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The military coup in Myanmar in February 2021 caused widespread disruption to medical education. Many psychiatry trainees and trainers joined the Civil Disobedience Movement (CDM), resulting in the suspension of formal postgraduate psychiatry training nationwide and posing a serious threat to the future psychiatric workforce. In response, Myanmar CDM psychiatrists, supported by the psychiatrist diaspora, developed an alternative pathway to sustain postgraduate psychiatry training in a conflict setting.
Aims/Objectives
To restore postgraduate psychiatry training while maintaining academic standards, clinical competency, and professional integrity through an innovative, digitally enabled, and internationally supported training model.
Methods:
Biweekly online Continuing Medical Education (CME) sessions commenced in March 2021. By September 2023, CDM psychiatrists collaborated with retired academics and diaspora psychiatrists from the United Kingdom, United States, and Australia to develop a formal curriculum. The programme was finalised in December 2023 and approved by the Federal Health Professional Council and Interim University Councils. An online Master of Medical Science (Psychiatry) programme was launched on 15 January 2024. The programme focused on clinical knowledge development through weekly Zoom lectures and Moodle-based learning, and clinical skills development through supervised practice, CME case discussions, and workplace-based assessments. Research training was deferred due to safety concerns.
Results:
Trainee engagement was monitored through assignment completion, participation in synchronous teaching, and completion of supervised clinical attachments. Ten trainees enrolled. Assignment completion reached 100%, participation in teaching was at least 75%, and clinical attachment completion exceeded 90%. Between April and May 2025, seven trainees completed final assessments, including multiple-choice examinations and virtual clinical examinations with live assessors and simulated patients. All seven trainees passed and were certified as qualified psychiatrists. A 360-degree evaluation demonstrated high satisfaction among trainees, supervisors, and assessors.
Conclusion:
Despite severe disruption, Myanmar’s CDM psychiatrists successfully revitalised postgraduate psychiatry training using a decentralised, digitally enabled, and internationally supported model. This experience demonstrates that high-quality postgraduate psychiatry education can be sustained in fragile and conflict-affected settings and offers a scalable framework for global mental health workforce development.
Acknowledgements: We acknowledge all Civil Disobedience Movement (CDM) mental health professionals in Myanmar and the Myanmar psychiatrist diaspora worldwide for their collective leadership, academic contribution, and unwavering commitment to sustaining postgraduate psychiatry training under conflict conditions.
Armed conflict and political instability are major determinants of population mental health, disrupting service delivery, workforce sustainability, and prevention systems. Following the 2021 military coup in Myanmar, formal psychiatric training pathways and national mental health services were severely fragmented or collapsed. In response, the Myanmar Board of Psychiatry (M.B.Psych) was reconstituted in 2025 to support a population-oriented, task-shared mental health system operating under complex humanitarian conditions.
Aims
To describe a national public mental health model integrating workforce development, service delivery, prevention, and community-based interventions in a protracted conflict setting.
Methods:
A descriptive programme analysis was conducted using routine training, service delivery, and supervision data from M.B.Psych activities between January and December 2025. Interventions were mapped across core public mental health domains, including promotion, prevention, treatment, capacity building, and system governance.
Results:
M.B.Psych implemented a multi-layered mental health system spanning community, primary, and specialist care. Workforce capacity was strengthened through postgraduate psychiatric training, undergraduate teaching, medical education programmes, and international global mental health certification, with seven psychiatrists qualifying during the study period, supporting continuity of specialist care despite widespread displacement.
Population-level preventive and promotive interventions included nationwide Psychological First Aid, Mental Health and Psychosocial Support (MHPSS), mhGAP training, suicide prevention services, and school-based mental health programmes. Task-sharing enabled trained volunteers, lay counsellors, and primary care clinicians to deliver frontline care with structured psychiatric supervision.
Clinical services were delivered through an integrated hybrid model combining tele-mental health, primary mental health clinics, suicide prevention hotlines, and targeted on-ground psychiatric deployment in conflict-affected regions. Diaspora psychiatrists provided sustained supervision, psychotherapy training, and clinical governance support. Contextually adapted resources, including a Myanmar-language WHO Group PM+ manual and military-focused MHPSS materials, supported scalable and culturally appropriate interventions.
