To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Despite the increasing rates of carbapenem-resistant Acinetobacter baumannii (CRAB) carriage among hospitalized patients in endemic settings, the role of active surveillance cultures and cohorting is still debated. We sought to determine the long-term effect of a multifaceted infection-control intervention on the incidence of CRAB in an endemic setting.
Methods:
A prospective, quasi-experimental study was performed at a 670-bed, acute-care hospital. The study consisted of 4 phases. In phase I, basic infection control measures were used. In phase II, CRAB carriers were cohorted in a single ward with dedicated nursing and enhanced environmental cleaning. In phase III large-scale screening in high-risk units was implemented. Phase IV comprised a 15-month follow-up period.
Results:
During the baseline period, the mean incidence rate (IDR) of CRAB was 44 per 100,000 patient days (95% CI, 37.7–54.1). No significant decrease was observed during phase II (IDR, 40.8 per 100,000 patient days; 95% CI, 30.0–56.7; P = .97). During phase III, despite high compliance with control measures, ongoing transmission in several wards was observed and the mean IDR was 53.9 per 100,000 patient days (95% CI, 40.5–72.2; P = .55). In phase IV, following the implementation of large-scale screening, a significant decrease in the mean IDR was observed (25.8 per 100,000 patient days; 95% CI, 19.9–33.5; P = .03). An overall reduction of CRAB rate was observed between phase I and phase IV (rate ratio, 0.6; 95% CI, 0.4–0.9; P < .001).
Conclusions:
The comprehensive intervention that included intensified control measures with routine active screening cultures was effective in reducing the incidence of CRAB in an endemic hospital setting.
Psoriasis is a chronic, systemic, immune-mediated, inflammatory skin disease associated with significant comorbidities. Globally, there are an estimated 60 million people living with psoriasis (PLwP). There is a growing body of evidence on the role of diet in psoriasis management, and demand for dietary advice is high. However, there are no specific, evidence-based dietary guidelines. This scoping review summarises the literature on use and effectiveness of diet in the management of psoriasis to improve understanding of the evidence and assist PLwP and healthcare professionals (HCPs) to discuss diet. The findings were categorised into three themes: (1) dietary intakes of PLwP, (2) the perceived role of diet in psoriasis management and (3) dietary approaches to manage psoriasis symptoms. In cross-sectional studies PLwP were reported to have higher fat and lower fibre intakes compared with controls, and lower psoriasis severity was associated with higher fibre intake. However, research is limited. PLwP perceive diet to have an impact on symptoms and make dietary modifications which are often restrictive. Systematic reviews and RCTs found certain dietary approaches improved symptoms, but only in specific populations (e.g. PLwP with obesity and PLwP with coeliac disease), and evidence for supplement use is inconclusive. The grey literature provides limited guidance to PLwP; focusing on weight loss and associated comorbidities. Larger, controlled trials are required to determine dietary approaches for psoriasis management, especially in PLwP without obesity and non-coeliac PLwP. Further understanding of diet modification, information acquisition and experiences among PLwP will enhance holistic care for psoriasis management.
While startups are acknowledged for their potential to address sustainability issues, little is known on how to assess their impact, given the uncertainty they deal with and their lack of resources. This paper investigates the ones that are supposed to be ‘best-in-class’ in that matter, that is, startups targeting sustainability, in order to explore how they integrate sustainability impact assessment in their entrepreneurial process. We conducted a multiple case study of eight sustainable startups, based on a 2-year longitudinal research in their incubator to gather multiple sources of information. Our results revealed that the integration of the triple bottom line in the entrepreneurial process has a major effect on startups’ sustainability impact assessment practices. ‘Born-sustainable startups’, which have aimed for the triple bottom line since idea generation, have more robust tools and routines than ‘Transitioned sustainable startups’, which integrated the triple bottom line during prototype/validation.
Wartime pressures to protect national military and security interests inevitably create threats to civil liberties. This essay reviews the abuses of the period, carried on by public officials as well as citizens who saw themselves as acting on their behalf. There was a remarkable range of targets—with few spies to find, broadly defined disloyalty sufficed. The attempt to create a unified, loyal culture extended to wide areas of the culture, such as the teaching of history, aided by volunteers. The public and private efforts brought ruined reputations, imprisonments, public shaming, murders, and awful behavior on the part of courts and citizens. These were bad times for civil liberties. This essay reviews the history and explores the legacies.
In 2015, Douglas NeJaime and Reva Siegel identified complicity-based conscience claims as a subcategory of religious liberty claims, which feature objections to generally applicable laws based on religious convictions that harm third parties. Here, we observe that Muslim-Americans have filed or joined amicus curiae briefs in support of litigants on both sides of the recent complicity-based conscience cases of Masterpiece Cakeshop v. Colorado (2018), Bostock v. Clayton County (2020), and Fulton v. City of Philadelphia (2021). This divergence of legal views within the Muslim-American community points to a broader rift in society generally toward issues involving the navigation of identity and faith in the context of American liberalism. In this article, we show that opposing arguments by Muslim-Americans in these complicity-based conscience cases presuppose two different conceptions of liberalism: (1) liberalism as the pursuit of broad religious, cultural, and value pluralism (modus vivendi), and (2) liberalism as the pursuit of social cohesion, assimilation, and fraternité among diverse constituencies (vivre ensemble). Muslim-Americans who advance a modus vivendi vision of liberalism base their arguments mainly on the view that Islam and other minority religions involve specific beliefs, doctrines, and moral injunctions regarding, inter alia, rules of personal conduct in society that deserve distinctive legal protections. Muslim-Americans who support a vivre ensemble conception of liberalism prioritize the uniform enforcement of civil rights laws over religion-based objections and, in doing so, seek an overlapping consensus between their beliefs and prevailing conceptions of expansive civil liberties.
