We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Antibiotic overuse for asymptomatic bacteriuria is common in older adults and can lead to harmful outcomes including antimicrobial resistance. Our objective was to evaluate the impact of a simple scoring tool on urine culturing and antibiotic prescribing for adults with presumed urinary tract infections (UTI).
Design:
Quasi-experimental study using interrupted time series with segmented regression to evaluate urine culturing and urinary antibiotic use and length of stay (LOS), acute care transfers, and mortality 18 months before and 16 months after the intervention.
Setting:
134-bed complex continuing care and rehabilitation hospital in Ontario, Canada.
Participants:
Nurses, nurse practitioners, physicians, and other healthcare professionals.
Intervention:
A multifaceted intervention focusing on a 6-item mnemonic scoring tool called the BLADDER score was developed based on existing minimum criteria for prescribing antibiotics in patients with presumed UTI. The BLADDER score was combined with ward- and prescriber-level feedback and education.
Results:
Before the intervention, the mean rate of urine culturing was 12.47 cultures per 1,000 patient days; after the intervention, the rate was 7.92 cultures per 1,000 patient days (IRR 0.87; 95% CI, 0.67–1.12). Urinary antibiotic use declined after the intervention from a mean of 40.55 DDD per 1,000 patient days before and 25.96 DDD per 1,000 patient days after the intervention (IRR 0.68; 95% CI, 0.59–0.79). There was no change in mean patient LOS, acute care transfers, or mortality.
Conclusions:
The BLADDER score may be a safe and effective tool to support improved diagnostic and antimicrobial stewardship to reduce unnecessary treatment for asymptomatic bacteriuria.
The evolution of glaciers and ice sheets depends on processes in the subglacial environment. Shear seismicity along the ice–bed interface provides a window into these processes. Such seismicity requires a rapid loss of strength that is typically ascribed to rate-weakening friction, i.e., decreasing friction with sliding or sliding rate. Many friction experiments have investigated glacial materials at the temperate conditions typical of fast flowing glacier beds. To our knowledge, however, these studies have all found rate-strengthening friction. Here, we investigate the possibility that rate-weakening rock-on-rock friction between sediments frozen to the bottom of the glacier and the underlying water-saturated sediments or bedrock may be responsible for subglacial shear seismicity along temperate glacier beds. We test this ‘entrainment-seismicity hypothesis’ using targeted laboratory experiments and simple models of glacier sliding, seismicity and sediment entrainment. These models suggest that sediment entrainment may be a necessary but not sufficient condition for the occurrence of basal shear seismicity. We propose that stagnation at the Whillans Ice Stream, West Antarctica may be caused by the growth of a frozen fringe of entrained sediment in the ice stream margins. Our results suggest that basal shear seismicity may indicate geomorphic activity.
In the late nineteenth and early twentieth centuries, New York State trust companies were successful, grew quickly, and failed rarely. The few failures, however, played a leading role in shaping the rules that governed trust companies. Because trust company failures were consistently interpreted as isolated departures from the norm of conservative management, trust companies were able to continue to participate in the rule-making process. The institutions that evolved promoted financial stability by imposing the costs of failure on decision makers and discouraging risky behavior. These failures shed new light on the treatment of failure and the development of corporate governance and financial regulation in the United States
History refers both to the past and to the systematic study of the past. Attempts to make a case for history in economics generally emphasize the first definition. There are benefits from increased attention to the past. This paper argues that significant benefits can be gained from increased attention to the systematic study of the past, the historian's craft. The essence of the historian's craft is the critical evaluation of sources. Failure to critically evaluate sources has the potential to lead to erroneous conclusions, whether one is using historical documents or more recently created data.
Lax regulation enabled trust companies to take excessive risks, according to previous studies of the Panic of 1907, leading to a loss of confidence and massive runs. These studies have, however, given relatively little attention to the historical development of trust companies. This article argues that a more historical perspective can lead to a better understanding of the institutional framework and the actions of trust companies. Depositors did not lose confidence because of inadequate regulation; depositors lost confidence in specific trust companies because of false rumors, and diversity among trust companies hindered cooperation to halt the Panic.
