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Candida auris , an emerging fungal pathogen with significant morbidity and mortality, can be difficult for health care facilities to identify, isolate, and control. We present our identification and infection control response to Candida auris at a 695-bed academic level I trauma center in Florida. • Candida auris is an easily transmissible emerging pathogen. • Relatively few hospital-grade disinfectants carry a kill claim for Candida auris. • Point-prevalence colonization screening impacted discharge planning. • Basic infection prevention practices, such as hand hygiene, remain paramount. [ABSTRACT FROM AUTHOR]

In the decade since the largest Ebola Virus Disease (EVD) outbreak in history, hospitals within the United States have discovered deficiencies in EVD infection control protocols. A large academic level I trauma medical center and frontline EVD receiving hospital in northeast Florida conducted a large-scale review and revision of the facility's EVD infection control protocols to increase preparedness. The revision process revealed opportunities for improvement and highlighted the need for excellent resource management and interdepartmental communication. • Ebola Virus Disease (EVD) infection control plans require significant resources. • Deficiencies in EVD infection control plans are easily developed. • Hospital's review of EVD infection control plan identified gaps. • Revision of EVD infection control plan helped enhance preparedness. [ABSTRACT FROM AUTHOR]

Management of obstetrical and gynecologic patients with hernias poses challenges to providers. Risks for hernia development include well-described factors that impair surgical wound healing and increase abdominal pressure. Among the diverse populations cared for by obstetricians and gynecologists, pregnant patients and those with gynecologic malignancies are at the highest risk for hernia formation. This article provides an overview of the existing literature, with a focus on patients cared for by obstetrician–gynecologists and commonly encountered preoperative and intraoperative scenarios. We highlight scenarios when a hernia repair is not commonly performed, including those of patients undergoing nonelective surgeries with known or suspected gynecologic cancers. Finally, we offer multidisciplinary recommendations on the timing of elective hernia repair with obstetrical and gynecologic procedures, with attention to the primary surgical procedure, the type of preexisting hernia, and patient characteristics. [ABSTRACT FROM AUTHOR]

• Driven by net-zero policies, major landscape shifts expected in rural Europe. • Injustices arise from potential climate-influenced landscape transformations. • Empirical environmental justice study of three rural European landscapes. • Unequal land access central to rural environmental justice. [ABSTRACT FROM AUTHOR]

Digoxin has been associated with reduced interstage mortality for patients with functional single ventricles with aortic hypoplasia or ductal-dependent systemic circulation. The NEONATE (type of stage 1 palliation operation, postoperative extracorporeal membrane oxygenation, discharge with opiates, no digoxin at discharge, postoperative arch obstruction, moderate to severe tricuspid regurgitation without an oxygen requirement, and extra oxygen required at discharge in patients with moderate to severe tricuspid regurgitation) score can stratify patients by risk of death or transplantation (DTx) on the basis of clinical factors. The study investigators suspected a variable transplant-free survival benefit of digoxin in high-risk vs low-risk patients. National Pediatric Cardiology Quality Improvement Collaborative patients discharged after stage 1 palliation with complete data were categorized as high- or low-risk on the basis of a modified NEONATE score. The primary outcome of DTx was evaluated. A mixed-effect regression evaluated associations between digoxin prescription and risk factors. A total of 1199 patients were included; 399 (33%) were high risk. Baseline demographics were similar between the cohorts. Blalock-Taussig shunt or a hybrid operation, postoperative extracorporeal membrane oxygenation, opiate prescription, and significant tricuspid regurgitation or arch obstruction were more common in high-risk patients. The odds of DTx were 65% lower in high-risk patients prescribed digoxin compared with patients who were not (P =.001). Digoxin prescription was associated with 60.8% lower DTx in the high-risk cohort (7.8% vs 19.9%; P =.001). There was no significant difference in the DTx rate according to digoxin prescription in the low-risk cohort (4.7% vs 5.7%; P =.46). Blalock-Taussig shunt, aortic arch obstruction, and significant tricuspid regurgitation were most strongly associated with deriving a benefit from digoxin. Digoxin use is associated with significant improvement in transplant-free survival in high-risk but not in low-risk interstage patients. A tailored approach to the use of digoxin in interstage patients may be warranted. [Display omitted] [ABSTRACT FROM AUTHOR]

