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Ordering Clostridioides difficile diagnostics without appropriate clinical indications can result in inappropriate antibiotic prescribing and misdiagnosis of hospital onset C. difficile infection. Manual processes such as provider review of order appropriateness may detract from other infection control or antibiotic stewardship activities.
We developed an evidence-based clinical algorithm that defined appropriateness criteria for testing for C. difficile infection. We then implemented an electronic medical record–based order-entry tool that utilized discrete branches within the clinical algorithm including history of prior C. difficile test results, laxative or stool-softener administration, and documentation of unformed bowel movements. Testing guidance was then dynamically displayed with supporting patient data. We compared the rate of completed C. difficile tests after implementation of this intervention at 5 hospitals to a historic baseline in which a best-practice advisory was used.
Using mixed-effects Poisson regression, we found that the intervention was associated with a reduction in the incidence rate of both C. difficile ordering (incidence rate ratio [IRR], 0.74; 95% confidence interval [CI], 0.63–0.88; P = .001) and C. difficile–positive tests (IRR, 0.83; 95% CI, 0.76–0.91; P < .001). On segmented regression analysis, we identified a sustained reduction in orders over time among academic hospitals and a new reduction in orders over time among community hospitals.
An evidence-based dynamic order panel, integrated within the electronic medical record, was associated with a reduction in both C. difficile ordering and positive tests in comparison to a best practice advisory, although the impact varied between academic and community facilities.
This essay explores attitudes towards childhood in the surrealist novel but does so not via the familiar lens of psychoanalysis but via the concept of ’nostalgia’ as theorized by Svetlana Boym in her book The Future of Nostalgia (2001). Taking two contrasting examples of surrealist writing on childhood – Giorgio de Chirico’s seminal Hebdomeros (1929) on the one hand and Michel Leiris’s autobiographical novels Manhood (1939) and Scratches (1948) on the other – it is argued that, in both cases, Boym’s concept of ’reflective nostalgia’ (as opposed to ’restorative nostalgia’) provides a useful tool of analysis. However, the melancholic tone of de Chirico’s writing – with its stylistic debts to Lautréamont and Nietzsche – has a regressive dimension, and lacks the self-reflexivity specified in Boym’s account of a critically incisive ’reflective’ nostalgia. By contrast, Leiris’s more robust exploration of his male sexuality, along with the ’anthropological’ tenor of his analysis of the linguistic and material universe of childhood, fits more productively with Boym’s conception of a positive role for nostalgia within modernism.
At various stages of the COVID-19 pandemic, face coverings have been recommended and encouraged as one of the interventions to reduce transmission of the SARS-CoV-2 virus. However, in the earlier stages of the pandemic, decisions on face coverings relied primarily on evidence based on other viral respiratory infections. More direct evidence on the use of face coverings with COVID-19 developed in tandem with the pandemic.
Health Technology Wales undertook an ultra-rapid review to inform national guidelines, the work assessed the evidence on the effectiveness of face coverings to reduce SARS-CoV-2 transmission. We also reviewed evidence on the efficacy of different types of face coverings.
We conducted a systematic literature search for evidence to address (i) the effectiveness of face coverings to reduce the spread of COVID-19 in the community, and (ii) the efficacy of different types of face coverings designed for use in community settings. We identified a rapid review in 2021 by Public Health England that closely aligned with our review questions. This provided the main source for identifying relevant studies, supplemented by a search for publications following their search date.
We identified two evidence reviews (including the Public Health England review) that examined the effectiveness of face coverings on reducing transmission of SARS-CoV-2; reporting on 31 and 39 studies, respectively. Two further primary studies were published after the two evidence review searches were included. Overall, the evidence suggested that face coverings may provide benefits in preventing SARS-CoV-2 transmission, although the higher-quality studies suggested that these benefits may be modest. Medical masks appeared to have higher efficacy than fabric masks, although the evidence was mixed.
At the time of this review, evidence on the effectiveness of face coverings remains limited and conclusions rely on low-quality sources of evidence with high risk of bias, although higher-quality evidence points to some benefit. Face coverings may play a role in preventing transmission of SARS-CoV-2, particularly as part of a bundle of other preventative measures.
Émile Legrand was the leading scholar of modern Greek in late nineteenthcentury France; he also made a collection of songs sung by his mother and her neighbours, all lacemakers, in the village of Fontenay-le-Marmion in Normandy. Lacemakers in many parts of Europe had a distinctive work culture characterized by ballad singing, but this is the only evidence of lacemakers’ repertoire from Normandy. I speculate that Legrand's experiences growing up within this culture influenced his career as the progenitor of Akritic studies.
