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This study aims to evaluate differences in healthcare utilization among patients with ischemic stroke in metropolitan versus non-metropolitan Manitoba.
Methods:
This study is a population-level analysis using the Discharge Abstract Database from Manitoba. The database includes all patients who received care in a Manitoba facility for ischemic stroke between April 2019 and March 2023. Data were collected on patient demographics, comorbidities and geographical location of stroke presentation (metropolitan Winnipeg vs non-metropolitan). Outcomes included length of stay (LOS), treatment, discharge disposition and mortality. Regression analysis was performed to analyze outcomes, adjusting for age, sex and comorbidities.
Results:
3704 (71.6%) patients were admitted in Winnipeg, and 1471 (28.4%) patients were admitted in non-metropolitan Manitoba. Patients presenting to Winnipeg were younger (mean age 72.3 vs 74.3 years) and had higher rates of atrial fibrillation, hypertension, diabetes, chronic kidney disease and heart failure. Patients presenting to Winnipeg had a shorter LOS (16.1 days vs 18.4 days, coefficient 0.05, 95% CI −4.54 to −1.27), had higher rates of intravenous thrombolysis (adjOR 5.13, 95% CI 3.85–6.84), were less likely to be discharged home (39.8% vs 57.5%, adjOR 0.47, 95% CI 0.41–0.53) and were more likely to be transferred for inpatient stroke rehabilitation (adjOR 3.46, 95% CI 2.64–4.54). There were no differences in in-hospital mortality. There was a higher incidence of stroke in Winnipeg compared to non-metropolitan Manitoba (F-statistic 23.84, p = 0.0028).
Conclusions:
This study illustrates differences in healthcare utilization outcomes between patients living in metropolitan Winnipeg versus non-metropolitan Manitoba presenting with ischemic stroke.
This study presents the integrated results of stable carbon (δ13C) and nitrogen (δ15N) isotope and aDNA analyses, conducted to examine dietary and mobility practices in two mid- to late Byzantine communities in western Anatolia: the coastal cosmopolitan site of Kadıkalesi Anaia and the rural inland settlement of Barcın Höyük. Isotopic data from thirty-eight individuals indicate that both populations primarily consumed terrestrial C₃-based resources. At Kadıkalesi, δ15N values show greater variability, suggesting more differentiated access to animal protein sources, whereas the rural community at Barcın Höyük exhibits isotopic homogeneity, consistent with more uniform dietary practices and an equitable access to food. Kadıkalesi also shows intra-site dietary variation by age and sex, while Barcın is again more homogeneous. At Barcın, aDNA results indicate a predominant local genetic continuity, suggesting a stable population; a single instance of external ancestry is attested by a male individual with affinities to western populations, particularly from eastern Europe, in line with historical military resettlement patterns (stratiotika ktemata). By integrating isotopic and genomic evidence, this study demonstrates how ancestry and mobility shaped dietary habits, offering insights into the interplay of urbanism, mobility, and social organization in the Byzantine period.
The Supreme Court is less constrained than political science has recognized. Motivated justices can dramatically alter politics without deferring to actors in the other branches. Subverting constraints, justices can aggrandize power and impose their irreducible preferences. Using Reconstruction as an example, this article brings new evidence to support the claim that an autonomous Court precipitated the end of Reconstruction. I make three essential arguments: First, the Republican commitment to federal civil rights protection extended longer than is traditionally supposed. Second, the architect of postbellum constitutionalism, Justice Bradley, harbored long-standing fear of Black equality and enfeebled the Reconstruction amendments when neither legal nor political imperatives compelled him to do so. Last, Bradley’s interventions substantially hindered Reconstruction by facilitating the “redemption” of southern state governments. This article employs mixed-methodology, using a difference-in-differences analysis and novel archival data. Contrary to scholarship arguing that the Court simply followed a Republican retreat, the Court dramatically reshaped the political-social development of Reconstruction.
This study aimed at investigating the clinical, individual, and systemic factors influencing paediatricians’ and family physicians’ clinical decision-making process in the vaccination of children during infection from the physician’s perspective.
Methods:
A qualitative study through semi-structured in-depth interviews was conducted among 10 paediatricians and 10 family physicians working in Ankara, Türkiye. The audio-recorded interviews were translated into written texts, and the obtained data was analysed using the thematic analysis method proposed by Braun and Clarke.
