Background: Urinary tract infection (UTI) is the most dominant case, around 40% of healthcare-associated infections (HAIs). UTI related to catheter placement called as Catheter-Associated Urinary Tract Infection (CAUTI). Catheterization is considered as a port of entry that lead to infection. In sepsis patients, CAUTI can significantly affect clinical outcomes. Prolonged CAUTI can worsen but can be prevented via suitable intervention, particularly in septic patients with urine catheters. To effectively prevent and manage diseases, gathering data focusing on surveillance is essential. Hence, examining multiple risk variables associated with CAUTI is vital, including age, gender, diabetes mellitus, kidney failure, frequency and duration of catheterization, and duration of antibiotic usage before urine culture. Method: A quantitative study using a cross-sectional design by selecting samples using total sampling was conducted at RSPAD Gatot Soebroto (n=42). All sepsis patients using catheters met the inclusion criteria. The data obtained was analysed (univariate, bivariate and multivariate), which will be presented in table and narrative format. Results: It was found that 21 sepsis patients with catheters confirmed CAUTI. Risk factors in septic patients with catheters that have a significant relationship with CAUTI are diabetes mellitus (p=0.013), kidney failure (p=0.005), length of stay (p=0.013), duration of antibiotic usage before urine culture (p=0.031), frequency of catheterization (p=0.028), and duration of catheterization (p=0.013). However, age (p=0.739) and gender (p=0.757) did not have a significant relationship. In the multivariate test was found that the most significant variables were kidney failure (p=0.006; OR=22.219; 95%CI=2.424- 293.744) and duration of catheterization (p=0.009; OR=19.147; 95%CI=2.070-177.149). Conclusion : Our findings indicate that kidney failure and duration of catheterization are the most significant risk factors for septic patient who develop CAUTIs. To enhance the clinical outcomes of sepsis patients prone to CAUTI, it is crucial to identify the risk factors as a part of treatment management and infection prevention control.

Background/Aim: Early removal of indwelling urinary catheters (IDC) is an effective strategy to prevent catheter- associated urinary tract infection (CAUTI). We hypothesized a standardized Trial-Off-Catheter (TOC) protocol would reduce catheter utilisation and CAUTI rates in a community hospital. We aim to reduce catheter utilisation ratio and CAUTI rate per 1000 catheter days by 10% over a period of three months (post-intervention) in three pilot wards with the highest catheter usage. Methods: An IDC review board and a TOC protocol were designed collectively as a team in Yishun Community Hospital based on literature reviews. Roadshows were conducted at the three pilot wards and implemented over 2 months. 2-weekly audit was conducted by Infection Control Nurses on 3 process measures, (1) IDC were reviewed appropriately with IDC review board, (2) Appropriate usage of TOC protocol, (3) Compliance with TOC protocol. Results: Within three months’ post-intervention, IDC utilisation ratio reduced by 18%, CAUTI rate per 1000 catheter days reduced by 45%, percentage of IDC reviewed appropriately increased to 91%, zero CAUTI event related to the use of protocol and 77% successful catheter removal with TOC protocol. Conclusion: CAUTI prevention require continuous effort with multimodal strategies and support from various stakeholders. A standardized TOC protocol can reduce variation in practices among physicians/ nurses with different levels of experience with TOC. A standardized care process ensures efficient utilization of resources to achieve the desired clinical outcomes for patients.

The Convention on Biological Diversity, ratified by 196 countries including South Korea, aims to protect at least 30% of the world’s land, inland waters and marine areas by 2030 as part of the Kunming–Montreal Global Biodiversity Framework. Beyond increasing protected areas (PAs), promoting biodiversity by protecting different ecosystem types is crucial. We investigated whether South Korea’s PAs evenly cover various ecosystem types. We examined overlaps between the Korean Database of Protected Areas (KDPA) and the Korean adapted Ecosystem Typology (KET) map, which modified the International Union for Conservation of Nature (IUCN) Global Ecosystem Typology (GET) three-level ecosystem functional group map based on South Korea’s land cover. Compared to the biogeographical ecoregion map, the KET map provides finer ecological detail on representation within PAs and reveals the under-representation of human-influenced ecosystems; eight human-influenced ecosystem functional groups, including rice paddies and urban and industrial ecosystems that may contribute to biodiversity or cultural value, had <10% protection. The T2.2 deciduous temperate forest type dominates, covering 54.79% of PA area across 18 of 27 PA categories. This concentrated protection has led to up to 24 overlapping PA designations in certain locations. Expanding protection for under-represented ecosystems and diversifying governance could help South Korea align with global biodiversity goals.

