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To identify host and clinical risk factors contributing to the development of Clostridioides difficile infection (CDI) among colonized patients.
Design:
Retrospective, matched case-control study.
Setting:
Duke University Health System, including 3 hospitals and affiliated outpatient clinics.
Participants:
Adult patients who underwent ≥2 two-step C. difficile tests (nucleic acid amplification test (NAAT) followed by toxin enzyme immunoassay) between 03/15/2020–12/31/2023. Cases were patients with C. difficile colonization (NAAT+/toxin–) who converted to CDI (NAAT+/toxin+) within 90 days; controls were colonized patients who remained toxin-negative. Cases were matched to controls by date of index testing (±1 year).
Methods:
Data collection encompassed a 90-day “pre-exposure” period preceding index testing and a ≤ 90-day “exposure” period between index and repeat testing. Antibiotic use was stratified by risk for each period. Multivariate conditional logistic regression with forward selection was used to identify predictors of progression.
Results:
Among 2,212 colonized patients, 71 cases and 133 matched controls were identified. Several host and clinical characteristics were independently associated with progression to CDI in our multivariate model. Notably, high-risk antibiotic use across the pre-exposure and exposure periods was associated with greater odds of progression to CDI compared to other patterns of antibiotic use (adjusted odds ratio 2.70; P = .03).
Conclusions:
Sustained exposure to high-risk antibiotics was a strong predictor of the progression from C. difficile colonization to infection, underscoring the need for further research on longitudinal stewardship strategies for CDI prevention, particularly among patients previously identified as colonized.
Between the 1890s and the 1940s, a diverse group of Chilean diplomats, businessmen, and intellectuals sought to convert Japan into a principal consumer of Chile’s struggling nitrate fertilizer industry (saltpetre). The commercial effort to revive Chile’s export development model through Japanese markets also evolved into an intention to emulate Japan’s formula for sturdy nation-building and for fortifying the economic sovereignty against North Atlantic capital. Ultimately, this article situates Chilean–Japanese relations within a global moment of decolonization and development that sought to reform North Atlantic dominion over international affairs. That Latin American nation- and order-building were shaped not only by the binary embrace or rejection of models from the United States and Europe, but also by ideas from Japan, the Pacific, and Latin America itself, illustrates the possibilities for and sophistication of Global South designs for international engagements and development, even if their counterfactual imaginaries did not always materialize as intended.
The fetus and neonate are especially vulnerable to toxic effects of polychlorinated biphenyls (PCBs), that have been shown to perturb behavioral and neuropsychological development. This study aimed to examine the long-term effects of developmental exposure to PCBs. Doses selected were environmentally relevant to those found in epidemiological studies, on the central nervous system (CNS) of adult rat offspring. Pregnant Sprague Dawley rats were fed cookies that contained a mixture of fourteen PCBs or vehicle (corn oil) daily. PCB doses were 0.011 mg/kg maternal body weight/day (“low”) or 1.10 mg/kg maternal body weight/day (“high”), for 42 days throughout gestation and lactation. Adult offspring were euthanized on postnatal day 450. A battery of immunohistochemical markers of brain structure and function were selected to assess possible effects of developmental PCB exposure. Using a 3×2 factorial design (treatment and sex), two-way analysis of variance revealed significant effects of treatment through the CNS, with no main effect of sex or interaction effects. In comparison with controls, both low and high dose developmental PCB exposure significantly (p < 0.05) increased inhibitory enzyme glutamic acid decarboxylase (GAD67) immunoreactivity in the cerebellar vermis, and decreased lipofuscin autofluorescence in the locus coeruleus (LC). Low dose developmental PCB exposure significantly decreased the perimeter of endothelial cells in the periaqueductal gray, ventral orbitofrontal cortex; and decreased lipofuscin in the dorsal striatum, compared to controls. Findings support the Developmental Origins of Health and Disease concept, which broadly posits that early-life perturbations may influence health trajectories over the lifespan.
Saltmarsh habitat provides important ecosystem services, such as water quality regulation, carbon sequestration and flood defence, but is experiencing losses globally. Historically, this has been caused by land claim, and more recently by rising sea levels. Several methods have been implemented to compensate for saltmarsh habitat loss, including realigning defences, transplanting vegetation, and building structures such as sedimentation fields to enclose areas of mudflat and encourage sediment deposition. It has been suggested that sedimentation fields may offer saltmarsh restoration without the limitations identified in other restoration approaches, such as poor drainage and anoxia caused by changes to the sediment structure due to prior human activity. In this article, we argue that restoration through sedimentation fields should be viewed as a continuation of human activity influencing natural processes, rather than a method that overcomes the influence of prior human activity on saltmarsh ecosystem functioning. This opinion is evidenced by a critical review of the (pre-)historic human activity and saltmarsh restoration attempts at Rumney Great Wharf, Severn Estuary, Wales, where sedimentation fields were constructed between 1989 and 2005 and extended in 2024. We then evaluate the research requirements that need to be addressed to ensure the successful implementation of future schemes, including further understanding of the interactions between physical and biological processes, to enhance ecosystem functioning in sites restored using sedimentation fields.
