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During the pandemic (H1N1) 2009 outbreak, Minnesota, New Mexico, and Oregon used several surveillance methods to detect associated deaths. Surveillance using unexplained death and medical examiner data allowed for detection of 34 (18%) pandemic (H1N1) 2009-associated deaths that were not detected by hospital-based surveillance. [ABSTRACT FROM AUTHOR]

Describes the continued decline of reported Haemophilus influenzae type b (Hib) disease cases and underscores the need for investigation of Hi invasive disease cases. Information on the national surveillance made by several countries; Purpose of some state for conducting active laboratory-based surveillance in selected areas; Vaccination history of children with Hib invasive disease in 1996 and 1997.

Reports on the progress made in eliminating Haemophilus influenzae Type b among infants and children in the United States. Haemophilus influenzae Type b (HIB) as the cause of serious invasive diseases among children aged less then five years; Creation of vaccine and surveillance done on its administration; Surveillance being coordinated by the United States Centers for Disease Control and Prevention (CDC); Statistics regarding cases of HIB from 1987-1997; Findings.

Background: The nursing faculty shortage in the United States presents a challenge to maintaining a robust healthcare workforce. Meaningful recognition (MR) is an evidence-based practice that improved nurse burnout (BO) in the clinical setting. There is limited literature on its impact on nurse faculty., Purpose: Three colleges of nursing implemented The DAISY Diseases Attacking the Immune SYstem Award for Extraordinary Nursing Faculty as an MR program to improve compassion satisfaction (CS) and BO among nursing faculty., Methods: This project employed a pre- and post-survey design to assess changes in faculty CS, BO, and secondary traumatic stress using the ProQOL Professional Quality of Life version 5., Discussion: The results suggest that while the implementation of MR programs did not significantly alter these metrics, the faculty maintained stable levels of CS despite the stressful COVID-19 pandemic., Conclusion: Additional research is needed to explore the potential for MR to mitigate faculty BO., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The phenolic polymer lignin is one of the primary chemical constituents of the plant secondary cell wall. Due to the inherent plasticity of lignin biosynthesis, several phenolic monomers have been shown to be incorporated into the polymer, as long as the monomer can undergo radicalization so it can participate in coupling reactions. In this study, we significantly enhance the level of incorporation of monolignol ferulate conjugates into the lignin polymer to improve the digestibility of lignocellulosic biomass., Results: Overexpression of a rice Feruloyl-CoA Monolignol Transferase (FMT), OsFMT1, in hybrid poplar (Populus alba x grandidentata) produced transgenic trees clearly displaying increased cell wall-bound ester-linked ferulate, p-hydroxybenzoate, and p-coumarate, all of which are in the lignin cell wall fraction, as shown by NMR and DFRC. We also demonstrate the use of a novel UV-Vis spectroscopic technique to rapidly screen plants for the presence of both ferulate and p-hydroxybenzoate esters. Lastly we show, via saccharification assays, that the OsFMT1 transgenic p oplars have significantly improved processing efficiency compared to wild-type and Angelica sinensis-FMT-expressing poplars., Conclusions: The findings demonstrate that OsFMT1 has a broad substrate specificity and a higher catalytic efficiency compared to the previously published FMT from Angelica sinensis (AsFMT). Importantly, enhanced wood processability makes OsFMT1 a promising gene to optimize the composition of lignocellulosic biomass., (© 2024. The Author(s).)

Background: Little is known about hybrid PhD nursing students' experiences., Method: The purpose of this study was to describe and analyze the experiences of PhD nursing students in a hybrid program using a convergent mixed methods design. Recent nursing PhD alumni ( n = 18), and current PhD students ( n = 4) were recruited at a research-intensive university in the southwestern United States., Results: Four metainferences were identified: (1) the facilitator of faculty as both advisors and mentors; (2) the facilitator of peers as support, motivation, and a source of advice that preceded advisors; (3) the barrier of receiving conflicting feedback from advisory and dissertation committees; and (4) the barrier of not understanding the PhD student process., Conclusion: Peer support is fundamental for hybrid PhD nursing student success; conflicting feedback and not understanding the process are significant barriers. Strategies are recommended to mitigate barriers to facilitate hybrid PhD nursing students' success. [ J Nurs Educ . 2024;63(5):328-331.] .

