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Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. However, they lack specimen collection and diagnosis dates to assign location of onset. Algorithms to classify CDI onset location using claims data have been published, but the degree of misclassification is unknown.
Methods:
We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016–2021 to Medicare beneficiaries with fee-for-service Part A/B coverage. We calculated sensitivity of ICD-10-CM codes in claims within ±28 days of EIP specimen collection. CDI was categorized as hospital, long-term care facility, or community-onset using three different Medicare claims-based algorithms based on claim type, ICD-10-CM code position, duration of hospitalization, and ICD-10-CM diagnosis code presence-on-admission indicators. We assessed concordance of EIP case classifications, based on chart review and specimen collection date, with claims case classifications using Cohen’s kappa statistic.
Results:
Of 12,671 CDI cases eligible for linkage, 9,032 (71%) were linked to a single, unique Medicare beneficiary. Compared to EIP, sensitivity of CDI ICD-10-CM codes was 81%; codes were more likely to be present for hospitalized patients (93.0%) than those who were not (56.2%). Concordance between EIP and Medicare claims algorithms ranged from 68% to 75%, depending on the algorithm used (κ = 0.56–0.66).
Conclusion:
ICD-10-CM codes in Medicare claims data had high sensitivity compared to laboratory-confirmed CDI reported to EIP. Claims-based epidemiologic classification algorithms had moderate concordance with EIP classification of onset location. Misclassification of CDI onset location using Medicare algorithms may bias findings of claims-based CDI studies.
Failure to attract external financing is a common puzzle for start-up firms and often leads to the use of entrepreneurs' personal funding, typically with the help of their family. With little entrepreneurial experience, nascent entrepreneurs will have no factual signals to show external investors, except their characteristics or those of their family. The literature mainly focuses on the net effects of entrepreneurs' personal capital endowments in isolation on start-up capital structure despite emerging appreciation of the importance of family-related factors. However, little is known about which combinations of capital endowments across capital dimensions (i.e., human, social, and financial capital) or generations (i.e., parent and child) will likely affect the level of external funding. Drawing on signaling theory, we adopt a configurational approach to examine the compositions of intergenerational capital endowments that are sufficient to shape external funding. Conducting a fuzzy-set qualitative comparative analysis of Chinese privately owned enterprises of nascent entrepreneurs, we identify four typical family prototypes that feature intergenerational capital endowments for low external funding. Findings highlight the significance of family dynamics in China and their role in shaping new venture financing by displaying intergenerational signals.
Widespread claims of voter fraud following the 2020 election were leveraged in an attempt to overturn the result. While many studies have focused on White Americans’ acceptance of these claims, few have examined the responses of Americans of color. This study explores how racial civic pride influences attitudes toward voter fraud claims among different racial groups. We turn to the 2020 CMPS and find that for Black, Latino, and Asian Americans, increased racial civic pride correlates with reduced belief in voter fraud. In contrast, White Americans with higher racial civic pride are more likely to believe such claims. This divergence is evident across all partisan groups. For non-White Americans, racial civic pride is tied to historical struggles for voting rights and racial justice, with voter fraud allegations threatening these values. Conversely, for White Americans, high racial civic pride is linked to preserving their dominance and status. Finally, we find that voter fraud beliefs are not without consequence: they diminish trust in electoral democracy, result in greater support for restrictive electoral policies, and increase support for future violence. Together, these results highlight the differential influence of race and racial civic pride on Americans’ democratic beliefs.