The knowledge of the Social Determinants of Health (SDH) approach implies Health in All Policies and thorough cultural and social transformations, as well as whole-of-government, whole-of-society policies and governance to address health inequities. Nonetheless, this article argues that in the currently dominant rational decision-making model in health policymaking, these policy implications from the knowledge of the SDH approach would lead to an intrinsic contradiction with the logic of modern bureaucracy based on the legal authority as suggested by Max Weber. Using two examples of social determinants of health — universal health coverage and housing issues — this article demonstrates the potential of the polis model proposed by Deborah Stone to take advantage of the knowledge of the SDH approach to pursue structural policy interventions.
This methodological study investigated how the distribution of training sessions—massed, equal spacing, and expanding spacing—affects L2 phonetic learning, focusing on Mandarin-speaking learners’ perception of the English /ɛ/–/æ/ contrast. While most previous phonetic training studies have used massed schedules, the current quasi-experimental design revealed that both types of spaced practice significantly outperformed massed practice in terms of immediate gains and long-term retention. Effect sizes in the spaced groups were approximately double those of the massed group. No significant differences emerged between equal and expanding spacing. These findings suggest that distributed practice—regardless of spacing type—can enhance both the magnitude and durability of L2 phonetic learning. Crucially, this study makes it possible to revisit past findings based on massed training paradigms and to consider whether adopting alternative timing schedules could unlock greater learning potential—for instance, by doubling the size and durability of training effects through the use of spaced conditions.
Multiple response (MR) items—such as multiple true-false, multiple-select, and select-N items—are increasingly used in assessments to identify partial knowledge and differentiate latent abilities more accurately. Allowing multiple selections, MR items provide richer information and reduce guessing effects compared to single-answer multiple-choice items. However, traditional scoring methods (e.g., Dichotomous, Ripkey, Partial scoring) compress response combination (RC) data, losing valuable information and ignoring issues like local dependence and incompatibility across item types. To address these challenges, we introduce a novel psychometric model framework: the Multiple Response Model with Inter-option Local Dependencies (MRM-LD), and its simplified version, the Multiple Response Model (MRM). These models preserve RC data across MR item types, offering a more comprehensive understanding for MR assessment. Parameters for MRM-LD and MRM were estimated using Markov chain Monte Carlo algorithms in Stan and R. Empirical data from an eighth-grade physics test showed that MRM-LD and MRM outperform Graded Response Model and Nominal Response Model combined with three scoring methods, by retaining more test information, improving reliability and validity, and providing more detailed analysis of item characteristics. Simulation studies confirmed the proposed models perform robustly under various conditions, including small samples and few items, demonstrating their applicability across diverse testing scenarios.
Political parties in Europe are undergoing profound transformations, with many abandoning traditional brands. This study analyzes party names as indicators of ideological and organizational change, combining an original content analysis across 28 European countries (1945–2023) with two conjoint survey experiments. We find that “nonparty” names have become the majority, reflecting a shift away from ideology toward alternative forms of identification. While movement names appear in wavelike patterns linked to protest cycles, such as after the 2008 Great Recession, nonclassical names are especially prevalent among new, opposition, and right-wing parties. However, a paradox emerges: despite their growing adoption, nonclassical names do not easily yield the anticipated electoral benefits, as new parties seem to gain little from abandoning classical naming conventions. By tracing long-term naming trends and integrating survey-based experimental evidence, we advance debates on party transformation, political branding, and the evolving interplay between electoral and movement politics in contemporary democracies.
