Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid Resuscitation to Characterize a Novel Doppler Starling Curve: A Prospective Observational Pilot Study.

Background: The likelihood of a patient being preload responsive-a state where the cardiac output or stroke volume (SV) increases significantly in response to preload-depends on both cardiac filling and function. This relationship is described by the canonical Frank-Starling curve. Research Question: We hypothesize that a novel method for phenotyping hypoperfused patients (ie, the "Doppler Starling curve") using synchronously measured jugular venous Doppler as a marker of central venous pressure (CVP) and corrected flow time of the carotid artery (ccFT) as a surrogate for SV will refine the pretest probability of preload responsiveness/unresponsiveness. Study Design and Methods: We retrospectively analyzed a prospectively collected convenience sample of hypoperfused adult emergency department (ED) patients. Doppler measurements were obtained before and during a preload challenge using a wireless, wearable Doppler ultrasound system. Based on internal jugular and carotid artery Doppler surrogates of CVP and SV, respectively, we placed hemodynamic assessments into quadrants (Qx) prior to preload augmentation: low CVP with normal SV (Q1), high CVP and normal SV (Q2), low CVP and low SV (Q3) and high CVP and low SV (Q4). The proportion of preload responsive and unresponsive assessments in each quadrant was calculated based on the maximal change in ccFT (ccFTΔ) during either a passive leg raise or rapid fluid challenge. Results: We analyzed 41 patients (68 hemodynamic assessments) between February and April 2021. The prevalence of each phenotype was: 15 (22%) in Q1, 8 (12%) in Q2, 39 (57%) in Q3, and 6 (9%) in Q4. Preload unresponsiveness rates were: Q1, 20%; Q2, 50%; Q3, 33%, and Q4, 67%. Interpretation: Even fluid naïve ED patients with sonographic estimates of low CVP have high rates of fluid unresponsiveness, making dynamic testing valuable to prevent ineffective IVF administration.

The development and acceptability of an educational and training intervention for recruiters to neonatal trials: the TRAIN project.

BACKGROUND: Suboptimal or slow recruitment affects 30-50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to develop and assess the acceptability of an education and training intervention for recruiters to neonatal trials. In this paper, we report the development and acceptability of TRAIN. METHODS: TRAIN involved three sequential phases, with each phase contributing information to the subsequent phase(s). These phases were 1) evidence synthesis (systematic review of the effectiveness of training interventions and a content analysis of the format, content, and delivery of identified interventions), 2) intervention development using a Partnership (co-design/co-creation) approach, and 3) intervention acceptability assessments with recruiters to neonatal trials. RESULTS: TRAIN, accompanied by a comprehensive intervention manual, has been designed for online or in-person delivery. TRAIN can be offered to recruiters before trial recruitment begins or as refresher sessions during a trial. The intervention consists of five core learning outcomes which are addressed across three core training units. These units are the trial protocol (Unit 1, 50 min, trial-specific), understanding randomisation (Unit 2, 5 min, trial-generic) and approaching and engaging with parents (Unit 3, 70 min, trial-generic). Eleven recruiters to neonatal trials registered to attend the acceptability assessment training workshops, although only four took part. All four positively valued the training Units and resources for increasing recruiter preparedness, knowledge, and confidence. More flexibility in how the training is facilitated, however, was noted (e.g., training divided across two workshops of shorter duration). Units 2 and 3 were considered beneficial to incorporate into Good Clinical Practice Training or as part of induction training for new staff joining neonatal units. CONCLUSION: TRAIN offers a comprehensive co-produced training and education intervention for recruiters to neonatal trials. TRAIN was deemed acceptable, with minor modification, to neonatal trial recruiters. The small number of recruiters taking part in the acceptability assessment is a limitation. Scale-up of TRAIN with formal piloting and testing for effectiveness in a large cluster randomised trial is required.

Radicals from tributyl phosphate decomposition: a combined electron paramagnetic resonance spectroscopic and computational chemistry investigation.

