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Antibiotic overuse for asymptomatic bacteriuria is common in older adults and can lead to harmful outcomes including antimicrobial resistance. Our objective was to evaluate the impact of a simple scoring tool on urine culturing and antibiotic prescribing for adults with presumed urinary tract infections (UTI).
Design:
Quasi-experimental study using interrupted time series with segmented regression to evaluate urine culturing and urinary antibiotic use and length of stay (LOS), acute care transfers, and mortality 18 months before and 16 months after the intervention.
Setting:
134-bed complex continuing care and rehabilitation hospital in Ontario, Canada.
Participants:
Nurses, nurse practitioners, physicians, and other healthcare professionals.
Intervention:
A multifaceted intervention focusing on a 6-item mnemonic scoring tool called the BLADDER score was developed based on existing minimum criteria for prescribing antibiotics in patients with presumed UTI. The BLADDER score was combined with ward- and prescriber-level feedback and education.
Results:
Before the intervention, the mean rate of urine culturing was 12.47 cultures per 1,000 patient days; after the intervention, the rate was 7.92 cultures per 1,000 patient days (IRR 0.87; 95% CI, 0.67–1.12). Urinary antibiotic use declined after the intervention from a mean of 40.55 DDD per 1,000 patient days before and 25.96 DDD per 1,000 patient days after the intervention (IRR 0.68; 95% CI, 0.59–0.79). There was no change in mean patient LOS, acute care transfers, or mortality.
Conclusions:
The BLADDER score may be a safe and effective tool to support improved diagnostic and antimicrobial stewardship to reduce unnecessary treatment for asymptomatic bacteriuria.
Vitamin D deficiency in infants is widely prevalent. Most paediatric professional associations recommend routine vitamin D prophylaxis for infants. However, the optimal dose and duration of supplementation are still debated. We aimed to compare the efficacy and safety of different vitamin D supplementation regimens in term and late preterm neonates. For this systematic review and network meta-analysis, we searched MEDLINE, the Cochrane Central Register of Controlled Trials and Embase. Randomised and quasi-randomised clinical trials that evaluated any enteral vitamin D supplementation regimen initiated within 6 weeks of life were included. Two researchers independently extracted data on study characteristics and outcomes and assessed quality of included studies. A network meta-analysis with a Bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. Primary outcomes were mean serum vitamin D concentrations and the proportion of infants with vitamin D insufficiency (VDI). We included twenty-nine trials that evaluated fourteen different regimens of vitamin D supplementation. While all dosage regimens of ≥400 IU/d increased the mean 25(OH)D levels compared with no treatment, supplementation of ≤250 IU/d and 1400 IU/week did not. The CoE varied from very low to high. Low CoE indicated that 1600 IU/d, compared with lower dosages, reduced the proportion of infants with VDI. However, our results indicated that any dosage of ≥800 IU/d increased the risk of hypervitaminosis D and hypercalcaemia. Data on major clinical outcomes were sparse. Vitamin D supplementation of 400–600 IU/d may be the most effective and safest in infants.
Consultations with the Centers for Disease Control and Prevention’s Division of Healthcare Quality Promotion revealed patient harms associated with ophthalmic care. Adherence to core infection prevention and control principles, tailored guidance for ophthalmic settings, and compliance with manufacturing and compounding standards could decrease adverse events and patient exposures to contaminated products.
Few views have seen a more precipitous fall from grace than hedonism, which once occupied a central position in the history of ethics. Recently, there have been efforts to revive interest in the view, including well-motivated pleas for contemporary ethicists to at least take the view seriously. In this article, I argue for the seriousness of hedonism on metaethical grounds. Taking J.S. Mill's argument for hedonism as a test case, I show that historically, classic hedonism was grounded metaethically via a commitment to two positions: empiricist epistemology and the view that pleasure occurs in sensation. Together, these two positions provided principled grounds for various iterations of classic hedonism. Moreover, these two positions are still serious options in both contemporary epistemology and the contemporary literature on the nature of pleasure. Insofar as a contemporary ethicist takes those two views seriously, they ought to take classic hedonism seriously as well.
