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This is a continuation of the paper [J. Symb. Log. 87 (2022), 1065–1092]. For an ideal $\mathcal {I}$ on $\omega $ we denote $\mathcal {D}_{\mathcal {I}}=\{f\in \omega ^{\omega }: f^{-1}[\{n\}]\in \mathcal {I} \text { for every } n\in \omega \}$ and write $f\leq _{\mathcal {I}} g$ if $\{n\in \omega :f(n)>g(n)\}\in \mathcal {I}$, where $f,g\in \omega ^{\omega }$.
We study the cardinal numbers $\mathfrak {b}(\geq _{\mathcal {I}}\cap (\mathcal {D}_{\mathcal {I}} \times \mathcal {D}_{\mathcal {I}}))$ describing the smallest sizes of subsets of $\mathcal {D}_{\mathcal {I}}$ that are unbounded from below with respect to $\leq _{\mathcal {I}}$.
In particular, we examine the relationships of $\mathfrak {b}(\geq _{\mathcal {I}}\cap (\mathcal {D}_{\mathcal {I}} \times \mathcal {D}_{\mathcal {I}}))$ with the dominating number $\mathfrak {d}$. We show that, consistently, $\mathfrak {b}(\geq _{\mathcal {I}}\cap (\mathcal {D}_{\mathcal {I}} \times \mathcal {D}_{\mathcal {I}}))>\mathfrak {d}$ for some ideal $\mathcal {I}$, however $\mathfrak {b}(\geq _{\mathcal {I}}\cap (\mathcal {D}_{\mathcal {I}} \times \mathcal {D}_{\mathcal {I}}))\leq \mathfrak {d}$ for all analytic ideals $\mathcal {I}$. Moreover, we give example of a Borel ideal with $\mathfrak {b}(\geq _{\mathcal {I}}\cap (\mathcal {D}_{\mathcal {I}} \times \mathcal {D}_{\mathcal {I}}))=\operatorname {\mathrm {add}}(\mathcal {M})$.
More than 50% of patients with dementia visit the emergency department (ED) each year. Patients with dementia experience frequently unrelieved symptoms that can benefit from palliative care. Response to palliative care needs in the ED can be quite challenging and access to palliative care is generally scarce. The aim of this scoping review is to assess ED use and responsiveness to palliative care needs of patients with dementia in their last year of life.
Methods
A scoping literature review following the Joanna Briggs Institute methodology. Electronic search of the literature was undertaken in Medline (PubMed), Web of Science, Scopus, Scielo, and APA PsycInfo, last updated on 19 February 2024.
Results
Twenty-four studies were identified and confirmed that patients with dementia frequently resort to the ED near the end of life, frequently more than once in their last year of life. Eight studies directly addressed palliative care needs, suggesting significant rates of palliative care needs among patients with dementia and in comparison, to other oncological or non-oncological conditions. Infections and neuropsychiatric symptoms were the main reasons of admission to the ED. Access to palliative care was confirmed to be low.
Significance of results
This scoping review indicates that patients with dementia frequently resource to the ED in their last year of life with unmet palliative care needs. Although scarce access to palliative care and the existence of important barriers in the ED, palliative care intervention in this setting can be seen as an opportunity to attend palliative care needs and referral to palliative care services.
This study evaluates the implementation of a blood culture (BCx) algorithm in the neurology ICU (NICU) to reduce BCx event (BCE) rates. Results show a reduction in BCE rates, without increasing adverse outcomes. The findings support the feasibility of BCx algorithms for improving diagnostic stewardship in the specialized NICU population.
Age estimates from bomb 14C dating conflict with a well-recognized age reading protocol (grinding, polishing and staining in the sagittal plane) for otoliths of European eel (Anguilla anguilla). Proper alignment of calculated hatch years for 14C measurements taken from the earliest otolith growth—among the smallest otolith extractions to date for successful 14C analysis due to the advent of gas-AMS—was not achieved using age estimates from an accepted method. The realignment of otolith 14C values to a tropical bomb 14C reference chronology, which is most applicable to the Sargasso Sea as the natal origin of European eel, led to an increase of the original age estimates by 8 to 32 years. A maximum age of approximately 46 years was determined for the European eel specimen with the most massive otolith, of which mass is a reasonable proxy for age and was instrumental in identifying age estimate discrepancies. By extending the otolith mass-to-age relationships from this study to the most massive otoliths available from archived otoliths of Norway, an increase of up to several decades from the original otolith age estimates was discovered, leading to support for a potential lifespan of 70–100 years in the natural environment.
