It is a feature of modern nationhood that a declaration of independence is reified as a key inflection point, a specific moment in time during which a region and its people cease to be beholden to something else and begin to chart their own collective course. Independence thus represents both an end and a beginning. It is both a process and a goal. Independence is usually understood as a political act, a metaphorical coming of age, a goal achieved, and an event that brings hope. This collection of six recent books on independence in Age of Revolutions across the Atlantic world fit together to show how wartime worlds and worldviews may not fit as neatly into the textbook national story. They share an intellectual project of moving beyond the usual actors and narrative trajectories to introduce us to new perspectives on the events by looking at different regions and demographics: Austrian diplomats, British Foreign Office bureaucrats, Irish radicals, New England whalers, African traders, Chilean popular classes, Mexico City's night watchmen, and many others. These six authors tug at the standard chronology of Atlantic independence as well, pulling it back to the 1770s and extending its living impact into the 1850s. Taken together, they remind us that independence is a tricky concept, one that can look quite different depending on one's place in a broader matrix. Wars eventually end, but combative words and unreconciled worldviews collide and continue the struggle.

Background: Reflexive urine culturing, a strategy wherein urine cultures are only performed on samples with pyuria, is increasingly being used to reduce unnecessary urine cultures, healthcare costs, and inappropriate antibiotics. To support implementation of a reflexive urine-culture order for pediatric patients aged <18 years, we assessed the proportion of urine cultures that would be avoided with reflexive urine culturing, and we calculated the sensitivity and negative predictive value (NPV) of the ≥10 white blood cells (WBC) per high-powered field (HPF) threshold for diagnosing urinary tract infections (UTI) in patients aged <18 years who presented to the pediatric emergency department (ED). Methods: A retrospective review of patients <18 years with a urine culture performed from January to May 2022 in an urban, tertiary-care, pediatric ED was performed. A positive urine culture was defined as ≥50,000 CFU/mL for catheterized specimens and ≥100,000 CFU/mL for clean-catch or unspecified specimens. Pyuria was defined as ≥10 WBC/HPF. ‘True UTI’ was defined as a positive urine culture with a consistent clinical presentation (eg, fever or dysuria). Sensitivity, specificity, and NPV were calculated using the pyuria threshold of ≥10WBC/HPF compared to the gold standard of a ‘true UTI.’ Results: During the study period, 658 patients aged <18 years had urine cultures sent, of which 46 (7%) were positive. In all, 407 urine cultures (61.9%) were obtained by clean catch, 233 (35.4%) were obtained by urethral catheterization, 2 (0.3%) were obtained by Foley catheter, and 16 (2.4%) were unspecified. Among the 46 positive cultures, 32 (69.6%) had ≥10 WBC/HPF, and 55 (9.0%) of 612 negative cultures had ≥10 WBC/HPF. Of the 14 patients with positive urine cultures without pyuria, 8 had a contaminated sample or asymptomatic bacteriuria, 3 had urologic abnormalities, and 3 were infants aged <3 months. Of the 14 patients, 3 (21.4%) had a consistent clinical presentation for UTI and were treated with antibiotics: 2 were infants aged <3 months and 1 had urologic abnormalities. Using the ≥10 WBC/HPF threshold compared to ‘true UTI,’ sensitivity was 91.4%, specificity was 91.5%, positive predictive value was 36%, and NPV was 99.5%. Sensitivity and NPV increased to 100% when infants aged <3 months and urologic patients with positive urine culture were excluded. We estimated a cost saving of ~$200,000 had reflexive testing been in place. Conclusions: A reflexive urine culture for specimens with ≥10 WBC/HPF would have reduced the number of urine cultures substantially because 571 (86.8%) of 658 urine cultures would not have been performed. To prevent missed diagnoses of UTI, infants aged <3 months and children with urologic abnormalities should be excluded from this diagnostic stewardship intervention.

Disclosures: None

In his epic poem Paradise Regained (1671), John Milton has Satan observe that “The childhood shows the man/As morning shows the day/ Be famous then/ By wisdom. As the empire must extend/ So let extend thy mind o’er all the world.” As parents and as patriots, the leaders of Latin America's revolutions for independence wanted bright futures for both their children and their young nations. In many ways, the goals they set for each were the same: enhanced commercial opportunities, a political arena marked by greater freedom of speech and open debate, the rule of law, government with a strong moral center in which the privileged members of society had a responsibility to set a good example, and, perhaps most cherished of all, access to modern scientific and secular education. As figurative parents of emerging nations, and as biological parents of impressionable youth, these creole founding fathers wished to instill useful patriotic values in their national and personal families alike. Bridging the Enlightenment and Romantic eras, Latin American independence rhetoric blurred the distinction between nation-building and paternity, indicating that its leaders saw themselves as parents in more than one sense.

The events of Alberto Masferrer's life and the parallel evolution of his social thought reveal much about the broader forces which shaped El Salvador and Central America during his generation. His lifetime brackets the consolidation of the Salvadoran state and the formation of modern social groups. Alberto Masferrer was born in 1868, the age of the Liberal presidents' ascendence throughout Central America; he died in 1932 as Depression-era dictators assumed power throughout that same region. In fact, 1932 is a watershed year in Central American history. With Agustín Farabundo Martí's failed Communist uprising in El Salvador and the murder of Augusto Cesar Sandino in Nicaragua, the early 1930s brought a decisive end to the possibility for Masferrer's idealized type of elite-led reform and instead turned opponents toward ideologically-motivated popular revolt. Alberto Masferrer, like most intellectuals, struggled with ideas and power. He realized that the liberal reforms of the late nineteenth century Presidents not only had failed to improve the material and moral condition of the majority of his countrymen, but actually had degraded them. Though Masferrer's admiring biographer Matilde Elena López observed that “[t]he reality of man exploited by an unjust society is the central idea of his life,” it remains no easy task to categorize the cranky journalist's thought for, indeed, he does not fit neatly into any single ideology. Masferrer the humanist gave primary importance to the betterment of social and economic conditions for those living on the material plane, while Masferrer as a Christian stressed the otherworldly values of humility, hard work, patience and charity. Masferrer the communist called for a return to the ejidal landholding system of the traditional Indian communities and a guaranteed standard of living for all Salvadorans, but Masferrer the corporatist recognized the existence of a natural state of hierarchy and felt that harmony would prevail if each remained true to his pre-ordained vocation. Masferrer the aesthetic arielista venerated language and culture, but Masferrer the criollista could not be restrained to the world of pure art and consistently returned to earth to criticize uneven social conditions. Masferrer the hispano-falangist idealized a strong and vigorous nation, yet Masferrer the pacifist abhorred violence and aggressiveness.