The literature shows that social media enhances individual stakeholders’ ability to directly influence firm behaviors, paying less attention to how it enables different stakeholder groups to influence firms collectively. Drawing on the stakeholder multiplicity perspective in stakeholder theory, this study theorizes and empirically demonstrates that social media can empower lower-salience stakeholders to drive the actions of higher-salience stakeholders to influence firm behaviors. By analyzing 506 consumer crises involving foreign and local companies in China from 2000 to 2020, we find that firms take more substantial responsibility when confronted with consumers’ social-media-based collective actions than when confronted with conventional channels of consumer complaints. This heightened responsibility stems mainly from collective actions’ tendency to spur law-enforcing agencies into addressing alleged firm misdeeds, demonstrating a stakeholder multiplicity effect of social media empowerment. We also identify the institutional contingency of this effect, showing that local governments’ bureaucratic capacity positively moderates collective actions’ effect on law-enforcing actions, whereas their intervention in firms’ operational decisions negatively moderates law-enforcing actions’ effect on firms’ responsibility assumption. This study extends the understanding of social media's relationship with stakeholder influence and consolidates the stakeholder multiplicity perspective in stakeholder theory.
Environmental impacts of food systems have stimulated research to examine how to create healthy diets that will be more sustainable while meeting nutrient requirements. Increasing compliance with existing food-based dietary guidelines in most jurisdictions could be a first step to improve health and reduce environmental impact. MyPlanetDiet was an all-Ireland 12-week randomised controlled trial designed to inform sustainable healthy dietary guidelines. Healthy adults (n 355) aged 18–64 years with moderate-to-high greenhouse gas emitting (GHGE) diets were recruited from three study sites on the island of Ireland. The aim of this research is to assess the relationship between dietary intakes, diet-related environmental impacts and metabolic health using baseline data collected during the MyPlanetDiet study. Dietary assessments collected using Foodbook24 were used to calculate diet-related GHGE, adherence to healthy eating guidelines (HEG) and healthy eating index (HEI) score. Anthropometrics and metabolic health markers (e.g. lipids, glucose and insulin) were included. Overall HEG adherence was low, with 43 % meeting zero or one HEG food group recommendations. Adherence to 4 + HEG food group targets was associated with 31 % lower diet-related GHGE compared with those with lowest adherence. Higher HEG adherence was associated with lower BMI and waist circumference and higher HEI scores. While our findings suggest HEG adherence is associated with positive health and environmental impacts, substantial behaviour change will be needed to meet existing HEG. Further research is needed to assess response and acceptability to HEG. However, adherence to HEG may be an important first step to reducing the environmental impact of food consumption.
This paper examines the impact of demographic change on political perceptions, specifically attitudes toward the January 6th attack on the U.S. Capitol. Utilizing data from the 2020 Collaborative Multiracial Post-Election Survey, we explore how changes in county-level nonwhite populations influence whether individuals label the event as a protest or an insurrection. Our findings reveal a curvilinear relationship: respondents in counties with moderate increases in nonwhite populations are more likely to view the event as an insurrection, while those in counties with substantial increases tend to see it as a protest. This pattern holds across racial groups but is primarily driven by respondents who did not vote for President Trump. The study shows the broader implications of demographic shifts on political stability and social cohesion, highlighting how changes in racial and ethnic composition shape interpretations of major political events. These insights are crucial for understanding voter behavior and political messaging in the 2024 presidential election.
Here we evaluate the skin coefficient of friction for steady turbulent radial wall jets across smooth and rough surfaces. Although the Colebrook equation has been used successfully for many decades to evaluate friction factors for flows through smooth and rough pipes, how roughness affects the skin friction coefficient for steady turbulent radial wall jets remains unclear. Here we explore a Colebrook-type equation for skin friction coefficients associated with single-phase turbulent radial wall jets arising from orthogonally impinging circular jets. The fully iterative solution, based on well-established concepts of turbulent wall-bounded flow, is presented along with a power-law approximation and a non-iterative approximation for the friction coefficient derived therefrom. We find the skin coefficient of friction defined on the peak radial velocity to be a function of position over rough but not smooth surfaces in contrast to pipe friction factors that remain independent of axial position. These results follow expected trends, explain prior heterogeneity in power-law expressions for the skin friction coefficient and have significant implications for the industrial use of jets in mixing vessels.
