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This study assessed knowledge, perceptions, practices, and barriers regarding Antimicrobial Stewardship (AMS) among community pharmacists in New Zealand.
Design:
A cross-sectional study using a self-administered online questionnaire distributed nationwide to community pharmacists.
Methods:
A structured questionnaire was distributed via email to 3,226 pharmacists between January and March 2025, assessing demographics, knowledge of antimicrobial resistance (AMR) and antibiotic use, perceptions of AMS, current practices, and barriers. A total of 325 responses underwent quantitative analysis using Mann–Whitney U and Kruskal–Wallis tests (P < .05). The Relative Importance Index ranked barriers.
Results:
Most respondents (82.8%) perceived community pharmacists as holding a significant role in AMS. While demonstrating strong AMR knowledge (median score 5/7) and positive attitudes (82.7% agreed AMS should be implemented in community pharmacies), practices varied considerably. Patient education on proper antibiotic use was consistent (81.6% always/often), but education on resistance issues was less frequent (40.6% occasionally). Only 27.7% always/often reviewed prescriptions against local guidelines. Primary barriers were lack of time (66.5%), lack of support from higher authorities (64.3%), inadequate staff numbers (61.5%), and limited access to patient records (54.2%). Younger, less experienced pharmacists demonstrated higher knowledge scores (P < .05).
Conclusions:
Community pharmacists in New Zealand are well-positioned for effective AMS but are hindered by structural and system-level barriers rather than knowledge deficits. Recommendations include developing AMS guidelines tailored to community pharmacists, implementing joint training with prescribers, and establishing annual e-learning refresher modules.
How does the threat of a dominant ally withdrawing affect public attitudes toward defense spending and defense cooperation in alliances? Despite extensive literature on foreign policy attitudes, we lack research that causally examines this pivotal question in a realistic setting. Addressing this gap, we utilize the novel circumstances surrounding the coin-toss 2024 US presidential election to test how the unprecedented uncertainty of the US commitment to NATO affects public attitudes toward defense in allied countries. Using a preregistered survey experiment in the United Kingdom, Sweden, and Germany, we investigate how an uncertain election defined by contrasting candidate rhetoric influenced European public opinion in an era of renewed Russian military threats. We find that US threats of withdrawal made respondents significantly more willing to spend on defense, and less willing to support continued defense cooperation in NATO. We demonstrate that threats of withdrawal also increased the public’s preference for national security autonomy, and explore whether declining confidence in NATO allies explains this effect. By inciting fears of abandonment, threats of withdrawal create concrete consequences not only for defense spending preferences, but also the types of cooperation that allies may pursue in lieu of the dominant ally’s commitment.
Business management education is increasingly making use of artificial intelligence as an emerging technology that will lead to major societal changes in learning and knowledge endeavours. This editorial article focuses on the link between business management and artificial intelligence as an enabler of social policy changes. This means considering the history of artificial intelligence and how business management education has evolved in recent years. By doing so, it encourages more focus on creative uses of social policy in terms of discussion about educational initiatives. This is helpful in gaining more insight into the novel and entrepreneurial ways business management education can embed artificial intelligence and improve overall learning outcomes.
The New Prometheans is divided into four sections. Section I, “The new political quadrilateral,” reviews the formation of a new quadrilateral in the United States: right-wing neoliberals, white evangelicals, Trumpian fascists, and rich tech bros. Each folds to some degree into the priorities and ethos of the others to form a larger resonance machine. It is also unstable. Section II, “Dreamscapes of the tech bros,” explores more closely the existential priorities, rage against death, crude understandings of intelligence, and economic patterns of insistence of the tech bros, focusing on quotations from figures such as Marc Andressen, Elon Musk, and Jeff Bezos. After advancing a preliminary critique, Section III, “Steps toward an alternative onto-cosmology,” presents alternative images of nonhuman modes of production, the porosity of knowledge, the element of creative responsiveness in thinking, the ubiquity of events, and the exploration of timescapes. These provide better ways to challenge and displace the shallow and cruel images of human mastery, smartness, computer brain uploads, time, and capitalist expansion. Critique is important but never enough. Finally, in Section IV, we look at how earthbound, entangled humanists can offer an alternative to the dreamscape of escape to Mars.
We have analysed photometric data from a sample of pulsating stars observed by the Transiting Exoplanet Survey Satellite. By applying Fourier and prewhitening techniques, we extracted the significant frequencies for each star. We investigated the presence of rotationally split multiplets and evaluated frequency spacings using the Kolmogorov-Smirnov test. These analyses allow us to estimate stellar parameters such as the large frequency spacing, which in turn provides insights into the stellar mean densities. However, identifying clear multiplets and frequency spacings in δ Scuti stars remains challenging due to the complexity of their oscillation spectra. Our rotationally-split mode findings are yet to be confirmed, while the K-S test revealed no convincing large frequency spacings that could be used toward mass estimation. We derived orbital periods for stars we identified to be in binary systems. We provide spectral type classifications to confirm the δ Sct and/or γ Dornature of the stars we found. Out of 43 stars presented in this paper, 18 are identified as δ Sct/γ Dor hybrids (including five candidates), 20 as δSct stars, one as a γ Dor star and four as binary systems without any signature of pulsation.
