In a world of increasing human movement and displacement, language learning is an educational concern with significant implications for social inclusion in contexts of migration. This review of recent research analyses 40 empirical studies which explore various aspects of language education with adult migrants, investigating what they reveal regarding pedagogical approaches and the impact of policy on language learning, teaching, and assessment. It identifies issues in relation to diversity among adult migrant learners, the value of multilingual practices and the recognition of multiliteracies, as well as the potential of digital learning and affective approaches to language teaching. In addition, this review shows how migration and integration policies can influence language instruction, considering programme design, testing requirements, the learning of minoritised languages, and the role of educators in this field. It outlines directions for further research in areas including critical multilingual approaches to language teaching, equitable forms of assessment, trauma-informed pedagogy, the development of inclusive policies, and teacher education. This paper can thus inform educators, researchers, and policymakers by providing insights which may guide language-related educational support for adult migrants.

Background: Central line-associated bloodstream infection (CLABSI) is one of the four most common healthcare-associated infections worldwide and often results in serious consequences, including prolonged treatment duration, increased antibiotic usage costs, and higher mortality risk. In Vietnam, the CLABSI rate in intensive care units (ICUs) remains high, ranging from 5 to 10 episodes per 1,000 central venous catheter (CVC)-days. Therefore, implementing a CLABSI prevention bundle in ICUs is urgently necessary to ensure patient safety. Methods: A CLABSI prevention bundle was developed, consisting of an insertion bundle and a maintenance care bundle. Training and implementation were conducted in three ICU units: Neurosurgical ICU Dept. (NsICU), Internal Cardiology Dept. (IC), and Cardiac surgery resuscitation Dept. (CSR) from February to September 2025. External audits were conducted on all CVC insertion cases and 5% of CVC maintenance care opportunities in the three departments. Results: The total number of insertion bundle observation opportunities in NsICU, IC, and CSR were 67, 35, and 43 respectively, with average compliance rates increasing over time as follows: 96.76% (range 91.67–100%), 89.46% (range 79.63–95.83%), and 97.18% (range 85–100%). The total number of maintenance care observation opportunities in NsICU, IC, and CSR were 86, 63, and 53 respectively, with average compliance rates over time increasing as follows: 78.07% (range 70–87.5%), 87.75% (range 75–100%), and 82.41% (range 72.73–100%). Despite this, there were certain periods with low compliance rates for both the insertion and maintenance care bundles, particularly in areas such as proper hand hygiene procedures, insufficient antiseptic contact time, and non-compliance with drying time requirements. The average CLABSI rates post-intervention compared to pre-intervention in NsICU, IC, and CSR decreased from 2.38 to 1.6 (P=0.54), from 3.15 to 2.57 (P=0.68), and from 2.4 to 2.02 (P=0.75), respectively. Conclusion: The initial implementation of the CLABSI prevention bundle in three clinical departments led to progressively improved compliance with both CVC insertion and maintenance care practices, contributing to a reduction in CLABSI rates compared to the pre-intervention period.

