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This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge.
Methods:
Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire.
Results:
IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16–985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing.
Conclusion:
The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.
While increasing seafood consumption may help address micronutrient deficiencies and metabolic disorders, evidence supporting this recommendation in the Indian context remains limited and inconclusive. Using the nationally representative cross-sectional 2019-2021 National Family Health Survey dataset, we investigated the association of fish consumption frequency with anemia and metabolic disorders (overweight/obesity, hypertension, and hyperglycemia) among adult men (aged 15-54 years) and women (aged 15-49 years) in India. A control function (CF) method was employed to examine the association in individuals who consumed fish daily and those who reported consuming fish daily/weekly. The analysis was restricted to conformed non-vegetarians (who reported ever consuming egg, fish, or meat). Overall, 86.9% of men and 74.7% of women were conformed non-vegetarian. CF analysis revealed that both daily and daily/weekly fish consumption were associated with a reduced risk of anemia among both men and women. Daily fish consumers exhibited increased likelihood of overweight/obesity (men: β: 0.405, 95%CI: 0.074, 0.735, p:0.017; women: β: 0.248, 95%CI 0.125, 0.370, p<0.001). Conversely, daily/weekly fish intake was associated with a reduced risk of overweight/obesity in men (β: -0.041, 95%CI: -0.069, -0.013; p:0.004). Daily/weekly fish consumption was associated with a reduced risk of hypertension and increased odds of hyperglycemia among men. Fish consumption demonstrated a potentially protective relationship against hypertension in women, regardless of how often they consumed fish, while also being associated with a higher prevalence of hyperglycemia. Indian adults can improve their health by eating more fish, which can help fight anemia and may also reduce overweight/obesity and high blood pressure.
Psychotic symptoms in depression are linked to worse outcomes, and treatment options are limited. Ketamine and esketamine are effective antidepressants, yet most studies have excluded patients with a history of psychotic symptoms.
Aims
To evaluate by systematic review the efficacy and safety of ketamine and esketamine in treating patients with unipolar or bipolar depressive episodes with psychotic features.
Method
A comprehensive search of the PubMed, Ovid and Web of Science databases was conducted up to 2 November 2023. We included any study that reported the use of ketamine or esketamine in patients with depressive episodes with psychotic symptoms. The primary outcomes assessed were variations in depressive and psychotic symptoms and the incidence of adverse events. The protocol was preregistered in PROSPERO (CRD42023488524).
Results
Ten studies were included, encompassing 60 patients with unipolar depression with psychotic symptoms and 19 patients with bipolar depression with psychotic symptoms. Treatment with (es)ketamine showed mean score changes on the Montgomery–Åsberg Depression Rating Scale ranging from −13.7 to −18.2 points in open-label studies of patients with unipolar depression with psychotic symptoms. Up to 50% of participants achieved remission. The largest study with patients with bipolar depression with psychotic symptoms reported a mean Montgomery–Åsberg Depression Rating Scale score change of −14.9 points. Adverse events were mostly mild and transient. There were no reports of switches to (hypo)mania or deterioration of psychotic symptoms, and in six studies there was substantial improvement of the latter.
Conclusions
The available evidence suggests that (es)ketamine shows antidepressant effects in patients with depressive episodes with psychotic features and has a reasonable safety profile. However, the heterogeneity of the studies included in this review and the high risk of bias warrant caution in interpreting the findings and underscore the need for further trials to confirm these preliminary results.
