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Haemophilus influenzae (Hi) can cause meningitis and other serious invasive disease. Encapsulated Hi is classified into six serotypes (a-f) based on chemical composition of the polysaccharide capsule; unencapsulated strains are termed nontypeable Hi (NTHi). Hi serotype b (Hib) was the most common cause of bacterial meningitis in children in the pre-Hib vaccine era, and secondary transmission of Hi among children (e.g., to household contacts and in child care facilities) (1,2) led to the Advisory Committee on Immunization Practices (ACIP) recommendation for antibiotic chemoprophylaxis to prevent Hib disease in certain circumstances.* High Hib vaccination coverage since the 1990s has substantially reduced Hib disease, and other serotypes now account for most Hi-associated invasive disease in the United States (3). Nevertheless, CDC does not currently recommend chemoprophylaxis for contacts of persons with invasive disease caused by serotypes other than Hib and by NTHi (non-b Hi). Given this changing epidemiology, U.S. surveillance data were reviewed to investigate secondary cases of invasive disease caused by Hi. The estimated prevalence of secondary transmission was 0.32% among persons with encapsulated Hi disease (≤60 days of one another) and 0.12% among persons with NTHi disease (≤14 days of one another). Isolates from all Hi case pairs were genetically closely related, and all patients with potential secondary infection had underlying medical conditions. These results strongly suggest that secondary transmission of non-b Hi occurs. Expansion of Hi chemoprophylaxis recommendations might be warranted to control invasive Hi disease in certain populations in the United States, but further analysis is needed to evaluate the potential benefits against the risks, such as increased antibiotic use.

Women report lower sexual satisfaction than men. Given that sexual dissatisfaction adversely impacts health and well-being, it is imperative that we investigate why women are sexually dissatisfied. In the present study, we explored whether women’s benevolently sexist attitudes might predict their sexual dissatisfaction. In a sample of 308 (Mage = 38.09) heterosexual American women who had previously had sex with a man, we hypothesized that women’s benevolent sexism would be associated with an increased adoption of the traditional sexual script (i.e., an increased propensity for submissiveness and passivity during sex) and that this, in turn, would be associated with increased sexual dissatisfaction. We also hypothesized that the relationship between the adoption of the traditional sexual script and sexual dissatisfaction would be moderated by the degree to which participants enjoy submissiveness. Overall, we did not find support for our model: benevolent sexism did not predict sexual dissatisfaction. However, we did find that adopting the traditional sexual script was predictive of sexual dissatisfaction for women who do not enjoy submissiveness. These findings contribute to an emerging literature pertaining to women’s sexual health. Specifically, results suggest that benevolent sexism does not contribute to women’s experiences of sexual dissatisfaction. Instead, they suggest that sexual dissatisfaction in women may (in part) be driven by their engagement in sexual roles that do not align with their sexual preferences. Theoretical and clinical implications for these findings are discussed.

We describe two cases of XDRPseudomonas aeruginosainfection caused by a strain of public health concern recently associated with a nationwide outbreak of contaminated artificial tears. Both cases were detected through database review of genomes in the Enhanced Detection System for Hospital-Associated Transmission (EDS-HAT), a routine genome sequencing-based surveillance program. We generated a high-quality reference genome for the outbreak strain from one of the case isolates from our center and examined the mobile elements encodingblaVIM-80andblaGES-9carbapenemases. We then used publicly availableP. aeruginosagenomes to explore the genetic relatedness and antimicrobial resistance genes of the outbreak strain.

Introduction Acute large vessel occlusion (LVO) can be secondary to thromboembolism or intracranial atherosclerotic disease (ICAD). Data on LVO management due to underlying ICAD are scarce. We hypothesized that patients with ICAD have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD. Methods We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between January 14, 2018 and October 24, 2021. Presence of ICAD at LVO site was determined by the interventionalist. We compared in‐hospital mortality, 90‐day mortality, and 90‐day modified Rankin Scale (mRS) scores between those with and without ICAD, in unadjusted and adjusting logistic regression models. Results Among 215 patients (mean age 67.1±16.0 years; 60.5% female; 80.5% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥ 2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.054). In‐hospital and 90‐day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0–2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in‐hospital mortality (OR = 4.1, 95% CI 1.7‐9.7), 90‐day mortality (OR = 3.7, 95% CI 1.6‐8.6), and poor functional outcome at 90 days (OR = 5.5, 95% CI 1.6‐19.4). Conclusions Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT. Further research is warranted to understand factors associated with worse outcomes and investigate alternative interventional approaches and medical management in this high‐risk population.