Background: The COVID-19 pandemic resulted in negative consequences for nurse well-being, patient care delivery and outcomes, and organizational outcomes., Objective: The purpose of this study was to explore the experiences of nurses working during the COVID-19 Pandemic in the United States., Design: This study used a qualitative descriptive design., Settings: The setting for this study was a national sample of nurses working during the COVID-19 pandemic in the United States over a period of 18 months., Participants: Convenience and snowball sampling were used to recruit 81 nurses via social media and both national and state listservs., Methods: Using a single question prompt , voicemail and emails were used for nurses to share their experiences anonymously working as a nurse during the COVID-19 pandemic. Voicemails were transcribed and each transcript was analyzed using content analysis with both deductive and inductive coding., Results: The overarching theme identified was Unbearable Suffering. Three additional themes were identified: 1) Facilitators to Nursing Practice During the COVID-19 Pandemic, 2) Barriers to Nursing Practice During the COVID-19 pandemic, with the sub-themes of Barriers Within the Work Environment, Suboptimal Care Delivery, and Negative Consequences for the Nurses; and lastly, 3) the Transitionary Nature of the Pandemic.., Conclusions: The primary finding of this study was that nurses experienced and witnessed unbearable suffering while working during the COVID-19 pandemic that was transitionary in nature. Future research should consider the long-term impacts of this unbearable suffering on nurses. Intervention research should be considered to support nurses who have worked during the COVID-19 pandemic, and mitigate the potential long-term effects., Tweetable Abstract: A study on nurses experiences during the pandemic reveals their unbearable suffering. Read here about the reasons nurses are leaving., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Aim: To explore the resilience of children, six to thirteen years old, living on a Northern Plains American Indian Reservation using a situation specific nursing theory., Background: American Indian and Alaska Native children experience mental health inequities compared to their white peers, including substance use, suicide, depression, and anxiety. Resilience is a strength of children that can be leveraged to improve their mental health., Design: A parallel convergent mixed methods design., Methods: A community advisory board culturally adapted resilience instruments. During two weeks in summer 2022, forty-seven children/caregiver dyads completed surveys about the child's resilience. Descriptive statistics gave the scores of each child's personal, relational, and total resilience. A subset of 20 children participated in a semi-structured interview., Results: Children scored high on overall resilience, and higher on the relational subscale than the personal subscale. Caregiver survey scores were not significantly correlated with their child's scores and were higher than the children's scores. Qualitative coding revealed six themes of resilience. Integration of data showed a concordance and expansion of the quantitative data across themes., Conclusion: The children reported high resilience supported by a strong ecosystem of relationships. Resilience, as explained through children's voices, corroborated with findings from the surveys., Implications for Nursing: Findings will help nurses across sectors of primary, secondary, and tertiary care create resilience-enhancing interventions and prevent mental health crises in this community., Impact Statement: This findings from this study will inform local mental health interventions on the Reservation. The study provides a reproducible design to adapt to other Indigenous communities., Public Contribution: A community advisory board was a partner in every stage of the study. Children and caregivers participated in data collection., Contribution to the Wider Clinical Community: This research provides knowledge that will further social justice efforts within nursing to promote health equity across diverse populations., (© 2023 John Wiley & Sons Ltd.)

