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Nurse practitioners, especially in remote rural areas in low- and middle-income countries, initiate treatment for numerous conditions including therapy against infections. For a sustained and meaningful reduction in antimicrobial resistance, nurse practitioners should confidently play a greater role as stewards of antibiotic therapy. Therefore, this study investigated the self-confidence level, perceptions, and professional development needs of nurse practitioners as stewards of antibiotic therapy in remote countryside areas in KwaZulu-Natal, South Africa.
Methods:
Data collection took place at six healthcare facilities in rural areas in KwaZulu-Natal, South Africa. Questionnaires, with open-ended and 5-point Likert-scale-based items, were distributed to nurse practitioners employed, ie, participants, at the research sites.
Results:
One hundred and thirty (n = 130) participants filled and returned questionnaires; 31% (n = 41) and 69% (n = 89) were males and females, respectively. Over 64% (n = 83) of nurse practitioners were not aware of the extent of inappropriate utilization of antibiotics in South Africa, with a median of 3 (interquartile range (IQR 2–3). Over 70% (n = 91) of participants knew that inappropriate utilization of antimicrobials was harmful to patients, with a median of 4 (IQR 3–5). Only 30% (n = 39) of participants felt confident enough to play a meaningful role as stewards of antimicrobial therapy.
Conclusions:
There is a need for continuous professional development programs on antimicrobial stewardship to enhance self-confidence among nurse practitioners in rural areas.
The troublesome weed Johnsongrass [Sorghum halepense (L.) Pers.] is predicted to expand its range under climate change. In the process, it is likely to become more competitive in corn (Zea mays L.) production areas of the northeastern United States and southern Canada. A replicated greenhouse experiment was conducted to measure interspecific and intraspecific competition between an S. halepense biotype from central New York State (northern range edge) and corn under drought and well-watered conditions. Drought stress significantly reduced the biomass and height of corn and S. halepense in both rounds of the experiment (P < 0.001). Drought stress increased the root-to-shoot ratio of S. halepense (P < 0.001) and reduced the root-to-shoot ratio of corn (P < 0.001). In one run of the experiment, corn produced 19.3% more aboveground biomass (P < 0.001) and 6.6% more height (P < 0.001) when competing with an S. halepense plant (interspecific competition) than when competing with a second corn plant (intraspecific competition). Drought conditions increased the advantage of corn plants grown under interspecific relative to intraspecific competition (P = 0.012). In that round of the experiment, biomass of S. halepense was 12.9% higher under intraspecific competition than interspecific competition in the well-watered treatment and 15.5% higher under intraspecific competition than interspecific competition in the drought treatment (main effect of competition, P = 0.002). Differences between competition treatments were smaller in the other round of the experiment (P > 0.05). Our findings suggest that the New York S. halepense biotype used in this study may not be as competitive as biotypes found in this weed’s range core in more southern regions of the United States. However, anticipated effects of climate change may increase the abundance and competitiveness of this species in the northeastern United States.
Scholars have extensively studied the diffusion of criminal laws across the American states, and this paper examines an overlooked story of penal diffusion: the mid-twentieth-century spread of habitual offender laws. These laws, which escalated sentences for repeat offenders, proliferated across the states decades before the enactment of the three-strikes laws to which they bore remarkable resemblance. But whereas prior research has traced the legislative diffusion of habitual offender laws, this article alternatively explores how state courts’ interpretations of habitual offender laws diffused across jurisdictions. Using an innovative theoretical framework blending judicial diffusion research with literatures in neo-institutional theory, this article reveals how state courts borrowed legal decisions from other states to interpret, legitimize, and alter laws within their own jurisdictions. This reveals how state courts can shape the trajectory of legislative diffusion in enduring and profound ways. This study’s unique theoretical framework uses the history of habitual offender laws as a case study to explore underappreciated features and dynamics of the diffusion process that have shaped the development of American criminal law.
AI and Image illustrates the importance of critical perspectives in the study of AI and its application to image collections in the art and heritage sector. The authors' approach is that such entanglements of image and AI are neither dystopian or utopian but may amplify, reduce or condense existing societal inequalities depending on how they may be implemented in relation to human expertise and sensibility in terms of diversity and inclusion. The Element further discusses regulations around the use of AI for such cultural datasets as they touch upon legalities, regulations and ethics. In the conclusion they emphasise the importance of the professional expert factor in the entanglements of AI and images and advocate for a continuous and renegotiating professional symbiosis between human and machines. This title is also available as Open Access on Cambridge Core.
