BACKGROUND: In the hospital environment, carbapenemase-producing Pseudomonas aeruginosa (CPPA) may lead to fatal patient infections. However, the transmission routes of CPPA often remain unknown. Therefore, this case study aimed to trace the origin of CPPA ST357, which caused a hospital-acquired pneumonia in a repatriated critically ill patient suffering from Guillain-Barré Syndrome in 2023.
METHODS: Antimicrobial susceptibility of the CPPA isolate for 30 single and combination therapies was determined by disk-diffusion, Etest or broth microdilution. Whole-genome sequencing was performed for three case CPPA isolates (one patient and two sinks) and four distinct CPPA ST357 patient isolates received in the Dutch CPPA surveillance program. Furthermore, 193 international P. aeruginosa ST357 assemblies were collected via three genome repositories and analyzed using whole-genome multi-locus sequence typing in combination with antimicrobial resistance gene (ARG) characterization.
RESULTS: A Dutch patient who carried NDM-1-producing CPPA was transferred from Kenya to the Netherlands, with subsequent dissemination of CPPA isolates to the local sinks within a month after admission. The CPPA case isolates presented an extensively drug-resistant phenotype, with susceptibility only for colistin and cefiderocol-fosfomycin. Phylogenetic analysis showed considerable variation in allelic distances (mean = 150, max = 527 alleles) among the ST357 isolates from Asia (n = 92), Europe (n = 58), Africa (n = 21), America (n = 16), Oceania (n = 2) and unregistered regions (n = 4). However, the case isolates (n = 3) and additional Dutch patient surveillance program isolates (n = 2) were located in a sub-clade of isolates from Kenya (n = 17; varying 15-49 alleles), the United States (n = 7; 21-115 alleles) and other countries (n = 6; 14-121 alleles). This was consistent with previous hospitalization in Kenya of 2/3 Dutch patients. Additionally, over half of the isolates (20/35) in this sub-clade presented an identical resistome with 9/17 Kenyan, 5/5 Dutch, 4/7 United States and 2/6 other countries, which were characterized by the blaNDM-1, aph(3\')-VI, ARR-3 and cmlA1 ARGs.
CONCLUSIONS: This study presents an extensively-drug resistant subclone of NDM-producing P. aeruginosa ST357 with a unique resistome which was introduced to the Netherlands via repatriation of critically ill patients from Kenya. Therefore, the monitoring of repatriated patients for CPPA in conjunction with vigilance for the risk of environmental contamination is advisable to detect and prevent further dissemination.

BACKGROUND: International medical trainees, including residents and fellows, must cope with many challenges, such as differences in cultural hierarchical systems, languages, and acceptance. Nonetheless, the need for adjustment perpetuates even after training is completed abroad. When some international trainees return to their countries of origin, they continue to face adjustment challenges due to reverse culture shock. Others must make many further readjustments. This study presents an exploration of the adjustment and coping strategies of international medical learners after returning to their countries of origin upon completion of their programs.
METHODS: This study employed a qualitative approach grounded in interpretivism and utilised inductive thematic analysis following Braun and Clarke\'s method. Semi-structured, in-depth individual interviews were employed to explore the participants\' coping strategies. Participants included international medical learners who were (1) international medical graduates who had already returned to their countries of origin, (2) non-Canadian citizens or nonpermanent residents by the start of the programs, and (3) previously enrolled in a residency or fellowship training programme at the University of Toronto, Ontario, Canada.
RESULTS: Seventeen participants were included. Three main themes and seven subthemes were created from the analysis and are represented by the Ice Skater Landing Model. According to this model, there are three main forces in coping processes upon returning home: driving, stabilising, and situational forces. The sum and interaction of these forces impact the readjustment process.
CONCLUSIONS: International medical learners who have trained abroad and returned to their countries of origin often struggle with readjustment. An equilibrium between the driving and stabilising forces is crucial for a smooth transition. The findings of this study can help stakeholders better understand coping processes. As healthy coping processes are related to job satisfaction and retention, efforts to support and shorten repatriation adjustment are worthwhile.

