Initial Culture Research Articles

El desempeño organizacional en las compañías del sector comercial salvadoreño

The study on organizational performance in companies in the commercial sector in El Salvador provides valuable information for decision makers. It is essential to know how the actions, attitudes and behaviors of workers influence this performance. The research was carried out using a quantitative descriptive approach through primary and secondary sources. The data were analyzed in graphs covering the competencies of personal awareness, social awareness, and personal and social behaviors. The results indicate that both personal and social awareness are fundamental in shaping the organizational culture of business enterprises. These competencies influence job performance and contribute to organizational development. Regarding social and personal behavioral competencies, it was observed that, in some cases, men demonstrate better performance within organizations. In conclusion, organizational performance in companies in the commercial sector in El Salvador is strongly influenced by the awareness and behavioral competencies of their workers. This affects both the productivity and competitiveness of companies, making these competencies key areas for development and continuous improvement within organizations.

Divergent impacts of animal bioturbation on methane and nitrous oxide emissions from mariculture ponds.

Aquaculture systems are of increasing concern as an important source of atmospheric methane (CH4) and nitrous oxide (N2O). However, the role of animals in regulating CH4 and N2O emissions from aquaculture systems remains unclear. Here, we established mesocosm trials to investigate impacts of bioturbation of different aquaculture species (i.e., clam, shrimp, and crab) on CH4 and N2O fluxes in a mariculture pond. Across the initial, middle, and final culturing stages, mean CH4 flux in mesocosm without animals was 4.81 ± 0.09 µg CH4 m‒2 h‒1, while the existence of clam, shrimp, and crab significantly increased CH4 flux by 35.3 %, 80.6 %, and 138 %, respectively. Bioturbation significantly decreased dissolved oxygen (DO) concentration by 5.19‒44.8 % but increased porewater CH4 concentration by 14.1‒59.9 %, indicating that lowered DO caused by animal respiration promoted CH4 production in sediment. Moreover, bioturbation of animals significantly increased ebullitive CH4 fluxes by 41.0‒216 %, contributing 57.4‒77.2 % of the increased CH4 emission in mesocosms with animals. However, shrimp and crab significantly reduced N2O flux by 30.3 % and 42.5 %, respectively, primarily due to lowered DO conditions suppressing nitrification and limiting NO3‒ supply for denitrification. By contrast, clam significantly increased N2O emission by 181 % because its filter-feeding behavior excreted more NH4+ and NO3‒ into overlying water and thereby facilitating N2O production. The N2O concentration in overlying water was 1.72‒2.83-fold of that in porewater, and the calculated diffusive N2O flux was 1.80‒37.5 % greater than chamber-measured N2O efflux. This implied that N2O might be primarily produced in overlying water rather than sediments, and the produced N2O can either evade as water-air fluxes or diffuse downwards into sediments to be consumed. Overall, our study advocates that aquaculture-related climate mitigation strategies should place more attention on the divergent impacts of animal bioturbation on CH4 and N2O emissions.

P-1624. Are Follow-Up Blood Cultures Necessary in Children with Gram-Negative Rod Bacteremia?

Abstract Background The utility of follow-up blood cultures (FUBCs) in children with a gram-negative rod (GNR) bacteremia is unclear. A prior pediatric study showed that FUBC positivity rate was 21%. Many adult studies have demonstrated that a FUBC is not always necessary in the setting of a UTI. Primary objectives were to determine 1. the rate of positivity in follow up blood cultures in children with gram negative bacteremia 2. To understand the clinical risk factors associated with positivity in follow up blood cultures in children with gram-negative rod bacteremia.Figure 1Flowchart depicting chart analysis Methods A retrospective cohort study in patients < 21 years of age at Children’s National Hospital that had a positive blood culture for gram negative rods from 01/2013 to 06/2023. FUBC was defined as a subsequent blood culture collected at least 24 hours after and < 7 days from the time of collection of the initial positive blood culture. Structured chart review was performed to collect clinical features, source of bacteremia, time to positivity, and FUBC positivity and contamination rate . Univariate analysis of each risk factor with FUBC positivity and multi-variable logistic regression model for association of each risk factor with FUBC positivity will be performed. Figure 1 - Flowchart depicting chart analysis.Table 1.Demographics and Clinical Characteristics of patients Results In an analysis of 35 patients, rate of FUBC positivity was 23% (n=9), contamination rate in the FUBC was 11% (n=1). Clinical factors of and outcomes are depicted in Table 1 and 2. E.coli was the most common organism found in the initial blood culture depicted in Figure 2.Table 2.Blood culture data and outcomes Conclusion Preliminary results for this ongoing study demonstrate that FUBC positivity was 22% in children with gram negative bacteremia, which is higher than what has been reported in adult studies. More data and subset analysis required for immunocompromised patients and patients with a central line.Figure 2Microbiologic distribution by percentage for initial and follow-up blood culture Disclosures All Authors: No reported disclosures