Objectives: Antibiotic resistance is a global issue that has significant negative effects on both health and the economy. Klebsiella pneumoniae is grouped with Enterococcus faecium, Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. (ESKAPE) as multidrug-resistant (MDR) bacteria worldwide. The challenges associated with controlling life-threatening infections caused by MDR organisms have pushed research focus toward alternative treatments, which include bacteriophage therapy. Therefore, this study aimed to isolate the carbapenem-resistant K. pneumoniae (CRKP) specific phages from the hospital sewage water effluent for future application in a clinical setting. Methods: Sewage samples were obtained from different points of hospital effluent. The collected samples were primarily filtrated and centrifuged to recover, purify, and concentrate the bacteriophage. The lytic phages were detected using a spot assay. Subsequently, the specific CRKP phages were isolated using the double agar layer method, where the four CRKP clinical isolates were used as the host system. Results: Altogether, 30 sewage samples were collected from different points of hospital treatment plant at the Hospital Universiti Sains Malaysia (Hospital USM). Each samples were screened with four different clinical CRKP strains, giving rise to a total of 120 screened plates. Lytic phages were isolated in 50 /120 (41.70%) of the screened plates. The diameter of isolated CRKP lytic phages ranged between 0.01-0.7 cm. The phage titer ranged between 6×103−1.6×109 plaque- forming units per milliliter (PFU/ml). Conclusion: The lytic phages were isolated in abundance from the hospital treatment plant and exhibited a wide range of inhibitions against the CRKP, indicating its therapeutic potential in the future. However, further studies are required to comprehend the process of in vivo phage-mediated selection.

The population changes in waterbirds are recognised as a global issue. Many waterbird species, especially migratory ones, are undergoing population changes. Monitoring these changes is crucial for waterbird conservation. However, the lack of data to quantify these populations hinders comprehension of the factors responsible for these changes. Although a few studies have investigated the long-term trends of waterbirds in the Republic of Korea (ROK), most have concentrated on a limited number of species and groups. Understanding these changes enables us to identify which species are vulnerable and develop more effective conservation measures accordingly. This study aimed to investigate the population dynamics of waterbirds in the ROK from 2000 to 2024. Data from the Winter Waterbird Census of Korea were used to analyse trends across various waterbird groups and species. The results showed diverse population trajectories, with some species experiencing notable increases while others underwent severe declines. Among the observed trends, several globally threatened species, such as the White-naped Crane Grus vipio and Oriental Stork Ciconia boyciana, exhibited significant population growth. This is largely a testament to the effectiveness of conservation interventions aimed at these species. However, the study also identified population declines of some species, such as the Tundra Swan Cygnus columbianus and Common Pochard Aythya ferina, indicating pervasive threats due to habitat loss and degradation. Lastly, several recommendations are made regarding the identified population trends that should be used to guide future conservation efforts in the East Asian–Australasian Flyway. This study, with its comprehensive and detailed findings, reiterates the importance of long-term monitoring data for developing effective conservation measures.

Objectives: Environmental hygiene of patient zones in the wards of TTSH- a 1700 bedded hospital in Singapore is upkept through twice daily HTC. An outbreak in two wards end March 2023 with high levels of Adenosine Triphosphate (ATP) found on surfaces after cleaning corroborated that the cleaning process was ineffective [1]. Though operatives undergo on-job training (OJT), they expressed difficulty in understanding the purpose of such cleaning and remembering the steps. To address these gaps, a new training and competency framework was developed. We thus sought to evaluate its usefulness in improving compliance to HTC. Method: The framework, effected from May 2023, consisted of three domains: standardized education, competency assessment, and feedback mechanisms[2, 4]. Educational materials explaining the importance of HTC and overall infection prevention were developed in three common languages to facilitate understanding for operatives of different races. Under the framework, all existing and new operatives undertake a 2-day classroom teaching and OJT, before a competency check. Upon passing the first competency, they are given a two-week probation. Another assessment is done before certifying them competent. Operatives who fail twice are redeployed to non-clinical areas. The audit team gave direct feedback during monthly audits to evaluate performance and provide ongoing support and reinforcement. Results: The compliance of HTC in the patient zone picked up immediately from 71% in April to 92% in June. However, a decrease to 68% was observed between September to December 2023, but soon picked up to 82% in February 2024 after retraining was conducted. Decrease in ATP levels after cleaning further validated increase efficiency of HTC. Conclusions: These results highlight that structured learning rapidly improves the thoroughness of cleaning [2, 3]. Ongoing assessment and feedback are essential to address subsequent deficiencies and for corrective actions to be taken promptly [2, 4]. This framework may be useful for teams seeking to optimize strategies in environmental hygiene.

