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This study examines whether behaviourally informed training can improve the effectiveness of phone-based tax debt collection in a public-sector setting. In collaboration with the Bulgarian National Revenue Agency, we implemented a two-day training programme for call centre agents focused on persuasion, negotiation and behavioural influence techniques derived from behavioural science and nudge theory. The impact of the intervention is assessed using descriptive comparisons of monthly aggregated debt-collection performance indicators before and after the training. We find that, following the intervention, trained agents achieved markedly better outcomes relative to pre-intervention periods, including an increase of approximately 20% in the total amount of debt collected over the subsequent three months and a higher rate of secured payment agreements. Notably, these improvements contrast with historical seasonal patterns that typically show a decline in collections during the same period. While the analysis is descriptive and does not permit definitive causal inference, the results provide strong indicative evidence that targeted behavioural training can enhance compliance outcomes in live, interpersonal interactions. The study contributes to the behavioural public policy and persuasion literatures by extending behavioural insights beyond written or digital nudges to real-time, conversational settings. From a practical perspective, the findings highlight the potential value of soft-skills and behavioural training for frontline public servants as a scalable and cost-effective tool for improving tax administration performance.
Electroconvulsive therapy (ECT) is an effective treatment of severe manifestations of mental illness. Since delay in initiation of ECT can have detrimental effects, prediction of the need for ECT could improve outcomes via more timely treatment initiation. Therefore, this study aimed to predict the need for ECT following admission to a psychiatric hospital.
Methods:
This study was based on electronic health record (EHR) data from routine clinical practice. Adult patients admitted to a hospital within the Psychiatric Services of the Central Denmark Region between January 2013 and November 2021 were included in the study. The outcome was initiation of ECT >7 days (to not include patients admitted for planned ECT) and ≤67 days after admission. The data was randomly split into an 85% training set and a 15% test set. On the 7th day of the inpatient stay, machine learning models (extreme gradient boosting) were trained to predict initiation of ECT and subsequently tested on the test set.
Results:
The cohort consisted of 41,610 patients with 164,961 admissions. In the held out test set, the trained model predicted ECT initiation with an area under the receiver operating characteristic curve of 0.94, 47% sensitivity, 98% specificity, positive predictive value of 24% and negative predictive value of 99%. The top predictors were the highest suicide assessment score and mean Brøset violence checklist score in the preceding three months.
Conclusions:
EHR data from routine clinical practice may be used to predict need for ECT. This may lead to more timely treatment initiation.
This study investigated changes in serum folate and B12, and associations with endurance performance and bone outcomes, in women during military training. Women (n = 137) had serum folate and B12, haematological markers, and endurance performance (2.4 km run) measured at the start (week 1) and end (week 13) of British Army basic training. Whole-body areal bone mineral density and markers of bone metabolism were measured at week 1. Training decreased serum folate (mean change [95% CI], −2.3 [−3.0, −1.6] nmol∙L-1, p < 0.001), B12 (−16 [−32, 0] pmol∙L-1, p = 0.042), haemoglobin (−0.7 [−0.9, −0.5] g∙dL-1, p < 0.001), and red blood cell (RBC) count (−0.2 [−0.3, −0.2] × 10^9∙L-1, p < 0.001), but had no effect on mean corpuscular volume (p = 0.438) or erythrocyte distribution width (p = 0.088). There was no association between serum folate, serum B12, haemoglobin, or RBC count with run time (p ≥ 0.518). Serum B12 was not associated with areal bone mineral density or bone metabolism at week 1 (p ≥ 0.152). Higher serum folate was associated with lower plasma c-telopeptide cross-links of type I collagen (standardised β [95% CI] = −0.31 [−0.48, −0.15], p < 0.001), but not whole-body bone mineral density or plasma procollagen type I N-terminal propeptide (p ≥ 0.152). Serum folate and B12 decreased after military training in women, resulting in a high prevalence of folate deficiencies at the end of training. Low serum folate may contribute to increased bone resorption, the implications of which are unclear.
