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Ling Li unveils the often-hidden inner workings of the Party as the ruler of a party-state. The Party has crafted and relied on an integrated regulatory system, where politics and law are fused, to govern both its internal operations and its relations with the state. Drawing on two decades of in-depth research, Li delves into the “black box” of decision-making in the Party-state, analysing the motivations and strategies driven individual and institutional choices in corruption, anti-corruption investigation, and power struggles at the Politburo. This insightful book reveals the critical role of rules and institutions within the Party, illuminates the complex relationship between corruption and regime stability, and captures the evolving dynamics of the Party-state relations. A must-read for students, academics, business leaders, and policymakers alike, this book is a vital guide for anyone who seeks a nuanced understanding of law, politics and governance in China and its global implications.
Nd-Hf isotope evolution in arc magmas has been widely used to trace the advance and retreat of subduction zones over time. However, the reliability of this method has been questioned. One way to assess its validity is by comparing it with LaN/YbN or Sr/Yb ratios, which are well-established proxies for crustal thickness. In this study, we present new Nd-Hf isotopic data from the Permian to Triassic Hangay Batholith in the western Mongol-Okhotsk Orogen (Hangay Mountains), to evaluate the role of Nd-Hf isotopes in tracing crustal thickness variations along convergent plate boundaries. Our results show that granitoids from the Hangay Batholith likely originated from partial melting of crustal materials, with a possible mantle contribution. These granitoids have moderate εNd(t) and εHf(t) values, with no significant shift from Permian to Triassic, which contrasts with the continuous crustal thickening indicated by LaN/YbN ratios. This inconsistency between Nd-Hf isotope evolution and crustal thickness variation is likely due to the heterogeneous crustal architecture in this accretionary orogen. Our findings highlight the need for caution when linking Hf and Nd isotope evolution with extensional and contractional tectonics.
After right ventricular outflow tract obstruction reconstruction for CHD, surgical pulmonary valve replacement, or transcatheter pulmonary valve replacement may be performed if complicated by moderately severe or severe right ventricular outflow tract dysfunction. However, for patients whose anatomy is not suitable for transcatheter pulmonary valve replacement, surgical pulmonary valve replacement is the only option, but it has a higher rate of perioperative complications and longer hospitalisation for patients. In two cases of severe transcatheter pulmonary valve replacement in which percutaneous pulmonary valve implantation could not be performed directly due to the presence of a large right ventricle, a significant decrease in right ventricular function, and significant widening of the pulmonary arteries, we used a new hybridisation procedure to partially fold and reduce the diameter of the significantly widened pulmonary artery trunk without cardiopulmonary bypass by surgically opening the thorax in a median way, and then successfully implanted a percutaneous self-expanding pulmonary valve valve, with good immediate results in the postoperative period. The postoperative recovery was rapid and the recent results were excellent.
Broad-spectrum antibiotic use in febrile neutropenia is often driven by concerns for severe and drug-resistant infections. In select patients who do not have an active infection and improve, their prolonged and unnecessary use contributes to antimicrobial resistance, drug toxicity, and increased healthcare costs. We describe the implementation of an antibiotic de-escalation protocol to reduce inappropriate antibiotic use in febrile neutropenia among hematology patients.
Methods:
We conducted baseline analysis (January–June 2024) of antibiotic use in febrile neutropenia cases admitted under hematology. Interventions included the (i) development of an antibiotic de-escalation protocol to guide clinical management, (ii) a roadshow to educate and improve uptake of this protocol, and (iii) regular feedback via “report cards” for hematology teams. The primary outcome was the proportion of febrile neutropenia cases with inappropriate antibiotic use, with secondary measures including adverse outcomes (in-hospital mortality, Clostridioides difficile infection, need for intensive care).
Results:
Baseline data indicated inappropriate antibiotic use rates of 45.5–66.7% per month from January to June 2024, with 13–28 days of inappropriate therapy. The protocol was developed in July 2024, with a subsequent roadshow to promote its uptake. Regular feedback was provided in the form of “report cards” every 2-monthly thereafter. Post-intervention, inappropriate antibiotic use decreased to a median of 23.35% from July to December 2024, with no observed increase in adverse outcomes.