Subject-Sensitive Invariantism (SSI) and Epistemic Contextualism (EC) are rival theories in epistemology. Both involve shifting epistemic standards, but they differ in how they explain this shiftiness. SSI is primarily a metaphysical thesis about the knowledge relation, whereas EC is primarily a semantic thesis about knowledge attributions. This paper revisits some of the central problems faced by SSI, especially those concerning Dutch books and third-person knowledge ascriptions. The main aim is to show that existing responses that stay true to SSI do not succeed, leaving SSI in serious jeopardy. Some strategies put forward by, or on behalf of, SSI-friendly philosophers fare better. But these involve forsaking central features of SSI, ceding ground to EC, and falling back on a defense of impurism. I sketch what such an impurist fallback position might look like and argue that the more ground it cedes to EC, the more attractive it will be. It is shown that such an impurist, contextualist position can handle all the difficulties I discuss in relation to SSI. The paper concludes by briefly considering what new challenges this kind of position faces instead.
Given a unital $C^*$-algebra and a faithful trace, we prove that the topology on the associated density space induced by the $C^*$-norm is finer than the Bures metric topology. We also provide an example when this containment is strict. Next, we provide a metric on the density space induced by a quantum metric in the sense of Rieffel and prove that the induced topology is the same as the topology induced by the Bures metric and $C^*$-norm when the $C^*$-algebra is assumed to be finite dimensional. Finally, we provide an example where the Bures metric and induced quantum metric are not metric equivalent. Thus, we provide a bridge between these aspects of quantum information theory and noncommutative metric geometry.
The overuse and inappropriate use of antimicrobials have led to environmental waste and drug shortages. This challenges the ecological and economical sustainability of our healthcare system and worsens antimicrobial resistance.
Antimicrobial stewardship programs (ASP) commonly consider the cost of drug acquisition but may be failing to recognize the hidden costs of multi-dose intravenous regimens including additional nursing administration time, tubing and fluids, and potentially increased hospital length of stay. They also rarely consider the environmental impact of medical waste creation and disposal, which contributes to the global antimicrobial resistance crisis. These costs are harder to calculate but crucial to a comprehensive assessment of a medication’s total impact. In this invited commentary, we provide an example of a stewardship evaluation at our institution focused on changing from meropenem (MER) to ertapenem (ETP) for infections caused by extended-spectrum beta-lactamase producing organisms. We found that despite an increase in acquisition costs, changing from MER to ETP is associated with overall savings and decreased waste production. A secondary analysis suggests that stay length may also be improved with this substitution.
We present a holistic approach to antimicrobial stewardship that considers the total cost of an antimicrobial. By broadening their view to include hidden costs and secondary effects, ASPs can further demonstrate their value to the healthcare system, reduce resistance, and improve their environmental impact.
Epistemic trust in others frequently cannot be disentangled from interpersonal trust more generally, but the epistemic implications of how we affectively express our trust in others are under-investigated. This essay claims that gratitude, despite its empirically undeniable importance to human flourishing generally, is also important epistemically and in several intersecting ways. To be grateful to a person is to represent the world differently in key respects. Gratitude, even if it is for past non-epistemic benefits, should play an important role in shaping who we epistemically rely on. Gratitude for specifically epistemic benefits is an important way in which we show our attunement to epistemic value and contribute to the incentive structures that make much of our public knowledge and informational ecosystems possible. Likewise, ingratitude is a crippling epistemic vice that renders our dependence on quality sources of information fragile and vulnerable to capture by misinformation.
