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Conservation practitioners require cost-effective and repeatable remotely sensed data for assistive monitoring. This paper tests the ability of standard remotely piloted aircraft (DJI Phantom 4 Pro) imagery to discriminate between plant species in a rangeland environment. Flights were performed over two 0.3–0.4 ha exclusion plot sites, established as controls to protect vegetation from translocated animal disturbance on Dirk Hartog Island, Western Australia. Comparisons of discriminatory variables, classification potential, and optimal flight height were made between plot sites with different plant species diversity. We found reflectance bands and height variables to have high differentiation potential, whilst measures of texture were less useful for multisegmented plant canopies. Discrimination between species varied with omission errors ranging from 13 to 93%. Purposely resampling c. 5 mm imagery as captured at 20–25 m above terrain identified that a flight height of 120 m would improve capture efficiency in future surveys without hindering accuracy. Overall accuracy at a site with low species diversity (n = 4) was 70%, which is an encouraging result given the imagery is limited to visible spectral bands. With higher species diversity (n = 10), the accuracy reduced to 53%, although it is expected to improve with additional bands or grouping like species. Findings suggest that in rangeland environments with low species diversity, monitoring using a standard RPA is viable. [ABSTRACT FROM AUTHOR]

Global efforts to improve menstrual health and sexual and reproductive health and rights (SRHR) are fundamentally intertwined and share similar goals for improving health and well-being and increasing gender equality. Historically, however, the two fields have operated independently and missed opportunities to build upon their biological and sociocultural linkages. Biological touchpoints connecting the two fields include genital tract infections, menstrual disorders, contraception, and menopause. From a sociocultural perspective, intersections occur in relation to the experience of puberty and menarche, gender norms and equity, education, gender-based violence, and transactional sex. We describe evidence linking menstrual health and SRHR and offer recommendations for integration that could strengthen the impact of both fields. [ABSTRACT FROM AUTHOR]

Most archaeological lithic raw material studies depend upon a macroscopic classification. However, since the human eye is a limited tool, some inconsistencies in classification may arise. Thus, a process for evaluating and increasing the reliability of macroscopic classification is needed. We present the results of a blind test designed to evaluate consistency in macroscopic lithic materials analysis, based on archaeological material taken from the Acheulo‐Yabrudian site Qesem Cave (Israel), focusing on interobserver error, aimed at identifying consistencies and weaknesses within our own study scheme. Twelve students, with various degrees of experience and familiarity with the Qesem material, sorted 100 randomly selected flint pieces into flint types, based on a previously established database, after a brief tutorial process. In addition, the authors, LW and AA, performed the same test. We then compared the results, using LW's results as an anchor. Our results show that experience affects the consistency in classification, demonstrating that it is an acquired skill. Furthermore, the blind test allowed us to identify weaknesses within the classification scheme. We suggest that blind tests should be regularly used to check accuracy and reproducibility of results and to assess the definitions set by the analyst, allowing fine‐tuning and calibration of the classification process. [ABSTRACT FROM AUTHOR]

Metallocenes are a promising candidate for future spintronic devices due to their versatile and tunable magnetic properties. However, single metallocenes, e.g., ferrocene, sublimate below room temperature, and therefore the implementation for future applications is challenging. Here, a method to prepare biferrocene thin films using organic molecular beam deposition (OMBD) is presented, and the effect of substrate and deposition rate on the film structure and morphology as well as its chemical and magnetic properties is investigated. On Kapton and Si substrates, biferrocene interacts only weakly with the substrate, and distinct grains scattered over the surface are observed. By incorporating a 3,4,9,10-perylenetetracarboxylic dianhydride (PTCDA) seeding layer and depositing biferrocene at high deposition rates of 1.0 Å s-1, it is possible to achieve a well-ordered densely packed film. With spintronic applications in mind, the magnetic properties of the thin films are characterized using superconducting quantum interference device (SQUID) magnetometry. Whereas initial SQUID measurements show weak ferromagnetic behavior up to room temperature due to oxidized molecule fragments, measurements of biferrocene on PTCDA capped with LiF show the diamagnetic behavior expected of biferrocene. Through the successful deposition of biferrocene thin films and the ability to control the spin state, these results demonstrate a first step toward metallocene-based spintronics. [ABSTRACT FROM AUTHOR]

Cyclic multiredox centered systems are currently of great interest, with new compounds being reported and developments made in understanding their behavior. Efficient, elegant, and high-yielding (for macrocyclic species) synthetic routes to two novel alkynyl-conjugated multiple ferrocene- and biferrocene-containing cyclic compounds are presented. The electronic interactions between the individual ferrocene units have been investigated through electrochemistry, spectroelectrochemistry, density functional theory (DFT), and crystallography to understand the effect of cyclization on the electronic properties and structure. [ABSTRACT FROM AUTHOR]

Cyclic multiredox centered systems are currently of great interest, with new compounds being reported and developments made in understanding their behavior. Efficient, elegant, and high-yielding (for macrocyclic species) synthetic routes to two novel alkynyl-conjugated multiple ferrocene- and biferrocene-containing cyclic compounds are presented. The electronic interactions between the individual ferrocene units have been investigated through electrochemistry, spectroelectrochemistry, density functional theory (DFT), and crystallography to understand the effect of cyclization on the electronic properties and structure. [ABSTRACT FROM AUTHOR]

Biferrocene systems offer a motif that incorporates multiple redox-active centres, enabling redox control, high levels of stability and near perfect conductance levels, and thus is an ideal participant within future molecular electronic systems. However, the incorporation of biferrocene can be restricted by current synthetic routes. Herein, we discuss a new method for the synthesis and incorporation of biferrocenyl motifs within extended conjugated systems. We have synthesised a family of compounds featuring biferrocenyl-ethynyl units with various pendant heteroaromatic linkages. The new compounds are probed with use of cyclic voltammetry, UV/Vis/near-infrared (NIR) spectroelectrochemistry and X-ray crystallography to gain further understanding of their structural and electronic properties. [ABSTRACT FROM AUTHOR]