Conclusions:
The implementation of a structured de-escalation protocol, combined with frequent education and feedback, effectively reduced inappropriate antibiotic use in febrile neutropenia without compromising patient safety.
Internet addiction (IA) refers to excessive internet use that causes cognitive impairment or distress. Understanding the neurophysiological mechanisms underpinning IA is crucial for enabling an accurate diagnosis and informing treatment and prevention strategies. Despite the recent increase in studies examining the neurophysiological traits of IA, their findings often vary. To enhance the accuracy of identifying key neurophysiological characteristics of IA, this study used the phase lag index (PLI) and weighted PLI (WPLI) methods, which minimize volume conduction effects, to analyze the resting-state electroencephalography (EEG) functional connectivity. We further evaluated the reliability of the identified features for IA classification using various machine learning methods.
Methods
Ninety-two participants (42 with IA and 50 healthy controls (HCs)) were included. PLI and WPLI values for each participant were computed, and values exhibiting significant differences between the two groups were selected as features for the subsequent classification task.
Results
Support vector machine (SVM) achieved an 83% accuracy rate using PLI features and an improved 86% accuracy rate using WPLI features. t-test results showed analogous topographical patterns for both the WPLI and PLI. Numerous connections were identified within the delta and gamma frequency bands that exhibited significant differences between the two groups, with the IA group manifesting an elevated level of phase synchronization.
Conclusions
Functional connectivity analysis and machine learning algorithms can jointly distinguish participants with IA from HCs based on EEG data. PLI and WPLI have substantial potential as biomarkers for identifying the neurophysiological traits of IA.
No studies have investigated the effects of virtual reality (VR) on the persecutory idea of reference (IOR) or delusions of reference (DOR) in patients with psychosis. This study examined the efficacy and safety of VR therapy in stable outpatients with psychosis and explored relationships between primary outcomes and psychological factors using path analysis.
Methods
Seventy-eight patients were randomly assigned to either the VR-treatment (VR-T) or VR-control (VR-C) group. The VR-T group viewed three 360° 3D videos or four animated videos; the VR-C group viewed the same seven videos with muted voices or 11 360° 3D videos of natural scenes. Pre- and post-assessments were performed using the Psychotic Symptom Rating Scale-Delusions (PSYRATS-D) and Revised Green et al. Paranoid Thought Scale (R-GPTS) as a primary outcome measure. Several self-rating scales measuring schema, depression, brooding, negative evaluation, attribution bias, and self-esteem were administered. Safety was assessed after sessions 1 and 10, and path models were constructed.
Results
Between-group analysis showed a significant improvement in PSYRATS-D scores in the VR-T group compared with the VR-C group. Regarding self-rating scales, the between-group analysis revealed a significant group × time interaction only for the Social and Occupational Functioning Assessment Scale (SOFAS) score. The frequency of VR sickness was high, but its severity was mild. Fear of Negative Evaluation Scale and Beck Depression Inventory scores were found to have mediating roles.
Conclusions
VR therapy effectively reduced delusions in young, stable psychosis patients with mild and tolerable side effects. Future studies should develop diverse VR content for older populations.
Emerging evidence indicates that gene–environment interactions (GEIs) are important underlying mechanisms for the development of schizophrenia (SZ). We investigated the associations of polygenic risk score for SZ (PRS-SZ), environmental measures, and their interactions with case–control status and clinical phenotypes among patients with schizophrenia spectrum disorders (SSDs).
Methods
The PRS-SZ for 717 SSD patients and 356 healthy controls (HCs) were calculated using the LDpred model. The Korea-Polyenvironmental Risk Score-I (K-PERS-I) and Early Trauma Inventory-Self Report (ETI-SR) were utilized as environmental measures. Logistic and linear regression analyses were performed to identify the associations of PRS-SZ and two environmental measures with case–control status and clinical phenotypes.
Results
The PRS-SZ explained 8.7% of SZ risk. We found greater associations of PRS-SZ and total scores of the K-PERS-I with case–control status compared to the ETI-SR total score. A significant additive interaction was found between PRS-SZ and K-PERS-I. With the subdomains of the K-PERS-I and ETI-SR, we identified significant multiplicative or additive interactions of PRS-SZ and parental socioeconomic status (pSES), childhood adversity, and recent life events in association with case–control status. For clinical phenotypes, significant interactions were observed between PRS-SZ and the ETI-SR total score for negative-self and between PRS-SZ and obstetric complications within the K-PERS-I for negative-others.