The radiation- and chemically-induced radicals from tributyl phosphate (TBP) have been characterized by EPR spectroscopy and theoretical calculations. The yield of X-ray-generated TBP radicals measured by a PBN spin trap is 0.22 µmol J-1 (2.1 radicals/100 eV) at room temperature (298 K). The EPR spectra obtained by irradiating TBP with an electron beam at 77 K are in close agreement with literature data for samples irradiated with gamma- and X-rays [https://doi.org/10.1007/BF02165504, https://doi.org/10.1016/1359-0197(89)90319-6]. Possible conformers of alkyl-type, TBP-derived radicals were analyzed by Density Functional Theory calculations. The main contribution to the experimental spectrum at 77 K is shown to be made by a conformer of the CH3˙CHCH2-radical, which contains all carbon atoms of the butyl group in the same plane. The EPR spectra of TBP radicals induced by the OH radical in aqueous solution were measured for the first time using a continuous flow system. The formation of the alkyl-type TBP radicals CH3˙CHCH2-, ˙CH2CH2-, and -CH2˙CHO- in the ratio of 5/4/1 was detected; their spectral assignment was based on quantum chemical calculations with rotational averaging of HFC constants for the corresponding beta- and alpha-protons.

Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma.

PURPOSE: The perioperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for T1-T2 renal cell carcinoma (RCC) are well established. We aim to determine whether LRN is a comparable alternative to open radical nephrectomy (ORN) in the treatment of T3 RCC using a matched pair analysis study design. METHODS: A review of a prospectively collected database at the Western General Hospital, Edinburgh, between 2000 and 2011 was conducted. Patient pairs were matched based on age at operation, gender, histological subgroup, maximal tumour diameter, TNM stage and grade. Patient demographics, operative and post-operative outcomes were compared. Overall, cancer-specific and progression-free survival [overall survival, cancer-specific survival (CSS) and progression-free survival (PFS)] were estimated using the Kaplan-Meier method. RESULTS: From 252 patients with T3 disease, 25 pairs were matched. Patients were of median age 66.2 years, 64 % male. Tumours were all clear cell RCC, were stage pT3a (32 %) or pT3b and had maximal tumour diameters of 8.7 cm for LRN and 10.0 cm for ORN. Estimated blood loss (100 ml LRN; 650 ml ORN, p < 0.001) and length of post-operative hospital stay (4 days LRN: 9 days ORN, p < 0.001) were lower in the LRN group. Operation time and post-operative complication rates were comparable. CSS and PFS were comparable with a mean CSS of 91.3 months for LRN and 88.7 months for ORN. CONCLUSION: This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.

Perineural Invasion Is Associated With Function-evoked Pain and Altered Extracellular Matrix in Patients With Head and Neck Squamous Cell Carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is painful, and perineural invasion (PNI) has been associated with the worst pain. Pain due to HNSCC is diverse and may vary based on clinicopathological factors. This study aims to characterize different pain patterns linked with PNI, its influence on daily functioning, and gain insights into molecular changes and pathways associated with PNI-related pain in HNSCC patients. We conducted a cross-sectional study across 3 medical centers (n = 114), assessing pain phenotypes and their impact on daily functioning using 2 self-reported pain questionnaires, given to patients prior to their cancer surgery. Furthermore, we conducted RNA-seq analysis utilizing the The Cancer Genome Atlas dataset of HNSCC tumor from patients (n = 192) to identify genes relevant to both PNI and pain. Upon adjusting for demographic and clinicopathological variables using linear regression models, we found that PNI independently predicted function-evoked pain according to the University of Calfornia San Francisco Oral Cancer Pain Questionnaire, as well as the worst pain intensity reported in the Brief Pain Inventory. Distinct pain patterns were observed to be associated with daily activities in varying manners. Our molecular analyses revealed significant disruptions in pathways associated with the extracellular matrix structure and organization. The top differentially expressed genes linked to the extracellular matrix are implicated in cancer development, pain, and neurodegenerative diseases. Our data underscore the importance of properly categorizing pain phenotypes in future studies aiming to uncover mechanistic underpinnings of pain. Additionally, we have compiled a list of genes of interest that could serve as targets for both cancer and cancer pain management. PERSPECTIVE: PNI independently predicts function-evoked pain. Different pain phenotypes affect daily activities differently. We identified a list of candidate genes involved in the extracellular matrix structure and function that can be targeted for both cancer and cancer pain control.

