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The objective of the study was to assess the implementation of antimicrobial stewardship (AMS) in the referral hospitals in the South West Region of Cameroon.
Methods:
A cross-sectional survey was carried out in November 2024 across four hospitals in the South West Region of Cameroon: Limbe Regional Hospital, Buea Regional Hospital Annex, Baptist Hospital Mutengene, and Kumba Baptist Health Center. For data collection, we used the standard WHO checklist to assess AMS activities at the healthcare facilities designed for low- and middle-income countries. Key informant interview involving the AMS focal persons of various hospitals enabled data collection.
Results:
Limbe Regional Hospital has the highest full implementation rate of AMS activities (67%), while Buea regional hospital is the least of fully implemented activities (19%). An average of 49% of all AMS activities are fully implemented across the healthcare facilities, partially implemented activities made up 28%, only 3% of the activities are in the planning phase but not yet started. A 13% of the activities are not implemented across the studied facilities, while 7% of the activities are not implemented but identified as a priority.
Conclusion:
Although the rate is still low, there is good progress in implementation of AMS activities with most activities either fully or partially implemented; however, no health facility included AMS activities in their annual plans with key performance indicators, no management of any hospital allocated financial and human resources to initiate AMS activities. Strengthening institutional commitment and AMS training are recommended.
Neil Steinkamp and Samantha DiDimenico, strategic consultants who have done extensive work on access-to-justice issues, offer a unique how-to guide for engaging courts and community stakeholders in order to generate quantitative and qualitative data that can contribute to reform efforts. Focusing on “civil Gideon,” a growing set of efforts to establish a “right to counsel” akin to what criminal defendants have long enjoyed under the Sixth Amendment, Steinkamp offers a step-by-step roadmap for developing an empirically rigorous and comprehensively informed dialogue toward regulatory reform.
Judge Carolyn Kuhl (L.A. Superior Court), until recently the chief judge of the nation’s largest trial court system, offers an important contribution to the debate about whether and how to relax “courthouse UPL” – the possibility that judges, court clerks, other court staff, and AI-enabled chatbots might plausibly narrow the justice gap by providing self-represented litigants with necessary assistance. At once a history lesson and an in-the-trenches look at a decade of L.A. court reforms, Judge Kuhl shows how the anxieties about judicial and court neutrality have given way to a rich array of reform options that are producing concrete lessons for other judicial reformers looking for alternatives to conventional forms of legal help.
This chapter explores the interconnections between European colonialism and European integration, in particular in the creation of the single market. It examines the emergence of regional (EU) social and labour law against the backdrop of decolonization, arguing that the EU market integration project, and the ability to embed that market in the ‘social’, owe much to the ‘racial capitalism’ of European colonial dominance over the territory and resources of other regions. Exploring the temporal and the spatial dimensions of EU integration, a key argument of the chapter is that there has been no clean break between the colonial past of the constituent Member States of the EU, and the neocolonial present of the European project. This ongoing legacy can be seen in the ways in which the development of the EU’s social dimension, or ‘social regionalism’, influences and constrains the policy space available for another regionalism project, the African Union, to develop its own version of social regionalism.
Helicopter-based shooting using either a .308 semi-automatic rifle or a semi-automatic 12-gauge shotgun is widely used to manage non-native ungulate populations in Australasia, but the animal welfare outcomes of these two firearms have not been robustly compared. We conducted a randomised field study to compare the animal welfare outcomes of helicopter-based shooting of fallow deer (Dama dama) using a shotgun with three types of lead-based shot (Winchester® 00 Buck, 1 Buck or 4 Buck) relative to a .308 rifle with 135-grain lead-based bullets in New South Wales, Australia, in 2023. All deer that were shot at (n = 390) were killed. Time-to-event curves for times from pursuit to first shot, first shot to insensibility, and the sum of these two metrics (‘total time’), were similar among the four ammunition types. The mean number of shots fired per deer was similar across all four ammunition types, but the mean number of wound tracts per deer increased across the four ammunition types with the number of projectiles per cartridge. All deer subjected to post mortem examination had $ \ge $ 1 wound tract or projectile in the thorax. Our study indicates that using a .308 semi-automatic rifle or a 12-gauge semi-automatic shotgun for helicopter-based shooting of non-native deer, when the latter is used at ranges ≤ 30 m, provides similar animal welfare outcomes.
ANTHEM 2.0 is a tool to aid in the verification of logic programs written in an expressive fragment of CLINGO ’s input language named MINI-GRINGO, which includes arithmetic operations and simple choice rules but not aggregates. It can translate logic programs into formula representations in the logic of here-and-there and analyze properties of logic programs such as tightness. Most importantly, ANTHEM 2.0 can support program verification by invoking first-order theorem provers to confirm that a program adheres to a first-order specification or to establish strong and external equivalence of programs. This paper serves as an overview of the system’s capabilities. We demonstrate how to use ANTHEM 2.0 effectively and interpret its results.
