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To evaluate the potential sources and current screening strategies for the multidrug-resistant fungal pathogen Candida auris in the US Military Health System (MHS).
Methods:
Utilizing the Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), 6 instances of C. auris colonization or infection were identified within the MHS in 2024. Relevant medical and social history, drug susceptibilities, and next-generation genetic sequencing were obtained from MRSN and the electronic medical record. Hospital screening protocols for C. auris were reviewed in the affected facilities.
Results:
One case of C. auris infection and 5 cases of C. auris colonization in 2024 were identified in the MHS. Only 1 case of colonization was likely related to international travel; 5 patients had no recent travel history before infection or colonization. One patient was an active duty service member. Prior hospitalizations and infections were the most common risk factors present in each case. Two isolates had antimicrobial susceptibilities analyzed, both of which suggested resistance to fluconazole. Two of the 3 facilities had C. auris screening protocols in place to screen select individuals with risk factors; however, only 1 of the 6 cases presented was identified through these screening protocols. No cases of nosocomial transmission were found.
Conclusions:
C. auris remains a formidable threat to the MHS, with 6 cases identified in 3 treatment facilities, with 2 isolates demonstrating resistance to azoles. Screening protocols should reflect the domestic and international threats of this pathogen.
Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time–order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults.
Methods
We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time–order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1–5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders.
Results
We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time–order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23).
Conclusions
Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.
The Ming dynasty’s survival depended on locating and employing men with the ability to direct military forces, and contemporary observers were deeply concerned with the nexus of command, troop morale, and dynastic fighting capacity. This essay focuses on the years following the Tumu Crisis of 1449, a time when dynastic authorities were particularly alive to issues of military ability, and it draws on the perspectives of two men, the Minister of War, Yu Qian 于謙 (1398–1457), and another more junior official, Ye Sheng 葉盛 (1420–72). The essay offers a snapshot of how military ability was defined, cultivated, assessed, and rewarded. Further, it suggests that, read carefully, the writings of Ye Sheng and Yu Qian not only offer insight into the views of elite civil officials but also shed light, however faint and wavering, on military labor and working conditions for those who fought and commanded for a living.
The upbringing and professional career of Wu Jian (1462–1506) and his uncle, Wu Cong, shed light on two key issues. First is the gradual transformation of merit nobles within the Ming polity, particularly their role in dynastic defenses. Second is the dynasty’s continued efforts to secure military ability through instituting new practices, including the education and training of young merit nobles and entrusting capable civil officials with substantial military responsibilities. Before turning to Wu Jian’s career, however, we first consider the experiences of his mother and other women, whose abilities both in managing large, complex households and negotiating with the dynastic state, were essential to the fortunes of all merit noble families.
Recounting the experiences of Wu Ruyin and his son, Wu Weiying, who between them held the title of Marquis of Gongshun in succession from 1599 to 1643, this chapter and the preceding one address two overarching issues. First, they explore how institutions and administrators persevere amidst crisis. It may be tempting to caricature late Ming bureaucrats as obdurately clinging to the past, but men like Wu Ruyin and Wu Weiying adapted to new demands by incorporating new technologies and new ways within established frameworks. Few felt the need to abandon the “institutions of the imperial forefathers.” Second, these chapters examine the place of merit nobles in late Ming society. Wu Ruyin and Wu Weiying were not men of the people, but by function of their social circles, they actively engaged in the capital’s broader cultural activities, and by virtue of their jobs as senior military administrators, they commanded surprisingly detailed information about common soldiers and officers, war captives and refugees, and even rumors circulating through Beijing. This chapter first examines Wu Ruyin’s role as the emperor’s representative in ceremony, which included officiating at rituals, offering prayers, and hosting banquets, and second, considers his experiences as a military administrator in a time of acute challenges.
Using Wu Jin’s tenure as Marquis of Gongshun from 1449 to 1461, this chapter explores issues of ability and difference in a time of upheaval at the Ming court. It traces the Wu family as it shifted from immigrant family at the empire’s western edge to members of the capital elite. The chapter also explores the divergent experiences of other Mongolians and merit noble families within the Ming polity.
Recounting the experiences of Wu Ruyin and his son, Wu Weiying, who between them held the title of Marquis of Gongshun in succession from 1599 to 1643, this chapter and the next address two overarching issues. First, they explore how institutions and administrators persevere amidst crisis. It may be tempting to caricature late Ming bureaucrats as obdurately clinging to the past, but men like Wu Ruyin and Wu Weiying adapted to new demands by incorporating new technologies and new ways within established frameworks. Few felt the need to abandon the “institutions of the imperial forefathers.” Second, these chapters examine the place of merit nobles in late Ming society. Wu Ruyin and Wu Weiying were not men of the people, but by function of their social circles, they actively engaged in the capital’s broader cultural activities, and by virtue of their jobs as senior military administrators, they commanded surprisingly detailed information about common soldiers and officers, war captives and refugees, and even rumors circulating through Beijing. This chapter first examines Wu Ruyin’s role as the emperor’s representative in ceremony, which included officiating at rituals, offering prayers, and hosting banquets, and second, considers his experiences as a military administrator in a time of acute challenges.
