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To describe an outbreak of Burkholderia cepacia complex at a tertiary care hospital in Karachi, Pakistan, highlighting contributing factors, potential sources, and system-level gaps identified during the investigation.
Design:
Outbreak investigation.
Setting:
A 655-bed tertiary care teaching hospital in Karachi, Pakistan.
Participants:
All individuals who had positive blood cultures by non-lactose fermenting, oxidase-positive, Gram-negative rods that could not be further characterized.
Methods:
On September 26, 2020, the Department of Infection Prevention and Hospital Epidemiology (DIPHE) was notified of multiple positive blood cultures. An outbreak investigation was initiated, including chart reviews, laboratory analysis, environmental sampling, assessing central line insertion practices, and evaluating the manufacturing site. Clinical Laboratory Standards Institute (CLSI) guidelines were used for microbiological identification and susceptibility testing.
Results:
Thirty-five patients with positive cultures were identified between September 15 and October 22, 2020. While environmental sampling did not yield growth, significant breaches at the suppliers‘ facility were identified in chlorhexidine gluconate (CHG) storage and quality control. Although cultures of CHG were negative, the product’s withdrawal led to a marked decline in new cases. Moreover, while resources were unavailable for genomic testing, antimicrobial susceptibility patterns were similar in all the case strains, suggesting a common source.
Conclusion:
This outbreak highlights the role of contaminated disinfectants in healthcare-associated infections. It also revealed systemic gaps in disinfectant quality control, storage facilities, and diagnostic capacity, delaying outbreak recognition and response. It is essential to strengthen regulatory oversight, implement standardized testing protocols, and enhance microbiological diagnostic infrastructure to lower the risk of similar outbreaks.
To assess frequency and correlates of meal-kit use across five countries using population-level data.
Design:
Online surveys conducted in 2022 assessed past week meal-kit use. Binary logistic regression models examined sociodemographic and nutrition-related correlates of meal-kit use, including self-reported home meal preparation and cooking skills, commercially prepared meal consumption, and healthy eating, weight change, and sustainability efforts.
Setting:
Canada, Australia, United Kingdom, United States (US), and Mexico.
Participants:
20,401 adults aged 18-100 years.
Results:
Overall, 14% of participants reported using meal-kits in the past week. Use was highest in the US (18%) and lowest in Canada (9%). Meal-kit use was greater among individuals who were younger, male, minority ethnicity, had high educational attainment, higher income adequacy, or children living in the household (p<0.01 for all). Use was greater for those who participated in any food shopping (vs. none), those who prepared food sometimes (3-4 days/week or less vs. never), and those who reported ‘fair’ or better cooking skills (vs. poor; p<0.05 for all). Consuming any ‘ready-to-eat’ food (vs. none) and visiting restaurants more recently (vs >6 months ago; p<0.001 for all) was associated with greater meal-kit use. Eating fruits/vegetables more than 2-times/day and engaging in diet modification efforts were also associated with increased meal-kit use, as was engaging in weight change or sustainability efforts (p<0.001 for all).
Conclusions:
Meal-kits tend to be used by individuals who make efforts to support their health and sustainability, potentially valuing ‘convenient’ alternatives to traditional home meal preparation; however, use is concentrated amongst those with higher income adequacy.
Antiquities in the Middle East region face various threats, including illicit trade, theft, and forgery. This research examines a leather manuscript obtained by the Palestinian Tourist Police following the arrest of an antiquities smuggler. The manuscript contains Phoenician inscriptions along with symbols such as the Menorah, Shofar, and a plant branch. Radiocarbon dating using accelerator mass spectrometry (AMS) techniques determined the manuscript’s date to be post-1950 CE. Therefore, the results indicate that the manuscript is a modern forgery, likely created for commercial purposes. Additionally, the text contains several grammatical errors, further supporting the conclusion that it is not an authentic historical artifact.
This study explores the role of framing, time pressure (TP), and gender in modulating altruism in preschoolers (4- and 5-year-olds, N = 115), using a Dictator Game (DG) paradigm. Besides confirming a strong tendency toward altruistic sharing in this age cohort, results allow us to investigate the psychological factors behind such a tendency. Initial resource allocation is manipulated by presenting both a Give and a Take condition to participants, which reveals the combined influence of status quo bias (more resources are shared in the Take condition than in the Give condition) and the endowment effect (fewer resources are shared in the Give condition than in the Take condition). Introducing TP results in greater sharing across both conditions, which confirms previous results and improves on them, allowing us to clarify that the intuitive heuristic activated by TP favors sharing specifically, rather than mere preservation of the status quo (otherwise we would observe increased sharing with TP only in the Take condition). Finally, a significant interaction between framing and gender is observed, with girls sharing more than boys in the Give condition and less than boys in the Take condition. This suggests that the traditional view of girls as being more generous than boys in DGs may be an experimental artifact of overreliance on Give-only paradigms, and it reveals instead that girls are more sensitive to fairness, whereas boys are more influenced by respect for the initial resource allocation. Overall, these findings provide valuable insight into the psychological determinants of altruism in early childhood, with important implications for adult studies as well.