This paper is concerned with the existence of normalized solutions for the following class of Hamiltonian elliptic systems:
\begin{align*}\left\{\begin{array}{ll}- \Delta u = \lambda u + |v|^{q-2}v \quad \text{in } \mathbb{R}^{N}, \\ - \Delta v = \lambda v + |u|^{p-2}u \quad \text{in } \mathbb{R}^{N}, \\ \displaystyle\int_{\mathbb{R}^N}(|u|^2 + |v|^2) = m,\end{array}\right.\end{align*}
where $m \gt 0$ and $2 \lt p,q \lt 2^{*}=2N/(N-2)$. We prove that a normalized solution exists for different ranges of $p,q$. A typical feature of this class of problems is that the associated energy functionals are strongly indefinite; that is, the domain has a saddle-point geometry in which both positive and negative subspaces of the quadratic form are infinite-dimensional. Another difficulty is the lack of the compact embedding $H^{1}(\mathbb{R}^N) \hookrightarrow L^{2}(\mathbb{R}^N)$, which persists also if we restrict ourselves to a radial setting. Our main result is novel for this class of systems.
We present the case of an 8-year-old male with frequent premature ventricular contractions and mild left ventricular dysfunction, who was found to carry heterozygous variants in both FLNC and CTNNA3. Medical therapy resulted in improved systolic function and reduced arrhythmia burden. This rare combination suggests a potential genotype–phenotype correlation in paediatric arrhythmogenic cardiomyopathy.
Negative urgency is a transdiagnostic risk factor for a plethora of mental disorders. Internalizing symptoms are embedded in theories of negative urgency, yet we know little regarding how developmental changes in each coincide, and if changes in one predict changes in the other across middle adolescence. This study filled these voids in the literature, with N = 754 (52% female) community-recruited youth from the National Consortium on Alcohol NeuroDevelopment in Adolescence (NCANDA) study reporting internalizing symptoms and negative urgency annually. Negative urgency and internalizing symptoms were highly correlated at the between-person level, and between-person correlations were nearly double in size within male versus female adolescents. At the within-person level, changes in negative urgency and internalizing symptoms co-occurred across ages 14–18 but not age 13. Age 14 within-person changes in negative urgency prospectively predicted age 15 within-person changes in internalizing symptoms, and this effect was nearly double in size within female versus male adolescents. Findings held when accounting for externalizing symptoms, other impulsive personality traits, parenting, and school transitions. Results indicate that relations between negative urgency and internalizing symptoms were demonstrated across and within adolescents, with time-varying changes in negative urgency at age 14 being particularly impactful in terms of future internalizing symptoms.
Trauma-related psychopathology is markedly elevated among refugee populations, particularly those living in sustained displacement. While economic, social and psychological factors have been linked to the deterioration of mental health following trauma and displacement, these factors have rarely been investigated concurrently and longitudinally. Consequently, there is little information on the potential longitudinal mechanisms driving mental ill-health in displacement settings. This study explored the temporal association between economic stressors, social stressors, emotion dysregulation and psychopathology in 1,235 refugees displaced in Indonesia.
Methods
Refugee participants from Farsi, Dari, Arabic, Somali and English-speaking backgrounds completed an online survey at four timepoints, 6 months apart. Factors of interest were measured using validated instruments including the Patient Health Questionnaire (to assess depressive symptoms), Posttraumatic Diagnostic Scale (to assess posttraumatic stress [PTS] symptoms), Post-Migration Living Difficulties Checklist (to index economic and social stressors) and Difficulties in Emotion Regulation Scale (to assess emotion dysregulation).
Results
Random-intercept cross-lagged panel analysis revealed that economic stressors and emotion dysregulation were central to the longitudinal course of trauma-related psychopathology. Specifically, economic stressors were associated with subsequent increases in PTS symptoms (B = 0.07, p = 0.047), depressive symptoms (B = 0.17, p < .001) and social stressors (B = 0.28, p < .001), while emotion dysregulation was antecedent to increases in PTS (B = 0.16, p < .001), depression symptoms (B = 0.13, p < .001), and social stressors (B = 0.10, p = .017). Additionally, depression was associated with subsequent increases in economic stressors (B = 0.18, p = .001) and social stressors were associated with subsequent increases in economic stressors (B = 0.12, p = .037).
Conclusions
The current study identified both economic stressors and emotion dysregulation as the main drivers of psychopathology for refugees. This indicates that both the structural barriers encountered in the environment and one’s internal capacity have a substantial impact on wellbeing. These findings highlight that alongside psychological interventions, policy changes that facilitate economic empowerment are critically, and equally, important.
To synthesize evidence on institutional spillover effects of antimicrobial use (AMU) on antimicrobial resistance (AMR) and Clostridioides difficile infections on individuals without direct antimicrobial exposure.
