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Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections
(2024)
Angelique E Boutzoukas
;
Natalie Mackow
;
Abhigya Giri
;
Lauren Komarow
;
Carol Hill
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P &lt; 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P &lt; 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P &lt; 0.001].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.</jats:p> </jats:sec>
Scopus© Citations 1 3
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China’s Global Governance as a Tool for Accelerating International Sustainable Development and Pandemic Security
(2024)
Brice Tseen Fu Lee
;
Walker Darke
;
Jan-Niclas F. Schubert
<jats:p> This study explores China’s robust response to the Coronavirus Disease-2019 pandemic, employing health diplomacy and soft power strategies to boost international relations and global health outcomes. China’s contributions to international organisations, investments in biotechnology and provision of medical aid underline its pivotal role in health diplomacy. The country’s approach, encompassing the Health Silk Road and vaccine diplomacy, is viewed through the lens of soft power theory and health diplomacy theory. It is revealed that China’s initiatives, while offering valuable global health benefits, also strategically enhance its global influence and international relations. This article offers policy recommendations and underscores the importance of international cooperation, equitable access to health interventions, and the embrace of digital health technologies. </jats:p>
Scopus© Citations 2 4
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The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial
(2023)
Lu Ma
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Xin Hu
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Lili Song
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Xiaoying Chen
;
Menglu Ouyang
Scopus© Citations 221 1
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Maslow’s Hierarchy of Needs: A Framework for Understanding China’s SOEs, SMEs and Decentralisation
(2023)
Brice Tseen Fu Lee
;
Juan Pablo Sims
<jats:p> This study delves into the intricate interplay between state-owned enterprises (SOEs), disposable income and economic decentralisation within China’s economic landscape, all underpinned by the principles of Maslow’s hierarchy of needs. It highlights the unique roles of SOEs and small and medium enterprises (SMEs), while assessing disposable income’s effect in bolstering support for decentralisation. Emphasis is placed on whether a higher disposable income often a product of SOEs’ control over vital industries and utility prices can catalyse public enthusiasm for decentralisation. Utilising a spectrum of analytical techniques on secondary data, the study uncovers vital patterns that suggest a symbiotic relationship between SOEs and SMEs in advancing economic growth and decentralisation. The findings offer valuable insights for policy development and further understanding of the nexus between SOEs, disposable income and decentralisation, as contextualised within Maslow’s hierarchy of needs. </jats:p>
Scopus© Citations 6 7
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Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant <i>Acinetobacter Baumannii</i> Among Patients From Different Global Regions
(2023)
Minggui Wang
;
Lizhao Ge
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Liang Chen
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Lauren Komarow
;
Blake Hanson
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality.</jats:p> <jats:p>Clinical Trials Registration. NCT03646227.</jats:p> </jats:sec>
3Scopus© Citations 102
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El budismo en el discurso político chino: construcción de una narración patriótico-religiosa
(2017)
María Elvira Ríos Peñafiel
<jats:p>Tres son las grandes persecuciones que el budismo debió enfrentar y superar en la historia de China y variadas las maneras en que ha debido crear un discurso que se adecúe a las circunstancias culturales y políticas para sostener su doctrina. A principios del siglo XX se destaca un discurso modernizador, para luego adecuar los conceptos religiosos a la ideología comunista. En la actualidad, el budismo debe responder a la política patriótica del “Sueño Chino”. En este texto se pretende analizar la narración político-religiosa por medio del uso de conceptos e ideas que circulan en los medios de comunicación y conferencias que la Asociación Budista de China difunde al pueblo creyente. </jats:p>
11Scopus© Citations 1
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El soft power en la política exterior de China: consecuencias para América Latina
(2013)
Isabel Rodríguez Aranda
;
Diego Leiva Van de Maele
2
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Low blood pressure and adverse outcomes in acute stroke: HeadPoST study explanations
(2020)
Menglu Ouyang
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MUÑOZ VENTURELLI, PAULA ANDREA
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Laurent Billot
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Xia Wang
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Lili Song
Scopus© Citations 12 1
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Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
(2019)
MUÑOZ VENTURELLI, PAULA ANDREA
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Xian Li
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Sandy Middleton
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Caroline Watkins
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LAVADOS GERMAIN, PABLO MANUEL
<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( <jats:styled-content style="fixed-case">AIS</jats:styled-content> ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Use of 8 <jats:styled-content style="fixed-case">AIS</jats:styled-content> processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect‐free” care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 1.62–3.09). Defect‐free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Use of evidence‐based care is associated with improved clinical outcome in <jats:styled-content style="fixed-case">AIS</jats:styled-content> . Strategies are required to address regional variation in the use of proven <jats:styled-content style="fixed-case">AIS</jats:styled-content> treatments. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique Identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 02162017. </jats:p> </jats:sec>
1 8Scopus© Citations 21
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Breaking the South-South FTA Mould: Why China ‘Went OECD’ with New Zealand?
(2018)
Fernando M. Schmidt Hernandez
<jats:p> China and New Zealand were able to sign a Free Trade Agreement (FTA) in 2008, in spite of the large differences in standards under which they were respectively negotiating trade agreements in the international arena. This article starts with a descriptive analysis of these differences between each country’s standards in terms of FTA quality. With the description of these standards, which seem to stand on opposite sides of a continuum, we examine why China and New Zealand decided to forego the standards under which they had negotiated previous agreements in order to find a middle ground. This process of convergence showcases how the interests of both parties moved them towards the adoption of a middle ground which enabled them to negotiate a win-win agreement. </jats:p>
Scopus© Citations 2

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