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To examine rural–urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI).
Observational cohort study.
Using the IBM MarketScan Commercial Database (2010–2015), we identified US commercially insured women aged 18–44 years coded for uncomplicated UTI and prescribed an oral antibiotic agent. We classified antibiotic agents and durations as appropriate versus inappropriate based on clinical guidelines. Rural–urban status was defined by residence in a metropolitan statistical area. We used modified Poisson regression to determine the association between rural–urban status and inappropriate antibiotic receipt, accounting for patient- and provider-level characteristics. We used multivariable logistic regression to estimate trends in antibiotic use by rural–urban status.
Of 670,450 women with uncomplicated UTI, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Compared to urban women, rural women were more likely to receive prescriptions with inappropriately long durations (adjusted risk ratio 1.10, 95% CI, 1.10–1.10), which was consistent across subgroups. From 2011 to 2015, there was slight decline in the quarterly proportion of patients who received inappropriate agents (48.5% to 43.7%) and durations (78.3% to 73.4%). Rural–urban differences varied over time by agent (duration outcome only), geographic region, and provider specialty.
Inappropriate antibiotic prescribing is quite common for the treatment of uncomplicated UTI. Rural women are more likely to receive inappropriately long antibiotic durations. Antimicrobial stewardship interventions are needed to improve outpatient UTI antibiotic prescribing and to reduce unnecessary exposure to antibiotics, particularly in rural settings.
This chapter comprises the following sections: names, taxonomy, subspecies and distribution, descriptive notes, habitat, movements and home range, activity patterns, feeding ecology, reproduction and growth, behavior, parasites and diseases, status in the wild, and status in captivity.
The rapid emergence of rights of Nature over the past decade across multiple contexts has fostered increasing awareness, recognition, and, ultimately, acceptance of rights of Nature by the global community. Yet, too often, both scholarly publications and news articles bury the lede – namely, that the most transformative cases of rights of Nature have been consistently influenced and often actually led by Indigenous peoples. In this article we explore the ontologies of rights of Nature and earth jurisprudence, and the intersections of these movements with the leadership of Indigenous peoples in claiming and giving effect to their own rights (while acknowledging that not all Indigenous peoples support rights of Nature). Based on early observations, we discern an emerging trend of increased efficacy, longevity, and transformative potential being linked to a strongly pluralist approach of lawmaking and environmental management. A truly transformative and pluralist ecological jurisprudence can be achieved only by enabling, and empowering, Indigenous leadership.
Prospectively acquired Canadian cerebrospinal fluid samples were used to assess the performance characteristics of three ante-mortem tests commonly used to support diagnoses of Creutzfeldt–Jakob disease. The utility of the end-point quaking-induced conversion assay as a test for Creutzfeldt–Jakob disease diagnoses was compared to that of immunoassays designed to detect increased amounts of the surrogate markers 14-3-3γ and hTau. The positive predictive values of the end-point quaking-induced conversion, 14-3-3γ, and hTau tests conducted at the Prion Diseases Section of the Public Health Agency of Canada were 96%, 68%, and 66%, respectively.
In 2015, excavations at Stainton Quarry, Furness, Cumbria, recovered remains that provide a unique insight into Early Neolithic farming in the vicinity. Five pits, a post-hole, and deposits within a tree-throw and three crevices in a limestone outcrop were investigated. The latter deposits yielded potentially the largest assemblage of Carinated Bowl fragments yet recovered in Cumbria. Lipid analysis identified dairy fats within nine of these sherds. This was consistent with previous larger studies but represents the first evidence that dairying was an important component of Early Neolithic subsistence strategies in Cumbria. In addition, two deliberately broken polished stone axes, an Arran pitchstone core, a small number of flint tools and debitage, and a tuff flake were retrieved. The site also produced moderate amounts of charred grain, hazelnut shell, charcoal, and burnt bone. Most of the charred grain came from an Early Neolithic pit and potentially comprises the largest assemblage of such material recovered from Cumbria to date. Radiocarbon dating indicated activity sometime during the 40th–35th centuries cal bc as well as an earlier presence during the 46th–45th centuries. Later activity during the Chalcolithic and the Early Bronze Age was also demonstrated. The dense concentration of material and the fragmentary and abraded nature of the pottery suggested redeposition from an above-ground midden. Furthermore, the data recovered during the investigation has wider implications regarding the nature and use of the surrounding landscape during the Early Neolithic and suggests higher levels of settlement permanence, greater reliance on domesticated resources, and a possible different topographical focus for settlement than currently proposed.
The uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.
