Objectives: The recent experience of the COVID-19 pandemic emphasized the critical need for a surveillance system to alert healthcare facilities about the admission of patients with emerging infectious diseases (EID), thereby preventing nosocomial transmissions. Methods: Tan Tock Seng Hospital, an 1800-bed acute tertiary-care hospital in Singapore, transitioned to a new- generation electronic medical record system, Epic, in August 2022. Leveraging the system’s capabilities, we developed an algorithm to generate the line-list of suspected Middle East Respiratory Syndrome (MERS) patients, in alignment with the screening guidelines provided by Singapore’s Ministry of Health. The algorithm first identifies patients who presented within 14 days (maximum incubation period) of their travel to Arabic peninsular countries. This information is documented by the emergency department’s triage nurses. Additionally, patients with suspected MERS indicated in the problem list or diagnosis by attending clinicians, particularly emergency-medicine physicians or infectious-disease physicians, are included. Furthermore, patients who are ordered for a MERS- Coronavirus polymerase chain reaction test, are identified. The algorithm can also be further modified as and when the case definition of the EID changes. Results: The surveillance report constructed with Epic algorithm can be scheduled for daily generation or generated on demand within a few minutes. This newer approach is more time- and resource-efficient compared to the manual surveillance process, which necessitates at least three staff members to engage in a series of prolonged manual processes. The report, by extracting information directly from Epic in near real-time, also minimizes the likelihood of errors that may occur during the manual process. Subsequently, the team of epidemiologists identifies the suspected MERS patients form the generated report and efficiently follow up them until a diagnosis of MERS is excluded. Conclusions: Harnessing Epic’s capabilities, we constructed an algorithm to efficiently and swiftly identify suspected MERS patients, enabling the timely implementation of infection prevention strategies to prevent nosocomial transmission.

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious in humans, and in May 2021, an outbreak occurred in the Wanhua district of Taiwan. During the Coronavirus disease 2019 (COVID-19) pandemic, we implemented various rules to prevent the spread of SARS-CoV-2- alpha in the hospital. This included establishing four special wards (dedicated care wards) specifically for patients infected with SARS-CoV-2-alpha. When patients were discharged, we conducted real-time polymerase chain reaction (RT-PCR) testing on the terminal environment to ensure that SARS-CoV-2- alpha was not present. Maintaining a negative test result was crucial for preventing cross-infection and further outbreaks. The goal of this study was to identify effective intervention measures to improve the quality of terminal cleaning and achieving overall infection control in the hospital. Methods: After cleaning and disinfection of the dedicated care wards by the cleaning staff as per the recommendations of the Centers for Disease Control (CDC), we collected three swabs from different areas in one ward. We used Roche and GeneXpert instruments for COVID-19 RT-PCR testing. However, because the test results were not ideal, we introduced ultraviolet-C (UV-C) machines and a disinfectant solution containing hydrogen peroxide (H2O2) into our current cleaning and disinfection procedures. Results: The negative test result ratios for RT-PCR testing were 80.13% when cleaning was done with bleach- only method as a disinfectant (without intervening with other methods); 92.81% when intervening with UV-cC machine disinfection for 5 minutes was done before bleach disinfection; 96.19% when bleach was replaced with a disinfectant solution containing H2O2 and intervening with UV-C disinfection. Conclusion: The quality of terminal cleaning and disinfection was a key factor in reducing nosocomial outbreaks. We could consider using UV-C machine and H2O2 disinfectant to intervene in the current bleach disinfection method to enhance the quality of terminal cleaning and disinfection in the hospital.

For organisations, change is becoming a necessity to adapt to the demands of an ever-shifting external environment. In such an environment, conflicting forces create frictions that organisations must address. This study explores the mechanisms through which organisations activate the path towards strategic agility. A single case study approach is used to develop a framework that traces the path to strategic agility in the context of paradoxical tensions. The work shows that strategic agility is the result of four action dimensions that involve values, decision-making processes, knowledge and data management, and of the interconnection of internal and external structures. Instead of eliminating tensions, strategic agility enables organisations to dynamically navigate them. Our work provides organisations with a useful framework for dealing with paradoxes in order to maintain performance in challenging contexts.

