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For every $0 \lt \alpha\le\infty$ we construct a continuous pure mixing map (topologically mixing, but not exact) on the Gehman dendrite with topological entropy $\alpha$. It has been previously shown by Špitalský that there are exact maps on the Gehman dendrite with arbitrarily low positive topological entropy. Together, these results show that the entropy of maps on the Gehman dendrite does not exhibit the paradoxical behaviour reported for graph maps, where the infimum of the topological entropy of exact maps is strictly smaller than the infimum of the entropy of pure mixing maps. The latter result, stated in terms of popular notions of chaos, says that for maps on graphs, lower entropy implies stronger Devaney chaos. The conclusion of this paper says that lower entropy does not force stronger chaos for maps of the Gehman dendrite.
Fosterage was widely practised in Ireland in the Middle Ages. It even survived in some form in certain parts of the country into the nineteenth century. The institution was highly regulated in the medieval period. It is the purpose of this article to consider the nature of fosterage and the role of the foster mother. Central to a better understanding of childcare arrangements at the time, and to the bonds which developed from them, are the questions of the age at which fosterage began and of whether or not wet-nursing commonly occurred. It will be argued that custody of infants from a very early age was much more common than has often been supposed and that wet nurses were frequently necessary, and well respected, participants in the upbringing of foster children.
Paediatric cardiac catheterization in children with CHD requires anaesthetic techniques that balance procedural conditions with physiological risk. We evaluated anaesthesia management at a tertiary centre and examined associations between anaesthesia strategy and peri-procedural outcomes.
Methods:
This single-centre retrospective cohort included 307 catheterization procedures after exclusions. Anaesthesia was categorized as general anaesthesia or sedation. The primary outcome was any recorded complication.
Results:
Median age was 7.0 years (interquartile range 2.0–13.0), and 155/307 (50.5%) procedures were performed under general anaesthesia and 152/307 (49.5%) under sedation. Overall, 49/307 (16.0%) procedures were associated with at least one recorded complication; complications were more frequent with general anaesthesia than with sedation (20.6% versus 11.2%, p = 0.024). In diagnostic catheterization/angiography (n = 175), general anaesthesia was independently associated with higher odds of any complication compared with sedation (adjusted odds ratio 2.78, 95% confidence interval 1.12–6.91; p = 0.028).
Conclusions:
In this cohort, general anaesthesia was associated with higher recorded complication rates than sedation, and this association persisted after adjustment within diagnostic catheterizations. Comparisons within interventional procedures were limited by sparse sedation data. These findings support procedure-specific, risk-adjusted evaluation when selecting anaesthesia strategy in the paediatric catheterization laboratory.
The COVID-19 pandemic disrupted education and training which led academia to revise well-established instructional content and strategies. This report described and evaluated the curricular response of public health preparedness at Penn State to the COVID-19 pandemic.
Methods
We describe an online, hybrid course focused on the development, approval, and dissemination of the SARS-CoV-2 vaccines. The course was offered in the spring of 2021 and covered real-time laboratory, public health, emergency management, homeland security, medical, and policy aspects of the vaccines. Additionally, we report the student evaluation results of those who completed the course.
Results
The median and mode scores for student evaluations were 7, on a scale of 1 (lowest) to 7 (highest). Students enjoyed the instructors because they were employed in strategic positions and explained real-world challenges. Students reported the course as “timely” and “breaking down complex concepts into simple understanding.”
Conclusions
Penn State responded to the COVID-19 pandemic with an innovative course that developed students’ real-time understanding of pandemic response. Students gained knowledge and skills relevant to the practice of public health. Based on the positive student feedback, the course will serve as a model for future classes on public health and emergency management.
This article argues that an emerging body of ‘target laws’ – legislation that incorporates binding, quantified environmental targets with specified deadlines – represents a crucial evolution in environmental governance. Whereas traditional environmental risk regulation was valuable for managing discrete environmental impacts, it has proven inadequate to address systemic challenges like climate breakdown and ecosystem collapse. Target laws, by contrast, are better equipped to deliver the transformative change needed to respond to systemic threats. Drawing on examples from climate legislation and the European Union’s Nature Restoration Law, the analysis demonstrates how target laws can overcome environmental law’s persistent vulnerabilities to short-termism, marginalization, and public obscurity. However, targets are paradoxical entities that inject considerable complexity into legal frameworks, creating novel challenges around temporality, legal status, implementation, and enforceability. While acknowledging these formidable difficulties, the article contends that target laws merit vigorous defence as they offer environmental legislation unprecedented dynamism, resilience, and transformative potential.
The Emergency Paramedic Act (EPA; Notfallsanitätergesetz), implemented in 2014, expanded the legal authority of German paramedics to independently perform defined invasive and pharmacological interventions under specific conditions. However, real-world implementation of these competencies within the physician-based German Emergency Medical Services (EMS) system remains insufficiently described.
Objective:
The aim of this study was to evaluate the frequency, type, temporal development, and regional variation of invasive and pharmacological/therapeutic interventions performed independently by paramedics over a six-year period.
