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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.
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.
Reaction of a Mg-Al carbonate layered double hydroxide (LDH) with boric acid leads to a borate-pillared LDH with the stoichiometry [Mg0.65Al0.35(OH)2][B3O5]0.35.0.65H2O and an interlayer spacing of 1.07 nm. Infrared and 11B magic angle spinning nuclear magnetic resonance data are consistent with the presence of polymeric triborate anions of the type [B3O4(OH)2]nn- in the interlayer galleries so that the material can be formulated as [Mg0.65Al0.35(OH)2][B3O4(OH)2]0.35.0.30H2O. The flame-retardant properties of the borate-pillared material and the carbonate precursor in composites with ethylene vinyl acetate copolymer were compared. Introduction of the borate anion leads to a significant enhancement in smoke suppression during combustion without compromising the flammability of the material. This is related to the synergistic effect between the host layers of the LDH and the borate anions uniformly distributed in the interlayer region.
The presence of obstacles in the propagation path is a critical factor in air-to-ground (AG) communication. The behavior of wireless signal propagation depends on several variables, such as frequency, building height, elevation angle, and street design. This paper aims to compare the three established line of sight (LOS) probability model based on actual site data, including the building geometry in suburban environment. The comparison between these three models using the site data provide a guideline for selecting the LOS probability model based on the optimistic and pessimistic predictions. The shadowing loss was evaluated at frequencies 2 and 3.5 GHz with an elevation angle of 20° in two suburban locations at Universiti Tun Hussein Onn Malaysia. Three prediction models, ITU-R P.1410-5, Holis and Pechac, and Pang et al., available in the literature were used to identify and compare the line-of-sight probability. By focusing on the shadowing model in suburban area, the guideline for optimizing LOS communications or navigation in these challenging environments can be developed. The finding highlights the importance of considering building height in AG communication for network performance evaluation and design.
Circulating n-3 PUFA, which integrate endogenous and exogenous n-3 PUFA, can be better used to investigate the relationship between n-3 PUFA and disease. However, studies examining the associations between circulating n-3 PUFA and colorectal cancer (CRC) risk were limited, and the results remained inconclusive. This case–control study aimed to examine the association between serum n-3 PUFA and CRC risk in Chinese population. A total of 680 CRC cases and 680 sex- and age-matched (5-year interval) controls were included. Fatty acids were assayed by GC. OR and 95 % CI were calculated using multivariable logistic regression after adjustment for potential confounders. Higher level of serum α-linolenic acid (ALA), docosapentaenoic acid (DPA), DHA, long-chain n-3 PUFA and total n-3 PUFA were associated with lower odds of CRC. The adjusted OR and 95 % CI were 0·34 (0·24, 0·49, Pfor trend < 0·001) for ALA, 0·57 (0·40, 0·80, Pfor trend < 0·001) for DPA, 0·48 (0·34, 0·68, Pfor trend < 0·001) for DHA, 0·39 (0·27, 0·56, Pfor trend < 0·001) for long-chain n-3 PUFA and 0·31 (0·22, 0·45, Pfor trend < 0·001) for total n-3 PUFA comparing the highest with the lowest quartile. However, there was no statistically significant association between EPA and odds of CRC. Analysis stratified by sex showed that ALA, DHA, long-chain n-3 PUFA and total n-3 PUFA were inversely associated with odds of CRC in both sexes. This study indicated that serum ALA, DPA, DHA, long-chain n-3 PUFA and total n-3 PUFA were inversely associated with odds of having CRC in Chinese population.
The wheat aphid Sitobion miscanthi (CWA) is an important harmful pest in wheat fields. Insecticide application is the main method to effectively control wheat aphids. However, CWA has developed resistance to some insecticides due to its extensive application, and understanding resistance mechanisms is crucial for the management of CWA. In our study, a new P450 gene, CYP4CJ6, was identified from CWA and showed a positive response to imidacloprid and thiamethoxam. Transcription of CYP4CJ6 was significantly induced by both imidacloprid and thiamethoxam, and overexpression of CYP4CJ6 in the imidacloprid-resistant strain was also observed. The sensitivity of CWA to these two insecticides was increased after the knockdown of CYP4CJ6. These results indicated that CYP4CJ6 could be associated with CWA resistance to imidacloprid and thiamethoxam. Subsequently, the posttranscriptional regulatory mechanism was assessed, and miR-316 was confirmed to participate in the posttranscriptional regulation of CYP4CJ6. These results are crucial for clarifying the roles of P450 in the resistance of CWA to insecticides.
Rising economic inequality has put capitalism on trial globally. At the same time, existential environmental threats worsen while corporations continue to pollute and distort government policy. These twin crises have converged in calls to revamp government and economic systems and to revisit socialism, given up for dead only 30 years ago. In Capitalism and the Environment, Shi-Ling Hsu argues that such an impulse, if enacted, will ultimately harm the environment. Hsu argues that inequality and environmental calamities are political failures – the result of bad decision-making – and not a symptom of capitalism. Like socialism, capitalism is composed of political choices. This book proposes that we make a different set of choices to better harness the transformative power of capitalism, which will allow us to reverse course and save the environment.