To assess the 52-week efficacy and safety of brolucizumab 6 mg administered every 4 weeks compared with aflibercept 2 mg dosed every 4 weeks in eyes with neovascular age-related macular degeneration (nAMD) and persistent retinal fluid. Multicenter, randomized, double-masked phase 3a study. Participants with recalcitrant nAMD (persistent residual retinal fluid despite previous frequent anti–vascular endothelial growth factor treatment). Eyes were randomized (2:1) to intravitreal brolucizumab 6 mg or aflibercept 2 mg every 4 weeks up to and including week 100. The primary end point was analysis of noninferiority in mean best-corrected visual acuity (BCVA) change from baseline to week 52 (margin, 4 letters). Other key end points included change in central subfield thickness (CST) from baseline to week 52, fluid-free status (no intraretinal fluid and no subretinal fluid), and safety. At week 52, brolucizumab was noninferior to aflibercept in BCVA change from baseline (least squares mean difference, –0.6 Early Treatment Diabetic Retinopathy Study letters; 95% confidence interval [CI], –2.1 to 0.9; P < 0.001). A total of 4.8% and 1.7% of participants reported a 15-letter or more BCVA loss from baseline at week 52 in the brolucizumab and aflibercept groups, respectively. In eyes treated with brolucizumab compared with those treated with aflibercept, the CST was reduced significantly (P < 0.001), and a significantly greater proportion of eyes were fluid free at week 52 (40.4% brolucizumab vs. 19.0% aflibercept; 95% CI, 13.9–29.0; P < 0.001). Incidence of intraocular inflammation (IOI), including retinal vasculitis and retinal vascular occlusion, were 9.3% (0.8% and 2.0%) for brolucizumab versus 4.5% (0% and 0%) for aflibercept, respectively. Visual acuity outcomes in previously treated participants with nAMD and persistent retinal fluid receiving brolucizumab 6 mg dosed every 4 weeks were noninferior to aflibercept 2 mg dosed every 4 weeks, with superior anatomic outcomes. However, incidences of IOI, including retinal vasculitis and retinal vascular occlusion, also were higher, leading to study termination. [ABSTRACT FROM AUTHOR]

ED health care professionals are at the frontline of evaluation and management of patients with acute, and often undifferentiated, illness. During the initial phase of the SARS-CoV-2 outbreak, there were concerns that ED health care professionals may have been at increased risk of exposure to SARS-CoV-2 due to difficulty in early identification of patients. This study assessed the seroprevalence of SARS-CoV-2 antibodies among ED health care professionals without confirmed history of COVID-19 infection at a quaternary academic medical center. This study used a cross-sectional design. An ED health care professional was deemed eligible if they had worked at least 4 shifts in the adult emergency department from April 1, 2020, through May 31, 2020, were asymptomatic on the day of blood draw, and were not known to have had prior documented COVID-19 infection. The study period was December 17, 2020, to January 27, 2021. Eligible participants completed a questionnaire and had a blood sample drawn. Samples were run on the Roche Cobas Elecsys Anti-SARS-CoV-2 antibody assay. Of 103 health care professionals (16 attending physicians, 4 emergency residents, 16 advanced practice professionals, and 67 full-time emergency nurses), only 3 (2.9%; exact 95% CI, 0.6%-8.3%) were seropositive for SARS-CoV-2 antibodies. At this quaternary academic medical center, among those who volunteered to take an antibody test, there was a low seroprevalence of SARS-CoV-2 antibodies among ED clinicians who were asymptomatic at the time of blood draw and not known to have had prior COVID-19 infection. • ED health care professionals are often the first point of hospital contact for patients with an acute illness. There were concerns that ED health care professionals may have been at increased risk of exposure to SARS-CoV-2. • At a single institution, there was a seroprevalence of 2.9% for SARS-CoV-2 antibodies among ED health care professionals who had never been formally diagnosed with COVID-19. • Adherence to infection control protocols, including implementation of universal masking and use of appropriate personal protective equipment for patients with suspected or confirmed COVID-19 or confirmed exposures, can effectively mitigate risk of transmission in health care settings. [ABSTRACT FROM AUTHOR]