Complete exploration of design spaces is often computationally prohibitive. Classical search methods offer a solution but are limited by challenges like local optima and an inability to traverse dislocated design spaces. Quantum computing (QC) offers a potential solution by leveraging quantum phenomena to achieve computational speed-ups. However, the practical capability of current QC platforms to deliver these advantages remains unclear. To investigate this, we apply and compare two quantum approaches – the Gate-Based Grover’s algorithm and quantum annealing (QA) – to a generic tile placement problem. We benchmark their performance on real quantum hardware (IBM and D-Wave, respectively) against a classical brute-force search. QA on D-Wave’s hardware successfully produced usable results, significantly outperforming a classical brute-force approach (0.137 s vs 14.8 s) at the largest scale tested. Conversely, Grover’s algorithm on IBM’s gate-based hardware was dominated by noise and failed to yield solutions. While successful, the QA results exhibited a hardware-induced bias, where equally optimal solutions were not returned with the same probability (coefficient of variation: 0.248–0.463). These findings suggest that for near-term engineering applications, QA shows more immediate promise than current gate-based systems. This study’s contribution is a direct comparison of two physically implemented quantum approaches, offering practical insights, reformulation examples and clear recommendations on the utilisation of QC in engineering design.
Space–time correlations of velocity and high-Schmidt-number ($Sc \approx 2000$) passive scalar fields are investigated in turbulent pipe flow using particle image velocimetry and planar laser-induced fluorescence, respectively. Both the velocity and scalar fields exhibit characteristic elliptical patterns in their respective space–time correlations. The elliptic approximation model, originally developed for the velocity field, is applied to estimate convection and sweeping velocities for both fields. In both fields, the convection velocity decreases, while the sweeping velocity increases, along the pipe radius. The convection velocity ratio between the scalar and velocity fields shows that high-Schmidt-number scalar fluctuations are advected faster than the velocity fluctuations. Similarly, the sweeping velocity of the scalar fluctuations is found to be larger than that of the velocity fluctuations. Furthermore, the high-Schmidt-number scalar is found to decorrelate more rapidly than the corresponding velocity, with the scalar Taylor microscale distinctly smaller than the velocity Taylor microscale.
Like many newer EU Free Trade Agreements, the Trade and Cooperation Agreement (TCA) includes commitments concerning labour and social standards and environment and climate policy under the title the ‘Level Playing Field’. This title includes non-regression provisions, which prohibit reducing or weakening certain standards ‘in a manner affecting trade’, and novel rebalancing provisions, which allow the parties to take unilateral measures if material impacts on trade are arising as a result of significant divergences in levels of protection in specific areas of regulation. Although terminology linking trade to labour and environmental issues is becoming reasonably common in trade agreements, there has only been limited consideration as to what trade effects or impacts actually need to be demonstrated. This paper argues that the language of ‘manner affecting trade’ and ‘material impact on trade’ in the TCA denotes a ‘conditions of competition’ test as opposed to a stricter, and relatively more difficult to satisfy, trade remedies model. It further considers the possible application of the provisions in the context of the UK’s 2022 strikes measures, highlighting that even if a conditions of competition test is used, there are serious questions as to whether the non-regression and rebalancing provisions in the TCA are efficacious in achieving values-based objectives.
We give a construction of integral local Shimura varieties which are formal schemes that generalise the well-known integral models of the Drinfeld p-adic upper half spaces. The construction applies to all classical groups, at least for odd p. These formal schemes also generalise the formal schemes defined by Rapoport-Zink via moduli of p-divisible groups, and are characterised purely in group-theoretic terms.
More precisely, for a local p-adic Shimura datum $(G, b, \mu)$ and a quasi-parahoric group scheme ${\mathcal {G}} $ for G, Scholze has defined a functor on perfectoid spaces which parametrises p-adic shtukas. He conjectured that this functor is representable by a normal formal scheme which is locally formally of finite type and flat over $O_{\breve E}$. Scholze-Weinstein proved this conjecture when $(G, b, \mu)$ is of (P)EL type by using Rapoport-Zink formal schemes. We prove this conjecture for any $(G, \mu)$ of abelian type when $p\neq 2$, and when $p=2$ and G is of type A or C. We also relate the generic fibre of this formal scheme to the local Shimura variety, a rigid-analytic space attached by Scholze to $(G, b, \mu , {\mathcal {G}})$.
