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To describe neutropenic fever management practices among healthcare institutions.
Design:
Survey.
Participants:
Members of the Society for Healthcare Epidemiology of America Research Network (SRN) representing healthcare institutions within the United States.
Methods:
An electronic survey was distributed to SRN representatives, with questions pertaining to demographics, antimicrobial prophylaxis, supportive care, and neutropenic fever management. The survey was distributed from fall 2022 through spring 2023.
Results:
40 complete responses were recorded (54.8% response rate), with respondent institutions accounting for approximately 15.7% of 2021 US hematologic malignancy hospitalizations and 14.9% of 2020 US bone marrow transplantations. Most entities have institutional guidelines for neutropenic fever management (35, 87.5%) and prophylaxis (31, 77.5%), and first-line treatment included IV antipseudomonal antibiotics (35, 87.5% cephalosporin; 5, 12.5% penicillin; 0, 0% carbapenem).
We observed significant heterogeneity in treatment course decisions, with roughly half (18, 45.0%) of respondents continuing antibiotics until neutrophil recovery, while the remainder having criteria for de-escalation prior to neutrophil recovery. Respondents were more willing to de-escalate prior to neutrophil recovery in patients with identified clinical (27, 67.5% with pneumonia) or microbiological (30, 75.0% with bacteremia) sources after dedicated treatment courses.
Conclusions:
We found substantial variation in the practice of de-escalation of empiric antibiotics relative to neutrophil recovery, highlighting a need for more robust evidence for and adoption of this practice. No respondents use carbapenems as first-line therapy, comparing favorably to prior survey studies conducted in other countries.
This paper critically examines Confucian proposals for social welfare espoused by contemporary Confucian moral and political theorists, who promote a familialist, residual welfare state in which welfare provision should be the family's primary responsibility and public assistance be a last resort only available to the poor without family support. By investigating the situation in South Korea, a country whose welfare system bears a striking resemblance to the Confucian ideal, I argue that the Confucian scheme is inherently flawed. It considers poverty to be a personal failure, idealizes the family as a single unity of common interest free from power hierarchies, and lacks knowledge about social reproduction. Their proposal in actuality humiliates and excludes disadvantaged and marginalized people from social protection, abdicates the state's responsibility for the well-being of citizens, and colludes with capitalism in free riding on women's unpaid labor.
Small, disc-shaped shell beads are recorded as mortuary offerings in many Neolithic and Bronze Age burials in Southeast Asia. Yet the provenance of these artefacts is often obscure, as production processes involve the removal of diagnostic morphological features, negating taxonomic classification. Here, the authors report on the combined isotopic and morphological analysis of a subset of shell beads from the site of Ban Non Wat in north-east Thailand. In addition to identifying freshwater sources for nearly all the beads, the results suggest the presence of multiple shell production centres—each with access to distinct aqueous environments—and widespread exchange in the Bronze Age.
This article examines the ways in which Brazil's African foreign policy during the Ernesto Geisel administration (1974–9) utilised notions of ‘racial democracy’ and the nation's Africanity in framing itself as an intrinsic partner to the continent across the Atlantic. It does this through an analysis of Brazil's involvement at the Second World Black and African Festival of Arts and Culture (FESTAC’77, 15 January–12 February 1977), hosted in Lagos, Nigeria. The international event celebrated past and present contributions of Black and African cultures to global civilisation. An assessment of the Brazilian government's delegation to FESTAC’77 shows how the Geisel administration attempted to depict Brazil as a harmoniously integrated society, where, through a historic process of mixing, the nation's racial identity was united into an equitable whole. In contrast, the propagation of these ideas at FESTAC’77 left the regime's racial ideology vulnerable to attack from international and domestic audiences.
The dynamics of our species’ dispersal into the Pacific remains intensely debated. The authors present archaeological investigations in the Raja Ampat Islands, north-west of New Guinea, that provide the earliest known evidence for humans arriving in the Pacific more than 55 000–50 000 years ago. Seafaring simulations demonstrate that a northern equatorial route into New Guinea via the Raja Ampat Islands was a viable dispersal corridor to Sahul at this time. Analysis of faunal remains and a resin artefact further indicates that exploitation of both rainforest and marine resources, rather than a purely maritime specialisation, was important for the adaptive success of Pacific peoples.
