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Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder leading to vascular malformations in different organ systems. Approximately 10% of patients with HHT have brain vascular malformations (BVMs). Due to the negative health consequences related to BVMs, screening with MRI is recommended. There are no health jurisdictional standards for medical imaging protocols in North America or elsewhere. The objective of this project is to adopt a provincial standardized operating protocol (SOP) to improve diagnostic accuracy and reduce inappropriate imaging in patients with and without HHT in Alberta.
Methods:
Multiple fora were held among the five Alberta Health Services zones with stakeholders from urban, suburban and rural radiology groups, neurology, pulmonology and hematology. The consensus process took five years to complete between 2015 and 2020. The content of the fora was approved by all participants.
Results:
The SOP was implemented in February 2020 and defines that screening for BVMs must include standard unenhanced brain MRI (sagittal T1, axial fluid-attenuated inversion recovery and axial T2) with susceptibility-weighted imaging (SWI), a 3T or 1.5T magnet strength and minimum imaging standards to include 3 mm contiguous slice thickness.
Discussion:
Incorporation of SWI allowed for the elimination of MR contrast to improve access to the local performance of studies within the province, facilitating virtual care.
Conclusion:
A provincial SOP for BVM screening in patients with suspected or confirmed HHT was successfully implemented in Alberta. Gadolinium was avoided, as it was felt to be unnecessary for screening purposes and might complicate imaging at more remote sites.
The purpose of this study is to determine the effects of the perceived trauma levels of women at reproductive age after earthquakes on their menstruation cycle.
Methods
This descriptive and correlational study was conducted between March 17, 2023, and April 17, 2023, after the earthquakes that happened in Turkey on February 6, 2023 and affected 11 cities. The study was conducted with 355 women. Data were collected using an online questionnaire form prepared via Google Forms. Data collection was performed using a Participant Information Form and the Post-Earthquake Trauma Level Determination Scale.
Results
According to the multiple regression analysis results, the significant predictors of perceived trauma levels after the earthquakes included the severity of dysmenorrhea (β-coefficient = 0.164, P = .007), characteristics of vaginal discharge (β-coefficient = 0.136, P = .027), and itching in the perineum (β-coefficient = −0.220, P = .001). These variables explained 12.4% of the total variance in the perceived trauma levels of the participants.
Conclusions
The perceived trauma levels of women after the earthquakes had significant effects on the severity of dysmenorrhea, characteristics of vaginal discharge, and itching in the perineum. Health professionals should not overlook the effects of women’s perceived trauma levels on their menstruation cycles after earthquakes and evaluate the issue considering these aspects.
In this paper I argue that the accepted reconstruction of Suetonius’ De viris illustribus has been shaped by unexamined assumptions that have been allowed to take on the appearance of fact. I begin by surveying the scholarly reconstruction of this work from the fifteenth century until today. I then examine two key underlying assumptions: that Suetonius planned and published his series of literary lives as a single compendious work and that it excluded men who were not writers or wrote in Greek; in both cases I propose alternative hypotheses. I lastly test these alternatives by sketching a new approach to a possible Suetonian book De philosophis. I conclude that the more we rid ourselves of a priori assumptions about De viris illustribus, the more clearly we can see that Suetonius’ interests and approach were remarkably consistent throughout all his lives.
We theoretically investigate the small-amplitude broadside oscillations of an annular disk within an unbounded fluid domain. Specifically, we formulate a semi-analytical framework to examine the effects of the oscillation frequency and pore radius on the disk’s added mass and damping coefficients. By leveraging the superposition principle, we decompose the complex original problem into two simpler ones. The force exerted on the disk by the fluid is linked to the solutions of these sub-problems through the reciprocal theorem; the first solution is readily available, while the second is derived asymptotically, assuming a small inner radius. Both solutions are evaluated by transforming dual integral equations into systems of algebraic equations, which are then solved numerically. Building on these solutions, we extract asymptotic expressions for the variations of the quantities of interest in the limits of low and high oscillatory Reynolds numbers. Notably, at high frequencies, we uncover a previously overlooked logarithmic term in the force coefficient expansions, absent in prior scaling analyses of oscillating solid (impermeable) disks. Our findings indicate that, when viscosity plays a dominant role, an annular (porous) disk behaves similarly to a solid one, with reductions in the force coefficients scaling with the cube of the pore radius. We also discover, perhaps surprisingly, that, as inertial effects intensify, the damping coefficient initially increases with the pore radius, reaches a maximum and subsequently declines as the disk’s inner hole enlarges further; at its peak, it can exceed the value for an equivalent solid disk by up to approximately 62 % in the asymptotic limit of extremely high oscillatory Reynolds number. Conversely, the added mass coefficient decreases monotonically with increasing porosity. The decay rate of the added mass in the inertial regime initially scales with the cube of the pore radius before transitioning to linear scaling when the pore radius is no longer extremely small. Although our analysis assumes a small pore radius, direct numerical simulations confirm that our asymptotic formulation remains accurate for inner-to-outer radius ratios up to at least $1/2$.
