Candida auris is an emerging yeast that is frequently resistant to antifungal drugs. C. auris can cause invasive infections associated with high mortality and can colonize patients asymptomatically, which facilitates transmission in health care settings. Since it was first reported in the United States in 2016, C. auris has been identified in multiple states, with increasing numbers of cases reported annually. Monitoring national trends in cases identified through clinical testing and screening for colonization is critical to guide infection prevention and control efforts. 2022-2024. State and jurisdictional health departments voluntarily report clinical and screening C. auris cases to CDC using standardized case definitions of the Council of State and Territorial Epidemiologists. Clinical cases are defined as detection of C. auris from specimens collected for diagnostic purposes; screening cases are defined as detection from colonization screening swabs. Cases were reported to CDC through the Research Electronic Data Capture (REDCap) or Data Collation and Integration for Public Health Event Response (DCIPHER) platforms. Data included patient age and sex, case type, specimen type (for clinical cases), health care facility type, Antimicrobial Resistance Laboratory Network geographic region, and specimen collection date. Analyses were descriptive and limited to cases with specimens collected during 2022-2024. During 2022-2024, a total of 13,507 clinical C. auris cases were reported to CDC, increasing from 2,882 in 2022 to 4,428 in 2023 and 6,197 in 2024, with smaller annual percentage increases over time (53.7% from 2022 to 2023 and 39.9% from 2023 to 2024). Most clinical cases occurred among adults aged ≥45 years (87.8%) and among males (61.0%). The most common specimen types among all clinical cases were urine (31.5%) and blood (30.2%); by year, the proportion of blood as the specimen type was 34.4% in 2022, 30.2% in 2023, and 25.6% in 2024. Most clinical cases were identified through specimens collected in acute care hospitals (76.6%) and long-term acute care hospitals (17.8%).During the same period, a total of 27,853 screening cases were reported to CDC, increasing from 6,226 in 2022 to 9,195 in 2023 and 12,432 in 2024. Screening cases most frequently occurred among adults aged ≥45 years (90.0%) and males (57.9%). Among cases with known facility type, the proportion of specimens collected in acute care hospitals increased from 24.7% in 2022 to 50.7% in 2024, whereas the proportion of specimens collected in long-term acute care hospitals decreased from 56.1% to 35.7% during the same period. The number of clinical and screening C. auris cases reported to CDC increased during 2022-2024, indicating ongoing transmission in U.S. health care settings. Although annual percentage increases in clinical cases declined over time, absolute case counts reported to CDC continued to rise. The increasing proportion of screening cases with specimens collected in acute care hospitals might reflect increased use of screening in acute care hospitals, including screening at admission. Because of increases in the number of reported C. auris cases, sustained infection prevention and control efforts in health care facilities, including adherence to transmission-based precautions, environmental disinfection with agents effective against C. auris, and communication of C. auris status during patient transfers remain essential to preventing clinical infections and colonization. Because this pathogen is frequently resistant to antifungal drugs, continued investment in laboratory capacity and surveillance, including antifungal susceptibility testing and screening of patients at high risk for C. auris infection, can support timely detection and guide prevention strategies. Ongoing public health coordination at federal, state, and local levels is critical to limit further spread and to address emerging antifungal drug resistance.

