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The REstarting Safe Education and Testing program for children with medical complexity was implemented in May 2021 at the University of Wisconsin to evaluate the feasibility of in-home rapid antigen COVID-19 testing among neurocognitively affected children. Parents or guardians administered BinaxNOW rapid antigen self-tests twice weekly for three months and changed to symptom and exposure testing or continued surveillance. In-home testing was feasible: nearly all (92.5%) expected tests were conducted. Symptomatic testing identified seven of nine COVID-19 cases. School safety perceptions were higher among those opting for symptom testing. Clinical Trials.gov identifier: NCT04895085. (Am J Public Health. 2022;112(S9):S878–S882. https://doi.org/10.2105/AJPH.2022.306971 )

Patient Safety Learning Labs (PSLL) are a program funded by US Agency for Healthcare and Quality, and represent a substantial investment by the US federal government to strengthen capacities for applying system engineering methods in healthcare to improve patient safety. Human factors professionals have been well represented in the program as investigators and consultants. This panel is composed of leaders in 4 PSLLs, as well as overall program leaders, to address questions on the PSLL program, roles of human factors professionals in the program, and considerations for success PSLLs. The panel will help those human factors professionals contemplating forming PSLLs or active in a PSLL, and solicit input from human factors communities on ways to achieve effective collaborations for enhanced patient safety.

CONTEXT Most care occurs in home and community settings; however, the best approaches to improve CMC health are poorly understood. OBJECTIVE We sought to summarize evidence from interventions in the home and community to improve health for children with medical complexity (CMC) using comprehensive conceptions of CMC health. DATA SOURCES PubMed, CINAHL, Scopus, and Cochrane databases. STUDY SELECTION Included studies evaluated interventions for CMC caregivers in home or community settings and evaluated at least 1 outcome in 10 domains of CMC health. DATA EXTRACTION Data were extracted on participant characteristics, intervention activities, and outcomes. Interventions were categorized thematically into strategies, with results summarized by effects on outcomes within each health domain. RESULTS The 25 included interventions used 5 strategies: intensive caregiver education (n = 18), support groups (n = 3), crisis simulation (n = 2), mobile health tracking (n = 1), and general education (n = 1). Substantial variation existed in the extent to which any outcome domain was studied (range 0–22 studies per domain). Interventions addressing 4 domains showed consistent improvement: support group and mobile health tracking improved long-term child and caregiver self-sufficiency; mobile health tracking improved family-centered care; intensive caregiver education and support groups improved community system supports. Three domains (basic needs, inclusive education, patient-centered medical home) were not studied. LIMITATIONS Risk of bias was moderate due primarily to limited controlled experimental designs and heterogeneous population and outcome definitions. CONCLUSIONS Interventions that improve CMC health exist; however, current studies focus on limited segments of the 10 domains framework. Consensus outcome measures for CMC health are needed.

While there is evidence that iron overload disorders are associated with type 2 diabetes, the relationship between hepatic iron overload and prediabetes remains unclear. We aimed to investigate the association between hepatic iron overload, as assessed by magnetic resonance imaging (MRI), and different glucose intolerance states in the population-based Study.We included data from 1622 individuals with MRI data, who did not have known type 2 diabetes (T2DM). Using an oral glucose tolerance testing, participants were classified as having isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT) or previously unknown T2DM. Hepatic iron and fat contents were assessed through quantitative MRI. We undertook linear and multinomial logistic regression models adjusted for potential confounders and MRI-assessed hepatic fat content to examine the association of hepatic iron overload with different glucose intolerance states or continuous markers of glucose metabolism. MRI-assessed hepatic iron overload was positively associated only with both 2-h plasma glucose (β = 0.32; 95%CI 0.04-0.60) and the combined IFG + IGT category (relative risk ratio = 1.87; 95%CI 1.15-3.06). No significant associations were found between hepatic iron overload and other glucose intolerance states or biomarkers of glucose metabolism, independently of potential confounders.MRI-assessed hepatic iron overload was associated with higher 2-h glucose concentrations and the combined IFG + IGT category, but not with other glucose intolerance states. Our findings suggest a weak adverse impact of hepatic iron overload on glucose metabolism, but further studies are needed to confirm these findings.

