Frequent Source Research Articles

P-1052. Identifying Facility and Specimen Type Associated with Screening-to-Clinical Candida auris Patients in the United States, 2013–2022

Abstract Background Candida auris (C. auris) is an emerging healthcare-associated fungal pathogen associated with high mortality and antifungal resistance. Targeted screening based on patient risk factors and facility type is important for identifying colonized patients and implementing recommended infection prevention and control (IPC) precautions. Understanding the epidemiology of C. auris colonized patients who subsequently have positive clinical specimens (screening-to-clinical patients (STC)) can help us understand the clinical course and impact of colonization. Methods Using national case surveillance data from 34 states and Washington DC, we described C. auris adult patients, as defined by Council of State and Territorial Epidemiologists, during 2013–2022. We analyzed facility and specimen source for STC patients and compared with screening or clinical only patients using chi-squared tests. Results Among 13,341 screening patients, 1,151 (9%) were STC. STC patients were more likely than screening only patients to be screened at long-term acute-care hospitals (LTACH) (48% vs 40%; p< 0.001) and were more likely than clinical only patients to have positive clinical specimens taken at LTACHs (35% vs 10%; p< 0.001). While blood was the most frequent clinical specimen source for STC and clinical only patients (39% and 35% respectively), respiratory specimens were more likely to be taken from STC patients than clinical only patients (12% vs 8%; p< 0.001). The median time between STC specimen collection was 47 days [interquartile range (IQR) 19-111] and was shorter for patients in LTACHs (median 37 days [IQR 17–78]) than ACHs (median 53 days [IQR 21–116]). Conclusion About half of STC patients were screened at LTACHs and over half of STC clinical specimens were collected at LTACHs. While blood specimens were most frequent clinical specimen source among STC, respiratory sources were more likely to be taken from STC patients than clinical only patients. As high-risk respiratory devices (e.g., mechanical ventilation) are associated with invasive infections, our findings emphasize the importance of timely diagnosis and monitoring STC patients with clinical respiratory sources in LTACHs to reduce risk of invasive infection. Disclosures All Authors: No reported disclosures

P-872. Clinical and Microbiological Trends in Citrobacter Bacteremia: A Study from South India

Abstract Background Citrobacter spp are anaerobic Gram-negative bacilli, accounting for approximately 0.8% of all Gram-negative infections. This study aims to elucidate the clinical manifestations and drug susceptibility in Citrobacter infections. Clinical features of patients with Citrobacter bacteremia and comparison between Citrobacter koseri and other Citrobacter spp Methods We conducted a retrospective analysis of Citrobacter spp. bacteremia cases from 2016 to 2022. We assessed clinical profile, species, antimicrobial susceptibility and 28-day outcome. Blood cultures were processed using the BacT/ALERT, Vitek 2 system was employed for bacterial identification and antimicrobial susceptibility testing and reported as per CLSI criteria. Isolates with intermediate susceptibility were classified as non-susceptible. Comparison of antibiotic susceptibility between C Koseri and other Citrobacter spp Results Over the 7 year study period, 25 cases of Citrobacter bacteremia were identified, 60% were males. The median age was 52.5 years (IQR: 46 – 75), with 2 pediatric cases. The annual incidence of Citrobacter bacteremia displayed an upward trend, from 12% in 2016 to 24% in 2022. C. koseri emerged as the predominant species (72%), followed by C. freundii (24%) and C. farmeri (4%). The majority of patients (72%) had diabetes, 16% had chronic liver disease, 12% had malignancy. Risk factors for Citrobacter bacteremia included the presence of an indwelling bladder catheter (76%) and a central venous catheter (44%). Urinary tract was the most frequent source (56%), followed by abdominal (20%) and soft tissue (8%); a newborn had meningitis with brain abscess. The mean for Pitt’s bacteremia score was 1.52±2.6. The mean Charlson’s co-morbidity index was 2.76±2.3. Clinical features for the entire cohort and comparative results between C Koseri and other Citrobacter spp (grouped as non-koseri) is depicted in figure 1. Ciprofloxacin susceptibility was higher among C koseri (94%) as compared to other spp (71%). Antibiotic susceptibility for ceftriaxone was almost similar between the 2 groups. Susceptibility rates for other antibiotics and comparison between C Koseri and other spp are shown in figure 2. All isolates were susceptible to ertapenem, imipenem and amikacin. The overall 28-day mortality rate was 12%. Conclusion We found C. koseri more commonly, urinary source as the most common source and device presence as a significant risk factor. Antibiotic susceptibility was better for C. koseri compared to others. Disclosures All Authors: No reported disclosures

