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A large body of research has established a relation between maternal education and children's neurocognitive functions, such as executive function and language. However, most studies have focused on early childhood and relatively few studies have examined associations with changes in maternal education over time. Consequently, it remains unclear if early maternal education is longitudinally related to neurocognitive functions in children, adolescents, and young adults. In addition, the associations between changes in maternal education across development and more broadly defined neurocognitive outcomes remain relatively untested. The current study leveraged a large multicohort sample to examine the longitudinal relations between perinatal maternal education and changes in maternal education during development with children's, adolescents', and young adults' neurocognitive functions (N = 2,688; M[subscript age] = 10.32 years; SD[subscript age] = 4.26; range = 3-20 years). Moreover, we examined the differential effects of perinatal maternal education and changes in maternal education across development on executive function and language performance. Perinatal maternal education was positively associated with children's later overall neurocognitive function. This longitudinal relation was stronger for language than executive function. In addition, increases in maternal education were related to improved language performance but were not associated with executive functioning performance. Our findings support perinatal maternal education as an important predictor of neurocognitive outcomes later in development. Moreover, our results suggest that examining how maternal education changes across development can provide important insights that can help inform policies and interventions designed to foster neurocognitive development. [This paper was written on behalf of program collaborators for Environmental Influences on Child Health Outcomes.]

Abstract Background A major challenge in epidemiology is knowing when an exposure effect is large enough to be clinically important, in particular how to interpret a difference in mean outcome in unexposed/exposed groups. Where it can be calculated, the proportion/percentage beyond a suitable cut-point is useful in defining individuals at high risk to give a more meaningful outcome. In this simulation study we compute differences in outcome means and proportions that arise from hypothetical small effects in vulnerable sub-populations. Methods Data from over 28,000 mother/child pairs belonging to the Environmental influences on Child Health Outcomes Program were used to examine the impact of hypothetical environmental exposures on mean birthweight, and low birthweight (LBW) (birthweight

Abstract Bronchiolitis is the leading cause of infant hospitalization. However, the molecular networks driving bronchiolitis pathobiology remain unknown. Integrative molecular networks, including the transcriptome and metabolome, can identify functional and regulatory pathways contributing to disease severity. Here, we integrated nasopharyngeal transcriptome and metabolome data of 397 infants hospitalized with bronchiolitis in a 17-center prospective cohort study. Using an explainable deep network model, we identified an omics-cluster comprising 401 transcripts and 38 metabolites that distinguishes bronchiolitis severity (test-set AUC, 0.828). This omics-cluster derived a molecular network, where innate immunity-related metabolites (e.g., ceramides) centralized and were characterized by toll-like receptor (TLR) and NF-κB signaling pathways (both FDR

Introduction: In the United States, more chronic and preventive healthcare is being delivered in the emergency department (ED) setting. Understanding the availability of preventive health services in the ED setting is crucial. Our goal was to understand the availability of a subset of preventive health services in US EDs and explore how that has changed over time. Methods: In 2022–2023, using the National Emergency Department Inventory (NEDI)-USA, we surveyed a random 20% (1,064) sampling of all 5,613 US EDs. We asked directors of these EDs about the availability of and preference for 12 preventive health services, social worker availability, self-reported percentage of uninsured ED patients, and measures of ED crowding. We also asked about perceptions of barriers to implementing preventive health services in the ED. We used unadjusted and multivariable logistic regression models to compare service frequency in 2022–2023 to prior findings from 2008–2009 that represented a 5.7% random sampling of all EDs. Results: Among 302 responders to the 2022–2023 survey (5.4% random sampling, 28.4% response rate), 94% reported offering at least one preventive health service, with a median of five services. The most common service offered was intimate partner violence screening (83%), while the least common was routine HIV screening (19%). Seven services (eg, intimate partner violence, alcohol risk, and smoking cessation screening) had a higher odds of being offered in 2022–2023 than in 2008–2009; findings were unchanged in sensitivity analyses. A small proportion of directors opposed offering preventive health services. However, many expressed concerns that preventive health services in the ED would lead to longer lengths of stay (56%), increased costs to their ED (58%), a diversion of staff time from providing acute care (50%), or that their patients would not have access to adequate follow-up (49%). Conclusion: Nearly all EDs offer at least one preventive health service. Many offer multiple services; rates were higher than those identified in 2008–2009, in both unadjusted and multivariable models. Although limited by the response rate, this work provides the most recent and comprehensive snapshot of the type and frequency of a subset of preventive health services currently offered in US EDs.

Introdução: Acinetobacter baumannii (Acb) é uma das principais bactérias associadas às infecções relacionadas à assistência à saúde, com potencial para aquisição de genes de resistência aos antimicrobianos. Durante a pandemia de COVID-19, houve aumento das taxas de isolamento de Acb, e detecção de isolados do clone IC2/CC2, que apresenta grande sucesso evolutivo e adaptativo, antes não circulante no Brasil. Objetivo: O objetivo deste trabalho é reportar a emergência de uma linhagem de Acb do clone IC2/CC2 co-produtor de OXA-23:NDM-1:ArmA em um hospital público de São Paulo, SP. Método: Rotineiramente, os isolados recebidos no Instituto Adolfo Lutz são identificados por MALDI-TOF, e submetidos a PCR para identificação do complexo clonal, pesquisa de genes de resistência aos carbapenêmicos (OXAs, KPC e NDM) e análise do perfil clonal por tipagem molecular (PFGE). Para este estudo, um isolado representativo foi selecionado para teste de sensibilidade aos antimicrobianos e sequenciamento do genoma total. Resultados: Entre 2021 e 2024, 168 isolados foram recebidos deste hospital, dos quais 52% (88/168) foram identificados como IC2/CC2 produtores de OXA-23. Destes, 19% (17/88) foram co-produtores de NDM. A análise do perfil clonal destes 17 isolados mostrou alta similaridade (> 87%) entre eles. O isolado selecionado para realização do teste de sensibilidade aos antimicrobianos foi classificado como multidroga resistente (MDR). Análises do resistoma demostraram a presença de genes codificadores para carbapenemases (blaOXA-23 e blaNDM-1), para enzimas modificadoras de aminoglicosídeos (aph(6)-Id, aph(3’)-VI) e para a 16S rRNA metiltransferase (armA), que confere alto grau de resistência a aminoglicosideos. O isolado foi tipado como ST218:KL7:OCL1. A filogenia realizada com outros genomas do IC2/CC2 da América do Sul identificou agrupamento com cepas de mesmo ST:KL provenientes tanto do Rio de Janeiro como de São Paulo. A transmissão hospitalar deste clone foi interrompida por meio de medidas educativas com envolvimento dos setores, e reforço a adesão às boas práticas para prevenção de infecção relacionada à assistência, com melhoria dos processos. Conclusão: Neste estudo, reportamos a emergência e disseminação clonal de Acb IC2/CC2 MDR co-produtor de OXA-23:NDM-1:ArmA em um hospital terciário da cidade de São Paulo, reforçando a necessidade de monitoramento para aplicação de medidas de contenção de um novo patógeno resistente no ambiente hospitalar.

