Morphological examination of recently collected barnacle specimens confirms the presence of Tesseropora atlantica (Cirripedia, Balanomorpha, Tetraclitidae) along the coastlines of Lanzarote and Fuerteventura, the easternmost islands of the Canary Archipelago. This constitutes the first documented occurrence of T. atlantica in the Canary Islands and establishes a new southern range limit for this relict species in the eastern Atlantic Ocean. Additionally, 16S and COI mitochondrial gene sequences were obtained for the first time for this species, allowing comparisons with related taxa. The study also explores plausible hypotheses concerning the species’ arrival in the Canary Islands.

Introduction: We propose to develop a Unique Device Identification (UDI) barcode tracking system for surgical instruments. This system aims to enhance hospital processes, thereby benefiting both patients and staff members. Methods: The UDI barcode tracking system for surgical instruments was implemented in March 2023: 1. Each surgical instrument underwent laser engraving with a UDI barcode, encompassing relevant data such as instrument name, image, model, specifications, origin, license, Instructions for Use (IFU), and total distribution quantity. 2. Upon scanning the engraved serial number, the system automatically discerns whether the instrument belongs to the designated set. 3. Mechanical, chemical, and biological monitoring indicators are integrated into the tracking system, with automatic adjudication for release into storage if criteria are met; otherwise, notifications are issued for review and retrieval by personnel. Results: 1. Between March 2023 and February 2024, a total of 157,614 instrument sets were equipped with this system, enabling staff to achieve a zero-error rate in rapid and precise instrument identification. 2.During this period, 4,026 cycles of high-temperature sterilization monitoring and 380 cycles of low- temperature H2O2 plasma sterilization monitoring were recorded. 3.Each monitoring cycle was digitally recorded, obviating the necessity for paper-based documentation and saving a total of 4,406 A4 paper sheets. 4. In the same timeframe, a total of 85,899 packages were dispensed, each linked to patient medical record numbers. Conclusions: The adoption of the surgical instrument UDI barcode tracking system by our institution’s central sterilization supply department has garnered participation from 622 individuals. It not only reduces the time spent by staff searching for items and conducting educational training but also automatically identifies whether the instrument belongs to the package, thereby enhancing inventory efficiency and reducing the incidence of errors. Sterilization monitoring indicators are automatically uploaded and intercepted to uphold patient safety.

Background: In University Medical Center Ho Chi Minh City (UMC), shelf life of sterilized packed items has been followed by time-related principle. However, duration of sterility has not been based on strong scientific evidence. Objectives: To determine the most appropriate shelf life for sterilized products according to packaging material and sterilization methods. Methods: All the experimental and the control samples (surgical instruments and linen) were prepared by four types of packaging materials (peel pouch, nonwoven, linen, and rigid container) and three types of sterilization methods (steam, Hydrogen Peroxide, Ethylene Oxide). After sterilization, sterilized samples were stored at CSSD’s storage and tested for microbial contamination in 07 periods: after 07 days, 14 days, 01 month, 03 months, 06 months, 12 months, and 18 months. Identification of the storage environment (shelf location, temperature, and relative humidity) were recorded as the same time collected samples. Results: Positive microbial cultures were seen in 0.44% (07 samples) of 1,574 samples. Up to 18 months, no organisms was cultured from any sample of (1) autoclaved surgical instrument packages wrapped in peel pouches, nonwoven, linen, (2) Hydrogen Peroxide sterilized surgical instrument packages wrapped in nonwoven, (3) Ethylene Oxide sterilized surgical instrument packages, and (4) autoclaved linen packages wrapped in nonwoven. Organisms detected were both Gram–Positive and Gram-Negative bacteria. Just only approximately 17% control samples grew bacteria. There was no any statistically significant relationship between positive experimental samples and packaging materials, sterilization methods, or storage conditions. Conclusions: Based on results of this experiment, shelf life of sterilized packed items should be still followed by time-related principle in UMC. However, the currently shelf life can be extended to reduce unnecessary costs and increase the usage rotation.

