Aims/Objectives/Background To reduce the risk of spreading infection and hospitals being overwhelmed, on the 18 th February 2020, NHS England advised patients with suspected COVID infection to contact NHS 111 instead of attending health care providers. In March 2020, 3 million NHS 111 calls were made; a record number and double the number of the previous year. Concerns have been raised that telephone triage may not be sufficiently accurate in identifying need for emergency care. We aim to assess accuracy of telephone triage in identifying patients who need emergency care amongst those with suspected COVID-19 and identify factors which affect triage accuracy. Methods/Design A cohort study of adults who contacted NHS 111 services provided by Yorkshire Ambulance Service between the 18 th March 2020 and 29 th June 2020 with symptoms indicating possible COVID-19 infection was completed. Callers were linked to ONS death registrations and routine health care data collected by NHS Digital. The accuracy of triage outcome (self-care/non-urgent assessment versus ambulance/urgent assessment) was assessed for death or organ support 30 days from first contact. Multi-variable logistic regression was used to identify factors associated with risk of false negative or false positive triage. Abstract 798 Figure 1 STROBE flow diagram of study population selection Abstract 798 Table 1 Performance of binary NHS 111 triage (ambulance or urgent assessment 4 hours or less) for composite outcome (death or organ support) Adverse outcome up to 30 days (3% , 2.8- 3.2% ) N=40, 261 Adverse Outcome No Adverse Outcome Ambulance/urgent assessment 890 15, 035 Sensitivity 74.2% (71.6- 76.6%) Positive Predictive Value 5.6% (5.2 - 6%) Self-care/non-urgent assessment 310 24, 025 Specificity 61.5% (61% - 62%) Negative Predictive Value 98.7% (98.6 - 98.9%) Results/Conclusions 3% of the 40,261 callers experienced an adverse outcome. Self-care/non-urgent assessment was recommended for 60%, with a small but non-negligible (1.3%) risk of subsequent deterioration. Triage achieved 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (61% to 62%) for the primary outcome. Multivariable analysis suggested some co-morbidities (e.g. respiratory disease) may be over-estimated, and others (e.g. diabetes) underestimated, as predictors of deterioration. Repeat contact with services appears to be an important under recognised predictor of adverse outcomes with 2 contacts (OR 1.77 95% CI: 1.14 to 2.75) and 3+ contacts (OR 4.02 95% CI: 1.68 to 9.65) associated with clinical deterioration when not provided with an ambulance/urgent clinical assessment.

Background Tools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compared accuracy to existing clinical decision making in a prehospital setting. Methods An observational cohort study using linked ambulance service data for patients attended by Emergency Medical Service (EMS) crews in the Yorkshire and Humber region of England between 26 March 2020 and 25 June 2020 was conducted to assess performance of the Pandemic Respiratory Infection Emergency System Triage (PRIEST) tool, National Early Warning Score (NEWS2), WHO algorithm, CRB-65 and Pandemic Medical Early Warning Score (PMEWS) in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support. Results Of the 7549 patients in our cohort, 17.6% (95% CI 16.8% to 18.5%) experienced the primary outcome. The NEWS2 (National Early Warning Score, version 2), PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging from 0.3 (NEWS2) to 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended. On index assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40). Conclusion Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.

Objectives Settings in identifying need for emergency care amongst those with suspected COVID-19 infection and identify factors which affect triage accuracy. Approach An observational cohort study of adults who contacted the NHS 111 telephone triage service provided by Yorkshire Ambulance Service between March and June 2020 with symptoms indicating possible COVID-19 infection. Patient-level data encompassing triage call, primary care, hospital care and death registration records relating to 40,261 adults were linked. The accuracy of triage outcome (self-care/non-urgent assessment versus ambulance/urgent assessment) was assessed for death or organ support 30 days from first contact. Multivariable logistic regression was used to identify factors associated with risk of false negative or false positive triage. Results Callers had a 3% (1,200/40,261) risk of serious adverse outcomes. Telephone triage recommended self-care or non-urgent assessment for 60% (24,335/40,261), with a 1.3% (310/24,335) risk of adverse outcomes 30 days from first contact. Telephone triage had 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (61% to 62%) for the primary outcome. Analysis suggested respiratory comorbidities may be over-appreciated and diabetes under-appreciated as predictors of deterioration. Repeat contact with triage service appears to be an important under-recognised predictor of deterioration. Conclusion Patients advised to self-care or receive non-urgent clinical assessment had a small but non-negligible risk of serious clinical deterioration. Repeat contact with telephone services needs recognition as an important predictor of subsequent adverse outcomes.

