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In a previously conducted stepped-wedge cluster randomized trial, a multicomponent Antimicrobial Stewardship intervention reduced mean duration of broad-spectrum antimicrobial treatment by 26.6% (from 6.5 to 4.8 days) in patients with moderate-severe community-acquired pneumonia (CAP). This study presents a detailed process evaluation of the multicomponent Antimicrobial Stewardship improvement intervention.
Methods:
The intervention consisted of educational activities (clinical lessons with prescription feedback, e-learning, pocket cards, and poster), local opinion leaders promoting guideline-adherent treatment, and prospective audit and feedback. The experiences with performing the intervention were evaluated using trial data; exposure data (clinical lessons, e-learning, and prospective audit and feedback); and semi-structured interviews conducted in December 2019 with eleven physicians from four hospitals.
Results:
Most intervention components were conducted as planned. However, clinical lessons and e-learning were scheduled more frequently, while prospective audit and feedback was temporarily interrupted in some hospitals. Clinical lessons were on average attended by 31% of the target audience and 44% completed the e-learning. Feedback was provided in 56% of patients receiving broad-spectrum antimicrobials. Clinical lessons, prospective audit and feedback, and local opinion leaders, were identified as the most effective components. Pocket cards were regarded as easy to implement. While e-learning content was judged useful, its perceived effectiveness was reduced by “e-learning fatigue.” The poster was considered of low effectiveness.
Conclusion:
Based on participant experiences, key components of an effective stewardship intervention for improving antimicrobial use in hospitalized CAP patients included prospective audit and feedback, clinical lessons with prescription feedback, pocket cards, and actively engaged local opinion leaders.
There is something utopian about constituent power, whether this is the unrealisable idea of “the people” or the world-building nature of constitutional change. However, in contemporary constitutional scholarship “utopia” is more often used as a pejorative critique of reform projects that are seen as idealistic ambitious calls for constitutional change, which might fail for being “too utopian”, “too idealistic”, “too unrealistic”. In an attempt to move beyond this critique, this article draws on alternative approaches to utopianism to uncover the temporal assumptions underpinning contemporary approaches to constituent power and highlights the different approaches that can be exposed if theories of utopian-thinking are foregrounded. Both utopia and constituent power are closely aligned with visions of alternative futures, and constitutional scholars agree that there is an intersection between utopian thinking and the subjectivities, temporalities and operationalisation of constituent power. Moving away from utilising utopia as a pejorative label and engaging instead with what it can expose about temporalities, offers alternative approaches to the study of constituent power.
It is established that the sporadic simple groups, the alternating groups and the projective special linear groups $L_2(p)$ for primes $p \geq 5$ are uniquely determined by their group orders and the minimum nontrivial codegrees of their irreducible characters.
Extensive research has examined whether political satire promotes or suppresses political discussion, but far less attention has been paid to how it shapes discourse quality. This study investigates the impact of political satire on discourse quality by scrutinizing the substance of online discussions in a non-democratic context. Drawing on manual content analysis of discussions on a major Chinese social media platform surrounding China’s controversial policy to raise the age of retirement, we analysed original posts and subsequent replies (N = 3,400) to assess the impact of satire on online political talk. The results show that political satire significantly decreases topic relevance and rationality, while exerting no significant effect on civility, and virtually precludes argument reciprocity. These findings contribute theoretically by shifting the focus from whether satire stimulates political engagement to how it influences the substantive quality of deliberation. They also invite a reassessment of the often-overemphasized optimistic role of political satire, highlighting its potential to erode rational and constructive discourse.
This article investigates the lives of Sufi leaders following the Turkish state’s abolition of Sufism in 1925. Examining the professions and career paths of Sufi shaykhs, it demonstrates that Sufi masters worked primarily in government jobs and institutions, and maintained a relatively high social status in the new nation-state, despite official denunciations of shaykhs as spiritual charlatans and parasites. As such, it argues that the state pursued a policy of inclusion and integration rather than one of persecution or elimination. While acknowledging that some Sufi leaders were victims of state policy, this article casts doubt on the persecution narrative and demonstrates a broad range of experiences and trajectories for Sufis in the early Turkish Republic. It illustrates that the state welcomed many shaykhs into the new institutions of the nation, including the Grand National Assembly, local government, schools, and libraries, as well as academia and the Directorate of Religious Affairs (Diyanet).
