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Psychiatry seems beleaguered: from underfunding of education, training, research and services to marginalisation within the healthcare world and even doubts about its relevance. Medical training, with advanced relational and formulation skills and a strong foundation of research, equips psychiatrists to exercise clinical leadership across the healthcare landscape. This expertise can and must be used to benefit patient care.
Given the surging economic and health costs associated with childhood stunting, identifying its associated factors is crucial. This study therefore explores a key determinant of long-term nutritional status, women’s participation in household decision-making in the context of Pakistan. To empirically estimate this association, three-level modelling was employed by pooling the data from two recent nationally representative survey rounds PDHS 2012–13 and PDHS 2017–18. Multilevel analysis was better suited compared to traditional methods for robust estimates because of the hierarchical nature of the data. Women’s decision-making power was measured by formulating an index through factor analysis from the direct questions about women’s participation in household decisions. This study found a positive association between women’s decision-making power and children’s nutritional growth at the national level, with no significant changes across the survey years. However, this relationship was moderated by regional variations, which was more pronounced in Sindh and relatively modest in other regions. The sensitivity analysis showed that among the different decision-making domains, only women’s participation in large household purchases was significantly and positively associated with child linear growth. The insights of this research suggest that nutrition-oriented policies should also consider non-nutritional factors, like women’s decision-making power when designing projects for target population. Meanwhile, it is also crucial to recognize that decision-making power is a contextual factor and its effect on child nutritional growth may vary across regions.
Unstable approaches are one of the main safety concerns that contribute to approach and landing accidents. The International Air Transport Association reports that, between 2012 and 2016, 61% of accidents occurred during the approach and landing phase, of which 16% involved unstable approaches. This study addresses this issue by applying the Functional Resonance Analysis Method to examine the dynamics of stable approaches. A total of 195 aviation safety reports, which referred to near-miss data from a single airline, were used in the analysis to identify both actual and aggregated variability. The findings revealed that variability mainly occurred in the following functions: control speed, configure aircraft for landing, communicate with air traffic control and manage flight paths. Effective communication, coordination and collaboration, as well as monitoring, briefings and checklists, were key factors in managing the variability of a stable approach. The study reveals how adopting a perspective of ‘how things go right’ provides insightful findings regarding approach stability, complementing traditional approaches focused on ‘what went wrong’. This study also highlights the value of utilising the Functional Resonance Analysis Method to analyse near-miss data and uncover systemic patterns in everyday flight operations.
Municipal parties in Canada are unique: They are not branches of national parties, they have no established ideological orientation and their lifespans vary considerably. In light of these characteristics, political scientists tend to overlook the factors that contribute to their emergence and disappearance as well as the diversity of their forms. The objective of this article is to fill this gap. Taking the city of Montreal as a case study, we draw on an electoral database spanning from 1960 to 2001 and a systematic press review to show that a party’s longevity is influenced by factors that are either external to the parties (institutional, economic and provincial political context) or internal to the parties (strong internal coordination, charismatic leader and ability to survive after a leader’s departure). For Montreal, this translates into a longer lifespan for two types of parties: platform-based parties and government coalitions.
Control of small turbojet engines is challenging due to the small number of sensors and actuators. In these engines, typically the spool speed and exhaust gas temperature are the measured variables and the fuel flow is the only manipulated variable. However, the thrust command must be achieved and the engine’s structural and operational limitations must be safeguarded. In this research, a minimum selector control structure with a saturation function is presented for controlling small turbojet engines. One control loop is considered to control the spool speed and another loop is used to manage the exhaust gas temperature. The output of the control loops is the fuel flow rate and the minimum value is selected between them. To prevent the compressor surge and combustor blow-out during engine acceleration/deceleration, a fuel flow rate saturation is defined. Due to the switching structure of the proposed controller and existence of the saturation function, stability analysis is a critical issue. Therefore, a methodology is presented to analyse the stability of the proposed structure. In simulation study, a nonlinear thermodynamic model that matches more than 90% with the test data is used and the response of the proposed controller is compared with a proportional integral (PI) controller. In a comprehensive scenario, the throttle degree varies from 75% to 100%. Using the PI controller, some outputs have some overshoot and the exhaust gas temperature exceeds the corresponding constraint by 40K. While the proposed minimum selector controller, in addition to accurately fulfilling the thrust command, fully protects the limitations governing engine variables.