The study compared 1-year outcomes between transcatheter aortic valve replacement (TAVR) patients with bicuspid aortic valve (BAV) morphology and clinically similar patients having tricuspid aortic valve (TAV) morphology. There are limited prospective data on TAVR using the SAPIEN 3 device in low-surgical-risk patients with severe, symptomatic aortic stenosis and bicuspid anatomy. Low-risk, severe aortic stenosis patients with BAV were candidates for the PARTNER 3 (Placement of Aortic Transcatheter Valves 3) (P3) bicuspid registry or the P3 bicuspid continued access protocol. Patients treated in these registries were pooled and propensity score matched to TAV patients from the P3 randomized TAVR trial. Outcomes were compared between groups. The primary endpoint was the 1-year composite rate of death, stroke, and cardiovascular rehospitalization. Of 320 total submitted BAV patients, 169 (53%) were treated, and most were Sievers type 1. The remaining 151 patients were excluded caused by anatomic or clinical criteria. Propensity score matching with the P3 TAVR cohort (496 patients) yielded 148 pairs. There were no differences in baseline clinical characteristics; however, BAV patients had larger annuli and they experienced longer procedure duration. There was no difference in the primary endpoint between BAV and TAV (10.9% vs 10.2%; P = 0.80) or in the rates of the individual components (death: 0.7% vs 1.4%; P = 0.58; stroke: 2.1% vs 2.0%; P = 0.99; cardiovascular rehospitalization: 9.6% vs 9.5%; P = 0.96). Among highly select bicuspid aortic stenosis low-surgical-risk patients without extensive raphe or subannular calcification, TAVR with the SAPIEN 3 valve demonstrated similar outcomes to a matched cohort of patients with tricuspid aortic stenosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Recently, formative feedback in writing instruction has been supported by technologies generally referred to as Automated Writing Evaluation tools. However, such tools are limited in their capacity to explore specific disciplinary genres, and they have shown mixed results in student writing improvement. We explore how technology-enhanced writing interventions can positively affect student attitudes toward and beliefs about writing, both reinforcing content knowledge and increasing student motivation. Using a student-facing text-visualization tool called Write & Audit , we hosted revision workshops for students (n = 30) in an introductory-level statistics course at a large North American University. The tool is designed to be flexible: instructors of various courses can create expectations and predefine topics that are genre-specific. In this way, students are offered non-evaluative formative feedback which redirects them to field-specific strategies. To gauge the usefulness of Write & Audit, we used a previously validated survey instrument designed to measure the construct model of student motivation (Ling et al. 2021). Our results show significant increases in student self-efficacy and beliefs about the importance of content in successful writing. We contextualize these findings with data from three student think-aloud interviews, which demonstrate metacognitive awareness while using the tool. Ultimately, this exploratory study is non-experimental, but it contributes a novel approach to automated formative feedback and confirms the promising potential of Write & Audit. • A new student-facing writing technology, Write & Audit, is introduced. • The tool offers formative feedback for specialized, disciplinary genres. • Our initial implementation of the tool in a statistics workshop shows promising results. • Student participants showed improvements in motivation. • Think-aloud data display the tool's encouragement of metacognitive reflection. [ABSTRACT FROM AUTHOR]

This paper uses simple electricity market models to demonstrate the workings of, and problems with, Ontario's zonal price/two-schedule electricity market design. The roles played by zonal prices, Shadow LMP prices, and out-of-market congestion payments are explained. This market design is compared and contrasted to the much better-known single-schedule designs with LMP pricing used in neighboring U.S. markets. The ways in which congestion payments can, and have been, gamed is highlighted and shown to be special cases of counter-trading "inc-dec games". The bizarre outcomes for interjurisdictional trading arising from Ontario's use of congestion pricing on its interties combined with uniform pricing on the internal grid are demonstrated. Some gaming problems identified in other markets are reviewed compared to Ontario's situation. Finally, the paper recaps the system operator's efforts to remedy the various problems with the market while preparing a fundamental redesign. [ABSTRACT FROM AUTHOR]

