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To evaluate potential modifications to the Centers for Disease Control and Prevention (CDC)’s Adult Sepsis Event (ASE) definition aimed at mitigating variable blood culturing practices, better-capturing cases where timely care may have prevented deterioration, and improving clinical credibility.
Design:
Retrospective observational study
Setting:
5 US hospitals
Patients:
Hospitalized adults, 2015–2022
Methods:
We assessed the impact of potential ASE modifications on community-onset sepsis incidence and mortality and reviewed 280 charts to assess positive predictive value (PPV) for clinical sepsis.
Results:
Among 1,101,252 hospitalized adults, 51,712 (4.7%) met community-onset ASE criteria (16.1% mortality). Expanding infection criteria to include present-on-admission infection codes when blood cultures were not drawn, non-blood clinical cultures, and discharge alive on antibiotic day three increased incidence by 15.0%, 12.2%, and 4.9%, respectively; all led to mild decreases in mortality rates. Expanding organ dysfunction criteria to include hypotension increased ASE incidence by 32.3% and decreased mortality by 18.5%. Broadening respiratory failure criteria to include noninvasive ventilation and high-flow oxygen had minimal impact. On chart review, original ASE criteria had 80% PPV for clinical sepsis. PPV was similar when identifying infection using present-on-admission infection codes instead of blood cultures and when including patients discharged alive on antibiotic day three. PPV decreased to 50% when using non-blood clinical cultures to identify infection, 17% when using single hypotension values alone to indicate organ dysfunction, and 30% when all ASE components occurred exactly 2 days vs within +/-1 day from the blood culture day.
Conclusions:
Our findings inform modifications to ASE to optimize its utility for national epidemiologic monitoring and quality measurement.
American silk moth, Antheraea polyphemus Cramer 1775 (Lepidoptera: Saturniidae), native to North America, has potential significance in sericulture for food consumption and silk production. To date, the phylogenetic relationship and divergence time of A. polyphemus with its Asian relatives remain unknown. To end these issues, two mitochondrial genomes (mitogenomes) of A. polyphemus from the USA and Canada respectively were determined. The mitogenomes of A. polyphemus from the USA and Canada were 15,346 and 15,345 bp in size, respectively, with only two transitions and five indels. The two mitogenomes both encoded typical mitochondrial 37 genes. No tandem repeat elements were identified in the A+T-rich region of A. polyphemus. The mitogenome-based phylogenetic analyses supported the placement of A. polyphemus within the genus Antheraea, and revealed the presence of two clades for eight Antheraea species used: one included A. polyphemus, A. assamensis Helfer, A. formosana Sonan and the other contained A. mylitta Drury, A. frithi Bouvier, A. yamamai Guérin-Méneville, A. proylei Jolly, and A. pernyi Guérin-Méneville. Mitogenome-based divergence time estimation further suggested that the dispersal of A. polyphemus from Asia into North America might have occurred during the Miocene Epoch (18.18 million years ago) across the Berling land bridge. This study reports the mitogenome of A. polyphemus that provides new insights into the phylogenetic relationship among Antheraea species and the origin of A. polyphemus.
The savannah–forest mosaic of the Rupununi region of Guyana is a dispersal corridor between large tracts of intact Guiana Shield forests and a subsistence hunting ground for Indigenous Makushi and Wapichan communities. We conducted a camera-trap survey at 199 sites across four major forested habitat types and used multi-species occupancy modelling to determine regional-scale drivers of mammalian occupancy at both species and community levels, accounting for imperfect detection. We detected 47 savannah- and forest-dwelling mammal species, with the occupancy of medium- and large-bodied terrestrial mammal species (community occupancy) positively related to per cent forest cover and negatively to the presence of gallery forest habitat. The occupancy of 15 of 30 species was positively related to forest cover, suggesting the importance of maintaining forested habitat within the broader mosaic comprising savannahs and intermediate habitats for sustaining maximum mammal diversity. Jaguar Panthera onca occupancy was associated with the presence of livestock, and giant anteater Myrmecophaga tridactyla occupancy was negatively associated with distance to the nearest road, both results of concern in relation to potential human–wildlife conflict. The probability of detecting terrestrial mammal species (community detectability) increased away from villages, as did the detectability of two large-bodied, hunted species, the lowland tapir Tapirus terrestris and collared peccary Pecari tajacu, potentially indicating the negative effects of subsistence and commercial hunting in this savannah mosaic habitat. We use our findings to discuss how management strategies for hunting, fire, timber harvest and agriculture within Indigenous titled lands could help ensure the sustainability of these traditional livelihood activities.
