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The Regulation (EU) 2021/2282 on Health Technology Assessment (HTAR), which applies as of January 2025, introduces the Joint Clinical Assessment (JCA) for selected health technologies and establishes a stakeholder network. This study aims to evaluate the expected impact of the implementation of the HTAR from a multi-stakeholder perspective, using Italy as a case study.
Methods
A scoping literature review was performed according to the PRISMA guidelines to inform the development of an interview guide. Target participants included Italian stakeholder representatives with an interest in the HTAR. One-on-one semi-structured interviews were conducted virtually at the end of 2024. The questions were categorized into three main topics: expected benefits and opportunities; foreseen risks or challenges; recommended actions. The interviews were transcribed verbatim and analyzed using thematic content analysis techniques.
Results
Thirteen participants included representatives from national and regional HTA bodies, health technology developers’ associations, health professional associations, patient organizations, and HTA experts. The JCA is expected to enhance the quality of clinical assessment and to result in faster and more equitable access to health innovations. However, the timing will depend on the extent to which Member States require complementary analyses. Health technology developers benefit from submitting a single JCA dossier, but often cope with limited evidence and short-term deadlines. The interviewees recommended harmonizing evidence standards, investing in HTA education and training, and fostering strategic stakeholder collaborations.
Discussion
The process of harmonization induced by the HTAR is beneficial to standardize clinical assessment at the EU level, but needs to reconcile different stakeholder perspectives.
Donald J. Trump began his second term with a tidal wave of presidential directives. A simple count does not equate to consequence—but, in aggregate, Trump’s directives had an important impact. Many of their targets were consistent with past presidential practice, although even then expanding prior claims to executive authority. Others, which exacted retribution on specific individuals or entities or ordered subordinates to disregard the law, were new and potentially dangerous. The long-term failure of Congress to rein in discretion embedded in past statute has empowered this and future presidencies.
Although donating to private charitable organizations has been studied extensively, donating to local governments remains little examined. We advance this literature by applying Bekkers and Wiepking’s prominent theoretical framework of charitable giving drivers. Using nationally representative data from about 9,000 Vietnamese citizens, we test the relevance of some of these drivers in explaining the willingness to donate to local governments for road improvements. Our results largely corroborate previous findings about the roles of awareness of need (perceived issue importance), costs (the requested donation amount), and efficacy (trust in government). We also find support for the roles of altruism (the desire to help fellow citizens) and solicitation (the government’s ask)––two drivers whose application to local government donations was unexplored. Theoretical and practical implications are discussed.
This article examines recruitment practices in Swedish polar expeditions during the late 19th and early 20th centuries, focusing on A.G. Nathorst’s Arctic voyages 1898 and 1899, the Swedish-Russian Arc-of-Meridian surveys 1898–1901, and the 1903 Antarctic rescue expedition. Drawing on preserved correspondence, this article explores who conducted recruitment, how it was done, and what competencies were sought. The expedition leader recruited other scientists on his own, relying on recommendations from fellow academics. Hiring of sailors involved several persons; the leader, the ship’s captain, other seamen and semi-professional commissioners. The default mode was to re-hire old shipmates. When that was not possible, new recruits were evaluated through acquaintances or based on their reputation. Experience of travel in icy waters was considered valuable. Sailors with references from scientific expeditions were especially sought after, and could use this to attain higher wages than was the norm in ordinary work at sea.
We define the tropical Tevelev degrees, ${\mathsf{Tev}}_g^{\mathtt{trop}}$, as the degree of a natural finite morphism between certain tropical moduli spaces, in analogy to the algebraic case. We develop an explicit combinatorial construction that computes ${\mathsf{Tev}}_g^{\mathtt{trop}} = 2^g$. We prove that these tropical enumerative invariants agree with their algebraic counterparts, giving an independent tropical computation of the algebraic degrees ${\mathsf{Tev}}_g$.
Donald Trump and his supporters claimed an historic mandate to provide critical legitimacy for the extraordinary changes the president initiated immediately after taking office. Did he actually receive such a mandate? The data show that he did not. His electoral victory was modest by historical standards, and the public did not view his election as a mandate for sweeping change and did not desire to accord the president additional power. Moreover, Trump did not campaign on many of the issues on which he took action, and the public opposed most of the president’s major changes in policy. These actions included drastically cutting or dismembering congressionally authorized agencies and programs, deporting most undocumented aliens, raising tariffs, and gutting foreign aid.
