American Journal of Infection Control

Importance: OPAT is an underutilized strategy in low- and middle-income countries (LMICs). Addressing the knowledge gaps among frontline physicians through structured interventions is vital for optimizing hospital bed utilization and antimicrobial stewardship. Objective: To assess whether a structured multidisciplinary care bundle is associated with improved patient enrollment and clinical care quality in an OPAT program in India. Design, Setting, and Participants: This pre-post quality improvement study was conducted in the Department of General Medicine at a tertiary care referral hospital in Rishikesh, India. Data from patient encounters during a 6-month pre-intervention period (December 1, 2023 to May 31, 2024) were compared with encounters during a 6-month post-implementation period (January 1, 2025 to June 31, 2025). Participants included all postgraduate residents serving as frontline clinical practitioners. Interventions: A structured OPAT bundle comprising a formalized educational curriculum (interactive didactic sessions and bedside practical training), standardized eligibility screening, and a coordinated telephonic monitoring protocol (from June 1, 2024 to December 31, 2024). Main Outcomes and Measures: The primary outcome was the change in the number of eligible patients enrolled in OPAT. Secondary outcomes included clinical process quality indicators (counseling, IV access arrangement, and monitoring compliance), 30-day rehospitalization rates, and therapy-related complications. Results: A total of 20 preintervention patient encounters were compared with 39 postintervention encounters, with similar baseline characteristics between groups (mean age, 37 vs 40 years; male gender, 65% vs 69.2%). Prior to implementation, only 33.3% (20 of 60) of eligible patients received OPAT, whereas 100% (39 of 39) of eligible patients were enrolled following the intervention (p < 0.001). Key clinical processes reached 100% compliance post implementation, including patient counseling (40% vs 100%; p < 0.001), pre-discharge IV access (40% vs 100%; p < 0.001), and daily telephonic monitoring (10% vs 100%; p < 0.001). Safety outcomes remained stable, with no significant differences in readmission rates (5.0% vs 0%; p = 0.34) or drug-related complications. Conclusions and Relevance: This quality improvement study provides evidence that a structured package of OPAT bundle interventions is associated with a transition to universal enrollment of eligible patients and perfect adherence to safety indicators. These results suggest that standardizing the outpatient transition through physician education and coordinated monitoring is a feasible and effective strategy for optimizing hospital resource utilization in LMICs.

Point-of-care Hepatitis C Virus (HCV) RNA assays reduce diagnostic turnaround time but depend on benchtop instrumentation and continuous electricity, limiting their deployment in the harm reduction and community settings where confirmatory testing is most needed, as people who use drugs (PWUD) carry a disproportionate share of the HCV burden in the United States. This is a systemic problem in diagnostic development, where decision-making and design requirements overlook point-of-use stakeholders. Closing the gap requires integrating real-world constraints throughout design rather than validating against user needs once a product already exists. Here, we apply a human-centered design (HCD) approach to inform rigorous, stakeholder-derived design requirements, implementation considerations, and early value proposition for a novel point-of-need HCV RNA test intended for deployment in harm reduction and community settings in Indiana. To determine design specifications grounded in real-world context, our objectives were (1) identifying and characterizing context-specific experiences and barriers to HCV testing among higher-risk populations; (2) assessing the perceived benefits and acceptability of the proposed test within real-world settings across direct and indirect user groups; and (3) translating the user needs and contextual constraints into design requirements and implementation considerations that support the test's clinical, operational, and user-centered value. We conducted 18 semi-structured interviews with frontline staff and HCV testing/treatment pipeline experts (n=11) and people who get tested (n=7) across harm reduction organizations, syringe service programs, and community testing settings, analyzed using Rapid Qualitative Analysis guided by the PARRQA framework. Stakeholders responded positively to a single-encounter point-of-need RNA test, and implementation considerations, including funding restrictions, staffing structures, and diverse deployment settings, directly shaped design requirements spanning turnaround time, sample type and volume, portability, result output, target operator, and ease of use. Benchmarking these stakeholder-derived specifications against the FIND Dx HCV target product profile (TPP) showed that stakeholder input confirmed, modified, or extended several TPP criteria and introduced requirements the TPP does not address. Together, these objectives constitute an upstream, evidence-driven design process that translates contextual and stakeholder knowledge into actionable engineering requirements, highlighting the need for diverse stakeholder engagement at all stages of the design process for closing the translation gap between laboratory-validated diagnostic tools and effective point-of-need deployment.

