorship by experienced patient advocates to support enhanced engagement by local PFACQS community members, and clear alignment with and line of sight on organizational quality and safety goals., Conclusion: Implementing a robust network of PFACQS focused on improving quality and patient safety requires leadership commitment to transparency, as well as mutual respect and trust. Establishing clear guidelines, structures, and processes supports early adoption. Openness to continuous improvement and adaptations are important to program success and contribute to program sustainability., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

We examine the effectiveness of economic and moral language used by employees when selling social issues to management. In contrast to prior work finding that employees believe it is best to use economic language to influence management to address social issues, we draw on the issue selling, persuasion, and behavioral ethics literatures to demonstrate that moral language is actually most influential-especially when the language is framed to align with the organization's values and/or mission. The results from a combination of 3 field survey studies and 1 experimental vignette study provide support for this hypothesis. In addition, we find support for obligation (i.e., manager's anticipated guilt), rather than inspiration (i.e., manager's prosocial motivation), as a mediator of this interactive effect. We discuss implications for literatures on issue selling, persuasion, and behavioral ethics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Coordination polymers show great potential for the tailored design of advanced photonic applications by employing crystal chemistry concepts. One challenge for achieving a rational design of nonlinear optically active MOF materials is deriving fundamental structure-property relations of the interplay between the photonic properties and the spatial arrangements of optically active chromophores within the network. We here investigate two-photon-absorption (TPA)-induced photoluminescence of two new MOFs based on a donor-acceptor tetraphenylphenylenediamine (tPPD) chromophore linker (H 4 TPBD) and Zn(II) and Cd(II) as metal centers. The TPA efficiencies are controlled by the network topologies, degree of interpenetration, packing densities, and the specific spatial arrangement of the chromophores. The effects can be rationalized within the framework of established excited-state theories of molecular crystals. The results presented here demonstrate the key effect of chromophore orientation on the nonlinear optical properties of crystalline network compounds and allow for establishing quantitative design principles for efficient TPA materials.

Deprotonation usually occurs as an unwanted side reaction in the Lewis pair polymerization of Michael acceptors, for which the conjugated addition of the Lewis base to the acid-activated monomer is the commonly accepted initiation mechanism. This has also been reported for B-P-based bridged Lewis pairs (BLPs) that form macrocyclic addition products. We now show that the formerly unwanted deprotonation is the likely initiation pathway in the case of Al-P-based BLPs. In a detailed study of a series of Al-P-based BLPs, using a combination of single-crystal diffraction experiments (X-ray and neutron) and mechanistic investigations (experimental and computational), an active role of the methylene bridge was revealed, acting as a base towards the α-acidic monomers. Additionally, the polymerization studies proved a living behavior combined with significantly high activities, narrow molecular mass distributions, and the possibility of copolymerization., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Bactrocera curvipennis (Froggatt) is a polyphagous pest fruit fly endemic to New Caledonia that is weakly attracted to the male lure cue-lure (CL). Effective male lures are important for the monitoring and management of numerous pest species of Dacinae fruit flies. However, if a species is weakly responsive to these lures its detection and control is difficult. Recently in Oceania and Asia, more attractive male lures (isoeugenol, methyl-isoeugenol, dihydroeugenol, and zingerone) were identified for several weakly CL- and methyl eugenol (ME)-responsive species. To determine if these lures may be more attractive to B. curvipennis, we field tested them in comparison to CL and ME in New Caledonia. Bactrocera curvipennis catch with isoeugenol-baited traps (mean 20.3 ± 3.0) was 15 times greater than with CL (1.3 ± 0.8) and catch with dihydroeugenol (5.7 ± 1.6) was four times greater than with CL. This is the first record of B. curvipennis responding to these lures. It was also the only species that responded to isoeugenol in this study. Bactrocera fulvifacies (Perkins) (Diptera: Tephritidae), a rarely encountered species 'nonresponsive' to male lures, was attracted to zingerone with its trap catch (2,574 flies) approaching that of Bactrocera tryoni (Froggatt) (Diptera: Tephritidae) at CL (2,724 flies). Another nonresponsive species, Dacus aneuvittatus (Drew) (Diptera: Tephritidae), was also trapped by zingerone-baited traps. This is the first record of these species responding to a male lure. The significantly greater response of B. curvipennis to isoeugenol would make it a considerably more effective attractant for use in surveillance and control programs., (© The Author(s) 2019. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The spectacled flying fox ( Pteropus conspicillatus) is listed as vulnerable to extinction in Australia. The species' restricted population is in decline, putatively attributed to decreasing habitat, climatic extremes, anthropogenic activities, and more recently, mass mortality events associated with tick paralysis and neonatal cleft palate syndrome. Knowledge of fundamental physiologic parameters of the species is limited. To address this knowledge gap, we sampled 50 wild-caught adult spectacled flying foxes in June (winter) in Far North Queensland, Australia. Hematologic and plasma biochemistry reference ranges were established, and a suite of urine biochemistry analytes were measured. Analyte values were compared within spectacled flying fox sex cohorts and between the spectacled flying fox and the paraphyletic black flying fox ( Pteropus alecto). Significant differences in multiple analytes (including erythrocyte, leucocyte, plasma, and urine biochemistry) were found between spectacled flying fox sex cohorts. The majority of spectacled flying fox analyte values did not differ significantly from black flying fox values. Of those analytes that differed between species (erythrocyte, platelet, eosinophil, liver enzyme, and triglyceride levels), the majority were plausibly explained by intraerythrocyte parasite burden and food resource type. Our findings provide baseline data essential to measure and meaningfully interpret flying fox population health in ecologic, conservation, and epidemiologic contexts.

