To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Background: Urinary tract infections (UTIs) are often misdiagnosed and mismanaged. Disease state stewardship initiatives targeting UTIs through the development of institutional guidelines and real-time prospective audit and feedback (PAAF) on provider management may have a significant impact on the overuse of antimicrobials. Objective: Our study evaluated the effectiveness of a UTI focused disease state stewardship intervention by assessing institutional guideline adherence before and after implementation. Methods: This retrospective quasi-experimental study was conducted at a tertiary-care academic medical center. Patients >18 years of age receiving antimicrobials for a UTI were included. A previously performed retrospective review of UTI management from September-November 2017 was used as the baseline. The UTI management guideline was implemented in July 2018, and service lines were educated. A PAAF initiative began in June 2019, whereby the antimicrobial stewardship team performed daily reviews of patients receiving antimicrobials for UTIs. Data was collected on their management, and providers were contacted in real time with recommendations based on the institutional guideline. Patients reviewed June–October 2019 were included in the postimplementation analysis. Patients were excluded if they were pregnant, underwent a urological procedure with risk of mucosal bleeding, or were an outside hospital transfer already on UTI therapy. The primary outcome of this study was to evaluate guideline adherence before and after the implementation of PAAF for the management of UTIs. Results: In total, 198 patients in the preintervention group and 246 in the PAAF group were included. The emergency department was the primary ordering service of urinalyses (60.1% vs 66.1%; P = .2287) in both periods and altered mental status as the main indication for testing (35.2% vs 31.3%; P = .5465). Treatment of asymptomatic bacteriuria and pyuria decreased significantly between the 2 periods: 74.8% versus 36.2% (P = .0001). Appropriate ordering of urinalyses (33.8% vs 68.3%; P = .0001) and urine cultures (29.3% vs 61.0%; P = .0001) also improved in the PAAF group. Recommendations made during PAAF included therapy discontinuation (66.7%), antimicrobial therapy change (15.5%), or duration modification (15.5%), and 59.5% of first interventions were accepted. Overall guideline compliance significantly improved from 13.1% in the preintervention period to 26.1% in the PAAF period (P = .0011). Conclusions: A UTI disease state intervention was associated with significant reductions in the treatment of asymptomatic presentations as well as an improvement in overall guideline adherence. We believe that this approach represents a powerful stewardship strategy for decreasing unnecessary antimicrobial usage.
When noticing the people we pass on the street, chatting briefly with someone in line behind us at a cafe, or engaging in any other brief social interaction with a person that we may never meet again, we naturally form impressions of their personality and characteristics. In other situations, as when meeting new coworkers, interviewers and potential romantic partners, our desire to form accurate impressions may be quite conscious and deliberate.
What are the consequences of nationalist unrest? This paper utilizes two original datasets, which cover 377 city-level anti-Japanese protests during the 2012 Senkaku/Diaoyu Island crisis and the careers of municipal leaders, to analyse the downstream effects of nationalist unrest at the subnational level. We find both political and economic consequences of China's 2012 protest demonstrations against Japan. Specifically, top Party leaders in cities that saw relatively spontaneous, early protests were less likely to be promoted to higher office, a finding that is consistent with the widely held but rarely tested expectation that social instability is punished in the Chinese Communist Party's cadre evaluation system. We also see a negative effect of nationalist protest on foreign direct investment (FDI) growth at the city level. However, the lower promotion rates associated with relatively spontaneous protests appear to arise through political rather than economic channels. By taking into account data on social unrest in addition to economic performance, these results add to existing evidence that systematic evaluation of leaders’ performance plays a major role in the Chinese political system. These findings also illuminate the dilemma that local leaders face in managing popular nationalism amid shifting national priorities.
Why do some Chinese cities take part in waves of nationalist protest but not others? Nationalist protest remains an important but understudied topic within the study of contentious politics in China, particularly at the subnational level. Relative to other protests, nationalist mobilization is more clustered in time and geographically widespread, uniting citizens in different cities against a common target. Although the literature has debated the degree of state-led and grassroots influence on Chinese nationalism, we argue that it is important to consider both the propensity of citizens to mobilize and local government fears of instability. Analysing an original dataset of 377 anti-Japanese protests across 208 of 287 Chinese prefectural cities, we find that both state-led patriotism and the availability of collective action resources were positively associated with nationalist protest, particularly “biographically available” populations of students and migrants. In addition, the government's role was not monolithically facilitative. Fears of social unrest shaped the local political opportunity structure, with anti-Japanese protests less likely in cities with larger populations of unemployed college graduates and ethnic minorities and more likely in cities with established leaders.