The turbulent evolution of the shallow water system exhibits asymmetry in vorticity. This emergent phenomenon can be classified as ‘balanced’, that is, it is not due to the inertial-gravity-wave modes. The quasi-geostrophic (QG) system, the canonical model for balanced motion, has a symmetric evolution of vorticity, thus misses this phenomenon. Here, we present a next-order-in-Rossby extension of QG, $\textrm {QG}^{+1}$, in the shallow water context. We recapitulate the derivation of the model in one-layer shallow water grounded in physical principles and provide a new formulation using ‘potentials’. Then, the multi-layer extension of the shallow water quasi-geostrophic equation ($\textrm {SWQG}^{+1}$) model is formulated for the first time. The $\textrm {SWQG}^{+1}$ system is still balanced in the sense that there is only one prognostic variable, potential vorticity (PV), and all other variables are diagnosed from PV. It filters out inertial-gravity waves by design. This feature is attractive for modelling the dynamics of balanced motions that dominate transport in geophysical systems. The diagnostic relations connect ageostrophic physical variables and extend the massively useful geostrophic balance. Simulations of these systems in classical set-ups provide evidence that $\textrm {SWQG}^{+1}$ captures the vorticity asymmetry in the shallow water system. Simulations of freely decaying turbulence in one layer show that $\textrm {SWQG}^{+1}$ can capture the negatively skewed vorticity, and simulations of the nonlinear evolution of a baroclinically unstable jet show that it can capture vorticity asymmetry and finite divergence of strain-driven fronts.
Examine the association between dementia and all-cause 5-year mortality among skilled nursing facility (SNF) residents exposed to Hurricane Sandy flooding.
Methods
This study analyzed Medicare fee-for-service (FFS) beneficiaries aged ≥65 receiving care in SNFs located in flooded ZIP codes in New York, New Jersey, and Connecticut (October 2012). A 20% Medicare FFS sample was linked to Minimum Data Set assessments, LTCFocus, Care Compare, and American Community Survey data. Flooding exposure was defined using 2012 U.S. Geological Survey flood shapefiles. Follow-up extended 5 years. Analysis included Kaplan-Meier curves, multivariable Cox models, and propensity-score matching.
Results
Of 1,627 SNF residents, 767 (47%) had dementia. Compared with those without dementia, they were older (≥85y: 52% vs 38%; P < 0.001), less often non-Hispanic White (67% vs 75%; P < 0.001), and more frequently dually eligible for Medicare/Medicaid (63% vs 40%; P < 0.001); Charlson comorbidity burden was similar (mean 4.9; P = 0.95.). Dementia was associated with higher 5-year mortality after full adjustment (HR 1.20, 95% CI 1.05-1.37), and propensity-score matching (HR 1.24, 95% CI 1.08-1.44). Median survival was 1.68 years vs 2.61 years.
Conclusions
SNF residents with dementia in flooded areas had higher 5-year mortality, underscoring the need for dementia-specific disaster plans.
The assumption that state behaviour is primarily driven by a survival interest remains widespread within international relations (IR), even as many others attract critique. This article problematises that assumption, arguing that the meaning of survival itself, not just states’ means of pursuing it, varies significantly. Common conceptions of state survival reflect a legal definition of sovereign statehood encompassing a permanent population, defined territory, government institutions, and political autonomy. Yet leaders and publics do not uniformly conceive and value these aspects of statehood, which often generate contradictory policy incentives. Expanding on recent works in ontological security studies, this article argues that national narratives produce diverse interpretations of state survival that generate distinct meanings and prioritisations among the core aspects of statehood. Put another way, states’ physical bodies and physical survival – as IR scholars frequently discuss these concepts – are chiefly ideational. These theoretical arguments are illustrated through case studies of Georgia and Kazakhstan, which displayed radically different interpretations of survival and, hence, threat perceptions and security choices during the early 1990s. Accounting for variations within the concept of survival – both across states and within a state over time – can help future research explain a broader range of state behaviour.