BACKGROUND Research and policy demonstrate the value and need for systematically identifying and preparing care partners for their caregiving responsibilities while their family member or friend living with dementia is hospitalized. The Care Partner Hospital Assessment Tool (CHAT) had undergone content and face validation and been endorsed as appropriate by clinicians to facilitate the timely identification and preparation of care partners of older adult patients during their hospitalization. However, the CHAT has not yet been adapted or prospectively evaluated for use with care partners of hospitalized persons living with dementia (PLWD). Adapting and testing the CHAT via a pilot study will provide the necessary evidence to optimize feasibility and enable future efficacy trials. OBJECTIVE To describe the study protocol for the adaptation and testing of the CHAT for use among care partners of hospitalized PLWD to better prepare them for their caregiving responsibilities after hospital discharge. METHODS Our protocol consists of two sequential phases, including a formative research and main trial. In Phase 1, we will use a participatory human-centered design process that incorporates PLWD and their care partners, healthcare administrators, and clinicians to adapt the CHAT for dementia care (i.e., D-CHAT). In Phase 2, we will partner with a large academic medical system to complete a pilot randomized controlled trial to examine the feasibility and estimate the size of the effect of the D-CHAT on care partners’ preparedness for caregiving. RESULTS The study protocol will yield: 1) a converged-upon, ready for feasibility testing, D-CHAT, 2) descriptive and feasibility characteristics of delivering the D-CHAT, and 3) effect size estimates of the D-CHAT on care partner preparedness. CONCLUSIONS We anticipate that the resultant D-CHAT will provide clinicians guidance on how to identify and better prepare care partners of hospitalized PLWD. In turn, care partners will feel equipped to fulfill caregiving roles for their family members or friends living with dementia. CLINICALTRIAL Dementia Care Partner Hospital Assessment Tool ClinicalTrials.gov Identifier: NCT05592366 https://clinicaltrials.gov/ct2/show/NCT05592366

BACKGROUND Research and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners’ active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. OBJECTIVE This paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. METHODS The A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. RESULTS The A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. CONCLUSIONS We anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/45274

The nearly 11 million unpaid caregivers ('family members or friends') who provide care to the 6.5 million people living with Alzheimer's disease and related dementias (ADRD) in the United States are frequently tasked with substantial and overwhelming care budgeting and planning. Yet, many of these caregivers encounter individual-level barriers that make it difficult to carry out care budgeting and planning tasks. An individual-level factor that is not well understood is the education level of ADRD caregivers.This ongoing study is investigating the role of caregiver education level in predicting confidence in ADRD care budgeting and planning.Caregivers of people living with ADRD residing in the United States completed the Caregiving Financial and Legal Planning Survey in 2022. Secondary analyses of cross-sectional data are currently underway. A total of 238 caregivers self-reported their confidence in care budgeting and planning, which was assessed by the following question "How confident are you in knowing about care budgeting and planning (1 = not at all confident, 5 = extremely confident). Those responding '4' or greater were designated as high confidence. Descriptive statistics were used to examine demographic characteristics of caregivers. Logistic regression analyses will be used to determine the relationship between caregiver education level and confidence in care budgeting and planning while controlling for demographic characteristics.The average caregiver was 52 years old (range 36-67), female (78%), white (82%), and had a bachelor's or equivalent level of education (34%). Thirty-five percent of the caregivers (83) reported high confidence. Logistic regression analyses are in progress.Results may suggest that caregivers with higher education levels feel more confident in care budgeting and planning. Practitioners and researchers may need to evaluate ways to improve training resources on how to budget and plan for ADRD care. A better understanding of factors that contribute to care budgeting and planning may inform tailored caregiving interventions and future social support policies.