European institutions are widely recognized as wielding regulatory power in a globalized market, exporting its standards across borders and between sectors. This paper asks what institutional dynamics catalyze European external regulatory impact on pharmaceutical governance in low- and middle-income countries (LMICs). The research focuses on two European regulatory bodies, the European Medicines Agency (EMA) and the European Patent Office (EPO), and explores the dynamics of their technocratic outreach beyond European borders. We find that trust is a key underlying institutional dynamic facilitating some forms of European external relations. The agencies extend their influence through technical assistance, collaboration, and work-sharing with LMIC regulators, fostering a one-sided relationship of “technocratic trust.” This trust, reinforced by international regulatory frameworks that position the EMA and EPO as “trustworthy” regulators, enables these agencies to expand their regulatory influence beyond Europe. By critically examining the impact of this trust-building on LMICs’ regulatory autonomy, this research contributes to the broader discourse on European regulatory power in global health governance and highlights potential implications for pharmaceutical markets and access in LMICs.
Fear of childbirth (FoB) is a common experience during pregnancy which can cause clinically significant distress and impairment. To date, a number of investigations of FoB have assumed that clinically significant FoB is best understood as a type of specific phobia. However, preliminary evidence suggests that specific phobia may not be the only diagnostic category under which clinically significant symptoms of FoB are best described.
Aim:
The current study is the first to investigate which DSM-5 diagnostic categories best describe clinically significant symptoms of FoB.
Method:
Pregnant people reporting high levels of FoB (n=18) were administered diagnostic interviews related to their experience of FoB.
Results:
Participants (n=18) were predominantly nulliparous (73.3%), cisgender women (83.3%). Of these, 14 (77.8%) met criteria for one or more DSM-5 anxiety-related disorders. Preliminary findings suggest that primary FoB may align with specific phobia criteria, whereas secondary FoB (following a traumatic birth) may be better classified under post-traumatic stress disorder (PTSD). FoB also featured in other anxiety-related disorders but was not the primary focus (e.g. obsessive-compulsive disorder). Four participants did not meet criteria for any DSM-5 disorder.
Conclusions:
Findings provide preliminary evidence that clinically significant FoB fits within existing DSM-5 categories, in particular specific phobia and PTSD. Although FoB-related concerns appears in other anxiety-related disorder categories, it does not appear as the primary focus. Although informative, due to the small sample employed in this research, replication in larger and more diverse samples is needed.
Inlight of varying outcomes from prior research concerning the relationship between different food groups and the risk of chronic kidney disease (CKD), this study was conducted to examine the relationship between the consumption of various food groups and CKD risk via a dose–dependent meta-analysis of prospective cohort studies. Searches were conducted in the Web of Science, PubMed and Google Scholar databases through January 2025. Out of 6460 publications, twenty-one studies were selected for final analysis. The results revealed that red meat consumption is associated with an increased risk of CKD (RR: 1·39; 95 % CI: 1·13, 1·71). Conversely, consumption of fish (RR: 0·88; 95 % CI: 0·80, 0·97), grains (RR: 0·87; 95 % CI: 0·77, 0·99) and legumes (RR: 0·83; 95 % CI: 0·72, 0·92) showed a protective effect against CKD. The linear dose–response analysis indicated that for every 100 g/d increment in red meat and total meat consumption, the risk of CKD escalated by 34 and 2 %, respectively. Furthermore, an increase of 15 g/d in dietary fish, 28 g/d in nuts and 50 g/d in legumes was associated with a 6, 21 and 13 % decreased risk of CKD, respectively. Overall, higher red meat intake correlates with a heightened CKD risk, whereas the consumption of fish, grains and legumes is associated with a lowered risk. Further longitudinal cohort studies with extended follow-up are recommended to validate our findings.
Kinship can be difficult to discern in the archaeological record, but the study of ancient DNA offers a useful window into one form of kinship: biological relatedness. Here, the authors explore possible kin connections at the post-Roman site of Worth Matravers in south-west England. They find that, while clusters of genetically related individuals are apparent, the inclusion of unrelated individuals in double or triple burials demonstrates an element of social kinship in burial location. Some individuals also carried genetic signatures of continental ancestry, with one young male revealing recent West African ancestry, highlighting the diverse heritage of early medieval Britain.