Octahedral transition metal complexes are increasingly recognised as useful tools for the development of complex cations that recognise and interact with specific DNA sequences and higher-order DNA topologies. The versatility and diversity of these complexes is particularly due to their rich photophysical and electrochemical properties at the octahedral metal centre, which can be modulated by changing the surrounding ligands. While X-ray crystallography provides uniquely direct structural information on metal-DNA binding, it is one of several essential approaches; solution-state methods such as NMR and complementary biophysical studies are critical for defining predominant binding modes in solution and in biologically relevant environments. Here, we present an overview of the different binding modes of some of these octahedral transition metal complexes with DNA, emphasising the structural and biophysical studies employed to understand metal complex–DNA interactions.
The onset of vortex breakdown in supersonic flows remains an unsolved problem in physics. In this study, a sufficient condition for spiral vortex breakdown to occur in supersonic flows was derived from the conserved total enthalpy at the vortex axis under complete supersonic inflow conditions. The theoretical threshold was simply determined by the relationship between the magnitudes of the kinetic and internal energies (i.e. axial velocity squared and static temperature, respectively) downstream. In addition, it was found that the squared velocity and static temperature in the sufficient condition were closely related to a rapid reduction in the helicity, which indicated that vortex breakdown occurred. Numerical simulations confirmed that the theoretical threshold corresponds to the onset of spiral vortex breakdowns in supersonic flows.
Since the Global Financial Crisis, the European Union (EU) has gone from crisis to crisis. The chronic growth and productivity problems have been compounded by the poor management of the Eurozone crisis, by the no-longer postponable green and digital transitions, and by the changing geopolitical environment, with the end of the old multilateral order. The European institutions still embed the principles of an old consensus based on market efficiency, and do not allow for macroeconomic and industrial policies for the structural transformation. We discuss possible reforms to realign the EU institutions with the needs and the challenges the bloc faces.
China’s growing technological power and the resulting US–China rivalry prompted various countries, including Japan, to adopt necessary countermeasures. This study examines Japan’s strategic approach to economic security and technology policy under the framework of policy emulation and vested interests. The US–China technology competition urged Japan to reformulate its technological strategies with the aim of reducing economic dependence on China. Japan’s policy reactions are characterized by policy emulation with two orientations: rational emulation to follow the US policy developments and symbolic imitation as a way of reverting to the previous industrial policy. Concurrently, Japan’s policy initiatives were constrained by vested interests to maintain stable economic relations with China and past cooperative practices formed by the Japanese business group.
The objective was to identify, critically appraise, and synthesize evidence on the effectiveness of dance interventions on quality of life (QoL) for adults aged 60+ living in long-term care (LTC).
Methods
A systematic review, initiated and co-led by patient partners, was conducted following a search across eight electronic databases. Eligible studies included randomized controlled trials, quasi-experimental, and observational designs reporting QoL or health-related QoL outcomes. Reviewers independently completed title/abstract and full-text screening. Data extraction included study characteristics, intervention details, outcome measures, use of theory, proposed mechanisms of action, and intervention effectiveness.
Findings
Seven studies involving 429 participants were included. Six studies reported improvements in QoL or health-related QoL. Five studies used a dance intervention targeted to a specific country or cultural group. Two studies identified potential mechanisms of action.
Discussion
Dance interventions may improve QoL in older adults living in LTC. Research with more theory-driven, mixed methods, and/or co-created designs is needed.
This editorial examines the current debate surrounding attention-deficit hyperactivity disorder prevalence, the perceived surge in diagnoses and the growing pressure on healthcare services. It discusses the wide methodological variation in recent studies, the limited pool of high-quality evidence and the challenges this creates when trying to understand true population rates. The article highlights the gap between stable epidemiological estimates and the marked rise in referrals, waiting lists, private assessments and prescribing. It explores how increased awareness, evolving diagnostic criteria and improved detection of previously unrecognised cases contribute to the overall picture, along with the role of social media and shifting societal attitudes. Implications for policy and clinical practice are outlined, emphasising the need for efficient clinical pathways, better-quality data and more comprehensive, multi-informant assessments.
The effective integration of palliative care along the hospital–home trajectory remains a challenge, with digital technologies representing a promising strategy to improve continuity and coordination of care. This study aimed to validate, through expert consensus, the objectives, functionalities, clinical content, organizational requirements, and barriers and facilitators of a technological resource to support the integration of palliative care from hospital to home.
