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To validate risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in patients hospitalized with community-acquired pneumonia (CAP).
Design:
Retrospective, single-center, cohort study from October 1, 2018, to March 31, 2023.
Setting:
Mayo Clinic Hospital in Phoenix, AZ.
Participants:
Adult patients with CAP, identified using ICD-10 diagnosis codes, receipt of systemic antibiotics for a “respiratory tract infection” within 48 hours of hospitalization, and availability of respiratory cultures.
Methods:
Multivariate logistic regression was used to identify factors independently associated with MRSA or P. aeruginosa isolation in respiratory cultures.
Results:
A total of 1,485 patients met inclusion criteria; 32 (2.2%) had MRSA and 81 (5.5%) had P. aeruginosa isolated from respiratory culture. Multivariate logistic regression analyses identified substance use disorder [aOR 8.29, P < .001], influenza [aOR 7.64, P = .003], lung abscess/empyema [aOR 4.58, P = .031], and peptic ulcer disease (PUD) [aOR 4.09, P = .017] as MRSA risk factors. Bronchiectasis [aOR 3.67, P < .001], PUD [aOR 3.48, P = .006], and COPD [aOR 2.60, P = .005] were independently associated with P. aeruginosa. Immunocompromised conditions, including transplantation (solid organ and hematopoietic stem cell) and malignant tumor were not independently associated with either organism.
Conclusions:
Our results substantiate previously demonstrated risk factors for MRSA and P. aeruginosa in CAP. We did not observe an independent association between immunosuppressed conditions evaluated and isolation of MRSA or P. aeruginosa.
Cost-effectiveness (CE) models are an important decision-making aid when making re-imbursement decisions within resource constrained health systems. However, unlike the results of clinical trials, the findings from cost-effectiveness are highly context dependent. They may depend on choice of comparators, local cost estimates, and current estimates of effectiveness and patient utilities.
Objectives
The objective of this project was to investigate whether a fully working model adaptable to a local context could be developed using an LLM based on a published manuscript.
Methods
We attempted to develop a working version of the CE model of venlafaxine treatment described by Sobocki et al. (Sobocki et al. Int J Clin Pract, April 2008, 62, 4, 623–632) in the R statistical language using ChatGPT 5.0 based on simple prompts and a PDF copy of the manuscript.
Results
The prompt “please develop R code for the model described in this paper” produced functioning R code that did not require modification. However, the published results were not replicated. The prompt “which parameters are not explicitly stated in the paper” identified the placebo relapse rate, background mortality, and venlafaxine acquisition cost as not fully reported and identified those were most influential. In addition, ChatGPT identified the key parameters offered to ‘back-fit’ plausible values for these parameters. Using these estimates the model results matched published results. The model was then validated by code inspection and independent replication in R.
Conclusions
ChatGPT 5 successfully replicated the model based on simple prompts and minimal iteration. It was also able to identify inadequately specified model parameters and, significantly, able to conduct a calibration exercise to estimate these. The ability of ChatGPT 5 to replicate published cost-effectiveness models is much improved on previous versions only requiring simply prompts and, in this case, producing code that ran ‘first time’. This model can be used to estimate the cost effectiveness of venlafaxine based on current costs and local contexts that may enable clinicians to make more informed clinical decisions. Will ChatGPT 5 ‘democratise’ cost-effectiveness analysis?
Disclosure of Interest
N. Hawkins: None Declared, R. Thompson Employee of: Viatris, K. Subramaniam Employee of: Viatris, P. Purushottamahanti Employee of: Viatris
Higher habitual dietary flavonoid intakes have been consistently associated with lower mortality and chronic disease risk(1). However, the role of flavonoid diversity has never been investigated. We aimed to investigate the independent roles of flavonoid intake quantity and diversity on the risk of all-cause mortality and major chronic disease incidence. In this cohort study, 124,805 UK Biobank participants [mean (SD) age: 60.2 (7.8) years; ~55% female] were followed for up to 11.8 years. Flavonoid intakes were estimated from repeated 24-hour dietary assessments and diversity calculated using our novel method which factors for both the variety and distribution of consumption. Associations with all-cause mortality and incidence of cardiovascular disease (CVD), type 2 diabetes (T2DM), total cancer, respiratory disease, and neurodegenerative disease were assessed using Cox models. Following mutual adjustment and after accounting for socio-demographic, lifestyle and dietary factors, both a higher quantity and a wider diversity of dietary flavonoid intake associated with a significantly lower risk of all-cause mortality and several chronic diseases: comparing higher (Quintile 5) to lower intakes (Quintile 1), the Hazard ratios (95% CIs) for quantity and diversity respectively were 0.84 (0.76–0.92) and 0.86 (0.78–0.95) for all-cause mortality, 0.88 (0.81–0.96) and 0.90 (0.82–0.98) for CVD, 0.75 (0.66–0.84) and 0.80 (0.70–0.91) for T2DM, 0.92 (0.85–0.99) and 0.92 (0.85–0.99) for cancer, and 0.91 (0.86–0.97) and 0.92 (0.86–0.98) for respiratory disease; only intake quantity associated with neurodegenerative disease risk [Q5 vs. Q1: 0.80 (0.68–0.94)]. We then tested for interactions between quantity and diversity of flavonoid intake (across all outcomes), and although none were observed (all p > 0.05) the independent associations still suggest there is a benefit to consuming a higher diversity beyond that of simply consuming a high quantity (and vice versa). In conclusion, consuming both a higher quantity and wider diversity of dietary flavonoids appears better for longer-term health than higher intakes of either component alone.