Background Much of the evidence underlying guidelines for producing accessible information for people with aphasia focuses on client preference for particular design features. There is limited evidence regarding the effects of these features on comprehension. Aims To examine the effects of specific design features on text comprehension. It was hypothesized that font style, letter case and supporting images would all have a significant impact on people with aphasias' ability to comprehend text. Methods & Procedures Participants ( N = 9) read 35 paragraphs and selected the most appropriate word or phrase from a choice of four to finish the final sentence. Reading comprehension was assessed in three conditions: font style, letter case and text with a supporting image. One-way analyses of variance (ANOVAs) with Bonferroni post-hoc tests were used to test the effect of each design feature on reading comprehension. Outcomes & Results People with aphasia comprehended significantly more written information when presented in sans-serif font than in a serif style ( p = .01) and when presented in lower case than in upper case ( p = .03). The inclusion of a single supporting image to illustrate a paragraph of text did not have a significant effect on comprehension. Conclusions & Implications This research supports the premise that font style and letter case have a significant effect on text comprehension, but that illustrating a paragraph of text with a single image may not significantly improve comprehension when text is written at a low readability level. Although it is critical to produce accessible information, improving comprehension is only one rationale for modified text presentation and therefore these results must be viewed in the context of other recommendations. [ABSTRACT FROM AUTHOR]

The lithic assemblages recovered from Qesem Cave can be divided into two distinct industries, the Amudian and the Yabrudian, based mostly on different proportions of blades and scrapers. The assemblages can also be divided chronologically and by area within the site, such as the shelf, and the hearth area. The goal of our study is to try to determine whether the assemblages vary in their use of the landscape and its resources. Were the same raw materials used in each case, or do the assemblages differ, either in proportions or in sources exploited? We have therefore undertaken an examination of a sample of approximately 6000 pieces, divided fairly equally between three assemblages: the Amudian and the Yabrudian from the shelf area, and the hearth area (which is Amudian). We begin by categorizing each distinct raw material as to rock type, and, since most of them are varieties of flint, distinguish individual types based on criteria such as colour, cortex characteristics, homogeneity, and any visible fossils. To date we have identified 51 raw material types, some of which are varieties of each other which will be grouped together later. Each lithic piece examined is recorded as to typological category, assigned a raw material type, and weighed. We are thus able to examine the differences in proportions of use of the raw material types in each assemblage, by typological category, and in terms of number of pieces and of weight of material used. This paper reports only on the data concerning numbers of pieces, and shows that some raw materials were selected for specific types of tools or technological requirements. In addition, we have started field work aimed at locating the sources of the flint varieties. We have located 15 potential sources, most within 5 km of the site, but also two located more than 15 km away. Comparison of samples from the geologic sources with samples from the site assemblages has allowed us to tentatively suggest the origins of 46 of the 51 raw material types. This gives us an idea of the extent of the territory exploited by the hominins at Qesem, how different raw materials were used for different purposes, and how use of these resources and territory differs between assemblages. [ABSTRACT FROM AUTHOR]

We report on the application of a novel approach to exploring the degree of landscape knowledge, wayfinding abilities, and the nature of decision-making processes reflected in the utilization of stone resources in the French Middle Paleolithic. Specifically, we use data from the site of the Bau de l'Aubesier to explore the reasons why a majority of the 350 raw material sources cataloged in the surrounding region appear not to have been utilized, including several located near the site and yielding high-quality lithic materials. To this end, we focus on the spatial relationships between sources as an explanatory variable, operationalized in terms of minimum travel times. Using geographic information system software and a generalized linear model of resource selection derived from the Bau assemblages, we compute source utilization probabilities from the perspective of hominins located off-site. We do so under three optimization scenarios, factoring in the intrinsic characteristics (e.g., quality) and time required to reach each source on the way to the Bau. More generally, we find that in slightly more than 50% of cases, seemingly viable sources may have been ignored simply because the minimum cost path leading back to the Bau passes through or requires only minimal deviations to reach, higher quality options. More generally, we found that throughout the entire region, a cost/benefit analysis of competing sources favors those from source areas known to have been utilized. Virtually all the available information on lithic procurement at the Bau is consistent with a model of landscape utilization premised on detailed knowledge of a very large area, an ability to accurately estimate travel times between locations, and a pragmatic strategy of stone resource exploitation based on minimizing costs (travel and search times) and maximizing utility. [ABSTRACT FROM AUTHOR]

The ethynyl-phenylene substituted 2,2′:6′,2′′-terpyridine (tpy) derivatives, 4-(phenyl-ethynyl)-2,2′:6′,2′′-terpyridine (L1), 4-(methoxyphenyl-ethynyl)-2,2′:6′,2′′-terpyridine (L2), 4-(tolyl-ethynyl)-2,2′:6′,2′′-terpyridine (L3) and 4-(nitrophenyl-ethynyl)-2,2′:6′,2′′-terpyridine (L4) have been used to synthesize four new [RuCl(2,2′-bipyridine)(Ln)]PF6 based complexes. Electronic absorption, resonance Raman, cyclic voltammetry and spectroelectrochemistry aided by DFT calculations were used to explore the influence of the alkynyl substituents on the electronic structures, photochemical and redox properties of the complexes. Furthermore, it is shown that the addition of ethynyl phenyl moieties to the 4-position of the tpy ligand does not have a detrimental effect on these complexes, or the analogous aqua complexes, with respect to their ability to photocatalyse the oxidation of 4-methoxybenzyl alcohol to the corresponding benzaldehyde. [ABSTRACT FROM AUTHOR]

We apply a resource selection model to the lithic assemblages from 11 archaeological layers at a Middle Palaeolithic site in southern France, the Bau de l’Aubesier. The model calculates how to weight each of 10 variables in order to best match the proportions of raw materials from various potential sources in the lithic assemblages. We then combine the variables into two sets of five each, those related to the characteristics of the raw materials themselves, and those related to the sources and the terrain around them. Running the model with each subset shows that the terrain variables always provide a better match to raw material use than do the raw material variables taken by themselves, but the best model is always the overall (10-variable) model. This means that terrain is most important in every case, but raw material properties also matter. Comparing the percentage contributions of each subset within the overall model, however, shows a clear change in emphasis in the upper layers versus the lower layers of the site. In the lower six layers, the percent contribution of the terrain variables is always greater than that of the raw material variables, but in the upper five layers the reverse is true: terrain still matters, but raw material becomes more important. We also look at faunal and basic tool typological data, which show a progressive change through time, as smaller prey become more important (and large prey less so), and tools and cores proportionally less abundant in the assemblages in the upper layers. We suggest that these results reflect a change in subsistence strategies at the time of a particularly harsh climate near the end of the Middle Pleistocene, and that hominin groups using this site continued to use this new approach throughout the rest of the Pleistocene. [ABSTRACT FROM AUTHOR]