Mars is dry today, but numerous precipitation-fed paleo-rivers are found across the planet's surface. These rivers' existence is a challenge to models of planetary climate evolution. We report results indicating that, for a given catchment area, rivers on Mars were wider than rivers on Earth today. We use the scale (width and wavelength) of Mars paleo-rivers as a proxy for past runoff production. Using multiple methods, we infer that intense runoff production of >(3-20) kg/m 2 per day persisted until <3 billion years (Ga) ago and probably <1 Ga ago, and was globally distributed. Therefore, the intense runoff production inferred from the results of the Mars Science Laboratory rover was not a short-lived or local anomaly. Rather, precipitation-fed runoff production was globally distributed, was intense, and persisted intermittently over >1 Ga. Our improved history of Mars' river runoff places new constraints on the unknown mechanism that caused wet climates on Mars.

There has long been interest in how leaders influence the unethical behavior of those who they lead. However, research in this area has tended to focus on leaders' direct influence over subordinate behavior, such as through role modeling or eliciting positive social exchange. We extend this research by examining how ethical leaders affect how employees construe morally problematic decisions, ultimately influencing their behavior. Across four studies, diverse in methods (lab and field) and national context (the United States and China), we find that ethical leadership decreases employees' propensity to morally disengage, with ultimate effects on employees' unethical decisions and deviant behavior. Further, employee moral identity moderates this mediated effect. However, the form of this moderation is not consistent. In Studies 2 and 4, we find that ethical leaders have the largest positive influence over individuals with a weak moral identity (providing a "saving grace"), whereas in Study 3, we find that ethical leaders have the largest positive influence over individuals with a strong moral identity (catalyzing a "virtuous synergy"). We use these findings to speculate about when ethical leaders might function as a "saving grace" versus a "virtuous synergy." Together, our results suggest that employee misconduct stems from a complex interaction between employees, their leaders, and the context in which this relationship takes place, specifically via leaders' influence over employees' moral cognition. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

We report the first multiscale, systematic field-based testing of correlations between orbital scale advanced spaceborne thermal emission and reflection radiometer visible near-infrared (VNIR)/shortwave infrared (SWIR) reflectance and thermal infrared relative emissivity and outcrop scale Raman spectroscopy, VNIR reflectance, X-ray diffraction (XRD), and laser-induced breakdown spectroscopy (LIBS) mineralogy and chemistry in a saline dry lakebed. This article is one of three reports describing the evolution of salt deposits, meteorological record, and surface and subsurface salt mineralogy in Dalangtan, Qaidam Basin, a hyperarid region of the Tibet Plateau, China, as potential environmental, mineralogical, and biogeochemical analogs to Mars. We have successfully bridged remote sensing data to fine scale mineralogy and chemistry data. We have defined spectral end-members in the northwestern Qaidam Basin and classified areas within the study area on the basis of their spectral similarity to the spectral end-members. Results of VNIR/SWIR classification reveal zonation of spectral units within three large anticlinal domes in the study area that can be correlated between the three structures. Laboratory Raman, VNIR reflectance, XRD, and LIBS data of surface mineral samples collected along a traverse over Xiaoliangshan (XLS) indicate that the surface is dominated by gypsum, Mg sulfates, Na sulfates, halite, and carbonates, with minor concentrations of illite present in most samples as well. Our results can be used as a first step toward better characterizing the potential of orbital reflectance spectroscopy as a method for mineral detection and quantification in salt-rich planetary environments, with the benefit that this technique can be validated on the ground using instruments onboard rovers.