La neuroinflamación es una integración compleja de las respuestas de todas las células presentes dentro del Sistema nervioso central, incluidas las neuronas, la macroglía, la microglía y los leucocitos infiltrantes. Los trastornos neuroinflamatorias ocurren cuando el sistema inmunológico se vuelve demasiado activo y ataca las células sanas, teniendo una patología de base circundando en sus alrededores. El sistema inmunológico puede dañar partes del sistema nervioso central. La biología celular es amplia a la hora de abordar y definir un cerebro que enfrente una inflamación. Comprender la acción proinflamatoria y antiinflamatoria en el cerebro depende de la microglía y los astrocitos; Varios estudios en animales han identificado marcadores inflamatorios, incluidos el ARNm de IL-1, TNF-α e IL-6. Revisión especial realizada por "Johns Hopkins Medicine International", se concluye que es de suma importancia comprender la neuroinflamación a partir de una lesión isquémica, proponer perspectivas de investigación y reconocer estudios in vitro que permitan buscar terapias alternativas para mejorar a los pacientes.

Background/Objective: Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma. Methods: We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2–17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was

RESUMO Este trabalho trata da influência das características anatômicas da madeira sobre a penetração e adesão de adesivos. Neste contexto, deu-se enfoque a diversidade estrutural e anatômica da madeira e seus papeis na performance de uma ligação adesiva.

RESUMO Este trabalho objetivou a verificação do efeito da secagem à temperatura de 100oC nas membranas de pontoações de Pinus taeda L., o que pode alterar a permeabilidade da madeira. Foram confeccionados blocos de madeira nas dimensões de 2,0 x 2,0 x 2,5 cm que, depois de secos à temperatura ambiente e em estufa a 100oC, foram submetidos a cortes anatômicos orientados, com o objetivo de avaliar o efeito da alta temperatura nas membranas de pontoações. Foi observado que, com a temperatura de 100oC, houve uma maior incidência de membranas de pontoações rompidas, o que pode aumentar a permeabilidade da madeira. A secagem a temperatura ambiente também apresentou rompimentos de membranas, mas de forma reduzida e localizada e, além disso, observou-se a presença de amido nas respectivas amostras.

RESUMO Este trabalho objetiva verificar os resultados obtidos em experimento de determinação de permeabilidade ao ar, pelo método de deslocamento de coluna d'água (Falling-Water Displacement Method) em amostras de madeira de Pinus caribaea Dougl. afetadas por queimadas periódicas na relva, sob as condições de secas ao ar e em estufa. Uma dispersão relativamente grande nos dados obtidos de permeabilidade foi verificado, tanto em amostras sob a condição de secas ao ar como nas de secas em estufa. Entretanto, sob a condição de secas em estufa, as amostras apresentaram uma maior permeabilidade ao ar. A provável presença de pontuações aspiradas, torus danificados, a razão entre lenho tardio e inicial, com a presença de irregulares anéis de lenho tardio, provavelmente, influenciaram esses resultados.

RESUMO A entrada dos produtos da indústria moveleira brasileira no competitivo comércio internacional ensejou a necessidade de melhores processos industriais, incluindo os de secagem. O processo de secagem por circulação forçada de ar à temperatura ambiente tem boas possibilidades de utilização industrial, e o aumento no aproveitamento de madeira de pinus e eucalipto proveniente dos plantios homogêneos pode gerar bons resultados neste processo de secagem.

Background Respiratory syncytial virus (RSV) bronchiolitis contributes to a large morbidity and mortality burden globally. While emerging evidence suggests that airway microRNA (miRNA) is involved in the pathobiology of RSV infection, its role in the disease severity remains unclear.Methods In this multicentre prospective study of infants (aged

El aumento en el consumo de prendas de vestir año a año genera una creciente demanda de materias primas y, por tanto, grandes cantidades de residual del proceso textil y confección con impacto a nivel ambiental en el componente aire, tierra y agua. La investigación precisa la cantidad de residuo generado por 7 empresas de Bogotá D.C durante el Q1 del año en curso previo conocimiento de sus procesos productivos por medio de observación directa que permitió categorizar el residuo textil por actividad en Hilatura (4.106,4 kg), Lavado y teñido de telas (10.500 m3 ), Confección (1.203 kg), Remate prenda (511 kg), No especificado (50 kg) y Otros (2,76 kg), encontrándose que la Licra (12% - 407 kg), Algodón perchado (10% - 343,57 kg) y el Rayón (9,7% - 340 kg) son los materiales con mayor generación de residuos.

Abstract Objectives Pediatric readiness varies widely among emergency departments (EDs). The presence of a pediatric emergency care coordinator (PECC) has been associated with improved pediatric readiness and decreased mortality, but adoption of PECCs has been limited. Our objective was to understand factors associated with PECC implementation in general EDs. Methods We conducted semistructured qualitative interviews with a purposively sampled set of EDs with and without PECCs. Interviews were completed, transcribed, and coded until thematic saturation was reached. Themes were identified through a consensus process and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Twenty‐four interviews were conducted and mapped to themes related to innovation, individuals and implementation process, outer setting (health system), and inner setting (hospital/ED). Addressing innovation, individuals, and implementation process, the primary theme was variability in how the PECC role was defined and who was responsible for implementing it. Regarding the outer setting, participants reported that limited system resources affected their ability to implement the PECC role. Key inner setting themes included concerns about limited visit volume, a lack of systems for measuring pediatric quality of care, and significant tension around change. Conclusions Implementation of the PECC role appears to be limited by heterogeneous interpretations of the PECC, de‐prioritization of pediatrics, and limited system resources. However, many participants described motivation to improve pediatric care and implement the PECC role in context of increasing pediatric visits; they offered strategies for future implementation efforts.

RESUMO A destilação simples do alcatrão vegetal gera uma tração oleosa obtida entre 120 °C e 250 °C. Esta fração, após redestilação na mesma faixa de temperatura e tratamento com soluções diluídas de hidróxido de sódio 10%, ácido sulfúrico 10%, bicarbonato de sódio 10% e éter metílico, dará origem aos fenóis brutos, que serão submetidos à destilação simples, aproveitando-se os vapores condensados entre 160 °C e 230° C para a produção dos adesivos fenólícos. Sugere-se a elaboração de três formulações, substituindo-se 0%, 50% e 100% de fenol comercial por fenóis do alcatrão. Os adesivos produzidos terão sua viscosidade, pH e teor de sólidos avaliados e, então, empregados para colar madeira sólida cujos corpos de prova serão submetidos a ensaios de ruptura sob tração, segundo especificações contidas na norma ASTM D 904-40, inerentes a estes ensaios.

