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Prior research has suggested an inverse correlation between dried fruit intake and type 2 diabetes mellitus (T2DM), yet the causal link remains uncertain. This study seeks to investigate the potential causal impact of dried fruit intake on T2DM, covering cases both with and without various complications, as well as glycaemic traits, using a two-sample Mendelian randomisation (MR) approach. Using MR analysis with genome-wide association study summary statistics, the primary analysis investigated the causal relationship between dried fruit intake and T2DM, both with and without complications, as well as glycaemic traits, employing the inverse variance weighted method. Supplementary analyses were conducted using MR-Egger and the weighted median method. Heterogeneity and intercept tests were utilised to evaluate the robustness of the study outcomes. The results show a significant association between dried fruit intake and T2DM without complications, as well as fasting insulin. Sensitivity analyses confirmed the robustness of the results and the independence from multicollinearity. However, no association was found between dried fruit intake and T2DM with various complications or other glycaemic traits. The significant association between dried fruit intake and T2DM without complications and fasting insulin persisted even after adjusting for BMI. This study offers genetic evidence endorsing the protective effects of dried fruit intake against T2DM, specifically for cases without complications, and in regulating fasting insulin. These findings suggest that dried fruit intake might serve as a primary preventive strategy for T2DM.
A well-functioning immune system requires balanced immune responses. In vitro studies have shown that plant stanols contribute to restoring the T-helper (Th)1/Th2 ratio when it is imbalanced. However, effects of plant stanols on healthy immune responses are unknown. Therefore, we studied effects of recommended (2·5 g/d) or high (9·0 g/d) plant stanol intakes on the Th1/Th2 cytokine balance in immunologically healthy subjects. In two RCTs, peripheral blood mononuclear cells (PBMCs) were isolated, cultured, and stimulated with 5 µg/ml Phytohemagglutinin-M to study ex vivo cytokine production. In the first study, twenty participants consumed margarines (2·5 g/d plant stanols) or control for three weeks. In the second study, nineteen participants consumed margarines and yogurts (9·0 g/d plant stanols) or control for four weeks. T-cell cytokine concentrations were measured in culture medium and in study 2 a standardized Th1/Th2 index was calculated. Serum lipids and non-cholesterol sterols were also measured. Compliance was confirmed by significant increases in serum total cholesterol (TC)-standardized sitostanol and campestanol levels in both studies. Changes in ex vivo cytokine production and Th1/Th2 index did not differ between intervention and control groups. In the first study, no statistically significant changes were observed in lipid and lipoprotein concentrations. In the second study, LDL cholesterol significantly decreased compared to control (–0·77 (–1·11, –0·42) mmol/l; P < 0·001). Recommended (2·5 g/d) or high (9·0 g/d) intakes of plant stanols did not alter PBMC ex vivo cytokine production in immunologically healthy subjects. This suggests that plant stanols might only affect immune function when Th1/Th2 immune responses are imbalanced.
An overview of findings from an in-depth inductive study of ‘the lexical, exegetical, conceptual, and theological study of evil from the Hebrew text of Genesis’ provides key insights into the broad use of the primary lexeme(s) for evil (ra as an adjective, raa as a verb, and raah as a noun). The use of evil is followed sequentially through each occurrence in Genesis to assess its meaning and concept contextually. The plot conflict of good and evil is observed from the beginning to its bookend. Evil is never called good nor found to be the absence of good, but rather, the corruption of creational and covenantal goodness. God is found to work in and through flawed and dysfunctional humans to overturn evil and accomplish his good creational and covenantal purposes.
Rising income and wealth inequality across the developed world has prompted a renewed focus on the mechanisms driving inequality. This paper contributes to the existing literature by studying the impact from life-cycle savings, intergenerational transfers, and fertility differences between the rich and the poor on the wealth distribution. We find that bequests increase the level of wealth inequality and that fertility differences between the rich and the poor amplify this relationship. The counterfactual exercises show that the interaction between bequests and differential fertility is quantitatively important for understanding wealth inequality in the United States.