Objective: The aims of this study were to explore the experiences of US clinical research nurses supporting the conduct of clinical trials before and during the COVID-19 pandemic and assess dimensions of burnout among these nurses using the Maslach Burnout Inventory-Human Services Survey., Background: Clinical research nurses are a subspecialty of nursing that supports clinical trial conduct. Postpandemic clinical research nurse well-being, including indicators of burnout, has not been established., Methods: A cross-sectional descriptive study via online survey was conducted., Results: A sample of US clinical research nurses scored overall high for the Maslach category of Emotional Exhaustion, moderate for Depersonalization, and moderate for Personal Achievement. Themes included together or apart, rewarding but challenging, and surviving or thriving., Conclusion: Supportive measures such as workplace appreciation and consistent change communication may benefit clinical research nurse well-being and reduce burnout during times of unpredicted crisis and beyond., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Microscopic analysis of plant anatomy is a common procedure in biology to study structure and function that requires high-quality sections for accurate measurements. Hand sectioning of specimens is typically limited to moderately soft tissue while harder samples prohibit sectioning by hand and/or result in inconsistent thicknesses., Results: Here we present both a clearly described hand-sectioning method and a novel microtome design that together provide the means to section a variety of plant sample types. The described hand-sectioning method for herbaceous stems works well for softer subjects but is less suitable for samples with secondary growth (e.g., wood production). Instead, the "Rapid-Tome" is a novel tool for sectioning both soft and tougher high-aspect-ratio samples, such as stems and roots, with excellent sample control. The Rapid-Tome can be 3D-printed in approximately 18 h on a mid-quality printer common at university maker spaces. After printing and trimming, Rapid-Tome assembly takes a few minutes with five metal parts common at hardware stores. Users sectioned a variety of plant samples including the hollow internodes of switchgrass (Panicum virgatum), fibrous switchgrass roots containing aerenchyma, and woody branches of eastern red cedar (Juniperus virginiana) and American sycamore (Platanus occidentalis). A comparative analyses with Rapid-Tome-produced sections readily revealed a significant difference in seasonal growth of sycamore xylem vessel area in spring (49%) vs. summer (23%). Additionally, high school students with no prior experience produced sections with the Rapid-Tome adequate for comparative analyses of various plant samples in less than an hour., Conclusions: The described hand-sectioning method is suitable for softer tissues, including hollow-stemmed grasses and similar samples. In addition, the Rapid-Tome provides capacity to safely produce high-quality sections of tougher plant materials at a fraction of the cost of traditional microtomes combined with excellent sample control. The Rapid-Tome features rapid sectioning, sample advancement, blade changes, and sample changes; it is highly portable and can be used easily with minimal training making production of thin sections accessible for classroom and outreach use, in addition to research., (© 2023. The Author(s).)

Purpose: The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers., Methods: English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2 months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables., Results: Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other., Conclusions: These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Rapid, accurate and frequent detection of the RNA of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and of serological host antibodies to the virus would facilitate the determination of the immune status of individuals who have Coronavirus disease 2019 (COVID-19), were previously infected by the virus, or were vaccinated against the disease. Here we describe the development and application of a 3D-printed lab-on-a-chip that concurrently detects, via multiplexed electrochemical outputs and within 2 h, SARS-CoV-2 RNA in saliva as well as anti-SARS-CoV-2 immunoglobulins in saliva spiked with blood plasma. The device automatedly extracts, concentrates and amplifies SARS-CoV-2 RNA from unprocessed saliva, and integrates the Cas12a-based enzymatic detection of SARS-CoV-2 RNA via isothermal nucleic acid amplification with a sandwich-based enzyme-linked immunosorbent assay on electrodes functionalized with the Spike S1, nucleocapsid and receptor-binding-domain antigens of SARS-CoV-2. Inexpensive microfluidic electrochemical sensors for performing multiplexed diagnostics at the point of care may facilitate the widespread monitoring of COVID-19 infection and immunity., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

