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Circadian clocks may mediate lifespan extension by caloric or dietary restriction (DR). We find that the core clock transcription factorClockis crucial for a robust longevity and fecundity response to DR inDrosophila. To identify clock-controlled mediators, we performed RNA-sequencing from abdominal fat bodies across the 24 h day after just 5 days under control or DR diets. In contrast to more chronic DR regimens, we did not detect significant changes in the rhythmic expression of core clock genes. Yet we discovered that DR induced de novo rhythmicity or increased expression of rhythmic clock output genes. Network analysis revealed that DR increased network connectivity in one module comprised of genes encoding proteasome subunits. Adult, fat body specific RNAi knockdown demonstrated that proteasome subunits contribute to DR-mediated lifespan extension. Thus, clock control of output links DR-mediated changes in rhythmic transcription to lifespan extension.

Objective: To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey. Setting: Acute-care hospitals. Participants: ASP leaders. Methods: Advance letters and electronic questionnaires were initiated February 2020. Primary outcomes were percentage of hospitals that (1) implemented facility-specific treatment guidelines (FSTG); (2) performed interactive prospective audit and feedback (PAF) either face-to-face or by telephone; (3) optimized diagnostic testing; (4) measured antibiotic utilization; (5) measured C. difficile infection (CDI); and (6) measured adherence to FSTGs. Results: Of 948 hospitals invited, 288 (30.4%) completed the questionnaire. Among them, 82 (28.5%) had Conclusions: Significant variation exists in the adoption of ASP leading practices. A minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs. Additional efforts are needed to expand adoption of leading practices across all acute-care hospitals with the greatest need in smaller hospitals.

The paralysis of the muscles controlling the hand dramatically limits the quality of life of individuals living with spinal cord injury (SCI). Here, we present a non-invasive neural interface technology that will change the lives of individuals living with cervical SCI (C4-C6). We demonstrate that eight motor- and sensory-complete SCI individuals (C5-C6, n = 7; C4, n = 1) are still able to task-modulate in real-time the activity of populations of spinal motor neurons with spared corticospinal pathways. In all tested patients, we identified groups of motor units under voluntary control that encoded a variety of hand movements. The motor unit discharges were mapped into more than 10 degrees of freedom, ranging from grasping to individual hand digit flexions and extensions. We then mapped the neural dynamics into a real-time controlled virtual hand. The patients were able to match the cue hand posture by proportionally controlling four degrees of freedom (opening and closing the hand and index flexion/extension). These results demonstrate that wearable muscle sensors provide access to voluntarily controlled neural activity in complete cervical SCI individuals.

Background Despite good safety data, the risk of peri-operative treatment with biologics in IBD is still discussed controversially. Recently, the prospective PUCCINI trial demonstrated that direct exposure to TNF-blockers within 12 wks. of abdominal surgery was not associated with more infectious complications. However, in daily clinical practice experiences on biological treatment peri-operatively are limited. In our current retrospective trial, we addressed the safety of different biologicals in a peri-operative setting. Methods Eligible pat. in this single center study were recruited from our IBD center between 2012 and 2022. Direct exposure to biologics was defined as exposure to biologics within 12 wks. before resective bowel surgery performed at our surgical department. To evaluate safety, the post-operative outcome focused on minor complications, defined as infectious complications, wound healing complications and major complications, defined as insufficiency of the anastomosis and abscess formation at surgery site post-operatively. Results A total of 447 IBD pat. (334 CD, 113 UC, 51.9% female) were included and followed for a median of 45 mo. [range 0-113]. Median age was 44 yrs. [19-89], median age at diagnosis was 24 yrs. [5-84] and median age at surgery was 41 yrs. [16/85]. Median disease duration until surgery was 11 yrs. [0-47]. 74.3% of pat. had moderate to severe disease activity at date of surgery. A total of 73.9% of pat. (326/447) had medical treatment at date of surgery, 61.5% of pat. (275/447) were treated with biologics within 3 mo. before surgery and 42.3% (189/447) had biologic treatment within 4 wks. before surgery. Overall, 36.9% of pat. (164/447) received infliximab, 13.0 % (58/447) adalimumab, 1.1% (6/447) golimumab, 5.8% (26/447) vedolizumab, and 6.5% (29/447) ustekinumab, peri-operatively. Most surgeries were planned electively (97.1%, 434/447) and performed laparoscopically (67.8%, 303/447). Minor and major post-operative complications occurred in 20.8% (93/447) of patients. Serious complications were observed in 9 pat., six had acute bleeding, one developed peritonitis and two died post-operatively (one with and one without biologics). Using logistic regression models, no significant differences regarding complications and safety were observed between pat. with versus without biologic treatment. Interestingly, CD pat. with direct exposure to biologics within 4 wks. were more likely to undergo minimal-invasive surgery (68.6%, 107/156) than pat. with biologics within 3 mo. before surgery (48.28%, 28/58, p=0.02). Conclusion This retrospective single center study of 447 IBD patients could demonstrate that biologic treatment before surgery, even within 4 wks, is not associated with a higher risk of complications.