Background: Digitalization and remote work have increased interest in work environments that reduce workload, negative mood, and fatigue. Low-interaction co-presence in virtual spaces may offer a new digital work environment, but its effects on subjective workload remain unclear. Objective: To examine the effects of the 3D-avatar work-support application gogh on subjective workload, mood, and fatigue. Methods: We conducted an open-label randomized two-period crossover trial in 40 gogh desktop users performing desk- or computer-based tasks. Participants completed 30-min task periods with and without gogh, separated by a 30-min break, in randomized order. The NASA Task Load Index (NASA-TLX) was the primary outcome, with the mood and fatigue domains of the Inventory Scale for Mood and Sense of Fatigue as secondary outcomes. Linear mixed-effects models used condition and period as fixed effects and participant as a random intercept. Results: All 40 participants completed both conditions. NASA-TLX scores were 42.3 +/- 12.9 with gogh and 51.7 +/- 15.1 without gogh; the adjusted mean difference was -9.5 (95% confidence interval (CI) -13.4 to -5.5). Adjusted mean differences were -11.4 for mood (95% CI -16.6 to -6.2) and -15.0 for fatigue (95% CI -20.3 to -9.7). Exploratory analyses showed lower Frustration, Effort, and Physical Demand with gogh. Conclusions: The gogh condition was associated with a decrease in post-task perceived workload, negative mood, and fatigue. This combined virtual co-working environment may reduce task-related psychological burden, although objective performance, productivity, and long-term occupational health effects require further study.

Background: Privacy curtains represent a uniquely difficult infection control surface because they are frequently touched by patients, visitors, and healthcare workers, yet are difficult to disinfect using routine environmental cleaning protocols. We sought to quantify the performance of a novel automated aerosolized hydrogen peroxide system against pathogens on privacy curtains. Methods: This study was performed in an enclosed office space ({approx} 65 m^3), approximating a patient exam room. Four Bacillus atrophaeus (ATCC 9372) biological indicators (BIs) were affixed to a standard polyester privacy curtain. A single one-minute fogging phase was followed by a ten-minute contact/aeration phase (total = 11 min). Four corresponding chemical indicators measured peak airborne aerosolized hydrogen peroxide concentration, and two control BIs were placed outside of the room. Results: All four BIs demonstrated complete inactivation (no growth after seven-day incubation), representing [&ge;] 4-log10 spore reduction. Peak dosages reached 42 ppm nearest the aerosolized hydrogen peroxide jet outlet, with the lowest value at the near point on the back side of the curtain reaching 27 ppm (exceeding the target dosage of 25 ppm). Control exposures failed to achieve sterilization. Conclusions: A next-generation aerosolized hydrogen peroxide dry-fogging disinfection system achieved full inactivation of resistant spores on both sides of privacy curtains within a short 11-minute automated cycle.

Purpose: Videourodynamics (VUDS) are used to assess bladder dysfunction and risk of upper urinary tract deterioration in patients with spina bifida (SB), but interpretation is subject to interrater variability. Machine learning models have previously classified bladder dysfunction severity and predicted incident hydronephrosis using VUDS data. This study evaluated the performance of adapted versions of these models in an independent external cohort. Materials and Methods: VUDS data were collected from SB patients who underwent VUDS at a single institution between 2016 and 2025. Previously developed machine learning frameworks were adapted for implementation in the independent dataset. Three models were utilized: a deep learning convolutional neural network model using pressure-volume data, a deep learning imaging model using fluoroscopic imaging data, and an ensemble model that averaged the risk data from the pressure-volume and fluoroscopic data. The models were evaluated for prediction of incident hydronephrosis and classification of bladder dysfunction severity compared to expert pediatric urologist reviewers. Results: 70 patients were included in the hydronephrosis cohort, of whom 13 (18%) developed incident hydronephrosis. The ensemble model outperformed individual modalities, with a concordance index of 0.77 (pressure-volume only: 0.70, imaging only: 0.72) and an overall AUROC of 0.75 (pressure-volume: 0.67, imaging: 0.74). For bladder dysfunction classification in 95 VUDS studies, the ensemble model achieved 71% accuracy compared to 60% for pressure-volume data alone and 66% for imaging alone, with no substantial disagreements with expert reviewers. Conclusions: The machine learning models that were developed to predict incident hydronephrosis and classify the severity of bladder dysfunction using VUDS data were able to be adapted to an external, independent dataset and perform with similar discrimination and accuracy as previously reported.