Aims/Objectives/Background In the first wave of the pandemic some ambulance services received three times their usual number of 999 calls. The increase was mostly due to calls from patients with respiratory symptoms. Call handlers must rapidly decide whether patients need an emergency face-to-face assessment or could access non-emergency services. We assess accuracy of emergency telephone triage in identifying patients with suspected COVID-19 infection who need an ambulance response and identify factors which affect triage accuracy. Methods/Design An observational cohort study of adults who contacted 999 emergency telephone services provided by Yorkshire Ambulance Service between the 18thMarch 2020 and 29th June 2020 with symptoms indicating possible COVID-19 infection was completed. Callers were linked to ONS death registrations and routine health care data collected by NHS Digital. The accuracy of triage outcome (ambulance dispatch versus telephone advice) was assessed for death or organ support 30 days from first contact. Multi-variable logistic regression was used to identify factors associated with risk of false negative or false positive triage. Results/Conclusions Of the 12, 655 callers, 11.1% experienced the primary outcomes. An ambulance was dispatched to 84.2% of callers. The decision to dispatch an ambulance achieved 95% sensitivity (95% CI: 93.7 to 96.1%) and 17.2% specificity (95% 16.5% to 17.9%) for adverse outcomes. Where an ambulance was not dispatched, patients had a 3.5% (2.8 to 4.4%) of subsequent deterioration. Of patients that received an ambulance only 57% were subsequently conveyed to hospital. Multivariable logistic regression modelling found false negative assessment was associated with younger age and female sex and false positive assessment was associated with malignancy, immunosuppression, respiratory and cardiovascular comorbidities. Emergency telephone triage of patients with suspected COVID-19 achieved a high sensitivity to serious adverse outcomes. Further research is required to identify ways specificity of triage could be improved to reduce unnecessary ambulance dispatch.

Extended spectrum beta lactamase (ESBL) producing bacteria are organisms of public health significance that have been implicated in prolonged hospital stay, treatment failures and higher fatalities. These organisms were originally thought to be widely distributed in hospital, but have since grown in terms of their epidemiological coverage. This study was therefore aimed at using pulse-field gel electrophoresis (PFGE) to understand the diversity of ESBL producing organisms originating from cockroaches in Ago-Iwoye, Nigeria. The diversity was determined by using a set of twenty six (26) ESBL producing bacterial strains isolated from cockroaches sampled in Ago-Iwoye community, Ogun State, Nigeria. PFGE analysis revealed three pulsotypes (distinct profile) with no distinct isolates present on a pulsotype. It was however observed that no pulsotype had less than two (2) isolates in any case, while isolates from different communities displayed identical profiles. In conclusion, clonal distributions of ESBL producing organisms on cockroaches are without bias to specimens and/or the community sampled. Keywords: ESBL; Gram negative bacteria; PFGE; Diversity;