The antiviral drug prescription landscape has changed as new antivirals for influenza treatment have been approved. Understanding this landscape is important to assess potential under- and mis-utilization and to address gaps in care. This study characterizes patterns in influenza antiviral use in US healthcare settings using a large claims database. We included prescriptions of four antivirals: oseltamivir, baloxavir, peramivir, and zanamivir in US healthcare settings between September 2016 and August 2023, using Komodo Health Database. We estimated the percentage of antiviral prescriptions associated with respiratory disease diagnoses, including influenza, COVID-19, and other respiratory conditions, and the percentage prescribed to patients at high risk of influenza complications. We used multinomial logistic regression to assess the association between patient and prescriber characteristics and the choice of antiviral. Between 865,885 and 3,092,822 influenza antiviral prescriptions were filled annually during the 2016-2017 through 2022-2023 influenza seasons among US insured individuals. Oseltamivir was the most prevalent antiviral type. Baloxavir use remained low, accounting for 1.8%-9.2% of total prescriptions since its 2018 approval. Between 55.6% and 75.4% of prescriptions had an associated influenza diagnosis, with the lowest proportion observed during the 2020-2021 season. Between 2.59% and 5.35% of antivirals were prescribed to high-risk patients. Influenza diagnosis and patient age were associated with prescribing baloxavir rather than oseltamivir. Among US insured individuals, oseltamivir remained the most prescribed antiviral during the 2016-2017 through 2022-2023 seasons, a pattern consistent with its broader FDA-approved indication across age groups and care settings relative to baloxavir, peramivir, and zanamivir.

Harm reduction vending machines (HRVMs) provide low-barrier access to supplies that reduce overdose deaths and infections. Evidence within Veterans Affairs (VA) and supportive housing settings is limited. We evaluated 8-month HRVM implementation measures at a VA Health Care System, mapped to RE-AIM (reach, effectiveness, implementation) domains. Prospective, single-system, single-arm, descriptive implementation evaluation across 15 HRVMs in VA health care and supportive housing settings. Measures/variables (RE-AIM): Reach-Veteran HRVM sign-ups/pathway, proportion accessed ≥1 product, sociodemographics; Effectiveness-resource acceptance (naloxone, overdose education, community harm reduction resources, substance use treatment, infection testing/care); Implementation-most frequently accessed products, comparisons by setting (total dispensed; proportion during business versus nonbusiness hours). HRVM software; staff-completed survey for Veterans at HRVM sign-up. Case descriptive analyses were used. Reach: 281 Veterans signed up for HRVM access, most commonly with colocated/on-site staff (54.8%). During the 8-month period, 70.8% accessed ≥1 product. Veterans were mean age of 60.2 ± 13.8 years, primarily male (90.2%), and represented diverse groups, with 40.2% white/Caucasian, 31.1% black/African American, and 10.8% Hispanic/Latinx. Among all Veterans, 44.8% accepted naloxone, 19.9% overdose education, 13.5% community harm reduction resources, 11.4% substance treatment resources, and 10.3% infection testing/treatment. 3567 products were dispensed, with a greater share at supportive housing versus health care settings (61.5% versus 38.5%), and housing settings showed substantially more after-hours dispensing (66.6%). On-site HRVM sign-ups were strongly associated with site-level dispensing (Spearman ρ = .80, P < .001). Frequently accessed items included syringes (n = 422), hygiene kits (n = 350), condoms (n = 337), and wound care kits (n = 312). HRVM colocation across health care and supportive housing reached Veterans and supported after-hours access where needs were greatest, while also linking many to naloxone, education, and health care resources. Findings demonstrate a feasible, scalable approach for integrating HRVMs into Veteran-centered public health strategies. Future research should evaluate longer term clinical outcomes, participant-reported outcomes, and cost.

Immunity to varicellazoster virus among health care workers in transplantation units.

Patients presenting with cannabis-related adverse events (AEs) and other problems are becoming increasingly prevalent in health care settings across the U.S. and Canada, increasing the burden on providers and health systems. Understanding how healthcare providers perceive and respond to cannabis AEs can inform medical training and clinical practices, health policy, and systems-level interventions. The study was conducted in Washington State, a U.S. state that legalized cannabis for non-medical use in 2012. Health care providers were invited to complete an anonymous online survey between December 2024 and March 2025, eliciting frequency and seriousness of various cannabis-related AEs, related clinical practices and procedures, knowledge and confidence addressing such problems, level of concern, and barriers and facilitators to identifying and intervening in such events. Three hundred and eighty-eight valid survey responses were included in the analysis. Most respondents were mdical doctors and worked in hospitals or primary care clinics. Thirty-five percent of respondents reported seeing cannabis AEs and use-related problems frequently (at least 2-3 times a month) in clinical practice. Severe cyclic vomiting was most common (70% reported it ever occurred) and was second to psychosis as "most serious" (33% and 34%). While most providers saw screening and intervening as important (90%), only 39.1% reported universally screening for cannabis and identified many barriers to intervening. Health care providers in a legal cannabis state have encountered AEs and other complications related to cannabis use, and many are concerned about their frequency and severity. According to study participants, expanding access to clinical guidelines, validated tools, referral pathways, and specialized training may enhance their willingness and capacity to screen and intervene effectively.

Methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 (CC398) carrying the lukS-PV/lukF-PV genes encoding the Panton-Valentine leukocidin (PVL) production is emerging as a concerning pathogen in the Czech Republic and Europe. This study aimed to investigate the clinical significance, epidemiology, and genetic characteristics of MRSA CC398 strains carrying the PVL genes.A total of 24 MRSA CC398 isolates were obtained from patients with skin and soft tissue infections. DNA was extracted from all isolates, and PCR amplification was used to confirm the presence of the mecA gene for methicillin resistance and the SA442 fragment for S. aureus identification. The affiliation to CC398 and the presence of the lukS-PV/lukF-PV genes were also confirmed by PCR. Sequencing was performed for all isolates to further characterize their genetic composition, including antibiotic resistance and virulence profiles.The isolates exhibited a multi-drug resistance profile, including resistance to beta-lactams and tetracyclines. Virulence factors such as immune evasion cluster genes and biofilm-forming genes were present in all isolates.These findings highlight the growing prevalence and spread of MRSA CC398 in community and healthcare settings and its ability to cause recurrent and difficult-to-treat skin and soft tissue infections. Clinicians should be aware of its presence, particularly in patients from regions where it is endemic, to enable appropriate antibiotic therapy and infection control measures.

Decoding why patients follow-or do not follow-fall-prevention instructions using the revised protection motivation theory: A cross-sectional study employing partial least squares structural equation modelling.

Pseudomonas aeruginosa is a multidrug-resistant pathogen, highly prevalent in ICU patients and is a rising concern globally. Multidrug resistance (MDR) and virulence of P. aeruginosa has been a major reason linked to the high rates of mortality in both developed and non-developed countries. The study focused specifically on main structural outer membrane proteins mainly oprI and oprL due to their significant role on both virulence and MDR by assessing their MDR from the isolates collected from various healthcare settings in Lahore, Pakistan. A total of 65 isolated were collected from different tertiary care hospitals of Lahore, Punjab. All isolates were identified and characterized using conventional methods. MDR patterns were assessed through disk diffusion method in accordance with CLSI 2024 guidelines. Detection of virulence genes (oprI and oprL) was performed using PCR amplification. Statistical and in silico analysis was performed to analyse the prevalence of P. aeruginosa and identification of potential vaccine targets provide alternative treatment strategies against infections caused by it. Out of all 65 isolates, total of 52 isolates was reportedly positive with P. aeruginosa and showed 100% resistance to β-lactams with high susceptibility to cephalosporins and fluoroquinolones. Multidrug resistance was reported in 70% isolates of P. aeruginosa. All isolates (100%) harbored the oprL gene while the oprI gene was detected in 85.5% of isolates. In silico characterization revealed strong binding B and T cell epitopes with 100% conservancy as potential multi-epitope candidates that warrant further in vivo and in vitro validation to overcome deadly infections caused by P. aeruginosa. In conclusion, MDR and virulence gene characterization by both molecular and computational methods will aid in developing multi-epitope vaccine candidate that can be tested in vitro and in vivo to overcome MDR and rising mortality rates in Pakistan.

Computational fluid dynamics and genotyping to explore airborne transmission of respiratory viruses in hospitals.