Abstract: Selection of an appropriate scale is an important decision in study design in many branches of science, since perceived patterns often change with the scales of spatial extent or resolution of an analysis. In previously published work, we created a resource selection model to determine the importance of several independent variables for the selection of lithic materials by hominins at a Middle Palaeolithic site in southern France. Two of these independent variables (calories exerted and difficulty of the terrain covered in travel from source to site) were calculated using elevation data extracted from maps. In the present paper, we examine the differences in model performance when the variables ‘Calories’ and ‘Difficulty’ are calculated using 1) three base maps for elevation that differed in map resolution (from finest to coarsest: a 1:25,000 topographic base map, SPOT DEM, and SRTM DEM), and 2) two different methods for determining the route from source to site (straight-line route and least-cost route; both methods exclude areas with slopes >60% from travel). Our best model was the one that used data calculated using the topographic base map; however, the SRTM DEM-based data produced models of essentially equal quality. Regardless of map scale, models that used data calculated using a straight-line route always outperformed models that used data calculated using a least-cost route. This supports our previous finding that a straight-line route is a more appropriate measure for the path from lithic source to site than a least-cost route. We conclude that the map resolution of each of the base maps used here is appropriate for analyses involving spatial data pertaining to Neandertal activity because this type of data is essentially always coarse-grained. [Copyright &y& Elsevier]

Abstract: The work reported here uses several approaches to examine the costs and benefits associated with exploiting potential sources of lithic raw material in the Vaucluse, southern France, and then tests the results against the proportions of raw materials from various sources found in the lithic assemblage of a Middle Palaeolithic site, the Bau de l’Aubesier. A previously published equation designed to quantify the attractiveness of each source proves to be significantly correlated with source use, but the results show that it can be improved. We then individually test the components of the attractiveness equation (raw material quality, source extent, terrain difficulty, and the size and abundance of raw material pieces at the source) and additional variables (Calories expended to get from the source to the site using a straight-line route, Calories expended using a least-cost path, surface distance of the source from the site, and distance to the closest used source) using generalized linear models. Since very similar raw materials can be found at more than one source, we combine such similar sources into source areas, and test the area of the source area (AOSA) and the total area of sources within the source area (AOSISA), as two additional independent variables. The best model shows that raw material quality, source extent, abundance of large and very large rocks, and AOSISA, are positively correlated with use of sources, while terrain difficulty, abundance of small and medium rocks, Calories, and AOSA, are negatively correlated with source use. This shows that the hominins at the Bau de l’Aubesier optimized their raw material procurement to get the most good quality material that they could, while minimizing the time and energy spent getting and using it. [Copyright &y& Elsevier]

The recent availability of new antiretroviral agents for the treatment of human immunodeficiency virus (HIV) infection has increased treatment options and has improved the durability, tolerability, and long-term efficacy of antiretroviral therapy, even among patients with extensive treatment experience and high levels of drug resistance. This expansion of therapeutic options has led to a revision of current treatment guidelines, which now state that the goal of antiretroviral therapy in all patients is suppression of the plasma HIV RNA level to !50 copies/mL. Successful management of infection for treatment-experienced patients with the new agents requires an understanding of their pharmacology and resistance patterns and the appropriate use of laboratory testing to optimize regimen selection. This review discusses the use of recently approved antiretroviral agents in the management of HIV infection in treatment-experienced patients. [ABSTRACT FROM AUTHOR]

Provenance studies can tell us which sources of lithic raw material were used in the past, but can they tell us why? After all, many factors can have entered into a person’s choice to use one source rather than another. Those factors can be grouped into two categories, the geologic/geographic characteristics of the source itself (quality, abundance, size of pieces, etc.), and the human factors (direction of travel, time available, social restrictions, etc.). This paper demonstrates how the geologic/geographic characteristics can be quantified and calculated together to give one value, the attractiveness of the source, which can then be used in a gravity model approach to predict which sources ‘should’ have been used more than others. Deviations from the predicted pattern point to situations where the human factors were of greater or lesser importance. The values are also used to delineate geographical areas within which particular sources would be likely to be used (‘areas of influence’), which gives us a useful new way of understanding the landscape within which the prehistoric group lived. [ABSTRACT FROM AUTHOR]

The interpretation of stone tool assemblages is difficult. How can provisioning choices, travel, and technological organization, when combined with the vagaries of use, discard, deposition, and preservation, be identified through material remains? The choice of lithic raw material sources in the past depended on many factors. The distance from source to site, often mentioned in archaeological studies, can be misleading if simple distance is measured as if the world is a fiat sheet extending in all directions. The transportation of raw materials requires physical effort, and effort expenditure depends not only on distance but also on topography, so the choice of a raw material in the past may have been influenced by the relative terrain difficulty around different sources. Calculation of the energy required to walk from several lithic sources to two Middle Palaeolithic archaeological sites in southern France, when contrasted with the use of the raw materials from each source, demonstrates that terrain difficulty needs to be taken into account to understand past behavior. [ABSTRACT FROM AUTHOR]

To determine the effect of human immunodeficiency virus (HIV) infection and other factors on infective endocarditis (IE) among injection drug users (IDUs), the incidence of IE was determined according to HIV status in a cohort of IDUs. A nested case-control study assessed IE risk factors. IE incidence (117 cases) was higher among HIV-seropositive than HIV-seronegative IDUs (13.8 vs. 3.3 cases/1000 person-years) during 1988-1998. Multivariate analysis of HIV-infected case patients revealed an inverse association between IE and CD4 lymphocyte count (odds ratio [OR] for 200-499 cells/mm³, 2.01; OR for <200 cells/mm³, 3.61) and with alcohol intake (OR for 121 drinks/week, 0.43; OR for > 21 drinks/week, 0.32). Women had an increased risk of IE (OR, 3.26), as did persons with increasing injection drug use frequency (OR for less than daily use, 3.15; OR for at least daily use, 6.07). This study confirms that IE is more common among IDUs with advanced HIV immunosuppression even after accounting for injection drug use behaviors. [ABSTRACT FROM AUTHOR]

