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A growing number of studies focus on how governments can manage audience costs when they want to back down from international crises. In line with previous studies, especially Kohama et al. (2024), this paper argues that the Japanese government can use a variety of reasons to justify its decisions to de-escalate while minimizing domestic audience costs. I found that governments can reduce audience costs using several rhetorical devices, reinforcing the current understanding of audience costs. However, my design, which presented a fait accompli scenario by China against Japan, yielded significantly different results regarding audience costs compared to previous studies on the subject. Specifically, the results of this study indicate that the public might not value economic development following a fait accompli as highly as in less severe scenarios. The results also suggest that leaders might have a harder time backing down after a loss of territory compared to other forms of provocation.
Spatial analysis and disease mapping have the potential to enhance understanding of tuberculosis (TB) dynamics, whose spatial dynamics may be complicated by the mix of short and long-range transmission and long latency periods. TB notifications in Nam Dinh Province for individuals aged 15 and older from 2013 to 2022 were analyzed with a variety of spatio-temporal methods. The study commenced with an analysis of spatial autocorrelation to identify clustering patterns, followed by the evaluation of several candidate Bayesian spatio-temporal models. These models varied from simple assessments of spatial heterogeneity to more complex configurations incorporating covariates and interactions. The findings highlighted a peak in the TB notification rate in 2017, with 98 cases per 100,000 population, followed by a sharp decline in 2021. Significant spatial autocorrelation at the commune level was detected over most of the 10-year period. The Bayesian model that best balanced goodness-of-fit and complexity indicated that TB trends were associated with poverty: each percentage point increase in the proportion of poor households was associated with a 1.3% increase in TB notifications, emphasizing a significant socioeconomic factor in TB transmission dynamics. The integration of local socioeconomic data with spatio-temporal analysis could further enhance our understanding of TB epidemiology.
Comprehensive coherent structures around a surface-mounted low aspect ratio square cylinder in uniform flow with an oblique angle of $45^{\circ }$ were investigated for cylinder-width-based Reynolds numbers of 3000 and 10 000 by direct numerical simulation based on a topology-confined mesh refinement framework. High-resolution simulations and the critical-point concept were scrutinized to reveal for the first time the reasonable and compatible topologies of flow separation and complete near-wall structures, due to their extensive impact on various engineering applications. Large-scale horseshoe vortices are observed at two notable foci in the viscous sublayer. Within this layer, a wall-parallel jet is formed by downflow intruding into the bottom surface at the half-saddle point, then deflecting in the upstream direction and finally penetrating the bottom surface until the half-saddle point. A pair of conical vortices on the cylinder's top surface switch themselves on two sides of the square cylinder, where the switching frequency is identical with that of the sway of the side shear layer. The undulation of the Kelvin–Helmholtz instability is identified in the instantaneous development of a conical vortex and side shear layer, where the scaling of the ratio of the Kelvin–Helmholtz and von Kármán frequencies follows the power-law relation obtained by Lander et al. (J. Fluid Mech., vol. 849, 2018, pp. 1096–1119). Large-scale arch-shaped vortex is often detected in the intermediate wake region of a square cylinder, involving two interconnected portions, such as the leg portion separated from leeward surfaces and head portion rolled up from the top surface. The leg portion of the arch-shaped vortex was rooted by two foci near the bottom-surface plane.
There is a broad consensus that inequality is harmful for sustainable development. Kuznets (1955) observed the historical record of growth and inequality in some industrialized countries. As incomes grew, inequality first increased and then decreased after a peak. However, recent studies show that inequality can reduce economic growth and increase poverty, and it is possible that an economy can grow without rising inequality, especially in the early stages (Alesina and Rodrik 1994; Persson and Tabellini 1994; Deininger and Squire 1998; Bourguignon 2003). Inequality can also increase the social conflict and violence (Cramer 2003; Østby 2013; Ferrer-i-Carbonell and Ramos 2014). Inequality is also found to be negatively correlated with happiness and life satisfaction (Dolan, Peasgood and White 2008; Schneider 2015; Tran, Nguyen and Van Vu 2018). Understanding the trends and drivers of inequality is, therefore, very important not only for researchers but also policymakers.
In this study, we examine changes in inequality in Vietnam over time and analyse potential drivers of inequality using decomposition and regression methods. Although Vietnam has achieved relatively broad-based economic growth, there is still a large gap in living standards between population subgroups. Thus, in this study we also investigate the gaps in living standards between the Kinh majority and ethnic minorities in Vietnam. Using the richly detailed Vietnam Household Living Standards Surveys (VHLSSs) of 2002 to 2016, we estimate inequality levels and patterns based on different living standards indicators.
Vietnam is an interesting case to look at. Since 1987, the economy of Vietnam has experienced rapid economic growth as well as structural transformation from a centrally planned economy to a market-based economy. As a result of economic growth, poverty has decreased dramatically with the poverty headcount ratio (using the international poverty line of US$1.25 a day (2005 PPP)) falling from 43.6 per cent in 1993 to 14.3 per cent in 2008 (World Bank 2013). In 2016, according to the international poverty line of US$3.20 a day (2011 PPP), the rate was around 8.6 per cent (World Bank 2018). Extreme poverty is almost eliminated, with only 2 per cent of the population living on less than 2011 PPP US$1.90 per day.