Theories about the neural control of movement are largely based on movement-sensing devices that capture the dynamics of predefined anatomical landmarks. However, neuromuscular interfaces such as surface electromyography (sEMG) can potentially overcome the limitations of these technologies by directly sensing the motor commands transmitted to the muscles. This allows for the continuous, real-time prediction of kinematics and kinetics without being limited by the biological and physical constraints that affect motion-based technologies. In this work, we present a deep learning method that can decode and map the electrophysiological activity of the forearm muscles into movements of the human hand. We recorded the kinematics and kinetics of the human hand during a wide range of grasping and individual digit movements covering more than 20 degrees of freedom of the hand at slow (0.5 Hz) and fast (1.5 Hz) movement speeds in healthy participants. The input of the model consists of three-hundred EMG sensors placed only on the extrinsic hand muscles. We demonstrate that our neural network can accurately predict the kinematics and contact forces of the hand even during unseen movements and with simulated real-time resolution. By examining the latent space of the network, we find evidence that it has learned the underlying anatomical and neural features of the sEMG that drive all hand motor behaviours.

Light at night (LAN) has been associated with negative health consequences and metabolic risk factors. Little is known about the prevalence of LAN in older adults in the United States and its association with CVD risk factors. We tested the hypothesis that LAN in older age is associated with higher prevalence of individual CVD risk factors. Five hundred and fifty-two community-dwelling adults aged 63−84 years underwent an examination of CVD risk factor profiles and 7-day actigraphy recording for activity and light measures. Associations between actigraphy-measured LAN, defined as no light vs. light within the 5-hour nadir (L5), and CVD risk factors, including obesity, diabetes, hypertension, and hypercholesterolemia, were examined, after adjusting for age, sex, race, season of recording, and sleep variables. LAN exposure was associated with a higher prevalence of obesity (multivariable-adjusted odds ratio [OR] 1.82 [95% CI 1.26−2.65]), diabetes (OR 2.00 [1.19−3.43]), and hypertension (OR 1.74 [1.21−2.52]) but not with hypercholesterolemia. LAN was also associated with (1) later timing of lowest light exposure (L5-light) and lowest activity (L5-activity), (2) lower inter-daily stability and amplitude of light exposure and activity, and (3) higher wake after sleep onset. Habitual LAN in older age is associated with concurrent obesity, diabetes, and hypertension. Further research is needed to understand long-term effects of LAN on cardiometabolic risks.

Background Standardized measurement of health care-associated infections is essential to improving nursing home (NH) resident safety, however voluntary enrollment of NHs in Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) requires several steps. We sought to prospectively identify NH structural, process or staff characteristics that affect enrollment and data submission among a cohort of NHs receiving facilitated implementation. Methods The evaluation employed a mixed methods approach. The meta-theoretical Consolidated Framework for Implementation Research was used to analyze reported facilitators and challenges. Primary and secondary outcomes were time to NHSN enrollment and data submission, respectively. Results Of 36 participating NHs, 27 (75%) completed NHSN enrollment and 21 (58%) submitted 1 or more months of infection data during the 8-month study period. Mean days to complete enrollment was 82 (standard deviation [SD] = 24, range = 51-139) and days to first data submission was 112 (SD = 45, range = 71-245). Characteristics of NH staff liaisons associated with shorter time to enrollment included infection prevention and control knowledge, personal confidence, and responsibility for infection prevention and control activities. Facility characteristics were not associated with outcomes. Discussion Time to NHSN enrollment and submission related more to characteristics of the person leading the process than to characteristics of the NH. Conclusions External partnerships that provide real-time support and resources are important assets in promoting successful NH participation in NHSN.

