The “shape bias” – the tendency to generalize new nouns by their shape rather than features like colour or texture – is considered a cornerstone of early noun learning. However, the magnitude, development, and cross-cultural generality of this bias remain debated. We conducted a pre-registered meta-analysis and meta-regression of 71 studies to synthesize the evidence base. Our analysis revealed a robust overall effect, confirming the existence of a shape bias. However, this effect was characterized by extreme between-study heterogeneity (I2 = 0.95). Critically, meta-regression analyses failed to support hypothesized developmental changes, with a constant model across ages providing the most parsimonious fit. The literature is overwhelmingly dominated by studies of English-speaking children, preventing meaningful tests of cross-linguistic or cross-cultural variation. Diagnostic tests were also consistent with the possibility of publication bias, though these patterns can also arise from methodological heterogeneity and should be interpreted with caution. Together, these findings indicate that procedural variation, and potentially publication bias, more than currently testable theoretical moderators, account for the variability in the literature, severely limiting the ability to distinguish between theories of the shape bias’s origins.

Authors and Affiliations: Frank Frankovsky III, Thane Thomas, Mark Sigler, MD, Joshua Preator, DO, James Morris, MD, MPH, FACEP, Jennifer Clary, MSN, RN, CIC, Stephanie Stroever, PhD, MPH Background: Healthcare Infection Control Practices Advisory Committee (HICPAC) guideline 2.2.11 recommends replacement of central venous catheters inserted emergently under non-sterile conditions as soon as possible and ideally within 48 hours. The extent of compliance with this recommendation and associated outcomes in emergency department (ED)–placed central lines remains unstudied. Methods We conducted an observational study of adult patients admitted following central line placement in the ED at two hospitals in West Texas between June 2024 and August 2025. Patients who died in the ED were excluded. The primary outcome was time to central line removal or replacement after admission. Central lines were classified as emergent (non-sterile) if placed without maximal sterile barrier precautions and documented as such in a standardized ED log. Conditions of line placement were verified by investigator chart review and, when necessary, direct discussion with the team involved in placement. Patient demographics, indications for line placement, and clinical outcomes were abstracted from the medical record. Median time to removal or replacement was calculated for sterile and non-sterile lines and compared using the Wilcoxon rank-sum test; p-values <0.05 were considered statistically significant. Sensitivity analyses excluded patients who died after hospital admission. Results A total of 284 patients were included, of whom 121 (42.6%) had non-sterile central lines placed. Mean age was 64.5 years, with similar distribution by sex. Common indications for line placement included altered mental status (24.3%), cardiac arrest (19.0%), and shortness of breath (14.8%). Median time to removal/replacement was shorter for non-sterile lines than sterile lines (56.2 vs 90.7 hours; p = 0.038). This difference was not observed in sensitivity analyses excluding patients who died after admission (p = 0.775), suggesting survivorship or competing risk bias. No central line–associated bloodstream infections (CLABSI) were identified. Conclusion No CLABSI events were observed despite median central line dwell times exceeding the 48-hour threshold referenced in HICPAC guidance. Early mortality among patients with emergently placed lines may have limited the opportunity for infection to occur. These findings emphasize the role of concurrent infection prevention measures and highlight the need for multidisciplinary strategies to support timely replacement of emergently placed central lines.