Elastoviscoplastic (EVP) fluid flows are driven by a non-trivial interplay between the elastic, viscous and plastic properties, which under certain conditions can transition the otherwise laminar flow into complex flow instabilities with rich space–time-dependent dynamics. We discover that under elastic turbulence regimes, EVP fluids undergo dynamic jamming triggered by localised polymer stress deformations that facilitate the formation of solid regions trapped in local low-stress energy wells. The solid volume fraction $\phi$, below the jamming transition $\phi\lt\phi_J$, scales with $\sqrt {\textit{Bi}}$, where $\textit{Bi}$ is the Bingham number characterising the ratio of yield to viscous stresses, in direct agreement with theoretical approximations based on the laminar solution. The onset of this new dynamic jamming transition $\phi \geqslant \phi _J$ is marked by a clear deviation from the scaling $\phi \sim \sqrt {\textit{Bi}}$, scaling as $\phi \sim \exp {\textit{Bi}}$. We show that this instability-induced jamming transition – analogous to that in dense suspensions – leads to slow, minimally diffusive and rigid-like flows with finite deformability, highlighting a novel phase change in elastic turbulence regimes of complex fluids.
This comment argues for the recognition of ecocide as an international crime, focusing on its contemporary legal relevance and the growing momentum for its codification. Originally coined in 1970 to describe wartime environmental destruction, the term ecocide was framed in parallel to genocide and grounded in the post–World War II development of international criminal law. Although initial legal efforts to formalize ecocide, including proposed conventions and debates during the drafting of the Rome Statute, failed to secure sufficient political support, these early shortcomings have been re-energized by rising environmental consciousness and sustained legal advocacy, particularly by the Stop Ecocide Foundation. Recent developments, including the 2021 legal definition proposed by the Independent Expert Panel and the 2024 amendment proposal to the Rome Statute advanced by Pacific Island nations, reflect a renewed and increasingly actionable international consensus. By examining the conceptual genealogy of ecocide and its doctrinal links to international humanitarian and criminal law, this comment contends that recognizing ecocide as a core international crime is not only a normative necessity but also a legally coherent and pragmatic step. It directly responds to the scale and urgency of present environmental crises and addresses a longstanding gap in the enforcement architecture of international criminal law.
As apex predators, giant otters (Pteronura brasiliensis) are susceptible to the bioaccumulation of heavy metals, particularly in regions where gold-mining contributes to mercury (Hg) pollution. This is the broadest-scale study assessing Hg and selenium (Se) concentrations in the Pantanal. Samples from 10 sites across the Pantanal were analysed using inductively coupled plasma mass spectrometry. We constructed a two-factor generalized additive model (GAM) to investigate the relationship between Hg concentrations in giant otters and their location along river courses in gold-mining areas. To determine the feasibility of merging the dataset from the present study with the dataset of a previous study carried out by our group during 2016–2017, we included the datasets as a factor in the analysis. The GAM results supported the feasibility of merging the datasets. Additionally, we measured Se concentrations due to their potential to mitigate Hg toxicity. Higher Hg levels were found in otters from watercourses near gold-mining areas, with concentrations decreasing downstream, revealing a contamination gradient and the extensive impact of local pollution on wetlands. The highest Hg concentration was recorded in the Bento Gomes River, within a gold-mining area, whereas otters from unconnected sites exhibited lower Hg levels.
Adherence to healthy dietary patterns, including fruits, vegetables and whole grains, is linked to improved health outcomes. However, limited research has explored this association in Latin American populations. This study aimed to investigate the association between adherence to a healthy eating score (unweighted and weighted) and all-cause mortality risk in a Chilean population. This longitudinal study included 5336 Chilean participants from the Chilean National Health Survey 2016 and 2017. Six healthy eating habits were considered to produce the healthy eating score (range: 0–12): consumption of seafood, whole grains, dairy products, fruits, vegetables and legumes. A weighted score was also developed. Participants were categorised into quartiles based on their final scores, with the healthiest quartile used as the reference group. Associations between healthy eating score and all-cause mortality were performed using Cox proportional hazard models adjusted for confounders. After a median follow-up of 5·1 years, 276 (5·2 %) participants died. In the fully adjusted model, compared with participants in the healthiest quartile of the score (Q4), those in the unhealthiest quartile (Q1) had 1·61 (95 % CI: 1·14, 2·27) times higher all-cause mortality risk. A similar association was observed for the weighted healthy eating score (1·52 (95 % CI: 1·03, 2·23)). An inverse trend was observed for both scores (P < 0·05). Sensitivity analyses excluding participants who died within the first 2 years showed consistent results 1·63 (95 % CI: 1·09, 2·42). Individuals with the lowest healthy eating score (unweighted or weighted) had a higher mortality risk compared with their counterparts. A healthy eating score is associated with mortality risk in the Chilean population.
