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Timely detection of pathogen-related outbreaks in hospitals is important for preventing onward transmission and can be supported by automated outbreak detection systems (AODS). Many methods overlook in-hospital patient transfers and focus only on patient locations at the time of sampling. This study compares three approaches for incorporating patient transfers into AODS.
Design:
Two existing AODS frameworks, a local percentile-based system and a statistical modeling-based system were extended to include patient transfers: 1) grouping wards into communities based on frequent patient exchange, 2) including prior ward visits in the past 14 days, and 3) including both prior ward visits and time spent on wards. Alerts generated were reviewed for clinical relevance.
Setting:
Data from January 2014 to December 2021 from a University Medical Center in the Netherlands.
Results:
Using the percentile-based approach, the baseline scenario detected 99 possible outbreaks. Extension with ward community groupings, prior ward visits, and prior ward visits accounting for time spent in each ward increased this number with 16 (+15%), 42 (+42%), and 106 (+110%) possible outbreaks, respectively. Of the alerts generated by including individual patient transfer history, 35% were judged as requiring investigation. The trade-off between increased detection and relevance was less favorable for the other approaches. Similar findings were found for statistical modeling-based methods.
Conclusions:
Inclusion of patient transfer data in AODS improved sensitivity, at the cost of increasing the alert burden. Therefore, ongoing refinement should further optimize the balance between accurate outbreak detection and a manageable alert burden.
Effective soil nutrient management remains a critical determinant of agricultural profitability among smallholder farmers. This research evaluates the economic viability of fertilizer trials for teff and sorghum crops under different landscape positions in the dryland areas of northeastern Ethiopia. The study employed a randomized complete block design (RCBD) comprising nine treatments across three districts. Data from 855 experimental plots were analysed using a linear mixed-effects model (LMEM) across the slope gradients of foot slope, mid slopes, and hill slopes. Partial budget analysis, value-to-cost ratios (VCRs), and sensitivity analysis were employed to evaluate the economic feasibility of nutrients. The result from the LMEM revealed that fertilizer treatments, crop type, and slope position significantly affect net benefits. The results also showed that profitability declined progressively from the foot slope to the mid slope and further to the hill slope. The mixed model results indicated that the NP fertilizer has substantially increased net benefits relative to other treatments. Moreover, the partial budget, VCR, and sensitivity analyses also confirmed that NP fertilizer produced the highest economic return for both crops. A sensitivity analysis further confirmed the robustness of the NP fertilizer under the price fluctuation scenarios of inputs (fertilizer and both crops). Therefore, the NP is an economically viable fertilizer for both teff and sorghum producers. Strategic soil and nutrient management practices tailored to different landscape positions will further enhance farm profitability in the study areas.
The main goal of this article is to examine how vanishing norms have freed presidents of both major political parties to abuse their clemency power to pursue their own personal interests rather than the traditional purposes of mercy or serving the public interest. In the piece, I look more closely at the pardon power in practice, considering vanishing norms related to both mass pardons and individual pardons over the last half century. I explain how certain clemency decisions helped clear room for controversial clemency decisions by our most recent three presidents, and how their actions will likely continue to undermine norms and make clemency even more of a political tool in the future.
Projections of health/social care spending highlight risks to future fiscal sustainability. This concern is based, in part, on six assumptions, which we argue are uncertain: (1). Populations will continue to age; (2). Health is a function of age; (3). Health/social care need is driven by health; (4). Health/social care spending is driven by need; (5). Inequalities are unimportant; (6). Increasing dependency ratios risk fiscal sustainability. We propose three hypotheses which reframe the debate: (1). Health/social care spending primarily results from political decisions on supply; (2). Prevention policies alone are unlikely to reduce fiscal pressures; (3). Fiscal sustainability is best achieved by combining prevention with decommodification and ‘realistic medicine’.
This paper examines the reasons behind the sudden emergence of anti-foreigner populism in the mainstream during the July 2025 House of Councilors election. Starting with a comparative analysis of the right-wing organizations Zaitokukai (in the 2010s) and Sanseito (now), the paper argues that, against the background of exclusionist sentiment fostered during the pandemic and rising populism causing elites to lose control of the narrative on migration, the visibility of foreigners in everyday life in Japan has reached a psychological tipping point, a symbolic perceived threat to a homogenous identity that manifests itself in feelings of anxiety, injustice, and ultimately overt xenophobia.
