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Objective: Past research suggests students have differing definitions of sexual assault, violence and intimate partner violence (IPV). To adequately develop violence prevention efforts, it is important to examine how college students understand these terms and associated behaviours. The purpose of this study was to identify which behaviours are categorised as IPV by college women and whether there are any 'grey areas' when it comes to IPV. Design: A three-phase e-Delphi study was conducted with US college women to reach consensus on the behaviours commonly associated with IPV. Setting: The study was conducted in one large, Southeastern USA university. Method: In a first phase of work, participants answered open-ended questions about the behaviours they associated with IPV and related terms. In phase 2, participants categorised the behaviours identified in phase 1. In phase 3, consensus was reached by the 12 women who completed all three phases of work. Results: Women agreed on a list of 45 behaviours that constitute IPV as well as behaviours that fall into a 'grey area', with many of the latter occurring between boyfriends/girlfriends. Conclusion: Findings from the study contribute to the current knowledge base concerning IPV among US college students and their understanding of which behaviours are acceptable by intimate partners and which are not. Future research is needed with a larger more representative sample to extend the current findings. However, interim findings can be used to drive future research and may provide some insight into current student perceptions of IPV.

We conducted surveillance for carbapenem-resistant Enterobacterales (CRE) during 2016-2020 at 10 US sites and extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) during 2019-2020 at 6 US sites. Among 159 CRE cases in children (median age 5 years), CRE was isolated from urine for 131 (82.4%) and blood from 20 (12.6%). Annual CRE incidence rate (cases/100,000 population) was 0.47-0.87. Among 207 ESBLE cases in children (median age 6 years), ESBL-E was isolated from urine of 196 (94.7%) and blood of 8 (3.9%). Annual ESBL-E incidence rate was 26.5 in 2019 and 19.63 in 2020. CRE and ESBL-E rates were >2-fold higher among infants than other age groups. Most CRE and ESBL-E cases were healthcare-associated community-onset (68 [43.0%] for CRE vs. 40 [23.7%] for ESBL-E) or community- associated (43 [27.2%] for CRE vs. 109 [64.5%] for ESBL-E). Programs to detect, prevent, and treat multidrugresistant infections must include pediatric populations (particularly the youngest) and outpatient settings. [ABSTRACT FROM AUTHOR]

Background Because interventions are available to prevent further recurrence in patients with recurrent Clostridioides difficile infection (rCDI), we identified predictors of multiple rCDI (mrCDI) in adults at the time of presentation with initial CDI (iCDI). Methods iCDI was defined as a positive C difficile test in any clinical setting during January 2018–August 2019 in a person aged ≥18 years with no known prior positive test. rCDI was defined as a positive test ≥14 days from the previous positive test within 180 days after iCDI; mrCDI was defined as ≥2 rCDI. We performed multivariable logistic regression analysis. Results Of 18 829 patients with iCDI, 882 (4.7%) had mrCDI; 437 with mrCDI and 7484 without mrCDI had full chart reviews. A higher proportion of patients with mrCDI than without mrCDI were aged ≥65 years (57.2% vs 40.7%; P <.0001) and had healthcare (59.1% vs 46.9%; P <.0001) and antibiotic (77.3% vs 67.3%; P <.0001) exposures in the 12 weeks preceding iCDI. In multivariable analysis, age ≥65 years (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.55–2.35), chronic hemodialysis (aOR, 2.28; 95% CI, 1.48–3.51), hospitalization (aOR, 1.64; 95% CI, 1.33–2.01), and nitrofurantoin use (aOR, 1.95; 95% CI, 1.18–3.23) in the 12 weeks preceding iCDI were associated with mrCDI. Conclusions Patients with iCDI who are older, on hemodialysis, or had recent hospitalization or nitrofurantoin use had increased risk of mrCDI and may benefit from early use of adjunctive therapy to prevent mrCDI. If confirmed, these findings could aid in clinical decision making and interventional study designs. [ABSTRACT FROM AUTHOR]

Background We described changes in 2016─2020 carbapenem-resistant Enterobacterales (CRE) incidence rates in 7 US sites that conduct population-based CRE surveillance. Methods An incident CRE case was defined as the first isolation of Escherichia coli , Klebsiella spp. or Enterobacter spp. resistant to ≥1 carbapenem from a sterile site or urine in a surveillance area resident in a 30-day period. We reviewed medical records and classified cases as hospital-onset (HO), healthcare-associated community-onset (HACO), or community-associated (CA) CRE based on healthcare exposures and location of disease onset. We calculated incidence rates using census data. We used Poisson mixed effects regression models to perform 2016─2020 trend analyses, adjusting for sex, race/ethnicity, and age. We compared adjusted incidence rates between 2016 and subsequent years using incidence rate ratios (RRs) and 95% confidence intervals (CIs). Results Of 4996 CRE cases, 62% were HACO, 21% CA, and 14% HO. The crude CRE incidence rate per 100 000 was 7.51 in 2016 and 6.08 in 2020 and was highest for HACO, followed by CA and HO. From 2016 to 2020, the adjusted overall CRE incidence rate decreased by 24% (RR, 0.76 [95% CI,.70–.83]). Significant decreases in incidence rates in 2020 were seen for HACO (RR, 0.75 [95% CI,.67–.84]) and CA (0.75 [.61–.92]) but not for HO CRE. Conclusions Adjusted CRE incidence rates declined from 2016 to 2020, but changes over time varied by epidemiologic class. Continued surveillance and effective control strategies are needed to prevent CRE in all settings. [ABSTRACT FROM AUTHOR]