P-1626. Impact of Repeat Blood Cultures Among Adult Cancer Patients with Gram-Negative Bacilli Bacteremia on Patient-Oriented Outcomes

Abstract Background Gram-negative bacilli (GNB) bacteremia is a common and often fatal infection with mortality rates estimated to be 14-34%. Follow-up blood cultures (FUBCs) are blood cultures that are repeated after an initial positive culture. FUBCs are used to assess the appropriateness and duration of antimicrobial therapy. Currently, no guidelines exist regarding the use of FUBC for GNB bacteremia, and the utility is not well-studied in adults living with cancer. We aimed to characterize the impact of FUBC in GNB bacteremia on patient-centered outcomes in patients with cancer. Methods We conducted a single-center, retrospective study in patients ≥18 years, hospitalized during 2022, living with cancer, and with laboratory-confirmed GNB bacteremia. FUBC was defined as a blood culture performed within 7 days of initial positive blood culture. We gathered information on the source of bacteremia, identified organisms, presence of antimicrobial resistance, and comorbidities. Categorical variables were compared using Chi-square or Fisher’s exact test. Independent predictors of length of hospital stay were obtained via generalized linear model analysis. Logistic regression analysis was used to identify predictors of unplanned hospital readmission and mortality. Results Overall 94% (590/626) of patients with GNB bacteremia had a FUBC at our institution. Among those with FUBC, the majority were without growth (73%). 116/590 (20%) of patients had persistent GNB bacteremia. Patients with persistent or alternative growth on FUBC had higher mortality compared to those with negative FUBC (41% and 53% vs 17%, p< 0.001). Patients with a new organism on FUBC had longer length of stay compared to those with no growth on FUBC (aOR 1.55, 95% CI [1.09-2.20]). Patients with a single organism on repeat culture had a higher rate of mortality. Conclusion The majority of patients with FUBC did not show growth. We observed that patients who underwent FUBC had lower mortality than those without FUBC. Patients with new organisms identified on FUBC were associated with longer length of stay. Patients with positive FUBC may be characterized as high risk for mortality. Despite the majority of FUBC without growth, there may be a mortality benefit in identifying those patients with positive FUBC in patients living with cancer. Disclosures Natalie J Dailey Garnes, MD, MPH, MS, AlloVir: Grant/Research Support

Understanding what violent street crime, globalization, and ice cream have in common

AbstractResearch SummaryIn recent years, nutrition researchers have found that ice cream may have as many health benefits as low‐fat milk or yoghurt for those with diabetes or at risk of diabetes. Nonetheless, they have resisted reporting this finding to the media, the public, or other researchers. This observation got me thinking about how preconceived assumptions and biases affect social science in general and criminology in particular, are affected by the preconceived assumptions and biases of those who produce them. In this essay, I argue that the production of criminology is a cultural enterprise that reflects the attitudes and values of those who produce it. In my address for the Stockholm Prize, I summarize the main thesis of my Losing Legitimacy book and then discuss two recent projects that were influenced by the idea that strong social institutions reduce criminal behavior. The first examines the impact of the death of Freddie Gray in Baltimore in 2015 on crime and arrest rates. The second examines the impact of globalization on national homicide rates. In both cases, the results were unexpected.Policy ImplicationsAs scientists, it is critical that we evaluate research based on its theoretical soundness and methodological sophistication rather than whether it fits a currently hot topic or politically popular perspective. Science progresses by the constant process of evaluating theoretical propositions with empirical data—regardless of where those data lead us. Openness about crime and reactions to crime is no less important than honesty about the positive benefits of ice‐cream consumption.

