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To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults.
Design:
Pre-post quasi-experimental study.
Setting:
Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers.
Patients:
Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023.
Methods:
A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods.
Results:
The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC/DOT by 16.1%. No significant differences were observed in Clostridioides difficile infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups.
Conclusions:
A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.
Quarries are information-rich anthropic landscapes, but their unique characteristics often limit the effectiveness of traditional archaeological documentation strategies. Here, the authors present a novel interdisciplinary method for the documentation and analysis of these landscapes, focusing on two ancient marble quarries on the Mediterranean island of Naxos. The workflow, combining lidar, photogrammetry, sculptural and architectural study, geoscience, ecological study and archaeological survey, provides a means for the systematic documentation of quarry landscapes in the Mediterranean and beyond, and aims to promote an understanding of premodern extractive activities not as isolated occurrences but as important aspects of interconnected, evolving landscapes.
An I.R.B. supreme council member and the I.R.A. 2nd Northern Division commandant, Charlie Daly was executed at Drumboe on 14 March 1923. Daly’s case shows how, through I.R.B. auspices, Free State G.H.Q. planned a joint northern offensive with republicans to avert civil war, while deploying the resources of the new state (and false promises) to engineer the support or at least neutrality of the Northern I.R.A. Eoin O’Duffy and Richard Mulcahy connived to remove Daly from his command because of his opposition to the Treaty, with events coming to a head at the ‘Beggar’s Bush inquiry’ on 2 March 1922. In due course, the Free State elite killed every senior republican brother party to the northern intrigue, including Joe McKelvey and Daly, the latter of whom was shot alongside Seán Larkin from Derry — a witness to GHQ ‘crookedness’ the previous March.
We identify a parsimonious set of factors from a large pool of candidates for explaining hedge fund returns, ranging from equity market, anomaly, and trend-following factors to macroeconomic factors. The resulting 9-factor model, including five anomaly factors, outperforms existing hedge fund models both in sample and out of sample, with a significant reduction in alphas while showing substantial cross sectional performance heterogeneity. Further analysis based on fund holdings confirms the model’s ability to capture returns from arbitrage trading. Overall, the anomaly factors help quantify hedge fund strategies and risk exposures and improve fund performance evaluation.
The Parsi Sanskrit Yasna, attributed to Nēryōsangh, presupposes a sophisticated philological system that features historical, religious, and cultural elements. This philological system, developed in a multicultural environment, reflects both the Zoroastrian tradition and contemporary Indian society. Centuries later, Eugène Burnouf effectively utilised the same system to make significant advances in comparative Indo-Iranian studies. This article examines Burnouf’s philological approach and his rediscovery and revival of the original philological system of the Sanskrit Yasna, thanks to a multilingual and multicultural scope that allowed him to understand the text and draw important comparative patterns from it. The article emphasises the importance of multidisciplinary studies to fully explore the historical implications of the philological system, urging us to revisit its methodology in light of current knowledge and technology.
Joseph Raz’s service conception of legitimacy says citizens must obey the state when its directives allow them to comply with reason better than they would by deciding independently. Yet citizens’ capacity to decide for themselves is endogenous to state authority: the more they defer, the less competent they might become. Consequently, a state might secure its legitimacy through a self-fulfilling dynamic whereby citizens need state authority only because they have grown dependent upon it. This article diagnoses the problem and explains how the service conception can guard against it. Besides Raz's account, its argument applies to any theory of legitimacy with a “service” component.
Mass dispersion in oscillatory flows is closely tied to various environmental and biological processes, differing markedly from dispersion in steady flows due to the periodic expansion and contraction of particle patches. In this study, we investigate the Taylor–Aris dispersion of active particles in laminar oscillatory flows between parallel plates. Two complementary approaches are employed: a two-time-variable expansion of the Smoluchowski equation is used to facilitate Aris’ method of moments for the pre-asymptotic dispersion, while the generalised Taylor dispersion theory is extended to capture phase-dependent periodic drift and dispersivity in the long-time asymptotic limit. Applying both frameworks, we find that spherical non-gyrotactic swimmers can exhibit greater or lesser diffusivity than passive solutes in purely oscillatory flows, depending on the oscillation frequency. This behaviour arises primarily from the disruption of cross-streamline migration governed by Jeffery orbits. When a steady component is superimposed, oscillation induces a non-monotonic dual effect on diffusivity. We further examine two well-studied shear-related accumulation mechanisms, arising from gyrotaxis and elongation. Although these accumulation effects are less pronounced than in steady flows due to flow unsteadiness, gyrotactic swimmers respond more strongly to the unsteady shear profile, significantly modifying their drift and dispersivity. This work offers new insights into the dispersion of active particles in oscillatory flows, and also provides a foundation for studying periodic active dispersion beyond the oscillatory flow, such as periodic variations in shape and swimming speed.
After World War II, many countries, including Nigeria, embraced Keynesian “welfarist” policies to stimulate economic growth and enhance the well-being of their citizens. However, in the late 1960s and early 1970s, a global economic crisis prompted a shift towards neoliberalism, leading to the commodification of social institutions and the implementation of policies such as privatization, trade liberalization and deregulation in Nigeria. This shift had a significant impact on Nigeria’s socio-legal economy, particularly in terms of property rights in company ownership. The article raises concerns about the structural injustice and growing inequality resulting from these neoliberal policies. It advocates for a legal framework that addresses these issues and proposes reconceptualizing private property rights in company ownership in Nigeria. This proposed framework aims to counter the dominance and power of property-owning elites and mitigate the structural injustice induced by neoliberal policies in Nigeria.
