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Field hospitals are deployable hospitals that treat patients directly on site before they are transported to permanent medical facilities. The supply of sterile surgical instruments is important, but not every field hospital is equipped with a sterile processing department. This concept therefore attempts to test a method of reprocessing surgical instruments under field conditions that can at least provide a provisional form of disinfection in case of logistic breakdowns.
Methods
Development, testing, and evaluation of a provisional chemical reprocessing procedure for reusable surgical instruments using hydrogen peroxide. The evaluation was carried out visually, microbiologically, and with regard to material damage.
Results
The concept is easy to implement but requires thorough training. The reprocessed surgical instruments were free of residual protein, showed no bacteriological growth, and were not damaged by the chemical reprocessing even after 10 cycles.
Conclusions
Provisional reprocessing of reusable surgical instruments seems possible using high-level chemical disinfection with hydrogen peroxide (3% for 150 minutes or 7.5% for 30 minutes) in case of necessity due to logistic breakdowns and patients that need immediate treatment. In addition, a multibarrier approach that includes hygiene measures and antibiotic stewardship is required to effectively reduce the risk of surgical site infections.
Workers with a vulnerable position on the labour market face difficulties finding and maintaining decent work. An increasing body of research on the demand-side of the labour market investigates the involvement of employers in active labour market policies, often referred to as employer engagement. However, the concept of employer engagement varies, causing ambiguity in its definition and use in research. This scoping review investigated sixty-three documents (e.g., peer reviewed scientific papers and grey literature) on employer engagement and outlines the current conceptualisations of employer engagement. By combining the conceptualisations taking a stakeholder-oriented approach, a four stakeholder group perspective on employer engagement was developed. With the organisation as an entity, HRM, line managers, and institutional stakeholders. This review deepens the understanding of employer engagement and contributes to the literature by taking an interdisciplinary approach and offers suggestions for future research.
This article explores the evolution and shifting interpretations of the dissolution of the Kingdom of Hungary and the creation of its successor states as reflected in the historiographies of Central European nations. It analyses the complex interaction between politics and the socio-cultural milieu, on the one hand, and historiography, on the other. A palpable tension exists between the national narratives and the efforts to construct a commonly accepted story. Inspired by the entangled history approach, the paper identifies common features within these historiographies, which exist despite ostensibly distinct points of departure. Additionally, major interpretative trends in the area up to the present day are characterised, and the impact of the socio-cultural turn and the recent centenary of the First World War critically assessed. The article argues for the practicality of moderate national narratives, which should take into consideration recent developments in the discipline and can help bridge the divide between nation-states on sensitive issues.
Medusozoa comprise a diverse group of marine invertebrates that includes cubozoans, hydrozoans, staurozoans, and scyphozoans, which play a fundamental role in marine ecosystems. In Cuba, with exceptions, most of the studies of the phylum Cnidaria have focused on the scleractinian corals. However, their close relatives, the jellyfish have been poorly addressed, limiting themselves to isolated records of some species. In this study, we aimed to update the list of medusozoan species registered in Cuba and compare it with the registries in the Greater Caribbean region. Peer-reviewed publications, museum collections, field-trips, global repositories, and social networks were accomplished to compile a species list. Twenty-one new species are recorded, and the distribution of 11 species previously reported is expanded. Cuba, with 361 species is the country with the highest species richness in the Caribbean region: 342 species of Hydrozoa are distributed in 69 families, 16 species of Scyphozoa are distributed in 10 families, and three species of Cubozoa each belong to one family. Analysing the studies of Medusozoa reveals significant heterogeneity in jellyfish species composition across the Caribbean region, where Cuba, Puerto Rico, Mexico, and the USA are the countries with the highest species richness. A high similarity was observed between the assemblages from Cuba and the USA. The number of jellyfish species reported for Cuba constitutes a baseline for ecological studies of their integrated role in marine ecosystems. Studies in the Caribbean region are heterogeneous, with an imbalance in the sampling effort in time and space and probably underestimate the number of species known.
The magnitude and duration of the COVID-19 pandemic has highlighted the need for countries to continuously reflect and improve on their ongoing response. The World Health Organization (WHO) introduced the guidance for conducting COVID-19 intra-action reviews (IARs) in July 2020. As of November 25, 2022, 136 IARs have been conducted by 78 countries in all 6 WHO regions. IARs are country-led and outcomes country-owned, with the flexible methodology enabling countries to focus on COVID-19-related priority issues in their national and subnational contexts. WHO’s approach to promoting the use of IARs recognizes the importance of 3 learning modalities: countries learning through self-reflection, countries learning from each other, and WHO and partners learning from countries to improve WHO guidance and tools. Moving forward, the value of reflective learning in public health emergencies can be further enhanced by institutionalizing an ongoing learning mindset and translating reflective learning-based recommendations into policy change and action.