Background and Objectives Episodes of lucidity (ELs), or a transient return of abilities believed to be lost in people living with dementia, are a growing area of interest. These events hold important implications for care, caregiving, and our understanding of underlying etiologies. Research on ELs is largely limited to retrospective reports. The perspectives of professional and family caregivers on ELs and research approaches can inform efforts to define and study lucidity. The present study examined family caregiver and hospice clinician experiences with and perspectives on ELs in people living with dementia and observational approaches to studying these events. Research Design and Methods This exploratory, descriptive qualitative study employed semistructured interviews (N = 20 caregivers, N = 6 clinicians). Data were analyzed using Rapid Identification of Themes and subsequent duplicate review of interview data to enhance trustworthiness. Results Most participants readily recalled events they perceived as ELs, describing a transient return of abilities they felt was significant and/or meaningful. Defining features, interpretations, and the perceived impact of ELs varied, although ELs were commonly conceptualized as a manifestation of self. Caregivers described extensive efforts to detect patterns and supportive social conditions for ELs. Participants supported use of audiovisual observation to study ELs and provided recommendations for privacy, workflow, and caregiver engagement. Discussion and Implications Interpretations of ELs are heterogeneous, and recognition of these events may necessitate close familiarity with the person living with dementia. Participants endorse observational approaches and integration of caregivers in this research.

Participatory design, or co-design, is an effective method for creating useful digital products with older adults. However, little is known about older adults’ perceptions of virtual co-design. The purpose of this study was to explore ADRD care partner perceptions of their participation in virtual co-design, including the degree to which participants felt their participation influenced the design. After participating in a 5-session virtual co-design process, care partners completed individual semi-structured interviews and surveys focused on exploring their perceptions of the co-design process. Surveys used three sliding scale items and open text responses. Interview transcripts and survey data were analyzed using thematic analysis and descriptive statistics, respectively. Co-designers were Nf7 older adults (71% female) with a mean age of 65. On a scale of 1–100, co-designers rated the extent to which their own participation influenced the design process at a mean of 88, their fellow co-designers at 90, and the research team at 82. Thematic analysis identified five design process perceptions: 1) the process built community among co-designers; 2) sessions were well-facilitated and organized; 3) the prototype would be helpful to other care partners like them; 4) co-designers felt ownership over the prototype; and 5) co-designers had long-term goals for the product. Results suggest that care partners perceived themselves as having considerable influence on the final prototype. Those designing interventions for ADRD care partners should be encouraged that involving them in the design process may provide unanticipated benefits to care partners and build an intervention responsive to care partner needs.

Purpose Limbo-keratoplasty enables visual improvement and limbal stem cell transplantation at the same. During follow-up, most grafts show vascularization of the limbus. However, it is unclear whether vascularization is harmful due to immunologic effects or helpful to nourish the limbal stem cells and is therefore necessary for a clear graft. The aim of our study is to analyze the influence of graft vascularization on graft survival following homologous limbo-keratoplasty. Methods In this retrospective study, we assessed all consecutive limbo-keratoplasties performed in our hospital. All eyes with suitable photo-documentation were included and divided into two groups (limbal stem cell deficiency and corneal dystrophy). We categorized the grade of vascularization (0, 1, 2, 3, 3b) and analyzed clear graft survival, recurrence of the underlying disease and the endothelial cell density (ECD) with regard to the reason for the graft. Event rates were estimated with the Kaplan–Meier method. Results A total of 79 eyes with limbal stem cell deficiency and 15 with corneal dystrophies were analyzed. A high degree of graft vascularization had a tendency for better graft survival in limbal stem cell deficiency, whereas in corneal dystrophies, grafts with no vascularization had preferable outcomes. Recurrence-free graft survival was only seen in grade 1 and 3 vascularization in corneal dystrophies. Conclusion Vascularization of the limbus seems to have an impact on the long-term outcome of limbo-keratoplasty. The effect seems to be favorable in limbal stem cell deficiency and on recurrence rates in corneal dystrophies. However, the latter might be overshadowed by an unfavorable immunologic effect in corneal dystrophies where the baseline immunologic risk profile is commonly more favorable than in limbal stem cell deficiency.

Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medications for people with ADRD to guide future design decisions for technology interventions. Data were collected through virtual contextual inquiry in which caregivers (Nf24) sent daily multimedia text messages depicting medication management activities for seven days each, followed by an interview that used the messages as prompts to understand medication management needs. We applied the persona development method to the data to identify distinct caregiver personas, i.e., evidence-derived groups of prospective users of a future intervention. We used team-based affinity diagramming to organize information about participants based on intragroup (dis)similarities, to create meaningful clusters representing intervention-relevant attributes. We then used group consensus discussion to create personas based on attribute clusters. The six identified attributes differentiating personas were: 1. medication acquisition, 2. medication organization, 3. medication administration, 4. monitoring symptoms, 5. care network, 6. technology preferences. Three personas were identified based on differences on those attributes: Regimented Ruth (independent, proactive, tech savvy, controls all medications), Intuitive Ian (collaborative, uses own judgment, some technology, provides some medication autonomy), Passive Pamela (reactive, easy going, technology novice, provides full medication autonomy). These personas can be used to guide technology intervention design by evaluating how well intervention designs support each of them.

The growing field of patient ergonomics is built on an understanding that patients and their social network members increasingly play a key role in managing their health and healthcare across a wide range of settings including the home, workplace, and community. Over the last several years, we have traced, explored, and debated emerging research in this area, including the theories, methods, and strategies for implementation that are needed to support this new area of human factors and ergonomics. In this current panel, we begin a new dialogue in this space, one that is inspired not only by our previous discussions but also by recent conversations in our community about the need for human factors and ergonomics to consider issues of inclusivity, diversity, and social justice. To that end, each of our five panelists will present the patient ergonomics research they are conducting within a historically marginalized community or population and highlight lessons learned from their experiences. This presentation of work spanning considerations of gender, age, race, geographic setting, educational background, and disability will serve as a foundation for a wider discussion with the audience about how patient ergonomics as a field can prioritize and support this type of work.

The aim of our study was to investigate the association of hepatic steatosis derived from quantitative ultrasound and magnetic resonance imaging (MRI) with prediabetes in a large population-based study conducted in Northeast Germany. Hepatic steatosis was assessed through transabdominal ultrasound and quantitative MRI. For analysis we included 1622 subjects with MRI who participated in an oral glucose tolerance test and reported no known type 2 diabetes mellitus (T2DM). We classified participants as proposed by the American Diabetes Association: isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT), and undiagnosed T2DM. Regression models were adjusted for age, sex body mass index and alcohol consumption. We observed positive associations of hepatic steatosis with glycated hemoglobin, fasting glucose and insulin, 2-h glucose and insulin, as well as homeostasis model assessment-insulin resistance index. Similarly, individuals having hepatic steatosis as defined by MRI had a higher relative risk ratio (RR) to be in the prediabetes groups i-IFG (RR = 1.6; 95% confidence interval (CI) 1.2; 2.2), i-IGT (RR = 3.3, 95% CI 2.0; 5.6) and IFG + IGT (RR = 2.5, 95% CI 1.6; 3.9) or to have undiagnosed T2DM (RR = 4.8, 95% CI 2.6; 9.0). All associations were attenuated when defining hepatic steatosis by ultrasound. Hepatic steatosis is associated with prediabetes and undiagnosed T2DM in the general population. Quantitative liver MRI revealed stronger associations with prediabetes and undiagnosed T2DM compared to ultrasound, which indicates the higher sensitivity and specificity of MRI to determine hepatic steatosis.

Though episodes of lucidity (EL) in Alzheimer’s disease and related dementia (ADRD), reportedly more common near end of life, have significant implications for care, they are poorly understood due to underdeveloped methodological approaches for capturing and measuring these events. This prospective observational study addresses these gaps through audiovisual observation among persons with ADRD surrounding end of life to inform data-driven definitions for EL and distinguish EL from routine fluctuations in ADRD. Audiovisual observation is well-suited to addressing gaps in operationalization of EL, providing an objective data source to assess verbal and nonverbal communication, the primary means through which EL are evidenced. Our study is designed to establish optimal procedures for capturing audiovisual data of targeted populations and timeframes to maximize opportunities for detecting EL. Operationalization of EL will be informed by computational linguistic and behavioral-event coding of linguistic and non-linguistic communication features of EL and associated temporal qualities.

Andreprevotia sp. strain IGB-42 is a chitin-degrading bacterium isolated from the soil of an anthill. The genome contains 4.7 Mb, a G+C content of 61.31%, 4,257 predicted open reading frames, and a set of industrially interesting chitinase genes.