While antitrafficking federal and state policies, service programs, and advocacy efforts have expanded significantly since the passage of the Trafficking Victims Protection Act in 2000, little is known about how social work research and practice engage with the distinct vulnerabilities of foreign-national minors subjected to labor trafficking. This scoping review examines existing social work scholarship on labor trafficking of immigrant children and youth. The authors' findings suggest that while human service professionals play a critical role in identifying and supporting trafficked youth-often through schools, healthcare settings, and social service agencies-research remains disproportionately focused on sex trafficking. Although the 12 studies partially addressed child labor trafficking, their primary focus was on domestic child trafficking more generally, often using aggregated data that combined sex and labor trafficking survivors under the broader category of human trafficking. The authors highlight key gaps in research and propose directions for strengthening social work's engagement with labor-trafficked immigrant youth, ensuring more informed and effective responses to their needs.

Prevalence of diabetic kidney disease in Brazil: A systematic review with meta-analysis.

Cost-Utility and Budget Impact Analysis of Pharmacogenetic-Guided Antiplatelet Therapy for Acute Coronary Syndrome in Thailand.

Candidozyma (Candida) auris has emerged as a multidrug-resistant pathogen with the capacity to persist in healthcare environments. This study investigated bidirectional interactions between biocidal exposure and antifungal susceptibility, including both minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs), in a real-life disinfection scenario, and further evaluated membrane dynamics and efflux pump activity using rhodamine 6G (R6G) uptake/efflux assays. Four clinical isolates and one reference strain were exposed to ethanol (EtOH), chlorine (CHLOR), chlorhexidine (CHX), and triclosan (TRC) for 30s, 5min, and 24h. Post-exposure MIC and MFC values were determined for antifungals-amphotericin B (AMB), voriconazole (VOR), and anidulafungin (ANI)-as well as for the same biocides, following CLSI M27-A3 guidelines. Data were expressed as log₂ fold changes relative to baseline. All experiments were performed in technical triplicates to ensure reproducibility of MIC/MFC measurements. Statistical analyses were conducted using biological comparisons across the five parental isolates and their corresponding post-exposure derivatives. In this exploratory proof-of-concept study, a total of 64 isolate-condition datasets derived from five parental C. auris isolates were evaluated under 12 biocidal exposure conditions, allowing assessment of time-dependent adaptive susceptibility shifts across multiple exposure scenarios. In total, 30 short-term (30s / 5min) and 2 long-term (24h) derivatives were generated from 4 different biocides (EtOH, CHX, TRC, and limited CHLOR data). All 32 biocide-exposed isolates underwent MIC/MFC testing against three antifungals (AMB, VOR, ANI) and three main biocides (EtOH, CHX, TRC), followed by biocide-free serial passaging to assess stability. Baseline MIC distributions were as follows: AMB 0.25-2 µg/mL, VOR 4-16 µg/mL, and ANI 0.01-0.25 µg/mL. After exposure, VOR MICs showed significant reduction to 3.05-4.22 mg/L with TRC exposure being nominally significant before FDR adjustment (raw p=0.043). AMB remained stable (0.47-0.67 mg/L, all p>0.05), while ANI showed non-significant variability in MIC values to 0.04-0.09 mg/L (non-significant, p>0.05). Biocidal MICs also showed changes: EtOH remained heterogeneous (p>0.05), CHX decreased significantly with CHX pre-exposure (p=0.042), and TRC showed non-significant increases. Biocidal exposure produced agent-specific antifungal effects: ANI demonstrated modest non-significant directional shifts in MIC values across all biocides, AMB remained stable with heterogeneous responses, and VOR displayed significant MIC reduction only with TRC exposure. TRC and CHX yielded the most consistent effects in both antifungal and biocidal susceptibility. R6G assays suggested alterations in efflux activity after TRC and CHX exposure, whereas EtOH impaired efflux. Most changes decreased after drug-free passages, indicating adaptive rather than fixed resistance. C. auris demonstrates dynamic and mostly reversible tolerance patterns affecting both antifungals and biocides. R6G assays provided indirect functional observations consistent with altered membrane transport dynamics following biocidal exposure, which may have contributed to the observed adaptive susceptibility shifts. The observed susceptibility shifts highlights the adaptive potential of this pathogen under disinfection stress and underscores the need to consider cross-tolerance when designing infection control strategies in healthcare settings.

