This paper offers a substantial improvement in the revision-theoretic approach to conditionals in theories of transparent truth. The main modifications are (i) a new limit rule; (ii) a modification of the extension to the continuum-valued case; and (iii) the suggestion of a variation on how universal quantification is handled, leading to more satisfactory laws of restricted quantification.

Background: As the incidences of preterm births and surgical cases increases, so do cases of neonatal sepsis in CMH. Furthermore, the common etiology of neonatal sepsis are multidrug-resistant bacteria which increase the risk of mortality. Cefepime is a fourth-generation cephalosporin which is increasingly being utilized in NICUs. Theoretically, continuous infusion of beta lactam antibiotics could maximize the time- dependent bactericidal activity and improve the probability of target attainment. This study aims to determine the effectiveness and safety of continuous cefepime administration in managing sepsis. Methods: This is retrospective cohort study on infants who suspected late onset sepsis from 2021 to 2023. The independent variables are continuous infusion and intermittent infusion, with outcomes including mortality rate, reduction in septic markers, use of antibiotic combinations, duration of antibiotic use, and renal function test. Result: There were 106 subjects receiving cefepime (56 continuous and 50 intermittent infusions; p>0.05). No significant differences in demographic data such as gestational age, prematurity condition, birth weight, and surgical conditions were found between the two methods. Out of 66 subjects with proven sepsis, 28% were classified as MDR, 12% as XDR, and 16% as PDR. No difference in sepsis-related mortality outcomes was observed between the two methods (64.3% vs. 70%; p=0.532). Continuous administration reduced C-reactive protein (80.52 vs. 51.69 mg/L; p=0.000) and procalcitonin (11.9 vs. 6.72 ng/mL; p=0.008) more effectively than intermittent. In surgical cases, continuous administration reduced the risk of multidrug therapy (RR 0.5 CI 95% 0.243-0.902; p=0.045). There was no difference renal function impairment between two methods. Conclusion: Cefepime continuous infusion can significantly reduce infection markers compared to intermittent administration. In surgical cases, continuous cefepime administration reduces the risk of multidrug therapy. The use of continuous cefepime can be considered as part of antibiotic stewardship in the NICU.

Background: Enhancing environmental hygiene resulted in a reduction of multidrug-resistant microorganisms colonization and healthcare-associated infections. There has been less studies to compare the effects of practice observation with other methods. This study aimed to compare correlations between visual inspection, practice observation and aerobic colony count (ACC) and verify the effectiveness. Methods: A prospective study was conducted in a medical intensive care unit from May 2021 to November 2022. High-touch surfaces were assessed by visual inspection (clean or not clean) and practice observation (compliant or not compliant) to compare the correlations by using ACC with the cut-off point of 2.5 CFU/cm2 as a golden standard. Results: Among 569 samples, the pass rate by ACC was 90.5%, the clean rate by visual inspection was 73.3%, and the compliant rate by practice observation was 47.1%. The concordance was 245 surfaces (43.1%) of the three methods. There was no correlation between visual inspection and ACC (p<0.001, φ=0.184). The correlations were weak positive between visual inspection and practice observation and between practice observation and ACC (p<0.001, φ=0.212, 0.233). The median aerobic colony count of “compliant” group (0.00 CFU/cm2) was significantly lower than “not compliant” (0.40 CFU/cm2) (p<0.001). The median aerobic colony count of “clean” groups (0.08 CFU/cm2) was also significantly lower than “not clean” groups (0.20 CFU/cm2) (p<0.001). Conclusion: Practice observation is more reliable than visual inspection. Therefore, visual inspection can be used for low risk area to maintain visibly clean. In high risk area, an integrated program is critical to combine practice observation with other methods to monitor cleanliness.

