Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits.

BACKGROUND: The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes. AIM: We aimed to quantify practice change following TARGET. METHODS: Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann-Whitney test. RESULTS: The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018-2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and <1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively. CONCLUSION: In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.

Bacteriological Profiles in Early-Onset-Sepsis (EOS) and Late-Onset-Sepsis (LOS) in Neonates.

Aim This audit is performed to see the bacteriology profiles in early-onset sepsis (EOS) and late-onset sepsis (LOS) to compare the microorganisms identified and the antibiotic sensitivity results against hospitals' guidelines for empiric treatment of early and late-onset sepsis. Methods We retrospectively collected the neonate's microbiological data from the laboratory which included the date blood culture (BC) samples were collected, patients' day of life when the samples were collected to determine whether it was EOS or LOS, time to positivity of BC, and antibiotic susceptibility results. Results In EOS, most infection was caused by Gram-positive organisms which were 12 out of 14 isolates (85.7%) with GBS as the most common pathogen identified. In LOS, the number of infections caused by Gram-negative organisms, which were 14 of 25 isolates (56%) was higher than those caused by Gram-positive organisms, which were 11 out of 25 isolates (44%). E. coli was identified as the leading pathogen causing BSI. All organisms were sensitive to the antibiotics used according to the protocol. Conclusion Escherichia coli was the most common organism and was sensitive to the first-line antibiotics used. Group B Streptococcus is still the main pathogen in EOS. The rate of antibiotic resistance is low. The audit showed the importance of analysing the bacteriological and antibiotic susceptibility pattern to ensure optimal treatments are administered to infants.

Participatory co-design and normalisation process theory with staff and patients to implement digital ways of working into routine care: the example of electronic patient-reported outcomes in UK renal services.

BACKGROUND: Successful implementation of digital health systems requires contextually sensitive solutions. Working directly with system users and drawing on implementation science frameworks are both recommended. We sought to combine Normalisation Process Theory (NPT) with participatory co-design methods, to work with healthcare stakeholders to generate implementation support recommendations for a new electronic patient reported outcome measure (ePRO) in renal services. ePROs collect data on patient-reported symptom burden and illness experience overtime, requiring sustained engagement and integration into existing systems. METHODS: We identified co-design methods that could be mapped to NPT constructs to generate relevant qualitative data. Patients and staff from three renal units in England participated in empathy and process mapping activities to understand 'coherence' (why the ePRO should be completed) and 'cognitive participation' (who would be involved in collecting the ePRO). Observation of routine unit activity was completed to understand 'collective action' (how the collection of ePRO could integrate with service routines). RESULTS: The mapping activities and observation enabled the research team to become more aware of the key needs of both staff and patients. Working within sites enabled us to consider local resources and barriers. This produced 'core and custom' recommendations specifying core needs that could be met with customised local solutions. We identified two over-arching themes which need to be considered when introducing new digital systems (1) That data collection is physical (electronic systems need to fit into physical spaces and routines), and (2) That data collection is intentional (system users must be convinced of the value of collecting the data). CONCLUSIONS: We demonstrate that NPT constructs can be operationalised through participatory co-design to work with stakeholders and within settings to collaboratively produce implementation support recommendations. This enables production of contextually sensitive implementation recommendations, informed by qualitative evidence, theory, and stakeholder input. Further longitudinal evaluation is necessary to determine how successful the recommendations are in practice.

Peritonsillar Abscess at a Dedicated Otolaryngology Emergency Department.

Aim Peritonsillar abscess (PTA) is the most common suppurative complication of acute tonsillitis. It requires urgent specialist treatment due to the risk of progression to airway compromise. We aimed to review referral pathways to a dedicated otolaryngology emergency department (ORL-ED), identify causative organisms and discuss COVID-19 implications. Methods A retrospective review of patients presenting to the ORL-ED between January 2018 and December 2019 was undertaken. Data extracted included demographics, referral source, treatment, microbiology results and length of stay. Statistical analysis of seasonal variation of presentation and causative organisms employed Chi-Square and Fisher's Exact Test, respectively. Results There were 53 PTA presentations. 51 were admitted accounting for 44.3% (51/115) of ED admissions. The median patient age was 31 years (IQR 20-40yrs). GP referral accounted for 48/53 (90.6%). There was no statistically significant seasonality (χ2=5.94, p=0.11) in presentation. Microbiology samples were available for 44 patients. Streptococcus was identified in 19/44 (43.2%) patients. 85% (45/53) of patients received Co-amoxiclav. Discussion PTA is a perennial condition with diverse causative organisms. Antibiotic choice should reflect this. The majority of patients are referred from primary care, emphasising the role of the GP in initial diagnosis and the importance of clinical education in this regard.