P-1753. Impact of a Microbiology Reporting Change on Treatment Selection and Clinical Outcomes for Organisms at Low-Risk for Significant AmpC Production

Abstract Background AmpC β-lactamase production can be induced after exposure to beta lactam antimicrobials, most notably ceftriaxone (CRO), leading to development of resistance on therapy. New guidance from IDSA indicates that the risk of AmpC enzyme production is not equal among all Enterobacterales and those deemed low-risk may be treated with CRO. The purpose of this study was to evaluate the impact of a microbiology reporting change made in collaboration with our antimicrobial stewardship program (ASP) to guide antibiotic selection for low-risk AmpC organisms. Methods This was a pre-test, post-test quasi-experimental study with data collected by chart review. A microbiology comment warning against the potential for inducible resistance on therapy with CRO was present pre-test and was removed in the post-test period. A didactic education session was given by ASP to medicine services. The study enrolled hospitalized patients ≥1 month old treated for infection with a low-risk AmpC organism (Serratia marcescens, Morganella morganii, Proteus vulgaris, and Providencia spp.) pre- (3/21-2/22) and post-intervention (8/22-7/23). Further inclusion and exclusion criteria are in table 1. The primary outcome was rate of carbapenem-sparing definitive treatment. Secondary outcomes were rate of CRO definitive therapy along with 30-day readmission, retreatment, mortality, and development of CRO resistance. Results 73 patients were included: 36 (49%) pre- and 37 (51%) post-intervention. Patient, infection, and treatment characteristics are described in table 2.Serratia marcescens was the most common organism isolated with the most frequent sources being respiratory and urinary. There was no significant difference in the rate of carbapenem-sparing therapy between the pre- (83%) and post-(81%) intervention, p=0.59. No difference was found in CRO as definitive therapy in either group (25% vs. 33%, p=0.49) as well. No difference was seen in secondary clinical outcomes (table 3). For those with repeat positive cultures within 30 days, none developed CRO resistance. Conclusion The combination of changing microbiology reporting and a single ASP education session did not change antibiotic selection for low-risk AmpC producing organisms. Despite updated guidance the uptake in practice is slow. Disclosures All Authors: No reported disclosures

P-1483. Clinical Features and Outcomes of KPC and NDM Carbapenemase-Producing Enterobacterales Infection in the Era of Avibactam

Abstract Background Carbapenemase-producing Enterobacterales infections (CPEi) often have poor prognosis and high mortality. However, no local studies compare KPC and NDM-CPEi treated with ceftazidime-avibactam (CA) or ceftazidime-avibactam plus aztreonam (CA+ATM). Methods Prospective cohort study. We included episodes of KPC and NDM-CPEi in patients admitted to a university hospital (from August 2018 to April 2023) who received definitive antibiotic treatment (AT) with CA or CA+ATM, respectively. We compared clinical characteristics and outcomes with 30-day follow-up. We performed a logistic regression for 30-day mortality analyses. Results One hundred and fifty-six episodes of CPEi were included (117 KPC and 39 NDM). Median APACHE II score was 15 (10-21) vs. 16 (10-20.5), p=0.755. Patients were immunocompromised in 53.8% vs. 41%, p=0.165. Bacteremia was present in 47% vs. 59%, p=0.196, and urinary and abdominal were the most frequent clinical sources of infection (44.4% vs. 38.5%, p=0.513; and 9.4% vs 15.4%,p=0.224; respectively). Klebsiella spp. was the main isolate in both groups (75.2% vs. 87.2%, p=0.117). Empirical AT was appropriate in 59.8% vs. 56.4%, p=0.707; and they received empirical CA in 45.3% vs 38.5%, p=0.456. Septic shock occurred in 24.8% vs. 35.9%, p=0.179. Seven and 30-day mortality and infection-related mortality were 3.4% vs. 0%, p=0.312; 13.7% vs. 25.6%,p=0.082; and 4.3% vs. 12.8%, p=0.071. APACHE II >20 [OR 5.9 (95% CI 1.97-17.98), p=0.002], and skin and soft tissue infection [OR 6.02 (95% CI 1.22-29.62), p=0.027] were independently associated with 30-day mortality, while the 7-day clinical response was a protective factor [OR 0.04 (95% CI 0.004-0.405) p=0.006]. Conclusion In patients with KPC and NDM-CPEi treated with CA or CA+ATM, clinical features and outcomes were similar. Mortality was associated with the severity and the source of infection while the seven-day clinical response was a protective factor. Our data support the role of CA AND CA+ ATM in these types of infections. Disclosures Diego Torres, Medical Doctor, Gador: Honoraria|GSK: Advisor/Consultant|Khight Therapeutics: Honoraria|MSD: Honoraria

Caring for the mental health of Afghan refugee youth through a decolonial paradigm: A qualitative analysis of distress, coping mechanisms, and priorities for treatment.

