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To determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent cares (PUCs) by patient race/ethnicity, insurance, and language.
Design:
Multi-center cohort study.
Setting:
Nine organizations (92 locations) from 22 states and Washington, DC.
Participants:
Patients ages 6 months–18 years evaluated April 2022–April 2023, with acute viral respiratory infections, otitis media with effusion (OME), acute otitis media (AOM), pharyngitis, community-acquired pneumonia (CAP), and sinusitis.
Methods:
We compared the use of first-line (FL) therapy as defined by published guidelines. We used race/ethnicity, insurance, and language as exposures. Multivariable logistic regression models estimated the odds of FL therapy by group.
Results:
We evaluated 396,340 ARI encounters. Among all encounters, 351,930 (88.8%) received FL therapy (98% for viral respiratory infections, 85.4% for AOM, 96.0% for streptococcal pharyngitis, 83.6% for sinusitis). OME and CAP had the lowest rates of FL therapy (49.9% and 60.7%, respectively). Adjusted odds of receiving FL therapy were higher in Black Non-Hispanic (NH) (adjusted odds ratio [aOR] 1.53 [1.47, 1.59]), Asian NH (aOR 1.46 [1.40, 1.53], and Hispanic children (aOR 1.37 [1.33, 1.41]), compared to White NH. Additionally, odds of receiving FL therapy were higher in children with Medicaid/Medicare (aOR 1.21 [1.18–1.24]) and self-pay (aOR 1.18 [1.1–1.27]) compared to those with commercial insurance.
Conclusions:
This multicenter collaborative showed lower rates of FL therapy for children of the White NH race and those with commercial insurance compared to other groups. Exploring these differences through a health equity lens is important for developing mitigating strategies.
Accurate appraisal of one’s own abilities (i.e., insight) is necessary for appropriate compensatory behaviors and sustained independence during aging. Although insight is often purported to be related to executive functioning (EF), nuanced understanding of the cognitive correlates of insight for functional abilities among nondemented older adults is lacking. Because insight shares neuroanatomic underpinnings with time-based prospective memory (PM), the present study examined the contributions of time-based PM, beyond event-based PM and other potential cognitive confounds (i.e., episodic memory, time estimation, and EF), in predicting insight into one’s own performance on instrumental activities of daily living (IADLs) among community-dwelling older adults.
Method:
A group of 88 nondemented, community-dwelling older adults completed performance-based measures of time- and event-based PM, episodic memory, time estimation, and EF, as well as IADL tasks followed by self-appraisals of their own IADL performance as indices of insight.
Results:
Time-based PM was moderately-to-strongly associated with insight, beyond event-based PM, time estimation, and episodic memory [F(1,83) = 11.58, p = .001, ηp2 = .122], as well as beyond EF and demographic covariates [F(1,79) = 10.72, p = .002, ηp2 = .119].Specifically, older adults who performed more poorly on a time-based PM task overestimated the efficiency of their own IADL performance to a greater extent.
Conclusions:
Findings suggest that nondemented older adults with poorer time-based PM may be more prone to inaccurately appraising their functional abilities and that this vulnerability may not be adequately captured by traditional EF measures.
Social-creative metaverses, which foster user creativity and encourage user-generated content, promise a revolution in digital creativity. However, metaverse developers often enforce strict regulations on user-generated content through user terms and conditions, restricting or permitting its reuse. These rules place an artificial barrier between users and their copyright, often waiving moral rights and making economic rights subject to mandatory licences. Using Second Life as a case study, this article demonstrates how metaverse regulations undermine users’ intellectual property rights and control over their creations. Furthermore, it examines emerging intellectual property policies in Japan, South Korea, and China, noting a lack of awareness regarding the impact of these regulatory layers on user creativity. Highlighting the importance of the external regulation of user terms and conditions, the article proposes potential policies and strategies for East Asia and beyond to protect users’ copyright ownership and mitigate the negative effects of restrictive metaverse terms and conditions.
A discourse-syntax interface-based approach to three types of focus – Information Focus, Corrective or Contrastive Focus, and Mirative Focus – is discussed in this paper. In my approach, I address the role of discourse/agreement features in the syntactic process of Agree in the Minimalist Program as well as their possible combination with an Edge Feature to trigger attraction of each discourse category, comparing Spanish and English. The data I examine are taken from experimental work, based on two original experiments that test the grammaticality/acceptability of sentences with fronted and in situ focus by native speakers of English and Spanish. The parametric variation detected in the two languages is accounted for by an analysis based on the availability of inheritance of discourse features in the relevant language alongside the activation of an Edge Feature, triggering movement of the relevant discourse category.
