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This study aimed to compare appropriateness of restricted antimicrobial prescriptions, as assessed by antimicrobial stewardship program (ASP) prospective audit and feedback (PAF), between those ordered by medical trainees versus staff. Secondary objectives were to determine whether certain timing factors and other independent variables impacted prescription appropriateness.
Design:
Single center, retrospective cohort study.
Setting:
The University of Alberta Hospital a 700-bed tertiary care hospital in Edmonton, Canada.
Participants:
Prescriptions of six health-authority restricted antibiotics subject to ASP PAF between 2018 and 2023. Cases were excluded if prescriber role or prescription dates or times were unavailable.
Methods:
Data from a local ASP quality improvement database was extracted. Multiple logistic regression analysis was completed with adjusted odds ratios (aOR) reported.
Results:
A total of 3,687 restricted antibiotic prescriptions subjected to PAF were included in this study, of which 1,163 (31.5%) were assessed as not appropriately prescribed. Prescriptions written by medical trainees did not have higher odds of appropriateness compared to staff (aOR 1.09 [95% CI 0.94–1.28], P = .25). Weekend prescriptions had a reduced odds of being appropriate (aOR 0.71 [0.60–0.84], P < .0001). Through the course of the Coronavirus Disease 2019 (COVID-19) pandemic, appropriateness improved from 56.2% (prepandemic), 71.5% (peri-pandemic) to 76.9% (postpandemic).
Conclusions:
No differences were noted in restricted antibiotic prescription appropriateness between medical trainees and staff. Weekend prescriptions were less likely to be appropriate. Improved appropriateness over time may be multifactorial, including implementation of ASP preceding the pandemic. Further studies examining timing factors associated with appropriateness are needed.
The analysis of the radiocarbon age of dissolved organic carbon (DOC) is fundamental for understanding the aquatic component of the global carbon cycle, yet the technique is not routinely available at radiocarbon laboratories. This study presents validation experiments for an improved wet oxidation method for 14C-DOC analysis in a freshwater matrix. Emphasis in design protocol for the method was placed on the quantitative removal of inorganic carbon, and a background level consistent with modern accelerator mass spectrometry (AMS) radiocarbon measurements. The method utilizes a pre-oxidized potassium persulfate oxidant in crimp-sealed vials with rigorous multi-stage helium purging to achieve and maintain a sample without atmosphere carbon dioxide and the contamination of modern 14C (14C-free). Method validation of 14C-free samples are demonstrated with procedural blanks, phthalic anhydride (PhA), and an International Atomic Energy Agency Oxalic Acid standard (IAEA-C8).
Design Neurocognition, a field bridging Design Research and Cognitive Neuroscience, offers new insights into the cognitive processes underlying creative ideation. This study adopts a micro-perspective on design ideation by examining convergent and divergent thinking as its core components. Using 32-channel EEG recordings, it investigates how educational background (Industrial Design Engineering vs. Engineering Design) influences designers’neural activity (alpha, beta, and gamma frequency bands), behavioral responses, and perceived stress during ideation tasks. Data from forty participants reveal a consistent and meaningful interaction between brain activity, behavior, and self-reported stress, highlighting that educational background significantly modulates cognitive and neural patterns during ideation. Importantly, perceived stress shows strong negative correlations with neural power across all frequency bands, suggesting a close alignment between subjective experience and physiological measures. By integrating neural, behavioral, and psychological data, this study advances the understanding of the neurocognitive mechanisms driving design ideation and establishes a methodological foundation for bridging Design and Cognitive Neuroscience. These findings contribute to building a unified evidence base for future human-centred and neuro-informed design research.
Atop El Castillo, the largest pyramid within the Maya site of Chichen Itza, in Mexico’s Yucatan Peninsula, stand two ruined columns that once portrayed the feathered serpent deity K’uk’ulkan. 3D-imaging technologies have identified scattered sculptural fragments belonging to these columns, allowing a digital reconstruction that opens new possibilities for their conservation.
In 1915, a Denver murder case became a national story, not because of the identities of the perpetrator or victim but because of a reluctant trial witness: Judge Ben B. Lindsey. A pioneer of Progressive Era juvenile justice, Lindsey was charged with contempt of court for refusing to disclose the details that a twelve-year-old boy shared with him. His refusal led to a six-year-long battle over ideas of confidence and secrecy between a juvenile court judge and a minor. This article analyzes the murder trial and consequent contempt of court case as reflective of a clash over questions of law, justice, and public interest and highlights the role of ordinary people, including children, in debating these ideas. It argues that, as legal actors engaged in a conflict between legal formalism and socialized law, members of the public debated their own perceptions and vernacular understandings of law, justice, and the role of the juvenile court.