Wholesale electricity markets have several features that increase the likelihood of collusion, including frequent interaction, multimarket contact, and a high degree of information transparency. As a result, screening techniques for detecting collusive agreements are desired. This study surveys the literature on screens for collusion and collusion in electricity markets. We discuss key features of non-competitive behaviour to be reflected in screens and suggest directions for improved screening in this industry. In particular, due to recent improvements in these methods, there is considerable potential to include machine learning and data mining techniques in screens in the electricity sector. • Literature review of screening techniques used to detect collusion • Challenges and opportunities in the use of screens in wholesale electricity markets • Discussion of recent developments in machine learning and its potential use in collusive screens [ABSTRACT FROM AUTHOR]

There is increasing interest in GDF15 analogs as therapeutic agents for obesity. In this issue of Cell Metabolism , Benichou et al. report the first clinical trial of such a drug in obese humans. [ABSTRACT FROM AUTHOR]

GDF15 regulates its anorexic effects through the hindbrain area postrema (AP) and nucleus of the solitary tract (NTS) neurons where its receptor, glial-derived neurotrophic factor receptor alpha-like (GFRAL), is expressed. The actions of GDF15 may interact with other appetite regulators elevated in obesity, such as leptin. Here, we report that in mice with high-fat-diet-induced obesity (HFD), the combined infusion of GDF15 and leptin causes significantly greater weight and adiposity loss than either treatment alone, indicating potentiation between GDF15 and leptin. Furthermore, obese, leptin-deficient ob/ob mice are less responsive to GDF15, as are normal mice treated with a competitive leptin antagonist. GDF15 and leptin induce more hindbrain neuronal activation in HFD mice than either treatment alone does. We report extensive connections between GFRAL- and LepR-expressing neurons and find LepR knockdown in the NTS to reduce the GDF15-mediated activation of AP neurons. Overall, these findings suggest that leptin signaling pathways in the hindbrain increase GDF15's metabolic actions. [Display omitted] • GDF15 + leptin causes greater weight loss than either treatment alone in mice • GDF15-induced body weight loss is reduced in mice without functional leptin • GDF15 + leptin induces more hindbrain neuronal activation than either treatment alone • A LepRNTS → AP circuit is involved in GDF15 + leptin-induced activation of the AP GDF15 is a stress-induced protein that plays a crucial role in regulating body weight by acting in the hindbrain. Here, Breit et al. reveal that as an infusion, GDF15 and leptin co-operate to enhance weight and adiposity loss, mediated in part by hindbrain neuronal interconnection between GDF15-GFRAL and leptin-LepR pathways. [ABSTRACT FROM AUTHOR]

To demonstrate the additive effects of augmented feedback, virtual reality (VR), and exergaming on motivation and walking speed performance. Within-subjects, repeated measures design. Spain Rehabilitation Center, University of Alabama at Birmingham. Individuals with hemiparesis who are in the chronic phase of recovery from stroke (>6 months) whom are able to follow instructions, and walk independently without needing physical assistance for at least three minutes. Participants will be asked to walk as fast and safely as they can while on a robotic in three conditions: (1) with simple visual augmented feedback without a VR interface, (2) with a basic VR interface and (3) with a VR exergame. 30-seconds fast walking speed was measured on a robotic treadmill (KineAssist-MX®). Intrinsic motivation was measured after each walking condition using the Intrinsic Motivation Inventory (IMI). In this preliminary analysis (n=4 participants; age range: 35-70 years;) participants had baseline fast walking speeds between 0.50-1.48 m/s. The change in walking speeds, with and without performance feedback, were as follows: 0.19-0.49 m/s for augmented feedback, 0.22-0.45 m/s for basic VR, and 0.16-0.42 m/s for VR exergame. IMI-Interest and Enjoyment Subscale scores ranged from: 5.9-6.9 after augmented feedback, 5.4-6.9 after basic VR, and 6.4-6.7 after VR exergame. This preliminary report suggests that individuals' post-stroke can walk faster when they are provided with performance feedback compared to their fast walking speed without receiving any performance feedback. In terms of intrinsic motivation, no trend was observed across participants nor conditions indicating that intrinsic motivation is about the same level when walking with different types of augmented feedback. David Brown declares the following financial interests and personal relationships which may be considered as potential competing interests: He is a named inventor on the intellectual property associated with the KineAssist and does receive a share of royalties for any sales of this robotic treadmill. Saleh Alhirsan and Carmen Capo-Lugo do not have any conflicts of interests to declare. [ABSTRACT FROM AUTHOR]

