Governments shape policy outcomes using two distinct mechanisms: rules and discretion. A simple decomposition strategy is proposed for distinguishing between these policymaking mechanisms on income inequality in the American states from 1986 to 2020. This analytical strategy is easily applicable to other policy settings. The statistical evidence, for the most part, that income inequality observed in the American states is generally unaffected by both TELs and partisan control of state governments—the lone exception being unified Republican state governments operating under a TEL. The decomposition evidence, however, shows that this is primarily the result of discretionary policymaking differences among partisan governments. This study underscores the importance of disentangling policy mechanisms that jointly occur when evaluating the consequences of government policymaking authority.

The 1677 invasion of Ukraine got the Ottoman Empire embroiled in war with Russia. Scholarship on the 1683 siege of Vienna rarely mentions the Ukrainian campaign although it significantly weakened Ottoman military capacities and may have saved Vienna. This article examines how the Porte’s decision to invade Ukraine came about. The sultan’s grandiose imperial visions and false intelligence of Russian military strength were key factors. Easy victory was expected and the original plan to seize Hungary and Vienna was not given up. Only a catastrophic defeat by the Russians in August 1677 challenged the Porte’s strategic priorities. But Kara Mustafa did not give up his preference for a Hungarian campaign. He promised the Hungarians that the Ottoman army would join the ongoing anti-Habsburg rebellion in spring 1678. Meanwhile he allowed them to attack the Habsburgs with French and Polish support. The analysis draws on German, French, Hungarian, Ukrainian, Russian, and Polish sources; they reveal that the invasion of Ukraine was not planned in advance and greatly contested among Ottoman leaders. The Habsburgs understood the geopolitical significance of the Ukrainian campaign but could not breathe a sigh of relief before the sultan finally declared war against Russia in April 1678.

Background: The molecular and epidemiological landscape of C. difficile infection (CDI) has evolved markedly in the last decade; however, limited information is available contrasting differences between adult and pediatric populations. We describe a multicenter study evaluating healthcare-associated (HA) and community-associated (CA) adult and pediatric-CDI identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) network from 2015 to 2022. Methods: Hospitalized patients with CDI were identified from up to 84 hospitals between 2015–2022 using standardized case definitions. Cases were confirmed by PCR, cultured, and further characterized using ribotyping and E-test. We used two-tailed tests for significance (p≤0.05). Results: Of 30,817 cases reported, 29,245 were adult cases [HA-CDI (73.2%), CA-CDI (26.8%)] and 1,572 were pediatric cases [HA-CDI (77.7%), CA-CDI (22.3%)]. From 2015 to 2022, HA-CDI rates decreased 19.7% (p=0.007) and 29.4% (p=0.004) in adult and pediatric populations, respectively (Figure 1). CA-CDI rates remained relatively stable in the adult population (p=0.797), while decreasing 60.7% in the pediatric population (p=0.013). Median ages of adult and pediatric patients were 70 (interquartile range (IQR), 58–80) and seven (IQR, 3–13) years, respectively. Thirty-day all-cause mortality was significantly higher among adult vs. Pediatric CDI patients (11.0% vs 1.4%, p < 0.0001). No significant differences in other severe outcomes were found. Ribotyping and susceptibility data were available for 4,620 samples: 3,558 adult (77.0%) and 1,062 pediatric (23.0%). The predominant adult and pediatric ribotypes (RT) were 106 (12.2/16.2%), 027 (11.4/3.2%), and 014 (8.8/8.2%). Overall, RT027 prevalence significantly decreased from 17.9% in 2015 to 3.2% in 2022 (p=0.003), while RT106 increased from 8.5% to 14.4%. Resistance rates among adult and pediatric isolates were similar for all antimicrobials tested except moxifloxacin (16.2% vs. 6.2%, p < 0.0001, respectively). Adult moxifloxacin resistance decreased from 30% to 6.3% from 2015 to 2022 (p=0.006). Adults with moxifloxacin-resistant CDI were older (median: 74 vs. 69 years, p < 0.001) and had higher thirty-day all-cause mortality (13% vs. 9.8%, p=0.041) and recurrence (10% vs. 5.7%, p < 0.001) compared to those with moxifloxacin non-resistant CDI, while these trends were not observed in pediatric patients. Among RT027 strains, moxifloxacin resistance decreased from 91.0% in 2015 to 7.1% in 2022. There was one metronidazole-resistant pediatric sample in 2018 and no resistance to vancomycin or tigecycline in either population. Conclusion: We have found differences in the epidemiological and molecular characteristics of adult and pediatric CDI, with higher thirty-day all-cause mortality among adults. Overall, RT106 has replaced RT027 as the predominant ribotype with a concomitant decrease in fluoroquinolone resistance.

During the 1660s and 1670s, the Ottoman Empire reached the peak of its expansion with military invasions of Ukraine and Habsburg Hungary, parts of central Europe that had traditionally been regarded as beyond the Porte's horizons. Many Ukrainians and Hungarians welcomed the Ottomans as liberators; they saw the sultan as a more benevolent ruler than the Russian tsar, the Polish king, and the Habsburg emperor. This article reconstructs the political, social, and religious dimensions of pro-Ottoman hopes as well as the popular revolts that resulted from these hopes. Comparing Ukrainian and Hungarian engagements with the Ottomans reveals the divergent and overlapping aspects of a largely forgotten historical reality, that is, the quest of many Orthodox and Protestant Europeans to consider a Muslim alternative to the Christian empires that oppressed them. The article draws on a treasure trove of little studied sources, both archival and published, in multiple languages.