Background: Nasal colonization with Staphylococcus aureus is a well-established risk factor for central line–associated bloodstream infections (CLABSIs). Many institutions have adopted screening and targeted decolonization strategies using intranasal mupirocin; however, real-world implementation remain incompletely characterized. Methods: We conducted a retrospective cohort study at University Hospitals Cleveland Medical Center to evaluate implementation of S. aureus screening and decolonization protocol among hospitalized adults undergoing central venous catheter (CVC) or peripherally inserted central catheter (PICC) placement. All patients aged ≥18 years admitted between October 1, 2023, and May 5, 2025, who had a catheter placed were included. Patients with documented bloodstream infection at the time of catheter placement were excluded. Primary implementation outcomes were: (1) proportion of patients screened for S. aureus colonization, and (2) proportion of colonized patients who received prophylactic intranasal mupirocin. Secondary outcomes included overall mupirocin use, bloodstream infection (BSI), and CLABSI rates. Mixed effects logistic regression was performed to identify factors associated with screening uptake. Results: Among 11,107 central lines placed, 63.4% underwent S. aureus screening. Of those screened, 22.6% tested positive for Staph aureus. Only 21.2% of colonized patients received intranasal mupirocin, corresponding to an overall mupirocin use rate of 5.3%. Across all central lines placed during the study period, the overall BSI and CLABSI rates were 0.91% and 0.67%, respectively. In adjusted analyses, screening was more likely among patients with arm insertion sites (OR 1.68, 95% CI 1.34–2.12), left-sided catheter (OR 1.18, 95% CI 1.07–1.29), increasing catheter lumens (three lumens: OR 1.27, 95% CI 1.11–1.47; four lumens: OR 2.22, 95% CI 1.58–3.12), ICU location (OR 1.66, 95% CI 1.49–1.84), and hematology–oncology services (OR 1.51, 95% CI 1.12–2.03). Although catheter type itself was not independently associated with screening, patients receiving PICCs demonstrated a positive, though non-significant, trend toward higher screening uptake compared with CVCs (OR 1.15, 95% CI 0.91–1.47). Tunneled catheters (OR 0.87, 95% CI 0.79–0.97) and a higher number of prior inpatient admissions were associated with lower odds of screening, while demographic characteristics and most comorbidities were not. Conclusions: S. aureus screening uptake among patients with central lines was low, and gaps at subsequent steps in the process resulted in fewer than one quarter of colonized patients receiving mupirocin. This stepwise breakdown in implementation highlights opportunities to improve protocol reliability by reducing decision points through more standardized approaches.

Background: High-level disinfection (HLD) of ultrasound probes is a required patient safety and regulatory practice. Automated vaporized hydrogen peroxide (VHP) systems, widely implemented for HLD since 2011, involve sizable capital costs, substantial maintenance requirements, and lengthy probe turnaround times. Chlorine dioxide foam has been used for ultrasound probe HLD in Europe since the late 1990s and received U.S. Food and Drug Administration clearance in 2023, consistent with the ANSI/AAMI ST58 standard. Evidence describing operational impact and feasibility in U.S. outpatient practice remains limited. Objective: To compare workflow and probe turnaround times between two ultrasound probe HLD methods and to evaluate the feasibility of chlorine dioxide foam implementation, including staff training requirements and adherence to reprocessing protocols. Methods: From October 2025 to January 2026, we conducted a quality improvement study examining the transition from automated VHP to manual chlorine dioxide foam for transducer HLD in an outpatient urology practice. A total of six registered nurses and four medical assistants participated in the study. Training provided to staff included manufacturer-provided online training, 1:1 in-person instruction, and direct observation to confirm competence with the new reprocessing protocol. Workflow steps for both HLD methods were mapped and compared. Outcomes measured included probe turnaround time (defined as the interval from immediate post-use handling to readiness for subsequent clinical use); number of workflow steps; feasibility of protocol-specific staff training; and adherence to the reprocessing protocol. Results: Each of the methods had a comparable number of workflow steps. Average probe turnaround time for chlorine dioxide was four minutes, while the automated VHP system required 14–15 minutes. Most participants completed manufacturer-provided online training. All participants received 15 minutes of 1:1 in-person instruction and direct observation. Overall, direct observation demonstrated high adherence to the reprocessing protocol. The manual foam process was integrated into routine clinical workflows without disruption to patient care. Conclusion: In a single outpatient urology practice, manual chlorine dioxide foam disinfection was feasible to implement and integrated into existing workflows with considerably shorter probe turnaround time while maintaining staff adherence. Results informed our policy on workflow steps, training, and documentation. Observations were conducted over a limited period, and findings may not be generalizable to other clinical settings.

Background: Patients with NAAT positive/toxin EIA-negative C. difficile infections (TNCDI) represent a spectrum from fulminant infection to asymptomatic colonization. We assessed differences in patient and provider factors associated with TNCDI treatment. Methods: A retrospective review was performed of all hospitalized patients ≥ 18 years with TNCDI from Jan 1st 2018 to Dec 31st 2024. Patients who received anti-CDI treatment were compared to those who did not using chi squared and Mann-Whitney U test. Variables with P≤0.2 were considered for inclusion in the final multivariable model. Results: We identified 550 patients with TNCDI; 488 (88.7%) received treatment while 62 (11.3%) did not (Table). The annual number of cases of untreated TNCDI significantly increased from 2018 to 2024 (p=0.026) (Figure). There were no significant differences in age, race, BMI, or provider services between the two groups. A higher proportion of untreated TNCDI occurred among women and in community-acquired cases. In multivariate analysis, community-acquired diagnosis of infection (within 72 hours of admission) was the only significant predictor of treatment (OR for treatment 0.50, p=0.03) (Table). In unadjusted analysis, treated TNCDI patients had higher LOS after diagnosis and mortality compared to untreated patients. Conclusion: The vast majority of TNCDI received anti-CDI treatment, though the proportion of untreated TNCDI cases increased significantly over time, likely reflecting antibiotic stewardship-based improvements. Patient and provider factors were similar between treated and untreated TNCDI groups, although small sample size of untreated TNCDI patients limited power. Treated TNCDI was associated with significantly longer LOS and mortality compared to untreated TNCDI.