Despite the compounded adversities that displaced youth must navigate throughout their forced migration, they consistently exhibit steadfastness in caring for themselves and their families. Extant scholarship, however, often frames these individuals as needy and inept at informing the models of mental health care they are offered. In this study, we use semistructured interviews to learn from the experiences of Afghan refugee youth (N = 34; M age = 19; range 18-24) who were resettled in the United States after the United States withdrawal from Afghanistan in August of 2021 and explore their insights that can inform decolonial and equitable mental health services. Specifically, we elucidate their most salient sources of psychological distress, current coping mechanisms, and priorities for treatment, with a specific focus on the unique experiences of accompanied versus unaccompanied youth. Unaccompanied youth reported more frequent and intense sources of distress, including pre-resettlement (e.g., exposure to life-threatening sociopolitical conflicts) and post-resettlement challenges (e.g., limited access to basic resources and legal status precarity). Youth used faith-based, relationship-based, and ethnocultural-based mechanisms of coping. While 62% of participants reported doubts about the usefulness of mental health care, most of those who expressed an openness to treatment prioritized clinicians who have personal experience in navigating common challenges among refugees. We situate these findings within decolonial and intersectional theoretical frameworks that capture the nuances of Afghan refugee experiences and offer recommendations for ensuring refugee youth's rights to access equitable mental health services.

Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of de Quervain Tenosynovitis: A Randomised Control Open Label Equivalence Trial.

Background: De Quervain (DQ) tenosynovitis is a frequent source of wrist pain amongst middle-aged adults. Steroid injections are recommended after conservative methods fail, despite unclear mechanisms. The effectiveness of platelet-rich plasma (PRP) for DQ is not well-studied. To address this gap, we conducted a randomised controlled trial comparing the efficacy of PRP and corticosteroid (CS) injections for treating DQ. Methods: This prospective, randomised and open-label trial was conducted at a tertiary care hospital in India. Adult patients aged 18-60 were randomly assigned to receive either ultrasound-guided triamcinolone acetonide injections or autologous PRP in the first extensor compartment. Outcomes were measured at baseline and at 1, 4 and 12 weeks using the VAS and quick disabilities of arm, shoulder and hand (QuickDASH) questionnaires. Results: Eighty-six age- and sex-matched patients, with an average disease duration of 14 weeks in both groups, were enrolled. Both the CS and PRP groups demonstrated a significant reduction in pain scores and improvement in functions at 1, 4 and 12 weeks. However, between the groups, the degree of improvement in pain was more in CS group at 1 week and similar improvements between the groups at 4 and 12 weeks. Regarding hand function, the CS group exhibited notable at 1 and 4 weeks based on the QuickDASH scale. Yet, by the 12th week, hand function improvements were comparable between both groups. Conclusions: This study suggests that PRP is equivalent to CS in reducing pain in DQ tenosynovitis. Hand function improved more significantly in the CS group at 1 and 4 weeks post-injection. Both PRP and CS are safe and equally effective treatments for DQ. Level of Evidence: Level I (Therapeutic).

An online loop closing current calculation method for complex distribution networks considering source and load uncertainties

AbstractTo address the challenges posed by frequent source and load fluctuations in existing loop closing current calculation methods, this paper proposes an online loop closing current calculation method that considers source and load uncertainties. First, a dual‐stack dynamic monitoring system is utilized to obtain real‐time voltage and current variations before and after disturbances. Second, Thevenin's theorem is employed to build an equivalent model of the distribution network, simplifying the complex network into a combination of an independent voltage source and a series impedance. Then, the steady‐state loop closing current is calculated based on the open‐circuit voltage and equivalent impedance at both sides of the loop closing point. Next, the optimal frequency method is applied to determine the equivalent impedance and attenuation time constant at a specific frequency, achieving accurate calculation of the transient loop closing current. Finally, simulations are conducted to model the fluctuations in distributed generation and load, analysing the steady‐state and transient loop closing currents. The simulation results demonstrate that the proposed method accurately captures the effects of source and load fluctuations on the loop closing current in dynamic environments, with minimal calculation error, indicating its high practicality.

