To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This study evaluated the impact of a multimodal antimicrobial stewardship intervention on fluoroquinolone (FQ) use for prophylaxis in outpatient urologic procedures.
Methods:
This single-center retrospective cohort study included patients from the South Texas Veterans Affairs (VA) outpatient urology clinic who underwent procedures between December 1, 2020, and February 29, 2024. Interventions included academic detailing, provider-specific FQ use reports, and prospective urine culture reviews with feedback. One pre-intervention cohort (PRE) and three post-intervention cohorts (POST2021, POST2022, POST2023) were analyzed. The primary outcome was FQ days of therapy (DOT); secondary outcomes included inappropriate prescriptions, post-operative complications, emergence of FQ resistance within 1 year, and Clostridioides difficile infection within 30 days of prophylaxis.
Results:
This analysis included data from 548 patients (150 PRE, 139 POST2021, 168 POST2022, 91 POST2023). Median age was similar across groups (p = 0.20), with over 90% male in each cohort (p = 0.07). Over one-third in each cohort received pre-operative oral antibiotics, 25% of which were FQs. More than 90% received pre-operative IV antibiotics, and over 50% received post-operative oral antibiotics. A significant reduction in FQ DOT/100 procedures was noted from pre- to post-intervention groups (98.6 PRE, 49.6 POST2021, 53.5 POST2022, 45.1 POST2023). No significant differences were observed in the secondary clinical outcomes.
Conclusion:
A multimodal stewardship initiative reduced FQ use before urologic procedures, mainly due to decreased IV use. Further efforts are needed to optimize pre-operative FQ use and address drivers of post-operative antibiotic prescribing.
The main objective of this article is to examine history textbooks as sites of discursive contestation regarding the treatment of the 1986 Jeltoqsan protests, a pivotal moment in post-independence Kazakhstani collective memory. This research analyzes the multilayered and inter-discursive domains of Jeltoqsan across the History of Kazakhstan textbooks published between 1992 and 2024. It focuses on four key contested themes between official narratives and those of protest mourners and sufferers: the portrayal of Dinmukhamed Qonaev, whose dismissal sparked the protests; the role of former President Nursultan Nazarbaev in handling the aftermath; the framing of Jeltoqsan as either an ordinary event or an uprising for significant political change; and ethnic or non-ethnic dimension of the protests. The findings reveal discursive competition and conflict in articulating the official and protestor narratives.
This paper examines Cyrenaica’s capacity for cereal production, focusing on Cyrene’s wheat output supporting the Greek cities. It also explores the region’s favourable agricultural conditions and presents local Hellenistic inscriptions that document cereal cultivation over three centuries. The paper argues that the wheat sent from Cyrene to the Greeks during the Hellenistic period was offered as a donation rather than exported for profit. This argument is supported by three main points: first, the quantities mentioned represent only a quarter, or possibly less, of Cyrene’s annual wheat production; second, a Greek poetic inscription from Cyrene (second or early third century AD) praises the city for donating one hundred ships of grain to aid the Greeks; and, third, literary references describe Cyrenaica and Cyrene as renowned for cereal production, particularly wheat. Literary references, together with epigraphic evidence, also reflect the ongoing demand for wheat among both Greeks and Romans. It concludes that Cyrene was one of the important sources of wheat for these nations, and that it was widely known as a provider of free wheat shipments during times of hardship. It also suggests that Cyrene commemorated the Hellenistic wheat consignment because it was given as a gift.
Improving udder health on dairy farms requires knowledge about the prevailing mastitis pathogens in order to take appropriate measures. The aim of this research communication was to evaluate the association between two sampling approaches for determining the prevalence of mastitis pathogens in dairy herds. Sampling approaches tested included (a) bacteriological investigation of randomly selected cows independent from stage of lactation (random sampling) and (b) sampling of cows two weeks prior to drying off (dry-off sampling). Using linear regression, the prevalence of mastitis pathogens were compared on herd-level for groups of specific pathogens. Associations between the prevalence estimated by the two approaches were found for Staphylococcus aureus, Streptococcus dysgalactiae, Streptococcus uberis and Gram-negative bacteria but not for other esculin-positive streptococci. This study indicated that both sampling approaches provide farmers with an overview of the prevalence of mastitis pathogens in their herds, with the dry-off results also being used to target antibiotic use to infected quarters.