Middle east respiratory syndrome coronavirus (MERS-CoV): An underestimated betacoronavirus with pandemic potential.

Predicting type II diabetes mellitus in young and middle-aged adults: A machine learning approach using the Utah population database.

Personalized case management for caregivers of children with chronic illnesses or disabilities: A non-randomized controlled trial.

To synthesize qualitative evidence on how healthcare personnel experience, perceive and enact elderspeak, patronizing speech and infantilizing communication in interactions with older adults across healthcare contexts. Qualitative meta-synthesis. A systematic database search identified studies reporting healthcare personnel's experiences, perceptions and use of elderspeak and other patronizing communication with older adults. Findings from the included studies were synthesized and interpreted. Medline, Embase, APA PsycINFO, CINAHL and Scopus were searched in July 2024 and updated in November 2025. Thirteen qualitative studies were included. Two descriptive themes were generated: (i) Elderspeak as a communication practice that erodes personhood and (ii) Elderspeak as an institutionalized and normalized communication as behavioural regulation. These informed the analytical theme: Elderspeak as a tension between care, control and personhood. Findings suggest that elderspeak is often used with caring intentions and to facilitate care delivery, cooperation and organizational routines. However, these communication practices may simultaneously constrain older adults' autonomy, participation and personhood. Elderspeak is not merely an individual communication habit but a socially and institutionally embedded practice normalized in everyday care. While it may support care routines and cooperation, it can also position older adults as dependent, less competent or less autonomous, contributing to the erosion of personhood despite caring intentions. Addressing elderspeak requires attention to both communication practices and the organizational contexts in which they occur. Reducing elderspeak requires educational and reflective initiatives that help healthcare personnel recognize how communication practices, such as collective pronouns, terms of endearment, directive language and speaking on behalf of older adults, may unintentionally undermine autonomy and personhood. Promoting person-centred, dignity-affirming communication should be integrated into professional development and quality-improvement initiatives. Reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. This study is a meta-synthesis; therefore, it does not include patient or public involvement in its design, conduct or reporting. PROSPERO: CRD42024557148.

Middle East Respiratory Syndrome coronavirus (MERS-CoV) is a zoonotic virus first identified in 2012, responsible for severe respiratory illness and a high case fatality rate of approximately 35%. MERS-CoV is primarily transmitted from dromedary camels to humans, but human-to-human transmission, particularly in healthcare settings, has led to outbreaks beyond the Middle East, including a major epidemic in South Korea in 2015. Despite its significant public health threat and potential for future outbreaks, no approved vaccines or therapeutic agents are available for MERS-CoV. To address this urgent need, the Korea National Institute of Health (KNIH) developed therapeutic monoclonal antibodies derived from B cells of convalescent MERS patients. Among these, KNIH-88, a non-receptor-binding domain (non-RBD) S1-specific antibody, was selected for preclinical development. In this study, KNIH-88 was produced with high purity under controlled manufacturing conditions and extensively characterized for structural and physicochemical properties, including molecular weight, charge, hydrophobicity, and high molecular weight (HMW) profile. KNIH-88 demonstrated strong binding affinity to MERS-CoV Spike protein and potent neutralizing activity in vitro. To ensure stability and facilitate rapid deployment in outbreak scenarios, a lyophilized formulation of KNIH-88 was developed, maintaining structural integrity and biological activity under long-term storage. Collectively, these findings support KNIH-88 as a promising therapeutic antibody for MERS-CoV, combining potent antiviral efficacy, structural stability, and a formulation suitable for stockpiling and emergency use in endemic regions.