Background: In response to mounting antibiotic resistance and overuse, antimicrobial stewardship continues to serve as a major evolving initiative within healthcare institutions. Handshake stewardship utilizes in-person feedback to help facilitate intervention communication, in hopes of fostering clinician-ASP relationships and providing real-time education. This “face-to-face” approach has been demonstrated to improve antibiotic days of therapy (DOT) while also being perceived by treating teams as more favorable when compared to written feedback. Methods: Integrated ID/Pharmacy rounds occurred daily Monday – Friday, excluding holidays during the months of December 2024 to March 2025. The current hospital admitting structure separates individual hospitalist teams and internal medicine teaching resident teams. Teaching and hospitalist teams each have their own designated floors. To assess the long-lasting impact of ongoing antimicrobial stewardship education and intervention, an alternating checker box design was utilized, where ID/pharmacy rounds alternated between both designated teaching floors and used a hospitalist floor as control, where routine ASP review occured daily. Primary endpoints were antibiotic discontinuation, antibiotic deescalation and intravenous to oral conversion. Patients with an Infectious Diseases consultation were excluded. Results: Primary endpoints were antibiotic discontinuation, antibiotic deescalation and intravenous to oral conversion. Secondary endpoints included impact on length of stay and associated hospital acquired infections (C difficile). Overall: 196/388 patients (50.5%). Hospitalist control floor: 69/190 (36.3%). Teaching: 127/198 (64.6%); for the active teaching rounding group (75/106 (70.8%)) vs ASP education only (52/92 (57.6%)). For Hospitalist control floor vs teaching floor: p < 0.00001. Active teaching rounds vs ASP education: p = 0.037 Conclusion: Active participation and strong presence of ID pharmacy and ID physicians in daily medicine rounds, posiively impacts antibiotic utilization. It secures a direct line of communication and fosters strong relationships between departments, that ultimately benefits patient care, reduces lenght of stay and optimizes antibiotic utilization in terms of deescalation, duration of treatment and targeted antibiotic selection. Limitations include low availability of ID physicians for daily rounds, limited number of ID pharmacists for dailys ASP review and occasional disregard of recommendations by medicine teams.

Background: Genomic surveillance detects healthcare-associated outbreaks that are often missed by traditional methods, offering substantial benefits for infection prevention. However, its use introduces complex ethical dilemmas regarding patient notification and disparities in outbreak detection between institutions with and without genomic capabilities. Methods: We applied the Centers for Disease Control and Prevention's 2020 ethical considerations regarding patient notification and the Ethical Infection Prevention and Control (EIPAC) framework to two hypothetical scenarios involving genomic surveillance programs. Our analysis was informed by qualitative research reporting the types of harm experienced by patients across detected and undetected outbreaks. Results: We identified ethical justifications for patient notification when both genomic and epidemiologic evidence suggest transmission, as well as considerations militating for and against notification when epidemiologic evidence supporting genomic findings is absent (Figure). We also demonstrated ethical concerns arising from institutional disparities in genomic capability such that patients in hospitals without genomic surveillance may suffer preventable harm and remain uninformed due to lack of detection. A harms matrix illustrates physical, psychological, and ethical harms depending on detection and disclosure status. Conclusion: Hospitals adopting genomic surveillance face new ethical duties to disclose transmission events, while those that do not engage in such surveillance risk perpetuating inequities in patient safety and transparency. National guidance is urgently needed to ensure consistency in notification and promote ethical adoption of genomics. Coordinated frameworks from professional societies should define genetic thresholds warranting disclosure, address disparities in pathogen genomic detection methods, and uphold patient trust in the genomic era.

We give a method to produce faithful representations of the groups $G(n,m)=\langle X, Y \ \vert \ X^m = Y^n \rangle $ in $\mathrm {GL}_2(\mathbb {C}[t^{\pm 1}, q^{\pm 1}])$. These groups are Garside groups and the Garside normal forms of elements of the corresponding monoid can be explicitly recovered from the matrices, in the spirit of Krammer’s proof of the linearity of Artin’s braid groups. We use this method to construct several explicit faithful representations of the above groups, among which a representation which generalizes the reduced Burau representation of $B_3 \cong G(2,3)$ to a large family of groups of the form $G(n,m)$ with n, m coprime (which are torus knot groups). Like the Burau representation, this representation specializes to a representation of a reflection-like quotient that we previously introduced, called 2-toric reflection group. As a byproduct, we get a “Burau representation” for some exceptional complex braid groups, which also shows that the latter embed into their Hecke algebra.