Ultra-processed foods (UPFs), defined using frameworks such as NOVA, are increasingly linked to adverse health outcomes, driving interest in ways to identify and monitor their consumption. Artificial intelligence (AI) offers potential, yet it’s application in classifying UPFs remains underexamined. To address this gap, we conducted a scoping review mapping how AI has been used, focusing on techniques, input data, classification frameworks, accuracy, and application. Studies were eligible if peer-reviewed, published in English (2015–2025), and they applied AI approaches to assess or classify UPFs using recognised or study-specific frameworks. A systematic search in May 2025 across PubMed, Scopus, Medline, and CINAHL identified 954 unique records with eight ultimately meeting the inclusion criteria; one additional study was added in October following an updated search after peer review. Records were independently screened and extracted by two reviewers. Extracted data covered AI methods, input types, frameworks, outputs, validation, and context. Studies used diverse techniques, including random forest classifiers, large language models, and rule-based systems, applied across various contexts. Four studies explored practical settings: two assessed consumption or purchasing behaviours, and two developed substitution tools for healthier options. All relied on NOVA or modified versions to categorise processing. Several studies reported predictive accuracy, with F1 scores from 0.86 to 0.98, while another showed alignment between clusters and NOVA categories. Findings highlight the potential of AI tools to improve dietary monitoring and the need for further development of real-time methods and validation to support public health.
The development of the forcing method has shown that several key questions regarding infinite sets cannot be settled under ZFC alone. The most widely supported view is that this undecidability simply reflects the limitations of ZFC in addressing all mathematical problems. This perspective has motivated an extensive search for new axioms—the so-called large cardinal axioms—which, when added to ZFC, yield a deeper and more robust understanding of the set-theoretic universe. Along this line, the dissertation is divided into three thematic blocks, each of them framed within these extensions of ZFC:
• Very large cardinals at the threshold of Kunen inconsistency, with a focus on elementarity and cardinal correctness (Chapter 2).
• Generalized Descriptive Set Theory at singular strong limit cardinals of countable cofinality, with a focus on two regularity properties (Chapter 3).
• Covering lemmas and Woodin’s HOD Dichotomy through the lens of Shelah’s pcf theory (Chapter 4).
Specifically, Chapter 2 establishes an inconsistency result using tools from singular cardinal combinatorics and Shelah’s pcf theory, proving the nonexistence of cardinal preserving elementary embeddings into V and establishing thereby a limitation in the hierarchy of large cardinal axioms. The proof is based on the notion of good scales and its connection with Jónsson cardinals. Chapter 3 proves a consistency result obtained via a Prikry-type forcing construction, providing a singular-cardinal analogue of Solovay’s theorem. This thematic block is inspired by Woodin’s Axiom $I_0$ which provides the appropriate axiomatic framework to develop Generalized Descriptive Set Theory in generalized Baire/Cantor spaces at singular cardinals. Concretely, we construct a model of ZFC where $\kappa $ is a strong limit singular cardinal with countable cofinality, and every subset of ${}^\omega \kappa $ in $L(V_{\kappa +1})$ has both the $\kappa $-Perfect Set Property and the $\vec {\mathcal {U}}$-Baire Property. Chapter 4 further explores the study of “covering lemmas” and Woodin’s HOD Dichotomy, employing both the perspective and the tools of pcf theory. Specifically, the connection between the cover property and a new pcf-theoretic concept—called the scale property—is analyzed. This analysis builds a bridge between combinatorial principles in pcf theory and the structural behavior of HOD.
To evaluate the right ventricle function by conventional echocardiographic methods and strain analysis in the long term after balloon pulmonary valvuloplasty. In addition, we investigated the relationship between pulmonary regurgitation, demographic data at the time of the procedure, and right ventricle dysfunction in late follow-up.
Methods:
The records of patients submitted to balloon pulmonary valvuloplasty from 2001 to 2015 in a single centre were reviewed. From that sample, a revised cohort was formed, and the patients were submitted to clinical and echocardiographic evaluations.