Pathogenic Burden, Antimicrobial Resistance Pattern and Clinical Outcome of Nosocomial Bloodstream Infections in Intensive Care Unit.

Purpose: Nosocomial bloodstream infections with multidrug-resistant microorganisms have become a common health threat in intensive care settings worldwide. Understanding antimicrobial resistance and the outcomes of these infections is crucial for addressing this issue. This study aimed to investigate the burden, antimicrobial resistance, and 28-day outcomes of nosocomial bloodstream infections in the intensive care unit. Materials and Methods: This retrospective study was conducted in a multispecialty intensive care unit at a tertiary care hospital in western India. Adult patients aged ≥18 years with bloodstream infections acquired after 48 h of admission were included in the analysis. Results: A total of 245 patients suspected of having nosocomial infections in the intensive care unit were evaluated, and 179 were included in the study. Gram-negative bacteremia was identified in the majority of cases, affecting 111 (62%) patients. Carbapenem-resistant Acinetobacter baumannii was the most prevalent pathogen, found in 21.2% (38/179) of patients. Candida species were detected in 37 (20.6%) cases, and gram-positive cocci were identified in 31 (17.3%) patients, with vancomycin-sensitive Enterococci being the most common gram-positive cocci isolated from blood. The central venous catheter was the most frequent source of bloodstream infection, identified in 66 (36.9%) patients. Among all patients, 28-day mortality was observed in 102 (57%) patients. Higher quick sepsis-related organ failure (qSOFA) scores at the onset of bloodstream infection, central venous catheters as a source of infection, inability to initiate early appropriate therapy and septic shock at the onset of bloodstream infection were identified as independent predictors of mortality in patients with nosocomial bloodstream infections. Conclusion: An increased burden of gram-negative bacilli and Candida was found to cause nosocomial bloodstream infections, with very high rates of antimicrobial resistance. Early appropriate diagnosis and treatment play a critical role in improving survival. Additionally, enhanced infection prevention and control practices are necessary to mitigate the heavy burden of infections caused by multidrug-resistant organisms in critical care settings.

AN ANATOMICAL VARIATION OF THE PERONEUS QUARTUS MUSCLE: A CASE STUDY

The peroneus quartus (PQ), an extraneous assessory muscle of the ankle, is found in the lateral compartment of the leg. It is the most frequent source of genesis and its insertion is along the peroneus brevis muscle into the calcaneo retrotrochlear prominence. We noticed a peculiar variation of the muscle that arises from the lateral surface of the fibula in between the two peroneal muscles. A lateral malleolus that was protruding from the skin was crammed with tendons. The muscle was discovered to be attached to the peroneal trochlea. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. It is rarely involved in pathologic processes of the foot and ankle. Only a few reports exist in the literature involving peroneus quartus in a “retro malleolar conflict” (lateral ankle stenosis), sometimes in association with longitudinal attrition and tears of the peroneus brevis. The presence of this muscle in individuals can complain of ankle pain with throbbing and tingling sensation along with swelling. It could include the ankle weakness along with ankle instability.1

Sand Fly Fauna in Urban Parks in the Brazilian Western Amazon: Potential Areas for American Cutaneous Leishmaniasis Transmission.

Sand flies are a group of insects (Diptera, Psychodidae, Phlebotominae) in which some species may transmit agents of leishmaniasis. This study aimed to analyze the sand fly fauna in urban parks in Rio Branco, capital of Acre state, addressing its diversity, infection by Leishmania, and food sources in sand fly females. The sand flies were collected with CDC-type automatic light traps installed in three urban parks in Rio Branco: Captain Ciríaco, Horto Florestal and Chico Mendes. For comparison analysis of species richness and diversity between the parks, we analyzed rarefaction and prediction curves. For detection of Leishmania spp., molecular tests were performed by polymerase chain reaction (PCR) using ITS1 as a marker, followed by genetic sequencing. Identification of the blood meal source in engorged females was performed by PCR using a fragment of the cytochrome b gene (cyt b), followed by sequencing and phylogenetic analysis. A total of 2,672 specimens were collected, distributed in 14 genera and 35 species. Of these, Nyssomyia antunesi and Evandromyia walkeri predominated, and important proven and suspected vectors were also found. Horto Florestal was the park with the greatest diversity, richness, and evenness of species, while the Captain Ciríaco presented the lowest diversity and richness. A female of Ny. antunesi was PCR-positive for Leishmania guyanensis. Human blood was the most frequent food source detected, mainly in Ev. walkeri and Ny. antunesi. This research showed that the studied parks of Rio Branco can act as foci for the maintenance of Leishmania, and people who frequent these urban areas may be in risk for contracting leishmaniasis.