Conclusion:
This public mental health model demonstrates that equitable, population-based mental health systems can be sustained during armed conflict through task-sharing, digital delivery, diaspora engagement, and integrated education–service frameworks. The Myanmar experience offers transferable lessons for global mental health system strengthening in fragile and conflict-affected settings.
Acknowledgements
The authors acknowledge the commitment and resilience of all Civil Disobedience Movement (CDM) mental health professionals, psychiatrists, psychologists, trainees, volunteers, and the Myanmar psychiatrist diaspora who contributed to service delivery, training, supervision, and community mental health support under extremely challenging conditions.
To develop and assess interpretable machine-learning models for sarcopenia risk assessment among physically inactive middle-aged and older adults using two large population-based datasets from the UK and the US.
Background:
Physical inactivity represents a major modifiable risk factor for sarcopenia in aging populations, yet prediction models specifically targeting this high-risk subgroup remain limited. This study developed and evaluated interpretable machine-learning models for sarcopenia risk stratification in physically inactive middle-aged and older adults using large-scale UK and US population-based data.
Methods:
We analyzed physically inactive participants from the English Longitudinal Study of Ageing (ELSA, 2012; n = 1,146) and the US National Health and Nutrition Examination Survey (NHANES, 1999–2006 and 2011–2018; n = 2,733). Sarcopenia and physical inactivity were defined using cohort-specific measurements and cutoffs. Within each cohort, six machine-learning algorithms were trained using 70/30 training–testing splits, Synthetic Minority Oversampling Technique to address class imbalance, and five-fold cross-validation for hyperparameter optimization. Model performance was evaluated using area under the curve, accuracy, precision, recall, and F1 scores. Shapley Additive Explanations quantified predictor contributions, and stratified analyses explored heterogeneity by age and body-composition strata.
Findings:
Random forest demonstrated optimal performance across both cohorts (area under the curve: 0.817 and 0.801; accuracy: 83.8% and 83.1%). Shapley Additive Explanations analysis revealed waist-to-height ratio as the dominant predictor, followed by age, frailty score, and poverty-income ratio. Stratified analyses showed heterogeneous risk patterns across age groups and body-composition categories.
In extreme environments, hexapod robots are highly susceptible to locomotor failure due to leg structure damage or electronic circuit interruptions. Such failures are particularly critical in ipsilateral two-leg loss, where most conventional hexapod designs fail to maintain stability. This paper introduces a hexapod robot platform equipped with a functional arm (FA) and proposes a fault-tolerant strategy based on FA compensation. The FA serves as a task-oriented module under normal conditions and as a compensatory leg during instability caused by leg loss, enabling rapid recovery of stability and walking capacity without complex adjustments to the remaining legs. An optimization algorithm was developed for gait adjustment, using the longitudinal stability margin as the optimization objective with the compensation median angle θ and swing angle α as key parameters. The optimal compensatory positions of the FA were identified for both the ipsilateral middle-hind leg and front-hind leg failure scenarios. Experimental results demonstrate a marked improvement in both walking stability and capability after FA compensation. For both failure modes, the robot’s attitude fluctuations were significantly suppressed, and the stride length was substantially increased, affirming the feasibility and effectiveness of the proposed approach in enhancing the environmental adaptability of multi-legged robots.
Methylphenidate is sometimes used to address residual symptoms of major depressive disorder (MDD), but concerns about psychiatric destabilization and limited long-term evidence have constrained its use. We examined the psychiatric safety of methylphenidate in adults with MDD in a large, real-world cohort.
Methods
Using the TriNetX Global Collaborative Network, we identified adults with MDD who initiated methylphenidate and matched them 1:1 with controls who did not receive methylphenidate. Patients with attention-deficit/hyperactivity disorder, bipolar disorder, mania, or recent psychiatric destabilization were excluded. The primary outcome was a composite of all-cause hospitalization or emergency room visits; secondary outcomes included hospitalization, emergency visits, suicidal behavior, manic episodes, and recurrence of MDD. Hazard ratios (HRs) were estimated with Cox proportional hazards models after propensity score matching.