The $k^{-23/6}$ wave action spectrum with an inverse cascade is one of the fundamental Kolmogorov–Zakharov solutions for gravity wave turbulence, which is part of the citation for the Dirac Medal in 2003. Instead of confirming this solution, however, several existing simulations and experiments suggest a spectrum of $k^{-3}$ in set-ups corresponding to the inverse cascade. We provide a theoretical explanation for the latter, considering the condensate that naturally forms in finite domains of experiments/simulations. Our new theory hinges on: (1) derivation of a spectral diffusion equation when non-local interactions with the condensate become dominant, for the first time systematically formulated for quartet-interaction systems; and (2) careful analysis of the asymptotics of interaction coefficient with a remarkable cancellation of all leading-order terms.
This paper examines the habitus of contemporary Thailand based on the concepts developed by Pierre Bourdieu and their operationalisation to Thai society developed by Boike Rehbein's principles, which explain how contemporary habitus is linked to social inequality and mobilisation participation. Thailand has two key social structures: precapitalist and capitalist. Both create and reproduce different types of habitus. The paper used a mixed-methods research approach to analyse social inequality and challenges in Thailand since 2019. Data collection was conducted during the years between 2021 and 2022 from 400 surveys and fifteen qualitative interviews. The paper proposes eight habitus types rooted in Thai social structures with seven characteristics for explaining contemporary Thai society. The pre-capitalist structure generates the following habitus types: subsistential, traditionalist, and powerful (phuyai). The capitalist structure generates the following types: desperate, individualist, aspirant, and content creator. Between these two structures is the conformist. All habitus types share some characteristics. Authoritarianism is the fundamental trait of the predominant habitus types in Thai society, which are interconnected with social structures, thereby reflecting the consequences of social inequality and mobilisations. The demographic most affected by social inequality is the desperate group, but a more significant habitus for mobilisation participation is that of content creator, which is considerably small now but is likely to increase. Traditionalist and conformist groups are less likely to protest and, to a lesser degree, this is true of the subsistential and powerful types. Moreover, rationales of being affected by social inequality and reacting differently are distinct characteristics of each type, and socio-economic positions interplayed with social media influences.
This work is devoted to a theoretical and numerical study of the dynamics of a two-phase system vapour bubble in equilibrium with its liquid phase under translational vibrations in the absence of gravity. The bubble is initially located in the container centre. The liquid and vapour phases are considered as viscous and incompressible. Analysis focuses on the vibrational conditions used in experiments with the two-phase system SF$_6$ in the MIR space station and with the two-phase system para-Hydrogen (p-H$_2$) under magnetic compensation of Earth's gravity. These conditions correspond to small-amplitude high-frequency vibrations. Under vibrations, additionally to the forced oscillations, an average displacement of the bubble to the wall is observed due to an average vibrational attraction force related to the Bernoulli effect. Vibrational conditions for SF$_6$ correspond to much smaller average vibrational force (weak vibrations) than for p-H$_2$ (strong vibrations). For weak vibrations, the role of the initial vibration phase is crucial. The difference in the behaviour at different initial phases is explained using a simple mechanical model. For strong vibrations, the average displacement to the wall stops when the bubble reaches a quasi-equilibrium position where the resulting average force is zero. At large vibration velocity amplitudes this position is near the wall where the bubble performs only forced oscillations. At moderate vibration velocity amplitudes the bubble average displacement stops at a finite distance from the wall, then large-scale damped oscillations around this position accompanied by forced oscillations are observed. Bubble shape oscillations and the parametric resonance of forced oscillations are also studied.
Theodor W. Adorno suggested that music is mediated by socially derived forms of reason, a provocation here considered with respect to neoliberalism. Drawing on a Foucauldian understanding of neoliberalism, which in Wendy Brown's summary takes neoliberalism as ‘a specific and normative mode of reason’, I consider what this means for immanent features of music and processes of its composition. This critical attention to music's formal, aesthetic register enables me to go beyond the more well-established (although nonetheless valuable) frameworks for discussing music and neoliberalism, which focus on music's relation to labour conditions and creative industries. A range of music and sonic art is discussed, work by Chino Amobi, Brian Eno, Bryn Harrison, Sarah Hennies, Johannes Kreidler, Wolfgang Rihm, Marina Rosenfeld, and John Zorn. I ultimately argue that some core features of Adorno's conception of critical art and music need reformulating for the neoliberal age.
