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Background: Antimicrobial resistance is a growing problem in Candida spp., leading to treatment challenges and increased morbidity and mortality. The World Health Organization (WHO) fungal priority pathogens list classifies C. glabrata, C. tropicalis, and C. parapsilosis as high priority and leading causes of candidemia with high fluconazole resistance. In the US, these organisms are the most frequently isolated non-albicans Candida species. In 2016, the Antibiotic Resistance Laboratory Network (ARLN) was created to monitor resistance threats, including in Candida spp. This study describes the proportion of resistance in C. glabrata, C. parapsilosis, and C. tropicalis isolates sent to the Southeast ARLN from 2017 to 2023. Methods: This study evaluated C. glabrata, C. parapsilosis, and C. tropicalis submitted to the Southeast ARLN from Alabama, Florida, Georgia, Louisiana, Mississippi, and Tennessee from February 2017- September 2023. Species identification was confirmed by Bruker Biotyper matrix assisted laser desorption-ionization time of flight (MALDI-TOF). Antifungal susceptibility testing (AFST) was performed using TREK frozen broth microdilution panels. Minimum inhibitory concentration values from the clinical instrument were used to determine susceptibility based on Clinical and Laboratory Standards Institute (CLSI) standard interpretations from the 2020 CLSI M60 guidelines. Data were extracted from the laboratory information management system. Analyses were conducted using SAS v9.4. Results: AFST testing was performed on 660 C. glabrata, 500 C. parapsilosis, and 233 C. tropicalis isolates from within the Southeast region. The predominant specimen sources by species were blood 25.30% C. glabrata; other/not specified 27.80% C. parapsilosis; and lower respiratory 36.91% C. tropicalis. Resistance to fluconazole is as follows: C. glabrata, 12.88%; C. parapsilosis, 3.41%; C. tropicalis, 36.64%. Resistance to voriconazole is as follows: C. parapsilosis, 1.00%; C. tropicalis 30.04%. Resistance to at least one echinocandin (Anidulafungin, Capsofungin, Micafungin) is as follows: C. glabrata, 1.67%; C. parapsilosis, 0.60%; C. tropicalis, 0.43%. Overall, there was a decreasing trend in resistance to fluconazole, and voriconazole in all three species between 2017 and 2023. Conclusions: Antifungal resistance in non-albicans Candida species represents an emerging public health threat, however, within the Southeast region, ARLN data has shown a decreasing trend of azole resistance. This may be due in part to changes in reporting requirements and submission criteria from within the region. Nevertheless, C. tropicalis showed high resistance to azoles within the Southeast region. These Candida species should be monitored to inform clinical decision making and identify resistance patterns in other US regions due to their increase in resistance worldwide.

We investigated how three co-dominant arctic shrubs (Betula nana, Salix pulchra, and Ledum palustre ssp. decumbens) responded to long-term treatment with N+P fertilizers and greenhouses in a factorial field experiment at Toolik Lake, Alaska. Our goal was to understand the relationship between growth of individuals and species abundance in the community, and the mechanism by which one species achieves dominance under changed environmental conditions. We compared aboveground growth and allocation patterns in individual ramets 15 yr of age with community abundance measured by quadrat harvests. Ramets of all three species substantially increased their stem biomass with fertilization, but the increase was much larger for Betula than for the other two species. In quadrat sampling, only Betula appreciably increased its biomass per unit area with fertilization or greenhouse treatment. For Salix in all treatments, and Ledum in the two fertilizer treatments, ramet density per unit area decreased more than growth of surviving 15-yr-old ramets was promoted, so community biomass of these species declined. In contrast, Betula increased its ramet density in all treatments by producing new shoots from stems older than 15 yr, even though stem mortality was also increased in the two fertilizer treatments. Betula increased its growth in part by a major change in allocation, from producing mostly short shoots to producing many more long shoots. As a result, the number of branches and the rate of production of new meristems greatly increased. This developmental plasticity allowed extensive growth that led to development of a dense canopy and imposed light limitation on the other species. The flexible growth strategy of Betula points to the importance of meristem availability and developmental constraints in determining plant response to environmental change. Developmental controls over meristem availability are not usually considered in ecological paradigms for allocation, but they may be useful for predicting plant response to changes in nutrient availability in other ecosystems.

1 Species interactions will probably be important in determining plant community structure as availability of soil nutrients changes due to climate warming or anthropogenic N deposition. We removed dominant species, combinations of species, and entire plant functional types, in fertilized and unfertilized plots in tussock tundra. 2 After 2 years, graminoids responded more strongly to fertilizer than other growth forms, and the responses of graminoids and deciduous shrubs to fertilizer were greater under neighbour removal than in the intact community. Deciduous shrubs, evergreen shrubs and graminoids increased their biomass with fertilization, whereas non-vascular plants decreased. 3 Dominant species from each growth form usually responded strongly to fertilization, but half of all subdominant species responded weakly or not at all. Few species responded to neighbour removal. 4 Soil nutrient availability, however, was elevated significantly by both fertilization and neighbour removal. Neighbour removal increased nutrient availability in fertilized plots by up to two orders of magnitude, and availability of NH4 +and NO3 -in some unfertilized removal treatments was greater than in the fertilized intact community. 5 The failure of many plant species to respond with enhanced growth to soil nutrients made available by neighbour removal, despite their response to fertilization, could be due to (i) tundra plants having such rigid niche complementarity that they are unable to utilize these additional resources, or (ii) insufficient time having elapsed for the remaining species to respond, because nutrients derived from neighbour removal probably became available later than nutrients added as fertilizer. 6 There may be a high potential for loss of available nutrients from the tundra ecosystem when species composition changes, if the remaining plants cannot adjust to use nutrients made available by the loss of their neighbours.

