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The historiography of hospital infections conceptualises most bacterial infections occurring in hospitals as inherently institutional. This paper challenges this notion and argues that from very early on, microbiologists working inside and outside of hospitals began to understand the link between the hospital and the community when explaining outbreaks of infections in hospitals. Looking at discussions in Britain and elsewhere in the era of the Staphylococcus aureus crisis after the Second World War, this chapter draws particular attention to key sites of hospital-community transfer, i.e. neonatal infection, as well as influenza. It argues that in both examples, the institutional nature of hospital infections remains unclear and that the community needs to be seen as a crucial site for infection control in hospitals.
Hospital acquired infection (HAI] - referred to as ‘nosocomial’ infection in US terminology - emerged as a specific policy concern in the mid-twentieth century, although it has a much longer lineage. This chapter uses a comparative Anglo-American perspective to repositions the debate on the history of HAIs, which has to date been focused on scientific understanding of infection through the use of evolutionary paradigms, the development of new approaches such as clinical epidemiology and the enduring fascination with the discovery, use and abuse of antibiotics and associated rise of antimicrobial resistance (AMR). Some of this historical research has marginalised or ignored (by choice or ignorance) the key issue that health care is an economic, as well as a scientific-clinical activity. These lacunae are particularly evident when historians discuss how responses to HAIs resulted in the formation of protocols and teams, which they invariably articulate as comprised of clinical/technical staff (surgeons, physicians, nurses, microbiologists and epidemiologists). There has been minimal recognition that hospital administrators and managers could (and did) play key roles in these developments because of the significant and increasing impact of HAIs on hospital costs, arising in part through concerns about length of patient stay, and through the roles of insurance companies in the Unites States and economists at national policymaking levels in the UK.
Bring life to your curriculum with this comprehensive, yet versatile book that explores core disaster medicine principles through vivid emergency medicine cases. Each case has been crafted to suit a wide range of learners – from novice to practitioner. The ready-to-teach cases are scalable and customizable to any learning environment, from low-resource teaching settings to high-fidelity simulation labs. Covering the basics of simulation to advanced disaster response strategies, cases cover natural and human-made disasters, including pandemics, building collapses, mass gathering medicine, and blast injuries, providing hands-on learning opportunities that can be used to enhance understanding and retention. Each case follows a standard structure including teaching objectives, discussion points, a timeline, and critical actions. With a mix of scenarios and flexible application, this resource will ensure every learner is prepared with the knowledge and skills necessary to navigate complexities associated with real-world emergencies while learning core disaster medicine principles.
This comprehensive, hands-on, practical guide is essential for all health professionals working in early pregnancy. Highly illustrated with ultrasound images and annotated diagrams of normal and abnormal pregnancies, it demonstrates how ultrasound can be used to identify and manage complications in early pregnancy. Completely updated with new chapters on terminology and classification in early pregnancy and the use of ultrasound in the management of early pregnancy complications, this new edition uses new classification and terminology throughout the book as defined by the European Society of Human Reproduction and Embryology. As well as multiple ultrasound images, the text includes schematic diagrams, tables, flow charts and lists of key learning points, making it an easily accessible learning tool. A key resource for obstetricians, gynaecologists, sonographers, nurses and midwives, it also supports those undertaking the Royal College of Obstetricians and Gynaecologists' Special Interest Training Module in complex early pregnancy and non-elective gynaecology.
The diversity of Rhabdias includes 101 species, 71 of which parasitize the lungs of anurans, caudates, gymnophionans, and some occur in reptiles worldwide. Currently, 26 species are found in the Neotropical region, and in Brazil, there are 16 nominal species, a relatively low number considering the high diversity of potential hosts. Here, we describe a new species of Rhabdias found in Physalaemus albonotatus, with morphological and molecular data, as well as phylogenetic analyses using sequences of the mitochondrial gene Cytochrome Oxidase Subunit I (COI). Rhabdias taquariensis n. sp. differs from other known species by a set of morphometric traits and by presenting a well-defined internal shape of the cephalic dilation. Molecular analyses revealed that R. taquariensis n. sp. exhibits a significant divergence of 13.6% in COI compared to the Rhabdias cf. stenocephala species complex. Additionally, phylogenetic reconstructions indicate that the new species represents a distinct lineage, external to a clade formed by species such as Rhabdias fuelleborni, Rhabdias cf. stenocephala, and Rhabdias waiapi. Rhabdias taquariensis n. sp. is the 27th species described in the Neotropical region and the 16th in Brazil, the first description of a species of the genus Rhabdias for Physalaemus albonotatus, and one of the few Rhabdias species described for the Cerrado biome.
After performing an abortion in 1973, Dr. Kenneth Edelin was indicted and convicted of manslaughter. Dr. Edelin’s conviction was reversed 50 years ago. However, the conflict between the medical and legal systems, the use of abortion prosecution to control patients and providers, and the framing of a fetus as a person feel just as relevant to today’s abortion landscape.