The heating effect of electromagnetic waves in ion cyclotron range of frequencies (ICRFs) in magnetic confinement fusion device is different in different plasma conditions. In order to evaluate the ICRF heating effect in different plasma conditions, we conducted a series of experiments and corresponding TRANSP simulations on the EAST tokamak. Both simulation and experimental results show that the effect of ICRF heating is poor at low core electron density. The decrease in electron density changes the left-handed electric field near the resonant layer, resulting in a significant decrease in the power absorbed by the hydrogen fundamental resonance. However, quite a few experiments must be performed in plasma conditions with low electron density. It is necessary to study how to make ICRF heating best in low electron density plasma. Through a series of simulation scans of the parallel refractive index (n//) of the ICRF antenna, it is concluded that the change of the ICRF antenna n// will lead to the change of the left-handed electric field, which will change the fundamental absorption of ICRF power by the hydrogen minority ions. Fully considering the coupling of ion cyclotron wave at the tokamak boundary and the absorption in the plasma core, optimizing the ICRF antenna structure and selecting appropriate parameters such as parallel refractive index, minority ion concentration, resonance layer position, plasma current and core electron temperature can ensure better heating effect in the ICRF heating experiments in the future EAST upgrade. These results have important implications for the enhancement of the auxiliary heating effect of EAST and other tokamaks.
The Connecting People and Community for Living Well initiative recognizes that communities, specifically multisector community teams, are a critical part of the provision of programs and supports for those affected by dementia. Effective collaboration and building and supporting the collective well-being of these multisector community teams is key to their success and sustainability. This research sought to understand what supports the well-being of community teams. Focus groups were conducted with multisector community teams who support those impacted by dementia from across four rural communities. The research team used thematic analysis to identify patterns emerging within and across focus groups. The findings highlighted three areas of importance: the need for a resource to support teams to measure, monitor, and describe the impact of their actions; ongoing support from a system-level team; and the development of local and/or provincial policy and infrastructure that supports sustaining collaborative community-based work.
People with disfigurements often face prejudice, exclusion and discrimination in employment and across other life contexts. Law's response to this evidence is flawed both by its own limited and illogical scope and its failure to understand the perspectives of those people who may need to use it. Drawing on interviews with both people with lived experience of disfigurement and employers, the book sketches out different approaches to the complex social problem of discrimination against people with visible differences. It also asks whether, in our changing social context, law should widen its protection beyond disfigurement. Would a protected characteristic of appearance offer viable legal rights to the many millions of us who do not have a disfigurement but who are prone to a few spots, whose ears stick out more than we would like, or who are carrying an extra stone in weight?
Luigi Cadorna remains one of the most controversial generals in Italian history. Appointed chief of the armed forces in 1914, he led the Italian army in the field from May 1915 until the aftermath of their calamitous defeat at Caporetto in 1917. In this major new biography, Marco Mondini traces Cadorna's rise, the nature of his command, the course of the Isonzo campaign, and the battles over his post-war reputation. He brings a new cultural perspective to Cadorna's life, demonstrating the role of Italy's military and national culture, the myths of the Risorgimento, and the mobilization of propaganda in creating an effective cult of personality. Utilizing ego-documents, memoirs, letters and public writings, Mondini delves into the ideology and psychology that combined to create such an untouchable autocrat, arguing that the history of fascism in Italy cannot be fully understood without appreciating Cadorna's role in the First World War.