The nature of capital investment is that an upfront expenditure is made with the hope of producing a stream of benefits over time that more than pay for the initial expenditure. Capital investments are thus risky, because that stream of benefits may not materialize. The economic environment may deteriorate, induced by new patterns of trade or a technological advancement creating fresh competition. Or the legal environment may darken, if it is later discovered that the production process is harmful, or if product is harmful in a way that was unknown at the time of investment. When those economic or legal threats present themselves, owners of capital rally to preserve the value of their capital. The bigger the capital, the stronger the rally. When capital owners attempt, through legal, political, or extra-legal means to protect their capital from these changes, they are said to engage in rent-preserving activities. The result is a costly policy conflict.
While it would be impractical to try and regulate capital investment, it is still surprising that there is so little to deter risky investments. It is still easy to invest in capital equipment that produces harmful effects or products. The reasoning would seem to be the notion that capital investments are purely private decisions. We leave it to the private investor to consider the private benefits. As to the potential for public harm, a dual system of ex post and ex ante disincentives are supposed to send a signal to prospective investors. Ex post, liability could be costly, and could serve as a deterrent for engaging in potentially harmful behavior, by investing in harmful capital. Ex ante, a regulatory state is supposed to intercept the most dangerous industrial practices, and should disincentivize the capital investments that enable them. These dual disincentives have been insufficient in stemming the investment in harmful capital.
Capitalism is not the reason that humankind has so badly mistreated its environment. It is true that capitalism has taken a very wrong turn, and having gone down this route, it is difficult to change it. But there is nothing about capitalism preordaining it to produce environmental destruction. Capitalism has taken on a malignant form, but it has been steered by mistaken political choices, born of political failures, greed, tribalism, and that toxic cocktail of human arrogance mixed with abject ignorance.
In May 2020, during the COVID-19 crisis, which pummeled markets and industries of almost all types, fourteen Republican senators and two Republican congressmen wrote to the President, urging him to “use every administrative and regulatory tool at your disposal to prevent America’s financial institutions from discriminating against America’s energy sector … .”
Just a little more than 150 years after the publication of Das Kapital, by the eponymous Karl Marx, capitalism finds itself under scrutiny again. For a time the failures of Marxism, as a political ideology, and the failures of socialism, as a means of economic organization, were so globally apparent that there seemed no longer to be anything to argue about. Inequality has now rekindled the old debate over capitalism versus alternative forms of government or economic organization.
Differences in degree are masked by a simple capitalism-versus-socialism dichotomy. Nevertheless, this book takes up this debate on these simplified terms, and with respect to only one question, but one of existential importance to humankind: How will human civilization right its horribly, tragically errant relationship with the planet it inhabits?
While Adam Smith did not name it, he identified capitalism as something profoundly different, something that would break feudalism, and something that would generate wealth previously unimaginable. To argue that something so transformative could happen without royal edict or conscious purpose, driven only by self-interest, was heretical. But it is a big and consequential mistake to leap to the conclusion that capitalism is “natural” and self-executing. It became a canard that all capitalism needed was “free” markets, unspoiled by government interference. Markets depend upon rules and institutions for governance. Capitalism is more than markets alone, and requires more by way of governance. Even in Smith’s eighteenth-century England, there still had to be “tolerable administration of justice.” Capitalism was then, is now, and will always be dependent up the selective coercion of legal rules and institutions. For example, the enforcement of promises requires the coercion of courts, or at least norms broad enough to be institutional in nature.
There is much work to be done. This chapter sets out a list of five proposed environmental taxes. This is by no means a comprehensive list of worthwhile environmental taxes. What else don’t we know? These are five of the most important externalities to price. Some of these taxes have multiple effects. In fact, some of the effects overlap across different taxes. Some account can be made for overlap, so as not to double tax the same harmful activity, except of course for multiple harms. Each tax is described briefly, along with some discussion of the harms and the implementation and enforcement issues. Each proposed tax is worthy of a book-length discussion, but my purpose here is to introduce the need for the tax, and to lay out a roadmap for implementation, hoping the reader will forgive the omissions necessitated by considerations of space.
The cornerstone of this book’s proposal is a system of environmental taxes, which will serve as price signals for polluting activities. This part of the proposal is so central because prices are the cornerstone of a healthy market economy; without prices, there is no market. With inaccurate prices, markets will function, but they will misallocate resources. That describes how the entire world, including even Sweden, functions: the value of the global environment is almost never accurately priced into day-to-day activities. An environmental tax, if set at the correct level, would reflect the cost of some harm inflicted upon the environment, and therefore act as an appropriate price for that harm. An environmental tax would typically be levied upon some small but measurable unit of pollution: a ton of carbon dioxide, a ton of sulfur dioxide, or a pound of nitrogen oxides.