Objectives: The competency of infection control nurses (ICNs) plays a pivotal role in enhancing the quality of healthcare facilities. This descriptive study aimed to assess the competency level of ICNs in South Korea and identify influencing factors. Method: An online self- administered questionnaire survey was conducted through an announcement on the Korean Infection Control Nurses Association website. An online self-administered questionnaire was distributed via the Korean Infection Control Nurses Association website, garnering responses from 199 participants out of 450 approached. Statistical analyses, including descriptive statistics and multiple regression analysis, were conducted using SPSS/WIN 27.0 software. Result: Analysis reveals that participants had an average age of 34.8 (8.4) years and an average of 5.0 (4.7) years of experience in infection control. The competency score for infection control was 3.6 out of 5. Competency levels varied across domains, with the highest scores observed in employee safety and infection control domains, while the lowest scores were in infectious disease identification and communication domains. Significant variables affecting competency, as identified through univariate analysis, included awareness of infection control competency, age, education level, ICN experience, position, and possession of an infection control specialist license. Ultimately, factors influencing ICN competencies were determined to be awareness of infection control competencies, attainment of a master’s degree or higher, over 5 years of ICN experience, and age over 50, collectively explaining 45.6% of the variance. Conclusion: Enhancing the competency of ICNs is crucial for effective infection control in medical settings. Strategies to improve awareness of infection control competencies and provision of continuous education support and career development programs for ICNs are essential to achieve this goal.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAb) and carbapenem-resistant Pseudomonas aeruginosa (CRPa) are critical priority MDROs. They can develop resistance to last-line antibiotics, complicating infection treatment, leading to longer hospital stays, higher costs, and mortality. Objectives: To describe trends in CRAb and CRPa prevalence and antibiotic susceptibility in the access, watch, and reserve groups of positive blood cultures. Methods: This was a descriptive observational study using data from positive blood cultures at Dr Sardjito General Hospital from 2020-2023. Bacterial identification and antibiotic susceptibility testing were performed using the Vitec-2 Compact system. Patient demographics and clinical data were obtained from the microbiology LIS and electronic medical recods. Results: A total of 3603 positive blood cultures were obtained. CRAb rates were 85%, 62%, 68%, 78%, while CRPa were 26%, 21%, 12%, 25% respectively. CRAb antibiotic susceptibility in access group: 2%, 8%, 5%, 3%, in watch group: 27%, 28%, 27%, 22% and in reserve group: 33%, 58%, 37%, 30%. CRPa susceptibility was reduced in all groups: 13%, 30%, 13%, 6% in access, 0%, 4%, 0%, 19% in watch, and 13%, 7%, 13%, 14% in reserve group. CRPa was more susceptible in the access group, while CRAb was more susceptible in the watch and reserve groups suggesting that CRPa infections were more difficult to treat. The highest prevalence was in 2020, possibly due to failure to control antibiotic use during the early Covid-19 pandemic. A decrease in both MDR pathogens in 2021 was associated with intense ASP activities in the second year of the pandemic. Increasing prevalence in the following years may be due to a lack of stewardship following a change in the internal antimicrobial stewardship team structure. Conclusions: These data indicate that consistent ASP had important role in controlling CRAb and CRPa. Changing the structure of antimicrobial stewardship team should be well prepared to ensure a good adaptation.