In the years following independence, history-writing increasingly became a strategic instrument of nation-building and a means of constructing a “usable past.” Using the South African writer Bloke Modisane’s research on the Maji Maji War in Tanzania as its point of departure, this article examines how newly independent African states navigated the politics of historical production in the early postindependence period. Although deeply invested in African history, Modisane was not a formally trained historian and remained on the margins of the emerging Dar es Salaam School of History. His uneasy reception in Tanzania not only underscores the tension between Pan-African ideals and national imperatives, but the challenges faced by intellectuals working outside official or institutional structures. While he never completed his research to the point of publication, revisiting his experience reminds us that the history of African history was also shaped by incomplete, interrupted, and forgotten efforts to write the past.
Borderline personality disorder (BPD) is a clinically significant and extensively studied personality disorder (PD), associated with substantial impairment, risk, treatment needs, and health-system burden. Contemporary debates about its classification now occur within diagnostic systems that already move beyond purely categorical models, including ICD-11 and the DSM-5 Alternative Model for Personality Disorders. The central question is therefore not simply whether dimensional assessment should be incorporated into PD diagnosis, but how general personality disorder diagnosis, named categorical patterns, dimensional characterization, and outcome/risk assessment should be clinically coordinated. This article examines BPD as a focal case for this broader categorical-dimensional problem. We review the clinical contributions and limitations of categorical and dimensional approaches, consider evidence supporting the reliability, validity, clinical utility, and treatment relevance of BPD, and propose a clinical sequencing model for PD assessment. The model is not intended as a new diagnostic architecture or diagnostic algorithm. Rather, it begins with establishing the presence of general personality disorder, then asks whether a named PD pattern is clinically meaningful, before proceeding to dimensional characterization and outcome/risk assessment. We argue that dimensional progress does not require the abandonment of named personality disorder diagnoses when they remain clinically and empirically meaningful. Within this framework, BPD can remain an organizing construct while categorical diagnosis is prevented from becoming the endpoint of clinical formulation.
This article explores how Chilean business elites remember the Unidad Popular (UP) government (1970–1973) and how these memories shape their current political culture. Drawing on interviews, it distinguishes between two generational groups: those who experienced the UP as adults and those who lived through it as children or adolescents or did not live it firsthand. The study examines how memories of political confrontations and commodity shortages form a conservative collective narrative that resists systemic reform. These recollections often legitimize the 1973 military coup and the subsequent neoliberal transformations. The research shows that personal experiences, as well as narratives passed down through generations, contribute to the construction of a political culture among economic elites that privileges stability over change. By analyzing these memory dynamics, the article underscores the importance of elite historical consciousness in shaping their vision of Chile’s political present and its possible future.
By a detailed comparison of leaky magnetohydrodynamic waves in coronal magnetic flux tubes with leaky electromagnetic waves in dielectric media, it is shown that the latter kind may be called quasi-normal modes, since they can be regularised by a normalisation which systematically cuts off the contribution of the external homogeneous region, whereas such a possibility is forbidden for the former kind by the conservation of magnetic flux. Consequently, leaky magnetohydrodynamic waves cannot be systematically applied to coronal seismology, i.e. to the inverse spectral problem of determining the different equilibrium distributions of the fields by comparing the spectra they produce with the observed ones.
This article examines how digital finance communities, exemplified by Reddit’s WallStreetBets (WSB), have transformed the cultural logic of financial participation. While earlier research has largely focused on the technological facilitation or social framing of retail investment behaviour, we foreground the symbolic, performative, and epistemic dimensions of financial subject formation in digital contexts. Through a multimethod analysis of WSB during the GameStop (GME) phenomenon, we show how financial investment becomes culturally embedded through memes, insider language, affective rituals, and shared fictional expectations. Our findings demonstrate how digital communities pluralise financial subjectivity, from ironic, self-deprecating speculators to moralised holders and conspiratorial believers in collective financial futures. Crucially, we identify a series of shifts in epistemic style and argumentation logic, tracing a transformation from rational-ironic to mimetic, morally-affective, and finally, conspiratorial forms of financial knowledge. To capture this progression, we propose an original four-phase cultural model that reveals how digital financial communities create, stabilise, and fragment shared belief systems. In so doing, we contribute to the sociology of financialisation by highlighting how subcultural formations on digital platforms generate alternative epistemologies, shared fictions, and affectively charged visions of economic agency.
