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We assessed the impact of an oral care initiative on non-ventilator-associated hospital-acquired pneumonia (NV-HAP) risk using two different measurement strategies.
Methods:
We evaluated changes in NV-HAP events among all patients admitted to 17 VA Medical Centers (1) across the period 10/01/2015–12/31/2019, and (2) one-year pre- vs post- each hospital’s oral care initiative start date. We modeled and compared observed versus predicted NV-HAP events per hospitalization using (1) an electronic clinical definition and (2) diagnosis codes, adjusting for patients’ demographics, vital signs, and laboratory results at presentation.
Results:
Among 333,257 hospitalizations, 1,922 (0.58%) met NV-HAP electronic clinical criteria and 2,386 (0.72%) diagnostic coding criteria. The risk of NV-HAP defined by electronic clinical criteria was 0.62% in October 2015 and 0.54% in December 2019 (estimated difference –0.084% [95% CI: –0.17%, 0.0056%]; the risk of NV-HAP defined by diagnostic coding decreased from 1.0% to 0.48% (estimated difference –0.53% [–0.63%, –0.43%]). In the one-year pre- vs post-analysis, there was no evidence of effect of the implementation on NV-HAP using either electronic clinical criteria (adjusted risk difference –0.078% (95% CI: –0.25%, 0.091%) or diagnostic coding criteria (adjusted risk difference –0.021% (95% CI: –0.18%, 0.14%).
Conclusions:
In a large multi-center study of hospitalized patients, we were unable to identify a clear effect of an oral care initiative on NV-HAP using electronic clinical criteria or diagnostic coding criteria.
Flows enabled by phoretic mechanisms are of significant interest in several biological and biomedical processes, such as bacterial motion and targeted drug delivery. Here, we develop a homogenisation-based macroscopic boundary condition that describes the effective flow across a diffusio-phoretic microstructured membrane, where the interaction between the membrane walls and the solute particles is modelled via a potential approach. We consider two cases where potential variations occur (i) at the pore scale and (ii) only in the close vicinity of the boundary, allowing for a simplified version of the macroscopic flow description, in the latter case. Chemical interactions at the microscale are rigorously upscaled to macroscopic phoretic solvent velocity and solute flux contributions, and added to the classical permeability and diffusivity properties of the membrane. These properties stem from the solution of Stokes advection–diffusion problems at the microscale, some of them forced by an interaction potential term. Eventually, we show an application of the macroscopic model to develop minimal phoretic pumps, showcasing its suitability for efficient design and optimisation procedures.
We study constant Q-curvature metrics conformal to the the round metric on the sphere with finitely many point singularities. We show that the moduli space of solutions with finitely many punctures in fixed positions, equipped with the Gromov–Hausdorff topology, has the local structure of a real algebraic variety with formal dimension equal to the number of the punctures. If a nondegeneracy hypothesis holds, we show that a neighbourhood in the moduli spaces is actually a smooth, real-analytic manifold of the expected dimension. We also construct a geometrically natural set of parameters, construct a symplectic structure on this parameter space and show that in the smooth case a small neighbourhood of the moduli space embeds as a Lagrangian submanifold in the parameter space. We remark that our construction of the symplectic structure is quite different from the one in the scalar curvature setting, due to the fact that the associated partial differential equation is fourth-order rather than second-order.
Individual-level solutions, such as lifestyle changes, are often regarded as cost-effective complements to systemic policies like government regulations in addressing climate change. However, some argue that exposure to these solutions may shift focus away from systemic interventions, potentially crowding-out support for large-scale policies. Across two experiments in Iran (N = 303) and Australia (N = 308 and 625), we tested whether exposure to different numbers of individual and systemic policies would affect individuals’ perception of systemic climate solutions. Results showed that, regardless of country or exposure type, whether through daily life or experimental manipulation, participants consistently supported systemic policies and changes, attributed greater responsibility to the government, perceived minimal conflict between systemic and individual approaches, rated systemic policies as more effective than individual ones, and viewed individual actions as only moderately substitutable for systemic solutions. These findings challenge the crowding-out hypothesis, suggesting that exposure to individual solutions does not diminish support for systemic policies or structural reforms.
Maximising creativity requires an enriched imagination that uses all five senses. This study explored the effects of a reduced visual–auditory multisensory stimuli environment on creativity. Nineteen participants took the Alternative Uses Test (AUT) under the nine decreased visual–auditory multisensory stimuli conditions. Fluency and originality were evaluated as a part of the creativity assessment. The number of ideas from the AUT determined the fluency level, and the three judges’ evaluations determined originality. A study on associative conceptual network analysis explored the word associations of selected nouns from the AUT under nine reduced visual–auditory multisensory stimuli experimental conditions, revealing outdegree centrality scores to evaluate creative potential. The results suggest that the decreasing visual stimuli inhibit fluency whereas auditory stimuli do not, and that originality is enhanced when stimuli are reduced, whether visual or auditory, unless there is a notable divergence between the visual and auditory conditions. These results highlight the importance of perceptual focus and cognitive load regulation in fostering creative potential.