BackgroundMiddle-aged and older adults requiring skilled home healthcare (‘home health’) services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition.Objectives(1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers’ perspectives and (2) Identify IM-related process failures.MethodsMultisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams.ResultsWe identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults’ and informal caregivers’ mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information).ConclusionsIM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions.

People and animals share the same environment and antibiotics are used in both. Thus, antibiotics resistance is a major common issue for human and veterinary medicine. The potential impact of antibiotics use in animals on resistance in humans is frequently the focus of debate. In this paper the transmission pathways of resistant bacteria between animals and humans are described and the question is addressed whether a reduction in antibiotics use in animals contributes to the improvement of the resistance situation in humans. Direct contact between humans and animals, transmission of bacteria via food, and indirect transmission via emissions in the environment and the subsequent exposure of humans via the environment are the major transmission routes to be considered. It can thus be established that the relevance of these various transmission routes varies significantly among bacterial species. Furthermore, despite numerous investigations, the exact significance of transmission pathways and the bacteria transferred for the resistance situation in humans cannot yet be precisely quantified. There is evidence that antibiotics use in animals fosters the spread of resistant organisms in animals. Recent studies also suggest that there might be a relationship between antibiotics use in animals and the occurrence of resistance in humans. However, this relationship is complex, and for a better understanding of it and the role of the various transmission pathways, further collaborative studies between veterinary and medical science are needed.

The usage of antimicrobial drugs (AMs) leads to an increase in antimicrobial resistance (AMR). Although different antimicrobial usage (AMU) monitoring programs exist for livestock animals in Germany, there is no such system for horses. However, with the increasing usage of electronic practice management software (EPMS), it is possible to analyze electronic field data generated for routine purposes. The aim of this study was to generate AMU data for German horses with data from the Clinic for Horses (CfH), University of Veterinary Medicine Hannover (TiHo), and in addition to show that different processes of data curation are necessary to provide results, especially considering quantitative indices. In this investigation, the number of antimicrobial doses used and the amount and percentage of active ingredients applied were calculated. Data contained all drugs administered between the 1st of January and the 31st of December 2017. A total of 2,168 horses were presented for veterinary care to the CfH and 34,432 drug applications were documented for 1,773 horses. Of these, 6,489 (18.85%) AM applications were documented for 837 (47.21%) horses. In 2017, 162.33 kg of active ingredients were documented. The most commonly used antibiotic classes were sulfonamides (84.32 kg; 51.95 %), penicillins (30.11 kg; 18.55%) and nitroimidazoles (24.84 kg; 15.30%). In 2017, the proportion of Critically Important Antibiotics (CIA)—Highest Priority used was 0.15% (0.24 kg) and the proportion of CIA—High Priority used was 20.85% (33.85 kg). Of the total 9,402 entries of antimicrobial active ingredients, the three with the largest number used were sulfonamides [n = 2,798 (29.76%)], trimethoprim [n = 2,757 (29.76%)] and aminoglycosides [n = 1,381 (14.69%)]. Comparison between Administered Daily Dose (ADA) and Recommended Daily Dose of CfH (RDDCfH), showed that 3.26% of ADA were below RDDCfH, 3.18% exceeded RDDCfH and 93.55% were within the range around RDDCfH. This study shows that data generated by an EPMS can be evaluated once the method is set up and validated. The method can be transferred to evaluate data from the EPMS of other clinics or animal species, but the transferability depends on the quality of AMU documentation and close cooperation with respective veterinarians is essential.

Microbial biosurfactants represent a promising alternative for current petrochemical or oleochemical surfactants. Mannosylerythritol lipids (MEL) are highly promising glycolipids produced mainly by basidiomycetous fungi of the Ustilaginomycetes class. A large variety of structures has already been found in wild-type strains. Moreover, novel structures can be designed by combining different strains and substrates, by genetic engineering or by enzymatic modification. Nevertheless, large-scale production of the different structures in bioreactors leading to higher yields and thus a more economic process still needs to be addressed in more detail. So far, it has only been investigated for two different strains, leaving space for further process optimization. This chapter is intended to give an overview of state of the art from a scientific perspective on mannosylerythritol lipids, focusing on its structural variety and how this can be tailored by employing different microorganisms and cultivation strategies to fit the various fields of application.

