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Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance.
Contemporary US Supreme Court nominations are unavoidably and inevitably political. Although observers worry that political contestation over nominations undermines support for qualified nominees and threatens the Court's legitimacy, there is little empirical evidence to support these claims. The authors argue that political contestation over judicial nominations provides cues that shape the public's impressions about nominees and the Court and polarizes public opinion across partisan lines. Data from a conjoint experiment administered in the first days of the Trump presidency support this argument. Political rhetoric attributed to President Trump and Senate Democrats substantially polarized partisans’ views of nominees and evaluations of the Court's legitimacy, with Republicans (Democrats) expressing significantly more (less) favorable attitudes. Additional analyses suggest that contestation generates divergent partisan responses by affecting views about the nominee's impartiality. These findings challenge existing perspectives that depict attitudes toward the judiciary as resistant to partisan considerations and have important implications for the Court's legitimacy in a polarized era.
Though the demographic characteristics of judicial nominees in the United States have gained increased political attention in recent years, relatively little is known about how they affect public opinion toward judicial nominees and courts. We evaluate these relationships in the context of race and gender using a conjoint experiment conducted during a recent vacancy on the U.S. Supreme Court. We find consistent evidence that Americans are more supportive of coracial nominees, particularly among white Republicans and Black Democrats, but no evidence of a similar effect on the basis of gender. Our results have important implications for theories of descriptive representation and suggest limits to its use as a means for generating political support for judicial nominees.
Only 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis within 2 years. Efforts are thus underway to refine risk identification strategies to increase their predictive power. Our objective was to develop and validate the predictive accuracy and individualized risk components of a mobile app-based psychosis risk calculator (RC) in a CHR sample from the SHARP (ShangHai At Risk for Psychosis) program.
In total, 400 CHR individuals were identified by the Chinese version of the Structured Interview for Prodromal Syndromes. In the first phase of 300 CHR individuals, 196 subjects (65.3%) who completed neurocognitive assessments and had at least a 2-year follow-up assessment were included in the construction of an RC for psychosis. In the second phase of the SHARP sample of 100 subjects, 93 with data integrity were included to validate the performance of the SHARP-RC.
The SHARP-RC showed good discrimination of subsequent transition to psychosis with an AUC of 0.78 (p < 0.001). The individualized risk generated by the SHARP-RC provided a solid estimation of conversion in the independent validation sample, with an AUC of 0.80 (p = 0.003). A risk estimate of 20% or higher had excellent sensitivity (84%) and moderate specificity (63%) for the prediction of psychosis. The relative contribution of individual risk components can be simultaneously generated. The mobile app-based SHARP-RC was developed as a convenient tool for individualized psychosis risk appraisal.
The SHARP-RC provides a practical tool not only for assessing the probability that an individual at CHR will develop full psychosis, but also personal risk components that might be targeted in early intervention.
In this paper we develop a novel ray solver for the time-harmonic linearized Euler equations used to predict high-frequency flow–acoustic interaction effects from point sources in subsonic mean jet flows. The solver incorporates solutions to three generic ray problems found in free-space flows: the multiplicity of rays at a receiver point, propagation of complex rays and unphysical divergences at caustics. We show that these respective problems can be overcome by an appropriate boundary value reformulation of the nonlinear ray equations, a bifurcation-theory-inspired complex continuation, and an appeal to the uniform functions of catastrophe theory. The effectiveness of the solver is demonstrated for sources embedded in isothermal parallel and spreading jets, with the fields generated containing a wide variety of caustic structures. Solutions are presented across a large range of receiver angles in the far field, both downstream, where evanescent complex rays generate the cone of silence, and upstream, where multiple real rays are organized about a newly observed cusp caustic. The stability of the caustics is verified for both jets by their persistence under parametric changes of the flow and source. We show the continuation of these caustics as surfaces into the near field is complicated due to a dense caustic network, featuring a chain of locally hyperbolic umbilic caustics, generated by the tangency of rays as they are channelled upstream within the jet.
Highly magnetized accretion disks are present in high-mass X-ray binaries (HMXBs). A potential mechanism to explain the transition between the High/Soft and Low/Hard states observed in HMXBs can be attributed to fast magnetic reconnection induced in the turbulent corona. In this work, we present results of global general relativistic MHD (GRMHD) simulations of accretion disks around black holes that show that fast reconnection events can naturally arise in the coronal region of these systems in presence of turbulence triggered by MHD instabilities, indicating that such events can be a potential mechanism to explain the transient non-thermal emission in HMXBs. To find the zones of fast reconnection, we have employed an algorithm to identify the presence of current sheets in the turbulent regions and computed statistically the magnetic reconnection rates in these locations obtaining average reconnection rates consistent with the predictions of the theory of turbulence-induced fast reconnection.