Background Beginning in October 2016, the Centers for Medicare & Medicaid Services (CMS) issued expanded guidance requiring accrediting organizations and state survey agencies to report serious infection control breaches to relevant state health departments. This project sought to characterize and summarize The Joint Commission's early experiences and findings in applying this guidance to facilities accredited under the ambulatory and office-based surgery programs in 2017. Methods Surveyor notes were retrospectively reviewed to identify individual breaches, and then the Centers for Disease Control and Prevention's Infection Prevention Checklist for Outpatient Settings was used to categorize and code documented breaches. Results Of 845 ambulatory organizations, 39 (4.6%) had breaches observed during the survey process and reported to health departments. Within these organizations, surveyors documented 356 breaches, representing 52 different breach codes. Common breach domains were sterilization of reusable devices, device reprocessing observation, device reprocessing, disinfection of reusable devices, and infection control program and infrastructure. Eight of the 39 facilities (20.5%) were cited for not performing the minimum level of reprocessing based on the items' intended use, reusing single-use devices, and/or not using aseptic technique to prepare injections. Conclusion The CMS infection control breach reporting requirement has helped highlight some of the challenges faced by ambulatory facilities in providing a safe care environment for their patients. This analysis identified numerous opportunities for improved staff training and competencies as well as leadership oversight and investment in necessary resources. More systematic assessments of infection control practices, extending to both accredited and nonaccredited ambulatory facilities, are needed to inform oversight and prevention efforts.

The 2014–2016 Ebola epidemic in West Africa provided an opportunity to improve our response to highly infectious diseases. We performed a systematic literature review in PubMed, Cochrane Library, CINAHL, EMBASE, and Web of Science of research articles that evaluated benefits and challenges of hospital Ebola preparation in developed countries. We excluded studies performed in non-developed countries, and those limited to primary care settings, the public health sector, and pediatric populations. Thirty-five articles were included. Preparedness activities were beneficial for identifying gaps in hospital readiness. Training improved health-care workers’ (HCW) infection control practices and personal protective equipment (PPE) use. The biggest challenge was related to PPE, followed by problems with hospital infrastructure and resources. HCWs feared managing Ebola patients, affecting their willingness to care for them. Standardizing protocols, PPE types, and frequency of training and providing financial support will improve future preparedness. It is unclear whether preparations resulted in sustained improvements. Prospero Registration. CRD42018090988.

Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.

Background: Violent workplace deaths among health care workers (HCWs) remain understudied in the extant literature despite the potential for serious long-term implications for staff and patient safety. This descriptive study summarized the number and types of HCWs who experienced violent deaths while at work, including the location in which the fatal injury occurred. Methods: Cases were identified from the Centers for Disease Control and Prevention’s National Violent Death Reporting System between 2003 and 2016. Coded variables included type of HCW injured, type of facility, and location within the facility and perpetrator type among homicides. Frequencies were calculated using Excel. Findings: Among 61 HCW deaths, 32 (52%) were suicides and 21 (34%) were homicides; eight (13%) were of undetermined intent. The occupations of victims included physicians (28%), followed by nurses (21%), administration/support operations (21%), security and support services (16%), and therapists and technicians (13%). Most deaths occurred in hospitals (46%) and nonresidential treatment services (20%). Within facility, locations included offices/clinics (20%) and wards/units (18%). Among homicide perpetrators, both Type II (perpetrator was client/patient/family member) and Type IV (personal relationship to perpetrator) were equally common (33%). Conclusion/ Applications to Practice: Suicide was more common than homicide among HCW fatal injuries. Workplace violence prevention programs may want to consider both types of injuries. Although fatal HCW injuries are rare, planning for all types of violent deaths could help minimize consequences for staff, patients, and visitors.