Nutrition is crucial for the growth of children and adolescents. This study investigated multiple nutritional problems and influencing factors among 2,423 students aged 6-17 in Guizhou Province, using questionnaire surveys, physical examinations, and blood tests. Multifactorial logistic and Poisson regression analyses were used to identify determinants of overnutrition and undernutrition. The results showed a distinct profile compared to national averages: wasting was more prevalent (9.6%), while overweight (8.6%) and obesity (5.0%) were less common. Notably, hyperuricemia (27.6%) and zinc deficiency (17.9%) were elevated, whereas classical metabolic syndrome (2.3%) was lower, delineating a regional pattern that prioritizes these emerging and micronutrient issues. Marginal vitamin A deficiency (17.2%) and vitamin D inadequacy (50.9%) remained significant. Older age (11-17 years) was a strong risk factor for overnutrition-related disorders and hyperuricemia (All p<0.001). Overweight/obesity increased risks of hyperuricemia and metabolic syndrome (All p<0.001). Being female was a major risk factor for undernutrition (PR=1.27, 95%CI: 1.19-1.35, p<0.001) and vitamin D deficiency (AOR=2.51, 95%CI: 2.10-3.00, p<0.001), but a protective factor against hyperuricemia (AOR=0.34, 95%CI: 0.27-0.41, p<0.001). Frequent sugary drink consumption (≥3/week) elevated hyperuricemia risk (AOR=1.33, 95%CI: 1.05-1.69, p=0.020). This study underscores a complex double burden of malnutrition in western China, characterized by specific priority areas, and necessitates tailored, multi-component interventions such as limiting sugary drinks and focusing nutrition support on adolescent girls.
To explore cancer patients’ understanding of Advance Care Planning (ACP) and identify the main barriers hindering its effective implementation in clinical practice.
Methods
This qualitative descriptive study included Brazilian women with breast cancer aged 18–75 years, all with preserved functional status, recruited by convenience sampling. Exclusion criteria were difficulty using online calls or significant communication impairment. Data collection involved a sociodemographic questionnaire and a follow-up interview. After receiving an informational brochure, participants were contacted by video call 14 days later and asked, “How do you understand what ACP is?” Interviews were conducted confidentially at home, transcribed, and analyzed according to qualitative research reporting guidelines.
Results
Sixty-one women participated. Most had difficulty understanding ACP; nearly 40% could not define it. Main barriers included cultural resistance to discussing death, reliance on family members or physicians for decision-making, and lack of clear information. Many participants confused ACP with preventive care. A conceptual multilevel model was developed, showing how cultural taboos, family dependence, and systemic inertia interact to sustain barriers through a feedback loop in which cultural avoidance reinforces structural gaps and institutional neglect.
Significance of results
This study provides evidence on how ACP is understood and misinterpreted by cancer patients in a middle-income Latin American setting, an area that remains underrepresented in the literature. By demonstrating that misconceptions, cultural taboos, and systemic barriers operate through a reinforcing multilevel process, the findings offer a conceptual framework that explains why ACP remains marginal in routine oncology care. The model highlights critical points for intervention, including patient education, professional communication, and institutional support, and is directly applicable to similar sociocultural contexts characterized by strong family involvement and biomedical dominance. These results have clear implications, supporting the integration of ACP as a proactive, relational, and value-based process rather than a late end-of-life intervention.
Suicide is a significant global public health concern, particularly among adolescents, with substantial implications for economies, societies and individuals’ mental well-being. Understanding its patterns and intention and psychosocial determinants in a given context can suggest potential intervention points. This population-based cross-sectional study aimed to document suicidal ideas, behaviors and intensity among youths aged 14 to 25 in the Nairobi metropolitan area and associated socio-economic position, demographic indicators and potential intervention points. A diverse sample of 1,972 participants was recruited from urban and peri-urban settings within the Nairobi metropolitan area. Data analysis included descriptive statistics, chi-square tests and logistic regression. Our findings confirm a high prevalence of suicidal ideas and behavior in the youth (19.9% and 3.6%, respectively), with very few significant differences between the urban and peri-urban areas. The severity of suicidal ideation and behavior reported methods and reasons, and the socio-demographic profile of participants, point to multiple potential intervention targets. These findings ought to be used to design, manage and evaluate suicide prevention programs.
Since the first report of erythromycin-resistant Bordetella pertussis (B. pertussis) in Arizona in 1994, macrolide-resistant strains have emerged worldwide, threatening pertussis control. This systematic review and meta-analysis aimed to quantify the prevalence and temporal trends of this resistance. Four databases (PubMed, Embase, Cochrane Library, Web of Science) were searched for studies on B. pertussis antimicrobial susceptibility through December 2024. Among 57 included studies (1994–2024), pooled resistance rates (breakpoint ≥32 mg/L) were: erythromycin 21% (95% CI 11–32%), azithromycin 25% (95% CI 12–40%), clarithromycin 15% (95% CI 4–30%), and clindamycin 49% (95% CI 28–70%). Subgroup analyses by country, year, and test method are presented. No trimethoprim/sulfamethoxazole (STX) resistance was reported. Six Japanese isolates showed high-level nalidixic acid resistance (MIC >256 mg/L). Seventy-seven studies contributed to MIC90 data for carbapenems, tetracyclines, aminoglycosides, quinolones, macrolides, cephalosporins, and others. Selected penicillins and intravenous third-generation cephalosporins demonstrated strong in vitro activity, suggesting alternative treatment options. Macrolide-resistant B. pertussis has increased significantly over the past decade. Due to the high burden of antibiotic resistance in China, enhanced surveillance is warranted, while continued monitoring in other countries also remains necessary.
