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This paper presents a compact, ultrawideband (UWB), high-gain antipodal Vivaldi antenna (AVA), which consists of two metal layers and a dielectric substrate. The top metal layer is a radiation fin with a microstrip feeding line, and the bottom metal layer is composed of the same radiation fin with a gradient grounding line and a clover-shaped director. Here, the director composed of three elliptical parasitic patches is employed along the radiation direction to enhance the gain. In order to expand the operating bandwidth and further improve the gain, a comb-like radiation fin with four gradual partially elliptical slots in its outer side is introduced to expand the surface current path and reduce reverse current; therefore, the presented AVA is only 0.75λL × 0.30λL × 0.007λL, where λL is the wavelength at the lowest operating frequency. Simulation and measurement results show that the proposed AVA possesses a frequency range from 2.2 to 48 GHz. The peak realized gain is over 14.3 dBi at 12 GHz, and the average gain within the entire operating frequency band is over 10.9 dBi. As a result, the proposed AVA is a good candidate for those applications that require UWB, high-gain, and miniaturized antennas.
Blood culture over-ordering is a recognized diagnostic stewardship challenge, contributing to contamination, inappropriate antimicrobial escalation, and laboratory burden. Validated tools to guide culture ordering at initial patient assessment are lacking.
Objective:
We aim to derive and externally validate a two-step diagnostic stewardship rule for blood culture ordering in the emergency department (ED) patients with suspected infection.
Methods:
We derived the Stepwise Culture Assessment with NEWS and NLR in ED (SCANNED) rule using consecutive blood cultures from a Singapore ED (April–July 2025) and validated it in Vancouver, Canada (2016–2019). The rule uses age-stratified National Early Warning Score (NEWS) thresholds (Step 1), followed by neutrophil-lymphocyte ratio (NLR) ≥5 for remaining patients (Step 2). Thresholds were selected via exhaustive grid search, optimizing culture reduction while constraining the false-negative rate to <5%.
Results:
We included 1,224 derivation and 808 validation encounters. Blood culture positivity was 9.6% (117/1,224) and 13.8% (112/808), respectively. The optimal rule (NEWS ≥5 if age <75 or NEWS ≥3 if age ≥75; NLR ≥5 for remainder) reduced cultures by 18.8% (95% CI 16.6–20.9%) in derivation and 15.1% (95% CI 12.8–17.6%) in validation, missing <5% of bacteremia cases in both cohorts. Performance was consistent across infection sources, including unclear/occult infections (17.5% reduction, 3.7% false-negative rate).
Conclusion:
The SCANNED rule represents a practical diagnostic stewardship intervention that can reduce unnecessary blood cultures by 15–19% while maintaining >95% sensitivity for bacteremia. It requires no electronic health record integration and can be applied at triage. Prospective validation is needed before clinical implementation.
This study employs two measures of social support: local relatives support (LRS) and informal credit and savings group membership (IGM), from three pooled cross-sections of rural Zimbabwean farmer-households, to investigate the role of social support in the number of sustainable land management practices (SLMPs) that they adopt. The results indicate that households with greater self-sufficiency capabilities are more likely to receive social support in the form of IGM and less likely to receive it in the form of LRS. Secondly, being spatially proximate to neighbours that receive social support is associated with the farmer-household also receiving social support. Thirdly, receiving social support increases the likelihood of adopting more SLMPs. Fourthly, households without social support would have adopted more SLMPs if they had received social support. Finally, self-enforcing social support in the form of IGM is associated with a higher likelihood of SLMP adoption compared to LRS, which depends on relatives’ benevolence.
Whether the $FS$-domain of closed discs in the plane is a retract of a bifinite domain is a long-standing open problem in domain theory, which has been stated in textbooks and several other references. In this paper, we give a positive answer to this question. As preparation, we present some rules for the inductive construction of a Plotkin-poset. Then, we inductively construct a bottomed Plotkin-poset based on closed circular rings in the plane with rational radii and rational centers. Since every element in this bottomed Plotkin-poset is compact, it follows that the ideal completion of this Plotkin-poset is a bifinite domain. Furthermore, an embedding-retraction pair is established between the domain of closed discs in the plane and this bifinite domain.
James Aird stands at the forefront of music printing in Glasgow, introducing a style of business that had been attempted sporadically in the city prior to his own first endeavours in 1782. His initial establishment opened c. 1776 and grew into a successful music publishing business, with about one hundred attributable works surviving today. Aird survived the financial challenge of sequestration, not uncommon in the local business community, and in the last months of his life faced a bitter legal case. His legacy is evident in the output of his immediate successors, who bought some of his printing plates after his death to establish and sustain their own publishing houses. This article reviews the few details already known about Aird’s career and augments these using newly uncovered archival documents. The appendix provides the fullest list to date of his publications, including lost works.
When reporting differences in the incidence or proportion of a binary outcome between groups, common measures include absolute risk difference, relative risk (RR), and odds ratio (OR). For studies in which the primary outcome is a difference in proportions between two groups, Prehospital and Disaster Medicine prioritizes the absolute risk difference as the principal measure of effect, accompanied by a 95% confidence interval and P-value. Relative risk may be reported secondarily when appropriate. Odds ratios should generally be avoided as they are frequently misinterpreted and may exaggerate the apparent magnitude of an effect. Odds ratios should be limited to situations in which they are required by the selected statistical method.