Results
Of 425,190 eligible patients, 3,211 matched pairs were included (mean age, 55.8 years; 58% female). Over 1 year, the composite outcome occurred less frequently in the methylphenidate group than in controls (574 vs. 694; HR, 0.85; 95% CI, 0.76–0.95). No significant differences were observed for hospitalization, emergency visits, suicidal behavior, manic episodes, or MDD recurrence. Results were consistent across subgroups defined by sex, age, and antidepressant class.
Conclusions
In adults with MDD, methylphenidate use was associated with a lower risk of hospitalization or emergency visits and was not linked to increased risk of suicidality, mania, or recurrence. These findings support the psychiatric safety of methylphenidate as an adjunctive treatment for selected patients, though longer follow-up is needed.
Carbonatite is one of the major archives of rare earth elements (REEs), and in some cases, its formation is linked to the deep subduction of carbonated ocean crust and REE-rich sediments. The formation conditions of hydroxyl REE carbonate, [Sm(CO3)OH] or ‘hydroxylbastnäsite-(Sm)’ (it is not presently an IMA-approved mineral), in a subduction zone were simulated at 3 GPa and 1073 K. The crystal structure of Sm(CO3)OH was determined using single crystal X-ray diffraction (XRD), which shows the crystal to be hexagonal with cell parameters a = b = 12.2143 (7) Å, c = 9.8393 (6) Å, V = 1271.26 (17) Å3, and space group $P\bar 6$. The high-pressure properties of synthesized Sm(CO3)OH were investigated using in-situ synchrotron powder XRD and Raman spectroscopy at pressures up to 20.9 and 20.6 GPa at ambient temperature, respectively. Additionally, the structural stability of Sm(CO3)OH under pressure and temperature conditions up to 5.9 GPa and 473 K was also investigated using Raman spectroscopy. A third-order Birch–Murnaghan equation of state fitted to the ambient temperature and high-pressure data points yielded K0 = 76 (11) GPa with K0ʹ = 13 (2), and K0 = 127 (2) GPa if K0ʹ is constrained to a value of 4. Analysis of axial compressible moduli shows an apparent compression anisotropy of Sm(CO3)OH: Ka = 215 (5) GPa and Kc = 265 (5) GPa. Raman spectra of the synthesized quenchable crystal of Sm(CO3)OH displayed no detectable phase transition at the pressure range from ambient to 20.6 GPa, and no noticeable phase transition when the temperature and pressure were increased from ambient conditions to 473 K and 5.9 GPa, respectively. These results suggest that the [Sm(CO3)OH] phase may play a potential role as a conveyor for the migration of rare earth elements (REE), carbon (C) and water (-OH) to the deep Earth during plate subduction.
Ferrisia dasylirii (Cockerell) (Hemiptera: Coccomorpha: Pseudococcidae) is a polyphagous mealybug species and native to North America, but has spread to Asia and Africa. In this study, we report F. dasylirii for the first time from China using an integrated taxonomy approach combining morphological characters and molecular analyses of the mitochondrial cytochrome oxidase subunit 1 gene. It was found on 12 tropical fruit species in Hainan Province: Annonaceae: Annona squamosa L. and A. squamosa ‘Purple’; Myrtaceae: Eugenia brasiliensis Lam. and Psidium guajava L.; Malvaceae: Theobroma cacao Linn.; Lecythidaceae: Lecythis pisonis Cambess.; Sapotaceae: Pouteria campechiana (Kunth) Baehni and P. sapota (Jacq.) H.E.Moore & Stearn; Rubiaceae: Coffea liberica W. Bull ex Hiern; Cunoniaceae: Davidsonia pruriens F. Muell; Arecaceae: Areca catechu Linn.; Musaceae: Musa nana Lour.; Malpighiaceae: Malpighia emarginata Sesse & Noc.ex DC.; and Phyllanthaceae: Phyllanthus emblica Linn. This record increases the known geographic range of F. dasylirii and underscores the importance of combined morphological and molecular approaches for accurate mealybug identification.
