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To evaluate the impact of implementing a clinical care guideline for uncomplicated gram-negative bloodstream infections (GN-BSI) within a health system.
Design:
Retrospective, quasi-experimental study.
Setting:
A large academic safety-net institution.
Participants:
Adults (≥18 years) with GN-BSI, defined by at least one positive blood culture for specific gram-negative organisms. Patients with polymicrobial cultures or contaminants were excluded.
Interventions:
Implementation of a GN-BSI clinical care guideline based on a 2021 consensus statement, emphasizing 7-day antibiotic courses, use of highly bioavailable oral antibiotics, and minimizing repeat blood cultures.
Results:
The study included 147 patients pre-intervention and 169 post-intervention. Interrupted time series analysis showed a reduction in the median duration of therapy (–2.3 days, P = .0016), with a sustained decline (slope change –0.2103, P = .005) post-intervention. More patients received 7 days of therapy (12.9%–58%, P < .01), oral antibiotic transitions increased (57.8% vs 72.2%, P < .05), and guideline-concordant oral antibiotic selection was high. Repeat blood cultures decreased (50.3% vs 30.2%, P < .01) without an increase in recurrent bacteremia. No significant differences were observed in 90-day length of stay, rehospitalization, recurrence, or mortality.
Conclusions:
Guideline implementation was associated with shorter antibiotic therapy durations, increased use of guideline-concordant oral antibiotics, and fewer repeat blood cultures without compromising patient outcomes. These findings support the effectiveness of institutional guidelines in standardizing care, optimizing resource utilization, and promoting evidence-based practices in infectious disease management.
Amur honeysuckle [Lonicera maackii (Rupr.) Herder] is an aggressive invader of forests throughout the eastern United States. While self-pollination has been identified as an important trait of invasive plant species, this trait is understudied, and L. maackii is anecdotally described as lacking this characteristic. To examine the ability of L. maackii to self-pollinate, we selected 171 individual shrubs distributed across nine sites. Each site was grouped into one of three invasion types: heavy, light, and sprouting (sites on which a basal cutting treatment previously occurred, but L. maackii was allowed to reestablish). We compared the number of berries, seeds per berry, and seed germination rates of self- and open-pollinated flowers by pairing branches covered with pollination bags before flower emergence with uncovered branches on the same individual shrub. Out of 171 individuals, 48 produced berries from self-pollination within pollination bags (28%), with 48% of bagged branches exhibiting some degree of necrosis or chlorosis, presumably due to increased temperature and humidity. Berries from self-pollination produced 1.5 ± 1.4 (mean ± 1 SD) seeds per berry, whereas berries resulting from open pollination produced 3.3 ± 1.5 seeds per berry. In a germination trial, 47.3% of self-pollinated seeds germinated compared with 41.7% of open-pollinated seeds. This study has shown that L. maackii can self-pollinate and set viable seed, providing the species with an important mechanism to increase population abundance during the early stages of invasion.
This Element reviews the current state of what is known about the visual and vestibular contributions to our perception of self-motion and orientation with an emphasis on the central role that gravity plays in these perceptions. The Element then reviews the effects of impoverished challenging environments that do not provide full information that would normally contribute to these perceptions (such as driving a car or piloting an aircraft) and inconsistent challenging environments where expected information is absent, such as the microgravity experienced on the International Space Station.
NASA’s all-sky survey mission, the Transiting Exoplanet Survey Satellite (TESS), is specifically engineered to detect exoplanets that transit bright stars. Thus far, TESS has successfully identified approximately 400 transiting exoplanets, in addition to roughly 6 000 candidate exoplanets pending confirmation. In this study, we present the results of our ongoing project, the Validation of Transiting Exoplanets using Statistical Tools (VaTEST). Our dedicated effort is focused on the confirmation and characterisation of new exoplanets through the application of statistical validation tools. Through a combination of ground-based telescope data, high-resolution imaging, and the utilisation of the statistical validation tool known as TRICERATOPS, we have successfully discovered eight potential super-Earths. These planets bear the designations: TOI-238b (1.61$^{+0.09} _{-0.10}$ R$_\oplus$), TOI-771b (1.42$^{+0.11} _{-0.09}$ R$_\oplus$), TOI-871b (1.66$^{+0.11} _{-0.11}$ R$_\oplus$), TOI-1467b (1.83$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-1739b (1.69$^{+0.10} _{-0.08}$ R$_\oplus$), TOI-2068b (1.82$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-4559b (1.42$^{+0.13} _{-0.11}$ R$_\oplus$), and TOI-5799b (1.62$^{+0.19} _{-0.13}$ R$_\oplus$). Among all these planets, six of them fall within the region known as ‘keystone planets’, which makes them particularly interesting for study. Based on the location of TOI-771b and TOI-4559b below the radius valley we characterised them as likely super-Earths, though radial velocity mass measurements for these planets will provide more details about their characterisation. It is noteworthy that planets within the size range investigated herein are absent from our own solar system, making their study crucial for gaining insights into the evolutionary stages between Earth and Neptune.
