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Antibiotics are frequently prescribed for acute sinusitis despite national guidelines recommending antibiotics only if specific symptom criteria are met. We aimed to define the proportion of acute sinusitis encounters meeting criteria for antibiotic prescribing, characterize prescribing practices, and identify factors associated with guideline-discordant prescribing.
Design:
This retrospective cohort study included 1,000 randomly selected adult ambulatory encounters with a primary diagnosis of acute sinusitis between January 1, 2024 and March 31, 2024. Encounter notes were reviewed for appropriate antibiotic prescribing criteria as per national guidelines. Encounters were evaluated for drug selection and duration concordance based on local guidelines. A multivariable logistic regression analysis was performed to identify predictors of inappropriate antibiotic prescribing.
Setting:
Emergency departments, urgent care centers, and primary care clinics.
Results:
Antibiotic prescribing criteria were met for 67.6% of included encounters. Antibiotics were prescribed in 93.5% of encounters that met prescribing criteria, and 80.2% of encounters that did not. Both drug selection and duration were guideline-concordant in 49.2% of total encounters. On multivariable analysis, predictors of inappropriate antibiotic prescribing included cough (OR 2.15, 95% CI 1.08–4.29; P = 0.03) and symptom duration between 7 and 9 days (compared to <6 days; OR 7.70, 95% CI 3.24–18.31; P < 0.001). Electronic encounters were associated with lower odds of prescribing compared to in-person encounters (OR 0.03, 95% CI 0.01–0.09; P < 0.001).
Conclusions:
Most encounters for acute sinusitis result in an antibiotic prescription, despite prescribing criteria not being met. These findings may aid antimicrobial stewardship programs in benchmarking and optimizing antibiotic prescribing for acute sinusitis.
Data convey information about greenhouse gas emissions, financial flows, and climate impacts. Such information is used to give meaning to the unfolding climate crisis and global efforts to respond to it. Moreover, data are assumed to increase transparency and accountability (see Gupta and van Asselt 2019), and related reporting and disclosure mechanisms work to facilitate continuous engagement with relevant governance fora and processes (Heyvaert 2018, 110–111). Importantly, in addition to supporting meaningmaking, transparency, accountability, and engagement, data themselves have emerged as a central means of climate change governance. They have become operational elements of institutionalized mobilization, organizing, and steering. At the global level, the United Nations (UN) Climate Change Secretariat, for example, relies on data to strategically structure governance processes, animate implementation activity, and coordinate between actor groups (Mai and Elsässer 2022), and at the transnational level, cross-border climate governance initiatives have begun to collect local climate data to position cities as central players in climate change governance (Mai 2024). Thus, rather than merely supporting or being the outputs of governance processes, data, in a very real sense, do governing work. They constitute and restructure relations between actors, create and sustain novel forms of power and authority, and disrupt existing modes of claiming legitimacy (see Johns 2021). This chapter refers to such governing work as the ‘datafication’ of climate change governance. As data transform ‘what counts as known, probable, certain, and in the process’ (Hong 2020, 1), they powerfully reconfigure existing and give rise to alternative modalities for governing.
In Africa, heads of government and civil society representatives have linked climate resilience to the urgent need to address the continent's debt crisis. The African Leaders Nairobi Declaration on Climate Change has called for a restructuring and relief from the debt as being essential to achieving climate goals, along with access to health and education (African Union 2023). A 2023 statement clarifies that Africa is bearing the social and economic brunt of global warming despite not being responsible for it. Dealing with the catastrophic effects of climate change on lives, livelihoods, and economies through loans is further exacerbating the ‘great financial divide’ between wealthy nations and African countries. This is neither sustainable nor just.
These negotiations reflect historical processes of social exclusion, economic dominance, and political control that have marginalized not just specific communities but also entire geographies. The climate discourse is not spared from this and remains vulnerable to reproducing inequities. The most recent reflection of this is Papua New Guinea's decision to withdraw from the 29th Climate Conference of Parties (COP29) calling it a ‘total waste of time’ (Bush 2024), as there remains inaction on the part of big emitters to reform the economic models to reduce emissions and rich nations to ensure _nancing.