Methods
A methodological consensus study using a modified Delphi technique was conducted over two rounds. A multidisciplinary panel of experts with experience in palliative care, digital health, and healthcare organization participated. In the first round, experts evaluated an initial set of items derived from the literature and clinical practice. Items were analyzed for consensus and, based on qualitative comments, linguistically refined. In the second round, experts reassessed the items to confirm consensus and evaluate the stability of responses. A 4-point Likert scale was used. Consensus was defined as ≥75% of responses indicating “Agree” or “Strongly agree,” with calculation of the Item Content Validity Index (I-CVI) and the coefficient of variation.
Results
Thirty-three experts participated in both rounds, corresponding to a 100% retention rate. All items reached consensus in the first round and maintained consensus and high stability in the second round. Agreement levels were high across all domains, with I-CVI values ≥0.78 and coefficients of variation below 0.25, confirming the content validity of the final set of items. No items were excluded throughout the Delphi process.
Significance of results
This study validated a comprehensive and structured set of essential components for the development of a technological resource to support the integration of palliative care from hospital to home. The high levels of consensus and stability achieved support the clinical and organizational relevance of the resource, providing a solid foundation for its development, implementation, and future evaluation.
Patients with major depressive disorder (MDD) are known to be at a heightened risk of suicide. Research indicates that comorbid anxiety may further elevate this risk. However, studies specifically examining the prevalence of anxiety and its associated factors among patients with MDD and history of a recent suicide attempt (RSA) remain limited.
Aims
To investigate the prevalence of anxiety and the factors associated with its severity in patients with MDD.
Method
A total of 1718 patients with MDD were included. Hypothesis testing and binary logistic regression were employed to examine differences in anxiety severity and clinical factors between patients with and without an RSA, as well as the association between anxiety severity and RSA. Subsequently, patients with MDD were categorised into three subgroups based on anxiety severity. One-way analysis of variance and multivariate logistic regression were then conducted to identify factors associated with anxiety symptoms.
Results
Anxiety severity was identified as an independent correlate of RSA. Compared with patients with anxiety, patients with MDD and significant or severe anxiety had a 2.9-fold and 11.8-fold increased risk of RSA, respectively. Furthermore, Hamilton Rating Scale for Depression score, Positive and Negative Syndrome Scale positive subscale score, and thyroid function indices (free triiodothyronine and thyroid-stimulating hormone levels) were also determined to be independent correlates of anxiety severity.
Conclusions
Anxiety is associated with risk of RSA in patients with MDD, and depressive symptoms, positive psychotic symptoms and thyroid function may be related factors for severity of anxiety.
Does the way people talk about time affect how they think about it? Whereas English speakers describe the duration of events most often in terms of spatial length (e.g., a long night), Greek speakers tend to talk about duration in terms of multidimensional spatial size (e.g., mia megali nychta, tr. a big night) or amount (e.g., poli ora, tr. much time). After quantifying these linguistic patterns, we gave non-linguistic tests of duration estimation to English and Greek speakers. English speakers’ estimates were influenced more strongly by irrelevant length information and Greek speakers’ by irrelevant amount information, consistent with verbal metaphors for duration in English and Greek. Next, we tested duration estimation with concurrent verbal interference, to confirm that the observed effects did not depend on participants verbally labeling the stimuli during the task. Finally, we trained English speakers to use Greek-like metaphors for duration, which resulted in Greek-like performance on a non-linguistic duration estimation task. Results show that (a) people who talk about time differently also think about it differently, (b) these effects are not due to participants’ using verbal labels during the task, and (c) language can play a causal role in shaping even basic non-linguistic mental representations of time.
Economic liberalisation and labour market reforms have radically transformed China’s socio-economic landscape. Although awareness of disability equality has improved – particularly following the introduction and enforcement of disability quota schemes – existing research has not yet adequately explored the lived experiences of disabled individuals within these frameworks. This deficiency is especially glaring in the context of public-sector employment, which is often considered a more stable and secure option for workers. Using institutional theory and its three-pillar framework from W.R. Scott’s Institutions and organizations: Ideas, interests, and identities, this paper aims to fill this research gap by investigating key institutional features of public-sector employment, focusing on bianzhi, pre-employment physical examinations and workplace social dynamics. By doing so, it aims to assess the real-world impact of progressive policies such as disability quotas on disabled workers. Our findings indicate that structural institutional barriers continue to impede and marginalise disabled employees in the public-employment sector, underlining the need for a more robust and collaborative strategy to elevate awareness of disability equality in China.