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Respiratory syncytial virus (RSV), although frequently reported in pediatric populations, is also associated with significant morbidity and mortality in vulnerable adults. From an Infection Control perspective, it is therefore of particular concern in hospital and long-term care settings.
Objective:
We report an RSV outbreak that occurred in the memory care unit of a Veterans Affairs-affiliated long-term care facility where the characteristics of the resident population posed unique challenges to halting transmission.
Setting:
The outbreak occurred in a 30-bed unit within a 230-bed Veterans Affairs-affiliated long-term care facility in Florida.
Methods:
An investigation was performed in coordination with the local Department of Health. All residents on the affected unit had dementia with resulting difficulty participating in infection prevention measures, including isolation, masking, and hand hygiene. Interventions implemented included twice weekly RSV testing, enhanced cleaning protocols, staggered mealtimes/outdoor dining, and cancellation of group activities, visitations, and new admissions. A retrospective case–control study was performed to assess for potential risk factors for acquiring RSV.
Results:
Over a 21-day period in 2022, 20 out of 29 residents tested positive for RSV within the affected unit. No other units were involved. Univariate analysis did not find any statistically significant risk factors for acquiring RSV infection, although small sample size may have impacted the results.
Conclusions:
A multifaceted approach was ultimately successful in preventing ongoing transmission of RSV within and beyond the unit. The infection control techniques utilized in this unique patient population could potentially be applicable to challenging outbreak situations at other facilities.
A museum should be a place where cultures, dialogue, and social relations are enhanced. Given the renewed public interest in the topic, the author poses the question: Is there a need and a possibility to decolonize ethnographic museums? Should we have common and shared practices? In an attempt to eliminate colonial vestiges in museums, an analysis of literature and practices leads the author to analyze five European ethnographic museums in order to understand their merits and shortcomings. The subjectivity of these institutions and the diversity with which colonization can be presented makes the proposal of a single generalized solution not preferable. An objective analysis, based on actions and variables, drives the author to determine, however, that in order to revitalize museum practices, there is a need to create a sharable framework. The design of minimum standards can help museums set clear and measurable goals to achieve a higher level of decolonization.
This letter investigates the electoral effects of symbolic class signalling through ‘cultural consumption’ in contemporary politics. We explore how politicians referring to an activity related to class-specific ‘cultural consumption’ – drinking beer in a pub or listening to classical music with a glass of wine – appeals to voters. We argue that symbolic class signalling has gained in importance due to the political realignment along the cultural dimension, and we expect radical right parties to benefit most from it. Our conjoint survey experiment with 1,550 respondents in Switzerland in January/February 2023 confirms our expectation. While many voters are biased against politicians claiming to enjoy classical music and wine, politicians drinking beer in a pub appeal particularly to radical right working-class voters without tertiary education. These findings contribute to our understanding of the role of symbolic politics and class identity in times of political transformation.
The physical fidelity of turbulence models can benefit from a partial resolution of fluctuations, but doing so often comes with an increase in computational cost. To explore this trade-off in the context of wall-bounded flows, this paper introduces a framework for turbulence-resolving integral simulations (TRIS) with the goal of efficiently resolving the largest motions using a two-dimensional, three-component representation of the flow defined by instantaneous wall-normal integrals of velocity and pressure. Self-sustaining turbulence with qualitatively realistic large-scale structures is demonstrated for TRIS on an open-channel (half-channel) flow configuration using moment-of-momentum integral equations derived from Navier–Stokes with relatively simple closure approximations. Evidence from direct numerical simulations (DNS) suggests that TRIS can theoretically resolve $35\,\%{-}40\,\%$ of the turbulent skin friction enhancement for friction Reynolds numbers between $180$ and $5200$, without a noticeable decrease or increase as a function of Reynolds number. The current implementation of TRIS can match this resolution while simulating one flow through time in ${\sim}1$ minute on a single processor, even for very large Reynolds numbers. The framework facilitates a detailed apples-to-apples comparison of predicted statistics against data from DNS. Comparisons at friction Reynolds numbers of $395$ and $590$ show that TRIS generates a relatively accurate representation of the flow, while highlighting discrepancies that demonstrate a need for improving the closure models. The present results for open-channel flow represent a proof of concept for TRIS as a new approach for wall-bounded turbulence modelling, motivating extension to more general flow configurations such as boundary layers on immersed objects.
Rapid molecular diagnostics, such as the BIOFIRE® Blood Culture Identification 2 (BCID2) panel, have improved the time to pathogen identification in bloodstream infections. However, accurate interpretation and antimicrobial optimization require Infectious Disease (ID) expertise, which may not always be readily available. GPT-powered chatbots could support antimicrobial stewardship programs (ASPs) by assisting non-specialist providers in BCID2 result interpretation and treatment recommendations. This study evaluates the performance of a GPT-4 chatbot compared to ASP prospective audit and feedback interventions.