T staging esophageal tumors with x rays.

With histopathology results typically taking several days, the ability to stage tumors during interventions could provide a step change in various cancer interventions. X-ray technology has advanced significantly in recent years with the introduction of phase-based imaging methods. These have been adapted for use in standard labs rather than specialized facilities such as synchrotrons, and approaches that enable fast 3D scans with conventional x-ray sources have been developed. This opens the possibility to produce 3D images with enhanced soft tissue contrast at a level of detail comparable to histopathology, in times sufficiently short to be compatible with use during surgical interventions. In this paper we discuss the application of one such approach to human esophagi obtained from esophagectomy interventions. We demonstrate that the image quality is sufficiently high to enable tumor T staging based on the x-ray datasets alone. Alongside detection of involved margins with potentially life-saving implications, staging tumors intra-operatively has the potential to change patient pathways, facilitating optimization of therapeutic interventions during the procedure itself. Besides a prospective intra-operative use, the availability of high-quality 3D images of entire esophageal tumors can support histopathological characterization, from enabling "right slice first time" approaches to understanding the histopathology in the full 3D context of the surrounding tumor environment.

Cat Foster Program Outcomes: Behavior, Stress, and Cat-Human Interaction.

Recent research has demonstrated that cats (Felis catus) have greater social potential and flexibility than was previously assumed. However, many traditional cat care practices have been influenced by the misconception that cats are socially aloof. This can result in less support or guidance for cat-focused programs that may promote improved success or welfare. For example, while dog fostering programs-even overnight programs-are considered highly beneficial, with research to back these claims, relatively little research has been dedicated to understanding the potential risks and benefits of cat fostering programs. Therefore, the aim of this study was to empirically evaluate the social, behavioral, and stress response outcomes associated with placing shelter cats in an overnight or short-term foster environment. While neither overnight nor 1-week fostering lead to a statistically significant improvement in human-directed social behavior or stress levels, foster cats also did not display increased fear or aggression in the foster home and did not have higher cortisol levels. Therefore, cat fostering-even short-term fostering-does not appear to be more stressful or problematic for this species than remaining in a shelter. This information could contribute to life-saving efforts by providing empirical evidence that cats can be safely moved into foster homes, even for short durations, when shelter space is limited. More research is needed to evaluate the potential effects of longer-term fostering in cats, as well as cat fostering practices that could lead to greater welfare benefits.

Influence of adherence to the national guidance on nutrition screening and dietitian referral on clinical outcomes of those requiring parenteral nutrition.

BACKGROUND: National guidance in the UK on nutrition support suggests that all patients should be screened on initial admission to hospital and, where appropriate, be referred to a healthcare professional. The present study aimed to investigate whether initial nutrition screening influenced the outcome of patients who received parenteral nutrition (PN). METHODS: Data were prospectively evaluated on 100 consecutive patients referred to the multidisciplinary PN team in a teaching hospital. Information was obtained from medical notes, electronic patient records, completed PN prescription charts, dietetic record cards and nursing care plans. Patients who were treatable by nutritional supplements or enteral nutrition were not included. Patients were divided into two groups: guidance compliant and guidance noncompliant, in order to compare outcome measures such as the duration of PN treatment, total number of PN bags used per patient and length of hospital stay. Comparison of data between the two groups was carried out using either the independent samples t-test or the Mann-Whitney U-test. RESULTS: There was no difference in outcome measures between the guidance compliant and noncompliant groups. Patients in the guidance noncompliant group were more likely to be in general (77%) than critical wards (23%). Patients who were in the guidance compliant group received nutrition support earlier. CONCLUSIONS: Compliance with the national guidance in the UK on screening did not improve outcomes in patients requiring parenteral nutrition in this cohort. Initial nutrition screening prior to PN administration warrants further investigation to ensure value is added to patient care.

