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Urinary tract infections are commonly overdiagnosed. To minimize overdiagnosis, some laboratories utilize reflex algorithms that use urinalyses as preliminary screening before potentially proceeding to urine culture. However, the optimal urinalysis cutoffs for this diagnostic stewardship intervention remain poorly defined.
Methods:
We performed a retrospective, cross-sectional analysis from 2/1/21–1/31/23 in the Los Angeles County Department of Health Services healthcare system. We examined patient encounters in which urinalysis was ordered synchronously with urine culture. We categorized urine culture isolates as uropathogens or non-uropathogens. We calculated receiver operating characteristic curves of urinalysis parameters’ ability, singularly or in combination, to identify uropathogens.
Results:
Among 80,949 paired urinalysis and urine cultures (17,488 inpatient, 20,716 emergency department, 42,745 outpatient), cultures yielded 35% (n = 28,993) uropathogens, 4% (n = 2960) non-uropathogens, 37% (n = 29,951) contaminants, and 24% (n = 19,045) no growth. Among urinalysis parameters, white blood cells (WBCs) had the highest diagnostic accuracy (area under the curve (AUC)=0.722, [95% CI 0.718–0.725]), followed by leukocyte esterase (AUC = 0.700, [95% CI 0.690–0.701]), bacteria (AUC = 0.673, [95% CI 0.670–0.677]), nitrite (AUC = 0.627, [95% CI 0.625–0.630]), and squamous epithelial cells (AUC = 0.530, [95% CI 0.526–0.534]). WBC AUC values were consistent across healthcare settings (outpatient, emergency department, and inpatient). The urinalysis parameter combination with the highest AUC, WBC plus bacteria, performed worse than WBCs alone (AUC = 0.711 vs. AUC = 0.722, p = 0.001).
Conclusion:
WBC on microscopic urinalysis demonstrated the highest diagnostic accuracy for predicting uropathogens in urine cultures. Stewardship programs should consider prioritizing urinalysis WBC count as the screening tool to optimize urine culture utilization.
This study presents a mixed-methods analysis of the integration of social justice into legal practice in Hong Kong. While social justice within the legal field is a growing area of interest, research on how it can be enhanced through legal education remains relatively limited. This study aims to explore how higher education law courses can be leveraged to better incorporate social justice principles into contemporary legal practice. The research adopts a mixed-methods approach, including a quantitative analysis of questionnaires completed by 99 current law students in Hong Kong and a thematic analysis of interviews conducted with 33 students and legal professionals in the region. Findings suggest the potential benefits of increasing the emphasis on social justice within law programs at Hong Kong universities. The study also raises important questions about the optimal content and methods for delivering social justice education in legal curricula.
Dicamba-resistant (DR) soybean cultivars are essential elements in managing broadleaf weeds in modern production systems. However, limited information is available regarding yield reductions associated with dicamba rates that were previously registered for postemergence weed control and off-label dicamba rates in these cultivars. This study aimed to characterize and quantify the effects of postemergence dicamba applications on two DR soybean cultivars. Field trials were conducted in 2022 and 2023, with dicamba applied at 0 to 1,440 g ae ha⁻¹ during the V5 to V6 stages. Visible injury increased with dicamba rate, reaching 18% (Cultivar A) to 20% (Cultivar B) at 1,440 g ae ha⁻¹ at 3 d after treatment, but symptoms declined to <10% by 4 wk after treatment (WAT). Chlorophyll fluorescence was not significantly affected at 2 and 4 WAT. Height reduction at 4 WAT occurred only at the highest dicamba rate (1,440 g ae ha⁻¹), but differences disappeared by maturity. Dry biomass reduction was also dose-dependent, reaching 16% for Cultivar A and 10% for Cultivar B at the highest rate. Pod reduction in DR soybean was minor (<3.5%) and not significant. Applications of dicamba from 288 to 864 g ae ha⁻¹ resulted in minimal yield reductions (<5%) and no significant biomass reduction. At a dicamba dose of 1,152 g ae ha⁻¹, yield reductions reached 7% and 9% for Cultivars A and B, respectively, while the highest rate (1,440 g ae ha⁻¹) resulted in yield reductions of 12% (Cultivar A) and 14% (Cultivar B). Despite over-the-top application restrictions, these results confirm that DR soybean cultivars tolerate rates (≤720 g ae ha⁻¹) of dicamba that were previously registered for postemergence weed control with minimal (<5%) yield reduction and recover rapidly from transient injury. However, applications above these rates can reduce yield by up to 14%, highlighting the importance of adhering to recommended dicamba use guidelines.