Introduction: A common form of Renal Replacement Therapy is haemodialysis. Haemodialysis (HD) patients require a vascular access. Because of Frequent hospitalization the HD patients are at higher risk of developing infections. Positive Blood culture, IV antimicrobial use and signs of inflammation at vascular access site are the three dialysis events that can cause substantial morbidity and mortality in patients.The objective is to identify and implement strategies to prevent dialysis events within the facility by providing appropriate analyses of dialysis events. Methodology: A prospective surveillance study was performed between April’23 and November’23 at our outpatient HD facility. All HD patients were eligible for the study if they received HD on first two working days of the month. We conducted a pre-stage study for two months from April’23 to May’23 and collected data. After detailed analysis, implementation measures were included in month of June’23. The surveillance was regarded as a process improvement project and further data for dialysis events were collected till month of November’23. Interventions: The following interventions were adopted as process improvement in hemodialysis unit; 1). Revision of the current antimicrobial policy of dialysis unit 2). Implementation of Core interventions to prevent the dialysis event like hand hygiene observation, catheter/vascular access care observation, staff education, patient education, catheter removal, CHG for skin preparation, Catheter hub disinfection and regular surveillance with feedback of Dialysis events. 3). Revised policy for regular RO water plant disinfection and microbiological testing Results: 755 patients were reviewed for dialysis events during the 09-month study period. A total of 16 dialysis events were reported with overall dialysis events rates was - 2.09/100 patient-months. The rate of IV antimicrobial use was-1.19/100 patient-months and the positive blood culture rate was-0.92/100 patient-months Gram-negative bacilli were predominant in patients with central lines (n = 9); however, skin commensals and gram negative bacilli were also identified in patients with fistula or graft (n = 2). A reduction in dialysis events from 3.3 /100 patient days to 1.08/100 patient days was observed after the implementation of core interventions. Conclusion: Dialysis events were significantly more frequent in patients with tunnelled or non-tunnelled central venous lines compared to those with fistula or graft. In haemodialysis patients, good compliance with antimicrobial policy and regular monitoring of core interventions will reduce the risk of dialysis events.

This article maps out and evaluates the rise of ‘Deliberative Rights Theory’ (‘DRT’), a novel field of human rights analysis drawing on ideas from deliberative democracy. Deliberative democracy addresses dilemmas such as how deliberative and democratic inputs into public decision-making can each be influential, without either one dominating the other. This is especially apt for human rights, as settling complex and contentious rights cases (eg on COVID-19 vaccination, internet speech or assisted dying) calls for both technical deliberation and democratic input. There is an acute risk of noncompliance with – or even backlash against – rights decisions that lack either type of input. DRT’s normative strand of research explores conditions for uncoerced interactions between diverse participants in rights decision-making (eg ‘reasoned persuasion’, ‘epistemic diversity’ and ‘temporal deferral’). These conditions allow for an ‘integration’ of both deliberation and democracy in the course of decision-making about rights. This relatively nuanced and promising answer to the deliberation-democracy dilemma helps to account for DRT’s rising prominence. By contrast, ‘strategic’ approaches expect participants to leverage their status or power to push for outcomes they favour. The article contends that strategic approaches implicit in many existing rights theories cannot solve the deliberation-democracy dilemma, but rather allow one type of input (deliberative or democratic) or one type of institution (eg a court or legislature) to dominate. A further, institutionalist strand of research addresses how to realise DRT’s high normative ideals. The article suggests that court-focused rights models are frequently inadequate. Newer approaches, such as the mini-public model increasingly prominent in deliberative democracy, can best integrate democracy and deliberation for rights decision-making.

Tomato (Solanum lycopersicum L.) is extremely sensitive to inhibitors of acetohydroxyacid synthase (AHAS; also known as acetolactate synthase [ALS]). Utilizing ethyl methanesulfonate mutagenesis of seeds of the commercial tomato line ‘M82’, we developed a tomato mutant, HRT1, that showed high resistance to imidazolinone herbicides (which act by inhibiting AHAS) in the greenhouse and under field conditions. The activity of AHAS extracted from HRT1 was significantly less affected by imidazolinone herbicides than that from the parental line M82. Following imazapic treatment, no differences were found in the content of free branched-chain amino acids in HRT1 tissues as compared to a dramatic decrease in M82 tissues. No differences were found in the susceptibility of AHAS to sulfonylurea herbicides. A single point transition mutation of C to T in the AHAS1 gene located on chromosome 3 was detected. This mutation resulted in substitution of alanine by valine at amino acid position 194, corresponding to 205-Alal in Arabidopsis. Ligand–protein contact analysis showed that replacement of alanine by the larger hydrophobic valine residue results in increased repulsion, hindering herbicide binding. Segregation analysis indicated that the resistance to imidazolinones in line HRT1 is due to a single recessive gene.