The grey-headed flying fox ( Pteropus poliocephalus) is a species endemic to coastal eastern Australia. This study presents a comprehensive set of biochemistry, hematology, and urinalysis biomarkers from which reference values were derived. Blood samples collected from free-ranging P. poliocephalus were submitted for hematology ( n = 140) and plasma biochemistry ( n = 161) and urine for urinalysis ( n = 95). The values for P. poliocephalus were broadly consistent with those values published for other Australian Pteropus species. Statistically significant within-species age and sex effects were observed: adult P. poliocephalus had higher mean corpuscular volume, mean corpuscular hemoglobin, urea, creatinine, bilirubin, alanine transferase (ALT), protein, globulin, urinary specific gravity, and urinary ketones, whereas subadults had higher mean red blood cell, white blood cell (WBC), lymphocyte, and monocyte counts, and juveniles had higher mean neutrophil count and alkaline phosphatase; male P. poliocephalus had higher mean reticulocyte count, alanine transferase, glucose, and urinary ketones, whereas females had higher mean WBC, lymphocyte, and monocyte counts. The findings inform both clinical and research scenarios for P. poliocephalus in captivity or rehabilitation and for health assessments of free-living populations.

Effective male fruit fly attractants, such as cue lure (CL) and methyl eugenol (ME), are important in the monitoring and management of pest species through lure and kill techniques of trapping and male annihilation. However, some species are only weakly responsive to these lures, making their detection and control difficult. Zeugodacus diversus (Coquillett), a pest of cucurbit flowers in Asia, is weakly attracted to ME. Recently in Australia and Papua New Guinea, the eugenol analogues isoeugenol, methyl-isoeugenol, and dihydroeugenol were found to be effective attractants for species with a weak response to ME and CL, as well as several nonresponsive species. Additionally, studies from the early 1900s indicated that Z. diversus was attracted to isoeugenol. To determine if these eugenol analogues may be more effective attractants for Z. diversus, we field tested them in Bangladesh in comparison to ME, as well as CL and zingerone. Z. diversus was significantly more attracted to all three eugenol analogues than ME, with it most attracted to methyl-isoeugenol. Its attraction to methyl-isoeugenol was 49 times greater than its attraction to ME (respective means 23.58 flies/trap/day (FTD) and 0.48 FTD). Z. diversus was also consistently trapped at methyl-isoeugenol at all trap clearances including when populations were low, whereas it was only trapped at ME at 6 out of the 13 clearances. This study demonstrates that methyl-isoeugenol is a highly attractive lure for Z. diversus and would be a valuable inclusion as an attractant in monitoring and male annihilation programs.

Male fruit fly attractants, cue-lure (CL) and methyl eugenol (ME), are important in the monitoring and control of pest fruit fly species. Species respond to CL or ME but not both, and there are conflicting reports on whether combining CL (or its hydroxy analogue raspberry ketone) and ME decreases their attractiveness to different species. Fruit fly monitoring programs expend significant effort using separate CL and ME traps and avoiding lure cross-contamination, and combining the two lures in one trap would create substantial savings. To determine if combining lures has an inhibitory effect on trap catch, CL and ME wicks placed in the same Steiner trap were field tested in comparison to CL alone and ME alone in Australia and Papua New Guinea (PNG). In Australia, 24 out of 27 species trapped were significantly more attracted to CL or ME alone than the combination ME/CL lure, including the pests Bactrocera bryoniae (Tryon), B. frauenfeldi (Schiner), B. kraussi (Hardy), B. neohumeralis (Hardy), B. tryoni (Froggatt) (CL-responsive), and B. musae (Tryon) (ME-responsive). In PNG, 13 out of 16 species trapped were significantly more attracted to CL or ME alone than the ME/CL combination, including the pests B. bryoniae, B. frauenfeldi, B. neohumeralis, B. trivialis (Drew), Zeugodacus cucurbitae (Coquillett) (CL-responsive) and B. dorsalis (Hendel), B. musae, and B. umbrosa (Fabricius) (ME-responsive). This study shows that combining CL and ME in the one trap in equal parts significantly reduces catches of most species of Dacini fruit flies in Australia and PNG., (© The Author(s) 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Workplace deviance harms the well-being of an organization and its members. Unfortunately, theory and prior research suggest that deviance is associated with job stressors, which are endemic to work organizations and often cannot be easily eliminated. To address this conundrum, we explore actions individuals can take at work that serve as buffering conditions for the positive relationship between job stressors and deviant behavior. Drawing upon conservation of resources theory, we examine a resource-building activity (i.e., learning something new at work) and a demand-shielding activity (i.e., taking time for relaxation at work) as potential boundary conditions. In 2 studies with employee samples using complementary designs, we find support for the buffering role of learning but not for relaxation. When employees learn new things at work, the relationship between hindrance stressors and deviance is weaker; as is the indirect relationship mediated by negative emotions. Taking time for relaxation at work did not show a moderating role in either study. Therefore, although relaxation is a response that individuals might be inclined to turn to for counteracting work stress, our findings suggest that, when it comes to addressing negative emotions and deviance in stressful work environments, building positive resources by learning something new at work could be more useful. In that way, doing more (i.e., learning, and not relaxing) is associated with less (deviance) in the face of job stressors. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)