Background Decolonization decreases risk of healthcare-associated and post-discharge infections. Most decolonization data are derived from methicillin-resistant Staphylococcus aureus (MRSA) studies, although results have been extended to other multidrug-resistant organisms (MDRO). Understanding MDRO target outcomes and preferred product characteristics may inform new decolonization protocols, products, and strategic integration into infection prevention practices. Methods We surveyed 134 Society for Healthcare Epidemiology of America (SHEA) Research Network-affiliated US healthcare facilities on MDRO surveillance, isolation, and deisolation practices. The survey asked about decolonization practices, needs, and gaps. The survey was administered via REDCap from 1/7/25-2/25/25, and responses were de-identified. Frequencies and proportions were analyzed in REDCap and Excel. This survey was considered nonhuman subjects research by the Mass General Brigham Institutional Review Board. Results Of 134 facilities surveyed, 52 (39%) completed the decolonization section of the survey. 38/52 (73%) facilities reported performing some form of decolonization. Of these, 87% said the most important decolonization outcome is reduced risk of progression to infection. Lab-based clearance (8%) and reduced risk of transmission (5%) were considered less important. Using carbapenem-resistant Enterobacterales (CRE) as an example of an MDRO without established decolonization products or protocols, respondents’ interest in decolonization increased with patient vulnerability to invasive disease (Figure 1). Preferred decolonization agent characteristics varied by patient population, e.g. a majority selected transmission interruption in the non-intensive care unit compared to patient-specific efficacy in the transplant population (Figure 2). Half of the surveyed facilities reported having unmet decolonization needs. Across all patient types, the most commonly reported reasons not to decolonize were “efficacy not worth the effort”, “wouldn’t protect the patient” and “effect won’t last” (Figure 3). Approximately one quarter of respondents said they would not want to decolonize for “other” reasons including, “no established protocol” and “unclear evidence”. Conclusions Facilities reported valuing decolonization as a means to prevent progression to infection, but transmission prevention was rarely selected as an important outcome of decolonization. Due to reported preferences of agent characteristics by patient population, there may be opportunities for development of population-specific products. Product design should prioritize decolonization agents that are easy to administer, highly effective, and provide long-lasting impact. Evidence-based, standardized decolonization protocols, particularly for gram negative MDRO, are needed to address barriers and support decolonization in prevention of transmission as well as infection.

Background: Parvovirus B19 causes a spectrum of illness in children, from asymptomatic infection to severe organ-invasive disease, particularly in immunocompromised hosts. Current infection prevention guidelines recommend prolonged isolation for patients with chronic infection, yet no validated quantitative PCR threshold exists to guide discontinuation of precautions. This uncertainty may lead to extended isolation and resource utilization. Objective: To evaluate the association between quantitative parvovirus B19 PCR levels and clinical manifestations in pediatric patients and explore implications for infection control practices. Methods: We conducted a retrospective observational study of patients aged 0–18 years who underwent quantitative parvovirus B19 PCR testing in a quaternary care hospital system from January–December 2024. Demographics, clinical features, and treatment were abstracted from the electronic medical record. Encounter-level and patient-level characteristics were summarized using Fisher’s exact and Kruskal-Wallis tests. Multivariable generalized estimating equation (GEE) models assessed factors associated with symptomatic infection. Optimal viral load cut-off associated with symptomatology was determined using Youden’s index. A patient with symptomatic infection was defined as having one or more signs/symptoms associated with clinical parvovirus B19 infection (fever, rash, arthropathy, cytopenias, carditis, hepatitis, etc.) that was not explained by a pre-existing underlying condition. Results: Among 103 patients (median age 7 years [IQR 4–11]), 224 encounters were analyzed; 57% were symptomatic (Table 1). Median viral load was 647,500 IU/mL (IQR 6,800–15,500,000) in symptomatic encounters versus 2,000 IU/mL (IQR 900–8,400) in asymptomatic (p<0.001). An optimal threshold of ?25,000 IU/mL (log10 ?4.4) was strongly associated with symptoms (adjusted OR [aOR] 6.54, 95% CI 1.98–21.64; p=0.002). Additional predictors associated with symptoms included hemoglobinopathy (aOR <700; p<0.001) and diagnostic testing indication (aOR 155.01, p<0.001). Viral load was not associated with organ-invasive disease or treatment response. Conclusions: Higher parvovirus B19 viral loads are associated with symptomatic infection, but not with organ invasion or treatment initiation. A threshold of ?25,000 IU/mL may inform future infection prevention guidance, potentially helping to modify isolation practices and improving resource utilization.