SEN virus (SENV) is a recently discovered group of DNA viruses whose members (SENV-D and SENV-H) are linked to posttransfusion hepatitis. Of 397 injection drug users (IDUs) in Baltimore, Maryland, SENV-D infection was detected by polymerase chain reaction in serum samples from 130 (32.7%) and SENV-H infection in 149 (37.5%). Of 41 IDUs in whom SENV-D DNA was initially detected, retesting for viral persistence a median of 9.3 years later detected SENV-D in 25 (61.0%), whereas SENV-H was detected on retesting in only 14 (26.9%) of 52 IDUs in whom the virus was originally found. Reinfection was apparent (>5% nucleotide difference) in 77.8% of IDUs who repeatedly tested positive for SENV-D DNA and in 55.6% of those who repeatedly tested positive for SENV-H DNA. Among Baltimore IDUs, SENV-D and SENV-H infections are common and dynamic, including both viral clearance and reinfection. The clinical significance of SENV infection in this setting remains unknown. [ABSTRACT FROM AUTHOR]

We conducted surveillance for carbapenem-resistant Enterobacterales (CRE) during 2016-2020 at 10 US sites and extended-spectrum β-lactamase--producing Enterobacterales (ESBL-E) during 2019-2020 at 6 US sites. Among 159 CRE cases in children (median age 5 years), CRE was isolated from urine for 131 (82.4%) and blood from 20 (12.6%). Annual CRE incidence rate (cases/ 100,000 population) was 0.47-0.87. Among 207 ESBLE cases in children (median age 6 years), ESBL-E was isolated from urine of 196 (94.7%) and blood of 8 (3.9%). Annual ESBL-E incidence rate was 26.5 in 2019 and 19.63 in 2020. CRE and ESBL-E rates were >2-fold higher among infants than other age groups. Most CRE and ESBL-E cases were healthcare-associated community-onset (68 [43.0%] for CRE vs. 40 [23.7%] for ESBL-E) or community-associated (43 [27.2%] for CRE vs. 109 [64.5%] for ESBL-E). Programs to detect, prevent, and treat multidrugresistant infections must include pediatric populations (particularly the youngest) and outpatient settings. [ABSTRACT FROM AUTHOR]

Presents an annotated bibliography of studies in Caribbean and South American literature from 1991-92. Anglophobe Caribbean literature; Interviews; General studies; Studies of poetry; Fiction; Drama; Individual authors.

A series of palladium complexes bearing ferrocene substituted α-diimine ligands was synthesized and investigated for ethene polymerization at different conditions to modulate the extent of "chain-walking" mechanism and regulate branching and topology of resulting polyethylenes. All ferrocene substituted complexes catalyzed living/controlled ethene polymerization. The ability of ferrocene substituted palladium complexes to provide polyethylenes with dendritic topology was proved by measuring their Mark-Houwink plots. In-situ chemical oxidation of ferrocene moieties via silver triflate was used to affect the catalyst electronic structure and support the "chain-walking" mechanism. Oxidation of palladium catalyst led to its destabilization while the catalytic activity of newly formed sites was substantially increased. It was demonstrated that catalyst oxidation is a powerful tool to regulate the topology of resulting polyethylenes. Image 1 • Newly synthesized Pd complexes with ferrocene substituted α-diimine ligands. • All complexes provide living/controlled ethene polymerization. • Chemical oxidation of Pd complexes gives more densely branched polyethylenes. • Redox switch of Pd catalyst can regulate the PE topology. [ABSTRACT FROM AUTHOR]

• Protection from COVID-19 remains important, particularly for healthcare personnel. • Healthcare personnel in 22 U.S. states were enrolled in a case-control study. • Overall, a bivalent mRNA dose conferred 34% protection against COVID-19. • Effectiveness was similar by subgroup, but waned from 55% to 22% after two months. • Up-to-date vaccination is recommended to optimize protection against COVID-19. Bivalent mRNA vaccines were recommended since September 2022. However, coverage with a recent vaccine dose has been limited, and there are few robust estimates of bivalent VE against symptomatic SARS-CoV-2 infection (COVID-19). We estimated VE of a bivalent mRNA vaccine dose against COVID-19 among eligible U.S. healthcare personnel who had previously received monovalent mRNA vaccine doses. We conducted a case-control study in 22 U.S. states, and enrolled healthcare personnel with COVID-19 (case-participants) or without COVID-19 (control-participants) during September 2022–May 2023. Participants were considered eligible for a bivalent mRNA dose if they had received 2–4 monovalent (ancestral-strain) mRNA vaccine doses, and were ≥67 days after the most recent vaccine dose. We estimated VE of a bivalent mRNA dose using conditional logistic regression, accounting for matching by region and four-week calendar period. We adjusted estimates for age group, sex, race and ethnicity, educational level, underlying health conditions, community COVID-19 exposure, prior SARS-CoV-2 infection, and days since the last monovalent mRNA dose. Among 3,647 healthcare personnel, 1,528 were included as case-participants and 2,119 as control-participants. Participants received their last monovalent mRNA dose a median of 404 days previously; 1,234 (33.8%) also received a bivalent mRNA dose a median of 93 days previously. Overall, VE of a bivalent dose was 34.1% (95% CI, 22.6%–43.9%) against COVID-19 and was similar by product, days since last monovalent dose, number of prior doses, age group, and presence of underlying health conditions. However, VE declined from 54.8% (95% CI, 40.7%–65.6%) after 7–59 days to 21.6% (95% CI 5.6%–34.9%) after ≥60 days. Bivalent mRNA COVID-19 vaccines initially conferred approximately 55% protection against COVID-19 among U.S. healthcare personnel. However, protection waned after two months. These findings indicate moderate initial protection against symptomatic SARS-CoV-2 infection by remaining up-to-date with COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Background Because interventions are available to prevent further recurrence in patients with recurrent Clostridioides difficile infection (rCDI), we identified predictors of multiple rCDI (mrCDI) in adults at the time of presentation with initial CDI (iCDI). Methods iCDI was defined as a positive C difficile test in any clinical setting during January 2018–August 2019 in a person aged ≥18 years with no known prior positive test. rCDI was defined as a positive test ≥14 days from the previous positive test within 180 days after iCDI; mrCDI was defined as ≥2 rCDI. We performed multivariable logistic regression analysis. Results Of 18 829 patients with iCDI, 882 (4.7%) had mrCDI; 437 with mrCDI and 7484 without mrCDI had full chart reviews. A higher proportion of patients with mrCDI than without mrCDI were aged ≥65 years (57.2% vs 40.7%; P <.0001) and had healthcare (59.1% vs 46.9%; P <.0001) and antibiotic (77.3% vs 67.3%; P <.0001) exposures in the 12 weeks preceding iCDI. In multivariable analysis, age ≥65 years (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.55–2.35), chronic hemodialysis (aOR, 2.28; 95% CI, 1.48–3.51), hospitalization (aOR, 1.64; 95% CI, 1.33–2.01), and nitrofurantoin use (aOR, 1.95; 95% CI, 1.18–3.23) in the 12 weeks preceding iCDI were associated with mrCDI. Conclusions Patients with iCDI who are older, on hemodialysis, or had recent hospitalization or nitrofurantoin use had increased risk of mrCDI and may benefit from early use of adjunctive therapy to prevent mrCDI. If confirmed, these findings could aid in clinical decision making and interventional study designs. [ABSTRACT FROM AUTHOR]