An overview of new experimental results obtained at the GOL-NB multiple-mirror trap over the past two years is presented. The main scientific objectives of GOL-NB are the direct demonstration of the multiple-mirror confinement efficiency with hydrogen plasma. The device has a configuration that simulates, at reduced plasma parameters, the configuration of a reactor-class facility with a central gas dynamic trap and sections with a strong magnetic field attached to it, which can be turned on both as long solenoids or as multiple mirrors. Plasma is heated by 1 MW neutral beam injection. The following elements are discussed in the paper: magnetohydrodynamic (MHD) stability, plasma parameters in the central trap, neutral beam trapping and fast ion spectrum, comparison of the multiple-mirror and solenoidal configurations at high collisionality, and measures for the reduction in neutral density. The main goals of the experiments were plasma properties characterisation in the central trap and studies of plasma flow in the strong-field sections. We also introduce two new systems for additional plasma heating, a low-energy electron beam mounted at the exit plasma receiver and a 13.56 MHz ICRH system, which is under tests at several kilowatts of input power.
In children, oxygen support in the prone position may be preferred for certain conditions such as acute respiratory distress syndrome. However, it is very difficult to place such patients in the supine position to obtain an electrocardiogram. We aimed to determine the effectiveness of prone back 12-lead electrocardiogram and detect electrocardiogram changes in healthy children.
Methods:
The present study comprised 50 healthy children aged between 3 and 7 years. The patients first underwent a supine electrocardiogram test used in routine practice. Back electrocardiogram in prone position was obtained by placing six of the precordial leads (prone V1–prone V6) to the back of the patient.
Results:
The average P wave, Q wave, R wave, S wave, and T wave amplitudes were significantly smaller in prone back leads (prone V1–prone V5) compared to supine precordial leads (supine V1–supine V5) (p < 0.001). The only exceptions were that the mean T wave amplitude in prone V3 and supine V3 was similar, and the mean Q wave amplitude in prone V5 and supine V5 was similar. The average P wave, Q wave, S wave, and T wave amplitudes were similar when prone V6 was compared with supine V6.
Conclusion:
A back electrocardiogram in the prone position is a useful and practical approach that provides valuable information to the clinician.
The Lagrangian-averaged Navier–Stokes-$\alpha$ (LANS-$\alpha$) model, a turbulence closure scheme based on energy-conserving modifications to nonlinear advection, can produce more energetic simulations than standard models, leading to improved fidelity (e.g. in ocean models). However, comprehensive understanding of the mechanism driving this energetic enhancement has proven elusive. To address this, we derive the fast quasi-geostrophic limit of the three-dimensional, stably stratified LANS-$\alpha$ equations. This provides both the slow, balanced flow and the leading-order fast wave dynamics. Analysis of these wave dynamics suggests that an explanation for the energetic enhancement lies in the dual role of the smoothing parameter itself: increasing $\alpha$ regularises the dynamics and simultaneously generates a robust landscape of wave–wave resonant interactions. Direct numerical simulations show that $\alpha$ plays an analogous role to the Burger number (${\textit{Bu}}$) in governing the partition of energy between slow and fast modes – and, consequently, the time scale of geostrophic adjustment – but with key differences. Increasing $\alpha$, regardless of the relative strengths of rotation and stratification, extends the persistence of wave energy by delaying the dominance of the slow modes. We find that the creation of an energy pathway involving only fast waves is a universal outcome of the regularisation across all values of ${\textit{Bu}}$, accompanied by a restructuring of slow–fast–fast interactions. These insights unify the LANS-$\alpha$ model’s characteristic energetic enhancement with, in some cases, its known numerical stiffness, identifying potential pathways to mitigate stability issues hindering the broader application of LANS-$\alpha$-type models.
An ‘institutional turn’ has been detected in archaeology, with several scholars drawing from institutional economics to help explain various economic and political developments, including in the Viking Age. Generally, institutional analysis encompasses both political and cultural change, casting light on underlying rule systems, motivations, and mechanisms. This note responds to an article in Archaeological Dialogues by Anders Ögren et al., which argues for the application of the new institutional economics to viking studies, but focuses largely on one author, Douglass North, from that tradition. North’s views evolved, and in some respects he moved closer to the ideas of Thorstein Veblen, who was part of the original institutional economics. Overall, we need to draw more widely from institutional economics, including from inspiring earlier contributions.