In the German National Cohort (GNC), 30,000 individuals are examined with whole-body MRI (wbMRI), of which about 3000 participants are expected to receive an incidental finding (IF) disclosure. In order to get feedback from participants and to evaluate the IF-management procedure of the wbMRI substudy, a follow-up questionnaire was developed. This single-center pilot trial was aimed to get a first impression on feasibility reproducibility and validity of such a survey in order to take necessary adjustments before initiating the survey among several thousand participants. The questionnaires were sent out in test–retest manner to 86 participants who received a wbMRI examination in January–February 2016 at the imaging center in Neubrandenburg. The ratio of participants with and without IF notification was 1:1. Descriptive statistics was performed. A first response of 94% and completion proportion of 99% were achieved. Participants were satisfied with the examination procedure. Ninety-five percent of participants considered it very important to receive notification of IFs. Participants reported minimal stress levels while waiting for a possible IF notification letter, but high stress levels when an IF letter was received. Phrasing of the IF reports was rated in 97% as well understandable and in 55% as beneficial to health status. This questionnaire will serve researchers within the GNC as a fundamental instrument not only for quality management analyses but also for the investigation of still unacknowledged scientific and ethical questions contributing to evidence-based guidelines concerning the complex approach to IFs in future population-based imaging. • Evidence-based guidelines for reporting incidental findings in population whole-body MRI are lacking. • Pilot-testing of a questionnaire for the evaluation of practical and ethical aspects of the procedure to report incidental findings in the German National Cohort shows a high level of acceptance and high return rate by participants. • Participants reported minimal stress levels while waiting for a possible incidental finding notification letter, which increased significantly, when such a letter was received.

BACKGROUND/OBJECTIVES: People with dementia (PwD) frequently use emergency care services. To mitigate the disproportionately high rate of emergency care use by PwD, an understanding of contributing factors driving reliance on emergency care services, and identification of feasible alternatives is needed. This study aimed to identify clinician, caregiver, and service providers’ views and experiences of unmet needs leading to emergency care use among community-dwelling PwD, and alternative ways of addressing these needs. DESIGN: Qualitative, employing semi-structured interviews with clinicians, informal caregivers, and aging service providers. SETTING: Wisconsin, United States. PARTICIPANTS: Informal caregivers of PwD (4), emergency medicine physicians (4), primary care physicians (5), geriatric healthcare providers (5), aging service providers (6), and community paramedics (3). MEASUREMENTS: Demographic characteristics of participants and data from semi-structured interviews. FINDINGS: Four major themes were identified from interviews: 1) system fragmentation influences emergency care use by PwD, 2) informational, decision-making, and social support needs influence emergency care use by PwD, 3) ED are not designed to optimally address PwD and caregiver needs, and 4) options to prevent and address emergency care needs of PwD. CONCLUSION: Participants identified numerous system and individual-level unmet needs, and offered many recommendations to prevent or improve ED use by PwD. These novel findings, aggregating the perspectives of multiple dementia-care stakeholder groups, serve as the first step to developing interventions that prevent the need for emergency care or deliver tailored emergency care services to this vulnerable population through new approaches.