Hydroclimate whiplash, defined as the rapid transition between unusually wet and dry conditions, is expected to intensify under climate change, yet its population health impacts remain largely unknown. Here we quantified the association between hydroclimate whiplash and mortality across the contiguous United States from 2003 to 2023 using monthly county-level mortality records, standardized precipitation evapotranspiration index data, and two-stage time-series models. We identified overall and direction-specific dry-to-wet and wet-to-dry whiplash events at seasonal and sub-annual timescales and across 5-, 10-, and 20-year recurrence intervals. More severe whiplash events were associated with higher all-cause mortality risk; 5-, 10-, and 20-year sub-annual overall whiplash events increased mortality risk over five months by 3.4%, 4.5%, and 5.7%, respectively. Elevated risks were observed across cause-specific mortality outcomes, with the strongest association for infectious diseases. We estimated that 103,471 deaths were attributable to overall whiplash during the study period. These findings identify hydroclimate whiplash as an emerging climate-related public health threat and suggest that adaptation strategies focused on single hazards may underestimate the health burden of rapid, sequential hydroclimatic extremes.

Background Mortality in sepsis is often considered a direct consequence of infection and organ dysfunction, although many deaths occur after withdrawal of life sustaining treatment. The clinical factors leading to these decisions and their implications for interpreting sepsis mortality are not well characterized. Methods We performed a secondary analysis of a prospective observational cohort of adults with physician adjudicated sepsis at a tertiary academic medical center. Patients who transitioned to comfort measures only (CMO) during the index hospitalization underwent structured chart review to characterize baseline health and functional status, clinical severity, care preferences, anticipated outcomes following survival, and the primary reason for CMO transition. Results Among 239 patients with adjudicated sepsis, 42 (17.6%) transitioned to CMO. These patients had substantial underlying disease, including malignancy in 76% and immunocompromised status in 62%. However, 88% lived at home before hospitalization, 52% were independent in activities of daily living, an additional 26% were partially independent, and 90% were full code on admission. Progressive multi organ failure (19%), refractory septic shock (19%), and irreversible respiratory failure (12%) accounted for half of CMO transitions, while advanced frailty (5%) and poor baseline functional status (2%) were infrequent primary reasons. Median time from admission to CMO was 16 days (IQR 7 to 33), and median time from admission to death was 18 days (IQR 11 to 35). Anticipated ventilator dependence (62%), dialysis dependence (36%), and cognitive impairment frequently influenced goals of care discussions. Overall, 38 patients died during the index hospitalization, and 35 (92%) of these deaths followed transition to CMO. Conclusions Most CMO transitions in this cohort occurred after an evolving course of severe sepsis and were driven primarily by progressive organ dysfunction and failure to recover rather than advanced frailty or poor baseline function. These findings identify failure to recover after the acute septic insult as an important clinical trajectory and highlight the need to account for treatment limitation when interpreting sepsis mortality. Understanding why some patients recover from sepsis associated organ dysfunction while others progress to irreversible organ failure may help identify patients and mechanisms for future therapeutic intervention.

