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.

Crop rotations in the United States increasingly involve few crops dominated by corn frequently combined with soybeans. We assess factors tied to corn acreage intensification over the past two decades. Using state-level data of 11 U.S. Corn Belt states from 2000 to 2021, we applied a panel fixed effects instrumental variable modeling approach to investigate these linkages. Findings suggest Conservation Reserve Program acreage releases, crop prices, ethanol demand, farm size, productivity, and genetically modified varieties positively impact corn acreage intensity. These results imply crop planting decisions are complex and are not uniquely attributed to biofuel considerations.

Scholars in economics, psychology, and business have recently defined narrative as the underlying mechanism by which humans internally process information and drive a decision forward. In this paper, we study narrative's use in design across Design Society publications. We discuss how narrative's role as the driver of design decision-making is an important, but missing, element of the design literature. We explain how engineers will be expected to move the design process forward despite facing decisions where the information is simultaneously too much to process, conflicting, and incomplete.

Background: IDSA guidelines recommend withholding treatment in patients with asymptomatic bacteriuria in the absence of systemic signs of infection. However, some patients with bacteriuria may not be able to express symptoms either due to presence of indwelling catheter, underlying complicated urologic anatomy, dementia, or altered mental status (AMS). Clinicians frequently treat bacteriuria in this population with antimicrobial therapy due to concern for sepsis. To determine treatment need, we aimed to review prevalence and risk factors for bacteremic urinary tract infection (UTI) in a cohort of hospitalized inpatients without definitive signs and symptoms of a UTI. Methods: This retrospective cohort study of inpatients with a positive urine culture who presented without definitive signs or symptoms of a UTI was conducted between July 1, 2017, and June 30, 2022, in 68 academic and community hospitals (Michigan Hospital Medicine Safety Consortium). Signs and symptoms were obtained from medical record review 3 days before and after urine-culture collection. Bacteremic UTI was defined as any positive blood culture growing at least 1 organism matching the urine culture. Risk factors for bacteremic UTI were assessed using multivariable logistic regression models with results expressed as odds ratios (ORs) for dichotomous variables and relative risks (RRs) for continuous variables. Results: Of 11,793 patients meeting study criteria, 73.6% were female with a median age of 78.2 years. Overall, 41.8% had AMS, 33.8% had dementia, 15.6% had an indwelling urinary catheter, and 54.6% had complicated urologic history (eg, urologic surgery). Of these, 166 patients (1.4%) developed bacteremic UTI. On adjusted analysis, male sex, hypotension, heart rate >90, urinary retention, fatigue, log of serum leukocytosis [1 log increase in serum WBC = 2.718 × serum white blood cell count (WBC)], and pyuria with >25 WBC per high-powered field (WBC/hpf) on urinalysis were associated with bacteremic UTI (Table). Older age, presence of an indwelling catheter, complicated urologic history, functional decline, AMS, dementia, and change in urine were not associated with higher odds for bacteremic UTI (Table). Of patients with AMS and no definitive signs or symptoms of a UTI, only 89 (1.8%) of 4,932 developed a bacteremic UTI. Conclusions: Bacteremic UTI is relatively rare in hospitalized inpatients presenting with bacteriuria without symptoms of UTI. Predictors of bacteremic UTI included male sex, hypotension, tachycardia, urinary retention, fatigue, serum leukocytosis, and higher levels of pyuria (>25 WBC/hpf) on urinalysis. Our findings provide stewards a framework to risk stratify inpatients of older age who present with positive urine cultures but without (or are unable to express) signs or symptoms of UTI.

Disclosures: None

Engineering design research has largely focused on normative models of decision analysis based on small world causal frames where uncertainty can be resolved as probabilities or probability distributions. However, today we need to design solutions for our built environment that are sustainable, just, and able to adapt. Because of the scale and complexity of our world, designs that address sustainability, justice, and adaptability are dominated by unresolvable uncertainty. This requires large world frames and new engineering design frameworks and tools that provide a much broader and nuanced understanding of the impact of our engineering decisions. In this paper we propose that these tools will need to link quantitative and qualitative data and engineering judgment using narrative decision-making processes. To support this, we provide two examples where engineering decision-making is based in part on narrative processes. We then identify five research areas that require additional research to support large-world frames including (1) how can we create microcosms that enable transition between large- and small-world frames and (2) how engineers develop conviction to act using the narratives they create.

Indigenous peoples of Ecuador have organized and mobilized over the past thirty years, partly to reshape their identities after centuries of domination. This research is a preliminary effort to explore the contemporary complexity of that identity. Best viewed as a quantitative case study, this analysis uses responses from seventy-six indigenous college students to a self-administered questionnaire. The authors found that indigenous students with greater “acculturation experiences” with mestizo culture were more strident in rejecting elements of that culture than were their colleagues who had had fewer encounters with mestizo elements of Ecuadorian society. While the tendency to identify oneself ethnically by rejecting the dominant culture represents only one dimension of ethnic identity (maintaining distinctiveness), the authors consider the findings important for future research on the dynamics of the process of ethnic identification.

In the national consciousness, Ecuador is a mestizo nation. However, it is also an ethnically diverse nation with sizable minorities of indigenous and Afro-descended peoples. In national surveys, there is also a considerable minority who self-identify as blanco (white). Although there is strong evidence of continuing discrimination and prejudice toward both indigenous and Afro-descended peoples, there is little public discussion or political action addressing such issues. The emergence of a powerful and resilient indigenous movement in the late 1980s gained international interest and acclaim in the 1990s, in part because of the peaceful mobilization efforts and effective bargaining tactics of the movement. However, indigenous leaders usually have not engaged in a discourse of racismo and/or discriminación. There has been much less social movement solidarity and activism among Afro-Ecuadorians, but their leaders commonly employ a discourse of racismo and discriminación. In August and September 2004, a survey of more than eight thousand adult Ecuadorians was conducted in regard to racism and related topics. In this research, we use several measures from this survey that focus on awareness of and sensitivity to issues of racism, prejudice, and discrimination. Self-identification of respondents enables us to contrast the responses of whites, mestizos, Indians, and Afro-Ecuadorians to the measures. Other independent variables of interest are level of education, the region in which the respondent resides, and whether the respondent lives in an urban or rural area. Regression results show differences among the ethnic groups in levels of awareness of racism, but more powerful predictors are level of education and rural residence.

The effects of transgenic corn use and federal biofuel policies on state-level cropping patterns in the US Corn Belt region are investigated using state-level data from 2000 to 2019. During this time, producers moved away from diverse cropping patterns and toward simpler rotational practices. Empirical evidence indicates that the intensification of corn acres planted was positively impacted by the spread of genetically modified (GM) soybeans—used as a proxy for GM corn for biofuel usage—but the effects of biotech advancements on producer planting decisions vary across states. This suggests that future policy changes affecting corn production decisions at the farm level will also be heterogeneous across states.