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To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs).
Design:
Retrospective cohort study.
Methods:
Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method.
Results:
Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively.
Conclusions:
MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.
Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disorder characterised by mucocutaneous telangiectasia, leading to recurrent epistaxis in nearly all affected individuals. Treatment strategies are broadly categorised into conservative, medical and surgical approaches. This study aimed to provide a concise summary of the existing literature on epistaxis associated with hereditary haemorrhagic telangiectasia.
Methods
The Medline/PubMed database was searched for relevant articles using the keywords ‘hereditary haemorrhagic telangiectasia’, ‘Osler-Weber-Rendu’ and ‘epistaxis’.
Results
Out of 93 reviewed articles, 59 contained pertinent information. Interventions were categorised into self-delivered therapy, intravenous treatment, in-office procedures and surgical intervention.
Conclusion
A stepwise approach to managing epistaxis in patients with HHT involves a gradual escalation of treatments, starting with conservative measures and progressing to more invasive interventions as necessary. Topical oils can be efficient and intranasal bevacizumab injection shows promise, but more data are needed. Surgical options range from bipolar cautery and laser therapy to complete closure of the nasal cavity. Proper patient selection remains crucial.
Puttapaite, Pb2Mn2+2ZnCr3+4O2(AsO4)4(OH)6·12H2O, is a new mineral from the Beltana deposit, Puttapa, Flinders Ranges, South Australia, Australia. It forms rosette-like aggregates to 50 micrometers across composed of diamond-shaped tablets to 45 micrometers in length and 5 micrometers in thickness. Crystals are flattened on {001} and the observed forms are {001} and {110}. The calculated density is 3.562 g/cm–3. Optically, puttapaite is biaxial (−) with α = 1.700(5), β = 1.720(5), γ = 1.730(5) and 2V (meas.) = 67(1)°. Electron microprobe analyses gave the empirical formula (based on 36 oxygen atoms pfu) Pb1.96(Mn2+1.52Ca0.28Sr0.22)Σ2.02(Zn0.40Mg0.39Cu0.15)Σ0.94(Cr3+2.89Al0.45Fe3+0.40,Mn3+0.26)Σ4.00O2[(AsO4)3.71(Cr6+O4)0.29]Σ4.00(OH)6.13·11.87H2O. Puttapaite is monoclinic, C2/m, with a = 12.405(3), b = 10.565(2), c = 12.311(3) Å, β = 106.06(3)°, V = 1550.4(6) Å3 and Z = 2.
The structure was solved using synchrotron single-crystal X-ray diffraction data and refined to R1 = 0.1189 on the basis of 915 observed reflections with F0 > 4σ(F0). Puttapaite has a unique structure that consists of M4O16 clusters that share corners with TO4 tetrahedra, which in turn share corners with M1 octahedra in the [010] direction. Clusters link in the [001] direction via corner sharing M2 octahedra to form sheets parallel to {100}. Pb anions lie between the sheets.
Let $X=GC$ be a group, where C is a cyclic group and G is either a generalized quaternion group or a dihedral group such that $C\cap G=1$. In this paper, X is characterized and, moreover, a complete classification for $X$ is given, provided that G is a generalized quaternion group and C is core-free.
I argue that current normative discussions of the responsibility for structural injustice are marred by an inadequate socio-theoretical view of structures and their functioning. This view reduces the relation between structures and actions to one of constraint: structures mainly inhibit transformative action; transformative action can only come from outside structures. I offer an alternative view of structures and their functioning that, drawing on and extending Sewell’s and Haslanger’s conceptions of structures and Arendt’s view of action, shows that actions are structurally and publicly constituted—they acquire social meaning in relation to structures, in a process of public interpretation—which is why they can transform the structures where they originate. Responsibility to dismantle unjust structures should then be understood as “structural responsibility”: responsibility to act from one’s structural position in ways that can disrupt the mechanisms of structural maintenance.
This work presents a passive intelligent surface designed at 2.45 GHz that has the capability of transmitting and reflecting electromagnetic waves that are incident upon it. The proposed surface does not require any circuitry or power source to function. Therefore, it makes a cost-effective and simple intelligent surface. It is a simple metallic structure that has embedded waveguide slots on its surface, allowing the waves to couple for transmission. A prototype of the proposed surface is designed using an aluminum foil and analyzed for both transmission and reflection of the wave. Further, the designed surface is investigated for tuning the directionality of the radiated field from the antenna. For this purpose, a coplanar patch antenna is first designed and then combined with the surface to tune the directionality of the radiated field of this antenna. The outcome of the measured performance validates that the proposed surface has the potential capability of field reconfiguration in wireless communication for Wi-Fi, WLAN, and Bluetooth applications.