PurposeLong COVID literature often describes new-onset symptoms or conditions following SARS-CoV-2 infection; however, Long COVID also encompasses the exacerbation of pre-existing conditions. We describe health conditions reportedly worsened by COVID-19 illness and associated concerns in U.S. adults. MethodsWe collected longitudinal data from adults 18 years and older participating in the Track Post COVID-19 Conditions, an active Long COVID cohort surveillance project. Respondents completed surveys 3-, 6-, and 12- months after COVID-19 illness, beginning in July 2023. In each survey, respondents were asked whether they had any health conditions or concerns that were made worse by COVID-19. Those with an affirmative response were asked to specify the worsening condition(s) via free text. Some respondents used this free text to describe challenges or experiences related to their worsening conditions. This report categorizes and quantifies reported conditions and concerns by body system categories and qualitatively describes associated challenges and experiences using direct quotes from respondents free text responses. ResultsAmong 2,227 adults, 263 (11.8%) respondents reported at least one worsening condition or concern following COVID-19 illness. Of these, nearly 32% reported a worsening respiratory condition or concern. Adults with worsening pre-existing conditions reported challenges accessing adequate care, completing daily activities, and managing their symptoms following COVID-19. DiscussionWhile Long COVID literature often focuses on the development of new-onset long-term symptoms, more than 1 in 10 adults reported worsening of a pre-existing condition following COVID-19. Reported challenges with accessing care and daily activities highlight potential need for accommodations or support for adults with Long COVID.

Individuals of Vietnamese descent comprise a majority of the United States nail salon workforce. Whereas prior research has centered on chemical exposures, thematic analysis of interviews with Vietnamese nail salon workers around Baltimore, Maryland examined the lived experiences of nail salon workers. Six themes were identified: (1) nail work as a familial livelihood and a sacrifice-oriented pathway towards intergenerational mobility; (2) perceived flexibility within the workplace with low control; (3) professional pride grounded in artistry, detail, and customer care; (4) cumulative occupational risks; (5) emotional labor as an expected and core component of nail salon work; and (6) limited perceived capacity to change working conditions. These findings suggest that the occupational pressures in nail salon work cannot be solely framed as a lack of worker knowledge or motivation towards adopting safer practices. Intervention success depends on a holistic view of workers' lives, whose choices are shaped by family obligations, customer demands, and conditions largely outside their control. Therefore, efforts to improve nail salon health may benefit from shifting the burden of risk management away from individual workers and engaging the wider community.

Objective Non-healing diabetic foot ulcers (DFUs) stall in an alkaline and pro-inflammatory microenvironment that delays healing and increases the risk of complications. Since an acidic pH has been correlated with healing, wound acidification has become an appealing strategy to perturb the DFU microenvironment and promote wound closure. While reducing wound pH has shown promising results, the effects of pH on inflammation and the microbiome have not been well characterized. Along with inflammation, microbial communities are critical to the wound microenvironment and are associated with healing trajectories. We aimed to explore the longitudinal effects of altering pH on the DFU microbiome and inflammatory profile. Approach 10 subjects, each with a chronic DFU, were treated with a polyglycolic acid/ poly(lactide-co-caprolactone) bioresorbable matrix over a 4-week period, and changes in wound pH, volume, inflammation, and microbiome were evaluated every 14 days. Results Wounds decreased significantly in pH (p<0.001) and volume (p<0.05). Wound-specific changes to both bacterial and fungal communities occurred, with alkaline wounds increasing in bacterial diversity as pH decreased. Wound size and baseline pH were found to be associated with microbial composition, and larger wounds were elevated in pro-inflammatory chemokines. Innovation To capture the complete bacterial and fungal presence, 16S and ITS amplicon sequencing was used to assess community-level changes to wound acidification. Conclusions The relationship between greater wound size, microbial composition, alkalinity, and inflammation demonstrates their interconnected role in the DFU microenvironment and wound severity. This work supports that wound acidification may have the potential to perturb microbial communities with a greater effect on alkaline DFUs.