Autistic adolescents are at higher risk of self-harm, suicidal behaviours, and emotion dysregulation compared with their non-autistic peers. Dialectical behaviour therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviour with emerging literature of the application of DBT for autistic populations. Despite this, no qualitative research has investigated the experiences of autistic adolescents of standard DBT. Therefore, this study aimed to explore autistic adolescents’ experiences of non-adapted DBT. Ten adolescents who had or were seeking an autism diagnosis, and were in a DBT programme, completed semi-structured interviews. Qualitative data from the interviews were analysed using reflexive thematic analysis. Themes were generated for each objective. Objective 1 included themes about the lived experience of autistic adolescents accessing DBT, including: ‘The impact of invalidation’, ‘Fostering acceptance and understanding’, ‘What does autism mean to me?’, and ‘Autism and mental health difficulties’. The themes regarding Objective 2 were about the experiences of the various modes of DBT and were organised by each client-facing mode. Objective 3 included themes highlighting the experience of utilising DBT skills in daily life, which included: ‘Barriers to skills use’, ‘Supporting skills use’, and ‘Skills practice or masking?’. Finally, Objective 4 included themes regarding the recommendations participants had for optimising DBT for autistic people: ‘Improving written materials’ and ‘General accessibility advice’. These findings suggest for DBT therapists to embody cultural humility, curiosity, validation, and flexibility when building neuro-affirmative competencies for supporting autistic individuals. Results are discussed in relation to the application and acceptability of DBT for this group.
Key learning aims
(1) Recent publications (e.g. Keenan et al., 2023) have explored the experience of autistic adults accessing DBT and highlighted the need for clinicians to work collaboratively with clients and make reasonable adjustments to improve autistic adults’ understanding and adherence to DBT.
(2) To date, no qualitative studies have explored the experience of autistic adolescents accessing the Rathus and Miller (2015) Adolescent DBT model. The current study explores the views of autistic adolescents on how autism is discussed and considered by clinicians when supporting them to access different components of DBT when describing the strengths and barriers they experience.
(3) Adopting a bottom-up approach, we identify key themes from adolescents’ perspectives on how to support them to access and engage with different DBT components, ranging from making environmental adaptations to meet individual sensory needs to improve accessibility, to providing more opportunities for personalised learning using neuro-affirmative examples that can improve generalisability of skills in everyday life. We provide recommendations for clinicians to consider on ways of adapting the process and content of DBT to increase accessibility and engagement for autistic adolescents in treatment.
Disclosing transition plans to meet future net zero climate targets requires organisations to fundamentally move beyond traditional historical-oriented stewardship reporting towards forward-looking accountability to meet their obligations to their future shareholders and stakeholders. However, despite a range of varying requirements concerning disclosure of climate-related targets to meet the Paris Agreement, confusion remains over the appropriate form, content and standard of transition plan disclosure that are required to implement these targets. The former UK based Transition Plan Taskforce set out globally leading requirements for transition plan reporting in 2023, however the extent to which these recommendations have since been implemented has not yet been comprehensively analysed. This paper summarises the key differences between UK, European and International guidelines for transition plans and then discusses the results of an analysis of variations in transition plan reporting practices by a sample of globally large financial and industrial organisations. It is predicted that a combination of both firm-level climate risk and country-level institutional factors are associated with the propensity to produce public transition plans. The empirical results are largely supportive of these predictions. Firms with greater levels of engagement with climate risk (as proxied by the CDP score), and UK and-or EU based firms, are more likely to produce climate transition plans. The empirical results are corroborated by qualitative analysis, which compares examples of good practice transition plan reporting by a sub-sample of firms within each industry sector. It is concluded that the resulting lack of clarity by regulatory authorities, and diversity in transition plan reporting practices by globally large financial and industrial firms, may potentially result in confusion and a lack of informed decision-making by their stakeholders and policymakers concerning climate-related resilience and risk mitigation actions.
