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To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs).
Design:
Retrospective cohort study.
Methods:
Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method.
Results:
Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively.
Conclusions:
MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.
Puttapaite, Pb2Mn2+2ZnCr3+4O2(AsO4)4(OH)6·12H2O, is a new mineral from the Beltana deposit, Puttapa, Flinders Ranges, South Australia, Australia. It forms rosette-like aggregates to 50 micrometers across composed of diamond-shaped tablets to 45 micrometers in length and 5 micrometers in thickness. Crystals are flattened on {001} and the observed forms are {001} and {110}. The calculated density is 3.562 g/cm–3. Optically, puttapaite is biaxial (−) with α = 1.700(5), β = 1.720(5), γ = 1.730(5) and 2V (meas.) = 67(1)°. Electron microprobe analyses gave the empirical formula (based on 36 oxygen atoms pfu) Pb1.96(Mn2+1.52Ca0.28Sr0.22)Σ2.02(Zn0.40Mg0.39Cu0.15)Σ0.94(Cr3+2.89Al0.45Fe3+0.40,Mn3+0.26)Σ4.00O2[(AsO4)3.71(Cr6+O4)0.29]Σ4.00(OH)6.13·11.87H2O. Puttapaite is monoclinic, C2/m, with a = 12.405(3), b = 10.565(2), c = 12.311(3) Å, β = 106.06(3)°, V = 1550.4(6) Å3 and Z = 2.
The structure was solved using synchrotron single-crystal X-ray diffraction data and refined to R1 = 0.1189 on the basis of 915 observed reflections with F0 > 4σ(F0). Puttapaite has a unique structure that consists of M4O16 clusters that share corners with TO4 tetrahedra, which in turn share corners with M1 octahedra in the [010] direction. Clusters link in the [001] direction via corner sharing M2 octahedra to form sheets parallel to {100}. Pb anions lie between the sheets.
One of the ‘critical goals’ for psychiatric liaison services is reducing hospitalisation. Psychotropic medication is a treatment for psychosis, although research determining the efficacy of early medication administration is lacking.
Aims
To determine whether commencing psychotropic medication within 2 days of psychiatric liaison input in the accident and emergency (A&E) department is correlated with length of in-patient psychiatric admissions for patients with psychosis.
Method
We gathered data on patients presenting to A&E sites covered by South London and Maudsley (SLaM) National Health Service Trust, who were subsequently admitted to and discharged from SLaM psychiatric in-patient wards with discharge diagnosis of psychosis between 2015 and 2020. The analysis set comprised 228 patients waiting in the A&E department under psychiatric liaison care for ≥2 days, of which 140 were started on medication within those 2 days (group A) and 88 were not (group B). Group A was divided into A1 (patients restarted on previous psychotropic medication taken within 1 week) and A2 (others, including those new to psychotropic medication or with past usage).
Results
Although Kaplan–Meier survival curves with log-rank tests demonstrated no statistically significant difference of in-patient admission duration between groups A and B or groups B1 and B2, further analysis revealed that subgroup A1 had statistically significant shorter admissions than group B (P = 0.05).
Conclusions
Restarting patients with psychosis on medication they were taking within the week before A&E department attendance, within 2 days of arrival at the A&E department, is associated with statistically significant shorter admissions. The limitation is a relatively small sample size.
Antimicrobial resistance (AMR) is positioning as one of the most relevant threats to global public health and threatens the effective treatment of an ever-growing number of bacterial infections in various healthcare settings, particularly in acute care and surgical units, as well as in the community. Among multidrug-resistant (MDR) gram-negative bacteria (MDRGNB), Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii require special attention, since they account for most of the mortality associated with bacterial infections and are often MDR. It is clear that there is an important global variation in antibiotic resistance profiles among MDRGNB species. Extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, DTR-P. aeruginosa, and MDR-A. baumannii are the focus of this review. Here, we summarize a series of relevant studies on risk factors associated with colonization and infection with these MDRGNB. Likewise, we offer a comparative overview of those studies providing scoring systems to predict the risk of infection with these MDR pathogens, and their pros and cons. Despite the variable accuracy of published risk factors for predicting colonization or infection with MDRGNB, these scores are valuable tools that may help anticipate colonization and infection among those colonized. More importantly, they may help reduce unnecessary use of broad-spectrum antimicrobials and guiding the selection of an optimal treatment.
