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 stewardship programs (ASPs) are crucial to prevent the emergence of antibiotic resistance and to improve outcomes for patients. A validated instrument rooted in a theoretically derived implementation science framework will increase our understanding of ASP implementation and enable comparisons across implementation sites.
Design:
Methods:
Antibiotic stewards (infectious disease pharmacists and physicians) were recruited from Veterans Affairs (VA) hospitals to complete a survey on stewardship implementation. We used the Consolidated Framework for Implementation Research (CFIR) to guide development of an ASP implementation survey assessing 22 potential determinants of implementation across five domains of CFIR. We conducted confirmatory factor analyses (CFA) to assess construct validity of 8 construct measures and evaluated internal consistency.
Results:
A total of 150 stewards completed the survey from 110 VA hospitals. CFA for most CFIR constructs exhibited good fit. Internal consistency for CFIR construct subscales (Cronbach’s alpha) ranged from 0.54–0.96, indicating modest to strong internal consistency. Determinants that were rated highly present at the sites (across site means ≥ 4.0 or above) included Self-Efficacy, Engaging, Evidence Strength and Quality and Relative Advantage, indicating stewards found ASP evidence compelling and felt their personal involvement was effective in engendering positive results for the ASP.
Conclusions:
Psychometric properties indicate validity of the first CFIR-based survey of determinants for ASP implementation outcomes. Clinical, quality improvement, and research teams can use this survey to identify contextual determinants of ASP implementation and use this information to guide selection of strategies and compare results across multiple sites.
In today’s insurance market, numerous cyber insurance products provide bundled coverage for losses resulting from different cyber events, including data breaches and ransomware attacks. Every category of incident has its own specific coverage limit and deductible. Although this gives prospective cyber insurance buyers more flexibility in customizing the coverage and better manages the risk exposures of sellers, it complicates the decision-making process in determining the optimal amount of risks to retain and transfer for both parties. This article aims to build an economic foundation for these incident-specific cyber insurance products with a focus on how incident-specific indemnities should be designed for achieving Pareto optimality for both the insurance seller and the buyer. Real data on cyber incidents are used to illustrate the feasibility of this approach. Several implementation improvement methods for practicality are also discussed.
Emerging data surrounding the rise in antimicrobial resistance have prompted a shift towards shorter antibiotic durations. Studies show similar clinical outcomes comparing shorter antibiotic courses to longer ones for uncomplicated Gram-negative bloodstream infections (BSI). However, there is a lack of data to inform durations of therapy for Streptococcal BSI.
Methods:
This was a retrospective cohort study of patients admitted to University of Utah Health with uncomplicated Streptococcal BSI. Inverse probability of treatment weighting (IPTW) was used to estimate the average treatment effects (ATE) of antibiotics administered for 10 days or fewer (short duration) versus more than 10 days (long duration). The primary outcome was a composite of recurrent BSI, all-cause mortality, and readmissions at 30 days from end of therapy.
Results:
Five hundred patients were screened and 196 were included in the final analysis. The most common sources were skin and soft tissue infections. The median duration in the short and long groups were 8 (IQR, 7–10) and 15 days (IQR, 14–17), respectively. The ATE of short versus long duration of antibiotics was not significant for the composite primary outcome (18% vs 18%; OR = 1.42 [95% CI: 0.57 to 3.53]).
Conclusions:
We found no appreciable difference in outcomes between patients treated with short versus long antibiotic durations for uncomplicated Streptococcal BSI. Given low absolute rates of mortality and recurrent BSI, along with the lack of evidence indicating a significant difference related to treatment duration, it is reasonable to consider shorter durations. Future research is needed to confirm our findings.