Values play important roles in science, yet their influence on ethical and scientific recommendations is overlooked. This paper examines how interactions between values complicate the uptake of recommendations. We discuss two challenges: (i) value trade-offs, where one value is pursued at the cost of another, and (ii) value synergies, where values reinforce each other. We argue that overlooking trade-offs leads to unrealistic recommendations, while oversimplifying synergies leads to ineffective ones. Both hinder the uptake of recommendations. We propose strategies to address these issues, illustrated by the 2023 National Academies of Sciences report on the use of population descriptors in genomics.
Modern legal understanding of command responsibility has been largely informed by the 1946 case of General Tomoyuki Yamashita in Manila, which established the rules that commanders are responsible for their troops’ crimes. This article shifts focus to a segment of war crimes trials held by the British military authorities in Hong Kong, to examine three trials in relation to the issue of command responsibility of the commanders of the Japanese military police for crimes perpetrated by the Kempeitai during the Japanese military occupation. By examining the court transcripts of these trials, this article explores the various arguments surrounding the criminal responsibility of the accused commanders and how wartime responsibilities were constructed after the war. This article argues that the British legal personnel moved beyond approaching civilian war crimes in terms of individual misconduct alone to hold commanders liable for crimes arising from organizational and command failures. These trials also offer an interesting example of the wider debates over the skewed application of law vis á vis the lack of procedural clarity, lax rules of evidence, inaccurate factual determinations, and the limits of postwar justice. As such, this article makes an original contribution to Hong Kong legal history and deepens our understanding of the British attempts to achieve colony-wide demand for retribution after WWII.
The article examines the state theory of French public lawyer Raymond Carrré de Malberg. It argues that he responds in a highly original way to a crisis of public law government that is tied to the emergence of the social sciences and to the democratization of society. The analysis ties Carré de Malberg’s attempt to salvage the idea of public law government to his reflections on the referendum, which he will reject as incompatible with the regime of the Third Republic, only to rehabilitate it in his late work. The analysis brings to light a depletion of the ideological resources of public law government, which speaks to a European-wide crisis of public law. As we shall show, it also speaks to an overarching crisis of a bourgeois society that had channeled its power through the legislature but realized that this organ of government would not continue to be the seat of power in society.
Immunologic, metabolic and increasingly ‘immuno-metabolic’ approaches, are prominent in contemporary psychiatric discourse, yet translation into clinical practice remains variable. In this Feature, we pragmatically ask where signal ends and speculation begins, and what this means for the clinical psychiatrist. Autoimmune encephalitis provides a rare but instructive yardstick in which antibody-based mechanisms map onto distinct neuropsychiatric syndromes and respond to targeted immunotherapy. However, while the broader concept of autoimmune psychosis may extend beyond this tightly defined niche, it remains largely experimental and requires stronger evidence. More broadly applicable concepts, including an immuno-metabolic subtype of depression, are increasingly supported by mechanistic work, with attendant treatment implications, although differentiation from routine holistic care remains less clear. In psychosis and severe mental illness, immune and cardiometabolic dysfunction may contribute to both psychiatric and physical disease burden beyond lifestyle or treatment effects alone. Emerging therapies, including GLP-1-based (glucagon-like peptide-1-based) approaches, may bind these threads together with gains for body and mind, but specific evaluation within psychiatry continues. Overall, our view is that the opportunities are not lost, but for robust translation, there is an ongoing need for precise, incremental research, interdisciplinary collaboration and rigorous communication of nuance.
This thesis investigates combinatorial principles from order theory and Ramsey theory with a focus on foundational aspects within the framework of reverse mathematics and computability theory. The first part focuses on order dimension theory, a classical topic at the intersection of order theory and combinatorics. Intuitively, the dimension measures how “far” a poset is from being linearly ordered. We are interested in statements that give an upper bound to the dimension of a poset in terms of the dimension of its subposets, obtained by removing one or more points. We analyze these bounding theorems, calibrating their logical strength within subsystems of second-order arithmetic. The second part examines the notion of strong indivisibility, a particular Ramsey-like property. We focus on countable structures, with particular emphasis on Cameron’s classification theorem of strongly indivisible graphs. We study this classification from the perspectives of reverse mathematics and computable combinatorics, investigating the role of induction axioms and effective constructions. In the final part, we study a very general finite Ramsey theorem, where both the sets being colored and the homogeneous set must satisfy some largeness notion. Historically, largeness notions were associated with countable ordinals and systems of fundamental sequences. To extend this approach, we develop a more flexible framework using blocks and barriers. Since the complexity of barriers can be measured by countable ordinals, we define and study Ramsey ordinals, a generalization of the well-known Ramsey numbers of classical finite Ramsey theory.
Central nervous system stimulants like methamphetamines and cocaine are known to increase the risk of intracranial haemorrhage (ICH) in adults. However, the effects of prenatal methamphetamine exposure on neonatal cerebrovascular outcomes remain underexplored despite its growing prevalence.