Quantitative results from regional climate models (RCMs) run over ice sheets are frequently used to make projections of surface melt, ice-shelf stability, and subsequently sea-level rise. However, modelled relevant mass fluxes need to be evaluated first before using future output data for projections. This study makes the case for a two-step framework when evaluating RCMs. Firstly, the reliability of the RCM when forced with reanalysis data must be assessed through comparison with historical observations. Secondly, the accuracy of using a non-observationally constrained Earth System Model as forcing must be assessed through comparison with the reanalysis forced run during the same historical period. Simulating surface melt in Antarctica with the RCM RACMO2.3p2 is given as an example. Applying this two-step procedure we show that RACMO2.3p2 respectively forced with ERA5 and CESM2 is robust for modelling contemporary and future surface melt in Antarctica. Building on this conclusion, we briefly discuss an application, i.e. three future SSP realizations of melt-over-accumulation across the Antarctic ice sheet until 2100 are presented, providing insights into the future sensitivity to meltwater ponding of major Antarctic ice shelves.
This chapter traces the historical trajectory of Algeria’s relationship with the EU from the post-Second World War period and Algerian independence, to the present. It examines key agreements and legal frameworks, shedding light on how the colonial history produced complexities in defining Algeria’s status in relation to European integration. The narrative extends to explore broader geopolitical initiatives such as the Euro–Mediterranean Cooperative Proposal, the Union for the Mediterranean, and the European Neighbourhood Policy, and assesses the effectiveness of these policies in addressing issues like migration, security, and border control. The study highlights the evolving nature of the Euro–Algerian relationship, emphasizing its multifaceted character beyond economic interests. In navigating this relationship, the analysis underscores the importance of a nuanced approach, considering the diverse interests and challenges faced by both Algeria and the European Union in the context of Euro– Mediterranean relations.
It remains a little-known fact that from March 1766 to May 1767 Jean-Jacques Rousseau – fleeing from persecution in France and Switzerland – stayed in the remote hamlet of Wootton in Staffordshire. There he composed the first half of his Confessions in a garden hermitage, a structure half natural and half architectural, ever since known as Rousseau’s Cave. Our paper records the hermitage in its current state (exposed to the elements); it creates a digital reconstruction of the hermitage as it was in Rousseau’s lifetime; and it provides digital access to a monument that is otherwise not generally accessible.
Our paper records a modest but fairly typical eighteenth-century garden hermitage and also, with the highest quality digital reconstructions and fly-throughs, provides a new insight into the creation of one of the world’s greatest works of literature.
The paper contributes substantial new material to the study of Jean-Jacques Rousseau and also contributes to garden history and the phenomenon of the garden hermitage.
Normal matrices, or matrices which commute with their adjoints, are of fundamental importance in pure and applied mathematics. In this paper, we study a natural functional on the space of square complex matrices whose global minimizers are normal matrices. We show that this functional, which we refer to as the non-normal energy, has incredibly well-behaved gradient descent dynamics: despite it being nonconvex, we show that the only critical points of the non-normal energy are the normal matrices, and that its gradient descent trajectories fix matrix spectra and preserve the subset of real matrices. We also show that, even when restricted to the subset of unit Frobenius norm matrices, the gradient flow of the non-normal energy retains many of these useful properties. This is applied to prove that low-dimensional homotopy groups of spaces of unit norm normal matrices vanish; for example, we show that the space of $d \times d$ complex unit norm normal matrices is simply connected for all $d \geq 2$. Finally, we consider the related problem of balancing a weighted directed graph – that is, readjusting its edge weights so that the weighted in-degree and out-degree are the same at each node. We adapt the non-normal energy to define another natural functional whose global minima are balanced graphs and show that gradient descent of this functional always converges to a balanced graph, while preserving graph spectra and realness of the weights. Our results were inspired by concepts from symplectic geometry and Geometric Invariant Theory, but we mostly avoid invoking this machinery and our proofs are generally self-contained.
The present work brings to light the vibrations emerging when a circular cylinder, elastically mounted along a rectilinear path in quiescent fluid, is subjected to a forced rotation about its axis. These rotation-induced vibrations (RIV) are explored numerically for ranges of the four governing parameters. The Reynolds number and the reduced velocity (inverse of the non-dimensional natural frequency of the oscillator), based on the surface velocity of the rotating body and its diameter, are varied up to $100$ and $250$, respectively, and the structural damping ratio up to $50\,\%$. The structure to displaced fluid mass ratio ranges from $0.1$ to $1000$. Vibrations are found to occur over a vast region of the parameter space, including the four orders of magnitude of the mass ratio under study, and high levels of structural damping. The amplitude of RIV may exceed $30$ body diameters, while their frequency varies and deviates from the oscillator natural frequency, even though it is always lower. Despite its simplicity and the steady nature of the actuation, the system exhibits a considerable diversity of behaviours. Three distinct RIV regimes are encountered: two periodic regimes whose responses differ by their spectral contents, i.e. sinusoidal versus multi-harmonic, and an aperiodic regime. These regimes are all closely connected to flow unsteadiness, in particular via the interplay of the cylinder with previously formed vortices, which persist in the vicinity of the body.