Blood meal analysis: unveiling the feeding preferences of Aedes aegypti and Aedes albopictus in a dengue-endemic area.

Studies have suggested animals as possible reservoir hosts for flaviviruses transmitted by Aedes mosquitoes; however, there is limited evidence for the dengue virus in Malaysia. One of the possible ways to determine the zoonotic potential for any pathogen transmission is through blood meal analysis which can provide valuable insights into the feeding preferences of the mosquitoes. Unfortunately, limited information is available on the feeding preferences of Aedes mosquitoes in Malaysia. Thus, this study aimed to identify the blood-feeding preferences of Aedes aegypti and Aedes albopictus from different ecotypes in Selangor, Malaysia. The field mosquitoes were collected using a modified backpack aspirator and CDC light trap. The collected mosquitoes were initially classified based on degrees of blood digestion according to the Sella scale before extracting the DNA. The presence of vertebrate DNA was detected using nested PCR, and samples positive for vertebrate DNA were further subjected to species-specific PCR targeting the common animals found at the study locations. In general, 51 of 187 field caught Aedes mosquitoes were positive for the presence of vertebrate DNA in their blood meal. The most frequent blood meal source was human (38.2%), followed by monkey (12.7%), bovine (10.9%), chicken (7.3%) and dog (3.6%). The human blood index (HBI) of Ae. albopictus collected across the four different ecotypes revealed that, Ae. albopictus collected near human dwellings showed 100% anthropophilic tendency. Interestingly, there were two Aedes mosquitoes, Ae. aegypti (n=1) and Ae. albopictus (n=1) positive for both human and monkey blood. Since sylvatic dengue continues to flourish in Southeast Asia, this finding from blood meal analysis shows the potential for zoonotic transmission by Aedes mosquitoes in these locations. However, further research must be carried out to understand the role of animals as potential reservoir hosts for the dengue virus, especially through the detection of the virus in the blood meal.

"Pyogenic Spondylodiscitis from Oral Odontogenic Origins: A Frequently Overlooked Entity".

Primary spondylodiscitis occurs through the hematogenous spread of a pathogen entering the body via a point of entry. The infection's origin often remains unclear. During dental procedures or through minor traumas, oral bacteria can enter the bloodstream and disseminate throughout the body. This study's objective was to further investigate the role of odontogenic (i.e., teeth-related) causes of spondylodiscitis, especially in cases where another infective focus could not be identified initially. Retrospective analysis. In a cohort of 340 consecutive patients with primary spondylodiscitis treated at a Level I Spine Center from 01/01/2018 to 12/31/2022, those with oral bacteria in blood cultures or disc tissue samples and available orthopantomograms (OPG, i.e. panoramic X-ray of the teeth) (please define this-general readership will not know what this is) were retrospectively reevaluated for odontogenic origins. Patients with secondary spondylodiscitis from a previous operation (< 3 months) in the same segment were excluded. Radiological features indicating an infectious dental focus included apical (in the mandible/maxilla?) radiolucency of the tooth, impacted teeth, residual roots, and vertical or cup-shaped bone loss. Patients' medical records, imaging data, laboratory, microbiological and histopathological findings, and surgical reports were analyzed. The term oral bacteria refers to the whole microbiome of the oral cavity. Periodontal bacteria are bacterial species implicated in periodontal diseases. For further classification, periodontal bacteria were assigned to one of five complexes previously described. The most frequent infective source was (what joints?) an infection of the major joints of the extremeties (14.1%), followed by ulcers of the extremities (10.3%) and urosepsis (10.0%). An odontogenic origin was initially identified in 8.9%. In 33.1% of cases, the source of infection was not found. Oral bacteria were found in 38 cases (13.3%) of 286 (i.e. all cases with a positive pathogen detection) of the 33.1% of cases?. Six of these had an identified focus of the throat, and six had an initially clear dental focus. Of the remaining 26 cases, OPG was available for 14. Re-evaluation of OPG revealed an odontogenic focus in 9 out of 14 cases (64.3%). Two of these cases had a concomitant infective focus, while in 7 cases, initially, no infectious focus was found. An odontogenic origin for spondylodiscitis was more prevalent than initially presumed, particularly in patients where no source was identified at first sight. We therefore recommend a thorough diagnostic dental work-up as a standard procedure for patients with primary spondylodiscitis.