n-6 PUFA, especially linoleic acid (LA) but also arachidonic acid (AA), have been inversely associated with CHD. However, mechanisms underlying these associations are not fully known. We investigated the associations of the serum concentrations of total n-6 PUFA, LA, AA, γ-linolenic acid (GLA) and dihomo-γ-linolenic acid (DGLA), with the odds of myocardial ischaemia during exercise, a predictor of future cardiac events. A total of 1871 men without a history of CHD from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) aged 42–60 years were included. All participants performed a maximal symptom-limited exercise stress test, using an electrically braked bicycle ergometer. Multivariable-adjusted logistic regression was used to assess the OR for exercise-induced myocardial ischaemia in quartiles of the serum n-6 PUFA concentrations. After multivariable adjustment, men in the highest v. the lowest serum AA concentration had 50 % lower odds for exercise-induced myocardial ischaemia (OR 0·50, 95 % CI 0·34, 0·76; P-trend across quartiles < 0·001). For the other PUFA, the OR (95 % CI) were 1·00 (0·69, 1·46; P-trend = 0·89) for LA, 1·07 (0·75, 1·53; P-trend = 0·40) for GLA and 0·74 (0·51, 1·07; P-trend = 0·16) for DGLA. Among the n-6 PUFA, higher serum concentration of AA was associated with lower odds for myocardial ischaemia during an exercise test in middle-aged and older men. This may provide one mechanism for the previously observed possible cardioprotective properties of AA. Our findings also suggest that n-6 PUFA should not be considered as one homogenous group.
Increased intestinal leakiness and associated systemic inflammation are potential contributors to osteoarthritis (OA) and postural imbalance in the geriatric population. To date, no successful treatment to correct postural imbalance in OA is known. We aimed to explore the effects of a multistrain probiotic upon postural imbalance in OA-affected patients. In this randomised, double-blind trial with a placebo group, 147 patients suffering from knee OA (age span = 64–75 years) were divided into placebo (n 75) and probiotics (n 72) study groups. Vivomix 112 billion, multistrain probiotic was given once a day for 12 weeks. The outcomes of study variables were determined first at baseline and later after 12 weeks of intervention. These were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee flexion range of motion (ROM), pain intensity by visual analogue scale, handgrip strength (HGS), gait speed and balance control assessed in standing, semi-tandem and tandem stances. We determined plasma zonulin to determine intestinal leak along with c-reactive protein and 8-isoprostanes levels. A total of 136 OA patients taking placebo (n 71) and probiotics (n 65) were analysed. The probiotics group exhibited a reduction in pain intensity, disease severity and WOMAC scores along with improvement in balance scores, HGS and walking speed (P < 0·05 for all), no change in ROM, resting pain and 8-isoprostanes levels. The correlation analysis revealed a robust association of balance scores with plasma markers of intestinal leakiness and inflammation in probiotics but not in the placebo group. Probiotics reduce postural imbalance in OA patients partly due to a reduction in intestinal leakiness.
The prevalence of poor linear growth among African children with perinatally acquired HIV remains high. There is concern that poor linear growth may to lead to later total and central fat deposition and associated non-communicable disease risks. We investigated associations between height-for-age Z score (HAZ) and total and regional fat and lean mass measured by dual-energy X-ray absorptiometry, expressed as internal population Z scores, among 839 Zimbabwean and Zambian perinatally HIV-infected male and female adolescents aged 11–19 years. Stunting (HAZ < –2) was present in 37 % of males and 23 % of females. HAZ was strongly positively associated with total, trunk, arm and leg fat mass and lean mass Z scores, in analyses controlling for pubertal stage, socio-economic status and HIV viral load. Associations of linear growth with lean mass were stronger than those with fat outcomes; associations with total and regional fat were similar, indicating no preferential central fat deposition. There was no evidence that age of starting antiretroviral therapy was associated with HAZ or body composition. Non-suppressed HIV viral load was associated with lower lean but not fat mass. The results do not support the hypothesis that poor linear growth or stunting are risk factors for later total or central fat deposition. Rather, increased linear growth primarily benefits lean mass but also promotes fat mass, both consistent with larger body size. Nutritional and/or HIV infection control programmes need to address the high prevalence of stunting among perinatally HIV-infected children in order to mitigate constraints on the accretion of lean and fat mass.