This article offers an intersectional and temporospatial analysis of female visibility during religious activity in urban spaces in Republican Rome. The focus is on the regular religious activity of prominent female religious officials – Vestals, flaminica Dialis, and regina sacrorum – and collectives of women – married and enslaved women – as religious activity and roles could empower some women, and provide regular opportunities for visibility in the city. I argue that such an approach and focus reshape our understanding of the visibility of women in urban spaces, challenging traditional scholarly views of female domesticity and invisibility. A temporospatial lens reveals that women of various roles and statuses were regularly visible in a wide array of urban spaces, seemingly irrespective of their public, private, or sacred nature. There appears to have been limited spatial segregation by gender. Instead, a woman’s intersectional statuses and temporality were key dimensions differentiating female visibility. There was no singular gendered rhythm, but plural rhythms in interaction and conflict, and female religious officials played key roles in directing these rhythms and bringing harmony to the religious calendar. Futurity and the preservation of the community lay at the core of this female religious activity. Ultimately, time’s place was pivotal.
Sheath-ends are poorly represented in works regarding weaponry of the Cimmerian period (10th–7th century BC), despite forming an important component, particularly among the melee weapons of the time. There are several reasons for this neglect: until recently, the number of known sheath-ends was quite small, thus making it impossible to speak of types, variants or cultural affiliations; also, most of the previously published sheath-ends are spread over a large territory and were published many decades ago. Therefore, some of them may be unknown to researchers due to the age of publications, as well as linguistic and cultural barriers. Over the past few years, a larger number of new sheath-ends has emerged. Some of them belong to previously known types, others are completely new. Their analysis is here conducted using the comparative method. The total number of sheath-ends now known makes it possible to begin a discussion about their types, chronology and origins, which will undoubtedly develop as new finds appear.
This study demonstrated the incidences of hospital-acquired colonization by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and vancomycin-resistant enterococci (VRE) of 22%, 8%, and 8% among hematologic malignancy patients. Difference in time to colonization detection between VRE (14 d) and ESBL-E and CRE (7 d) may inform appropriate surveillance measures.
The essence of the Metaverse lies in the inter-subjectivity revealed by phenomenology. The many-worlds model reveals the significance of interaction and communication for digital human existence. The Metaverse exhibits a rhizomatic structure of narrative from multiple small universe interpretations, particularly the cross-embedding and close coupling between digital relational orders and analog legal orders formed through interface revolution. Virtuality-reality interfacing permits rational design based on exchange concepts, yielding twelve fundamental digital-age juridical propositions from subject interaction ordering mechanisms. These propositions indicate that with consumer sovereignty and distributed autonomous organizations, the Metaverse will transform order principles. A corridor system connecting cyberspace to off-chain society will be built using code and smart contracts as dual interfaces, producing varied relationship-law combinations.
In p-adic Hodge theory and the p-adic Langlands program, Banach spaces with $\mathbf {Q}_p$-coefficients and p-adic Lie group actions are central. Studying the subrepresentation of G-locally analytic vectors, $W^{\mathrm {la}}$, is useful because $W^{\mathrm {la}}$ can be studied via the Lie algebra $\mathrm {Lie}(G)$, which simplifies the action of G. Additionally, $W^{\mathrm {la}}$ often behaves as a decompletion of W, making it closer to an algebraic or geometric object.
This article introduces a notion of locally analytic vectors for W in a mixed characteristic setting, specifically for $\mathbf {Z}_p$-Tate algebras. This generalization encompasses the classical definition and also specializes to super-Hölder vectors in characteristic p. Using binomial expansions instead of Taylor series, this new definition bridges locally analytic vectors in characteristic $0$ and characteristic p.
Our main theorem shows that under certain conditions, the map $W \mapsto W^{\mathrm {la}}$ acts as a descent, and the derived locally analytic vectors $\mathrm {R}_{\mathrm {la}}^i(W)$ vanish for $i \geq 1$. This result extends Theorem C of [Por24], providing new tools for propagating information about locally analytic vectors from characteristic $0$ to characteristic p.
We provide three applications: a new proof of Berger-Rozensztajn’s main result using characteristic $0$ methods, the introduction of an integral multivariable ring $\widetilde {\mathbf {A}}_{\mathrm {LT}}^{\dagger ,\mathrm {la}}$ in the Lubin-Tate setting, and a novel interpretation of the classical Cohen ring $\mathbf {{A}}_{\mathbf {Q}_p}$ from the theory of $(\varphi ,\Gamma )$-modules in terms of locally analytic vectors.
