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This paper outlines the experience of establishing a partnership for clinical services and academic training across two very different countries: Zambia and Ireland. Drawing upon the experience of setting up other similar international partnerships, the process of understanding the two very different cultural and clinical contexts has developed collaboratively over the course of the past 2 years, and has resulted in valuable insights and joint working. In line with local priorities, the Zambian colleagues in the partnership have prioritised the support for postgraduate training in psychiatry to enable the expansion of services, and allow greater population access. In particular, there is evidence of unmet need in the areas of substance use psychiatry, and child and adolescent psychiatry.
The collaboration will increase cultural awareness among psychiatrists and trainees in Ireland and deepen their knowledge and understanding of international psychiatry. This programme is mutually beneficial and has the potential to greatly improve relationships between the mental health service providers of the two nations.
This study aimed to determine the optimal Biological Effective Dose (BED)-based compensation strategy for treatment interruptions in left-sided breast cancer radiotherapy, with a focus on evaluating cardiac substructures to address a previously unmet clinical need.
Methods:
Twenty patients with left-sided breast cancer who had received radiotherapy were retrospectively enrolled.
Simulations assumed treatment interruptions (number of interruption days) occurred after the first week, ranging from 1 to 10 days. Three BED-based compensation strategies were evaluated: (A) maintaining total fractions and days while delivering twice-daily treatments; (B) maintaining total days while increasing the dose per fraction; and (C) keeping the dose per fraction constant while extending the overall treatment course. Original uninterrupted plans served as the baseline. BEDs for the planning target volume (PTV), simultaneous integrated boost (SIB), cardiac substructures and other organs at risk (OARs) were calculated. Physical and BED differences among the schemes were systematically compared.
Results:
Compared to the original scheme, physical doses to PTV and SIB were lower in Scheme B but higher in Scheme C. As interruptions increased from 1 to 10 days, PTV and SIB doses in Scheme B decreased to minimum values of 42.71 Gy and 50.58 Gy, respectively, while Scheme C resulted in maximum values of 58.60 Gy and 67.15 Gy. Analysis of BED changes (ΔBED) in OARs revealed that the left anterior descending artery (LAD) was the most affected cardiac substructure, with ΔBED values of 0.41, –1.20 and 0.60 for Schemes A, B and C, respectively, at 10 interruption days. Among other OARs, the left lung showed the highest ΔBED changes (0.39, –0.30 and 0.32, respectively). Most OAR comparisons reached statistical significance (ANOVA, p < 0.05).
Conclusion:
Compensation strategies for radiotherapy interruptions significantly influence the BED of OARs, particularly in the LAD and left lung. Scheme B most effectively reduced the BED of OARs but requires replanning. Schemes A and C offer clinical convenience at the cost of a higher BED of OARs. The choice of compensation strategy should be individualised based on clinical priorities and patient-specific anatomy.
How does tax regressivity at the top affect public support for taxation? In this article, we run an information provision experiment in the United States with a quota-representative sample of around 4,000 people and randomly present respondents with factual information about total tax rates by income group. We find that informing respondents that the superrich pay lower total tax rates than other people not only increases support for raising taxes on the rich but also lowers support for taxing the middle class. Our results highlight an important hidden cost of tax regressivity at the top: if left unaddressed, it risks undermining public support for broad-based taxation.
Why do women and men vote differently in presidential elections? Much research on gender and vote choice has focused on the United States and Western Europe, with less attention to the Global South. We develop a theory of sex gaps in presidential voting, which shows how ideology, feminism, and gendered personalities may help explain them. To test this, we designed and fielded surveys for presidential elections in Chile in 2021, Brazil in 2022, and Argentina in 2023. Results show that ideology and feminism largely explain men’s and women’s divergent votes for presidential candidates. Leftists, self-identified feminists, and respondents with more feminist attitudes were more likely to vote for Gabriel Boric instead of José Antonio Kast, Luiz Inácio Lula da Silva over Jair Bolsonaro, and Sergio Massa rather than Javier Milei. Unlike in the United States, Latin Americans’ gendered personalities do not seem to influence their vote choice.
The global syndemic of obesity, undernutrition, and climate change – three interconnected challenges – threatens both human and planetary health. This review focuses on one critical intersection: older populations living with overweight and obesity in the context of sustainable nutrition. Obesity and sarcopenia, particularly the co-occurrence called sarcopenic obesity, are often overlooked until the onset or exacerbation of other diseases necessitates secondary care. Preventing sarcopenic obesity requires reducing excess fat mass while preserving muscle mass and function. This involves lowering total energy intake while ensuring adequate protein intake in terms of quantity, quality, and distribution, combined with physical activity, particularly resistance exercise. Short-term studies show that both the source and dose of dietary protein significantly influence muscle protein synthesis rates. Longer-term studies examining the impact of plant-based diets on muscle health in older adults with or without overweight or obesity remain limited. Animal proteins have shown a modest advantage over most plant-based proteins in supporting muscle mass. Qualitative studies suggest that emphasizing both the health benefits and palatability of plant-based protein sources is key to promoting dietary changes in older adults. In older adults with obesity, it is challenging to combine energy restriction with higher protein intake, especially when protein sources are plant-based. To prevent and treat sarcopenic obesity in older adults and support planetary health, a shift toward more plant-based protein sources is required, while ensuring sufficient protein quantity and quality to preserve muscle health during weight loss.