Economic growth is not associated with rising inequality in Vietnam. Estimates from VHLSSs show that inequality of expenditure has been very stable in Vietnam.
Leonetti and Luca [‘On the iterates of the shifted Euler’s function’, Bull. Aust. Math. Soc., to appear] have shown that the integer sequence $(x_n)_{n\geq 1}$ defined by $x_{n+2}=\phi (x_{n+1})+\phi (x_{n})+k$, where $x_1,x_2\geq 1$, $k\geq 0$ and $2 \mid k$, is bounded by $4^{X^{3^{k+1}}}$, where $X=(3x_1+5x_2+7k)/2$. We improve this result by showing that the sequence $(x_n)$ is bounded by $2^{2X^2+X-3}$, where $X=x_1+x_2+2k$.
To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs).
Design:
From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms.
Setting:
The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries.
Patients:
In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs.
Methods:
For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs).
Results:
The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03–1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03–1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03–1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23–1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31–4.01; P <.0001) or at a teaching hospital (aOR, 2.91; 95% CI, 2.22–3.83; P < .0001), hospitalization in a middle-income country (aOR, 2.41; 95% CI, 2.09–2.77; P < .0001). The ICU type with highest risk was adult oncology (aOR, 4.35; 95% CI, 3.11–6.09; P < .0001), followed by pediatric oncology (aOR, 2.51;95% CI, 1.57–3.99; P < .0001), and pediatric (aOR, 2.34; 95% CI, 1.81–3.01; P < .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01; 95% CI, 2.71–3.33; P < .0001), followed by femoral (aOR, 2.29; 95% CI, 1.96–2.68; P < .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48; 95% CI, 1.02–2.18; P = .04).
Conclusions:
The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.
Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs.
Design:
Prospective cohort study.
Setting:
This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries.
Participants:
The study included patients admitted to ICUs across 24 years.
Results:
In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16–1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P < .0001).
Conclusions:
Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.
To examine whether mothers’ perceived neighbourhood food access is associated with their own and their young children’s consumption of animal-flesh food, fruits and vegetables in peri-urban areas of Cambodia.
Design:
A cross-sectional survey measured food consumption frequency and perceived neighbourhood food access, the latter including six dimensions of food availability, affordability, convenience, quality, safety and desirability. Multivariate logistic regression was used to assess the association between perceived food access and food consumption.
Setting:
Peri-urban districts of Phnom Penh and Siem Reap, Cambodia
Participants:
198 mothers of children between 6 and 24 months old.
Results:
Over 25 % of the mothers and 40 % of the children had low consumption (< once a day) of either animal-flesh food or fruits and vegetables. Compared with perceived high food access, perceived low food access was associated with an adjusted 5·6-fold and 4·3-fold greater odds of low animal-flesh food consumption among mothers (95 % CI 2·54, 12·46) and children (95 % CI 2·20, 8·60), respectively. Similarly, relative to perceived high food access, perceived low food access was associated with 7·6-times and 5·1-times higher adjusted odds of low fruits and vegetables consumption among mothers (95 % CI 3·22, 18·02) and children (95 % CI 2·69, 9·83), respectively.
Conclusions:
Mothers’ perceived neighbourhood food access was an important predictor of their own and their young children’s nutrient-rich food consumption in peri-urban Cambodia. Future work is needed to confirm our findings in other urban settings and examine the role of neighbourhood food environment in the consumption of both nutrient-rich and nutrient-poor food.
The insane criminal has nowhere any home: no age or nation has provided a place for him. He is everywhere unwelcome and objectionable. The prisons thrust him out; the hospitals are unwilling to receive him. And yet humanity and justice, the sense of common danger, and a tender regard for a deeply degraded brother-man, all agree that something should be done for him—that some plan must be devised different from, and better than any that has yet been tried, by which he may be properly cared for, by which his malady may be healed, and his criminal propensity overcome.
This study compared the plan dosimetry between the intensity-modulated radiation therapy (IMRT) and field-in-field (FIF) technique for head-and-neck cancer using the Elekta Monaco treatment planning system (TPS).
Materials and methods:
A total of 20 head-and-neck cancer patients were selected in this study. IMRT and FIF plans for the patients were created on the Monaco TPS (ver. 5.11.02) using the 6-MV photon beam generated by the Elekta Synergy linear accelerator. The dose–volume histograms, maximum doses, minimum doses, mean doses of the target volumes and organs-at-risk (OARs), conformity index (CI), homogeneity index (HI) and monitor units (MUs) were determined for each IMRT and FIF plan. All IMRT plans passed the patient-specific quality assurance tests from the 2D diode array measurements (MatriXX Evolution System, IBA Dosimetry, Germany).