Keywords: Émile Legrand; Digenes Akrites; Gérard de Nerval; folksongs of Normandy; lacemakers; work culture
The Frenchman Émile Legrand (1841–1903) is best remembered as the progenitor of a subdiscipline in Greek letters – “Akritic studies.” In 1875 he was the first editor of a recently discovered manuscript of the Byzantine epic poem “Digenes Akrites,” the border warrior. And he was the first to propose a relationship between this medieval epic and modern ballads concerning the exploits of one Digenes Akritas. Four further manuscripts of the poem were located before the First World War, one of them also edited by Legrand. Scholars still debate their relationship to the oral ballads, whether the written poems rely on oral precursors, and if they concern any identifiable historical persons. In ways familiar to readers of Joep Leerssen's work, such philological and folkloric erudition has had political repercussions. The poems and songs of Akrites/Akritas were used to bolster the resurrected Greek state's ambitions over the lost territories of the Hellenes, stretching deep into Asia Minor.
Though Legrand showed little interest in classical Greek, he was devoted to the modern language; in addition to the two Akrites manuscripts he edited hundreds of other texts drawn from other manuscripts, early printed works and oral literature, some collected by himself. But the path which led him to the Chair of Modern Greek at the Paris School of Oriental Languages in 1887 was tortuous. The son of a village carpenter from Normandy, his parents encouraged him to enter the priesthood. He studied at the seminaries of Lisieux and Bayeux, but while he retained a religious sensibility he did not feel a vocation.
A friend of mine  mentioned a problem to me, which he was told had an interesting solution involving an unexpected square root. I have not seen this problem described elsewhere, so I have carried out my own analysis, which I will present here. In fact the solution involves not only square roots, but also higher roots … and a logarithm.
Many contend that U.S. state parties are increasingly polarized and nationalized, meaning that they have adopted divergent positions matching their national counterparts’ positions. Such trends reflect a transformation of America's historically decentralized party system. Yet, the precise timing of these related trends—as well as the mechanisms underpinning them—remain unclear. We assess these dynamics using a novel data set of 1,783 state party platforms between 1918 and 2017. Applying tools from automated and manual content analysis, we document a dramatic divergence in the topics emphasized by Democrats and Republicans starting in the mid-1990s, just as congressional speech became polarized. During this period, cross-state differences in each party's agenda decreased and regional/sectoral issues became less prominent, suggesting tight connections between polarization, nationalization, and state agendas. We also find that innovative phrases increasingly debut in state (not national) platforms. Overall, the evidence undercuts claims of top-down polarization emanating from national party leaders in Washington, DC. Polarization at the state and federal levels coincided with the development of an integrated network of activists spanning multiple levels of the polity.
We present the data and initial results from the first pilot survey of the Evolutionary Map of the Universe (EMU), observed at 944 MHz with the Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The survey covers
of an area covered by the Dark Energy Survey, reaching a depth of 25–30
rms at a spatial resolution of
11–18 arcsec, resulting in a catalogue of
220 000 sources, of which
180 000 are single-component sources. Here we present the catalogue of single-component sources, together with (where available) optical and infrared cross-identifications, classifications, and redshifts. This survey explores a new region of parameter space compared to previous surveys. Specifically, the EMU Pilot Survey has a high density of sources, and also a high sensitivity to low surface brightness emission. These properties result in the detection of types of sources that were rarely seen in or absent from previous surveys. We present some of these new results here.
The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
The two major approaches to studying macroevolution in deep time are the fossil record and reconstructed relationships among extant taxa from molecular data. Results based on one approach sometimes conflict with those based on the other, with inconsistencies often attributed to inherent flaws of one (or the other) data source. Any contradiction between the molecular and fossil records represents a failure of our ability to understand the imperfections of our data, as both are limited reflections of the same evolutionary history. We therefore need to develop conceptual and mathematical models that jointly explain our observations in both records. Fortunately, the different limitations of each record provide an opportunity to test or calibrate the other, and new methodological developments leverage both records simultaneously. However, we must reckon with the distinct relationships between sampling and time in the fossil record and molecular phylogenies. These differences impact our recognition of baselines and the analytical incorporation of age estimate uncertainty.