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To characterize the incidence of contact precautions (CPs) on a palliative care unit (PCU) at a tertiary hospital in Canada.
Design:
Descriptive retrospective chart review.
Setting:
Palliative care unit.
Participants:
Adults admitted to the PCU who were placed on CPs during admission.
Methods:
A retrospective chart review was conducted on all PCU admissions for 25 months from September 24, 2022, to October 29, 2024. Patient orders, clinical notes, medication records, microbiology results, and transport documentation were reviewed. A descriptive and basic comparative statistical analysis was performed.
Results:
CPs were used in 13 of 549 patient encounters (2.37%), with an incidence of 2.02 per 1,000 PCU patient-days. Indications included known MRSA (5/13), suspected CPO (4/13), new MRSA (3/13), and known vancomycin-resistant Enterococcus (1/13). The mean duration of CPs was 15.4 ± 14.1 (range 0.2–47.8) days. Mean hospital and PCU lengths of stay in the CP group were 24.8 ± 14.7 and 14.6 ± 14.8 days, respectively, compared to 23.8 ± 31.3 and 11.7 ± 11.7 days in the non-CP group (P = .816 for hospital stay; P = .491 for PCU stay). No significant differences were observed between groups in age, sex, or length of stay. Antibiotics were used in 9/13 patients, and 5/13 patients remained on CPs until death on the PCU.
Conclusions:
This study is the first known retrospective review of CP use in palliative care. Further research is needed to explore its impact on infection outcomes, mortality, and patient-centered measures.
Iron mining waste is produced from the iron ore mining operations of El Ouenza Mine (north-east Algeria), and it is not currently recycled to preserve the environment. The current study aims at developing sustainable clay bricks by mixing clay with different proportions of iron mining waste (ranging from 10 to 50 wt.%) and fired at 850°C and 950°C. Addition of 30 wt.% Iron mining waste had a positive effect on the physical and mechanical properties of the fired clay bricks. Linear shrinkage, water absorption and porosity were reduced, while compressive and flexural strengths were increased. Furthermore, up to 30 wt.% of iron mining waste addition to the mixtures improved compressive and flexural strengths to 59.17 and 10.06 MPa, respectively, when the bricks were fired at 950°C. According to their thermal conductivity, the bricks with 10–50 wt.% iron mining waste are considered as thermal insulators, with thermal conductivity values ranging from 0.45 to 0.56 W m–1 K–1. Adding 30 wt.% of iron mining waste can lead to the production of eco-friendly bricks with high mechanical and thermal properties, generating economic and environmental benefits.
Alors que la constitutionnalité de la Loi sur la laïcité de l’État était contestée devant la Cour supérieure du Québec, détournant les regards pour les orienter vers la question du port de symboles religieux dans la fonction publique, se jouait un autre enjeu de laïcité sur un terrain inattendu. Les politiques gouvernementales de gestion de la pandémie de COVID-19 allaient en effet mettre à l’épreuve deux principes aux fondements de la laïcité québécoise – la séparation des Églises et de l’État ; la liberté de conscience et de religion –, sans que ces atteintes ne soient diagnostiquées comme telles. Cet article se penche sur cet impensé des débats récents sur la laïcité québécoise à partir d’un rappel de ses fondements historico-juridiques, puis d’une analyse des effets du dispositif juridique mis en place pour lutter contre la COVID-19 sur l’autonomisation de l’État à l’égard du religieux et la liberté de conscience et de religion.
Generative artificial intelligence (GenAI) has been heralded by some as a transformational force in education. It is argued to have the potential to reduce inequality and democratize the learning experience, particularly in the Global South. Others warn of the dangers of techno-solutionism, dehumanization of learners, and a widening digital divide. The reality, as so often, may be more complicated than this juxtaposition suggests. In our study, we investigated the ways in which GenAI can contribute to independent language learning in the context of Pakistan. We were particularly interested in the roles of five variables that have been shown to be particularly salient in this and similar contexts: learners’ Generative Artificial Intelligence-mediated Informal Digital Learning of English (GenAI-IDLE) participation, AI Literacy, Foreign Language Enjoyment (FLE) and Foreign Language Boredom (FLB), and their second language Willingness to Communicate (L2 WTC). Employing a structural equation modelling approach, we surveyed 359 Pakistani English as a foreign language (EFL) learners to investigate their interrelationships between variables. The results demonstrate that EFL learners’ GenAI-IDLE activity directly and positively influences AI literacy and FLE. Students’ AI literacy and FLE play a chain-mediating role in the relationship between GenAI-IDLE participation and L2 WTC. However, FLB lacks predictive power over L2 WTC. We discuss the implications of these results for language learning, in particular in low-resource contexts.