When a drop impinges onto a deep liquid pool, it can yield various splashing behaviours, leading to a crown-like structure along the free surface. Under high-speed impact conditions, the upper portion of the thin-walled crown may undergo necking and encapsulate a large bubble, which remains fascinating and is rarely discussed in the literature. In this work, we numerically study this physical process based on the volume-of-fluid and adaptive mesh refinement framework. Our meticulous observations have allowed us to unveil a spectrum of repeatable early-time jet behaviours, vorticity structures and crater evolution, underscoring the rich and complex nature of drop-impact phenomenon. We show that the interplay between aerodynamic pressure and surface tension on the liquid crown could play a significant role in its bending and surface closure. A regime map, incorporating both early-stage jet dynamics and overall bubble-canopy formation, is established across a wide parameter space. This study provides a comprehensive understanding of the diverse splashing regimes, offering insights into the fundamental characteristics of drop-impact phenomenon.
This study aims to develop a curve-fitting approach for long-term COVID-19 mortality projections and evaluate its effectiveness as a scalable, data-driven tool for pandemic forecasting.
Methods
The basic characteristics of a dynamic curve-fitting approach capable of generating long-term projections are described. To demonstrate its utility, the model was retrospectively applied using mortality data from the start of the pandemic, January to June 2020 (6-month data), to project into the period between June 2020 and April 2021 (11-month projections).
Results
For scenarios with the best fit, the difference between observed and projected total deaths varied in the projection period between 7.7% and 28.2%.
Discussion
When the COVID-19 pandemic started in early 2020, there was lack of understanding regarding its long-term impact. Available mathematical models were complex and typically provided short- and mid-term projections. The approach described generates long-term projections that are relatively easy to implement and can be enhanced to include other parameters such as vaccine impact or virus variants. The method could prove to be a valuable tool during a future pandemic.
The city-state (polis) is undoubtedly one of the most fundamental aspects of Greek history. John Ma’s book is a monumental study of the history of the Greek polis in the very long term.1 It starts from the collapse of the Bronze Age palaces around 1200 bce and takes the story to the end of ancient poleis around 600 ce; alongside the immense temporal extent, Ma impressively covers the whole of the Eastern Mediterranean. In my view, this is unquestionably the most significant contribution to the study of Greek history over the last two decades. It is the first attempt to focus the history of the polis not on the archaic and classical periods, but on the Hellenistic and early imperial poleis. The reason for this, and the most significant contribution of the book, is Ma’s concept of the ‘great convergence’: the spread across the eastern Mediterranean between 400–200 bce of a democratic model of the polis based on citizen equality, assemblies, the provision of public goods, and the disappearance of older models based on oligarchy and characterized by disenfranchised citizens, subject communities, and serf populations. At the same time, the dominance of large-scale geopolitical actors such as the Hellenistic kingdoms and later Rome put an end to the ‘Hundred Years War’ between 450–350 (another important conceptual innovation), in which dominant poleis tried to subjugate and conquer other poleis; after 350 bce, poleis’ attempts at expansion usually incorporated smaller communities on equal terms. The book is structured around the great convergence: earlier chapters examine the diverse world of the poleis before the convergence, while later chapters explore the transformation of the polis and its employment by the Roman Empire, once the Mediterranean stopped being a multipolar world. This very rich book functions both as an excellent survey of numerous Greek communities, as well as an impressive synthesis offering a new periodization of Greek history. It will undoubtedly generate major new debates among Greek historians, which are urgently needed in our field.