American states continue to experiment with new forms of electoral institutions, including various nonpartisan election systems. One such rule, the “top-two” procedure, allows all voters to choose any candidate in the primary, advancing whichever two candidates obtain the most votes to the general election. These general elections may feature two candidates of the same party. This paper uses data from California, the largest state to adopt this rule, to examine participation and competition in the last five elections before the top-two procedure (2002 to 2010) and the first five after it (2012 to 2020), investigating the potential trade-off between the roll-off and increased competition. We find that while roll-off occurs with copartisan elections, the compensating increases in competition are substantial. Furthermore, with this system, the meaningful competition shifts toward the higher turnout general elections, which calls into question whether there is much of a participatory cost at all. Additionally, we leverage the unusual cases of write-in candidates to illustrate the electoral dynamics of these elections, highlighting the difficulty of implementing accountability with cross-party elections while demonstrating the behavioral potential of copartisan elections.
Adverse childhood experiences (ACEs) can cause morphological brain alterations across the lifespan, contributing to increased vulnerability to mental and physical disorders. Despite extensive research on ACEs-related brain alterations, the protective or augmenting role of modifiable lifestyle factors such as physical activity has been largely underexplored, representing a key gap in our understanding of trauma-related neuroplasticity. To close this gap, we aimed to investigate how lifetime physical activity (LPA) influences the relationship between ACEs and morphological brain alterations.
Methods
Moderation analyses using Hayes’ PROCESS macro examined the interaction between ACEs and LPA on the volume of limbic system-related regions – hippocampus, amygdala, anterior cingulate cortex (n = 81).
Results
While LPA showed no moderating effect on hippocampal or anterior cingulate volume, the model concerning the volume of the amygdala was significant. This model explained 8.1% of the variance in amygdala volume (p = 0.002) and the interaction of LPA and ACEs contributed 7.9% of this variance, with a significant effect (β = −0.221 p ≤ 0.001). That indicated LPA moderates ACEs-related structural changes in the amygdala, a key component of the central circuitry of emotion and stress sensitization. Notably, only in individuals with low physical activity were ACEs associated with increased volume of amygdala.
Conclusions
Our findings underscore the behavioral dependency of the structural adaptations of the amygdala following childhood adversities. These results emphasize the therapeutic potential of incorporating physical activity into interventions for trauma-exposed individuals, offering a behavioral approach to mitigating stress-related neurobiological changes.
Military robotic swarming is expected to herald a disruptive change in warfare. This article analyses how both the technoscientific promises and problematizations of robotic swarming in the military relate to transformations in the way wars are cognized and conducted by liberal societies. This analysis will be conducted through the lens of a more-than-human biopolitics. Firstly, the paper traces how a new understanding of life, established by complexity sciences, has enabled entanglements and translations between different forms of life and how these have informed the military imaginaries and design principles of military swarming. Secondly, the problematization of robotic swarms as potentially running out of human control is re-interpreted in terms of this re-conceptualizing and appropriation of a more-than-human life. The central argument here is that a biomimetic robotic swarm not only inherits the desired properties of a natural swarm but also its inherent risks. Thirdly, it is analysed how military approaches to the government of robotic swarms and their dangerousness move to a less centralized and less direct form of Command and Control (C2), aiming to maximize the benefits of swarming while minimizing its risks. The article concludes by discussing how this new C2 paradigm of governing at the ‘edge of chaos’ points us to the need to rethink the legal ordering of swarming.
This article examines the determinants of the profitability of European wine companies using dynamic panel models, analyzing 1,025 firms from 14 countries between 2015 and 2021. Unlike previous research that focused mainly on financial variables, this study incorporates financial, nonfinancial, macroeconomic, and institutional factors to provide a broader understanding of profitability drivers. Given significant differences between the individual categories, separate analyses were conducted for small and medium-sized enterprises (SMEs) and large and very large companies (LVL) companies. The results show that higher debt reduces profitability, while a higher ratio of cash flow to operating revenue and firm growth improves profitability. Investment in fixed assets increases the profitability of SMEs, while net asset turnover positively affects both SMEs and LVL firms. Labor productivity significantly influences profitability when SMEs and LVL firms are analyzed separately. Public and private limited companies are more profitable than partnerships or sole traders. Finally, the rule of law positively affects SME profitability.