Coercive measures to manage disruptive or violent behaviour are accepted as standard practice in mental healthcare, but systematic knowledge of potentially harmful outcomes is insufficient.
Aims
To examine the association of mechanical restraint with several predefined somatic harmful outcomes.
Method
We conducted a population-based, observational cohort study linking data from the Danish national registers from 2007 to 2019. The primary analyses investigated the association of mechanical restraint with somatic adverse events, using panel regression analyses (within-individual analysis) to account for repeated exposures and outcomes. Secondary between-group analyses were performed with a control group exposed to types of coercion other than mechanical restraint.
Results
The study population comprised 13 022 individuals. We report a statistically significant association of mechanical restraint with thromboembolic events (relative risk 4.377, number needed to harm (NNH) 8231), pneumonia (relative risk 5.470, NNH 3945), injuries (relative risk 2.286, NNH 3240) and all-cause death (relative risk 5.540, NNH 4043) within 30 days after mechanical restraint. Estimates from the between-group analyses (comparing the exposed group with a control group of 22 643 individuals) were non-significant or indicated increased baseline risk in the control group. A positive dose–response analysis for cardiac arrest, injury and death supported a causative role of mechanical restraint in the reported associations.
Conclusions
Although the observed absolute risk increases were small, the derived relative risks were non-negligible considering that less restrictive interventions are available. Clinicians and decision makers should be aware of the excess risk in future decisions on the use of mechanical restraint versus alternative interventions.
I argue that current normative discussions of the responsibility for structural injustice are marred by an inadequate socio-theoretical view of structures and their functioning. This view reduces the relation between structures and actions to one of constraint: structures mainly inhibit transformative action; transformative action can only come from outside structures. I offer an alternative view of structures and their functioning that, drawing on and extending Sewell’s and Haslanger’s conceptions of structures and Arendt’s view of action, shows that actions are structurally and publicly constituted—they acquire social meaning in relation to structures, in a process of public interpretation—which is why they can transform the structures where they originate. Responsibility to dismantle unjust structures should then be understood as “structural responsibility”: responsibility to act from one’s structural position in ways that can disrupt the mechanisms of structural maintenance.
Describing the equality conditions of the Alexandrov–Fenchel inequality [Ale37] has been a major open problem for decades. We prove that in the case of convex polytopes, this description is not in the polynomial hierarchy unless the polynomial hierarchy collapses to a finite level. This is the first hardness result for the problem and is a complexity counterpart of the recent result by Shenfeld and van Handel [SvH23], which gave a geometric characterization of the equality conditions. The proof involves Stanley’s [Sta81] order polytopes and employs poset theoretic technology.
Text readability assessment aims to automatically evaluate the degree of reading difficulty of a given text for a specific group of readers. Most of the previous studies considered it as a classification task and explored a wide range of linguistic features to express the readability of a text from different aspects, such as semantic-based and syntactic-based features. Intuitively, when the external form of a text becomes more complex, individuals will experience more reading difficulties. Based on this motivation, our research attempts to separate the textual external form from the text and investigate its efficiency in determining readability. Specifically, in this paper, we introduce a new concept, namely textual form complexity, to provide a novel insight into text readability. The main idea is that the readability of a text can be measured by the degree to which it is challenging for readers to overcome the distractions of external textual form and obtain the text’s core semantics. To this end, we propose a set of textual form features to express the complexity of the outer form of a text and characterize its readability. Findings show that the proposed external textual form features can be used as effective evaluation indexes to indicate the readability of text. It brings a new perspective to the existing research and provides a new complement to the existing rich features.