In null instantiation (NI) an optionally unexpressed argument receives either anaphoric or existential interpretation. One cannot accurately predict a predicator's NI potential based either on semantic factors (e.g., Aktionsart class of the verb) or pragmatic factors (e.g., relative discourse prominence of arguments), but NI potential, while highly constrained, is not simply lexical idiosyncrasy. It is instead the product of both lexical and constructional licensing. In the latter case, a construction can endow a verb with NI potential that it would not otherwise have. Using representational tools of sign based construction grammar, this Element offers a lexical treatment of English null instantiation that covers both distinct patterns of construal of null-instantiated arguments and the difference between listeme-based and contextually licensed, thus construction-based, null complementation.
Received theories of self-deception are problematic. The traditional view, according to which self-deceivers intend to deceive themselves, generates paradoxes: you cannot deceive yourself intentionally because you know your own plans and intentions. Non-traditional views argue that self-deceivers act intentionally but deceive themselves unintentionally or that self-deception is not intentional at all. The non-traditional approaches do not generate paradoxes, but they entail that people can deceive themselves by accident or by mistake, which is controversial. The author argues that a functional analysis of deception solves these problems. On the functional view, a certain thing is deceptive if and only if its function is to mislead; hence, while (self-)deception may but need not be intended, it is never accidental or a mistake. Also, self-deceivers need not benefit from deception and they need not end up with epistemically unjustified beliefs; rather, they must 'not be themselves'. Finally, self-deception need not be adaptive.
The aim of this Element is to forge new conceptual tools to give more ecological power to the human imagination. Imagination, both an innovative force and one that distances and blinds, is central to the ecological crisis as well as its potential resolution. Human imagination creates a bubble of denial, fostering the illusion of a smooth, reassuring, controlled, and neatly compartmentalized world. This Element critically contrasts the harmful modern concepts of reality and imagination with a more grounded “earthly” and “animal” imagination. It proposes to overcome the tension between two currents in environmental thought: those advocating imagination for utopian transformation, and proponents of realism, urging confrontation with the material world beyond anthropocentrism. Through analysis of key contemporary environmental work alongside insights from ethology and biosemiotics, the Element underpins the concept of “animal imagination,” offering an alternative approach to environmental imagination and activism that fosters deeper engagement with the living world.
The human hand’s exceptional dexterity and compliance, derived from its rigid-soft coupling structure and tendon-driven interphalangeal coordination, inspire robotic grippers capable of versatile grasping and force adaptation. Traditional rigid manipulators lack compliance for delicate tasks, while soft robots often suffer from instability and low load capacity. To bridge this gap, we propose a biomimetic multi-joint composite finger integrating a 3D-printed rigid phalanges (46–51 mm) with dual fabric-reinforced pneumatic bladders, mimicking human finger biomechanics. This hybrid design combines hinge-jointed rigidity and anisotropic fabric constraints, enabling two rotational degrees of freedom with higher radial stiffness, achieving 2.18× higher critical burst pressure (240 kPa) than non-reinforced bladders, while preserving axial compliance. Experimental validation demonstrates a 4.77 N maximum fingertip force at 200 kPa and rapid recovery (< 2s) post-impact. The composite finger exhibits human-like gestures (enveloping, pinching, flipping) and adapts to irregular/fragile objects (e.g., eggs, screws) through coordinated bladder actuation. Assembled into a modular gripper, it sustains 1 kg payloads and executes thin-object flipping via proximal-distal joint synergy. This rigid-soft coupling design bridges compliance and robustness, offering high environmental adaptability for applications in industrial automation, human–robot interaction, and delicate manipulation.
Qiu Jun’s Supplement was meant as a handbook for bringing peace and order to “All-under-Heaven” (tianxia), but it was also intended as a guide to delimit the perimeters of the Ming state. The paired chapters 143 and 144, titled “The Boundary between the Chinese within and the Non-Chinese from Beyond,” are the focus of this chapter not only because they offer an excellent illustration of the fundamental tension that has long existed in the practice of Chinese statecraft between the claim of universality, on the one hand, and the reality of demarcating (and defending) one’s domain, on the other, but also because they provide a clear example of how the traditional rhetoric concerning the divide between “Chinese” (hua) and “non-Chinese” (yi) had to be repressed during the subsequent Qing dynasty when China was under Manchu rule.