Methods:
This prospective observational study assessed 43 consecutive real-world cases of bacteremia at a 399-bed VA Medical Center from January to May 2024. The GPT-chatbot utilized “chain-of-thought” prompting and external knowledge integration to generate recommendations. Two independent ID physicians evaluated chatbot and ASP recommendations across four domains: BCID2 interpretation, source control, antibiotic therapy, and additional diagnostic workup. The primary endpoint was the combined rate of harmful or inadequate recommendations. Secondary endpoints assessed the rate of harmful or inadequate responses for each domain.
Results:
The chatbot had a significantly higher rate of harmful or inadequate recommendations (13%) compared to ASP (4%, p = 0.047). The most significant discrepancy was observed in the domain of antibiotic therapy, where harmful recommendations occurred in up to 10% (p <0.05) of chatbot evaluations. The chatbot performed well in BCID2 interpretation (100% accuracy) but provided more inadequate responses in source control consideration (10% vs. 2% for ASP, p = 0.022).
Conclusions:
GPT-powered chatbots show potential for supporting antimicrobial stewardship but should only complement, not replace, human expertise in infectious disease management.
Many philosophers think that doing philosophy cultivates valuable intellectual abilities and dispositions. Indeed this is a premise in a venerable argument for philosophy’s value. Unfortunately, empirical support for this premise has heretofore been lacking. We provide evidence that philosophical study has such effects. Using a large dataset (including records from over half a million undergraduates at hundreds of institutions across the United States), we investigate philosophy students’ performance on verbal and logical reasoning tests, as well as measures of valuable intellectual dispositions. Results indicate that students with stronger verbal abilities, and who are more curious, open-minded, and intellectually rigorous, are more likely to study philosophy. Nonetheless, after accounting for such baseline differences, philosophy majors outperform all other majors on tests of verbal and logical reasoning and on a measure of valuable habits of mind. This offers the strongest evidence to date that studying philosophy does indeed make people better thinkers.
We explore the role that large fires played in the early development of the Japanese fire insurance industry. Using a prefecture-level data set spanning 30 years, our econometric analysis shows that large fires led to an increase in new policies and policy renewals, consistent with historical narratives that insurance companies used these events to advertise their business. We also show that this subsequent surge in policies led to more small fires due to arson. Anecdotal evidence suggests that it is more likely to have been due to moral hazard rather than adverse selection.
We assessed patient experience of care, comparing current and past smokers, and whether frequency of advice to quit smoking impacts patient rating of care.
Background:
Experience of care may be a concern for people who smoke and affect their partnership with healthcare providers.
Methods:
We surveyed adults aged over 35 years who had visited a general practitioner (GP) for health care in the past year (n = 611 current and n = 275 ex-smokers). Questions assessed smoking history, experience of care, anticipation of stigma, and perceptions of smoking cessation advice received in general practice.
Findings:
Fewer than half (48.8%) of current smokers reported ‘always’ or ‘usually’ being advised to quit smoking, or being advised in a way that motivated them to quit by a GP or other care provider at their GP practice. Current smokers tended to delay or avoid help seeking when needed and experienced more anticipation of stigma in healthcare settings. Conversely, respondents who reported being advised to quit more frequently rated overall quality of care more highly. These data show that asking about smoking and providing advice to quit smoking was acceptable to most respondents and associated with higher ratings of quality of care. However, advice should be provided in a way that motivates patients, without exacerbating the stigma associated with smoking, which may impact help seeking.
The Biden administration requested comments regarding “Public and Private Sector Uses of Biometric Technologies” in the Federal Register from October 2021 to January 2022. This generated 130 responses, helped shape the “Blueprint for an AI Bill of Rights,” and resulted in Executive Order 14110 on “Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence.” While the Trump administration immediately rescinded this executive order, these comments provide insight into salient AI biometrics technologies and relevant political players. We first identify AI biometric technologies before asking which institutions and individuals commented (RQ1), and what the substance and tenor of responses were regarding the opportunities and threats posed by AI biometrics (RQ2-a) based on respondent type (RQ2-b). We use text mining and qualitative analyses to illuminate how uncertainty about AI biometric technology in this nascent policy subsystem reflects participants’ language use and policy preferences.
The Western European prison reforms of the 1960s and 1970s were based, among other things, on the claim that prison labour should match the conditions of free labour as closely as possible. In reality, prison labour remained forced labour and thus followed its own logic, within which social security and remuneration did not correspond to the free labour market conditions. Prisoners were not and are not workers in the true sense of the word; rather, they oscillate between forced labour and non-work. This article deals with this contradiction, which is still inherent in prison labour in many Western democracies today. Using the example of West Germany, it historicises the relationship between work and punishment behind bars and attempts to show that although the punitive nature of prison work has changed since the late 1960s, it has ultimately never been lost – despite criminal policy objectives to the contrary. It was a normative question of values: how much equality did prisoners deserve?