In the realm of data-to-text generation tasks, the use of large language models (LLMs) has become common practice, yielding fluent and coherent outputs. Existing literature highlights that the quality of in-context examples significantly influences the empirical performance of these models, making the efficient selection of high-quality examples crucial. We hypothesize that the quality of these examples is primarily determined by two properties: their similarity to the input data and their diversity from one another. Based on this insight, we introduce a novel approach, Double Clustering-based In-Context Example Selection, specifically designed for data-to-text generation tasks. Our method involves two distinct clustering stages. The first stage aims to maximize the similarity between the in-context examples and the input data. The second stage ensures diversity among the selected in-context examples. Additionally, we have developed a batched generation method to enhance the token usage efficiency of LLMs. Experimental results demonstrate that, compared to traditional methods of selecting in-context learning samples, our approach significantly improves both time efficiency and token utilization while maintaining accuracy.
We prove two results concerning percolation on general graphs.
• We establish the converse of the classical Peierls argument: if the critical parameter for (uniform) percolation satisfies $p_c<1$, then the number of minimal cutsets of size n separating a given vertex from infinity is bounded above exponentially in n. This resolves a conjecture of Babson and Benjamini from 1999.
• We prove that $p_c<1$ for every uniformly transient graph. This solves a problem raised by Duminil-Copin, Goswami, Raoufi, Severo, and Yadin, and provides a new proof that $p_c<1$ for every transitive graph of superlinear growth.
A previous controlled study showed advantages of 2% Chlorhexidine Gluconate-Alcohol (CHG) over Povidone-Iodine-Alcohol in preventing infections after peripheral venous catheter placement. We applied these findings in a real-world before/after healthcare intervention and found that introduction of CHG disinfection was not associated with a major change of incidence in local skin complications.
Glide-snow avalanches release at the soil-snow interface and are currently difficult to predict. This is mostly due to a limited understanding of the release process and a lack of data, particularly of the snowpack and underlying soil conditions prior to release. Here, we synthesize the current process understanding on the source of interfacial water—a key factor in glide-snow avalanche release—in a simple explanatory model. The model classifies days with and without glide-snow avalanche activity using thresholds applied to proxies including snow liquid water content (LWC), soil temperature, soil LWC and meteorological parameters. These proxies were measured on Dorfberg (Davos, Switzerland) in the 2021/22 to 2023/24 seasons. The best-performing thresholds for the snow, soil and meteorological time series were determined through quasi-random sampling and were in line with previous field studies. Soil temperature and snow LWC were the most relevant variables to explain avalanche occurrence. These results demonstrate the importance of combining snow, soil and meteorological data for improving the forecasting of glide-snow avalanche activity.
Interfaces subjected to strong time-periodic horizontal accelerations exhibit striking patterns known as frozen waves. In this study, we experimentally and numerically investigate the formation of such structures in immiscible fluids under high-frequency forcing. In the inertial regime – characterised by large Reynolds and Weber numbers, where viscous and surface tension effects become negligible – we demonstrate that the amplitude of frozen waves scales proportionally with the square of the forcing velocity. These results are consistent with vibro-equilibria theory and extend the theoretical framework proposed by Gréa & Briard (2019 Phys.Rev.Fluids4, 064608) to immiscible fluids with large density contrasts. Furthermore, we examine the influence of both Reynolds and Weber numbers, not only in the onset of secondary Faraday instabilities – which drive the transition of frozen wave patterns toward a homogenised turbulent state – but also in selecting the dominant wavelength in the final saturated regime.
To describe changes in the community food environment between 2010 and 2022 in all municipalities in the state of Rio Grande do Sul (RS), Brazil, and to evaluate the possible associated sociodemographic inequities.
Design:
This ecological study was based on an analysis of the distribution and density of food retail establishments between 2010 and 2022 and their associations with the sociodemographic characteristics of the municipalities. Sociodemographic and food retail variables were extracted from secondary government databases. The establishments were classified according to the degree of processing of the foods they predominantly sold. Non-parametric tests and linear and Prais–Winsten regressions were used to analyse data.
Setting:
State of RS, Brazil.
Participants:
All 497 municipalities.
Results:
There was a significant reduction in overall food retail density (Coef.: –2·97; 95 % CI: –3·34, –2·61; P < 0·001). The greatest reduction occurred in establishments that sourced ultra-processed foods (Coef.: –3·34; 95 % CI: –3·65, –3·02; P < 0·001), which, despite the decrease, remained the most widely present. In 2022, the density of these establishments (median: 24·5; min/max: 4·4–124·8) was twice the density of establishments supplying fresh/minimally processed foods and culinary ingredients (median: 13·1; min/max: 0·0–95·8). Cities with greater social vulnerability had lower densities of establishments and greater reductions in the density of establishments over the evaluated period.