n-6 PUFA, especially linoleic acid (LA) but also arachidonic acid (AA), have been inversely associated with CHD. However, mechanisms underlying these associations are not fully known. We investigated the associations of the serum concentrations of total n-6 PUFA, LA, AA, γ-linolenic acid (GLA) and dihomo-γ-linolenic acid (DGLA), with the odds of myocardial ischaemia during exercise, a predictor of future cardiac events. A total of 1871 men without a history of CHD from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) aged 42–60 years were included. All participants performed a maximal symptom-limited exercise stress test, using an electrically braked bicycle ergometer. Multivariable-adjusted logistic regression was used to assess the OR for exercise-induced myocardial ischaemia in quartiles of the serum n-6 PUFA concentrations. After multivariable adjustment, men in the highest v. the lowest serum AA concentration had 50 % lower odds for exercise-induced myocardial ischaemia (OR 0·50, 95 % CI 0·34, 0·76; P-trend across quartiles < 0·001). For the other PUFA, the OR (95 % CI) were 1·00 (0·69, 1·46; P-trend = 0·89) for LA, 1·07 (0·75, 1·53; P-trend = 0·40) for GLA and 0·74 (0·51, 1·07; P-trend = 0·16) for DGLA. Among the n-6 PUFA, higher serum concentration of AA was associated with lower odds for myocardial ischaemia during an exercise test in middle-aged and older men. This may provide one mechanism for the previously observed possible cardioprotective properties of AA. Our findings also suggest that n-6 PUFA should not be considered as one homogenous group.
The prevalence of poor linear growth among African children with perinatally acquired HIV remains high. There is concern that poor linear growth may to lead to later total and central fat deposition and associated non-communicable disease risks. We investigated associations between height-for-age Z score (HAZ) and total and regional fat and lean mass measured by dual-energy X-ray absorptiometry, expressed as internal population Z scores, among 839 Zimbabwean and Zambian perinatally HIV-infected male and female adolescents aged 11–19 years. Stunting (HAZ < –2) was present in 37 % of males and 23 % of females. HAZ was strongly positively associated with total, trunk, arm and leg fat mass and lean mass Z scores, in analyses controlling for pubertal stage, socio-economic status and HIV viral load. Associations of linear growth with lean mass were stronger than those with fat outcomes; associations with total and regional fat were similar, indicating no preferential central fat deposition. There was no evidence that age of starting antiretroviral therapy was associated with HAZ or body composition. Non-suppressed HIV viral load was associated with lower lean but not fat mass. The results do not support the hypothesis that poor linear growth or stunting are risk factors for later total or central fat deposition. Rather, increased linear growth primarily benefits lean mass but also promotes fat mass, both consistent with larger body size. Nutritional and/or HIV infection control programmes need to address the high prevalence of stunting among perinatally HIV-infected children in order to mitigate constraints on the accretion of lean and fat mass.
The third edition of this successful textbook has been redesigned to reflect the progress of the field in the last decade, including the latest studies of the Higgs boson, quark–gluon plasma, progress in flavour and neutrino physics and the discovery of gravitational waves. It provides undergraduate students with complete coverage of the basic elements of the Standard Model of particle physics, assuming only introductory courses in nuclear physics, special relativity and quantum mechanics. Examples of fundamental experiments are highlighted before discussions of the theory, giving students an appreciation of how experiment and theory interplay in the development of physics. The author examines leptons, hadrons and quarks, before presenting the dynamics and the surprising properties of the charges of the different forces, concluding with a discussion on neutrino properties beyond the Standard Model. This title is also available as open access on Higher Education from Cambridge University Press.
An important contributor to the decreased life expectancy of individuals with schizophrenia is sudden cardiac death. Arrhythmic disorders may play an important role herein, but the nature of the relationship between schizophrenia and arrhythmia is unclear.
Aims
To assess shared genetic liability and potential causal effects between schizophrenia and arrhythmic disorders and electrocardiogram (ECG) traits.
Method
We leveraged summary-level data of large-scale genome-wide association studies of schizophrenia (53 386 cases, 77 258 controls), arrhythmic disorders (atrial fibrillation, 55 114 cases, 482 295 controls; Brugada syndrome, 2820 cases, 10 001 controls) and ECG traits (heart rate (variability), PR interval, QT interval, JT interval and QRS duration, n = 46 952–293 051). We examined shared genetic liability by assessing global and local genetic correlations and conducting functional annotation. Bidirectional causal relations between schizophrenia and arrhythmic disorders and ECG traits were explored using Mendelian randomisation.