Background: Technological advancements have made ultrasound devices more portable and user-friendly. Even when ultrasound machines and probes are visibly clean, clinically important pathogenic organisms have been grown from them (Shokoohi et al, 2015). Ultrasound machines could therefore serve as a fomite for pathogens known to cause healthcare-associated infections. Thorough cleaning and disinfection of ultrasound equipment greatly reduces the microbial burden and lessens the chance of clinically important infections. However, studies indicate suboptimal cleaning practices and a lack of training among ultrasonographers [Westerway et al 2019]. Aims and Objectives: To assess the standard of ultrasound/probe cleaning within the hospital at POCUS and to benchmark it against hospital policy. Assess the level of probe reprocessing training received by operators. Develop and implement interventions based on targeted need assessment and evaluate their effectiveness. Method and Outcome: A study of ultrasound/probe reprocessing practices identified serious concerns. The cleaning of USG probes was suboptimal for critical, semi-critical, and non-critical probes as per the Spaulding classification. The compliance level for tracking and tracing was unacceptable. Lack of knowledge, inadequate access to cleaning supplies and equipment, and time constraints were primary barriers to guideline-based disinfection. Interventions were guided by the audit results. To better educate Ultrasonographers, an educational tool was created with best practices for USG machine and probe cleaning and disinfection, an instructional video, a summary of cleaning steps, and links to best-practice guidelines. We were able to significantly improve the thoroughness of cleaning ultrasound machines and probes by using targeted interventions. Conclusion: For ultrasound-guided procedures, non-compliance implies greater risks. The results of this study confirm the concern expressed by a global survey of ultrasound users which suggested that ultrasound cleaning procedures are inadequate and that users are unaware of recommended practices.

This study aims to determine the age and growth of Anguilla anguilla from Lake Bafa, Türkiye. A total of 128 samples of European eel were purchased from a small-scale fisherman who caught them in Lake Bafa in November 2016 and 2017, using 34-mm mesh size and 15-m-long fyke nets. The total length (TL) and total weight were measured, and the sex, age, and life stage were identified. The mean TL for females was 54.1 ± 10.1 (36.1–76.2) cm, and for males 43.6 ± 3.7 (35.7–47.8) cm. Yellow and silver eel mean TLs were 48.9 ± 6.6 (35.7–63.7) and 61.9 ± 10.8 (39.9–77.2) cm, respectively, and for pooled data 53.3 ± 10.3 (35.7–77.2) cm. The growth for pooled samples was positive allometric. The age of eels varied from 2 to 9 years. The Von Bertalanffy growth parameters for pooled specimens were determined as L∞ = 71.9 cm, K = 0.25, and t0 = −0.11. The sex ratio (M:F = 1:11.2) was biased in favour of females. It is inferred from this and other studies that eels in Türkiye have comparable length and age distributions in similar habitats.

This article examines the ways that alternative musicians in Lebanon tactically engage in corporate collaborations as a mode of aspirational cartography. Drawing on ethnographic fieldwork, it explores three artists’ entanglements with Red Bull, underscoring the imaginative, ethical, and aesthetic manoeuvres musicians undertake in pursuit of alternative futures through strategic corporate affiliation. I build on Appadurai’s theory of aspiration in order to argue that in cases like Lebanon, aspiration is a cartographic undertaking through which musicians sonically map and shape spaces of possibility. In the absence of governmental support or infrastructure for the arts, transnational corporations take on developmental roles, allowing artists to leverage personal relationships, material resources, and aesthetic and creative control in pursuit of possibility.

We study universal-existential fragments of first-order theories of fields, in particular of function fields and of equicharacteristic henselian valued fields. For example, we discuss to what extent the theory of a field k determines the universal-existential theories of the rational function field over k and of the field of Laurent series over k, and we find various many-one reductions between such fragments.

Dedicated to the memory of Alexander Prestel (1941–2024)