To assess the role of fear of falling and balance confidence in a clinician guarding (overhead) vs. overhead harness condition. To validate and assess a safe top walking speed measure for participants with TBI. Repeated measures over 3 days (1 testing environment per day) for overground (clinical standard), overhead track (suspended torso and thigh harness), and robotic treadmill (harness system over a treadmill belt). Participants will complete walking assessments using the 10-meter walk test, 5 times sit-to-stand, and 6-minute walk test. Top walking speed is performed in the robotic treadmill safety-enhanced environment. Fear of fall and walking confidence are assessed at baseline. The Moody Neurorehabilitation Institute in Galveston, TX provides inpatient post-acute brain injury rehabilitation. We will conduct evaluations on site in their gymnasium. Our study sample will include 28 post-TBI individuals currently enrolled at the Moody Neurorehabilitation Institute. Participants must be 1) English-speaking, 2) 18+ years old, 3) ambulatory with or without assistive devices, 4) medically stable (controlled hypertension, no arrhythmia, stable cardiovascular status), 5) for subjects with expressive aphasia, a caregiver must be able to provide assistance when needed. Repeated measures design, no applied interventions. Comfortable Walking Speed (meters/second): 10-meter walk test (comfortable) Fast Walking Speed: 10-meter walk test (fast) Top Walking Speed: In the robotic treadmill environment (safety-enhanced), participants are instructed to do their best to keep up with the speed set by the administrator. The fastest speed successfully completed is documented as the top walking speed. Strength: 5 times sit-to-stand. Endurance: 6-minute walk test. Preliminary results from the first 8 participants show that walking strength and fast walking speeds are predictors of top walking speeds obtained in the robotic treadmill environment, but it is too soon to make statistically significant conclusions. Complete data will be collected and analyzed by the conference date. Methods that reduce the fear of falling during walking assessments are critically needed, as true walking ability may be greater than standard overground tests can determine. None. [ABSTRACT FROM AUTHOR]

Translational research describes the process of applying observations and scientific discoveries made in the laboratory to clinical applications that can improve the health of individual patients, most often through clinical trials. To apply the findings of translational research studies to the broader population, the study population must accurately reflect the group of patients afflicted by a particular disease. Yet, it is well known that significant disparities exist for underrepresented groups and lower socioeconomic populations in clinical trials. In fact, only 20% of randomized controlled studies published in high-impact oncology journals include subgroup analyses to assess differences in outcomes based on race or ethnicity. 1 If effective interventions to decrease health disparities in research are to be implemented, it is critical to understand the multifactorial influences that create such differences. These are complex and include individual patient factors, family and social support, provider and organizational factors, as well as policy and community factors. Patient access to tertiary or quaternary care academic centers or designated cancer centers with the funding and resources to carry out translational research and knowledge of ongoing available research endeavors is often critical. Active community engagement and outreach and deep understanding of a particular health system's catchment area are necessary to increase both awareness and participation in clinical trials. Without significant progress in biomedical research patient recruitment, existing racial and ethnic health disparities will be challenging to overcome. [ABSTRACT FROM AUTHOR]