Background: SSI cases in patients undergoing SC procedures are still a problem. Routine bundles are being implemented but infections still occur. So, it is necessary to evaluate existing bundles. Research objective: To compare the incidence of post-SC SSIs between the implementation of routine bundles in hospitals with new SSI bundles. Method: Quantitative research using a prospective cohort method on pregnant women of childbearing age (WCA) aged 15-49 years who were treated in the Dr. Hasan Sadikin General Hospital, Bandung. Data collection was carried out in the period October- November 2023 where SC was carried out. The sampling technique that will be used in this research is a non-probability sampling technique with a consecutive sampling method. The instruments used are the SSI indicator profile, hospital standard tool bundles, and new SSI tool bundles. Data analysis used the Fisher Exact test to compare the two groups and the efficacy formula to calculate the effectiveness of implementing the two bundles. Research Results: There were 710 cases of SC, and in 60 research samples in both groups for one month, the results of the intervention group with new bundles of SC showed 100% effectiveness with no cases or 0% during the 0-30 days post-SC operation monitoring period while the control group with hospital procedure bundles had one case or 3.3%. The Fisher Exact test analysis showed no significant difference (P> 0.005) between the intervention group with new SC bundles and the control group with hospital procedure bundles (P=1.000). Conclusion: The implementation of the new SSI bundles in the intervention group was proven to be effective with no cases of SSI when compared to the control group with hospital procedure bundles which contained one case of SSI.

Introduction: Urinary tract infection (UTI) is a common healthcare-associated problem. UTI has a lower mortality prevalence than other infections, but it is at high risk of leading to sepsis and increased treatment costs. Therefore, the objective of the study is to describe the epidemiology and burden of disease and determine factors associated with healthcare-associated UTI in the intensive care units (ICUs). Methods: A cross-sectional study was conducted on 4.028 patients admitted to the ICU, Neuro Surgical ICU, and ICU - Cardiovascular Surgery Department at a teaching hospital in Ho Chi Minh City from 2017 to 2022. The study collected secondary data through electronic medical records, including age, gender, diagnosis, department, urinary catheter use, urinary catheter retention time, treatment, and urine test results. Results: The prevalence of UTI in ICUs was 4.0%, of which CAUTI accounts for the highest prevalence, with the typical pathogen being E. coli. The Neuro Surgical ICU had the highest incidence and catheter-used prevalence in ICUs. UTIs were concentrated in people over 80 years old, females, and brain diseases. The length of the hospital stay was long, and the cost of the hospital stay was unaffordable, up to hundreds of millions of VND. The study found factors associated with the prevalence of UTI, such as age, gender, department, diseases, and urinary catheters. Patients with urinary catheters have a 10.98 times higher prevalence of UTI (p < 0.001; PR = 10.98, 95% CI 4.87–24.76) compared to patients without urinary catheters. Conclusions: The results of the study demonstrated that UTI remains a burden on the healthcare system, especially in ICUs. Implementing a UTI prevention package for patients with catheters is important. Besides, it is necessary to maintain continuous training for healthcare workers to properly and timely insert, remove, and replace catheters.

‘Deliberative Rights Theory’ evaluates what deliberative democratic scholarship can contribute to the constitutional question of how to protect fundamental rights and freedoms. That scholarship primarily focuses on what occurs within the legislature, judiciary and citizen assemblies to test the relationship between deliberation and rights. This article argues that what occurs within federalism can also significantly influence rights deliberation and thus should be part of the conversation. The article explores federalism’s effect on rights deliberation through two case studies from the COVID-19 pandemic. The first considers Australia’s decision to close its international border and the way federalism influenced discussion and debate on the right of citizens to return to the country. The second considers Canada’s decision to end the ‘Freedom Convoy’ against vaccination mandates and the way federalism affected discussion and debate on the right to protest. The article concludes by considering some directions for future research on the topic.