This paper considers what anti-colonial surrealist praxis can provide those of us interested in the nexus of aesthetics and world politics. Thinking beyond the commonly held notion of surrealism as a European cultural movement, I engage with the writings of 20th-century anti-colonial surrealists, namely, Suzanne Césaire, Aimé Césaire, and René Ménil. In doing so, I argue that anti-colonial surrealism is beyond a movement, a selection of methods, a genre or a set of ideas. Instead, I aim to position anti-colonial surrealist praxis as an epistemology that allows us to move beyond the limitations of representation, both by surfacing historical intimacies (rather than gaps) between content and form, while also questioning the demarcation between art and politics. I illustrate my argument’s resonance in the contemporary political moment through an engagement with aesthetic interventions produced by Sai, an artist exiled from contemporary Myanmar. Sai’s absurdist creative interventions and material drawn from in-depth interviews and ethnographic observations allow me to demonstrate the political possibilities of an ‘anti-colonial surrealist praxis’ approach, in its conception of aesthetics as co-constitutive, rather than only representative, of the political.
The European Organization for Nuclear Research (CERN) in Geneva, Switzerland, is renowned for operating the world’s largest particle accelerator and is often regarded as a model of high-profile international collaboration. Less well known, however, is a key episode from the late 1950s, when CERN clashed with the research priorities of similar organizations. The issue centred on a CERN-sponsored study group on controlled thermonuclear fusion, which brought together scientists from CERN member states, as well as representatives from the European Atomic Energy Community (Euratom), the European Nuclear Energy Agency (ENEA) and the US Atomic Energy Commission (AEC). While their meetings succeeded in creating an international network for exchanging reports and coordinating projects to avoid duplication, the initiative failed to establish joint fusion research programmes in Europe. This article explores the reasons behind this outcome to provide insights into intergovernmental power dynamics and scientific competition and how these two factors favoured the creation of a new fusion research institution in the UK, the Culham Laboratory. In doing so, the article contributes to a deeper understanding of the role of science in European integration, while also highlighting that CERN’s involvement in application-oriented research remains an underexplored aspect of its history.
This paper investigates the nonstandard use of first‑person singular pronouns (myself and I) in coordinate constructions, such as John and I or John and myself. Native English speakers frequently disregard prescriptive grammar rules by using subject or reflexive forms in place of object forms in sentences like Give those papers to John and I. The frequency of such nonstandard usage raises questions, such as when and why speakers substitute nominative or reflexive pronouns for object pronouns in coordinate constructions, and what evidence exists for the existence of fixed constructions like X and I or X and myself. To address these questions, the study analyzes data from the Corpus of Contemporary American English (COCA). Findings provide strong evidence for the existence of an X and I construction in that the nonstandard form is common after the coordinator but not before. Evidence for an X and myself construction is weaker, since untriggered reflexives also appear outside coordinate constructions. First‑person singular forms are more likely to appear in hypercorrect and untriggered forms that other pronouns. The research suggests that X and I may be stored in a chunk, possibly due to overgeneralizations resulting from prescriptive corrections during language acquisition.
This CFD study investigates the aerodynamic characteristics of various internal grid patterns of grid fins without missile bodies, focusing on their influence on aerodynamic performance in subsonic flight regimes. Research examines four distinct grid fin lattices through comprehensive numerical simulations at Mach numbers 0.1, 0.3 and 0.5, for varying high angles of attack ranging between 0o ≤ α ≤ +45o. For validation, comparison between current numerical results and a previous experimental study results was carried out (good agreement within 9.8% error). The numerical results reveal that the diamond cell pattern demonstrates increased lift generation but incurs higher drag, while the square pattern minimises drag and pitching moment, favouring weight-efficient designs. The hexagonal grid fin excels in stall delay and post-stall performance, enhancing manoeuverability and stability at the expense of increased pitching moments. The triangular pattern offers balanced aerodynamic performance with high aerodynamic efficiency at lower speeds, making it versatile for various applications. The analysis offers key insights into grid cell pattern’s aerodynamic effects, aiding grid fin design optimisation for improved aerodynamic efficiency and controllability across various flight conditions and high angles of attack.