Ferrocenediyl systems offer a motif that incorporates multiple functionality and redox-active centers, enabling these units to be used as molecular scaffolds in linear and cyclic compounds. Herein, we discuss a new modular methodology for the synthesis and incorporation of ferrocenediyl motifs within extended conjugated systems. We have synthesized a family of compounds featuring ferrocenediyl-ethynyl units with various para-substituted aromatic linkages. Extended linear, open-chain species have been isolated and understanding towards the analogous cyclic compounds gained. The new compounds have been probed using NMR, mass spectrometry, cyclic voltammetry and X-ray crystallography to gain further understanding of their structural and electronic properties. [ABSTRACT FROM AUTHOR]

Background We described changes in 2016─2020 carbapenem-resistant Enterobacterales (CRE) incidence rates in 7 US sites that conduct population-based CRE surveillance. Methods An incident CRE case was defined as the first isolation of Escherichia coli , Klebsiella spp. or Enterobacter spp. resistant to ≥1 carbapenem from a sterile site or urine in a surveillance area resident in a 30-day period. We reviewed medical records and classified cases as hospital-onset (HO), healthcare-associated community-onset (HACO), or community-associated (CA) CRE based on healthcare exposures and location of disease onset. We calculated incidence rates using census data. We used Poisson mixed effects regression models to perform 2016─2020 trend analyses, adjusting for sex, race/ethnicity, and age. We compared adjusted incidence rates between 2016 and subsequent years using incidence rate ratios (RRs) and 95% confidence intervals (CIs). Results Of 4996 CRE cases, 62% were HACO, 21% CA, and 14% HO. The crude CRE incidence rate per 100 000 was 7.51 in 2016 and 6.08 in 2020 and was highest for HACO, followed by CA and HO. From 2016 to 2020, the adjusted overall CRE incidence rate decreased by 24% (RR, 0.76 [95% CI,.70–.83]). Significant decreases in incidence rates in 2020 were seen for HACO (RR, 0.75 [95% CI,.67–.84]) and CA (0.75 [.61–.92]) but not for HO CRE. Conclusions Adjusted CRE incidence rates declined from 2016 to 2020, but changes over time varied by epidemiologic class. Continued surveillance and effective control strategies are needed to prevent CRE in all settings. [ABSTRACT FROM AUTHOR]

The authors reflect on family planning and its relationship with the United Nations eight Millennium Development Goals. They suggest that research has confirmed that family planning has an impact on global development goals which will remain after the year 2015. They argue that awareness of the benefits of family planning must be raised among global decision makers and development planners and that investments need to be made into research on contraceptive technology and service delivery.

Background Protection against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]) can limit transmission and the risk of post-COVID conditions, and is particularly important among healthcare personnel. However, lower vaccine effectiveness (VE) has been reported since predominance of the Omicron SARS-CoV-2 variant. Methods We evaluated the VE of a monovalent messenger RNA (mRNA) booster dose against COVID-19 from October 2021 to June 2022 among US healthcare personnel. After matching case-participants with COVID-19 to control-participants by 2-week period and site, we used conditional logistic regression to estimate the VE of a booster dose compared with completing only 2 mRNA doses >150 days previously, adjusted for multiple covariates. Results Among 3279 case-participants and 3998 control-participants who had completed 2 mRNA doses, we estimated that the VE of a booster dose against COVID-19 declined from 86% (95% confidence interval, 81%–90%) during Delta predominance to 65% (58%–70%) during Omicron predominance. During Omicron predominance, VE declined from 73% (95% confidence interval, 67%–79%) 14–60 days after the booster dose, to 32% (4%–52%) ≥120 days after a booster dose. We found that VE was similar by age group, presence of underlying health conditions, and pregnancy status on the test date, as well as among immunocompromised participants. Conclusions A booster dose conferred substantial protection against COVID-19 among healthcare personnel. However, VE was lower during Omicron predominance, and waning effectiveness was observed 4 months after booster dose receipt during this period. Our findings support recommendations to stay up to date on recommended doses of COVID-19 vaccines for all those eligible. [ABSTRACT FROM AUTHOR]

In this article the authors reflects on an incidence of outbreak of fungal meningitis in the U.S. in October 2012 that was resulted from injections of contaminated steroids. The medication was packaged and marketed by the compounding pharmacy, New England Compounding Center Inc. They raise concern over the risks associated with pharmacy compounding and protection of patients from unsafe pharmaceutical products. They mention that compounding pharmacies does not require to demonstrate the safety and efficacy of their products or to follow the standards related to manufacturing and labeling of products.

Background Most multicenter studies of US pediatric sepsis epidemiology use administrative data or focus on pediatric intensive care units. We conducted a detailed medical record review to describe sepsis epidemiology in children and young adults. Methods In a convenience sample of hospitals in 10 states, patients aged 30 days–21 years, discharged during 1 October 2014–30 September 2015, with explicit diagnosis codes for severe sepsis or septic shock, were included. Medical records were reviewed for patients with documentation of sepsis, septic shock, or similar terms. We analyzed overall and age group–specific patient characteristics. Results Of 736 patients in 26 hospitals, 442 (60.1%) had underlying conditions. Most patients (613 [83.3%]) had community-onset sepsis, although most community-onset sepsis was healthcare associated (344 [56.1%]). Two hundred forty-one patients (32.7%) had outpatient visits 1–7 days before sepsis hospitalization, of whom 125 (51.9%) received antimicrobials ≤30 days before sepsis hospitalization. Age group–related differences included common underlying conditions (<5 years: prematurity vs 5–12 years: chronic pulmonary disease vs 13–21 years: chronic immunocompromise); medical device presence ≤30 days before sepsis hospitalization (1–4 years: 46.9% vs 30 days–11 months: 23.3%); percentage with hospital-onset sepsis (<5 years: 19.6% vs ≥5 years: 12.0%); and percentage with sepsis-associated pathogens (30 days–11 months: 65.6% vs 13–21 years: 49.3%). Conclusions Our data suggest potential opportunities to raise sepsis awareness among outpatient providers to facilitate prevention, early recognition, and intervention in some patients. Consideration of age-specific differences may be important as approaches are developed to improve sepsis prevention, risk prediction, recognition, and management. [ABSTRACT FROM AUTHOR]