Antimicrobial resistance (AMR) poses a significant global health threat, projected to cause 10 million deaths annually by 2050. Addressing AMR requires a coordinated, multidisciplinary approach encompassing infectious disease (ID) clinicians, pharmacists, microbiologists, infection preventionists, and policymakers. The inaugural AMR Summit, hosted by bioMérieux in collaboration with Tampa General Hospital and the University of South Florida Morsani College of Medicine in November 2024, convened experts from various fields to explore innovative strategies for combating AMR. Key topics discussed included the role of multidisciplinary teams in antimicrobial stewardship programs, advancements in rapid diagnostic tests and antimicrobial susceptibility testing, the application of implementation science in AMR, and the integration of next-generation sequencing in ID diagnostics. The summit underscored the importance of diagnostic innovation, interdisciplinary collaboration, policy, advocacy, and public engagement in advancing efforts against AMR.
The purpose of this study is to thoroughly examine the concept and significance of corruption in the European Union from an ethical standpoint and analyse statistical data on the level of corruption and attitudes towards it, using the example of Italy, Greece and Latvia. For effective research on the subject, it is important to use the hermeneutical method and quantitative analysis. The study considers corruption and ethics, identifies the essence, their concept and content, and demonstrates the connection between them. The analysis of an international regulatory act related to the fight against corruption is conducted and, based on this analysis, the forms of corruption are determined. The influence of corruption on society and various spheres of state government, both in general, in the international arena (and directly within the European Union), and on the example of individual states (Italy, Greece and Latvia) is established. The level of corruption is analysed in accordance with the Corruption Perceptions Index Transparency International, and the best and worst indicators among the member states of the European Union are highlighted. As a result of the study, the most thorough definitions of the concepts of ethics and corruption are provided, the relationship between these concepts is demonstrated, and statistical data on the level of corruption in the world’s countries (in particular, in relation to the selected states) are established. Changes in the perception of the level of corruption in 27 European Union states from 2012 to 2023 are also analysed. This study emphasizes the importance of compliance with ethical behaviour by representatives of the civil service and enterprises. The specific problem of employees exceeding their powers, which leads to public disbelief in the effectiveness of the government of their state, is also noted. In addition, the study showed that focusing on ethical issues can substantially contribute to preventing and combating corruption.
Woodrats of the genus Neotoma are an important study system for ecological and paleoecological research. However, paleontological studies are often hindered by the difficulty of identifying woodrat remains to species. We address this limitation by using 2D landmark-based geometric morphometrics to classify 199 lower first molars (m1s) of five extant western North American Neotoma species (N. albigula, N. cinerea, N. fuscipes, N. lepida, and N. macrotis) collected throughout California. We then use discriminant analysis of principal components (DAPC) models to identify Late Pleistocene fossils of unknown species from the Rancho La Brea Tar Pits in Los Angeles, California. DAPC correctly identifies ∼85–90% of extant individuals to species, with most misclassifications occurring between sister taxa N. fuscipes and N. macrotis. Most fossil m1s are classified as N. macrotis by DAPC, which may be the first confirmation of N. macrotis in the fossil record. We show that landmark-based geometric morphometric analyses are generally effective at differentiating m1s of extant Neotoma species in California and they are an auspicious method for unknown fossil identification. Further applications of this method across a broader range of geographic locations and species will better contextualize its utility.
3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) has shown promising safety and efficacy in phase 3 studies of post-traumatic stress disorder, but has not been investigated for a primary diagnosis of major depressive disorder (MDD).
Aim
We aimed to explore the proof of principle and safety as a first study with MDMA-AT for MDD, and to provide preliminary efficacy data.
Method
Twelve participants (7 women, 5 men) with moderate to severe MDD received MDMA in 2 open-label sessions 1 month apart, along with psychotherapy before, during and after the MDMA sessions, between January 2023 and May 2024. The primary outcome measure was mean change in Montgomery–Asberg Depression Rating Scale (MADRS), and the secondary outcome measure was mean change in functional impairment as measured with the Sheehan Disability Scale (SDS), both from baseline to 8 weeks following the second MDMA session. We used descriptive statistics and the two-tailed Wilcoxon signed-rank test to compare baseline and outcome scores. Repeated measures were analysed by a mixed-effects model.
Results
Baseline MADRS was 29.6 (s.d. 4.9). Feasibility was demonstrated with sufficient recruitment and retention. MADRS scores were significantly reduced post treatment compared with baseline (mean difference –19.3, s.e. 2.4, CI –14.8 to –23.8, P < 0.001). SDS scores significantly decreased from baseline (mean difference –11.7, s.e. 2.2, CI –7.5 to –15.9, P = 0.001). There were no adverse events of special interest, and no unexpected or serious adverse events.