El presente estudio permite comprender a través de las narrativas digitales como el ser humano entiende y se apropia de su entorno, además de ello es capaz de crear su cultura desde una formación integral. En este sentido, se asumió el reto de crear historias mediante una herramienta innovadora como es el storytelling para que los estudiantes transmitan sus ideas y se reconozcan como ser social que transforma y transmite los saberes de la sociedad, construyendo bienestar propio y colectivo como lo describe Arendt (2.000). Es así como se involucran elementos conceptuales y metodológicos de aprendizaje en el ámbito educativo a partir de procesos de comunicación interactiva. Así mismo se orienta a crear acciones didácticas de mejora para una nueva estrategia que permita la efectividad en la comunicación, desde el acto pedagógico. Lo anterior se evidencia con la articulación de las narrativas digitales en lo que respecta a desarrollar las competencias lectoras y escritoras. Como estrategia se ha considerado pertinente la creación y narración de historias storytelling en espacios virtuales de aprendizaje como medio para difusión de producciones literarias académicas.

Objectives: This study reports the genomic characterization of the multidrug resistant Salmonella Newport strain 195_20 recovered from the diarrheic faeces of a foal in Brazil and co-harbouring the mcr-9, blaCMY-2 and qnrB19 antibiotic resistance genes. Methods: Bacterial isolate positive for mobile colistin resistance gene (mcr-9) was submitted to antimicrobial susceptibility testing by disk diffusion and broth microdilution for colistin and polymyxin B. The isolate was submitted to whole genome sequencing by Illumina technology and Nanopore Sequencing. Conjugation assays, plasmid sizes determined by S1-PFGE and plasmid content were investigated by hybrid assembly after MinIon long reads sequencing. Results: Isolate 195_20 was identified as sequence type ST45, resistant to penicillin and cephalosporins (ampicillin, ceftazidime, ceftriaxone and cefotaxime), aminoglycosides (streptomycin and gentamicin), phenicol (chloramphenicol), quinolones and fluoroquinolones (nalidixic acid, ciprofloxacin, and pefloxacin), folate pathway antagonists (sulfonamides and trimethoprim-sulfamethoxazole), and tetracycline. A transferable IncHI2/IncHI2A plasmid sized ca. 262kb was found to carry the mcr-9 gene in a module consisting of IS903-mcr-9-wbuC-IS26. In addition, an 174kb IncC and a 48kb IncN plasmid were also identified in the 195_20 isolate, carrying blaCMY-2 and qnrB19, respectively. Conclusions: Not surprisingly, isolate 195_20 was susceptible to polymyxins, possibly due to absence of qseBC regulatory operon. Presence of mobile colistin resistance (mcr-9), third-generation cephalosporins (blaCMY-2) and quinolone (qnrB19) resistance determinants in zoonotic pathogens from animals in close contact with humans alerts for the possible route of transmission between these different reservoirs.

RESUMO A indústria madeireira brasileira se encontra num estágio tecnológico atrasado em relação aos países mais industrializados portanto, a necessidade de sua modernização é urgente. A obtenção dos certificados internacionais de qualidade devem ser objetivados, com a finalidade de proporcionar uma produção de bens com qualidade e custos competitivos no mercado internacional, além do que, essas certificações significam o passaporte para o ingresso neste mercado. Além disso, é imperioso que se crie um mercado atuante de residuos provenientes do setor madeireiro, o que contribuirá para um uso mais racional dos recursos florestais, possibilitando reduzir custos de produção e criar alternativas energéticas como os processos de briquetagem.

RESUMO Em uma economia estável, com abertura gradual da economia, acirra-se a competição de mercado e modernização torna-se necessidade de extrema importância. O Brasil necessita de uma política florestal séria com definições claras de objetivos, prioridades e estratégias. A partir disso, o país poderá transformar a potencialidade em realidade.

Abstract Background Corynebacterium diphtheriae complex was formed by the species C. diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis in the recent past. In addition to C. diphtheriae, C. ulcerans and C. pseudotuberculosis species can carry the tox gene, which encodes diphtheria toxin. Currently, three new species have been included in the complex: Corynebacterium rouxii, Corynebacterium silvaticum, and Corynebacterium belfantii. C. rouxii is derived from the ancient Belfanti biovar of C. diptheriae. We provide the complete genome sequences of two non-toxigenic strains C. rouxii isolated from a cat with a purulent infection in Brazil. The taxonomic status and sequence type, as well as the presence of resistance and virulence genes, and CRISPR-Cas system were additionally defined. Results The genomes showed an average size of 2.4 Mb and 53.2% GC content, similar to the type strain of the species deposited in Genbank/NCBI. Strains were identified as C. rouxii by the rMLST database, with 95% identity. ANI and DDH in silico were consistent with values above the proposed cut-off points for species limit, corroborating the identification of the strains as C. rouxii. MLST analyses revealed a new ST, which differs from ST-537 only by the fusA allele. No horizontal transfer resistance gene was predicted in both genomes and no mutation was detected in the constitutive genes gyrA and rpoB. Some mutations were found in the seven penicillin-binding proteins (PBPs) detected. The tox gene was not found, but its regulatory gene dtxR was present. Among the predicted virulence genes are those involved in iron uptake and adherence, in addition to the DIP0733 protein involved in epithelial cell adhesion and invasion. The CRISPR-Cas type I-E system was detected in both genomes, with 16 spacer sequences each. Of them, half are unknown according to the databases used, indicating that there is an unexplored reservoir of corynebacteriophages and plasmids. Conclusions This is the first genomic study of C. rouxii reported in Brazil. Here we performed taxonomic analysis and the prediction of virulence factors. The genomic analyses performed in this study may help to understand the potential pathogenesis of non-toxigenic C. rouxii strains.

Abstract Background For surveillance of episodic illness, the emergency department (ED) represents one of the largest interfaces for generalizable data about segments of the US public experiencing a need for unscheduled care. This protocol manuscript describes the development and operation of a national network linking symptom, clinical, laboratory and disposition data that provides a public database dedicated to the surveillance of acute respiratory infections (ARIs) in EDs. Methods The Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) network includes 26 academic investigators, from 24 sites, with 91 hospitals, and the Centers for Disease Control and Prevention (CDC) to survey viral infections. All data originate from electronic medical records (EMRs) accessed by structured query language (SQL) coding. Each Tuesday, data are imported into the standard data form for ARI visits that occurred the prior week (termed the index file); outcomes at 30 days and ED volume are also recorded. Up to 325 data fields can be populated for each case. Data are transferred from sites into an encrypted Google Cloud Platform, then programmatically checked for compliance, parsed, and aggregated into a central database housed on a second cloud platform prior to transfer to CDC. Results As of August, 2023, the network has reported data on over 870,000 ARI cases selected from approximately 5.2 million ED encounters. Post-contracting challenges to network execution have included local shifts in testing policies and platforms, delays in ICD-10 coding to detect ARI cases, and site-level personnel turnover. The network is addressing these challenges and is poised to begin streaming weekly data for dissemination. Conclusions The RESP-LENS network provides a weekly updated database that is a public health resource to survey the epidemiology, viral causes, and outcomes of ED patients with acute respiratory infections.