Background: Admission to a room previously occupied by a patient with Clostridioides difficile infection (CDI) has been identified as a risk for CDI. However, previous studies have not included molecular typing to definitively link healthcare-associated CDI (HA-CDI) cases to prior room occupants or to residual spore contamination on surfaces. Methods: In an acute care hospital, we conducted a 1-year cohort study to determine the proportion of HA-CDI cases linked to prior room occupants with CDI or to room surfaces remaining contaminated after post-discharge cleaning and disinfection. Cultures were collected from post-discharge CDI and non-CDI rooms. Whole genome sequencing was used to determine relatedness of isolates. We calculated the percentage of HA-CDI cases infected with isolates genomically related to prior room or ward-level exposures. Results: Of 5,746 patients admitted, 22 had community-associated CDI and 55 were diagnosed with HA-CDI. C. difficile was recovered from 79 of 327 (21%) post-discharge rooms, including 14 of 36 (39%) CDI rooms and 83 of 287 (29%) non-CDI rooms. Of 1,773 patients with room-level exposure to prior CDI patients or contaminated surfaces, 21 (1%) developed HA-CDI, but none were infected with genomically-related isolates (Figure 1.A). Of 49 patients developing HA-CDI after ward-level exposures, 3 were infected with isolates genomically related to prior CDI patients or contaminated surfaces on the ward (1.B). Conclusion: Despite frequent exposure to rooms previously occupied by patients with CDI or contaminated with C. difficile, no HA-CDI cases were linked to prior room exposures based on whole genome sequencing.

Background: Device stewardship is an important infection prevention opportunity for catheter-associated urinary tract infection reduction. This starts with the avoidance of initial catheter placement without definitive clinical need, especially with the option of alternative of non-invasive foley devices for both male and female anatomy. Urinary catheter placement in the Emergency Department (ED) is an area of opportunity where catheter placement could be avoided in favor of non-invasive management. This study assessed potential unnecessary catheter placement in a community hospital-based ED with a focus on ED-placed urinary catheters removed within 24 hours of admission. Methods: All patient encounters with an indwelling urinary catheter placed in 3 community hospital EDs from May 20, 2024 through September 29, 2025 were included. Encounters for patients who required chronic urinary catheterization (defined as the presence of a urinary catheter for ≥ 45 days) who had catheter replacement in the ED were excluded. The frequency of possible unnecessary catheter placement was defined as the number of catheters removed within 24 hours out of the total encounters. A subset of charts for encounters with a possible unnecessary catheter placed were reviewed to assess for commonalities to guide quality improvement. Results: During the study period, across all 3 facilities, 27.7% (385/1391) of urinary catheters placed in the ED were removed within 24 hours with a similar frequency at each individual facility (Hospital 1 = 24.6% (82/334), Hospital 2 = 24.9% (121/486), Hospital 3 = 31.9% (182/571)). The monthly frequency of possible unnecessary catheter placement ranged between 12.5% to 48.4% (Figure 1). Based on chart review, several common themes were noted, including placement in patients with altered mental status without hemodynamic instability and in patients with brief transient hemodynamic instability weaned from low dose inotropic medications and ventilation within 24 hours of admission. A clinical decision-making tool was created targeting recurrent scenarios that might warrant catheter avoidance (Figure 2). Discussion: ED placement of urinary catheters that were quickly removed by clinical teams upon admission was common across 3 community-based hospitals, highlighting possible unnecessary placement upon evaluation by the inpatient teams. A proposed clinical decision tool was created to help guide physicians in the reasoning behind the perceived need for catheter placement in the ED versus waiting to evaluate clinical need upon admission based upon patient course and failure of alternative methods for urine output management.

