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3% (5/79) of the no PET subgroup. The most common follow-up modality after a negative PET scan was a CT scan (47/67, 70.1%), with a median interval of 3.1 months. Clinical variables including nodule location/size, chronic obstructive pulmonary disease, family history of lung cancer, pack-years, and number of years quit in former smokers were not significantly associated with greater cancer risk among PET-negatives.

For LungRADS-4/PET-negative lesions, the cancer risk remained high despite lack of activity on PET. As such, we believe the current surveillance practice of continuing to follow LungRADS-4/PET-negative patients as LungRADS-4 patients is appropriate.

For LungRADS-4/PET-negative lesions, the cancer risk remained high despite lack of activity on PET. As such, we believe the current surveillance practice of continuing to follow LungRADS-4/PET-negative patients as LungRADS-4 patients is appropriate.Sapindus saponins are obtained from the outer bark of Sapindus mukorossi Gaertn. (S. mukorossi), and they have become an interesting subject in the search for new anti-acne agents without resistance. This study aimed to screen the synergistic antibacterial combination from Sapindus saponins and investigated the synergistic antibacterial action via targeting the cell membrane of Cutibacterium acnes (C. acnes) to reduce the effective dose. The combination of Sapindoside A and B (SAB) was obtained with synergistic activity against C. acnes. VX-765 solubility dmso SAB led to the leakage of ions and disturbed the membrane morphology of C. acnes. The spectral features of cell membrane composition showed obvious changes based on Raman spectroscopy, and changes in membrane protein microenvironment were also observed by fluorescence spectroscopy. Among the above results, the contribution of Sapindoside A was greater than that of Sapindoside B to the synergistic combination of SAB. Furthermore, molecular docking demonstrated that Sapindoside A interacted with penicillin-binding protein 2, playing an important role in peptidoglycan synthesis for the cross wall, and showed a higher binding score than Sapindoside B, further indicating that the greater contribution in the synergistic action of SAB on membrane proteins. Collectively, these results showed that the synergistic antibacterial action of SAB against C. acnes could be achieved by attacking cell membrane, and Sapindoside A played a major role, suggesting that SAB has the potential to be the natural anti-acne agent additive in the cosmetic industry.

Unrepresented adults are individuals who lack decision-making capacity and have neither an available surrogate decision maker nor an applicable advance directive. Currently, the prevalence of unrepresented nursing home (NH) residents and how medical decisions are made is unknown. We examined (1) the prevalence of unrepresented NH residents, (2) NH policies and procedures to address medical decision making for those residents, and (3) NH staff's perceptions of medical decision making for unrepresented residents.

We reviewed resident medical records and NH policy and procedure documents. We also conducted a survey of NH staff using an investigator-developed questionnaire.

Sixty-six staff members recruited from 3 NHs (433 residents total) in 1 metropolitan area of Georgia, USA.

Medical records and policy and procedure documents were reviewed using preset criteria. The survey included 31 structured and open-ended questions regarding medical decision-making practices for unrepresented residents (eg, awarenand legal professionals, and other key stakeholders should discuss practical approaches and policies to systematically identify unrepresented residents and to improve NHs' medical decision-making practices for them.

Although prevalence in the 3 NHs was low, NH care providers, ethical and legal professionals, and other key stakeholders should discuss practical approaches and policies to systematically identify unrepresented residents and to improve NHs' medical decision-making practices for them.

We aimed to assess the burden of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in Swiss long-term care facilities (LTCFs) to describe the molecular epidemiology, describe the intrainstitutional and regional clusters of resistant pathogens, and identify independent institution- and resident-level factors associated with colonization.

Cross-sectional study.

From August to October 2019, we performed a point prevalence study among residents from 16 LTCFs in Western and Eastern Switzerland (8 per region).

Residents underwent screening for ESBL-producing Enterobacterales (ESBL-E); whole-genome sequencing (WGS) was performed. We gathered institution-level (eg, number of beds, staff-resident ratio, alcoholic hand rub consumption) and resident-level [eg, anthropometric data, time in facility, dependency, health care exposure, antibiotic treatment, proton-pump inhibitor (PPI) use] characteristics. Factors associated with colonization were identified using a generalized linear model.

Among 11ciated with carriage of ESBL producers. This study adds to the growing list of adverse outcomes associated with PPIs, calling for action to restrict their use in the long-term care setting.

Overall ESBL-E prevalence in Swiss LTCF residents is low. Yet, we identified several clusters of residents with identical pathogens within the same institution. This implies that particularly affected institutions might benefit from targeted infection control interventions. PPI use was the only modifiable factor associated with carriage of ESBL producers. This study adds to the growing list of adverse outcomes associated with PPIs, calling for action to restrict their use in the long-term care setting.

Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time.

Retrospective, repeated cross-sectional analysis.

Long-term residents not receiving hospice care in freestanding NHs that participated in 1 or both surveys in 2013 and2017.

Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the 2years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer's disease, and those with any infection including urinary tract infections (UTIs).

Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively.