This study examined the role of coping resources – self-efficacy (problem-focused) and emotion regulation (emotion-focused) – in supporting mental health and social functioning among refugees in a transit setting in Indonesia. Using a latent profile analysis approach with 1,214 participants, three distinct coping profiles were identified: high coping resources, high emotion-focused coping resource, and low coping resources. Results showed that high coping resources were associated with better mental health and social functioning outcomes. Emotion-focused coping resources were more strongly associated with better mental health, while problem-focused coping resources were closely linked to social functioning. This study highlighted the importance of coping flexibility and offers practical implications for strength-based interventions in transit displacement settings.

Background: The adult intensive care unit comprises a total of 18 beds. On October 18, 2023, a text notification alerted us to a patient whose wound culture tested positive for Enterococcus faecium (VRE). Following protocol, an Anus VRE screening was conducted on the adjacent bed, revealing three additional positive cases, suggesting a cluster outbreak. Investigation and management were initiated. Methods: Through interviews, observations, medical record reviews, and expanded VRE screenings, a total of 8 beds tested positive, resulting in a positivity rate of 44.4% (8/18), all cases being colonization. Root cause analysis identified failures in hand hygiene among healthcare workers (HCWs), failure to wash hands before donning gloves, incorrect sequencing of environmental cleaning and disinfection, and inadequate implementation of contact isolation precautions. Measures included conducting Anus VRE screening for ICU admissions from October 15th to 18th, increasing the frequency of unit cleaning and disinfection, providing education and training, auditing hand hygiene practices and isolation measures, and centralizing VRE patient care. Results: Utilization of multiple measures for controlling drug-resistant bacterial infections, including auditing hand hygiene, environmental cleaning and disinfection, implementing contact isolation precautions, and conducting environmental sampling, yielded negative results. Observation until November 30th showed no new cases, effectively controlling the spread of drug-resistant bacteria and preventing healthcare-associated infections due to VRE. Discussion: Despite HCWs’ often busy clinical care responsibilities leading to neglect of hand hygiene or substituting handwashing with glove usage, and lapses in implementing contact isolation precautions, no healthcare-associated infections occurred, and patients were successfully discharged without disease exacerbation or fatalities. Environmental sampling was conducted post-environmental disinfection. Additionally, all VRE-positive patients were identified as Enterococcus faecium (VRE). Due to limitations, PFGE testing couldn’t be conducted, hence strain and susceptibility determination confirmed the same VRE colonization event within the hospital.

Objectives: Chronic wounds are commonly manifested with biofilms that result in delayed healing and recurring infection episodes. Due to increasing antimicrobial resistance, antiseptics have played a significant role in wound infection management. To date, there is no standardised method to assess the ‘true’ antimicrobial efficacy of different antimicrobials, especially in testing condition that stipulate a high protein environment in the wound. As clinicians often rely on the antimicrobial efficacy profiles for product selection, a rigorous testing is warranted. Hypochlorous acid (HOCl)-based solutions have been introduced as a good alternative for wound cleansing but the assessment of its antimicrobial activities in a stipulate wound environment is limited. In this study, we assessed the in vitro bactericidal activities of 7 commercially available wound irrigation products commonly found in South-East Asia. Method: The evaluation was conducted using quantitative suspension method, EN 13727 in either low or high protein conditions. Results: Under low protein conditions, four out of the five HOCl products achieved bactericidal activity (≥ 5 log10 reduction factor; RF) within 2 to 5 minutes, and only one product achieved 5 log RF at 15 seconds. None of the HOCl achieved 5 log RF under high protein, even after 30 minutes of exposure time. In contrast, protein interference on the antimicrobial activities of polyhexamethylene biguanide-based product is less pronounced (low protein: 60 seconds vs. high protein: 2 minutes to attain ≥ 5 log RF). Octenidine dihydrochloride is the only active not affected by protein interference achieving ≥ 5 log10 RF within 15 seconds in both low and high protein conditions. Conclusion: These findings warrant the need to screen antimicrobial wound care products, especially HOCl-based products, in high protein condition to better reflect the antimicrobial activities in wound care.

Selecting appropriate texts for second language (L2) learners is essential for effective education. However, current text difficulty models often inadequately classify materials for L2 learners by proficiency levels. This study addresses this deficiency by employing the Common European Framework of Reference for Languages (CEFR) as its foundational framework. A cohort of expert English-L2 educators classified 1,181 texts from the CommonLit Ease of Readability corpus into CEFR levels. A random forest model was then trained using 24 linguistic complexity features to predict the CEFR levels of English texts for L2 learners. The model achieved 62.6% exact-level accuracy across the six granular CEFR levels and 82.6% across the three overarching levels, outperforming a baseline model based on three existing readability formulas. Additionally, it identified shared and unique linguistic features across different CEFR levels, highlighting the necessity to adjust text classification models to accommodate the distinct linguistic profiles of low- and high-proficiency readers.