Chronic diseases and spondylodiscitis.

Our research was focused to find a relation between the occurrence of spondylodiscitis and occurrence of chronic diseases. We were trying to discover some new risk factors and relations between chronic disorders in our research group. This analysis was also focused to detect factors that prolong the hospitalization of patients and worsen their prognosis. A study was carried out involving patients with spondylodiscitis treated between 2013 and 2022. A statistical analysis expressed by several coefficients was calculated in software IBM SPSS 21. The study group comprised 32 (53.3%) females and 28 (46.7%) males. During the period the overall incidence of spondylodiscitis was increasing (except the year 2020 where only 2 patients were treated) with a peak in 2019. The average age of patients was 69.3 (±12.3) years, and the highest incidence was in the age group 60-69 years (n = 19, 31.7%). The most impacted vertebral region was lumbar (n = 29, 48.3%). The most prevalent associated comorbidity was some cardiovascular disorder (n = 39, 65%) followed by diabetes mellitus (DM) (n = 23, 38.3%). Genitourinary system was the most common source of primary infection (n = 22, 36.7%). Average length of stay was 34.3 (±14.5) days and surgery prolonged hospitalization period. Mortality rate was 1.7%. The results of our study are confirmed by the data of other European and non-European studies. We confirmed diabetes mellitus and hypertension as the most common non-infectious risk factors of spondylodiscitis and the presence of pathogens in genitourinary system as the most frequent source of primary infection.

Methodical approaches to spatial identification of probable sources of obnoxious odors in ambient air based on fuzzy logic

The article describes a task of searching for an unknown source of odor pollution. This task is classified as ‘considerably uncertain’, for which formal solution is proposed. The issue of obnoxious odor is relevant for many residential areas in large cities and industrial centers. Despite strict governmental control of emissions, including those from recycling facilities, undetermined pollution sources often become a reason for numerous people’s complaints. Odor pollution is known to affect human health including the respiratory, cardiovascular and nervous systems; to reduce life quality and adaptation capacity. Industrial enterprises, treatment and recycling facilities are the most frequent sources of odor pollution. Complexity of air quality control is caused by subjectivity typical for odor perception and their multicomponent structure. The suggested approach to searching for obnoxious odor sources is based on using statistical data about complaints made by people and up-to-date methods of the fuzzy set theory. Statistical data on people’s complaints are subjective and emotional in their essence. In this method, an odor is represented as a linguistic variable that considers odor quality and intensity and weather and climatic conditions (wind speed and direction). The method assumes that an odor source is located in the direction opposite to the wind speed vector at the moment a complaint was registered. A possible location of an odor source was identified by superposing wind directions and considering impacts of a ‘pollution plume’, which had an area of dispersion of substances / a mixture of substances responsible for an odor. To perform more precise spatial searching for odor sources, the task was solved using fuzzy logic methods and a fuzzy conclusion considering a high level of uncertainty. The function of belonging was introduced to identify whether a point belonged to the multitude of probable locations of an odor source. Fuzzy model parameters were identified by using numeric experiments. The suggested approached, which is based on analyzing statistical data about people’s complaints, has been shown to not only conform to up-to-date trends in applied use of the fuzzy set theory but also to be able to solve the relevant task of identifying sources of odor pollution in ambient air. The approaches outlined in the article expand a sphere where the fuzzy set theory can be used introducing a new application trend for it, which is to determine reasons for differences between data obtained by laboratory control of ambient air quality and calculated dispersion of chemical emissions from stationary and mobile pollution sources.

