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This paper describes the normative profile of Kant’s ‘provisional property’ in the Doctrine of Right, by highlighting the contrast between a claim that merits the designation of ‘provisional property’ and a mere ‘pretended claim’. In contrast to a pretended claim, a claim of provisional property is duty-implying; moreover, the legitimating conditions of provisional property give it a robust justification, such that its duty-implying force does not rely on a wrong-tolerating permission. I will also argue that the proposed reconstruction does not harm Kant’s argument leading to the normative necessity of civil states.
Case-based learning (CBL) is increasingly used across health professions education to promote clinical reasoning and professional competencies. In paediatric cardiology, rapid advances in diagnostics, interventions, and multidisciplinary care have intensified the need for educational approaches that integrate complex knowledge with real-world problem-solving.
Methods:
This narrative review outlines the theoretical foundations of CBL and examines the available literature on its implementation and effectiveness in medical education generally and paediatric cardiology specifically. Emerging applications of CBL, including simulation, virtual reality, and international collaborative case conferences, were also reviewed. Key design principles for effective CBL were explored, including case selection, alignment with competency-based curricula, faculty development, and assessment strategies.
Results:
Evidence suggests that CBL enhances clinical reasoning, knowledge integration, learner engagement, and the development of professional competencies. In paediatric cardiology, CBL supports the application of complex diagnostic and management principles within authentic clinical contexts. Emerging technology-enhanced approaches and international collaborative learning initiatives further expand opportunities for interactive and multidisciplinary education. However, challenges remain, including significant time and resource requirements, digital inequities, and the need for more rigorous evaluation of educational outcomes.
Conclusion:
Well-designed CBL appears to be a powerful educational strategy for preparing paediatric cardiology clinicians to deliver increasingly complex, team-based care. Future directions include greater integration of technology-enhanced learning, simulation-based approaches, and global educational networks to support trainees and practitioners across diverse practice settings while strengthening evidence for educational effectiveness.
Through the extensive literature review that examines the importance of children’s peer cultures, Lew-Levy and Amir’s paper not only succeeded in elaborating on the existing evolutionary theory of cultural learning but also contributed to the development of adjacent research domains. I would like the authors to further discuss the issues of age differences, transformation and resilience, and social justice.
Attempting to understand quantum claims as describing physical systems leads to well-known difficulties. In this regard, quantum mechanics is like ethics: Attempting to understand moral claims as describing physical systems leads to (different) well-known difficulties. I argue that the quasi-realist strategy for addressing the latter issue can also help with the former. Quasi-realism starts from a nonrepresentationalist understanding of a particular type of claim and proceeds to argue that we can nevertheless recover the roles of those claims in discourse that are typical of realism. I defend a quasi-realist interpretation of quantum mechanics.
This note offers a response to Bakshi’s critical discussion of Schurz’s claim that meta-induction provides a non-circular justification of object-induction (induction at the object-level of events). Bakshi raises two issues: 1. The problem of identifying object-inductive methods, and 2. the problem of determining the pool of simultaneously accessible prediction methods. In this reply, a solution to the identification problem is offered, based on existing work. Concerning the problem of pool-determination, induction-independent criteria are proposed that justify disregarding Goodman-type methods.