Abstract Carbapenem-resistant Klebsiella pneumoniae (CRKP) are highly disseminated worldwide, and isolates co-resistant to other antimicrobial agents pose a threat to effective antimicrobial therapy. Therefore, evaluation of novel antimicrobial drugs is needed to identify potential treatments with better outcomes. We evaluated the in vitro activity of novel antimicrobial drugs/combinations against 97 KPC-producing Klebsiella pneumoniae isolates recovered from different hospitals in Brazil during 2021–2022. Clonality, resistance and virulence genes were detected by whole-genome sequencing. The majority of the isolates (54.6%) were classified as extensively drug resistant or multidrug resistant (44.3%); one isolate showed a pandrug resistance phenotype. The most active antimicrobial agents were meropenem-vaborbactam, cefiderocol, and ceftazidime-avibactam, with sensitivities higher than 90%; resistance to ceftazidime-avibactam was associated with KPC-33 or KPC-44 variants. Colistin and polymyxin B were active against 58.6% of the isolates. The 97 isolates were distributed into 17 different sequence types, with a predominance of ST11 (37.4%). Although high in vitro susceptibility rates were detected for meropenem-vaborbactam and cefiderocol, only ceftazidime-avibactam is currently available in Brazil. Our findings showed limited susceptibility to antimicrobial drugs employed for infection treatment of carbapenem-resistant K. pneumoniae, underscoring the urgent need for stringent policies for antimicrobial stewardship to preserve the activity of such drugs.

Abstract Bronchiolitis is the most common lower respiratory infection in infants, yet its pathobiology remains unclear. Here we present blood DNA methylation data from 625 infants hospitalized with bronchiolitis in a 17-center prospective study, and associate them with disease severity. We investigate differentially methylated CpGs (DMCs) for disease severity. We characterize the DMCs based on their association with cell and tissues types, biological pathways, and gene expression. Lastly, we also examine the relationships of severity-related DMCs with respiratory and immune traits in independent cohorts. We identify 33 DMCs associated with severity. These DMCs are differentially methylated in blood immune cells. These DMCs are also significantly enriched in multiple tissues (e.g., lung) and cells (e.g., small airway epithelial cells), and biological pathways (e.g., interleukin-1-mediated signaling). Additionally, these DMCs are associated with respiratory and immune traits (e.g., asthma, lung function, IgE levels). Our study suggests the role of DNA methylation in bronchiolitis severity.

Abstract Background Epigenetic clocks are promising tools for assessing biological age. We assessed the accuracy of pediatric epigenetic clocks in gestational and chronological age determination. Results Our study used data from seven tissue types on three DNA methylation profiling microarrays and found that the Knight and Bohlin clocks performed similarly for blood cells, while the Lee clock was superior for placental samples. The pediatric-buccal-epigenetic clock performed the best for pediatric buccal samples, while the Horvath clock is recommended for children's blood cell samples. The NeoAge clock stands out for its unique ability to predict post-menstrual age with high correlation with the observed age in infant buccal cell samples. Conclusions Our findings provide valuable guidance for future research and development of epigenetic clocks in pediatric samples, enabling more accurate assessments of biological age.

Public health faces daily challenges due to increasing reports of pathogenic microorganisms with new antimicrobial resistance. Klebsiella michiganensis, an emerging pathogen, poses difficulty in its identification using conventional techniques. This study presents the first documented case of NDM-1-producing K. michiganensis in Brazil, identified as the new ST418. Initially, the isolate from a tracheal secretion was misidentified as K. oxytoca. However, accurate identification was achieved through ANI analyses. Whole-genome sequencing was conducted to characterize the genetic context of the resistance genes, to identify virulence factors, and to construct a phylogenetic tree. The blaNDM-1 gene was found to be harbored on an IncFIB plasmid approximately 112 kb in length, which was transferable in conjugation assays. The detection of carbapenem resistance genes in this species highlights the importance of public health vigilance, as it may serve as a reservoir and disseminator of significant resistance genes.

Epinephrine autoinjectors (EAIs) are used for the treatment of severe allergic reactions in a community setting; however, their utility is limited by low prescription fulfillment rates, failure to carry, and failure to use due to fear of needles. Given that delayed administration of epinephrine is associated with increased morbidity/mortality, there has been a growing interest in developing needle-free, easy-to-use delivery devices. neffy (epinephrine nasal spray) consists of three Food and Drug Administration (FDA)-approved components: epinephrine, Intravail A3 (absorption enhancer), and a Unit Dose Spray (UDS). neffy’s development pathway was established in conjunction with the FDA and the European Medicines Agency and included multiple clinical trials to evaluate pharmacokinetic and pharmacodynamic responses under a variety of conditions, such as self-administration and allergic and infectious rhinitis, as well as an animal anaphylaxis model of severe hypotension, where neffy demonstrated a pharmacokinetic profile that is within the range of approved injection products and a pharmacodynamic response that is as good or better than injections. The increased pulse rate (PR) and blood pressure (BP) observed even one minute following the administration of neffy confirm the activation of α and β adrenergic receptors, which are the key components of epinephrine’s mechanism of action. The results suggest that neffy will provide a safe and effective needle-free option for the treatment of severe allergic reactions, including anaphylaxis.

Bronchiolitis, a viral lower respiratory infection, is the leading cause of infant hospitalization, which is associated with an increased risk for developing asthma later in life. Bronchiolitis can be caused by several respiratory viruses, such as respiratory syncytial virus (RSV), rhinovirus (RV), and others. It can also be caused by a solo infection (e.g., RSV- or RV-only bronchiolitis) or co-infection with two or more viruses. Studies have shown viral etiology-related differences between RSV- and RV-only bronchiolitis in the immune response, human microRNA (miRNA) profiles, and dominance of certain airway microbiome constituents. Here, we identified bacterial small RNAs (sRNAs), the prokaryotic equivalent to eukaryotic miRNAs, that differ between infants of the 35th Multicenter Airway Research Collaboration (MARC-35) cohort with RSV- versus RV-only bronchiolitis. We first derived reference sRNA datasets from cultures of four bacteria known to be associated with bronchiolitis (i.e., Haemophilus influenzae, Moraxella catarrhalis, Moraxella nonliquefaciens, and Streptococcus pneumoniae). Using these reference sRNA datasets, we found several sRNAs associated with RSV- and RV-only bronchiolitis in our human nasal RNA-Seq MARC-35 data. We also determined potential human transcript targets of the bacterial sRNAs and compared expression of the sRNAs between RSV- and RV-only cases. sRNAs are known to downregulate their mRNA target, we found that, compared to those associated with RV-only bronchiolitis, sRNAs associated with RSV-only bronchiolitis may relatively activate the IL-6 and IL-8 pathways and relatively inhibit the IL-17A pathway. These data support that bacteria may be contributing to inflammation differences seen in RSV- and RV-only bronchiolitis, and for the first time indicate that the potential mechanism in doing so may be through bacterial sRNAs.

Abstract Objective: n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake. Design: Pooled pregnancy cohort studies. Setting: Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020. Participants: A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use. Results: Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1–2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35–40 v.