This review aims to (1) provide an overview of research investigating the relationship between body composition, specifically fat free mass (FFM) and fat mass (FM), appetite, and energy intake (EI) and (2) to investigate potential mechanisms underlying these relationships, with a focus on ageing. Appetite and EI are influenced by complex, multifactorial pathways involving physiological, psychological, environmental, social, and cultural factors. Early research investigating the association of body composition with appetite and EI focused on FM, however the role of FFM in appetite control is gaining increasing attention. Studies have shown that FFM is positively associated with EI in younger populations including infants, adolescents and adults. In contrast, FM appears to have no association or a weak inverse association with appetite/EI. However, research in older adults is limited and the underlying mechanisms are not fully understood. It has been suggested that one way in which FFM may influence appetite and EI is by impacting resting metabolic rate (RMR). FFM, which includes metabolically active tissues including skeletal muscle and organs, represents the largest determinant of RMR and therefore may influence appetite and EI by ensuring the energetic requirements of crucial tissue-organs and metabolic processes are reached. Given that declines in FFM and RMR are common with ageing, they may be possible targets for interventions aimed at improving appetite and EI. While current evidence in older adults supports a positive association between FFM and appetite, further longitudinal studies are needed to explore this relationship in different contexts, along with the underlying mechanisms.
Early modern European powers were beset by episodic unrest as they sought to consolidate their authority and build empires. We examine how growing state communication networks and the penetration of society impacted unrest by combining original and detailed parish-level data from pre-Revolutionary France on the expansion of the horse-post relay network with rebellion in this period. Using a staggered difference-in-differences framework, we find that new horse-post relays are associated with more local rebellion. We argue that the main mechanisms are the material consequences of state centralization. New horse-post relays are linked with more rebellion against state agents and associates—the military, police, tax collectors, and the judiciary—that conscripted civilians, enforced taxes and laws, and increasingly monopolized roads. Pre-existing state and administrative fragmentation also mediated this relationship. Our findings have implications for the scholarly understanding of the co-evolution of states and order.
Long-acting injectable (LAI) antipsychotics are not routinely offered and, thus, are underutilized despite their many advantages over oral formulations. In this special collection of articles, the reader will find overviews of the art and science of prescribing this important treatment option. Guidance is offered regarding incorporating LAIs in treatment planning, including inpatient, outpatient, and jail settings. Reviewed is the evidence surrounding the use of LAIs for patients in their first episode of schizophrenia, as well as switching from oral agents and other common issues that come up in day-to-day practice. Also provided is a comprehensive summary of each of the currently available formulations of LAIs, and some pragmatic reasons why one would be considered over another. In the end, the reader will come away with the notion that LAIs are not a “last resort” but an important and useful treatment modality that ought to be considered more often.
Substantial evidence supports the efficacy of cognitive bias modification (CBM) for attention and interpretation. However, CBM targeting memory bias (CBM-M) remains underexplored despite its clinical relevance. This study examines the effectiveness and neurobiological mechanisms of CBM-M.
Methods
Fifty-eight individuals with elevated anxious and depressive personality traits (>1 SD) were randomly assigned to either CBM-M or sham training (n = 29 per group) in a parallel, double-blind, randomized controlled trial. The intervention involved eight sessions over 1 month. CBM-M aimed to enhance positive autobiographical memory (AM) recall by focusing on positive and negative words, whereas sham training lacked this enhancement module. Anxiety and depressive traits and symptoms, explicit and implicit memory biases, and AM specificity were assessed. Additionally, intrinsic functional connectivity was measured via functional magnetic resonance imaging, and cortisol levels were assayed via saliva collected at 10 time points across 2 days before and after the intervention.
Results
Both groups showed reduced anxiety and depressive traits from pre- to post-intervention. Compared with sham training, CBM-M specifically reduced stress vulnerability, negative explicit memory bias, and daytime cortisol levels, with a large effect size. Improvement in memory bias correlated with stress vulnerability and cortisol reductions. CBM-M also enhanced amygdala functional connectivity with the anteromedial orbitofrontal cortex in comparison with sham training from pre- to post-intervention.