This study employs direct numerical simulations to examine the effects of varying backpressure conditions on the turbulent atomisation of impinging liquid jets. Using the incompressible Navier–Stokes equations, and a volume-of-fluid approach enhanced by adaptive mesh refinement and an isoface-based interface reconstruction algorithm, we analyse spray characteristics in the environments with ambient gas densities ranging from 1 to 40 times the atmospheric pressure under five different backpressure scenarios. We investigate the behaviour of turbulent jets, incorporate realistic orifice geometries and identify significant variations in the atomisation patterns depending on backpressure. Two distinct atomisation types emerge, namely jet-sheet-ligament-droplet at lower backpressures and jet-sheet-fragment-droplet at higher ones, alongside a transition from dilute to dense spray patterns. This variation affects the droplet size distribution and spray dynamics, with increased backpressure reducing the spray's spreading angle and breakup length, while increasing the droplet size variation. Furthermore, these conditions promote distributions that induce rapid, nonlinear wavy motion in liquid sheets. Topological analysis of the atomisation field using velocity-gradient tensor invariants reveals significant variations in topology volume fractions across different regions. Downstream, the droplet Sauter mean diameter increases and then stabilises, reflecting the continuous breakup and coalescence processes, notably under higher backpressures. This research underscores the substantial impact of backpressure on impinging-jet atomisation and provides essential insights for nozzle design to optimise droplet distributions.
In this study, a novel kinematic modeling method of parallel mechanism is proposed. It can obtain position and posture space simultaneously in a single model. Compared with the traditional method only based on inverse kinematics, the novel method can significantly improve computational performance. The original evaluation metric $\mathfrak{R}$ is proposed to evaluate the performance of the two modeling methods. Three groups of experiments with different calculation times are carried out for the classical PPU-3RUS parallel mechanism, and the new RS-3UPRU parallel mechanism after the effectiveness and wide applicability of the novel modeling method is proved. The calculation time and output rate are recorded, respectively, and then the respective $\mathfrak{R}$ values are obtained by weighting. The results show that the novel modeling method has better performance.
The global transition towards diets high in calories has contributed to 2.1 billion people becoming overweight, or obese, which damages male reproduction and harms offspring. Recently, more and more studies have shown that paternal exposure to stress closely affects the health of offspring in an intergenerational and transgenerational way. SET Domain Containing 2 (SETD2), a key epigenetic gene, is highly conserved among species, is a crucial methyltransferase for converting histone 3 lysine 36 dimethylation (H3K36me2) into histone 3 lysine 36 trimethylation (H3K36me3), and plays an important regulator in the response to stress. In this study, we compared patterns of SETD2 expression and the H3K36me3 pattern in pre-implantation embryos derived from normal or obese mice induced by high diet. The results showed that SETD2 mRNA was significantly higher in the high-fat diet (HFD) group than the control diet (CD) group at the 2-cell, 4-cell, 8-cell, and 16-cell stages, and at the morula and blastocyst stages. The relative levels of H3K36me3 in the HFD group at the 2-cell, 4-cell, 8-cell, 16-cell, morula stage, and blastocyst stage were significantly higher than in the CD group. These results indicated that dietary changes in parental generation (F0) male mice fed a HFD were traceable in SETD2/H3K36me3 in embryos, and that a paternal high-fat diet brings about adverse effects for offspring that might be related to SETD2/H3K36me3, which throws new light on the effect of paternal obesity on offspring from an epigenetic perspective.
Systolic blood pressure (SBP) is significantly associated with body composition in children and adolescents. However, which one of the components of body composition is the dominant contributor to SBP in children and adolescents remains unclear. We, therefore, aimed to determine the dominant contributor to SBP among components of body composition in a large cohort of American children and adolescents derived from the National Health and Nutrition Examination Survey with cross-sectional analysis. In total, 13 618 children and adolescents (median age 13 years; 6107 girls) with available data on whole-body dual-emission X-ray absorptiometry measurements were included. Multiple linear regression showed that SBP was associated with higher total fat-free mass in boys (β = 0·49, P < 0·001) and girls (β = 0·47, P < 0·001) and with higher total fat mass only in boys (β = 0·12, P < 0·001) after adjustment for covariates. When taking fat distribution into consideration, SBP was associated with higher trunk fat mass (boys: β = 0·28, P < 0·001; girls: β = 0·15, P < 0·001) but negatively associated with leg fat mass (Boys: β = −0·14, P < 0·001; Girls: β = −0·11, P < 0·001), in both boys and girls. Dominance analysis showed that total fat-free mass was the dominant contributor to SBP (boys: 49 %; girls: 55·3 %), followed by trunk fat mass (boys: 32·1 %; girls: 26·9 %); leg fat mass contributed the least to SBP in boys (18·9 %) and girls (17·8 %). Our findings indicated that total fat-free mass was not only associated with SBP but also the most dominant contributor to SBP variation in American children and adolescents.