Globally, more than 13 % of adolescents have clinically significant mental health problems, with anxiety and depression comprising over 40 % of cases. Despite the high prevalence of anxiety disorders among youth, dietary research has been focused on youth with depression, resulting in a significant knowledge gap regarding the impact of anxiety on adolescent diet quality. Adolescents with diagnosed anxiety disorders and healthy controls were included in this study. Anxiety symptoms were measured using the Screen for Child Anxiety-Related Disorders. Diagnosis of anxiety disorder was determined using the Kiddie Schedule for Affective Disorders and Schizophrenia interview. Five diet quality indices were scored from FFQ. Diet quality indices associated with anxiety symptoms in the correlation matrix were interrogated using multiple linear regression modelling. All models were adjusted for depression. One hundred and twenty-eight adolescents (mean age 14·8 years (sd: 2·1); 66·4 % female) were included in this cross-sectional analysis. Although healthy controls and outpatient participants had similar unhealthy dietary index subscale scores, outpatient participants had lower healthy index scores. Higher anxiety symptoms were associated with lower healthy dietary indices in univariate analysis; after adjusting for comorbid depression; however, anxiety symptoms were no longer associated with dietary indices following adjustment for multiple testing (P = 0·038 to P = 0·077). The association between anxiety symptoms and a poor diet is attenuated by depression. The results of this study support the need for an integrated approach to the assessment of mental and physical well-being and further research aimed at understanding the unique contribution of depression to healthy dietary patterns.
The coloniality of power stands as a major framework for theorizing race within the context of Latin America, providing an influential account of the origin of race in the Spanish colonization of the Americas. Without abandoning the task of theorizing the ways in which race functions in Latin America, this article asks: what is obscured by an insistence on 1492 as the moment when race emerged, and what different understandings of race can be made available by connecting the colonization of the Americas to a different set of temporal and spatial referents? Specifically, I develop a “prismatic” approach to analyze the impact of fifteenth-century Iberian blood purity statutes on the development of race without positing these as the new, singular origin of race. This article thus suggests an alternative genealogy of racialization while providing a critical engagement with the coloniality of power’s account of race.
A 54-question survey about System Healthcare Infection Prevention Programs (SHIPPs) was sent out to SHEA Research Network participants in August 2023. Thirty-eight United States-based institutions responded (38/93, 41%), of which 23 have SHIPPs. We found heterogeneity in the structure, staffing, and resources for system infection prevention (IP) programs.
Active components from plants are an alternative therapy to parasite control, addressing the widespread multidrug resistance populations. Linalyl acetate (LA), an ester abundantly found in plants of the genus Lavandula, was tested in vitro against third-stage larvae (L3) of Haemonchus spp. and Trichostrongylus spp. using the larval migration test at 0.89, 2.24, 4.47, 8.95, 17.9, 35.8, 71.6, and 143.2 mg/ml. After an initial incubation of 18 h, the total content of each tube was transferred to a 24-well plate that allowed active L3 to migrate through a nylon mesh (second incubation). Although LA exhibited 100% efficacy in reducing larval migration at 8.95 and 17.9 mg/ml, it showed reduced activity (5%) at 143.2 mg/ml. The data revealed a hormetic biphasic response characterised by an inverted U-shaped concentration-response curve. While hormesis has been previously documented in insecticidal and allelopathic contexts, this study reports the occurrence of hormesis induced by a phytochemical component against two species of nematodes for the first time. This distinctive stimulation-and-inhibition effect should be considered when selecting new compounds for preclinical testing.