Direct comparison of results of humans and monkeys is often complicated by differences in experimental conditions. We replicated in head unrestrained macaques experiments of a recent study comparing human directional precision during smooth pursuit eye movements (SPEM) and saccades to moving targets (Braun & Gegenfurtner, 2016). Directional precision of human SPEM follows an exponential decay function reaching optimal values of 1.5°-3° within 300 ms after target motion onset, whereas precision of initial saccades to moving targets is slightly better. As in humans, we found general agreement in the devel-opment of directional precision of SPEM over time and in the differences between direc-tional precision of initial saccades and SPEM initiation. However, monkeys showed over-all lower precision in SPEM compared to humans. This was most likely due to differences in experimental conditions, such as in the stabilization of the head, which was by a chin and a head rest in human subjects and unrestrained in monkeys.

Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.

Summary Eye movements are an integral part of human visual perception. They allow us to have a small foveal region with exquisite acuity and at the same time a large visual field. For a long time, eye movements were regarded as machine-like behaviors in response to visual stimulation 1 , but over the past few decades it has been convincingly shown that expectations, intended actions, rewards and many other cognitive factors can have profound effects on the way we move our eyes 2 , 3 , 4 . In order to be useful, our oculomotor system must minimize delay with respect to the dynamic events in the visual scene. The ability to do so has been demonstrated in situations where we are in control of these events, for example when we are making a sandwich or tea 5 , and when we are active participants, for example when hitting a cricket ball 6 . But what about scenes with complex dynamics that we do not control or directly take part in, like a hockey game we are watching as a spectator? A semantic influence on gaze fixation location during viewing of tennis videos has been suggested before 7 . Here we use carefully annotated hockey videos to show that the brain is indeed able to exploit the semantic context of the game to anticipate the continuous motion of the puck, leading to eye movements that are fundamentally different than when following exactly the same motion without any context.

Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.Funding: The Pew Charitable TrustsDisclosures: None

Smooth pursuit and motion perception have mainly been investigated with stimuli moving along linear trajectories. Here we studied the quality of pursuit movements to curved motion trajectories in human observers and examined whether the pursuit responses would be sensitive enough to discriminate various degrees of curvature. In a two-interval forced-choice task subjects pursued a Gaussian blob moving along a curved trajectory and then indicated in which interval the curve was flatter. We also measured discrimination thresholds for the same curvatures during fixation. Motion curvature had some specific effects on smooth pursuit properties: trajectories with larger amounts of curvature elicited lower open-loop acceleration, lower pursuit gain, and larger catch-up saccades compared with less curved trajectories. Initially, target motion curvatures were underestimated; however, ∼300 ms after pursuit onset pursuit responses closely matched the actual curved trajectory. We calculated perceptual thresholds for curvature discrimination, which were on the order of 1.5 degrees of visual angle (°) for a 7.9° curvature standard. Oculometric sensitivity to curvature discrimination based on the whole pursuit trajectory was quite similar to perceptual performance. Oculometric thresholds based on smaller time windows were higher. Thus smooth pursuit can quite accurately follow moving targets with curved trajectories, but temporal integration over longer periods is necessary to reach perceptual thresholds for curvature discrimination. NEW & NOTEWORTHY Even though motion trajectories in the real world are frequently curved, most studies of smooth pursuit and motion perception have investigated linear motion. We show that pursuit initially underestimates the curvature of target motion and is able to reproduce the target curvature ∼300 ms after pursuit onset. Temporal integration of target motion over longer periods is necessary for pursuit to reach the level of precision found in perceptual discrimination of curvature.

