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Patient involvement in health technology assessment (HTA) at the organizational level remains relatively underreported in Asia. In 2022, Singapore’s Agency for Care Effectiveness (ACE) established a Consumer Panel to provide strategic advice on strengthening patient participation in HTA processes and policy development. The Panel comprises representatives from local patient organizations, collectively covering a range of health conditions and bringing extensive lived experience within Singapore’s healthcare system. This Perspective outlines ACE’s approach to forming the Panel and highlights its contributions during the inaugural term, including co-developing patient involvement processes, supporting health literacy efforts, and fostering collaboration between ACE and patient communities. Panel members’ reflections on their role and future directions for advancing patient partnership in HTA are also discussed. Beyond improving the quality and relevance of ACE’s work, the Consumer Panel’s achievements provide a valuable example for health authorities in other countries seeking to meaningfully involve patients at the organizational level.
AM CVn stars are ultra-compact semi-detached binaries consisting of a white dwarf primary and a hydrogen-depleted secondary. In this paper we present spectroscopic and photometric results of 15 transient sources pre-classified as AM CVn candidates. Our analysis confirms 9 systems of the type AM CVn, 3 hydrogen-rich cataclysmic variables (accreting white dwarfs with near-main-sequence stars for donors) and 3 systems that could be evolved cataclysmic variables. Eight of the AM CVn stars are analysed spectroscopically for the first time, which increases the number of spectroscopically confirmed AM CVns by about 10%. TESS data revealed the orbital period of the AM CVn star ASASSN-20pv to be Porb =27.282 min, which helps to constrain the possible values of its mass ratio. TESS also helped to determine the superhump periods of one AM CVn star (ASASSN-19ct, Psh = 30.94 min) and two cataclysmic variables we classify as WZ Sge stars (Psh = 90.77 min for ZTF18aaaasnn and Psh =91.6 min for ASASSN-15na).We identified very different abundances in the spectra of the AM CVns binaries ASASSN-15kf and ASASSN-20pv (both Porb ∼ 27.5 min), suggesting different type of donors. Six of the studied AM CVns are X-ray sources, which helped to determine their mass accretion rates. Photometry shows that the duration of all the superoutbursts detected in the AM CVns is consistent with expectations from the disc instability model. Finally, we provide refined criteria for the identification of new systems using all-sky surveys such as LSST.
Large grant-making philanthropic foundations in the UK and the EU can have a significant influence over environmental law and as such are worthy of more attention from environmental law scholars. Through analysis of publicly available documents, we identify in this paper an absence of consistent transparency by these foundations. This makes their influence hard to understand, hard to research, hard even to see at work in the world. Transparency is complex and challenging, however. And so, rather than berating problematic approaches, we explore through interviews with actors in the field, as well as the academic literature, both the difficulties that foundations experience in pursuing transparent practices and the benefits of transparency. We conclude by identifying some principles for improved visibility of foundation work.
The efficacy of using luminescence dating on glacial deposits is tested for a portion of the Marine Isotope Stage (MIS) 6 Laurentide Ice Sheet margin in southwestern Indiana. We assess small-aliquot quartz optically stimulated luminescence (OSL) and feldspar infrared-stimulated luminescence (IRSL) dating of glaciofluvial, glaciodeltaic, and aeolian sediments against a well-established soil stratigraphy and a cosmogenic 10Be depth profile. Results indicate that standard blue-light OSL regenerative protocols used on MIS 2 glacial sediments in the region warrant caution when duplicated for MIS 6 sediments. Quartz OSL ages underestimate age by up to 50% compared with cosmogenic and feldspar post-IR IRSL200 ages. Presence of unstable or hard-to-bleach OSL signal components that cannot be removed with modified preheat protocols yields unreliable data. While dates obtained using post-IR IRSL200 protocols on feldspar are affected by partial bleaching and anomalous fading, these factors can be accounted for. Discrimination of negligible-fading small-aliquot data allowed us to obtain post-IR IRSL200 ages between 103 ± 12 and 241 ± 28 ka. Post-IR IRSL200 ages are mostly consistent with 10Be depth-profile dating and stratigraphic constraints and represent a viable option to study glaciofluvial sedimentation during MIS 6 and older glaciations in the region.