Climate Justice seeks that the climate discourse reject exclusion and recognize marginalization of people and places. In doing so, it creates a complex process of embedding questions of power, hierarchy, fairness, and relief as necessary to understand climate change.
Texts are defined by their decontextualizability, including decontextualization from the sensory experience of their transmission. Nevertheless, text, like all of language, is always encountered in some material form. This paper explores how readers make use of distinct text modalities to coordinate individual reading activities into a collective experience of textual unity. I present a semiotic analysis of meetings of a Taipei-based reading group alongside explicit metapragmatic talk from readers on the affordances of different text formats, such as audiobooks, e-books, and print. I show how readers leverage differences and similarities between the same text in different formats to achieve degrees of alignment, coherence, and coordination, even in the absence of agreement on truth-conditional propositional content. I argue that the ability of text to serve as an anchor for social life depends upon interactional practices that alternately foreground and background the sensory dimensions of acts of reading.
India ranks seventh in the 2021 Global Climate Risk Index (Germanwatch 2021), and in 2017, it was the second most-affected country in terms of casualties related to extreme weather (Germanwatch 2017). Water pollution, food and water shortages (Niti Aayog 2019), waste management, and biodiversity loss (Kumari, Wate, and Anil 2014, 107) are just some of India's problems. Its large population coupled with a severe economic dependency on agriculture (FAO 2023) exposes it to severe vulnerabilities. Owing to its geography and high economic dependence on climate-sensitive sectors, India is one of countries most vulnerable to climate change (Harjeet Singh 2015). ‘Food security of India may be at risk in the future due to the threat of climate change leading to an increase in the frequency and intensity of droughts and floods, thereby affecting production of small and marginal farms.’ (Ministry of Environment and Forest 2009, 78). As a protector of people's rights, Indian courts are legally bound to protect the environment.
The chapter's research method involves an analysis of the literature and review of the judicial precedent. The chapter aims to compare the judicial precedents of the Supreme Court of India and the National Green Tribunal (NGT) to understand the evolution of their response to environmental litigation.
Article 48A in the Constitution of India obliges the government to protect the environment and conserve the natural resources of the country.
A methodology for impedance control based on mechanical vibration theory was presented to select stiffness and damping to meet the desired dynamic response using modal analysis. This methodology provided profound insights into how changes in stiffness and damping matrices influence a robot’s dynamic response under impedance control, by determining natural frequencies and damping ratios in the modal space. In this paper, our analytical and experimental results challenge the claim of a recent paper stating that the use of a null-space projection does not affect the outcomes, which appears to be a claim that is valid based only on their specific choice of stiffness and damping matrices and robot configuration. Through experiments using a 7-DOF Franka Emika Panda robot, we demonstrate the influence of both stiffness/damping matrices and the weighting matrix of null-space control on the responses of robot manipulators with degrees of redundancy performing primary and secondary tasks. We also introduce and show insights of the benefits of switching between the statically and the dynamically consistent projection matrices, contributing to the broader understanding of the dynamic response of redundant robotic manipulators.
Rising levels of household food insecurity in England, and associated health and well-being impacts for children, have led to calls to expand access to free school meals (FSM). Policymakers have been hesitant to extend provision of FSM due to concerns surrounding acceptability, affordability and implementation challenges. The most effective strategies for expanding FSM are not yet fully understood. This work aims to fill this gap by examining school meal policy from the perspective of multiple stakeholders, to provide actionable recommendations for policies that could expand school meal provision.
Design:
A qualitative interview study design was used. The data were analysed using the Framework Method, underpinned by the Context and Implementation of Complex Interventions (CICI) framework. Themes were categorised into context-related and implementation-related factors. Detailed recommendations were discussed at the macro, meso and micro levels of the school food system.
Setting:
The study was conducted in England, UK.
Participants:
Seventeen stakeholders represented the views of local, regional and national government, policy, academia and schools.
Results:
Stakeholders indicated that policies should prioritise stigma reduction and integrate expansion of school meals with existing school policies where possible, including the monitoring of school food standards and ensuring maintenance of school food quality. Stakeholders also suggested improvement to the administrative process and communication with families and recommended a joined-up approach linking interventions with common goals across the whole food system.