The coronavirus disease 2019 (COVID-19) pandemic has brought about the unprecedented expansion of highly sensitive molecular diagnostics as a primary infection control strategy. At the same time, many laboratories have shifted focus to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) research and diagnostic development, leading to large-scale production of SARS-CoV-2 nucleic acids that can interfere with these tests. We have identified multiple instances, in independent laboratories, in which nucleic acids generated in research settings are suspected to have caused researchers to test positive for SARS-CoV-2 in surveillance testing. In some cases, the affected individuals did not work directly with these nucleic acids but were exposed via a contaminated surface or object. Though researchers have long been vigilant of DNA contaminants, the transfer of these contaminants to SARS-CoV-2 testing samples can result in anomalous test results. The impact of these incidents stretches into the public sphere, placing additional burdens on public health resources, placing affected researchers and their contacts in isolation and quarantine, removing them from the testing pool for 3 months, and carrying the potential to trigger shutdowns of classrooms and workplaces. We report our observations as a call for increased stewardship over nucleic acids with the potential to impact both the use and development of diagnostics. IMPORTANCE To meet the challenges imposed by the COVID-19 pandemic, research laboratories shifted their focus and clinical diagnostic laboratories developed and utilized new assays. Nucleic acid-based testing became widespread and, for the first time, was used as a prophylactic measure. We report 15 cases of researchers at two institutes testing positive for SARS-CoV-2 on routine surveillance tests, in the absence of any symptoms or transmission. These researchers were likely contaminated with nonhazardous nucleic acids generated in the laboratory in the course of developing new SARS-CoV-2 diagnostics. These contaminating nucleic acids were persistent and widespread throughout the laboratory. We report these findings as a cautionary tale to those working with nucleic acids used in diagnostic testing and as a call for careful stewardship of diagnostically relevant molecules. Our conclusions are especially relevant as at-home COVID-19 testing gains traction in the marketplace and these amplicons may impact on the general public.

Printed circuit boards (PCBs) offer a promising platform for the development of electronics-assisted biomedical diagnostic sensors and microsystems. The long-standing industrial basis offers distinctive advantages for cost-effective, reproducible, and easily integrated sample-in-answer-out diagnostic microsystems. Nonetheless, the commercial techniques used in the fabrication of PCBs produce various contaminants potentially degrading severely their stability and repeatability in electrochemical sensing applications. Herein, we analyse for the first time such critical technological considerations, allowing the exploitation of commercial PCB platforms as reliable electrochemical sensing platforms. The presented electrochemical and physical characterisation data reveal clear evidence of both organic and inorganic sensing electrode surface contaminants, which can be removed using various pre-cleaning techniques. We demonstrate that, following such pre-treatment rules, PCB-based electrodes can be reliably fabricated for sensitive electrochemical biosensors. Herein, we demonstrate the applicability of the methodology both for labelled protein (procalcitonin) and label-free nucleic acid ( E. coli -specific DNA) biomarker quantification, with observed limits of detection (LoD) of 2 pM and 110 pM, respectively. The proposed optimisation of surface pre-treatment is critical in the development of robust and sensitive PCB-based electrochemical sensors for both clinical and environmental diagnostics and monitoring applications.

Background: In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011., Methods: The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use., Results: Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001)., Conclusions: Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact., (Published by Oxford University Press for the Infectious Diseases Society of America 2020.)

Background: Doctor of Nursing Practice (DNP) students often experience challenges that can cause poor academic performance and attrition. Known threats to nurses' professional quality of life and patient care include compassion fatigue and presenteeism; it is not known how these phenomena carry over from prior nursing experience to DNP students' academic experiences and subsequent NP practice. Adverse Childhood Experiences (ACEs) can also threaten nursing students' coping ability and overall wellbeing. Building resilience can combat the negative effects related to professional quality of life and traumatic experiences and promote nursing student success., Objectives: Measure compassion fatigue, presenteeism, ACEs, and resiliency in DNP students., Design: A cross-sectional survey was conducted with three cohorts of DNP students., Setting: A DNP program at a large public American University., Participants: DNP students (n = 118) from four NP specialty tracks: Family, Pediatric, Psychiatric Mental Health, and Adult-Gerontology Acute Care., Methods: Online surveys were sent to three cohorts of DNP students: one group before beginning the program and two groups, one year apart, before starting clinical rotations in the program. Surveys included measures for compassion fatigue, presenteeism, ACEs, and resiliency., Results: The demographics of this study sample was similar to other published DNP student samples. The students reported moderate levels of compassion fatigue, presenteeism, and resiliency. ACE scores ranged from 0 to 8 out of 10, and 50% reported at least one ACE., Conclusions: Survey results from three DNP student cohorts indicate that many are pursuing advanced practice nursing education with a history of traumatic childhood events, demands of balancing work and school, and moderate resiliency levels. Many have symptoms of negative professional quality of life and presenteeism that could inhibit their job satisfaction and quality of care as an NP. Promoting DNP students' resiliency may improve their ability to thrive amidst academic and professional challenges., (Copyright © 2021. Published by Elsevier Ltd.)

