Respiratory virus transmission in healthcare settings is not well understood. To investigate the transmission dynamics of common healthcare-associated respiratory virus infections, we performed retrospective whole genome sequencing (WGS) surveillance at three teaching hospitals.

From January 2, 2018, to January 4, 2020, nasal swab specimens positive for rhinovirus, influenza virus, human metapneumovirus (HMPV), or respiratory syncytial virus (RSV) from patients hospitalized for ≥3 days were sequenced. High-quality genomes were assessed for genetic relatedness using ≤3 single nucleotide polymorphisms (SNPs) as a cutoff, except for rhinovirus (≤10 SNPs). Patient health records were reviewed for genetically related clusters to identify epidemiological connections.

We collected 436 viral specimens from 359 patients: rhinovirus (n = 291), influenza virus (n = 50), RSV (n = 48), and HMPV (n = 47). Of these, 42%% (152/359 patients) were from a pediatric hospital, and 58% were from adult hospitals. WGS was performed on 61.2% (178/291) rhinovirus, 78% (39/50) influenza virus, 90% (43/48) RSV, and all HMPV specimens. Among high-quality genomes, we identified 14 genetically related clusters involving 36 patients (range: 2–5 patients per cluster). We identified common epidemiological links for 53% (19/36) of clustered patients; 63% (12/19) of patients had same-unit stays, 26% (5/19) had overlapping hospital stays, and 11% (2/19) shared common providers. On average, genetically related clusters spanned 16 days (range: 0 − 55 days).

WGS offered new insights into respiratory virus transmission dynamics. These advancements could potentially improve infection prevention and control strategies, leading to enhanced patient safety and healthcare outcomes.

Conduct disorder and childhood head injuries frequently co-occur and are linked to a higher risk of later delinquency. While both are known to disrupt reward-related neural circuits, this study investigated whether their combined presence leads to a unique disruption in these pathways, potentially accounting for the increased risk of delinquency.

Using neuroimaging data from the baseline (age 9–10) assessment from the Adolescent Brain and Cognitive Development (ABCD) study, four groups were compared: children with conduct disorder (CD, n = 588), a mild traumatic brain injury (mTBI, n = 1,216), both (mTBI+CD, n = 252), and typically developing controls (TD, n = 705). Neural activation in eight regions of interest (amygdala, hippocampus, nucleus accumbens, caudal anterior cingulate cortex, rostral anterior cingulate cortex, medial orbitofrontal cortex, thalamus, and insula) during reward anticipation and receipt were assessed during the monetary incentive delay task.

After controlling for several covariates, including sex, ADHD, and internalizing problems, the mTBI+CD group displayed greater left amygdala and hippocampal activation during reward receipt compared to all other groups. While they displayed increased activation in the right hippocampus and thalamus compared to TD controls and the right hippocampus compared to the mTBI group, they did not differ from the CD group. No group differences emerged during reward anticipation.

Increased left amygdala and hippocampus activation in children with conduct disorder and a history of mild traumatic brain injury may reflect robust encoding of emotionally charged reward experiences, potentially reinforcing memory-guided, reward-seeking behaviors.

Carbapenem-resistant Acinetobacter baumannii (CRAB) carriage in post-acute care hospitals (PACH) reflects both importation of colonized patients and within-PACH transmission. We studied within-PACH transmission by examining the sameness of CRAB clusters, as identified by Fourier-transform infrared (FTIR) spectroscopy.

We conducted a point-prevalence survey in 55 wards in 18 Israeli PACH in 2021. Patients (n = 1,733) were screened for CRAB, and 461 isolates from 357 patients underwent FTIR typing (IR Biotyper, Bruker). We assigned each patient isolate to its cluster and paired each patient-cluster combination with every other patient-cluster combination. We examined the relationship between physical proximity of pairs (n = 75,047) and FTIR cluster sameness using generalized estimating equation logistic regression. To estimate within-ward transmission, we compared proportions of cluster sameness within wards versus between institutions.

The 461 CRAB isolates formed 23 FTIR clusters. Compared to being in different institutions, being in the same ward was associated with significantly higher odds of sharing the same cluster (odds ratio: 3.6, p < 0.001). Odds ratios were highest for patients in the same room (6.2) or adjacent rooms (6.1) (p < 0.001 for both). Based on same-cluster pairs we estimated that 70% of prevalent CRAB cases resulted from within-ward transmission.

CRAB strain similarity was strongly associated with spatial proximity within PACH wards, indicating that within-ward transmission is an important contributor to CRAB carriage prevalence. Similar risk in same and adjacent rooms suggests transmission via shared staff or equipment. Ward-level infection control interventions are warranted to interrupt spread.

Behavioral health needs are highly prevalent among individuals receiving long-term services and supports (LTSS), yet palliative care (PC) models in these settings often underemphasize psychiatric symptom management. This study explores interdisciplinary staff perspectives on behavioral health as a core domain of PC across nursing home and Program of All-Inclusive Care for the Elderly (PACE) sites.