Self-promotion, widespread in the workplace, has received extensive attention from scholars. However, due to the narrow one-dimensional structure of traditional self-promotion and the limitations of theoretical thinking, its antecedents and consequences are still unclear. Therefore, we propose a new pair of self-promotion behaviors (sole self-promotion and joint self-promotion), and develop the measures based on a more grounded definition of self-promotion. In phase 1, we developed the scales of sole self-promotion and joint self-promotion (sample 1), and assessed their psychometric properties (i.e., content validity, factor structure, and reliability) by using two samples (samples 2 and 3). In phase 2, using three-wave data (sample 4) with two sources (employees and coworkers), we tested the overall model based on social comparison theory, examining the antecedents and consequences of sole and joint self-promotion, and exploring the different effects of these two behaviors on career success. Overall, our research offers new insight into self-promotion research and provides a useful tool to evaluate employee self-promotion. Implications for theory and practice, and suggestions for future research are discussed.
Celestial navigation is an important means of maritime navigation; it can automatically achieve inertially referenced positioning and orientation after a long period of development. However, the impact of different accuracy of observations and the influence of nonstationary states, such as ship speed change and steering, are not taken into account in existing algorithms. To solve this problem, this paper proposes an adaptively robust maritime celestial navigation algorithm, in which each observation value is given an equivalent weight according to the robust estimation theory, and the dynamic balance between astronomical observation and prediction values of vessel motion is adjusted by applying the adaptive factor. With this system, compared with the frequently used least square method and extended Kalman filter algorithm, not only are the real-time and high-precision navigation parameters, such as position, course, and speed for the vessel, calculated simultaneously, but also the influence of abnormal observation and vessel motion status change could be well suppressed.
The present study aimed to explore the association between dietary patterns in abdominal obesity obtained by reduced-rank regression (RRR) with visceral fat index (VFI) as a dependent variable and dyslipidemia in rural adults in Henan, China. A total of 29538 people aged 18–79 were selected from the Henan Rural Cohort Study. RRR analysis was used to identify dietary patterns; logistic regression analysis and restricted cubic spline regression models were applied to analyze the association between dietary patterns in abdominal obesity and dyslipidemia. VFI was used as a mediator to estimate the mediation effect. The dietary pattern in abdominal obesity was characterized by high carbohydrate and red meat intake and low consumption of fresh fruits, vegetables, milk, etc. After full adjustment, the highest quartile of dietary pattern scores was significantly associated with an increased risk of dyslipidemia (OR: 1·33, 95 % CI 1·23–1·44, Ptrend < 0·001), there was a non-linear dose–response relationship between them (Poverall-association < 0·001, Pnon-lin-association = 0·022). The result was similar in dose-response between the dietary pattern scores and VFI. The indirect effect partially mediated by VFI was significant (OR: 1·07, 95 % CI 1·06–1·08). VIF explained approximately 53·3 % of odds of dyslipidemia related to the dietary pattern. Abdominal obesity dietary pattern scores positively affected VFI and dyslipidemia; there was a dose-response in both relationships. Dyslipidemia progression increased with higher abdominal obesity dietary pattern scores. In addition, VFI played a partial mediating role in relationship between abdominal obesity dietary pattern and dyslipidemia.
The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives.
Methods
A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined.
Results
Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12–3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02–1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99–12.25) in mothers, 6.39 in sisters (95% CI 3.78–10.82), and 5.65 (95% CI 3.38–9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49–5.26).
Conclusions
Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed – namely suicidal young adults and women with a strong family history of suicide.
Embryos undergo chaotic division and decrease in quality on day 3 with a reduction in the rates of subsequent blastocyst formation. Disordered cleavage causes a deterioration in embryonic quality, here we assessed the relationship between an cleavage model in first mitosis and the chromosomal status of human embryos, and discuss the potential biological and clinical implications for the cleavage model as a single parameter that can be used to assess embryonic quality. Thirty-two infertile couples, with normal karyotypes and who underwent their first IVF cycle were recruited to donate one normal two-cell-stage embryo each for this study between 2019 and 2020. Twenty-eight two-cell embryos underwent preimplantation genetic testing of each blastomere, and four chaotic-division embryos were stained with Hoechst and cultured in a confocal laser-scanning microscopy incubator system. This system showed high specificity and PPV but low sensitivity and NPV using the CM in the prediction of euploidy, indicating that CM could be considered a screening method for embryo selection; additional observational studies using the CM to select transferable embryos are needed before it can be used in clinical practice.
