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Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time.
Design and Setting:
We conducted a prospective cohort study using electronic health record data at a quaternary Children’s Hospital.
Patients:
We included hospitalized children with central catheters.
Methods:
Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates.
Results:
Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12–1.37). Although not statistically different, observed rates were lower than expected rates for later years.
Conclusions:
Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.
This essay considers religion in Pirandello’s oeuvre from a historical point of view, that is to say, as firmly anchored in a post-Copernican modernity in which, as philosopher Friedrich Nietzsche famously proclaimed, “God is dead,” and relativity came to be understood as scientific fact in the wake of Albert Einstein’s investigations. The essay asks whether a consistent meditation on religion can be found in Pirandello’s oeuvre and therefore considers several works, among them, The Late Mattia Pascal; Shoot!; Lazarus; and One, No One, and One Hundred Thousand. Particular focus is given to the ways in which these writings demonstrate Pirandello’s interest in mysticism, a non-dogmatic Catholic Modernism, and his rejection of any transcendent God, a belief which corresponded to his humoristic view of life more generally, tied as they both were to his uneasiness over life’s lack of certainty.
Societal guidelines offer a weak recommendation to perform cystoscopy for female patients with recurrent urinary tract infections (rUTI) of advanced age and/or with high-risk features. These guidelines lack the support of robust data and are instead based on expert opinion. In this retrospective cohort study, we aim to determine the utility of cystoscopy in patients with and without high-risk features for rUTI.
Materials and methods:
We identified 476 women who underwent cystoscopy for the evaluation of rUTI at a single tertiary academic medical center from May 1, 2015 and March 15, 2021. Patients were excluded if they had a competing indication for cystoscopy. Risk factors, demographic information, cystoscopic findings, and patient outcomes were analyzed.
Results:
192 (41.1%) were classified as having complicated UTI. We identified six patients (1.3%) with findings that prompted management to significantly impact patient outcomes. All six patients had high-risk features. 14 patients (3.0%) were found to have mucosal abnormalities prompting biopsy, three of which required general anesthesia. All 14 biopsies were ultimately benign.
Conclusions:
Our findings demonstrate a low diagnostic yield and increased risk exposure for women undergoing cystoscopy for the evaluation of complicated rUTI. Additionally, our observations support prior studies indicating that cystoscopy has limited utility in the evaluation of rUTI without high-risk features.
Nitrogen fixation from pasture legumes is a fundamental process that contributes to the profitability and sustainability of dryland agricultural systems. The aim of this research was to determine whether well-managed pastures, based on aerial-seeding pasture legumes, could partially or wholly meet the nitrogen (N) requirements of subsequent grain crops in an annual rotation. Fifteen experiments were conducted in Western Australia with wheat, barley or canola crops grown in a rotation that included the pasture legume species French serradella (Ornithopus sativus), biserrula (Biserrula pelecinus), bladder clover (Trifolium spumosum), annual medics (Medicago spp.) and the non-aerial seeded subterranean clover (Trifolium subterraneum). After the pasture phase, five rates of inorganic N fertilizer (Urea, applied at 0, 23, 46, 69 and 92 kg/ha) were applied to subsequent cereal and oil seed crops. The yields of wheat grown after serradella, biserrula and bladder clover, without the use of applied N fertilizer, were consistent with the target yields for growing conditions of the trials (2.3 to 5.4 t/ha). Crop yields after phases of these pasture legume species were similar or higher than those following subterranean clover or annual medics. The results of this study suggest a single season of a legume-dominant pasture may provide sufficient organic N in the soil to grow at least one crop, without the need for inorganic N fertilizer application. This has implications for reducing inorganic N requirements and the carbon footprint of cropping in dryland agricultural systems.
With an annual growth in travel demand of about 5% globally, managing the environmental impact is a challenge. In 2019, the International Civil Aviation Organisation (ICAO) issued emission reduction targets, including well-to-wake greenhouse gas (GHG) emissions reduced at least 50% from 2005 levels by 2050. This discusses several technologies from an aircraft design perspective that can contribute to achieving these targets. One thing is certain: aircraft will look different in the future. The Transonic Truss-Braced Wing and Flying V configurations are promising significant efficiency improvements over conventional configurations. Electric propulsion, in various architectures, is becoming a feasible option for general aviation and commuter aircraft. It will be a growing field of aviation with zero-emissions flight and opportunities for special missions. Lastly, this paper discusses methods and design processes that include all relevant disciplines to ensure that the aircraft is optimised as a complete system. While empirical methods are essential for initial design, Multidisciplinary Design Optimisation (MDO) incorporates models and simulations integrated in an optimisation environment to capture critical trade-offs. Concurrent design places domain experts in one site to facilitate collaboration, interaction, and joint decision-making, and to ensure all disciplines are equally considered. It is supported by a Collaborative Design Facility (CDF), an information technology facility with connected hardware and software tools for design analysis.
The rapidly growing field of immunopsychiatry combines expertise and insights from immunology, psychiatry and neuroscience to understand the role of inflammation and other immune processes in causing and treating mental illness. This represents a major shift in mental health science, traditionally focused on psychological and neuronal mechanisms of depression, psychosis and dementia. This book provides the first comprehensive overview of recent, inter-disciplinary research linking disordered function of the immune system to the brain and mental illness. It offers a broad and deep perspective on the implications of immune system involvement in psychiatric disorders, including a balanced focus on basic science and clinical applications. Chapters cover the scientific evidence linking immune processes to major mental illnesses such as schizophrenia, depression, anxiety and dementia. An invaluable guide for graduate students, doctors in training, scientific researchers and others interested in the link between the immune system and mental health.
This paper examines grass-fed beef producer preferences for cattle traits using data from a mail survey of 384 U.S. grass-fed beef producers. Conjoint analysis and Likert scale questions were used to determine preferences. Generally, results indicated that producers preferred easy-to-handle, heavy, black, and relatively lower-priced feeders raised from their own cows. The Kernel density figures for source, color, and temperament confirm the mixed logit standard deviation estimates that suggest heterogeneity in producer preferences.