In recent years, justices on the US Supreme Court have made explicit historical arguments about US schools in order to promote a broader role for religion in US public schools. For example, in Espinoza v. Montana (2020), Chief Justice Roberts cited the late historian Carl F. Kaestle to buttress his arguments, but did so in a way that misrepresented Kaestle’s nuanced account. This article compares the justices’ historical arguments to the best evidence from the historical record. The essay argues that historians of education—whatever their political beliefs—can and should guide policy by providing reliable, accurate historical information.
A new series of 22 radiocarbon dates provides new insights on the origin and distribution of the Early Trypillian archaeological culture in modern-day Moldova and Ukraine. The paper presents data from the sites of preceding groups (5 dates), highlighting gaps in the agricultural settlement of the region, dates related to the Early Trypillia directly (14 dates) and dates from the ceramic hunter-gatherers’ sites that yielded some Early Trypillian pottery (3 dates). The results indicate that the expansion of Early Trypillia into Moldovan and Ukrainian forest-steppe took place during 47–45th centuries BCE and it was a relatively fast colonization likely spanning only 3–5 generations.
The chronology of the Inka Empire is poorly resolved, with most scholars utilizing a post hoc ethnohistoric reconstruction of imperial expansion as a common reference point. Radiocarbon-based analyses can now accomplish sufficient resolution for meaningful independent estimates of Inka chronology, however, and it is incumbent upon archaeologists to develop such appraisals. Here we produce a Bayesian analysis of radiocarbon data from the Upper Loa River area of northern Chile to estimate the timing of Inka incorporation of this region. In order to accurately associate samples with Inka rule, only radiocarbon dates from Inka sites without prior occupations are used (n = 34), producing a model for the onset of Inka rule of AD 1401–1437 (95% hpd) with a median date of AD 1420. This estimate is further used as a point of comparison for understanding diachronic imperial processes in the region. Site-level models of a variety of site types indicate that the Inka rapidly founded several administrative/mining bases at the onset, followed by the addition of smaller infrastructure components during a second pulse of activity near the middle of the 15th century. Date assemblages at the agricultural sites of Topaín and Paniri also indicate a decline in activity at the former and an increase in activity at the latter from early on in Inka rule. These results provide a high-resolution data point for reconstructing Inka imperial chronology, and expanding such studies will be essential to understanding processes of Inka imperialism at larger scales.
In 2023, during the underwater archaeological documentation of the port of Puteoli, a submerged Nabataean temple was located and partially investigated. The authors present the first results of these new research activities, including a reconstruction of part of the building and details of two altars and some inscribed slabs.
Within computer-based and live electronic music, the values of competition, power, control and innovation dominate. Women continue to be under-represented in technical roles across production, management and software development. To address this imbalance, I examine how feminist frameworks and values can be applied to challenging the biases that influence uneven gender distribution within music technology development. Focusing on live embodied composition and computing where performative and design roles intersect, I explore the work of women composers who design or co-create bespoke systems that feature the body, reimagining the norms of music technology development while exposing insights about gender, race and body types in the sound and music industries. Referencing the work of Laetitia Sonami and Lauren Sarah Hayes, I argue that their embodied design practices constitute a type of activism that promote the feminist values of human computer interaction (HCI), including collaboration, transparency and empathy, countering dominant audio equipment and software design values oriented towards precise, perfected and disposable designs created in a hierarchical fashion.
This research communication aimed at assessing the microbial quality and preparation practices of dahi/thayir, a popular traditional fermented milk product, in households from two distinct agroecological zones in Kerala, India, namely the high-range and central midland, We highlighted the significant variations and potential food safety concerns associated with regional differences in production methods. The local climate significantly influenced the incubation temperature of dahi/thayir, thereby influencing the types of microflora involved in the fermentation process. Data on preparation practices and sensory preferences were collected from producers during the sampling process, covering 200 households. There were significant variations in preparation practices between the two regions, particularly concerning the type of container used, inoculation rate and incubation period. Samples from the high-range region exhibited significantly higher acidity and coliform count as well as yeast and mold count than the central midland region. The household fermentation of milk is often uncontrolled, causing increased acidity levels. This uncontrolled fermentation favored the growth of contaminants such as coliforms and yeast, posing a potential threat to food safety. This study underscores the importance of understanding microbial quality variations and preparation practices in dahi/thayir production, emphasizing the need for proper fermentation techniques and hygienic practices to ensure the safety and quality of this traditional fermented milk product.