WHO-designated critical-priority Enterobacterales are increasingly detected beyond healthcare settings, with reports in marine wildlife suggesting broader environmental dissemination and raising potential concerns about wildlife health. Procellariiformes are highly migratory pelagic seabirds and key sentinels of ocean health, yet colonisation by these bacteria remains understudied. To address this gap, we evaluated critical Enterobacterales in samples from Procellariiformes admitted to a rehabilitation centre on the southern coast of Brazil. Thirty-one Enterobacterales isolates, pre-selected based on β-lactam resistance from the CePRAM/R3 Animal culture collection, were retrospectively analysed and characterised phenotypically and genotypically. Among these, 17 (54.8%) met WHO critical-priority criteria. Fifteen were resistant to third-generation cephalosporins, with frequent detection of blaCTX-M-1 and co-resistance to quinolones, aminoglycosides, and tetracyclines. Two isolates (Enterobacter roggenkampii and Escherichia coli) produced NDM-1 and underwent whole-genome sequencing; both carried blaNDM-1 on an IncA/C2 plasmid and had extensive resistomes. The E. coli co-produced NDM and CTX-M-8 and encoded a broad virulence repertoire consistent with an APEC-associated genotype. In silico analyses revealed determinants associated with heavy-metal, biocide tolerance, osmotic and ionic stress responses, suggesting genomic potential for persistence in saline and contaminated environments. Three host species carrying critical-priority Enterobacterales are currently listed as threatened, underscoring conservation and One Health concerns. The detection of critical-priority, virulent Enterobacterales among pre-selected resistant isolates from Procellariiformes supports their relevance in One Health surveillance, while also highlighting potential risks to threatened hosts. These findings support integrated One Health surveillance and mitigation efforts spanning wildlife, marine environments, and human activities.

Social frailty is increasingly recognised among people living with heart failure and is linked to a range of clinical and psychosocial risk factors, with significant implications for health outcomes. However, inconsistencies in the conceptualisation and measurement of social frailty, coupled with a lack of systematic reviews, hinder evidence synthesis and the development of targeted interventions. This scoping review aimed to map current evidence on the definition, measurement tools, prevalence, associated factors and health-related outcomes of social frailty in individuals with heart failure. Following the PRISMA-ScR guidelines, a comprehensive electronic search was conducted in June 2025 across eight databases: Web of Science, PubMed, CINAHL Complete, Scopus, Embase, Cochrane, CNKI and Wanfang. Search terms were guided by the Population-Concept-Context mnemonic, focusing on heart failure, social frailty, and healthcare or community settings and in accordance with the aim of the review. A total of 27 articles were included. No unified definition of social frailty was identified, and existing assessment tools exhibited heterogeneity. Prevalence rates varied widely across settings and measurement tools. Factors associated with social frailty included sociodemographic characteristics, socioeconomic status, clinical severity, psychological status and contextual factors. Social frailty was consistently linked to adverse outcomes such as diminished quality of life, increased rehospitalisation risk and higher mortality. The current literature highlights significant conceptual and methodological gaps in understanding social frailty in heart failure. Standardised definitions, validated assessment tools and deeper exploration of underlying mechanisms are needed to guide effective interventions and improve holistic care for people living with heart failure. Routine assessment of social frailty, including living arrangements, perceived social support and social participation, may facilitate the early identification of older people with heart failure who are at increased clinical and social risk. Identification of social frailty may help uncover unmet social needs and facilitate timely referral to social and community resources. As coordinators of holistic care, nurses can promote multidisciplinary collaboration and support tailored interventions that address both symptom burden and social functioning, thereby helping to reduce functional limitations and social isolation. Technology-enabled approaches, such as digital health platforms, care robots and interactive tools, may provide additional opportunities to enhance social engagement, improve access to care and promote more holistic and person-centred heart failure management.