Methods:
A retrospective, descriptive multicenter analysis of digital EMS documentation was conducted across three districts in Saxony, Germany, from January 1, 2019 through December 31, 2024. All missions were screened (n = 197,842). Paramedic-led missions without physician presence were included; physician-attended missions and non-emergency interfacility transports were excluded. Interventions were classified according to the 2024 Federal Association of Medical Directors of EMS competency catalogue. Frequencies were analyzed by year and district. Temporal trends were assessed using the Mann–Kendall test, and regional differences were explored using one-way ANOVA with Tukey HSD post hoc testing. All inferential analyses were exploratory.
Results:
Of 197,842 missions, 156,417 (79.1%) were paramedic-led without physician presence. Invasive procedures occurred in 7.6% of missions and were predominantly peripheral intravenous (IV) access (5.7%). Advanced airway management and intraosseous (IO) access were rare (<0.1%). Pharmacological/therapeutic administrations occurred in 11.3% of missions and increased from 9.4% in 2019 to 12.1% in 2024 (Mann–Kendall test), whereas overall invasive procedure rates remained stable.
Conclusion:
Ten years after implementation of the EPA, invasive and pharmacological interventions performed independently by German paramedics remain relatively infrequent and largely confined to basic measures. Advanced procedures are rarely applied, reflecting continued structural characteristics of the physician-based EMS model.
To assess the impact of ethnicity on survival following paediatric cardiac surgery.
Methods:
Observational study of a regional tertiary paediatric cardiac surgical centre in Yorkshire, UK. All children (age 0–15 years) undergoing their first cardiac surgical procedure from January 2005 to December 2021 inclusive. The primary outcome was 5-year survival. Secondary outcomes included 30-day, 1-year, and pre-discharge survival.
Results:
3,508 children (46% female) underwent their first cardiac surgical procedure during the study period. Within the study cohort 2,578 (73%) children were White, 634 (18%) were South Asian, 95 (3%) were Black and 201 (6%) were from other ethnic groups. South Asian children were more likely to have a functionally single-ventricle (10% vs. 7% White; relative risk 1.41, 95% confidence interval 1.15–1.69).
Mortality after surgery, adjusted for deprivation, was higher for South Asian (hazard ratio 1.50, 1.12–2.01) and Black children (hazard ratio 1.69, 0.93–3.06), compared to White children. Survival differences were not present at discharge or 30 days post-procedure, but widened progressively at 90 days, 1 year and 5 years. This was not influenced by diagnosis or pre-operative risk factors. One-year survival improved for South Asian children across the study period and was similar to that of White children from 2017–2021 (94.7% (89.8–97.3%) vs. 96.8% (94.9–97.9%) White).
Conclusions:
Black and South Asian children have a greater risk of death following cardiac surgery compared to White children, independent of pre-operative risk. The majority of excess deaths occurred after hospital discharge. Although inequities have steadily reduced over the past two decades, the explanation for this effect remains unclear.
Protein intake is essential for maintaining physiological functions, with standard recommendations suggesting ∼0.7 g/kg/day for healthy adults. In recent years, high-protein diets have gained popularity due to their potential metabolic benefits, including reduced visceral adiposity, improved hormonal regulation, and preservation of muscle mass. However, the effects of high-protein intake on gut microbiota and overall health remain controversial. Emerging evidence indicates that excessive protein consumption, particularly from animal sources, may negatively impact gut health by increasing intestinal permeability, promoting chronic low-grade inflammation, and impairing mucosal immunity. These effects appear to depend on protein source, intake level, duration, and host-specific factors such as age, metabolic status, and immune function. While moderate protein intake seems to have minimal effects on microbial diversity, chronic high intake may disrupt gut microbiota composition and favor pro-inflammatory profiles, potentially contributing to metabolic dysfunction. Additionally, co-ingested dietary factors, including fat content, processed meat compounds, and fiber intake, may confound these outcomes. Certain populations, such as athletes, older adults, and individuals with type 2 diabetes, may benefit from higher protein intake, although these effects are context-dependent. In contrast, high-protein diets may be detrimental for individuals at risk of chronic kidney disease. Overall, the gut microbiota plays a central role in mediating the health effects of dietary protein, highlighting the importance of balanced and personalized nutritional strategies.
This paper explores and compares smoking advertisements and anti-smoking and anti-cancer messages in Australia’s migrant press, particularly newspapers, from 1930 to 1960. It investigates the ways in which smoking was promoted to migrant communities through their newspapers, contrasts this with the increasing prevalence of anti-smoking and broader anti-cancer messages, and explores whether there were any shifts in advertising and in anti-smoking messages following the growing research linking smoking and cancer (particularly lung cancer) from 1950. These messages were ultimately tied to this growing research, as well as the various Australian state and national anti-cancer campaign committees which emphasised early diagnosis and swift treatment as the best method to combat a range of cancers. Yet the Australian authorities, although finally acknowledging the dangers of cigarette smoking, rejected any government intervention other than providing the medical reports to the public. Greek-language newspapers (notably To Ethnico Vema) form an important case study; however, other foreign-language and migrant community papers were also consulted, including Italian, Jewish, and French.