ABSTRACT Combining and comparing microbiome data from distinct infant cohorts has been challenging because such data are inherently multidimensional and complex. Here, we used an ensemble of machine-learning (ML) models and studied 16S rRNA amplicon sequencing data from 4,099 gut microbiome samples representing 12 prospectively collected infant cohorts. We chose the childbirth delivery mode as a starting point for such analysis because it has previously been associated with alterations in the gut microbiome in infants. In cross-study ensemble models, Bacteroides was the most important feature in all machine-learning models. The predictive capacity by taxonomy varied with age. At the age of 1–2 months, gut microbiome data were able to predict delivery mode with an area under the curve of 0.72 to 0.83. In contrast, ML models trained on taxa were not able to differentiate between the modes of delivery, in any of the cohorts, when the infants were between 3 and 12 months of age. Moreover, no ML model, alternately trained on the functional pathways of the infant gut microbiome, could consistently predict mode of delivery at any infant age. This study shows that infant gut microbiome data sets can be effectively combined with the application of ML analysis across different study populations.IMPORTANCEThere are challenges in merging microbiome data from diverse research groups due to the intricate and multifaceted nature of such data. To address this, we utilized a combination of machine-learning (ML) models to analyze 16S sequencing data from a substantial set of gut microbiome samples, sourced from 12 distinct infant cohorts that were gathered prospectively. Our initial focus was on the mode of delivery due to its prior association with changes in infant gut microbiomes. Through ML analysis, we demonstrated the effective merging and comparison of various gut microbiome data sets, facilitating the identification of robust microbiome biomarkers applicable across varied study populations.

Antimicrobial resistance (AMR) poses an imminent threat to global public health, driven in part by the widespread use of antimicrobials in both humans and animals. Within the dairy cattle industry, Gram-negative coliforms such as Escherichia coli and Klebsiella pneumoniae stand out as major causative agents of clinical mastitis. These same bacterial species are frequently associated with severe infections in humans, including bloodstream and urinary tract infections, and contribute significantly to the alarming surge in antimicrobial-resistant bacterial infections worldwide. Additionally, mastitis-causing coliforms often carry AMR genes akin to those found in hospital-acquired strains, notably the extended-spectrum beta-lactamase genes. This raises concerns regarding the potential transmission of resistant bacteria and AMR from mastitis cases in dairy cattle to humans. In this narrative review, we explore the distinctive characteristics of antimicrobial-resistant E. coli and Klebsiella spp. strains implicated in clinical mastitis and human infections. We focus on the molecular mechanisms underlying AMR in these bacterial populations and critically evaluate the potential for interspecies transmission. Despite some degree of similarity observed in sequence types and mobile genetic elements between strains found in humans and cows, the existing literature does not provide conclusive evidence to assert that coliforms responsible for mastitis in cows pose a direct threat to human health. Finally, we also scrutinize the existing literature, identifying gaps and limitations, and propose avenues for future research to address these pressing challenges comprehensively.

Chagas disease is a Neglected Tropical Disease with limited and ineffective therapy. In a search for new anti-trypanosomal compounds, we investigated the potential of the metabolites from the bacteria living in the corals and sediments of the southeastern Brazilian coast. Three corals, Tubastraea coccinea, Mussismilia hispida, Madracis decactis, and sediments yielded 11 bacterial strains that were fully identified by MALDI-ToF/MS or gene sequencing, resulting in six genera—Vibrio, Shewanella, Mesoflavibacter, Halomonas, Bacillus, and Alteromonas. To conduct this study, EtOAc extracts were prepared and tested against Trypanosoma cruzi. The crude extracts showed IC50 values ranging from 15 to 51 μg/mL against the trypomastigotes. The bacterium Mesoflavibacter zeaxanthinifaciens was selected for fractionation, resulting in an active fraction (FII) with IC50 values of 17.7 μg/mL and 23.8 μg/mL against the trypomastigotes and amastigotes, respectively, with neither mammalian cytotoxicity nor hemolytic activity. Using an NMR and ESI-HRMS analysis, the FII revealed the presence of unsaturated iso-type fatty acids. Its lethal action was investigated, leading to a protein spectral profile of the parasite altered after treatment. The FII also induced a rapid permeabilization of the plasma membrane of the parasite, leading to cell death. These findings demonstrate that these unsaturated iso-type fatty acids are possible new hits against T. cruzi.

Introdução/Objetivo: Infecções por bactérias resistentes aos antimicrobianos são difíceis de tratar e podem resultar em pior prognóstico ao paciente. Neste estudo, avaliamos a atividade in vitro de novos antimicrobianos/concentrações contra isolados clínicos de Klebsiella e Pseudomonas resistentes aos carbapenêmicos. Métodos: Foram incluídos neste estudo 149 isolados clínicos (57 P. aeruginosa e 92 K. pneumoniae KPC+), de pacientes não repetidos, atendidos em 57 diferentes hospitais de 21 municípios brasileiros. Isolados produtores de metalo-carbapenemases foram excluídos. Todos os isolados foram caracterizados como imipenem-resistente (disco-difusão ou método dilucional). Estes isolados foram testados contra meropenem-vaborbactam (MV), cefiderocol (FDC), ceftazidime-avibactam (CZA), imipenem-relebactam (IR), plazomicina (PLZ), cefoperazone-sulbactam (CPS), eravaciclina (ERV), e ceftolozane-tazobactam (CT) (por fitas de gradiente de concentração), e colistina e polimixina B (por microdiluição em caldo). Resultados: Os antimicrobianos mais ativos contra K. pneumoniae foram CZA (96,7% de sensibilidade), MV (94,6%) e FDC (93,5%); colistina e polimixina B foram ativas contra 56,5% dos isolados de K. pneumoniae. Para P. aeruginosa, o antimicrobiano mais ativo foi FDC (100% de sensibilidade), seguido por CT (87,7) e CZA (84,2%); 5,3% e 3,5% dos isolados foram resistentes à colistina e polimixina, respectivamente. Conclusão: Altas taxas de sensibilidade foram detectadas para antimicrobianos com uso restrito no país, indicando a necessidade de contínuo monitoramento e fortalecimento de políticas de controle de seu uso. Com isso, espera-se preservar a atividade destes fármacos contra patógenos resistentes causadores de infecções, principalmente no ambiente hospitalar. Apoio: CNPq, FAPESP, FESIMA.