Recently, autonomous aerial systems have received unparalleled popularity and applications as varied as they are innovative in the civil domain. The unmanned aerial vehicle (UAV) is now the subject of intensive research in both aeronautical and automotive engineering.
This paper presents a new, robust gain-scheduled adaptive control strategy for a class of UAV with linear parameter varying (LPV) models. The proposed controller synthesis involves a set of pre-tuned linear quadratic regulator (LQR) combined with fractional-order PID controllers supervised with an adaptive switching law. The main innovation in this work is the enhancement of the classical gain-scheduling adaptive control robustness for systems with LPV models by combining a set of robust LQR + fractional-order PID compensators. The stability of the resulting controller is demonstrated and its efficiency is validated using a numerical simulation example on a civilian UAV system airspeed and altitude control to illustrate its practical efficiency and achieved robustness.
The COVID-19 pandemic exacerbated psychological distress, but limited information is available on the shifts in mental health symptoms and their associated factors across different stages. This study was conducted to more reliably estimate shifts in mental health impacts and to identify factors associated with symptoms at different pandemic stages.
Methods
We performed a national repeated cross-sectional study at stable (2021), recurrence (2022), and end-of-emergency (2023) stages based on representative general national population with extensive geographic coverage. Anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia symptoms were evaluated by GAD-7, PHQ-9, IES-R and ISI scales, respectively, and their associated factors were identified via multivariable linear regression.
Results
Generally, 42,000 individuals were recruited, and 36,218, 36,097 and 36,306 eligible participants were included at each stage. The prevalence of anxiety, depression and insomnia symptoms increased from 13.7–16.4% at stable to 17.3–22.2% at recurrence and decreased to 14.5–18.6% at end of emergency, while PTSD symptom continuously increased from 5.1% to 7.6% and 9.2%, respectively (all significant, P < 0.001). Common factors associated with mental health symptoms across all stages included centralized quarantine, frontline work and residence in initially widely infected areas. Centralized quarantine was linked to anxiety, depression, PTSD and insomnia during the stable, recurrence and end-of-emergency stages. Frontline workers exhibited higher risks of anxiety, depression and insomnia throughout these stages. Individuals in initially widely infected areas were more likely to experience depression and PTSD, particularly during the stable and recurrence stages. Stage-specific risk factors were also identified. Lack of outdoor activity was associated with anxiety, depression and insomnia during the stable and recurrence stages. Residents in high-risk areas during the recurrence stage correlated with increased anxiety and insomnia. Suspected infection was tied to anxiety and insomnia in the recurrence and end-of-emergency stages, while the death of family or friends was linked to PTSD during recurrence and to depression, PTSD and insomnia at the end-of-emergency stage.
Conclusions
Mental health symptoms increased when pandemic recurred, and could remain after end-of-emergency, requiring prolonged interventions. Several key factors associated with mental symptoms and their variations were identified at different pandemic stages, suggesting different at-risk populations.
This article investigates how early modern migrants articulated identification with their host society in the context of the late eighteenth-century Dutch Republic, a period preceding modern nationalism. Drawing on a unique dataset derived from the Prize Papers – a collection of testimonies from captured sailors interrogated by British Admiralty courts – we analyze migrants’ declarations of sovereign allegiance. We assess how factors such as duration of residence, local citizenship (poorterschap), occupational rank, and marital status influenced migrants’ identification with their adopted polity. Using logistic regression, we find that civic institutional embeddedness, reflected in city citizenship, and occupational rank, especially among ship captains, significantly predicted identification with the Dutch Republic. In contrast, duration of residence and marital status had weak and statistically insignificant effects. Our findings highlight that pre-national forms of identification were deeply embedded in civic and institutional contexts rather than simply reflecting modern nationalist sentiments. By combining quantitative analysis with targeted archival research into individual biographies, this study demonstrates the complex interplay between institutional opportunities and personal networks in shaping migrants’ allegiances, thereby offering a nuanced historical perspective relevant to contemporary debates on civic integration.