Acknowledgments: The authors thank the frontline environmental services teams for conducting and providing results of the HTC audits.

This paper investigates the time N until a random walk first exceeds some specified barrier. Letting $X_i, i \geq 1,$ be a sequence of independent, identically distributed random variables with a log-concave density or probability mass function, we derive both lower and upper bounds on the probability $P(N \gt n),$ as well as bounds on the expected value $E[N].$ On barriers of the form $a + b \sqrt{k},$ where a is nonnegative, b is positive, and k is the number of steps, we provide additional bounds on $E[N].$

Objectives: Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop- Mediated Isothermal Amplification (LAMP) method is faster and easier to perform compared to polymerase chain reaction (PCR)-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance. Methods: We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method limit of detection (LOD) and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The LOD of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI. Results: The LOD of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the LOD of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation. Conclusions: This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.

Background: Throughout healthcare, the physical environment presents an important source of pathogens that can cause healthcare associated infections (HAIs) To keep patients safe, hospitals must maintain a clean environment and minimize the presence of pathogens. Objectives: 1. To identify through environmental monitoring the level of cleanliness in area of pediatrics isolation ward. 2.To assessments of environmental cleaning practice of environmental service (EVS) staff, and healthcare worker. Methodology: This retrospective study was done in pediatrics isolation ward, tertiary hospital. Sample sizes were 1 EVS staff, 3 nurses aid, and 102 environmental sites. Data were collected from database of infection control program between February 29, to March 2, 2024 via Infection control assessment and response (ICAR: tool for assessing cleaning practice of EVS staff, personnel by direct performance observations), visual assessment, and monitored the residual bioburden by adenosine tri phosphate (ATP) tests, and swab culture of the surface. Data were analyzed by using descriptive statistics. Results: The results of this study revealed that level of cleanliness in area of ward by ATP test found, contaminated spots were highest (61.76%, 21/34) and clean spots were lowest (38.24%, 13/34), while swab culture method found contaminated spots were higher (55.88%, 19/34), clean spots were lower (44.12%, 15/34), and visual monitoring found contaminated and clean spots were 35.29%, 12/5 and 64.71%, 22/34 respectively. The most of contaminated sites were bed rails, toilet sink, Treatment and IV care car, door handle, mop, Light scope & blade (5.88%, 6/102). As the results proved the most organisms were Acinetobacter spp., Escherichia coli, and Pseudomonas spp., respectively. Conclusion: This study suggests that the environmental cleaning in specialized area must be monitored continuous with standard methods. It is necessary to promote education and training staffs follow update practice guidelines, especially the participation of disciplinary team motivated effective activities in reducing the microbial contamination.

Objectives: Energy devices (EDs), such as Harmonic, Ligasure, Thunderbeat and Trocar are widely used in Minimally Invasive Surgeries. They are expensive and designed for single use. However, due to the limitation of resources, they have been reused in some cases. Therefore, we aimed to assess the efficacy of EDs reprocessing by Adenosine Triphosphate (ATP) method. Methods: This was a cross-sectional description study. After first clinical using, EDs were taken to cleaning. Every ED was cleaned three times. Efficacy cleaning was assessed after each cleaning procedure by ATP method. ATP <200 RLUs (Relative Light Units) was benchmark as efficient cleaning process. Results: A total of 611 EDs were studied, including 269 of Harmonic, Ligasure, Thunderbeat, 298 of Trocar, and 44 other types. Detachable devices accounted for about 32.7%. Overall, after three consecutive cleanings, the median ATP values were decreased dramatically (957 RLUs, 160 RLUs, and 62 RLUs, respectively). This was a significant reduction in ATP levels between three stages (p < 0.05). There were 63.5%, 84.3%, and 92.8% EDs that had ATP < 200 RLUs after first, second, third cleaning respectively. Approximately 90% of EDs were still functional after three cleaning times. Nondetachable items were to be more difficult to clean than detachable ones (p = 0.0003, OR 1.3 [1.1 – 1.5]). Conclusions: Our data suggest that monitoring efficacy cleaning of surgical instruments in general and single-use energy devices in particular with ATP can identify a number of different influence factors, like the instrument condition, reprocessing procedure, or especially their structure. ATP measurement seems to be a valid technique that allows an immediate repeat of the manual cleaning if the results exceed the established cutoff of 200 RLUs.