Background: Due to concern for ongoing colonization and substantial risks posed by horizontal transmission of RGN in acute care settings, it is common practice in many institutions to employ indefinite CP once a patient tests positive for resistant bacteria. However, it is important to recognize the adverse environmental and patient care costs of CP which has led institutions to consider structured CP discontinuation policies. Emerging evidence supports implementation of practices to safely discontinue CP in select patients following a defined period without subsequent positive cultures. Despite this, standardized methods to identify eligible patients remain unexplored. Objective: As a part of a larger study to evaluate our institution’s adopted policy of contact precaution (CP) discontinuation for resistant gram negative organisms (RGNs) after one year of no subsequent positive cultures, we aimed to assess the utility of a retrospective audit of medical records as a strategy to identify patients eligible for CP discontinuation. Methods: A retrospective chart review of patients with identified RGNs in the Children’s Hospital of Philadelphia (CHOP) electronic medical record (EMR) system from May 2021 to November. In concordance with the internal policy established November 202 recommending removal of contact precautions after one year without subsequent RGN culture positivity, each chart was assessed for the date and organism of the initial infection as well as last positive culture to determine eligibility for CP removal. Patients with carbapenem resistant organisms or those with cystic fibrosis were excluded from the review. Results: Of the/of the identified patients were determined to be eligible for de-labeling. The time required to determine eligibility status in the EMR was approximately 1 minute per patient totaling around 2.5 hours of review. Conclusion: This review identified a significant proportion of RGN-positive patients for whom standing CP were not removed in real time, allowing for an efficient update of CP status to align with hospital policy. Removal of CP not only alleviates a significant environmental and financial burden but also could contribute to a more positive patient/family experience during the hospital stay. The results of this study suggest that employing prospective plans for chart audits as CP discontinuation policies are modified would improve resource utilization.