The research of parallel mechanism (PM) configuration involves many problems. From topology to configuration, dimensional constraint, etc., how to establish the relationship between topology and configuration with effective methods is a long-term challenge for the configuration design. In this paper, the chemical molecular spatial structure (CMSS) is linked with the configuration of symmetrical parallel mechanism (SPM). Starting from the methane molecule (CH4), a spatial structural topological relation is obtained. Based on graph theory and the spatial structural topological relation, a new expression method with topological graph and its kinematic pair adjacency matrix for spatial SPM is proposed. Then, the expression and analysis for the characteristics of spatial SPM are obtained. Finally, by taking the 3-RPS PM and the 3-RRC PM as examples, the effectiveness and corresponding consistency of the proposed expression method are successfully verified. The proposed new expression method paves the way for the subsequent digital and automated design and analysis of the SPM configuration.
The coronavirus disease (COVID-19) pandemic and resulting restrictions on physical access to long-term care homes culminated in health declines for older adults living there and their families. Knowledge gaps exist regarding maintaining social connectedness when physically separated. The study aimed to explore family members’ perceptions of the impact that restrictions on physical access to long-term care homes had on the experience of social connectedness between family members and older adults living in long-term care. The method used was a qualitative description, using in-depth semi-structured interviews. Themes arising from inductive qualitative content analysis of 21 interviews with family members included: (a) lack of connection threatening mental, emotional health, and physical health; (b) navigating trust in the unknown; (c) feelings of stress and anxiety for family members; and (d) technology – an asset, but not for everyone. Study findings suggest more emphasis should be placed on supporting social connections between older adults and their families in the context of long-term care beyond COVID-19.
Eigenvectors of the observability and controllability Gramians represent responsive and receptive flow structures that enjoy a well-established connection to resolvent forcing and response modes. However, whereas resolvent modes have demonstrated great potential to guide sensor and actuator placement, observability and controllability modes have been leveraged exclusively in the context of model reduction via input and output projections. In this work, we introduce interpolatory, rather than orthogonal, input and output projections, that can be leveraged for sensor and actuator placement and open-loop control design. An interpolatory projector is an oblique projector with the property of preserving certain entries in the vector being projected. We review the connection between the resolvent operator and the Gramians, and present several numerical examples where we perform both orthogonal and interpolatory input and output projections onto the dominant forcing and response subspaces. Input projections are used to identify dynamically relevant disturbances, place sensors to measure disturbances, and place actuators for feedforward control in the linearized Ginzburg–Landau equation. Output projections are used to identify coherent structures and place sensors aiming at state reconstruction in the turbulent flow in a minimal channel at $Re_{\tau }=185$. The framework does not require data snapshots and relies only on knowledge of the steady or mean flow.
Este trabajo busca conocer las estrategias tecnológicas, los rangos de acción y la conectividad en las estrategias humanas de ambientes marginales. Se discute, para el caso del sur de Mendoza, el modelo clásico de trashumancia cazadora recolectora entre tierras bajas y altas. El estudio se centra específicamente en El Payén y en el uso de la obsidiana andina Laguna del Maule. En El Payén, esta obsidiana ocupa el primer lugar entre las variedades conocidas y su uso se vinculó a circuitos de movilidad estacional que involucraban tierras bajas y altas. La obsidiana Laguna del Maule posee dos subtipos geoquímicos, el Subtipo 1 registrado en cordillera, y el Subtipo 2 localizado en depósitos fluviales distales. En este trabajo modelamos las estrategias de interacción de tierras altas con tierras bajas, enfocándonos en modelos propuestos para La Payunia, que ponen énfasis en la tecnología lítica y se articulan con análisis geoquímicos y geoarqueológicos. Los resultados sostienen que las poblaciones de El Payén obtenían este recurso mediante distintas estrategias tecnológicas: un aprovisionamiento serial del Subtipo 2, con circuitos de movilidad centrados en tierras bajas; diferente al Subtipo 1 de aprovisionamiento cíclico, que habría involucrado la interacción entre tierras altas y tierras bajas.
The HOLLYWOOD sign is arguably the world's most famous language object. Emblematic of prestige and cultural capital, the sign can be found not just in Los Angeles, but in citations all over the world. Beginning with the history of its valorization, HOLLYWOOD is shown to emanate symbolic value through a set of enregistered semiotic features. Drawing upon a set of globally sourced citations of HOLLYWOOD, the circulation and stratified bundling of size, emplacement, alignment, typeface, and color indicates how the citation of language objects is mediated by political economy. A process of diffuse citation is further observed, in which the quotation of language features is not overt, but the source of emanation is still tangible, revealing HOLLYWOOD as the source of a global linguistic-semiotic register. As this register circulates in citations overt and diffuse, language objects are revealed as key sites for the reproduction of commodity values. (The Hollywood sign, language object, citation, enregisterment, global emblems, recontexualization)*