Islands of the West Indies are among the most historically impacted by agriculture, yet agricultural influences on forests there have been little studied. This research compared tree species richness and vegetation structure between farmed lands, post-agriculture secondary forests and mature remnant forests in two watersheds in Saint Lucia, and sought to understand the current distribution of these habitats in terms of land use and watershed topography. Farms devoted to annual crops had few trees and much exposed soil. By contrast, agroforests had abundant (mostly planted) trees and vegetation structure comparable to secondary forests. Secondary forests had highest overall species richness, but mature forests had the most developed vegetation structure. Variations in habitat distribution reflected different land use histories, with the more rugged west coast long dominated by tree crop farming and the east coast experiencing a recent boom-bust cycle in bananas. Mature and secondary forests were more likely found at higher altitude, further from roads and at sites more difficult to access, the combined result of government protection of key forest and watershed reserves and farmers’ preferential abandonment of marginal lands. For conservationists, this return of forests is reason for optimism and it presents strategic opportunities for public land acquisition or collaborative management to further forest and watershed protection objectives.
The onset of the Great Depression did not spark a surge in personal bankruptcy. For debtors in default, state garnishment law played a significant role in the decision to file for bankruptcy. Only states that made it easy to garnish a debtor's wages experienced significant increases in bankruptcy as a consequence of the Depression.
Britain's Glorious Revolution of 1688 is one of the most widely studied cases of institutional change. Recent institutional analyses of the Glorious Revolution, however, have failed to address one of the central issues in political science: control of the state's comparative advantage in violence. This paper examines this issue through analysis of the standing army debates of the late 1690s. Participants in the debates disputed whether a standing army or a militia would be the most effective institutional arrangement to guard against threats from abroad and tyranny at home. Both sides of the debate analyzed the effects of a standing army in terms of the incentives that it created for soldiers, citizens, the monarch, and foreign governments.
We illustrate mechanisms that can give rise to path dependence in legislation. Specifically, we show how debtor-friendly bankruptcy law arose in the United States as a result of a path dependent process. The 1898 Bankruptcy Act was not regarded as debtor-friendly at the time of its enactment, but the enactment of the law gave rise to changes in interest groups, changes in beliefs about the purpose of bankruptcy law, and changes in the Democratic Party's position on bankruptcy that set the United States on a path to debtor-friendly bankruptcy law. An analysis of the path dependence of bankruptcy law produces an interpretation that is more consistent with the evidence than the conventional interpretation that debtor-friendliness in bankruptcy law began with political compromises to obtain the 1898 Bankruptcy Act.
Rational-choice theories of the state have been used in attempts to explain how variations in policy result from differences in constraints. But these theories give little attention to how the state comes to know what the constraints are. This article provides a dramatic example of the process of discovering economic and political constraints by examining Iran's policies toward the opium trade during the reign of Reza Shah Pahlavi (1921–1941).
The 1884 receivership of the Wabash, St. Louis, and Pacific Railway is widely regarded as a turning point in the development of corporate insolvency law. It is said to have created a “new-fashioned receivership,” which enabled debtors to initiate and, to a great extent, control receiverships. It is said that these new-fashioned receiverships facilitated reorganization of the insolvent firm at the expense of creditors' rights. An examination of the history of railroad receiverships reveals that for decades before 1884 judges allowed managers to initiate receiverships, appointed managers as receivers, and forced creditors to accept changes in their contractual rights. Judges also refused to extend reorganization procedures to corporations outside the railroad industry, justifying their special treatment of railroads on the grounds that the foremost obligation of railroads was to serve the public. Analysis of railroad bond prices supports the conclusion that creditors' rights were not transformed by the courts in the mid-1880s.
Throughout the nineteenth century, merchants and manufacturers involved in interstate commerce sought federal bankruptcy legislation to overcome diverse and discriminatory state laws that raised the cost of credit and impeded interstate trade. In the last two decades of the nineteenth century, they formed a national organization to lobby for bankruptcy legislation. While many scholars have seen the passage of federal bankruptcy legislation as a response to the economic depression of the 1890s, this article shows that it was the formation of this national organization, rather than the economic crisis, that was the primary force behind the Bankruptcy Act of 1898.
We report the analysis of 154 hours of nearly continuous high-speed photometric data on the pulsating DB white dwarf (DBV) GD 358 obtained during the Whole Earth Telescope (WET) run of May 1990. The Fourier transform (FT) of the light curve is dominated by power in the range from 1200 – 1700μHz with more than 180 significant peaks in the total transform. We also see significant power at the sums and differences of the dominant frequencies, indicating the importance of nonlinear behavior. We can use this data to obtain an accurate total stellar mass, and surface He layer mass. The implied surface He layer mass, if correct, provides a significant and surprising challenge to stellar evolution theory, as well as the theory of chemical mixing.
Recommend this
Email your librarian or administrator to recommend adding this to your organisation's collection.