Surface quasi-geostrophic (SQG) theory describes the two-dimensional active transport of a scalar field, such as temperature, which – when properly rescaled – shares the same physical dimension of length/time as the advecting velocity field. This duality has motivated analogies with fully developed three-dimensional turbulence. In particular, the Kraichnan – Leith – Batchelor similarity theory predicts a Kolmogorov-type inertial range scaling for both scalar and velocity fields, and the presence of intermittency through multifractal scaling was pointed out by Sukhatme & Pierrehumbert (2002 Chaos12, 439–450), in unforced settings. In this work, we refine the discussion of these statistical analogies, using numerical simulations with up to $16\,384^2$ collocation points in a steady-state regime dominated by the direct cascade of scalar variance. We show that mixed structure functions, coupling velocity increments with scalar differences, develop well-defined scaling ranges, highlighting the role of anomalous fluxes of all the scalar moments. However, the clean multiscaling properties of SQG transport are blurred when considering velocity and scalar fields separately. In particular, the usual (unmixed) structure functions do no follow any power-law scaling in any range of scales, neither for the velocity nor for the scalar increments. This specific form of the intermittency phenomenon reflects the specific kinematic properties of SQG turbulence, involving the interplay between long-range interactions, structures and geometry. Revealing the multiscaling in single-field statistics requires us to resort to generalised notions of scale invariance, such as extended self-similarity and a specific form of refined self-similarity. Our findings emphasise the fundamental entanglement of scalar and velocity fields in SQG turbulence: they evolve hand in hand and any attempt to isolate them destroys scaling in its usual sense. This perspective sheds new lights on the discrepancies in spectra and structure functions that have been repeatedly observed in SQG numerics for the past 20 years.
This research examines in detail the complex nonlinear forces generated when steep waves interact with vertical cylindrical structures, such as those typically used as offshore wind turbine foundations. These interactions, particularly the nonlinear wave forces associated with the secondary load cycle, present unanswered questions about how they are triggered. Our experimental campaigns underscore the occurrence of the secondary load cycle. We also investigate how the vertical distributions of the scattering force, pressure field and wave field affect the nonlinear wave forces associated with the secondary load cycle phenomena. A phase-based harmonic separation method isolates harmonic components of the scattering force’s vertical distribution, pressure field and wave field. This approach facilitates the clear separation of individual harmonics by controlling the phase of incident waves, which offers new insights into the mechanisms of the secondary load cycle. Our findings highlight the importance of complex nonlinear wave–structure interactions in this context. In certain wave regimes, nonlinear forces are locally larger than the linear forces, highlighting the need to consider the secondary load cycle in structural design. In addition, a novel discovery emerges from our comparative analysis, whereby very high-frequency (over the fifth in harmonic and order) oscillations, strongly correlated to wave steepness, have the potential to play a role in structural fatigue. This new in-depth analysis provides a unique insight regarding the complex interplay between severe waves and typical cylindrical offshore structures, adding to our understanding of the secondary load cycle for applications related to offshore wind turbine foundations.
Michael Sata’s presidency in Zambia (2011–14) marked a notable attempt to revive statist development ideas rooted in the country’s postindependence era. While the preceding MMD government had begun reintroducing limited state intervention, its commitment remained constrained. Sata, by contrast, articulated a more assertive vision of state-led development, echoing the UNIP-era model under Kenneth Kaunda. Drawing on policy documents, speeches, and survey data, this article situates Sata’s politics and policies within broader public dissatisfaction with neoliberal reforms and highlights enduring tensions in Africa’s poststructural adjustment era between market-oriented policies and demands for greater state involvement.
Part of a series of longitudinal studies of churchgoing in British towns and cities, this article traces the statistical history of church attendance in London over the past two hundred years. Among other sources, it utilises national religious censuses in 1851 and 1979–2005 and metropolitan ones in 1886–7, 1902–3, 1933–4 and 2012, presenting results as an index of attendance (IA), expressing attendances as percentage of population. Throughout the late nineteenth and twentieth centuries, London’s IAs fell continuously and were mostly below those in other conurbations. Following an uptick around the millennium, net decline resumed after 2012.