A local guideline for the management of patients hospitalized with skin and soft tissue infections was implemented at an academic, safety-net hospital. Immediate reductions in use of broad-spectrum antibiotics and durations of therapy were sustained over the subsequent 12 years.
In the wealth of literature on ethnic variation, ethnicity is often considered independently of other social characteristics. However, prioritizing ethnicity in this way risks overlooking the potential impact of other social factors. In this study, we demonstrate an intersection between ethnicity and social class based on a sociolinguistic corpus of Australian English, representing some of the country’s largest ethnic groups (Australians of Anglo-Celtic, Italian, Greek, and Chinese backgrounds), stratified according to age, gender, and social class. Rather than beginning with the social groupings, we first identify linguistic groupings to then consider how these groupings align with social dimensions. Cluster analyses of speaker random intercepts derived from independent regression analyses of 10 linguistic variables in recordings from 159 speakers reveal primary divisions for age, reflecting change over time, and secondary divisions for ethnicity in conjunction with social class, highlighting the interconnected nature of these social dimensions in linguistic variation.
We aimed to determine the prevalence of antimicrobial resistance, carriage of Panton-Valentine leucocidin (PVL), and the clonal structure of MRSA isolates collected from skin and soft tissue infections at a tertiary care hospital in Pakistan. Between August 2021 and May 2022, 154 non-repetitive MRSA isolates were consecutively collected and characterized by antimicrobial susceptibility testing, SCCmec typing, spa typing, and detection of PVL by PCR. MLST clonal complexes (CCs) were inferred from spa type using the Based Upon Repeat Pattern (BURP) algorithm. High levels of resistance were observed to ciprofloxacin (85.7%), erythromycin (76.0%), sulfamethoxazole (68.8%), gentamicin (68.8%), fusidic acid (57.8%), tetracycline (55.8%), and clindamycin (42.2%). Clonal analysis revealed 16 lineages, with the most frequent being CC8-MRSA-IV (27.3%), PVL-positive “Bengal Bay” CC1/ST772-MRSA-V (26.0%), and CC1-MRSA-IV (16.2%). PVL was detected in 45.5% of isolates across multiple lineages. Our findings highlight the coexistence of high antimicrobial resistance and frequent PVL carriage among MRSA in Pakistan. Given the association of PVL with severe infections and the limited treatment options for multidrug-resistant strains, these data underscore a significant public health concern and the need for systematic surveillance and prudent antibiotic use.
The phylogenetic relationships among arthropods remain contentious because morphological studies face challenges in resolving certain branches. Particularly difficult are relationships within and between the stem arthropods, owing largely to too few well-preserved fossil representatives. Additional fossil evidence, particularly from exceptional deposits like the Silurian Waukesha Lagerstätte in Wisconsin, helps to bolster our views on the evolutionary history of arthropods by providing well-preserved examples of novel taxa that could fit between early diverging stem-arthropod clades and modern euarthropods, thus building possible bridges between the two. Formed in karstification-induced troughs of the Manistique Formation paleoslope, the Waukesha Lagerstätte preserves a unique biota of organisms from the Telychian Age, mostly through secondary precipitation of francolite. Perhaps most well known from this deposit are the many peculiar and enigmatic arthropod taxa that could help resolve early arthropod cladistic relationships. We add to the growing body of work on the diversity, phylogeny, and taxonomic descriptions of the Waukesha biota by detailing a previously unnamed bivalved arthropod, informally called ‘the butterfly animal’ in past literature—which we here designate as Papiliomaris kluessendorfae n. gen. n. sp. We also conducted a Bayesian phylogenetic analysis that placed several recently described Waukesha taxa as basal members of the ‘Mandibulate’ clade within the Euarthropoda.