Introduction: To avoid Clostridium difficile infection in the healthcare facility is an important work. There were many methods to do in the C. difficile infection (CDI) reduction bundle, including cleaning and disinfection. After cleaning and disinfection, we can do an environmental examination to check whether it contains C.difficile or not. Traditional, we did the culture to check but it have to wait 24-48 hours. This method was so slow, so in this study, we try to use the molecular methodology to detect C.difficile. Methods: We collected the specimen after 16 hours when the cleaning and disinfection. Then we used the POCT real-time PCR((POCKIT central C.difficile, GeneReach Biotechnology Corp, Taiwan)) and culture agar to detect whether C.difficile is present or not. In this study, we collected 48 specimens from CDI patients’ environments when they transferred to another space or left. Results: We found all the POCT real-time PCR results were the same compared to the culture results. That’s to say, the POCT real-time PCR can replace the culture method and improve the term around time on the diagnosis of C.diffiicle. Conclusion: The molecular method could replace the traditional culture due to it was quick and precise. Patients can’t wait for the culture result in clinical, especially in the ICU. Once delayed, the mortality rate would arise. In other words, the POCKIT central C.difficile is useful in clinical. It can be used to detect whether C.difficile survives on the surface or not. However, due to the limitation of the sample count, the statistical significance was not complete. So we will collect the sample to finish this study.

Invasive Escherichia coli disease (IED) is associated with high hospitalization and mortality rates, particularly among adults aged ≥60 years. O-antigens are virulence factors required for E. coli survival. To inform EXPEC9V development, a novel glycoconjugate vaccine targeting E. coli O-antigens that is no longer in active clinical development, this retrospective observational study describes O-serotype prevalence among E. coli isolates from IED patients. Eligible patients were identified from medical record databases (9 January 2018–8 November 2019) across 17 tertiary care hospitals in Europe, North America, and Asia. To estimate vaccine serotype coverage of EXPEC9V, E. coli isolates were O-serotyped using whole-genome sequencing and agglutination. Antimicrobial susceptibility testing was also performed. Nine hundred and two patients were enrolled, of whom 690 (76.5%) were aged ≥60 years. Common serotypes were O25, O2, O6, O1, O15, O75, O16, O4, and O18, with O25 being the most reported (17.3%). In patients aged ≥60 years, 422/637 E. coli isolates were EXPEC9V O-serotypes. EXPEC9V O-serotype prevalence did not substantially differ when stratified according to sex, presence of a positive blood culture, sepsis, fatality, or multidrug resistance. Consistent with previous studies, serotype O25 was most prevalent and associated with ~20% of cases. An EXPEC9V vaccine serotype coverage of 66.2% was observed for IED patients aged ≥60 years.

Throughout the history of philosophy, numerous philosophers have formulated theories about the connection between law and freedom. However, few have suggested that freedom and love are inherently connected. According to Hegel, the family and marriage represent the initial tangible manifestation of freedom, embodied in ethical and self-conscious love. This contentious thesis pertains to Hegel’s endorsement of the modern bourgeois family and his assertion regarding a compulsory and heteronormative conception of conjugal love. I analyse Hegel’s family theory in what follows, emphasizing the marital relationship as delineated in Outlines of the Philosophy of Right. I examine the significance and ramifications of his dismissal of the marriage contract to illustrate how this creates a paradox. I propose an alternative interpretation of these passages by emphasizing the relationship between love and law within marital relations. I advocate the importance of law within the family and demonstrate its significance to marriage. I assert that Hegel’s understanding of the family, especially regarding marriage, highlights the tensions present in the complex relationship between the legal aspect of marriage as a contract and the ethical aspect rooted in self-conscious love. To achieve this, I firstly reconstruct Hegel’s conception of the family and explore his understanding of marriage as sexual drive, desire, passion and contract. Secondly, I explore Hegel’s notion of ethical and self-conscious love, examining the relationship between law and love to reveal the paradox of marriage. Third, I discuss Hegel’s views on divorce and marriage settlements to demonstrate why marriage cannot overcome the contract. Finally, I discuss why Hegel’s response to the issues he identifies in the theories of his contemporaries is inadequate and how marriage and conjugal love threaten freedom. My claim is that marriage entails a paradoxical relationship between love and law, which calls into question the suitability of marriage to realize freedom.