This study protocol combines clinical simulations with climatic chamber experiments, to evaluate 1) the impact of heat stress on hospital nurses physiological strain, physical and mental fatigue, vigilance, and clinical performance; and 2) the efficacy of a practical cooling intervention (i.e. electric fan) in mitigating the negative impact of heat stress. UK-based, registered adult nurses working in hospital settings will be recruited to partake in a repeated-measures cross-over design study, consisting of five separate 3-hour experimental sessions simulating clinical work, and taking place within a climatic chamber at Southampton General Hospital (UK). Sessions will differ by ambient temperature and cooling intervention as follows: 1) control (CTR; 18{degrees}C, 50% relative humidity [RH]); 2) warm (WARM; 26{degrees}C, 50%RH); 3) warm with electric fan (WARM+FAN; 26{degrees}C, 50%RH); 4) hot (HOT; 34{degrees}C, 50%RH); 5) hot with electric fan (HOT+FAN; 34{degrees}C, 50%RH). This study has been registered on a publicly accessible clinical trial registry (ISRCTN45793399). During each session, participants will first complete a standardised fatigue-induction protocol simulating shift work (i.e. low-intensity cycling with cognitive tasks); followed by a simulated hospital ward round involving six simulated patients and two simulated cardiac arrest scenarios. Nursing cognitive and physical performance will be assessed using a standardised observational assessment battery, along with objective cardiopulmonary resuscitation (CPR) performance metrics. Physiological responses will be assessed by monitoring changes in core temperature (Tcore), skin temperature (Tskin), heart rate, and whole-body sweat loss (WBSL). Fatigue and vigilance will be measured using the Swedish Occupational Fatigue Inventory (SOFI) and Brief Psychomotor Vigilance Task (PVT-B), respectively. Baseline (i.e. prior to fatiguing protocol) to post simulation changes in 1) vigilance assessed via the PVT-B (i.e. a determinant of role-specific cognitive performance); 2) CPR quality score (i.e. a determinant of role-specific physical performance); and 3) Tcore (i.e. a determinant of thermo-physiological state); will be analysed using linear mixed models to determine the effects of ambient temperature and cooling intervention on nurses clinical and physiological performance. By providing a controlled methodological framework for assessing the effects of heat exposure on hospital nurses physiological, perceptual, and clinical performance, this study will provide empirical evidence on air temperature-related changes in nursing performance and physiological strain and the role of cooling interventions in modifying these responses. This will support the development of evidence-based climate adaptation strategies to protect healthcare staff wellbeing and maintain patient safety during periods of extreme heat.

Occupational ocular injuries are a preventable yet neglected public health problem, particularly in low- and middle-income countries. Maintenance workers are exposed to diverse ocular hazards daily, yet compliance with protective measures is consistently poor. A descriptive cross-sectional study was conducted among 85 maintenance workers at the Maintenance and Essential Services Organization (MESO) of Kwame Nkrumah University of Science and Technology (KNUST), Ghana, recruited through stratified convenience sampling across seven occupational sections. A structured questionnaire assessed knowledge of ocular hazards and protective equipment, attitudes toward ocular safety, and safety practices. Data were analyzed using IBM SPSS version 26 (IBM Corp., Armonk, NY, USA); chi-square and Fishers exact tests assessed associations (p < 0.05). Participants were predominantly male (84/85, 98.8%), with a mean age of 44.5 {+/-} 10.4 years. Overall knowledge was good (mean 9.40 {+/-} 1.59 out of 11), but attitude and practice scores were average (2.78 {+/-} 0.92 and 3.27 {+/-} 0.93, respectively). Most workers correctly identified goggles and face shields as protective, but only about half recognized that ordinary sunglasses and spectacles offer inadequate protection. Although 97.6% (83/85) recognized the need for ocular protection, only 7.1% (6/85) reported consistent protective eyewear use, and fewer than half (45.9%, 39/85) had received formal ocular safety training. Routine general protective equipment use was significantly associated with ocular protection use (Fishers exact test, p = 0.011). Sand and dust particles were the leading causes of injury and only 25% (5/20) of injured workers sought formal care. Workers demonstrated good knowledge but poor attitudes and practices toward ocular safety, suggesting that knowledge alone does not translate into protective behaviour even within a relatively well-resourced institutional setting. Findings suggest that limited access to task-appropriate protective eyewear may represent an important institutional barrier. Institutional PPE supply and section-specific safety training are essential to bridge this knowledge-practice gap.