Circular shell rings along the South Atlantic coast of the United States are vestiges of the earliest sedentary villages in North America, dating to 4500–3000 BP. However, little is known about when Indigenous communities began constructing these shell-ring villages. This article presents data from the Hokfv-Mocvse Shell Ring on Ossabaw Island, Georgia. Although shell rings are often associated with the earliest ceramics in North America, no ceramics were encountered in our excavations at Hokfv-Mocvse, and the only materials recovered were projectile points similar to points found over 300 km inland. Bayesian modeling of radiocarbon dates indicates that the ring was occupied between 5090 and 4735 cal BP (95% confidence), making it the earliest dated shell ring in the region. Additionally, shell geochemistry and oyster paleobiology data suggest that inhabitants were living at the ring year-round and had established institutions at that time to manage oyster fisheries sustainably. Hokfv-Mocvse therefore provides evidence for Indigenous people settling in year-round villages and adapting to coastal environments in the region centuries before the adoption of pottery. The establishment of villages marks a visible archaeological shift toward settling down and occupying island ecosystems on a more permanent basis and in larger numbers than ever before in the region.
Feminists have long argued that emotions have a rightful place in politics. Anger, specifically, is often said to play a crucial role in alerting people to oppression and motivating resistance. The task of this paper is to elaborate these claims and to outline a conception of the political value of anger. In doing so, I argue against the view that anger is valuable only if and because it expresses a sound moral judgment. Instead, we should see rage, in the first place, as simply a response to having one's practical aims in the world thwarted—there need be nothing moral or righteous about this feeling for it to have political potential. Second, unlike those who highlight anger's connection with love or claims for equal dignity, I emphasize its tendency towards aggression. With this non-moralized conception of anger in hand, we can see how rage reveals practical problems in a way that can spur on a dialectical process of political articulation and organized action. The resulting standpoint from which one can articulate and resist one's oppression based on one's rage is not inherent in the experience of anger—rather, it needs to be seen as a political achievement in itself.
Let $k\geq 4$ be an integer. We prove that the set $\mathcal {O}$ of all nonzero generalised octagonal numbers is a k-additive uniqueness set for the set of multiplicative functions. That is, if a multiplicative function $f_k$ satisfies the condition
for arbitrary $x_1,\ldots ,x_k\in \mathcal {O}$, then $f_k$ is the identity function $f_k(n)=n$ for all $n\in \mathbb {N}$. We also show that $f_2$ and $f_3$ are not determined uniquely.
For five decades now the various levels of government in the United States, through the use of affirmative action and diversity policies, have sought a more racially and gender-wise equitable society with respect to equal employment opportunity. Governments established hiring goals for women and racial minorities. Goals became quotas as state and local governments (and private employers) that were dependent on federal money made certain that goals produced desired results by preferring people based on their race or gender. This article is a case study of how the Commonwealth’s welfare cabinet over two decades ago used long-standing civil service regulations and policies to pursue preferential employment practices while conterminously pursuing greater societal equity by reducing governmental oversight of welfare programs. All this foreshadowed President Biden’s iteration of affirmative action—federal equity directives regarding employment preferences and greater conditions of equality. After the events described herein, Democratic Kentucky transformed itself into a Republican state.
Thin-film equations are utilised in many different areas of fluid dynamics when there exists a direction in which the aspect ratio can be considered small. We consider thin free films with Marangoni effects in the extensional flow regime, where velocity gradients occur predominantly along the film. In practice, because of the local deposition of surfactants or input of energy, asymmetric distributions of surfactants or surface tension more generally, are possible. Such examples include the surface of bubbles and the rupture of thin films. In this study, we consider the asymmetric thin-film equations for extensional flow with Marangoni effects. Concentrating on the case of small Reynolds number $ Re $, we study the deposition of insoluble surfactants on one side of a liquid sheet otherwise at rest and the resulting thinning and rupture of the sheet. The analogous problem with a uniformly thinning liquid sheet is also considered. In addition, the centreline deformation is discussed. In particular, we show analytically that if the surface tension isotherm $\sigma = \sigma (\varGamma )$ is nonlinear (surface tension $\sigma$ varies with surfactant concentration $\varGamma$), then accounting for top–bottom asymmetry leads to slower (faster) thinning and pinching if $\sigma = \sigma (\varGamma )$ is convex (concave). The analytical progress reported in this paper allows us to discuss the production of satellite drops from rupture via Marangoni effects, which, if relevant to surface bubbles, would be an aerosol production mechanism that is distinct from jet drops and film drops.