Boreal forests play a critical role in the global carbon cycle as they are one of the largest terrestrial carbon sinks globally. In this study, we employ explainable machine learning (ML) techniques to investigate the influence of environmental and vegetation variables on net ecosystem exchange (NEE), focusing specifically on the effects of diffuse radiation. We utilize a sub-hourly resolution data set including satellite and in-situ observations from three boreal or hemiboreal forest research stations across the latitudes 58–68° N to capture latitudinal variability in forest carbon uptake. Using SHAP (Shapley Additive Explanations) values, we identify key drivers influencing NEE and quantify their importance across various ML model architectures. Photosynthetically active radiation (PAR), diffuse radiation, normalized difference vegetation index, and soil temperature were identified as the variables having the largest explanatory power for NEE across the ML models. ML models using only these variables result in $ {R}^2\approx 0.8 $ and RMSE$ \approx 2.3 $$ \mu \mathrm{mol}\;{\mathrm{m}}^{-2}\hskip0.1em {\mathrm{s}}^{-1} $. Further analysis of SHAP values indicates that higher diffuse radiation (DiffPAR) is associated with more negative NEE (stronger carbon sink). SHAP analysis highlights this effect much more clearly than raw DiffPAR measurements, because it accounts for interactions with other environmental factors. This suggests that the diffuse radiation effect emerges from interactions between DiffPAR and co-varying environmental factors (such as cloudiness and total PAR). Cases identified by SHAP ($ \mathrm{DiffPAR}\ \mathrm{SHAP}<-2 $) have a median NEE $ 1.55\mu \mathrm{mol},{\mathrm{m}}^{-2},{\mathrm{s}}^{-1} $ more negative than cases with raw $ \mathrm{DiffPAR}\ge 400 $. When applied to ML models, SHAP uncovers nonlinear, context-dependent interactions between diffuse radiation and other drivers of NEE without assuming a priori relationships.
A diagnosis code-based algorithm classifies outpatient antibiotic prescribing as almost always (Tier 1), sometimes (Tier 2), and almost never (Tier 3) appropriate. This algorithm has been leveraged to quantify antibiotic appropriateness and direct stewardship initiatives for adults and children, primarily based on Tier 3 encounters receiving antibiotics, but has not been validated.
Objective:
To assess the performance of the algorithm for assessing antibiotic appropriateness in pediatric outpatients.
Methods:
Using a pediatric care network of primary care, urgent care, and emergency departments from January 1–December 31, 2024, encounters were classified into tiers using the ICD10 algorithm. Manual chart review was performed on a stratified random sample of 300 (100 per setting) Tier 3 encounters with antibiotics using a structured protocol derived from local and national guidelines to determine antibiotic appropriateness overall and by location. Survey weights were applied to obtain estimates for all Tier 3 encounters with antibiotic prescriptions. The positive predictive value (PPV) for Tier 3 in identifying inappropriate antibiotic prescribing was calculated.
Results:
Of 272,698 encounters, 115,508 (42%) had an antibiotic prescription. The algorithm classified 10,370 (9%) as Tier 3. In the stratified manual validation sample, 170/300 were classified as appropriate, corresponding to a survey-weighted estimate of 58% appropriate (95% CI, 52%–64%) and a PPV of 42% for Tier 3 as a marker of inappropriate antibiotic use.
Conclusions:
The established algorithm did not reliably predict antibiotic appropriateness in this pediatric outpatient population, demonstrating a need for pediatric-focused algorithms for measuring outpatient antibiotic stewardship.
To evaluate the effect of copper-coated high-touch surfaces on environmental microbial burden and healthcare-associated infection (HAI) rates.
Design:
Observational cohort study over 20 months.
Setting:
Pediatric intensive care and oncology inpatient units in a tertiary care hospital.
Participants:
All patients admitted to rooms with or without copper-coated surfaces.
Exposure:
Spray-on copper coating applied to high-touch surfaces in patient rooms.
Methods:
Patients were admitted to rooms according to routine hospital practices. Demographic and clinical data were collected for a subset of patients admitted to rooms with copper-coated surfaces and matching control rooms. Environmental samples were collected from high-touch surfaces to quantify bacterial colony counts. HAIs were identified via a surveillance database and reported per 10,000 patient days. Poisson regression and negative binomial mixed-effects model were used for analysis.
Results:
Patients in copper-coated rooms were more likely to have an infection on admission (29.7% vs 2.9%; P = .003). Bacterial colony counts trended lower in copper-coated rooms (rate ratio (RR) 0.74, 95% CI 0.50–1.08; P = .11; absolute rate difference −12.25, 95% CI −26.12–2.10), with variability by surface type. HAI rates trended higher in copper-coated rooms compared to control rooms (48.2 vs 30.5 per 10,000 patient days; RR 1.58, 95% CI 0.78–3.20; P = .20).
Conclusions:
Copper-coated surfaces were not associated with statistically significant reductions in microbial burden or HAI rates. Contributing factors may include low baseline microbial load, low baseline HAI rates, variable copper alloy efficacy, short study duration, and differences between patients in intervention and control rooms.