P-2257. Pseudomonas aeruginosa and other Bacterial Infections After Lung Transplant: Risk Factors, Airway Stenosis and other Clinical Outcomes

Abstract Background Pseudomonas aeruginosa (PsA) and other bacterial infections after lung transplant can lead to worse patient outcomes. The aim of this study was to investigate whether isolation of microbial pathogens post-lung transplantation increased the risk of airway stenosis requiring bronchoscopic interventions. Table 1Table 1.Demographic, donor/recipient characteristics, peri-operative/post-operative characteristics and outcomes. Methods A single-center retrospective study of lung transplant recipients (LTR) between January 2017 and October 2023 was performed. Our center performs routine surveillance bronchoscopies at 1, 3, 6 and 12 months. Donor/recipient characteristics, microbiologic data, bronchoscopy findings and interventions, and 1-year outcomes were analyzed. Results In this 6.8-year study period, 327 subjects underwent lung transplant with survival greater than 30 days. The most common indication for lung transplant was restrictive lung disease. 64 (20%) had PsA infections, 77 (23%) had non-PsA bacterial infections (infect), and 186 (57%) did not have a bacterial infection within 6-months post-transplant. Recipient and donor characteristics were similar among the cohorts. A greater proportion of the PsA and infect cohorts required dialysis and mechanical ventilation and/or ECMO for >48 hours and had a longer index hospitalization than the uninfected cohort [Table 1]. A greater proportion of the PsA and infect cohorts developed airway stenosis requiring bronchial intervention (22% vs 17% vs 2%, p=< 0.001). The median time to first infection post-transplant occurred prior to the development of stenosis (72 vs 112 days; 52 vs 110 days). 44% of LTR with PsA growth had fluoroquinolone resistance on the initial culture. Rates of rejection and 1-year survival were not statistically different among the cohorts. Conclusion PsA and other bacterial infections within the first 6-months post lung transplantation led to a higher incidence of airway stenosis requiring bronchial intervention but was not associated with increased mortality or rejection at 1-year. The impact of treating bacterial colonization and other strategies to minimize post-transplant bacterial infections and decreasing the occurrence and time to airway stenosis needs further study. Disclosures All Authors: No reported disclosures

P-806. How close are we to achieving the trifecta of optimal treatment duration, route of therapy, and repeat blood culture testing for uncomplicated gram-negative bacteremia?

Abstract Background A 2021 consensus document outlined recommendations for treatment duration, oral antibiotic use, and need for repeat blood cultures in patients with uncomplicated gram-negative bacteremia. Data support 7 days of effective therapy and oral step-down therapy in clinically stable patients. Repeat blood cultures were not recommended except for patients with concern for endovascular infection. We sought to evaluate the percentage of our gram-negative bacteremia cases that would be defined as uncomplicated and how well our practices for these cases aligned with the 2021 recommendationsTable 1.Antibiotic days of therapy Methods This retrospective cohort study included adult patients hospitalized between 1/1/2022 and 12/31/22 who had a blood culture with growth of a gram-negative organism and who received ≥ 4 days of antibiotics for the bacteremia. Effective therapy required both use of an antibiotic to which the organism was susceptible and source control. Unnecessary IV therapy was defined as continuation of IV therapy in patients with clinical stability for ≥ 24 hours who had an oral treatment option available.Table 2.Repeat blood cultures Results During 2022, 251 unique patients were hospitalized with gram-negative bacteremia and received ≥ 4 days of antibiotics, 130 (52%) of whom were classified as having uncomplicated bacteremia. The average duration of effective therapy was 11.8 days and 74.6% of patients received ≥ 10 days. Unnecessary IV therapy was continued for an average of 3.8 days and 33 (34%) were not transitioned to an orally available option by day 4 of clinical stability. Repeat blood cultures were done in 86 (66%) patients but were indicated in only 18 (14%). Twenty-two (26%) repeat blood cultures were collected < 48 hours after the initial positive blood culture Conclusion Using the 2021 consensus recommendations as a guide, more than half of patients with uncomplicated gram-negative bacteremia at our institution received longer than recommended durations of therapy, were not transitioned to an oral option when clinically stable and had repeat blood cultures done when not indicated. A multifaceted intervention to achieve the trifecta of optimal treatment duration, route of therapy, and repeat blood culture testing for uncomplicated gram-negative bacteremia is planned. Disclosures All Authors: No reported disclosures

P-1628. Impact of the BioFire® FilmArray® BCID2 Panel and Antimicrobial Stewardship on Clinical Outcomes in Patients with Antimicrobial Resistant Bacteremia

