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Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of oxygen delivery devices. A hospital program designed to reduce the number of pressure ulcers from medical devices was successful. The program involved the development of a team that focused on skin, the results were then published for the staff to track their performance, and it was found that using foam dressings helped reduce the pressure from the device. The incidence of ulcers from medical devices has remained at zero at this hospital since this program was implemented. Keywords: pressure ulcer, medical device related

Many professional organizations and associations hold conventions and conferences on an annual basis. Health Education professional associations take part in this process. Using a historical research perspective, this article delineates conference themes for four prominent professional Health Education associations: the American Association for Health Education (AAHE), the American Public Health Association (APHA), the American School Health Association (ASHA), and the Society for Public Health Education (SOPHE). Data were collected, examined, analyzed by thematic content analysis, and then organized by association, year and location. Development of an appropriate methodology for thematic data collection and analysis are described. [ABSTRACT FROM AUTHOR]

The effects of air pollution on health outcomes are well-established. However, little is known about perceptions of air pollution and how it may influence exercise behaviours. The aim of this study was to understand the perceived importance of air pollution during planned exercise, and where relevant, explore how those perceptions may differ between those living in different locations. A questionnaire was disseminated to several running and cycling clubs in the United Kingdom, covering population characteristics to determine urban, rural or coastal residents and exercisers, self-reported asthma, perceptions of air quality during active travel, planned exercise and attitudes towards learning more about the topic. Anonymised responses were gained from 381 adult participants (≥18 years and 60% female), 119 of whom answered questions related to active travel. More than half (54%) of all respondents think about the air quality they are exposed to during exercise and how it may affect their health. More urban than rural respondents (59% vs. 47% and p = 0.03) think about air quality and the impact it may have on their health when exercising. There were insufficient coastal respondents for direct comparison. Most survey respondents (57%) state that they would take the most severe course of action regarding exercise behaviour by avoiding it altogether during periods of heavy road traffic. Individuals with self-reported asthma (n = 60), irrespective of place of residence, are the most likely to be conscious of the potential effects of air pollution on their health and exercise performance compared to counterparts without self-reported asthma., (© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Clinical Relevance: Vision screening is important for detecting undiagnosed vision conditions that are common in school-aged children. However, current vision screening protocols are poor at detecting vision conditions that are most common in the Aotearoa New Zealand paediatric population., Background: Uncorrected refractive error and amblyopia are the most common causes of visual impairment in children. The most appropriate vision screening method depends on the refractive error profile of the population. This study aimed to: estimate the prevalence of refractive errors and amblyopia risk factors among children living in Aotearoa New Zealand; describe previous participation in preschool vision screening and determine the diagnostic accuracy of potential screening methods., Methods: Children aged 7-10 years received comprehensive eye examinations, including cycloplegic refraction, in their school. Eye examination results were assessed for refractive error and amblyopia risk factors. The sensitivity and specificity of individual vision tests for detecting any vision conditions was calculated to assess the most effective tests for vision screening., Results: Eye examinations were completed for 237 children and cycloplegic refraction data was available for 220 of these children. Significant refractive error (need for glasses) was detected in 23.6% of children (7.7% myopia, 7.7% hyperopia, 15.0% astigmatism). Amblyopia risk factors were detected in 9.1% of children. Preschool vision screening had been completed by 78.5% of children. Distance visual acuity screening alone had a sensitivity of 39% for detecting vision conditions, with addition of the Spot Vision Screener improving sensitivity to 65%., Conclusion: Astigmatism is the most frequent refractive error among children aged 7-10 years living in Aotearoa New Zealand. Distance visual acuity screening alone is ineffective in detecting refractive error in children in Aotearoa New Zealand. Further research investigating refractive errors across the paediatric population in Aotearoa New Zealand is required to determine the optimal timing and appropriate protocols for school-aged vision screening.