Importance: Hospital antimicrobial consumption data are widely available; however, large-scale assessments of the quality of antimicrobial use in US hospitals are limited., Objective: To evaluate the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia (CAP) or urinary tract infection (UTI) present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment., Design, Setting, and Participants: This cross-sectional study included data from a prevalence survey of hospitalized patients in 10 Emerging Infections Program sites. Random samples of inpatients on hospital survey dates from May 1 to September 30, 2015, were identified. Medical record data were collected for eligible patients with 1 or more of 4 treatment events (CAP, UTI, fluoroquinolone treatment, or vancomycin treatment), which were selected on the basis of common infection types reported and antimicrobials given to patients in the prevalence survey. Data were analyzed from August 1, 2017, to May 31, 2020., Exposure: Antimicrobial treatment for CAP or UTI or with fluoroquinolones or vancomycin., Main Outcomes and Measures: The percentage of antimicrobial use that was supported by medical record data (including infection signs and symptoms, microbiology test results, and antimicrobial treatment duration) or for which some aspect of use was unsupported. Unsupported antimicrobial use was defined as (1) use of antimicrobials to which the pathogen was not susceptible, use in the absence of documented infection signs or symptoms, or use without supporting microbiologic data; (2) use of antimicrobials that deviated from recommended guidelines; or (3) use that exceeded the recommended duration., Results: Of 12 299 patients, 1566 patients (12.7%) in 192 hospitals were included; the median age was 67 years (interquartile range, 53-79 years), and 864 (55.2%) were female. A total of 219 patients (14.0%) were included in the CAP analysis, 452 (28.9%) in the UTI analysis, 550 (35.1%) in the fluoroquinolone analysis, and 403 (25.7%) in the vancomycin analysis; 58 patients (3.7%) were included in both fluoroquinolone and vancomycin analyses. Overall, treatment was unsupported for 876 of 1566 patients (55.9%; 95% CI, 53.5%-58.4%): 110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.6%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%])., Conclusions and Relevance: The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals. These assessments, performed over time, may inform evaluations of the effects of antimicrobial stewardship initiatives nationally.

More than 783 million people worldwide are currently without access to clean and safe water. Approximately 1 in 5 cases of mortality due to waterborne diseases involve children, and over 1.5 million cases of waterborne disease occur every year. In the developing world, this makes waterborne diseases the second highest cause of mortality. Such cases of waterborne disease are thought to be caused by poor sanitation, water infrastructure, public knowledge, and lack of suitable water monitoring systems. Conventional laboratory-based techniques are inadequate for effective on-site water quality monitoring purposes. This is due to their need for excessive equipment, operational complexity, lack of affordability, and long sample collection to data analysis times. In this review, we discuss the conventional techniques used in modern-day water quality testing. We discuss the future challenges of water quality testing in the developing world and how conventional techniques fall short of these challenges. Finally, we discuss the development of electrochemical biosensors and current research on the integration of these devices with microfluidic components to develop truly integrated, portable, simple to use and cost-effective devices for use by local environmental agencies, NGOs, and local communities in low-resource settings.