Abstract Background Bloodstream infections (BSIs) carry high rates of morbidity and mortality, with delays in appropriate therapy associated with worse outcomes. Given limited available literature, our objective was to describe the impact of BioFire® FilmArray® Blood Culture Identification 2 (BCID2) panel implementation on clinical outcomes in patients with organisms not covered by empiric regimens. Methods This was a retrospective review comparing adults with extended-spectrum β-lactamase (ESBL), carbapenemase (CRE), or AmpC-producing Enterobacterales, Acinetobacter baumannii, Stenotrophomonas maltophilia, or Enterococcus species BSIs pre- (7/2020–12/2021) and post- (7/2022–12/2023) BCID2 implementation. Patients were excluded if the initial positive blood culture (BCX) was from an outside facility, had organisms not on the BCID2 panel, or if they died or were discharged prior to BCX results. The primary outcome was time from BCX positivity to initiation of effective therapy. Process measures included pharmacist interventions. Clinical outcomes included recurrence, resistance development, readmission, Clostridioides difficile infection, and mortality. Results 319 patients were included (pre-BCID2 n=128; post-BCID2 n=191), with a median age of 69 years (57-81). The most common infecting organisms were Enterococcus spp. (44%) and ESBL Enterobacterales (41%), and the majority were from urinary (35%) or intra-abdominal (28%) sources. Time to effective therapy was significantly shorter post-BCID2 (7 v. 4 hours, p=0.011), particularly among those with ESBL (40 v. 5 hours, p< 0.001), high-risk AmpC-producing organism (41 v. 6 hours, p=0.174), and E. faecium infections (17 v. 5 hours, p=0.067). Antimicrobial stewardship pharmacists performed more interventions post-BCID2 (34% v. 49%, p=0.006) with a higher number of interventions performed pre-MALDI-TOF speciation (22% v. 39%, p=0.002). Given low event rates, we were unable to demonstrate clinically meaningful differences in secondary endpoints between groups.Figure 1.Primary Outcome: Time to Effective Therapy Conclusion Implementation of BCID2 in conjunction with antimicrobial stewardship was associated with shorter time to effective therapy. Further studies are needed to understand the impact of this on patient-related outcomes. Disclosures All Authors: No reported disclosures

P-406. Implementation of an Initial Specimen Blood Culture Diversion Device to Reduce Blood Culture Contamination: Lessons Learned

Abstract Background Blood culture (BCx) contamination (BCxC) leads to unnecessary antibiotic exposure, increased hospital stay, and cost. Despite best practices, our health system’s BCxC rates remain above the 1% benchmark. Implementation of an initial specimen diversion device (ISDD) have demonstrated reduced BCxC rates. 3,4 We assessed the impact of the Kurin Lock® ISDD on BCxC and vancomycin utilization in adult emergency departments (EDs), intensive care and step-down units (ICU/SD). Methods The Kurin Lock® was implemented in 3 Lifespan health system hospitals (The Miriam Hospital [TMH] ED October2022; Rhode Island Hospital [RIH] and Newport Hospital [NH] EDs January 2023, and in all 3 hospital’s ICU/SD units June 2023). We included adult BCx obtained by nurses (all hospitals) or phlebotomists (NH only). BCx were drawn per protocol; growth was monitored with the BioMérieux VIRTUO System. BCxC rates were calculated dividing the number of contaminated cultures (per CDC NHSN commensal list) by the total number of BCxs/month. Mean BCxC rates prior to Kurin Lock® implementation (6 months) and after implementation (subsequent months through December 2023), excluding the month of implementation, were compared using the Wilcoxon rank-sum test. An interrupted time-series analysis was performed using binomial regression models; vancomycin days of therapy (DOT) for ’bacteremia’ was analyzed using generalized linear models. Results Overall mean BCxC rates for all hospitals and locations decreased from 3% to 1.9% after ISDD implementation (P=0.009). This decline was observed in all EDs but only statistically significant in RIH ICUs/SDs. In the time-series analysis, an abrupt 65% decline in BCxC was observed immediately after implementation in all hospitals and locations (P = 0.04). Lower BCxC rates were sustained after 200 days in the ICUs/SDs and 400 days in the EDs; however, an upward trend was observed with time. Vancomycin DOT was not significantly different pre- vs. post-Kurin Lock® implementation (41/1000 patient days vs. 37/1000 patient days, P=0.9). Conclusion A sustained decline in BCxC is achievable with the Kurin Lock® ISDD in academic and community hospital settings. But consistent education on best practices is key to guarantee the efficacy and cost-effectiveness of this intervention. Disclosures Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)

P-881. A Retrospective Review of Enterobacter cloacae complex Bacteremia: 2019-2023