This article presents an analytical framework for studying implementation failure in minimum income programs targeted against poverty and applies it to a case study focused on the recent introduction in Spain of the first national minimum income programme, the Minimum Living Income (MLI). The framework combines two criteria (the type of agent potentially triggering failure, and the type of administrative challenge) to produce four types of implementation problems in targeted minimum income schemes: identification failure, administrative incapacity, nontake-up, and overpayments. We apply this framework in the case of MLI by conducting an exhaustive review of empirical research on its implementation problems. This evidence suggests that the special political circumstances in which the MLI was approved, some features of its design, and its insertion into a complex institutional landscape of regional minimum incomes, explain part of these problems. We conclude with some final remarks and recommendations.
Antimicrobial resistant infections are expected to increase the rate of antibiotic treatment failure in patients during a mass casualty incident. We aim to examine the potential impact of rising antimicrobial resistance (AMR) on medical preparedness and response to a nuclear detonation in the United States (U.S.) using a model to estimate the number of casualties with secondary bacterial infections overlaid with real-world data on the burden of antibiotic-resistant pathogens.
Methods
The population of injured individuals needing treatment was estimated from a simulation involving a 100-kiloton nuclear detonation in a major U.S. metropolitan area. Contemporary antibiotic resistance rates for eight key bacterial pathogens were derived from the SENTRY Microbiology Visualization Platform.
Results
Our model estimated that up to 65% of the casualties could be at risk to develop a secondary bacterial infection requiring antibiotic treatment which, when combined with the increasing burden of AMR in U.S., could result in up to one third of those patients who are injured and infected being at risk for treatment failure due to antibiotic resistance.
Conclusions
The burden of AMR on the emergency response to a mass casualty incident, as described, could be a significant hinderance to efforts to treat infections and protect lives.
This Review has occasionally taken note of the passing of individuals who have made seminal contributions to the public international law of international trade.1 When Frieder Roessler died on 25 July 2024, the editors undertook to memorialize Frieder's legacy with a Symposium about Frieder the international civil servant, Frieder the scholar and teacher, Frieder the institution builder in advocacy for the legal rights of developing countries, and Frieder the friend to admirers around the world and over the course of several decades.
Dissociative disorders frequently co-occur with post-traumatic stress disorder (PTSD), yet many individuals lack adequate treatment. Existing interventions often prioritise reducing arousal over promoting safety and self-soothing, tending to neglect the bodily experience.
Aims
This randomised clinical within-person pilot study examined the effects of the nest position, a physiotherapeutic intervention designed to enhance safety and self-soothing, on patients with dissociative disorders and healthy controls (German Clinical Trials Register No.: DRKS00030669).
Method
Eighteen patients with dissociative disorders and 18 healthy controls alternated between the nest position and a neutral supine position across two rounds of a measurement session. The order of the experimental conditions (nest position or supine only) was randomised for each participant. We assessed self-reported distress and comfort (Subjective Units of Distress and Comfort) and autonomic nervous system activity during three baseline phases and imagination of stressful and comforting situations.
Results
Both patients and healthy controls experienced lower distress and greater comfort in the nest position. Heart rate and sympathetic tone decreased, particularly in the healthy controls. There were no significant changes in parasympathetic tone in both groups. Linear mixed models revealed a significant effect of the nest position on distress, comfort and sympathetic tone.
Conclusions
The nest position is a potentially promising additional intervention for highly dissociative patients. Our findings help to better understand the importance of self-soothing and safety in these individuals and to address the research gap in physiotherapy within in-patient mental health care.
How can populist authoritarian incumbents justify remaining in power when the golden age they promised remains unrealized? We argue that audiovisual products such as videos are particularly suited to enlivening the histories that so many populists evoke in seeking to legitimize their rule. Political science’s traditional focus on speech-based legitimation, however, leaves audiovisual tools largely overlooked. The few studies that do engage these tools test for audience effects, but the content itself and the political strategies behind its curation and dissemination remain undertheorized. By adding an audiovisual lens to studies of authoritarian legitimation, we identify a regime durability strategy we term selective revivification. We specify the cognitive and affective characteristics of videos that quickly communicate information-dense, emotionally evocative messages, arguing that they engagingly distill specific historical elements to portray incumbent rule as not just legitimate but also necessary. In advancing our argument, we construct an original dataset of all existing narration-based YouTube videos shared by six regime institutions in Turkey from the establishment of YouTube in 2005 to 2022 (n = 134). We use quantitative analysis to identify when video usage emerges as a strategy, as well as patterns of dissemination and content elements. We then use intertextual analysis to extract common historical themes and production techniques. The audiovisual tools we specify and the selective revivification strategy they enable fill gaps in studies of authoritarian legitimation while adding to political scientists’ toolkits for wider inquiry.