Introduction: Crowded Emergency and Trauma Department (ETD) have been associated with adverse patient outcomes and higher mortality rates. Crowding and lack of alcohol-based hand rubs (ABHRs) have been found to correlate with lower compliance to hand hygiene (HH) protocols among healthcare workers (HWs). This project aimed to improve and sustain HH compliance (HHC) among HWs in the ETD by adapting to the World Health Organization (WHO) HH Multimodal Improvement Strategy. Methodology: This is a cross-sectional study in ETD, Sarawak General Hospital, a university-affiliated, public tertiary-care hospital in Malaysia. It spanned 12 months, from Jan 2023 to Jan 2024. The intervention involved installing wall-mounted automated ABHR dispensers at multiple fixed locations in ETD. Pre-, during, and post-12 weeks intervention HHC audit were conducted according WHO’s gold-standard direct observation method. We conducted a sequential trend analysis and compared proportions across these periods using a linear logistic regression model to assess the improvement and sustainability of HHC. Results & Discussion: Mean HHC improved from 66% (383/579) (95% confidence interval [CI], 62.1%-70.0%) in the pre- intervention period to 81% (321/397) (95% CI, 76.6%-84.6%) in the intervention period, and further sustained at 85% (302/352) (95% CI, 81.7%-89.3%) in the post-intervention period (P value<0.05). The positive coefficient of 1.13 in the model, when moving from the pre- to the post-intervention period indicates a positive trend in HH compliance. The availability of adequate wall-mounted automated ABHR dispensers at multiple fixed locations at ETD created easy accessibility of ABHRs for HWs and acted as visual reminders for good HH behavior at the ETD. Conclusions: Having wall-mounted automated ABHR dispensers in various fixed locations proved effective in promoting good HH among HWs in emergency settings. It’s essential to have fixed ABHR dispenser placement in crowded - areas like the ETD to improve and sustain HHC among HWs.

Introduction: Optimising antibiotic prescribing in hospitals through antimicrobial stewardship (AMS) initiatives is essential in addressing the global threat of antimicrobial resistance. Methods: Point prevalence surveys were performed in April 2019 and November 2022 utilizing the Hospital National Antimicrobial Prescribing Survey (NAPS) tool. The study aimed to evaluate the prevalence of antibiotic use among inpatients and monitor antibiotic prescribing quality in 2022 compared to 2019 in a Malaysian teaching hospital as part of AMS core elements. Results: The prevalence of antibiotic use remained relatively stable between 2019 and 2022 (44.1% vs. 42.3%), with no significant change observed. Prescription patterns, including the type of antimicrobials, treatment modalities, and prescriptions per patient, showed insignificant differences between the two surveys. Antibiotics from the World Health Organisation (WHO) Access group constituted up to 47% of prescriptions in 2022, while usage of antibiotics from Watch group decreased from 57% to 53%, albeit insignificantly. Notably, there was a non- significant increase in appropriate prescribing for surgical prophylaxis in 2022 (40% vs 16.7%, p=0.078), alongside a less prevalent in prolonged surgical prophylaxis (28% in 2022 vs. 50% in 2019). Despite static prevalence and prescribing patterns, compliance with guidelines (p<0.006) and appropriate prescribing (p<0.002) showed significant improvement. The likelihood of compliance and appropriate prescribing was approximately 1.8-fold higher in 2022 compared to 2019. However, an increase in prescription of unnecessary broad-spectrum antibiotics was observed (23.1% vs 48%, p=0.002). Multiple logistic regression revealed that inappropriate prescribing significantly occurred when antibiotic indication was poorly documented (adjusted OR 3.67;95% CI 1.28–10.53; p=0.016). Conclusion : While prescribing patterns remained relatively unchanged, our findings highlight notable improvement in antibiotic prescribing quality. However, challenges persist, including the increased use of unnecessary broad-spectrum antibiotics. Continued efforts in AMS are imperative to address these issues and further enhance prescribing practices.