Conclusions:
Crucially, sufficient financial support is essential for successful implementation.
We present the Galactic Plane Monitor (GPM), a dedicated low-frequency radio transient survey conducted with the Murchison Widefield Array at 200 MHz. The GPM targets an underexplored region of transient parameter space spanning timescales from seconds to weeks, where recent discoveries of unusual Galactic radio sources—including long-period transients and other coherent emitters—suggest a rich and largely uncharted population. Leveraging the MWA’s wide field of view, we carried out 72 observing epochs between June 2022 and March 2025, searching ∼ 5,000 sq. deg. of the Southern Galactic plane. We developed a multi-stage processing pipeline to search for variability across a broad range of timescales, from intra-snapshot (4 s to minutes), to inter-snapshot (minutes to hours), and inter-epoch (days to years). This approach combines image differencing, statistical variability metrics, and visual inspection to robustly identify transient candidates while mitigating the effects of ionospheric variability and imaging artefacts. In parallel, we produced deep mosaics using a “lucky imaging” strategy to maximise sensitivity to faint persistent sources. We present the detections of five long-period radio transients, seven eclipsing binary millisecond pulsars, seven intrinsically variable pulsars, and the detection of refractive interstellar scintillation and night-time interplanetary scintillation. The GPM represents a key step toward fully mapping the dynamic low-frequency radio sky and informs the design of next-generation transient surveys with the SKA Observatory.
The design-based paradigm may be adopted in causal inference and survey sampling when we assume Rubin’s stable unit treatment value assumption (SUTVA) or impose similar frameworks. While often taken for granted, such assumptions entail strong claims about the data-generating process. We develop an alternative design-based approach: we first invoke a generalized, non-parametric model that allows for unrestricted forms of interference, such as spillover. We define an associated set of inferential targets and discuss their interpretation under SUTVA and a weaker assumption that we call the “no unmodeled revealable variation assumption” (NURVA). We then reconstruct the standard paradigm, reconsidering SUTVA at the end rather than assuming it at the beginning. Despite its similarity to SUTVA, we demonstrate the practical limitations of NURVA alone for identifying substantively interesting quantities. In so doing, we provide clarity on the nature and importance of SUTVA for applied research.
Four species of Lygus bugs (Hemiptera: Miridae), Lygus lineolaris, L. keltoni, L. elisus, and L. borealis, are native pests of many crops throughout North America. In eastern Canada, a European parasitoid, Peristenus digoneutis (Hymenoptera: Braconidae), occurs adventively from intentional releases made in the 1980s in the northeastern region of the United States of America. In the Canadian prairies, P. mellipes and P. howardi are common native parasitoids that attack the first and second generations of Lygus, respectively, albeit at low levels. Therefore, relocation of P. digoneutis has been considered to enhance biological control in western Canada. We investigated the potential for competition between the native and exotic Peristenus spp. in laboratory settings. Our results showed that no statistically significant effects of simultaneous or sequential competition occurred on the success of parasitism by the native species, particularly for P. howardi. Minor reductions in parasitism by P. mellipes were observed only when the exotic species was added one day before the native species. From these findings, we conclude that the risk for competitive displacement of native Peristenus spp. by P. digoneutis is low. The potential benefits of having a parasitoid with two generations and the likely additive mortality effects on Lygus bug pests should outweigh the low environmental risks of introducing P. digoneutis.
As diffusion scholars increasingly focus on the various mechanisms underlying the spread of policy innovations, it is important to establish clear theoretical foundations for each one. Elite socialization—innovations that diffuse because of the convergence of lawmakers and policy advocates around norms of appropriateness—is the most underdeveloped mechanism in the American diffusion literature. This is a critical oversight given the application of socialization in other contexts and the success of interstate policy networks in seeding policy cascades across the states. This article remedies this problem both by providing a theoretical foundation for elite socialization as an explanation for diffusion via interstate policy networks in the United States and differentiating this mechanism from four other common diffusion mechanisms. It offers testable core and peripheral assumptions and illustrative case studies of strict voter ID and organ donor law diffusion. Finally, it presents a research agenda for systematically testing socialization diffusion, which includes a discussion of methodological opportunities and challenges.