Healthcare has deleterious impacts on the environment through production of massive amounts of waste leading to generation of greenhouse gas (GHG) emissions. Single-use materials used for preparation and administration of intravenous (IV) medications are a large component of hospital waste. Transitioning medications from the IV-to-oral (PO) route, called switch therapy, may be a means of decreasing unnecessary waste and associated emissions arising from hospital care.
Methods:
This was a retrospective cohort study involving adult patients receiving IV antimicrobials with a highly bioavailable PO equivalent at a large academic medical center. For a randomly selected subset of patients, the mean number of IV days of therapy (DOT) for which PO therapy could have been administered based on our institution’s policy was determined for each antimicrobial. This proportion was applied to the full cohort to estimate the total unnecessary IV DOT. A GHG emissions estimation tool was used to estimate the emissions generated from the excess antimicrobials.
Results:
During the study period, 15,037 IV DOT were administered, of which 9,694 DOT (64%) were estimated to be unnecessary. This was estimated to have generated 2,049 kilograms of total waste and 0.353 metric tons of carbon dioxide equivalents, equivalent to 904 miles driven.
Conclusions:
Optimizing IV-to-PO antimicrobial switch policies may be an effective way to decrease hospital environmental impact through reduction of single-use supply waste and associated emissions. Future work should prioritize evaluating other potential antimicrobial stewardship interventions as a means to reduce GHG emissions.
Clostridioides difficile infection (CDI) is common among patients undergoing hematopoietic stem cell transplantation (HSCT). Oral vancomycin prophylaxis may effectively prevent CDI in certain populations. We investigated the effectiveness of oral vancomycin primary prophylaxis in preventing CDI in HSCT patients.
Methods:
We searched six databases from inception to March 21, 2025, for studies comparing the incidence of CDI in HSCT patients who received oral vancomycin primary prophylaxis versus those who did not. We built a Bayesian random-effects model for meta-analysis. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of positive vancomycin-resistant Enterococcus cultures, blood stream infections, graft-vs-host disease, and length of hospital stay. We also assessed for heterogeneity and publication bias using Robust Bayesian Meta-Analyses.
Results:
Six studies met inclusion criteria with a total of 1,236 patients. Four of the studies were of fair to good quality. Oral vancomycin primary prophylaxis reduced the incidence of CDI during hospitalization (OR 0.31; 95%CrI 0.16–0.59). Studies were weakly heterogeneous but had strong publication bias. Oral vancomycin primary prophylaxis reduced the odds of CDI by 12% after accounting for publication bias (OR 0.88; 95%CrI 0.32–1.16), although this reduction was not statistically significant. Secondary outcomes were similar in both groups.
Conclusion:
Oral vancomycin primary prophylaxis prevented CDI in HSCT patients without significantly affecting secondary outcomes. However, after controlling for publication bias, these findings were no longer significant. Further studies are needed to provide stronger evidence for or against this intervention, assess long-term safety, and assess potential effects on antimicrobial resistance.
Cultural transfers between metropolitan cores and colonial peripheries, have been a constant feature of the history of modern nationalism. Anti-colonial movements also influenced to some extent the development and strategies of European national movements before 1939. After 1945, and with particular intensity following the Algerian War of Independence, claims for national self-determination from the colonial possessions of the European empires also influenced the development of regional and national movements within Western Europe. This was flanked by the adoption of Marxist-Leninist and New Left doctrines by the post-war generation leading Western European minority nationalisms. The article deals with the reformulation of national self-determination in Europe under the influence of anti-colonial thought, particularly since the adoption of the theories of “internal colonialism”, and the new dimension given to the theory of national liberation by authors such as Frantz Fanon. It also looks at the emergence of radical ethno-nationalist parties in the 1960s and their commitment to this new wave of anti-colonial self-determination. Finally, the attempts of some of these movements to articulate a transnational programme will be analysed.