An arbitrary Lagrangian–Eulerian finite element method and numerical implementation for curved and deforming lipid membranes is presented here. The membrane surface is endowed with a mesh whose in-plane motion need not depend on the in-plane flow of lipids. Instead, in-plane mesh dynamics can be specified arbitrarily. A new class of mesh motions is introduced, where the mesh velocity satisfies the dynamical equations of a user-specified two-dimensional material. A Lagrange multiplier constrains the out-of-plane membrane and mesh velocities to be equal, such that the mesh and material always overlap. An associated numerical inf–sup instability ensues, and is removed by adapting established techniques in the finite element analysis of fluids. In our implementation, the aforementioned Lagrange multiplier is projected onto a discontinuous space of piecewise linear functions. The new mesh motion is compared to established Lagrangian and Eulerian formulations by investigating a pre-eminent numerical benchmark of biological significance: the pulling of a membrane tether from a flat patch and its subsequent lateral translation.
In 1408, as the Great Western Schism entered its fourth decade, the Parisian community of Celestine monks asked Pierre d’Ailly to write a life of their founder, Pietro Morrone, who served as Pope Celestine V in 1294. D’Ailly found in him an example that suited his times: a pope could resign without damage to the Church at large. With cardinals from both obediences ready to withdraw support from Avignon’s Benedict XIII and Rome’s Gregory XII, both of whom resisted resignation, d’Ailly made his case for papal resignation via his life of Celestine V.
This paper broaches ‘natural theology’ in terms of the conceptual systems through which revelation is understood, as opposed to questions regarding the sources of revelation. I do so by analysing Barth’s rejection of natural theology in terms of what it can mean to treat a logic of prior possibility as determining what revelation’s conditions of possibility must be. I begin by reading Emil Brunner’s ‘Nature and Grace’ alongside Ludwig Wittgenstein’s reflections on mathematical necessity in order to show that Brunner’s thinking of possibility subordinates the necessities of revelation to what Wittgenstein calls ‘the logical machine’. I then argue that Barth’s rejection of natural theology involves rejecting the workings of this machine and so rejecting the axiomatic force of prior possibility for theology. I conclude by tracing two consequences of this rejection, one related to creativity, the other to political crisis.
By observing China’s domestic media landscape and state policies during the COVID-19 pandemic, this paper proposes the concept of “propaganda state 2.0” as a framework for exploring autocratic state propaganda from a holistic perspective. It contends that state propaganda in China remains an agitprop apparatus deeply embedded in the totality of the authoritarian regime, which it both serves and is served by. This system performs both conventional persuasion and indoctrination functions, as well as fulfilling the now underestimated mission of agitation, which can enhance the credibility of propaganda messages. This framework emphasizes the legacies of China’s past “propaganda state” and effectively explains how the party-state transformed the pandemic into opportunities to win popular support, and how this resulted in a debacle. Theoretically, the article highlights how state propaganda in contemporary China can shape, if not dictate, state policy, while serving as a more organic framework that bridges the “hard” and “soft” propaganda literatures.
The misuse of antibiotics and the consequential rise in antimicrobial resistance (AMR) represent a significant global health concern. Cyprus currently reports to ESAC-Net the total consumption of antimicrobials, without distinguishing between hospital- and community-based antibiotic use. As a result, these data can only provide generalized insights into antimicrobial trends in the country.
Aim:
To evaluate antibiotic prescribing patterns in national outpatient services in Cyprus.
Material and methods:
We retrospectively analyzed the national community antibiotic prescriptions in Cyprus for the period 2020 – 2022. Data on community antimicrobial prescription were extracted from the National Insurance Organization (HIO) database. Orally administered dispensed antibiotics were categorized according to the WHO Anatomical Therapeutic Chemical (ATC) classification and by the WHO’s AWaRe (Access, Watch, Reserve) classification of antibiotics. Antibiotic prescriptions were calculated in both packages consumed and per 1000 beneficiaries, overall, by year, age groups, and medical specialty of prescribers.
Results:
During the period of 2020 – 2022, in total 1,458,723 antibacterial prescriptions for systemic use were ordered in Cyprus for outpatients. The annual rates of prescriptions per 1,000 beneficiaries demonstrated an increasing trend from 535.7 in 2020 to 653 in 2022, respectively. A decrease by 3.1% in the prescription of WHO “Access” antibiotics was observed, reaching 42.3% in 2022, which is much lower than the WHO’s goal of 60% and the EU’s goal of 70% for “Access” antibiotic consumption.
Conclusions:
Between 2020 and 2022, antibiotic prescriptions in the community of Cyprus showed an overall increase, accompanied by a declining trend in the proportion of “Access” antibiotics prescribed.
