Florida Department of Health

Addressing the mounting plastic waste problem requires system-level solutions, along with interventions that promote behavioral change. In low-resource countries, inadequate, if not absent, waste management systems lead to unsafe disposal practices, including open burning. While theory-informed approaches are essential for identifying enablers and barriers to target behavior change, their application is limited in these settings. Given the lack of a theory-driven synthesis of behavioral strategies to address plastic waste, this systematic review aimed to: (1) synthesize behavioral interventions related to plastic waste management in low-resource countries; (2) map these interventions to the behavior change wheel (BCW), using the capability-opportunity-motivation-behavior model, and the theoretical domains framework (TDF); and (3) classify implementation strategies to inform theory-driven intervention design. This review is the first to use the BCW to examine behavioral interventions related to plastic waste management in low-resource countries. Nine bibliographic databases: APA PsycInfo, CINAHL, Embase, Environment Complete, Global Health, GreenFile, Health Source: Nursing Academic, PubMed, and Web of Science Core Collection were searched. We included English-language human studies up to 9 April 2025, that evaluated interventions or policies targeting individual- or community-level behaviors related to plastic waste management in low-, lower-middle, or upper-middle income countries. We excluded studies from high-income countries, and those focused on environmental impacts, industrial or municipal waste streams, ecosystems or animals without human behavioral components, COVID-19-specific waste, or hypothetical modeling without real-life interventions. Forty-three studies met the inclusion criteria. Study quality was assessed using the mixed methods appraisal Tool. Interventions spanned 27 low-resource countries and targeted diverse populations, including schoolchildren, households, market vendors, and community organizations. Education was the most frequent BCW intervention function (76.7%), followed by environmental restructuring, incentivization, persuasion, and training. Mapping revealed that behavioral interventions relied most frequently on the TDF domains of environmental context, knowledge, skills, and social influences. Some domains, such as beliefs about capabilities, reinforcement, and identity, received moderate attention, while appealing to emotion or the use of behavioral regulation, were underutilized. Behavioral interventions for plastic waste management in low-resource countries have predominantly emphasized awareness-raising but insufficiently leveraged other BCW intervention functions and TDF domains. Integration of motivational, emotional, and identity-based strategies alongside structural support can enhance the sustainability of behavior change.

Background: Non-Hispanic Black (NHB) women experience the highest risk of stroke in the United States, necessitating targeted awareness strategies. Despite increased awareness of stroke symptoms, delayed presentation to the hospital remains a significant barrier to timely treatment in this population. Public education, particularly symptom recognition and rapid activation of emergency medical services (EMS) is essential to reducing prehospital delays and improving stroke care. Especially amongst the high-risk population. We proposed that targeted, interactive social media campaigns could increase engagement and reduce time to hospital presentations in high-risk populations. Methods: The Florida Stroke Registry (FSR), a state-mandated quality improvement program, supports statewide stroke care by analyzing acute stroke and administrative data. FSR launched a tailored stroke recognition campaign for NHB women. Messaging was informed by multiethnic, multidisciplinary stakeholder focus groups, featured two BEFAST scenarios emphasizing 911 activation. Formats included 30-second animations still images, and a landing page. Distribution leveraged Meta (Facebook, Instagram, Messenger) and Google Ads (YouTube, Gmail, Search), targeting demographics, interests, and search keywords. The 3-month campaign was launched in one county with a high NHB population, identified via census tract data. Engagement metrics, impressions (message displays) and reach (unique users interacting), were collected daily and aggregated for the first two months. Social media metrics are collected daily and are reported in aggregate representing the first two months of the social media campaign. Results: From June–July 2025, Meta delivered 1.89M impressions, reaching 133K users: 1.20M video and 691K static image impressions. Videos generated 1.05M plays, including 132K 3-second views, 4,099 completions (95% watch rate), 23,864 views at 25%, 11,280 at 50%, and 6,294 at 75%. The campaign yielded 1,165 link clicks, with an average frequency of 14.19 views per (133K) user. Conclusions: A tailored, targeted social media stroke recognition campaign achieved high engagement, exceeding exposure targets and indicating strong potential for message recall and awareness. This community-informed, precision-targeted approach shows promise for scalable education strategies that may influence health-seeking behavior and improve outcomes.