High-definition transcranial direct current stimulation (HD-tDCS) has the potential to improve cognitive functioning following neurological injury and in neurodegenerative conditions. In this case report, we present the first use of HD-tDCS in a person with severe anterograde amnesia following carbon monoxide poisoning.
Method:
The participant underwent two rounds of HD-tDCS that were separated by 3 months (Round 1 = 30 sessions; Round 2 = 31 sessions). We used finite element modeling of the participant’s structural MRI to develop an individualized montage that targeted multiple brain regions involved in memory encoding, as identified by Neurosynth.
Results:
Overall, the participant’s objective cognitive functioning improved significantly following Round 1, declined during the 2 months without HD-tDCS, and again improved following Round 2. Subjective informant reports from family and medical personnel followed this same pattern of improvement following each round with a decline in between rounds. We also provide preliminary evidence of altered brain activity during a learning/memory task using functional near-infrared spectroscopy, which may help establish the physiological effects of HD-tDCS in future work.
Conclusion:
Overall, these findings reinforce the potential value of HD-tDCS as a user-friendly method of enhancing cognition following anoxic/hypoxic brain injury.
The velocity gradient tensor can be decomposed into normal straining, pure shearing and rigid rotation tensors, each with distinct symmetry and normality properties. We partition the strength of turbulent velocity gradients based on the relative contributions of these constituents in several canonical flows. These flows include forced isotropic turbulence, turbulent channels and turbulent boundary layers. For forced isotropic turbulence, the partitioning is in excellent agreement with previous results. For wall-bounded turbulence, the partitioning collapses onto the isotropic partitioning far from the wall, where the mean shearing is relatively weak. By contrast, the near-wall partitioning is dominated by shearing. Between these two regimes, the partitioning collapses well at sufficiently high friction Reynolds numbers and its variations in the buffer layer and the log-law region can be reasonably modelled as a function of the mean shearing strength. Altogether, our results highlight the expressivity and broad applicability of the velocity gradient partitioning as advantages for turbulence modelling.
This paper studies a novel Brownian functional defined as the supremum of a weighted average of the running Brownian range and its running reversal from extrema on the unit interval. We derive the Laplace transform for the squared reciprocal of this functional, which leads to explicit moment expressions that are new to the literature. We show that the proposed Brownian functional can be used to estimate the spot volatility of financial returns based on high-frequency price observations.
SARS-CoV-2 asymptomatic surveillance testing (AST) is a common strategy to minimize the risk of nosocomial infection in patients and healthcare personnel. In contrast to admission screening, post-admission AST was less widely adopted.
Objective:
This study describes the diagnostic yield of post-admission serial SARS-COV-2 testing in hospitalized patients at a large cancer center with mostly double-occupancy rooms.
Design:
Retrospective cohort study design. Post-admission SARS-CoV-2 tests were examined over a 18 month study period. Positive results were reviewed to determine true hospital-onset infections using a combination criteria of screening all sample cycle threshold (Ct) values >30, results of non-concordant repeat testing, and clinical symptoms.
Results:
Post-admission serial testing of 15,048 hospitalized patients during an 18-month study period at a tertiary care cancer center detected hospital-onset infection in 1.6% (n = 245 patients). Among all hospital-onset positive SARS-CoV-2 RNA tests, 13% were clinically false positive. Most true infections were mild to moderate in severity.
Conclusions:
In summary, post-admission serial testing in a high-risk setting is a low-yield strategy with several unfavorable effects and should no longer be routinely applied.
We propose an individual claims reserving model based on the conditional Aalen–Johansen estimator, as developed in Bladt and Furrer ((2023a) arXiv:2303.02119.). In our approach, we formulate a multi-state problem, where the underlying variable is the individual claim size, rather than time. The states in this model represent development periods, and we estimate the cumulative density function of individual claim sizes using the conditional Aalen–Johansen method as transition probabilities to an absorbing state. Our methodology reinterprets the concept of multi-state models and offers a strategy for modeling the complete curve of individual claim sizes. To illustrate our approach, we apply our model to both simulated and real datasets. Having access to the entire dataset enables us to support the use of our approach by comparing the predicted total final cost with the actual amount, as well as evaluating it in terms of the continuously ranked probability score.
Using the Statistical Analysis System (SAS) program shared here, all US hospitals can calculate hospital-specific hospital-acquired infection threshold counts for achieving a pre-specified benchmarked Standardized Infection Ratio performance percentile.