I propose a novel account of epistemic reputation as the social standing of agents, groups, and institutions based on their epistemic profiles within a community. Using a functionalist approach, I argue that epistemic reputation is pervasive in our societies because it facilitates navigation within social epistemic networks. Consequently, it holds significant importance as second-order evidence in testimonial belief formation. This proposal integrates reputation research, which has traditionally been relegated to the periphery of social epistemology, into the core of epistemology of testimony. As a result, we gain a deeper understanding of the burden and epistemic responsibility associated with epistemic injustice. This approach also promises to illuminate the concept of humility for experts in a new light.
This study aimed to translate, culturally adapt, and validate the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Colorectal Cancer for Serbian patients.
Methods
The prospective cohort study was conducted at the Clinic for Digestive Surgery, University Clinical Center of Serbia, and included 150 Serbian-speaking colorectal adenocarcinoma patients undergoing colorectal surgery. The translation process involved rigorous forward and backward translations, pilot testing with patients, and statistical analysis for psychometric validation, including internal consistency, reliability, convergent and discriminant validity, concurrent validity, and known-groups validity.
Results
Results showed good internal consistency across most scales (Cronbach’s alpha values ranging from 0.769 to 0.855), with excellent split-half reliability (0.872). Convergent and discriminant validity analyses confirmed the questionnaire’s capacity to measure constructs it was theoretically related. The significant correlations were observed between corresponding scales and items of EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Known-groups analysis demonstrated the tool’s ability to distinguish between patient groups based on tumor location, stoma presence, and neoadjuvant therapy.
Significance of results
The Serbian version of the EORTC QLQ-CR29 is a reliable and valid instrument for assessing the quality of life in Serbian colorectal cancer patients, reflecting its potential for widespread clinical application.
The article examines ideologies behind linguistic conversion—a widespread transition to Ukrainian from Russian—which intensified in Ukraine after the onset of Russian aggression in 2014, and particularly after the 2022 full-scale invasion. Employing ‘new speakerness’ as a theoretical lens, the study draws on biographical interviews with twenty-one new full-time Ukrainian speakers recruited among participants in informal language-learning initiatives in Ukraine. The primary focus is on the ways in which the new speakers legitimise their ownership of the Ukrainian language: how they imagine their positions in the socially constructed traditional hierarchies of Ukrainian speakers, based on the mastery of the standard language, and what new ideologies arise out of their challenges. The findings reveal that, in most of the cases, traditional hierarchies are deconstructed as new ideologies prioritising fluency and elevating translingual practice emerge in the linguistic safe spaces of grassroots language courses and community clubs. (New speakers, language ideologies, linguistic conversion, suržyk, linguistic safe spaces, Russo-Ukrainian war)
Given the growing global prevalence and significant impact of depression and anxiety, both in general and within the workplace, understanding the underlying mechanisms contributing to emotional disorders is essential. This study examined whether self-esteem mediates the relationship between experiential avoidance and emotional disorders, focusing on depression and anxiety. We conducted a cross-sectional analysis of 174 outpatients from a community mental health center, who completed self-report measures of experiential avoidance, self-esteem, depression, and anxiety. We used the PROCESS macro for mediation analysis, and the results indicated that self-esteem significantly mediated the relationship between experiential avoidance and both depression and anxiety. We analyzed the mediation model within the framework of self-determination theory, which suggested that interventions aimed at reducing experiential avoidance and enhancing self-esteem could be effective for emotional disorders. In this study, we highlight the importance of addressing both experiential avoidance and self-esteem in the therapeutic context. We also discuss implications for clinical practice and limitations of the current study.
What explains the demand and supply of criminal governance? Contrary to traditional explanations of criminal governance as top-down control, this study integrates bottom-up demands for assistance and top-down supply of aid and coercion. We argue that the demand for criminal governance stems from civilians’ drive to satisfy their primary necessities, while security concerns motivate criminals to supply governance to prevent civilian resistance. The theory focuses on three main factors: economic difficulties, articulation/resistance capacity, and government response. The empirical strategy uses multiple list experiments conducted in Mexico, Honduras, Guatemala, and El Salvador. On the demand side, results indicate that economic difficulties and civilian articulation capacity shape the demand for criminal aid. On the supply side, criminals largely neglect people’s economic needs. When criminals help, they do it for cheap and to neutralize potential civilian resistance or to compete against the state. However, when economic conditions worsen, criminals revert to imposing lockdowns.