Experiences of Student Circus Arts Performers Undertaking a Shoulder Rehabilitation Program Via Telehealth Consultation During the COVID-19 Pandemic.

OBJECTIVE: To explore the subjective experiences of student circus arts performers with atraumatic shoulder instability undertaking a 12-week shoulder rehabilitation program during the COVID-19 pandemic lockdown, in Melbourne, Australia. METHODS: Using a qualitative design, 14 circus arts students from the National Institute of Circus Arts (Australia) were individually interviewed via teleconsultation. All interviews were recorded, transcribed, and analysed using inductive thematic analysis. RESULTS: Five overarching themes were identified: (i) impact (physical and mental), (ii) opportunity, (iii) developing routine, (iv) client-therapist relationship, and (v) transformation. All participants reported positive physical changes to their shoulder including increases in strength, stability, range of motion, less pain, "clicking" and "clunking," improved posture, muscle memory, as well as carry-over to functional circus activities. The pandemic's mental impact varied across the cohort, with positive and negative experiences described in relation to cognitive, social, and affective factors. Most performers felt the pandemic provided an opportunity to focus on rehabilitation of their shoulder. The program effects were also underpinned by positive client-therapist relationships and a progressive transformation of learning where students gained knowledge of their condition, developed tools to manage their current shoulder impairment, and learned how to apply this new knowledge to future management of their condition. CONCLUSION: A shoulder exercise intervention delivered via teleconsultation during the COVID-19 pandemic resulted in subjective reports of positive physical changes to the participants' shoulder health complaint. This was facilitated through client-physiotherapist relationships, providing structure during uncertain times, and by providing education to help in understanding their condition and its future management.

The Neonatal Early Onset Sepsis Calculator; in Clinical Practice.

Aims To determine the impact of applying the Neonatal Early Onset Sepsis Calculator (NEOSC) to clinical practice. We evaluated this multivariable risk prediction model, used in the assessment of infants >35 weeks GA, at risk of neonatal sepsis. Methods A retrospective, cohort study comparing the rates of blood culture use in a large maternity hospital before and after the introduction of the NEOSC. Cases were ascertained from the records of the Department of Microbiology. The key variables were the number of blood cultures (all gestational ages, <72 hours old), infant antibiotic use and sepsis rates. Data for three years prior to NEOSC use (January 2015 - December 2017) were compared with 15 months (January 2018 - Q1 2019) after it was implemented. Results Pre- and post- NEOSC use, the total blood cultures taken annually were: 1,312 (2015), 1,149 (2016), 1,319 (2017) and 702 (2018), 192 (Q1 2019) respectively, a statistically significant reduction [p < 0.00001, 95% CI]. There was no significant difference in rates of either: culture-confirmed GBS-sepsis [p value 0.18, 95% CI] or other-pathogen sepsis [p value 0.32, 95%CI] in term infants between the two periods. There was a significant reduction in antibiotic use in the first 24 hours of life (average 11.3% pre-NEOSC and 5.9% after NEOSC was implemented) [p < 0.00001, 95% CI]. Conclusion The introduction of the NEOSC has reduced blood culture and antibiotic use. This has been achieved without any increase in infection rates.

Diagnostic Limitations in Congenital Zika Virus Infection.

This is the first documented case of an infant with congenital Zika virus infection (ZVI) born in Ireland. A term infant was delivered with an antenatal diagnosis of severe microcephaly. First trimester bloods confirmed maternal ZVI and although the infant did not have Zika virus RNA or Zika-specific IgM in her blood or urine, she had multiple clinical features of congenital ZVI and Zika virus RNA was present in the placenta.

Species identity dominates over environment in shaping the microbiota of small mammals.

The mammalian gut microbiota is considered pivotal to host fitness, yet the determinants of community composition remain poorly understood. Laboratory studies show that environmental factors, particularly diet, are important, while comparative work emphasises host genetics. Here, we compare the influence of host genetics and the environment on the microbiota of sympatric small mammal species (mice, voles, shrews) across multiple habitats. While sharing a habitat caused some microbiota convergence, the influence of species identity dominated. In all three host genera examined, an individual's microbiota was more similar to conspecifics living elsewhere than to heterospecifics at the same site. Our results suggest this species-specificity arises in part through host-microbe codiversification. Stomach contents analysis suggested that diet also shapes the microbiota, but where diet is itself influenced by species identity. In this way, we can reconcile the importance of both diet and genetics, while showing that species identity is the strongest predictor of microbiota composition.