Direct numerical simulations of turbulent channel flows with thermally unstable stratification laden with finite-size particles are performed using the fictitious domain method. The effects of particle concentration, size and specific heat capacity on turbulence and heat transfer are investigated at the friction Reynolds number 180, the Prandtl number 0.7, the Richardson number 20 and both density ratio and thermal conductivity ratio being unity. The natural convection circulations in the unstable stratification case cause the occurrence of streamwise streaks of vortex, velocity and temperature. Compared with the neutral case, the particle-induced flow drag enhancement is more significant for the unstable stratification case, mainly because the particle-induced reduction in the fluid Reynolds shear stress is much less significant for the unstable stratification case, which may be caused by the weaker suppression effects of the particles on the Rayleigh–Bénard circulations and the streamwise vortex packages. In contrast to the neutral case where the particles attenuate the fluid turbulent heat flux and thereby the Nusselt number, the particles enhance the fluid turbulent heat flux and thereby the Nusselt number for the unstable stratification case. The above particle effects are stronger for higher particle volume fractions or smaller particle sizes, when the other parameters are fixed. As the specific heat capacity ratio increases, the Nusselt number increases as a result of the increase in the solid turbulent heat flux contribution.
Multi-plane light conversion (MPLC) is a versatile technique that enables arbitrary manipulation of optical fields, and is numerically investigated as a novel avenue for coherent beam combining (CBC) applications. The optical parameters have been investigated to guide the MPLC design, indicating that the number of phase planes and plane spacing serve as pivotal factors. The channel scalability is simulated, revealing that the plane spacing should be increased in a larger array to maintain high performance under a few-plane limit. CBC of up to 1027 lasers has been numerically demonstrated with near-diffraction-limited beam quality (M2 of 1.16 and combining efficiency close to 100%) with only seven phase plates. Beam steering is investigated, revealing that steering capability is related to both the number of multiplexed modes in MPLC and their mode fidelities, and the main-lobe power ratio of 87.1% at one divergence angle is achieved in a 10-mode MPLC with five phase plates.
We present a high-brightness, nanosecond pulsed blue laser source at 476.8 nm through efficient quadruple-harmonic generation from a thulium-doped yttrium lithium fluoride (Tm:YLF) master oscillator power amplifier operating at 1.9 μm. The fundamental-frequency stage produces 42 mJ pulses at 1907.3 nm with a narrow linewidth of 0.19 nm at 1 kHz. Through cascade second-harmonic generation using low-walk-off lithium triborate crystals, we achieve 10.52 mJ blue laser pulses with 16.1 ns duration, corresponding to a peak power of 0.65 MW and exhibiting excellent energy stability of 0.47%. The system maintains exceptional beam quality (M2x = 1.46, M2y = 1.27) at maximum output power, attributed to the negative thermal-optical properties of the Tm:YLF crystal, end-pumped amplification architecture and optimized nonlinear conversion. This work demonstrates a compact and efficient route to high-brightness (~2.49 GW·cm–2·sr–1) pulsed blue laser emission, which is particularly suitable for advanced marine scientific applications including underwater LiDAR and communication systems.
Orthopaedic inpatients have distinct clinical traits. This study aimed to quantify the burden of nosocomial infections (NIs) on orthopaedic patients. A nested case–control study (2022–2024) at the China National Orthopaedic Medical Center compared orthopaedic inpatients with and without NIs and matched cases and controls 1:3 to evaluate the burden of NIs. A national economic burden analysis was subsequently conducted under various scenarios. Among 120,764 eligible patients, 338 (0.28%) developed NIs. A total of 321 cases were matched with 916 controls. The economic and temporal burdens of NIs are US$2,100 and 5 days per case respectively. Haematologic NIs had the highest additional cost (US$4,295) and the second longest extended stay (9 days). In terms of initial hospitalisations and readmissions, surgical site infections extended hospital stays by 20 days and increased costs by US$4,881. The top three diagnosis-related groups (DRGs) with high burdens are ZC11, ZJ15, and IE21 for costs and ZJ15, IE21, and IB19 for duration. In the mixed-region scenario, orthopaedic specialty hospitals nationwide incur US$5.23 million in direct medical costs annually because of NIs. These findings indicate that NIs significantly affect orthopaedic patients both individually and nationally, necessitating focused prevention and control for high-burden DRGs and specific infections.