Now in its third edition, this textbook is a comprehensive introduction to the multidisciplinary field of mobile robotics, which lies at the intersection of artificial intelligence, computational vision, and traditional robotics. Written for advanced undergraduates and graduate students in computer science and engineering, the book covers algorithms for a range of strategies for locomotion, sensing, and reasoning. The new edition includes recent advances in robotics and intelligent machines, including coverage of human-robot interaction, robot ethics, and the application of advanced AI techniques to end-to-end robot control and specific computational tasks. This book also provides support for a number of algorithms using ROS 2, and includes a review of critical mathematical material and an extensive list of sample problems. Researchers as well as students in the field of mobile robotics will appreciate this comprehensive treatment of state-of-the-art methods and key technologies.
Ever since we began to build software systems that interacted with humans, there have ethical concerns about the ways in which we interact with them. In [830], for example, Weizenbaum observes of the world’s first chatterbot that “ELIZA shows, if nothing else, how easy it is to create and maintain the illusion of understanding, hence perhaps of judgment deserving of credibility. A certain danger lurks there.”2 Fast forward more than 60 years, and this observation that a “certain danger lurks there” has emerged as a range of different concerns about the ways in which software (and hardware) systems are developed and deployed, and the range of data that modern data-driven systems rely upon. The space of machine ethics is vast, and a large number of texts, papers, and policy documents now exist on the subject.
Sensing is a key requirement for any but the simplest mobile behavior. In order for Robot to be able to warn the crew of Lost in Space that there is danger ahead, it must be able to sense and reason about its sensor responses. Sensing is a critical component of the fundamental tasks of pose estimation – determining where the robot is in its environment; pose maintenance – maintaining an ongoing estimate of the robot’s pose; and map construction – building a representation of the robot’s environment.
Robotic systems, and in particular mobile robotic systems, are the embodiment of a set of complex computational processes, mechanical systems, sensors, user interface, and communications infrastructure. The problems inherent in integrating these components into a working robot can be very challenging. Overall system control requires an approach that can properly handle the complexity of the system goals while dealing with poorly defined tasks and the existence of unplanned and unexpected events. This task is complicated by the non-standard nature of much robotic equipment. Often the hardware seems to have been built following a philosophy of “ease of design” rather that with an eye toward assisting with later system integration.
The ability to navigate purposefully through its environment is fundamental to most animals and to every intelligent organism. In this book we examine the computational issues specific to the creation of machines that move intelligently in their environment. From the earliest modern speculation regarding the creation of autonomous robots, it was recognized that regardless of the mechanisms used to move the robot around or the methods used to sense the environment, the computational principles that govern the robot are of paramount importance. As Powell and Donovan discovered in Isaac Asimov’s story “Runaround,” subtle definitions within the programs that control a robot can lead to significant changes in the robot’s overall behavior or action. Moreover, interactions among multiple complex components can lead to large-scale emergent behaviors that may be hard to predict.
Later chapters consider the algorithms and representations that make these capabilities possible, while this chapter concentrates on the underlying hardware, with special emphasis on locomotion for wheeled robots.
For autonomous robots it may seem like we can avoid needing the ability to make maps automatically. That is, it is sometimes assumed that a robot should be able to take for granted the a priori availability of a map. Unfortunately, this is rarely the case. Not only do architectural blueprints or related types of maps fail to be consistently reliable (since even during construction they are not always updated to reflect necessary alternations), but, furthermore, numerous aspects of an environment are not likely to appear on a map, such as tables, chairs, and transitory objects.