A defeater is, very broadly, a consideration that reduces or completely takes away justification from a subject’s belief about a certain proposition. According to a widely endorsed view, justifiers and defeaters require evidential support. However, a number of philosophers argue that unjustified beliefs can serve as defeaters as well. Call the former type of defeater an ‘evidential defeater’ and the latter a ‘doxastic defeater’. Doxastic defeaters are highly controversial. First of all, they seem to be flatly incompatible with evidentialism. Moreover and more alarmingly, if we accept that unjustified beliefs can be defeaters, we have to accept that unjustified beliefs can serve as justifiers as well. A further unwelcome implication is that epistemically irresponsible subjects could immunise themselves from defeat by generating their own defeater-defeaters. Problems like these have led philosophers to reject doxastic defeaters altogether. This paper argues that doxastic defeaters are intelligible given a dualistic conception of rationality.
A 69-year-old man had an abnormal intracardiac course of a pacemaker lead. CT angiography demonstrated a window between the right upper pulmonary vein and the superior caval vein. The window was treated with covered stents in the superior caval vein, which was complicated by a chronic pericardial effusion that was treated with a pericardial window 6 months later.
Together Cæsar and Cotton left an immense trove of English state papers on all matters of subjects. While Cæsar spent much of his lifetime as an officer of state, e.g., Master of the Rolls, they both devised innumerable works of great value. For instance, both he and Cotton expounded upon the issue of the post-nati and other arguments made in the conferences on the union with Scotland in Parliament. With their cessation in 1607, Cæsar undertook his most significant follow-up work: “That neither any General Statute nor Nativity only make a Man (whose Parents were Strangers) to be a Natural Subject in any Country.” Later duplicated by Cotton in Titus, F. IV., the intricacies of its two pages remained long-guarded in the private possession of such great men as Lords, Secretaries of State, and Prime Ministers. Only two centuries after Cæsar commenced its work did it come full circle to the British Museum—itself, ironically, formed from the seized library of Cotton. As for legal precedent, it is unique in that its broad historical scope predated the complexities of England's permanent royal colonies in America. During this period, every regnant—except for Charles I and James II—would assent unto major naturalization or alien statutes during their reign, all of which remained common law throughout England, the Empire, and America until, at the least, 1863.
This study focused on exploring the relationship between antimicrobial use indicators, including the modified antibiotic heterogeneity index (mAHI), and the carbapenem susceptibility in Pseudomonas aeruginosa.
Design:
Survey-based observational study conducted across multiple facilities.
Setting:
Public community hospital institutions.
Methods:
This survey was conducted in 15 community hospitals in Japan. Indicators, such as the defined daily doses (DDDs), days of therapy (DOTs), antibiotic heterogeneity index (AHI), and mAHI, were analyzed for P. aeruginosa carbapenem susceptibility using Spearman’s rank correlation. The predictive accuracies of the AHI and mAHI for carbapenem susceptibility were compared using DeLong’s test for the 2 correlated receiver operating characteristic curves.
Results:
No significant correlations were observed between DDDs or DOTs and carbapenem susceptibility. However, a significant correlation was observed between carbapenem susceptibility and the mAHI (r = 0.261, P = .02), which also demonstrated a higher predictive accuracy for high susceptibility rates than that of the AHI (area under the curve: 0.75 vs 0.58, p < .01). The optimal mAHI cutoff value for predicting 90% susceptibility was 0.765, with a sensitivity of 67.7% and specificity of 76.5%.
Conclusions:
The mAHI may be a better predictor of carbapenem susceptibility than other commonly used indicators. This study underscores the utility of the mAHI as an effective indicator of antimicrobial usage patterns for managing carbapenem susceptibility in P. aeruginosa. Incorporating the mAHI into antimicrobial stewardship programs could enhance the effectiveness of antimicrobial interventions across diverse healthcare settings.
Racism is increasingly recognised as a key contributor to poor mental health. However, the existing literature primarily focuses on its effects on adults.
Aim
To identify literature on the association between experiences of racism and mental health in children and young people in the UK.
Method
Inclusion criteria were: (a) peer-reviewed publications containing original data; (b) UK-based research; (c) included examination of associations between mental health and experiences of direct or indirect racism (quantitative or qualitative); (d) inclusion of an assessment of mental health outcomes; (e) participant ages up to and including 18 years of age or (if the range went beyond 18) with a mean age of 17 years or less. Six databases were searched between 2000 and 2022; an initial 11 522 studies were identified with only eight meeting the inclusion criteria.