Dynamics of spheroidal particle migration within the elasto-inertial square duct flow of Giesekus viscoelastic fluids were studied by using the direct forcing/fictitious domain method. The results show rich migration behaviours, a spheroidal particle gradually transitions from the corner (CO), channel centreline (CC), inertial rotational (IR), diagonal line and cross-section midline equilibrium positions with a decrease in the elastic number, depending on the initial particle position, initial particle orientation and fluid elasticity. From the effect of secondary flow, the IR equilibrium position is reported when the fluid inertia is relatively strong. Six (five) kinds of rotational behaviours are observed for the elasto-inertial migration of prolate (oblate) spheroids. Moreover, the critical elastic number is determined for the migration of spheroidal particles in Giesekus fluids. Near the critical elastic number, oblate and prolate spheroids can simultaneously maintain the CC, CO and IR equilibrium positions, and the initial orientation of particles affects their final rotational modes and equilibrium positions. Through comprehensive analysis, empirical formulas governing the ability of oblate and prolate spheroids to maintain the CC equilibrium position are proposed as $\textit{Wi} = 0.055\,\textit{Re}{-0.1}$ and Wi = 0.045 Re−0.35 when n = 0.5, 0.01 ≤ Wi ≤ 1. Due to the different directions of the pressure forces acting on the particles and the forces from the first normal stress difference and the second normal stress difference, the equilibrium position in Giesekus fluids is rapidly increased by increasing the secondary flow at higher elastic numbers, which is contrary to the phenomenon observed in the Oldroyd-B fluid.
A total of 60 healthy lambs were randomly assigned to three treatment groups: control (CON), and groups receiving basal diet (dry matter base) supplemented with 400 mg/kg (CA400) and 800 mg/kg (CA800) of cinnamaldehyde (CA), the CA additive used silicon dioxide as adsorbent and the CA content was 25% (m/m). The study lasted 75 days, including a 15-day pre-trial and a 60-day trial period. Results showed average daily gain, feed-to-gain ratio, as well as digestibility rates of organic matter and crude protein were significantly improved compare with CON (P < 0.05). Serum total protein and immunoglobulin G levels were elevated in both CA groups (P < 0.05). The CA800 group had significantly higher total superoxide dismutase compared to CON, while glucose (Glu) levels were lower in CA groups (P < 0.05). Ruminal ammonia nitrogen level was significantly lower in the CA groups compared to CON (P < 0.05). The total volatile fatty acid concentration was highest in the CA400 group, followed by CON, with the lowest in the CA800 group; the acetate/propionate ratio tended to be lower in the CA groups (P > 0.05). The abundance of Bacteroidetes in CA800 group was significantly higher than that in CON (P < 0.05), and the abundance of Firmicutes in CA400 and CA800 groups were significantly decreased (P < 0.05). The abundance of Prevotella in CA400 and CA800 groups was significantly increased (P < 0.05), while abundance of Rikenellaceae_RC9_gut_group was significantly lower than that in CON group (P < 0.05). In conclusion, the addition of SiO2 adsorbing CA to the diet of lambs can improve the growth performance, nutrient apparent digestibility, antioxidant and immune ability, and changed composition of ruminal bacterial community, addition of 400 mg/kg (equivalent to 100 mg/kg pure) has the best effect.