Results
There was no evidence for global genetic correlation, except between schizophrenia and Brugada syndrome (rg = 0.14, 95% CIs = 0.06–0.22, P = 4.0E−04). In contrast, strong positive and negative local correlations between schizophrenia and all cardiac traits were found across the genome. In the most strongly associated regions, genes related to immune and viral response mechanisms were overrepresented. Mendelian randomisation indicated that liability to schizophrenia causally increases Brugada syndrome risk (beta = 0.14, CIs = 0.03–0.25, P = 0.009) and heart rate during activity (beta = 0.25, CIs = 0.05–0.45, P = 0.015).
Conclusions
Despite little evidence for global genetic correlation, specific genomic regions and biological pathways emerged that are important for both schizophrenia and arrhythmia. The putative causal effect of liability to schizophrenia on Brugada syndrome warrants increased cardiac monitoring and early medical intervention in people with schizophrenia.
In confined systems, the entrapment of a gas volume with an equivalent spherical diameter greater than the dimension of the channel can form extended bubbles that obstruct fluid circuits and compromise performance. Notably, in sealed vertical tubes, buoyant long bubbles cannot rise if the inner tube radius is below a critical value near the capillary length. This critical threshold for steady ascent is determined by geometric constraints related to the matching of the upper cap shape with the lubricating film surrounding the elongated part of the bubble. Developing strategies to overcome this threshold and release stuck bubbles is essential for applications involving narrow liquid channels. Effective strategies involve modifying the matching conditions with an external force field to facilitate bubble ascent. However, it is unclear how changes in acceleration conditions affect the motion onset of buoyancy-driven long bubbles. This study investigates the mobility of elongated bubbles in sealed tubes with an inner radius near the critical value inhibiting bubble motion in a vertical setting. Two strategies are explored to tune bubble motion, leveraging variations in axial and transversal accelerations: tube rotation around its axis and tube inclination relative to gravity. By revising the geometrical constraints of the simple vertical setting, the study predicts new thresholds based on rotational speed and tilt angle, respectively, providing forecasts for the bubble rising velocity under modified apparent gravity. Experimental measurements of motion threshold and rising velocity compare well with theoretical developments, thus suggesting practical approaches to control and tune bubble motion in confined environments.
Textual sources from the Egyptian New Kingdom highlight a societal desire to preserve tombs for life after death, yet extensive architectural renovations and tomb robbing often followed the interment of elite individuals. Rather than posing a threat to conceptions of the afterlife, the author argues that these post-mortem activities were conducted with respect and the intention of forming connections. Using the identification of an unusual ritual structure from the Third Intermediate Period inside the reused Nineteenth Dynasty tomb of Paenmuaset (TT362) at Thebes (Luxor) as a basis, the author explores respect in ever-changing burial spaces as a key feature of tomb reuse.
Musculoskeletal disorders and age-related musculoskeletal decline are major contributors to the burden of ill health seen in older subjects. Despite this increased burden, these chronic disorders of old age receive a relatively small proportion of national research funds. Much has been learned about fundamental processes involved in ageing from basic science research and this is leading to identification of key pathways that mediate ageing which may help the search for interventions to reduce age-related musculoskeletal decline. This short review will focus on the role of reactive oxygen species in age-related skeletal muscle decline and on the implications of this work for potential nutritional interventions in sarcopenia. The key physiological role of reactive oxygen species is now known to be in mediating redox signalling in muscle and other tissues and ageing leads to disruption of such pathways. In muscle, this is reflected in an age-related attenuation of specific adaptations and responses to contractile activity that impacts the ability of skeletal muscle from ageing individuals to respond to exercise. These pathways provides potential targets for identification of logical interventions that may help maintain muscle mass and function during ageing.
The study used a methodological design to adapt a Turkish translation and validate the Bolton Compassion Strengths Indicators scale.