According to sexual selection theory, the sexes are faced with opposing evolutionary goals. Male fitness benefits from access to females, whereas female fitness is constrained by food resources and safety for themselves and their offspring. Particularly in large solitary carnivores, such as polar bears (Ursus maritimus), these divergent goals can potentially lead to conflict between the sexes. Outside the mating season, when polar bears are on the move across vast distances, the consequences of such conflict can become apparent when individuals arrive at the same food source. To investigate interrelationships between the sexes, we observed successive polar bears visiting a bird breeding colony to feed on clutches of eggs. We found that males succeeded females more frequently and more closely than expected by chance. Moreover, when males were closer to conspecifics, they walked faster, spent less time in the colony and ingested less food. In contrast, female foraging performance was not associated with proximity to other bears. Irrespective of proximity, females generally spent short periods in the colony and ingested fewer clutches than males. Our results suggest that in polar bears, there is a trade-off between the benefits of food intake and the opportunities (in males) and risks (in females) posed by encountering conspecifics., (© 2024. The Author(s).)

Aim: This study aimed to determine adherence with follow-up from the New Zealand pre-school vision screening programme. The study also examined associations between pre-school vision screening outcomes and cognitive measures assessed at the 54-month follow-up in the Growing Up in New Zealand study cohort., Methods: A cross-sectional retrospective record review of pre-school vision screening outcomes and hospital ophthalmology records with linkage to Growing Up in New Zealand cohort study data., Results: Of 176 children referred from vision screening, 21.6% did not attend a referral appointment. Of 138 children who attended a referral appointment, 21.0% did not attend one or more follow-up appointments. Ethnic differences were observed in attendance at referral appointments (attended Māori 13%, Pacific 22.5%, European/Other 64.5%; not attended Māori 26.3%, Pacific 28.9%, European/Other 44.7%; P = 0.04) and follow-up appointments (attended Māori 11.9%, Pacific 15.6%, European/Other 72.5%; not attended Māori 17.2%, Pacific 48.3%, European/Other 34.5%; P = 0.001). Vision screening outcome was significantly associated with letter naming fluency scores (P = 0.01) but not name and numbers scores (P = 0.05)., Conclusions: Non-attendance at referral and follow-up appointments limits the efficacy of vision screening, particularly for children of Māori and Pacific ethnicity. Children referred from vision screening achieve lower scores on letter naming fluency, a key predictor of reading ability in later childhood. Equity-based improvements are required to ensure that all children referred from vision screening receive appropriate follow-up eye care., (© 2024 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the authors when they discovered and reported to the editors that articles containing population samples drawn from similar cohorts of healthy participants without psychosis were erroneously included in the psychosis subgroup of the meta-analysis. This error in the systematic review processes ultimately affects the findings in the meta-analysis. The authors deeply apologize for this error., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Pressure injury prevention is complex, and rates continue to rise. Checklists reduce human error, improve adherence and standardization with complex processes, focus attention on evidence-based practices derived from clinical practice guidelines and are arranged in a systematic manner to manage the entirety of a patient's risk for preventable outcomes. The original Standardized Pressure Injury Prevention Protocol was created to provide a checklist of pressure injury prevention measures but needed revision and validation., Purpose: This article describes the revision and content validity testing of the Standardized Pressure Injury Prevention Protocol Checklist 2.0 that took place in 2022., Methods: Using the International 2019 Clinical Practice Guideline as a foundation, items were identified/revised, and expert review of the items was obtained. The Standardized Pressure Injury Prevention Protocol 2.0 underwent three rounds of revision by experts from the National Pressure Injury Advisory Panel. A panel of eight national experts completed the content validity survey. Individual item content validity index and total scale content validity index were used to summarize the content validity survey scores., Results: The individual item content validity index scores ranged from 0.5 to 1.0. One item (using a mirror to look at heels) was rated as 0.5, three items were 0.75, 20 items were 0.875 and 23 items were 1.0. The item scoring 0.5 was deleted. Those items scoring 0.75 were revised using the content experts' recommendations. The total scale content validity index was 0.93., Conclusion: The Standardized Pressure Injury Prevention Protocol 2.0 provides a standardized checklist of evidence-based items that operationalize a rigorous clinical practice guideline for the prevention of pressure injuries. Early intervention using a standardized approach and evidence-based checklist that can be integrated into the workflow of the direct-care nurse and provider provides the best opportunity for successful and sustainable pressure injury prevention., (© 2023 John Wiley & Sons Ltd.)