Results
Five of the identified studies provided quantitative data and three provided qualitative data. The majority of studies (7/8) focused on children and young people aged 10 years and over; only one focused on children under the age of 10 years. Measurements of racism varied among the studies providing quantitative data. Only four studies directly focused on the effects of racism on the mental health of children and young people.
Conclusion
Although the included studies highlighted potential negative impacts of experiences of racism on children and young people in the UK, this review shows the lack of available literature to inform policy and practice. No studies examined the impact of internalised racism, systemic and institutional racism, or intersectionality.
This study presents a simple frequency-dependent regime-switching vector autoregression (VAR) model, where each regime and its associated parameters in the VAR are characterized by their distinct spectral properties. Empirical applications to several key macroeconomic variables reveal clear frequency-dependent switching dynamics, with each regime exhibiting distinctive features regarding spectral properties, volatility, and impulse responses. We compare this model with a conventional regime-switching model (typically studied in the time domain) and highlight several key differences between the two approaches.
North Carolina growers have long struggled to control Italian ryegrass, and recent research has confirmed Italian ryegrass biotypes resistant to nicosulfuron, glyphosate, clethodim, and paraquat. Integrating alternative management strategies is crucial to effectively control such biotypes. The objectives of this study were to evaluate Italian ryegrass control with cover crops and fall-applied residual herbicides and investigate cover crop injury from residual herbicides. This study was conducted during the fall/winter of 2021-22 in Salisbury and fall/winter of 2021-22 and 2022-23 at Clayton, NC. The study was designed as a 3x5 split-plot, where the main plot consisted of three cover crop treatments (no-cover, cereal rye at 80 kg ha-1, and crimson clover at 18 kg ha-1), and the subplots consisted of five residual herbicide treatments (S-metolachlor, flumioxazin, metribuzin, pyroxasulfone, and nontreated). In the 2021-22 season at Clayton, metribuzin injured cereal rye and crimson clover 65% and 55%, respectively. However, metribuzin injured both cover crops ≤6% in 2022-23. Flumioxazin resulted in unacceptable crimson clover injury with 50% and 38% in 2021-22 and 2022-23 in Clayton and 40% at Salisbury, respectively. Without preemergence herbicides, cereal rye controlled Italian ryegrass 85% and 61% at 24 WAP in 2021-22 and 2022-23 at Clayton and 82% in Salisbury, respectively. In 2021-22, Italian ryegrass seed production was lowest in cereal rye treatments at both locations, except when cover crop was treated with metribuzin. For example, in Salisbury, cereal rye plus metribuzin resulted in 39324 seeds m–2, compared to ≤4386 seeds m–2 from all other cereal rye treatments. In 2022-23, Italian ryegrass seed production in cereal rye was lower when either metribuzin or pyroxasulfone were used PRE (2670 and 1299 seeds m–2, respectively) when compared to cereal rye without herbicides (5600 seeds m–2).
Pot studies outdoors under natural environmental conditions were conducted to determine leafy spurge biomass reduction resulting from broadcast application of 2,4-D (2,244 g ae ha-1) with and without wiper-applied glyphosate. Glyphosate (575 g ae L-1) was applied at 0, 33, 50, and 75% diluted concentrate with a wiper 24 hrs after 2,4-D was broadcast applied. Injury estimates and shoot biomass did not differ between plants treated with 2,4-D-only or the addition of wiper-applied glyphosate 21 days after treatment. Shoot regrowth biomass of plants treated with 2,4-D-only was approximately 560% greater compared to nontreated plants three months after treatment. Plants treated with wiper-applied glyphosate had shoot regrowth biomass of less than 10% compared to the nontreated plants 3 months after treatment. Root biomass of 2,4-D-only treated plants (160% of nontreated plants) followed a similar pattern of shoot regrowth biomass. Root biomass of plants treated with wiper-applied glyphosate exhibited approximately 50% reductions compared to nontreated plants. The concentrations of glyphosate tested reduced all vegetative metrics equally; therefore, all labeled concentrations should be effective. The results of the experiment show that broadcast-applied 2,4-D is more effective at reducing leafy spurge biomass with the addition of wiper-applied glyphosate.