Introdução/Objetivo: A bactéria Klebsiella pneumoniae resistente a carbapenêmicos é considerada um patógeno prioritário de acordo com a OMS e o CDC. No Brasil, há predomínio de K. pneumoniae produtora de KPC, considerada endêmica em diversos hospitais. Além da resistência a carbapenêmicos, geralmente os isolados de Klebsiella KPC+ apresentam resistência a outros fármacos, o que suscita a investigação de novos antimicrobianos/combinações com potencial efeito terapêutico. Um dos fármacos mais recentes introduzidos no mercado é ceftazidima-avibactam (CZA), que apresenta atividade contra KPC mas não contra metalo-carbapenemases. A resistência a CZA ainda é pouco reportada, mas deve ser monitorada a fim de preservar sua atividade. Neste estudo, objetivamos realizar a caracterização fenotípica e genômica de três isolados de K. pneumoniae com resistência a CZA enviadas a nosso laboratório de referência. Métodos: Os isolados foram identificados por MALDI-TOF MS e submetidos a teste de sensibilidade por disco difusão e/ou microdiluição em caldo (para polimixina B, colistina e ceftazidima-avibactam). O DNA total bacteriano foi extraído por kit comercial e sequenciado nas plataformas Illumina e Oxford Nanopore (para caracterização completa dos plasmídeos). As análises foram realizadas por ferramentas de bioinformática. Resultados: De 97 isolados investigados, três (3%) apresentaram resistência a CZA (MIC > 32 mg/L), sendo dois sensíveis à polimixina e colistina (MIC = 0,125), e foi resistente (MIC = 32 mg/L). A resistência a imipenem e meropenem foi observada apenas em um destes isolados; os outros dois tiveram a sensibilidade aos carbapenêmicos preservada. A análise molecular acusou a identificação dos alelos KPC-33 (n = 2) e KPC-44 (n = 1), em isolados pertencentes aos sequence types ST11, ST258 e ST6326. Os genes blaKPC-33 e blaKPC-44 foram encontrados em diferentes plasmídeos, na seguinte configuração: KPC-33/IncFIIK-IncFIB(pKpQil)/ST6326; KPC-33/IncN/ST11; KPC-44/IncX3-IncU/ ST258. Conclusão: A resistência a CZA observada nestes três isolados é atribuída à presença de variantes do gene blaKPC-2. Por estarem localizados em diferentes plasmídeos em diferentes clones bacterianos provenientes de diferentes hospitais, a possibilidade de disseminação clonal pode ser descartada, sugerindo atuação da pressão de seleção como maior contribuinte para emergência da resistência a CZA.

A detecção rápida e acurada de carbapenemases em bactérias Gram-negativas é de suma importância para prevenção da disseminação de patógenos resistentes no ambiente de assistência à saúde, e para racionalização da antibioticoterapia, uma vez que o tratamento correto tem impacto positivo na sobrevida dos pacientes. Os testes imunocromatográficos foram desenvolvidos para fornecer resultados qualitativos rápidos e confiáveis sem necessidade de profissionais especializados para realização do método, auxiliando desta maneira, na identificação de carbapenemases. O objetivo do estudo foi avaliar o desempenho do teste rápido Carbapenem-resistant K.N.I.V.O. Detection K-Set Lateral Flow Assay (Genobio, China) para detecção das carbapenemases KPC, NDM, IMP, VIM e OXA-48 em um painel de bactérias previamente caracterizadas por PCR convencional, PCR em tempo real ou sequenciamento de genoma completo. Para realização do teste K.N.I.V.O., uma colônia do isolado bacteriano foi homogeneizada em solução de tratamento do kit, com posterior inoculação de 50 µL desta suspensão no local indicado do cassete; a leitura foi realizada após 15 minutos. No total, foram avaliados 44 isolados, sendo 32 deles com no mínimo uma carbapenemase, e 12 isolados negativos. Houve alta sensibilidade (97%) e especificidade (100%) do teste imunocromatográfico; o único resultado discordante foi um resultado falso negativo para o isolado de Klebsiella pneumoniae produtor de KPC-33. Os Valores Preditivos Positivo (VPP) e Negativo (VPN) foram de 100% e 92% respectivamente; e acurácia de 98%. O teste apresentou-se eficiente para detecção de dupla produção das carbapenemases KPC e NDM, além de variantes de KPC (como KPC-2, KPC-3, KPC-44), IMP-1, VIM-2 e outras enzimas. Apesar do custo ainda elevado, o teste imunocromatográfico que pode ser utilizado como opção de detecção de carbapenemase em casos específicos, praticamente à beira do leito. De forma geral, o teste imunocromatográfico apresentou elevada acurácia com as vantagens da rapidez, simplicidade de execução e de leitura do resultado, e multiplexação de alvos. Agradecimento: Empresa pH7id pela doação dos kits usados neste estudo.

A resistência aos antimicrobianos é uma das maiores ameaças à saúde pública. Diversos patógenos estão envolvidos na disseminação e resistência a várias classes, incluindo os β-lactâmicos, tornando as opções terapêuticas escassas. O objetivo deste trabalho foi de fornecer um panorama do monitoramento laboratorial de bactérias Gram-negativas causadoras de infecções relacionadas à assistência à saúde (IRAS) no estado de São Paulo, analisando dados pré-pandemia (2019), fase crítica (2020/2021), redução na taxa de letalidade (2022) e fim da emergência sanitária (2023). No total, 3.327 isolados foram recebidos no Instituto Adolfo Lutz, provenientes de 46 municípios do estado. Os patógenos mais prevalentes pertencem ao Complexo Acinetobacter baumannii (Acb 36,3%), Complexo Klebsiella pneumoniae (Kpn 28,3%) e Pseudomonas aeruginosa (Pa 11,1%). Houve aumento expressivo na frequência de Acb entre 2019 (13%), 2020 (39,2%) e 2021 (48,2%), com destaque para 2021, responsável por 50% do total de Acb de todo o período, e queda em 2022 (36,3%) e 2023 (18,1%). Cerca de 99% dos isolados de Acb foram sensíveis a polimixina B (CIM

Introdução e objetivo: No estado de São Paulo as capivaras são as principais hospedeiras amplificadoras da Rickettsia rickettsii, agente etiológico da febre maculosa brasileira (FMB), para o carrapato vetor Amblyomma sculptum. No entanto, muitas áreas com presença de capivaras e A. sculptum permanecem livres de R. rickettsii, indicando que outros fatores podem estar envolvidos na circulação da R. rickettsii em uma determinada área. Anteriormente, observou-se que as áreas endêmicas para FMB se diferenciam das não endêmicas pela predominância de A. sculptum na primeira, em contraponto à predominância de Ambyomma dubitatum na segunda. Considerando que carrapatos A. dubitatum encontram-se frequentemente infectados por Rickettsia bellii, uma possível interferência de R. bellii na capacidade amplificadora da capivara para R. rickettsii poderia explicar a distribuição heterogênea de R. rickettsii nas populações de A. sculptum no estado de São Paulo. Assim, o presente estudo teve como objetivo avaliar experimentalmente se uma exposição prévia a carrapatos A. dubitatum infectados com R. bellii é capaz de reduzir a amplificação da R. rickettsii para carrapatos A. sculptum. Métodos: Foram utilizadas nove cobaias divididas em três grupos experimentais. Três cobaias infestadas com carrapatos A. dubitatum infectados com R. bellii (Grupo GB), quatro cobaias infestadas com carrapatos A. dubitatum não infectados (Grupo GD) e duas cobaias não expostas a carrapatos A. dubitatum (Grupo GC). Após as infestações com A.dubitatum, cada cobaia foi infestada com uma única fêmea de A. sculptum infectada com R. rickettsii e em seguida com larvas de A. sculptum não infectadas. As larvas ingurgitadas foram coletadas e, após realizarem ecdise, foram submetidas à extração de DNA. As amostras de DNA foram testadas utilizando-se um protocolo de PCR convencional para detecção de riquétsias do grupo da febre maculosa. Resultados: Todas as cobaias apresentaram manifestações clínicas compatíveis com uma infecção por R. rickettsii. Cinco das seis cobaias dos grupos GD e GC vieram a óbito em contraponto a apenas uma das cobaias do grupo GB. A taxa de infecção por R. rickettsii entre os carrapatos do grupo GB foi de 21% (17/80), sendo significantemente menor que a taxa de 54% (60/111) observada nos grupos GD e GC (p < 0,00001). Conclusão: A exposição prévia a carrapatos A. dubitatum infectados com R. bellii reduziu a capacidade amplificadora de R. rickettsii das cobaias para o carrapato A. sculptum.