Cognitive behavioural therapists and practitioners often feel uncertain about how to treat post-traumatic stress disorder (PTSD) following rape and sexual assault. There are many myths and rumours about what you should and should not do. All too frequently, this uncertainty results in therapists avoiding doing trauma-focused work with these clients. Whilst understandable, this means that the survivor continues to re-experience the rape as flashbacks and/or nightmares. This article outlines an evidence-based cognitive behavioural therapy (CBT) approach to treating PTSD following a rape in adulthood. It aims to be a practical, ‘how to’ guide for therapists, drawing on the authors’ decades of experience in this area. We have included film links to demonstrate how to undertake each step of the treatment pathway. Our aim is for CBT practitioners to feel more confident in delivering effective trauma-focused therapy to this client group. We consider how to assess and formulate PTSD following a rape in adulthood, then how to deliver cognitive therapy for PTSD (CT-PTSD; Ehlers and Clark, 2000). We will cover both client and therapist factors when working with memories of rape, as well as legal, social, cultural and interpersonal considerations.
Key learning aims
To understand the importance of providing effective, trauma-focused therapy for survivors of rape in adulthood who are experiencing symptoms of PTSD.
To be able to assess, formulate and treat PTSD following a rape in adulthood.
How to manage the dissociation common in this client group.
To be able to select and choose appropriate cognitive, behavioural and imagery techniques to help with feelings of shame, responsibility, anger, disgust, contamination and mistrust.
For therapists to learn how best to support their own ability to cope with working in a trauma-focused way with survivors of rape and sexual violence.
Ultrasound-guided wire localisation may improve intra-operative identification and outcomes of non-palpable cervical lymphadenopathy in a previously treated neck. We undertook a literature search and present our case series to determine the safety and efficacy of ultrasound-guided wire localisation.
Methods
A search of databases up to 29 April 2024 was performed. At our tertiary centre, ultrasound-guided wire localisation was utilised for 20 patients with cervical lymphadenopathy between February 2021 and April 2024.
Results
Seventeen studies with a combined total of 92 patients were identified, with one complication reported. Within our case series, all 20 patients had accurate lesion localisation using ultrasound-guided wire localisation and none required repeat operations.
Conclusion
Ultrasound-guided wire localisation is a safe and cost-effective technique for lesions in an otherwise difficult area to operate, providing confidence to the multidisciplinary team, particularly where histopathology indicates benignity. Surgical outcomes do not appear worse than outcomes without ultrasound-guided wire localisation. We advocate its use provided appropriate patient selection is considered.
In the era of the competition for the first transatlantic flight at the beginning of the nineteenth century, numerous accidents occurred. Whereas engine failure, bad weather and navigational problems are usually held responsible, the human factor has hardly been addressed.
Methods
In view of current insights, an inventory was made of possible physiologic and otoneurologic factors that could have contributed to failures and accidents.
Results
Extreme fatigue, hyperventilation with vestibular hyperreactivity and airsickness may have played roles. When flying in the dark and in clouds, pilots were subject to spatial disorientation because of vestibulo-visual conflicts and gravitational misinformation. The loudness of the engines was deafening, which may have caused noise-induced vertigo. In some cases, asymptomatic third-window lesions may have become manifest and may have contributed to dizziness.
Conclusion
Accidents and failures in the early days of aviation were not only the result of technical defects. Undoubtedly, human physiology played a role as well.
This article examines the complex dynamics between the intelligentsia and the broader population in the formation of national identity by looking at a case of intra-societal conflict. The article focuses on Western Belarus – the northern portion of the Polish-Soviet frontier in the interwar period – which was historically influenced by Polish, Belarusian, Lithuanian and Ukrainian cultures. In this region, the Belarusian intelligentsia's efforts to promote national enlightenment were initially met with scepticism and even hostility from the broader population. The discrepancy between the intelligentsia's self-perceived role as the nation's vanguard and society's apathy towards issues related to national identity led to internal conflict. Drawing upon Belarusian and Polish archival collections, the Belarusian interwar press and oral history interviews, the article offers an alternative understanding of the challenges associated with the process of nation-building in Eastern Europe in highlighting the often overlooked perspectives of the ordinary people who were at the centre of these intellectual endeavours.