Dr. Mark Rupp served as Medical Director of the Infection Prevention Department at Nebraska Medicine for 28 years and as Chief of the Division of Infectious Diseases for 14 years before assuming his current role as Interim Chair of the Department of Internal Medicine at the University of Nebraska Medical Center (UNMC) in 2025. He is a Past President of the Society for Healthcare Epidemiology of America (SHEA; 2009) and delivered the SHEA Lecture at IDWeek 2020.
Dr. Rupp has authored more than 200 peer-reviewed articles, 48 book chapters, three textbooks, and holds three U.S. patents. He is an internationally recognized expert in clinical infectious diseases and healthcare epidemiology and is a frequent national and international speaker, educator, and media contributor.
Authoritarian regimes have increasingly leveraged foreign media to project influence within democracies, yet evidence of these co-opted outlets’ actual effects remains scarce. This study presents findings from a field experiment conducted during Taiwan’s 2020 general election, assessing the impact of The China Times, a Beijing-backed media conglomerate, on voter behavior and attitudes. The experiment incentivized participants to engage in sustained consumption of real-time news from this outlet in the weeks leading up to the election. Results from a panel survey linked to individual-level web-tracking data reveal that exposure to The China Times sways voters in favor of the People’s Republic of China (PRC). These effects, however, are primarily driven by nonpartisan and PRC-friendly voters. To the extent that I find effects among PRC-skeptics, they show evidence of backfiring. As Beijing’s media co-optation extends beyond Taiwan, my findings have broader implications for understanding the effectiveness and limitations of authoritarian influence operations.
This article explores the Detached Papers of the Company of Merchants Trading to Africa, an underused sub-series within The National Archives’ T 70 collection. These records offer a unique and detailed insight into the British administration of West African forts, and the lives of enslaved people forced to work in these fortifications. While the Royal African Company has been the subject of extensive scholarship, the Company of Merchants – its successor – remains understudied. Through letters, minute books, fort lists, and financial records, the Detached Papers, recently catalogued at item level for the first time, provide a critical and untapped source on the eighteenth-century Atlantic world, revealing overlooked narratives of local relationships, familial networks, and the operational structures that underpinned the transatlantic trade in enslaved Africans. This article focuses on three key areas to exemplify the importance of these records for future research: the cultural and political life of the Fante; the networks and influence of Company Governor Richard Miles; and the identities and experiences of enslaved people in British-controlled forts. By engaging with the fragmentary nature of these records, the article interrogates archival silences to surface the submerged histories of exploitation, agency, and survival within the archives of enslavement.
Ischaemic heart disease (IHD) is a global health issue, with people of Indian origin facing earlier onset and more severe cases, leading to higher mortality at younger ages compared to Western countries. Indian migrants maintain similar risks post-migration. Managing modifiable risk factors and improving risk knowledge and health-seeking behaviours are essential, but research on IHD risk perceptions among Indian migrants is limited.
Aim:
This study explores how first-generation Indian migrants perceive their IHD risk and the factors influencing these perceptions.
Methods:
As a component of a mixed- method study, a qualitative descriptive study design was employed to examine study participants perception of their IHD risk and the influencing factors. Semi-structured interviews were conducted with Indian migrants residing in metropolitan Melbourne, Victoria using multiple Indian languages and English. Data were analysed in the original language, with findings reported in English. NVivo software was used for data management and analysis. A qualitative content analysis was conducted using a hybrid coding approach where the main categories were developed deductively and subcategories were developed inductively from the data.
Results:
Twenty interviews were conducted with participants aged 32 to 70, 55% of whom were female, with an average stay in Australia of 11.2 years. The main themes included: perceptions shaped by personal experiences, especially family history, with most underestimating their risk; migration, cultural norms, and time constraints hindering behaviour change; family support, religious beliefs, and longevity aspirations motivating healthier behaviours; and limited primary healthcare engagement and culturally appropriate health resources. These results are discussed within the context of Capability, Opportunity and Motivation model of behaviour change (COM-B).