Noise properties of rectifying and non-rectifying nanopores.

Achieving a full understanding of the noise in resistive pulse sensing experiments is central to the development of this important single molecule technique. Here, we present a comprehensive study of the noise properties of conical glass nanopores as components in an ionic circuit by studying the power spectral density of the system in salt solutions at a range of concentrations. We begin by investigating the ionic current rectification of the pores, showing that it is only observed above a critical Dukhin number in agreement with theoretical predictions. We then investigate the noise properties of the pores and demonstrate that the fluctuations in the ionic current at no applied potential difference can be well modelled over four decades of frequency as thermal fluctuations over a complex impedance. Finally, we show that-when an ionic current flows-1/f noise dominates the power spectrum below ∼100 Hz. Fluctuations in the surface current govern the low-frequency 1/f noise, with the asymmetric shape of the pore leading the magnitude to scale with [Formula: see text], faster than predicted by Hooge's empirical relation.

Examining the mediational role of psychological flexibility, pain catastrophizing, and visceral sensitivity in the relationship between psychological distress, irritable bowel symptom frequency, and quality of life.

The aim of the current study was to use Structural Equation Modelling (SEM) to examine whether psychological flexibility (i.e. mindfulness, acceptance, valued-living) mediates the relationship between distress, irritable bowel syndrome (IBS) symptom frequency, and quality of life (QoL). Ninety-two individuals participated in the study (12 male, 80 female, Mage = 36.24) by completing an online survey including measures of visceral sensitivity, distress, IBS-related QoL, mindfulness, bowel symptoms, pain catastrophizing, acceptance, and valued-living. A final model with excellent fit was identified. Psychological distress significantly and directly predicted pain catastrophizing, valued-living, and IBS symptom frequency. Pain catastrophizing directly predicted visceral sensitivity and acceptance, while visceral sensitivity significantly and directly predicted IBS symptom frequency and QoL. Symptom frequency also had a direct and significant relationship with QoL. The current findings suggest that interventions designed to address unhelpful cognitive processes related to visceral sensitivity, pain catastrophizing, and psychological distress may be of most benefit to IBS-related QoL.

Natural Infections With Pigeon Paramyxovirus Serotype 1: Pathologic Changes in Eurasian Collared-Doves ( Streptopelia decaocto) and Rock Pigeons ( Columba livia) in the United States.

Pigeon paramyxovirus serotype 1 (PPMV-1) is a globally distributed, virulent member of the avian paramyxovirus serotype 1 serogroup that causes mortality in columbiformes and poultry. Following introduction into the United States in the mid-1980s, PPMV-1 rapidly spread causing numerous mortality events in Eurasian collared-doves ( Streptopelia decaocto) (ECDOs) and rock pigeons ( Columba livia) (ROPIs). The investigators reviewed pathological findings of 70 naturally infected, free-ranging columbiforms from 25 different mortality events in the United States. Immunohistochemistry targeting PPMV-1 nucleoprotein was used to determine the tissue distribution of the virus in a subset of 17 birds from 10 of the studied outbreaks. ECDOs (61 birds) and ROPIs (9 birds) were the only species in which PPMV-1-associated disease was confirmed by viral isolation and presence of histologic lesions. Acute to subacute tubulointerstitial nephritis and necrotizing pancreatitis were the most frequent histologic lesions, with immunolabeling of viral antigen in renal tubular epithelial cells and pancreatic acinar epithelium. Lymphoid depletion of bursa of Fabricius and spleen was common, but the presence of viral antigen in these organs was inconsistent among infected birds. Hepatocellular necrosis was occasionally present with immunolabeling of hypertrophic Kupffer cells, and immunopositive eosinophilic intracytoplasmic inclusion bodies were present in hepatocytes of 1 ECDO. Immunopositive lymphocytic choroiditis was present in 1 ECDO, while lymphocytic meningoencephalitis was frequent in ROPIs in absence of immunolabeling. This study demonstrates widespread presence of PPMV-1 antigen in association with histologic lesions, confirming the lethal potential of this virus in these particular bird species.

The vitamin B12 and Se status of lambs during their transition from milk-fed monogastric to grazing herbivore.