Maintaining optimal growth of preterm infants after hospital discharge remains a challenge. There has been no data on the long-term growth trajectory of preterm infants in Indonesia. We aimed to describe the growth trajectory of preterm infants up to 24 months of corrected age and its variation among gestational age groups. A longitudinal study was conducted in Cipto Mangunkusumo Hospital, Jakarta, from 2018 to 2020. All preterm infants who were discharged during the study period were included. Growth trajectory analysis used weight-for-age, length-for-age and weight-for-length z-score of 3-month time intervals across gestational age groups using repeated measure ANOVA and generalised estimating equation regression. Length trajectory was specifically reported as a stunted proportion. Among 306 preterm infants included, most were moderate preterm (49·67 %) and low birth weight (69·93 %). Overall weight-for-age at 0 months was in the median of the curve, then decreased at 3 months but consistently increased slowly until 24 months. The weight-for-age trends were unique across gestational age groups but statistically similar (P= 0·263). The proportion of stunted gradually decreases to 13·40 % at 24 months, mostly among the moderate preterm group in the first 6 months (P< 0·001), but then becomes similar at 24 months. All subjects were in the normal range for weight-for-length but had variations in trends across gestational age groups (P< 0·001). Growth trajectory differed between weight, length and weight-for-length in the first 24 months and varied among gestational age groups. Close follow-up is crucial to ensure optimal growth after neonatal intensive care unit discharge.
Since COVID-19, Indonesia has legalized telemedicine in medical services, including Return to Work (RTW). RTW programs help occupational injury-disabled workers return to work. This research examines how telemedicine supports RTW for employees with occupational injuries.
Methods
The study used Interrupted Time Series Analysis (ITSA) to find patterns and trends in RTW program telemedicine case numbers and claim settlements over time. A total of 1 314 data were obtained from the Indonesian National Social Security Agency on Employment (BPJS Ketenagakerjaan) from July 1, 2015, to December 2022.
Results
Telemedicine reduces the frequency of recurrent occupational injuries in persons with impairments (Relative Risk [RR] = 0.59). In addition, the integration of telemedicine into health care practices exhibits promising prospects in terms of mitigating the financial burden on social security programs. This is supported by a robust RR (0.6).
Conclusions
Telemedicine reduced the number of repeat cases and optimized medical claims cost in the RTW program during the COVID-19 pandemic. The results will contribute to policy and assist health care professionals and employers in improving RTW outcomes for disabled people.
This paper focuses on a particular group of human figures attested on a number of Late Helladic (LH) IIIA2–B1 pictorial kraters which show specific attributes: they have long hair, wear an elaborate cloak-like robe and bear a sword on their chest. Furthermore, they appear in clearly peaceful representations like chariot or processional scenes. These accurately rendered ‘Sword Bearers’ have so far been assumed to be of male sex due to the presence of the sword; the interpretation proposed here, that they are women, is based on the presence of distinctive female traits as also found on female representations on pictorial vessels and other media of the same period. Particularly striking is the similarity with the enigmatic ‘Sword Bearer’ from the Cult Centre of Mycenae, who is the sole contemporary model of a female figure with a sword wrapped in a long cloak. Though not postulating that these figures are female warriors, attention will be drawn to the fact that weapons have a strong association to the female imagery as well to the sphere of ritual – a sphere in which women played, as is well known, a predominant role in Aegean culture.
There is a need to utilise formal education to ensure and support the effective participation of communities in the disaster risk management process. The negative outcomes of disasters occurring as a result of various disasters in Turkiye show that the society is inadequately prepared. Therefore, the best fight against disasters can be carried out within the scope of formal education activities. In this study, the content and infrastructure of a curriculum for the management of disaster risks at the university level is presented at the conceptual level. Disaster literacy curriculum can contribute to the management of current and future disaster risks. However, there is a need to expand the implementation and measurement of the effectiveness and feasibility of the curriculum as a public health intervention tool. Finally, the support of the national education system needs to be ensured.