Individuals with childhood experience of out-of-home care (OHC) face elevated risks of criminal behavior and poor mental health compared with the majority population. Evidence on how trajectories of offending and psychiatric disorders covary among individuals with experience of OHC is needed. This study is based on a cohort of 14,608 individuals (n = 1,319 with OHC experience) born in the Stockholm metropolitan area in 1953 (49% women) from birth to age 63 (2016). Group-based multi-trajectory modeling among those with at least one offense or psychiatric disorder (40.5% of the men, 16.6% of the women) identified four co-occurring trajectories for both sexes. Multinomial regression analyses showed that adolescent OHC placement, particularly in institutions and for behavioral reasons, was linked to higher odds of early-adulthood-limited or decreasing offending and psychiatric trajectories. Most individuals recover from offending and psychiatric disorders by retirement, but placed individuals in particular remain at high risk for offending, alongside psychiatric disorders, throughout early adulthood. Early assessment and tailored attention to needs and risk levels is important when designing long-term care services to mitigate this. Research on underlying mechanisms, and on collaboration between the welfare, justice, and psychiatric care systems, can help to design effective intervention strategies and policies.
The various meanings of ‘legitimacy’ – Constitution-making procedure as a tool to achieve the right content of a new constitutional document – The effect of the procedure on the actual social and political context – Trade-offs between the various conceptions of legitimacy – Inherent tensions between transparency and political compromise, and between inclusivity and elite support – Direct democratic involvement aggravating polarisation – When the time is not ripe for constitution-making, recommended substitute strategies – Various procedural options: popular drafting, constituent assemblies, ordinary parliaments, expert bodies, roundtables, referenda – The dangers of (Kelsenian) constitutional revolutions
Over the past decade, several multi-institutional research consortia have formed within the North American pediatric surgical community. In this article, we describe our experience with the creation and implementation of the Eastern Pediatric Surgery Network, a large and comprehensive research consortium designed to produce a wide array of high-quality clinical studies within our subspecialty. In 2020, a vision statement and rules of governance were established at thirteen academic pediatric surgery divisions in the eastern United States. The research consortium was organized based on four major pillars, namely legal ownership of aggregate data, horizontal leadership structure, mandatory participation in adopted studies, and a broad research portfolio that encompasses the full breath of the specialty. Over the past five years, the number of research projects has dramatically expanded over time and includes participation from 24 different medical centers. Despite a lack of dedicated sponsored extramural support for most projects, there have been 28 abstracts presented at national conferences and 12 manuscripts published in peer-reviewed journals. It is our hope that sharing our experience with creating this organization can help to inform others interested in establishing the academic infrastructure to engage in multi-institutional, evidence-based clinical research in other medical specialties and beyond.
Grandiose delusions have received comparatively little attention in the literature and there is limited empirical evidence assessing the efficacy of cognitive behaviour therapy for psychosis (CBTp) for individuals with grandiose beliefs. This case study presents Noah, a 23-year-old referred to our Early Intervention Service with persistent grandiose beliefs alongside other psychotic experiences. Noah received 26 sessions of CBTp. Scores on measures of perseverative thinking, delusional distress and conviction, wellbeing, and daily functioning were completed at baseline, mid-therapy, end of therapy, and at follow-up 12 weeks after the end of therapy. Results demonstrated improvement across all measures, particularly preservative thinking about beliefs. Improvement in all but one outcome was not only sustained but continued to increase at follow-up. This is one of few known reports on using CBTp with an individual with current grandiose delusions.
Highlights
(1) To explore the use of CBTp with a young male experiencing grandiose beliefs.
(2) To apply learning from recent research on grandiose delusions into the delivery of CBTp.