AIM: To estimate how the lamb's transition from a monogastric at birth to a grazing ruminant at weaning affects its dietary intake of trace nutrients from milk and pasture, and to determine whether its vitamin B12 and Se status changes during that period. METHODS: We reviewed published reports of field trials in New Zealand where flocks were managed on mixed sward pastures without additional supplements. Information on intakes of milk and pasture was drawn from studies of suckling lambs grazing with ewes for up to 20 weeks. We calculated the quantities of vitamin B12, Co and Se ingested and absorbed by lambs between birth and weaning. Trace nutrient status was based on concentrations of vitamin B12 in serum and Se in blood. Six studies met our inclusion criteria regarding age of lambs, supplementation and sampling frequency. In each, blood had been collected at regular intervals from birth to weaning. Changes over time in concentrations of vitamin B12 and Se were analysed using regression procedures. RESULTS: Estimated Se intake increased from approximately 5 µg/day near birth to 25 µg/day near weaning, but Se absorbed was less variable, being approximately 10 µg/day. Estimated vitamin B12 intake near birth was approximately 8 µg/day and increased to 90 µg/day by weaning, with the amount being absorbed increasing from 0.8 to 9 µg/day. Concentrations of trace elements in unsupplemented lambs among the six studies varied from deficient to adequate. Linear regressions indicated that there was little change in concentrations of vitamin B12 and Se between birth and weaning in four studies (p>0.05), and mean concentrations measured at docking did not differ from those at weaning in four studies where this could be assessed (p>0.1). CONCLUSIONS AND CLINICAL RELEVANCE: From newborn to weaned, a lamb's physiology develops from monogastric to ruminant. The change in diet from milk to pasture presents markedly different chemical forms and concentrations of some trace nutrients. Despite this, the vitamin B12 and Se status of the unsupplemented lambs in these studies changed little during their transition period. This finding supports early monitoring of lambs' trace element status. If a trace element deficiency is detected in lambs at or before docking, then administering supplements may be appropriate. If status is found to be adequate, then it will likely remain so until weaning, at which time the animals' trace element status should be re-evaluated.

Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study.

OBJECTIVE: To determine the incidence of maternal bacteraemia during pregnancy and for 6 weeks postpartum, describe the gestation/stage at which sepsis occurs, the causative microorganisms, antibiotic resistance and review maternal, fetal and neonatal outcome. DESIGN: Prospective review. SETTING: Two tertiary referral, maternity hospitals in Dublin, Ireland. POPULATION: During 2005-2012 inclusive, 150 043 pregnant women attended and 24.4% of infants born in Ireland were delivered at the hospitals. METHODS: Demographic, clinical, microbiological and outcome data was collected from women with sepsis and compared with controls. MAIN OUTCOME MEASURES: Incidence, bacterial aetiology, gestation/stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome. RESULTS: The sepsis rate was 1.81 per 1000 pregnant women. Escherichia coli was the predominant pathogen, followed by Group B Streptococcus. Sepsis was more frequent among nulliparous women (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07-1.79) and multiple births (OR 2.04; 95% CI 0.98-4.08). Seventeen percent of sepsis episodes occurred antenatally, 36% intrapartum and 47% postpartum. The source of infection was the genital tract in 61% (95% CI 55.1-66.6) of patients and the urinary tract in 25% (95% CI 20.2-30.5). Sepsis was associated with preterm delivery (OR 2.81; 95% CI 1.99-3.96) and a high perinatal mortality rate (OR =5.78; 95% CI 2.89-11.21). Almost 14% of women required admission to augmented care. The most virulent organisms were Group A Streptococcus linked to postpartum sepsis at term and preterm Escherichia coli sepsis. CONCLUSIONS: Maternal sepsis is associated with preterm birth, a high perinatal mortality rate and nulliparous women.

Utilizing relative potency factors (RPF) and threshold of toxicological concern (TTC) concepts to assess hazard and human risk assessment profiles of environmental metabolites: a case study.