This analysis focuses on the institutional talk of sea-kayak guides and their clients in order to understand how guides negotiate the interactional balance of giving orders to maintain a safe and timely excursion while facilitating a fun and recreational experience. Using a mixed-method analysis including Conversation Analysis, ethnography, and statistics, this study examines 576 instances of directives found in video recordings of twenty-five Alaskan kayaking ecotourism excursions and explores the practices guides use in their talk to maintain control of an excursion while not coming across as domineering. By systemically examining directives’ design, directives are found to reveal both their temporal urgency in addition to the precipitating events that necessitate them, such as client behaviors or environmental stimuli. This study's analysis contributes to our understanding of how interactants mitigate face-threatening actions and focuses attention on the interactional work that directives and their accounts achieve in an institutional setting currently underinvestigated (Directives, mixed-methods, Conversation Analysis, ethnography, ecotourism)*
Declining sea ice is expected to change the Arctic's physical and biological systems in ways that are difficult to predict. This study used stable isotope compositions (δ13C and δ15N) of archaeological, historic, and modern Pacific walrus (Odobenus rosmarus divergens) bone collagen to investigate the impacts of changing sea ice conditions on walrus diet during the last ~4000 yr. An index of past sea ice conditions was generated using dinocyst-based reconstructions from three locations in the northeastern Chukchi Sea. Archaeological walrus samples were assigned to intervals of high and low sea ice, and δ13C and δ15N were compared across ice states. Mean δ13C and δ15N values were similar for archaeological walruses from intervals of high and low sea ice; however, variability among walruses was greater during low-ice intervals, possibly indicating decreased availability of preferred prey. Overall, sea ice conditions were not a primary driver of changes in walrus diet. The diet of modern walruses was not consistent with archaeological low sea ice intervals. Rather, the low average trophic position of modern walruses (primarily driven by males), with little variability among individuals, suggests that trophic changes to this Arctic ecosystem are still underway or are unprecedented in the last ~4000 yr.
In the Middle Ages, Christian women as well as men committed themselves to the practices of prayer, meditation, and asceticism that were the conditions usually associated with the mystical life. Some of them also committed themselves to producing texts in which they strove to communicate what they learned through their practices. The history of scholarship on medieval Christian mysticism has traditionally privileged texts by male authors as representing the pinnacle or at least the mainstream of mystical accomplishment, thereby marginalizing texts by women as secondary or derivative. Recent attention to women's texts as representing “feminine” mysticism is usually marked by an insistence on their affectivity and on “paramystical” physical phenomena. These approaches obscure how thoroughly affective many mystical texts by men are, how male mystics were often influenced by women, and how male texts about female mystics tended to emphasize paramystical experience. “Women's mysticism” is thus a problematic category, and the attention to women's mystical texts in this essay is not an assertion of any inherently female essence to the subject matter. What is common to most if not all women's mystical literature is an awareness of the suspicion about women's authority to teach, or a discomfort with cultural assumptions about the nature of women and their religiosity. These commonalities are due, of course, not to an essential female nature but to women's awareness of cultural norms that ascribed to them a particularly carnal nature, and that positioned men as authoritative teachers, mediators of sacramental grace, and confessors of sins.
I offer here a characterization of mystical life that is relevant for the study of both male and female medieval mystics. It is a life structured by “tuning” the self – body, mind, and emotions – to seek the presence of the divine, and preparing the self to be invaded or flooded or lifted up, thus losing a clear sense of the boundaries of the self. The emphasis here is on a structured life of practice, not a single type of “peak experience.” Furthermore, where extraordinary psychological experiences are described, they are often not the primary focus of the authors’ concerns; rather, mystical authors are often primarily concerned with praising God, teaching proper devotion, and leading the moral life.
The years between the early fourteenth and the mid sixteenth century are of considerable interest in the history of the prelate. In some respects, this era might be regarded as a golden age of prelacy, culminating in the appearance of great ecclesiastical dignitaries across much of Europe, such as Wolsey, d'Amboise, Cisneros, Lang and Jagiellon. In terms of their political weight, their grandeur and their wide-ranging cultural patronage, these early sixteenth-century ‘cardinal-ministers’ arguably represented a high point in prelatical influence. Nor should they be regarded as wholly distinct from their clerical contemporaries: recent studies of Renaissance cardinals and the early Tudor episcopate indicate that the next rank of senior churchmen were no less concerned to express the importance and dignity of their office. However, the period c. 1300–c. 1560 also witnessed a developing critique of prelacy – not unconnected with these eye-catching assertions of ecclesiastical status and power – with complaints about senior members of the Church hierarchy a commonplace in the literature and preaching of the day. To these criticisms were added attacks on the very concept of the prelate, which was rejected as unscriptural by John Wyclif and his followers: a critique which would be taken up enthusiastically by sixteenth-century reformers in England and Europe.