Quantifying the predation impact of an expanding mesocarnivore on declining small‐game species

AbstractHuman‐wildlife conflicts have increased and are particularly acute when predators are involved. A frequent source of conflict is some people's misbeliefs related to the alleged impact of predators on game species and livestock. In this context, quantifying the impact of expanding predators on their prey can be useful in designing conflict mitigation strategies. We estimated the predation impact of the Egyptian mongoose (Herpestes ichneumon), an expanding mesocarnivore in southwestern Europe, on European rabbit (Oryctolagus cuniculus) and red‐legged partridge (Alectoris rufa) populations, two declining prey species highly valued by hunters. We estimated mongoose densities in three areas of central Spain through live capture, GPS/VHF tagging, camera‐trapping and spatial mark‐resight models. Rabbit and partridge densities were estimated through transect counts and distance sampling. We quantified the mongoose diet by scat analysis. Finally, we compared the number of individuals consumed by the predator population with the estimated total prey populations. European rabbits were the most important mongoose food in two of the study areas, whereas red‐legged partridges were rarely consumed in all the areas. Rabbit density varied widely among study areas (14.0–881.4 rabbits/km2), while partridge density was low in all the areas (2.3–6.9 partridges/km2). The predation impact on rabbits was low in the area with the highest rabbit density (1.9–3.8% of estimated population) and higher (5.6–29%) in the other areas. In contrast, the predation impact on partridge populations was low (&lt;9%) in all the study areas. This is the first study that estimates the Egyptian mongoose impact on small‐game species, a necessary step to deal with the conflicts over the management of this expanding species. The study of predation impact may contribute to the effective management of human‐wildlife conflicts involving predators, by improving the understanding of where additional management may take place to protect prey species or deter predator populations.

Eco-epidemiological aspects and risk factors associated with human Chagas disease in rural areas of the state of Piauí, Brazil

BackgroundPiauí is located in Northeastern Brazil, an endemic area for Chagas disease, with the Brazilian semiarid representing the second region in number of people infected by the parasite Trypanosoma cruzi. The state of Piauí is one of the most socially vulnerable territories with direct impact on the access to diagnosis and treatment of Chagas disease for the population living in rural communities. Triatoma brasiliensis is the vector species of greatest epidemiological importance in Northeastern Brazil. We investigated the triatomine fauna and risk factors associated to T. cruzi transmission in two municipalities, Pedro II and Oeiras, located in different mesoregions of Piauí.MethodsTwenty-three rural areas were selected for triatomines search and serological survey of the population. The analysis of triatomines consisted on identifying T. cruzi infection index by microscopy and kDNA-PCR followed by parasite genotyping through the use of multilocus PCR to characterize the discrete typing units (DTUS), and the identification of food sources using PCR directed to the 12S rRNA gene of vertebrates and sequencing.ResultsA total of 1,043 triatomines identified as T. brasiliensis, Triatoma pseudomaculata, Rhodnius nasutus, Rhodnius sp. and Panstrongylus lutzi were collected. The overall positivity for T. cruzi was 4.6% and 11.4% by microscopy and kDNA-PCR, respectively. The DTUs TcV (∼ 44%) and TcI (∼ 43%) were the most prevalent in either single or mixed infections. This is the first report of TcV and TcVI infections in vectors of Piauí. The most frequent blood source was Homo sapiens (46.5%), of which ∼ 42% individuals (28/67) were collected indoors and four of them (14.3%) tested positive for T. cruzi kDNA in Pedro II. Chicken (∼ 19%), domestic cat (∼ 17%) and others were also identified as feeding sources for triatomines. Serological survey revealed 2% seroprevalence. Variables as age over 60 years (p = 0.01), Black race (p = 0.002) and occupation as retired (p = 0.004) significantly influenced the seropositivity.ConclusionDespite the reduced seroprevalence of the population, the epidemiological scenario of Chagas disease in both municipalities highlights the risk of the re-emergence of domestic vector-borne transmission. Ensuring continued entomological surveillance and vector control programs and providing access to diagnosis and treatment for the susceptible population are still needed.

Recommendations for monitoring adherence and fidelity in pragmatic trials based on experience in the Pain Management Collaboratory.