There is currently no standard paradigm for hazard and human risk assessment of environmental metabolites for agrochemicals. Using an actual case study, solutions to challenges faced are described and used to propose a generic concept to address risk posed by metabolites to human safety. A novel approach - built on the foundation of predicted human exposures to metabolites in various compartments (such as food and water), the threshold of toxicological concern (TTC) and the concept of comparative toxicity - was developed for environmental metabolites of a new chemical, sulfoxaflor (X11422208). The ultimate aim was to address the human safety of the metabolites with the minimum number of in vivo studies, while at the same time, ensuring that human safety would be considered addressed on a global regulatory scale. The third component, comparative toxicity, was primarily designed to determine whether the metabolites had the same or similar toxicity profiles to their parent molecule, and also to one another. The ultimate goal was to establish whether the metabolites had the potential to cause key effects - such as cancer and developmental toxicity, based on mode-of-action (MoA) studies - and to develop a relative potency factor (RPF) compared to the parent molecule. Collectively, the work presented here describes the toxicology programme developed for sulfoxaflor and its metabolites, and how it might be used to address similar future challenges aimed at determining the relevance of the metabolites from a human hazard and risk perspective. Sulfoxaflor produced eight environmental metabolites at varying concentrations in various compartments - soil, water, crops and livestock. The MoA for the primary effects of the parent molecule were elucidated in detail and a series of in silico, in vitro, and/or in vivo experiments were conducted on the environmental metabolites to assess relative potency of their toxicity profiles when compared to the parent. The primary metabolite, X11719474 found in soil, crops and, potentially, at low concentrations, in groundwater, was the most extensively studied, with genetic, acute, short-term rat and dog, rodent reproductive and developmental toxicity studies, and MoA studies conducted. These data supported that the toxicity profile for X11719474 was limited to liver effects via the same MoA as the parent and, overall, X11719474 was significantly less toxic than parent. Subsequently, the comparative toxicology programme was extended to cover all metabolites of sulfoxaflor. Based on structure (i.e., similarity of metabolite structures to one another), toxic effects in comparison with parent (i.e., consistency of the toxicity profiles and confidence in terms of ability to read across), residue compartment (e.g., crop, soil, water) and predicted level of exposure, fewer studies were required for establishing safety of these metabolites compared to X11719474. For example, for some metabolites with very low predicted environmental concentrations only genotoxicity testing was required. For some metabolites with low predicted concentrations, for example only present in liver, a TTC approach was utilized. This strategy of comparative assessment utilizing MoA data, relative potency, hazard characterization, read-across, predicted exposure and TTC provided a robust database, which minimized animal use, comprehensively assessed the hazard and human risk presented by these metabolites.

Follow up of infants born to women with hepatitis B in the National Maternity Hospital.

Infants born to women with hepatitis B virus (HBV) are at risk of vertical transmission. This risk is significantly reduced with correct post-natal treatment After initial perinatal management and neonatal treatment, these infants receive subsequent follow up HBV immunisations at two, four and six months. These infants then require post vaccination serological testing. This review was conducted to determine the number of infants born to mothers with HBV in the National Maternity Hospital who had appropriate post vaccination serological testing. There were seventy-eight HBV infections identified antenatally in the years 2010 and 2011 resulting in seventy live born infants at our institution. Thirteen (18.6%) infants had evidence of post vaccination serological testing. This is below international rates of follow up. There is an urgent need for a centralised national programme to ensure adequate follow up and management of all infants born to women with HBV in Ireland.

Perinatal Treponema pallidum: evidence based guidelines to reduce mother to child transmission.

Universal antenatal screening for T. pallidum is standard in Irish maternity units. The prevalence of adult syphilis has increased in Ireland. We audited the neonatal management of infants exposed to T. pallidum in utero. A cross sectional retrospective analysis of all pregnancies with confirmed positive serology for T. pallidum from January 2005 to December 2010 was conducted at the National Maternity Hospital, Holles St. Data were analysed using SPSS 14.0. Ethical approval was obtained. There were 55,058 live births during the study period. Fifty-eight women had positive serology and 41 met inclusion criteria. Infant evaluation and follow up was decided by allocation to an evidence based algorithm. Twenty-one infants (51%) were accurately allocated and assessed, 5 (12%) had a partial assessment and the algorithm was incorrectly applied in 15 (36%) of cases. Failure to adhere to evidence based neonatal guidelines is common and undermines efficacy of the screening program.

Effects of quantitative trait loci and the myostatin locus on trace and macro elements (minerals) in bovine liver, muscle and kidney.