In this article, we evaluate (a) which major life events (MLEs) in the personal domain (relocation, new friendship, romantic relationship, marriage, parenthood, and grandparenthood) impact on perceived linguistic change among 309 Austrians, and (b) which quantitatively and qualitatively captured individual differences affect this relationship. Bayesian regression modeling revealed that age at the time of the MLE and proficiency in (non)standard varieties were particularly predictive of individual-level perceived linguistic change, as were psychological factors such as event-related characteristics and psychological resilience. Qualitative analyses focusing on whether individuals reported an MLE-related strengthened orientation towards vernacularity or standard language illustrated that individual-level perceived linguistic change was mediated by a complex constellation of MLE-resultant changes in social networks and socioaffective factors.*
In grammaticalization studies, reanalysis is understood as the assignment of new meaning to formally unchanged elements, supported by bridging contexts compatible with the old and the reanalyzed meaning. The source determination hypothesis (SDH) predicts that parallel grammaticalization trajectories occur crosslinguistically, as similar source meanings give rise to similar inferences. One such pattern is the development of recent past markers from FINISH constructions. While grammaticalization pathways are well-documented crosslinguistically, the SDH has never been tested experimentally. In this study, we examine whether modern English speakers are sensitive to inferences arising from a bridging context identified as relevant to the grammaticalization of Old Spanish FINISH into a recent past marker. In a temporal distance judgment task, we examined whether the bridging context identified for Old Spanish facilitates an inference of temporal immediacy in contemporary English, where the construction has not been grammaticalized. In line with the SDH, the bridging context enhanced an inference of immediacy in contemporary English (Exp. 1), with specific grammatical features of the source determining its strength (Exp. 2). These results not only demonstrate the viability of testing hypotheses about language change using experimental pragmatics but also call for empirically refining the concept of source determination.
Patient involvement in health technology assessment (HTA) is nascent globally especially in Asia. The aim was to assess patient awareness, involvement, and learning needs of HTA, particularly in Asia.
Method
An online survey assessed HTA awareness, involvement, and learning needs among patients and caregivers across 33 countries from October 2021 to July 2022.
Results
The survey of 170 participants (127 Asians, 43 non-Asians) revealed that 52.3 percent (89 of 170) were unaware of HTA, only 14.1 percent (24 of 170) engaged in HTA, and only 9.3 percent (15 of 161) had received training. The Asian group exhibited significantly lower HTA awareness (mean score 24.6 vs. 30.4, p < 0.05) and had lower participation rates in HTA discussions (10.2 percent, 13 of 127) compared to the non-Asian group (25.6 percent, 11 of 43) (p < 0.05). Among participants without prior HTA training, 68.5 percent (100 of 146) expressed a learning need.
Conclusion
Patient awareness and involvement in HTA were low globally, particularly in Asia. There was a strong patient learning need for HTA globally.
Preserving viable infective stages of chicken ascarids under laboratory conditions facilitates the maintenance of characterized nematode strains for research purposes. We investigated the survivability of Ascaridia galli eggs exposed to low temperatures and the cryoprotectant dimethyl sulfoxide (DMSO). Two egg developmental stages (unembryonated or fully embryonated) were stored at 4°C, –20°, or –80°C in sterile water or with 5% and 10% DMSO for 1, 2, 4, or 8 weeks. Egg survival was assessed by morphology following post-storage incubation in 0.1 N H2SO4 at 26°C for unembryonated eggs or with a viability dye exclusion test of hatched larvae for the embryonated eggs. The results revealed that neither DMSO nor the hardy chitinous eggshell protected eggs from freezing damage, and not a single egg survived even for 1 week of storage at –20° or –80°C. DMSO at 10% significantly reduced (P < 0.0001) overall egg survival and embryonation capacity with increasing storage time at 4°C compared to water alone. For both egg developmental stages, egg survival was maintained in 5% DMSO at a rate similar to that in water alone. Unembryonated A. galli eggs survived refrigeration better than embryonated eggs with larval viability declining linearly at almost a double rate in the latter (9.75%/week) compared to the former (5.64 %/week). We conclude that DMSO is unlikely to provide cryoprotection for A. galli eggs and also causes concentration-dependent toxicity with increasing exposure time. Furthermore, survival during refrigeration is better for unembryonated than embryonated eggs.
The failure to make LAI the default route over the same oral when both are available is a lost opportunity to improve outcomes for people with schizophrenia. A striking example is the lost opportunity to improve life expectancy. A sophisticated pharmacoepidemiologic study from Sweden matched antipsychotic prescriptions with mortality rates and found that receiving an LAI version improved longevity by about 30% compared to its equivalent oral counterpart. Published a decade ago, it seems to have had little impact within US mental health services. This paper attempts to explain some of the reasons for complacency in adapting LAIs as a preferred approach for oral that have an LAI option available. Hypotheses include (1) not appreciating the importance of accurate information to guide present and future treatment recommendations, (2) considering LAIs primarily for adherence interventions rather than their more general benefit as a superior information platform, (3) how fear of disclosing nonadherence is a primary cause of misinformation, and (4) complacency with status quo acceptance of misinformation without fully appreciating how it harms future outcomes. The outcome benefits that come from changing from the oral to the LAI, if available, will continue. Advances in formulation technology have greatly improved the safety and flexibility of recent LAIs compared to earlier formulations, and formulation advances will allow for additional antipsychotics currently limited to oral formulation to expand to having an LAI version readily available.