To examine whether different message frames increase public support for a community-identified policy solution to improve food security in remote Aboriginal and Torres Strait Islander communities in Australia.
Design:
An online experimental study in which participants were randomly assigned to one of three message frames: human rights, fairness or community-identified solution or a control condition. Logistic regression models were used to assess associations between message frames and support for an electricity subsidy policy. Interaction analyses explored whether participant characteristics moderated these effects.
Setting:
Australia.
Participants:
A nationally representative sample of 1555 Australian adults recruited through an online panel.
Results:
Message framing had limited overall impact on policy support. The human rights frame generated the highest support for the proposed subsidy, while the fairness frame generated the lowest; however, these differences were modest. We found that regardless of frame used, Greens supporters, those with postgraduate degrees or those who watched the news more frequently, tended to have higher levels of agreement with the policy solution.
Conclusion:
Although message framing is widely used in advocacy to increase policy support, its impact in this context appears constrained. These findings underscore the complexity of shifting public attitudes toward policies benefiting structurally disadvantaged communities and suggest that more targeted, audience-specific framing may be necessary. Further research should explore why certain frames underperform among particular groups and examine how agreement and emotional engagement jointly shape support for policy change.
This chapter reviews the imaging approach in suspected child physical abuse, including differing presentations of child physical abuse as well as recommendations for screening children at risk. Imaging strategy of the skeleton, including radiography, chest CT, ultrasound, whole-body MR and radionuclide bone imaging is reviewed.
Negative urgency is a transdiagnostic risk factor for a plethora of mental disorders. Internalizing symptoms are embedded in theories of negative urgency, yet we know little regarding how developmental changes in each coincide, and if changes in one predict changes in the other across middle adolescence. This study filled these voids in the literature, with N = 754 (52% female) community-recruited youth from the National Consortium on Alcohol NeuroDevelopment in Adolescence (NCANDA) study reporting internalizing symptoms and negative urgency annually. Negative urgency and internalizing symptoms were highly correlated at the between-person level, and between-person correlations were nearly double in size within male versus female adolescents. At the within-person level, changes in negative urgency and internalizing symptoms co-occurred across ages 14–18 but not age 13. Age 14 within-person changes in negative urgency prospectively predicted age 15 within-person changes in internalizing symptoms, and this effect was nearly double in size within female versus male adolescents. Findings held when accounting for externalizing symptoms, other impulsive personality traits, parenting, and school transitions. Results indicate that relations between negative urgency and internalizing symptoms were demonstrated across and within adolescents, with time-varying changes in negative urgency at age 14 being particularly impactful in terms of future internalizing symptoms.
Visual analogue scales (VAS) are rating scales consisting of an individual item measuring a given construct typically coded 0 to 100 with labeled anchors. In body image research, VAS were originally developed to assess overall appearance and weight satisfaction, but have since been used as rating systems for other body image constructs (e.g., muscle dissatisfaction). VAS can be administered online and/or in-person to children, adolescents, and/or adults and are typically free to use. This chapter first discusses the development of the original VAS and other body image VAS, and then provides evidence of VAS psychometrics. Regarding factor structure, VAS tend to be single-item constructs, although it is possible to combine and average multiple items to tap one construct. Internal consistency reliability, test-retest reliability, convergent validity, and discriminant validity support the use of VAS for body image assessment. Next, this chapter provides examples of commonly used VAS, instructions for administration, the most commonly used item response scale, and the scoring procedure. Logistics of use are provided for readers.
Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.