Background: Timely conversion of intravenous (IV) antibiotics to oral (PO) therapy remains a core principle of antimicrobial stewardship. Appropriate transition from IV to PO medications reduces the potential for adverse events such as line infections and thrombophlebitis but may also reduce healthcare costs by potentially facilitating a timelier discharge. In addition, IV to PO supports sustainability initiatives by reducing the environmental impact of single-use IV bags and tubing, and PO antibiotics are prepared more quickly by pharmacy and administered easier by nursing, lessening staffing requirements. Methods: Emory Healthcare developed a fully automated dashboard to monitor IV to PO transitions and assess adherence to institutional protocols. The dashboard details antibiotic utilization and documented indication for select IV and PO agents among inpatients at Emory Healthcare from January 2024 to the current year-to-date. Selected antibiotics were chosen based on their inclusion in the Emory Healthcare IV to PO Medication Conversion by Pharmacist Protocol. The dashboard integrates data from the electronic health record including antibiotic selection, infection type, and days of therapy. The data is organized into sections and graphs for streamlined viewing and clear interpretation. Results: A dashboard was successfully created to monitor IV to PO therapy conversions. The first section (Figure A) shows days of therapy (DOT), which can be filtered by operating unit and indication. The second section (Figure B) displays DOT filtered by route and indication for the specific antibiotics included in the Emory Healthcare IV to PO conversion protocol. The third section (Figure C) displays DOT filtered by route and antibiotic for all indications. The antibiotic and indication charts can additionally be filtered to include any combination of antibiotics, indications, facility, unit type, and units. The dashboard also includes tables with antibiotic route of administration data stratified by facility, unit type (ie. oncology, emergency, operating room, acute care), and individual unit. Conclusion: The dashboard provides a novel tool for ASPs to continuously assess utilization and adherence to the Emory Healthcare IV to PO conversion protocol. The dashboard is interactive, customizable, and data is readily available, making it a key tool for optimizing stewardship practices. The data can also be used to identify stewardship opportunities, set quality improvement targets, and quickly display information to key stakeholders.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an opportunistic organism that can cause serious infections that are difficult to treat. CRAB often possesses concerning resistance mechanisms, including carbapenemase enzymes, which can spread resistance through mobile genetic elements. Prevention-driven point prevalence surveys (PPSs), a strategy outlined in the Centers for Disease Control and Prevention’s multidrug-resistant (MDRO) prevention guidance, can enable early identification of colonized patients and inform targeted infection control measures to mitigate transmission. From 2024-2025, the Louisiana Office of Public Health partnered with a long-term acute care hospital (LTACH) to implement prevention-driven PPSs for CRAB. Methods: LTACHs were targeted due to the increased risk of MDRO colonization among high-acuity patients admitted for prolonged periods. A webinar was held for LTACH facilities in a region of the state with a high CRAB burden, and one facility agreed to participate. The PPSs were conducted quarterly for one year. Testing was performed by the Southeast Antimicrobial Resistance Laboratory Network (ARLN) and included organism confirmation, real-time polymerase chain reaction to detect carbapenemase genes, antimicrobial susceptibility testing, and whole genome sequencing (WGS). Methods are described on ARLN's website. Genetic relatedness and pairwise single nucleotide polymorphism (SNP) differences among isolates were analyzed using the National Center for Biotechnology Information Pathogen Detection Isolate Browser. Result: From February 2024 to January 2025, 121 specimens were collected from 87 patients. Screening sites included axilla-groin (71%), wounds (20%), and rectum (9%). Five percent (4/87) of the patients were found to be colonized with CRAB. These isolates were resistant to all carbapenems tested (meropenem, doripenem, and imipenem), produced OXA-23 or OXA-24/40 carbapenemases, and two of the isolates were pan-resistant. Three CRAB patients were identified within the same SNP cluster and were closely related, averaging 12 SNP differences. One CRAB patient was also colonized with Stenotrophomonas maltophilia. Additionally, 4 different patients (5%) tested positive for Pseudomonas aeruginosa; 3 were carbapenem-resistant, and of these, 1 was pan-resistant. Colonized patients exhibited typical risk factors for MDRO colonization, including underlying conditions, wounds, recent antimicrobial exposure, and indwelling device use. Conclusion: Screenings enabled routine assessment of CRAB colonization burden. PPSs identified colonized patients who may have otherwise gone unrecognized, allowing for timely implementation of infection control actions. WGS detected a previously-unknown cluster, indicating transmission within healthcare facilities. These findings align with and support current MDRO containment guidance and underscore the importance of conducting screenings in high-risk healthcare settings to reduce MDRO exposure among vulnerable patients.

Background: Blood culture contamination (BCC) is a persistent problem in the hospital, contributing to unnecessary antibiotic exposure, excessive diagnostic testing, increased length of stay, and higher costs. For patients with suspected or confirmed sepsis, BCC has particularly serious implications, as early identification of the causative pathogen and prompt initiation of appropriate antimicrobial therapy are critical. National benchmarks define <3% contamination as acceptable, yet emerging evidence supports a more ambitious goal of ?1%, particularly in high-risk populations such as patients with sepsis. Methods Using a sequential practice change across three time periods: (1) no blood culture diversion device (2019–2020), (2) implementation of manual blood diversion device (BDD) #1 (2021–2022), and (3) automatic BDD#2 (2023–present), we have achieved a 74% reduction in BCC (Figure 1). In this project, we further evaluated the impact of this overall reduction on patients admitted with suspected or confirmed sepsis. Results Data were extracted for adult patients admitted to the hospital who had a final discharge diagnosis of sepsis, regardless of their initial admission diagnosis. A total of 154 blood cultures were analyzed across the three time periods. During period 1 (2019 & 2020), 6/62 cultures were contaminated (9.7%). After implementation of manual BDD#1 (11/17/2021-2022), BCC decreased to 2/30 cultures (6.7%). After transition to automatic BDD#2 (1/20/2023-present), BCC further declined to 3/62 cultures (4.8%). One-way analysis of variance (ANOVA) demonstrated a statistically significant difference in BCC rates across the time periods, with post hoc comparisons showing a significantly lower contamination rate when using BDD#2 as compared with both no BDD and manual BDD#1. Additionally, manual BDD#1 was used in 48% (30/62) of the blood culture collections versus to 78% for automatic BDD#2, with staff feedback indicating greater ease of use with the automatic BDD#2 system. Conclusion Adoption of BDD was associated with a 50% (9.7-4.8%) reduction in BCC, with the lowest rates following implementation of automatic BDD#2. Compliance with BDD use was also highest with automatic BDD#2, and staff reported greater ease of use. These findings underscore the importance of optimizing BCC practices as a key component of sepsis management, antimicrobial stewardship, and patient safety efforts. Additional research is needed to identify strategies to further reduce BCC in sepsis patients, with particular attention to BDD usability, workflow integration, and process adherence during real-world use.