Conclusions
Our findings suggest that the use of aggregate scores for genetic and environmental measures, PRS-SZ and K-PERS-I, can more accurately predict case–control status, and specific environmental measures may be more suitable for the exploration of GEIs.
Fine particulate matter (PM2·5) is a known risk factor for heart failure (HF), while plant-based dietary patterns may help reduce HF risk. This study examined the combined impact of PM2·5 exposure and a plant-based diet on HF incidence. A total of 190 092 participants from the UK Biobank were included in this study. HF cases were identified through linkage to the UK National Health Services register, with follow-up lasting until October 2022 in England, August 2022 in Scotland and May 2022 in Wales. Annual mean PM2·5 concentration was obtained using a land use regression model, while the healthful plant-based diet index (hPDI) was calculated using the Oxford WebQ tool based on two or more 24-hour dietary assessments of seventeen major food groups. Cox proportional hazard models assessed the associations of PM2·5 and hPDI with HF risk, and interactions were evaluated on additive and multiplicative scales. During a median of 13·4-year follow-up, 4351 HF cases were recorded. Participants in the highest PM2·5 tertile had a 23 % increased HF risk (hazard ratio: 1·23, 95 % CI: 1·14, 1·32) compared with those in the lowest tertile. Moderate or high hPDI was associated with reduced HF risk relative to low hPDI. The lowest HF risk was observed in individuals with high hPDI and low PM2·5 exposure, underscoring the protective role of a plant-based diet, particularly in areas with lower PM2·5 levels. A healthy plant-based diet may mitigate HF risk, especially in populations exposed to lower PM2·5 levels.
This study elucidated the impacts of coenzyme Q10 (COQ10) supplementation in a high-fat diet (HFD) on growth, lipid metabolism and mitochondrial function in spotted seabass (Lateolabrax maculatus). Totally five diets were formulated: a diet with normal fat content (11 % lipid, NFD), a HFD (17 % lipid) and three additional diets by supplementing 5, 20 or 80 mg/kg of COQ10 to the HFD. After an 8-week culture period, samples were collected and analysed. The results demonstrated that COQ10 inclusion prevented the HFD-induced deterioration of growth performance and feed utilisation. COQ10 alleviated the deposition of saturated fatty acids following HFD intake and promoted the assimilation of n-3 and n-6 PUFA. Moreover, COQ10 administration inhibited the surge in serum transaminase activity and reduced hepatic lipid content following HFD ingestion, which was consistent with the results of oil red O staining. In addition, HFD feeding led to reduced hepatic citrate synthase and succinate dehydrogenase activities and decreased ATP content. Notably, COQ10 administration improved these indices and up-regulated the expression of mitochondrial biogenesis-related genes (pgc-1α, pgc-1β, nrf-1, tfam) and autophagy-related genes (pink1, mul1, atg5). In summary, supplementing 20–80 mg/kg of COQ10 in the HFD promoted growth performance, alleviated hepatic fat accumulation and enhanced liver mitochondrial function in spotted seabass.
Machine learning (ML) models have been developed to identify randomised controlled trials (RCTs) to accelerate systematic reviews (SRs). However, their use has been limited due to concerns about their performance and practical benefits. We developed a high-recall ensemble learning model using Cochrane RCT data to enhance the identification of RCTs for rapid title and abstract screening in SRs and evaluated the model externally with our annotated RCT datasets. Additionally, we assessed the practical impact in terms of labour time savings and recall improvement under two scenarios: ML-assisted double screening (where ML and one reviewer screened all citations in parallel) and ML-assisted stepwise screening (where ML flagged all potential RCTs, and at least two reviewers subsequently filtered the flagged citations). Our model achieved twice the precision compared to the existing SVM model while maintaining a recall of 0.99 in both internal and external tests. In a practical evaluation with ML-assisted double screening, our model led to significant labour time savings (average 45.4%) and improved recall (average 0.998 compared to 0.919 for a single reviewer). In ML-assisted stepwise screening, the model performed similarly to standard manual screening but with average labour time savings of 74.4%. In conclusion, compared with existing methods, the proposed model can reduce workload while maintaining comparable recall when identifying RCTs during the title and abstract screening stages, thereby accelerating SRs. We propose practical recommendations to effectively apply ML-assisted manual screening when conducting SRs, depending on reviewer availability (ML-assisted double screening) or time constraints (ML-assisted stepwise screening).