Design:
Systematic review.
Methods:
Three databases were searched through August 2024 for studies evaluating spillover effects of AMU on unexposed individuals in institutional settings. Study characteristics, AMU, and outcomes were extracted. Study quality was assessed based on underlying methodology to detect spillover effect. A hybrid synthesis, including effect direction and meta-analysis of studies reporting continuous AMU and non-aggregate outcomes was utilized. Reporting followed PRISMA guidelines.
Results:
Of 5916 screened studies, five observational studies met inclusion criteria. Three were conducted across 68 hospital wards (ward-level exposure), and two across 693 nursing homes (facility-level exposure). Three studies evaluated all antimicrobial classes; two focused on penicillins, fluoroquinolones, and carbapenems. Two studies examined C. difficile, one MRSA, one carbapenem-resistant Enterobacterales, and one reported combined AMR and C. difficile outcomes. Low to moderate quality evidence indicated a positive spillover effect direction with increasing facility AMU. Meta-analysis of three studies yielded a pooled IRR of 1.54 (95% CI 0.85–2.80) per 100 days of therapy per 1,000 patient-days, with significant heterogeneity (I2 = 97.6%).
Conclusions:
This review identified five studies suggesting a positive association between institutional AMU and collateral risks of AMR and C. difficile among unexposed individuals. Findings were limited by methodological heterogeneity and potential publication bias. Standardizing terminology, specifying spillover mechanisms, and adopting robust observational designs can enhance future research on spillover effects.
We investigate whether time pressure exacerbates or mitigates bubbles in laboratory experiments. We find that under high time pressure price volatility is lower and market prices are closer to their fundamental value. This is due to participants using simpler adaptive forecasting strategies, instead of the self-reinforcing extrapolative expectations that they use under low time pressure, and which are conducive to the emergence of bubbles. In addition, by substantially increasing the number of decision periods in our experiment, we find that in the long run prices tend to converge to their fundamental value, also in the absence of time pressure.
For as vivid the academic debate around issues of algorithmic bias, discrimination and unfairness has been in the context of EU law, little attention has been paid thus far to the way in which such instances have been dealt with by courts. This article examines from a non-discrimination law perspective how domestic courts of Member States as well as the European Court of Justice have approached cases of algorithmic bias in automated decision-making, by focusing on the judges’ engagement with discrimination-related considerations. For the purposes of my analysis, I propose a taxonomy of judgments dealing with cases of algorithmic bias and analyse a number of examples accordingly to showcase the distinct features of each category. In this regard, a first distinction is drawn between judgments relating to cases of ‘algorithmic discrimination’ and those concerning cases of ‘unfair algorithmic differentiation’. Depending on the extent to which courts take into account any risks of discrimination in the cases falling under the second category, I further distinguish between judgments of ‘discrimination reflection’, those of ‘discrimination awareness’, and those of ‘discrimination silence’. On the basis of this classification, I then attempt to shed more light on how non-discrimination and data protection law may interact with each other in practice in cases of algorithmic bias. Finally, the article concludes with some reflections on the prevailing tendency to address equality concerns through recourse to data protection rules.
This study focuses on a unique Facebook group: ‘Cyprus Immigrants Organisation’, whose members are mostly refugees who were once held in camps in Cyprus in the late 1940s and their descendants. The study offers a content analysis of 687 posts and comments published by group members during 2022. It reveals how a Facebook group made possible, produced, and promoted narratives of a topic that receives relatively little attention in the literature, media, and other memory spaces. The study highlights the range of memory-related content and activities within a Facebook group. We found three main activities of memory work within the group: (a) Members try to shape a coherent narrative of the events; (b) Members discuss acts of remembrance, suggesting additional activities and sharing personal initiatives; (c) Members aim to emphasise their personal connection and belonging to the Cyprus exiles’ community by sharing photographs, artwork, and documents. These memory practices, alongside processes such as gathering knowledge, sharing memories, shaping narratives, and commemorating, highlight the uniqueness of a Facebook group as a platform for memory. These kinds of activities would not be possible on such a scale without the digital environment or, more specifically, a Facebook group. With numerous narratives and collaborative knowledge gathering, the group exemplifies a democratised process of multi-generational memory work and narrative construction.
Knowledge of academic collocations is important for academic communication. Examining its relationship with knowledge of academic words and general high-frequency words should provide insights into the relative value of prior knowledge of different kinds of single words for the development of collocational knowledge in academic contexts, thus expanding our understanding of vocabulary knowledge beyond the current conception of individual word knowledge. Yet no studies have addressed this issue, mainly due to the lack of validated tests for academic words and collocations. This study employed three pairs of newly developed tests to measure Vietnamese EFL learners’ knowledge of academic collocations, academic words, and general high-frequency words. Results showed that at the form-recall level, both academic word and general high-frequency word knowledge were positively associated with academic collocation knowledge, with academic words having a stronger relationship. At the form-recognition level, only academic words and academic collocations were positively correlated.