Abstract Summary The proliferation of pathogen bioinformatics pipelines has outpaced the community’s ability to compare them on common ground. Self-reported performance numbers, ad-hoc evaluation datasets, and inconsistent metrics make pipeline selection difficult for clinical and public-health researchers. We present PathoBench , an open web platform that addresses this gap through three coordinated mechanisms: (i) a curated registry of 26 standard benchmark datasets across 10 human pathogens, each with persistent identifiers and direct download links; (ii) pathogen-specific evaluation metrics that submissions must report, allowing direct head-to-head comparison only on the same dataset; and (iii) a credibility framework combining mandatory dataset attestation, ORCID-linked attribution, public peer comments, and administrator verification. As a case study, four published Mycobacterium tuberculosis drug-resistance pipelines were evaluated against the WHO TB mutation catalogue, demonstrating the framework’s discriminating power. PathoBench is open for community contributions across all ten supported pathogens. Availability and implementation PathoBench is freely available at https://pathobench.vercel.app . Source code is released under the MIT license at https://github.com/BPHL-Molecular/pathobench . The platform requires no installation for end users; programmatic access is available via a Supabase REST API. Contact yibo.dong@flhealth.gov Supplementary information Supplementary data are available at Bioinformatics online.

The Centers for Disease Control and Prevention’s Core Elements of Antibiotic Stewardship for Nursing Homes is a guide for antibiotic stewardship (ABS) efforts in long-term care facilities and recommends that the core elements be implemented in a stepwise fashion. To understand the depth of ABS programs in long-term care facilities in Florida, an infection prevention and control needs assessment which included questions about the core elements that have been implemented was conducted. The needs assessment was conducted through an online survey from December 6, 2022, through February 9, 2023. Of 302 total respondents, 73 responded to questions about antibiotic stewardship: 80.8% were from skilled nursing facilities/nursing homes (SNF/NH), 15.1% were from assisted living facilities (ALF), and 4% were from continuing care retirement communities or other facilities. Descriptive statistics and bivariate analysis using Fisher’s exact test or chi-square test to compare SNF/NH with ALF were conducted. SNF/NH were significantly more likely to have an ABS plan than ALF (p< 0.001). While inclusion of core elements varied, those included most by SNF/NH were “Facility has a written statement of support for antibiotic stewardship” (96.6%) and “Facility has an individual who is responsible for stewardship efforts who has training in antibiotic stewardship” (96.6%). Those included least by SNF/NH were “Facility provides education to families on antibiotic use” (73.2%), and “Facility reports antimicrobial stewardship outcome data to staff and providers” (81.0%). The most-used method of tracking antibiotic use was Antibiotic Days of Therapy (75% of responding ALF and 85.5% of responding SNF/NH). Infections preventionists (95.7%) were more likely to rate ABS training as important for themselves than administrators (71.4%) or Assistant/Directors of Nursing (77.8%) were (p=0.055). All responding SNF/NH in the state had ABS programs that incorporated several of the core elements but few ALF reported having an ABS plan. While facility-specific antibiotic use may not be as high in an ALF as in a SNF/NH, there are over 106,000 ALF beds in the state so implementation of AMS best practices in those facilities may have a positive influence on antibiotic use. Cindy Prins, PhD, MPH, Becton, Dickinson and Company: Advisor/Consultant Venugopalan Veena, PharmD, Merck: Grant/Research Support