There is a long-standing controversy in Greek History about whether the othismos, or ‘push’, of the hoplite phalanx mentioned by classical authors was real or metaphorical. Experimental archaeology – structural and finite element analysis with both physical reconstructions and computer modelling (presented non-technically here) – suggests that the archaic Greek hoplite panoply of bell cuirass, Corinthian helmet, and large bowl-shaped shield (aspis), which seems at first to present contradictory design choices, in fact offered important mechanical advantages under compressive force; that cuirass, helmet, and shield were designed or evolved to work together to allow the Greek warrior to survive and fight in a pushing mass of men without being crushed or asphyxiated. The hoplite othismos was, then, real and was presumably practised from the earliest era to which this equipment can be dated, the late eighth century bc.
Encoding only-type exclusive focus in discourse involves complex computation and integration of knowledge from multiple linguistic domains. We present a comprehensive analysis of syntactic, semantic, prosodic, and discourse contextual features of 864 utterances with only and its Mandarin equivalents zhi(you) produced by Mandarin–English bilingual preschoolers and matched monolinguals (age 2–6, Study 1), and by Mandarin-speaking parents (Study 2), all sampled from naturalistic interactions. The results revealed largely target-like syntactic positioning and semantic association of only and zhi(you) in both languages in the bilinguals, with cross-linguistic influence between only and zhi. Interestingly, the bilingual children, like their Mandarin monolingual peers, employed longer duration but not raised mean pitch to shift the prosodic stress to the intended focus, although both acoustic features, in addition to positional and contextual cues, were instantiated in the focus utterances in the Mandarin parental input, suggesting prolonged development in focus-prosody mapping in children independent of bilingualism.
Sulforaphane (SFN), a bioactive compound derived from glucoraphanin in cruciferous vegetables such as broccoli, has been extensively studied for its therapeutic potential across diverse disease categories. SFN exerts its effects through well-characterised pathways, including the Keap1/Nrf2 axis, which regulates phase II detoxification enzymes, and epigenetic mechanisms such as histone deacetylase inhibition. This review evaluates clinical trials registered on ClinicalTrials.gov, focusing on those using SFN or broccoli-derived extracts.
As a result, we identified 84 trials, of which 39 have been published. Results suggest SFN’s potential in regulating redox and inflammatory pathways, improving metabolic and cardiovascular outcomes, and exerting anti-cancer and neuroprotective effects. For healthy subjects, SFN enhanced detoxification and reduced inflammation. In cancer patients, SFN showed promise in early-stage prostate and breast cancer, particularly in GSTM1-positive individuals, but had limited effects in advanced cases. For brain disorders, SFN demonstrated symptomatic improvements in autism spectrum disorder and cognitive benefits in schizophrenia but lacked robust biomarker integration. SFN had minimal impact on respiratory diseases but showed supportive roles in allergic rhinitis therapy. Metabolic disease studies revealed glycaemic control improvements in type 2 diabetes but no benefits for hypertension. Approximately 50% of completed trials remain unpublished, raising concerns about publication bias. While published results highlight SFN’s therapeutic potential, limited sample sizes and inconsistent outcomes underscore the need for more extensive, stratified trials. This review emphasises the importance of integrating mechanistic insights and precision medicine approaches to maximise SFN’s clinical utility.
The International Association of Democratic Lawyers (IADL), founded in Paris in 1946 by a group of antifascist lawyers, has long been dismissed as a Soviet front organization. Yet, this characterization overlooks its complex and multifaceted history. This paper reassesses IADL’s first thirty years, exploring its origins, internal debates, and cross-border engagement. Drawing on archival records, this article argues that—despite a period of Communist influence—the IADL contributed to international legal and political discourse by advancing an original approach defined here as radical legal internationalism. Through this framework, IADL lawyers questioned Cold War ideological boundaries and brought into dialogue Communist, progressive, New Left, decolonial, and liberal rights traditions. The article also uncovers the IADL’s significant role in promoting international law and human rights through trial observation, UN advocacy, and missions of inquiry. In challenging the dominant account of the Left’s delayed and uneasy embrace of human rights, this article calls for a broader understanding of Cold War-era legal internationalism and highlights an alternative tradition of legal activism.