Kidneys are crucial for systemic lactate homeostasis, and a proper lactate balance subsequently supports normal kidney structure and function. The physiological lactate production-clearance axis along the proximal-distal tubular network may represent an important mechanism for maintaining tubulointerstitial microenvironmental balance. In the context of kidney diseases, the dynamic changes in lactate levels reveal the process of renal metabolic remodelling and even participate in the regulation of disease occurrence and progression.
Methods
This review systematically combs the maintenance of renal lactate homeostasis under physiological conditions and integrates current research findings on the roles of lactate in the initiation and progression of various kidney diseases, as well as the underlying core molecular mechanisms.
Results
Existing studies confirm that, in a variety of kidney diseases, abnormal lactate levels are closely associated with the occurrence of renal metabolic remodelling, and lactate itself can further regulate the progression of kidney diseases. Targeted regulation of lactate metabolism or lactate-related mechanisms of action is expected to provide a new perspective for the treatment of kidney diseases.
Conclusion
The exploration of lactate-related mechanisms offers potential insights for developing novel strategies for early diagnosis and therapeutic intervention of kidney diseases; however, more in-depth studies are still required to translate these findings into clinical practice.
We offer a novel analysis of conspiracy theorizing, according to which conspiracy theory communities are engaged in collective projects of storytelling. Other recent accounts start by analyzing individual conspiracy theorists’ psychologies. We argue that a more explanatorily unifying account emerges when we start by analyzing conspiracy theorizing as a social practice. This helps us better account for conspiracy theorists’ psychological heterogeneity. Some individual theorists care about uncovering the truth, while others incorporate truth into their theorizing in subtler ways; viewed as a social phenomenon, though, the function of conspiracy theorizing is not to discover the truth, but to tell good stories.
Few village-born social movements have influenced international relations as much as the campaign against Myitsone Dam in Burma (Myanmar). This village-born resistance led in 2011 to the suspension of a major Burmese and Chinese infrastructure project. This suspension became a symbol of democratization in Burma and a much-discussed setback of Chinese development-investment abroad. However, research literature on the Myitsone Dam has tended to conflate the local rural resistance with the broader ethnic Kachin and Burmese anti-dam movements. In contrast, this study focuses specifically on the local villages directly affected by the project, exploring their diverse stories and responses to the mega-project. Combining diverse published sources with ethnographic fieldwork and interviews done since 2010, it tells a story of displacement, resistance, social divisions, and complex relations with outsiders. This is a two-part article series. Another article – Part 1 – explores the Myitsone Dam’s rural story from its earliest days until the mega-project’s fall. This article – Part 2 – examines what has occurred after the mega-project’s suspension. It explores local village experiences after most residents had been resettled into relocation villages, from 2010 until now. This story begins with a bomb attack against the project and traces the village struggles until a post-coup gold mining boom.
Left atrial appendage aneurysms are uncommon cardiac anomalies often discovered incidentally, with potential to cause arrhythmias or thromboembolic events, prompting surgical correction. Herein, we present the successful surgical treatment of a left atrial appendage aneurysm identified in a 7-year-old asymptomatic patient.
Computational archaeology and theoretical archaeology often appear as separate domains within the field, each driven by distinct methodologies and objectives. Through the lens of discussions held at the 2021 Central European Theoretical Archaeology Group (CE-TAG) conference and analysis of a follow-up questionnaire, this study explores the current trends and intersections between these areas to identify opportunities for meaningful integration. We highlight key challenges, such as the theoretical underpinnings of computer-assisted methods, the epistemological implications of data-driven approaches, and the need for open-science practices. Our findings emphasize the importance of mutual understanding and collaboration, particularly in research and education, in bridging divides and enhancing the synergy between these domains. By addressing shared concerns such as bias, scalability, and methodological transparency, we propose a framework for fostering innovation in both computational and theoretical archaeology while maintaining their shared goal of interpreting the human past.
A vast body of literature studies how national identities explain immigration attitudes. In Europe, however, migration policy is largely Europeanised, requiring a European perspective. This article distinguishes between civic and cultural European identities and theorises how the two identity types relate to characteristics of immigrants with respect to admission decisions. Among others, we introduce the novel hypothesis that value congruence among Europeans and immigrants matters. The analyses of observational data and conjoint experiments show that Europeans with a cultural identity hold more restrictive attitudes; civics particularly prioritise immigrants who share their own values, while culturals more strongly reject immigrants who are culturally distant (ie Afghans and Muslims). Despite these differences, the following finding stands out: The more distant immigrants are perceived, the less likely they are to be admitted by Europeans from both identity types, raising serious questions about the role of humanitarian reasons in immigration decisions.