We give a new definition of matrix Schwarzian derivative, which is simpler than the Lagrange Schwarzian derivative and also provides an alternative to other definitions which appear in the literature. Some basic properties are discussed, in particular, analogs of Möbius invariance and the result of a change of independent variable, these being the two properties of the scalar Schwarzian derivative often considered to account for its universality. We then use our new definition of matrix Schwarzian derivative to construct new Schwarzian matrix ordinary and partial differential equation hierarchies: a Schwarzian matrix second Painlevé hierarchy and a Schwarzian matrix Korteweg–de Vries hierarchy, respectively. In addition, we define a new matrix second Painlevé hierarchy.

Background: Carbapenemase-producing Enterobacterales (CPE) spread silently and offer limited treatment options, making contact screening essential. We evaluated the real-world implementation of contact screening, focusing on screening timing (at exposure vs. at readmission) and positivity rates by room type and carbapenemase enzyme. Methods: This retrospective observational study was conducted at a 2,700-bed tertiary care hospital and included patients identified as contacts of CPE index cases with exposure between 1 January and 31 May 2024. Contacts were defined as patients who shared a room or occupied open beds in the same intensive care unit (ICU) with an index case during the period from 4 days before the index patient’s positive specimen collection until the reporting of results. Screening was performed with stool or rectal swabs either at the time of exposure or upon readmission within 6 months. CPE acquisition was defined as detection of isolates harbouring the same carbapenemase enzyme as the corresponding index case. Acquisition rates were compared by screening timing, room type, and carbapenemase enzyme. Samples were processed using culture or the Xpert Carba-R assay. Result: Among 2,003 contacts linked to 336 index patients, 1,401 (70%) underwent screening, of whom 37 (2.6%) tested positive. Immediate screening identified 30/1,184 (2.5%) positives, while readmission screening detected 7/217 (3.2%); two additional acquisitions were identified from clinical specimens among unscreened readmitted contacts. Acquisition was more frequent after exposure to KPC-producing organisms than NDM-producing organisms (3.7% [26/706] vs. 1.5% [8/520]; p=0.02) and higher in multi-patient rooms than in two-bed or open-bed ICU settings combined (3.4% [34/1004] vs 0.8% [3/397]; p=0.006). Conclusion: CPE acquisition was more likely following exposure to KPC-producing organisms and in multi-patient rooms. Systematic readmission screening identified additional carriers who would otherwise have been missed. These findings support tailored infection-prevention strategies that consider carbapenemase enzyme and the physical care environment, particularly in healthcare systems where multi-patient rooms are common.