Introduction: Acute large vessel occlusion (LVO) can be secondary to thromboembolism or intracranial atherosclerotic disease (ICAD). Data on LVO management due to underlying ICAD are scarce. We hypothesized that patients with ICAD have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD. Methods: We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between January 14, 2018 and October 24, 2021. Presence of ICAD at LVO site was determined by the interventionalist. We compared in-hospital mortality, 90-day mortality, and 90-day modified Rankin Scale (mRS) scores between those with and without ICAD, in unadjusted and adjusting logistic regression models. Results: Among 215 patients (mean age 67.1±16.0 years; 60.5% female; 80.5% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p=0.027 and 29.0% vs. 14.7%, p=0.035, respectively). Substantial reperfusion (TICI ≥2b) was achieved less often (84.2% vs. 94.4%, p=0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p=0.054). In-hospital and 90-day mortality were more common (36.8% vs. 15.8%, p=0.003 and 52.6% vs. 26.6%, p=0.002, respectively) and favorable functional outcome (mRS 0-2) at 90 days was less common (7.9% vs. 33.9%, p=0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in-hospital mortality (OR=4.1, 95% CI 1.7-9.7), 90-day mortality (OR=3.7, 95% CI 1.6-8.6), and poor functional outcome at 90 days (OR=5.5, 95% CI 1.6-19.4). Conclusions: Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT. Further research is warranted to understand factors associated with worse outcomes and investigate alternative interventional approaches and medical management in this high-risk population.

ObjectiveMALT1 regulates immunity and inflammation in multiple ways, while its role in rheumatoid arthritis (RA) is obscure. This study aimed to investigate the relationship of MALT1 with disease features, treatment outcome, as well as its effect on Th1/2/17 cell differentiation and underlying molecule mechanism in RA.MethodsTotally 147 RA patients were enrolled. Then their blood Th1, Th2, and Th17 cells were detected by flow cytometry. Besides, PBMC MALT1 expression was detected before treatment (baseline), at week (W) 6, W12, and W24. PBMC MALT1 in 30 osteoarthritis patients and 30 health controls were also detected. Then, blood CD4+ T cells were isolated from RA patients, followed by MALT1 overexpression or knockdown lentivirus transfection and Th1/2/17 polarization assay. In addition, IMD 0354 (NF-κB antagonist) and SP600125 (JNK antagonist) were also added to treat CD4+ T cells.ResultsMALT1 was increased in RA patients compared to osteoarthritis patients and healthy controls. Meanwhile, MALT1 positively related to CRP, ESR, DAS28 score, Th17 cells, negatively linked with Th2 cells, but did not link with other features or Th1 cells in RA patients. Notably, MALT1 decreased longitudinally during treatment, whose decrement correlated with RA treatment outcome (treatment response, low disease activity, or disease remission). In addition, MALT1 overexpression promoted Th17 differentiation, inhibited Th2 differentiation, less affected Th1 differentiation, activated NF-κB and JNK pathways in RA CD4+ T cells; while MALT1 knockdown exhibited the opposite effect. Besides, IMD 0354 and SP600125 addition attenuated MALT1’s effect on Th2 and Th17 differentiation.ConclusionMALT1 regulates Th2 and Th17 differentiation via NF-κB and JNK pathways, as well as correlates with disease activity and treatment outcome in RA.