Objective: Carbapenem-resistant Acinetobacter baumannii (CRAB) infections present a significant public health challenge in the United States due to multidrug resistance, substantial added inpatient costs, and subsequently high mortality rates. Method: A decision-analytic model was developed to evaluate the cost-effectiveness of sulbactam-durlobactam compared to colistin for treating CRAB infections, using data from the Acinetobacter Treatment Trial Against Colistin (ATTACK) trial, in which patients received either sulbactam-durlobactam or colistin alongside imipenem-cilastatin. The model incorporated survival rates, clinical outcomes (complete or incomplete cure), and the incidence and costs of acute kidney injury, which is more frequent in colistin-treated patients. Deterministic sensitivity analysis and two scenario analyses were performed. Results: The base case analysis estimated an expected per-patient cost of $57,887 for sulbactam-durlobactam compared to $55,157 for colistin. Patients treated with sulbactam-durlobactam had higher survival than those treated with colistin (0.66 versus 0.46), corresponding to 0.19 additional life saved per patient. The incremental cost-effectiveness ratio (ICER) for sulbactam-durlobactam compared with colistin was $14,097 per additional life saved. The ICER was most sensitive to the proportion of survivors with incomplete clinical cure for both treatments, the costs of sulbactam-durlobactam and cefiderocol, and survival outcomes in patients treated with sulbactam-durlobactam. Scenario analyses showed that the cost-effectiveness of sulbactam-durlobactam was sensitive to clinical cure outcomes, with ICERs ranging from $69,758 per additional life saved to dominance favoring sulbactam-durlobactam under different assumptions. Conclusions: Although treatment costs were higher, sulbactam-durlobactam has a favorable cost-effectiveness profile as compared with colistin when accounting for the costs of managing acute kidney injury.

In 2024, Chicago experienced a measles virus outbreak. Air samples collected as part of routine respiratory virus surveillance from three hospitals that received measles patients were retrospectively analyzed. Measles virus was detected in air samples from one emergency department across five weeks when measles patients were present and another when no known cases were present. Two of three viral sequences derived from air samples were identical to measles patients. The source of one diverging sequence could not be identified and may represent a case not identified by traditional surveillance methods. Air sampling may supplement measles investigation, surveillance and response.

Objectives: Capturing adequate blood volume for blood cultures is critical for accurate detection of bloodstream infections. Pediatric volume targets vary by age and weight, whereas adult targets are standardized. The BD BACTEC FXI Culture System (FXI) contains an integrated calibrated load cell capable of automatically reporting blood volume measurements for each vial loaded onto the system. This study evaluated the accuracy of the FXI's blood volume measurements in simulated pediatric and adult patients. Methods: Mock pediatric and adult blood draws were performed, using bagged whole blood, to replicate real-world collection protocols. Syringe-collected blood volumes ranged from 2.0 to 15.0 mL for pediatric patients, depending on mock patient weight, and were fixed at 40.0 mL for adults. Samples were inoculated into BD BACTEC Peds Plus/F, Plus Aerobic/F, and Lytic/10 Anaerobic/F Culture Vials, with a target volume of 2.0 to 10.0 mL per bottle. Reference blood volumes were determined gravimetrically using manually obtained pre- and post-inoculation weights with a blood-specific gravity of 1.055 g/mL and were compared to the automatically measured, gravimetric-based blood volumes reported by the BACTEC FXI Culture System. Results: Automated volume estimates were accurate to a mean error of -0.03 mL per bottle (SD, 0.40 mL; n=168; 95% CI, -0.09 mL, 0.03 mL) and -0.08 mL (SD, 0.79 mL; n=72; 95% CI, -0.26 mL, 0.10 mL) when assessing total volume collected per patient. Conclusions: Our findings demonstrate that the automated system can quantify blood volumes in BACTEC culture vials and support blood volume monitoring for pediatric and adult collections. The gravimetric approach is also amenable to full automation for efficient and accurate blood volume determination.