We present a dataset of 1,119 radiocarbon dates and their contexts for Oaxaca, Mexico, a best effort to include all published dates, plus hundreds of unpublished samples. We illustrate its potential and limitations with five examples: (1) dated stratigraphy in stream cutbanks show how aggradation, downcutting, and stability responded to global climate and human activities; (2) 14C samples from Late/Terminal Formative contexts allow interregional comparisons of temple and palace construction, use, and abandonment; (3) new 14C dates provide better understanding of events during the Late Classic/Epiclassic, a problematic time in the ceramic chronology; (4) individual Classic/Postclassic residential contexts had long durations—several hundred years; and (5) model constraints from other data permit refinement at times of calibration curve deviation, as during AD 1400–1600. We recommend further chronological refinement with best-practice standards, new samples, existing collections, and statistical modeling.
Access to clean and reliable water is critically important for health, well-being, and economic development. The natural, built, and social systems – which interact with each other and comprise the water system-of-systems – are threatened by intensifying hazards and stressors like crumbling infrastructure, floods, droughts, storms, wildfires, sea level rise, population growth, cyber threats, and pollution. Marginalized communities, including disadvantaged and rural communities and Tribal nations with insufficient access to clean water or regenerative sources of water, are often the most impacted. Responses to these issues are hampered by fragmented and uncoordinated governance and management. A multi-stakeholder structured engagement process at the SWIM conference and workshop held in December 2023 identified the most critical current and future issues facing the water sector and what needs to change to find solutions. This paper synthesized these issues. Highlighted issues were the vulnerability and lack of resilience of water systems to hazards and stressors, inequities associated with water scarcity, and water quality problems – all affected by climate change, land-use change, and socio-economic changes. The Smart One Water (S1W) vision provided an important context for the conference. This paper expands the S1W vision with a synthesis of discussions about S1W-related fundamental concepts, practices, and implementation barriers.
This study obtains expressions for the force and moment coefficients for a finite-span circular cylinder rolling on a plane wall. It is assumed that a small, but finite, gap exists between the cylinder and the wall, as a result of, for example, surface roughness. Using the method of matched asymptotic expansions, the flow is decomposed into an inner solution, valid in the narrow interstice between the cylinder and the wall, and an outer solution, valid far from the interstice. Then, the force and moment coefficients are expressed as the sum of a gap-dependent term, which is computed from the inner solution, and a gap-independent term, which is computed from the outer solution. Solutions to the inner flow are obtained by solving numerically the two-dimensional Reynolds equation for the lubrication flow in the interstice. The inner solution depends only on a single parameter, the cylinder aspect ratio divided by the gap-diameter ratio, and the effects of this parameter on the gap-dependent force and moment coefficients are deduced. Solutions to the outer flow are obtained using thee-dimensional numerical simulations for a range of Reynolds numbers, cylinder aspect ratios and cylinder rotation rates. Then, the variation of the force and moment coefficients against each of these terms is obtained.
On the Ethiopia–Somaliland border, harsh checkpoints imposed in 2015 relegated Somali kontarabaan (contraband) traders – mainly women – to precarious livelihoods. Beginning with an ethnographic description of crossing through these checkpoints, this chapter outlines a contradictory dynamic: Jigjiga, Ethiopia’s premier smuggling hub, has become the capital of a local government bent on hyper-securitizing its borders. Intensifying border security interventions and a wave of return-migration among the global Somali diaspora have made many local merchants viscerally aware of their marginality and immobility in contrast to people with foreign passports and government connections. For small-scale traders, Ethiopia’s borders tend to operate as dividers. For government-connected elites and diaspora returnees, the same borders often enable opportunities for business connections and mutually profitable alliances. This chapter uses this observation to critique what it calls the “connective cities, divisive borders” portrait of globalization. It explains the importance of thinking about borders and cities as interconnected spaces of daily life. It introduces the book’s main arguments: that African urbanites are active agents who work to refashion geopolitical borders and create opportunities from them, and that everyday practices of exchange and mobility in the city do not just produce urban space but also resonate more broadly into border management.