Conclusions
CBM-M reduced stress vulnerability and elicited neural changes in amygdala–anteromedial orbitofrontal cortex interactions, which were involved in social reward and AM recall. Future research should identify the most responsive populations and elucidate underlying mechanisms.
The objective of this work is to investigate the unexplored laminar-to-turbulent transition of a heated flat-plate boundary layer with a fluid at supercritical pressure. Two temperature ranges are considered: a subcritical case, where the fluid remains entirely in the liquid-like regime, and a transcritical case, where the pseudo-critical (Widom) line is crossed and pseudo-boiling occurs. Fully compressible direct numerical simulations are used to study (i) the linear and nonlinear instabilities, (ii) the breakdown to turbulence, and (iii) the fully developed turbulent boundary layer. In the transcritical regime, two-dimensional forcing generates not only a train of billow-like structures around the Widom line, resembling Kelvin–Helmholtz instability, but also near-wall travelling regions of flow reversal. These spanwise-oriented billows dominate the early nonlinear stage. When high-amplitude subharmonic three-dimensional forcing is applied, staggered $\Lambda$-vortices emerge more abruptly than in the subcritical case. However, unlike the classic H-type breakdown under zero pressure gradient observed in ideal-gas and subcritical regimes, the H-type breakdown is triggered by strong shear layers caused by flow reversals – similar to that observed in adverse pressure gradient boundary layers. Without oblique wave forcing, transition is only slightly delayed and follows a naturally selected fundamental breakdown (K-type) scenario. Hence in the transcritical regime, it is possible to trigger nonlinearities and achieve transition to turbulence relatively early using only a single two-dimensional wave that strongly amplifies background noise. In the fully turbulent region, we demonstrate that variable-property scaling accurately predicts turbulent skin-friction and heat-transfer coefficients.
The present work aims at exploring the scale-by-scale kinetic energy exchanges in multiphase turbulence. For this purpose, we derive the Kármán–Howarth–Monin equation which accounts for the variations of density and viscosity across the two phases together with the effect of surface tension. We consider both conventional and phase conditional averaging operators. This framework is applied to numerical data from detailed simulations of forced homogeneous and isotropic turbulence covering different values for the liquid volume fraction, the liquid–gas density ratio, the Reynolds number and the Weber number. We confirm the existence of an additional transfer term due to surface tension. Part of the kinetic energy injected at large scales is transferred into kinetic energy at smaller scales by classical nonlinear transport while another part is transferred to surface energy before being released back into kinetic energy, but at smaller scales. The overall kinetic energy transfer rate is larger than in single-phase flows. Kinetic energy budgets conditioned in a given phase show that the scale-by-scale transport of turbulent kinetic energy due to pressure is a gain (loss) of kinetic energy for the lighter (heavier) phase. Its contribution can be dominant when the gas volume fraction becomes small or when the density ratio increases. Building on previous work, we hypothesise the existence of a pivotal scale above which kinetic energy is stored into surface deformation and below which the kinetic energy is released by interface restoration. Some phenomenological predictions for this scale are discussed.
In times of new geopolitical challenges, many states have revived the concept of total defence, in which all citizens contribute to national defence efforts. How authorities communicate the need of this new defence strategy and when such crisis communication leads to an increased defence willingness is an important research question. We hypothesise that individuals who feel a sense of empowerment or an increased risk of war when exposed to crisis communication are more willing to engage in the defence. To evaluate our hypotheses, we collected representative survey data from 2,068 Swedish respondents, at the same time as the Swedish Civil Contingencies Agency was distributing a new brochure on expectations on and advice for citizens in case of war. By analysing the responses of individuals who had read or not read the brochure, we gauge the impact of the crisis communication on defence willingness. The results show that individuals experiencing a higher sense of empowerment and perceiving a higher risk of war when having read the booklet were more willing to engage in total defence activities. This has important implications for our understanding of how specific types of crisis communication influence commitment and defence willingness in the population.
This study examines the impact of climate change, defined as long-term changes in temperature and precipitation patterns due to natural and human factors, on women's employment in Burkina Faso, highlighting labour market participation and gender disparities. Using a static computable general equilibrium model calibrated with a gender-specific social accounting matrix, it evaluates two climate scenarios: a 2.4°C temperature increase and a 7.5 per cent decrease in precipitation by 2050. The results indicate that these climate shocks significantly reduce women's employment opportunities. The supply of paid labour for women may decrease by 3.9 per cent, with skilled women experiencing greater job losses than their unskilled counterparts. In rural areas, the domestic workload could increase by up to 0.28 per cent, further limiting women's labour market participation. These changes reinforce gender inequalities and contribute to a decline in real GDP. To counter these effects, investments in climate-resilient agriculture, water and energy infrastructure, and women's entrepreneurship are essential. Gender-responsive policies are needed to promote inclusive economic growth and reduce employment disparities.