Conclusions:
The reduction in food retail outlets disproportionately affected the most vulnerable municipalities and negatively impacted the availability of healthy foods. These findings reinforce the need for food and nutrition policies that promote equity in the food environment.
Plastic pollution is a pervasive and urgent environmental issue, caused by our unsustainable use of single-use plastics (plastic items that are commonly discarded after one use). Many of these plastics are used in food packaging, frequently ending up in the environment. A potential solution to this problem is packaging reuse systems, meaning systems to incentivize consumers to return used packaging for refill (by charging a deposit) or appealing to environmentally conscious consumers to bring in their own packaging for shopping (e.g., in zero-waste stores). Deposit return systems (DRS) are well-established in several countries; however, they are often used for single-use packaging with the purpose to improve the recycling rate of plastic packaging (and therefore do not focus on reuse). Further, DRS mainly apply to beverages, not solid food containers. Nevertheless, they are well-studied systems, highlighting key concerns for the implementation of innovative solutions to keep packaging waste out of the environment (e.g., aspects of hygiene, transport and logistics, brand identity and consumer behavior). In this study, we explore how packaging reuse systems are implemented for solid and semi-solid food products by two organizations (one in Canada and the other in Germany) concerned with reducing plastic waste in the food sector.
On 27 October 2021, Cambridge University’s Jesus College commemorated the historic return to Nigeria of the bronze statue of a cockerel called “Okukur.” This was looted from the ancient Kingdom of Benin in 1897 by British colonizers. The college resolved to relinquish ownership to the Oba, who is the cultural, religious, and legal head of Benin. On 23 March 2023, Nigeria’s President Muhammadu Buhari decreed that the “ownership of the artefacts… is vested in the Oba.” The genesis of this order was controversies about the ownership, control, and management of returning objects. This article analyzes the role of the traditional institution of governance in the socio-legal politics of cultural heritage restitution in Nigeria. Building on the traditional leadership’s claims on the returned artworks, it explains the need to use the momentum of restitution to evaluate and improve the effectiveness of the national and international legal systems to protect cultural heritage.
This study aimed to evaluate the impact of a pharmacist-led support system on the administration rate of vancomycin (VCM) loading dose, 0–24-hour area under the concentration–time curve (AUC0–24), incidence of acute kidney injury (AKI), and all-cause mortality in hospitalized patients.
Design:
This retrospective study with interrupted time series analysis was conducted from January 2021 to May 2024.
Setting:
A public tertiary referral center providing acute and specialized inpatient care in Japan.
Patients:
Among the 587 hospitalized patients who received VCM during the study period, 326 were evaluated.
Intervention:
The intervention comprised implementation of a pharmacist-led support system involving prospective prescription review and direct intervention when a VCM loading dose (25–30 mg/kg) was not prescribed.
Results:
The loading dose administration rate increased significantly by 43.2% immediately introducing the support system (95% confidence interval: 8.40–77.90; P = 0.0156), without significant trend change thereafter. AUC0–24 also increased significantly (241.0 vs 307.0; P < 0.001); there were no significant differences in AKI incidence or 90-day mortality.
Conclusions:
The support system improved the loading dose administration rate and AUC0–24 without significantly increasing AKI or mortality. The improvement was immediate and sustained over 122 weeks, supporting its use in institutions aiming to optimize VCM loading doses where evidence remains limited.
Coercive control (CC) represents a significant proportion of intimate partner violence (IPV) cases in the UK and globally. While theoretical models on CC exist, none so far includes a psychological perspective. As cognitive behavioural theory (CBT) has a robust evidence base as an IPV intervention for women survivors, it can also be used in the development of a psychological model for CC, from the perspective of survivors. Such a model may have utility as a psychotherapeutic formulation tool and providing training on psychological aspects and impact of CC to other professionals involved in survivors’ care.
Method:
Fourteen women with self-identified experience of CC were screened and interviewed. Constructivist grounded theory was used to analyse the interviews.
Results:
Six theoretical codes were developed: vulnerability factors (difficult childhood experiences, negative previous romantic relationships, and low self-esteem), cognitions (thoughts about worthlessness, isolation, being deserving of the abuse, confusion, hope, being treated unfairly, and suicidal ideation), affect (shame, fear, sadness, and anger), maintaining factors (perceived consequences of leaving, financial situation, low self-esteem, and social norms), behaviours (unhelpful coping strategies of dissociation, subjugation, avoidance, and substance misuse, and protective factors were spending time with loved ones, physical activity, and committing to career and interests), and impact (poor physical health, depression, anxiety, trauma, financial difficulties, and chronic mistrust).