In 1804, an elder courtier named Ban’deyri Hasan Manikufaanu (1745–1807) chronicled the sea voyage of the sovereign of the Maldives, Sultan Muhammad Mueenuddeen I (r. 1799–1835). The purpose of the voyage was to visit the islands of Ari Atoll. Manikufaanu crafted 171 verses according to the rules of a Maldivian genre of poetry called raivaru. The work is known as Dhivehi Arumaadhu Raivaru (‘Raivaru that chronicled the journey of the Maldivian royal fleet’). In this article, I demonstrate how the verses provide a lens into early nineteenth-century Maldivian boat construction, court music, navigational routes, regnal travel, royal ensigns, sailing, and seamanship, all of which have not been sufficiently explored in Indian Ocean studies. In contrast to scholarship on travelogues that emphasises Muslim men’s experiences of heterotopia when they travelled across the Indian Ocean on steamships to maritime ports, this article centres on a provincial journey of a royal fleet of sailing ships taken by the sultan of the Maldives and other noblemen to visit Maldivian commonfolk who lived on islands that formed part of an atoll in the middle of the Indian Ocean.
Cognitive intra-individual variability (IIV) is a neuropsychological marker reflecting divergent performance across cognitive domains. In this brief communication, we examined whether clinical severity, apolipoprotein E (APOE) ε4 carriers, and higher polygenic risk were associated with higher cognitive IIV, and whether higher polygenic risk and cognitive IIV synergistically influence clinical severity.
Method:
This large study involved up to 24,248 participants (mean age = 72) from the National Alzheimer’s Coordinating Center (NACC) and multiple regression controlling for age, sex, and education was used to analyze the data.
Results:
We found that disease severity (B = 0.055, SE = 0.001, P < 0.001), APOE ε4 carriers (B = 0.02, SE = 0.003, P < 0.001), and higher polygenic risk (B = 0.02, SE = 0.004, P < 0.001) were associated with higher cognitive IIV. Polygenic risk and cognitive IIV also interacted to influence clinical severity, beyond APOE ε4 (B = 0.11, SE = 0.05, P = 0.02), such that individuals with high polygenic risk and cognitive IIV had the greatest clinical severity.
Conclusions:
Heightened polygenic risk and increased cross-domain cognitive variation are implicated in dementia and may impact clinical decline in tandem.
This policy brief analyzes the effects of reclassifying large swaths of the federal civilian workforce currently appointed to the competitive service into Schedule F (Policy/Career Schedule) appointments. We review the policy when it was first introduced in 2020 and reinstated with amendments in 2025. In doing so, we draw from decades of extant literature within the organizational sciences to analyze the validity of one of its main assertions, that is, moving federal workers toward at-will employment is beneficial. Our analysis shows that, as it currently stands, the proposed reclassification into Schedule F would generate widespread, chronic job insecurity and fail to improve federal workers’ performance or accountability, in addition to other physical and psychological adverse consequences. It would also result in significant, negative outcomes for federal agencies in terms of their reduced ability to attract and retain competent civil servants, lower economic efficiency, and ultimately negatively impact the customers of federal agencies by increasing costs for lower quality governmental services.
We investigated differences in cognition between variants of progressive supranuclear palsy (PSP) including PSP-Richardson (PSP-RS) and subcortical and cortical variants using updated diagnostic criteria and comprehensive neuropsychological assessment.
Method:
We recruited 140 participants with PSP (age = 71.3 ± 6.9 years; education = 15.0 ± 2.8 years; 49.3% female) who completed neurological and neuropsychological assessment. Participants received diagnoses of PSP clinical variants at their evaluation (or retrospectively if evaluated before 2017) according to the Movement Disorder Society PSP criteria. We grouped variants as PSP-RS (62 participants), PSP-Cortical (25 with PSP-speech/language and 9 with PSP-corticobasal syndrome), and PSP-Subcortical (27 with PSP-parkinsonism, 11 with PSP-progressive gait freezing, and 6 with PSP-postural instability). Analysis of covariance adjusted for age assessed for differences in neuropsychological performance between variants across cognitive domains.
Results:
PSP-Cortical participants performed worst on measures of visual attention/working memory (Spatial Span Forward/Backward/Total), executive function (Frontal Assessment Battery), and language (Letter Fluency). PSP-RS participants performed worst on verbal memory (Camden Words). There were no significant group differences for the MoCA or indices of visuospatial function. There were no sex or education differences between PSP groups; however, there were differences in age at visit and disease duration.