Summary: Background: Bronchiolitis is a leading cause of infant hospitalization. Recent research suggests the heterogeneity within bronchiolitis and the relationship of airway viruses and bacteria with bronchiolitis severity. However, little is known about the pathobiological role of fungi. We aimed to identify bronchiolitis mycotypes by integrating fungus and virus data, and determine their association with bronchiolitis severity and biological characteristics. Methods: In a multicentre prospective cohort study of 398 infants (age

Abstract This study analyzes the genomic findings of the first report of Salmonella isolate carrying the bla CTX-M-55 gene, recovered from a bacteremic patient from Brazil. A bacterial isolate positive for the bla CTX-M-55 gene was submitted to antimicrobial susceptibility testing by disk diffusion and epsilometric test. Whole genome sequencing was performed using Illumina technology. Conjugation assay was performed; plasmid sizes determined by S1-PFGE and plasmid content were investigated by hybrid assembly after MinION long reads sequencing. Isolate 288_18 was identified as sequence type ST13, resistant to ampicillin, cefotaxime, ceftazidime, cefepime, ceftriaxone, and aztreonam. A transferable IncFII plasmid sized approximately 67 kb was found to carry the bla TEM-1 and bla CTX-M-55 in a module consisting of IS26-bla TEM-1B -WbuC-bla CTX-M-55-IS26. In addition, an 117 kb IncI1plasmid was also identified in the 288_18 isolate, but without additional resistance genes. To the best of our knowledge, this is the first report of bla CTX-M-55 in Salmonella isolated from human infection in Brazil. The occurrence of bla CTX-M-55 in the IncFII epidemic plasmid in a relevant clinical human isolate of Salmonella Agona underscores the urgent need for enhanced and effective continuous surveillance for controlling its dissemination.

Abstract Background Health-related social needs (HRSN) are associated with higher chronic disease prevalence and healthcare utilization. Health systems increasingly screen for HRSN during routine care. In this study, we compare the differential prevalence of social risk factors and social needs in a Medicaid Accountable Care Organization (ACO) and identify the patient and practice characteristics associated with reporting social needs in a different domain from social risks. Methods Cross-sectional study of patient responses to HRSN screening February 2019-February 2020. HRSN screening occurred as part of routine primary care and assessed social risk factors in eight domains and social needs by requesting resources in these domains. Participants included adult and pediatric patients from 114 primary care practices. We measured patient-reported social risk factors and social needs from the HRSN screening, and performed multivariable regression to evaluate patient and practice characteristics associated with reporting social needs and concordance to social risks. Covariates included patient age, sex, race, ethnicity, language, and practice proportion of patients with Medicaid and/or Limited English Proficiency (LEP). Results Twenty-seven thousand four hundred thirteen individuals completed 30,703 screenings, including 15,205 (55.5%) caregivers of pediatric patients. Among completed screenings, 13,692 (44.6%) were positive for ≥ 1 social risk factor and 2,944 (9.6%) for ≥ 3 risks; 5,861 (19.1%) were positive for social needs and 4,848 (35.4%) for both. Notably, 1,013 (6.0%) were negative for social risks but positive for social needs. Patients who did not identify as non-Hispanic White or were in higher proportion LEP or Medicaid practices were more likely to report social needs, with or without social risks. Patients who were non-Hispanic Black, Hispanic, preferred non-English languages or were in higher LEP or Medicaid practices were more likely to report social needs without accompanying social risks. Conclusions Half of Medicaid ACO patients screened for HRSN reported social risk factors or social needs, with incomplete overlap between groups. Screening for both social risks and social needs can identify more individuals with HRSN and increase opportunities to mitigate negative health outcomes.

Este trabajo presenta el diseño y desarrollo de una novedosa metodología basada en técnicas estadísticas, que permite realizar una caracterización energética de procesos industriales, cumpliendo con los lineamientos de la norma internacional NTC ISO 50001:2019, cuya implementación es recomendada por la Unidad de Planeación Minero-Energética en la versión 2022-2030 del Plan Indicativo del Programa de Uso Racional y Eficiente de Energía en Colombia. La norma ISO 50001 exige tener una referencia cuantitativa (línea de base energética) del desempeño energético en los procesos que se propone calcular a través de modelos de regresión bayesianos. Además, esta metodología también permite identificar las variables o eventos que tienen mayor relevancia en su eficiencia energética, para en una etapa posterior implementar control sobre ellos y, de este modo, controlar el desempeño energético del proceso mediante la manipulación de estas variables.

A comprehensive genetic analysis of the relationship between childhood obesity and childhood asthma identifies shared mechanisms and potential mediators linking the two pediatric disorders.

Background : Increased body mass index (BMI) and metabolic syndrome (MetS) have been associated with adverse outcomes in viral syndromes. We sought to examine associations of increased BMI and MetS on several clinical outcomes in patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods : The registry of suspected COVID-19 in emergency care (RECOVER) is an observational study of SARS-CoV-2-tested patients (n=27,051) across 155 United States emergency departments (EDs). We used multivariable logistic regression to test for associations of several predictor variables with various clinical outcomes. Results : We found that a BMI ≥30 kg/m2 increased odds of SARS-CoV-2 test positivity (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23–1.38), while MetS reduced odds of testing positive for SARS-CoV-2 (OR, 0.76; 95% CI, 0.71–0.82). Adjusted multivariable analysis found that MetS was significantly associated with the need for admission (OR, 2.11; 95% CI, 1.89–2.37), intensive care unit (ICU) care (OR, 1.58; 95% CI, 1.40–1.78), intubation (OR, 1.46; 95% CI, 1.28–1.66), mortality (OR, 1.29; 95% CI, 1.13–1.48), and venous thromboembolism (OR, 1.51; 95% CI, 1.07–2.13) in SARS-CoV-2-positive patients. Similarly, BMI ≥40 kg/m2 was significantly associated with ICU care (OR, 1.97; 95% CI, 1.65–2.35), intubation (OR, 2.69; 95% CI, 2.22–3.26), and mortality (OR, 1.50; 95% CI, 1.22–1.84). Conclusion : In this large nationwide sample of ED patients, we report a significant association of both high BMI and composite MetS with poor outcomes in SARS-CoV-2-positive patients. Findings suggest that composite MetS profile may be a more universal predictor of adverse disease outcomes, while the impact of BMI is more heavily modulated by SARS-CoV-2 status.