The study of the word problems of groups dates back to Dehn in 1911, and has been a central topic of study in both group theory and computability theory. As most naturally occurring presentations of groups are recursive, their word problems can be thought of as a computably enumerable equivalence relation (ceer). In this article, we study the word problem of groups in the framework of ceer degrees, introducing a new metric with which to study word problems. This metric is more refined than the classical context of Turing degrees.

Classically, every Turing degree is realized as the word problem of some c.e. group, but this is not true for ceer degrees. This motivates us to look at the classical constructions and show that there is a group whose word problem is not universal, but becomes universal after taking any nontrivial free product, which we call $*$-universal. This shows that existing constructions of the Higman embedding theorem do not preserve ceer degrees. We also study the index set of various classes of groups defined by their properties as a ceer: groups whose word problems are dark (equivalently, algorithmically finite as defined by Miasnikov and Osin), universal, and $*$-universal groups.

Introduction: Hemodialysis (HD) is the most common renal replacement therapy modality for chronic kidney disease patients. Nearly 80% of patients starting HD use a non-tunneled double lumen (DL) catheter as the first vascular access. However, the use of this access may increase the risk of both exit site and bloodstream infections. This study aims to identify the risk factors for infection related to non-tunneled DL catheters in HD patients at Dr. Kariadi Hospital, Semarang, Indonesia. Methods: A retrospective cross-sectional study design was applied among adult patients who underwent HD using non-tunneled DL catheter in the Hemodialysis Unit at Dr. Kariadi Hospital between January 2022 and March 2024. Data were collected from medical histories and patients’ medical records, then analyzed using SPSS 21. P-values less than 0.05 were considered statistically significant. Results: This study involved 72 adult HD patients, with 58% male subject. Among them, 23 (31.9%) subjects experienced infections related to non-tunneled DL catheter. These infections included exit site infections (21%) and bloodstream infections (95%). The most dominant microorganism in infected patients was Staphylococcus aureus. The location of catheter insertion in the femoral vein (p = 0.03) and a high white blood cell count (p = 0.03) were significant risk factors for infection. However, factors such as age, diabetes mellitus, duration of catheter insertion > 3 months, serum iron levels, hypoalbuminemia, and anemia were not significant risk factors (p > 0.05). Conclusion: In conclusion, catheter insertion in the femoral vein and a high white blood cell count were identified as contributing factors to infections related to non-tunneled DL catheters in HD patients.

Introduction: Nowadays, surgical site infection is one of the four common types of healthcare-associated infections. There are many preventive measures applied and surgical hand hygiene (SHH) is the most effective and the simplest measure. This study aimed to assess the knowledge, practices of SHH among staff and the relationship between knowledge and practice of SHH in Viet Nam. Methods: An analytical cross-sectional study was conducted at the University Medical Center (UMC) in Ho Chi Minh City in 2022. The study employed a set of pre-prepared questions for the knowledge assessment section. For the practical assessment section, the research team conducted indirect observation through cameras and filled out a monitoring checklist. The data were analyzed using Stata 13.2. Results: Of the 271 healthcare workers, surgeons had the highest proportion at 48.7%, which was 18.6 times higher than that of anesthesiologists. The majority of healthcare workers received training on SHH, accounting for a rate of 95.6%. Among the participants, the overall compliance of SHH before entering the operative room accounted for 85.6%. The percentage of correct general knowledge reached 73.8%, and there was a relationship between correct knowledge and correct practice with p < 0.01. Conclusion: Our data suggests that having correct general knowledge of SHH is a crucial factor in accurately practicing SHH. Therefore, providing training to impart accurate knowledge about SHH to healthcare staff is necessary to enhance the overall compliance rate of SHH before entering the operating room.