Among persons with an initial Clostridioides difficile infection (CDI) across 10 US sites in 2018 compared with 2013, 18.3% versus 21.1% had ≥1 recurrent CDI (rCDI) within 180 days. We observed a 16% lower adjusted risk of rCDI in 2018 versus 2013 (P  < .0001). [ABSTRACT FROM AUTHOR]

The article presents the author's comments about the article "Glottogenesis and Anatomically Modern Homo sapiens: The Evidence for and Implications of a Late Origin of Vocal Language," by Richard G. Milo and Duane Quiatt, published in the present issue of the journal. According to the author, the article states that phonemic language originated in anatomically modern human beings. She does not accept that prehistoric human languages were not phonemic.

The article presents the author's opinion on the report "The Excavations in Kebara Cave, Mt. Carmel," that appear in the December 1992 issue of the journal "Current Anthropology." According to her, the identification of the differential distribution of bone concentrations throughout Kebara Cave in Israel is an excellent example of the interaction of geology and archaeology. She said that the report is an excellent contribution to one's understanding of Mousterian behavior.

Carbapenem-resistant Enterobacterales (CRE) are a growing public health concern due to resistance to multiple antibiotics and potential to cause health care-associated infections with high mortality. Carbapenemase-producing CRE are of particular concern given that carbapenemase-encoding genes often are located on mobile genetic elements that may spread between different organisms and species. In this study, we performed phenotypic and genotypic characterization of CRE collected at eight U.S. sites participating in active population- and laboratory-based surveillance of carbapenem-resistant organisms. Among 421 CRE tested, the majority were isolated from urine (n = 349, 83%). Klebsiella pneumoniae was the most common organism (n = 265, 63%), followed by Enterobacter cloacae complex (n = 77, 18%) and Escherichia coli (n = 50, 12%). Of 419 isolates analyzed by whole genome sequencing, 307 (73%) harbored a carbapenemase gene; variants of blaKPC predominated (n = 299, 97%). The occurrence of carbapenemase-producing K. pneumoniae, E. cloacae complex, and E. coli varied by region; the predominant sequence type within each genus was ST258, ST171, and ST131, respectively. None of the carbapenemase-producing CRE isolates displayed resistance to all antimicrobials tested; susceptibility to amikacin and tigecycline was generally retained. [ABSTRACT FROM AUTHOR]

Background: To test the ease of use, reliability, responsiveness and construct validity of the Patient Generated Index, an individualised quality of life score, in older people attending a Medicine for Older People Day Hospital. Methods: Prospective longitudinal study in patients attending a specialist Medicine for Older People Day Hospital in Scotland. The Patient Generated Index was administered at baseline, one week later, and at the end of Day Hospital attendance. Functional Limitations Profile, Hospital Anxiety and Depression Score, Barthel index and global subjective impressions of change were also collected and compared with baseline scores and change in Patient Generated Index scores. Reliability was assessed using intraclass correlation coefficients in subjects reporting no change in global quality of life; responsiveness was assessed using effect size and Guyatt coefficients in subjects reporting change in global quality of life. External validity was assessed via correlation with measures of physical function, comorbid disease and psychological state. Results: 75 patients were enrolled, mean age 81 years. Mean completion time was 5.0 minutes at baseline. Reliability was moderate (intraclass correlation coefficient 0.72) but there were weak and inconsistent responses to change (effect sizes 0.02 to 0.15; Guyatt responsiveness coefficient 0.29). Patient Generated Index scores correlated with Functional Limitation Profile scores (r = 0.51, p < 0.001), baseline anxiety score (r = -0.25, P = 0.039) and baseline depression score (r = -0.37, P = 0.002) but displayed only weak, non-significant correlation with number of comorbid diseases (r = -0.22, P = 0.07), number of medications (r = -0.21, P = 0.08) and Barthel score (r = 0.09, p = 0.45). Conclusion: The Patient Generated Index appears moderately reliable and easy to complete, but is poorly responsive to change, limiting its usefulness in clinical practice or research. [ABSTRACT FROM AUTHOR]

Current models for the exceptional preservation of Burgess Shale fossils have focused on either the HF-extractable carbonaceous compressions or the mineral films identified by elemental mapping. BSEM, EDX and microprobe analysis of two-dimensionally preserved Marpolia, Wiwaxia and Burgessia identifies the presence of both carbonaceous and aluminosilicate films for most features, irrespective of original lability. In the light of the deep burial and greenschist facies metamorphism documented for the Burgess Shale, the aluminosilicate films are identified as products of late-stage volatilization and coincident mineralization of pre-existing compression fossils, whereas the three-dimensionally preserved gut-caecal system of Burgessia is interpreted as an aluminosilicate replacement of a pre-existing carbonate phase. The case for late diagenetic emplacement of aluminosilicate minerals is supported by the extensive aluminosilicification of trilobite shell and (originally) calcareous veinlets in the Burgess Shale, as well as documentation of other secondarily aluminosilicified compression fossils. By distinguishing late diagenetic alteration from the early diagenetic processes responsible for exceptional preservation, it is possible to reconcile the range of preservational modes currently expressed in the Burgess Shale. [ABSTRACT FROM AUTHOR]

Small-scale farms represent about 80% of the farming area of China, in a context where they need to produce economic and environmentally sustainable food. The objective of this work was to define management zone (MZs) for a village by comparing the use of crop yield proxies derived from historical satellite images with soil information derived from remote sensing, and the integration of these two data sources. The village chosen for the study was Wangzhuang village in Quzhou County in the North China Plain (NCP) (30°51′55″ N; 115°02′06″ E). The village was comprised of 540 fields covering approximately 177 ha. The subdivision of the village into three or four zones was considered to be the most practical for the NCP villages because it is easier to manage many fields within a few zones rather than individually in situations where low mechanization is the norm. Management zones defined using Landsat satellite data for estimation of the Green Normalized Vegetation Index (GNDVI) was a reasonable predictor (up to 45%) of measured variation in soil nitrogen (N) and organic carbon (OC). The approach used in this study works reasonably well with minimum data but, in order to improve crop management (e.g., sowing dates, fertilization), a simple decision support system (DSS) should be developed in order to integrate MZs and agronomic prescriptions. [ABSTRACT FROM AUTHOR]