Abstract Background Enterobacter cloacae complex is one of the most common Enterobacterales considered at moderate to high risk for clinically significant AmpC production. AMP-C betalactamases confer resistance to broad spectrum cephalosporins and common beta-lactam betalactamases including Amoxicillin-Clavulanate and Piperacillin-Tazobactam. Carbapenems are often used empirically when this organism is isolated but there is a current gap in the literature regarding in which circumstances non-carbapenem antibiotics can be used safely for patients with enterobacter cloacae complex infections. The aim of this study was to examine independent predictors of mortality for patients with enterobacter cloacae complex bacteremia and identify patients which can appropriately receive non-carbapenem based therapy safely and effectively without negative impacts on mortality. Methods We conducted a retrospective analysis of 285 episodes of enterobacter cloacae complex bacteremia. The main outcome measure was mortality at 30 days.The χ2 or Fisher's exact test were used to compare categorical variables. To identify the independent risk factors of infection and mortality, a binary logistic regression model was used to control for the effects of confounding variables. Results Of 285 patients 17.5% (50) were deceased at 30 days, 110 patients received a beta-lactam betalactamase inhibitor combination initially and 80 patients received an initial broad spectrum cephalosporin. Of 209 patients for whom antibiotic data was available 73 were changed to a carbapenem within 24 hours of the initial blood culture being drawn. In univariate analysis only source was identified as a statistically significant risk factor for mortality at 30 days. In univariate and multivariate binary logistic regression analysis change to carbapenem within 24 hours of blood culture was not an independent risk factor of death at 30 days. Conclusion Change to carbapenem within 24 hours of cultures being taken was not an independent risk factor of 30 day mortality. Further studies are needed to determine in what group broad spectrum cephalosporins or beta-lactam betlactamase inhibitors are appropriate therapy for enterobacter cloacae. Disclosures All Authors: No reported disclosures

P-835. The microbiological characteristics of Acinetobacter baumannii associated with early mortality in patients with bloodstream infection

Abstract Background Despite the rapid deaths due to Acinetobacter baumannii bacteremia, the clinical impact of the microbiological characteristics of A. baumannii strains on early mortality (EM) is unclear. We aimed to identify the microbiological characteristics of A. baumannii strains associated with EM. Methods Clinical information and isolates from patients with A. baumannii bacteremia from January 2015 to December 2021 were collected. We collected patients’ clinical data, including demographic data, clinical severity, source of infection, and antibiotic therapy. EM was defined as death within 3 d of the initial positive blood culture, whereas late mortality meant death within 5–30 d. The microbiological characteristics of A. baumannii were analyzed using multilocus sequence typing, polymerase chain reactions, and a Galleria mellonella in vivo infection model.Figure 1.The virulence of Acinetobacter baumannii isolates by Galleria mellonella infection model.(A) Health index scores of larvae injected with isolates from the early mortality (EM), late mortality (LM), and 30-d survivor groups. (B) Health index scores of larvae injected with ST191 and non-ST191. (C) Health index scores of larvae injected with isolates carrying bfmS and those without bfmS. (D) Health index scores of larvae injected with isolates carrying bauA and those without bauA. The circles, squares, and triangles represent the mean, and the lines indicates standard error of the mean. The health index score of larvae was calculated by summing the scores for activity, cocoon formation, melanization, and survival. Health index scores of fifteen larvae were summed at every 24-h time point. Results Among 130 patients, 69 (53.1%) died within 30 d, and 38 (55.1% of 30-d deaths) were classified as EM and 27 (39.1% of 30-d deaths) as LM. Sequence type 191 (ST191) was the most prevalent ST, consistently identified throughout the study period. ST191 strain was more prevalent patients with EM than in 30-d survivors (31.6% vs. 6.6%, P = 0.001). Regarding virulence genes, bfmS was more frequent (92.1% vs. 47.5%, P < 0.001), whereas bauA was less frequent (13.2% vs. 52.5%, P < 0.001) in patients with EM than in 30-d survivors. Higher clinical severity, pneumonia, and ST191 infection were identified as independent risk factors for EM. In the G. mellonella infection model, ST191, bfmS+, and bauA- isolates showed higher virulence than non-ST191, bfmS-, and bauA+ isolates, respectively. Conclusion ST191 and bfmS were more frequently found in the EM group. ST191 infection was also an independent risk factor for EM and highly virulent in the in vivo model. Tailored infection control measures based on these characteristics are necessary for A. baumannii bacteremia management. Disclosures All Authors: No reported disclosures