Conclusion:
The study highlights key factors influencing IHD risk perceptions among Indian migrants. By understanding these specific risk perceptions and cultural nuances, healthcare professionals can develop and implement more effective, culturally sensitive health promotion and disease prevention strategies. This tailored approach can lead to better patient outcomes and a more equitable healthcare system.
The aim of this review was to identify, review, and synthesize primary qualitative literature to answer the question “what are the roles and experiences of informal caregivers providing care to a person with non-malignant respiratory disease at end of life from the perspectives of the caregiver and recipient of care?”
Methods
This qualitative systematic review was undertaken using thematic synthesis. Electronic databases (British Nursing Database, Cumulative Index to Nursing and Allied Health Literature Plus, Medline, PsycInfo, ProQuest Sociology, Allied and Complementary Medicine Database [AMED]) covering nursing, medicine, and social sciences were systematically searched from inception to October 2024. Studies were included if they reported data on the experiences and roles of caregivers in non-malignant respiratory disease at end of life, from the perspective of the caregiver or the person with non-malignant respiratory disease. Twenty-two papers met the eligibility criteria and were included in the review. Quality assessment was undertaken using the JBI Critical Appraisal Checklist for Qualitative Research.
Results
Thematic synthesis of the data generated five analytical themes: Caregivers experience shifting identity and new roles; Adaptation is necessary to cope with loss and change; Caregivers need more information and coordinated care services; Emotional effects of caregiving; and Future uncertainty and facing death. The findings illustrated the complexity of the caregiving role and highlight unmet needs during the end of life stage.
Significance of results
This evidence synthesis highlights the significant contribution caregivers make in the lives and deaths of those with non-malignant respiratory disease. Challenges of caregiving in this context increase the stress of caregivers, including unpredictable disease progression and difficult symptoms such as breathlessness. There are persistent inequalities between malignant and non-malignant care pathways. Caregivers would welcome more recognition and information from healthcare professionals to support their role.
The influence of one of a bilingual’s languages on the other is known as cross-linguistic influence (CLI). In grammatical gender acquisition, CLI can occur during gender discovery, assignment and agreement. The present study investigates CLI in Dutch as a heritage language, a language with a non-transparent gender system, in two groups of bilingual children. One (i.e., Dutch-German bilingual children) is acquiring languages with similar gender systems and the other (i.e., Dutch-French bilingual children) is acquiring languages with more distant gender systems. We found CLI in gender discovery, gender assignment and gender agreement for the Dutch-German group but not for the Dutch-French group. Moreover, CLI simultaneously facilitated and hindered gender acquisition within the children, depending on the gender congruency of the nouns. This suggests co-activation of grammatical gender values in bilingual children. The findings help us better understand when cross-linguistic influence takes place and how it affects acquisition in bilingual children.
Though critic Paul Scudo predicted in 1850 that the French romance would be ‘more respected by posterity than many weighty scores’, the once-ubiquitous song genre has all but disappeared from modern recitals and musicological histories. While the reasons for this erasure are undoubtedly multifaceted, I argue that the loss of the vocal performance practices that animated the genre played a significant role. Specifically, French singers in the domestic sphere – commonly labelled ‘romance singers’ and exemplified by figures like the tenor Richelmi – cultivated an entirely different vocal production than the one popularzied by Gilbert Duprez and typically heard in classical singing today. This technique, known as the timbre clair (clear timbre), was produced using a rising larynx and a lowering soft palate, resulting in a bright, thin, delicate, and even slightly nasal sound that became a hallmark of early and mid-nineteenth-century French singing. Moreover, composers and audiences expected singers to adopt a declamatory approach when performing romances, to constantly vary the colour of their voices for expressive effect. By so doing, performers imbued these seemingly simple songs with a sophistication and nuanced meaning not readily apparent in the scores themselves. This study of timbral aesthetics – which, I suggest, ought to be more seriously explored in modern performance contexts – undercuts conceptions of the genre as vacuous or meaningless and sheds light on an essential aspect of the nineteenth-century French sound world.