Results:
The retrospective and the revised cohort analyses included 73 and 18 patients, respectively. In the follow-up, pulmonary regurgitation was observed in all patients, and there was a significant worsening of its magnitude over time (p < 0.001); the severity of pulmonary regurgitation was associated with balloon pulmonary valvuloplasty performed in patients with weight < 3 kg (p < 0.03), body surface area < 0.3 m2 (p < 0.04), and < 1 year of age (p < 0.006). Global longitudinal systolic strain of the right ventricle was abnormal in 8 of 18 patients, and conventional methods were abnormal in 2 of 18 patients (p = 0.001). There was a significant relationship between severe pulmonary regurgitation and right ventricle dysfunction detected only by strain evaluation (p = 0.01).
Conclusions:
The severity of pulmonary regurgitation was related to the impairment of right ventricle function detected by strain. The predictors of pulmonary regurgitation severity in late follow-up were age < 1 year, weight < 3 kg, and body surface area < 0.3 m2.
A few years ago, G. Oberdieck conjectured a multiple cover formula that determines the number of curves of fixed genus and degree passing through a configuration of points in an abelian surface. This formula was proved by the author using tropical techniques and Nishinou’s correspondence theorem. Using the same techniques, we give a much shorter proof of the multiple cover formula for point insertions, relying on the same geometrical idea, but avoiding any kind of tropical enumeration.
We combine Indigenous and Western scientific ontologies to explore the deep history of pinyon pine in the Holocene Great Basin. We address 61 Theft of Pine Nuts (TPN) oral histories transcribed over the last 152 years. Contemporary Paiute, Shoshone, and Wá∙šiw storytellers still tell these narratives, which five Indigenous coauthors heard growing up. Considered judiciously and in concert with independent corroboration, these traditional oral histories (often dismissed as “myths”) potentially convey significant historical landmarks. Four themes emerge: (1) pine nuts have been a driving force in Indigenous Great Basin lifeways for millennia, (2) TPN oral histories pinpoint homelands beyond which pinyon trees grow today, (3) TPN narratives encode shifting animal biodiversity, and (4) massive ice barriers (likely dating to the Late Pleistocene) thwarted pine-nut thieves. We seek out elements encoded in oral histories that reflect pinyon-pine ecology and pinyon as a long-term vehicle of survivance among Indigenous Great Basin communities. Our findings reflect Roger Echo-Hawk’s (2000:90) wise counsel that “written words and spoken words need not compete for authority in academia, nor should the archaeological record be viewed as the antithesis of oral records. Peaceful coexistence and mutual interdependence offer more useful paradigms for these ‘ways of knowing.’”
The “innovation championship” model has been instrumental in explaining policy innovations in China’s local governments, particularly at the provincial level. However, discrepancies between this model and real-world cases raise questions about its broader applicability. To address this, we employ a dichotomous framework (innovation generation/borrowing) and conduct multi-level quantitative analyses of government work reports. Our analysis suggests that between 2003 and 2022, most provincial innovations were driven by the championship model, which relies on central government recognition, while others were shaped by peer recognition mechanisms. Together, these form a “central and peer” (CP) model that prioritizes innovation generation while incorporating a degree of innovation borrowing. This CP model differentiates the innovation functions among provincial governments, which have formed a collective innovation network: pioneering provinces generate model policies, while others capitalize on these opportunities. Moreover, the extent of the central authority’s influence determines the relative importance of these two mechanisms.
This study examined the metacercariae of trematodes in cnidarian jellyfish around Japan to demonstrate the importance of the jellyfish as the second intermediate or paratenic hosts. Trematodes were sampled from cnidarian jellyfish in seven coastal regions of Japan between 2024 and 2025. Trematodes (adults and metacercariae) were also obtained from marine fish and arrow worms and included for data comparisons. DNA barcoding was used for the species identification of metacercariae in the jellyfish and for elucidating their partial life cycles. Eight cnidarian species (245 individuals) were sampled, with metacercarial infection detected in seven host species. Based on morphological and molecular analyses, the metacercariae were classified into nine species belonging to three families, Accacoeliidae, Hemiuridae, and Lepocreadiidae. Six of these species were identified as the same species of adults isolated from fish hosts around Japan, although species names of two of the six remained unclear. The remaining three trematode species were assumed to belong to Lepocreadiidae, a major group of fish trematodes. These findings indicate that cnidarian jellyfish are important intermediate or paratenic hosts of fish trematodes in Japanese waters, as has been reported in other areas in previous studies. Moreover, a metacercaria occasionally detected in an arrow worm was identified as the same species as those in jellyfish, suggesting predator–prey relationships between these hosts. The study also synonymised Tetrochetus hamadai Fukui and Ogata, 1935, T. aluterae (Hanson, 1955), and T. mitenevi Zubchenko, 1978, with T. coryphaenae Yamaguti, 1934, based on molecular and morphological data.
