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Economic sanctions have inflicted various economic difficulties on Iranian families. The extent to which these sanctions-induced calamities have affected Iranian older adults’ material well-being remains unknown. Meanwhile, inadequate institutional support for the disadvantaged older population may worsen their precarious economic well-being. We use household-level surveys and quantile regression analysis to explore changes in Iranian older persons’ material well-being during the sanctions era. We also examine whether Iran’s pension system has alleviated the adverse effects of economic sanctions. Our investigation indicates that older adults’ material well-being decreases during sanctions. However, those without pension coverage are economically more vulnerable compared with pensioners. Among the non-pensioners, low-income and low-consumption ones are susceptible to relatively more considerable material well-being losses. To protect these vulnerable groups, policymakers should implement appropriate policy interventions, such as expansions in non-contributory anti-poverty schemes.
This article offers a review of John Conolly's book of 1847 concerning the construction and administration of asylums for the mentally ill, which gives detailed advice on the selection and management of staff and remarks on the role of the medical superintendent.
The Wehrmacht's stunning victories in the first three years of the Second World War produced a euphoric response among Nazi leaders. Suddenly, the East became a vast expanse of nearly limitless possibilities, and creating a new racial order topped the list. Although most historians have focused on the Volksdeutsche, the regime also planned to settle veterans after the war's conclusion to serve as model Germans, farmers, and a “living wall” to defend the East. As the war dragged on into 1942 and these men continued to fight, the regime turned to disabled veterans to garrison the East. The SS designed a racial selection process that proved too restrictive to generate enough applicants and, during 1943 and 1944, settlement officials revised standards. In the process, contingency, constrained practices, and contested ideology all cast the boundaries of race, gender, sexuality, able-bodiedness, and disability as much more malleable than Nazi propaganda projected.
Pursuant to Article 63 of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), a state may require other treaty parties to disclose their intellectual property case law ‘of general application’. While most domestic judgments in common law are indeed of general application, civil law systems theoretically employ judgments as reference only. Nevertheless, to value consistency and predictability, the hybridisation of civil law jurisdictions is increasingly leading them to devise special lists of judgments that acquire formal or factual binding status on lower-ranked courts. This trend is particularly evident in China, whose Supreme People's Court's ‘Guiding Cases’ join other specific categories of holdings within ‘Judicial Interpretations’ and further guideline documents that are factually binding domestically. When the United States and the European Union requested, through the World Trade Organization, that China disclose the full range of its case law of general application, China responded that civil law jurisdictions do not issue judgments that are binding beyond the parties. This article examines the limitations and merits of the Chinese stance.
The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities.
Methods:
We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls.
Results:
A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain (OR 0.37; 95% CI: 0.29–0.47, p < 0.001) and type 2 diabetes mellitus (OR 0.39; 95% CI: 0.29–0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine (OR 8.62; 95% CI: 4.99–14.88, p < 0.001), followed by post-traumatic stress disorder (OR 6.63; 95% CI: 4.13–10.64, p < 0.001) and anxiety (OR 3.58; 95% CI: 2.23–5.75, p < 0.001).
Conclusion:
Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.
A uniform representation of the mean turbulent velocity profile in the sum of a wall function and a wake function, already introduced for other parallel geometries, is applied to an open channel. The open channel with its wake function is thus found to coherently fit in to the same theoretical picture previously drawn for plane Couette, plane closed-channel and circular-pipe flow, and to share with them a universal law of the wall and a universal logarithmic law with a common value of von Kármán's constant.
Anxiety in pregnancy and after giving birth (the perinatal period) is highly prevalent but under-recognised. Robust methods of assessing perinatal anxiety are essential for services to identify and treat women appropriately.
Aims
To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective).
Method
We conducted a prospective longitudinal cohort study of 2243 women who completed five measures of anxiety and depression (Generalized Anxiety Disorder scale (GAD) two- and seven-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS)) during pregnancy (15 weeks, 22 weeks and 31 weeks) and after birth (6 weeks). To assess diagnostic accuracy a sample of 403 participants completed modules of the Mini-International Neuropsychiatric Interview (MINI).
Results
The best diagnostic accuracy for anxiety was shown by the CORE-10 and SAAS. The best diagnostic accuracy for depression was shown by the CORE-10, SAAS and Whooley questions, although the SAAS had lower specificity. The same cut-off scores for each measure were optimal for identifying anxiety or depression (SAAS ≥9; CORE-10 ≥9; Whooley ≥1). All measures were psychometrically robust, with good internal consistency, convergent validity and unidimensional factor structure.