The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.
Subglacial lake exploration is of great interest to the science community. RECoverable Autonomous Sonde (RECAS) provides an exploration tool to measure and sample subglacial lake environments while the subglacial lake remains isolated from the glacier surface and atmosphere. This paper presents an electronic control system design of 200 m prototype of RECAS. The proposed electronic control system consists of a surface system, a downhole control system, and a power transfer and communication system. The downhole control system is the core element of RECAS, and is responsible for sonde status monitoring, sonde motion control, subglacial water sampling and in situ analysis. A custom RS485 temperature sensor was developed to cater for the limited size and depth requirements of the system. We adopted a humidity-based measurement to monitor for a housing leak. This condition is because standard leak detection monitoring of water conductivity may be inapplicable to pure ice in Antarctica. A water sampler control board was designed to control the samplers and monitor the on/off state. A high-definition camera system with built-in storage and self-heating ability was designed to perform the video recording in the subglacial lake. The proposed electronic control system is proven effective after a series of tests.
From June 28 to November 22, 2018, the Chinese People’s Liberation Army Navy – PLA(N) – Peace Ark hospital ship had conducted Mission Harmony 2018, providing humanitarian medical assistance and carrying out international cooperation, in 4 Pacific island countries and 6 Central and South American countries. Compared with its application only in onshore outreach medical teams in the previous Mission Harmony, portable ultrasonography was used both onboard and onshore in Mission Harmony 2018. The purpose of this study was to assess the performance of onboard portable ultrasonography in PLA(N) Peace Ark hospital ship during Mission Harmony-2018, share our onboard working experience, and provide a reference for humanitarian assistance missions in the future. A retrospective review was performed on a cohort of patients checked by onboard portable ultrasonography. Patients’ gender, age, the distribution of examined organs, and multiple applications of the portable ultrasonography were analyzed. Some limitations of portable ultrasonography on the mission and possible improvements in the future were also discussed. A total of 5277 cases (mean age: 43.74 years; range: 2 months–105 years) of ultrasound examinations were performed during the mission; among them, 3126 (59.2%) cases were performed by portable ultrasonography, including 3024 onboard cases and 102 onshore cases. The portable ultrasonography had been applied in many scenarios, for example, onboard emergency triage process, onboard bedside medical support, and onshore outreach medical service, which had become one of the indispensable auxiliary examination methods for its compatibility, portability, and flexibility. The onboard deployment of portable ultrasonography played a versatile and irreplaceable role in the humanitarian medical assistance and medical cooperation carried out by the PLA(N) Peace Ark hospital ship, and will contribute to such kind of missions in the future.
The Emeishan large igneous province (ELIP) in SW China is considered to be a typical mantle-plume-derived LIP. The picrites formed at relatively high temperatures in the ELIP, providing one of the important lines of argument for the role of mantle plume. Here we report trace-element data on olivine phenocrysts in the Dali picrites from the ELIP. The olivines are Ni-rich, and characterized by high (>1.4) 100×Mn/Fe value and low (<13) 10 000×Zn/Fe value, indicating a peridotite-dominated source. Since the olivine–melt Ni partition coefficient (KDNiol/melt) will decrease at high temperatures and pressures, the picrites derived from peridotite melting at high pressure, and that crystallized olivines at lower pressure, can generate high concentrations of Ni in olivine phenocrysts, excluding the necessity of a metasomatic pyroxenite contribution. Based on the Al-in-olivine thermometer, olivine crystallization temperature and mantle potential temperature (TP) were calculated at c. 1491°C and c. 1559°C, respectively. Our results are c. 200°C higher than that of the normal asthenospheric mantle, and are consistent with the role of a mantle thermal plume for the ELIP.
Iridium (Ir) has an extremely high melting point (2443 °C), high chemical stability and is one of the most promising high-temperature materials. However, Ir is more difficult to process compared with other face-centered cubic metals, such as Ni and Al, which limits its applications. To solve this problem, we study the effect of 32 alloying elements (X) on stacking fault energy of dilute Ir-based alloys generated by shear deformation using the first-principles calculations. The investigation reveals that there are many alloying elements studied herein decrease the stacking fault energy of face-centered cubic (fcc) Ir, and the most effective element in reducing stacking fault energy of fcc Ir is Zn. The microscopic mechanism is caused by electron redistribution in the local stacking fault area. These results are expected to provide valuable guidance for the further design and application of Ir-based alloys.
