The global spread of convergent Klebsiella pneumoniae, which combines multidrug resistance with hypervirulence, poses a major clinical threat, but its environmental dissemination remains poorly understood. Here, we show that wild migratory gulls along the Georgian Black Sea coast harbor clinically important, convergent isolates belonging to internationally dominant clonal lineages. We identify 33 carbapenem-resistant K. pneumoniae, predominantly globally disseminated high-risk clones (ST307 and ST395) carrying the blaNDM-5 carbapenemase gene. Ten isolates represent convergent pathotypes with hypervirulence markers, and four exhibit resistance to the last-resort antibiotic cefiderocol. Long-read sequencing reveals mosaic plasmids that co-encode resistance and virulence determinants. In addition, GPS telemetry shows that these gulls frequently use anthropogenic sites, including wastewater treatment plants and landfills. These findings indicate that migratory birds are carriers of critically resistant pathogens, highlighting the role of human-impacted environments in their broader dissemination across One Health interfaces.
A funnel plot indicates whether result deviations are real or due to chance. Other methods are needed to determine whether deviating results are due to quality deficiencies or other factors. A funnel plot can easily show whether there are performance deviations in individual units or groups of units.
Background: Chest radiography (CXR) is the most common imaging modality used to diagnose pulmonary tuberculosis (PTB). Accurate computer-aided detection (CAD) CXR software may aid physicians in low-resource, high tuberculosis (TB) endemic settings where radiologists are scarce. Methods: A retrospective pilot study comparing the assessment of humans and CAD was conducted on analogue CXRs from Guinea-Bissau and Ethiopia with the objective of comparing the interpretation of CXRs regarding PTB by CAD (qXR, Qure.ai) with that of two experienced Ethiopian radiologists (A and B). To improve the applicability of this method in low-resource settings, an analysis was performed on images of CXRs taken by mobile phones. Two reference standards were applied: final TB diagnosis by clinical or laboratory findings (i.e., GeneXpert (GX)-confirmed TB). Results: We included 498 CXRs. Radiologist A identified 50, radiologist B identified 99, and the software identified 81 as indicative of TB. The overall area under the curve (AUC) for the receiver operating characteristic (ROC) curve of the software was 0.84 for GX-confirmed cases. At the prechosen cut-off value of 0.5, the sensitivity of CAD CXR was 76.5%, and the specificity was 85.9%. Radiologist A’s assessments were 64.7% sensitive and 91.9% specific, while radiologist B´s assessments were 76.5% sensitive and 82.3% specific for GX-confirmed cases. The agreement regarding TB-related findings between the radiologists combined (k=0.45) and each radiologist and the software (k=0.56) was moderate. Conclusion: Our study revealed that CAD CXR performs comparably to experienced radiologists in diagnosing TB even when it is applied to analogue CXRs photographed by mobile phones. Trial registration: PACTR201611001838365
This article examines the potential implications of the implementation of artificial intelligence (AI) in health care for both its delivery and the medical profession. To this end, the first section explores the basic features of AI and the yet theoretical concept of autonomous AI followed by an overview of current and developing AI applications. Against this background, the second section discusses the transforming roles of physicians and changes in the patient-physician relationship that could be a consequence of gradual expansion of AI in health care. Subsequently, an examination of the responsibilities physicians should assume in this process is explored. The third section describes conceivable practical and ethical challenges that implementation of a single all-encompassing AI healthcare system would pose. The fourth section presents arguments for regulation of AI in health care to ensure that these applications do not violate basic ethical principles and that human control of AI will be preserved in the future. In the final section, fundamental components of a moral framework from which such regulation may be derived are brought forward, and some possible strategies for building a moral framework are discussed.
Situating Sustainability reframes our understanding of sustainability through related concepts, practices, and case studies. The point of departure is the continual need to be conscious of how environmental knowledge and sustainability are issues constituted by long-standing inequalities. This book addresses the necessity in sustainability science to recognize how diverse cultural histories define environmental politics today. The differing geographic scope of this volume is joined by the disciplinary diversity of the contributors and their wide-ranging areas of specialization, bringing together researchers from cultural studies, anthropology, literature, law, behavioral science, urban studies, design, and development. As a truly transdisciplinary work, Situating Sustainability calls for research guided by the humanities and social sciences in collaboration with local actors informed by histories of place. The authors of this volume believe that situating sustainability cannot limit itself to the geographic borders of nations, epistemic standpoints, or to unmasking perspectives that falsely present themselves as objective or universal. The approach includes not only material practices like extraction or disaster recovery, but extends into the domains of human rights, education, and academic interdisciplinarity. Researchers are joined by artists whose work provides a platform to conduct research at the edges of performance, knowledge production, and critical commentary on socio-ecological infrastructures. All this will enable readers to better understand what sustainability means (or might yet mean) in their own locations, and how work in one place might support the efforts of others in other places. Designed for students, scholars, and interested readers, Situating Sustainability introduces the conceptual practices that inform the leading edge of engaged research in sustainability.