In August 1914, when the First World War broke out in Europe, the Indian Branch of the St. John Ambulance Association (ISJAA) immediately started to organise relief provisions for the British Indian Army troops. With the sizable expansion of its pre-war ambulance and first aid agenda during the war, this non-state organisation ventured into various fields of humanitarian war work in the following four years; these fields were usually linked to, or seen as, ‘Red Cross work’. In colonial India, where until 1920 no ‘national’ Red Cross society formally existed, the ISJAA strikingly decided to fill the void. In 1914, it identified itself as the Red Cross representative in India.
This chapter shifts the focus to the humanitarian work undertaken by the ISJAA, calling for a more nuanced examination of the historical contexts surrounding the so-called Red Cross humanitarianism. Existing research has emphasised the global reach and significant impact of the Red Cross movement during the First World War, while often failing to acknowledge the contributions of other humanitarian actors who played a crucial role in providing relief.1 Historian Rebecca Gill has powerfully reminded us to ‘acknowledge the relevance of a multi-levelled history of the local, national, imperial, and international’ when it comes to understanding humanitarianism. However, she erroneously refers to the war participation of a Red Cross society in India when she actually means the ISJAA.2 By focusing on the latter's relief work, the chapter illustrates the existence of alternative humanitarian actors of significance in the provision of relief to soldiers during wartime in the British Empire.
Behavioural activation is effective for depression, but its effectiveness in treating adults with depression when delivered by lay workers remains unclear.
Aims
To examine the effectiveness of behavioural activation delivered by lay workers, compared with any control group, in reducing depressive symptoms in adults.
Method
This systematic review searched six databases from inception to January 2025, for randomised controlled trials (RCTs) comparing behavioural activation and any control conditions for individuals with depression when delivered by lay workers. Additional searches were conducted in the international trial registries and reference lists (PROSPERO registration CRD42024625620). Risk of bias was assessed using the Cochrane Collaboration’s Risk-of-Bias 2 tool. Random effects meta-analysis was conducted using the Metafor package in R.
Results
Of 9614 initial studies, six RCTs met the inclusion criteria and were included. A total of 1118 participants in the intervention groups and 1596 in the control groups. The findings demonstrated a small but statistically significant effect in reducing depressive symptoms in favour of the intervention group (standardised mean difference: −0.28, 95% CI −0.46 to −0.09; p = 0.0029). However, the risk of bias was high across all studies, with substantial heterogeneity (I2 = 76%).
Conclusions
Evidence from this review and meta-analysis suggests that behavioural activation, when delivered by trained lay workers, may offer an effective approach for reducing depressive symptoms in adults, particularly in settings with limited access to specialist mental healthcare professionals. However, high risk of bias and heterogeneity of the included studies means that these findings should be interpreted with caution.
While initially piloted as the technology behind cryptocurrencies, the distributed ledger technology underlying Bitcoin, that is, blockchain, now extends to use cases beyond mere virtual currencies. Technologists and blockchain evangelists have been quick to overlook the excessive carbon footprint of Bitcoin, the world's first cryptocurrency, and have attempted to expand the use cases of blockchain to areas beyond virtual currencies, finance, and payments (Huang, O’Neill, and Tabuchi 2021). This technology that brings together characteristics of decentralization, peer-to-peer computing, hash functions, asymmetric public–private key cryptography, and consensus algorithms to form a shared, immutable, and non-repudiable database is considered to have tremendous potential in fields such as identity and access management, healthcare, supply chain tracking, climate change, and so on (De Filippi and Wright 2018). Therefore, unsurprisingly, blockchain technology is now touted as the Panglossian solution to a myriad of problems ranging from financial inclusion to aid and climate change (Marke 2018).
This chapter attempts to ascertain whether the claims of blockchain as a solutionist technology for climate change, in reality, reflect and entrench the incumbent power asymmetries and the global digital divide in the guise of disintermediation and collective capitalism. This chapter applies the extant concepts of techno-colonialism and data colonialism to critically examine blockchain-based initiatives in the climate change sector.