We conducted a secondary analysis of a multi-site survey assessing PC needs across 13 LTSS sites within a large health system in New York State. We examined 5 survey items related to psychiatric symptom management, analyzing frequency, comfort, perceived benefit, and training interest. Multivariable logistic regression was used to assess associations between staff characteristics and behavioral health-related outcomes.

Among 597 respondents, 60.5% reported that over half of their patients could benefit from psychiatric symptom management, and nearly half (49.2%) reported managing such symptoms weekly or more. Forty percent identified psychiatric symptom management as one of the top three ways PC specialists could help their patients, and 44.6% expressed interest in further behavioral health training as part of further PC training. Prior professional experience with PC was associated with greater recognition of behavioral health needs among patients (aOR 1.6), greater likelihood of managing psychiatric symptoms (aOR 2.0), and greater comfort doing so (aOR 1.5).

Behavioral health emerged as a salient and frequently encountered domain of serious illness care among LTSS staff, particularly in nursing home and PACE settings. Staff with prior PC experience were more engaged and confident in addressing psychiatric symptoms. Findings underscore the need for PC models in LTSS to better integrate behavioral health – through training, interdisciplinary collaboration, and care delivery redesign – to meet the complex needs of medically and psychiatrically vulnerable populations.

Observational studies suggested an association between childhood maltreatment and neuropsychiatric disorders; however, mediators remain disputed.

We aimed to confirm the relationship between childhood maltreatmen and neuropsychiatric disorders, and to identify addiction-related, biological, behavioural, cognitive, socioeconomic and epigenetic mediators.

We used two-sample Mendelian randomisation and publicly available genome-wide association data to evaluate the effect of genetically predicted childhood maltreatment (N = 143 473) on the risk of six neuropsychiatric disorders (up to N = 500 199). We used two-step Mendelian randomisation to determine the proportion of the effect of childhood maltreatment on disorders that was mediated by mediators. We used multivariable Mendelian randomisation to determine the direct effect of childhood maltreatment on disorders accounting for mediators. We used epigenetic Mendelian randomisation to determine the effect of DNA methylation at childhood maltreatment-associated CpG sites on disorders.

Childhood maltreatment was significantly associated with higher risk of attention-deficit/hyperactivity disorder (ADHD) (odds ratio 10.09, 95% CI: 4.76–21.40), major depressive disorder (MDD) (odds ratio 1.89, 95% CI: 1.32–2.70) and schizophrenia (odds ratio: 5.89, 95% CI: 1.46–23.78). We determined that 4.14–22.17% of the effect of childhood maltreatment was mediated by addiction-related behaviours (smoking initiation, leisure screen time and substance abuse), cognitive traits (executive functioning, intelligence and risk tolerance) and educational attainment. We found that the direct effects of childhood maltreatment on ADHD (odds ratio 2.57) and schizophrenia (odds ratio 5.10) were less than the total effects, while the direct effect on MDD (odds ratio 1.95) remained relatively unchanged. We found altered DNA methylation levels at 3, 4 and 19 CpG sites to be significantly associated with ADHD, MDD and schizophrenia, respectively.

These results emphasise the need for preventative strategies to reduce childhood maltreatment prevalence, including strengthening support for high-risk families and responsive strategies to mitigate consequences for victims, with clinical screening for childhood maltreatment history and holistic approaches addressing addiction-related, cognitive and socioeconomic mediators.

The Association of Otolaryngologists in Training wanted to assess trainee well-being.

A survey was developed that incorporated the Copenhagen Burnout Inventory, the short Warwick–Edinburgh Mental Wellbeing Scale and the Brief Resilience Scale plus questions on working conditions.

There were 190 responses and while most respondents had low or moderate levels of burnout, 15 per cent had high personal burnout and 13 per cent had high work-related burnout. The mean well-being score for respondents was lower than for the whole population mean. In addition, 39 per cent of respondents reported their mental well-being had been slightly affected in a negative way by their working environment and conditions in the last 6 months, and 26 per cent reported it being significantly affected negatively. Of these, 43 respondents reported an impact on patient safety.

This first-ever survey of ENT trainees in the UK identified several areas of concern, including how the working environment and conditions affect trainee well-being and impact patient safety.

Button batteries are a common household item that are, unfortunately, attractive to young children. If ingested, they are corrosive and potentially fatal. Button battery ingestion is frequently unwitnessed, delaying the diagnosis. In the USA, approximately 6,000 accidental ingestions occur annually (2.2 deaths per year over a decade on average). Community awareness of this danger appears to be low.

We conducted a 22-question online questionnaire-based study to assess and raise awareness of this exceptional childhood risk.

A total of 561 survey responses were analysed; 77 per cent were female, and 60 per cent were aged 30–50. Despite 87 per cent using button batteries, 65 per cent did not consider their safety, and 68 per cent found existing packaging warnings inadequate. Notably, 80 per cent recognised the potential for fatality, but 88 per cent were unaware that a spoonful of honey could delay this corrosive process.

Challenges persist regarding the design and marketing of button batteries and public awareness of their ingestion. Action is required to prevent further tragedies.