This study presents the first record of Miyalachnus sorini Kanturski & Lee, 2024 (Aphididae: Lachninae) in South Korea, thereby extending its known distribution beyond Japan and identifying a new host plant, Prunus sargentii (Rosaceae). We describe diagnostic morphological traits across multiple life stages and compare them with those of Japanese populations. Comparative analyses with Japanese populations demonstrated consistent morphological differentiation, notably elevated ratios of the ultimate rostral segment to antennal segments across multiple morphs in the Korean population, indicating potential ecological adaptation. DNA barcoding using the mitochondrial cytochrome c oxidase I gene revealed low intraspecific divergence (average 0.2%) and interspecific divergence (average 10.5%) between Miyalachnus sp. and M. sorini. Haplotype analysis was performed to investigate the relationship between host plants and cryptic genetic diversity. These findings enhance our understanding of the morphological and genetic diversity of M. sorini and underscore the importance of monitoring its spread for informed pest management strategies.
Rural cancer survivors have worse outcomes than their urban counterparts. To improve outcomes, it is essential that rural survivors participate in research, yet they are underrepresented in cancer research. The aim of this study was to assess urban-rural differences in participation in a cancer survivorship survey and differences in mode of participation (mail, online, or phone) by rurality and age.
Methods:
We developed a survivorship needs assessment survey and invited cancer survivors to participate by mail, online, or phone. We compared participation between rural and urban invitees and examined differences in mode of participation by rurality and age.
Results:
A quarter (25.47%) of invited rural patients and 27.84% of invited urban patients participated in the survivorship study. The probability of participation by urban survivors was approximately 1.09 times higher than for rural survivors (χ2(1) = 4.31, p = 0.038). Rural survivors were more likely to participate by mail (average difference [Rural-Urban] = 9.64%, p < 0.001), while urban survivors were more likely to participate online (average difference [Urban-Rural] = 8.77%, p < 0.001). As participant age increased, the likelihood of survey participation by mail increased (1.16% per year of age, p < 0.001) while the probability of participating online decreased by 1.20% per year of age (p < 0.001).
Conclusion:
To ensure equitable access to research for rural and older cancer survivors, researchers should design studies with a range of participation modes. Non-digital methods, such as mailed paper surveys, appear to promote participation among rural and older survivors.
This article combines book history and urban history to examine the spread of the print trade and facilities for reading in Scotland by the 1820s, using a Scotland-wide trade directory as its main source. The article demonstrates how support for reading, including printers, bookshops and venues for reading, extended far and wide within the Scottish urban hierarchy – from the largest cities to the smallest towns and villages. Variations between different types of towns are discussed, and local case studies provide further insights. The article provides fresh perspectives on Scottish urbanization, through its snapshot view of Scotland’s towns in the mid-1820s.
Admission to shared hospital rooms are a risk factor of healthcare-associated (HA) SARS-CoV-2. Quantifying the impact of engineering controls such as ventilation and filtration is essential to informing resource utilization and infection prevention guidelines.
Methods:
Multicenter test-negative study of patients exposed to SARS-CoV-2 in shared rooms across five hospitals between January and October, 2022. Independent variables tested were measured air changes per hour (ACH), presence of any room mechanical ventilation (RMV), or portable high-efficiency particulate air (HEPA) filter. Covariates included facility (number of beds in room, outbreak status of unit), source patient (presence of symptoms, RT-PCR cycle threshold (Ct) value), and exposed patient factors (age, sex, time from last SARS-CoV-2 vaccine, previous SARS-CoV-2 infection, exposure duration). Multilevel logistic mixed models used to estimate the impact of engineering controls on transmission.
Results:
Among 468 exposed patients, secondary attack rate was 26.3% (range 7.5–33.3% across hospitals). In multivariable analysis, increased ACH was associated with decreased odds of infection (adjusted odds ratio (aOR) 0.88, 95% CI 0.78–1.00; p=.046) as were exposure duration and Ct value of source patient. Presence of RMV was also associated with decreased odds of infection (aOR 0.51, 95% CI 0.27–0.95; p=.034) while use of portable HEPA filter was not significant (aOR 0.58, 95% CI 0.26–1.31; p=.18).
Conclusions:
Improved ventilation was independently associated with lower odds of SARS-CoV-2 infection among exposed roommates. Ensuring RMV is present and optimizing ACH may significantly mitigate the risk of HA-SARS-CoV-2. Future prospective studies should assess optimal ACH thresholds and the impact of portable HEPA filters.
This paper presents a new problem for the inference rule commonly known as “inference to the best explanation” (IBE). The problem is that uncertainty about parts of one’s evidence may undermine the inferrability of a hypothesis that would provide the best explanation of that evidence, especially in cases where there is an alternative hypothesis that would provide a better explanation of only the more certain pieces of evidence. A potential solution to the problem is sketched, in which IBE is generalized to handle uncertain evidence by invoking a notion of evidential robustness.