Greenhouse and field experiments were conducted in Kansas to test various postemergence herbicides for crop safety and weed control in pearl millet. Five pearl millet hybrids were used in greenhouse experiments and three hybrids (Hyb1, Hyb-2k, Hyb-3k) were used in field experiments at two sites. All herbicides were found to be safe (1% to 5% injury) for use on all pearl millet hybrids in both greenhouse and field experiments at 28 d after application (DAA), except imazamox and nicosulfuron, which were noted to cause 22% to 35% injury. At Site 1 at 42 DAA, 2,4-D, dicamba, bromoxynil + pyrasulfotole, 2,4-D + bromoxynil + fluroxypyr, and dicamba + 2,4-D effectively controlled Palmer amaranth by 88% to 91%, and density was reduced to 2 to 4 plants m−2 compared with 18 plants m−2 in nontreated control plots. The least control (60% to 65%) and greatest density (8 plants m−2) of Palmer amaranth was observed after applications of imazamox and nicosulfuron. In contrast, green foxtail was effectively controlled by 91% to 92%, and density was reduced to just 2 plants m−2 when imazamox and nicosulfuron were applied, whereas 13 plants m−2 were recorded in a nontreated control plot at 42 DAA. No weed emergence was observed at Site 2 regardless of treatment, including nontreated plots. High grain yields were recorded (Hyb1, 3,866 to 4,619 kg ha−1; Hyb-2k, 2,222 to 3,699 kg ha−1; and Hyb-3k, 822 to 1,315 kg ha−1) at both sites after applications of 2,4-D + bromoxynil + fluroxypyr. These results highlight that the postemergence herbicides tested in this study, except imazamox and nicosulfuron, can be safely used for weed control in fields of pearl millet.

Objectives: The development of medical technology has led to increasingly intricate surgical instruments, varying in types and structures. This complexity has posed challenges in the instrument reprocessing.The Emergency Care Research Institute in the United States has continuously issued alerts regarding the reprocessing of instruments or endoscopes from 2013~2020, It is evident that failure to perform thorough cleaning in accordance with the standards may result in organic debris on the instruments, posing the risk of infection or even death to patients Methods: We collected data on 39 visibly soiled instruments reported by the OR from 2021 to October 2023. Through personnel interviews, questionnaires, and identification of types of soiled instruments,we identified key issues using fishbone diagram analysis, the findings as follows (1).only 48% of OR personnel had received precleaning education and training, 75% of respondents cited being too busy for not precleaning (2).CSSD staff demonstrated a cleaning cognitive test success rate of 81%, particularly challenging were instruments with intricate designs, requiring specialized cleaning procedures (3). Failure to provide different cleaning methods depending on the level of residues or difficulty to clean.The following strategies are proposed:(1). Enhanced precleaning education and training for OR staff (2).Use of enzymatic precleaning products to saturate instruments prior to cleaning. 3. Development of a classification system for instruments requiring longer cleaning times. Results: Between November 2023 to March 2024, one visibly soiled instrument was reported, marking a significant drop from an incidence rate of 1.15 to 0.20 per month. Cognitive test success rate rose from 81 to 97%. Implementing different methods based on the difficulty of cleaning or the complexity of features, as well as enzymatic precleaning products, were universally adopted in the OR Conclusion: Thorough cleaning is a crucial process for effective sterilization. Collaborative efforts between CSSD and OR significantly reduce the possibility of cross-contamination

A series of laboratory experiments were conducted to break seed dormancy and to investigate the germination ecology of prostrate knotweed (Polygonum aviculare L.) populations for designing weed management practices in eastern Australia. Foundational studies identified sodium hypochlorite (NaOCl) immersion of seeds for 8 h as the most effective method for breaking seed dormancy and enhancing germination. Therefore, in the subsequent seed germination ecology experiments, seeds treated with NaOCl for 8 h followed by a 10-min water rinse were used, and two populations (Gatton and Nangwee) were selected for the studies. The Gatton population exhibited higher germination than the Nangwee population at alternating day/night temperatures ranging from 15/5 to 30/20 C. Germination in both populations did not vary at day/night temperatures ranging from 20/10 C to 30/20 C. Therefore, considering P. aviculare as a winter-season weed in Australia, an optimal temperature of 20/10 C was selected for further light/dark, salt and osmotic stress, residue cover, and burial depth studies. Averaged over populations, germination of P. aviculare peaked at 92% under alternating light/dark conditions but declined to 49% in complete darkness, confirming the species’ positive photoblastic nature. Under stress (salt and osmotic) conditions, the Gatton population maintained ∼50% germination at 250 mM NaCl and −0.8 MPa osmotic potential and showed higher tolerance to these stresses than the Nangwee population. Moderate residue cover (2 to 4 Mg ha⁻¹) enhanced seedling emergence (up to 58% in Nangwee and 36% in Gatton), likely due to improved surface moisture and partial light availability. However, seed burial beyond 4 cm nearly eliminated emergence due to light exclusion and mechanical resistance. These findings suggest that P. aviculare is well adapted to surface soil conditions and may thrive in reduced-tillage, residue-retained systems. Strategic deep tillage and surface-targeted herbicides are essential for effective management of this light-sensitive, residue-adapted weed.