After 2010, hundreds of diaspora Somalis left seemingly stable lives in cities of North America, Europe, and Australia and flocked to invest in Jigjiga, a post-conflict boomtown ruled by an unstable authoritarian administration. This chapter follows these diaspora businesspeople beyond Ethiopia’s borders and explores how their motivations for, and practices of, return-migration to Ethiopia are shaped by the experiences of migrant life in cities outside the Horn of Africa. Drawing on fieldwork among Somali businesspeople in South Africa and the US as well as Jigjiga, I show that Somali return-migrants to Jigjiga are driven by a complex mix of motivations, including responsibilities for family support, perceptions of business opportunity in the Horn of Africa, and experiences of precarity and risk in cities abroad. The implication is that social transformations in the Ethiopia–Somalia borderlands cannot be analyzed only at a local level. These ongoing shifts in securitization and urbanization in the Horn’s borderlands are entangled with “urban borderwork” in cities far beyond Ethiopia. This analysis not only situates Jigjiga in a broader world of cities and social relations; it also pushes us to think more deeply about the dynamic relationship between city-making and border-making in the world more broadly.
For Somali merchants in eastern Ethiopia, border securitization seems to be driving urban inequality. Ethiopia’s governing elites have instrumentalized borders, offering exclusive import–export licenses to political supporters, including diaspora return-migrants. In turn, the beneficiaries of these trade schemes speculate in sectors such as urban real estate. The “informal” kontarabaan (contraband) markets in Jigjiga are a seeming locus of resistance to these new elite collaborations. In contrast to the securitized checkpoints around the city, officials rarely try to regulate smuggling within the dense urban market. But is this really an issue of governance versus informality, political elites versus lower-class traders, and border security versus urban tolerance? Looking closely at people’s transactions in urban space, this chapter shows how expectations about obligation and reciprocity crosscut apparent social divisions in the city. In their daily interactions, both merchants and government regulators often draw on ideals of Somali nonhegemonic or “egalitarian” ethos to explain and justify their activities. Yet the way these egalitarianisms function in the city looks different than the idealized “egalitarian society” of anthropological lore. I show how people’s practices of reciprocity and exchange are spatial work that affects how “transformations of space” including walls, streets, and borders operate in daily life.
When Ethiopia aligned itself with the US in the global war on terror after 2001, top–down security interventions in the Ethiopia–Somalia borderlands led Somali secessionist conflict to spiral out of control. The protracted “state collapse” of neighboring Somalia spawned regional instability throughout the 1990s. In what is today Somali Regional State (SRS), the Ogaden National Liberation Front (ONLF) spearheaded Somali-led rebellion against the new Ethiopian federal government. Somali rebels massacred Chinese oil workers in 2007 and attempted to assassinate SRS’s president in Jigjiga in 2008. Why, then, did diaspora Somalis begin returning from stable lives in North America and Europe to invest in Jigjiga before these conflicts had even settled? This chapter addresses this question by tracing how SRS authorities sought to create alliances among the global Somali diaspora. Through an ethnographic analysis of the dramatic change in diaspora–homeland relations that unfolded after 2010, it argues that border securitization in the Horn of Africa is not just a matter of topography – of territorial control, walls and razor wire, and security patrols. It is also a matter of reorganizing a complex topology of transnational relationships.
This chapter offers a pathbreaking urban history of the Ethiopia–Somalia borderlands. Eastern Ethiopia’s cultural distinctions and tense interethnic relations are often described in terms of broad contrasts between Somali nomadic pastoralism and the sedentary agriculture of Ethiopian highland populations. A close reading of historical accounts tells a different story. Beginning with a discussion of present-day ethnic competition and cooperation in the marketplace, I trace Jigjiga’s social relations back in time, showing how towns including Jigjiga have been crucial sites of interethnic encounters, identity formation, and cultural change. Shifting the focus away from Ethiopia’s tense history of ethno-territorial politics, I suggest that in the city, everyday interactions between identity groups are significantly shaped by expectations about transactability: who is trustworthy, who is not, and who is a legitimate target for cheating or for collaboration. This argument places urban encounters at the center of understanding the salience of ethnic and clan identities in eastern Ethiopia. I argue, furthermore, that urban encounters in Jigjiga play an important role in how distinct identity groups relate to geopolitical borders outside the city and have done so throughout Jigjiga’s history.
In August 2018, ʿAbdi Moḥamoud ʿUmar, president of Ethiopia’s Somali Regional State, was ousted and arrested by federal security forces. ʿAbdi had led an unprecedented decade-long push to securitize the Ethiopia-Somaliland border, to “Ethiopianize” Somalis, and to entice Somali migrants living abroad to return to Ethiopia and collaborate with the regional government. Yet a significant number of those who collaborated with and benefited from the regime also celebrated its downfall. This concluding chapter describes these more recent events as an entry-point to reflecting on the broader implications of the book’s argument that city-making and border-making are deeply intertwined in today’s world. It addresses three specific possible counterarguments, which serve to highlight the themes of the book and link them to broader debates in economic anthropology, border studies, migration studies, and urban studies.