MALT1 regulates immunity and inflammation in multiple ways, while its role in rheumatoid arthritis (RA) is obscure. This study aimed to investigate the relationship of MALT1 with disease features, treatment outcome, as well as its effect on Th1/2/17 cell differentiation and underlying molecule mechanism in RA.Totally 147 RA patients were enrolled. Then their blood Th1, Th2, and Th17 cells were detected by flow cytometry. Besides, PBMC MALT1 expression was detected before treatment (baseline), at week (W) 6, W12, and W24. PBMC MALT1 in 30 osteoarthritis patients and 30 health controls were also detected. Then, blood CD4MALT1 was increased in RA patients compared to osteoarthritis patients and healthy controls. Meanwhile, MALT1 positively related to CRP, ESR, DAS28 score, Th17 cells, negatively linked with Th2 cells, but did not link with other features or Th1 cells in RA patients. Notably, MALT1 decreased longitudinally during treatment, whose decrement correlated with RA treatment outcome (treatment response, low disease activity, or disease remission). In addition, MALT1 overexpression promoted Th17 differentiation, inhibited Th2 differentiation, less affected Th1 differentiation, activated NF-κB and JNK pathways in RA CD4MALT1 regulates Th2 and Th17 differentiation

Additional file 16. The discovery and the synthesis of GSK761, GSK064, GSK675 and GSK306.

The Fully-Depleted Silicon On Insulator (FDSOI) technologies are deployed for a wide range of applications (digital, analog, RF, etc.) requiring a large variety of MOS transistors. These transistors are defined by several dedicated specificities such as their threshold voltage or their gate oxide thickness. Usually, the surface potential (SP) based compact model of FDSOI MOSFET supposes an undoped channel with metal gate in front and back contact [1–3]. These models are not sufficiently accurate for real devices; thus, in the modern compact models [1–3], a lot of parasitic effects must be included such as the substrate depletion. This paper describes the recent improvements of L-UTSOI standard model, with the introduction of the poly-depletion effect and an enhanced model of the substrate doping effects. These model extensions are validated against silicon experimental data and available in the latest official model release.

Zero/few-shot transfer to unseen services is a critical challenge in task-oriented dialogue research. The Schema-Guided Dialogue (SGD) dataset introduced a paradigm for enabling models to support any service in zero-shot through schemas, which describe service APIs to models in natural language. We explore the robustness of dialogue systems to linguistic variations in schemas by designing SGD-X - a benchmark extending SGD with semantically similar yet stylistically diverse variants for every schema. We observe that two top state tracking models fail to generalize well across schema variants, measured by joint goal accuracy and a novel metric for measuring schema sensitivity. Additionally, we present a simple model-agnostic data augmentation method to improve schema robustness., Comment: AAAI 2022

With the maturity of CMOS technologies and their use for low power various analog and digital applications, some additional effects must be modeled or enhanced to improve the accuracy of SPICE models. Indeed, with the decrease of supply voltages/currents and the use of the back bias in Fully-Depleted Silicon On Insulator (FDSOI) technologies, the devices operate close to the weak-moderate inversion, where gm/Id Figure is impacted by effects like the depletion of source/drain electrodes and the parasitic currents such as Impact ionization current in moderate inver-sion and Gate Leakage current in weak inversion, can have a significant impact on the model accuracy. This paper describes the latest significant improvements of L-UTSOI model (formerly Leti-UTSOI) related to version 102.4. These model extensions are validated against Silicon experimental data.

An ultraviolet (UV) spectroradiometer is refurbished and upgraded with a fore-optical module. In addition to measuring total UV irradiance, the UV spectroradiometer can measure solar direct beam and sky radiance at any preset azimuth and elevation angle. This double Czerny-Turner spectroradiometer, with an ion-etched holographic grating operating in the first order with 3600 lines per mm, enables wavelength scanning range from 290 nm to 410 nm, with a nominal bandwidth of 0.1 nm. It can operate with a step-size of 0.0005 nm and a full width at half maximum of 0.1 nm. It has an out-of-band rejection ratio of approximately 10–10. This high resolution spectroradiometer can be used as a reference instrument for UV radiation measurements and to monitoring atmospheric gases (O3, SO2, NO2). Recently laboratory work suggests that water vapor displays structured absorption features over 290-350 nm region with maximum and minimum cross-sections of 8.4×10-25 and 1.4×10-25 cm2/molecule. To investigate the water vapor absorption features in UV region in real atmosphere, we did a series of field observations by using this high resolution spectroradiometer. A residual analysis method is developed to analyze the absorption of atmospheric components and to retrieve the atmospheric optical depth. The residual spectra of multiple cases have spectral features similar to that of in-lab measured water vapor absorption in some wavelength regions, and the inferred ozone amount from residual analysis agrees with OMI retrievals. Through multiple case studies, the magnitude of residual optical depth from observed UV spectra is sensitive to the atmospheric water vapor amount. The greater the water vapor path, the larger the difference between observational spectra and calculated spectra without considering water vapor absorption.