This article examines the fate of the Soviet community in North Korea, arguing that its trajectory closely mirrored the evolving relationship between the Soviet Union and the Democratic People’s Republic of Korea (DPRK). Between the 1940s and the 1990s, Moscow-Pyongyang relations transformed from quasi-colonial Soviet dominance in the late 1940s to Pyongyang’s successful assertion of political independence in the mid-1950s, followed by antagonism in the 1960s and 1970s, a thaw in the mid-1980s, and, finally, a decline into insignificance from the 1990s to the early 2020s. Similarly, the Soviet community shifted from a position of political influence to a marginalized group that eventually disappeared altogether.
The narrative begins with the community’s formation following the Soviet occupation of North Korea in 1945 and traces its evolution through the shifting geopolitical landscape of the Cold War. The article explores the roles of various subgroups within the community—Soviet administrators, ethnic Koreans with Soviet citizenship, and ordinary Soviet citizens—highlighting the unique social and political challenges each faced under the Kim regime. It examines the community’s decline in the late 1950s as Kim Il-sung consolidated power, expelling Soviet advisers and enforcing naturalization policies that compelled most members of this group to abandon their Soviet ties or endure severe discrimination.
Drawing on recently declassified Russian archival documents, the article provides a fresh empirical perspective and offers a periodization of the community’s history. In doing so, it sheds light on a little-known aspect of Soviet-North Korean relations and the broader dynamics of post-colonial transitions.
Antibiotic stewardship programs (ASPs) aim to optimize antibiotic prescribing, as prolonged use increases the risk of adverse events, antimicrobial resistance, and unnecessary healthcare costs. This study aimed to determine the period prevalence of prolonged antibiotic treatment durations for community-onset infections in Dutch hospitals and to identify risk factors.
Methods:
A retrospective cohort study was conducted among adults treated for urinary tract infections (UTI), respiratory tract infections (RTI), or skin and soft tissue infections (SSTI) in four Dutch secondary care hospitals from January 1, 2021, to December 31, 2023. Patients were included if they were admitted for ≥12 hours and treated with antibiotics within 48 hours. Antibiotic prescriptions were linked to infectious diagnoses to calculate length of therapy and compared against national guidelines to assess prolonged treatment. Backward stepwise multivariable logistic regression was used to identify risk factors.
Results:
Of 9,878 admissions, 39.6% had UTIs, 44.9% RTIs, and 15.4% SSTIs. Prolonged antibiotic use was observed in 30%, with the highest proportion in RTIs (49.6%). Among RTIs, prolonged use occurred in 51.0% of community-acquired pneumonia (CAP) and 55.9% of aspiration pneumonia, with a combined median excess duration of 1.6 days (IQR: 0.9–3.6)). Prolonged use was 14.3% in UTIs and 13.1% in SSTIs. Risk factors included positive cultures, intravenous-to-oral switch, aspiration pneumonia or CAP (RTIs), and cystitis (UTIs).
Conclusions:
A high period prevalence of patients with RTIs receiving prolonged antibiotic treatment was observed. The identified risk factors should be considered in ASPs to improve prescribing and reduce non-guideline-concordant antibiotic therapy.
Supporting voice hearers to explore and make meaning of their voice-hearing experiences can be helpful, but many mental health workers lack confidence or do not feel they have the skills required to do this. Although more is needed, some resources and training are available to assist workers in this area. To date, there are no suitable measures to evaluate the impact of these resources and training. Therefore, Supporting Voice Hearers Measure (SVHM) was developed. SVHM is a 23-item scale designed to evaluate mental health workers’ beliefs, attitudes, confidence and behaviours related to working with voice hearers.
Aims
To describe the development and testing of the SVHM.