Silvopastoral systems (SPSs) constitute a modality of agroforestry systems in which trees or shrubs, pastures and animals mutually grow, interacting with the environment, and providing several ecosystem services. This review aims to comprehensively discuss the ecosystem services provided by SPSs in different countries, highlighting the diverse ways these systems can contribute to human well-being and environmental sustainability, also emphasizing the importance of management strategies, the differences among systems and the main shortcomings and challenges to optimizing ecosystem service delivery from SPSs. The review focused on global studies, mainly those published between 2010 and 2024, directly relevant to the topic. We used Google Scholar, Scopus and Web of Science databases for literature screening. SPSs have demonstrated worldwide potential to enhance human food and forage production, nutrient cycling, soil fertility, biological nitrogen fixation, carbon sequestration, greenhouse gas mitigation, erosion control, microclimate regulation, pollination, control of pests and diseases, biodiversity, residue absorption, water quality, spiritual enrichment, recreation and aesthetic experiences. However, most ecosystem services provided by SPSs depend on climate conditions, soil type, choice of species, system design and management practices to ensure that such benefits are not provided at the cost of other important services. Interaction among components is a major challenge for system management and evaluations. Adopting SPSs has the potential to promote sustainable agriculture. Long-term studies are needed to elucidate the implications of multiple interactions within the system and their impact on ecosystem service delivery. Public policies, including evaluating ecosystem services, should be developed to promote the adoption of SPSs.
To investigate the effect of heated-cigarette smoking on voice.
Methods
Participants completed a survey including three sections: section-1 comprised demographic data, section-2 comprised visual analogue scale grading of voice changes and fatigue and section-3 consisted of the voice handicap index-10.
Results
Two hundred and eighty-two participants filled the survey. Heated-cigarette smokers had a significantly higher mean voice handicap index-10 score compared to non-smokers (p < 0.05). The difference in voice handicap index-10 scores between heated- and combustion-cigarette smokers was not statistically significant. The number of abnormal voice handicap index-10 scores was higher in heated-cigarette smokers compared to non-smokers (p < 0.05) and significantly higher in combustion-cigarette and dual heated- and combustion-cigarette smokers compared to the other 2 groups (p < 0.05). Non-smokers had significantly lower grades of voice changes and fatigue when compared to combustion and dual heated- and combustion-cigarette smokers (p < 0.05).
Conclusion
Smokers of heated cigarettes have a significantly higher mean voice handicap index-10 score compared to non-smokers and higher grade of voice changes and fatigue.
The Irish Constitution contains a pre-enactment abstract review procedure under Article 26 whereby, before signing a Bill into law, the President can refer the Bill to the Supreme Court for a decision on its constitutionality. However, only 16 such references have ever been made. The reason Irish Presidents have been cautious about sending Bills to the Supreme Court for abstract review relates to the fact that if a Bill survives the Article 26 review process, it then acquires an immunity from further challenge under Article 34.3.3. This has sometimes been referred to as a ‘seal of constitutionality’ and the absolute nature of this blanket immunity has been criticised because it means that, in practice, the review process is rarely used. By its very nature, abstract review suffers from the defect that the provisions are being looked at in a vacuum, without the benefit of a concrete factual scenario and it may be that circumstances later arise which could result in an unconstitutionality that was not apparent when the Bill was initially examined. For this reason, Presidents will sometimes decide not to refer a Bill, even one which is considered controversial, for fear of closing off the Bill to potential future challenges; they may feel it is better for challenges to occur organically as situations arise rather than to prevent a situation where a future challenge is blocked by the immunity following the review process. As Hogan has put it, ‘[w]ithout a plaintiff, a court may fail to anticipate side-effects or unintended consequences of the law’. The paucity of occurrences means that when the procedure is invoked, there is a great interest (amongst members of the legal and academic communities at least) in the process and outcome.