Results:
The results showed that the dose distribution to the target volumes of IMRT plans was better than FIF plans, while the dose (mean or max dose) to the OAR was significantly lower than FIF plan, respectively. IMRT and FIF resulted in planning target volume coverage with mean dose of 71·32 ± 0·76 and 73·12 ± 0·62 Gy, respectively, and HI values of 0·08 ± 0·01 (IMRT) and 0·19 ± 0·06 (FIF). The CI for IMRT was 0·98 ± 0·01 and FIF was 0·97 ± 0·01. For the spinal cord tolerance (maximum dose < 45 Gy), IMRT resulted in 39·85 ± 2·04 Gy compared to 41·37 ± 2·42 Gy for FIF. In addition, the mean doses to the parotid grand were 27·27 ± 7·48 and 48·68 ± 1·62 Gy for the IMRT and FIF plans, respectively. Significantly more MUs were required in IMRT plans than FIF plans (on average, 846 ± 100 MU in IMRT and 467 ± 41 MU in FIF).
Conclusions:
It is concluded that the IMRT technique could provide a better plan dosimetry than the FIF technique for head-and-neck patients.
Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.
Methods:
Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.
Results:
We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).
Conclusions:
PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
Los Angeles County’s Office of Diversion and Reentry (ODR) has removed over 3800 people from the largest jail system in the country. Across various diversion programs, ODR’s fundamental goal is to provide permanent, lifetime care for each diverted person. This article describes ODR’s various diversion programs, and elucidates the types of elaborate clinical and court-related interventions that are necessary to remove persons with serious mental disorders from jail custody. As Los Angeles continues to build the necessary community-based continuum of mental health care, ODR’s model proves that thoughtfully removing persons with serious mental disorders from jail is possible and necessary for the health of both patients and community.
We prove the existence of a discrete correlation spectrum for Morse–Smale flows acting on smooth forms on a compact manifold. This is done by constructing spaces of currents with anisotropic Sobolev regularity on which the Lie derivative has a discrete spectrum.
As someone who has spent most of his career writing about others, i find it odd to see myself, or what passes for me, being written about by others, especially academics, the people with whom I am most familiar. Who is this “Viet Thanh Nguyen” that they are discussing? Is he the one whose name appears as such on the cover of the Vietnamese translation of his short story collection, The Refugees, instead of as Nguyên Thanh Vie t, his Vietnamese name? Has “Viet Thanh Nguyen” disabled, in himself, the authenticity that most Vietnamese people hold dear and that he has been reminded of constantly throughout his life, symbolized in his name and his mother tongue? More important and urgent to him, is “Viet Thanh Nguyen,” in being discussed in such a manner, already dead?
The mineralogy and crystal chemistry of a new talc ore deposit situated at Thu Ngac commune, Thanh Son district, Phu Tho province, Vietnam, was investigated using X-ray fluorescence, electron microprobe, X-ray diffraction, Fourier transform infrared spectroscopy, solid-state nuclear magnetic resonance (29Si and 1H) and colorimetry.
Both chemical and crystal-chemical analyses showed that the talcs from the Phu Tho province are very pure because they contain few accessory minerals (chlorite, amphibole and goethite) and few substitutions of Si by Fe and Al in their crystal structure. The talc ore may well meet the standards required for a wide range of industrial applications.
The Delirium Drug Scale (DDS) is an evaluation scale developed to assess a patient's drug burden for delirium. The primary goal is to validate the association between the DDS score and the incidence of delirium.
Methods:
This study was an observational retrospective cross-sectional chart review study in patients aged 75 years and older. It was carried out in three emergency departments of a tertiary care university health center. Patients were included if a medication list was available. Delirium present upon admission was assessed during the first five days of admission.
Results:
A total of 1,205 subjects were included in the analysis. The mean age was of 83.4 years, and 62.4% were female. The prevalence of delirium was 19.1%. A total of 745 patients (62%) were exposed to DDS medication. The relative risk for the low (1–2) and high (>2) exposure group according to the DDS score was of 1.26 (CI: 0.95; 1.66) and 2.18 (CI: 1.61; 2.96) compared to a score of 0. In the multivariate analysis, dementia, anxiety, insomnia, history of delirium, infection, and acute kidney failure were significantly associated to delirium. When adjusted for confounding variables, the DDS score was associated with the incidence of delirium with an odd ratio (OR) of 1.29 (CI: 1.16; 1.44).
Conclusions:
This study found that DDS score was associated with delirium incidence. The association persisted in the multivariate analysis adjusted for 26 known risks and precipitating factors for delirium.
Let $\mathscr{F}$ be a holomorphic foliation by curves defined in a neighborhood of $0$ in $\mathbb{C}^{2}$ having $0$ as a hyperbolic singularity. Let $T$ be a harmonic current directed by $\mathscr{F}$ which does not give mass to any of the two separatrices. We show that the Lelong number of $T$ at $0$ vanishes. Then we apply this local result to investigate the global mass distribution for directed harmonic currents on singular holomorphic foliations living on compact complex surfaces. Finally, we apply this global result to study the recurrence phenomenon of a generic leaf.