Background Area-based index of multiple deprivation (IMD) indicators of financial hardship lack individual specificity and sensitivity. This study compared self-reports of hardship with area measures in relation to health status. Methods Interviews in one London Borough, reported financial hardship and health status. Associations of health status with most and least deprived quintiles of the IMD 2015 were compared with self-reported hardship; always or sometimes 'having difficulty making ends meet at the end of the month' in relation to never. Results 1024 interviews reported hardship status in 1001 (98%). 392 people (39%) reported they 'always' or 'sometimes' had hardship. In multivariate analysis, self-reported hardship was more strongly associated with smoking; odds ratio = 5.4 (95% CI: 2.8–10.4) compared with IMD, odds ratio = 1.9 (95% CI: 1.2–3.2). Health impairment was also more likely with self-reported hardship, odds ratio = 11.1 (95% CI: 4.9–25.4) compared with IMD; odds ratio = 2.7 (95% CI: 1.4–5.3). Depression was similarly related; odds ratio = 2.4 (95% CI: 1.0–5.6) and 2.7 (95% CI: 1.2–6.6), respectively. Conclusions Self-reported hardship was more strongly related to health status than area-based indicators. Validity and implementation in routine health care settings remains to be established. [ABSTRACT FROM AUTHOR]

Background: Much of the evidence underlying guidelines for producing accessible information for people with aphasia focuses on client preference for particular design features. There is limited evidence regarding the effects of these features on comprehension. Aims: To examine the effects of specific design features on text comprehension. It was hypothesized that font style, letter case and supporting images would all have a significant impact on people with aphasias' ability to comprehend text. Methods & Procedures: Participants (N = 9) read 35 paragraphs and selected the most appropriate word or phrase from a choice of four to finish the final sentence. Reading comprehension was assessed in three conditions: font style, letter case and text with a supporting image. One-way analyses of variance (ANOVAs) with Bonferroni post-hoc tests were used to test the effect of each design feature on reading comprehension. Outcomes & Results: People with aphasia comprehended significantly more written information when presented in sans-serif font than in a serif style (p = 0.01) and when presented in lower case than in upper case (p = 0.03). The inclusion of a single supporting image to illustrate a paragraph of text did not have a significant effect on comprehension. Conclusions & Implications: This research supports the premise that font style and letter case have a significant effect on text comprehension, but that illustrating a paragraph of text with a single image may not significantly improve comprehension when text is written at a low readability level. Although it is critical to produce accessible information, improving comprehension is only one rationale for modified text presentation and therefore these results must be viewed in the context of other recommendations.

Background Protection against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]) can limit transmission and the risk of post-COVID conditions, and is particularly important among healthcare personnel. However, lower vaccine effectiveness (VE) has been reported since predominance of the Omicron SARS-CoV-2 variant. Methods We evaluated the VE of a monovalent messenger RNA (mRNA) booster dose against COVID-19 from October 2021 to June 2022 among US healthcare personnel. After matching case-participants with COVID-19 to control-participants by 2-week period and site, we used conditional logistic regression to estimate the VE of a booster dose compared with completing only 2 mRNA doses >150 days previously, adjusted for multiple covariates. Results Among 3279 case-participants and 3998 control-participants who had completed 2 mRNA doses, we estimated that the VE of a booster dose against COVID-19 declined from 86% (95% confidence interval, 81%–90%) during Delta predominance to 65% (58%–70%) during Omicron predominance. During Omicron predominance, VE declined from 73% (95% confidence interval, 67%–79%) 14–60 days after the booster dose, to 32% (4%–52%) ≥120 days after a booster dose. We found that VE was similar by age group, presence of underlying health conditions, and pregnancy status on the test date, as well as among immunocompromised participants. Conclusions A booster dose conferred substantial protection against COVID-19 among healthcare personnel. However, VE was lower during Omicron predominance, and waning effectiveness was observed 4 months after booster dose receipt during this period. Our findings support recommendations to stay up to date on recommended doses of COVID-19 vaccines for all those eligible. [ABSTRACT FROM AUTHOR]

Background Most multicenter studies of US pediatric sepsis epidemiology use administrative data or focus on pediatric intensive care units. We conducted a detailed medical record review to describe sepsis epidemiology in children and young adults. Methods In a convenience sample of hospitals in 10 states, patients aged 30 days–21 years, discharged during 1 October 2014–30 September 2015, with explicit diagnosis codes for severe sepsis or septic shock, were included. Medical records were reviewed for patients with documentation of sepsis, septic shock, or similar terms. We analyzed overall and age group–specific patient characteristics. Results Of 736 patients in 26 hospitals, 442 (60.1%) had underlying conditions. Most patients (613 [83.3%]) had community-onset sepsis, although most community-onset sepsis was healthcare associated (344 [56.1%]). Two hundred forty-one patients (32.7%) had outpatient visits 1–7 days before sepsis hospitalization, of whom 125 (51.9%) received antimicrobials ≤30 days before sepsis hospitalization. Age group–related differences included common underlying conditions (<5 years: prematurity vs 5–12 years: chronic pulmonary disease vs 13–21 years: chronic immunocompromise); medical device presence ≤30 days before sepsis hospitalization (1–4 years: 46.9% vs 30 days–11 months: 23.3%); percentage with hospital-onset sepsis (<5 years: 19.6% vs ≥5 years: 12.0%); and percentage with sepsis-associated pathogens (30 days–11 months: 65.6% vs 13–21 years: 49.3%). Conclusions Our data suggest potential opportunities to raise sepsis awareness among outpatient providers to facilitate prevention, early recognition, and intervention in some patients. Consideration of age-specific differences may be important as approaches are developed to improve sepsis prevention, risk prediction, recognition, and management. [ABSTRACT FROM AUTHOR]

Multidrug-resistant organisms are a major public health concern worldwide (1-4). Of particular concern has been the emergence of resistance to carbapenem antimicrobial drugs among Enterobacteriaceae (4,5). In the United States, [...]