Background: Socio-economic factors may play a role in patients’ risk for healthcare associated infections (HAI), including surgical site infections (SSI). The Area Deprivation Index (ADI) is a mapping tool that characterizes neighborhood-level socioeconomic disadvantage based on income, education, employment, and housing quality. A higher ADI score indicates a greater disadvantage. ADI has been studied extensively as a predictor for various patient outcomes. The purpose of this study was to establish whether an association exists between the national ADI score and SSI following abdominal hysterectomy at a 1400-bed academic center in northeast Ohio. Methods: At the Cleveland Clinic, SSIs are identified by Infection Preventionists using NHSN surveillance definitions. Using our surveillance software (EPIC, Bugsy, Verona, Wisconsin), we extracted all NHSN-defined inpatient abdominal hysterectomy procedures in adult patients between January 1, 2023 and December 31, 2024, including those with and without an SSI. We queried our electronic medical record data warehouse for the national ADI score recorded closest to the surgical procedure. Patients without an ADI score were excluded. Characteristics of patients with and without a SSI were summarized. Categorical variables were compared using a chi-square test and a two-tailed t-test was used to compare mean ADI scores. Results: During the study period 682 patients met criteria that underwent an inpatient abdominal hysterectomy, 26 developed an NHSN-defined SSI, including 15 superficial incisional SSI and 11 organ space SSI. Counts and attack rates of SSI, stratified by relevant factors are shown in the Table. Patients with an SSI had an average ADI of 71.81 while patients with no SSI had an average ADI of 62.29 (p=0.0573). Conclusion: In this study, the mean ADI trended higher for patients who developed a SSI following an abdominal hysterectomy, indicating a possible association between socio-economic factors and risk of a SSI. Although the test for difference in mean ADI did not achieve statistical significance, it highlights ADI as a readily obtainable patient characteristic that may contribute to post-operative infection risk. Further exploration of obtainable patient characteristics, including ADI score, is beneficial to inform best practice for optimal outcomes following an abdominal hysterectomy procedure.

Background: Building water systems are known reservoirs for Legionella species, which can lead to healthcare-acquired infections, particularly among immunocompromised patients. Ice machines present complex internal surfaces and components that can support biofilm formation, which makes remediation challenging. This study evaluated the number of mitigation cycles required to eliminate Legionella from hospital water sources, with a focus on ice machines. Methods: A retrospective review of environmental Legionella testing from 2024-2025 was conducted. This included positive results identified from ice machines, sinks, and showers through routine surveillance and outbreak investigations. For each contaminated source, the number of mitigation cycles required for each source to achieve negative results was assessed. A total of 18 ice machines and 25 sinks and showers that tested positive for Legionella species were included in the analysis. Results: A total of 367 water sources were sampled during the study period, including 55 ice machines and 312 sinks and showers. 25 sinks and showers tested positive (8% of total samples) over a two-year period and required a mean of 1.66 mitigation cycles, with no fixture requiring more than five cycles to achieve negative results. In comparison, 18 positive ice machines (33% of total samples) required a mean of 2.67 mitigation cycles to achieve negative Legionella results, with one machine requiring eight cycles. Overall, the ice machines required, on average, one additional mitigation cycle to achieve negative results compared to the sinks and showers. ANOVA testing revealed no statistically significant differences in the number of cycles to clear Legionella between the different sources (F(2,40)=2.65, p=0.083). Conclusion: Ice machines demonstrated a higher frequency of persistent Legionella positivity and required more remediation cycles compared with sinks and showers. While the results were not statistically significant, additional data may demonstrate clearer differences in Legionella clearance across different sources. The persistent positive ice machines prompted implementation of an enhanced sanitization process beyond manufacturer recommendations. This highlights the challenges associated with biofilm control in these devices. Standard cleaning practices based on ice machine manufacturer’s instructions for use (MIFU) may be insufficient at eliminating contamination. These findings support the need for enhanced mitigation strategies and routine environmental surveillance.