Shanlan upland rice, as a unique local rice germplasm resource in Hainan comprises abundant genetic diversity. One hundred and sixty two Shanlan upland rice accessions collected from diverse ecological regions in Hainan were systematically characterized based on 11 agronomic traits. The rich genetic diversity was confirmed by phenotypic data from two consecutive years (2023 and 2024). Coefficient of variation ranged from 14.11% to 46.04% in 2023 and from 11.45% to 44.82% in 2024, with panicle-related traits (number of primary branches, grain number of primary branches, number of secondary branches, grain number of secondary branches and grain number per main panicle) exhibiting particularly high variation. Correlation analysis revealed highly significant synergistic effects among yield-related traits. Cluster analysis of the 162 accessions consistently classified them into five major groups across both growing seasons. Through grain number per main panicle and seed setting rate investigation, three excellent resources were selected that demonstrated stable and superior performance in both seasons. Notably, Line 69 exhibited outstanding “large panicles with high seed-setting rate,” producing 261.4 and 305 grains per main panicle in 2023 and 2024, respectively, with seed-setting rates reaching 93.79% and 90.07%. This study presents phenotypic data for Shanlan upland rice, offers high-quality breeding materials for subsequent research, and lays a theoretical groundwork for conserving and exploiting Hainan’s rice resources.
Design Science is the discipline that studies the creation of artifacts – products, services, and systems and their embedding in our physical, virtual, psychological, economic, and social environments. This editorial is a collective effort of the Design Science Journal’s editorial board members, past and present. The journal’s inaugural 2015 editorial, “Design Science: Why, What and How,” reflected the thoughts and vision of that first editorial board for the new journal and the discipline it represented. The present contribution offers the reflections of editors who served the journal in the past 10 years. The individual contributions were not primed and are presented here unedited for conformity or consistency. Differently from the 2015 editorial, there is no effort to synthesize the individual contributions, leaving the task to our readers, who can draw their own conclusions about the Design Science Journal and community accomplishments to date, and the challenges ahead.
Gas-phase turbulence in a bubbling gas–solid fluidised bed is modelled using the data from particle-resolved direct numerical simulations. The subgrid particle-induced turbulent kinetic energy (TKE) is modelled as a function of filter width, filtered solid volume fraction, particle Reynolds number and filtered gas-phase strain rate tensor. Within the volume-filtered framework, we demonstrate that the fluid Reynolds stress models originally developed for a homogeneous system remain applicable to the inhomogeneous fluidised bed, provided that the inhomogeneous drag and particle-induced TKE models are used for the dissipation rate interfacial term. An algebraic model for the anisotropy of gas-phase velocity variance is developed by simplifying the proposed Reynolds stress equation model, which incorporates the effects from both filtered slip velocity and filtered fluid strain rate. The new models are shown to agree well with the direct numerical simulation data of clustered particle settling systems, indicating good applicability of our models for various clustered particle-laden flows.
The locomotion of microorganisms in complex fluids at low Reynolds numbers has been widely studied by ignoring fluid inertia. Here, we combine the asymptotic analysis and numerical simulations to explore the effect of fluid inertia on the dynamic mechanism of microorganisms swimming through viscoelastic fluids using Taylor’s swimming sheet model, undergoing small-amplitude undulations. Surprisingly, fluid inertia can enhance the speed and efficiency of the infinite-length sheet in viscoelastic fluids at finite Reynolds numbers, in stark contrast to the previous results found in Newtonian fluids. Moreover, speed and efficiency slightly exceed those Newtonian values at the small Weissenberg number due to a passive inertial response of the sheet. We associate this with the magnitude of the hydrodynamic force increasing at finite Reynolds numbers. These insights contribute to a deeper understanding of the inertial effect on the locomotion of microorganisms through complex fluids.
Antimicrobial resistance (AMR) is a global health crisis exacerbated by policies like China’s Volume-Based Procurement (VBP), which may inadvertently increase antimicrobial overuse. This study evaluates a clinical pharmacist-led Antimicrobial Stewardship (AMS) program with prospective audit for special-restricted antimicrobials under VBP.
Methods:
A retrospective quasi-experimental interrupted time-series analysis compared pre-intervention (2022) and post-intervention (2023–2024) data at Tongji Hospital, a tertiary hospital in Wuhan, China. Key metrics included Antimicrobial Use Density (AUD), prescription rationality, antimicrobial costs, and multidrug-resistant infection rates.