This review aims to systematically assess the current literature about prenatal epigenetic markers that lead to post-traumatic stress disorder susceptibility across the lifespan. Studies included in this review met several research criteria: Studies included (1) participants with a PTSD diagnosis according to the DSM-5, (2) prenatal epigenetic marker data that could be analyzed, and (3) explicit references to postnatal PTSD susceptibility. Our study sample fit within a timeframe of 2002 (the earliest recorded studies of prenatal susceptibility to post-traumatic stress disorder in the databases used) and February 2021 when the literature search for this review was terminated. Studies for this review were collated from PubMed, MEDLINE, Science Direct, and Boston College School of Social Work Library databases. A systematic search was conducted in these databases using basic keyword terms, such as "PSTD resilience" and "PTSD vulnerability," and then adding clarifying terms to refine specific searches, such as "epigenetics," "genetics," "epigenetic markers," "haplotypes," and "mRNA methylation." Based on these criteria and research methods, 33 studies remained for inclusion in the review sample. This review suggests that BDNF Val66-Met, a polymorphism of FKBP5, and an altered messenger ribonucleic acid methylation marker in NR3C1 present most often in cases of PTSD. These epigenetic markers might be implicated in central neurological processes related to post-traumatic stress disorder symptomatology.

This review presents the current state of understanding of trauma-informed modalities in light of current research in neuroscience, analyzing which brain structures and processes are impacted by these modalities. Studies included in the present review met the inclusion criteria of 1) addressing post-traumatic stress disorder (PTSD) in a specific population, 2) treatment of PTSD using any of the evidence-based trauma-informed modalities considered in this review, and 3) presenting functional magnetic resonance imagery (fMRI) data, derived from BOLD signals and voxel-compression maps, of brain structures impacted by these trauma-informed modalities. Articles for this review were collated through PubMed and MEDLINE, using key terms in descending order, such as 'childhood trauma', 'adolescent trauma', and 'adulthood trauma', to 'PTSD', 'fMRI', and so on, depending on the modality in question. Based on these criteria and research methods, 37 studies remained for inclusion in the present review. Among a number of critical findings, this review demonstrates that eye movement desensitization and reprocessing (EMDR) and mindfulness therapy effectively deactivate hindbrain regions implicated in the downregulation of autonomic nervous system (ANS) hyperarousal. This review also shows that trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR activate the hippocampus, anterior cingulate cortex (ACC), medial prefrontal cortex (mPFC), and orbitofrontal cortex (OFC)-areas that are implicated in crucial cognitive, affective, and behavioral processes that aid trauma survivors in navigating their challenges.

Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.

Clinical Relevance: Vision Bus Aotearoa is a fully equipped mobile eye health clinic designed to provide a novel platform for undergraduate optometry clinical training, community eye health research and deliver services to underserved communities., Background: Aotearoa New Zealand has inequitable access to eye health care. Vision Bus Aotearoa aims to work in partnership with communities to provide comprehensive mobile primary eye health care services while training optometry students, and integrating community eye health research., Methods: A description is provided of the governance model which has been involved throughout the project., Results: The process of vehicle manufacture, clinical set-up, funding models and service delivery are described. The aims of the project are detailed in terms of optometry teaching, clinical services in partnership with communities, and research integration and implementation., Conclusion: Vision Bus Aotearoa represents a valuable opportunity to deliver mobile eye health care to historically underserved communities, enhance undergraduate optometry teaching and to provide a unique platform for community eye health research.