In this essay, I point out that the age-limit norm is misrepresented and misperceived in current analyses of leadership changes in the Chinese Communist Party for two reasons. First, the method employed in these analyses fails to capture the complexity of the rules that constitute the norm. Second, the method is ill-equipped to reflect the stratification of power at the top of the Party. To rectify these issues, I provide a structured framework to examine the age distribution patterns of membership changes at national Party congresses. I conclude that the age-limit norm functions as a nondemocratic mechanism for the Party and its top leaders to facilitate the exit of current powerholders and redistribute power en masse in a peaceful manner with reduced cost, enhanced transparency, and reasonable credibility. The framework I offer can help reveal the hidden significance and resilience of the age-limit norm, which has thus far been overlooked, obscured, or underestimated in current analyses.
Greenhouse gas (GHG) emissions from shipping contribute meaningfully to climate change. Despite significant efforts of the International Maritime Organization over recent decades, existing measures are still inadequate for achieving net-zero GHG emissions in the shipping sector and multilateral negotiations hold little promise for improvement. This article considers the polluter pays principle (PPP) as an alternative or additional pathway for tackling marine GHG emissions. The article focuses on the challenges in identifying polluters, which is the key issue that must be addressed before the PPP can be applied. Specifically, the article presents an analytical framework and examines various approaches to identifying marine GHG emissions polluters. Firstly, it identifies the polluter from a general perspective, using three approaches: examining the issue broadly, reviewing international conventions and European Union initiatives that incorporate the PPP, and analyzing selected domestic legislation reflecting the PPP. The article then focuses on maritime shipping, considering specifically two types of contract of affreightment – charterparties and bills of lading – while highlighting key factors in identifying the polluter. In conclusion, the assessment of causal links, along with operational and management decisions regarding the vessel, attribute the status of primary polluter to the shipowner, demise charterer, and time charterer.
Rhopalosiphum padi is an important grain pest, causing severe losses during crop production. As a systemic insecticide, flonicamid can control piercing-sucking pests efficiently. In our study, the lethal effects of flonicamid on the biological traits of R. padi were investigated via a life table approach. Flonicamid is highly efficiently toxic to R. padi, with an LC50 of 9.068 mg L−1. The adult longevity and fecundity of the R. padi F0 generation were markedly reduced under the LC25 and LC50 concentrations of flonicamid exposure. In addition, negative transgenerational effects on R. padi were observed under exposure to lethal concentrations of flonicamid, with noticeable decreases in the reproductive period, adult longevity, total longevity, and total fecundity of the F1 generation under the LC25 concentration of flonicamid. Furthermore, the third nymph stage (N3), preadult stage, duration of the adult pre-reproductive period, duration of the total pre-reproductive period, reproductive period, adult longevity, total longevity, and total fecundity of the F1 generation were significantly lower under treatment with the LC50 concentration of flonicamid. The life table parameters were subsequently analysed, revealing that the intrinsic rate of increase (rm) and the net reproductive rate (R0) were significantly lower but that the finite rate of increase (λ) and the mean generation time (T) were not significantly different under the LC25 and LC50 concentrations of flonicamid. These data are beneficial for grain aphid control and are critical for exploring the role of flonicamid in the integrated management of this key pest.
Quantum learning models hold the potential to bring computational advantages over the classical realm. As powerful quantum servers become available on the cloud, ensuring the protection of clients’ private data becomes crucial. By incorporating quantum homomorphic encryption schemes, we present a general framework that enables quantum delegated and federated learning with a computation-theoretical data privacy guarantee. We show that learning and inference under this framework feature substantially lower communication complexity compared with schemes based on blind quantum computing. In addition, in the proposed quantum federated learning scenario, there is less computational burden on local quantum devices from the client side, since the server can operate on encrypted quantum data without extracting any information. We further prove that certain quantum speedups in supervised learning carry over to private delegated learning scenarios employing quantum kernel methods. Our results provide a valuable guide toward privacy-guaranteed quantum learning on the cloud, which may benefit future studies and security-related applications.