This rapid review used a systematic approach to examine the available literature on rehabilitation and reintegration (R&R) programs for women and children returning from contexts of violent extremism, examining common assumptions, inputs, activities and outcomes across diverse settings. Fifty-one documents including peer reviewed articles and grey literature were included in the analysis. The most common program activities identified included mental health services, community level social programs, promoting school and vocational enrollment, regular health services, and parenting training & education, though there was a lack of consensus around core program components. The analysis points to the need for a robust set of inputs and resources to implement R&R programs including government officials, child welfare, mental health professionals, teachers, law enforcement, healthcare, community leaders, and extended family. The review also uncovered a number of gaps. This includes the need to create clear and analytically distinct definitions of rehabilitation and reintegration that are applicable and relevant to key stakeholders, delineating age-appropriate activities and outcomes for young children, youth, and adults, defining frameworks for service delivery and coordination of stakeholders, and placing R&R programs within existing domains of public safety and restorative justice.

Women and children returning from areas formerly controlled by the Islamic State typically have experienced high levels of trauma and indoctrination, further complicating politically fraught efforts at reintegration and resettlement. Consequently, countries around the world are grappling with how best to manage the return of these women and children. To help better understand which types of programming can contribute to the successful, non-violent reintegration of these individuals, we incorporated ideas from existing Repatriation and Rehabilitation (R&R) literature, field practitioners, R&R subject matter experts, and literature from adjacent fields (e.g., refugee resettlement, criminal justice, psychological resilience) into a recommended best practice approach to supporting returning women and children. We propose a shift from \"R&R\" programming to what we call the \"5R\" framework: Repatriation/ Resettlement, Reintegration, Rehabilitation, and Resilience. This shift provides conceptual clarity related to how different program elements target proximal goals (e.g., wellbeing and personal safety, belonging and opportunity, non-violence, and dignity), and how programming can shift from more centrally- and government-held services to informal and community-based supports.

This paper probes how temporality is integral to the health examination regime that aims to protect citizens from infectious diseases in Taiwan. The paper finds that migrant workers in less-skilled occupations are examined more frequently than foreign professionals. Analyzing such differentiation, this paper argues that a hierarchy of sanitization is built on and increases the inequality between them and perpetuates instability in migrant workers\' circumstances. Applying a temporal approach to the study of health examination opens new inroads into our understanding of how a \"migration state\" achieves the exclusion of migrant workers by making them outsiders subject to permanent intrusion into their bodies.

This study analyzes the interplay of factors which drive states\' approaches to the repatriation and reintegration of Foreign Terrorist Fighters (FTFs) and their family members. The literature is dominated by descriptive studies of state policies that tend to explain states\' failure to repatriate and reintegrate citizens as the result of deference to governments\' national security decisions. Our study builds on these foundations to offer the scholarly and policy fields both a framework to explain why governments adopt distinct policy postures, and a means to enable these same actors to engage in more systematic analysis and development of repatriation and reintegration policy. This study argues that a balance of four considerations are crucial for explaining state behavior in this policy context: (i.) the scope of the issue, including the number of citizens considered FTFs or affiliated persons, geographic proximity, and access to the conflict, (ii.) existing legal basis for repatriation and reintegration, (iii.) instrumentalization for institution building, and (iv.) programming strategy for repatriation and reintegration. As a pilot study, this paper applies the framework to assess cases of the United States, the Netherlands, Kosovo, and Iraq. As FTF management issues are not a relic of the recent past but a persistent policy concern that warrants more nuanced and forward-looking attention, this study also considers the continued application of the framework to explore the different ways in which states may balance these four considerations in policy design and practice in the future.

The fear of the malingering soldier or veteran has existed in Australia since its first nationwide military venture in South Africa. The establishment of the Repatriation Department in 1917 saw the medical, military and political fields work collectively, to some extent, to support hundreds of thousands of men who returned from their military service wounded or ill. Over the next decades the medical profession occasionally criticised the Repatriation Department\'s alleged laxness towards soldier recipients of military pensions, particularly those with less visible war-related psychiatric conditions. In 1963 this reached a crescendo when a group of Australian doctors drew battle lines in the correspondence pages of the Medical Journal of Australia, accusing the Repatriation Department of directing a \'national scandal\', and provoking responses by both the Minister for Repatriation and the Chairman of the War Pensions Assessment Appeal Tribunal. Although this controversy and its aftermath does allow for closer investigation of the inner workings of the Repatriation Department, the words of the doctors themselves about \'phony cronies\', \'deadbeats\' and \'drongoes\' also reveal how the medical fear of the malingering soldier, and particularly the traumatised soldier-malingerer, lingered into the early 1960s and beyond. This paper will analyse the medical conceptualisation of the traumatised soldier in the 1960s in relation to historical conceptions of malingering, the increasingly tenuous position of psychiatry, as well as the socio-medical \'sick role\', and will explore possible links with the current soldier and veteran suicide crisis in Australia.