Background: Appropriate implementation of Transmission-Based Precautions (TBP) are necessary to decrease the risk of exposure to infectious pathogens and hospital-acquired infections (HAI). Through routine auditing, gaps were identified in the appropriateness of TBP orders within our institution. A multi-disciplinary quality improvement team was convened to implement a TBP stewardship pilot program with aim to increase TBP compliance and optimize use of personal protective equipment (PPE). Methods: Preintervention planning: A key-driver diagram (Figure 1) was created for the pilot program following multiple meetings with infectious diseases (ID) physicians, healthcare epidemiologists, infection preventionists (IP), and nursing leadership. Patients admitted to the ID ward and under the management of the ID service, consisting of 3 pediatrics residents, an ID Pharmacist, and the ID attending physician, were selected for the pilot program starting in October 2025. Protocol Design: Education materials were developed and distributed to members of the ID service, including nursing staff. The stewardship pilot program team, consisting of 4 IPs and 2 healthcare epidemiologists, conducted twice weekly chart reviews of ID ward patients to determine the appropriateness of TBP orders. The pilot program team would interface in-person to review the admitted patients with the ID service once weekly. To determine the impact of the pilot program, baseline and post-intervention TBP-appropriateness was compared using the chi-square test of proportions. Results: At baseline, 60% of patients were on appropriate TBP (n = 249). Following the implementation of the pilot program, the percentage of patients on appropriate TBP increased to 73% (n = 162), p < 0.01. During the interim analysis period, there were no noted outbreaks or documented HAIs on the ID ward. Conclusion: An interim analysis of the TBP stewardship pilot program demonstrated an improvement in the appropriateness of TBP applied to hospitalized patients. Based on qualitative comments from the physicians and nursing staff, the pilot program was well-received. Strengths of the program include real-time feedback, education, and review as well as increased visibility of the Infection Prevention & Control team. Future efforts will focus on increasing TBP-appropriateness to the 80% goal and quantifying the impact on PPE utilization.

Background: Candida growth in organ preservation fluid (OPF) is uncommon, with reported incidence ranging up to 4% of OPF. Its clinical significance is unclear, as many recipients remain asymptomatic, while on rare occasions, transmission can lead to severe donor-derived infections, most notably mycotic aneurysms, graft loss, and fatal hemorrhage. The current American Society of Transplantation (AST) guidance recommends prompt antifungal therapy when Candida is identified; however, real-world practice patterns and outcomes are not well described. Methods: We conducted a retrospective cohort study of adult solid organ transplant recipients at a tertiary academic center from January 2020 through October 2025. Patients with Candida-positive OPF cultures were identified through the medical record. We collected recipients' and donors' demographics, microbiological profiles, antifungal management, and clinical outcomes. Invasive candidiasis was defined as Candida isolated from blood or deep tissue/fluid within 90 days of transplant. Results: We identified 55 solid organ transplant recipients with Candida-positive OPF cultures (34 Kidney, 9 Liver, 12 Kidney-Pancreas). The most common isolates (37 patients) were C. albicans and C. glabrata. Treatment patterns and outcomes varied by organ type. Among Kidney recipients, 20.5% (7/34) received no antifungal therapy; notably, none of these untreated patients developed invasive candidiasis, graft loss, or vascular complications. All Liver recipients (n=9) received antifungal therapy, predominantly for <7 days (n=8). Despite treatment, Liver recipients had high morbidity: 22% (2/9) progressed to invasive candidiasis (peritonitis and vascular arteritis), and 67% (6/9) demonstrated vascular Doppler abnormalities. Median length of hospital stay was similar across treatment durations (p < 0.05) and similarly no increased readmission rate among all transplant groups. Conclusion: Our findings suggest that the risk of Candida-positive OPF is not uniform across organ types, indicating that current universal treatment recommendations may lead to over-treatment in some populations. Kidney recipients demonstrated favorable outcomes even without antifungal therapy. In contrast, liver recipients remained at risk for significant vascular morbidity and invasive infection regardless of treatment. Shifting to an organ-specific, risk-stratified management strategy can improve antifungal stewardship while ensuring safety for higher-risk recipients.