In this paper, we study the appearance of a spanning subdivision of a clique in graphs satisfying certain pseudorandom conditions. Specifically, we show the following results.
(i) There are constants $C\gt 0$ and $c\in (0,1]$ such that, whenever $d/\lambda \ge C$, every $(n,d,\lambda )$-graph contains a spanning subdivision of $K_t$ for all $2\le t \le \min \{cd,c\sqrt {\frac {n}{\log n}}\}$.
(ii) There are constants $C\gt 0$ and $c\in (0,1]$ such that, whenever $d/\lambda \ge C\log ^3n$, every $(n,d,\lambda )$-graph contains a spanning nearly balanced subdivision of $K_t$ for all $2\le t \le \min \{cd,c\sqrt {\frac {n}{\log ^3n}}\}$.
(iii) For every $\mu \gt 0$, there are constants $c,\varepsilon \in (0,1]$ and $n_0\in \mathbb N$ such that, whenever $n\ge n_0$, every $n$-vertex graph with minimum degree at least $\mu n$ and no bipartite holes of size $\varepsilon n$ contains a spanning nearly balanced subdivision of $K_t$ for all $2\le t \le c\sqrt {n}$.
Although all patient deaths affect clinicians, it remains unclear how the impact of suicides differs from other deaths. Is the trauma of losing a patient by suicide qualitatively distinct, or are the emotional, professional and organisational consequences of suicidal and non-suicidal deaths more similar than assumed?
Aims
To investigate the impact of patient suicide compared with other patient deaths on clinicians’ psychological well-being, clinical practice and career. To explore clinicians’ perspectives on how current support systems do, or do not, meet their needs.
Method
A mixed-methods approach was used. An online survey with two subsets of questions (one for suicidal and one for non-suicidal patient deaths) was circulated to clinicians across South London and Maudsley NHS Foundation Trust.
Results
A total of 122 responses were collected: two-thirds of respondents had experienced a patient suicide, with 53% reporting moderate and 12% reporting severe impact versus 36.6% reporting moderate and 4.2% severe for non-suicidal deaths. Non-suicidal death was associated with significantly lower impact (odds ratio 0.14, 95% CI [0.05, 0.41], p < 0.001) and less disruption to clinical practice. Blame emerged as a key factor shaping clinicians’ responses: 98% of respondents rated suicide as <60% predictable in secondary care, and 69% rated the ‘zero-suicide’ policy as unachievable.
Conclusions
Patient suicide has a heavier impact on clinicians, qualitatively distinct from other patient deaths. Blame shapes defensive responses in suicides, and internal questioning in non-suicidal deaths. The low-risk paradox and perceived unachievability of zero-suicide policies call for re-evaluation. Acknowledging predictability limits and clinicians’ support needs can help systems navigate the complex impact of patient suicides.
Neurological soft signs (NSS) are frequent in schizophrenia spectrum disorders (SSD) and have been linked to structural alterations in basal ganglia-thalamic (BGT) regions. We hypothesized that SSD patients would show BGT volume differences compared to healthy controls (HC) and that NSS severity would relate to BGT volume and surface morphology in a replicable pattern.
Methods
Structural 3T T1-weighted MRI scans were obtained from 327 SSD patients and 134 matched HC in Mannheim (Germany) and Bern (Switzerland). NSS were assessed using the Heidelberg Scale and the Neurological Evaluation Scale (NES). BGT volumes were segmented using FSL-FIRST and compared across groups using general linear models adjusted for age, sex, intracranial volume, and daily antipsychotic medication. Associations with NSS scores were tested using regression analyses.
Results
High-NSS compared to low-NSS SSD patients showed reduced left accumbens volume in both cohorts, with a significant main effect in the Mannheim cohort (β = −43.73, p = .002 uncorrected, p = .019 corrected) and a partial replication in the Bern cohort (β = −53.06, uncorrected p = .03, p > .05, corrected). In contrast, IF-related effects on left accumbens and bilateral thalamic volumes were cohort specific. Daily antipsychotic medication and illness duration did not mediate or moderate these associations.