Food insecurity is a growing problem on college campuses. By following a user-centered design process, our team envisioned how design can be a tool for enacting social justice. By posing the question "How might we support college students challenged by food insecurity?" we designed a product called the Food Locker that paired an online ordering system with a collection of lockers for students to discreetly and conveniently retrieve items from the campus food pantry. In this experience report, we introduce the growing problem of food insecurity on college campuses, discuss how this issue connects to concerns of inclusion, equity and access, and then detail the steps we took to design the Food Locker. We conclude by reflecting on the process, exploring next steps and calling for continued focus on using design to identify interventions for social justice through UCD.

BACKGROUND: We previously developed enzyme nanoparticles (ENP) of alcohol metabolism. This study was to evaluate protective effects of facilitated removal of blood alcohol and/or acetaldehyde on anti-HIV drugs and alcohol-induced liver injuries. METHODS: ENP were prepared for degrading alcohol completely (ENP1) or partially into acetaldehyde (ENP2), which were applied to mice of acute binge or chronic-binge alcohol feeding in the presence of antivirals (ritonavir and lopinavir). Liver pathologies were examined to assess the protective effects of ENP. RESULTS: In the acute model, ENP1 and ENP2 reduced the blood alcohol concentration (BAC) by 41% and 32% respectively within 4 hr whereas in control without ENP, BAC was reduced only by 15%. Blood acetaldehyde concentration (BADC) was increased by 39% in alcohol fed mice treated with ENP2 comparing to control. No significant effects of the anti-HIV drugs on BAC or BADC were observed. Plasma alanine aminotransferase (ALT) and expression of liver TNFα were both significantly increased in the alcohol fed mice, which were normalized by ENP1. In the presence of the antivirals, ALT was partially reduced by ENP1 or ENP2. In the chronic model, inflammation, fatty liver and ALT were increased, which were deteriorated by the antivirals. ENP1 partially reduced BAC, BADC, ALT, and expression of inflammation markers of TNFα, F4/80 and IL-6 and lipogenic factors of ACC, LXRα and SREBP1. ENP2 reduced BAC without significant effects on ALT, inflammation or lipogenesis. Antivirals and alcohol synergistically increased expression of organelle stress markers of CHOP, sXBP-1, ATF6 and GCP60. ENP1 reduced BAC, CHOP and sXbp-1. However, no effects of ENP1 were found on ATF6 or GCP60. CONCLUSIONS: Removal of blood alcohol and acetaldehyde by the enzyme nanoparticles protects the liver against alcoholic injuries, and the protection is less effective in chronic alcohol and antiviral feeding due to additional drug-induced organelle stresses.

BackgroundFollowing Haemophilus influenzae serotype b (Hib) conjugate vaccine introduction in the 1980s, Hib disease in young children dramatically decreased, and epidemiology of invasive H. influenzae changed.MethodsActive surveillance for invasive H. influenzae disease was conducted through Active Bacterial Core surveillance sites. Incidence rates were directly standardized to the age and race distribution of the US population.ResultsDuring 2009-2015, the estimated mean annual incidence of invasive H. influenzae disease was 1.70 cases per 100000 population. Incidence was highest among adults aged ≥65 years (6.30) and children aged

The article of record as published may be found at https://doi.org/10.1175/BAMS-D-16-0055.1 High-resolution observations of Hurricanes Patricia, Joaquin, and Marty in 2015 provide new insight into tropical cyclone structure and intensity change as part of the Tropical Cyclone Intensity field program.