This paper presents the development and characterization of a wideband noise source, involving Commercial Off-The-Shelf components. The noise source relies on avalanche noise generation by driving the base-emitter junction of a packaged Si–Ge Heterojunction Bipolar Transistor into reverse breakdown. The paper discusses the noise source operation principle and its extensive characterization in both mm-Wave K band, as well as in C and X bands. Two prototypes were implemented without including output impedance matching, such as to preserve the wideband capabilities of the noise source. Performances were validated in terms of output Excess Noise Ratio (ENR), values reaching 10.8 dB were obtained for the K band at 6.71 mA breakdown current, in a 24–32 GHz bandwidth and $21-102^{\circ}\mathrm{C}$ device temperature excursion. A calibration model is also provided, which fits ENR fluctuations with an average error under 0.05 dB, when considering the maximum current and temperature excursions, as compared with 0.8 dB ENR drift reported for the non-calibrated source. The C and X band validation in 4–6 and 10–12 GHz frequency ranges highlights ENR reaching 25.6 and 22.6 dB, respectively, at 6.9 mA bias current.
We begin from the beginning, or rather from the Romans’ interest in origins: Raphael Schwitter offers a monumental synthesis of Roman antiquarianism from the second century bc to the third century ad.1 Rightly identifying such a study as a gap in the scholarship, Schwitter approaches the subject in a comprehensive fashion, starting with a substantial section of introductory material, including an intriguing case study of the way the Romans explained the origins of the use of coins, and some methodological thoughts on what it means to deal with fragmentary texts, followed by an overview of antiquarian writing in Greece, before moving on to the main part of his study: a systematic overview of the contents, literary formats, and scholarly methods of antiquarian writing in the second and early first centuries bc, the first century bc, and the imperial age. As Schwitter himself admits, many of his conclusions necessarily have to remain in the realm of speculation, due to the extremely fragmentary nature of the evidence, but he still achieves his aim: i.e. to show that antiquarianism is a pervasive phenomenon, rather than the mere symptom of a crisis, and that is does not stem from scholarly curiosity per se or the aim to entertain, but to gain orientation in the present by elucidating its connection with the past. Throughout, his focus is on antiquarian monographs, i.e. works more or less exclusively dedicated to antiquarian questions, comprising aetiology, genealogy, and etymology, but also their interaction, e.g. with poetic texts. Schwitter’s study shows impressively that antiquarian writing was a pervasive facet of Latin literature, with a first, still somewhat experimental, phase especially focused on specialized disciplines such as grammar and law, a surge in interest and a growing specialization and differentiation in the first century bc, and a growing trend towards compilation and new contextualization in the imperial age.
In 2008 the first annual Go Topless Day was organized in the US. In 2012 the #FreeTheNipple campaign was launched, prefacing Lina Esco’s 2014 film of the same name. Bruce Willis’ daughter Scout went shopping topless; Jean-Paul Gaultier sent a male and female model down the catwalk with their nipples on show and wearing the Free the Nipple slogan; and Miley Cyrus flashed Jimmy Kimmel. These movements argue, as they say on the tin, that it should be acceptable by legal and cultural norms for women to bare their breasts in public. The question is one of equality and bodily autonomy, and the movement is a way of making women’s voices heard. In our current fraught times, these voices are angry. At International Women’s Day just this year, women from the FEMEN activist group marched topless in Paris to protest against the ‘Fascist Epidemic’ (these words painted on their chests). In their mission statement, FEMEN declare that ‘Our Mission is Protest! Our Weapon are bare breasts’ – and they profess themselves to be a ‘modern incarnation of fearless and free Amazons’.