The timing of corrective feedback (CF), alternatively called feedback timing, refers to the choice of a timepoint for providing corrections on second language (L2) errors or making comments on the appropriacy of L2 learners' verbal or nonverbal behaviors. A typical distinction related to the notion of feedback timing is between immediate and delayed feedback, but what constitutes immediate or delayed has been interpreted and defined in different ways. In one stream of research, immediate feedback is operationalized as feedback provided during a learning task and delayed feedback as feedback provided after a task is completed (Arroyo & Yilmaz, 2018*; Li Zhu & Ellis, 2016a*; Quinn, 2014*). One methodological variation in this distinction is interim feedback, which is provided after the first task is completed and before the second task is started (Li, Li, & Qian, under review). Interim feedback is relevant or possible when multiple tasks are performed. It refers to feedback provided during the interval(s) between tasks. Interim feedback is different from delayed feedback in that the latter refers to feedback provided after the task (if there is only one task) or all tasks (if there are multiple tasks) are completed and there is no further task performance following the feedback session. This way of conceptualizing feedback timing is based on the positioning of feedback during a task cycle, instead of the proximity to errors. Another way to examine feedback timing is to distinguish feedback provided immediately after an error is made and feedback delayed until a later time in the instructional cycle, such as one week later (Lavolette, Polio, & Kahng, 2015*). In this case, both immediate and delayed feedback can occur either during or after the completion of a learning task. A third way is to define feedback timing options in terms of their relation to instruction, namely whether feedback is provided immediately after explicit instruction or at a later stage after learners complete some practice activities (Fu & Li, 2022*). It should be clarified that this way of operationalizing feedback timing is markedly different from that in other studies in that it focuses on feedback's relation to instruction instead of errors. To conclude this section, it is necessary to point out that the conceptualization and operationalization of feedback timing should be reconsidered in L2 research. Feedback timing is not merely a matter of the length of interval or the distance between errors and feedback, and other parameters of the instructional system where errors occur are also involved or relevant, such as the distance between feedback and instruction, the positioning of feedback in a task cycle (such as within, after, or between tasks), and so on. These parameters are important because they contribute to the effectiveness of different timing options. Despite the variation in the operationalization of feedback timing, we argue that it is a unified construct that is theoretically justifiable, empirically examinable, and pedagogically valuable.
This study aims to evaluate the impact of low-carbohydrate diet, balanced dietary guidance and pharmacotherapy on weight loss among individuals with overweight or obesity over a period of 3 months. The study involves 339 individuals with overweight or obesity and received weight loss treatment at the Department of Clinical Nutrition at the Second Affiliated Hospital of Zhejiang University, School of Medicine, between 1 January 2020 and 31 December 2023. The primary outcome is the percentage weight loss. Among the studied patients, the majority chose low-carbohydrate diet as their primary treatment (168 (49·56 %)), followed by balanced dietary guidance (139 (41·00 %)) and pharmacotherapy (32 (9·44 %)). The total percentage weight loss for patients who were followed up for 1 month, 2 months and 3 months was 4·98 (3·04, 6·29) %, 7·93 (5·42, 7·93) % and 10·71 (7·74, 13·83) %, respectively. Multivariable logistic regression analysis identified low-carbohydrate diet as an independent factor associated with percentage weight loss of ≥ 3 % and ≥ 5 % at 1 month (OR = 0·461, P < 0·05; OR = 0·349, P < 0·001). The results showed that a low-carbohydrate diet was an effective weight loss strategy in the short term. However, its long-term effects were comparable to those observed with balanced dietary guidance and pharmacotherapy.
Characterised by the extensive use of obsidian, a blade-based tool inventory and microblade technology, the late Upper Palaeolithic lithic assemblages of the Changbaishan Mountains are associated with the increasingly cold climatic conditions of Marine Isotope Stage 2, yet most remain poorly dated. Here, the authors present new radiocarbon dates associated with evolving blade and microblade toolkits at Helong Dadong, north-east China. At 27 300–24 100 BP, the lower cultural layers contain some of the earliest microblade technology in north-east Asia and highlight the importance of the Changbaishan Mountains in understanding changing hunter-gatherer lifeways in this region during MIS 2.