Structural damage in turbomachinery is a primary origin of aeronautic accidents, which is receiving increased attention. This study is thus focused on the aeroelastic analysis of damaged blades, including the onset of flutter and underlying mechanisms. First, a high-fidelity fluid–solid coupling system is established with computational fluid dynamics (CFD) and computational structural dynamics (CSD) technologies, via which the dynamic aeroelastic analysis is conducted based on static aeroelastic deformation. Second, a damaged rotor blade is parametrically modelled with variable damage levels, extents, and positions. Finally, the modal identification method of spectral proper orthogonal decomposition (SPOD) is applied to observe flow details and provide physical insight into the flutter mechanism for damaged blades. Numerical analysis finds that there is a critical damage level below which the aeroelastic stability is positively improved with increasing damage level; otherwise, a significant loss of stability is induced. The damage location and extent further affect this critical damage level and the change rate crossing the threshold. The simulation with CFD/CSD finds that the high pressure near the trailing edge induced from boundary layer separation suppresses vibrations in stable conditions, but motivates vibrations during flutter, which is because of the high-pressure spread to nearing blades. SPOD modes reveal that high-frequency disturbances with large scale are primary factors inducing flutter, which is further stimulated by the high-order disturbances with small scale. This study provides a crucial foundation for the fatigue prediction for rotor blades in service and the optimisation design for high-performance turbomachinery in the near future.
Despite the increasing risk of disasters and health crises worldwide, we are failing to equip the new generation of health care workers with basic education and training in disaster medicine and global public health. Unfortunately, the teaching of disaster medicine is underrepresented in several countries worldwide.
Learning Objectives
Understand the role of education and training as integral components of disaster preparedness.
Recognize the fundamentals of adult learning and competency-based education and training.
Discover the general principles of education and training in disaster medicine.
Explore the state of the art of simulation-based training in disaster medicine.
In this paper, we numerically study the mechanism of the oscillatory flow dynamics associated with the tip vortex cavitation (TVC) over an elliptical hydrofoil section. Using our recently developed three-dimensional variational multiphase flow solver, we investigate the TVC phenomenon at Reynolds number $Re = 8.95 \times 10^5$ via dynamic subgrid-scale modelling and the homogeneous mixture theory. To begin, we examine the grid resolution requirements and introduce a length scale considering both the tip vortex strength and the core radius. This length scale is then employed to non-dimensionalize the spatial resolution in the tip vortex region, the results of which serve as a basis for estimation of the required mesh resolution in large eddy simulations of TVC. We next perform simulations to analyse the dynamical modes of tip vortex cavity oscillation at different cavitation numbers, and compare them with the semi-analytical solution. The breathing mode of cavity surface oscillation is extracted from the spatial-temporal evolution of the cavity's effective radius. The temporally averaged effective radius demonstrates that the columnar cavity experiences a growth region followed by decay as it progresses away from the tip. Further examination of the characteristics of local breathing mode oscillations in the growth and decay regions indicates the alteration of the cavity's oscillatory behaviour as it travels from the growth region to the decay region, with the oscillations within the growth region being characterized by lower frequencies. For representative cavitation numbers $\sigma \in [1.2,2.6]$, we find that pressure fluctuations exhibit a shift of the spectrum towards lower frequencies as the cavitation number decreases, similar to its influence on breathing mode oscillations. The results indicate the existence of correlations between the breathing mode oscillations and the pressure fluctuations. While the low-frequency pressure fluctuations are found to be correlated with the growth region, the breathing mode oscillations within the decay region are related to higher-frequency pressure fluctuations. The proposed mechanism can play an important role in developing mitigation strategies for TVC, which can reduce the underwater radiated noise by marine propellers.
We experimentally and numerically characterize rapidly rotating radiatively driven thermal convection, beyond the sole heat transport measurements reported by Bouillaut et al. (Proc. Natl Acad. Sci., vol. 118, 2021, e2105015118). Based on a suite of direct numerical simulations (DNS) and additional processing of the experimental data collected by Bouillaut et al. (Proc. Natl Acad. Sci., vol. 118, 2021, e2105015118), we report the simultaneous validation of the scaling predictions of the ‘geostrophic turbulence’ regime – the diffusivity-free or ‘ultimate’ regime of rapidly rotating convection – for the heat transport and the temperature fluctuations. Following such cross-validation between DNS and laboratory experiments, we further process the numerical data to validate the ‘geostrophic turbulence’ scaling predictions for the flow velocity and horizontal scale. Radiatively driven convection thus appears as a versatile set-up for the laboratory observation of the diffusivity-free regimes of various convective flows of geophysical and/or astrophysical interest.