Economic statistics inform citizens of general conditions, while central leaders use them to evaluate local officials. Are economic data systematically manipulated? After establishing discrepancies in economic data series cross-nationally, this article examines Chinese sub-national growth data. It leverages variation in the likelihood of manipulation over two dimensions, arguing that politically sensitive data are more likely to be manipulated at politically sensitive times. Gross domestic product (GDP) releases generate headlines, while highly correlated electricity production and consumption data are relatively unnoticed. In Chinese provinces, the difference between GDP and electricity growth increases in years with leadership turnover, which is consistent with juking the stats for political reasons. The analysis points to the political role of information and the limits of non-electoral accountability mechanisms in authoritarian regimes.
The reauthorization of the Pandemic and All-Hazards Preparedness Act in 2013 incorporated the dental profession and dental professionals into the federal legislation governing public health response to pandemics and all-hazard situations. Work is now necessary to expand the processes needed to incorporate and train oral health care professionals into pandemic and all-hazard response events.
A just-in-time (JIT) training exercise and immunization drill using an ex vivo porcine model system was conducted to demonstrate the rapidity to which dental professionals can respond to a pandemic influenza scenario. Medical history documentation, vaccination procedures, and patient throughput and error rates of 15 dental responders were evaluated by trained nursing staff and emergency response personnel.
The average throughput (22.33/hr) and medical error rates (7 of 335; 2.08%) of the dental responders were similar to those found in analogous influenza mass vaccination clinics previously conducted using certified public health nurses.
The dental responder immunization drill validated the capacity and capability of dental professionals to function as a valuable immunization resource. The ex vivo porcine model system used for JIT training can serve as a simple and inexpensive training tool to update pandemic responders’ immunization techniques and procedures supporting inoculation protocols.
How does redistributive policy affect the survival of authoritarian regimes? I argue that redistributive policy in favor of cities, while temporarily reducing urban grievances, in the long-run undermines regime survival by inducing urban concentration. I test the argument using cross-national city population, urban bias, and nondemocratic regime survival data in the post-WWII period. The results show that urban concentration is dangerous for dictators principally by promoting collective action, that urban bias induces urban concentration, and that urban bias represents a Faustian bargain with short-term benefits overwhelmed by long-term costs.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
In 2006, Palmer amaranth with confirmed resistance to glyphosate (GLY-R) was not controlled effectively in cotton with pyrithiobac, an acetolactate synthase (ALS)-inhibiting herbicide. Glyphosate at 870 g ae ha−1 or pyrithiobac at 70 g ai ha−1 applied postemergence provided 5 to 28% control of a putative GLY/ALS-R Palmer amaranth biotype in the field. Glyphosate at 6,930 g ha−1 and pyrithiobac at 420 g ha−1 applied alone provided no more than 89 and 65% control 1 to 8 wk after treatment (WAT), respectively. When applied as a tank mixture, glyphosate plus pyrithiobac at 870 + 70 g ha−1 provided between 16 and 41% control; glyphosate plus pyrithiobac at 6,930 + 420 g ha−1 controlled the Palmer amaranth in the field 89 to 95%. Dose-response analyses developed from greenhouse data indicated that the estimated glyphosate rates required to produce 50% injury and reduce plant fresh weights by 50% relative to the nontreated control in a suspected GLY/ALS-R Palmer amaranth biotype were 12 and 14 times greater, respectively, than the estimated values for the susceptible (S) biotype. The predicted pyrithiobac rates required to produce the same responses in the putative resistant population were 151 (50% injury) and 563 times (50% fresh weight reduction) greater than the estimated rates for the S biotype. Field and greenhouse analyses confirm that the Palmer amaranth biotype evaluated in both studies is resistant to glyphosate and an ALS-inhibiting herbicide.
Simulated or standardised patients have been used in medical education and other medical settings for some 30 years (Box 1). Their use encompasses undergraduate and postgraduate learning, the monitoring of doctors' performance and standardisation of clinical examinations. Simulation has been used for instruction in industry and the military for much longer (Jason et al, 1971) but the first known effective use of simulated patients was by Barrows & Abrahamson (1964), who used them to appraise students' performance in clinical neurology examinations.
The Care Programme Approach and its accompanying register were introduced in response to difficulties encountered in a young adult population. This paper describes the use of the register by an old age psychiatry service who do not routinely accept ‘graduate’ patients. Few patients had a diagnosis of dementia and most had psychiatric histories in excess of 10 years.
Email your librarian or administrator to recommend adding this to your organisation's collection.