Background: Door handles are frequently touched surfaces that can serve as fomites for transmission of pathogenic and antimicrobial-resistant bacteria. However, contamination of door handles in university settings in low-resource countries remains poorly characterised. This study determined the prevalence, bacteriological profile and antimicrobial susceptibility of bacterial contaminants on door handles at Mbarara University of Science and Technology (MUST) City Campus, Uganda. Methods: A laboratory-based cross-sectional study was conducted using stratified random sampling across hostels, lecture rooms, toilets, laboratories and offices. One hundred door handles were swabbed in the evening using a standardised technique and processed within 24 hours. Samples were cultured on blood and MacConkey agar. Bacterial isolates were identified using colony morphology, Gram staining and standard biochemical tests. Antimicrobial susceptibility was determined using the Kirby-Bauer disc diffusion method according to CLSI guidelines. Results: Of the 100 door handles sampled, 53 (53.0%) yielded bacterial growth, producing 59 isolates from five species, including three cases of polymicrobial contamination. Contamination was highest on toilet door handles (68.2%) and lowest on laboratory handles (20.0%). Gram-positive cocci predominated (89.8%), with Staphylococcus hyicus (47.5%) and Staphylococcus aureus (40.7%) being the most common isolates. Other organisms included Klebsiella pneumoniae (8.5%), Hafnia species (1.7%) and Staphylococcus saprophyticus (1.7%). High antimicrobial resistance was observed against azithromycin (61.0%), tetracycline (44.1%) and penicillin (40.7%). Gentamicin showed the greatest activity, with only 8.5% resistance, followed by chloramphenicol (20.3%). Resistance to cefixime and ceftriaxone among Gram-negative isolates suggested possible extended-spectrum beta-lactamase (ESBL) production, although these drugs were tested on only six isolates. Conclusion: Door handles at MUST City Campus harbour a substantial burden of bacterial contamination, including potentially pathogenic and antimicrobial-resistant organisms. This highlights the potential role of frequently touched surfaces in microorganism transmission within university environments. Recommendations: Routine disinfection of frequently touched surfaces, particularly toilet door handles, should be strengthened alongside improved hand hygiene and prudent antimicrobial use. Further studies should incorporate molecular confirmation of bacterial identification and resistance mechanisms, as well as minimum inhibitory concentration testing.

Antimicrobial resistance is a public health challenge, driving the need for rapid, cost-effective diagnostic support tools. Artificial intelligence (AI) may enable prediction of susceptibility to untested antibiotics from known susceptibility results, but prospective clinical validation is required before routine use. We evaluated an AI-based decision support method, trained on invasive isolates from the European Surveillance System (TESSy), for prediction of antibiotic susceptibility in clinical Escherichia coli urine isolates. The evaluation included 99 E. coli isolates from urine samples with diversity in age, sex, and antibiotic susceptibility. Predictions were evaluated for 14 antibiotics using patient metadata and susceptibility results for 4-8 antibiotics as input. Prediction uncertainty was handled using conformal prediction, allowing abstention when confidence was insufficient. EUCAST disk diffusion test results were used as reference and genomic sequence data was used to explore mechanisms of the AI performance. Without conformal prediction, 84% of predictions were correct when susceptibility results of six antibiotics were used to predict susceptibility to eight additional antibiotics. Across all predictions generated using susceptibility results for six antibiotics as input, the major and very major error rates were 19% and 12%, respectively. Prediction errors varied between antibiotics and were associated with certain phenotypic and genotypic resistance patterns. Conformal prediction reduced errors but increased abstentions; at confidence levels of 90%, 95%, and 97.5%, the model abstained in 9.6%, 14%, and 22% of instances. The method showed promising performance, but its clinical use remains limited and may require diagnostic data beyond susceptibility test results and demographic variables.