Kinetic theory offers a promising alternative to conventional turbulence modelling by providing a mesoscopic perspective that naturally captures non-equilibrium physics such as non-Newtonian effects. In this work, we present an extension and theoretical analysis of the kinetic model for incompressible turbulent flows developed by Chen et al. (Atmosphere, 2023, vol. 14(7), p. 1109), constructed for unbounded flows. The first extension is to reselect a relaxation time such that the turbulent transport coefficients are obtained consistently and better align with well-established turbulence theory. The Chapman–Enskog (CE) analysis of the kinetic model reproduces the linear eddy-viscosity and gradient diffusion models for Reynolds stress and turbulent kinetic energy flux at the first order, and yields nonlinear eddy-viscosity and closure models at the second order. In particular, a previously unreported CE solution for turbulent kinetic energy flux is obtained. The second extension is to enable the model for wall-bounded turbulent flows with preserved near-wall asymptotic behaviours. This involves developing a low-Reynolds-number model incorporating wall damping effects and viscous diffusion, with boundary conditions enabling both viscous sublayer resolution and wall function application. Comprehensive validation against experimental and direct numerical simulation data for turbulent Couette flow demonstrates excellent agreement in predicting mean velocity profiles, skin friction coefficients and Reynolds shear-stress distributions, although the near-wall-normal stress anisotropy is underestimated. The results show that averaged turbulent flow behaves similarly to rarefied-gas flow at finite Knudsen number, capturing non-Newtonian effects beyond linear eddy-viscosity models. This kinetic model provides a physics-based foundation for turbulence modelling with reduced empirical dependence.
This study evaluates the impact of the COVID-19 pandemic on the profile of bacterial resistance in healthcare-associated lower respiratory tract infections (HAI/LRTI), in an intensive care unit.
Setting:
City of Belém-PA.
Design:
This is a retrospective and analytical cross-sectional study, in which the resistance profile of HAI/LRTI bacterial isolates was evaluated over 2018–2022.
Results:
The review of HAI notifications revealed 330 lower respiratory tract infections during the study period. The bacteria with a significant change in the resistance profile between the period pre-COVID and the post-COVID periods were P. aeruginosa (P = .011), K. pneumoniae (P < .001) and A. baumannii (P = .001), with increased profiles multidrug-resistant, and extensively drug-resistant, and strains with pandrug-resistant profile, in 2020 and 2021. In the analysis by antibiotic class, there was a significant increase in A. baumannii resistance to carbapenems and K. pneumoniae resistance to carbapenems.
Conclusions:
Comparing the periods, there was an emergence of K. pneumoniae resistant to aminoglycosides and carbapenems; of P. aeruginosa with tendency to resistance to aminoglycoside, carbapenem, 4th generation cephalosporin and anti-pseudomonal penicillin + beta-lactamase inhibitor; of A. baumannii resistant to aminoglycoside, carbapenem, quinolone, anti-pseudomonal penicillin + beta-lactamase inhibitor and penicillin + beta-lactamase inhibitor and 4th generation cephalosporin.
Individuals aged 15–24 years, defined by WHO (2019) as “youth,” experience elevated mental health risks, yet most do not access timely support due to barriers including stigma, poor symptom recognition and limited help-seeking confidence. Mental health literacy (MHL) interventions aim to address these barriers, but evidence regarding their effectiveness, delivery modalities, cultural adaptation and methodological quality remains fragmented. This systematic review followed PRISMA 2020 guidelines and examined the characteristics and effectiveness of MHL interventions for youth aged 15–24 across Jorm’s (2000) three core domains of recognition, knowledge and attitudes. Five databases (CINAHL, APA PsycArticles, APA PsycInfo, Scopus and PubMed) were searched on 4 September 2024 for randomized and quasi-experimental studies, with narrative synthesis conducted due to heterogeneity and risk of bias assessed using a standardized tool. Twenty-four studies involving 13,624 participants were included. Mental health knowledge improved consistently across interventions and delivery formats, whereas recognition and attitudinal outcomes showed greater variability and were more strongly associated with diagnosis-specific content, contact-based elements and cultural adaptation. Only five studies explicitly reported cultural or contextual adaptation, and eight incorporated positive mental health components, of which only one evaluated positive mental health outcomes. The evidence base was dominated by high-income Western settings, with sparse representation from low- and middle-income countries. Most studies demonstrated moderate-to-high risk of bias, limiting definitive conclusions about efficacy. Overall, youth MHL interventions reliably improve knowledge, but evidence for sustained effects on recognition, stigma reduction and help-seeking remains mixed. Future research should prioritize culturally responsive, developmentally appropriate and methodologically rigorous designs, including systematic measurement of positive mental health outcomes, to strengthen the global evidence base.