Results:
Four main themes were identified in of thematic analysis: (I) Impact of clinical conditions on vaccination decisions, (II) attitudes of families and their communication processes with physicians, (III) impact of practice settings and institutional factors, and (IV) vaccine postponement and compensation approaches. It was observed that the decision-making processes of the paediatricians were mainly based on the clinical evaluation criteria, while family physicians considered the expectations of the families and institutional conditions. Also, the importance of establishing effective communication with vaccine-hesitant families has been emphasized by both groups of physicians.
Conclusion:
In the immunization of infected children, decision-making is shaped in addition to medical facts in relation to the parental attitude, organizational factors within health institutions, and personal experiences of medical staff. Decisions of paediatricians are largely grounded in medical facts, whereas family practitioners assess that social and organizational factors are of higher importance. Improved adherence to medical guidelines and communication competencies of medical professionals can contribute towards medical practice consistency.
In this retrospective cohort, chronic kidney disease stage III-V (P = .005), history of previous urinary tract infection within 3 months (P < .05), Revised Cardiac Risk Index for preoperative risk ≥2 (P = .002), and percutaneous nephrolithotomy procedure (P < .05) were associated with risks of infections after urological procedures among patients with negative urine culture screening.
Intrauterine growth restriction (IUGR) in newborn animals is linked to impaired intestinal health, yet the characteristics of their gut microbiota and circulating exosomal miRNAs remain incompletely understood. This study compared the cecal microbiota composition and serum exosomal miRNA profiles to characterize differences between IUGR and normal birth weight (NBW) piglets. Compared to NBW piglets, IUGR piglets displayed significant reductions in body and organ weights (heart, liver, kidney) as well as shorter jejunal and ileal lengths (p < 0.05). Microbial diversity, reflected by the Chao1 and Shannon index, was significantly reduced in IUGR piglets (p < 0.001). Taxonomic analysis revealed decreased abundances of Bacteroidetes, Fusobacteria, and Fusobacterium (p < 0.05), alongside increased abundances of potential pathogenic taxa, including Proteobacteria, Escherichia-Shigella, and Sutterella (p < 0.05). Moreover, three serum exosomal miRNAs (ssc-miR-16, ssc-miR-19b, and ssc-let-7c) emerged from the analysis as potential key regulators of IUGR. Functional enrichment analysis revealed that ssc-miR-16 and ssc-miR-19b were significantly increased in IUGR piglets, mainly targeting genes involved in cellular signaling, metabolism, and immune regulation, including the mTOR and infection-related pathways. In contrast, ssc-let-7c was significantly downregulated and linked to metabolic processes such as protein digestion and absorption. Collectively, these findings demonstrate that IUGR disrupts intestinal barrier development and microbial homeostasis, while identifying three serum exosomal miRNAs as potential biomarkers and mechanistic contributors to the pathological processes underlying IUGR.
Le 8 juin 2023, le Canada et les Pays-Bas ont saisi la Cour internationale de justice (CIJ) pour des violations de la 1984 Convention contre la torture et autres peines ou traitements cruels, inhumains ou dégradants attribuées à l’État syrien. À cette situation étatique, souvent décrite comme une zone où le droit et la justice n’avaient pas leur place, se superposent ainsi de premiers efforts pour que l’État rende des comptes. Au-delà de la possibilité dont dispose la Cour internationale de Justice (CIJ), en tant que visage institutionnel de la responsabilité étatique, de réduire ici le “fossé d’impunité,” cette affaire met également en lumière la tension existante entre deux visions opposées du droit international (“universaliste” et “souverainiste”) qui sont appelées à coexister dans le cadre de la lutte contre l’impunité. Bien que cette affaire, s’inscrivant dans une lignée jurisprudentielle favorable à l’élargissement de la fonction judiciaire de la CIJ, confirme la proximité avec le modèle “universaliste” eu égard à l’extension du locus standi devant son prétoire et à l’évolution de son mandat pour embrasser les contextes gouvernés par des violations massives des droits de la personne, il ne faudrait pas en déduire que le paradigme “souverainiste” a été effacé et remplacé.