Boot camps in neonatal-perinatal medicine fellowship programs: A national survey.

BACKGROUND: Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS: Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS: Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS: A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.

Accuracy of the nasal-tragus length measurement for correct endotracheal tube placement in a cohort of neonatal resuscitation simulators.

OBJECTIVE: Nasal-tragus length (NTL) estimates of endotracheal tube (ETT) depth are replacing weight-based estimates for endotracheal tube depth in neonates requiring endotracheal intubation. Existing neonatal simulators were designed before interest in using the NTL, and may lack fidelity in this measurement. The objective of this study is to evaluate the accuracy of the adjusted NTL formula and the Neonatal Resuscitation Program (NRP) gestational age/weight-based ETT depth chart in predicting proper endotracheal tube insertion depth in a cohort of neonatal simulators. STUDY DESIGN: The NTL and appropriate intubation depth to the mid-trachea were measured for 11 commonly used neonatal intubation simulators. RESULTS: The NTL+1 cm formula incorrectly estimates the mid-tracheal depth in 82% of simulators, and the weight-based chart incorrectly estimates depth in 75% of test simulators. Only one simulator experienced a mainstem intubation with ETT insertion to the depth predicted by the NTL+1 cm formula. CONCLUSIONS: The majority of neonatal resuscitation simulations lacked physical fidelity with regard to mid-tracheal ETT insertion depth. The NRP gestational age/weight-based chart outperformed the NTL+1 cm formula but still resulted in endotracheal tube misplacement in the majority of neonatal simulators. The majority of simulators had adequate functional fidelity using either method for ETT depth estimation.

Videotaped training in alcohol counseling for obstetric care practitioners: a randomized controlled trial.

OBJECTIVE: To determine the feasibility of videotaped training for obstetric care practitioners in motivational interviewing skills that could be used in brief patient consultations on problem drinking. METHODS: Thirty health care practitioners participated in a clinical trial using a 20-minute videotape to instruct them in motivational interviewing. Participants engaged in a pretest roleplay with an actress playing a drinking pregnant woman. Those randomly assigned to the experimental condition watched the motivational interviewing videotape. Control condition participants watched a 20-minute docudrama of a pregnant problem drinker. Both groups then engaged in a post-test roleplay similar to the pretest. Behavioral ratings of the roleplays and participant evaluations of the motivational interviewing video constituted the outcome measures. RESULTS: Participant evaluations indicated that the training video was clear in explaining and demonstrating the principles and skills of motivational interviewing. Change in behavioral ratings from pretest to post-test showed significant differences in motivational interviewing skills between the experimental and control groups. Obstetric care practitioners who viewed the training video were rated as showing greater empathy, minimizing patient defensiveness, and supporting women's beliefs in their ability to change. CONCLUSION: Obstetric care practitioners can improve their alcohol intervention skills through the use of a 20-minute videotaped instruction in motivational interviewing. Clinicians who improve their skills in motivational interviewing can intervene more effectively with their drinking pregnant patients. Using motivational interviewing with this population holds promise for helping prevent alcohol-related health problems.

Behavioral Self-Control Program for Windows: results of a controlled clinical trial.

Forty nonalcoholic heavy drinkers were randomly assigned to receive a computer-based version of behavioral self-control training either immediately after pretreatment assessment or after a 10-week waiting period. Results at each of 3 follow-ups strongly support the study hypotheses. Participants in the immediate treatment group significantly reduced their drinking relative to their pretreatment levels and relative to those in the delayed treatment condition at the initial follow-up, 10 weeks after the pretreatment assessment. The delayed group did not change their drinking behaviors during this period of time. However, they significantly reduced their drinking by the second follow-up conducted after they received training. At the 12-month follow-up, participants maintained the gains they had achieved during treatment. There were no interactions involving participant ethnicity or gender. Although use of other drugs was not specifically addressed, such use did not increase, and there was some evidence of a decline.

The community reinforcement approach with homeless alcohol-dependent individuals.