Half of people living in the USA do not consume tap water. Surveys have assessed perceptions of water and water utilities, but less is known about how these perceptions relate to the preference for tap or bottled water. The present analysis examined whether beliefs about tap water and the water utility were associated with drinking water preferences.
Design:
In a cross-sectional survey, six water beliefs were measured: trust in tap water, the water utility, and the local government; perceived safety and quality of tap water; and awareness that the water utility frequently tests tap water. Regression models adjusted for sociodemographic characteristics were used to estimate the odds of preferring tap over bottled water dependent on respondents’ beliefs about their tap water.
Setting:
Virginia, USA.
Participants:
Adults aged 18 years and older (n 808).
Results:
More than two-thirds of respondents had positive beliefs about their tap water, but only 54 % reported tap as their preferred drinking water source. All water beliefs, except for awareness of the frequency of water testing, were associated with higher odds of preferring tap water over bottled (adjusted OR range: 1·56–3·2).
Conclusions:
Our findings suggest that favourable tap water beliefs may be necessary, but not sufficient, to motivate people to drink from the tap. There remains a critical need for future research to bridge the gap between tap water perceptions and consumption, which should include enhancing the trustworthiness of tap water and the water utility as well as improving consumers’ perceptions of water quality and safety.
Decolonization, naturally, assumes the presence of colonization. For most formerly colonized states decolonization has meant: (1) honoring the inherited colonial treaties; and (2) accepting uti possidetis juris. But what does decolonization mean for the Bandung states that were never formally colonized? For these states, colonial treaties are allegedly unequal while uti possidetis is a restriction on acquiring imagined pre-colonial territories. This essay argues that Bandung’s platitudes about Third World unity notwithstanding, states that were never colonized, or non-colonials, had a different and at times tense relation to some of Bandung’s fundamental commitments. The cases of the law of the sea (LOS) negotiations between 1972 and 1982 and China’s claims to the South China Sea show that these tensions are still unresolved.
Active equity mutual funds that own shares in product-market competitors have higher risk-adjusted returns, even after fees. This positive association comes from their common ownership positions, and remains robust after controlling for industry concentration, common stock selection, and the tendency to invest in firms with more common ownership. These funds charge higher fees and are active voters: more likely to vote against executive pay-for-performance and for directors with existing directorships in competitors. Our findings suggest that actively managed equity mutual funds are incentivized to soften product-market competition, and proxy voting may serve as a mechanism for influencing corporate policy.
The Church of England has recently engaged again with issues of racism by setting up the Anti-Racism Taskforce in 2020, followed by the Archbishops’ Commission for Racial Justice in 2021. Both groups stressed the lack of progress in tackling racism in the Church and the need to raise awareness of racial injustice at all levels. This paper reports on the measurement of racial awareness among 3,167 clergy and lay people who took part in the Church 2024 survey. Eight items in the survey were used to create the racial awareness scale. Results suggested a mixed picture with a majority awareness that racial inequality is an important issue that needs to be addressed, a majority rejection of the idea that there may be local or institutionally embedded racism and enthusiasm for diversifying leadership but not for taking specific actions relating to historic slavery. Multiple regression analysis showed racial awareness was shaped by a complex mixture of individual, contextual and religious factors.
We remember history through our own national identities, and recollections of Bandung are no exception in that respect.1 Colonialism’s “illegitimacy” had many meanings for the twenty-nine countries that joined the 1955 conference. Countries like China and Japan in Northeast Asia and ancient kingdoms in Southeast Asia like Thailand sought civilizational equality during the colonial era. China has since recovered territory such as Hong Kong which it sees as having been acquired through unequal colonial era treaties,2 but elsewhere in Asia and Africa Bandung became a declaration of liberation instead. Today, however, there is a tendency to circumvent the complications of these historical differences when advancing a unitary understanding of Bandung’s Final Communiqué.3 This essay uses the example of North Borneo and juxtaposes that against well-known Chinese views in returning to a theme I have explored elsewhere.4 It argues that while some Bandung nations might find it undesirable to reject every incident of their European creation, others might simply treat all of colonialism’s acts as illegitimate.