The current study aimed to evaluate the association of major dietary patterns with anxiety in middle-aged adults in eastern China.
Design:
Dietary intake was assessed using a semi-quantitative FFQ. Binary logistic regression analysis was used to estimate OR and 95 % CI for anxiety according to quartiles of each dietary pattern score.
Setting:
Evidence regarding the relationship between dietary patterns and anxiety in the Chinese population is scarce.
Participants:
The study participants were 1360 Chinese adults aged 45–59 years, who participated in a health survey at the time of periodic check-up in the city of Linyi, Shandong Province, China.
Results:
Four major dietary patterns were identified by factor analysis: traditional Chinese, western, grains–vegetables and high-salt diets. After adjusting for potential confounders, participants in the highest quartile of the western pattern had greater odds for anxiety, compared with those in the lowest quartile (OR 1·35, 95 % CI 1·000, 3·086, P < 0·05). In contrast, participants in the highest quartile of the grains–vegetables pattern had lower odds for anxiety than did those in the lowest quartile (OR 0·78, 95 % CI 0·574, 1·000, P < 0·05). Moreover, no significant associations were observed between the traditional Chinese and high-salt patterns and the risk of anxiety.
Conclusions:
Our findings indicate that the western pattern is associated with an increased risk, and the grains–vegetables pattern is associated with a decreased risk of anxiety.
We present an experimental and numerical study of natural convection with moist air as convecting fluid. By simplifying the system as two-component convection, an experimental method is proposed for indirectly measuring the moisture transfer rates in buoyancy-driven flows. We verify the results using direct numerical simulations. It is found that the non-dimensionalized transfer rates for both sensible heat ($Nu_{T}$) and water vapour ($Nu_{e}$) are essentially determined by a generalized Grashof number $Gr$ (the ratio of combined buoyancy generated by the imposed temperature and vapour pressure gradients to viscous force), and are only weakly dependent on the buoyancy ratio $\unicode[STIX]{x1D6EC}$ (the ratio of buoyancy induced by temperature variation to that due to vapour pressure variation). Moreover, we show that the full set of control parameters $\{Gr,\unicode[STIX]{x1D6EC},Pr,Sc\}$ is more suitable than other choices for characterizing the two-component system under investigation. As a special case, the Schmidt number dependence for passive scalar transport rates in buoyancy-driven flows is also deduced.
Rabbits play an important role in people’s lives due to their high nutritional value and high-quality hair that can be used as raw material for textiles. Furthermore, rabbits are an important animal model for human disease, as genome-edited animals are particularly valuable for studying gene functions and pathogenesis. Somatic cell nuclear transfer (SCNT) is an important technique for producing genome-edited animals and it has great value in saving endangered species and in clone stem cell therapy. However, the low efficiency of SCNT limits its application, with the selection of suitable rabbit oocytes being crucial to its success. In the present study, we collected oocytes from ovarian follicles and stained them with 26 μM brilliant cresyl blue (BCB). We then matured the oocytes in vitro and used them for SCNT. Comparison of the BCB-positive oocytes with BCB-negative oocytes and the control group showed that the BCB-positive group had a significantly higher maturation rate (81.4% vs. 48.9% and 65.3% for the negative and control groups, respectively), cleavage rate (86.6% vs. 67.9% and 77.9%), blastocyst rate (30.5% vs. 12.8% and 19.6%), total number of blastocysts (90±7.5 vs. 65.3±6.3 and 67.5±5.7), and inner cell mass (ICM)/ trophectoderm (TE) index (42.3±4.2 vs. 30.2±2.1 and 33.9±5.1) (P<0.05). The BCB-positive group had a significantly lower apoptosis index (2.1±0.6 vs. 8.2±0.9 and 6.7±1.1 for the negative and control groups, respectively) (P<0.05). These findings demonstrate that BCB-positive oocytes have a higher maturation ability and developmental competence in vitro, indicating that BCB staining is a reliable method for selecting oocytes to enhance the efficiency of SCNT.