Homeless alcohol-dependent individuals were randomly assigned to receive either a behavioral intervention (i.e., the Community Reinforcement Approach [CRA]) or the standard treatment (STD) at a large day shelter. Ninety-one men and 15 women participated. The majority of participants were White (64%), but both Hispanic (19%) and Native American (13%) individuals were represented as well. Overall, the decline in drinking levels from intake through follow-ups was significant. As predicted, CRA participants significantly outperformed STD group members on drinking measures across the 5 follow-ups, which ranged from 2 months to 1 year after intake. Both conditions showed marked improvement in employment and housing stability.

Retrospective analyses of additional services for methadone maintenance patients.

We report on the 6-month outcome of a retrospective analysis of additional treatment services for patients entering a methadone maintenance program who transferred from community methadone treatment programs (n = 83) or entered off the street (n = 83) not currently on methadone. Patients were participating in a clinical treatment trial examining the effectiveness of Community Reinforcement Approach and Relapse Prevention. Patients in the methadone transfer group were using less heroin at intake than patients newly initiated onto methadone and both groups improved from additional treatment services in the following problem areas specifically: drug, alcohol, legal, employment, social, and in some measures of psychiatric distress. Therefore, both groups of patients in this study benefited from additional treatment services.

Long-term follow-up of behavioral self-control training.

Four samples of problem drinkers treated by behavioral self-control training were evaluated at 3.5, 5, 7 and 8 years following treatment, respectively. Of 140 cases, 99 (71%) were accounted for: 23 abstinent, 14 with controlled and asymptomatic drinking, 22 improved but still impaired, 35 unremitted and 5 deceased. Abstinent versus controlled-drinking outcomes were most strongly differentiated by pretreatment severity of alcohol problems and dependence and by the patients' pretreatment self-assessment and goals. Percentages of abstainers and of relapsed cases increased at long-term follow-ups. A reasonably constant percentage of known outcomes (14%) were clearly controlled and asymptomatic drinkers in each of the follow-up samples. Most of the long-term controlled drinkers had established this pattern within the first year following treatment. However, periods of controlled drinking during the first year did not reliably predict maintenance of this pattern. Successful asymptomatic drinkers were discriminable from other outcomes based on pretreatment characteristics.

MADD victim impact panels and stages-of-change in drunk-driving prevention.

OBJECTIVE: To assess the additional effects of Mothers Against Drunk Driving (MADD) Victim Impact Panels (VIPs) over the effects of a DWI (driving while intoxicated) school, on (1) moving individuals through the stages-of-change toward not drinking while driving and (2) drunk-driving recidivism. METHOD: A randomized experiment with 813 (75% male) DWI offenders in New Mexico measured progress through the stages-of-change at pretest, posttest, 1-year follow-up and 2-year follow-up. In addition, drunk-driving recidivism over 2 years was measured from state driving records. Individuals were randomly assigned to a DWI school or a DWI school plus a MADD VIP. RESULTS: No significant difference in movement through the stages-of-change, or in recidivism, occurred between respondents in the DWI-school-only treatment, and those in the DWI school plus VIP treatment. CONCLUSIONS: There was no additional effect of the MADD VIP, a relatively emotional intervention, over that of the DWI school, a relatively informational approach, on DWI behavior (whether measured by stages-of-change or by DWI rearrest data) over the 2-year period following the two interventions.

AIDS risk behavior in opioid dependent patients treated with community reinforcement approach and relationships with psychiatric disorders.

This study examined the Community Reinforcement Approach's (CRA) effect on AIDS risk behaviors and the relationship between comorbid psychiatric disorders and the risk for AIDS behavior in opioid dependent patients entering methadone maintenance treatment. Additionally, we looked at AIDS risk behaviors as they related to the Addition Severity Index (ASI), Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), and the Social Adjustment Scale-Self Report (SAS-SR). Subjects (N = 227) were drawn from a large clinical trial that examined the effectiveness of a Community Reinforcement Approach for treatment of opioid dependence. Both CRA and standard treatment demonstrated a significant effect on reduction of AIDS risk behaviors. There was no relationship found regarding comorbid psychiatric disorders with the risk for AIDS behavior. However, there were correlations with other psychiatric, social, and substance abuse variables. Multivariate analyses indicated that increased drug and legal ASI composite scores were the primary predictors of increased AIDS risk behavior.