This paper shows how Hegel’s philosophy of psychiatry was established within the framework of the unitary psychosis (Einheitspsychose). This psychiatric position considered that there was only one single mental illness with several distinct species. Due to some editions of Hegel’s works, this interpretative framework is often omitted. However, in this paper it is considered to be the key interpretative framework for understanding Hegel’s psychic nosography and therapeutic approach.

Objectives: Vertebral Osteomyelitis (VO) poses a formidable challenge, manifesting as infectious pathology affecting the vertebral body and intervertebral disc, marked by persistent back pain, unresponsiveness to conventional treatment, and elevated inflammatory markers. Timely therapy is crucial, emphasizing its impact on patient outcomes and aligning with antimicrobial stewardship principles. This study investigates the consequences of delayed appropriate antibacterial therapy on clinical outcomes, emphasizing its relevance within the context of optimizing antibiotic utilization. Methods: In a single-center cross-sectional study from January 2012 to December 2022, we focused on adult VO patients, diverging from standardized therapies to explore real-world treatment approaches. Criteria included clinical presentation, bacteriologic evidence, or imaging studies. Data, collected through the hospital’s clinical management software (HIS system), included demographic features, diseases, clinical history, laboratory findings, microbiological diagnoses, radiological details, complications, and outcomes. This analysis aims to provide nuanced insights into diverse management strategies and associated clinical outcomes related to VO while highlighting the pivotal role of antimicrobial stewardship. Results: The study involved 230 adult VO patients (mean age 64.7 years, male predominance 30.8%)(Table1). Positive microbiology cultures were found in 58.7% of cases, predominantly Gram-positive organisms. Patients with appropriate initial therapy had significantly lower severe back pain rates than those with inappropriate therapy (OR = 0.308, 95% CI 0.098, 0.971, p=0.044)(Table 2). Conclusions: Inappropriate antibiotics for VO treatment compromise symptomatic relief, emphasizing the pivotal role of antimicrobial stewardship. The study reveals significantly lower overall mortality rates and improved clinical symptoms with appropriate antibiotic therapy. In the context of VO’s severe illness and rapid deterioration, urgent enhancements in diagnostics and early appropriate antimicrobial therapy are crucial. This research provides substantive insights for optimizing VO management within the framework of antimicrobial stewardship, aiming to enhance patient outcomes and reduce healthcare system burdens.

Scholarship on minorities in the inter-war period have largely ignored the Flemish question. One obvious reason is that the Flemish accounted for a majority of Belgium’s population. This article, however, argues that the domestic and international historiography would benefit from considering the Flemish a minority, albeit a peculiar one. I suggest that the Flemish question embodies the contradictions of an age in which the nationality question ‘morphed into the minority question’ (as Holly Case has pointed out) without disappearing altogether. The article traces the evolution of different understandings of Flanders in the Belgo-Dutch-German transnational space and shows how such understandings challenge traditional conceptions of minorities, majorities, nationalities and kin states. The article further contributes to a broader shift in historiographies of nationalism and diversity in inter-war Europe by moving focus from East to West and considering minority questions as a pan-European phenomenon.

Introduction: During the years 2018-2019, Nan Hospitalhad tuberculosis screening rates of 69.15% and 74.24%, respectively, which were lower than the target (target > 90%). Consequently, tuberculosis patients were referred for further examination in various hospital units and treated in general rooms without proper isolation. Also, one and four healthcare personnel were diagnosed with pulmonary tuberculosis in 2018 and 2019, respectively. Additionally, the treatment success rates for pulmonary tuberculosis patients were 74.63% and 79.92%, respectively (target >85%). Therefore, to achieve these target goals, actions were taken following the national tuberculosis strategy using the FCD Nan model, which comprises of Fast screening (F), Cure (C), and do not spread (D). Objectives: To develop the tuberculosis patient-care system at Nan Hospital and assess the outcomes of the tuberculosis patient-care system in terms of FCD Nan model Methods: We used the PDSA quality improvement process as follows.

1. 1. Plan: Planning to implement the national tuberculosis strategy including fast screening, cure, and prevention of transmission.

2. 2. Do: Implementing the FCD Nan modelas follows.

