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Abrupt transitions in action representations of ACC neurons may be part of a mechanism that alters choice strategies as new information is acquired. © The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail journals.permission@oup.com.BACKGROUND The metropolitan area of Lima, Peru has a third of the nation's population living in slum dwellings that are hypothesized to contribute to inefficient household hygienic practices. The purpose of this study was to quantitatively assess which living conditions have the greatest impact on handwashing practices. METHODS A cross-sectional epidemiological design of participants ≥16 y of age from San Juan de Miraflores, a slum on the outskirts of Lima, Peru, was used. Poisson regression was applied to assess the impact of living conditions on handwashing practices. RESULTS We could not demonstrate a relationship between living conditions (home structure, overcrowding, water, grey water disposal) and reported handwashing. The reported lack of handwashing is associated with the number of children in the home (those with children less then 5 y of age were more likely not to report washing their hands) and length of stay in the slum in years. CONCLUSIONS Living conditions play an important role in one's health, therefore improved study designs are needed to determine which strategies are likely to be the most effective in improving outcomes for slum dwellers. © The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.BACKGROUND Azithromycin is frequently used to treat shigellosis however clinical outcomes are uncertain. METHODS We performed an observational cohort study in Bangladesh of patients with invasive diarrhea treated empirically with azithromycin. learn more Susceptibility testing was performed by broth microdilution and disk diffusion post hoc on all Shigella isolates and clinical response was correlated with in vitro susceptibility. RESULTS There were 149 Shigella culture positive patients in the primary analysis. Infection with Shigella with decreased susceptibility to azithromycin was significantly associated with persistence of diarrhea at day 5 (31% vs. 12%, relative risk 2.66 (1.34, 5.28)); culture positivity at day 5 or 6 (35% vs. 5%, RR 5.26 (1.84, 14.85)); and a higher rate of overnight hospitalization (58% vs. 39%, RR 1.49 (1.06, 2.09)). Shigella flexneri was more common than S. sonnei (58% vs. 36%), however S. sonnei constituted most of the isolates with decreased susceptibility to azithromycin (67%) and most of the MDR strains (54%), thus poor clinical outcomes were associated with S. sonnei. The current epidemiological cutoff for S. flexneri of ≥16 µg/ml to define decreased susceptibility to azithromycin was clinically predictive of poor outcome. Patients with S. sonnei and a low MIC (4 µg/ml) still had elevated rates of persistent diarrhea and culture positivity. CONCLUSIONS This study documents worse clinical outcomes for Shigella flexneri with decreased susceptibility to azithromycin, as well as S. sonnei, and supports the utility of susceptibility testing and clinical breakpoints for azithromycin. S. sonnei is an emerging drug resistant threat. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.BACKGROUND Persons who inject drugs (PWID) are at risk for invasive infections; however, hospitalizations to treat these infections are frequently complicated by against medical advice (AMA) discharges. This study compared outcomes among 1) PWID who completed a full course of inpatient intravenous (IV) antibiotics, 2) PWID who received a partial course of IV antibiotics but were not prescribed any antibiotics on AMA discharge, and 3) PWID who received a partial course of IV antibiotics and were prescribed oral antibiotics on AMA discharge. METHODS Retrospective, cohort study of PWID aged 18 years or older admitted to a tertiary referral center between 01/2016 and 07/2019, who received an Infectious Diseases consultation for an invasive bacterial or fungal infection. RESULTS 293 PWID were included in the study. 90-day all cause readmission rates were highest among PWID who did not receive oral antibiotic therapy on AMA discharge (n=46, 68.7%), compared with inpatient IV (n=43, 31.5%) and partial oral antibiotics (n=27, 32.5%). In a multivariate analysis, 90-day readmission risk was higher among PWID who did not receive oral antibiotic therapy on AMA discharge [adjusted hazard ratio (aHR)=2.32; 95% confidence interval (CI) 1.41 - 3.82] and not different among PWID prescribed oral antibiotic therapy on AMA discharge (aHR=0.99; 95% CI 0.62-1.62). Surgical source control (aHR=0.57; 95% CI 0.37 - 0.87) and addiction medicine consultation (aHR=0.57; 95% CI 0.38 - 0.86) were both associated with reduced readmissions. CONCLUSIONS Our single center study suggests access to oral antibiotic therapy for PWID who cannot complete prolonged inpatient IV antibiotic courses is beneficial. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.Populations of the brown stink bug, Euschistus servus (Say), in Florida peach orchards were monitored during the 2017 and 2018 growing seasons using yellow pheromone-baited pyramid traps. Peaches were evaluated at harvest for the presence of stink bug injury. A relationship between E. servus trap capture and fruit injury was used to estimate the economic injury level (EIL) for varying scenarios of crop price, per-hectare yield, and control costs. Economic thresholds were then set based on observed E. servus population trends and expected rates of increase. Thresholds were lowest in the period immediately following shuck split due to the rapid increase in E. servus populations during this period. Euschistus servus trap capture trended downward at the time of harvest. Therefore, increased E. servus management early in the Florida peach season provides the greatest overall benefit, whereas late season populations decline independent of management actions. The proposed EIL for Florida peaches determined by this study is 5.