This longitudinal study examined the cognitive development of Spanish children from monolingual backgrounds attending schools with varying levels of English exposure (13%–83%) to assess whether higher L2 exposure results in advantages over time. 229 children (ages 6–7) completed background (nonverbal reasoning (NVR), working memory (WM), L1 vocabulary, L2 vocabulary) and experimental tests measuring attentional/executive functions (selective attention, divided attention, switching, inhibition) at the beginning and end of year 1 of primary education. Generalized linear mixed-effects models, accounting for factors such as family educational level, onset of L2 exposure and language exposure outside of school, indicated that children’s cognitive skills benefit from (high) L2 exposure at school, with greater L2 exposure being linked to more enhanced attentional/executive skills as well as to a larger L2 vocabulary. These findings support the positive effects of immersion programs, suggesting that L2 exposure in school settings alone can contribute to more developed attentional/executive skills.

Objectives: Healthcare-associated respiratory viral infections (HA-RVI) remain a threat despite the fading memory of the pandemic. To better understand the impact of HA-RVI, we reviewed endemic respiratory viral infections in our tertiary academic hospital just before the pandemic. Methods: A retrospective analysis of a hospital epidemiology database with all patients tested positive for respiratory viruses between Jan2016 – Dec2019 was conducted. Testing was ordered by attending physicians and done using immunofluorescence assays or multiplex PCR. HA-RVI patients were identified based on positive virologic tests >48 hours after admission. Data analyses were performed on Vassar Stats. Results: Of the 1700 patients included in this study, 315(18.5%) had HA-RVI while 1385(81.5%) had community-acquired infections (CAI). Influenza, enterovirus/rhinoviruses and respiratory syncytial virus were the most common viruses. Compared with CAI, HA-RVI patients were older (mean age 37.129.7 vs 21.427.5 years, p<0.001), had recent hospitalisations (OR 1.5, 95% CI:1.1-2.1, p=0.007), underlying bronchial asthma or COPD (OR 2.8, 95% CI:1.5-5.3, p=0.002) and were immunosuppressed (OR 7.6, 95% CI:4.3-13.4, p<0.001). Interestingly, HA-RVI patients were less likely to have fever (49.8% vs 66.4%, p<0.001), cough (42.2% vs 67.3%, p<0.001) or shortness of breath (17.5% vs 26.6%, p=0.02). Despite fewer symptoms, HA-RVI patients were more likely to have pneumonia with abnormal chest x-rays (33.3% vs 22.7%, RR 1.14, 95% CI:1.02-1.29, p=0.04), longer lengths of stay (mean 21.236.7 vs 514 days, p<0.001), higher rates of ICU admission (14.9% vs 8.1%, OR 2.0, 95% CI:1.4-2.9, p<0.001), and mortality (4.8% vs 0.6%, OR 8.6, 95% CI:3.6-20.5, p<0.001). Conclusions: Patients who are older, have pre-existing respiratory disorders or are immunosuppressed face greater HA-RVI risk. HA-RVI patients are less likely to exhibit typical respiratory infection symptoms, potentially delaying diagnosis. This probably contributes to increased morbidity and mortality associated with HA-RVI which underscore the importance of hospital infection prevention even for endemic respiratory viruses.

Background: Vietnam has the national guidelines for infection control in hospitals and it also recommends the application of WHO’s IPCAF framework to do self-evaluation of infection prevention and control (IPC) activities and plan to improve them in hospitals. Objective: Our study aimed to implement the multimodal strategy for IPC, in which our expected outcome was the practices of doctors and nurses for pediatric ventilator-associated events (Ped-VAE). Design: We used the implementation research approach with the hybrid design of quasi-experimental pre-post comparison without control group. All 16 doctors and 32 nurses at the Department of PICU were observed 3 times that practicing the IPC packages for PedVAE guided by MOH. The implementation strategies used included Plan, Restructure, Train, and Quality Management. Results: Four over six steps practised by doctors and 5/10 steps practised by nurses for PedVAE were well practised after the intervention with significantly higher proportion of right practices (p<0.001). The practices of doctors had insignificant changes between pre-post intervention, including hand hygiene (85.4% and 83.3% of right practice at pre-post intervention, respectively) and daily assessment of weaning from mechanical ventilation (54.2%-68.7%). Most unchanged practices among nurses were steps of ensuring humidification and heating of inhaled gas for in patients with artificial airway.

All practice scores of the whole steps among doctors and nurses had statistically significant increase after intervention. Our implementation strategies were highly assessed by providers (doctors and nurses) and hospital managers in terms of the its acceptibility, feasibility and sustainability. Conclusion: The implementation of multimodal strategy in IPC for pediatric ventilator-associated events is effective and acceptable and feasible for hospitals at city/province level in Vietnam. In addition with improving practices of healthcare staffs, hospitals should regularly assess and upgrade ventilators machines to ensure the effectiveness of IPC.

