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To deconstruct the multiple levels of risk factors for Clostridioides difficile infection, using multilevel models (MLMs) accounting for patient movement.
Study Design and Setting:
Case-control study of patients hospitalized in three acute care Delaware hospitals, December 2019–December 2023.
Patients:
Cases were patients aged ≥18 years who tested positive for hospital-onset C. difficile infection. Controls were patients aged ≥18 years hospitalized more than 72 hours, who did not test positive for C. difficile infection.
Methods:
Hierarchical and cross-classified MLMs were used to calculate odds of C. difficile infection based on patient-level risk factors and to evaluate the variation in odds of infection attributable to environmental risk factors using the hospital unit(s) a patient was assigned to during hospitalization.
Results:
Our study included 1,223 patients (249 cases, 974 controls). In both models, greater odds of infection were associated with antibiotic exposure [adjusted odds ratio (aOR) = 11.20, 95% confidence interval (CI) = 7.19, 17.40; aOR = 12.80, 95% CI = 8.46, 19.40 for hierarchical and cross-classified models respectively] and health insurance (aOR = 1.74, 95% CI = 1.12, 2.68; aOR = 1.62, 95% CI = 1.03, 2.53; public vs. private). Median odds ratios (MOR) for both models indicated greater relevance of between-unit heterogeneity in the outcome than health insurance but less than antibiotic exposure (MOR = 1.83, 95% CI = 1.56, 2.30 and 2.71 95% CI = 2.10, 4.06).
Conclusion:
Using multilevel methods accounting for patient movement, we found that while antibiotic use is the most important risk factor in patients that developed C. difficile infection, environmental risk factors are additionally important and should be considered in research involving hospitalized patients and healthcare-associated infections.
Wolff-Parkinson-White syndrome, characterised by accessory pathways, is rarely seen with dextrocardia. We present a case of situs inversus-dextrocardia with Wolff-Parkinson-White syndrome successfully treated via catheter ablation using 3D mapping (EnSite Precision®). Adjustments included reversed electrocardiogram (ECG) electrode placement, EnSite patch positioning, and fluoroscopic views. Coronary sinus access required counterclockwise manoeuvers. Mapping identified a left-sided accessory pathway, necessitating transseptal puncture with mirror-image adjustments. Ablation at the optimal site resulted in success. This case highlights the feasibility of catheter ablation in dextrocardia with tailored procedural modifications.
Children are uniquely vulnerable to chemical, biological, radiological, and nuclear (CBRN) events due to anatomical, physiological, and psychological differences. Current decontamination practices are adapted from adult protocols.
Objective
To evaluate current practices, challenges, and special considerations in pediatric decontamination during CBRN events.
Method
A scoping review was conducted using six databases in accordance with PRISMA-ScR framework. Studies were eligible if they evaluated decontamination methods involving children (0-18 years) in real or simulated CBRN scenarios. Fourteen studies met the inclusion criteria, and data were thematically analyzed into four domains.
Results
Disrobing is widely recognized as a critical first step in the decontamination process, and 43% of the studies reviewed identified it as such. When done immediately and appropriately, it can remove a significant amount of contaminants. Although its effectiveness varies based on how much of the body is covered and the nature of the exposure. Dry decontamination was discussed in 21% of studies, and wet decontamination was the most commonly reported approach, appearing in 93%. Key pediatric challenges included hypothermia, psychological distress, separation from caregivers, and difficulties managing non-ambulatory or special needs populations. Few studies addressed age-specific protocols or long-term psychological impacts. The results are presented in procedural order to reflect the typical sequence of decontamination in CBRN response.
Conclusions
Current decontamination guidelines inadequately address pediatric-specific needs. There is a critical need for standardized, age-appropriate guidelines that integrate caregiver support and psychosocial considerations. A pediatric decontamination algorithm was developed to consolidate current evidence into a practical framework for CBRN mass casualty incidents.
The aim of this research is to examine student motivation to participate in general music classes. The research involves students aged 10–14 from a general education primary school in Croatia (N = 186). The results indicate that these students were motivated to engage in general music classes; however, a nonlinear decline in motivation was evident as students progressed through the school years. Girls were more motivated to participate in general music classes compared to boys, and students involved in additional musical activities reported higher levels of motivation. Furthermore, listening to music influenced students’ perceptions of general music lessons and was associated with their motivation.