Aims/Objectives/Background Emergency Medical Service (EMS) and other practitioners assessing patients with suspected COVID-19 in the community must rapidly determine whether patients need treatment in hospital or can self-care. Tools to triage patient acuity have only been validated in hospital populations. We aimed to estimate the accuracy of five risk-stratification tools recommended to predict severe illness and compare accuracy to existing clinical decision-making in a pre-hospital setting. Methods/Design An observational cohort study using linked ambulance service data for patients assessed by EMS crews in the Yorkshire and Humber region of England between 18th March 2020 and 29th June 2020 was conducted to assess performance of the PRIEST tool, NEWS2, the WHO algorithm, CRB-65 and PMEWS in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support. Abstract 867 Table 1 Triage tool diagnostic accuracy statistics (95% CI) for predicting any adverse outcome Tool N* C-statistic Threshold Proportion with score Sensitivity Specificity PPV NPV CRB-65 7470 0.79(0.78, 0.80) >0 0.54 0.89(0.88, 0.89) 0.54(0.53, 0.54) 0.29 (0.29, 0.30) 0.96 (0.95, 0.96) NEWS2 7435 0.80(0.78, 0.81) >1 0.75 0.96(0.96, 0.96) 0.30(0.29, 0.30) 0.23 (0.22, 0.23) 0.97 (0.97, 0.97) PMEWS 7460 0.81(0.80, 0.83) >2 0.72 0.98(0.97, 0.98) 0.34(0.33, 0.34) 0.24 (0.24, 0.24) 0.99 (0.98, 0.99) PRIEST 7470 0.83(0.82, 0.84) >4 0.66 0.97(0.97, 0.97) 0.41(0.40, 0.41) 0.26 (0.25, 0.26) 0.98 (0.98, 0.99) WHO 7470 0.64(0.64, 0.65) >0 0.74 0.98(0.97, 0.98) 0.31(0.30, 0.31) 0.23 (0.23, 0.24) 0.98(0.98, 0.99) *Totals rounded to nearest 5 Abstract 867 Figure 1 ROC curves showing triage tool performance for predicting any adverse outcome Results/Conclusions Of 7550 patients in our cohort, 17.6% (95% CI:16.8% to 18.5%) experienced the primary outcome. The NEWS2, PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging between 0.3 (NEWS2) and 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended (NEWS2; 0–1 vs 2+ and PMEWS; 0–2 vs 3+). On index (first) assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40) to the primary outcome. This does not account for clinical reasons not to convey patients to hospital who subsequently deteriorated. Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could therefore potentially improve EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool could significantly increase the sensitivity of triage without increasing the number of patients conveyed to hospital.

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In patients with complications after arthroplasty, common potential causes, such as malpositioning, mechanical problems, or infections, are usually investigated first. After exclusion of such causes, or in cases of local eczema, implant allergy might be suspected. We report a patient who developed pain and swelling of the knee with subsequent local eczema after cemented total knee arthroplasty.

Aristolochiae Fructus, a Chinese herbal medicine derived from the fruit of Aristolochia contorta Bge., contains nephrotoxic aristolochic acid analogues (AAAs). According to ancient medical texts, various medicinal parts of the fruit of A. contorta were ever used. In order to reveal which part could be safely and effectively used, it is necessary to analyze the chemical profiles of different medicinal parts. Herein we compared the chemical compositions and determined aristolochic acid I (AA-I) and aristolochic acid II (AA-II) in the four parts viz. outer pericarp, inner pericarp, septum, and seed. Ultra-high performance liquid chromatography equipped with quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) was applied for chemical profiling. Ultra-high performance liquid coupled with triple quadrupole mass spectrometry (UHPLC-QqQ-MS) was employed to quantify AA-I and AA-II in different parts. It was found that the chemical compositions of the four parts varied both qualitatively and quantitatively. A total of 10 AAAs, including 5 aristolochic acids and 5 aristolactams, together with 3 alkaloids, were unambiguously or tentatively identified by UHPLC-QTOF-MS. The quantitatively analytical results obtained by UHPLC-QqQ-MS showed that AA-I and AA-II exclusively accumulate in the seeds of A. contorta. These findings provide supporting data for the rational selection of medicinal parts.