The current study aims to assess associations between trimethylamine N-oxide (TMAO) levels and mortality, and to investigate modification effects of genetics. A total of 500 participants from a family-based cohort study were enrolled from 2005 to 2017 and followed up until 2020 in Fangshan District, Beijing, China. Serum TMAO levels were measured using the enzyme-linked immunosorbent assay (ELISA) kit. The primary outcomes were all-cause mortality, and deaths from cardiovascular disease (CVD) and stroke. During a median follow-up time of 7.38 years, 38 deaths were recorded, including 20 deaths due to CVD and 19 deaths due to stroke. Compared with the lowest TMAO quartile group, the hazard ratio (HR) for all-cause mortality was 1.35 (95% CI: 0.44,4.15), 1.65 (95% CI: 0.58,4.64), and 2.45 (95% CI: 0.91,6.57), respectively in higher groups. No association was observed between TMAO and CVD mortality. However, compared with the lowest TMAO concentration group, the HRs for stroke mortality was 1.93 (95% CI: 0.40,9.39), 1.91 (95% CI: 0.41,8.96), and 4.16 (95% CI: 0.94,18.52), respectively in higher groups (P for trend=0.046). Furthermore, polygenic risk score (PRS) for longevity modified the association of TMAO with all-cause mortality (P for interaction=0.008). The risk of mortality (HR=2.20, 95% CI: 1.06,4.57) was higher among participants with lower PRS compared with higher PRS (HR=1.00, 95% CI: 0.71,1.40). The study indicates that elevated serum TMAO levels are potentially associated with long-term mortality risk in rural areas of Northern China, especially for stroke deaths. Additionally, it provides novel evidence that genetic variations might modify the association.

Deliberative mini-publics are decision-making bodies that provide technical instruction to a set of randomly-selected citizens, who then deliberate over public policies. Mini-publics have long seen use across a range of policy areas globally. The appeal of using mini-publics lies in their integration of democratic and deliberative inputs, which can enhance the legitimacy of policy decisions and may even help to settle deeply divisive public debates. Yet whether mini-publics can be adapted to the adjudication of human rights remains an open question. This article provides the first general empirical evaluation of this question. It finds, first, an expanding set of bona fide deliberative mini-publics adjudicating rights disputes, on subjects from hate speech to Covid-19. However, a second and more complex analysis considers whether mini-publics can conduct the deliberations necessary to adjudicate rights disputes. Some theoretical commentary assumes that they can, given that rights adjudication requires factual or value-based analyses, to which lay citizens seem well suited. The article indeed finds evidence to support this conclusion, providing proof-of-concept that mini-publics can adjudicate rights disputes effectively. However, support for the conclusion is conditional: how well mini-publics invoke key rights doctrines depends on the nature of support and information provided to lay participants.

Introduction: Razors were being used for pre-operative hair removal in our Institute. As per international guidelines recommending the use of surgical clippers, we opted to study the effects of two pre-operative skin preparations in our Neurosurgical centre Objectives: Primary; Pre auditing period -Assess knowledge and skill in usage of Razor/Clipper as preoperative skin preparation methods, Provide training on Clipper method and assess the knowledge /awareness on merits and demerits of both methods, To implement the Clipper method as against Shaving Secondary ; Post auditing period -Investigate the efficacy and safety of clippers versus razors, on variety of biophysical parameters and Surgical Site Infection (SSI) Methods : PICO questions ; Population: Adult patients undergoing any type of surgical procedure, Intervention: Hair removal, Comparator: Different methods of Hair removal, Outcomes: Biophysical parameters and SSI •Target population: Sixty adult patients undergoing neurosurgical procedures. •Subjects: 30 each subjected to shaving and clipper methods •Pre and Post assessment of on 25 parameters /sub-parameters •Analysis by MS-Excel and SPSS. Results:•Preoperative -Prior skin injuries and/or reactions; adequacy of hair removal •Complete hair removal : 30 (100%) in the clipper group versus 3 (10%) by shaving (p = 0.0001). •30 mins after hair removal ; significantly less skin issues in the clipper group •Post operative - Skin injuries in 20 (66.6%) of the razor and none in the clipper group. •SSI - Two (6.6%) in the razor and none in the clipper group. Conclusions: The assessment showed that shaving leads to partial hair removal increasing the scores for skin issues, significant association between preoperative skin injuries and SSI, implying inverse correlation with the clipper method. This study provides insights into significance of among other biophysical parameters underscoring adoption of clipper as the standard practice for preoperative hair removal, in our setting thus enhancing patient safety.