Results:
The intervention significantly improved prescription appropriateness for special-restricted antimicrobials (80.24% vs. 93.83%, P < 0.005) and reduced AUD (47.87 vs. 34.25, P < 0.001). Total antimicrobial costs decreased by 41.26%, with a reduction in the incidence of multidrug-resistant infections from 0.084% to 0.062% (P < 0.05). Carbapenem use correlated with CRKP isolation rates (R = 0.62, P < 0.05). Clinical pharmacists rejected 10.24% of prescriptions, all accepted by physicians.
Conclusion:
Pharmacist-led prospective audits optimize antimicrobial use under VBP, mitigate resistance risks, and reduce costs, while acknowledging that concurrent infection control measures may have contributed to these trends. This model may inform similar interventions in other institutions, particularly those in resource-limited settings.
Previous studies highlighted the health benefits of coffee and tea, but they only focused on the comparisons between different consumptions. Consequently, the association estimate lacked a clear interpretation, as the substitution of beverages and distribution of doses were not explicitly prescribed. We focused on the ‘relative association’ to ascertain the optimal consumption strategy (including total intake and optimal allocation strategy) for coffee, tea and plain water associated with decreased mortality. Self-reported coffee, tea and plain water intake were used from the UK Biobank. Within a compositional data analysis framework, a multivariate Cox model was used to assess the relative associations after adjusting for a range of potential confounders. The lower mortality risk was observed with at least approximately 7–8 drinks/d of total consumption. When the total intake > 4 drinks/d, substituting plain water with coffee or tea was linked to reduced mortality; nevertheless, the benefit was not seen for ≤ 4 drinks/d. Besides, a balanced consumption of coffee and tea (roughly a ratio of 2:3) associated with the lowest hazard ratios of 0·55 (95 % CI 0·47, 0·64) for all-cause mortality, 0·59 (95 % CI 0·48, 0·72) for cancer mortality, 0·69 (95 % CI 0·49, 0·99) for CVD mortality, 0·28 (95 % CI 0·15, 0·52) for respiratory disease mortality and 0·35 (95 % CI 0·15, 0·82) for digestive disease mortality than other combinations. These results highlight the importance of the rational combination of coffee, tea and plain water, with particular emphasis on ensuring adequate total intake, offering more comprehensive and explicit guidance for individuals.
This study aimed to update the incidence of device-associated healthcare-associated infections (DA-HAIs), and to characterize pathogen distribution and carbapenem-resistant Enterobacteriaceae (CRE) detection among ICU patients in Shanghai, China.
Methods:
Prospective surveillance in 223 ICUs using standardized International Nosocomial Infection Control Consortium methodology (INICC) protocols collected patient-level data on demographics, microbiology, device use, and DA-HAIs. Trends, annual percent change (APC) and average annual percent change (AAPC) were estimated using Joinpoint regression models.
Results:
The overall DA-HAIs incidence density in ICUs was 1.67 per 1000 catheter-days for catheter-associated urinary tract infection (CAUTI) (95% CI: 1.62–1.73), 0.59 per 1000 central line-days for central line-associated bloodstream infection (CLABSI) (95% CI: 0.56–0.63), and 4.63 per 1000 ventilator-days for ventilator-associated pneumonia (VAP) (95% CI: 4.51–4.76). Significant reductions were observed in VAP (AAPC: −15.36%; P < 0.001) and CLABSI (AAPC: −11.23%; P < 0.001). Pathogen distributions varied by infection type, with Enterococcus faecium (17.22%) and Klebsiella pneumoniae (16.63%) predominating in CAUTI patients, Klebsiella pneumoniae (26.87%) in CLABSI patients, and Acinetobacter baumannii (37.60%) in VAP patients. The overall CRE detection rate was 33.67% in CAUTI patients, 37.56% in CLABSI patients, and 35.24% in VAP patients.
Conclusions:
Although DA-HAI rates showed significant declines, the persistently high CRE prevalence underscores substantial antimicrobial resistance challenges in Chinese ICUs.