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Older adults (≥65) often receive antibiotics in emergency departments (ED), where guideline concordance is low with both overuse and underuse; whether community disadvantage drives these patterns is unknown.
Methods:
We analyzed electronic health records from 1,318,281 ED encounters among 790,562 adults ≥65 (2015–2024). Outcomes were guideline concordance and components (overuse, underuse). To address omitted variables and reverse causality, we used two-stage instrumental-variable models with Social Vulnerability Index (SVI) and Social Deprivation Index (SDI) as exposures, instrumented by maximum state Earned Income Tax Credit, adjusting for patient, facility, state, and time covariates.
Results:
16.8% of encounters were non-concordant (overuse 9.5%; underuse 7.2%). Concordance improved to 83.8% in 2024. In IV models, each 10-point increase in SVI reduced concordance by 6.37 percentage points (pp) (SE 0.69) and each 10-point increase in SDI by 1.84 pp (SE .20; P < .0005). Declines reflected higher underuse (+0.43 pp per 10-point SVI; +0.12 pp per 10-point SDI) with less overuse (−0.10 and −0.30 pp). Concordance was higher for Black (+12.90 pp vs White) and Medicaid-insured patients (+5.40 pp vs commercial). Overuse was higher in rural (+7.90 pp vs metropolitan) and academic EDs (+5.00 pp vs non-academic), whereas underuse was more common in metropolitan (+42.50 pp) and non-academic EDs (+32.70 pp). Spatial analyses found high deprivation/low concordance in the South and low deprivation/high concordance in the Midwest.
Conclusions:
Community disadvantage may causally predict lower guideline-concordant antibiotic prescribing for older adults, primarily via underuse. Stewardship should address underuse and overuse and prioritize disadvantaged regions where gaps are greatest.
We investigate the developmental consequences of slave-raiding in Eastern Europe, the largest source of slaves in the early modern world after West Africa. Drawing on a wide-ranging new dataset, we estimate that at least five million people were captured from hundreds of locations across Eastern Europe between the fifteenth and eighteenth centuries. We hypothesize that, over time, raids encouraged an economically advantageous process of defensive state-building linked to raided societies’ resistance to and lack of integration into the slave trade. Using difference-in-differences and instrumental variables strategies, we find that exposure to raids is positively associated with long-run urban growth and related indicators of demographic and commercial development. Consistent with our posited mechanism, raided areas constructed more robust defensive infrastructures and attained higher levels of military, administrative, and fiscal capacity. Our findings suggest that the structure of slave production conditions its developmental legacies, cautioning against drawing generalizations from the African context.
This paper examines how tourism served as a vehicle for informal political propaganda in postwar Taiwan under Guomindang (GMD) rule. Following the Second World War, when the GMD began governing Taiwan, the government recognized tourism’s potential for ideological projection and national legitimation. Through analysis of tourism promotional materials, policy documents, and news reports from Taiwan, Hong Kong, and Southeast Asia, this paper demonstrates how Taiwan deliberately positioned itself as the authentic guardian of ‘Cultural China’ within a competitive regional context. The GMD government strategically deployed Chinese cultural traditions and landmarks as tourism attractions to establish Taiwan’s cultural legitimacy, particularly targeting overseas Chinese communities through ‘returning home tourism’ initiatives that framed Taiwan as the authentic homeland for all ethnic Chinese. Significantly, while Hong Kong promoted itself under the banner ‘The Orient is Hong Kong’ primarily to Western tourists, Taiwan’s dual strategy sought to attract both international visitors interested in experiencing ‘mysterious China’ and overseas Chinese through tourism experiences that showcased ‘Free China’ or ‘Cultural China’. This approach constituted a systematic attempt to legitimize Taiwan’s claim to represent China proper, even as its formal diplomatic position deteriorated in the 1970s. The paper argues that Taiwan’s tourism strategy represented a deliberate political calculation that transcended economic objectives, transforming cultural tourism into a powerful tool for asserting sovereignty and maintaining international relevance despite growing diplomatic isolation.