Using Wu Jijue’s career as a focal point, this chapter explores the power of appointment, the process of assessment, and the culture of patronage, before offering a few overarching observations about Wu Jijue’s experiences and what they say about China in the second half of the sixteenth century. The chapter also throws into clear relief how dramatically contemporary perceptions of the Wu family had changed from the early fifteenth century to the late sixteenth century. Once newly arrived immigrants at the edge of the realm whose Mongolian names and origins were obvious to all, the Wu family were now unquestionably “one-percenters,” a capital family ranking among the elites of the elites and whose foreign origins were completely overshadowed by its century-old ties to the imperial throne and service in the highest echelons of the dynastic administration.
The Wu family’s experiences illustrate in clear and human terms how institutions change over time. Far from lapsing into an ornamental or parasitic existence after the horrific purges of the Hongwu and Yongle reigns, merit nobles remained integral to the Ming dynasty. Reviewing the careers of the Wu men across the generations, we see their role change from field commanders, to a mix of field command and senior administration, and finally to exclusively capital administration. Rather than a caricatured image of corrupt irrelevance, merit nobles, properly considered, serve as a salutary reminder that military institutions, like other institutions, adapted to new circumstances. Examination of the Wu family yields a sharper understanding of who actually administered the dynasty’s core military institutions, what functions they served, and how they interacted with civil officials, palace eunuchs, officers, and the throne. Civil officials came and went, eunuchs held posts for longer, and military officers led campaigns, but merit nobles provided much of the continuity in personnel so essential for the operation of the Capital Training Divisions and Chief Military Commissions, pillars of the dynastic military.
Chapter 1 traces the experiences of Batu-Temür, his wife, their sons, and some 5,000 followers, who in 1405 migrated from the Mongolian steppe to the northwestern corner of the still-new Ming dynasty. In recognition of the military contributions of Batu-Temür and his sons, and their steadfast loyalty on refusing to join a local Mongolian insurrection, the Ming emperor granted the family a series of high-level military posts, gifts, honorary titles, a Chinese surname (Wu), and eventually investiture of Batu-Temür as Earl of Gongshun, a title that his descendants would hold until the mid seventeenth century. The Wu family’s experiences show both the Ming dynasty and recently arrived immigrants actively attempting to advance their interests in a time of rapid geopolitical change.
The last Marquis of Gongshun, Wu Weihua, not only survived but thrived during the traumatic transition from the fallen Ming dynasty to the newly founded Qing dynasty. His elder brother died in an epidemic of unprecedented scale in the capital, leaving vacant the title of marquis. His nephew was murdered in a rebel occupation of Beijing without parallel in the dynasty. His sovereign perished at his own hand (another unique event during the Ming period), and the Ming ruling house crumpled before his eyes. Wu Weihua then hurled himself across the dynastic divide, offering his services to the new Manchu regime in exchange for the title his family had held without interruption since the early fifteenth century. In addition to dogged pursuit of that title, he worked tirelessly to secure the survival – even prosperity – of his family in a new age, winning posts for his brothers and brokering at least one marriage alliance with the new Manchu elite.
The Introduction lays out the book’s arguments, organization, and significance. The basic arguments are: (1) there was more to the military than war; (2) there was more to government than civil officials; and (3) there was more to China than the Han majority. The story of the Wu family is told at three levels: (1) the professional and family lives of each generation of the men to hold the title Marquis of Gongshun, (2) broader events and trends occurring in Ming politics, society, economics, religion, and ethnic relations, and (3) periodic consideration of the big picture, that is, thinking about the Ming dynasty in its Eurasian context. Nearly all polities confront issues of ability and difference as they secure people of ability through means such as hereditary status, meritocratic evaluations, and patronage. Simultaneously, polities like the Ming dynasty developed institutional means to acknowledge and whenever possible leverage differences such as ethnicity, gender, professional training, and relation to the throne.
This chapter explores the career of Wu Kezhong from 1418, the year he succeeded his father’s investiture as Marquis of Gongshun, to 1449, the year he fell in combat. Like his father, Wu Kezhong served the Ming throne as a Mongolian specialist and military commander. Batu-Temür had offered his loyalty to the Ming throne at the head of some 5,000 supporters, and Wu Kezhong too acted as a patron and protector for the Mongolian community. Despite such similarities, both the dynasty and the place of Mongols in the polity were changing. Wu Kezhong was among the first generation of his family to live through imperial successions as first the Yongle and then Xuande emperor died, leaving the throne to new sovereigns who actively sought the support of proven commanders such as Wu Kezhong. The new sovereigns, especially the man for whom Wu Kezhong and his brother died, differed importantly from their forefathers not only in their styles of rulership but also in their policies. That mattered because, even more than his father, Wu Kezhong pursued patronage through imperial institutions, which required knowledge of salary structures, commutation rates, and the shifting balance of power at court.