Trust remains the foundation of the financial system, whether digital or physical. Financial trust structures and governance are fundamental to the stability and perception of money in both traditional and digital environments. Financial systems are thus built on two interconnected forms of trust: public trust in societal institutions and inter-organisational trust among financial actors such as banks, businesses, and state agencies. At the core of many hybrid operations lies the objective of weakening public trust in state institutions and social cohesion. Everyday infrastructures such as digital payment systems become plausible targets in a hybrid threat campaign. This study therefore investigates the following research question, ‘How do different hybrid threat scenarios impact key value dimensions of consumer trust in digital payment systems?’, through a scenario-based multi-criteria threat evaluation survey conducted in Sweden, Finland, and Germany. The study suggests that hybrid threat preparedness must include psychosocial dimensions of technical diagnostics. Financial trust is simultaneously procedural and emotional, and hybrid actors are increasingly adept at targeting both. The evidence affirms the need for a re-conceptualisation of digital financial infrastructure as a domain of national security.

Recent advances in learning dynamical systems from data have shown significant promise. However, many existing methods assume access to the full state of the system—an assumption that is rarely satisfied in practice, where systems are typically monitored through a limited number of sensors, leading to partial observability. To address this challenge, we draw inspiration from the Mori–Zwanzig formalism, which provides a theoretical connection between hidden variables and memory terms. Motivated by this perspective, we introduce a constant-lag neural delay differential equations (NDDEs) framework, providing a continuous-time approach for learning non-Markovian dynamics directly from data. These memory effects are captured using a finite set of time delays, which are identified via the adjoint method. We validate the proposed approach on a range of datasets, including synthetic systems, chaotic dynamics, and experimental measurements, such as the Kuramoto–Sivashinsky equation and cavity-flow experiments. Results demonstrate that NDDEs compare favorably with existing approaches for partially observed systems, including long short-term memory (LSTM) networks and augmented neural ordinary differential equations (ANODEs). Overall, NDDEs offer a principled and data-efficient framework for modeling non-Markovian dynamics under partial observability. An open-source implementation accompanies this article.

Cervicovaginal fluid (CVF) represents a promising biospecimen for ovarian cancer biomarker discovery, but metabolomics typically requires specialized collection methods. We assessed the feasibility of applying untargeted metabolomics to self-collected CVF from 10 ovarian cancer patients in the ORCHiD (Ovarian Cancer Epidemiology, Healthcare Access and Disparities) study using ultrahigh performance liquid chromatography-tandem mass spectroscopy. We detected 1107 compounds mapping to 1002 unique metabolite identifiers across 9 super chemical classes, with detection rates of 62–99%. One-third of detected metabolites overlapped with published studies, while two-thirds were novel. Sample-level detection profiles were broadly consistent. Untargeted metabolomics on self-collected CVF is technically feasible and enables metabolite discovery for population-based cancer research.

This exchange began in Chicago as a roundtable at the American Society for Church History’s annual conference in January 2026. It brought together scholars whose work has pushed the study of American liberal Protestantism in pathbreaking directions. In Chicago, we discussed how we came to study liberal Protestantism, how we defined the boundaries of this community, how we understood its place in American history and the history of liberalism, and the relationship between clergy and laity. After a lively conversation with an engaged audience, Church History invited the panelists to reflect further on these important questions and to print our discussion in this journal. The following exchange took place by correspondence during February and March 2026. We invited Thomas A. Tweed, who attended the original panel, to write a response. His thoughtful meditations on the meaning of “liberal” and “liberalism” appear after our exchange.