Three-dimensional short-crested water waves are known to host harmonic resonances (HRs). Their existence depends on their sporadicity versus their persistency. Previous studies, using a unique yet hybrid solution, suggested that HRs exhibit sporadic instability, with the domain of instability exhibiting a bubble-like structure which experiences a loss of stability followed by a re-stabilization. Through the calculation of their complete multiple solution structures and normal forms, we discuss the particular harmonic resonance (2,6). The (2,6) resonance was chosen, not only because it is of lower order, and thus more likely to be significant, but also because it is representative of a fully developed three-dimensional water wave field. Its appearance, growth rate and persistency are discussed. On our converged solutions, we show that, at an incidence angle for which HR (2,6) occurs, the associated superharmonic instability is no longer sporadic. It was also found that the multiple solution operates a subcritical pitchfork bifurcation, so regardless of the value of the control parameter, the wave steepness, a stable branch of the solution always exists. As a result, the analysis reveals two competing processes that either provoke and enhance HRs, or inhibit their appearance and development.
During the automatic docking assembly of aircraft wing-fuselage, using monocular camera or dual-camera to monitor the docking stage of the fork-ear will result in an incomplete identification of the fork-ear pose-position and an inaccurate description of the deviation in the intersection holes’ position coordinates. To address this, a quality inspection and error correction method is proposed for the fork-ear docking assembly based on multi-camera stereo vision. Initially, a multi-camera stereo vision detection system is established to inspect the quality of fork-ear docking assembly. Subsequently, a spatial position solution mathematical model of the fork-ear feature points is developed, and a spatial pose determination mathematical model of fork-ear is established by utilised the elliptical cone. Finally, an enhanced artificial fish swarm particle filter algorithm is proposed to track and estimate the coordinate of the fork-ear feature points. An adaptive weighted fusion algorithm is employed to fuse the detection data from the multi-camera and the laser tracker, and a wing pose-position fine-tuning error correction model is constructed. Experimental results demonstrate that the method enhances the effect of the assembly quality inspection and effectively improves the wing-fuselage docking assembly accuracy of the fork-ear type aircraft.
We present new constrained and free-swimming experiments and simulations in the inertial regime, with Reynolds number $\mbox{Re} = O(10^4)$, of a pair of two-dimensional and three-dimensional pitching hydrofoils interacting in a minimal school. The hydrofoils have an out-of-phase synchronisation, and they are varied through in-line, staggered and side-by-side formations within the two-dimensional interaction plane. It is discovered that there is a two-dimensionally stable equilibrium point for a side-by-side formation. This formation is super-stable, meaning that hydrodynamic forces will passively maintain this formation even under external perturbations, and the school as a whole has no net forces acting on it that cause it to drift to one side or the other. Previously discovered one-dimensionally stable equilibria driven by wake vortex interactions are shown to be, in fact, two-dimensionally unstable, at least for an out-of-phase synchronisation. Additionally, it is discovered that a trailing-edge vortex mechanism provides the restorative force to stabilise a side-by-side formation. The stable equilibrium is further verified by experiments and simulations for freely swimming foils where dynamic recoil motions are present. When constrained, swimmers in compact side-by-side formations experience collective efficiency and thrust increases up to 40 % and 100 %, respectively, whereas slightly staggered formations output an even higher efficiency improvement of 84 %, with an 87 % increase in thrust. Freely swimming foils in a stable side-by-side formation show efficiency and speed enhancements of up to 9 % and 15 %, respectively. These newfound schooling performance and stability characteristics suggest that fluid-mediated equilibria may play a role in the control strategies of schooling fish and fish-inspired robots.
In patients with treatment resistant depression (TRD), the ESCAPE-TRD study showed esketamine nasal spray was superior to quetiapine extended release.
Aims
To determine the robustness of the ESCAPE-TRD results and confirm the superiority of esketamine nasal spray over quetiapine extended release.
Method
ESCAPE-TRD was a randomised, open-label, rater-blinded, active-controlled phase IIIb trial. Patients had TRD (i.e. non-response to two or more antidepressive treatments within a major depressive episode). Patients were randomised 1:1 to flexibly dosed esketamine nasal spray or quetiapine extended release, while continuing an ongoing selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor. The primary end-point was achieving a Montgomery–Åsberg Depression Rating Scale score of ≤10 at Week 8, while the key secondary end-point was remaining relapse free through Week 32 after achieving remission at Week 8. Sensitivity analyses were performed on these end-points by varying the definition of remission based on timepoint, threshold and scale.
Results
Of 676 patients, 336 were randomised to esketamine nasal spray and 340 to quetiapine extended release. All sensitivity analyses on the primary and key secondary end-point favoured esketamine nasal spray over quetiapine extended release, with relative risks ranging from 1.462 to 1.737 and from 1.417 to 1.838, respectively (all p < 0.05). Treatment with esketamine nasal spray shortened time to first and confirmed remission (hazard ratio: 1.711 [95% confidence interval 1.402, 2.087], p < 0.001; 1.658 [1.337, 2.055], p < 0.001).