Conclusion
The study met the primary objectives of safety and feasibility, and provided indications of efficacy for MDMA-AT for MDD. Further studies with a randomised design are required to confirm these findings.
In the early 2000s, Ramakrishna asked the question: for the elliptic curve
\[E\;:\; y^2 = x^3 - x,\]
what is the density of primes p for which the Fourier coefficient $a_p(E)$ is a cube modulo p? As a generalisation of this question, Weston–Zaurova formulated conjectures concerning the distribution of power residues of degree m of the Fourier coefficients of elliptic curves $E/\mathbb{Q}$ with complex multiplication. In this paper, we prove the conjecture of Weston–Zaurova for cubic residues using the analytic theory of spin. Our proof works for all elliptic curves E with complex multiplication.
We prove a Poisson process approximation result for stabilising functionals of a determinantal point process. Our results use concrete couplings of determinantal processes with different Palm measures and exploit their association properties. Second, we focus on the Ginibre process and show in the asymptotic scenario of an increasing observation window that the process of points with a large nearest neighbour distance converges after a suitable scaling to a Poisson point process. As a corollary, we obtain the scaling of the maximum nearest neighbour distance in the Ginibre process, which turns out to be different from its analogue for independent points.
Bornite (Cu5FeS4) and digenite (Cu9–xFexS5; x = 0.4) have closely related cubic structures and are known for their range of superstructures derived from metal vacancies leading to larger unit cells expressed as n × a, where a = ∼5.5 Å and n is an integer. Such polymorphs can form during cooling from higher temperature bornite (Bn)–digenite (Dg) 1a solid solution (ss). The alleged basket-weave textures in natural bornite are investigated using high-angle annular dark field (HAADF) scanning transmission electron microscopy (STEM) imaging and energy-dispersive X-ray spectrometry. These techniques, combined with crystal modelling and STEM simulations, are suitable for depicting changes in phases related to crystal-structural modularity as they collectively better reproduce atomic distributions in real space. Bornite associated with either chalcocite or chalcopyrite from the Olympic Dam Cu-U-Au-Ag deposit, South Australia has non-stoichiometric Cu/Fe ratios and displays nanoscale basket-weave textures between the main components Bn2a and anilite (Cu7S4); Dg1a is preserved throughout, albeit as a minor phase. Anilite is a derivative of digenite, whereby a = b = √2aDg and c = 2aDg. Two intermediate phases, Dg3a and Bn2a4a, are documented and an additional phase, Bn2a6a, is tentatively suggested to occur in Fe-rich nanodomains within Bn2a. Considering the epitaxial relationships between all phases, we infer that basket-weave textures record phase transitions via polymorphic transformations of parent Bn2a and Dg1a during cooling. Observed phase assemblages are thus linked to cooling of Bn–Dgss in the range 70–87 mol.% Bn along a Cu6.18Fe1.26S5 – Cu9.12Fe0.89S5 tie-line defined from measured compositions. We depict three associations: Bn2a + Dg1a, Bn2a4a + Dg3a, and Bn2a4a/Bn2a6a + anilite, formed during cooling. Polymorph associations like these are relevant for enrichment of critical/precious metals in copper ores because Bi, Pb, Ag, Te and, probably also Au, if dissolved in Bn–Dgss, could be incorporated into superstructures during Cu-Fe-sulfide phase transitions.
To systematize the information and perspectives shared during the 2024 LATAM policy forum, which explored advancements in horizon scanning and early dialogue processes in the region, by analyzing the main discussion and identifying the main lessons.
Methods
This article is based on the discussions and background materials provided during the 1.5 days in-person 2024 Latin American Policy Forum (59 representatives from 11 countries). We gathered and systematized the information shared during the forum, including the results of a pre-forum survey. The Forum agenda included keynote presentations, breakout group activities, and plenary discussions to identify the main lessons and key messages from all different stakeholders’ points of view.
Results
The forum highlighted the growing recognition of the need for structured horizon scanning and early dialogue processes in Latin America. Key barriers were identified, including the absence of clear legal frameworks, limited data availability, and the need for capacity-building. Potential solutions included fostering regional cooperation, improving transparency, and creating pilot programs for early engagement. Engaging patients and the pharmaceutical industry was deemed essential for trust and foster alignment between HTA agencies and regulators.
Conclusions
Horizon scanning and early dialogue represent critical tools for improving health system preparedness and aligning innovation with local needs. Their implementation, however, requires coordinated efforts across multiple stakeholders, enhanced dialogue, and the development of supportive legal and regulatory frameworks.