Objectives: Neonatal intensive care unit (NICU) admits premature babies and neonates with acute illness who are under high infection risk due to immature immune response system. Infections caused by carbapenem- resistant Enterobacterales (CRE) is a serious threat to such patient population. A single case of CRE infection occurred in 36-bed NICU on July 2023. Infection control measures were put in place to prevent further CRE infection within the NICU. Methods: A neonate delivered at gestational age of 23 weeks and 6 days with birth weight of 650g was under mechanical ventilator care. On 35th day of life, CRE (Escherichia coli, New Delhi metallo-beta- lactamase-1 positive) was isolated from this neonate’s endotracheal suction material. After discussion with infection control physician, the bacterial culture was determined to have been resulted from colonization or localized infection, rather than invasive infection. Five measures were taken to prevent additional infection within the NICU. One, contact precaution was issued for CRE-infected baby, and an isolation ward and a designated nurse was assigned for the baby to prevent cross infection. Two, adherence to hand hygiene and personal protective equipment (PPE) application was monitored for medical personnel and visitors entering the NICU. Three, a checklist was designed specifically for disinfection of NICU isolation ward, and the designated cleaner and assistants were educated on the checklist. Four, testing with fluorescent markers was performed to validate cleaning. Five, the infectious disease specialist and the pharmacy analyzed the prescription pattern of broad-spectrum antibiotic among patients in NICU for systematic antibiotic regulation. Results: The following results were obtained after 2 weeks of infection control measures. 57 subjects underwent hand hygiene monitoring, on which 15.8%(9 case) of the subjects unadequately passed. Immediate feedback was provided upon these detections. Cleaning validation detected a single cases of inadequate disinfection (door to isolation ward), for which re-cleaning and education was performed. An increasing trend in consumption of 3rd generation cephalosporin (8.96% in April 2023 to 21.21% in June 2023) was found, and the neonatology department was advised to be more selective in prescription of broad- spectrum antibiotics. Conclusions: There was no CRE infection for 6 months following infection control measures. This case was determined to be an isolated case of CRE infection, and no further surveillance culture was obtained. Proactive infection control measures, including contact isolation, hand hygiene, environment cleaning, and regulation of broad-spectrum antibiotics, are necessary to prevent secondary infections that may follow an index CRE infection in the NICU.

How can a single-day cluster of public learning activities contribute to a larger ongoing public humanities agenda? This essay’s co-authors—facilitators of a public lecture and associated activities sponsored by a university academic department—revisit their strategic efforts to provide leadership for the one-day series of interconnected events, anchored in a Native scholar’s public lecture on sovereignty and citizenship. We write from a predominantly white university geographically removed from Native nations’ reservations and lacking a full-fledged curriculum in Indigenous studies. Yet we also write as members of a consortium committed to enhancing reciprocal learning with Indigenous peoples. Thus, we aimed to set this one-day program within our local collaborative’s sustained work to develop curriculum; engage multiple audiences in topics important to Native studies; and foster networks linking students, faculty, and staff with Native community members. In making visible aspects of “doing” public humanities that often remain unrecorded, this case study will assist others interested in taking on public humanities work, whether a small-scale, single-day program or initiatives extended across a long-term calendar. After describing the ongoing work, one university and Native community partners have been carrying out through a Native and Indigenous Peoples Initiative, and situating those efforts in connection with our collaborative’s shared values for community building, the essay revisits event management steps taken to tap into and support that endeavor. Acknowledging successful elements alongside challenges and opportunities not fully achieved, our case study also offers approaches for collaborative evaluation of public humanities programming.