Methods
The sample of the study consisted of 500 nursing students. Partial least squares structural equation modelling was used to analyze the construct and internal validiy. The values of average variance explained were analyzed for convergent validity. Tukey’s test of additivity examined the additivity, and Hotelling’s T2 test examined the mean difference between items. Internal consistency and test–retest reliability were ensured for reliability. Test and retest scores were compared by applying the paired samples t-test and Wilcoxon test, and the fit was analyzed through the intra-class correlation coefficient.
Results
The Turkish version of the scale consisted of 34 items and 8 subscales. The Cronbach’s alpha coefficient of the overall scale was 0.954. The scale was highly reliable and displayed psychometric solid properties.
Significance of results
It has been determined that the Turkish version of the Bolton Compassion Strengths Indicators scale is a comprehensive, easy-to-understand measurement tool with a broad perspective that can be safely applied to future nurse candidate students. The scale has been evaluated as a reliable measurement tool that can provide cross-cultural measurement.
Real-time strategy (RTS) games have provided a fertile ground for AI research with notable recent successes based on deep reinforcement learning (RL). However, RL remains a data-hungry approach featuring a high sample complexity. In this paper, we focus on a sample complexity reduction technique called reinforcement learning as a rehearsal (RLaR) and on the RTS game of MicroRTS to formulate and evaluate it. RLaR has been formulated in the context of action-value function based RL before. Here, we formulate it for a different RL framework, called actor-critic RL. We show that on the one hand the actor-critic framework allows RLaR to be much simpler, but on the other hand, it leaves room for a key component of RLaR–a prediction function that relates a learner’s observations with that of its opponent. This function, when leveraged for exploration, accelerates RL as our experiments in MicroRTS show. Further experiments provide evidence that RLaR may reduce actor noise compared to a variant that does not utilize RLaR’s exploration. This study provides the first evaluation of RLaR’s efficacy in a domain with a large strategy space.
In single-zone multi-node systems (SZMNSs), temperature controls rely on a single probe near the thermostat, resulting in temperature discrepancies that cause thermal discomfort and energy waste. Augmenting smart thermostats (STs) with per-room sensors has gained acceptance by major ST manufacturers. This paper leverages additional sensory information to empirically characterize the services provided by buildings, including thermal comfort, energy efficiency, and demand response (DR). Utilizing room-level time-series data from 1000 houses, metadata from 110,000 houses across the United States, and data from two real-world testbeds, we examine the limitations of SZMNSs and explore the potential of remote sensors. We discover that comfortable DR durations (CDRDs) for rooms are typically 70% longer or 40% shorter than for the room with the thermostat. When averaging, rooms at the control temperature’s bounds are typically deviated around −3 °F to 2.5 °F from the average. Moreover, in 95% of houses, we identified rooms experiencing notably higher solar gains compared to the rest of the rooms, while 85% and 70% of houses demonstrated lower heat input and poor insulation, respectively. Lastly, it became evident that the consumption of cooling energy escalates with the increase in the number of sensors, whereas heating usage experiences fluctuations ranging from −19% to +25%. This study serves as a benchmark for assessing the thermal comfort and DR services in the existing housing stock, while also highlighting the energy efficiency impacts of sensing technologies. Our approach sets the stage for more granular, precise control strategies of SZMNSs.
There is an urgent need for climate change–informed decision-making and adaptation actions for cultural heritage. Challenges arise in incorporating and balancing multiple considerations, including robust understandings of climate change vulnerability, the objectives of current management paradigms, the need for meaningful engagement, the risk of maladaptation, and constrained resources to implement. We offer a conceptual framework and guide to integrate climate science and cultural heritage management to produce a range of adaptation actions for cultural heritage, categorized as Acclimate, Dislocate, Abandon, Protect, and Tell the Story (ADAPT) approaches. The ADAPT framework is intended to aid archaeologists and other cultural heritage managers in developing and evaluating possible adaptation actions that directly respond to findings from climate change vulnerability assessments, critically integrating management postures and constraints, and coproducing climate change adaptations with Indigenous rightsholders and community stakeholders.