P-889. Therapeutic Failures of High Inoculum Infections with Cefazolin: Role of A Rapid Test and Prevalence of the Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections

Abstract Background Cefazolin (CFZ) remains a key therapy for MSSA bloodstream infections (BSIs), yet some studies suggest poorer outcomes when CFZ is used in the presence of cefazolin inoculum effect (CzIE). We developed a rapid colorimetric test with nitrocefin to detect CzIE in MSSA. Here, we report the performance of the rapid test in four recurrent BSIs caused by MSSA exhibiting the CzIE. Furthermore, we assess the local prevalence of CzIE using both standard broth microdilution (BMD) and the rapid test. Methods A chart review collected clinical data from four patients, including demographics, microbiologic features, antibiotic therapies, and clinical outcome. Patients were selected based on positive MSSA BSI after initial clearance, and availability of their index isolate. The nitrocefin-based rapid test was performed according to a published protocol. For the surveillance step, MSSA were collected from initial cultures of adult patients diagnosed with BSIs between July 2023 and April 2024 from 8 hospitals. The CzIE was assessed using BMD at standard (105) and high (107) inocula, with a cutoff CFZ MIC ≥ 16 μg/ml. The rapid test was performed in all isolates. Results All four patients had deep-seated infections, including endocarditis, osteomyelitis, or device-related infections, with two patients undergoing surgical interventions. While receiving CFZ therapy, all patients successfully cleared their MSSA BSI. After initial clearance, these patients received prolonged antibiotic therapy lasting ≥ 6 weeks, with 3 of 4 patients continuing with CFZ, as part of their initial therapy. Despite this, MSSA BSI recurred between 34 and 155 days after initial hospitalization. Notably, all index isolates tested positive for CzIE via the rapid test. During the surveillance period, we collected 196 isolates, with a 40% (79/196) prevalence of the CzIE based on BMD. The rapid nitrocefin test correctly identified 72 of 79 strains exhibiting the CzIE, with 91% sensitivity and 80.3% specificity. Conclusion These findings underscore a high prevalence of MSSA isolates exhibiting CzIE in BSIs. Patients infected with MSSA displaying CzIE may face an increased risk for recurrence when treated with CFZ. Further validation of these observations is warranted to better understand their clinical implications. Disclosures José M Munita, MD, MSD: Grant/Research Support|Pfizer: Grant/Research Support William R. Miller, M.D., Merck: Grant/Research Support|UptoDate: Royalties

Ways of shaping the Lean culture in enterprises in Poland

As we know from many publications, it is worth using Lean Management in modern enterprises. On the other hand, as scientists and practitioners emphasise, developing an appropriate organisational culture is necessary to obtain the proper results as part of Lean Management. Therefore, in parallel with the organisational changes related to implementing the Lean concept in the enterprise, various activities should be carried out to change the organisational culture into a culture favourable to Lean. There are many studies on how to change an organisation's culture, although it takes much work. Also, many publication threads in the recent period concern the features of the Lean organisational culture (the culture of a lean organisation) or the potential ways of creating this culture. However, knowledge on this subject still needs to be improved, especially from the point of view of management practice. Therefore, the main purpose of this article is to present basic information on the ways of shaping Lean organizational cultures in enterprises in Poland, with particular emphasis on manufacturing companies, based on literature studies and the results of empirical research carried out as part of the doctoral dissertation of one of the authors. The survey was conducted in 2022, using the CAWI method, on a sample of 55 companies. The presented results can be a valuable contribution to understanding the phenomenon of creating a Lean culture in enterprises in Poland. They can be also the basis for further research or analysis in this area.

Fluconazole step-down therapy versus echinocandins for the treatment of Candida glabrata invasive candidiasis with candidaemia.