Asian Americans are the fastest growing racial group in the US electorate, yet they are significantly under-represented in political office. How do predominantly immigrant groups like Asian Americans close this representation gap? We build on existing theories of minority representation and immigrant assimilation by highlighting the importance of a group’s political incorporation into American society. We argue that the representation of minority immigrant groups in political office requires social integration and the acquisition of civic resources, processes that can take considerable time. Using new data on Asian American state legislators spanning half a century, we find that immigration in prior decades is associated with greater political representation, while contemporaneous population size has either no independent impact or a negative one. Other indicators of immigrant social integration, including citizenship status, language ability, education, and income, also predict the likelihood of co-racial representation in political office. Our results suggest political representation gaps of immigrant groups narrow over time, though this may be a non-linear process. Our findings also imply that the least integrated members of immigrant groups are the most likely to be affected by representational deficits.
Bollywood films, the highly commercial films by Indian producers for Indian audiences, have always been Hindi-dominant, and despite the increased incorporation of English over time, the speech of urban elite main characters remains Hindi matrix. This is at odds with the code-switching patterns of urban elites in other Indian media, such as chat shows, and spoken conversation, where switching among such speakers is often English dominant. Young urban elites may use English in isolation; their Bollywood equivalents sometimes do so also, but always with standard syntax. In this article we show how for Bollywood films, English without code-switching typically occurs in the speech of anglicised minorities such as Goan Catholics; furthermore, their English is indexed by the morphosyntactic features of Indian English. This contrasts with usage outside film, where Indian English features have been shown to be broadly distributed. This conservatism of Bollywood speech reflects conflicting attitudes towards an endonormative variety of English within India.
After the two world wars, numerous Germans were forcibly removed or fled their homelands in eastern Europe, resettling in Germany. In both postwar periods, the Weimar Republic and the Federal Republic of Germany established compensation systems to indemnify the material losses and damages suffered by these refugees: the Gewaltschädengesetze (Violent Damages Laws) of 1921 and the Lastenausgleichsgesetz (Equalization of Burdens Law) of 1952. The article offers a unique comparative insight into the functioning of the two compensation mechanisms, examining six cases of applicants (or their heirs) who lost their homes twice in their lives and applied for compensation twice: first after the end of the First World War and then following the Second World War. The diachronic comparison reveals the complex nature of German national belonging, the persistence of the term Volksgemeinschaft in modern German history, and the role of class status in the context of compensation after both wars.
On 24 December 1871, Giuseppe Verdi’s opera Aida premiered in Cairo’s Khedivial Opera House. The Khedive of Egypt, Ismail, had commissioned Verdi to compose the opera as part of a larger program of urban renewal that had peaked with the Suez Canal’s inauguration in November 1869. Wide boulevards, landscaped gardens, and luxury hotels of iron, steel, and the improved glass of the nineteenth-century modernized sections of Cairo and Alexandria. In anticipation of the many guests who planned to attend the canal’s inauguration, Ismail funded the construction of a road leading directly from Cairo to the pyramids and patronized the construction of a Khedivial Opera House.1
The anthropic principle (AP) states that “what we can expect to observe must be restricted by the conditions necessary for our presence as observers”. But the phrase “our presence as observers” cannot be uniquely interpreted in the context of the theories within which AP is meant to be understood and applied: namely, for effective theories. We thus describe and defend a reformulation of AP, which we dub the effective observation principle (EOP). EOP describes what we can expect to observe in physical settings by considering our ‘observational situation’ (and not, specifically, ‘observers’)—understood solely in terms of effective theories.