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The clinical impact of carbapenem-resistant Acinetobacter baumannii (CRAB) remains controversial, with uncertainty about whether it directly contributes to mortality or merely reflects underlying patient’s morbidity. This study aimed to evaluate the impact of CRAB colonization and infection on patient outcomes.
Methods:
A retrospective cohort study was conducted in an Israeli tertiary hospital between January 2023 and December 2024. Patients were categorized into CRAB-negative (A group), CRAB-present on admission (POA, B group), and hospital-acquired CRAB (C group). Time-varying Cox proportional hazards models were used to estimate 30- and 90-day mortality risks while adjusting for immortal time bias. Kaplan–Meier and cumulative hazard curves were generated, and univariable Firth logistic regressions were performed as exploratory analyses.
Results:
Of 3,080 patients, 149 had CRAB-POA and 108 acquired CRAB. Risk factors for CRAB-POA included long-term care facility residence (odds ratio (OR) = 4.1) and mechanical ventilation (OR = 2.3). Hospital-acquired CRAB was associated with longer length of stay and ventilation. Time-varying Cox models adjusting for immortal time bias showed that both CRAB colonization and infection were associated with increased 30-day mortality (hazard ratio (HR) range: 1.95–2.88) and 90-day mortality (HR range: 2.11–2.93), compared with CRAB-negative patients. Implementation of enhanced screening and cohorting in the late study period was associated with reduced CRAB acquisition (OR = 0.13, 95% confidence interval (CI): 0.07–0.24) and mortality (OR = 0.62, 95% CI: 0.41–0.94).
Conclusions:
Both CRAB colonization and infection are associated with twofold increase in mortality after adjusting for disease severity. Enhanced infection control measures reduced acquisition and mortality.
Britain and Ireland are nations of beer drinkers. Beer has been part of their national identity despite it being regarded both positively as a dietary staple or necessity and negatively as the root cause of drunkenness and debauchery. There are many cultural traditions associated with beer drinking in Britain and Ireland. Contrary to popular belief, British ales are not served warm. Another tradition is ‘buying a round’. Since British pubs are traditionally small and crowded, getting to the bar was difficult, so one group member would ‘buy a round’. The famous Guinness story has kept Ireland on the beer map of the world. The Irish government even had to change its harp symbol to face in the other direction because Sir Arthur Guinness had trademarked the Irish harp for the Guinness Brewery. Finally, the traditional pub provides a community hub where locals and visitors alike can catch up, debate the issues of the day, and enjoy the regular Sunday roast. Long may these traditions continue.
The Cape Town Convention is widely regarded as the most successful international convention in terms of ratifications. This essay aims to explore the fundamental reasons behind this success. While it is undeniable that the Cape Town Convention receives substantial industrial support in response to urgent market demands and the innovative protocols it established, this essay argues that this alone does not fundamentally explain its success.
Instead, the underlying reason lies in the Convention’s ability to avoid the trap of a false dichotomy – where one side seeks to convince the other to agree with its viewpoint. Rather, the key is to strive for a viable compromise that accommodates the perspectives of both, or even multiple stakeholders. This proposition will be illustrated by drawing on the social science concept of coordination, through a comparative analysis of the drafting processes of the Cape Town Convention and the Hague Securities Convention.
A Midsummer Night’s Dream is one of Shakespeare’s most environmentally explicit dramas. Exploring how the play stages the relationship between humans and the natural environment, this article argues that its comedically flawed attempts to represent nature unsettle any sense of human dominion over the wild, offering a new environmental epistemology.
Microbial contamination of textiles in healthcare settings is common and hypothesized to contribute to pathogen transfer. This systematic literature review aims to summarize the current evidence on microorganism transfer to and from textiles in healthcare and on factors that influence transfer.
Design:
Systematic literature review.
Methods:
Cochrane, Medline/Ovid, EMBASE, and Web of Science were searched. Studies were included if the transfer experiment involved textiles as origin material or destination material, the transfer mechanism was described accurately, and transfer events were quantifiable. Results on transfer and factors associated with transfer were extracted.
