Empiric UTI guidelines assume geographically uniform resistance patterns that may not hold within sprawling cities. We map Escherichia coli susceptibility from primary care cultures and apply spatial scan statistics to detect high-resistance clusters for key oral agents. Clusters align with neighborhoods reporting informal antibiotic sales and limited culture access, while nearby districts remain closer to national averages. Results argue for locally refreshed empiric menus rather than city-wide first-line defaults alone.

Discharge summaries often leave unresolved drug discrepancies that surface only after patients return home. We evaluate a structured pharmacist reconciliation visit within seventy-two hours of discharge for adults with polypharmacy. The intervention arm shows fewer clinically significant discrepancies and a modest reduction in thirty-day unplanned readmissions, concentrated among patients with heart failure or anticoagulants. Process metrics indicate that physician callback pathways determine whether identified issues are corrected before harm occurs.

Specialized imaging biomarkers are rarely available in general diabetic foot clinics. We train gradient-boosted models on routinely recorded ulcer size, infection grade, glycemic control, and vascular scores to predict twelve-week non-healing. External validation at a second clinic maintains discrimination above chance and identifies infection grade plus ankle-brachial index as dominant contributors. Calibration plots improve after isotonic adjustment, supporting use as a triage aid rather than a standalone surgical decision tool.

Existing moral injury scales are lengthy for repeated staff wellness screening during prolonged surge cycles. We adapt and validate an eight-item inventory in frontline nurses recruited across medical and intensive care units. Exploratory and confirmatory analyses support a two-factor structure separating betrayal-related and self-transgression items, with acceptable internal consistency and expected correlations with burnout and intention to leave. Receiver operating analysis suggests a practical cutoff for flagging staff who may benefit from confidential counseling outreach.

Subsidy programs aim to cut indoor smoke exposure, yet adoption and sustained use vary widely across neighborhoods. We link clinic records of lower respiratory infections in children under five with household fuel surveys before and after a staged clean cookstove subsidy. Communities with higher sustained LPG use show larger declines in clinic visits, while mixed-fuel stacking attenuates benefits. Qualitative interviews highlight refill cost and supply reliability as stronger barriers than stove preference, informing subsidy design beyond hardware distribution alone.

Pooling labeled radiographs across hospitals often stalls on privacy and governance barriers. We train a shared triage network with federated averaging across four sites that never exchange raw images, evaluating urgent-finding recall against locally trained baselines. Federated models approach centralized performance for pneumothorax and consolidation flags while narrowing site-specific overfitting, although non-identical acquisition protocols still require periodic local fine-tuning. The study outlines operational checklists for federation rounds that clinical IT teams can adopt without relocating archives.

Commercial CGM devices are validated mainly under resting or steady aerobic conditions, leaving uncertainty about reading lag during brief anaerobic bursts. We compare interstitial versus capillary glucose at two-minute intervals across supervised HIIT sessions in adults with type 2 diabetes. Mean absolute relative difference widens during peak intervals yet returns within label claims by recovery, and a short warm-up protocol reduces early-session overestimation. Findings support cautious interpretation of real-time alerts during HIIT rather than blanket exercise restrictions based on CGM alone.

Introducción: La contaminación microbiológica del agua de consumo humano constituye un problema persistente en comunidades vulnerables donde las deficiencias en la infraestructura de abastecimiento, almacenamiento y saneamiento favorecen la contaminación secundaria. Objetivo: Evaluar la calidad microbiológica del agua para consumo humano y determinar la influencia de las condiciones de almacenamiento doméstico y las prácticas higiénico-sanitarias sobre la contaminación microbiológica en una comunidad vulnerable de Esmeraldas, Ecuador. Método: Se realizó un estudio observacional, analítico y transversal en 286 viviendas. Las muestras de agua procedentes de grifos, reservorios de cemento, reservorios plásticos y cisternas fueron analizadas mediante métodos microbiológicos estandarizados para la detección de bacterias y hongos. Paralelamente, se evaluaron prácticas higiénico-sanitarias mediante observación estructurada. Resultados: El 71 % de las muestras presentó contaminación microbiológica. Los reservorios plásticos (94 %) y de cemento (83 %) registraron las mayores tasas de contaminación, mientras que los grifos mostraron la menor proporción de muestras positivas (12 %). Los microorganismos predominantes fueron Escherichia coli, Salmonella spp. y Klebsiella spp., indicadores de contaminación fecal. La prueba de Chi-cuadrado evidenció una asociación significativa entre el tipo de almacenamiento y la contaminación microbiológica (χ² = 57,64; p < 0,0001). Conclusiones: Los hallazgos demuestran que las condiciones de almacenamiento doméstico constituyen un determinante crítico de la calidad microbiológica del agua, superando la influencia de la fuente de abastecimiento. Se recomienda fortalecer la infraestructura de almacenamiento, promover prácticas higiénicas adecuadas e implementar programas comunitarios de monitoreo microbiológico para reducir los riesgos para la salud pública.