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Cooperation among militant organizations contributes to capability but also presents security risks. This is particularly the case when organizations face substantial repression from the state. As a consequence, for cooperation to emerge and persist when it is most valuable, militant groups must have means of committing to cooperation even when the incentives to defect are high. We posit that shared ideology plays this role by providing community monitoring, authority structures, trust, and transnational networks. We test this theory using new, expansive, time-series data on relationships between militant organizations from 1950 to 2016, which we introduce here. We find that when groups share an ideology, and especially a religion, they are more likely to sustain material cooperation in the face of state repression. These findings contextualize and expand upon research demonstrating that connections between violent nonstate actors strongly shape their tactical and strategic behavior.
Background: Acute respiratory infections (ARIs) are a key target to improve antibiotic use in the outpatient setting. The Core Elements of Outpatient Antibiotic Stewardship provide a framework for improving antibiotic use, but data on safety and effectiveness of interventions to improve antibiotic use are limited. We report the impact of Core Elements implementation within Veterans’ Healthcare Administration clinics on antibiotic prescribing and patient outcomes. Methods: The intervention targeting treatment of uncomplicated ARIs (sinusitis, pharyngitis, bronchitis, and viral upper respiratory infections [URIs]) in emergency department and primary care settings was initiated within 10 sites between September 2017 and January 2018. The intervention was developed using the Core Elements and included local site champions, audit-and-feedback with peer comparison, and academic detailing. We evaluated the following outcomes: per-visit antibiotic prescribing rates overall and by diagnosis; appropriateness of treatment; 30-day ARI revisits; 30-day infectious complications (eg,, pneumonia,); 30-day adverse medication effects; 90-day Clostridium difficile infection (CDI); and 30-day hospitalizations. Multilevel logistic regression was used to calculate rate ratios (RR) with 95% CI for each outcome in the postintervention period (12 months) compared to the preintervention period (39–42 months). Results: There were 14,020 uncomplicated ARI visits before the intervention and 4,866 uncomplicated ARI visits after the intervention. The proportions of uncomplicated ARI visits with antibiotics prescribed were 59.17% before the intervention versus 44.34% after the intervention. A trend in reduced antibiotic prescribing for ARIs throughout the entire (before and after) observation period was evident (0.92; 95% CI, 0.90–0.94); however, a significant reduction in antibiotic prescribing after the intervention was identified (0.74; 95% CI, 0.59–0.93). Per-visit antibiotic prescribing rates decreased significantly for bronchitis and URI (0.54; 95% CI, 0.44–0.65), pharyngitis (0.76; 95% CI, 0.67–0.86), and sinusitis (0.92; 95% CI, 0.85–1.0). Appropriate therapy for pharyngitis increased (1.43; 95% CI, 1.21–1.68), but appropriate therapy for sinusitis remained unchanged (0.92; 95% CI, 0.85–1.0) after the intervention. Complications associated with antibiotic undertreatment were not different after the intervention: ARI-related revisit rates (1.01; 95% CI, 0.98–1.05) and infectious complications (1.01; 95% CI, 0.79–1.28). A potential benefit of improved antibiotic use included a reduction in visits for adverse medication effects (0.82; 95% CI, 0.72–0.94). Furthermore, 90-day CDI events were too sparse to model: preintervention incidence was 0.08% and postintervention incidence was 0.06%. Additionally, 30-day hospitalizations were significantly lower in the postintervention period (0.79; 95% CI, 0.72–0.87). Conclusions: Implementation of the Core Elements was safe and effective and was associated with reduced antibiotic prescribing rates for uncomplicated ARIs, improvements in diagnosis-specific appropriate therapy, visits for adverse antibiotic effects, and 30-day hospitalization rates. No adverse events were noted in ARI-related revisit rates or infectious complications. CDI rates were low and unchanged.
To develop a candidate definition for central line–associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants
Multicenter retrospective cohort study.
Neonatal intensive care units from 14 US children’s hospitals and pediatric facilities.
A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.
During 2009–2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).
While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.
Infect Control Hosp Epidemiol 2014;35(11):1391–1399
The Treaty of Lisbon introduced an extension of locus standi for private claimants by amending Article 263(4) TFEU. The provision contains a new third variant for actions against ‘regulatory acts which do not entail implementing measures’. However, it is far from clear to what extent the existing framework has actually been reformed. The CJEU has not yet had the opportunity to define the term ‘regulatory act’. In our view, this term has to be interpreted narrowly. It merely encompasses non-legislative acts enacted under Articles 290 and 291 TFEU. Those subordinate legal acts are characterised by a lack of democratic legitimacy, which justifies a lower threshold for judicial review. Hence, the possibilities for an action for annulment remain limited for private applicants. Effective remedies against legal acts of EU law are provided primarily by the courts of the Member States. The tentative reforms brought by the Treaty of Lisbon did not change the decentralised structure of the EU’s judicial system.
The effects of rapid rotation on stellar evolution can be profound but we are only now starting to gather the data necessary to adequately determine the validity of the many proposed models of rotating stars. Some aspects of stellar rotation, particularly the treatment of angular momentum transport within convective zones, still remain very poorly explored. Distinguishing between different models is made difficult by the typically large number of free parameters in models compared with the amount of available data. This also makes it difficult to determine whether increasing the complexity of a model actually results in a better reflection of reality. We present a new code to straightforwardly compare different rotating stellar models using otherwise identical input physics. We use it to compare several models with different treatments for the transport of angular momentum within convective zones.
This article addresses the question of whether higher education music courses adequately prepare young musicians for the critical transition from music undergraduate to professional. Thematic analyses of interviews with 27 undergraduate and portfolio career musicians representing four musical genres were compared. The evidence suggests that the process of transition into professional life for musicians across the four focus genres may be facilitated when higher education experiences include mentoring that continues after graduation, the development of strong multi-genre peer networks, the provision of many and varied performance opportunities and support for developing self-discipline and autonomy in relation to the acquisition of musical expertise. Implications for higher education curricula are discussed.