Results:
We included 21 studies with 490 transfer experiments. Considerable heterogeneity in all relevant study variables resulted in a very broad range of reported transfer proportions, from less than 1% to up to 100%. Cotton was the most frequently studied textile (13 studies) while Staphylococcus aureus was the most frequent pathogen of interest (13 studies). Highest transfer proportions (85–100%) were reported in transfer experiments from solid surfaces to textiles by wiping. Very low transfer proportions (0.01–2.5%) were reported in transfer experiments from textiles to textiles by pressure. Moisture and friction were associated with higher transfer.
Conclusions:
This study highlights the wide range of microbial transfer quantity from and to textiles in healthcare, depending on transfer mechanism, moisture, and other factors. The findings can inform the design of infection prevention and control (IPC) practices in healthcare.
The anglophone slang lexis has been recorded for 500 years and probably been used for much longer. Initially seen as a purely crime-based vocabulary, and despised as such, it has gradually moved into ‘civilian’ use: still outlawed, still looked down upon by many, but an essential part of the greater English language. The story is geographical as well as social: if slang was a British creation until the nineteenth century, the former colonies of the US and Australia have generated their own slangs. It is they, especially African Americans, who dominate the lexis now.
This chapter covers the economic theory and evidence about the impact of provider consolidations (mergers and acquisitions) in healthcare services. As expected, hospital combinations within local markets (horizontal) are associated with higher unit prices but no measurable improvement in metrics of quality or outcomes. Prices increase by about 15%. Currently 30%–40% of the US population lives in big cities with competitive hospital markets. However, an equal fraction lives in smaller cities that could support more competitive hospitals; public policy to encourage competition there would be appropriate. The chapter investigates economic theories of vertical integration across markets; results here are less robust. An example of enhanced market power through bundling is provided, but a health system’s ability to do so is limited by lower administrative cost to employers of dealing with a single insurer that covers sellers in such markets.
Edited by
Martin Nedbal, University of Kansas,Kelly St. Pierre, Wichita State University and Institute for Theoretical Studies, Prague,,Hana Vlhová-Wörner, University of Basel and Masaryk Institute, Prague
This chapter explores how five medieval religious songs with Czech texts transformed into musical signifiers of national identity in the nineteenth century. The songs under consideration are: Hospodine, pomiluj ny (“Lord, Have Mercy upon Us”), Buoh všemohúcí (“God Almighty”), Svatý Václave (“Saint Wenceslas”), Jezu Kriste, ščedrý kněže (“Jesus Christ, O Bounteous Prince”), and Ktož jsú boží bojovníci (“You Who Are the Warriors of God”). These samples of medieval sacred music gradually shed their predominantly religious functions to become prominent symbols of Czechness in music. As such, they have been discussed by generations of Czech musicologists and critics. These songs reflect both medieval and modern Czech cultural history. In the nineteenth century, incorporating these songs into new works was associated with the rise of Czech nationalism, illustrating how modern ethnocentric Czech identity is rooted in ancient traditions dating back to the Middle Ages.
Chapter 3 explores the relationship between increased social tension and the emergence of nascent conflict and finds traces of this stage in the Damascus Document. This chapter continues to examine how the emergence of violence in New Religious Movements such as the People’s Temple or the Branch Davidians can serve as an analytical lens for understanding the Dead Sea Scrolls.
This chapter deals with the economics of prescription drugs and of insurance coverage for them. Sellers of drugs have temporary market power because of patents. Drugs are supplied under a cost structure with high fixed costs of research, discovery, and approval followed by low marginal cost of producing additional units; this structure does not permit competitive markets to exist during the period of patient protection. Health systems buy drugs for inpatients in the usual way, but outpatient and pharmacy sold drugs are priced above marginal cost with prices often distorted by insurance coverage. The result can be high prices (though not necessarily increasing ones). A potential solution to the inefficiencies in this market is an agreement between insurers and drug sellers to buy a predetermined volume with the marginal price of additional units low or zero – the so called “Netflix” model. The intent of above-cost pricing for drugs is to encourage the supply of innovative products, but evidence on whether the current patient system in the US achieves an ideal outcome is lacking.