Conclusions
This bicentric MRI study provides converging evidence that NSS severity in SSD is associated with BGT alterations, particularly reduced left nucleus accumbens volume. However, thalamic and surface-level findings were cohort specific, indicating partial rather than uniform reproducibility. Associations were not explained by daily dosage of antipsychotic medication or illness duration.
If childhood was critical to cultural adaptation, we would expect to see regular innovation in Homo tool industries. However, the Acheulean, Mousterian, and early H. sapiens industries are remarkably stable. Evidence of prolific innovation is largely absent before the European Middle-Upper Paleolithic transition, which is associated with increased longevity in H. sapiens, suggesting that innovation was sparked by grandparenthood.
Peer cultures can contribute adaptive innovations, but their capacity for contribution depends on the environmental risk landscape. High-risk environments promote conservative cultural transmission, suppressing contributions from peer-driven exploration, while low-risk conditions allow peer cultures to thrive, generating, and spreading novel solutions. Socioeconomic stratification also influences these dynamics, creating cultural divides in how peer cultures operate.
Reinforcement sensitivity theory (RST) most clearly relates to internalizing disorders. But a weak behavioural inhibition system (BIS as defined by RST) could underlie externalising, in general, and psychopathy in particular (Fowles, 1980). Conventional “rationally derived” RST scales (rRST) are not anchored in neurally defined RST systems (nRST). So, here, we use both rRST and nRST measures to assess psychopathy traits. We operationalised psychopathy via a four-factor model (affective | interpersonal | disinhibition | boldness). We operationalised rRST via the Heym, Ferguson & Lawrence (2008) updated version of Carver and White’s (1994) BIS/BAS scales (BAS | BIS | FFFS). We operationalised nRST (goal inhibition system, GIS; goal repulsion system, GRS) via previously validated (Shadli et al., 2021) rhythmic power in the stop signal task (SST) and (goal approach system, GAS) via previously validated ERPs in the doors task. Initial bivariate correlations of psychopathy factors with rRST scales were as expected. We found no significant associations between psychopathy factors and nRST measures. A series of post hoc exploratory repeated measures ANOVAs guarded against non-linearity between psychopathy and nRST constructs. These found that: (1) Disinhibition traits might be explained (unexpectedly) by increased sensitivity in the GIS (i.e., conflict) and GRS (i.e., repulsion) and decreased sensitivity in the GAS (i.e., attraction). (2) Affective traits might be explained, as expected, by decreased sensitivity in the GIS and GRS. But an unexpected positive association was also found in the alpha frequency range for the GRS. So, nRST systems (particularly GIS) do not explain psychopathy. rRST scales were more aligned with expectations but were explained via their “rational” basis not RST per se. Unlike internalizing, nRST does not appear strongly related to externalising disorders in general and psychopathy in particular. rRST appears distinct from nRST.
Our commentary expands upon Lew-Levy and Amir’s insights into the role of peer culture in cultural evolution. Drawing on field data from the Koygu, Nyangatom, and Aka communities, we identify two modes of group transmission (concerted and cumulative) that contribute to the stability of peer cultures over time. We describe how culturally constructed niches shape peer learning, helping explain the intercultural diversity of peer cultures.
Disagreement holds a central place within standpoint theory, yet its intersection with the debate on peer disagreement has been largely overlooked. Standpoint theory emphasizes the situatedness of knowledge based on social positions – defined by factors such as gender, race, class, and other axes of identity. This fragmentation of knowledge creates a distinct challenge for traditional notions of epistemic peers as it would make epistemic peerhood, especially across identity groups, almost impossible. To accommodate this, I suggest broadening the notion of epistemic peers using a community model of knowledge. Furthermore, I explore the dynamics of peer disagreements when one interlocutor emerges from a marginalized position. In such situations, I contend that the marginalized perspective should be assigned more weight, posing a challenge to both steadfast and equal weight views. This argument culminates in the introduction of ‘Peer-Predominant Conciliationism’, a view suggesting that, under certain circumstances, it is rational to privilege a peer’s perspective over one’s own in peer disagreement.