Wednesday, October 22, 2025: 11:30 AM Background: Serious adverse events (SAEs) related to ceftriaxone, a widely used cephalosporin antibiotic, are considered rare. After a 2024 SAE cluster in Alabama, the Centers for Disease Control and Prevention (CDC), with state/local partners and the US Food and Drug Administration (FDA), conducted a nationwide investigation of SAEs, including deaths, among patients who received ceftriaxone.Table.Clinical summary of serious adverse event cases (n=26), September 2024–June 2025Abbreviations: SAE: serious adverse event, ACH: acute care hospital, ED: emergency department, OP: outpatient clinic, F: female, M: male, Pt: patient (used when sex not reported); NR: not reported, NOS: not otherwise specified, EKG: electrocardiogram, PEA: pulseless electrical activity, IV: intravenous, IM: intramuscular, N/A: not applicable, PMH: past medical history, CA: cancer, CAD: coronary artery disease, CHF: congestive heart failure, CKD/ESRD: chronic kidney disease or end stage renal disease; COPD: chronic obstructive pulmonary disease, DM: diabetes mellitus, HTN: hypertension, HLD: hyperlipidemia, dx: disease CPR: cardiopulmonary resuscitation.Figure 1a-b.Epidemic curve: Frequency of reported serious adverse event cases following ceftriaxone administration from September 2024 to June 2025, by event month and US region (a) or ceftriaxone manufacturer (b), n=26Figure includes SAEs meeting CDC case definition: Adverse events following injectable ceftriaxone exposure, occurring after September 1, 2024, which: 1) occurred within 6 hours after receipt of injectable ceftriaxone in a non-ICU setting, 2) resulted in death or required cardiopulmonary resuscitation (CPR), and 3) were not attributed by the treating provider(s) to a cause other than ceftriaxone administration (such as known infection, other underlying medical condition, or exposure to a medication or medical product other than ceftriaxone). Figure 1a (left) displays epidemic curve by US Census Bureau region, reflecting case-patient state of residence. Southern region includes AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV. Figure 1b (right) displays epidemic curve by the ceftriaxone product reported as administered to case-patient or present in the facility at the time of adverse event. Abbreviations: NR: not reported, US: United States. (R Core Team, 2024). Methods: CDC issued a national call for cases, defined as death or cardiopulmonary resuscitation within 6 hours of ceftriaxone receipt in non-intensive care settings without other apparent cause, occurring after Sep 1, 2024. Health departments collected clinical data for analysis at CDC. We further classified cases as anaphylaxis-type if determined by treating provider to be allergic or if involved two or more of: hypotension, respiratory compromise, cutaneous manifestations, and gastrointestinal symptoms. For SAEs reported Dec 2024-Jan 2025, FDA collected available ceftriaxone/diluent for testing and requested internal product investigations by manufacturers.Figure 2.Medications (other than ceftriaxone) prescribed proximal and prior to serious adverse event, by individual case-patient, n=23Abbreviations: ARB: angiotensin receptor blocker, ACE: angiotensin-converting enzyme, NSAID: non-steroidal anti-inflammatory drugs. Results: We report 26 cases (65% outpatient; 35% inpatient), including 12 deaths, from 22 healthcare facilities across 15 states from Sep 1, 2024 to Jun 30, 2025 (Figure 1a). Case-patients had a median age of 70 years (IQR: 60-81) and received 1g (n=15, 58%), 2g (n=9, 35%), or unspecified (n=2, 7%) ceftriaxone doses via intravenous (IV) push (n=15, 58%), IV infusion (n=9, 35%), or intramuscular injection (n=2, 7%). Presentations varied (Table); 69% (n=18) were anaphylaxis-type. Prior ceftriaxone exposure (n=16, 62%), cardiac comorbidities (n=20, 77%), and/or concurrent use of antihypertensives (n=17, 65%, Figure 2) were common. Product exposures included 22 lots from 6 ceftriaxone manufacturers (Figure 1b). FDA testing of ceftriaxone (5 lots, 4 manufacturers) and lidocaine diluent (3 lots, 2 manufacturers) found no evidence of tampering, adulteration, endotoxin, or purity/potency issues. Manufacturers (n=4) did not report product anomalies. Conclusion: SAEs, including deaths, can occur after ceftriaxone use. This investigation did not identify a common-source etiology, nor a link to a specific ceftriaxone product. Providers in all settings should monitor for SAEs, including anaphylaxis, and report to the FDA MedWatch Program. Disclosures: All Authors: No reported disclosures