The phenomenon of insect emergence represents a transfer of mass and energy from aquatic to terrestrial systems and is a critical part of ecosystem connectivity and functioning. Traditional methods of studying insect emergence rely on the capture of insects as they emerge and on morphological identification with taxonomic keys. This can be both time consuming and impact study populations, obstacles that can be removed with DNA obtained from biological remnants. The present proof-of-concept study investigated the potential of using exuviae collected from the water surface as a DNA source. Emergence trap samples and insect exuviae were collected from a pond and a small creek. Sample types were generally not statistically distinguishable, but the exuviae samples identified more orders containing amphibiotic insects and a higher level of diversity within these orders than the trap samples did. This higher level of diversity seen in exuviae samples may be due to limitations of emergence traps, including that they alter environmental variables in their collection area. We demonstrated that identification of emerging aquatic insects through metabarcoding of exuviae is a useful method for the study of insect emergence and could be used for biodiversity assessments and studies on emergence times and to better understand ecosystem connectivity.
The state of American politics would be improved, many argue, if more moderate and qualified people served in government. We investigate what draws such individuals to run, focusing on a dimension of politics that has received scant attention within the candidate-entry literature—the ability of candidates, once elected, to exercise meaningful influence over policy. In a conjoint experiment, we find that the opportunity to wield greater authority differentially increases moderates’ interest in seeking office, and that more qualified people express more interest in running for offices with greater authority, lower thresholds for passing legislation, and higher staff support. These findings have implications for political representation, government effectiveness, and the relationship between institutional reform and mass politics.
High-functioning depression (HFD) describes individuals experiencing persistent depressive symptoms, such as low mood and emotional exhaustion, while maintaining outward success. Owing to preserved functionality, the underlying distress is often unnoticed, misattributed or suppressed. HFD challenges existing psychiatric frameworks, delays diagnosis and increases the risk of progression to major depressive disorder and suicidality. Current screening tools may lack sensitivity, and stigma can lead to disengagement from therapy. Expanded diagnostic awareness, improved clinician training and culturally attuned care are essential for recognising and validating internal suffering in this overlooked population.
Our group has previously characterised a post-violet infrared stimulated luminescence (pVIRSL) signal and developed a post-violet infrared single-aliquot regenerative-dose (pVIR-SAR) protocol for estimation of paleodoses. The protocol provides an opportunity for measuring polymineral samples as violet stimulation prior to IRSL measurement, bleaches natural luminescence signal of quartz, and makes it possible to probe photo-transferred charges in feldspar through IR stimulation. This study presents the results of the pVIR-SAR protocol on natural polymineral fine- (4–11 μm) and coarse-grain (90–150 μm) samples, including volcanic ash, pottery, and fluvial deposits from varied geological provenances. The results show that pVIR-SAR ages of both these fine- and coarse-grain samples are consistent with geological reasoning and available age controls thereby suggest that with the use of the pVIR-SAR protocol, mineral separation can be dispensed. This study also reports on the bleachability, athermal fading rates, and alpha efficiencies of pVIRSL for these samples and corresponding results are compared with IRSL at 50°C and post-IR IRSL (pIRIRSL) at 290°C. The pVIRSL signal has a better bleachability and reproducibility compared to the pIRIRSL signal. For the fluvial deposits dated in this study, the fine-grain samples provide ages consistent with the expected chronology.
The discovery of Priscian’s Institutiones Grammaticae brought a new perspective to the grammatical analysis of the eighth and ninth centuries, as it heavily relied on the commentaries on Donatus’s Ars Minor and Ars Maior, and many scholars of the time were not entirely aware of Priscian’s contribution to the scholarly discussion within the didactical framework. Entwining Priscian’s interest in metalanguage and definitions into their studies, scholars brought the methods of dialectics into the study of grammar. As such, we refer to a few relevant figures within the medieval framework who played a relevant role. Between the eighth and ninth centuries, scholars such as Alcuin of York started to determine a theory of definitions rooted in dialectics by observing and commenting on the use of definitions in Donatus and Priscian. This is also the case of the glosses and lexica written in the Middle Ages that shed light both on the need for definitions and on the relationship between Latin metalinguistic definitions and Germanic languages. Among the works concerned with metalanguage, the glosses from St. Gall hold a special place. The teaching methods used in the Abbey of St. Gall survive in the translations and commentaries of the monk, scholar, and teacher Notker Labeo, whose didactic purpose is evident in his work.