Visual sensitivity is dynamically modulated by eye movements. During saccadic eye movements, sensitivity is reduced selectively for low-spatial frequency luminance stimuli and largely unaffected for high-spatial frequency luminance and chromatic stimuli (Nature 371 (1994), 511-513). During smooth pursuit eye movements, sensitivity for low-spatial frequency luminance stimuli is moderately reduced while sensitivity for chromatic and high-spatial frequency luminance stimuli is even increased (Nature Neuroscience, 11 (2008), 1211-1216). Since these effects are at least partly of different polarity, we investigated the combined effects of saccades and smooth pursuit on visual sensitivity. For the time course of chromatic sensitivity, we found that detection rates increased slightly around pursuit onset. During saccades to static and moving targets, detection rates dropped briefly before the saccade and reached a minimum at saccade onset. This reduction of chromatic sensitivity was present whenever a saccade was executed and it was not modified by subsequent pursuit. We also measured contrast sensitivity for flashed high- and low-spatial frequency luminance and chromatic stimuli during saccades and pursuit. During saccades, the reduction of contrast sensitivity was strongest for low-spatial frequency luminance stimuli (about 90%). However, a significant reduction was also present for chromatic stimuli (about 58%). Chromatic sensitivity was increased during smooth pursuit (about 12%). These results suggest that the modulation of visual sensitivity during saccades and smooth pursuit is more complex than previously assumed.

OBJECTIVETo assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014–2015 Ebola virus disease (EVD) epidemic in the United States.METHODSA survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children’s general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours. The average national wage was multiplied by labor hours to calculate overtime labor costs. Additional information collected included challenges, benefits, and perceived value of EVD preparedness activities.RESULTSThe average amount spent by hospitals on combined supply and overtime labor costs was $80,461 (n=133; 95% confidence interval [CI], $56,502–$104,419). Multivariate analysis indicated that small hospitals (mean, $76,167) spent more on staff overtime costs per 100 beds than large hospitals (mean, $15,737; PCONCLUSIONSThe financial impact of EVD preparedness activities was substantial. Overtime cost in smaller hospitals was >3 times that in larger hospitals. Planning for emerging infectious disease identification, triage, and management should be conducted at regional and national levels in the United States to facilitate efficient and appropriate allocation of resources in acute-care facilities.Infect Control Hosp Epidemiol 2017;38:405–410

To accurately foveate a moving target, the oculomotor system needs to estimate the position of the target at the saccade end, based on information about its position and ongoing movement, while accounting for neuronal delays and execution time of the saccade. We investigated human interceptive saccades and pursuit responses to moving targets defined by high and low luminance contrast or by chromatic contrast only (isoluminance). We used step-ramps with perpendicular directions between vertical target steps of 10 deg/s and horizontal ramps of 2.5 to 20 deg/s to separate errors with respect to the position step of the target in the vertical dimension, and errors related to target motion in the horizontal dimension. Interceptive saccades to targets of high and low luminance contrast landed close to the actual target positions, suggesting relatively accurate estimates of the amount of target displacement. Interceptive saccades to isoluminant targets were less accurate. They landed at positions the target had on average 100 ms before saccade onset. One account of this finding is that the integration of target motion is compromised for isoluminant targets moving in the periphery. In this case, the oculomotor system can use an accurate, but delayed position component, but cannot account for target movement. This deficit was also present for the postsaccadic pursuit speed. For the two luminance conditions, pursuit direction and speed were adjusted depending on the saccadic landing position. The rapid postsaccadic pursuit adjustments suggest shared position- and motion-related signals of target and eye for saccade and pursuit control.

We investigated in “art-naïve” German and Chinese participants the perception of color and spatial balance in abstract art. For color perception, we asked participants (a) to adjust the color of a single element in 24 paintings according to their liking and (b) to indicate whether they preferred their version of the painting or the original. For spatial perception, we asked participants (a) to determine the “balance point” of an artwork and (b) to indicate their preferences for the original or left-right reversed orientation of previously seen and unfamiliar paintings. Results of the color experiments suggest that, even though the interactive task was of a rather open-ended nature, observers’ color adjustments were not random but systematically influenced by each painting’s color palette. Overall, participants liked their own color choices about as much as the original composition. Results of the spatial experiments reveal a remarkable consistency between participants in their balance point settings. The perceived lateral position of the balance point systematically affected the left-right orientation preference for a given painting. We conclude that “art-naïve” observers are sensitive to the composition of colors and spatial structures in abstract art and are influenced by their cultural backgrounds when experiencing abstract paintings.

Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies.Infect Control Hosp Epidemiol 2016;1–6

It is well known that surfactant-suspended carbon nanotube (CNT) samples can be purified by centrifugation to decrease agglomerates and increase individually-dispersed CNTs. However, centrifugation is not always part of protocols to prepare CNT samples used in biomedical applications. Herein, using carboxylated multi-walled CNTs (cMWCNTs) suspended in water without a surfactant, we developed a Boehm titrimetric method for the analysis of centrifuged cMWCNT suspensions and used it to show that the surface acidity of oxidized carbon materials in aqueous cMWCNT suspensions was enriched by ∼40% by a single low-speed centrifugation step. This significant difference in surface acidity between un-centrifuged and centrifuged cMWCNT suspensions has not been previously appreciated and is important because the degree of surface acidity is known to affect the interactions of cMWCNTs with biological systems.

Significance Intensive research has focused on the question of how the visual system distinguishes between and accounts for retinal motion caused by eye movements or by physical object movements to maintain a stable world. So far, interactions between saccades and smooth pursuit movements during tracking responses and their specific effects on visual perception were mainly studied in isolation. We investigated the effect of corrective saccades on speed perception during pursuit initiation and found that the direction of corrective saccades influenced whether the observer perceived the tracked moving targets to be moving faster or more slowly than in pure pursuit trials. This small loss in perceptual accuracy is probably outweighed by the improvement in tracking through the rapid reduction in both position and velocity errors., Due to the foveal organization of our visual system we have to constantly move our eyes to gain precise information about our environment. Doing so massively alters the retinal input. This is problematic for the perception of moving objects, because physical motion and retinal motion become decoupled and the brain has to discount the eye movements to recover the speed of moving objects. Two different types of eye movements, pursuit and saccades, are combined for tracking. We investigated how the way we track moving targets can affect the perceived target speed. We found that the execution of corrective saccades during pursuit initiation modifies how fast the target is perceived compared with pure pursuit. When participants executed a forward (catch-up) saccade they perceived the target to be moving faster. When they executed a backward saccade they perceived the target to be moving more slowly. Variations in pursuit velocity without corrective saccades did not affect perceptual judgments. We present a model for these effects, assuming that the eye velocity signal for small corrective saccades gets integrated with the retinal velocity signal during pursuit. In our model, the execution of corrective saccades modulates the integration of these two signals by giving less weight to the retinal information around the time of corrective saccades.

Background The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. Methods The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. Results An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. Conclusion A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.

This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, "Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA," which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance. © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Background TNFα inhibitors are a well-known risk factor for active tuberculosis but less is known about the link between TNFα inhibitors and other mycobacterial diseases, particularly M. marinum. With the increase in use of these medications, and the trend toward more outdoors activities that include aquatic environment exposure, focus should be on better understanding of the link between use of TNFα inhibitors and the development of a severe M. marinum infection that might require earlier diagnosis and more aggressive antibiotic therapy. Methods We will describe our experience with three cases of aggressive cutaneous M. marinum infection in patients taking anti-TNFα that presented to Abington Memorial Hospital in Pennsylvania between 2014 and 2017. Results Age, gender, diagnosis Age, gender, diagnosis Anti TNFα, duration and indication Exposure Delay in diagnosis Treatment Progression 47 y.o F Cellulitis/lymphangitis Etanercept, 5 years, for RA Municipal pool 2 weeks Clarithromycin+ etmabutol Cleared in 2 months 34 y.o M cellulitis Infliximab, 7 years, UC Salt water fish tank 10 weeks Clarithromycin+ etmabutol Cleared in 3 weeks 62 y.o F Cellulitis/lymphangitis Adalimumab, 8 months, RA Barnacle injury 4 weeks Clarithromycin+ Rifampin Cleared in 1 month Conclusion TNFα is not only linked to active TB, but also associated with other mycobacterial diseases including M. marinum. While CDC reports a delay of 17 months from time of onset of symptoms to establishing the diagnosis, our three cases were diagnosed much earlier. Early diagnosis relies probably on involvement of Infectious diseases specialists early in the course of the illness and the readiness in sampling of the lesions. The challenge to the clinicians remain in the safety and the timing of resuming anti TNFα treatment after M. marinum infection. Disclosures All authors: No reported disclosures.