Candida glabrata is the second most common species responsible for invasive candidiasis, including candidaemia. Echinocandins are typically the first-line therapy for C. glabrata candidaemia, with the option to transition to oral fluconazole. Studies are needed to evaluate clinical outcomes in patients initially treated with echinocandins then transitioned to fluconazole. This was a retrospective, single-centre cohort study of patients with C. glabrata candidaemia from November 2011 to August 2023. Inpatients aged 18-89 years who received an echinocandin within 24 h of the initial positive blood culture were included. Patients were excluded if they received antifungal treatment less than 48 h, combination therapy, or fluconazole as initial therapy. The primary composite outcome was 30-day clinical failure. A total of 186 patients were included (n = 153 echinocandin only; n = 33 fluconazole step-down). The most common source of candidaemia was line-associated in both groups with the majority having source control (43% echinocandin versus 58% fluconazole; P = 0.32). Compared to fluconazole, patients in the echinocandin group had a higher rate of concomitant bacteraemia (45% versus 24%; P = 0.03) and endovascular complications (11% versus 0%; P = 0.05). There was no significant difference in treatment duration between echinocandin and fluconazole (16 versus 19 days; P = 0.46), incidence of persistent candidaemia (22% versus 24%; P = 0.7), or 30-day clinical failure (15% versus 9%; P = 0.58). Fluconazole appears to be a safe and reasonable step-down therapy in the management of C. glabrata candidaemia.

A Sneaky Culprit: Secondary Infectious Keratitis Due to Brevundimonas diminuta.

To describe a rare case of infectious keratitis secondary to Brevundimonas diminuta, a gram-negative bacillus with fluoroquinolone resistance and rare clinical isolation. A 50-year-old man with contact lens overuse presented with a large corneal ulcer and hand motion visual acuity. Initial treatment with fortified topical tobramycin and vancomycin yielded slow improvement, and initial culture grew Staphylococcus epidermidis, Staphylococcus hominis, and Corynebacterium bovis. Therapy was tapered to topical moxifloxacin. Loteprednol was added to reduce corneal inflammation after presumed sterilization. Persistent epithelial defect and worsening infiltrate after 3 weeks prompted repeat culture and corneal punch biopsy. Repeat culture revealed B. diminuta resistant to moxifloxacin. Treatment was modified to tobramycin, and therapeutic penetrating keratoplasty was pursued to prevent further stromal loss. Four months postoperatively, the cornea remained clear without recurrence or neovascularization. To our knowledge, this is the second reported culture-positive case of secondary infectious keratitis with B. diminuta, highlighting its rarity and potential for delayed identification. The atypical response to initial therapy underscores the importance of repeat cultures and corneal biopsy in persistent cases. This case contributes to the growing understanding of rare ocular pathogens, advocating for a vigilant clinical approach.

Impact of Leadership Style on Employee Green Behavior: The Mediating Role of Employee Over-Qualification Perception

This study examines the impact of Leadership Style on Employee Green Behavior and the mediating role of Employee Over-Qualification Perception. The findings reveal that Transformational Leadership significantly enhances Employee Green Behavior, while leadership support reduces Employee Over-Qualification Perception, thereby promoting pro-environmental actions. It is recommended that organizations focus on developing leadership capabilities and creating supportive environments to encourage Employee Green Behavior. The effect of leadership style is more pronounced for employees with high self-efficacy, indicating that companies should design incentive programs tailored to individual employee characteristics. The study also identifies that the influence of leadership style on pro-environmental behavior varies by company size, with larger enterprises needing to adjust strategies to effectively promote green behavior. Continuous training and cultural development are essential for building sustainable green organizations. Companies should establish dynamic evaluation systems to regularly update strategies and ensure the sustainability of pro-environmental behavior. Leaders should act as role models for green behavior, enhancing employees’ sense of belonging and fostering a culture of environmental participation across the organization. Evaluation systems should include multiple indicators to ensure the effectiveness and specificity of strategies. Through diversified training and cultural initiatives, companies can strengthen environmental awareness, maintain the continuity and stability of green behavior, and ultimately achieve harmony between corporate development and environmental sustainability.

Ghostly intrusion on a frightful Halloween night: a case report of dual valve endocarditis.

Multivalvular endocarditis (MVE) is an uncommon presentation and mostly involves mitral and aortic valves. Here, we present a case of an MVE with an unusual and bizarre presentation on a Halloween night with a massive degree of valve destruction and right- and left-side involvement requiring emergent surgery. A 51-year-old male patient with intravenous drug usage presented with anorexia, fever, and dyspnea, rapidly progressing to septic shock with multiorgan dysfunction. Initial blood cultures detected meticillin-sensitive Staphylococcus aureus, and antibiotic therapy was started. Transesophageal echocardiography revealed extensive valve destruction of both mitral and tricuspid valves, namely a mitral valve with large vegetation resembling a ghostly figure, causing severe mitral regurgitation. The patient was transferred for emergent mitral and tricuspid surgery. The particularity of this case, besides the bizarre images, is that, as a drug user, there are specific considerations regarding surgical strategy and options in this scenario that we discussed here.