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare associated infections. Colonization with MRSA increases the risk of subsequent nosocomial infection. The primary concern regarding widespread use of mupirocin is the emergence of mupirocin resistance. A prospective cross-sectional study in Singapore in 2013, found mupirocin resistance to be 31.6% in Changi General Hospital (CGH). Annual usage of mupirocin (g) in CGH was 36870 and hospital-onset MRSA bacteremia was 1.1/10,000 patient-days in 2013. Objective: To study the impact of hospital measures to reduce mupirocin resistance among MRSA by detection of mupirocin resistance in screening isolates. Method: Changi General Hospital is a 1000 bedded acute care hospital. Hospital wide measures were instituted in CGH to reduce mupirocin resistance in MRSA included a) universal body wash with Octenidine for all hospitalized patients in the wards with MRSA cubicles b) 2% mupirocin ointment removed from formulary (available for nasal decolonization only) A study was conducted on MRSA screening isolates from the Microbiology Laboratory between May and September 2019. These were obtained by swabbing nasal, axilla and groin on all newly admitted patients as part of an active surveillance program since 2013. The swabs were streaked onto MRSAiiselective media plates which were incubated at 35 °C for 20 hours and stored at 4 °C. E-test was performed to determine the susceptibility and minimum inhibitory concentration (MIC) of MRSA isolates to mupirocin, oxacillin and vancomycin, following the CLSI guidelines for S. aureus. MPCR (multiplex polymerase chain reaction) assay was used for the simultaneous identification of ileS-2 (primers MupA and MupB) and mecA (primers MecA1 and MecA2). PCR amplification of ileS- 2 gene for high level mupirocin resistance and Mec A gene was performed on Touch thermal cycler. Results: 200 MRSA isolates were tested. E-test revealed 5 isolates were detected to be High Level mupirocin- resistant (2.5%) and 69 isolates were detected to be oxacillin-resistant (74%). The MPCR assay detected mecA gene in 100% and ileS-2 gene in 3 isolates (1.5%). Conclusion: Our study indicated the low prevalence of high level mupirocin resistance among MRSA screening isolates in 2019 in CGH. This suggested that the hospital wide measures to reduce mupirocin resistance were effective.

Background: WHO estimates over 700,000 deaths globally annually due to antimicrobial resistance. One of the main factors of antimicrobial resistance is non-compliance with infection control measures. Contact alert markers must be installed in the patient area to remind officers to carry out infection transmission prevention to prevent the failure of infection control practices. The provision of red markers and information on the infection suffered by patients creates a stigma that is less accepted because of patient privacy. This study aimed to evaluate the modified marker with a batik design as local wisdom without infection information, as a reminder of infection control practices by officers, and to maintain patient privacy. Method: The Committee for Infection Prevention and Control modified the design of markers of patients with antimicrobial resistance. Batik markers were designed with hand hygiene reminders and batik motifs as local wisdom so as not to cause negative stigma. Batik markers were implemented in the patient’s bed area so that it was easy for officers to understand how to implement infection control practices and supervise patients with antimicrobial resistance. Results: Modifying the marker design was more acceptable to the patient’s family than the previous one. Adherence to supervision filling of antimicrobial resistance patients was performed in all patients. Adherence to Hand Hygiene increased by up to 4% in one month. With the Batik Marker, officers could easily recognize the marker so that infection control practices could be carried out according to hospital regulations. Conclusion: Antimicrobial resistance is an increasing health threat. A type A hospital requires an intradisciplinary approach and collaborative efforts to prevent and control it. Implementing Batik Markers at inpatient areas with antimicrobial resistance makes it easier for staff to implement increased contact awareness, supervision recording, and improved hand hygiene without causing rejection from the patient’s family.

Mixture of experts is a prediction aggregation method in machine learning that aggregates the predictions of specialized experts. This method often outperforms Bayesian methods despite the Bayesian having stronger inductive guarantees. We argue that this is due to the greater functional capacity of mixture of experts. We prove that in a limiting case of mixture of experts will have greater capacity than equivalent Bayesian methods, which we vouchsafe through experiments on non-limiting cases. Finally, we conclude that mixture of experts is a type of abductive reasoning in the Peircean sense of hypothesis construction.