Gene expression studies in organisms are often conducted using reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR), and the accuracy of RT-qPCR results relies on the stability of reference genes. We examined ten candidate reference genes in Sclerodermus guani, a parasitoid wasp that is a natural enemy of long-horned beetle pests in forestry, including ACT, EF1α, Hsc70, Hsp70, SRSF7, α-tubulin, RPL7A, 18S, 28S, and SOD1, regarding variable biotic and abiotic factors such as body part, life stage, hormone, diet, and temperature. Data were analysed using four dedicated algorithms (ΔCt, BestKeeper, NormFinder, and geNorm) and one comparative tool (RefFinder). Our results showed that the most stable reference genes were RPL7A and EF1α regarding the body part, SRSF7 and Hsc70 regarding the diet, RPL7A and α-tubulin regarding the hormone, SRSF7 and RPL7A regarding the life stage, and SRSF7 and α-tubulin regarding temperature. To ascertain the applicability of specific reference genes, the expression level of the target gene (ACPase) was estimated regarding the body part using the most stable reference genes, RPL7A and EF1α, and the least stable one, SOD1. The highest expression level of ACPase was observed in the abdomen, and the validity of RPL7A and EF1α was confirmed. This study provides, for the first time, an extensive list of reliable reference genes for molecular biology studies in S. guani.
This paper retrospectively analysed the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in some parts of China. Between January 2013 and December 2019, we collected 4,145 respiratory samples, including pharyngeal swabs and alveolar lavage fluid. The highest PCR-positive rate of M. pneumoniae was 74.5% in Beijing, the highest resistance rate was 100% in Shanghai, and Gansu was the lowest with 20%. The highest PCR-positive rate of M. pneumoniae was 74.5% in 2013, and the highest MRMP was 97.4% in 2019; the PCR-positive rate of M. pneumoniae for adults in Beijing was 17.9% and the MRMP was 10.48%. Among the children diagnosed with community-acquired pneumonia (CAP), the PCR-positive and macrolide-resistant rates of M. pneumoniae were both higher in the severe ones. A2063G in domain V of 23S rRNA was the major macrolide-resistant mutation, accounting for more than 90%. The MIC values of all MRMP to erythromycin and azithromycin were ≥ 64 μg/ml, and the MICs of tetracycline and levofloxacin were ≤ 0.5 μg/ml and ≤ 1 μg/ml, respectively. The macrolide resistance varied in different regions and years. Among inpatients, the macrolide-resistant rate was higher in severe pneumonia. A2063G was the common mutation, and we found no resistance to tetracycline and levofloxacin.
Klebsiella pneumoniae are common pathogens causing bloodstream infection (BSI) that increasingly express carbapenem resistance worldwide. To date, no study has precisely investigated the impact of carbapenem resistance in K. pneumoniae (CRKP) BSI on mortality.
Methods:
This retrospective study included 87 patients with CRKP BSI and 321 patients with carbapenem-susceptible K. pneumoniae (CSKP) BSI from 2015 to 2020. Propensity score analyses with stabilized inverse probability of treatment weighting (IPTW-S) was applied to balance covariates. The hazard ratio for 30-day mortality associated with carbapenem resistance was estimated using Cox regression and Kaplan-Meier curves.
Results:
The 30-day crude mortality rates were 43.7% in patients with CRKP BSI and 17.8% in patients with CSKP BSI (P < .001). Age ≥55 years, underlying hematological malignancies and hemodialysis were independently associated with mortality in CRKP BSI. A skin or soft-tissue infection source, urinary catheter, and underlying chronic obstructive pulmonary disease were predictors of mortality in CSKP BSI. The group characteristics were well balanced after IPTW-S. The adjusted hazard ratio for 30-day mortality for CRKP BSI was 1.607 (interquartile range, 0.814–3.171).
Conclusions:
Carbapenem resistance was not associated with a significant increase in 30-day mortality in KP BSI; patient and disease factors were primary determinants of outcomes.