Background: Children spend more than 90% of their time indoors, and early childhood education settings (ECEs) are an understudied, high-occupant-density indoor microenvironment where exposure to volatile organic compounds, particulate matter, and other toxicants has been documented. Limited knowledge exists on ECE-specific exposures affecting young children and how they compare to exposures in the home. Methods: This prospective, repeated-measures pilot study targeted enrollment of 44 preschool-aged children and 8 ECE staff across two geographically and sociodemographically distinct ECEs in metropolitan Atlanta, Georgia. Paired silicone wristbands, one home-designated and one ECE-designated, were exchanged between settings across three consecutive days and nights beginning at enrollment to characterize microenvironment-specific exposure. A single spot urine sample was also collected from each child. Continuous indoor air quality monitoring was conducted in two classrooms per site. Caregivers and ECE staff completed structured questionnaires assessing home and ECE environmental characteristics, child respiratory risk, and protocol feasibility and acceptability. Feasibility was evaluated using eight pre-specified indicators spanning recruitment and enrollment, wristband wear duration and loss by microenvironment, urine sample collection completeness, and survey completion by instrument and respondent group. Conclusion: This pilot will establish feasibility and acceptability parameters for a paired, multi-matrix silicone wristband protocol across home and ECE microenvironments. Findings will inform the design, sample size, and power calculations for a subsequent study testing indoor air interventions and pediatric respiratory outcomes in ECEs. Feasibility outcomes are reported in a companion manuscript.

Background. Direct livestock exposure is a risk factor for zoonotic influenza, including H5N1 highly pathogenic avian influenza (HPAI) A virus. But whether living in regions of high poultry and swine production intensity (PPI, SPI) increases risk of exposure to zoonotic influenza viruses independent of occupational livestock contact remains unclear. Objectives. To determine whether livestock workers and community members with no occupational livestock exposure in North Carolina, where poultry and swine production are increasingly co-located, are at higher risk of exposure to zoonotic influenza. Methods. Saliva samples from industrial livestock operation worker (ILO-W), ILO neighbor (ILO-N) and metropolitan area (Metro) households were analyzed for mucosal influenza A (H5N1, H1N1, and H3N2) hemagglutinin (HA) IgA and IgG antibodies to determine associations of PPI, SPI, exposure group, and detection of a swine-specific fecal contamination marker (Pig-2-Bac DNA) with influenza A antibody levels. Results. Residing in the highest PPI and SPI tertile was associated with significantly higher mucosal H5 and H1 HA IgA levels, including among residents without occupational livestock exposure. Households with occupational poultry or swine contact had significantly higher H5 IgA and IgG and H1 IgA levels compared to Metro households. In regression models accounting for clustering at the participant level, log10 anti-H5 HA mucosal IgA increased 0.16 (95% CI: 0.06, 0.27, p<0.005) and 0.10 (95% CI: 0.03, 0.17, p<0.005), per log10 increase in PPI and SPI, respectively, and 0.16 (95% CI: 0.03, 0.19, p<0.02) when Pig-2-Bac DNA was detected on household surfaces. Conclusions. Mucosal H5 HA IgA and IgG and H1 HA IgA were consistently elevated across different metrics of livestock exposure intensity, including residential exposure, occupational contact within a household, and a molecular marker of household swine fecal contamination in a state with intensive poultry and swine production.

In response to the growing need to recycle E-waste, specifically that of lithium-ion batteries (LIBs), the development of sustainable recycling methodologies will be vital. As one of the most sustainable and low-cost options, biohydrometallurgy (BioHM) uses biological organisms to facilitate the recovery of critical metals from spent LIBs. Despite the advantages of BioHM, its slow kinetics, due to the reliance on the metabolic activity of microorganisms, limit its large-scale application for the closed-loop recycling of LIBs. In this work, we investigate the correlation between the incubation time of Acidithiobacillus ferrooxidans (Atf) and its leaching efficiency of four common elements in LIBs: Li, Ni, Mn, and Co. We assess how specific incubation times along the biological growth curve affect the leaching efficiency of Li[Ni0.6Mn0.2Co0.2]O2 (NMC622), a model electrode material. Our results show that pH alone is not an accurate descriptor of the leaching efficiency of Atf cultures used at different growth stages. The addition of NMC622 during the bacterial lag phase reaches similar or even improved extraction compared to cultures used after reaching the exponential or stationary phases. A simple model of leaching dynamics shows predictions consistent with our experimental observations under the condition that the inhibition of bacterial growth by NMC is not severe. Our findings indicate that early-stage cultures can alleviate the kinetic bottleneck and improve the throughput of recovering critical materials from spent batteries.