In 2014, trained healthcare provider capacity was insufficient to deliver care to an estimated 70 000 persons in Maryland with chronic hepatitis C virus (HCV) infection. The goal of Maryland Community Based Programs to Test and Cure Hepatitis C, a public health implementation project, was to improve HCV treatment access by expanding the workforce. Sharing the Cure (STC) was a package of services deployed 10/1/14‐9/30/18 that included enhanced information technology and public health infrastructure, primary care provider training and practice transformation. Nine primary care sites enrolled. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing including risk factor or birth cohort (born between 1945 and 1965) based testing. Fifty‐three providers completed the STC training. STC providers identified 3237 HCV antibody‐positive patients of which 2624 (81%) were RNA+. Of those HCV RNA+, 1739 (66%) were staged, 932 (36%) were prescribed treatment, 838 (32%) started treatment, 721 (27%) completed treatment and 543 (21%) achieved cure. Among 1739 patients staged, 693 (40%) patients had a liver fibrosis assessment score < F2, rendering them ineligible for treatment under Maryland Medicaid guidelines. HCV RNA testing among HCV antibody‐positive people increased from 40% (baseline) to 95% among STC providers. Of 554 patients with virologic data reported, 543 (98%) achieved cure. Primary care practices can effectively serve as HCV treatment centers to expand treatment access. However, criteria by insurance providers in Maryland were a major barrier to treatment. [ABSTRACT FROM AUTHOR]

Background: Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) guidelines describe recommended therapy for Clostridioides difficile infection (CDI).Objective: To describe CDI treatment and, among those with severe CDI, determine predictors of adherence to the 2010 IDSA/SHEA treatment guidelines.Design: We analyzed 2013-2015 CDI treatment data collected through the Centers for Disease Control and Prevention's Emerging Infections Program. Generalized linear mixed models were used to identify predictors of guideline-adherent therapy.Patients: A CDI case was defined as a positive stool specimen in a person aged ≥ 18 years without a positive test in the prior 8 weeks; severe CDI cases were defined as having a white blood cell count ≥ 15,000 cells/μl.Main Measures: Prescribing and predictors of guideline-adherent CDI therapy for severe disease.Key Results: Of 18,243 cases, 14,257 (78%) were treated with metronidazole, 7683 (42%) with vancomycin, and 313 (2%) with fidaxomicin. The median duration of therapy was 14 (interquartile range, 11-15) days. Severe CDI was identified in 3250 (18%) cases; of 3121 with treatment data available, 1480 (47%) were prescribed guideline-adherent therapy. Among severe CDI cases, hospital admission (adjusted odds ratio [aOR] 2.48; 95% confidence interval [CI] 1.90, 3.24), age ≥ 65 years (aOR 1.37; 95% CI 1.10, 1.71), Charlson comorbidity index ≥ 3 (aOR 1.27; 95% CI 1.04, 1.55), immunosuppressive therapy (aOR 1.21; 95% CI 1.02, 1.42), and inflammatory bowel disease (aOR 1.56; 95% CI 1.13, 2.17) were associated with being prescribed guideline-adherent therapy.Conclusions: Provider adherence to the 2010 treatment guidelines for severe CDI was low. Although the updated 2017 CDI guidelines, which expand the use of oral vancomycin for all CDI, might improve adherence by removing the need to apply severity criteria, other efforts to improve adherence are likely needed, including educating providers and addressing barriers to prescribing guideline-adherent therapy, particularly in outpatient settings. [ABSTRACT FROM AUTHOR]

Background Few data suggest that Clostridioides difficile infections (CDIs) detected by toxin enzyme immunoassay (EIA) are more severe and have worse outcomes than those detected by nucleic acid amplification tests (NAATs) only. We compared toxin- positive and NAAT-positive-only CDI across geographically diverse sites. Methods A case was defined as a positive C. difficile test in a person ≥1 year old with no positive tests in the prior 8 weeks. Cases were detected during 2014–2015 by a testing algorithm (specimens initially tested by glutamate dehydrogenase and toxin EIA; if discordant results, specimens were reflexed to NAAT) and classified as toxin positive or NAAT positive only. Medical charts were reviewed. Multivariable logistic regression models were used to compare CDI-related complications, recurrence, and 30-day mortality between the 2 groups. Results Of 4878 cases, 2160 (44.3%) were toxin positive and 2718 (55.7%) were NAAT positive only. More toxin-positive than NAAT-positive-only cases were aged ≥65 years (48.2% vs 38.0%; P <.0001), had ≥3 unformed stools for ≥1 day (43.9% vs 36.6%; P <.0001), and had white blood cell counts ≥15 000 cells/µL (31.4% vs 21.4%; P <.0001). In multivariable analysis, toxin positivity was associated with recurrence (adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.61–2.23), but not with CDI-related complications (aOR, 0.91; 95% CI,.67–1.23) or 30-day mortality (aOR, 0.95; 95% CI,.73–1.24). Conclusions Toxin-positive CDI is more severe, but there were no differences in adjusted CDI-related complication and mortality rates between toxin-positive and NAAT-positive-only CDI that were detected by an algorithm that utilized an initial glutamate dehydrogenase screening test. [ABSTRACT FROM AUTHOR]

In healthcare settings, Acinetobacter spp. bacteria commonly demonstrate antimicrobial resistance, making them a major treatment challenge. Nearly half of Acinetobacter organisms from clinical cultures in the United States are nonsusceptible to carbapenem antimicrobial drugs. During 2012-2015, we conducted laboratory- and population-based surveillance in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee to determine the incidence of carbapenem-nonsusceptible A. baumannii cultured from urine or normally sterile sites and to describe the demographic and clinical characteristics of patients and cases. We identified 621 cases in 537 patients; crude annual incidence was 1.2 cases/100,000 persons. Among 598 cases for which complete data were available, 528 (88.3%) occurred among patients with exposure to a healthcare facility during the preceding year; 506 (84.6%) patients had an indwelling device. Although incidence was lower than for other healthcare-associated pathogens, cases were associated with substantial illness and death. [ABSTRACT FROM AUTHOR]

The article offers information on the Geological Association of Canada-Mineralogical Association of Canada (GAC-MAC) 2014 field trip to evaluate the geology, geoheritage and geotourism of Stonehammer Geopark located in New Brunswick, Canada. Topics covered include the geological features of Stonehammer Geopark, the Reversing Rapids, and details relating to the field trip's travel arrangements.