This study aimed to evaluate the agreement between three body composition devices and dual-energy X-ray absorptiometry (DXA) in assessing segmental body composition among healthy Iranian adults. This comparative study recruited 62 healthy adults (33 men and 29 women) from Tehran, Iran, using a convenience sampling approach. Socio-demographic data were collected, and segmental body composition was assessed using several devices, including the InBody 770, Anea Bioelectrical Impedance Analysis (BIA), Tanita BC-418, and DXA. Agreement between DXA and the BIA devices was evaluated using Lin’s concordance correlation coefficient. Additionally, Bland–Altman plots and mean percentage error were applied to assess the consistency between the two methods. The Anea, InBody 770, and Tanita BC-418 devices showed strong correlation with DXA for all segmental measurements (r≥0.74, p<0.05). Moderate agreement (concordance correlation coefficient (CCC): 0.90 ≤ CCC < 0.95) with the DXA method was found for some segments using the Anea (trunk fat mass, arms fat-free mass, legs fat-free mass, and trunk fat-free mass) and the InBody 770 (trunk lean body mass and trunk fat mass) devices. The estimation of legs fat mass was the least accurate across all BIA devices. Furthermore, subgroup analyses showed that the BIA devices provided more precise results in men and in individuals with a Body Mass Index (BMI) <25.00 kg/m2. The Anea BIA and InBody 770 devices show relatively acceptable validity for segmental body composition assessment. More research is needed to confirm these findings.
This study aims to assess whether there was any excess mortality among the Aboriginal and non-Aboriginal populations in the Northern Territory (NT), Australia, during the COVID-19 pandemic. A time-series analysis using death data (1997–2023) was applied separately to the monthly and yearly death counts to develop an excess mortality surveillance model (using Auto-Regressive Integrated Moving Average (ARIMA)) for the NT population. Excess mortality was calculated by comparing expected deaths with actual deaths. In 2022, there was a statistically significant excess mortality of 193 (p < 0.01), compared with 82 recorded COVID-19 deaths. Excess mortality was significant for both the Aboriginal (N = 91) and non-Aboriginal (N = 102) populations in 2022. Even though some months had significant excess mortality among both Aboriginal and non-Aboriginal populations, the recorded COVID-19 deaths were not high in these months. This was associated with the peak of COVID-19 fatalities. The ARIMA model demonstrates deviations from expected deaths and helps understand the pandemic’s impact on the NT. Excess deaths occurred in 2022; however, no large spikes in most of the months suggest public health success in the NT.
Monocrotaline (MCT) induces lung injury and pulmonary hypertension (PH) by a mechanism that is in part due to oxidative stress. The purpose of this study was to determine how MCT affected nutrient antioxidants retinol and alpha-tocopherol in a rat lung and liver. Rats were fed a purified diet (AIN-93G) one-week prior to a subcutaneous injection of MCT (60 mg/kg) and remained on the diet throughout the study. Three weeks after injection, the animals were euthanized, and the lungs and livers were analyzed for retinol, alpha-tocopherol, phospholipid (PL), and cholesterol content. Lung retinol concentrations were significantly lower in MCT-treated rats, 2.0 ± 1.2 (nmol/g lung) vs. vehicle control (VEH), 5.8 ± 1.4 (P < 0.01). However, liver retinol concentrations were not significantly different, 3.3 ± 1.3 vs. 2.5 ± 0.9 nmol/g liver. Alpha-tocopherol was significantly greater in MCT-treated rats in the lung, 145 ± 24 vs. 99 ± 13 nmol/g lung (P < 0.001), and liver, 107 ± 30 vs. 47.7 ± 4.8 nmol/g liver (P < 0.001). Phospholipid and cholesterol were significantly lower in the lung of the MCT-treated group, but not significantly different in the liver. In conclusion, retinol along with phospholipid, and cholesterol were decreased in the lungs whereas alpha-tocopherol was elevated in the lungs and liver in response to MCT. These findings along with others suggest a novel mechanistic link between MCT-induced oxidative stress, lung vitamin A depletion, inflammation and the impairment of alveolar cell proliferation and repair. Pulmonary retinol is important in the pathogenesis of MCT-induced lung injury.
We report a 24-year-old male with functional single ventricle who developed ventricular dysfunction associated with strangulation by a previous epicardial pacemaker lead. During conversion to dual-chamber pacing, the constricting ventricular lead was removed, with intraoperative echocardiography demonstrating improvement in apical contraction. Relief of mechanical compression, together with restoration of atrioventricular synchrony, likely contributed to the recovery of ventricular function.