This experimental study explored how adopting a deceptive stance affects linguistic processes during real-time production of multi-sentence texts in speaking and writing. Language production involves planning, monitoring and editing – processes that give rise to and are shaped by fluctuations in processing demands. Deception is assumed to influence these processes as speakers and writers manage competing communicative goals: to be coherent while concealing the truth. Narratives were elicited by asking participants to account for events from four short films: two truthful and two deceitful, in both speaking and writing. In speaking, deception decreased the total number of pauses, but in longer deceptive texts, pausing instead increased, suggesting adaptive adjustments to regulate overt cues to lying. In writing, deception decreased text revisions and altered pause behaviour, suggesting that writers modified their production patterns when altering information. Together, these findings suggest that deceptive language production involves shifts in planning, monitoring and editing processes that manifest differently across modalities: while speech shows suppression of pauses, writing reveals subtle changes in revision and pausing behaviour. These results highlight modality-specific signatures of deception and demonstrate how speakers and writers dynamically adapt their language production processes to align with communicative intent.
Assesses the macroevolutionary turnover of paleotropical planktic graptolites during the Late Ordovician Mass Extinction (LOME) via automated sequencing and capture-mark-recapture modeling. Graptolites exhibited a succession of turnover pulses (sensu Elizabeth Vrba) that were coincident with the main phases of the Hirnantian glaciation and during which the Diplograptina experienced declining metapopulation size, elevated extinction, zero species originations, and ultimately, complete extermination. Concurrently, the Neograptina (latest Katian temperate zone immigrants) exhibit pulses of both extinction and adaptive radiation. Thus, the LOME involved intense species selection and the wholesale alteration of the clade diversity structure of a major element of the zooplankton. The LOME is unlikely to have been a direct effect of ocean anoxia or sampling bias but rather resulted from Hirnantian climate change, which altered nutrient supplies and plankton community compositions along with ecological displacement and loss of habitat that together drove the succession of turnover pulses. This title is also available as open access on Cambridge Core.
The results of the taxonomic, taphonomic, and paleoecological analyses of Late Pleistocene micromammals from the Salto de Piedra paleontological locality are presented in this paper. Our results support the conclusion that the microfaunal remains were mainly accumulated by diurnal raptors in areas close to where the remains were deposited, as there is no evidence of transport. Taxonomically, the recovered micromammals include rodents currently inhabiting the Humid Pampa (Calomys cf. C. musculinus-laucha, Ctenomys sp., and Reithrodon auritus) and species that became extinct during the Late Pleistocene (Microcavia cf. M. robusta) and Holocene (Galea tixiensis). Additionally, remains of the Patagonian marsupial Lestodelphys halli and the amphibious sigmodontine Holochilus brasiliensis were identified. These analyses, along with the paleoecological and malacological studies at Salto de Piedra, confirm a trend toward increased humidity, consistent with the paleoenvironmental evidence documented for the region at the end of the Pleistocene. This study of the central Humid Pampa based on this small mammal record is of particular interest for interpreting the paleoenvironmental and paleoecological scenario, coinciding with the arrival of the first humans in the area and the extinction of the megafauna.
In the last century, economic sanctions have been used with increasing frequency as a tool of global governance, as well as in foreign policy. At the same time, they have long been criticized for their lack of success in achieving the stated goals of the sanctioners. However, what has received far less attention is the question of whether, and when, it is legitimate to impose sanctions. It has become increasingly clear that the humanitarian impact of sanctions may be devastating, affecting healthcare and food security, as well as harming vulnerable populations such as migrants. Sanctions may interfere with the work of humanitarian aid organizations, create diplomatic problems, and undermine the autonomy of sovereign states. Further, there can be significant legal questions regarding the use of sanctions, whether they are imposed by states or by institutions of global governance.
This chapter examines the devastating impact of the Gulf War and subsequent economic sanctions of the 1990s on Iraq’s healthcare system, arguing that the sanctions imposed can be understood as a form of silent warfare, causing long-term suffering and systemic collapse. The sanctions, aimed at compelling Iraq’s compliance with international demands, disrupted the country’s vital infrastructure, leading to widespread shortages of medical supplies, a mass exodus of healthcare professionals, and deteriorating public health. As hospitals faced chronic shortages, doctors were forced to adopt unorthodox medical practices, which, though necessary at the time, contributed to the rise of antimicrobial resistance (AMR) and the entrenchment of chronic health issues. The chapter underscores the ecological consequences of sanctions, with a focus on how this induced an ongoing public health crisis, not only within Iraq but across the broader region. It further explores the long-lasting effects of these adaptations on medical practices, such as improvisation in wound care and antibiotic use, which fostered conditions for the spread of resistant infections. By tracing the enduring repercussions of the sanctions, the chapter advocates for a rethinking of sanctions as a form of warfare that has far-reaching, long- lasting consequences for healthcare systems, particularly in conflict zones.