The black soldier fly (BSF) (Hermetia illucens) has gained global economic relevance as a sustainable resource for animal feed, organic waste bioconversion, and the production of nutrient-rich frass for agricultural use. Its ability to convert low-value waste streams into high-value proteins, lipids, and fertilisers makes BSF a key component of emerging circular-economy models. However, the influence of vegetable and fruit waste (VFW) substrates on insect performance, nutrient composition, frass quality, and economic efficiency remains poorly defined. This study evaluated five substrate levels obtained by mixing laying hen feed with VFW at 0%, 25%, 50%, 75%, and 100%, assessing their effects on the growth performance, body measurements, chemical composition, frass characteristics, and economic traits of BSF larvae and prepupae. The results showed that up to 75% VFW can be used to rear BSF up to 23 days of age without compromising growth traits. Substrate reduction ranged from 67.2% to 89.4%, and larval-to-prepupal conversion increased with feed intake. VFW level significantly affected larval and prepupal nutrient profiles, including dry matter, crude protein, ether extract, nitrogen-free extract, and chitin. Frass from the 100% VFW substrate exhibited the highest nutrient concentration, although this inclusion level impaired feed conversion due to elevated fibre content. Economic analysis indicated that using VFW can reduce substrate costs without negatively affecting revenue. Overall, a VFW inclusion level of up to 75% is recommended as the optimal balance between insect growth efficiency, nutrient recycling, and frass fertilising potential.
A coupled computational-fluid-dynamics/finite-element methodology is implemented to investigate the free aerodynamic separation of clusters of equally sized spheres arranged in regular configurations in Mach-20 flow, representing an idealized meteoroid-fragmentation scenario. The regular nature of the initial agglomeration geometries – touching sphere pairs, tetrahedral four-sphere arrangements and face-centred-cubic 13-sphere configurations – allows a systematic exploration of both individual sphere motions and bulk cluster dynamics as the initial orientation is varied. For sphere pairs, a stable lifting configuration arises when the spheres are in contact in a skewed configuration, a phenomenon that can also emerge in the more populous clusters. In the tetrahedral survey, comprising 38 initial orientations, shock surfing of downstream bodies is found to play a significant role in driving the separation dynamics. Despite substantial variations in detailed sphere motions with initial orientation, the trajectory type and final lateral velocity collapse reasonably well with the initial polar angle of the sphere within the cluster. Indices describing the bluntness and asymmetry of the initial configuration are introduced and correlate well with the collective cluster dynamics, though not always in an intuitive way. For the 13-sphere clusters, the dependency of individual sphere lateral velocities follows a similar trend with initial polar angle to the four-sphere case, suggesting that a simplified separation model may be possible for such configurations. The influence of the initial cluster bluntness on the bulk dynamics is somewhat reduced, however, indicating a tendency towards more homogeneous separation as the cluster population is increased.
Coordinated urban and rural development is crucial for reducing inequality and achieving common prosperity. Using panel data from 57 counties in Zhejiang Province from 2015 to 2019, this study examines the impact of digital economy development on the urban–rural income gap, with particular attention to its role in digital poverty alleviation and the underlying transmission mechanisms. The results show that while digital economy development contributes to poverty alleviation by significantly increasing household income in both urban and rural areas, it simultaneously widens the urban–rural income gap. The analysis of mechanisms reveals that nonagricultural employment (NAE), innovation, and entrepreneurship mediate this relationship, disproportionately benefiting urban areas. The heterogeneity analysis further indicates that human capital (HC) and business environment (BE) disparities amplify the widening effect of digital economy development on the urban–rural income gap, while improved infrastructure reduces barriers to resource flow, mitigating the gap. These findings highlight the dual effects of digital economy development, offering critical policy insights for promoting digital poverty reduction while addressing regional disparities to achieve common prosperity.
Hydrocalumite, a natural Ca-Al Layered Double Hydroxide (LDH), also known as a hydrated calcium aluminate and an aluminate ferrite monosubstituted (AFm) phase in cement chemistry, has been studied by single-crystal and powder X-ray diffraction, electron probe microanalysis and Raman spectroscopy on a sample from Boisséjour, Puy-de-Dôme, Auvergne-Rhône-Alpes, France. The mineral is monoclinic, space group P2/c, a = 10.0234(3), b = 11.5131(3), c = 16.2989(5) Å, β = 104.205(3)°, V = 1823.39(9) Å3 and Z = 4. The crystal structure has been refined to R1 = 0.0505 based on 6296 unique reflections. The empirical chemical formula of the mineral (Ca, Al, Cl according to electron probe microanalysis; CO2, OH and H2O on the basis of crystal-structure refinement and Raman spectroscopy) is Ca3.96Al2.04(OH)12.04Cl0.96(CO3)0.5˙5H2O that can be idealized as Ca4Al2(OH)12Cl(CO3)0.5·5H2O. The presence of (CO3)2– and (OH)– anionic groups and (H2O)0 molecules is confirmed by Raman spectroscopy. The strongest reflections in the powder X-ray diffraction pattern are (d in Å, Irel in %): 7.89, 100; 3.951, 34; 3.860, 59; 3.753, 26; 2.884, 73; 2.527, 27; 2.501, 38; 2.453, 64; 2.433, 30; 2.327, 25. The crystal structure study reveals the ordering of interlayer species: Cl– and (CO3)2– anions and H2O molecules, which means that both anions play a species-defining role in contrast to the previous suggestions on mono-anionic end-members (with either Cl or OH or CO3 anions). The ordering of two different anions is usually not observed for other LDHs and appears to be a crystal-chemical feature of the Ca-Al LDH members. This work is dedicated to the 150th anniversary of the Mineralogical Society of the UK and Ireland. Hydrocalumite is a mineral with a 90-year history starting from North Ireland, UK, and is a good example of joint efforts of different mineralogical scientific societies in deciphering scientific puzzles.