Introduction: The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors., Methods: We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges' g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges' g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger's test to assess risk of publication bias across the review sample., Results: Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus ( t  = 4.23, p  < 0.001) showing robust activation, followed closely by the R precuneus ( t  = 4.19, p  < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores ( r  = 0.910, p  < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger's test ( p  = 0.127)., Discussion: Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE., 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., (Copyright © 2023 Pierce, Johnson, Kim, Lear, Mast and Black.)

COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID-19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear-ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non-porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence-based recommendations on prevention of device-related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long-term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help., (© 2021 John Wiley & Sons Ltd.)

Steller's Jays (Cyanocitta stelleri) with swollen legs and feet resembling the signs of scaly leg have been commonly seen around Arcata, California, US. The clinical signs are thought to be caused by knemidokoptic mites, a group of parasites specialized on avian hosts. Between February 2019 and March 2020, we analyzed the long-term database of Steller's Jays collected by Humboldt State University for trends in the prevalence of signs of scaly leg, compared the gripping position in the feet of Steller's Jays with variable signs of this condition as an index of their ability to perch, identified the mites using a partial sequence of the cytochrome oxidase subunit I gene, and examined genetic distances between mites collected from different host species both sequenced in this study and from GenBank. Overall, 27% of jays recorded in the long-term database had shown signs of scaly leg. Jays with signs captured in this study had greater variability in and a reduced degree of contraction in the gripping position of their feet compared to jays without signs, suggesting that infestation may have an impact on the host's ability to perch. The cytochrome oxidase subunit I sequence (578 base pairs) from mites collected from Steller's Jays was compared to sequences from Knemidokoptes jamaicensis, Knemidokoptes derooi, and to unidentified Knemidokoptes spp. collected from different hosts. The mites from Steller's Jays were most closely related to Knemidokoptes jamaicensis but had a relatively high sequence divergence, 7.8%, supporting the possibility that the form infesting these jays may be an undescribed species., (© Wildlife Disease Association 2022.)

Background: Over the past several years, hyperdilute calcium hydroxylapatite (CaHA) has emerged as an effective modality for improving skin quality and managing laxity in the face, arms, hands, neck, décolletage, upper arms, abdomen, buttocks, and upper legs, as well as for treating cellulite and striae. Whereas undiluted CaHA is used to provide volume, hyperdilute CaHA is distributed across a much larger surface area in a more superficial plane to stimulate neocollagenesis and elastin formation over time. The absence of lymphocytic infiltrates and predominance of type 1 collagen in the tissue response to CaHA make hyperdilute CaHA a valuable tool for nonsurgical skin tightening., Objectives: The aim of this study was to provide practical step-by-step guidance on patient selection, dilution practices, and optimal injection technique to facilitate incorporation of the technique into clinical practice., Methods: Over the course of 3 regional meetings in the United States, 12 expert physician injectors participated in live webinars as part of a continuing medical education program., Results: The practical guidance in this manuscript is based upon the most frequently requested information by audience members and the information considered critical for success by the authors., Conclusions: The minimally invasive nature of filler injection results in little downtime, making this treatment particularly appealing. The recommendations presented are consistent with previously published consensus guidelines on hyperdilute CaHA but are intended to serve as "how-to" guidance based on the experience of expert injectors who have successfully treated the face and body., (© 2021 The Aesthetic Society.)