This study examines the practice of indigenous conflict resolution mechanisms in building a culture of peace in Bale zones, Oromia National Regional State, Ethiopia. For the purposes of this study, qualitative research approaches accompanied by key informant interviews and focus group discussions have been employed. About 114 participants were participated in this study. The study was took place in 2020/2021. The findings of the study depicted that the causes of conflict in the study areas are dynamic. The study areas peoples used indigenous conflict resolution mechanisms to address dynamic causes of conflicts and build a culture of peace in post-conflict resolution. The study reveals that the efficacy of indigenous conflict resolution mechanisms in addressing complex conflict at grass root level contributed a lot in the process of restoring peace in post-conflict resolution. On the other hand, the finding shows that currently the efficacy of indigenous conflict resolution mechanisms in building a sustainable peace is not as effective as the past. Among the others, looking litigation as the only means to get truth, problems related with elders, brokers, religion, and attitudinal issues are some of obstacles that are deteriorating the effectiveness of indigenous conflict resolution mechanisms in building a culture of peace. The study suggests that there is an urgent comprehensive strategy to restore the effectiveness of indigenous conflict resolution mechanisms and cooperatively safeguarding them from deterioration and transfer to future generation with its nature, principles, norms, procedures, and implementation mechanisms.

In the midst of recent protests and antiracism movements following the death of George Floyd in May of 2020 and other Black, Indigenous, and people of Color (BIPOC) murdered in the United States by police violence, protestors and advocates around the world recognized the need for Western governments and other institutions to reckon with their own imperial history-to acknowledge the linkage between the slave trade, colonialism, and racism in their countries. This recognition led to the tearing down of statues depicting racist colonial leaders and calling for museums who have perpetuated imperialism and racism through their acceptance and display of looted artifacts to return them. This article sought to answer the question posed in the call for papers, can the many manifestations of racism be effectively dealt with in our society if the status quo is unwilling to engage with the issues, address them, and relinquish power. Further the author argues that cultural looting has its roots in colonialism and racism and discusses implications of the linkage between one\'s stolen cultural heritage and individual and community well-being. Answers to the question include both yes, manifestations of racism can be addressed, and no, they cannot be addressed when institutions and governments refuse to engage, address the issue and do not relinquish power. The article also includes the author\'s thoughts on using a living heritage approach to preserve cultural heritage and offers suggestions that community psychologists, advocates and activists can help to decolonize museums as part of the broader social and racial justice movement.

In case of illness or injury of ship crew member during entire stay on board of the ship and until the end of repatriation, the shipowner is responsible for paying wages in full size and pays all expenses on medical care and arrival at final destination. Due to effect of external and internal factors, mental health of crew members became one of actual modern problems. The article considers main provisions of labor and collective agreement of crew member, determines responsibilities of shipowner for organizing repatriation and appropriate actions when its terms are increased, identifies problematic aspects of disorders of mental health of seaman on board the ship and substantiates possible solutions of modern problems.
При болезни или травме члена экипажа судна в течение всего времени пребывания на борту судна и до срока окончания репатриации судовладелец несет ответственность за выплату заработной платы в полном размере, а также оплачивает все расходы по предоставлению медицинской помощи и прибытию в конечное место назначения. Вследствие влияния внешних и внутренних факторов состояние психического здоровья членов экипажа стало одной из актуальных современных проблем. В статье рассмотрены основные положения трудового и коллективного договора члена экипажа, определены обязанности судовладельца по организации репатриации и соответствующие действия при увеличении ее сроков, выявлены проблемные аспекты нарушения психического здоровья моряка на борту судна, а также обоснованы возможные пути решения современных проблем.