Conflict-induced displacement in Pakistan: a sociological study of lived experiences of involuntary migration among Afghan immigrants

The involuntary migration of Afghans has emerged as a pressing global concern, presenting a complex interplay of social, legal, and economic challenges. This mass exodus, fueled by the pursuit of safety and refuge, has strained social and economic infrastructures, necessitating a comprehensive sociological analysis. This study investigates the lived experiences of Afghan immigrants and explores their coping strategies for overwhelming situations in the host community (Peshawar, Pakistan). Drawing on an interdisciplinary approach, the study synthesizes insights from migration sociology, cultural studies, and immigrant’s studies to comprehensively understand this complex intersection. By adopting a mixed research design using both survey and semi-structured interviews, and integrating legal, economic, and social perspectives, our investigation unveils the sociological dimensions shaping livelihood challenges and social impacts. The finding revealed the challenging legal and administrative hurdles faced by Afghan immigrants, the economic disparities, the complex dynamics of social integration, and accommodation issues within the host community. Amidst these challenges, this study found coping strategies of Afghan immigrants, which they had on individual, family, and community level. This study transcends academic inquiry, inviting us to embrace a holistic understanding that guides us toward more equitable and inclusive societies. This study contributes to migration sociology, and offers practical insights for policymakers and practitioners engaged in the complexities of involuntary migration and community development. It indorses sociologically grounded implications that call for inclusive policy interventions, cultural bridge-building initiatives, and community-driven efforts for long-term resilience. Charting future territories, we advocate for longitudinal and comparative analyses, recognizing the uncharted realm of gendered experiences in involuntary migration.

Concomitant Interstitial Pneumonia and Disseminated BCG Infection after Intravesical BCG Therapy: A Case Report

An 83-year-old man presented with persistent fever after intravesical BCG therapy for bladder cancer. Chest computed tomography (CT) and bronchoscopy revealed diffuse ground-glass opacities with multiple micronodules and lymphocyte-predominant bronchoalveolar lavage fluid with a high CD4/CD8 ratio, respectively. Therefore, corticotherapy for interstitial pneumonia was initiated. Anti-fast staining of the respiratory specimens was negative; however, anti-tuberculosis treatment was added based on CT findings suggesting disseminated BCG infection. Fifty days post-admission, Mycobacterium bovis BCG was identified in the initial sputum cultures. Concomitant interstitial pneumonia and BCG infection should be considered in patients with abnormal chest imaging following intravesical BCG therapy.

FIFA World Cup as a Catalyst for Cultural Change: A Comparative Analysis of Host Nations' Cultural Transformation from East Asia to the Middle East (2002-2022)

The FIFA World Cup's cultural impact extends beyond sporting achievement, fundamentally transforming host nations through complex social and institutional dynamics. This study examines these transformative mechanisms, with particular emphasis on Qatar 2022 as the first Middle Eastern host nation, analysing how mega-sporting events influence cultural evolution while preserving indigenous values. Through systematic historical analysis of five World Cup tournaments (2002-2018), the research identifies patterns of cultural impact and transformation across multiple societal dimensions. The findings reveal three primary vectors of cultural transformation: institutional reform initiatives, social integration processes, and strategic international perception management. Comparative analysis of previous hosts - South Korea/Japan (2002), Germany (2006), South Africa (2010), and Brazil (2014) - demonstrates how nations leveraged the tournament to address historical grievances, reshape global narratives, and catalyse domestic social reform. Each case study reveals distinct approaches to cultural transformation, from Germany's confrontation with historical legacy to South Africa's post-apartheid reconciliation efforts. Qatar's preparation introduces novel paradigms for balancing traditional cultural preservation with international standards, particularly evident in labour rights reform, infrastructure development, and cultural diplomacy initiatives. The research identifies critical success factors for cultural transformation through mega-sporting events: sustained institutional commitment to reform, strategic integration of cultural elements in infrastructure development, and proactive management of international perceptions. Qatar's experience provides insights into how host nations can challenge stereotypes while maintaining cultural authenticity. This study contributes to the theoretical understanding of mega-sporting events as catalysts for cultural change, extending beyond sports management to international relations and cultural diplomacy. The findings establish a framework for analysing how such events facilitate cultural transformation while preserving host nation identities. Results indicate that successful cultural change requires sustained commitment beyond the tournament timeframe, with significant implications for future host nations and international sporting organizations.