In this study, a radiative divertor simulator was developed using the linear magnetic mirror device KAIMIR, considering the center chamber as the upstream scrape-off layer and the expander chamber as the downstream region. To achieve divertor-relevant conditions, the gas feed system of the KAIMIR device was upgraded to increase the particle flux at the downstream region. In addition, a differential pumping system using a skimmer structure was implemented to enable independent control of the neutral pressure between the upstream and downstream regions by reducing the vacuum conductance between the chambers. With this system, a neutral pressure up to 70 mTorr was achieved in the expander chamber while maintaining plasma characteristics in the center chamber. Simulations were then conducted, where non-monotonic behaviour of the ion saturation current and line-integrated density was observed with increasing neutral pressure in the expander chamber, suggesting a transition from attached to detached plasma regimes. Visible emission profiles from fast camera measurements revealed enhanced recombination emission and the formation of localised low-temperature plasma near the downstream region. These results demonstrate that the upgraded KAIMIR device provides a controllable linear divertor simulator suitable for the investigation of radiative and detached divertor plasma physics in a linear configuration.

The distinction between bridge verbs, which allow long-distance questions out of their CP complement, and non-bridge verbs, which do not, is found in a range of languages. In the previous literature, this distinction has been variably attributed to the lexical semantic/discourse properties of the CP-embedding verbs, or the syntactic positioning of the dependent CP. In this study, we provide evidence for an alternative, learning-based account, whereby positive input evidence is needed for children to acquire the possibility of wh-dependencies across a CP-embedding verb, and to further generalize this property to all such verbs. We examine the bridge/non-bridge distinction in English and Mandarin, with a corpus analysis of child-directed speech and experimental evidence provided for each language. We demonstrate that while English shows a clear bridge/non-bridge distinction, Mandarin CP-embedding verbs are all bridge verbs for both argument and adjunct wh-dependencies. These findings are predicted by a difference in the structure of the input data available to English versus Mandarin children as they acquire long-distance wh-dependencies, along with the proposed learning-based account of the bridge effect.

Foreign language anxiety (FLA) has been widely studied over the past four decades, yet the effectiveness of anxiety-reduction strategies remains insufficiently understood. This article offers a critical review of research on FLA-reduction interventions, synthesizing the findings from experimental studies across four major categories: emotion regulation, cognitive restructuring, skill building, and classroom environment enhancement. While many strategies show promise, the field lacks a coherent, psychologically grounded framework for supporting anxious learners. Drawing on psychological theories including cognitive-behavioral, acceptance-based, and analytical frameworks and emerging Daoism-inspired psychological perspectives, this article argues for a conceptual shift in FLA research: from viewing anxiety as a surface-level symptom to be eliminated toward understanding it as a meaningful psychological signal that may reflect deeper learner-internal processes. The article proposes an interdisciplinary approach that integrates pedagogical practice with psychological insight, positioning anxiety as a potential catalyst for self-awareness and growth. Implications for language teaching and future directions for FLA research are discussed.

This article constructs a new genealogy for one of the central rhetorical tropes of conservative politics in the United States in recent decades: “job-killing regulation.” Explaining how Republican politicians since Ronald Reagan have wielded this slogan so potently in their war against environmental regulation requires us to attend both to the social history of American capitalism and to the history of neoliberal intellectual production. Neoliberal intellectuals, clustered around the Mont Pèlerin Society, began warning in the 1940s that leftist elites sought to sacrifice the livelihoods of the working class for the sake of their anti-industrial aesthetic preferences. But this line of argument gained little cultural or political purchase in the US until the crisis of deindustrialization that erupted in the 1970s, when executives began systematically threatening layoffs in response to new environmental regulations. These threats were mainly pretextual but incompetently handled by regulatory policy makers, creating a political opportunity that Reagan exploited skillfully.