Background: In 2026, demonstrating the value of healthcare epidemiology and infection prevention is critical amid vaccine and science denialism and federal funding cuts. As hospitals face increasing financial pressures, executives may question sustained investment in healthcare epidemiologists and infection preventionists. Clinicians and nurses may also disengage from pay-for-performance or value-based initiatives. This project aimed to present a practical method for quantifying program outcomes for senior leadership, expressed as lives saved and costs avoided. Methods: Twelve types of healthcare-associated infections (HAI), including device-associated, laboratory, and surgical site infections—were identified across an eight-hospital health system in upstate New York using standardized CDC National Healthcare Safety Network definitions. Attributable mortality estimates were derived from published evidence. In the absence of improvement, infection rates were assumed stable year to year. Rates (R) from 2024 were multiplied by corresponding 2025 denominators (device days, patient days, or surgeries) (PD2025) to calculate expected infections (EI). Infections prevented (IP) were calculated as IP2025 = EI2025 – OI2025, where OI represents observed infections. To estimate total lives saved (TS) in 2025 compared with 2024, infections prevented (IP2025) were multiplied by the attributable mortality (AM) of each infection type to obtain lives saved (LS), then summed: IP20251 ՠAM1 = LS1; TS = ?LS. One-way sensitivity analyses across reported mortality ranges were performed using R. Cost avoidance was determined using facility-specific HAI costs and nationally reported cost ranges. Results: In 2025, 67 HAIs were prevented, corresponding to about five additional lives saved compared with the previous year (Table). The method also allowed estimation of costs and bed days saved. In our health system, each central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) adds $97,588 and $61,939 in excess costs and 16.9 and 8.8 additional bed days, respectively. Using these and other adjusted HAI cost estimates for 2025, prevention of 67 infections yielded approximately $3.1 million in cost avoidance and 842 fewer inpatient bed days. Conclusion: Expressing outcomes as lives saved resonates more with executives and clinicians than abstract performance metrics. Because overuse of preventive measures (including unnecessary isolation) can cause collateral harm, prioritizing mortality outcomes is more relevant than pursuing reductions in rates or standardized infection ratios of all HAI types at any cost. This practical, generalizable method enables facilities, including those with limited research infrastructure, to quantify the impact of infection prevention and control and highlights the substantial effect of carbapenem-resistant Enterobacterales on overall mortality.

Organic vegetable production relies on ecologically based practices; however, insect pest management remains a major constraint, particularly in Brassica crops. Organic insecticides often provide inconsistent control, are expensive, and require repeated applications. Mesotunnels, medium-sized tunnels (0.9–1.0 m tall) covered with insect netting, have emerged as a pest management tool for organic vegetable growers. They function as physical barriers that exclude pests while maintaining near-ambient microclimatic conditions. This two-year field study was conducted during the fall growing seasons of 2024 and 2025 on certified organic land at Iowa State University Horticulture Research Station in Ames, Iowa, to evaluate the effectiveness of mesotunnels for pest management and season extension in organic napa cabbage (Brassica rapa var. pekinensis cv. ‘Minuet’). Treatments were arranged in a randomized complete block design with four replications: (i) Mesotunnel, (ii) Mesotunnel + OMRI-listed insecticide, (iii) OMRI-listed insecticide (pyrethrins, Bacillus thuringiensis, and potassium salts of fatty acids), (iv) Low tunnel, and (v) an untreated control. Weekly pest scouting quantified the abundance of key Brassicaceae pests, including caterpillars, flea beetles, harlequin bugs, and aphids. Microclimate variables, including temperature and relative humidity, were continuously monitored at canopy height within each treatment. Marketable and nonmarketable yield were assessed at harvest using USDA commercial grading standards. Across both years, mesotunnel-based treatments consistently reduced insect abundance and produced the greatest number and weight of marketable napa cabbage heads relative to the control. Mesotunnels also advanced crop maturity, resulting in a higher proportion of marketable heads at the first harvest compared with open-field conditions. This is likely associated with modified microclimatic conditions that supported vegetative growth and reduced pest pressure. These findings demonstrate that mesotunnels provide an effective, non-chemical pest management strategy that enhances yield and reduces reliance on organic insecticides in organic napa cabbage production systems.

Bernard Williams contends that philosophy is part of a broader humanistic enterprise of ‘making sense of’ ourselves and our activities, including the activity of science. Whereas the scientific enterprise purports to offer an absolute conception of the world as it is (independently of any local perspective on it), the humanistic enterprise cannot disengage itself from the contingent history of our ideas upon which it operates. While I agree with Williams that philosophy should be more attentive to history, his account of philosophy, from which he derives this conclusion, is fatally flawed, being unable to meet three perennial challenges to any principled defense of philosophy as a discipline: i.e., the questions of authority, incubativity and peculiarity. Those challenges can be met only if we understand philosophy not as a humanistic discipline that is part of the broader humanistic enterprise, but as a distinctively normative discipline that tasks itself with finding answers to explicitly or implicitly normative questions, in contrast to various scientific and humanistic disciplines of descriptive inquiry. In this paper, I argue for the equivalence of philosophicality with normativity, explicate the theoretical and practical implications of the normative account of philosophy, and defend it against potential objections.