Human microbiome variation is linked to the incidence, prevalence, and mortality of many diseases and associates with race and ethnicity in the United States. However, the age at which microbiome variability emerges between these groups remains a central gap in knowledge. Here, we identify that gut microbiome variation associated with race and ethnicity arises after 3 months of age and persists through childhood. One-third of the bacterial taxa that vary across caregiver-identified racial categories in children are taxa reported to also vary between adults. Machine learning modeling of childhood microbiomes from 8 cohort studies (2,756 samples from 729 children) distinguishes racial and ethnic categories with 87% accuracy. Importantly, predictive genera are also among the top 30 most important taxa when childhood microbiomes are used to predict adult self-identified race and ethnicity. Our results highlight a critical developmental window at or shortly after 3 months of age when social and environmental factors drive race and ethnicity-associated microbiome variation and may contribute to adult health and health disparities.

Abstract Objective Although 911 calls for acute shortness of breath are common, the role of emergency medical services (EMS) in acute asthma care is unclear. We sought to characterize the demographics, course, and outcomes of adult emergency department (ED) patients with asthma in the United States receiving initial EMS care. Methods We analyzed data from the 2016–2019 National Hospital Ambulatory Medical Care Survey (NHAMCS). We included patients aged ≥18 years with an ED visit diagnosis of asthma, stratifying the cases according to initial EMS care. Accounting for the survey design of NHAMCS, we generated nationalized estimates of the number of EMS and non‐EMS asthma visits. Using logistic regression, we determined the associations between initial EMS care and patient demographics (age, sex, race, and insurance type), ED course (initial vital signs, triage category, testing, medications), and outcomes (hospital admission, ED length of stay). Results Of 435 million adult ED visits during 2016–2019, there were ≈5.3 million related to asthma (1.3 million annually, 1.2%; 95% confidence interval [CI], 1.1%–1.4%). A total of 602,569 (150,642 annually, 11.3%; 95% CI, 8.6%–14.8%) ED patients with asthma received initial EMS care. Compared with non‐EMS asthma patients, EMS asthma patients were more likely to present with an “urgent” ED triage category (odds ratio [OR], 22.2; 95% CI, 6.6–74.9) and to undergo laboratory (OR, 2.78; 95% CI, 1.41–5.46) or imaging tests (OR, 2.42; 95% CI, 1.21–4.83). ED patients with asthma receiving initial EMS care were almost 3 times more likely to be admitted to the hospital (OR, 2.81; 95% CI, 1.27–6.25). There were no differences in demographics, ED use of β‐agonists or corticosteroids, or ED length of stay between EMS and non‐EMS asthma patients. Conclusions Approximately 1 in 10 adult ED patients with asthma receive initial care by EMS. EMS asthma patients present to the ED with higher acuity, undergo more diagnostic testing in the ED, and are more likely to be admitted. Although limited in information regarding the prehospital course, these findings highlight the more severe illness of asthma patients transported by EMS and underscore the importance of EMS in emergency asthma care.

Summary: Background: Hypertensive disorders of pregnancy (HDPs) have been associated with respiratory dysfunction during pregnancy and postpartum. In this study, we explored the associations between HDPs (gestational hypertension and preeclampsia) and the risk of incident asthma and chronic obstructive pulmonary disease (COPD) during adulthood and the potential mediating role of chronic hypertension. Methods: We included parous nurses in the Nurses’ Health Study II reporting a pregnancy lasting no less than 6 months. The associations between HDPs and asthma and COPD were estimated using Cox proportional hazards models with adjustment for confounders. Findings: We included 73,807 nurses [92.5% (68,246 of 73,807) White] in asthma analyses and 79,843 [92.4% (73,746 of 79,843) White] in COPD analyses, whose mean (SD, range) age, at baseline, were both 34.8 (4.7, 25.0–44.0) years. During 24 years of follow-up, we identified 2663 incident cases of asthma and 537 COPD. Compared with nurses without HDPs, nurses reporting HDPs had an increased HR for incident asthma and COPD of 1.22 (95% CI 1.10–1.36) and 1.39 (95% CI 1.11–1.74), respectively. The risk of asthma was similar when gestational hypertension and preeclampsia were assessed separately [HR = 1.25 (95% CI 1.08–1.43) and 1.24 (95% CI 1.11–1.38), respectively]. However, only nurses with preeclampsia had a higher risk of COPD (HR = 1.41, 95% CI 1.11–1.78). Mediation analyses estimated that chronic hypertension explained 18.6% (95% CI 8.9–35.0%) and 10.7% (95% CI 2.9–32.4%) of the associations between HDPs and asthma and COPD, respectively. Interpretation: HDPs may serve as useful markers of increased susceptibility to chronic respiratory diseases during adulthood. Funding: The National Institutes of Health grants.

BackgroundThe Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. ObjectiveTo guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response. MethodsWe used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability. ResultsOverall, 164 (87%) hospitals and EDs responded—126 (77%) completed telephone surveys. Most (n=148, 90%) receive emergency notifications from state-based systems. Forty (24%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18%); radiation specialists, 25 (15%); and trauma specialists, 20 (12%). Among critical access hospitals (CAHs) or EDs with

Abstract Objective Bronchiolitis within the first 3 months of life is a risk factor for more severe illness. We aimed to identify characteristics associated with mild bronchiolitis in infants ≤90 days old presenting to the emergency department (ED). Methods We conducted a secondary analysis of infants ≤90 days old with clinically diagnosed bronchiolitis using data from the 25th Multicenter Airway Research Collaboration prospective cohort study. We excluded infants with direct intensive care unit admissions. Mild bronchiolitis was defined as (1) sent home after the index ED visit and did not have a return ED visit or had a return ED visit without hospitalization, or (2) were hospitalized from the index ED visit to the inpatient floor for

ObjectiveOngoing pediatric cohort studies offer opportunities to investigate the impact of the COVID-19 pandemic on children's health. With well-characterized data from tens of thousands of US children, the Environmental influences on Child Health Outcomes (ECHO) Program offers such an opportunity.MethodsECHO enrolled children and their caregivers from community- and clinic-based pediatric cohort studies. Extant data from each of the cohorts were pooled and harmonized. In 2019, cohorts began collecting data under a common protocol, and data collection is ongoing with a focus on early life environmental exposures and five child health domains: birth outcomes, neurodevelopment, obesity, respiratory, and positive health. In April of 2020, ECHO began collecting a questionnaire designed to assess COVID-19 infection and the pandemic's impact on families. We describe and summarize the characteristics of children who participated in the ECHO Program during the COVID-19 pandemic and novel opportunities for scientific advancement.ResultsThis sample (n = 13,725) was diverse by child age (31% early childhood, 41% middle childhood, and 16% adolescence up to age 21), sex (49% female), race (64% White, 15% Black, 3% Asian, 2% American Indian or Alaska Native,