Greenhouse studies were conducted to determine the response of stevia to several herbicide modes of action applied 2 wk after transplanting (WAP). At 1 wk after treatment (WAT), aciflourfen, metribuzin, and carfentrazone injured stevia 34 to 39%. In contrast, S-metolachlor, linuron, halosufluron, ethalfluralin, pyroxasulfone, pendimethalin, and tryfloxysulfuron injured stevia <20%, 1 WAT. By 4 WAT, stevia injury was ≤ 19% regardless of treatment, except metribuzin and trifloxysulfuron with 84 and 69% injury, respectively. S-metolachlor, linuron, ethalfluralin, pendimethalin, and pyroxasulfone did not reduce aboveground biomass compared to the nontreated check, 4 WAT. Linuron, ethalfluralin, pendimethalin, and pyroxasulfone did not reduce belowground biomass. Linuron, pendimethalin, and ethalfluralin may provide new modes of action for POST-transplant weed management in stevia. However, further research is needed to evaluate the effect of these herbicides on stevia growth and quality in the field.

Introduction: HA-MDRAB infections and colonizations are known to pose an urgent threat to patients admitted to ICUs worldwide and are difficult to treat, which leads to significant mortality and morbidity. However, multimodal environmental cleaning strategies are effective for MDRAB prevention and control. Objective: The objective of this study is to evaluate the impact of multimodal environmental cleaning strategies in reducing HA-MDRAB rate in ICU in a tertiary teaching hospital, Universiti Malaya Medical Centre (UMMC). Methods: This is a retrospective analysis of patients admitted to an adult ICU over three periods (P); P1 (January 2018 - December 2019), P2 (January 2020 - June 2022), and P3 (July 2022 – December 2023). The total number of HA-MDRAB infections and colonizers and total patient days in ICU were collected monthly and HA-MDRAB rate per 1000 patient-days was analyzed. The five elements of infection prevention and control (IPC) multimodal strategies involving multidisciplinary teams were integrated with environmental cleaning since 2018, including tailored in-house training for environmental service staff (EVS), cleaning approach, techniques and product used, hospital-wide environmental cleaning policy, use of environmental audit checklist and giving frequent feedback to the EVS, and communication strategies to engage EVS and key stakeholders in order to promote organizational safety culture. Results: HA-MDRAB rates in ICU increased by 23% from 7.20 (P1) to 8.85 (P2) per 1000 patient days and decreased to 4.94/1000 patient days (P3) after the reinforcement of environmental cleaning strategies. During P2, the rates were higher from July - December 2021 (15.8/1000 patient days). Conclusion: Increase in HA-MDRAB rates was likely due to changes in infection control measures during COVID- 19 pandemic such as extensive workload compromising the compliance to environmental cleaning among EVS. With reinforcement of the environmental cleaning multimodal strategies, HA-MDRAB incidence reduced, emphasizing the importance of adherence to IPC practices in environmental cleaning.

Introduction: Stroke is the second leading cause of death worldwide, accounting for 4.4 million (9%) of the total 50.5 million deaths per year. Infections are among the highest complicating factors of stroke, particularly respiratory tract infections occurring in 23-65% of stroke patients. Stroke complications such as pneumonia and sepsis require ICU care and the use of antibiotics, which poses a risk of antibiotic resistance. The aim of this study is to determine the profile of antibiotic resistance and the factors influencing antibiotic resistance in pneumonia among stroke patients treated in the ICU. Method: This study uses a retrospective descriptive method involving 84 stroke patients with pneumonia treated at the ICU of RSUP Dr. Kariadi Semarang from January 2022 to December 2023. Results: Among stroke patients with pneumonia, 62 patients (73.8%) developed sepsis, with 64.5% of them experiencing antibiotic resistance. There was no significant difference in antibiotic resistance between stroke patients with pneumonia and those without pneumonia (p = 0.382). There was also no significant difference in antibiotic resistance between pneumonia patients with stroke who developed sepsis and those who did not (p = 0.756). The most commonly found bacteria were A. baumannii, P. aeruginosa, and K. pneumoniae. The antibiotic most commonly showing resistance was Ampicillin. Patients with diabetes mellitus had a 5.2 times higher risk of experiencing antibiotic resistance. Conclusion: Antibiotic resistance can occur in stroke patients with pneumonia and those progressing to sepsis. Diabetes mellitus is a significant risk factor for antibiotic resistance. Antibiotic management programs and infection control are needed to prevent antibiotic resistance in the ICU.