The long-term impact of eating duration on the risk of all-cause mortality remains unclear, with limited exploration of how different levels of energy intake and physical activity might influence this impact. To investigate, 24 484 American adults from the National Health and Nutrition Examination Survey spanning 1999–2018 were included. Eating duration was assessed via 24-h dietary recall, and all-cause mortality data were sourced from the National Death Index. The relationship between eating duration and all-cause mortality was analysed using Cox proportional hazards regression models, restricted cubic splines and stratification analysis with complex weighted designs. The median (IQR) of eating duration for participants was 12·5 (11·0, 14·0) h. In this study, 2896 death events were observed, and the median follow-up time (IQR) was 125 (77, 177) months. After multivariable adjustment, compared with Q1, Q2, Q3 and Q4 had reduced risks of all-cause mortality by 17, 15 and 13 %, respectively. Furthermore, each additional hour of eating duration was correlated with a 2 % decrease in the risk of all-cause mortality. Additionally, a non-linear dose–response relationship was observed between eating duration and the risk of all-cause mortality, showing a U-shaped relationship from 8·9 h to 15·3 h (P for non-linearity < 0·05). Interestingly, the non-linear dose–response relationship was observed exclusively among individuals with high energy intake or a lightly active physical activity level. These findings suggest potential health benefits from adjusting eating duration, though further prospective studies are needed for validation.
An important contributor to the decreased life expectancy of individuals with schizophrenia is sudden cardiac death. Arrhythmic disorders may play an important role herein, but the nature of the relationship between schizophrenia and arrhythmia is unclear.
Aims
To assess shared genetic liability and potential causal effects between schizophrenia and arrhythmic disorders and electrocardiogram (ECG) traits.
Method
We leveraged summary-level data of large-scale genome-wide association studies of schizophrenia (53 386 cases, 77 258 controls), arrhythmic disorders (atrial fibrillation, 55 114 cases, 482 295 controls; Brugada syndrome, 2820 cases, 10 001 controls) and ECG traits (heart rate (variability), PR interval, QT interval, JT interval and QRS duration, n = 46 952–293 051). We examined shared genetic liability by assessing global and local genetic correlations and conducting functional annotation. Bidirectional causal relations between schizophrenia and arrhythmic disorders and ECG traits were explored using Mendelian randomisation.
Results
There was no evidence for global genetic correlation, except between schizophrenia and Brugada syndrome (rg = 0.14, 95% CIs = 0.06–0.22, P = 4.0E−04). In contrast, strong positive and negative local correlations between schizophrenia and all cardiac traits were found across the genome. In the most strongly associated regions, genes related to immune and viral response mechanisms were overrepresented. Mendelian randomisation indicated that liability to schizophrenia causally increases Brugada syndrome risk (beta = 0.14, CIs = 0.03–0.25, P = 0.009) and heart rate during activity (beta = 0.25, CIs = 0.05–0.45, P = 0.015).
Conclusions
Despite little evidence for global genetic correlation, specific genomic regions and biological pathways emerged that are important for both schizophrenia and arrhythmia. The putative causal effect of liability to schizophrenia on Brugada syndrome warrants increased cardiac monitoring and early medical intervention in people with schizophrenia.
In confined systems, the entrapment of a gas volume with an equivalent spherical diameter greater than the dimension of the channel can form extended bubbles that obstruct fluid circuits and compromise performance. Notably, in sealed vertical tubes, buoyant long bubbles cannot rise if the inner tube radius is below a critical value near the capillary length. This critical threshold for steady ascent is determined by geometric constraints related to the matching of the upper cap shape with the lubricating film surrounding the elongated part of the bubble. Developing strategies to overcome this threshold and release stuck bubbles is essential for applications involving narrow liquid channels. Effective strategies involve modifying the matching conditions with an external force field to facilitate bubble ascent. However, it is unclear how changes in acceleration conditions affect the motion onset of buoyancy-driven long bubbles. This study investigates the mobility of elongated bubbles in sealed tubes with an inner radius near the critical value inhibiting bubble motion in a vertical setting. Two strategies are explored to tune bubble motion, leveraging variations in axial and transversal accelerations: tube rotation around its axis and tube inclination relative to gravity. By revising the geometrical constraints of the simple vertical setting, the study predicts new thresholds based on rotational speed and tilt angle, respectively, providing forecasts for the bubble rising velocity under modified apparent gravity. Experimental measurements of motion threshold and rising velocity compare well with theoretical developments, thus suggesting practical approaches to control and tune bubble motion in confined environments.
Textual sources from the Egyptian New Kingdom highlight a societal desire to preserve tombs for life after death, yet extensive architectural renovations and tomb robbing often followed the interment of elite individuals. Rather than posing a threat to conceptions of the afterlife, the author argues that these post-mortem activities were conducted with respect and the intention of forming connections. Using the identification of an unusual ritual structure from the Third Intermediate Period inside the reused Nineteenth Dynasty tomb of Paenmuaset (TT362) at Thebes (Luxor) as a basis, the author explores respect in ever-changing burial spaces as a key feature of tomb reuse.