There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.

In March 1674, Hungary's Lutheran and Calvinist clergy stood collectively accused of fomenting rebellion against the Habsburgs and seeking protection from the Ottomans. A widely publicized tribunal in Pozsony (Bratislava, Pressburg) resulted in systematic expulsions, incarcerations, and the sale of forty-two pastors as galley slaves. A voluminous body of historiography has been dedicated to the victims of the tribunal and their tribulations. It is commonly assumed that the accusations against the Protestant clergy were fabricated. This article shifts the focus from martyrologies, sermons, and narratives written after the year 1674 to eyewitness accounts in inquisitorial records, letters, petitions, official reports, and military dispatches from the years leading up to the Pozsony Tribunal. These unstudied testimonies in the Hungarian and Austrian archives reveal that a significant number of pastors participated in popular resistance and revolt against a brutal Habsburg Counter Reformation. Many put their hopes in the Ottomans whom they considered protectors against the destruction of their religion. These little-known developments shed light on important larger historical realities that have been eclipsed by Habsburg and Central European historians, namely, Hungarian popular hopes for liberation from the Habsburgs by the Ottomans which culminated in two major revolts in 1670 and 1672.

Background: Tecovirimat (TPOXX) is an antiviral drug only available via an Expanded Access Program (EAP) investigational new drug protocol and is recommended for treatment of select patients with monkeypox (mpox) infection. Alameda County Public Health Department prioritizes health equity but does not have a dedicated public health clinic. Therefore, we partnered closely with local healthcare providers that serve communities disproportionally impacted by mpox to ensure there was access to TPOXX. Using data collected during the outbreak we assessed whether populations in Alameda County most affected by mpox received treatment. Methods: We describe Alameda County patients with confirmed or probable mpox who received TPOXX during June–October 2022. Data were collected from case investigation interviews with patients and state-wide reportable disease database(s), which included demographic, clinical, and behavioral information. Confidence intervals (CIs) were calculated using the exact method for Poisson counts. We compared characteristics of mpox patients who received and did not receive TPOXX using the Pearson χ2 or Fisher exact test. P < .05 was considered significant. Results: Mpox case rates in Alameda County were highest among Black or African-American residents (35.6 per 100,000, 95% CI, 26.7–46.4) and Hispanic or Latinx residents (25.2, 95% CI, 20.2–31.0) compared to Asian residents (3.9, 95% CI, 2.3–6.1) and white residents (10.4, 95% CI, 7.7–13.9) residents. Among 242 mpox patients, 69 patients (28.5%) received TPOXX. The distribution of demographic and clinical characteristics among patients who received TPOXX was not significantly different than among those who did not, including residents aged 31–40 years (36.2% vs 34.7%), Black or African-American residents (20% vs 26.3%), Hispanic or Latinx residents (38.5% vs 41%), male residents (89.9% vs 95.3%), gay, lesbian, or same-gender loving residents (67.2% vs 67.4%) in the city of Oakland (63.2% vs 61.5%), or residents with human immunodeficiency virus infection (43.5% vs 36.6%). Conclusions: During the Alameda County mpox outbreak, nearly one-third of patients received TPOXX. Demographic and clinical characteristics were similar among TPOXX recipients and nonrecipients. A proactive approach to obtaining TPOXX in Alameda County and strong relationships with local providers may have allowed for treatment to be accessible to mpox patients. Regular review of outbreak data can inform public health activities, ensure health equity, and help refine local response efforts.

Disclosures: None

Pál Szepessy (1636–1685), a Calvinist noble, dedicated his life to the goal of turning Habsburg Hungary into an Ottoman vassal state. He spent much time in the Ottoman world, met with Grand Vizier Ahmed Köprülü (r. 1661–76) on at least four occasions, and regularly visited other Ottoman dignitaries. Szepessy outlined the traumatic effects of Habsburg military occupation and Counter-Reformation on Hungarian society. He was driven by the conviction that God had chosen the Ottomans as his avengers to liberate Hungary from the yoke of the Austrian Antichrist. Szepessy won Köprülü's support for armed uprisings and a guerilla war against the Habsburgs. He also influenced the grand vizier's decision to end the Polish-Ottoman war (1672–76) and turn the Ottoman army against the Habsburg Empire. When Köprülü died in November 1676, the blueprints for Habsburg Hungary's defection to the Ottoman Empire were already in place. They were reactivated by Kara Mustafa in 1682–83. Szepessy's initiatives (and similar efforts by other Hungarians) have been ignored by scholarship; their traces remain dispersed in the Austrian and Hungarian archives. My research draws on Szepessy's appeals to Köprülü; his correspondence with fellow Protestant nobles, family, and Transylvanian supporters; reports of Habsburg spies; dispatches of Habsburg residents at the Porte; and deliberations of the Habsburg War Council. Taken together these sources open a window on the life of an important trans-imperial subject whose life throws into question the clash of civilizations narrative that still dominates much of Habsburg and Central European historical studies.