To date, there has been a long-term debate between the monetarists and Keynesian schools on the elements of inflation in countries, whether monetary or fiscal. Over the years, with the advent of the political economics and the governments’ active participations to the economic and social activities, a new factor, among others, in the name of good governance – say, controlling the corruption level – has arisen as the decider of inflation in countries. This study aims to examine empirically whether money supply, government expenditure (both capital and revenue) and corruption do maintain any long-run associations and short-run dynamics with inflation for the panel of the world’s 20 leading countries. The results reveal a long-run association between the fiscal, monetary, and governance variables, and inflation; and in the short run, there are causal influences from total government expenditure, money supply and corruption to inflation in developed countries, but capital and revenue expenditures, money supply and corruption cause inflation in developing countries.
The ethics of the international monetary system (IMS) can be framed either as a case of background injustice or of structural injustice. Both ideas suggest that due to the background conditions, the interaction of agents, in a context of no rules, can lead to domination and unfairness. Moreover, both ideas emphasise the need to create regulation, or a structure, that prevents domination and unfairness. This article asks how (if at all) do monetary regimes, or each of the three scenarios that stem from the Mundell-Fleming trilemma, raise domination and unfairness. This article identifies domination and unfairness in both regimes with open capital markets: the one with floating exchange rates and the one with fixed exchange rates. Moreover, it offers a principle of non-domination, according to which institutions of the IMS ought to guarantee effective sovereignty of participant states or offer an equal distribution of this value when securing full effective sovereignty for all is not possible. For the last regime, of closed capital markets, this article identifies unfairness but no domination. By identifying domination and unfairness in each regime, this article proposes policies and regulation, or a structure, to prevent and mitigate these issues.
Mental health literacy (MHL) strategies are crucial for mental health promotion and prevention. This study aimed to determine the acceptability, feasibility, appropriateness and initial efficacy of an adapted MHL program in a community sample of adults in Kenya. This was a quasi-experimental pre-post study conducted from July 2023 through July 2024. The MHL program contained nine modules delivered over 3 days. Participants were assessed at baseline and immediately after the program. The primary outcomes were mental health knowledge and participants’ attitudes on mental health/illness. Secondary outcomes included depressive symptoms, anxiety symptoms, self-perceived social support, self-perceived wellbeing, MHL program acceptability, feasibility and appropriateness. Relative to baseline, we observed statistically significant improvement in mental health knowledge and attitude on mental health/illness postintervention. We also observed significant improvements in all secondary outcomes. The MHL program also emerged as contextually appropriate, acceptable and feasible. The adapted MHL program is acceptable and appropriate and can feasibly be delivered by trained non-specialist facilitators. Also, the MHL program has the potential to increase participants’ MHL and attitudes and reduce symptoms of common mental disorders and promote self-perceived wellbeing. Future research should explore how improvements can be sustained over the long term.
Linnaean taxonomy, which imposes hierarchical classifications based on morphological characteristics, has become deeply embedded in modern data architecture, from databases to metadata schemas to AI training datasets. With its hierarchical structure and rigid categorization, Linnaean taxonomy privileges one type of knowledge while marginalizing alternative taxonomies that offer more fluid, contextual, and relational understandings of the natural world. This paper examines how the legacy of Linnaean taxonomy continues to shape contemporary classification systems and artificial intelligence (AI). Indigenous knowledge systems, which include spiritual, cultural, and ecological dimensions, view entities not as isolated objects but as nodes in dynamic, interconnected networks. We draw from the French naturalist, Comte de Buffon, who, in line with Indigenous knowledge systems, viewed nature as continuous and contextual rather than discretely compartmentalized. The dominance of Linnaean-style classification in AI and data systems perpetuates colonial power dynamics and contributes to knowledge homogenization while losing Indigenous languages and classification systems crucial for addressing contemporary environmental challenges, particularly in agriculture and biodiversity conservation. In this Age of AI, we call for a holistic and ecological approach to archives. Therefore, we propose applying ‘rhizomatic hylomorphism,’ an ethnobiological, alternative classification that transcends hierarchical taxonomies to embrace multiplicity, relationality, and contextual meaning.