This article examines how algorithms are embedded in contemporary instrumental and electroacoustic practice, focusing on orchestration tools and AI-improvisation environments such as Orchidea and Somax2. Its central claim is that artificial intelligence in these systems extends spectralist compositional tendencies into new computational and performative contexts. Historically, instrumental resynthesis recreated analysed spectra through vocal-instrumental, or electronic means; today, AI-based frameworks broaden this logic, opening new aesthetics and modes of interaction. In both systems, spectral analysis underpins the segmentation, combination and transformation of sound within corpus-based synthesis. Orchidea maps spectral targets onto instrumental resources through forecasting and optimisation, enabling new approaches to orchestral design. Somax2 navigates its corpus in real time through multi-agent interaction with human performers, reframing improvisation as a dynamic feedback loop.
The idea of “self-reliance” has endured in Chinese political discourse for nearly a century, transcending profound changes in China’s political, economic and strategic circumstances. Although it is frequently misinterpreted as economic isolation or autarky, the idea of self-reliance in China has always acknowledged the country’s engagement with the global economy. Drawing on the discursive institutionalist concept of ideational resilience, we show that self-reliance comprises three interlocking elements: autonomy, interdependence and order-shaping. While these sit in tension with one another, they have also accommodated one another since the earliest articulations of the idea. This tripartite structure has enabled Chinese leaders since the Republican era to reinterpret and usefully deploy the idea of self-reliance. Our findings underscore the resilience of Chinese foreign economic policy ideas, as well as the ideational logic behind Xi Jinping’s seemingly contradictory pursuit of technological self-reliance, open global markets and greater connectivity with the developing world.
In this paper, I argue that Taurek’s positive view, namely that we ought to show equal respect and concern to those affected by our actions, commits him to saving the bigger number in some cases. This leads to an adjustment of his negative claim, namely that numbers don’t count. Numbers don’t count in the sense he was interested in, i.e., sums of harms or benefits (across different people) lack moral significance. Numbers do count, however, when considering how to act fairly which is what equal respect demands. This adjustment supports Taurek’s general view on how to think about moral matters.
We prove that the zero-divisor graph $\Gamma (P)$ of a Boolean poset P is both well-covered and Cohen–Macaulay. Furthermore, for a poset $\mathbf {P} = \prod _{i=1}^{n} P_i \ (n \ge 3)$, where each $P_i$ is a finite bounded poset satisfying $Z(P_i) = \{0\}$ for all i and $2 \le |P_1| \le |P_2| \le \cdots \le |P_n|,$ we show that the zero-divisor graph $\Gamma (\mathbf {P})$ is Cohen–Macaulay if and only if $\mathbf {P}$ is a Boolean lattice.
Metabolic dysfunction-associated steatotic liver disease is the most prevalent liver condition worldwide, affecting approximately 30% of the population globally. MASLD often coexists with hypertension, central obesity, type 2 diabetes, and dyslipidaemia, yet globally, national treatment strategies are still being established. Pharmacological options are limited and lifestyle modification to achieve weight loss through combining diet, physical activity (PA) and structured exercise remains the cornerstone of MASLD management. The Mediterranean diet (MedDiet) is an evidence-based dietary approach for MASLD prevention and treatment; however, its application in culturally and linguistically diverse, non-Mediterranean populations requires adaptation. In fact, the need for cultural adaptation for all lifestyle interventions (diet, physical activity, sleep) needs better acknowledgement and implementation. There are limited interventions which combine all lifestyle behaviours and even fewer that consider cultural safety and appropriateness Furthermore, limited healthcare staffing resources, geographical location and health system pressures highlight the need for more accessible and cost-effective delivery methods. This review summarises evidence on MedDiet for MASLD in multicultural populations, explores the synergistic benefits of combining with PA and sleep interventions, and provides practical recommendations for culturally tailored approaches. Finally, we outline future directions for research and healthcare delivery, emphasising the urgent need for holistic, culturally safe, culturally responsive, efficient, and digitally-enabled strategies to address the growing global burden of MASLD.
Immigrant and racialized Canadians constitute an increasing percentage of the older adult population. Attention is needed to the role of municipalities and their key partners in creating urban environments that are supportive of aging in place.
Objective/Methods
We conducted a qualitative descriptive sub-study of policy partners’ perceptions of age-friendly policies and initiatives as part of a larger community-based participatory project in Edmonton (Alberta, Canada).
Findings/Discussion
Nineteen participants, including elected municipal representatives, city administrators, advisory committee volunteers and seniors-serving organization staff, took part in semi-structured interviews, which was followed with a reflexive thematic analysis of the data. Participants described high levels of awareness about inequities faced by immigrant and racialized older adults. Advocacy and policy efforts, however, were constrained by insufficient funding, lack of capacity for sustainable initiatives, unclear jurisdictional boundaries and competing priorities.