Industrial upper limb exoskeletons offload the upper limb during overhead tasks to help prevent musculoskeletal disorders to the shoulder. Although numerous studies showed reduced shoulder muscle activity during upper limb exoskeleton use for overhead postures, it remains unknown whether and how upper limb exoskeletons provide support over a large shoulder workspace beyond overhead work. Therefore, this study evaluated the Ottobock Paexo Shoulder over a large shoulder workspace from overhead to hip height with shoulder abduction and adduction. Upper body kinematics, muscle activity, and subjective user feedback were obtained by three-dimensional motion capture, surface EMG, and questionnaires, respectively, and captured while participants performed static and dynamic work tasks with an electric screwdriver. Participants completed these tasks (1) without the exoskeleton, (2) with a disengaged exoskeleton, (3) with moderate exoskeleton support, and (4) with high exoskeleton support. Exoskeleton support reduced deltoid muscle activity (−9 to −24 s%, p ≤ .001) in postures with an abducted shoulder, including nonoverhead postures. Exoskeleton support modestly decreased shoulder flexion (−3 to −5°, p ≤ .001) and increased shoulder abduction (2 to 5°, p ≤ .032), but the movement patterns during the dynamic task were unaffected. Additionally, exoskeleton-related effects increased with increasing support, but the subjective perception of change also increased, and perceived comfort decreased. Our results indicate that the tested exoskeleton provides support beyond overhead work and that there is a trade-off between exoskeleton support and subjective perception. Accordingly, further optimization of user–exoskeleton interaction is warranted for long-term prevention of musculoskeletal disorders in overhead workers.

In this paper, we study the T-periodic solutions of the parameter-dependent ϕ-Laplacian equation

\begin{equation*}(\phi(x'))'=F(\lambda,t,x,x').\end{equation*}

Based on the topological degree theory, we present some atypical bifurcation results in the sense of Prodi–Ambrosetti, i.e., bifurcation of T-periodic solutions from λ = 0. Finally, we propose some applications to Liénard-type equations.

Dedicated to Professor Maria Patrizia Pera on the occasion of her 70th birthday

In recent years, organizational factors such as infection prevention climate have been recognized as important factors of healthcare workers’ adherence to infection prevention practices. However, there is a lack of instruments with good reliability and validity to measure infection prevention climate within organizations in Chinese context. Therefore, this study aims to translate, culturally adaptation and test for the psychometric properties of the Chinese version of Leading a Culture of Quality for Infection Prevention (CLCQ-IP). The original scale was translated into Chinese through 1) Forward translation; 2) Expert review; 3) Back translation; 4) Applicability evaluation. Then, a multicenter cross-sectional survey was conducted using the CLCQ-IP. Reliability in terms of internal consistency was evaluated. The content validity, exploratory factor analysis, confirmatory factor analysis, were tested for assessing the construct validity of the CLCQ-IP. After linguistic and cultural adaptation, the CLCQ-IP was finally formed with 19 items in 4 dimensions and a total 882 HCWs from 4 provinces finished the survey. The overall Cronbach’s alpha of the CLCQ-IP was 0.865. The items of content validity index, ICVI of the C-SPQ ranged from 0.875 to 1.00, and the scale of content validity index S-CVI/AVE was 0.894. In terms of construct validity, the exploratory factor analysis extracted a total of 4 factors, which were consistent with the original scale. The factor loadings of each item were above 0.70, and the cumulative variance contribution to the scale was 71.88 %. The Confirmatory factor analysis showed the good model indicators: x"/df =1.508, RMSEA=0.41, GFI=0.934, AGFI=0.912, NFI=0.953, TLI=0.981, CFI=0.984. The results of the study show empirical evidence of validity and reliability of CLCQ-IP can be highly recommended to be widely used among Chinses HCWs.