Background: Various studies have linked periods of warmer temperatures to an increased occurrence of surgical site infections (SSIs) and healthcare-associated infections in general. In an observational study, we sought to determine the pathogens for which this association was especially strong. Method: Patient- and procedure-related data of the SSI-module of the German nosocomial infection surveillance system were linked with monthly aggregated meteorological data from the German Meteorological Service for a period from 2000 to 2016. Due to high correlation with other meteorological parameters, analyses were executed focusing on the outside ambient temperature. Temperature was regarded as both a continuous variable and a categorical variable with different temperature intervals (5°C steps ranging from <5°C to ≥20°C). Through multivariable logistic regression analysis, adjusted odds ratios (OR) with 95% confidence intervals were calculated for SSI rates relating to temperature. SSIs were stratified by pathogen and depth of infiltration. Result: Altogether, 2,004,793 procedures, conducted in 1,455 German surgical departments and resulting in 32,118 SSIs, were included. A general association of warmer mean temperatures in the month of surgery with an increased SSI-risk was observed, particularly for SSIs caused by gram-negative pathogens. Stratification by pathogen revealed that the association was especially prominent for Acinetobacter spp, Pseudomonas aeruginosa, and certain Enterobacteriaceae. Per additional 1°C, we observed a 6% increase in the risk for SSIs caused by Acinetobacter spp (OR, 1.06; 95% CI, 1.04–1.09), and a 4% increase in the risk for SSIs caused by Enterobacter spp (OR, 1.04; 95% CI, 1.03–1.05). Among gram-positive pathogens, temperature-association was strongest for Staphylococcus aureus. Superficial SSIs showed a higher temperature-association than deeper SSIs. The risk for superficial SSIs with Acinetobacter spp significantly increased >10-fold after surgeries conducted in months with a mean temperature of ≥20°C in reference to <5°C. For Pseudomonas aeruginosa, we observed a >2-fold statistically significant increase in the risk for superficial SSIs, when comparing the same temperature categories (≥20°C vs <5°C). Conclusions: Our study demonstrated that higher temperatures were associated with increased SSI-rates caused by gram-negative bacteria. As a consequence, future SSI-prevention measures should place a higher emphasis on the parameter season as part of a more tailormade, personalized approach at infection prevention. For instance, it may be conceivable to seasonally adjust decolonizing regimes and certain prophylaxes. Underlying shifts in microbiome composition due to meteorological factors should be considered in further analyses. Given the expected rise of global temperatures until the end of the century, the topic gains relevance from multiple perspectives.

Funding: None

Disclosures: None

The use of decision-making capacity assessments (DMCA) in clinical medicine is an underdeveloped yet quickly growing practice. Despite the ethical and clinical importance of these assessments as a means of protecting patient autonomy, clinicians, philosophers, and ethicists have identified a number of practical and theoretical hurdles which remain unresolved. One ethically important yet largely unaddressed issue is whether, and to what extent physicians ought to inform and obtain consent from patients prior to initiating a capacity assessment. In what follows, I address the following question: Must, or should, physicians obtain consent for capacity assessments? I argue that physicians have an ethical obligation to obtain express patient consent for capacity assessments, and in doing so, I challenge the predominant view which requires physicians to merely inform patients without obtaining consent. I then identify an underlying philosophical paradox that complicates the clinician's duty to obtain consent: in short, consent is needed for an assessment of one's ability to consent. Finally, I recommend a practical solution to this paradox of consent for capacity assessments by proposing a model of double consent from both the patient and health care representative.

This article focuses on how people who formerly worked as bonded labourers adapt to the new realities of an insecure capitalist labour market. It examines how the past shapes the uncertain labour situation of the present, including resistance. The article reflects on the current experiences of precarious labour at industrial sites in western Nepal. It describes how former bonded labourers and their descendants have begun working as contract workers in a modern industrial food-processing factory, with the help of contractors related to them by kin. The article further shows that one of the defining features of their new life as contract labourers is its chronic precariousness. Undisguised forms of confrontation, such as open disregard for management instructions, are also part of their new reality in the labour market. Contract labourers are often strongly assertive in the face of managerial authority, and this assertiveness has been shaped largely by either past experiences or memories of bonded labour. The article contributes to debates about bonded labour and its transformations in South Asia. It also offers a reflection on the limited impact of the Nepali Maoist Revolution on precarious labour and on the ethnic dimensions of this segment of Nepali society. Finally, it contributes to discussions about industrialization and Adivasi communities in South Asia and beyond.

In her article ‘Connecting the past and the present’, Meike Pentrel examines the order of main clause and adverbial clause introduced by before or after in Samuel Pepys's diary from the point of view of the cognitive literature on processing constraints. The thread that is shared by all contributions of this special issue is that of the hypothesis of uniformitarianism, which states that cognitive processes have remained constant in the documented history of humanity. Pentrel aims at corroborating this hypothesis by testing if the processing constraints found at work in this seventeenth-century ego-document examined by her are similar to those that have been observed in contemporary language.

This article combines methodologies from corpus linguistics with an experimental-like setup more affiliated to psycholinguistic research. The resulting methodology allows us to gain more insight into cognitive motivations of language use in speakers from the past, and consequently to better assess their similarity to present-day speakers (the Uniformitarian Principle). One such cognitive motivation thought to be relevant in the early stages of grammatical constructionalization (grammaticalization) is covered by the evasive concept of ‘extravagance’ (i.e. the desire to talk in such a way that one is noticed). The methodology is tested on the Early Modern English extension of the [be Ving]-construction to progressive uses in present-tense main clauses. It is argued, on the basis of recurrent contextual clues, that [be Ving] in this novel use is motivated by extravagance. Interestingly, a comparison of two speaker/writer generations that are among the earliest to use this innovation with some frequency suggests that the encoding of extravagance shifted between them. At first, extravagance was signalled by coercion of the still stative semantics of [be Ving] into a progressive reading. In the second generation it had become an entrenched characteristic of the construction itself.

Ernietta plateauensis Pflug, 1966 is the type species of the Erniettomorpha, an extinct clade of Ediacaran life. It was likely a gregarious, partially infaunal organism. Despite its ecological and taxonomic significance, there has not been an in-depth systematic description in the literature since the original description fell out of use. A newly discovered field site on Farm Aar in southern Namibia has yielded dozens of specimens buried in original life position. Mudstone and sandstone features associated with the fossils indicate that organisms were buried while still exposed to the water column rather than deposited in a flow event. Ernietta plateauensis was a sac-shaped erniettomorph with a body wall constructed from a double layer of tubes. It possessed an equatorial seam lying perpendicular to the tubes. The body is asymmetrical on either side of this seam. The tubes change direction along the body length and appear to be constricted together in the dorsal part of the organism.