Enterococci are the third most common cause of infectious endocarditis (IE). The NOVA score was developed in Spain to identify patients at low risk for enterococcal IE for whom transesophageal echocardiography is unnecessary. The score is based on the number of positive cultures, source of infection, prior history of valve disease and presence of a murmur. It has not been validated in other patient populations. We conducted a retrospective cohort study of patients with enterococcal bloodstream infection (EBSI) during 2008–2012 in a large tertiary hospital in the United States. Our primary outcome was IE, defined using the modified Duke’s criteria. Our cohort consisted of 1117 patients with EBSI. The median age was 59 years (range 18–99); 590 (52.8%) were male; 129 (11.5%) were stem cell transplant patients, and 154 (13.8%) had valvular disease. The source of EBSI was: genitourinary in 91 subjects (8.1%), abdominal in 428 (37.8%), and unknown in 604 (54.1%). 581(52%) of ESBI patients had transthoracic echocardiography, 144(12.9%) had transesophageal, and 114(19.6%) had both. 117 (9.5%) of EBSI patients had endocarditis. Among individual components of the NOVA score, the independent IE risk factors were: prior valvular disease [odds ratio (OR) 1.01; 95% confidence interval (CI) 0.56–1.82], presence of a heart murmur (OR 11.8; CI 6.53–18.78), unknown origin of bacteremia (OR 4.02; CI 2.35–6.86), and number of positive blood cultures (OR 2.18; CI 1.35–3.58). The median NOVA score was 4 (interquartile range 0–5) (Figure 1). Among patients with a NOVA score <4, 40 (5.1%) had IE vs. 77 (23.7%) in with NOVA >4, (P < 0.001). The NOVA score explained 30.5% of the variability in the observed outcome of endocarditis. The Receiver-Operator Characteristic Area Under the Curve (AUC) for the NOVA score was 0.77 (95% CI 0.72–0.81; P < 0.001). Among 649 monomicrobial EBSI patients, 73 (11.2%) had IE; the ROC in this group was 0.76 (CI 0.69–084; P < 0.001). 9.5% of patient in our EBSI cohort had endocarditis. In our study population, 5.1% patients with a NOVA score <4 had endocarditis. The ROC for NOVA score was similar for all EBSI patients and those with monomicrobial infections. Percentage of patients with and without endocarditis by NOVA score. All authors: No reported disclosures.

BACKGROUNDThe long-term and cumulative effect of multiple episodes of bacteremia and sepsis across multiple hospitalizations on the development of cardiovascular (CV) events is uncertain.METHODSWe conducted a longitudinal study of 156 380 hospitalizations in 47 009 patients (≥18 years old) who had at least 2 inpatient admissions at an academic tertiary care center in St Louis, Missouri, from 1 January 2008 through 31 December 2012. We used marginal structural models, estimated by inverse probability weighting (IPW) of bacteremia or sepsis and IPW of censoring, to estimate the marginal causal effects of bacteremia and sepsis on developing the first observed incident CV event, including stroke, transient ischemic attack, and myocardial infarction (MI), during the study period.RESULTSBacteremia and sepsis occurred during 4923 (3.1%) and 5544 (3.5%) hospitalizations among 3932 (8.4%) and 4474 (9.5%) patients, respectively. CV events occurred in 414 (10.5%) and 538 (12.0%) patients with prior episodes of bacteremia or sepsis, respectively, vs 3087 (7.2%) and 2963 (7.0%) patients without prior episodes of bacteremia or sepsis. The causal odds of experiencing a CV event was 1.52-fold (95% confidence interval [CI], 1.21- to 1.90-fold) and 2.39-fold (95% CI, 1.88- to 3.03-fold) higher in patients with prior instances of bacteremia or sepsis, respectively, compared to those without. Prior instances of septic shock resulted in a 6.91-fold (95% CI, 5.34- to 8.93-fold) increase in the odds of MI.CONCLUSIONSPrior instances of bacteremia and sepsis substantially increase the 5-year risk of CV events.