The desegregation of Dallas Theological Seminary (DTS) offers a critical case study for scholars of American religious history, illuminating how white evangelical institutions responded to the racial transformations of the post-civil rights era. Unlike southern evangelical colleges that defended segregation on overt theological grounds, DTS never explicitly framed its exclusion of Black students within a scriptural mandate. Instead, the seminary’s shift from racial exclusion to intentional Black student recruitment in the 1970s reflects what Martin Luther King Jr. once described as a “more cautious than courageous” approach. Anchored in biblical literalism, DTS president John Walvoord’s reluctance to use scripture to justify segregation played a key role in the school’s transformation. This article fills a gap in the historiography by examining how institutional culture, theological commitments, and broader cultural pressures converged to produce a quiet and incremental model of desegregation—neither overtly racist nor actively prophetic—offering a more complex portrait of evangelicalism and race in the second half of the twentieth century.
Umbrella reviews (URs) synthesize findings from multiple systematic reviews on a specific topic. Methodological approaches for analyzing and presenting UR results vary, and reviewers often adapt methods to align with research objectives. This study examined the characteristics of analysis and presentation methods used in healthcare-related URs. A systematic PubMed search identified URs published between 2023 and 2024. Inclusion criteria focused on healthcare URs using systematic reviews as the unit of analysis. A random sample of 100 eligible URs was included. A customized, piloted data extraction form was used to collect bibliographic, conduct, and reporting data independently. Descriptive analysis and narrative synthesis summarized findings. The most common terminology for eligible studies was “umbrella reviews” (65%) or “overviews” (30%). Question frameworks included PICO (43%) and PICOS (14%), with quantitative systematic reviews included in most URs (98%), and 68% including randomized controlled trials. The most frequent methodological guidance source was Cochrane (32%). Data analysis commonly used narrative synthesis and meta-analysis, with Stata, RevMan, and GRADEPro GDT employed for presentation. Information about study overlap and certainty assessment was rarely reported.Variation exists in how data are analyzed and presented in URs, with key elements often omitted. These findings highlight the need for clearer methodological guidance to enhance consistency and reporting in future URs.
We explored the impact of infectious disease (ID) consultations on hospitalists’ prescribing of broad-spectrum, hospital-onset (BSHO) antibiotics. Periods with more ID consults had increased BSHO-DOT; however, this relationship was nonlinear, and ID consult frequency did not explain variability in prescribing. ID consultation should be considered when creating prescriber performance metrics.
Let a group Γ act on a paracompact, locally compact, Hausdorff space M by homeomorphisms and let 2M denote the set of closed subsets of M. We endow 2M with the Chabauty topology, which is compact and admits a natural Γ-action by homeomorphisms. We show that for every minimal Γ-invariant closed subset $\mathcal{Y}$ of 2M consisting of compact sets, the union $\bigcup \mathcal{Y}\subset M$ has compact closure.
As an application, we deduce that every compact uniformly recurrent subgroup of a locally compact group is contained in a compact normal subgroup. This generalizes a result of Ušakov on compact subgroups whose normalizer is compact.
This study discusses the intersection between Black/African Digital Humanities, and computational methods, including natural language processing (NLP) and generative artificial intelligence (AI). We have structured the narrative around four critical themes: biases in colonial archives; postcolonial digitization; linguistic and representational inequalities in Lusophone digital content; and technical limitations of AI models when applied to the archival records from Portuguese-colonized African territories (1640–1822). Through three case studies relating to the Africana Collection at the Arquivo Histórico Ultramarino, the Dembos Collection, and Sebestyén’s Caculo Cangola Collection, we demonstrate the infrastructural biases inherent in contemporary computational tools. This begins with the systematic underrepresentation of African archives in global digitization efforts and ends with biased AI models that have not been trained on African historical corpora.