We report the development of a Lab-on-PCB DNA diagnostic platform, exploiting peptide nucleic acid (PNA) sequences as probes. The study demonstrates the optimization and characterization of two commercial PCB manufacturing gold electroplating processes for biosensing applications. Using an optimized ratio of PNA with a spacer molecule (MCH), the lowest limit of detection (LoD) to date for PCB-based DNA biosensors of 57 fM is reported. The study also showcases a fully integrated Lab-on-PCB microsystem designed for rapid detection, which employs PCB-integrated sample delivery, achieving DNA quantification in the 0.1-100 pM range for 5 μL samples analyzed within 5 min under continuous flow. The demonstrated biosensor proves the capability of PCB-based DNA biosensors for high sensitivity and paves the way for their integration in Lab-on-PCB DNA diagnostic microsystems., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care-associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care-associated infections during a period of national attention to the prevention of such infections., Methods: At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey. Each hospital selected 1 day on which a random sample of patients was identified for assessment. Trained staff reviewed medical records using the 2011 definitions of health care-associated infections. We compared the percentages of patients with health care-associated infections and performed multivariable log-binomial regression modeling to evaluate the association of survey year with the risk of health care-associated infections., Results: In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Fewer patients had health care-associated infections in 2015 (394 patients [3.2%; 95% confidence interval {CI}, 2.9 to 3.5]) than in 2011 (452 [4.0%; 95% CI, 3.7 to 4.4]) (P<0.001), largely owing to reductions in the prevalence of surgical-site and urinary tract infections. Pneumonia, gastrointestinal infections (most of which were due to Clostridium difficile [now Clostridioides difficile]), and surgical-site infections were the most common health care-associated infections. Patients' risk of having a health care-associated infection was 16% lower in 2015 than in 2011 (risk ratio, 0.84; 95% CI, 0.74 to 0.95; P=0.005), after adjustment for age, presence of devices, days from admission to survey, and status of being in a large hospital., Conclusions: The prevalence of health care-associated infections was lower in 2015 than in 2011. To continue to make progress in the prevention of such infections, prevention strategies against C. difficile infection and pneumonia should be augmented. (Funded by the Centers for Disease Control and Prevention.).

This study investigated the feasibility of administering motor assessments, delivering rehabilitation via parent-led activities, and enhancing motor function in children with complex congenital heart defects. Gross and fine motor development were evaluated in 20 toddlers ages 12 to 26 months after either a superior cavopulmonary connection (SCPC) procedure or an arterial switch operation (ASO) using the Peabody developmental scale, version 2 (PDMS-2). Feasibility of assessment and program delivery were examined using open-ended interviews with parents. The ASO group scored consistently higher than the SCPC group in every subscore of the PDMS-2 (ASO gross motor quotient, 96.78 ± 7.396 vs SCPC gross motor quotient, 77.56 ± 7.715 [P < 0.001]; ASO fine motor quotient, 101.20 ± 6.512 versus SCPC fine motor quotient, 87.70 ± 9.945 [P = 0.002]; ASO total motor quotient, 98.78 ± 6.515 versus SCPC total motor quotient, 79.56 ± 8.095 [P < 0.001]). A lower total motor quotient was associated with the use of anticoagulant medication (-20.3 ± 4.6; P < 0.001), longer and more frequent hospital stays (respectively, -3.6 ± 1 .4; P = 0.01 and -0.8 ± 0.4; P = 0.02), and shorter times between the most recent surgery and the assessment date (2.1 ± 0.5; P < 0.001). Age-standardized scores were constant between baseline and follow-up evaluation (baseline gross motor quotient, 87 ± 12 vs. post-intervention gross motor quotient, 88 ± 15 [P = 0.89]; baseline fine motor quotient, 94 ± 11 vs. post-intervention fine motor quotient, 94 ± 12 [P = 0.55]; baseline total motor quotient, 89 ± 12 vs. post-intervention total motor quotient, 90 ± 14 [P = 0.89]), indicating achievement of the expected rate of development. The most common barrier to home activity completion was illness in the SCPC group and lack of interest in the ASO group. Providing enjoyable activities and incorporating the activities into the participants' schedules were keys to compliance. All the children were able to complete the assessments, and the parents reported a positive impact of the intervention on family life. Children who have had the SCPC procedure experience significant motor delays early in life. However, toddlers after ASO have age-appropriate motor skills. Completion of the rehabilitation program enables post-SCPC children to increase their rate of development to age-appropriate norms.

