During the fourth millennium BC, public institutions developed at several large settlements across greater Mesopotamia. These are widely acknowledged as the first cities and states, yet surprisingly little is known about their emergence, functioning and demise. Here, the authors present new evidence of public institutions at the site of Shakhi Kora in the lower Sirwan/upper Diyala river valley of north-east Iraq. A sequence of four Late Chalcolithic institutional households precedes population dispersal and the apparent regional rejection of centralised social forms of organisation that were not then revisited for almost 1500 years.

This article analyses the challenges that online marketplaces and e-commerce pose to traditional product liability doctrines. It uses a comparative perspective to examine whether an online platform can be liable to a consumer for a defective product purchased on its platform, and the adaption of product liability law to this challenge in a series of jurisdictions. It reflects on the role of litigation and regulation, focusing on Europe and the United States, and considers reform in a number of jurisdictions in this area. It concludes with proposals for increasing the accountability of online marketplaces for products sold on their websites.

Belligerents increasingly rely on media manipulation, propaganda, and communication to attain strategic advantages in conflict. Given the civilian propagandists’ clear role in creating tactical or strategic advantages for one side in the conflict, should these propagandists be considered combatants, and can they therefore be legitimately targeted because of their activities? This article overcomes traditional binary frameworks of distinction to argue that propagandists are indirectly participating civilians, i.e. participants who cannot be intentionally or directly killed in conflict. Because of their activities, propagandists, it argues, are liable to less-than-lethal harm, of which it identifies three types (destruction of property, privation of liberty, isolation). The article then proposes a necessary criterion – necessity – to decide if less-than-lethal harm is warranted against propagandists. It then creates four new criteria – denial of agency, falsehood, influence, gratification – to serve as assessment criteria able to decide what degree of harm a propagandist may maximally face. In making this argument, the article contributes to just war literature by proposing a novel way to evaluate the ethical status of a highly diverse, yet undoubtedly influential, category of war participants: those who undertake the ‘media battle’, outside of the military.

Background: Veterans Health Administration (VHA) community living centers (CLCs) provide postacute and long-term care. CLC veterans visit myriad locations outside their rooms (eg, rehabilitation, dialysis). Pathogen transmission during out-of-room visits is unknown. Methods: We recruited newly admitted veterans at 3 CLCs. After obtaining informed consent, we cultured nares, groin, hands, and 7 surfaces in the patient rooms. We accompanied veterans to up to 5 out-of-room visits and cultured patients’ hands and surfaces they touched. We tested for multidrug-resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and quinolone, carbapenem, and/or ceftazidime-resistant gram-negative bacteria (R-GNB). We defined transmission as a positive culture following an initial negative culture during the same visit. Results: We enrolled 137 veterans (median follow-up, 29 days; mean, 5.9 visits); 97% were postacute patients. We conducted 539 patient-room sampling visits (mean, 3.9 per veteran; 5,490 swabs) and accompanied 97 veterans to 266 out-of-room sampling visits (mean, 2.7 per veteran; 2,360 swabs). Of 137 patients, 47 (35%) were colonized with an MDRO at enrollment and 74 (58%) of 128 patients were colonized on any follow-up patient-room visits. Of 133 patients, 55 (41%) acquired a new MDRO, most often VRE (31 of 97, 32%). In patient rooms, toilet seats [114 (21%) of 538], curtains [101 (19%) of 530] and bedrails [98 (18%) of 539] were most frequently contaminated. Among 266 out-of-room visits, 17% had surfaces contaminated with MDROs, most commonly involving dialysis [4 (31%) of 13], radiology [2 (25%) of 8], and rehabilitation therapy [29 (18%) of 159] (Fig. 1).Transmission of MDROs during out-of-room visits was common and occurred in 18% of visits with 8% (9 MRSA and 12 VRE) acquiring a new MDRO on their hands and 12% (9 MRSA and 23 VRE) of MDRO transmission occurring from hands to a surface that the patient touched (Fig. 1). In 18 (58%) of 31 cases, the organism transmitted to a surface was on patient hands at the start of the visit. Transmission was most common during visits to dialysis (3 to patients and 2 to surfaces), radiology (1 to a patient and 2 to surfaces), and rehabilitation therapy (13 to patients and 21 to surfaces) (Fig. 2). Conclusions: New MDRO acquisition during VHA CLC stay was common, and nearly one-fifth of out-of-room visits resulted in MDRO transmission. Our analyses suggest that veterans’ hands may shed MDROs (MRSA and VRE) to surfaces. Interventions to reduce MDRO transmission during visits for rehabilitation, dialysis, and other therapies are needed.

Disclosures: None

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).