Targeted sprayers use artificial intelligence to enable on-the-go weed detection and herbicide application, reducing the need to spray entire fields with foliar herbicides. A targeted sprayer was evaluated for treating weeds in corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] cropping systems in the midwestern United States. Using a ONE SMART SPRAY sprayer, our objectives were to (1) evaluate the efficacy of different herbicide application programs: two-passes, spot-spray (SS) only, or simultaneous broadcast residual and SS foliar herbicides; (2) determine whether weed detection thresholds influence weed control; and (3) determine the cost for each herbicide program compared with a traditional broadcast application. Field experiments were conducted in 2022 and 2023 near Manhattan, KS, and in 2023 in Seymour, IL. Both green-on-brown (GOB; burndown applications) and green-on-green (GOG; in-crop applications) were applied. Main plot treatments consisted of four herbicide programs, and the split-plot consisted of four weed detection thresholds: herbicide Efficacy, Balanced, Savings, and a Broadcast application. The percentage of area infested with weeds within each plot was estimated visually 42 d after the GOG application. An “as-applied map” was constructed using raw sprayer data to show when nozzles were turned on or off within a subplot and used to determine herbicide program costs based on the percentage of each plot area sprayed. Results indicated that herbicide programs with simultaneous broadcast and SS components in many cases resulted in a similar area infested with weeds compared with broadcast applications with the same herbicide products. As expected, herbicide costs were lower in SS applications than in broadcast applications. The ONE SMART SPRAY sprayer demonstrated potential to reduce herbicide input costs without compromising weed control.
Norway exhibits one of the highest rates of colorectal cancer (CRC) in the world, and several dietary factors have been associated with the risk of CRC. With higher consumption of ultra-processed foods (UPF), a better understanding of how food processing affects CRC might be a new approach for prevention. The current findings are contradictory, and new findings indicate that CRC risk factors might affect colorectal subsites differently. We wanted to study the association between intake of UPF and CRC risk in Norwegian women. In this prospective cohort analysis encompassing 77 100 women (1625 cases) from the Norwegian Women and Cancer study, dietary intakes were collected using validated semi-quantitative FFQ and categorised using the Nova classification system. Multivariable Cox proportional hazard models were used to assess the association between intake of UPF and CRC risk. The average follow-up time was 17·4 years. A high UPF intake (fourth quartile), compared with a low UPF intake (first quartile), was statistically significantly associated with increased total CRC risk after adjusting for all covariates and energy intake (hazard ratio (HR) = 1·24; 95 % CI 1·04, 1·49, Pfor trend = 0·02). Furthermore, a high UPF intake, compared with a low UPF intake, was statistically significantly associated with right-sided colon cancer (HR = 1·58; 95 % CI 1·19, 2·09, Pfor trend < 0·001). More research is needed to understand the associations between UPF, UPF subgroups and total CRC as well as cancer in colorectal subsites.
This article analyzes historical claims about the Quyllurit’i pilgrimage (Cuzco, Peru). First, it discusses its relationship to Inka rituals and the Tupac Amaru rebellion. It shows that the way the rebellion affected the Ocongate church in 1782 was crucial for the later inscription of 1783 as the year of the pilgrimage’s miracle. It then analyzes how the conflicts between the Ocongate merchants and the hacienda Lauramarca over the commercialization of colono alpaca wool in the late nineteenth and early twentieth centuries are related to the creation of the first written account of the pilgrimage’s origins. This account was written in 1932, using the local archive shaped by the Great Rebellion, but without any evidence of anything that happened in 1783 in what is now the Quyllurit’i shrine. As the pilgrimage expanded beyond Ocongate, scholars who studied the pilgrimage in the 1970s used this first account to hypothesize its relationship to the Great Rebellion within tropes of indigenous cultural authenticity, continuity, and resistance.