This article discusses how the United Nations Food and Agriculture Organisation (FAO) shaped notions of rural life, rural community, and social reform in the context of South and Southeast Asian decolonisation. Building on scholarship analysing rural development either in term of continuities from the colonial era or as the result of specific circumstances after the Second World War, the argument here is that we can understand approaches to rural welfare after 1945 as the historical intersection of three factors: the rural specificities of decolonisation related to violence and mass displacement; FAO seeking relevance and legitimacy in the post-war order; and urban and rural elites objectifying rural life as a cornerstone of post-imperial nation-building. Empirically, the article analyses two (former) British colonies that experienced two different forms of decolonisation: territorial partition and imperial warfare. It relates these modes of decolonisation to the early formations of FAO’s rural expertise and argues that decolonisation was a structuring event for both local rural policy-making and the evolving international (rural) development agenda.
A new statistical definition for the mean turbulent boundary layer (TBL) thickness is introduced, based on identification of the wall-normal location where the streamwise velocity skewness changes sign, from negative to positive, in the outermost region of the boundary layer. Importantly, this definition is independent of arbitrary thresholds, and broadly applicable, including to past single-point measurements. Furthermore, this definition is motivated by the phenomenology of streamwise velocity fluctuations near the turbulent/non-turbulent interface (TNTI), whose local characteristics are shown to be universal for TBLs under low free-stream turbulence conditions (i.e. with or without pressure gradients, surface roughness, etc.) through large-scale experiments, simulations and coherent structure-based modelling. The new approach yields a TBL thickness that is consistent with previous definitions, such as those based on Reynolds shear stress or ‘composite’ mean velocity profiles, and which can be used practically, e.g. to calculate integral thicknesses. Two methods are proposed for estimating the TBL thickness using this definition: one based on simple linear interpolation and the other on fitting a generalised Fourier model to the outer skewness profile. The robustness and limitations of these methods are demonstrated through analysis of several published experimental and numerical datasets, which cover a range of canonical and non-canonical TBLs. These datasets also vary in key characteristics such as wall-normal resolution and measurement noise, particularly in the critical TNTI region.
This paper investigates the effect of taxation of polluting products and redistribution on pollution, income and welfare inequalities. We consider a two-sector Ramsey model with a green and a polluting good, two types of households and a subsistence level of consumption for the polluting good. The environmental tax is always effective in reducing pollution regardless of the level of subsistence consumption. However, this level, together with the redistribution rate, matters at the individual level as it shapes the impact of the environmental policy on individual consumption and welfare. Looking at the stability properties of the economy, a high subsistence level of polluting consumption leads to instability or indeterminacy of the steady state, while the environmental externality reduces the scope for indeterminacy. Increasing the tax rate and redistributing more to the worker affect the occurrence of indeterminacy and instability. Considering the subsistence level of consumption and the level of redistribution among households are of importance as it determines the effects of environmental tax policy in the long term and the stability of the economy in the short term.
Cumin (Cuminum cyminum L.) is an annual herbaceous plant from the Apiaceae family, renowned for its medicinal and culinary applications as the second most popular spice globally after black pepper. Germination is a critical stage in the life cycle of plants, particularly for medicinal plants, as it determines successful establishment and productivity. This study explores the impact of ploidy levels (diploid and tetraploid) and genotype interactions on germination traits, seed morphology and early seedling growth in five selected cumin genotypes (YAR1, KBA4, SKD6, SIV8 and NKM9). Induction of tetraploidy significantly influenced germination percentage, rate, seed vigour index, and morphological traits. Notably, diploid genotypes exhibited higher germination percentages, while tetraploid SKD6 displayed the highest germination speed and seedling biomass, demonstrating genotype-specific ploidy effects. For the first time, root growth kinetics were analyzed, revealing distinct growth patterns between diploid and tetraploid seeds. Morphometric evaluations showed that tetraploid seeds and embryos were significantly larger, attributed to the ‘gigas effect’, which enhances storage reserves and seed vigour. However, challenges such as embryo-less seeds and variability in genotype responses to ploidy manipulation were observed. These findings underscore the importance of targeted breeding strategies that optimize genotype-ploidy interactions to improve seed quality, germination performance and early growth in cumin. By advancing our understanding of polyploidy’s role in shaping key agronomic traits, this study provides a foundation for sustainable cultivation practices and enhanced productivity of medicinal plants.
In the near future, individuals and non-financial firms will use generative artificial intelligence (AI) to execute everyday financial tasks. Users may deploy ‘AI agents’ such as Apple’s Siri or Google’s Gemini to pay their bills, recommend financial products or manage investment portfolios, and perform myriad other financial activities. Although users may receive benefits from having AI agents offer financial services, these applications pose significant risks both to customers and to the financial system: they may fail to act in users’ best interests, engage in market manipulation, and cause financial instability. This essay argues that regulators are unprepared for technology firms to use open finance and AI architecture to provide individualized financial services without human interaction. It argues that AI agents are the next technological innovation in finance that should be regulated, but that US banking regulators lack authority to directly regulate deposit brokers, posing risks to financial stability and the general public.