Tackling the problem of rising antibiotic resistance requires valid and comparable data on the use of antimicrobial drugs in livestock. To date, no harmonized monitoring of antimicrobial usage in animals is available, and there is no system to assess usage data throughout Europe, thus hampering a direct comparison between different European countries. Most of the currently applied monitoring systems are based on sales data. Placement of sales data in relation to the population at risk requires overall assumptions about the weights of the animals treated and the doses applied. Only a few monitoring systems collect data in which the number of treated animals is reported exactly and does not need to be estimated. To evaluate the influence of different calculation methods on the standardizing procedure of antibiotic usage and benchmarking of farms, the treatment frequency for several farms (broiler, suckling piglets, and fattening pigs) was calculated in the following two different ways: first, based on the Used Daily Dose (TFUDD), and second, based on the Defined Daily Dose (TFDDD). To support this evaluation, consumption data from the Veterinary Consumption of Antibiotics Sentinel (VetCAb-S) project in Germany were used as example data. The results show discrepancies between both outcomes depending on the calculation method applied. In broiler holdings, the median values of TFDDD were 20.89% lower than the median values of TFUDD. In suckling piglets and fattening pig holdings, the median values of TFDDD were increased 77.14% and 16.33%, respectively, which may have serious implications for the benchmarking of farms. Furthermore, this finding reflects that the calculation procedure also has an impact on the comparison between populations. Therefore, UDD-based calculations should be preferred to run monitoring systems with a benchmark mission. If, in contrast, the DDD approach is chosen to compare antimicrobial usage between populations, additional considerations should be made to adjust for the addressed discrepancies.

Monitoring antimicrobial drug usage in animals at the national and international levels is important for identification and tracking if and how often quantities are used. This information can be used for many purposes, including raising awareness, comparing use patterns across countries, identifying trends over time, integrating with antimicrobial resistance data, conducting risk assessment, and evaluating the effectiveness of measures to manage antimicrobial usage. The goal of this article is to describe how monitoring systems for antimicrobial drug usage in animals are set up and conducted, using examples from specific countries as well as international efforts. Several key figures and variables are used to describe and evaluate antimicrobial consumption in animals, including the amount in kilograms of active ingredient, standardized units (e.g., number of defined daily dose animals, DDDAs) and number of treatments (e.g., number of used daily doses, UDDA). Data can be collected from a variety of sources including pharmaceutical sales, pharmacy dispensing, veterinary prescriptions, and farm records. In many countries, data analysis and reporting at the national level provide statistics on overall quantities used in animals, in some cases by animal species. Antimicrobial consumption data should be contrasted to the respective animal population, for example, the weight of different categories of livestock and slaughtered animals. Several countries have established antimicrobial usage monitoring systems. Most report overall sales data, but some provide usage data to the levels of animal species and production type. At the international level, several organizations (e.g., European Union, World Organization for Animal Health, World Health Organization) have initiatives to support the development of antimicrobial consumption data collection and reporting. However, these initiatives are ongoing and so far lack harmonization, which will be the biggest challenge for the future.

People and animals share the same environment and antibiotics are used in both. Thus, antibiotics resistance is a major common issue for human and veterinary medicine. The potential impact of antibiotics use in animals on resistance in humans is frequently the focus of debate. In this paper the transmission pathways of resistant bacteria between animals and humans are described and the question is addressed whether a reduction in antibiotics use in animals contributes to the improvement of the resistance situation in humans. Direct contact between humans and animals, transmission of bacteria via food, and indirect transmission via emissions in the environment and the subsequent exposure of humans via the environment are the major transmission routes to be considered. It can thus be established that the relevance of these various transmission routes varies significantly among bacterial species. Furthermore, despite numerous investigations, the exact significance of transmission pathways and the bacteria transferred for the resistance situation in humans cannot yet be precisely quantified. There is evidence that antibiotics use in animals fosters the spread of resistant organisms in animals. Recent studies also suggest that there might be a relationship between antibiotics use in animals and the occurrence of resistance in humans. However, this relationship is complex, and for a better understanding of it and the role of the various transmission pathways, further collaborative studies between veterinary and medical science are needed.