Cylicospirura is a genus of spirocercid nematodes infecting felids around the globe. Eleven species have been characterised, with C. felineus and C. subaequalis being reported in jaguarundis, Herpailurus yagouaroundi, from Brazil. Herein, we described spirocercid reddish worms collected from three jaguarundis from Costa Rica by using hierarchical clustering and dendrogram plots of morphological characters reported from our specimens and compared to other Cylicospirura spp., histopathological observations of associated lesions, and phylogenetic analyses of both mitochondrial and ribosomal loci. Nematodes were found within stomach nodules located in the submucosa causing a pyogranulomatous, multifocal, nodular, and sclerosing gastritis. In addition, the collected worms differed from their congeners by having a longer body and smaller muscular and glandular oesophagus, subsequently showing lower total oesophagus to body length percentage and ratio of glandular to muscular oesophagus. Cytochrome oxidase subunit 1 and internal transcribed spacer 1 analyses revealed that worms were 8.33 to 8.66% different from C. felineus, C. subaequalis, or C. petrowi and 15.2 to 15.4% different from C. petrowi, respectively. Moreover, sequences derived from collected worms clustered separately from other Cylicospirura spp. available in GenBank® in the phylogenetic trees. By using an integrative taxonomy approach, the nematodes collected from stomach nodules of jaguarundis were described as a new taxon, for which the name Cylicospirura wishkai sp. nov. is proposed.
Collagen supplementation (CS) has emerged as a promising therapeutic approach with potential benefits for managing metabolic syndrome (MetS)-related risk factors. This narrative review integrates human evidence with preclinical mechanistic insights into the metabolic actions of collagen. Anti-obesity effects are attributed to increased satiety, gastric distension, GLP-1 secretion, and enhanced fatty acid oxidation mediated by PPAR-α activation and AMPK signalling. In type 2 diabetes, collagen improves glucose homeostasis by enhancing insulin sensitivity, upregulating GLUT-4, and inhibiting DPP-IV, thereby prolonging incretin activity (GLP-1, GIP) and supporting β-cell function. The antihypertensive effect of collagen peptides (CP) is primarily linked to angiotensin-converting enzyme (ACE) inhibition, which reduces angiotensin II levels while promoting bradykinin-mediated vasodilation and nitric oxide release. Additionally, CP has shown potential in improving lipid profiles by modulating PPAR-γ and AMPK, increasing HDL-C and reducing LDL-C and triglycerides. Emerging evidence also supports a role for collagen in restoring gut microbiota balance, increasing short-chain fatty acid production, and reducing pro-inflammatory and oxidative pathways, contributing to systemic metabolic regulation. Overall, these findings suggest CS exerts multi-targeted benefits on MetS components through modulation of endocrine, inflammatory, and metabolic pathways. Nevertheless, larger, long-term clinical trials are warranted to determine optimal dosing regimens, evaluate long-term efficacy, and further elucidate microbiota-mediated effects.
Most people at the end of life wish to die at home. Lay carers are crucial to supporting a home death and key to a good death is management of symptoms; this may prevent unwanted hospital admissions. If a dying person is too weak to swallow, regular medicines are administered continuously via subcutaneous (SC) cannula. When symptoms “break through,” additional (or as-needed) doses can be given, usually by a visiting healthcare professional. Delayed symptom control can occur due to time taken for healthcare professionals to arrive at the home.
Lay carers can be trained to administer as-needed SC medicines; the practice is safe and legal in the UK, although not widely used. The “CARer-Administration of as-needed SC medication for breakthrough symptoms in people dying at home” (CARiAD) feasibility trial of lay carer administration in the UK was the first to conduct in-depth interviews with carers trained in the practice.