Glaciers that terminate in the ocean or lakes exhibit unique dynamics that can drive rapid change. These dynamics, governed by many complex and interacting processes, challenge calibration and validation of physics-based models. We take a data-driven approach to quantify the imprint of glacier–ocean interactions on global non-ice sheet glacier ice volumes. Using curated datasets, we build a hierarchy of models that capture the influence of ice shelves and grounded marine termini. We find that tidewater and lake-terminating glaciers are systematically thicker than glaciers ending on land. Summed globally, this effect accounts for about 20% of non–ice-sheet glacier volume. Thicker ice is observed both for glaciers with ice shelves, where buttressing supports upstream ice, and for water-terminating glaciers without shelves. We interpret this result in terms of a simple mechanical model whereby water pressure permits thicker termini than possible in air, consistent with theoretical limits on ice cliff height. Our results highlight how ice–ocean interactions shape the equilibrium geometry of glaciers, offering a large-scale complement to process-based studies of calving and frontal melt. While most global glacier models omit these interactions, our analysis motivates their inclusion in forecasts of glacier change and sea level rise.
Twin fetuses show a physiologically slower growth rate in the third trimester compared to singletons. Therefore, it has been suggested that the anthropometric evaluation of twins at birth should be performed using twin-specific charts. To be reliable, anthropometric charts need to fulfil certain methodological criteria to systematically review studies that have developed neonatal twin-specific anthropometric charts and assess their methodological quality. A comprehensive search was conducted across Cinahl, Embase, Global Index Medicus, PubMed, Scopus, Web of Science, Google Scholar, and relevant preprint repositories, followed by a predefined snowballing search. Two reviewers independently screened studies for eligibility, selecting those that have developed cross-sectional anthropometric charts for twins at birth, published since January 1990. Articles were excluded if they did not use anthropometric measurements at birth to construct charts. Two reviewers independently extracted data and performed quality assessment with a 16-item grading system. Sixty-eight studies were included, with all but one constructed reference, not standard, charts. Most studies did not meet the quality criteria: only 9% were prospectively designed, 34% reliably estimated gestational age, 19% reported standardized instruments, 28% described measurement techniques, and 26% did not stratify centiles by sex. This review reveals considerable methodological limitations in existing twin-specific neonatal anthropometric charts.
The EU Artificial Intelligence Act (AI Act) establishes a novel risk-based regulatory model for AI systems, categorising uses into four tiers: unacceptable (prohibited), high-risk (tightly regulated), limited-risk (transparency obligations), and minimal-risk (largely unregulated). This article develops a rigorous conceptual framework to analyse the Act’s logic of risk, reasonableness, and residual harm. It explains how the principles of precaution and proportionality shape the AI Act’s ex ante controls, requiring providers to anticipate reasonably foreseeable misuse and apply measures that reflect the state of the art.1 We propose criteria for calibrating key requirements (data governance, transparency, human oversight, robustness or cybersecurity) to the severity and uncertainty of risks, drawing on risk-regulation theory (e.g., Baldwin and Black’s responsive regulation and Sunstein’s cost-benefit rationality). The analysis also situates the EU approach within a comparative context, noting alignments and divergences with US and OECD AI frameworks – for example, the EU’s precautionary bans on biometric mass surveillance contrast with the US reliance on voluntary risk management guidelines. Specific high-impact use cases (biometric identification in public spaces, AI in critical infrastructure) illustrate how risk severity triggers stricter controls. The article concludes by discussing policy implications for implementation, including the role of harmonised standards and presumptions of conformity, the interface with parallel cybersecurity regimes (NIS2, DORA) as “risk multipliers,” and the need for further guidance and delegated acts to ensure that the AI Act’s proportional safeguards remain effective in the face of technological change.
The optically stimulated luminescence (OSL) sensitivity of quartz ranges across five orders of magnitude. Previous studies suggested that quartz OSL sensitivity is enhanced by solar exposure–burial irradiation cycles. Spatially resolved luminescence measurements and laboratory illumination–irradiation experiments were used to investigate the OSL sensitivity of quartz crystals from a granodiorite cobble and quartz grains from a fluvial sand. Quartz from the granodiorite cobble has low OSL sensitivity, showing an approximately linear sensitization path that resulted from laboratory illumination–irradiation cycles. The mean OSL sensitivity of quartz sand grains (100 grains) increased from ∼40 to 80 counts after 1260 illumination–irradiation cycles. Each grain has a specific sensitization trajectory due to illumination–irradiation cycles, suggesting that quartz crystal composition heterogeneities drive the OSL sensitization of their daughter sediment grains. Maximum OSL sensitivity of quartz sand grains is reached after illumination–irradiation cycles representing an accumulated dose of around 4000 Gy. This dose corresponds to sediment burial time of 2–4 Ma, which is unlikely to occur during a single sediment transport route. This study suggests that illumination–irradiation cycles are unable to produce quartz sand grains with OSL sensitivity up to five orders of magnitude higher than the sensitivity of parent crystals in igneous or metamorphic rocks.