Appropriate use of CT perfusion following aneurysmal subarachnoid hemorrhage: a Bayesian analysis approach.

BACKGROUND AND PURPOSE: In recent years CTP has been used as a complementary diagnostic tool in the evaluation of delayed cerebral ischemia and vasospasm. Our aim was to determine the test characteristics of CTP for detecting delayed cerebral ischemia and vasospasm in SAH, and then to apply Bayesian analysis to identify subgroups for its appropriate use. MATERIALS AND METHODS: Our retrospective cohort comprised consecutive patients with SAH and CTP performed between days 6 and 8 following aneurysm rupture. Delayed cerebral ischemia was determined according to primary outcome measures of infarction and/or permanent neurologic deficits. Vasospasm was determined by using DSA. The test characteristics of CTP and its 95% CIs were calculated. Graphs of conditional probabilities were constructed by using Bayesian techniques. Local treatment thresholds (posttest probability of delayed cerebral ischemia needed to initiate induced hypertension, hypervolemia, and hemodilution or intra-arterial therapy) were determined via a survey of 6 independent neurologists. RESULTS: Ninety-seven patients with SAH were included in the study; 39% (38/97) developed delayed cerebral ischemia. Qualitative CTP deficits were seen in 49% (48/97), occurring in 84% (32/38) with delayed cerebral ischemia and 27% (16/59) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.84 (0.73-0.96), 0.73 (0.62-0.84), 0.67 (0.51-0.79), and 0.88 (0.74-0.94), respectively. A subgroup of 57 patients underwent DSA; 63% (36/57) developed vasospasm. Qualitative CTP deficits were seen in 70% (40/57), occurring in 97% (35/36) with vasospasm and 23% (5/21) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.97 (0.92-1.0), 0.76 (0.58-0.94), 0.88 (0.72-0.95), and 0.94 (0.69-0.99), respectively. Treatment thresholds were determined as 30% for induced hypertension, hypervolemia, and hemodilution and 70% for intra-arterial therapy. CONCLUSIONS: Positive CTP findings identify patients who should be carefully considered for induced hypertension, hypervolemia, and hemodilution and/or intra-arterial therapy while negative CTP findings are useful in guiding a no-treatment decision.

Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates.

OBJECTIVE: To examine the use of long-term prophylactic mupirocin as part of a comprehensive strategy in reducing Staphylococcus aureus colonization and infection in a neonatal intensive care unit (NICU). STUDY DESIGN: Twice daily mupirocin was applied to all infants admitted to the NICU throughout hospitalization starting in 2004. S. aureus surveillance was implemented in 2008. The efficacy of these practices was evaluated with a retrospective review of infants admitted from 2004 to 2010 found to be colonized or infected with S. aureus. RESULT: During the study period, 66 of 6283 NICU infants had a S. aureus infection with 67% methicillin resistance. There were three distinctive S. aureus outbreaks, the first being a methicillin-resistant strain July 2004. After implementation of daily mupirocin, the outbreak was eradicated and the rate of S. aureus infection significantly decreased (1.82 to 0.40/1000 patient-days-at-risk, P=0.0049). Mupirocin was discontinued March 2005 followed by a methicillin-sensitive S. aureus outbreak November 2005. In December 2005, mupirocin was reinstituted and has continued to present day, again significantly reducing S. aureus infections (1.42 to 0.33/1000 patient-days-at-risk, P<0.0001) with zero isolates resistant to mupirocin. In the pre-mupirocin period, S. aureus colonization was upwards of 60% now with rates typically <5%. S. aureus colonization strongly predicted later invasive infection (P<0.0001). CONCLUSION: Although controversial, prophylactic mupirocin in all NICU infants has acted as a barrier to colonization and markedly decreased S. aureus infection rates over a 5-year period.