Method
Measurement properties explored included rating scale validity, unidimensionality, reliability, construct validity and person-fit statistics. Additionally, evaluations of concurrent validity, responsiveness and time taken to complete SVHM were completed.
Results
A total of 548 completions of SVHM were included in the analysis. One item was interfering with measurement precision and was subsequently removed. The resultant 22-item measure demonstrated generally good measurement properties according to the quality criteria set. It demonstrated good concurrent reliability with confidence in working with voice hearers (r = 0.49, p < 0.001), strong responsiveness and evidence of feasibility, with a median time for completion of 3 min 39 s.
Conclusions
These results suggest that SVHM is a promising measure of mental health workers’ beliefs, attitudes, confidence and behaviours related to working with voice hearers. Future research should explore how changes in mental health workers’ beliefs, attitudes, confidence and behaviours impact the experiences and outcomes achieved by the voice hearers they are working with.
This study examines how multiple dimensions of socio-emotional well-being relate to cognitive functioning in older adults, and whether the associations vary by cognitive status, depression, and socio-demographic factors.
Methods:
Data from the Harmonized Cognitive Assessment Protocol of the Survey of Health, Ageing and Retirement in Europe (n = 2,650; mean age = 76; 54.5% females) were used to test associations between life satisfaction, meaning in life, social connectedness, and loneliness with global, domain-specific cognitive performance, and informant-rated cognitive decline.
Results:
Linear mixed models, with individuals nested within five countries, found that higher life satisfaction, meaning in life, and social connectedness were associated with better cognitive outcomes, whereas greater loneliness was associated with worse performance and greater informant-rated decline. The largest effect sizes were observed for meaning in life (median β = .10) and loneliness (median β = −.09) across cognitive measures. The associations generally remained significant adjusting for well-known clinical (e.g., diabetes), behavioral (e.g., physical inactivity), and psychological (depressive symptomatology) risk factors for dementia. Moderation and sensitivity analyses suggested that associations with global cognition hinged on the inclusion of participants classified with cognitive impairment, while some domain-specific associations (e.g., loneliness and episodic memory) were observed only in individuals without cognitive impairment. Overall, evidence for moderation by cognitive status, depression and age was limited, and no moderation was observed for sex or education.
Conclusions:
The results underscore the importance of socio-emotional well-being in cognitive aging and highlight the need for longitudinal research to clarify mechanistic pathways and inform targeted interventions.
Long-term segregation (LTS) is used in mental health hospitals in England to manage individuals perceived to pose a sustained risk of harm to others. Increasing evidence indicates that LTS causes significant psychological and physical harm and may breach international human rights standards. The HOPE(S) programme (2022–2025) was introduced nationally to reduce, and ultimately end, the use of LTS for autistic people, individuals with learning disabilities and children and young people.
Aims
To explore the experiences of LTS from different perspectives and to examine its impact through a human rights lens.
Method
Qualitative data were collected from 73 participants, including people with lived experience of LTS, family members, HOPE(S) practitioners, clinical staff, commissioners and regulators. Reflexive thematic analysis was conducted as part of a wider, mixed-methods evaluation of the HOPE(S) programme.
Results
LTS was described by most participants as harmful, dehumanising and lacking in therapeutic value. Four interrelated themes emerged: (a) dehumanisation and erosion of personhood; (b) safeguarding and systemic failure; (c) psychological and relational harm; and (d) loss of hope and systemic inertia. These experiences reflected breaches of the Convention on the Rights of Persons with Disabilities, and of the Convention on the Rights of the Child.
Conclusions
LTS is not a therapeutic intervention and is associated with profound psychological harm and human rights violations. Systemic reform and implementation of rights-based, trauma-informed alternatives, such as the HOPE(S) model, are urgently required to safeguard well-being and dignity in mental healthcare.