Background: The surgical site infection (SSI) event is still the main cause of morbidity and increases the length of stay (LOS) in a hospital, costs, and deaths. One of the causes of SSI is nurses’ non-compliance with aseptic techniques. Exposure can be increased and variability in aseptic techniques can be minimized by implementing the aseptic non-touch technique (ANTT) strategy. This research investigated the effectiveness of implementing the ANTT method on reducing the number of SSI events in postoperative patients. Methods: This research used a pragmatic evaluation method with a mixed methods approach. The ANTT method was implemented through five stages i.e., planning, launching, educating, assessing, and monitoring. Data were collected using pre/post-questionnaires, structured interviews, and audit observations via the electronic audit. This research was conducted for 24 months and involved 138 nurses from three hospitals. Results: The mean compliance rate of aseptic techniques after implementing the ANTT method was 93%, with the glove use at 92%, contaminated gloves at 0%, aseptic area at 84%, contaminated aseptic area at 0%, disinfected procedure trays at 75%, protected keypart at 84%, contaminated keyparts by hands/ equipment at 2.6%, and hand hygiene after gloves at 98%. The rate of SSI events dropped from 0.3% to 0.1% in 12 months. There was a significant difference between the pre and post-implementation of the ANTT (P-value < 0.001). Moreover, implementing the ANTT method effectively reduced the SSI events in postoperative patients (P-value < 0.001). Conclusions: The implementation of ANTT improved compliance with safe and effective aseptic techniques. The ANTT compliance audit results reflect a reduction in the incidence of SSIs, thereby reducing costs and LOS in postoperative patients. The program will be expanded to five other group hospitals.

Introduction: Continuous Ambulatory Peritoneal Dialysis (CAPD) is a treatment method for Chronic Kidney Disease (CKD) that allows patients to undergo dialysis therapy at home. Although CAPD provides benefits in terms of flexibility, efficiency, and comfort, patients undergoing CAPD are at high risk of infections, including exit site infections, tunnel catheter infections, and Peritoneal Dialysis (PD) peritonitis. This study aims to identify risk factors associated with CAPD infections in CKD patients at Dr. Kariadi Hospital, Semarang, Indonesia. Methods: A retrospective cross-sectional study design was applied to adult CKD patients undergoing CAPD at Dr. Kariadi Hospital between January 2022 and March 2024. Data were collected from patients’ medical histories and records, then analyzed using SPSS 21. A p-value less than 0.05 was used to determine statistically significant variables. Results: This study involved 81 adult patients undergoing CAPD with 58% male subjects. There were 23 (31.9%) subjects who experienced CAPD infections. Subjects who had infections experienced exit-site infections (10,5%) and peritonitis (89,5%). The most dominant microorganism in infected patients was Staphylococcus epidermidis. Diabetes mellitus (p = 0.03) contributed as significant risk factors for infection, while hypoalbuminemia and overweight were not significant risk factors (p > 0.05). Conclusion: In conclusion, the incidence of CAPD-related infections was high with a predominance of Staphylococcus epidermidis. Diabetes mellitus is considered a contributing factor to the infection.

Morphological examination of recently collected barnacle specimens confirms the presence of Tesseropora atlantica (Cirripedia, Balanomorpha, Tetraclitidae) along the coastlines of Lanzarote and Fuerteventura, the easternmost islands of the Canary Archipelago. This constitutes the first documented occurrence of T. atlantica in the Canary Islands and establishes a new southern range limit for this relict species in the eastern Atlantic Ocean. Additionally, 16S and COI mitochondrial gene sequences were obtained for the first time for this species, allowing comparisons with related taxa. The study also explores plausible hypotheses concerning the species’ arrival in the Canary Islands.