Background: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics.Methods: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines.Results: Of 1131 included ARI visits, 380 (33.6%) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6% (39 of 44 visits) to 51.3% (59 of 115 visits), pre- vs. post-withdrawal periods (p < 0.005). The adjusted odds of concordance compared to "All Other Antibiotics" visits decreased from 24.4 (95% CI 9.0-66.3) pre-withdrawal to 5.5 (95% CI 3.5-8.8) post-withdrawal (p = .008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention ("All Other Antibiotics").Conclusions: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5 years of implementation resulted in a rise in guideline-discordant antibiotic use. [ABSTRACT FROM AUTHOR]

The study of the lithic assemblages of two French sites, the Bau de l’Aubesier and Payre, contributes new knowledge of the earliest Neanderthal techno-cultural variability. In this paper we present the results of a detailed technological analysis of Early Middle Palaeolithic lithic assemblages of MIS 8 and 7 age from the two sites, which are located on opposite sides of the Rhône Valley in the south-east of France. The MIS 9–7 period is considered in Europe to be a time of new behaviours, especially concerning lithic strategies. The shift from the Lower Palaeolithic to the Early Middle Palaeolithic is “classically” defined by an increase in the number of core technologies, including standardized ones, which are stabilized in the full Middle Palaeolithic (MIS 5–3), associated with the decline of the “Acheulean” biface. Applying a common technological approach to the analysis of the two assemblages highlights their technological variability with respect to reduction systems and end products. Differences between Payre and the Bau de l’Aubesier concerning raw material procurement and faunal exploitation only partially explain this multifaceted technological variability, which in our opinion also reflects the existence of distinct technological strategies within the same restricted geographic area, which are related to distinct traditions, site uses, and/or as yet unknown parameters. [ABSTRACT FROM AUTHOR]

A small scale sample nuclear waste package, consisting of a 28 mm diameter uranium penny encased in grout, was imaged by absorption contrast radiography using a single pulse exposure from an X-ray source driven by a high-power laser. The Vulcan laser was used to deliver a focused pulse of photons to a tantalum foil, in order to generate a bright burst of highly penetrating X-rays (with energy >500 keV), with a source size of <0.5 mm. BAS-TR and BAS-SR image plates were used for image capture, alongside a newly developed Thalium doped Caesium Iodide scintillator-based detector coupled to CCD chips. The uranium penny was clearly resolved to sub-mm accuracy over a 30 cm 2 scan area from a single shot acquisition. In addition, neutron generation was demonstrated in situ with the X-ray beam, with a single shot, thus demonstrating the potential for multi-modal criticality testing of waste materials. This feasibility study successfully demonstrated non-destructive radiography of encapsulated, high density, nuclear material. With recent developments of high-power laser systems, to 10 Hz operation, a laser-driven multi-modal beamline for waste monitoring applications is envisioned. [ABSTRACT FROM AUTHOR]

Importance: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly reported worldwide as a cause of infections with high-mortality rates. Assessment of the US epidemiology of CRE is needed to inform national prevention efforts.Objective: To determine the population-based CRE incidence and describe the characteristics and resistance mechanism associated with isolates from 7 US geographical areas.Design, Setting, and Participants: Population- and laboratory-based active surveillance of CRE conducted among individuals living in 1 of 7 US metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, and Oregon. Cases of CRE were defined as carbapenem-nonsusceptible (excluding ertapenem) and extended-spectrum cephalosporin-resistant Escherichia coli, Enterobacter aerogenes, Enterobacter cloacae complex, Klebsiella pneumoniae, or Klebsiella oxytoca that were recovered from sterile-site or urine cultures during 2012-2013. Case records were reviewed and molecular typing for common carbapenemases was performed.Exposures: Demographics, comorbidities, health care exposures, and culture source and location.Main Outcomes and Measures: Population-based CRE incidence, site-specific standardized incidence ratios (adjusted for age and race), and clinical and microbiological characteristics.Results: Among 599 CRE cases in 481 individuals, 520 (86.8%; 95% CI, 84.1%-89.5%) were isolated from urine and 68 (11.4%; 95% CI, 8.8%-13.9%) from blood. The median age was 66 years (95% CI, 62.1-65.4 years) and 284 (59.0%; 95% CI, 54.6%-63.5%) were female. The overall annual CRE incidence rate per 100<000 population was 2.93 (95% CI, 2.65-3.23). The CRE standardized incidence ratio was significantly higher than predicted for the sites in Georgia (1.65 [95% CI, 1.20-2.25]; P < .001), Maryland (1.44 [95% CI, 1.06-1.96]; P = .001), and New York (1.42 [95% CI, 1.05-1.92]; P = .048), and significantly lower than predicted for the sites in Colorado (0.53 [95% CI, 0.39-0.71]; P < .001), New Mexico (0.41 [95% CI, 0.30-0.55]; P = .01), and Oregon (0.28 [95% CI, 0.21-0.38]; P < .001). Most cases occurred in individuals with prior hospitalizations (399/531 [75.1%; 95% CI, 71.4%-78.8%]) or indwelling devices (382/525 [72.8%; 95% CI, 68.9%-76.6%]); 180 of 322 (55.9%; 95% CI, 50.0%-60.8%) admitted cases resulted in a discharge to a long-term care setting. Death occurred in 51 (9.0%; 95% CI, 6.6%-11.4%) cases, including in 25 of 91 cases (27.5%; 95% CI, 18.1%-36.8%) with CRE isolated from normally sterile sites. Of 188 isolates tested, 90 (47.9%; 95% CI, 40.6%-55.1%) produced a carbapenemase.Conclusions and Relevance: In this population- and laboratory-based active surveillance system in 7 states, the incidence of CRE was 2.93 per 100<000 population. Most CRE cases were isolated from a urine source, and were associated with high prevalence of prior hospitalizations or indwelling devices, and discharge to long-term care settings. [ABSTRACT FROM AUTHOR]