Conclusions:
In a large sample of participants with PSP, there were differences in cognition across PSP-RS, PSP-Subcortical, and PSP-Cortical variants, with PSP-Cortical and, to a lesser extent, PSP-RS, performing worse on tests of attention and executive function. These findings suggest cognitive distinctions among PSP clinical variants and highlight the value of neuropsychological assessment in differential diagnosis of PSP subtypes for more accurate and timely clinical classification.
Over the course of the eighteenth century, Russian rulers released dozens of decrees about petitions. First, the decrees regulated the format of petitions, emphasizing their formulaic nature and moving them away from the personal appeals with supplication and abasement that were present in earlier centuries. These decrees recognized that petitions were essential to the administrative functioning of the imperial Russian state but saw them as akin to forms or applications. Second, the decrees stated firmly that petitioners should not approach the ruler directly. In part, these decrees reflect the rulers’ irritation at being endlessly bothered by personal requests, but Russia’s rulers also gave a more serious justification for the ban on personal appeals: they had established the rule of law, which meant that their subjects did not need to bother them personally and instead should clearly know other authorities—courts, governors—to address for aid. While efforts to change the format of petitions largely succeeded, efforts to curtail petitions directly to the ruler largely failed. That failure likely reflects several factors: inefficiencies in the judicial or administrative system, contradictory laws that still made space for petitions because they were useful, and because they held the promise of getting help quickly.
An account of human subjectivity is built up from an analysis of the fundamental human desire for God. In conversation with Karl Rahner and Blaise Pascal, it is argued that this desire does not have any conceivable conditions of satisfiability. This leads to an account of human beings as fundamentally distractible, fragmented, opaque to themselves and non-self-identical; however, none of these are viewed as essentially problematic, arising instead out of the basic human–God relation rather than from a fallen condition. A range of implications for ethics and social criticism are briefly suggested.
In this paper, we initiate the study of higher rank Baumslag–Solitar (BS) semigroups and their related C*-algebras. We focus on two rather interesting classes—one is related to products of odometers and the other is related to Furstenberg’s $\times p, \times q$ conjecture. For the former class, whose C*-algebras are studied in [32], we here characterize the factoriality of the associated von Neumann algebras and further determine their types; for the latter, we obtain their canonical Cartan subalgebras. In the rank 1 case, we study a more general setting that encompasses (single-vertex) generalized BS semigroups. One of our main tools in this paper is from self-similar higher rank graphs and their C*-algebras.
Cognitive behavioural therapy for fatigue (CBT-F) and insomnia (CBT-I) are effective therapies. Little is known on their effectiveness when severe fatigue and insomnia co-occur.
Aims:
This observational study investigated whether the co-occurrence of fatigue and insomnia influences the outcomes of CBT-F and CBT-I. Furthermore, it was determined if changes in fatigue and insomnia symptoms are associated, and how often the co-occurring symptom persists after CBT.
Method:
Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, n = 241) received CBT-F and patients with insomnia disorder (n = 162) received CBT-I. Outcomes were fatigue severity assessed with the subscale of the Checklist Individual Strength (CIS-fat) and insomnia severity assessed with the Insomnia Severity Index (ISI). In each cohort, treatment outcomes of the subgroups with and without co-occurring symptoms were compared using ANCOVA. The association between changes in insomnia and fatigue severity were determined using Pearson’s correlation coefficient.
Results:
There were no differences in treatment outcomes between patients with and without co-occurring fatigue and insomnia (CBT-F: mean difference (95% CI) in CIS-fat-score 0.80 (−2.50–4.11), p = 0.63, d = 0.06; CBT-I: mean difference (95% CI) in ISI-score 0.26 (−1.83–2.34), p = 0.80, d = 0.05). Changes in severity of both symptoms were associated (CBT-F: r = 0.30, p < 0.001, CBT-I: r = 0.50, p < 0.001). Among patients no longer severely fatigued after CBT-F, 31% still reported insomnia; of those without clinical insomnia after CBT-I, 24% remained severely fatigued.
Conclusion:
CBT-F and CBT-I maintain their effectiveness when severe fatigue and insomnia co-occur. Changes in severity of both symptoms after CBT are associated, but the co-occurring symptom can persist after successfully treating the target symptom.
As part of a larger campaign to end diversity, equity, and inclusion, President Donald Trump’s recent Executive Order 14173 eliminated EO 11246 “Equal Employment Opportunity.” In this brief, we provided background on the often-misunderstood EO 11246 and discuss the potential implications of its reversal considering previous state legislation banning affirmative action and the current political context.