Background Certain anti-HIV drugs alone or in combination are often associated with liver damages, which are frequently worsened by alcohol consumption. We previously found an endoplasmic reticulum (ER) stress mechanism for the drug- and alcohol-induced hepatic injuries in animal models and in vitro hepatocytes. However, it is unknown whether anti-HIV drugs and alcohol induce similar cellular stress responses and injuries in liver nonparenchymal cells. Methods Primary mouse hepatocytes (PMH), kupffer cells (KC), and hepatocellular stellate cells (HSC) were freshly isolated from mouse liver and treated with DMSO, stress-inducing pharmaceutical agents, alcohol alone, or in combination with antiviral ritonavir (RIT), lopinavir (LOP), or efavirenz (EFV). Expression of cellular stress markers, protein colocalization, and cell death were analyzed with immunoblotting, immunocytochemistry, and positive double staining with Sytox green and Hoechst blue, respectively. Results Expression of the ER stress markers of BiP, CHOP, and SERCA and the autophagy marker LC3 was significantly changed in PMH in response to combined alcohol, RIT, and LOP, which was companied by increased cell death compared with control. In contrast, although pharmaceutical agents induced ER stress and cell death, no significant ER stress or cell death was found in KC treated with alcohol, RIT, LOP, and EFV singly or in combination. In HSC, alcohol, RIT, LOP, or EFV induced BiP, but not CHOP, SERCA, or cell death compared with vehicle control. Further in PMH, RIT and LOP or in combination with alcohol-induced dose-dependent inhibition of β-actin. Inhibition of β-actin by RIT and LOP was companied with an inhibited nuclear expression of the antioxidant response regulator Nrf2 and reduced GST downstream of Nrf2. Ascorbic acid treatment reduced the alcohol-, RIT-, and LOP-induced cell death. Conclusions The data suggest for the first time that sensitivities of hepatocytes and nonparenchymal cells to alcohol and anti-HIV drugs in vitro are different in terms of cellular stress response and cell death injury. Oxidative stress mediated by Nrf2 contributes to the alcohol- and drug-induced toxicity in the hepatocytes.

This study investigated the effects of types of post-reading instructional scaffolds on university-level English as a foreign language (EFL) learners’...

In this report we outline a strategy for using the ongoing removal of San Clemente Dam on Carmel River as a learning tool for dam removals in California. In 2013, NMFS, Federal, state and local partners began removing this 32m high dam at a cost of $84 million, with key objectives of improving habitat and ecological connectivity to benefit steelhead (National Marine Fisheries Service 2013a), a Federally threatened salmonid.

Alcohol intoxication causes serious diseases, whereas current treatments are mostly supportive and unable to remove alcohol efficiently. Upon alcohol consumption, alcohol is sequentially oxidized to acetaldehyde and acetate by the endogenous alcohol dehydrogenase and aldehyde dehydrogenase, respectively. Inspired by the metabolism of alcohol, we develop a hepatocyte–mimicking antidote for alcohol intoxication through the co–delivery of the nanocapsules of alcohol oxidase (AOx), catalase (CAT), and aldehyde dehydrogenase (ALDH) to the liver, where AOx and CAT catalyze the oxidation of alcohol to acetaldehyde, while ALDH catalyzes the oxidation of acetaldehyde to acetate. Administered to alcohol–intoxicated mice, the antidote rapidly accumulates in the liver and enables a significant reduction of the blood alcohol concentration. Moreover, blood acetaldehyde concentration is maintained at an extremely low level, significantly contributing to liver protection. Such an antidote, which can eliminate alcohol and acetaldehyde simultaneously, holds great promise for the treatment of alcohol intoxication and poisoning and can provide therapeutic benefits.

Widely-used Tropical Cyclone (TC) models include regional air-sea coupled dynamical models such as COAMPS-TC (Hao, et al, 2013), HWRF (Tallapragada, et al., 2014; Kim, et al., 2014) and GFDL (Bender et al., 2007; Gall, et al., 2011), global dynamical models such as GFS and ECMWF, and statistical-dynamical intensity-prediction models such as SHIPS, STIPS, L-GEM, RII (DeMaria and Kaplan, 1999; DeMaria, et al., 2005; Knaff et al., 2005; Jones, et al., 2006; DeMaria, 2009; DeMaria, 2010; Kaplan, et al., 2010). All of these models benefit from improved 3-D spatial observational plus enhanced temporal resolution, i.e. better 4-D capability. The need for enhanced 4-D profile observations is driven by the need for enhanced model resolution of the physics of small-scale processes such as convective events, boundary layer air-sea transfer processes and upper troposphere outflow jets. These requirements demand a concurrent enhancement in 4-D profile observational capability at finer spatial and temporal scales. Observations and observational strategies for initial condition specification and forecast validation within and around TCs require continual improvement to match these model demands while providing a basis for improvements in process understanding and parameterization on increasingly smaller scales.