Background: Neisseria gonorrhoeae culture is required for antimicrobial susceptibility testing, but recovering isolates from clinical specimens is challenging. Although many variables influence culture recovery, studies evaluating the impact of culture specimen collection timing and patient symptom status are limited. This study analyzed urogenital and extragenital culture recovery data from Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) program, a multisite project, which enhances local N. gonorrhoeae culture and antimicrobial susceptibility testing capacity., Methods: Eight SURRG jurisdictions collected gonococcal cultures from patients with N. gonorrhoeae-positive nucleic acid amplification test (NAAT) results attending sexually transmitted disease and community clinics. Matched NAAT and culture specimens from the same anatomic site were collected, and culture recovery was assessed. Time between NAAT and culture specimen collection was categorized as same day, 1 to 7 days, 8 to 14 days, or ≥15 days, and patient symptoms were matched to the anatomic site where culture specimens were collected., Results: From 2018 to 2019, among persons with N. gonorrhoeae-positive NAAT, urethral infections resulted in the highest culture recovery (5927 of 6515 [91.0%]), followed by endocervical (222 of 363 [61.2%]), vaginal (63 of 133 [47.4%]), rectal (1117 of 2805 [39.8%]), and pharyngeal (1019 of 3678 [27.7%]) infections. Culture recovery was highest when specimens were collected on the same day as NAAT specimens and significantly decreased after 7 days. Symptoms were significantly associated with culture recovery at urethral (P = <0.0001) and rectal (P = <0.0001) sites of infection but not endocervical, vaginal, or pharyngeal sites., Conclusions: Culture specimen collection timing and patient symptomatic status can impact culture recovery. These findings can guide decisions about culture collection protocols to maximize culture recovery and strengthen detection of antimicrobial-resistant infections., Competing Interests: Conflict of Interest and Sources of Funding: The authors have no conflicts of interest to disclose. Strengthening the US Response to Resistant Gonorrhea activities described in this article were supported by federal Antibiotic Resistance Initiative funding and administered through the US Centers for Disease Control and Prevention's Epidemiology and Laboratory Capacity for the Prevention and Control of Infectious Diseases Cooperative Agreement (CK19-1904)., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)

Background: Jurisdictions participating in Strengthening the US Response to Resistant Gonorrhea (SURRG) implemented specimen collection for culture and antimicrobial susceptibility testing from a sample of persons of all genders (at multiple anatomic sites) attending sexually transmitted disease clinics and community clinics. We describe the percentage and characteristics of patients whose isolates demonstrated reduced susceptibility (RS) to azithromycin, ceftriaxone, or cefixime., Methods: We included patients from clinics that participated in SURRG whose isolates underwent antimicrobial susceptibility testing by Etest. We defined RS as azithromycin minimum inhibitory concentrations (MICs) ≥2 μg/mL (AZM-RS), ceftriaxone MICs ≥0.125 μg/mL (CRO-RS), or cefixime MICs ≥0.25 μg/mL (CFX-RS). Patients with repeated infections appeared >1 time in the data. We calculated the frequency and percentage of patients with an isolate demonstrating RS by epidemiological characteristics., Results: During the period 2018-2019, 10,013 patients from 8 jurisdictions provided 10,735 isolates. Among 10,013 patients, 11.0% (n = 1099) had ≥1 isolate with AZM-RS (range by jurisdiction, 2.5%-18.0%). Approximately 11.3% of 8771 of patients visiting sexually transmitted disease clinics and approximately 8.8% of 1242 patients visiting community clinics had an AZM-RS isolate. Nearly 6% of 1013 females had an AZM-RS isolate; among males, the percents of patients with an AZM-RS isolate were 17.7% among 4177 men who have sex only with men and 6.1% among 3581 men who have sex only with women. Few (0.4%) patients had isolates with CFX-RS (n = 40) or CRO-RS (n = 43)., Conclusions: Although infections with reduced cephalosporin susceptibility were rare, AZM-RS infections were prevalent in this sample of patients in multiple jurisdictions and across gender and gender of sex partner categories., Competing Interests: Conflict of Interest and Sources of Funding: The authors have no conflicts of interest to disclose. Funding for the Strengthening the US Response to Resistant Gonorrhea activities described in this article was supported by federal Antibiotic Resistance Initiative funding and administered through the US Centers for Disease Control and Prevention's Epidemiology and Laboratory Capacity for the Prevention and Control of Infectious Diseases Cooperative Agreement (CK19-1904)., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)