Introduction: We propose to develop a Unique Device Identification (UDI) barcode tracking system for surgical instruments. This system aims to enhance hospital processes, thereby benefiting both patients and staff members. Methods: The UDI barcode tracking system for surgical instruments was implemented in March 2023: 1. Each surgical instrument underwent laser engraving with a UDI barcode, encompassing relevant data such as instrument name, image, model, specifications, origin, license, Instructions for Use (IFU), and total distribution quantity. 2. Upon scanning the engraved serial number, the system automatically discerns whether the instrument belongs to the designated set. 3. Mechanical, chemical, and biological monitoring indicators are integrated into the tracking system, with automatic adjudication for release into storage if criteria are met; otherwise, notifications are issued for review and retrieval by personnel. Results: 1. Between March 2023 and February 2024, a total of 157,614 instrument sets were equipped with this system, enabling staff to achieve a zero-error rate in rapid and precise instrument identification. 2.During this period, 4,026 cycles of high-temperature sterilization monitoring and 380 cycles of low- temperature H2O2 plasma sterilization monitoring were recorded. 3.Each monitoring cycle was digitally recorded, obviating the necessity for paper-based documentation and saving a total of 4,406 A4 paper sheets. 4. In the same timeframe, a total of 85,899 packages were dispensed, each linked to patient medical record numbers. Conclusions: The adoption of the surgical instrument UDI barcode tracking system by our institution’s central sterilization supply department has garnered participation from 622 individuals. It not only reduces the time spent by staff searching for items and conducting educational training but also automatically identifies whether the instrument belongs to the package, thereby enhancing inventory efficiency and reducing the incidence of errors. Sterilization monitoring indicators are automatically uploaded and intercepted to uphold patient safety.

Background: In University Medical Center Ho Chi Minh City (UMC), shelf life of sterilized packed items has been followed by time-related principle. However, duration of sterility has not been based on strong scientific evidence. Objectives: To determine the most appropriate shelf life for sterilized products according to packaging material and sterilization methods. Methods: All the experimental and the control samples (surgical instruments and linen) were prepared by four types of packaging materials (peel pouch, nonwoven, linen, and rigid container) and three types of sterilization methods (steam, Hydrogen Peroxide, Ethylene Oxide). After sterilization, sterilized samples were stored at CSSD’s storage and tested for microbial contamination in 07 periods: after 07 days, 14 days, 01 month, 03 months, 06 months, 12 months, and 18 months. Identification of the storage environment (shelf location, temperature, and relative humidity) were recorded as the same time collected samples. Results: Positive microbial cultures were seen in 0.44% (07 samples) of 1,574 samples. Up to 18 months, no organisms was cultured from any sample of (1) autoclaved surgical instrument packages wrapped in peel pouches, nonwoven, linen, (2) Hydrogen Peroxide sterilized surgical instrument packages wrapped in nonwoven, (3) Ethylene Oxide sterilized surgical instrument packages, and (4) autoclaved linen packages wrapped in nonwoven. Organisms detected were both Gram–Positive and Gram-Negative bacteria. Just only approximately 17% control samples grew bacteria. There was no any statistically significant relationship between positive experimental samples and packaging materials, sterilization methods, or storage conditions. Conclusions: Based on results of this experiment, shelf life of sterilized packed items should be still followed by time-related principle in UMC. However, the currently shelf life can be extended to reduce unnecessary costs and increase the usage rotation.

Objectives: The competency of infection control nurses (ICNs) plays a pivotal role in enhancing the quality of healthcare facilities. This descriptive study aimed to assess the competency level of ICNs in South Korea and identify influencing factors. Method: An online self- administered questionnaire survey was conducted through an announcement on the Korean Infection Control Nurses Association website. An online self-administered questionnaire was distributed via the Korean Infection Control Nurses Association website, garnering responses from 199 participants out of 450 approached. Statistical analyses, including descriptive statistics and multiple regression analysis, were conducted using SPSS/WIN 27.0 software. Result: Analysis reveals that participants had an average age of 34.8 (8.4) years and an average of 5.0 (4.7) years of experience in infection control. The competency score for infection control was 3.6 out of 5. Competency levels varied across domains, with the highest scores observed in employee safety and infection control domains, while the lowest scores were in infectious disease identification and communication domains. Significant variables affecting competency, as identified through univariate analysis, included awareness of infection control competency, age, education level, ICN experience, position, and possession of an infection control specialist license. Ultimately, factors influencing ICN competencies were determined to be awareness of infection control competencies, attainment of a master’s degree or higher, over 5 years of ICN experience, and age over 50, collectively explaining 45.6% of the variance. Conclusion: Enhancing the competency of ICNs is crucial for effective infection control in medical settings. Strategies to improve awareness of infection control competencies and provision of continuous education support and career development programs for ICNs are essential to achieve this goal.