This qualitative study, conducted as a follow-up to Lee’s (2014) experimental study, examined aspects and features of Instructional Conversation (IC) and IC discourse that serve to assist English as a foreign language (EFL) learners in their WebQuest writing performance. Interview data were collected from the three most successful online IC participants in Lee’s study and were subsequently analyzed using within-case and cross-case thematic analysis methods. Results indicated that (a) the structure/sequence of IC, (b) interactive participation, and (c) thematic focus assisted the EFL learners in their overall WebQuest writing performance, that (a) the structure/sequence of IC and (b) thematic focus assisted them in their performance on content, and that IC’s facilitation of understanding of content, along with the resulting improvement in other components of overall writing quality, assisted them in their performance on overall writing quality. An analysis of the texts from the online IC discussions in which the three interviewees participated revealed that the common themes identified through the cross-case analysis of the interview data were well manifested or reflected in the IC discussion data. Implications are discussed in both theoretical and practical terms.

To determine frequency of methicillin-resistant Staphylococcus aureus infections caused by strains typically associated with community-acquired infections (USA300) among persons with healthcare-related risk factors (HRFs), we evaluated surveillance data. Of patients with HRFs, 18%-28% had a "community-associated" strain, primarily USA300; of patients without HRFs, 26% had a "healthcare-associated" strain, typically USA100.

Background Physician experts hired and prepared by litigants provide most of the information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, the authors examined the feasibility and potential value of surveying peer physicians to assess standard of care. Methods The survey method for assessing standard of care was evaluated for a medical malpractice case involving an abdominoplasty that had a poor cosmetic result. An abstract of the case that included the patient's characteristics and physician's decisions that were most likely to influence patient outcome was created from the transcribed testimony of the plaintiff's expert witness. This abstract and a survey that included questions about four decisions made by the defendant were sent to 28 plastic surgeons in the Midwest who were identified by searches of public documents. Results Eleven plastic surgeons experienced in abdominoplasty completed the survey. Their responses in all four areas contrasted sharply with those of the highly credentialed medical expert for the plaintiff. Conclusions These results suggest that physician surveys are feasible and may provide very different results than those from expert witnesses about standard of care in medical malpractice cases.

BackgroundSince the introduction of the Haemophilus influenzae serotype b vaccine, H influenzae epidemiology has shifted. In the United States, the largest burden of disease is now in adults aged ≥65 years. However, few data exist on risk factors for disease severity and outcome in this age group.MethodsA retrospective case-series review of invasive H influenzae infections in patients aged ≥65 years was conducted for hospitalized cases reported to Active Bacterial Core surveillance in 2011.ResultsThere were 299 hospitalized cases included in the analysis. The majority of cases were caused by nontypeable H influenzae, and the overall case fatality ratio (CFR) was 19.5%. Three or more underlying conditions were present in 63% of cases; 94% of cases had at least 1. Patients with chronic heart conditions (congestive heart failure, coronary artery disease, and/or atrial fibrillation) (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.65-6.46), patients from private residences (OR, 8.75; 95% CI, 2.13-35.95), and patients who were not resuscitate status (OR, 2.72; 95% CI, 1.31-5.66) were more likely to be admitted to the intensive care unit (ICU). Intensive care unit admission (OR, 3.75; 95% CI, 1.71-8.22) and do not resuscitate status (OR, 12.94; 95% CI, 4.84-34.55) were significantly associated with death.ConclusionsWithin this age group, burden of disease and CFR both increased significantly as age increased. Using ICU admission as a proxy for disease severity, our findings suggest several conditions increased risk of disease severity and patients with severe disease were more likely to die. Further research is needed to determine the most effective approach to prevent H influenzae disease and mortality in older adults.

In 2009, in the Active Bacterial Core surveillance sites, penicillin was not commonly used to treat meningococcal disease. This is likely because of inconsistent availability of antimicrobial susceptibility testing and ease of use of third-generation cephalosporins. Consideration of current practices may inform future meningococcal disease management guidelines.