Background: Responding effectively to outbreaks of antibiotic-resistant gonorrhea (ARGC) in the future will likely prove challenging. Tabletop exercises (TTXs) may assist local, state, and federal public health officials evaluate existing ARGC outbreak response plans, strengthen preparedness and response effectiveness, and identify critical gaps to address before an outbreak., Methods: In 2018 to 2019, Centers for Disease Control and Prevention (CDC) collaborated with state partners to develop and implement TTXs to simulate a public health emergency involving an ARGC outbreak. Before the TTXs, 2 state-local health department pairs developed ARGC outbreak response plans. During each 1-day exercise (in Indiana and Illinois), participants discussed roles, clinical management, public health response, and communication based on predeveloped response plans. Observers identified outbreak response strengths and gaps, and participants completed feedback forms., Results: Forty-one (Illinois) and 48 people (Indiana) participated in each TTX, including sexually transmitted disease clinical staff, laboratorians, public health infectious disease program staff, and CDC observers. Strengths and gaps varied by jurisdiction, but identified gaps included: (1) local access to gonorrhea culture and timely antimicrobial susceptibility testing, (2) protocols for clinical management of suspected treatment failures, (3) communication plans, and (4) clarity regarding state and local responsibilities. The CDC observers identified opportunities to provide national-level technical assistance, foster local antimicrobial susceptibility testing, and develop further response guidance. Tabletop exercises summary reports were used to guide modifications to local response plans to address gaps., Conclusions: The TTXs allowed participants to practice responding to a simulated public health emergency and may have enhanced local response capacity. Centers for Disease Control and Prevention made TTX implementation materials publicly available., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)

Background: Neisseria gonorrhoeae (NG) continues to develop antimicrobial resistance (AR), and treatment options are limited. ARNG surveillance aids in identifying threats and guiding treatment recommendations but has traditionally been limited to sexually transmitted infection (STI) clinics. Large portions of STI care is delivered outside of STI clinics, such as emergency departments (EDs). These facilities might provide additional venues to expand surveillance and outbreak preparedness., Methods: Through the Strengthening the US Response to Resistant Gonorrhea program, Greensboro, NC, and Indianapolis, IN, identified 4 EDs in high-morbidity areas to expand culture collection. Patient demographics, culture recovery rates, and antimicrobial susceptibility results between EDs and local STI clinics were compared along with lessons learned from reviewing programmatic policies and discussions with key personnel., Results: During the period 2018-2019, non-Hispanic Black patients were the most represented group at all 6 sites (73.6%). Age was also similar across sites (median range, 23-27 years). Greensboro isolated 1039 cultures (STI clinic [women, 141; men, 612; transwomen, 3]; EDs, 283 [women, 164; men, 119]). Indianapolis isolated 1278 cultures (STI clinic, 1265 [women, 125; men, 1139; transwomen, 1]; ED, 13 all male). Reduced azithromycin susceptibility was found at the Indianapolis (n = 86) and Greensboro (n = 25) STI clinics, and one Greensboro ED (n = 8).Implementation successes included identifying an on-site "champion," integrating with electronic medical records, and creating an online training hub. Barriers included cumbersome data collection tools, time constraints, and hesitancy from clinical staff., Conclusions: Partnering with EDs for ARNG surveillance poses both challenges and opportunities. Program success can be improved by engaging a local champion to help lead efforts., Competing Interests: Conflict of Interest and Sources of Funding: The authors have no conflicts of interest to disclose. Funding for the Strengthening the US Response to Resistant Gonorrhea activities described in this article was supported by federal Antibiotic Resistance Initiative funding and administered through the US Centers for Disease Control and Prevention’s (CDC) Epidemiology and Laboratory Capacity for the Prevention and Control of Infectious Diseases ELC Cooperative Agreement (CK19-1904)., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)