The Acholla Archaeological Project is an international collaboration at the site of Acholla (Tunisia) between the Institut National du Patrimoine (INP), Dickinson College and the University of Oklahoma, with additional support from the University of Leicester and the Endangered Archaeology in the Middle East and North Africa (EAMENA) project. The first season of the project took place in June 2025, focusing on three main tasks: fieldwalking, topographic survey and architectural documentation. Over a period of two and a half weeks, an area of over 25 ha was covered by a fieldwalking team and nearly 40,000 finds were collected for study and analysis. Topographic and architectural surveys were also undertaken to begin the process of creating an updated plan of the site. The work accomplished this season has already yielded new information about Acholla and has provided a strong foundation for future fieldwork campaigns and further research at this important coastal site.
In her Time and History in Hegelian Thought and Spirit, Sally Sedgwick sets out to:
specify the extent to which we can accurately attribute to Hegel the view that human reason and the freedom it affords us are indebted for their nature to this temporal order of nature and history. Hegel’s concern with our reason’s development conveys not just his fascination with the past but his interest in how reason responds to and is anchored in and shaped by the past. (TH: 4)
In the first part of the book Sedgwick is concerned with freedom being temporally conditioned. The second part consists of the last two chapters and is concerned with the claim that ‘all our thought is indebted to this actual realm as well’ (TH: 8). Hegel repeatedly asserts, Sedgwick notes, ‘that none of us can escape our time in thought’ (TH: 143).
I am grateful to the Reviews Editor for the Hegel Bulletin, Susanne Herrmann-Sinai, for arranging this discussion of my book, Time and History in Hegelian Thought and Spirit (2023). I appreciate this opportunity to clarify and expand on some of the main ideas of the book, including those that are the most challenging to defend. I also owe thanks, of course, to each of my four critics for giving their valuable time to this project. In the context of so few pages, it is not possible to respond to every criticism; I have had to pick and choose. In the process, I may have failed to do full justice to my critics’ concerns.
This essay investigates the meaning of “nominal prices” in Adam Smith’s the Wealth of Nations, its contraposition to “real prices,” and the impact of Smith’s nominal prices upon his assessment of the prices of wheat over the centuries. I also consider measure and value in the Wealth of Nations as well as Smith’s threefold standard of measure: labor, wheat, money. Smith chose an unusual measure to investigate prices over time, with nominal prices being referred to a specific quantity of silver. This raises questions about the possible impact of centuries-old debates over debasement and the value of money on Smith’s measurement of value across times.
In this paper, we introduce a new technique to study the distribution in residue classes of sets of integers with digit and sum-of-digits restrictions. From our main theorem, we derive a necessary and sufficient condition for integers with missing digits to be uniformly distributed in arithmetic progressions, extending previous results going back to the work of Erdős, Mauduit and Sárközy. Our approach uses Markov chains and does not rely on Fourier analysis as many results of this nature do. Our results apply more generally to the class of multiplicatively invariant sets of integers. This class, defined by Glasscock, Moreira and Richter using symbolic dynamics, is an integer analogue to fractal sets and includes all missing digits sets. We address uniform distribution in this setting, partially answering an open question posed by the same authors.
Although the concept of sympathy is absent from the Wealth of Nations, this essay argues that it is the foundation that sustains the free market, gives it its moral limits, and enables its greater efficiency. Recognizing this function, which is not difficult to trace in the Wealth of Nations, allows us to understand why public policies that foster sympathetic relationships lead to greater wealth creation, while those that hinder such relationships impede exchange and reduce wealth. Similarly, when changes brought about by progress or personal ambitions and interests inhibit or distort the free play of sympathetic interaction, the awareness that sympathy is the lifeblood of a free society allows us to adjust public policies and restore the framework of security and order that provides the conditions for prosperity, recognition, and happiness for all.
This article explores female healthcare at the crossroads of bacteriology and obstetric research. Puerperal fever or childbed fever manifested as an epidemic since the nineteenth century, and in both Europe and America, it charted a distinct course for bacteriological research. With the identification of bacteriological causes, new sets of public health regimes were instituted in both regions. The experience of the colonies, however, differed. This paper focusses on how colonial discourse on obstetric nursing, midwifery, clinical hygiene, and maternal healthcare can be positioned in this global history of female health research. The paper explores why, in India, on one hand, bacteriological research in female health suffered in terms of priority (unlike that of cholera and plague) despite the alarming rate of maternal mortality. On the other hand, medical practitioners trained in Europe worked as the conduit through which the bacteriological research of Europe made its way into India. Contemporary documents reveal how colonial prerogatives were channeled through the race theories linked to Indian cultural practices related to midwifery and obstetric nursing, and how the female health discourse was still marred by the notion of tropicality.