   1. 1) Fast screening. We used a fast-track system, enhanced screening efficiency in both OPD and IPD units, established a Line group alert pop-up and AI CXR.

   2. 2) Cure. We adhered to treatment protocols,closely monitored cases, consulted specialists, utilized risk scoring for mortality, and nutritional alert.

   3. 3) Do not spread. We administered 3 measures for preventing transmission including administrative, environmental, and PPE measures.

3. 3. Study: Evaluating the FCD Nan model.

4. 4. Action: Identifying household contacts as a high-risk group and implementing screening for all household contacts due tothe discovery of new tuberculosis patients in the household contacts.

Acknowledgments : This study has been partially funded by the Nursing Association for Prevention and Control of Infections (NAPCI)

Objectives: This study was conducted to define the classification of the infection control and prevention (IPC) practices through task analysis method, and to perform importance-performance analysis (IPA) on IPC tasks, consequently providing operational guidelines for the department of IPC. Methods: To define the tasks of the IPC practices, the draft was developed through the legal and literature reviews, and the final IPC tasks were confirmed by content validity test. The IPC tasks were assessed by IPA method. The national surveys were conducted by the institutional and individual level from October to November, 2023. The institutional questionnaire was distributed nationally to the IPC director/manager of the tertiary hospitals, and IPC practitioners assessed the IPA of IPC task. Results: Two thirds (30/45) of the IPC director/manager responded the institutional questionnaire. A total of 135 IPC practitioners (32 physicians and 103 nurses) completed the IPA survey. The average beds of hospitals participated in this study were 1,060±436. The ICP staffing met the legal requirements in all hospitals. The IPC tasks were consisted of 11 categories and 38 items including surveillance and ICP planning. According to IPA, at a 1st quadrant (high in frequency and importance) surveillance, infectious patient management, health management and action planning of healthcare associated infection were placed. At a 2nd quadrant (high in importance but low in frequency), annual IPC planning was positioned. At a third quadrant (low in frequency and importance), ICP training, policy-making, general hygiene, and ICP staffing were placed. There was nothing at a 4th quadrant (high in frequency but low in importance). Conclusion: Most of IPC tasks are consistent in degree of importance and frequency except IPC planning. Based on IPA, priority-based task distribution should be considered to maximize the work efficacy and effectiveness.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare associated infections. Colonization with MRSA increases the risk of subsequent nosocomial infection. The primary concern regarding widespread use of mupirocin is the emergence of mupirocin resistance. A prospective cross-sectional study in Singapore in 2013, found mupirocin resistance to be 31.6% in Changi General Hospital (CGH). Annual usage of mupirocin (g) in CGH was 36870 and hospital-onset MRSA bacteremia was 1.1/10,000 patient-days in 2013. Objective: To study the impact of hospital measures to reduce mupirocin resistance among MRSA by detection of mupirocin resistance in screening isolates. Method: Changi General Hospital is a 1000 bedded acute care hospital. Hospital wide measures were instituted in CGH to reduce mupirocin resistance in MRSA included a) universal body wash with Octenidine for all hospitalized patients in the wards with MRSA cubicles b) 2% mupirocin ointment removed from formulary (available for nasal decolonization only) A study was conducted on MRSA screening isolates from the Microbiology Laboratory between May and September 2019. These were obtained by swabbing nasal, axilla and groin on all newly admitted patients as part of an active surveillance program since 2013. The swabs were streaked onto MRSAiselective media plates which were incubated at 35 °C for 20 hours and stored at 4 °C. E-test was performed to determine the susceptibility and minimum inhibitory concentration (MIC) of MRSA isolates to mupirocin, oxacillin and vancomycin, following the CLSI guidelines for S. aureus. MPCR (multiplex polymerase chain reaction) assay was used for the simultaneous identification of ileS-2 (primers MupA and MupB) and mecA (primers MecA1 and MecA2). PCR amplification of ileS- 2 gene for high level mupirocin resistance and Mec A gene was performed on Touch thermal cycler. Results: 200 MRSA isolates were tested. E-test revealed 5 isolates were detected to be High Level mupirocin- resistant (2.5%) and 69 isolates were detected to be oxacillin-resistant (74%). The MPCR assay detected mecA gene in 100% and ileS-2 gene in 3 isolates (1.5%). Conclusion: Our study indicated the low prevalence of high level mupirocin resistance among MRSA screening isolates in 2019 in CGH. This suggested that the hospital wide measures to reduce mupirocin resistance were effective.