Retroflex consonants represent a major class of language sounds, but our understanding of their phonetic and phonological properties remains limited. From the standpoint of acoustics, recent contributions are largely lacking. Few fully fledged empirical descriptive studies have been made available to establish their presence and characteristics in the world’s languages. Within retroflex consonants, liquids and nasals are particularly rare, and very little descriptive, theoretical, or historical research has been conducted on them. Bantu languages from Africa are not included in most large-scale surveys. Recent fieldwork in the Mai-Ndombe Province of the Democratic Republic of Congo (DRC) in Central Africa confirms the existence of nasal retroflexes in North Boma (Bantu B82). This paper offers the first acoustic description of these rare nasal segments in any Bantu language. North Boma nasal retroflexes are shown to constitute a discrete class within the language’s nasal inventory. Compared to their non-retroflex counterparts, they are significantly shorter; they also display spectral energy concentrated in the lower frequencies around their centre of gravity, more peaked energy concentrations, higher values of F1 and F1 bandwidth, and lower values of F2 bandwidth. Furthermore, we reconstruct the historical development of nasal retroflexes in North Boma and show that they are the regular outcome of the merger of Proto-Bantu *n and *nd to /n/ in stem-medial position. We hypothesise that retroflexion might be a phonological substrate feature originating in extinct non-Bantu languages once spoken by Batwa communities living and foraging in the region or by Ubangi speech communities now only attested further north. This contribution showcases how detailed phonetic documentation and description are an asset for historical research.
This study examines birth rates and infant mortality rates in Brazil among singletons, twins, and higher order multiples between 2010 and 2023. Data were obtained from the Brazilian Ministry of Health’s Live Birth Information System and Infant Mortality Information System. The dataset comprised 39,663,928 live births and 464,843 infant deaths occurring within the first year of life. Twin birth rates increased steadily over time, while singleton birth rates declined. The highest twin birth rates were observed in the Southeast (11.64‰) and South (11.47‰), whereas the lowest were observed in the North (7.81‰) and Northeast (9.23‰). Infant mortality among twins was approximately five times higher than among singleton, and higher order multiples faced an approximately threefold greater risk compared to singletons. Infant mortality rates were highest in the North and Northeast and lowest in the Southeast and South. Sex ratios varied by gestation type, with singletons showing the expected male bias and twins a slightly reduced male proportion, reflecting biological and regional influences on birth rates in Brazil. The data reveal a marked demographic shift between 2010 and 2023, with birth rates declining among women in their teens and 20s and increasing among those in their late 30s and 40s. Using Weinberg’s differential method, we identified divergent trends in zygosity: dizygotic birth rates increased significantly over time, whereas monozygotic rates remained stable. This contrast underscores the environmentally responsive nature of dizygotic twinning, particularly its association with advancing maternal age and assisted reproductive technologies, compared to the relatively biologically stable pattern of monozygotic twinning.
The COVID-19 pandemic presented a window of opportunity for policy change, but was not exploited as such everywhere. Surprisingly, in Switzerland, usually characterized by a stable political landscape and incremental policy changes, an unexpected reform, the Nursing Initiative, was adopted. This paper examines the underlying mechanisms driving this adoption, employing a cross-fertilization of the multiple streams framework with the programmatic action framework and relying on expert interviews. The analysis shows that partial streams coupling began years before the pandemic, facilitated by the strengthening of nursing care professions’ identity into a programmatic group. Switzerland’s direct democracy enabled the opening of an agenda window, allowing the programmatic group to effectively couple their policy with political dynamics in the policy process. Finally, the COVID-19 crisis acted as a decision window, opening from the problem stream and providing momentum for policy action and decision-making.
This paper addresses the prediction of positive rank for elliptic curves without the need to find a point of infinite order or compute L-functions. While the most common method relies on parity conjectures, a recent technique introduced by Dokchitser, Wiersema and Evans predicts positive rank based on the value of a certain product of Tamagawa numbers, raising questions about its relationship to parity. We show that their method is a subset of the parity conjectures approach: whenever their method predicts positive rank, so does the use of parity conjectures. To establish this, we extend previous work on Brauer relations and regulator constants to a broader setting involving combinations of permutation modules known as K-relations. A central ingredient in our argument is demonstrating a compatibility between Tamagawa numbers and local root numbers.