We prove that for any $k\geq 3$ for clause/variable ratios up to the Gibbs uniqueness threshold of the corresponding Galton-Watson tree, the number of satisfying assignments of random $k$-SAT formulas is given by the ‘replica symmetric solution’ predicted by physics methods [Monasson, Zecchina: Phys. Rev. Lett. 76 (1996)]. Furthermore, while the Gibbs uniqueness threshold is still not known precisely for any $k\geq 3$, we derive new lower bounds on this threshold that improve over prior work [Montanari and Shah: SODA (2007)]. The improvement is significant particularly for small $k$.
Asymptotic approximations are derived for the drift force and moment acting on bodies in incident plane surface waves. These approximations are based on the assumption that the wavelength is long compared with the length scale of the body or, equivalently, the frequency and wavenumber are small. Expansions in ascending powers of the wavenumber are developed for the Kochin function, which represents the far-field waves diffracted and radiated by the body. From these expansions the approximations of the drift force and moment are derived. If the body is unrestrained its motions in long waves are the same as the incident waves, to leading order, resulting in cancellation between the components of the Kochin function due to diffraction and radiation. It is necessary to expand these functions up to third order in the wavenumber to evaluate the leading-order terms of the drift force and moment. The approximations are compared with computations for small finite wavenumbers for several different floating and submerged bodies including spheres, spheroids and parallelepipeds. The characteristics of the drift moment are analysed to determine the angles of stable and unstable equilibrium relative to the waves.
Cardiopulmonary bypass-induced inflammation is associated with poor postoperative outcomes. Bypass exposure has been associated with shifts in lymphocyte populations. This study aimed to describe two cytokine profiles associated with T and NK cells and their effects on clinical markers of postoperative cardiovascular dysfunction in children undergoing cardiac surgery with cardiopulmonary bypass.
Methods:
Children from two major children’s hospitals undergoing corrective cardiac surgery with cardiopulmonary bypass were included. Plasma was collected pre-, 0 to 4 hours post- and 24 hours (when available) postoperatively. Plasma concentrations of cytokines were quantified using enzyme-linked immunosorbent assays. Delta cytokine concentrations were compared to vasoactive infusion score and percent fluid balance on postoperative day one. Vascular reactivity was assessed in a subset of the cohort. Confirmation of endothelial-specific effects of interferon-γ and interleukin-17A was performed in microvascular endothelial cells, assessing cytokine levels by enzyme-linked immunosorbent assays or trans-endothelial electrical resistance.
Results:
A total of 26 children were included in the analysis. Interferon-γ was inversely associated with vasoactive infusion score (p < 0.05), whereas interleukin-17A and interleukin-23 were associated with greater cumulative postoperative fluid balance (p < 0.01 and 0.03, respectively). Peak vascular reactivity is strongly associated with interferon-γ (p = 0.001), but not with circulating interleukin-17A. Human microvascular endothelial cell exposure to interferon-γ increased endothelial permeability and cytokine production.
Conclusions:
Interferon-γ and interleukin-17A may be associated with cardiovascular dysfunction in children after exposure to cardiopulmonary bypass, albeit with differential clinical features. Interferon-γ may directly impact vascular measures, while the impact of interleukin-17A may relate to fluid accumulation.
There is a widespread perception among academics, doctors and patients that the common law can effectively drive the development and incorporation of patients’ autonomy-based rights into medical practice. However, there is reason to doubt that this is correct.
We present a critical analysis of this view, prompted by themes that emerged from interviews with n=31 lawyers and n=24 doctors as part of a larger interdisciplinary study. We focus on the limitations of case law in driving autonomy-respecting clinical practice. Part I examines how the development and impact of decided cases is dominated by practical and economic considerations. It also considers the lack of understanding of case law among clinicians and the extent to which this limits its ability to drive change. Part II sets out our reasons for treating these limitations as a cause for concern. In Part III, we conclude by considering different levers for supporting case law in creating or confirming autonomy-respecting norms in medical practice, suggesting ways in which these might be developed further.