Does the process of writing a constitution have any impact on its durability? Using a cross-national analysis of 209 constitutions adopted since 1974, this study shows that the broader inclusion of different societal and political groups in constitution-making processes, rather than mere public participation, positively correlates with constitutional durability. Following self-enforcement theories, this study argues that to be self-enforcing and enduring, a constitution should be viewed as “fair” by every group in society to create a supporting constituency. This study suggests that an inclusive process can result in a “fair” constitution, which is deemed beneficial to every group in society and garners their willingness to defend and support the terms of the constitution. Confirming this argument, our statistical analysis shows that inclusive constitutions have 54 percent lower risk of replacement than noninclusive constitutions.
This study examines Swahili-language Islamic marital booklets (vijitabu) written between 1932 and 2020, focusing on their gendered chronotopes and nostalgic elements. These booklets, written by and for Muslim men, offer advice on marriage, sexuality, and related topics, reflecting societal changes and the influence of reformist Islam in East Africa. The analysis identifies four prominent chronotopic formulations: the contemporary East African context, the time and place of the Prophet Muhammad, the pre-Islamic world (jahiliya), and the modern West. A potential fifth chronotope, the afterlife (akhera), is contingent on adherence to the first four. The booklets valorize the Prophet Muhammad’s era while criticizing other temporal and spatial contexts, advocating for a return to early Islamic gender norms and marital practices to achieve happiness in the afterlife. This study highlights the booklets’ role in shaping gender norms and religiopolitical ideologies, revealing the interplay between nostalgia, religious authority, and sociopolitical context in East African Muslim communities.
Rebecca Aviel (Denver University (Sturm) Law) draws on her deep expertise in family law to illuminate ways in which domestic relations cases are exceptional relative to other legal areas where access concerns are acute. Family law’s exceptionalism, she contends, justifies thoroughgoing changes to that system’s adversarial architecture, such as permitting a single lawyer to represent both sides in a divorce, that are well-tailored to family law even if nonstarters in other parts of the civil justice system. Aviel also suggests that some innovative family law programs might travel well, informing reforms in other civil justice contexts even where they cannot be directly replicated.
Although German, as a grammatical gender language, requires noun–pronoun agreement in anaphora, exceptions to the rule occur, e.g., in possessive constructions when the gender-incongruent possessive pronoun sein (masculine/neuter, his/its) refers to feminine antecedents instead of congruent ihr (feminine, her). While this violation is merely grammatical for inanimate referents, it can provoke semantic mismatches for human possessors (especially gender-specific female nouns like die Hexei– seini (the witch – his/its), but less so with gender-indifferent human nouns, such as die Kontaktperson (the contact person). A self-paced reading (SPR) experiment tested the acceptability and processing of sentences in which incongruent sein referred to feminine possessors, which differed in animacy status (inanimate versus human). Introducing this agreement violation reduced acceptability and elevated reading and reaction times (RTs), but effects varied by antecedent animacy. These results suggest an animacy restriction in possessive reference and substantiate the impact of meaning-based gender cues on pronominalization.
‘Decolonization’ of research and teaching in EU law constitutes a starting point for examinations of EU law which can open up the world of European legal integration to a new generation of Black scholars and audiences, both across Europe and beyond. In this contribution I suggest what this starting point could look like – what happens when we take colonialism as the starting point for our interaction with EU law? How does a decolonial approach amend the purpose, principles and practice that inform our research and teaching in EU law today? I propose that relevant purposes include excavation, correction, dissemination and diversification. The principles that underlie this purpose include pro-democracy, intentionality and internationality while the practice of decolonizing research and teaching in EU law would focus on identifying omission, using empirical study to create new understanding of systems and working in collaboration with Black scholars.
Allison Hoffman (University of Pennsylvania Carey Law), an expert on health care regulation, focuses on tectonic changes to health care in recent decades. She offers a bracing account of these shifts, arguing that American doctors may have overreached in their efforts at influencing health care regulation. In so doing, physicians created profit pools that corporate interests proved all too adept at capturing, leaving doctors with lower professional status than they might have otherwise enjoyed. Hoffman suggests that lawyers, and legal reformers more generally, might learn from physicians’ cautionary tale of protectionism and profit.