The use of gyrokinetics, wherein phase-space coordinate transformations result in a phase-space dimensionality reduction as well as the removal of fast time scales, has enabled the simulation of microturbulence in fusion devices. The state-of-the-art gyrokinetic models used in practice are parallel-only models wherein the perpendicular part of the vector potential is neglected. Such models are inherently not gauge-invariant. We generalise the work of Burby & Brizard (2019 Phys. Lett. A vol. 383, no. 18, pp. 2172–2175) by deriving a sufficient condition on the gyrocentre coordinate transformation that ensures gauge invariance. This leads to a parametrised family of gyrokinetic models for which we motivate a specific choice of parameters that results in the smallest gyrocentre coordinate transformation for which the resulting gyrokinetic model is consistent, gyro-phase independent, gauge-invariant and has an invariant magnetic moment. Due to gauge invariance, this model can be expressed directly in terms of the electromagnetic fields rather than the potentials, and the gyrokinetic model thereby results in the macroscopic Maxwell’s equations. For the linearised model, it is demonstrated that the shear and compressional Alfvén waves are present with the correct frequencies. The fast compressional Alfvén wave can be removed by making use of a Darwin approximation. This approximation retains the gauge invariance of the proposed model.

Tetflupyrolimet is a novel herbicide that inhibits dihydroorotate dehydrogenase in susceptible weeds, including those in warm-season turfgrass and rice. Given that warm-season species are managed alongside cool-season species that may be sensitive to tetflupyrolimet, research on its lateral movement within turfgrass is warranted. Field experiments were conducted in spring 2023 and 2024 at North Carolina State University to evaluate the potential downslope movement of tetflupyrolimet (400 g ai ha−1) compared with that of pronamide (1,160 g ai ha−¹), an herbicide that is known to move downslope. The studies took place on a 9.5% sloped plot of hybrid bermudagrass that had been established on Cecil sandy loam soil, under two moisture regimes at application: field capacity (≈34% volumetric water content) and saturation (≈46% volumetric water content). Before experimentation, the aboveground hybrid bermudagrass canopy was mechanically removed, and perennial ryegrass was planted as an indicator species. Herbicides were applied to treated areas (2.2 m2) upslope of data collection areas (8.6 m2), with subsequent irrigation and rainfall (2.5 cm total) 24 h after application. Downslope movement was assessed at 2, 4, 6, and 8 wk after treatment via perennial ryegrass mortality assessments made via grid (15 cm2) count. Downslope distances associated with a 50% probability of perennial ryegrass mortality (mortality50) were 1.2 to 3.6 times greater for pronamide compared to tetflupyrolimet. The maximum distance tetflupyrolimet moved was 1.1 m (regardless of soil moisture condition) each year. Comparatively, maximum downslope movement distances for pronamide were 1.5 to 1.65 m under saturated conditions and 1.5 to 1.8 m at field capacity. Overall, these findings suggest a 1.1-m buffer from sensitive species is likely sufficient to prevent undesirable injury following tetflupyrolimet applications to hybrid bermudagrass under conditions similar to this study.

Background and objective: Preparation of medical devices is a critical component of healthcare services. Used reusable items require reprocessing and sterilization, which eliminate contaminant microorganisms, to ensure safety and availability prior to subsequent applications. The objective of this research is to develop medical device preparation guidelines which address existing quality issues for quality services. Methods: This action research was conducted in three phases. Phase one, research planning, literature review of APSICS guideline and work system development techniques 5M model. Phase Two included guideline implementation, observation and analysis. In the 1st year, staff members were trained to perform duties according to the new guidelines, new inspection categories were added, and cleaning procedures were improved. In the 2nd year, new policies for collection of used items were implemented, ATP test was introduced to improve microorganism detection. The team oversaw more staff training and quality control of RO water used in cleaning medical devices in the 3rd year. In the 4th year, more staff members were trained and water supply pipes were replaced to accommodate increasing RO water demands. Trained staff members received follow- ups and percentages of reprocessed medical items that passed quality criteria were monitored. Phase three was analysis and evaluation, using the number of staff members who received training, percentages of reprocessed medical items that passed quality criteria. Results: The number of staff members who performed tasks correctly increased every year. The percentage of reprocessed reusable medical items which met quality requirements from 2018 - 2022 showed a steady increase (R2 = 0.860) (91.82, 95.33, 98.95, 98.68 and 99.42, respectively).The score for compliance to APSICS guideline for cleaning & decontamination processes from 2020 - 2022 increased continuously (78.57,96.43, and 100.00). Conclusion: The approaches to medical device preparation align with 5M model requiring proper management for maximum efficiency and cost effectiveness.