Nontuberculous mycobacterial infections are becoming more common. Recently, Mycobacterium fortuitum and other rapidly growing mycobacteria have been found to cause severe skin and soft-tissue infections in association with nail salon whirlpool footbaths. We recently investigated a large outbreak of M. fortuitum furunculosis among women who received pedicures at a single nail salon. To better define the clinical course of such infections, we collected clinical details from physicians who were treating outbreak patients. We constructed multivariable linear models to evaluate the effect of antibiotic treatment on disease duration. Sixty-one patients were included in the investigation. The mean disease duration was 170 days (range, 41–336 days). Forty-eight persons received antibiotic therapy for a median period of 4 months (range, 1–6 months), and 13 persons were untreated. Isolates were most susceptible to ciprofloxacin and minocycline. Early administration of therapy was associated with shorter duration of disease only in persons with multiple boils (P < .01). One untreated, healthy patient had lymphatic disease dissemination.

Background: Hepatitis C virus (HCV) transmission at outpatient hemodialysis clinics is well documented, but little is known about HCV transmission risks in long-term care facilities (LTCFs) providing hemodialysis services. LTCFs can provide onsite hemodialysis for residents by contracting with a licensed hemodialysis clinic to either provide its staff to the LTCF or to train LTCF staff as caregivers. In August 2019, the Georgia Department of Public Health (DPH) was notified about an HCV seroconversion in patient A at a LTCF providing onsite hemodialysis. Methods: Three residents (including patient A) were receiving hemodialysis at the LTCF in August 2019; patients B and C had chronic HCV infection upon admission. Records were reviewed for medical history, behavioral risk factors, and healthcare exposures. We conducted onsite infection control assessments and interviewed staff. Serum specimens were collected for all 3 patients in August 2019 and HCV tested for genetic similarity using Global Hepatitis Outbreak Surveillance Technology (GHOST). Results: The facility reported initiating onsite hemodialysis in November 2018; facility staff were trained by a dialysis provider. Patient A, admitted in September 2018, was anti-HCV negative in June 2019 and both anti-HCV and HCV RNA positive in July 2019. Patient B was admitted in December 2018, discharged for 1 month in May 2019, and then readmitted. Patients A and B reported previous injection drug use, and they were not observed by staff to use during their stay and had limited mobility. Patient A was wheelchair confined and B was bed confined. Patient C was admitted in May 2019. HCV samples from patients A and B both had HCV genotype 1b and demonstrated 100% genetic relatedness, indicating that patient B was the likely source. Patient C had HCV genotype 1a. Hemodialysis was provided to residents simultaneously in a converted resident room with 4 hemodialysis stations, and the LTCF operated 2 shifts, 3 times per week. We observed multiple infection control gaps, such as preparation of IV medications and inadequate disinfection in the shared dialysis treatment area. Recommendations addressing gaps were issued, and a follow-up site visit was conducted to validate implementation. With the exception of May 2019, patients A and B received hemodialysis on the same shift and days from December 2018 to September 2019. Conclusions: Phylogenetic and epidemiological results indicate HCV transmission likely occurred during hemodialysis services provided by the LTCF. As the provision of dialysis expands to nontraditional settings such as LTCFs, it is essential that proper infection control procedures and oversight are in place. Funding: None Disclosures: None

Loans and grants are easily provided by private, tribal, state, and federal sources - and they are the most immediate method of assistance that governments can provide to increase the number of Indianowned businesses on and off reservations.7 Thus the provision of cash should be considered an even more pressing goal than increasing governmental financial support for programs that provide training in management and business skills.8 Loans for economic development were made available as early as the 1930s by the Bureau of Indian Affairs (BIA); however, it was not until the 1960s that the federal government began to offer funding for economic development to Native Americans through more mainstream agencies, such as the U.S. Department of Agriculture (USDA), Housing and Urban Development, and the Small Business Administration.9 While this method of encouraging economic development has its own flaws, the diversity of available funding at least has increased the dollar amount of available grants, and the number of development projects which ultimately receive federal support.10 Currently, there are 184 grant and loan programs available to support economic development in Indian country - some of which are specifically targeted to Indians, others of which may be utilized by a variety of applicants. Largely using USDA programming as a case study, this comment demonstrates that Indian communities are having serious difficulties accessing federal funding for economic development.12 Grant application processes are difficult to navigate.13 Moreover, funding levels for economic development on reservations are also largely disproportionate to population size or need - often because agencies lack up-to-date information on program usage and effectiveness as it relates to Native Americans.14 As a result, Indian communities may be leaving millions of dollars untouched in the Treasury every year - millions of dollars that were originally intended by Congress for economic development purposes. [...]if both Indian and non-Indian rural communities appreciated their commonalities, and that they share similar obstacles to economic growth and federal assistance, an alliance could be forged that could help all parties improve their economic circumstances. Part IV provides background information on federal rural development programming, and summarizes the economic development programming available to Indian communities. [...]it compares rural people's experiences with federal support (or lack of support) for economic development to the experiences of Native America.

The purpose of this descriptive, comparative study was to determine if there was a difference in NCLEX-RN performance between associate degree nursing graduates who were required to take pre-nursing remedial courses and those who were exempt. The sample consisted of 119 records of May, 1993 graduates from one campus of a four-campus community college nursing program who took the NCLEX-RN in Pennsylvania in July, 1993. Subjects who met the community college criteria of placement test scores in English, mathematics, and reading were exempt from taking remedial courses. Subjects who did not meet these criteria were required to take remedial courses in English, mathematics, and/or reading. A retrospective audit of nursing student records revealed that a larger percentage for whom there was a remedial course requirement failed the NCLEX-RN (16.5%) as compared to those for whom there was no remedial course requirement (2.5%) (chi square = 4.98, df = 1, p $<$.05).