We report on three cases of meningococcal disease caused by ciprofloxacin-resistant Neisseria meningitidis, one in North Dakota and two in Minnesota. The cases were caused by the same serogroup B strain. To assess local carriage of resistant N. meningitidis, we conducted a pharyngeal-carriage survey and isolated the resistant strain from one asymptomatic carrier. Sequencing of the gene encoding subunit A of DNA gyrase (gyrA) revealed a mutation associated with fluoroquinolone resistance and suggests that the resistance was acquired by means of horizontal gene transfer with the commensal N. lactamica. In susceptibility testing of invasive N. meningitidis isolates from the Active Bacterial Core surveillance system between January 2007 and January 2008, an additional ciprofloxacin-resistant isolate was found, in this case from California. Ciprofloxacin-resistant N. meningitidis has emerged in North America., (2009 Massachusetts Medical Society)

The Minnesota Department of Health began its unexplained critical illness and death due to possible infectious etiologies (UNEX) project in 1995. In 2006, it also began surveillance for all possible infectious disease-related and unexplained deaths investigated by medical examiners (MED-X). Surveillance for unexplained critical illness and death is focused on determining the etiology of an acute illness in a previously healthy person 50 years of age or younger whose illness is suggestive of an infectious disease. This article describes how the programs operate and how they have been able to identify the causes of a number of unexplained deaths in Minnesota. It also discusses the need for specimen collection, laboratory technologies used to identify infectious agents, and the importance of identifying etiologies of unexplained illnesses and deaths in order to prevent potential outbreaks in the greater population.

Nursing home residents are at high risk for invasive group A streptococcal (GAS) disease, and clusters of cases in nursing homes are common.To characterize the epidemiologic features of invasive GAS disease in nursing homes, we conducted active, statewide, population- and laboratory-based surveillance in Minnesota from April 1995 through 2006. Of 1,858 invasive GAS disease cases, 134 (7%) occurred in nursing home residents; 34 of these cases were identified as part of 13 clusters. Recognizing cases of GAS disease in nursing homes posed challenges. Measures to ensure identification of case-patients as residents of specific nursing homes need to be included in standard guidelines for the prevention and control of invasive GAS disease in this setting.

Rifampin-resistant meningococcal disease occurred in a child who had completed rifampin chemoprophylaxis for exposure to a sibling with meningococcemia. Susceptibility testing of 331 case isolates found only 1 other case of rifampin-resistant disease in Minnesota, USA, during 11 years of statewide surveillance. Point mutations in the RNA polymerase Beta subunit (rpoB) gene were found in isolates from each rifampin-resistant case-patient.

Population-based surveillance for unexplained death and critical illness possibly due to infectious causes (UNEX) was conducted in four U.S. Emerging Infections Program sites (population 7.7 million) from May 1, 1995, to December 31, 1998, to define the incidence, epidemiologic features, and etiology of this syndrome. A case was defined as death or critical illness in a hospitalized, previously healthy person, 1 to 49 years of age, with infection hallmarks but no cause identified after routine testing. A total of 137 cases were identified (incidence rate 0.5 per 100,000 per year). Patients' median age was 20 years, 72 (53%) were female, 112 (82%) were white, and 41 (30%) died. The most common clinical presentations were neurologic (29%), respiratory (27%), and cardiac (21%). Infectious causes were identified for 34 cases (28% of the 122 cases with clinical specimens); 23 (68%) were diagnosed by reference serologic tests, and 11 (32%) by polymerase chain reaction-based methods. The UNEX network model would improve U.S. diagnostic capacities and preparedness for emerging infections.