Aims
To assess whether prenatal methamphetamine exposure increases offspring ICH risk versus unexposed pregnancies, and to compare findings with 3,4-methylenedioxymethamphetamine (MDMA)/opioid exposures, including stratification by gestational age.
Method
This nationwide, population-based cohort study in Taiwan included pregnancies resulting in live births between 2004 and 2018, and followed offspring through 31 December 2019 to examine the association between prenatal exposure to methamphetamines, MDMA or opioids and incident ICH in offspring. The cohort included 53 455 pairs of pregnant women and their first offspring, with 10 691 exposed to illicit drugs and 42 764 matched controls. Cox proportional hazards models estimated adjusted hazard ratios (aHRs), accounting for maternal age, comorbidities, socioeconomic status and other confounders.
Results
Prenatal methamphetamine exposure was associated with a higher risk of ICH in offspring compared with unexposed controls (0.4 v. 0.2%, aHR = 1.72, 95% CI 1.06–2.79). This elevated risk persisted among those exclusively exposed to methamphetamines (aHR = 1.82, 95% CI 1.04–3.29). No statistically significant association was observed for MDMA (0.2 v. 0.2%; aHR = 1.58, 95% CI 0.64–3.93; p = 0.324) or illicit opioids (0.4 v. 0.2%; aHR = 1.43, 95% CI 0.81–2.53; p = 0.214). Stratified analyses showed methamphetamine exposure increased ICH risk among full-term infants (aHR = 4.30, 95% CI 2.08–8.88), with no statistically significant association observed in preterm infants (aHR = 1.00, 95% CI 0.52–1.93).
Conclusions
Prenatal methamphetamine exposure was associated with a higher risk of offspring ICH, particularly among full-term infants. These findings support the importance of efforts to reduce methamphetamine use during pregnancy.
This article analyzes the privatization of Telecom Italia as part of a broader historical evaluation of public ownership in a high-technology strategic sector. Drawing on archival material from Italian state-owned enterprises as well as national and European institutions, it traces the reorganization of the telecommunications conglomerate in the 1980s and 1990s, the European regulatory framework in which it unfolded, and the company’s post-divestment trajectory, thereby questioning the inevitability of privatization. The evidence shows that, before privatization, Telecom Italia had already become a profitable, technologically advanced, and internationally competitive firm under public ownership. The decision to divest reflected domestic political and fiscal priorities, as the European liberalization of the telecommunications market reshaped the rules while leaving member states a margin of maneuver. By comparing the public and privatized phases of the company’s development, the article contributes to the historical reassessment of state-owned enterprises and challenges the assumption that ownership change was functional to securing efficiency and competitiveness in the late twentieth-century telecommunications industry.
Currently, no globally agreed mid-upper arm circumference (MUAC) cut-offs exist to identify obesity in pregnant women. This study aimed to validate MUAC as an alternative to BMI for detecting maternal overweight/obesity and establish optimal cut-offs. An ambispective cohort study was conducted in six Eastern Ethiopian hospitals, involving 2502 singleton pregnant women enrolled before 16 weeks of gestation. Maternal weight and MUAC were measured twice (early and late pregnancy). Using early-pregnancy BMI as the gold standard, MUAC’s diagnostic accuracy was evaluated via linear regression and receiver operating characteristic (ROC) curves. Optimal MUAC cut-off points were determined using Youden’s index, and diagnostics were calculated to evaluate MUAC performance. A significant positive correlation was observed between BMI and MUAC (early pregnancy: r 0·69; late pregnancy: r 0·72). Optimal MUAC cut-offs for overweight were 25·95 cm (early) and 27·05 cm (late); for obesity, 27·75 cm (early) and 28·85 cm (late), with high sensitivity, specificity and predictive values. The regression equations were as follows: BMI during early pregnancy = 1·09 + 0·89 × MUAC (95 % CI 0·85, 0·93; P < 0·001) and late-pregnancy BMI = –1·69 + 0·94 × MUAC (95 % CI 0·90, 0·98; P < 0·001). The MUAC values ≥ 26 cm for maternal overweight and ≥ 28 for maternal obesity demonstrated good discriminatory performance and may serve as practical screening thresholds in resource-limited settings. Broader validation across diverse populations could facilitate the integration of MUAC into routine antenatal screening programmes, strengthening early identification and management of maternal overweight/obesity.
This article analyzes the development paradox posed by the energy transition. It examines the interplay between Zimbabwe’s lithium potential and the dominant role played by China in the sector. Zimbabwe’s attempts to become a leading supplier of lithium through a series of policy interventions coincides with China’s growing electric vehicle and battery markets that fuel the mineral’s demand. However, power asymmetries in the relationship—as well as domestic constraints posed by weak state capacity, political economy challenges, and social costs of mining—limit the Zimbabwe government’s ability to translate its mineral wealth into developmental outcomes. This illustrates the broader dilemma of the global energy transition for producer countries: critical minerals do not automatically yield development; instead, outcomes depend on enhancing domestic agency and regulating external influence.