During the early twentieth century, Catalonia experienced a period of great cultural and musical development through the Noucentisme movement, which aimed to elevate its national culture to a symbol of high art. The xeremies (shawms) of the cobla ensemble, which played the sardana genre, were integrated into symphonic and chamber repertoire. This required the technical improvement of the tible (treble) and tenora (tenor) xeremies, but also encouraged the invention of new instruments in the shawm family. The barítona (baritone shawm) was premiered in 1930 by the Banda Municipal de Barcelona and represents a milestone in Catalan music in the tumultuous period before the Spanish Civil War.
Child maltreatment increases the risk of emotional and behavioral problems, yet many children demonstrate resilience, functioning better than expected given their level of maltreatment exposure. Although resilience is a dynamic process shaped by children’s social support, including friendships, how different patterns of resilience and friendship support unfold together across development remains unclear. To better understand this process, we examined how patterns of emotional resilience, behavioral resilience, and friendship support co-develop across childhood and adolescence. We used group-based multi-trajectory modeling with data from the Avon Longitudinal Study of Parents and Children (N = 6, 518, 51% female) to identify distinct patterns of emotional and behavioral resilience (doing better-than-expected given their level of maltreatment exposure) and friendship support, across five timepoints from ages 6 to 17 years. We identified five trajectory groups. Nearly half the sample maintained high emotional and behavioral resilience and friendship support across development. While resilience trajectories varied, friendship support was generally high across groups. Most children followed trajectories of high resilience and perceived friendship support. Even among children with lower emotional and/or behavioral resilience trajectories, friendship support remained high, an encouraging finding. Future research should examine how children’s other relationships (e.g., with parents and siblings) unfold alongside resilience.
The main objective of this study was to analyse the changes of taxonomic, functional and phylogenetic diversities shown by bird assemblages at two contrasting vegetational types in Southern Mexico. Our main hypothesis was that we would find a higher diversity in Tropical Dry Forest (TDF) than in Oak Woodland (OW) due to a monotonic decrease in diversity with altitude. During eleven months, we surveyed both vegetation types to record bird species and abundances. We established points and simultaneously carried out 5-minutes count and soundscape recordings. We quantified our sampling effort by means of the sample coverage and calculated Hill numbers to express alpha and beta diversities. Contrary to our expectations, in terms of alpha taxonomic and functional diversities, the OW had consistently higher values than the TDF. After accounting for abundance data, we found a marked decrease in phylogenetic and taxonomic beta diversity, but an increase in functional diversity compared to the presence/absence matrix. The low beta phylogenetic diversity combined with the high beta functional diversity suggests that a small set of closely related species could have evolved in the dry slopes of the area, and by the action of niche differentiation developed different functional traits. The high functional beta diversity indicates a high complementarity between the avifaunas of each vegetation type, which is relevant in terms of conservation.
Unilateral absence of the pulmonary artery is a rare congenital defect requiring advanced imaging for diagnosis. We present two cases with a connection between a patent ductus arteriosus remnant and the left pulmonary artery. Therapeutic approaches, including imaging findings and management strategies, are discussed to highlight diagnostic and treatment considerations.
Flutter in lightweight airfoils under unsteady flows presents a critical challenge in aeroelastic stability and control. This study uncovers phase-dependent effects that drive the onset and suppression of flutter in a freely pitching airfoil at low Reynolds number. By introducing targeted impulsive stiffness perturbations, we identify critical phases that trigger instability. Using phase-sensitivity functions, energy-transfer metrics and dynamic mode decomposition, we show that flutter arises from phase lock-on between structural and fluid modes. Leveraging this insight, we design an energy-optimal, phase-based control strategy that applies transient heaving motions to disrupt synchronisation and arrest unstable growth. This minimal, time-localised control suppresses subharmonic amplification and restores stable periodic motion.
Balloon-expandable MyVal OCTACOR valves were evaluated in 3D-printed conduits under simulated flow. The 20 mm valve functioned from 16–24 mm, rupturing at 27 mm. The 29 mm expanded to 33 mm with mild insufficiency. Findings suggest OCTACOR valves may support repeated valve-in-valve procedures, with the 20 mm showing greater versatility for small-infant mitral replacements and as a potential alternative to Melody valves.
This study evaluated the effects of replacing ground corn with cassava root silage (CRS) in the supplement of grazing dairy cows on production yield, physicochemical characteristics, sensory attributes, and profitability of Minas Frescal cheese. Ten primiparous Girolando cows, with a mean weight of 373.45 ± 63.55 kg, a mean milk production of 12.48 ± 1.58 kg/d, and 76 days of lactation, were distributed into two 5 × 5 Latin squares. The animals were placed in the following five treatments: I, grazing without supplementation (WOS); II to V, grazing receiving 5 kg of dry matter (DM) of supplement without CRS (0 g/kg DM CRS) and with 260, 520 and 780 g/kg DM of CRS. Inclusion level of CRS did not affect (P > 0.067) physicochemical characteristics, sensory attributes, and production yield of cheese. However, cheese produced from supplemented animals had greater levels of protein (P = 0.025) and individual cheese production (kg of cheese/animal/day; P < 0.001) compared to WOS animals. Finally, the inclusion of CRS at up to 520 g/kg DM maximized cheese production by 0.73 kg of cheese/animal/day and gross revenue by 3.49 US$/animal/day, compared to WOS animals. In conclusion, replacement of ground corn with CRS in the supplement of dairy cows did not impact physicochemical characteristics and sensory attributes of Minas Frescal cheese. In addition, inclusion of CRS at up to 520 g/kg DM replacing ground corn in the supplement may be a suitable strategy for enhancing the profitability of Minas Frescal cheese production.