This study assessed the suitability of nutritional composition data from a commercial dataset for policy evaluation in Brazil.
Design:
We compared the proportions of packaged foods and beverages, classified according to the Nova food classification and the nutritional composition of matched products using data from a commercial database of food labels (Mintel-Global New Products Database (GNPD)) and the Brazilian Food Labels Database (BFLD), collected in 2017 as a ‘gold standard.’ We evaluated the agreement between the two datasets using paired t tests, Wilcoxon–Mann-Whitney test and the Intraclass Correlation Coefficient (ICC) for energy, carbohydrates, total sugars, proteins, total fats, saturated fats, trans-fats, sodium and fiber.
Setting:
Brazil.
Participants:
Totally, 11 434 packaged foods and beverages collected in 2017 provided by BFLD and 67 042 packaged foods and beverages launched from 2001 to 2017 provided by Mintel-GNPD.
Results:
The proportions of ultra-processed foods (UPF) were similar in both datasets. Paired products exhibited an excellent correlation (ICC > 0·80), with no statistically significant difference in the mean values (P ≥ 0·05) of most nutrients analysed. Discrepancies in fibre and fat content were noted in some UPF subcategories, including sweet biscuits, ice cream, candies, dairy beverages, sauces and condiments.
Conclusion:
The Mintel-GNPD dataset closely aligns with the BFLD in UPF distribution and shows a similar nutritional composition to a sample of matched foods available for purchase in stores, indicating its potential contribution to monitoring and evaluating food labelling policies in Brazil and in studies of food and beverages composition in food retail through the verification of policy compliance.
This study presents a comparative analysis of the radiocarbon dates obtained on paired samples of various organic materials extracted from a lake sediment core. AMS radiocarbon dating of bulk sediment, chironomid capsules, and Trapa seeds was conducted to assess whether systematic offsets exist in the dates obtained on material that are commonly used to develop chronological frameworks for lake-based paleoenvironmental research. The findings reveal significant discrepancies between 14C dates obtained on bulk sediment, chironomid capsules, and on the Trapa seeds used to develop a previously published age-depth model for a sediment core recovered from Deoria Tal, Garhwal Himalaya, India. The systematic offset between the bulk sediment, and to a lesser extent chironomid remains, and the Trapa seeds is attributed to the integration of allochthonous carbon in the bulk sediment, leading to older apparent ages. The 3.6‰ shift in the δ13C value of the bulk sediment at 252 cm is inferred to reflect an increase in the contribution of C4 plant matter to the lake. The increase in enriched δ13C organic matter, coincident with the increasing offset between the dates obtained on bulk sediment and chironomids, and those obtained on the Trapa seeds, between 800 and 400 cal BP, was likely driven by anthropogenic land use changes, as evidenced by the four-fold increase in Cerealia-type pollen during this interval. This study underscores the necessity of selecting appropriate materials for radiocarbon dating to ensure accurate chronological reconstruction and highlights the potential of using chironomids remains to develop robust radiocarbon chronologies for lake sediment records.
Since 2017, the world has been talking about the Uyghur people as a “Chinese minority” suffering mass violence at the hands of the Chinese government, which researchers and some countries describe as genocide. While China refutes these accusations and refers to them as “internal affairs,” both China and the rest of the world present the Uyghurs as an “ethnic minority,” thus deliberately denying the Sino-Uyghur colonial relationship that has lasted since the military invasion of East Turkestan in late 1949 by the People’s Liberation Army with the full support of Stalin. As an indigenous people under settler colonialism, the Uyghurs reject this categorization as a “minority,” which contributes to the eradication of their national identity and indigenous sovereignty.
This paper contributes to the literature on augmented wealth (the sum of public pension entitlements and net wealth) along three dimensions. First, it provides new country-specific estimates of augmented wealth for Austria in the year 2017 by combining data from the HFCS (Household Finance and Consumption Survey) and the social security registry. Second, it shows that the main results, which are based on statistical matching, are surprisingly similar to estimates that utilize direct survey responses or information on work history. This finding suggests that international comparisons might be possible even if the results are based on different methodologies. Third, the paper also contrasts the size and distribution of augmented wealth for Austria with comparable estimates for other countries. The household averages of the present value of pension entitlements and of private net wealth turn out to be similar (both amounting to around € 250,000), which is in line with the results for other countries like Switzerland, Germany, and the US. Also, the reduction in the Gini coefficient due to the inclusion of pension entitlements (a decrease from 0.73 to 0.53) is similar for Austria in comparison to other countries.