Purpose: Past studies of sepsis epidemiology did not address misclassification bias due to imperfect verification of sepsis detection methods to estimate the true prevalence.Methods: We examined 273,126 hospitalizations from 2008 to 2012 at a tertiary-care center to develop surveillance-aimed sepsis detection criteria, based on the presence of the sepsis-explicit International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.92 or 785.52), blood culture orders, and antibiotics administration. We used Bayesian multinomial latent class models to estimate the true prevalence of sepsis, while adjusting for the imperfect sensitivity and specificity and the conditional dependence among the individual criteria.Results: The apparent annual prevalence of sepsis hospitalizations based on explicit International Classification of Diseases, Ninth Revision, Clinical Modification codes were 1.5%, 1.4%, 1.6%, 2.2%, and 2.5% for the years 2008 to 2012. Bayesian posterior estimates for the true prevalence of sepsis suggested that it remained stable from 2008, 19.2% (95% credible interval [CI]: 17.9%, 22.9%), to 2012, 17.8% (95% CI: 16.8%, 20.2%). The sensitivity of sepsis-explicit codes, however, increased from 7.6% (95% CI: 6.4%, 8.4%) in 2008 to 13.8% (95% CI: 12.2%, 14.9%) in 2012.Conclusions: The true prevalence of sepsis remained high, but stable despite an increase in the sensitivity of sepsis-explicit codes in administrative data. (C) 2016 Elsevier Inc. All rights reserved.

PURPOSE:To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records, and subsequent medical coding of sepsis for billing purposes in recent years. METHODS:We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome criteria at a tertiary care center from 2008 to 2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period. RESULTS:When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization, and intensive care unit admission, the causal risk difference for receiving a discharge code for sepsis per 100 hospitalizations with systemic inflammatory response syndrome, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval [CI], 3.8%-4.0%), 3.4% (95% CI, 3.3%-3.5%), 2.2% (95% CI, 2.1%-2.3%), and 0.9% (95% CI, 0.8%-1.1%) from 2008 to 2011, respectively. CONCLUSIONS:Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented, and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence.

rate is 0.04-0.1 per 100,000 (10).In this study, the detection rates of V. cholerae O1 in stools from patients with severe diarrhea were 23% (49/213 cases) in 2012 and 14% (35/250 cases) in 2013, respectively.Although our investigation is merely the tip of the iceberg for studies of cholera in Myanmar, our data provide crucial initial insights into the genetic backgrounds of recent Yangon isolates of V. cholerae O1.Epidemiologic surveillance linked to laboratory investigations is need to minimize the risk for V. cholerae infection in children.

Fresh produce irrigated with contaminated water poses a substantial risk to human health. This study evaluated the impact of incorporating sediment information on improving the performance of machine learning models to quantify E. coli level in irrigation water. Field samples were collected from irrigation canals in the Southwest U.S., for which meteorological, chemical, and physical water quality variables as well as three additional flow and sediment properties: the concentration of E. coli in sediment, sediment median size, and bed shear stress. Water quality was classified based on E. coli concentration exceeding two standard levels: 1 E. coli and 126 E. coli colony forming units (CFU) per 100 ml of irrigation water. Two series of features, including (FIS) and excluding (FES) sediment features, were selected using multi-variant filter feature selection. The correlation analysis revealed the inclusion of sediment features improves the correlation with the target standards for E. coli compared to the models excluding these features. Support vector machine, logistic regression, and ridge classifier were tested in this study. The support vector machine model performed the best for both targeted standards. Besides, incorporating sediment features improved all models' performance. Therefore, the concentration of E. coli in sediment and bed shear stress are major factors influencing E. coli concentration in irrigation water.

We performed a combined approach to identify suspected allergy to knee arthroplasty (TKR): patch test (PT), lymphocyte transformation test (LTT), histopathology (overall grading; T- and B-lymphocytes, macrophages, and neutrophils), and semiquantitative Real-time-PCR-based periprosthetic inflammatory mediator analysis (IFN γ , TNF α , IL1- β , IL-2, IL-6, IL-8, IL-10, IL17, and TGF β ). We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion. They consisted of 20 patients with proven metal sensitization (11 with PT reactions; 9 with only LTT reactivity). Control specimens were from 5 complicated TKR patients without metal sensitization, 12 OA patients before arthroplasty, and 8 PT patients without arthroplasty. Lymphocytic infiltrates were seen and fibrotic (Type IV membrane) tissue response was most frequent in the metal sensitive patients, for example, in 81% of the PT positive patients. The latter also had marked periprosthetic IFN γ expression. 8/9 patients with revision surgery using Ti-coated/oxinium based implants reported symptom relief. Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies.

Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear.

Background. Arthroplasty patients with complications may be sensitized to implant components.Objectives. To quantify patch test reactions to implant materials in aseptic cemented arthroplasty patients with complications, and to evaluate the benefit of late patch test. reading at D6.Methods. Analyses of patch test reactions to baseline series and bone cement components and of the questionnaire-aided histories of 250 consecutive patients with suspected implant allergy were performed. Patch tests were read at D2, D3, and D6.Results. There were 187 positive reactions to the 29 allergens of the baseline series, and 52 to the seven allergens of the bone cement series. Forty-nine of 250 patients reacted to the bone cement series. In contrast to 'early allergens' such as fragrance mix, late reading at D6 increased the number of positive reactions by 11/32 for nickel, 1/5 for cobalt, and 2/4 for chromium. With bone cement components, most reactions were to gentamicin (25 of 250 patients), and 17 of 25 appeared only at D6.Conclusion. Late reading is useful for patch tests with metals and bone cement components. With only D2/D3 readings, 32 reactions to nickel, cobalt, chromium and bone cement components would have been missed. This underlines the utility of late reading in general and in complicated cemented arthroplasty patients, given the unexpectedly high number of gentamicin reactions.

The objective of this study was to investigate the observation of daptomycin resistance in Corynebacterium striatum, both in vivo and in vitro. We describe a case of C. striatum bacteremia in a patient with a left ventricular assist device (LVAD); the initial isolate recovered was daptomycin susceptible with a minimum inhibitory concentration (MIC) of 0.125 μg/ml. Two months later, and after daptomycin therapy, the individual became bacteremic with an isolate of C. striatum with a daptomycin MIC of >256 μg/ml. To study the prevalence of daptomycin resistance in C. striatum, clinical isolates of C. striatum were grown in broth culture containing daptomycin to investigate the emergence of resistance to this antimicrobial. Molecular typing was used to evaluate serial isolates from the index patient and the clinical isolates of C. striatum we assayed. In vitro analysis of isolates from the index patient and 7 of 11 additional C. striatum isolates exhibited the emergence of high-level daptomycin resistance, despite initially demonstrating low MICs to this antimicrobial agent. This phenotype was persistent even after serial subculture in the absence of daptomycin. Together, these data demonstrate that caution should be taken when using daptomycin to treat high-inoculum infections and/or infections of indwelling medical devices with C. striatum. To our knowledge, this is the first report characterizing the emergence of daptomycin resistance in C. striatum.

Recently, there has been interest in developing a predictive measure to assess pregnancy readiness/intention in clinical settings. Two such measures have been created but tested primarily in pregnant or postpartum populations. This study examined agreement between the pregnancy readiness measures in a diverse population of nonpregnant women.Women completed short questionnaires while waiting for clinical appointments. Participants’ responses to the pregnancy readiness measures were cross-tabulated to assess the level of agreement between the measures. Logistic regression was used to determine factors related to disagreement between the measures. Complete information was available for 220 women.Almost 55% of women had disagreement between the pregnancy readiness measures. Women with a high school education or less had 2.60 times the odds of disagreement (95% confidence interval 1.23–5.49), and women who did not use contraception had 2.40 times the odds of disagreement (95% confidence interval 1.18–4.87).Although both pregnancy readiness measures are promising tools that could potentially be adapted for use in public health or clinical settings, there are limitations to these measures. These measures should be further tested and refined through the use of qualitative methods to ensure that a valid measure is created for use in non-pregnant populations.