Sinusitis is a leading cause for outpatient antibiotics. An interruptive electronic health record alert was implemented to promote optimal antibiotic selection and duration for acute bacterial sinusitis when suboptimal treatment is ordered. After implementation, optimal antibiotic prescribing significantly increased 7% preintervention versus 30% postintervention, (unadjOR, 5.69; 95% CI, 2.36 – 13.72; P < .001).
Patients with non-English language preference (NELP) face significant barriers to safe and effective communication in palliative and supportive care. These barriers compromise quality, delay care, and heighten the risk of unmet psychosocial needs, particularly when compounded by health literacy concerns and limited access to translated resources.
Methods
We describe two Spanish-speaking patients with advanced cancer whose inpatient and outpatient supportive care was complicated by language barriers, leading to communication gaps, including symptom misinterpretation and inadequate family discharge education. These factors contributed to significant distress and safety risks.
Results
Interdisciplinary interventions, including professional interpreter use, bilingual supportive care psychology, teach-back education, medication relabeling in Spanish, and culturally tailored communication, helped restore trust, alleviate suffering, and align care with patient and family values. In one case, a lack of validated Spanish versions of the Edmonton Symptom Assessment System within the electronic medical record (EMR) hindered symptom self-reporting and safety. Following multiple requests, the EMR team initiated development of a Spanish-language template to facilitate future integration.
Significance of the results
Structural gaps in language accessibility compound distress, reduce autonomy, and threaten safety. These cases underscore that interpreter services alone are insufficient. Integrating validated multilingual tools into EMRs, standardizing translated discharge instructions, and expanding access to in-person interpreters are critical steps toward equitable care. Institutionalizing linguistically responsive systems is essential for ensuring safety, equity, and dignity in palliative care for patients with NELP.
This paper studies efficiency in the housing market in the presence of search frictions and endogenous entry of buyers and sellers. These two features are essential to explain the housing market stylized facts and to generate an upward-sloping Beveridge Curve in the housing market. Search frictions and endogenous entry create two externalities in the market. First, there is a congestion externality common to markets with search frictions. Sellers do not internalize the effect of listing a house for sale on other sellers’ probability of finding a buyer. Second, the endogenous entry of buyers leads to a participation externality, as new entrants in the market raise search costs for all buyers. The equilibrium is inefficient even when the Hosios-Mortensen-Pissarides condition holds. Using a calibration to the US housing market, we quantify the size of these externalities and how far the housing market is from the optimal allocation. The optimal vacancy rate and time-to-sell are about half their equilibrium counterparts, whereas the optimal number of buyers and homeowners are above their decentralized equilibrium values. Finally, we investigate how housing market policies restore efficiency in the housing market.
Digital health services in Kenya comprise mobile health applications (mHealth apps), electronic health records, telehealth and telemedicine, which form part of an expanding digital health assemblage. These are shaped by transnational development agendas and donor-driven public health interventions. This paper discusses the for-profit turn in the digitalisation of health care – what I term the ‘appisation’ of health – as a site of intensified commodification where users are reconfigured as digitised health consumers. While other scholars have argued that digitalisation functions as extractive in deepening market penetration into spheres of life we rely on, I extend these arguments by claiming that, far from enhancing access, these technologies exploit vulnerabilities through opaque governance mechanisms and algorithmic decision-making, while transferring responsibility for health from the state to the individual, thus creating new dependencies on market-mediated platforms. Using discursive interface analysis of two health apps in Kenya, I examine how consumer health apps embed vulnerabilities while consumer law remains structurally limited in confronting the collective harms they generate.
Blood culture contamination (BCC) leads to increased costs and patient harms. We reviewed 525 BCC cases and found 71.2% of BCC cases were ordered for indications with low risk for bacteremia and most received unnecessary tests and antibiotics. Diagnostic stewardship of blood cultures may reduce BCC and its associated costs.