Conclusions:
The results of this study constitute a preliminary CBT model of women survivors’ experiences of CC. Further research is required to test and further develop the model, especially the vulnerability factors and mental health implications of experiencing CC.
Key learning aims
(1) To provide information that supports the need for healthcare professionals to be aware of and receive training on coercive control.
(2) To provide insight into women survivors’ experiences of coercive control within heterosexual relationships.
(3) To provide guidance on how psychological professionals can work with women survivors of coercive control to formulate their experiences and plan interventions.
eSource – particularly EHR-to-EDC – is an emerging paradigm in clinical research that enables automated transfer of electronic health record (EHR) data into electronic data capture (EDC) systems, with the potential to reduce site burden, improve data quality and accelerate oncology clinical trial workflows. However, widespread implementation remains limited due to technical, regulatory and operational barriers. To address these challenges, the European Institute for Innovation through Health Data (i~HD) launched the eSource Scale-Up Task Force in 2024. This multi-stakeholder initiative brings together leading oncology centres and pharmaceutical sponsors to establish a consensus-driven roadmap for eSource adoption. Central to this effort are three foundational resources: readiness criteria for early adopters, a performance indicator framework for monitoring success and an operational playbook to guide implementation. This article provides a structured overview of the Task Force’s objectives, collaborative model and outputs, with specific attention to its focus on interoperability, regulatory alignment and real-world validation. While initially developed for oncology, the Task Force’s framework is applicable across therapeutic areas characterized by data-intensive workflows.
Antimicrobial resistance (AMR) poses an escalating global threat, transforming once-treatable infections into major health challenges. Although antibiotic misuse is a well-known driver of AMR, particularly in low- and middle-income settings, the silent epidemic may be fueled by socioeconomic disparities even in high-income countries. This systematic review investigates the relationship between socioeconomic status (SES) and AMR prevalence across high-income nations based on the World Bank classification.
Design:
The studies included in this review span multiple observational designs (cross-sectional, cohort, and case-control) across various high-income nations, assessing the association between SES indicators (eg, income, education, and household crowding) and AMR strains, primarily methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Escherichia coli.
Results:
Findings consistently indicate that lower SES correlates with higher AMR prevalence, particularly in MRSA infections (r = 0.76, Blakiston et al). The review highlights that indices of SES (often derived from government census data) are consistently associated with lower income, lower educational attainment, and increased household density with elevated AMR prevalence.
Conclusion:
The variability among studies in SES metrics, including income measures and deprivation indices, limits generalizability. Exceptions to this trend, noted in select studies focusing on distinct AMR strains like ceftriaxone-resistant E. coli, underscore the complexity of SES-related AMR mechanisms. This review supports public health initiatives aimed at targeting low-SES communities with AMR mitigation strategies, advocating for continued monitoring and intervention to curb AMR spread in vulnerable populations.
This cross-sectional study examined the association between diet price and diet quality in a national sample of Australian adults (n 1956). Diet recall data from the 2020 International Food Policy Study were linked to a national food and beverage price dataset. Daily diet price was calculated by summing the median non-promotional prices of all foods and beverages recorded in diet recall data, priced per gram (or millilitre) and adjusted for edible portions. Diet quality was determined using the Australian Dietary Guideline Index 2013 (scored out of 115). Linear regression models tested the association between the diet price (per dollar and per ten-dollar increments) and diet quality, adjusted for education, age and sex. A positive association was observed, where diet quality increased by 0·09 units (95 % CI 0·05, 0·14) for every $AU 1 increase in diet price. Daily diet price explained approximately 8 % of the variation in diet quality across the sample (R2 = 0·08). When categorised in ten-dollar increments, participants with diet prices < $AU 10/d had a lower mean diet quality score (51·96) compared with all other diet price categories, 5–6 points lower than those whose diet was > $30/d. Diet price appeared to be a modest yet significant determinant of diet quality for Australian adults in 2020. Additional analyses are needed to investigate these associations during recent food inflation. As diet quality appears to be lowest for people who spend the least on food, government action to increase priority communities’ food budgets may help improve the nutritional quality of population diets.