Strong constitutionalism usually conceives rights as instruments for protecting people. The problem with this conception is that it generates legal alienation, since it views people as passive recipients of protection, which is an exclusive matter for the state and, ultimately, for judicial review. In contrast, deliberative constitutionalism gives people an active role in deliberating about rights, among themselves as well as between them and the state. However, despite the development of deliberative constitutionalism, it is not yet clear what this view of rights requires of judicial review. Accordingly, this contribution to the Federal Law Review’s symposium issue on deliberative rights theory argues for deliberative judicial review, which is a form of judicial review that, by respecting and promoting democratic deliberation, offers better protection of rights, as well as greater impartiality and legitimacy. In support of this argument, the article first makes explicit that the guide that should orient judicial review is not deference or activism but rather democratic deliberation. Next it states that, from this guide, a form of judicial review should be inferred that is not merely substantial or merely procedural, but rather semiprocedural. It then argues that, notwithstanding contextual turns, weak constitutionalism combined with channels of social dialogue offers a better institutional basis for deliberative judicial review than strong constitutionalism. Lastly, it concludes that deliberative judicial review respects and contributes to articulating rights without legal alienation, i.e. through dialogue among all potentially affected persons.

Introduction: Nosocomial Bloodstream infection (BSI), including central line-associated blood stream infection (CLABSI) is important causes of morbidity and mortality. There are few studies describing the epidemiology of BSI in Viet Nam. Methods: A cross-sectional descriptive study was conducted in 3 intensive care units (ICUs) of the University Medical Center (UMC), Ho Chi Minh City from 2017 to 2022. The UMC service microbiology database was accessed to identify positive blood culture specimens during the period 2017–2022. Demographic and clinical details, antimicrobial management and patient outcome information were extracted from medical and laboratory records. Results: Of the 695 unique bacterial and fungal BSI episodes identified during the study period, 232 (33.4%) were community-acquired (CA), and 463 (66.6%) hospital-acquired (HA). The rate of BSI was 11.4% (463 cases/4.069 patients), in which CLABSI accounted for 59.8%. The incidence of CLABSI was 13.2% (307 cases/2.320 catheter patients) and the incidence rate was 5.8 cases per 1.000 catheter-days. On multivariable analysis, severe underweight, patient origin, central line placed in the femoral vein, duration catheter-days were significantly associated with CLABSI. We observed that prolonged duration catheter were the main risk CLABSI with 2.7- fold for 14-28 cathter-days (OR=2.7, 95% CI 2.4-3.1), 7.3-fold for more than 28 catheter-days (OR=7.3, 95% CI 5.7-9.4). The most common organisms were Gram-negative bacteria (76.2%), with K. pneumoniae (31.4%) and A. baumannii (12%) most prevalent. Gram-negative bacteria and Candida were more likely to cause infections in patients in critical care units. In addition, patients with BSI had significantly greater ICU costs than patients with Non-BSI (422 million VND (IQR 239–680) vs 184 million VND (IQR 18–92), p <0.05) Conclusions: Our data suggest that catheter duration is an important risk factor for CLABSI in the ICU. A significant daily increase in the risk of CLABSI after 28 days may warrant CVC replacement if intravascular access is necessary beyond that period.

Background: Antimicrobial Stewardship Program (ASP) is a global issue. World Health Organization (WHO) stated, there are 3 categories of antimicrobial: ACCESS, WATCH, and RESERVE. e-RASPRO as a digital ASP may alter antibiotic prescribing pattern by prioritizing ACCESS category as suggested by WHO. Methods: This manuscript was a ward retrospective survey data of 9 months Define Daily Dose (DDD) average before-after implementing the electronic-RASPRO (e-RASPRO) on ACCESS & WATCH antibiotic. Results: Number of inpatients 9 months before-after e-RASPRO implementation were 7,754 and 6,794. Within 9 months after implementing e-RASPRO there was a trend of antibiotic prescription shifting from WATCH category antibiotic to ACCESS category antibiotic. There was a trend of reduced Define Daily Dose (DDD) average of WATCH category antibiotic. 24.82% of 3rd generation Cephalosporin, 33.20% of Quinolones, 14.76% of Carbapenems and 100% of Piperacillin Tazobactam DDD average were reduced. While, in ACCESS Category Antibiotic, there were an elevation of Penicillin and Aminoglycosides DDD average up to 528.66% and 137.66%. Conclusion: T here are trend changing of DDD average from WATCH to ACCESS category antibiotic following the 9 months implementation of e-RASPRO. We need further study to judge the effectiveness of e- RASPRO as a digital ASP tools.