Most pragmatic trials follow the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria. The criteria specify unobtrusive measurement of participants' protocol adherence and practitioners' intervention fidelity but suggest no special monitoring strategies to assure trial integrity. We present experience with adherence/fidelity monitoring in the Pain Management Collaboratory (PMC) and provide recommendations for their monitoring in pragmatic trials to preserve inferences of treatment comparisons. In November 2021, we surveyed 10 of 11 originally funded PMC pragmatic trials to determine the extent to which adherence and fidelity data were being monitored. Of the 10 PMC trials, 8 track adherence/fidelity. The electronic health record is the most frequent source for monitoring adherence (7/10) and fidelity (5/10). Most adherence data are used to monitor participant engagement with the trial intervention (4/10) and are reviewed by study teams (8/10) and often with a data and safety monitoring board (DSMB) (5/10). Half of the trials (5/10) reported using fidelity data for feedback/training; such data are not shared with a DSMB (0/10). Only 2 of 10 trials reported having prespecified guidance or rules around adherence/fidelity (eg, stopping rules or thresholds for corrective action, such as retraining). As a best practice for pragmatic trials, we recommend early and regular adherence/fidelity monitoring to determine whether intervention delivery is as intended. We propose a 2-stage process with thresholds for intervening and triggers for conducting a formal futility analysis if adherence and fidelity are not maintained. The level of monitoring should be unobtrusive for both participants and those delivering the intervention; resulting data should be reviewed by an independent DSMB.

Danger on the Plate

In this essay we detail the widespread presence of food contamination rumors in the contemporary People’s Republic of China, focusing on claims that have recently been disseminated on China’s robust social media platforms. As in the West, Chinese consumers are skeptical of the motives of those who provide fast food and premade food, even believing that some providers intend to weaken the fabric of the nation or to use contaminated food as a form of genocide. Conspiracy theories particularly target the imagined malign motives of the United States and Japan. With the emergence of the “New China” as a member of the World Trade Organization, food conglomerates have entered the Chinese market, but suspicions of their intentions are rife. Although definitive proof for these claims is rare, such suspicions are treated as plausible, particularly when the beliefs target widely consumed meats or fruits. With the spread of Kentucky Fried Chicken throughout urban China, production of their poultry is a frequent source of anxious speculation. We use the dynamics of rumor to understand the global prevalence of food contamination beliefs, demonstrating through this case that culinary anxieties are not limited to the West.

Frequency and mechanism of injury for unintentional paediatric femoral fractures associated with consumer products over a 10-year period in the USA.

Femoral shaft fractures tend to be rare among children; however, these injuries are the most common major paediatric injuries treated by orthopaedic surgeons. The purpose of this study is to characterise the demographics and mechanisms of femoral injury associated with consumer products in the age group treated with spica casting, children 6 months to 6 years, to identify areas for injury prevention. Data from 2012 to 2021 were obtained from the National Electronic Injury Surveillance System maintained by the Consumer Products Safety Commission, documenting emergency department visits for unintentional injuries associated with consumer products. Narrative descriptions were analysed to identify common factors in the injury events such as location, products and mechanisms of action. From 2012 to 2021, the estimated incidence of femur fractures was 23.5 cases per 100 000 children with no significant difference in yearly frequency. The most common mechanism of injury was a fall with the most frequent fracture sources being bed/bunk beds (16.1%), floor (slips/falls, 9.7%) and trampolines (9.7%). Most fractures occurred at the patient's home (58.4%). The incidence of injury outside of the home and frequency of fractures involving play structures/trampolines increased with age. The incidence and demographic characteristics of paediatric femur fractures associated with consumer products have remained consistent over the past 10 years. As home was the most common location of fracture, prevention of femur fractures should focus on caregiver education around high-risk sources of fracture (bed, stairs and trampolines) and manufacturers should consider design alternatives that discourage potential misuse.

Application of microencapsulated phase change materials for controlling exothermic reactions

Abstract Thermal runaway is a frequent source of process safety issues, and the uncontrolled release of chemical energy puts reactors at risk. The design of the exothermic reactor faces challenges due to the selective sensitivity of the product to high temperatures and the need to increase the lifetime of the catalyst, optimize the product distribution, and improve the thermodynamic properties. Phase change material (PCM) encapsulation is recommended to reduce leakage, phase separation, and volume change problems. This work introduces encapsulated PCMs to improve reactor temperature control and minimize thermal runaway in exothermic processes. The warning temperature value setting effectively inhibits fugitive exothermic reactions and enhances heat transfer. When a sufficient quantity of encapsulated PCMs is input, the response speed will automatically accelerate. Spontaneous acceleration of the reaction rate due to thermal runaway of the reaction may be completely avoided by adding a sufficient amount of encapsulated PCM. Microencapsulation is used to control volume changes and inhibit thermal reactions. Preventive strategies include cooling, depressurization, safety release, emergency resources, and reaction containment. Encapsulated PCMs improve mechanical and thermal properties, surface-to-volume ratio, heat transfer surface, thermal capacity, and efficiency.