Shift work-induced circadian disruption has been linked to various cardiometabolic diseases, including obesity, diabetes and CVD. Limited studies have explored the impact of different variables such as night work durations, intensities and chronotype on cardiometabolic risk. This study aimed to determine the impact of circadian disruption on cardiometabolic risk markers in shift workers. This case–control study was conducted with 104 male workers (shift workers; n 52, mean age; 43·3 (sd 10·2), and non-shift workers; n 52, mean age; 41·2 (sd 9·8)). Shift work details were determined via an interviewer-administered questionnaire. Cardiometabolic risk was evaluated through anthropometric (height, weight, waist circumference and body composition), biochemical (fasting glucose and lipid profile), clinical (blood pressure) and dietary assessment (24-h recalls from working and non-working days). The chronotype was determined via the Munich Chronotype Questionnaire (MCTQ). Shift workers had significantly higher mean body fat percentage (31·7, 22·7 % P = 0·031), systolic blood pressure (SBP) (138·6, 128·5 mmHg P = 0·009), pulse rate (78·7, 72·3 bpm P = 0·015), TAG (1·60, 1·30 mmol/l P = 0·021) and LDL-cholesterol (3·90, 3·40 mmol/l P = 0·012) than non-shift workers. Evening chronotype shift workers had significantly higher visceral fat levels (12·8, 8·90 P = 0·001), SBP (137·0, 127·6 mmHg P = 0·006), pulse rate (82·7, 73·3 bpm P = 0·005) and LDL-cholesterol (4·00, 3·40 mmol/l P = 0·039) than shift workers with a morning chronotype. In conclusion, shift workers exhibited higher metabolic risk markers than non-shift workers. Shift workers with evening chronotypes had higher cardiometabolic risk than morning chronotypes. Further research is warranted to elucidate the underlying mechanisms and inform targeted interventions for individuals engaged in shift work, considering chronotypes.
Clinical response and remission may not fully reflect patient priorities in treatment-resistant depression (TRD). Health-related quality-of-life (HRQoL) outcomes should be assessed to comprehensively capture treatment benefits.
Methods
ESCAPE-TRD (NCT04338321) was a 32-week randomized, phase IIIb trial comparing esketamine nasal spray (NS) versus quetiapine extended release (XR), both alongside an ongoing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor, in patients with TRD. Symptom and HRQoL improvements were assessed using the Patient Health Questionnaire-9 (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life in Depression Scale (QLDS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) measures.
Results
Esketamine NS-treated patients (N=336) reached PHQ-9 remission (score ≤4) quicker than quetiapine XR-treated patients (N=340), and more had remission by Week 32 (34.5% vs. 18.2%; odds ratio [OR]: 2.39 [1.67, 3.41], p<0.0001). “Role Emotional”, “Mental Health”, and “Social Functioning” SF-36 domains showed significantly greater improvements in esketamine NS-treated patients compared with quetiapine XR-treated patients at Week 32 (p<0.05), returning to levels close to general population norms. More esketamine NS-treated patients had a meaningful improvement in their QLDS score by Week 32 (60.7% vs. 41.8%; OR: 2.16 [1.59, 2.94], p<0.0001), and reached this improvement quicker than quetiapine XR-treated patients. Proportions of patients reporting an EQ-5D-5L score of 1 (no problems) were significantly higher across all domains with esketamine NS versus quetiapine XR at Week 32 (p<0.05).
Conclusions
Esketamine NS produced superior improvements in HRQoL compared with quetiapine XR, indicating positive impacts on aspects of patients’ lives that matter to them, alongside clinical symptoms of TRD.
We study the mechanics of evaporation and precipitate formation in pure and bacteria-laden sessile whole blood droplets in the context of disease diagnostics. Using experimental and theoretical analysis, we show that the evaporation process has three stages based on evaporation rate. In the first stage, edge evaporation results in a gelated contact line along the periphery through a sol–gel phase transition. The intermediate stage consists of a gelated front propagating radially inwards due to capillary flow and droplet height regression in pinned mode, forming a wet-gel phase. We unearthed that the gelation of the entire droplet occurs in the second stage, and the wet-gel formed contains trace amounts of water. In the final slowest stage, the wet gel transforms into a dry gel, leading to desiccation-induced stress forming diverse crack patterns in the precipitate. Slow evaporation in the final stage is quantitatively measured using evaporation of trace water and associated transient delamination of the precipitate. Using the axisymmetric lubrication approximation, we compute the transient droplet height profile and the erythrocytes concentration for the first two stages of evaporation. We show that the precipitate thickness profile computed from the theoretical analysis conforms to the optical profilometry measurements. We show that the drop evaporation rate and final dried residue pattern do not change appreciably within the parameter variation of the bacterial concentration typically found in bacterial infection of living organisms. However, at exceedingly high bacterial concentrations, the cracks formed in the coronal region deviate from the typical radial cracks found in lower concentrations.