A quantitative trait locus (QTL) study of the concentrations of 14 trace and macro elements (minerals) in tissues of beef cattle was conducted in New Zealand. Back-cross calves with Jersey and Limousin ancestry (202 heifers and 211 steers) were generated using first-cross sires. This paper reports on testing for effects of QTL on the concentrations of minerals in liver, kidney and muscle in cattle at slaughter, following a growth phase during which rearing and finishing stages were on pasture. Fifteen QTL were identified (P < 0.05) on a genome-wide basis in combined-sire and within-sire analyses. In addition, the possible effect of the Limousin myostatin F94L allele was tested by fitting each calf's myostatin genotype, and 16 QTL were identified. Twelve were in common with those QTL identified previously, comprising six affecting the liver (copper and zinc, on two chromosomes each; plus iron and molybdenum), three affecting the kidney (calcium, copper and iron), and three affecting muscle (iron, strontium and zinc).

Oral Appliances for OSA Treatment: Meeting the Quadruple Aim.

INTRODUCTION: In order to better treat obstructive sleep apnea (OSA) in a more efficient and cost-effective way, a joint program between dental clinics and the sleep medicine clinic was piloted at Fort Hood, Texas. Obstructive sleep apnea negatively affects soldier readiness and deployability, leading to the need to establish a successful and proven workflow to treat these patients with oral appliance therapy (OAT). MATERIALS AND METHODS: We performed a retrospective review of a de-identified data set which included 288 patients from July 2016 to July 2020. Projected cost data were obtained from routinely collected sleep clinic positive airway pressure (PAP) data. Data were analyzed to determine treatment success and potential cost savings using OAT versus continuous positive airway pressure (CPAP). Patient workflow including successes and challenges with the program is summarized. RESULTS: About 85.5% of patients met criteria for successful control of their OSA using OAT as treatment. Five patients did not tolerate OAT and switched back to CPAP. A higher (less severe) O2 nadir on diagnostic polysomnography is moderately correlated with OAT success. Diagnostic Apnea-Hypopnea Index was inversely and weakly correlated with success. Two of the major challenges noted in the program were (1) loss of follow-up and (2) the length of time from oral appliance referral to fitting the oral appliance. If this program was successfully implemented at other Defense Health Agency (DHA) medical treatment facility (MTF) markets nationwide, a potential cost savings of over $500,000/year/MTF could be achieved. CONCLUSIONS: Oral appliance therapy has the potential to increase both readiness and deployability for active duty soldiers. Using baseline O2 nadir can help predict success with OAT patients, determining which patients will benefit from this joint program between the dental and medical sleep clinics. Future studies can aim to establish an evidence-based pathway for clinic testing and follow-up. If this patient workflow is implemented properly, there can be significant cost savings army-wide. This all helps The United States Medical Command (MEDCOM) align with the DHA's Quadruple Aim of increased readiness, better health, better care, and lower cost.

Experimental Infection of Mexican Free-Tailed Bats (Tadarida brasiliensis) with SARS-CoV-2.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus is thought to have originated in wild bats from Asia, and as the resulting pandemic continues into its third year, concerns have been raised that the virus will expand its host range and infect North American wildlife species, including bats. Mexican free-tailed bats (Tadarida brasiliensis) live in large colonies in the southern United States, often in urban areas and, as such, could be exposed to the virus from infected humans. We experimentally challenged wild T. brasiliensis with SARS-CoV-2 to determine the susceptibility, reservoir potential, and population impacts of infection in this species. Of 10 bats oronasally inoculated with SARS-CoV-2, 5 became infected and orally excreted moderate amounts of virus for up to 18 days postinoculation. These five subjects all seroconverted and cleared the virus before the end of the study with no obvious clinical signs of disease. We additionally found no evidence of viral transmission to uninoculated subjects. These results indicate that while T. brasiliensis are susceptible to SARS-CoV-2 infection, infection of wild populations of T. brasiliensis would not likely cause mortality. However, the transmission of SARS-CoV-2 from T. brasiliensis to or from humans, or to other animal species, is a possibility requiring further investigation to better define. IMPORTANCE As the COVID-19 pandemic has continued for 3+ years, there has been increasing concern that the SARS-CoV-2 virus will enter wildlife populations and potentially create new reservoirs where the virus could adapt to a new host and create variants. This is particularly possible with species that reside in man-made structures, in proximity to infected human populations. Mexican free-tailed bats (Tadarida brasiliensis) live in large colonies, often in urban settings and, thus, can be exposed by infected humans and potentially transmit the virus to new hosts. We experimentally challenged T. brasiliensis with SARS-CoV-2 and revealed that they are susceptible to the virus and excrete moderate amounts for up to 18 days postinoculation. This is important information for wildlife biologists, wildlife rehabilitation workers, and the general public that may contact these animals.