Do voters take into account the deaths of family members and close friends when evaluating the government’s response to the COVID-19 pandemic—particularly when that response is problematic or even negligent—as in the case of Mexico under the Andrés Manuel López Obrador (AMLO) administration? Using data from the 2021 Mexican Election Study, this research shows that opposition partisans who lost close friends or relatives to COVID-19 are more likely to evaluate the government’s response to the pandemic negatively. In contrast, National Regeneration Movement (MORENA) partisans do not hold accountable their co-partisan government. They are no more likely to evaluate the government’s response negatively, even when they experience the same losses. Experimental evidence further shows that MORENA partisans do not lower their evaluations of government performance after being informed about the country’s high COVID-19 mortality. They are also more likely to underestimate the number of COVID-19 deaths in the country, even after being presented with official mortality figures. These findings underscore how partisanship can cloud accountability, leading some voters to dismiss objective information and to judge government performance primarily through the lens of partisan loyalty. Partisanship can distort the accountability mechanism at the core of retrospective voting even during a major health crisis.
Understanding the causes and drivers of extinction is critical for mitigating future anthropogenic extinctions. This study explored the extinction process of the Crested Ibis Nipponia nippon in Japan, focusing on the last wild population on Sado Island. An integrated population model–population viability analysis (IPM-PVA) framework was applied to estimate demographic parameters and population dynamics using four historical data sources, i.e. population counts, records of dead or rescued individuals, reproductive data, and captures for captive breeding. The IPM estimated an average of 0.703 fledglings per breeding pair per season, with adult and juvenile survival rates of 0.870 and 0.730, respectively. Human disturbances were found to substantially reduce fecundity. PVA results indicated an extinction probability of 56.6% under observed historical conditions, which could have been reduced to 11.2% if human access to nesting forests had been restricted. The study identified low fecundity caused by human disturbance at nest-sites as a likely contributor to the species’ extinction. Despite the need for cautious interpretation due to data limitations, this study highlights the practical utility of the IPM-PVA framework in providing detailed insights into the extinction process.
Despite increasing efforts to promote and support breastfeeding, the United States continues to have some of the lowest exclusive and sustained breastfeeding rates globally. Foreign-born immigrants and refugees specifically have been reported to have high initiation but low exclusive breastfeeding (EBF) rates. This scoping review aims to explore what is known about strategies to support breastfeeding among foreign-born mothers in the United States using the Arksey & O’Malley framework for scoping reviews and PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Six databases were searched using a comprehensive search strategy and 2103 articles were identified, of which 31 met eligibility criteria and discussed 33 specific breastfeeding interventions. The articles describe a range of interventions, including breastfeeding promotion and education (n = 30), hands-on breastfeeding support (n = 9), material support like giving breastfeeding supplies and food (n = 16), social support (n = 18) and social marketing campaigns (n = 1) to promote community support for breastfeeding. Common strategies for implementing these interventions include individual counselling (n = 21), group breastfeeding education (n = 17), informational materials (n = 12) and family support promotion (n = 11). In total, 87·3% of the immigrant mothers targeted by these breastfeeding support interventions were Hispanic, and 4·5% and 7·0% were mothers of African and Asian descent, respectively. This study reveals limited data and key gaps in efforts to preserve the culture of breastfeeding and promote EBF among multicultural immigrant and refugee families, particularly non-Hispanic groups. Addressing these gaps will improve optimal infant feeding practices among foreign-born mothers in the United States and, consequently, maternal and infant health outcomes.