Musculoskeletal disorders and age-related musculoskeletal decline are major contributors to the burden of ill health seen in older subjects. Despite this increased burden, these chronic disorders of old age receive a relatively small proportion of national research funds. Much has been learned about fundamental processes involved in ageing from basic science research and this is leading to identification of key pathways that mediate ageing which may help the search for interventions to reduce age-related musculoskeletal decline. This short review will focus on the role of reactive oxygen species in age-related skeletal muscle decline and on the implications of this work for potential nutritional interventions in sarcopenia. The key physiological role of reactive oxygen species is now known to be in mediating redox signalling in muscle and other tissues and ageing leads to disruption of such pathways. In muscle, this is reflected in an age-related attenuation of specific adaptations and responses to contractile activity that impacts the ability of skeletal muscle from ageing individuals to respond to exercise. These pathways provides potential targets for identification of logical interventions that may help maintain muscle mass and function during ageing.
Obstetric violence is a structural form of gender, medical, and sexual violence perpetrated by health providers and institutions during pregnancy, birth, and postpartum. It can produce physical, psychological, and symbolic harm to pregnant/birthing people and their families. Obstetric violence results from structural conditions in the technocratic model of birth and the acceptance of biomedicine as the authoritative knowledge in health care. This phenomenon produces patients’ loss of autonomy and capacity to provide informed consent, which increases their vulnerability to unjustified medical procedures, resulting in negative birth experiences. In this paper, I argue that individual autonomy is necessary but not sufficient for legitimately consenting to obstetric care and preventing violence. The liberal framework of individual autonomy often ignores that childbirth is a social event where multiple individuals and cultural factors influence the consent process. Consequently, I discuss the role of relational autonomy in obstetric decision-making and describe some structural barriers that negatively intervene in this process. Finally, I propose that doulas and midwives can help nurture autonomy and caregiving skills in obstetric patients and health providers. This strategy protects the informed consent process, prevents obstetric violence, and can be effective in recentering childbirth in pregnant people and their families.
The Arbaeen ceremony is the largest annual mass gathering in the world, attracting millions of Muslim pilgrims each year. However, the event takes place during the summer in Iraq, coinciding with extreme heat and dust storms. Climate change hazards, such as heat waves and dust storms, can have destructive effects on human health, leading to increased mortality and the spread of various diseases. This manuscript recommends measures to stakeholders in emergency or public health management to develop a preventive plan for the Arbaeen ceremony. These measures include improving planning and risk assessment, enhancing capacities, reducing vulnerabilities, increasing knowledge and awareness among pilgrims, developing communication and support systems, ensuring compliance with safety protocols, and regularly assessing evacuation routes. Implementing these measures will contribute to ensuring the safety and well-being of participants during the Arbaeen ceremony in the years ahead.
This study investigates the influence of perceived organizational support (POS) on employees’ intentions to recommend their employer or leave the organization. Based on social exchange theory, it explores how POS affects employee well-being and shapes behaviors such as loyalty and advocacy. An online survey gathered data from 604 French employees across various sectors, analyzing variables like POS, positive and negative well-being, and intentions to leave or recommend the employer. Structural equation modeling was used to examine the relationships among these variables and to test the mediating role of well-being. Results show that POS positively influences employee well-being. High POS is associated with improved positive well-being, which decreases the intention to leave and increases the intention to recommend. Similarly, reduced negative well-being linked to high POS lowers the desire to leave and lessens negative effects on recommendation intentions. The study confirms the mediating role of well-being between POS and employee intentions. The study provides new insights into the impact of POS on employee intentions by highlighting the pathways of positive and negative well-being. For human resource practices, strengthening POS is essential to boost employee retention and encourage positive behaviors, thereby enhancing the organization’s reputation and attractiveness.
Across the world, political parties are incorporating social movement strategies and frames. In this study, we pivot from the dominant focus on party characteristics to analyze drivers of support for movement parties in six European countries. We report results from a choice-based conjoint survey experiment showing that contrary to previous research, movement party voters favor neither candidates who are institutional outsiders nor those who actively participate in protests. Candidate policy positions are the most important driver of the vote for movement parties. Movement party voters, additionally, prefer candidates who either display anti-elitist sentiments or who want to ensure the smooth running of the current political system. These insights invite renewed attention to movement parties as an electoral vehicle whose voters prioritize decisive policy change.