Conclusion
Esketamine nasal spray consistently demonstrated significant superiority over quetiapine extended release using all pre-specified definitions for remission and relapse. Sensitivity analyses supported the conclusions of the primary ESCAPE-TRD analysis and demonstrated robustness of the results.
We derive some key extremal features for stationary kth-order Markov chains that can be used to understand how the process moves between an extreme state and the body of the process. The chains are studied given that there is an exceedance of a threshold, as the threshold tends to the upper endpoint of the distribution. Unlike previous studies with $k>1$, we consider processes where standard limit theory describes each extreme event as a single observation without any information about the transition to and from the body of the distribution. Our work uses different asymptotic theory which results in non-degenerate limit laws for such processes. We study the extremal properties of the initial distribution and the transition probability kernel of the Markov chain under weak assumptions for broad classes of extremal dependence structures that cover both asymptotically dependent and asymptotically independent Markov chains. For chains with $k>1$, the transition of the chain away from the exceedance involves novel functions of the k previous states, in comparison to just the single value, when $k=1$. This leads to an increase in the complexity of determining the form of this class of functions, their properties, and the method of their derivation in applications. We find that it is possible to derive an affine normalization, dependent on the threshold excess, such that non-degenerate limiting behaviour of the process, in the neighbourhood of the threshold excess, is assured for all lags. We find that these normalization functions have an attractive structure that has parallels to the Yule–Walker equations. Furthermore, the limiting process is always linear in the innovations. We illustrate the results with the study of kth-order stationary Markov chains with exponential margins based on widely studied families of copula dependence structures.
Strontioborite, which was first described in 1960 and later discredited by the then named Commission on New Minerals and Mineral Names of the International Mineralogical Association (IMA CNMMN), has been re-investigated (electron microprobe, single-crystal and powder X-ray diffraction, crystal structure determination and IR spectroscopy) on two specimens, including the holotype, and revalidated by the IMA Commission on New Minerals, Nomenclature and Classification (CNMNC). Strontioborite is known only at the Chelkar salt dome (North Caspian Region, Western Kazakhstan), in halite rocks with bischofite, magnesite, anhydrite, halurgite, boracite, ginorite and celestine. It forms colourless lamellar, scaly or tabular crystals up to 2 mm across. The chemical composition (wt.%, H2O is calculated for (OH)4 = 4 H apfu, according to structural data; holotype/neotype) is: CaO 1.42/0.27, SrO 23.10/23.79, B2O3 67.37/67.57, H2O 8.73/8.72, total 100.62/100.37. The empirical formulae [calculated based on 15 O apfu = O11(OH)4 pfu] of the holotype and neotype specimens are Sr0.92Ca0.10B7.98O11(OH)4 and Sr0.95Ca0.02B8.02O11(OH)4, respectively. The idealised formula is Sr[B8O11(OH)4]. Strontioborite is monoclinic, space group P21, a = 7.6192(3), b = 8.1867(2), c = 9.9164(3) Å, β = 108.357(4)°, V = 587.07(3) Å3 and Z = 2. The strongest reflections of the powder X-ray diffraction pattern [d,Å(I)(hkl)] are: 7.22(100)(100), 5.409(61)(110), 4.090(64)(020), 3.300(48)(210), 2.121(30)($\bar{1}$24) and 2.043(37)(040, 024, $\bar{2}$24). The crystal structure, solved from single-crystal X-ray diffraction data (R = 0.0372), is based upon the (100) layers of polymerised B–O–OH polyanions [B8O11(OH)4]2– and Sr-centred nine-fold polyhedra SrO6(OH)3. The B–O–OH polyanion is the cluster of three tetrahedra and three triangles; these clusters are decorated by the [B2O2(OH)3] pyro-group consisting of two triangles. The layers are linked via vertices of Sr-centred polyhedra, which share seven vertices with B-centred polyhedra of one layer and two vertices with B-centred polyhedra of the adjacent layer, and by the system of H bonds. The crystal chemistry of strontioborite is discussed in comparison with other natural and synthetic borates.
Consider a branching random walk on the real line with a random environment in time (BRWRE). A necessary and sufficient condition for the non-triviality of the limit of the derivative martingale is formulated. To this end, we investigate the random walk in a time-inhomogeneous random environment (RWRE), which is related to the BRWRE by the many-to-one formula. The key step is to figure out Tanaka’s decomposition for the RWRE conditioned to stay non-negative (or above a line), which is interesting in itself.
In Caspers et al. (Can. J. Math. 75[6] [2022], 1–18), transference results between multilinear Fourier and Schur multipliers on noncommutative $L_p$-spaces were shown for unimodular groups. We propose a suitable extension of the definition of multilinear Fourier multipliers for non-unimodular groups and show that the aforementioned transference results also hold in this more general setting.