To study antibiotic use in livestock in a temporal context with the development of antimicrobial resistance, long-term changes in antibiotic use must be mapped and their possible causes must be explored. Therefore, the present work assesses the changes in antibiotic use over time in German livestock husbandry. In addition, factors associated with antibiotic use were analyzed to identify possible strategies for further reducing antimicrobial usage. For 2011, 2013 and 2014, antibiotic usage data were collected and examined within the VetCAb project. Three hundred participating pig holdings provided information on their antibiotic use based on obligatory application and delivery forms (ADFs) filled in by their veterinarian as well as information on their current stabling capacities for each production type held. Data on sow, piglet, weaner and fattening pig holdings were described separately, using the semi-annual treatment frequency (TF) to measure antibiotic consumption. Multiple linear mixed models were used to investigate the effects of time, farm size, region and farm management category on the treatment frequency. The study yielded significant time changes with p-values below 0.001 in antibiotic administration with a decreasing median TF in piglets from 3.8 in the first half of 2011 (IQR = 1.1-10.6) to 1.7 in the second half of 2014 (IQR = 0.2-4.5) and in fattening pigs from 5.1 in the first half of 2011 (IQR = 0.2-15.4) to 0.7 in the second half of 2014 (IQR = 0.1-6.7). Meanwhile the TF fluctuated between 8.2 and 12.2 in weaners during the observational period (IQRs between zero (lower quartile) and 37.9 (upper quartile)). Piglet, weaner and fattening pig holdings belonging to the upper third of the holdings in size used significantly more antibiotics than the other holdings investigated. Particularly for weaner and fattening pig holdings, a higher TF was noted for farms without breeding units. The region was only a significant factor in weaners. In conclusion, for 2011, 2013 and 2014, the present study shows a clear reduction in antibiotic treatment frequency in German pig holdings. In addition, the association with various factors such as herd size and farm organization on the antibiotic usage frequency is indisputable. Therefore, these factors should be included in monitoring systems and considered when evaluating intervention measures.

Long-chain a,o-dicarboxylic acids (DCAs) are versatile chemical intermediates of industrial importance used as building blocks for the production of polymers, lubricants, or adhesives. The majority of industrial long-chain DCAs is produced from petro-chemical resources. An alternative is their biotechnological production from renewable materials like plant oil fatty acids by microbial fermentation using oleogenious yeasts. Oleogenious yeasts are natural long-chain DCA producers, which have to be genetically engineered for high-yield DCA production. Although, some commercialized fermentation processes using engineered yeasts are reported, bio-based long-chain DCAs are still far from being a mass product. Further progress in bioprocess engineering and rational strain design is necessary to advance their further commercialization. The present article reviews the basic strategies, as well as novel approaches in the strain design of oleogenious yeasts, such as the combination of traditional metabolic engineering with system biology strategies for high-yield long-chain DCA production. Therefore a detailed overview of the involved metabolic processes for the biochemical long-chain DCA synthesis is given.

Background— The different effects of total body weight (TBW), fat-free mass (FFM), and fat mass (FM) on left ventricular (LV) geometry and function are complex. We investigated the associations of changes over time in TBW, FM, and FFM with changes in LV geometry and function. Methods and Results— We analyzed data from 1189 subjects (694 women), aged 44 to 86 years, from the baseline and the 5-year follow-up examination of the population-based SHIP (Study of Health in Pomerania). TBW was measured, and FFM and FM were calculated based on height-weight models derived from bioelectrical impedance studies. Echocardiographic measurements of LV geometry and function were performed according to the guidelines of the American Society of Echocardiography. Changes in body composition measures were associated with changes in LV geometry and function by multivariable-adjusted linear regression models. A 1-kg increase/decrease in TBW or FM was associated, respectively, with an increase/decrease of 0.89 g or 1.84 g in LV mass, whereas there was no such association on changes in FFM. Moreover, an increase in FM was associated with LV concentric remodeling and impairment of systolic and diastolic function parameters, whereas an increase in FFM was associated with LV eccentric remodeling and improved systolic and diastolic functional variables. Conclusions— Our findings indicate that changes in LV morphology and function depend on the type of body mass composition. Prospective data need to address whether specific changes in body composition over time may affect the risk for heart dysfunction more precisely than the change in TBW.

Objectives: To explore Candida guilliermondii for the production of long-chain dicarboxylic acids (DCA), we performed metabolic pathway engineering aiming to prevent DCA consumption during v-oxidation, but also to increase its production via the o-oxidation pathway. Results: We identified the major v- and o-oxidation pathway genes in C. guilliermondii and performed first steps in the strain improvement. A double pox disruption mutant was created that slowed growth with oleic acid but showed accelerated DCA degradation. Increase in DCA production was achieved by homologous overexpression of a plasmid borne cytochrome P450 monooxygenase gene. Conclusion: C. guilliermondii is a promising biocatalyst for DCA production but further insight into its fatty acid metabolism is necessary.