We argue that clinical negligence litigation is important as a guide to clinical practice and a means of enforcing autonomy-based patient rights but that it cannot be relied upon to drive changes in practice. Both professional guidance and legislation can augment case law but, for them to be effective, proper communication between doctors and legislators, courts, lawyers and insurance organizations is essential.
The Rohingya refugee crisis, a major humanitarian tragedy in contemporary global politics, has gradually precipitated major security challenges to Bangladesh and other states. This paper employs the Copenhagen School’s securitization theory to examine how securitization, especially by the Bangladeshi government and media, has framed these challenges as existential threats. It makes two basic contributions to existing literature on the Rohingya crisis. Firstly, it provides a theory-informed analysis of the security dimensions of the crisis, considering the interplay between the refugee crisis and national and regional security dynamics. Secondly, the paper explores how the refugees securitize their current plight. Empirically, the study utilizes interview data from 60 local residents, law enforcement agencies, and employees of local and international NGOs. The discussion suggests the possibilities and limitations of the securitization theory in the field of refugee or forced migration studies in the Global South.
Internal waves are an important feature of stratified fluids, both in oceanic and lake basins and in other settings. Many works have been published on the generic feature of internal wave trapping onto planar wave attractors and super-attractors in two and three dimensions and the exceptional class of standing global internal wave modes. However, most of these works did not deal with waves that escape trapping. By using continuous symmetries, we analytically prove the existence of internal wave whispering gallery modes (WGMs), internal waves that propagate continuously without getting trapped by attractors. The WGM’s neutral stability with respect to different perturbations enables whispering gallery beams, a continuum of rays propagating together coherently. The systems’ continuous symmetries also enable projection onto two-dimensional planes that yield effective two-dimensional billiards preserving the original dynamics. By examining rays deviating from these WGMs in parabolic channels, we discover a new type of wave attractor that is located along the channel’s critical depth – the depth at which the bottom slope is identical to the ray slope, instead of cross-channel, as in previous works. This new critical-slope wave attractor leads to a new understanding of WGMs as sitting at the border between the two basins of attraction. Finally, both critical-slope wave attractors and whispering gallery beams are used to propose explanations for along-channel energy fluxes in submarine canyons and tidal energy intensification near critical slopes.
This paper re-evaluates the significance of José Vicente Asuar (1933–2017), a pioneering figure in Latin American computer music, shifting the focus from the hardware construction of his COMDASUAR system to the innovative software he developed for algorithmic composition. While Asuar’s hybrid digital-analog computer is noteworthy, the true core of his contribution lies in his original machine language programs designed for the Intel 8080 microprocessor. This study examines how Asuar thought about and designed algorithms specifically created for generating musical structures, processing symbolic data in real-time, and enabling interactive performance. By analyzing newly discovered handwritten notebooks containing his meticulous code documentation, we uncover Asuar’s deep engagement with low-level programming to express complex musical ideas. His approach, focused on the computer as an “amplifier of the imagination,” prioritized the development of software to facilitate generative composition and real-time manipulation of musical parameters. This paper argues that Asuar’s legacy rests not solely on the COMDASUAR hardware but primarily on his visionary software architecture, which transformed the computer into a dynamic compositional partner. In doing so, he anticipated later developments in interactive music systems, demonstrating a pioneering approach to computer music that placed software innovation at its center.
This article examines the participation of women as authors in five leading law journals of a generalist nature in the UK. For its data points, it takes each author of an article in the Cambridge Law Journal, the Journal of Law and Society, Legal Studies, the Modern Law Review and the Oxford Journal of Legal Studies. From 2016 to 2020, around 900 authors have published over 700 articles in these five journals. The analysis of these results reveals discrepancies in women’s participation in legal publishing. It shows that those journals which publish fewer articles, publish fewer women authors. The article situates its data in a description of gender patterns within the academy generally and specifically within the UK law school. It draws on the experiences of gender publishing disparity in other disciplines where the debate is more established. It concludes with suggestions for changes in the publication process and further research to develop the picture of women’s publishing in law.