Conclusions
This study identified robust and effective methods of assessing perinatal anxiety and depression. We recommend using the CORE-10 or SAAS to assess perinatal anxiety and the CORE-10 or Whooley questions to assess depression. The GAD-2 and GAD-7 did not perform as well as other measures and optimal cut-offs were lower than currently recommended.
This article builds on recent works which challenge the dichotomy between religion and modern urban planning. The article focuses on a case-study in the Alsatian city of Mulhouse during the nineteenth century. Over a period of 30 years, Catholic parishioners and clergy repeatedly petitioned the town’s Calvinist industrial and municipal elite for a church to be built in the paternalist cités ouvrières housing district, culminating in the eventual construction of the church of Saint-Joseph by 1883. Through a close analysis of the archival records of these petitions, the discussions they sparked and the shifting local and national political dynamics of the city, this article argues that religious groups used myriad tactics to engage in modern planning and that municipal authorities were won over by these tactics if they were politically expedient.
Cactoblastis cactorum (Berg) (Lepidoptera: Pyralidae), the cactus moth, is native to South America with a widespread distribution in Argentina. The larvae consume the interior of Opuntia spp. (Cactaceae) plants. The moth was used as a biocontrol agent against invasive non-native Opuntia spp. in many countries around the world. The cactus moth arrived unintentionally in Florida, USA, expanded its range and threatened Opuntia-based agriculture and natural ecosystems in southern North America. The insect is also a pest of cultivated O. ficus-indica L. in Argentina. An endemic South American parasitoid, Goniozus legneri Gordth (Hymenoptera: Bethylidae), is used in inundative biological control programmes against lepidopteran pests. The goal of this work was to evaluate G. legneri as a biocontrol agent to be used in inundative releases against C. cactorum. Mortality of C. cactorum by G. legneri was assessed at different spatial scales, as well as the interactions with Apanteles opuntiarum Martínez & Berta (Hymenoptera: Braconidae), a common Argentine natural enemy of C. cactorum. The ability of G. legneri to paralyse, parasitise and kill C. cactorum was confirmed. The paralysis inflicted on C. cactorum larvae reduced larval damage to the plants by 85%. Using two parasitoid species increased the mortality of C. cactorum larvae, but it was highly dependent on the order of their arrival. The combined mortality caused by both parasitoids was higher than a single one, in particular when G. legneri arrived first (56 ± 1%), suggesting asymmetric competition due to the preference of G. legneri attacking previously parasitised larvae. Goniozus legneri has potential as an inundative biocontrol agent of C. cactorum, but its interaction with the classical biocontrol agent A. opuntiarum needs to be considered.
This study evaluated the feasibility and safety of a telehealth delivered exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). This was a 12-week, randomised controlled feasibility trial including twenty-eight adults aged > 45 years with NAFLD randomised to a home muscle strengthening program (3 d/week) with increased protein intake (target ∼1·2–1·5 g/kg/d) from predominately plant-based sources and behavioural change support (3–4 text messages/week) (Pro-Ex n 14) or usual care (UC, n 14). Feasibility was assessed via retention (≤ 10 % attrition), adherence (exercise ≥ 66 %; recommended daily protein serves ≥ 80 %) and safety (adverse events). Secondary outcomes included macronutrient intake (3 × 24-h records), weight, moderate-to-vigorous physical activity (MVPA) and 30 s sit-to-stand (STS) performance. Study retention was 89 %. Mean exercise adherence (Pro-Ex) was 52 % with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0·9 to 1·4/d) and animal protein decreased (1·5 to 1·2/d) after 12-weeks, but overall adherence (serves/day) was 32[RD1] % (plant) and 42 % (animal). Relative to UC, Pro-Ex experienced a mean 2·7 (95 % CI: 0·9, 4·4) increase in 30 s STS number, 46-minute (95 % CI: −153, 245) increase in MVPA, 1·7 kg (95 % CI: −3·5, 0·2) decrease in weight, 35·2 g (95 % CI: 11·0, 59·3) increase in protein. In adults with NAFLD a telehealth home exercise and dietary intervention was safe and improved habitual plant and animal protein intake, but overall adherence was modest suggesting more intensive healthcare support may be required.
Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD.
Participants and Measurements:
Older adults with major depression (N = 121, Ages 65–91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity.
Results:
Greater anxiety severity was associated with lower OFC volume (β = −68.25, t = −2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety.
Conclusions:
Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.
We study the dynamic interaction of two gravity currents in a confined porous layer, one heavier and one lighter, partly inspired by the practice of geological $\mathrm {CO}_2$ sequestration in oil fields. Two coupled nonlinear advective-diffusive equations are derived to describe the time evolution of the profile shape of both the upper (lighter) and lower (heavier) currents. At early times, the upper and lower currents remain separated and propagate independently. As time progresses, the currents approach each other and start to interact. We have identified eight different regimes of gravity current interaction at late times, impacted by four dimensionless parameters, representing the flow rate partition, ratio of buoyancy over the injection force, and the viscosity contrasts between the two injecting and displaced fluids. By defining appropriate similarity variables at either the early or late times, the governing partial differential equations (PDEs) reduce to different ordinary differential equations (ODEs), corresponding to the classic nonlinear diffusion solutions at early times and eight different self-similar solutions at late times when the currents attach to each other. It is of interest to note that in four of the eight regimes of late-time interaction (regimes 2, 6–8), self-similar solutions can be constructed by combining appropriately the three basic solutions (i.e. shock, rarefaction and travelling wave solutions) identified during single fluid injection in confined porous layers. In the four other regimes (regimes 1, 3–5), implicit solutions in the form of logarithm or error functions are obtained due to the influence of flow confinement and interaction of gravity currents. Potential implications of the model and solutions are also briefly discussed in the context of ${\rm CO}_2$-water co-flooding for simultaneous ${\rm CO}_2$ sequestration and oil recovery.
Evaluation of adult antibiotic order sets (AOSs) on antibiotic stewardship metrics has been limited. The primary outcome was to evaluate the standardized antimicrobial administration ratio (SAAR). Secondary outcomes included antibiotic days of therapy (DOT) per 1,000 patient days (PD); selected antibiotic use; AOS utilization; Clostridioides difficile infection (CDI) cases; and clinicians’ perceptions of the AOS via a survey following the final study phase.
Design:
This 5-year, single-center, quasi-experimental study comprised 5 phases from 2017 to 2022 over 10-month periods between August 1 and May 31.
Setting:
The study was conducted in a 752-bed tertiary care, academic medical center.
Intervention:
Our institution implemented AOSs in the electronic medical record (EMR) for common infections among hospitalized adults.
Results:
For the primary outcome, a statistically significant decreases in SAAR were detected from phase 1 to phase 5 (1.0 vs 0.90; P < .001). A statistically significant decreases were detected in DOT per 1,000 PD (4,884 vs 3,939; P = .001), fluoroquinolone orders (407 vs 175; P < .001), carbapenem orders (147 vs 106; P = .024), and clindamycin orders (113 vs 73; P = .01). No statistically significant change in mean vancomycin orders was detected (991 vs 902; P = .221). A statistically significant decrease in CDI cases was also detected (7.8, vs 2.4; P = .002) but may have been attributable to changes in CDI case diagnosis. Clinicians indicated that the AOSs were easy to use overall and that they helped them select the appropriate antibiotics.
Conclusions:
Implementing AOS into the EMR was associated with a statistically significant reduction in SAAR, antibiotic DOT per 1,000 PD, selected antibiotic orders, and CDI cases.
Most research on biased public sector hiring highlights local politicians’ incentives to distribute government positions to partisan supporters. Other studies instead point to the role of bureaucratic managers in allocating government jobs to close contacts. We jointly consider the relative importance of each source of biased hiring as an allocation problem between managers and politicians who have different preferences regarding public sector hiring and different abilities to realize those preferences. We develop a theoretical model of each actor’s relative leverage and relative preferences for different types of public sector positions. We empirically examine our theory using the universe of payroll data in Kenyan local governments from 2004 to 2013. We find evidence of both patronage and bureaucratic favoritism, but with different types of bias concentrated in different types of government jobs, as our theory predicts. Our results highlight the inadequacy of examining political patronage alone without incorporating the preferences and leverage of the bureaucratic managers who are intricately involved in hiring processes.
Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019.
Methods:
Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics.
Results:
Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services.
Conclusions:
TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.