The objective of this paper is to give voice to carers and show how experiences reflect benefits and challenges of lay administration at the end of life.
Methods
Qualitative interviews with carers trained in the practice. Interviews were analyzed using Interpretive Phenomenological Analysis.
Results
Caring for a loved one at home during the last days of life is complex. Accounts reveal a desire to fulfill a loved one’s wishes by keeping them at home and having the death they wanted. Carers were afraid of uncontrolled symptoms, especially pain, empowered by the ability to help and grateful to avoid long delays. Potential for carer burden and fears of hastening death require careful reassurance from health care professionals.
Significance of results
We learned that carers endorsed and embraced the opportunity to do more to keep their loved ones comfortable and at home. This is significant in making the case for wider access to the practice in the UK.
This study examines the role of gakushū manga, or educational Japanese comics, in shaping collective memory narratives of World War II. It explores whether these works diverge from or perpetuate Japan-centric interpretations of World War II by analysing thematic trends, representational strategies, and selective memory frameworks. The findings reveal a dominant emphasis on Japanese victimhood, mainly through graphic depictions of civilian suffering, while representations of foreign victims, such as Chinese and Korean civilians, remain abstract or marginalised. The responsibility of those in positions of leadership is selectively portrayed, often exonerating figures like Emperor Hirohito, and the actions of such militaristic leaders are contextualised within broader systemic ideologies.
These manga replicate postwar narratives by foregrounding societal complicity, deliberate omission, and the delegation of the ‘Other’ to the periphery, in line with broader patterns of media-driven nationalism. They provide nuanced critiques of Japan’s wartime conduct but simultaneously maintain a selective focus that minimises Japan’s responsibilities as an aggressor. This research underscores the need for a balanced collective memory to foster reconciliation and a more inclusive understanding of wartime legacies in East Asia.
In this paper, we explore the challenges and possibilities of environmental teacher education in the unravelling of a metacrisis. Drawing from multiple perspectives from post-growth literature, environmental sciences, political ecology and philosophy of education, we argue for the need to navigate complex environmental issues through simple yet profound narratives, what we term simplexity. As environmental educators working in the Pacific Northwest, we reflect on our distinct positionalities to propose five pedagogical touchstones that bridge the gap between overwhelming complexity and oversimplification in teacher education. These touchstones include: (1) challenging nature – culture divides and acknowledging alternative ontologies, (2) countering pessimistic views while fostering post-growth imaginaries, (3) confronting the Great Acceleration and ecological overshoot, (4) recognising power dynamics and colonial legacies in metropolis-periphery relations and (5) engaging with the aesthetic and embodied dimensions of climate disasters. Our framework seeks to propose pedagogical openings for teacher educators to cultivate agency and critical hope in environmental teacher education.
Studies have consistently found that up to 20% of people with anorexia nervosa experience a persistent illness, resulting in considerable psychosocial impairment, morbidity and mortality. This has been variously termed severe and enduring anorexia nervosa or longstanding anorexia nervosa (L-AN). Conflicting findings have hindered progress in distinguishing the nosological features of individuals with persistent illness.
Aims
This study aims to investigate the putative defining features of individuals reporting symptoms of L-AN, including consideration of their treatment trajectory.
Method
This cross-sectional study, drawing from a mixed-methods design, utilised a sample of symptomatic individuals who reported experiencing eating disorder treatment (n = 208). Several qualitative and quantitative data strands (a–c) were embedded within a single, self-report questionnaire measuring eating disorder severity and treatment experiences. Between-group comparisons were used to compare those of shorter (<3 years) and longer (>7 years) duration of illness.
Results
No between-group differences were found in measures of severity, including body mass index (kg/m2), eating disorder symptom scores, psychological distress or perceived health-related quality of life. However, those with L-AN had a significantly higher number of mental and physical health comorbidities, longer treatment delay, greater number of episodes of treatment and poorer subjective ratings of their treatment experiences.
Conclusions
Delineating L-AN by severity may be inappropriate; anorexia nervosa of any duration is a severe illness. This study suggests that treatments, or lack thereof, may have an inadvertent impact on duration of illness. Future focus needs to be on reconceptualising L-AN and its treatments. Treatment refinements informed by lived experience are proposed.