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“Moral distress” was introduced in nursing ethics to describe the experience of having the moral conviction about the right thing to do while having limited agency to enact it. It exists at the intersection of moral philosophy, moral psychology, and moral communities that influence our desires to act. Although moral distress has significantly impacted bioethics scholarship, it has had almost no presence in business ethics scholarship. We argue that moral distress is useful for understanding important problems of business ethics. We claim it may be missing from business ethics discourse not because it is not present but rather because it is ever-present, an existential condition brought on by the tension between profit maximization and other moral purposes. We consider how the moral communities of medicine and business can be morally supportive or distressing and set forth a taxonomy of moral conditions involving the relationship between knowledge, action, and desire.
Bodily isomerism, often referred to as “Heterotaxy,” is the clinical entity in which the thoracic organs are themselves mirror-imaged in the same individual. The thoracic isomerism can be right or left. The left thoracic isomerism always has both atria with their atrial appendages of left morphology and frequently a mixed atrioventricular connection. Usually, there are two well-developed ventricles; however, in some cases, there may be univentricular physiology. In the set of left thoracic isomerism, no case of imperforate tricuspid valve with severe hypoplasia associated with a vascular ring has been reported in the literature.
Neonatal truncal valve insufficiency carries high postoperative mortality. Mechanical replacement is challenging, and leaflet-sparing repair alone may be insufficient due to fragile tissue and annular dilatation. We report a successful case using geometry-based root reconstruction guided by body-weight–adjusted reference values. This native-tissue approach restored physiologic root geometry, preserved the valve, and enabled growth potential, demonstrating a feasible strategy for durable neonatal repair.
Mild cognitive impairment (MCI) involves measurable cognitive decline that does not yet significantly disrupt daily functioning but may signal increased risk of dementia. Reliable prediction of dementia conversion in MCI is essential for early intervention and optimized clinical trial design. This study aimed to evaluate the predictive performance of various machine learning (ML) classification algorithms using clinical and neuropsychological data.
Methods:
Data were drawn from the Gothenburg MCI Study and included 347 patients from a memory clinic, of whom 84 (24%) converted to dementia within two to six years. We applied 11 ML classification algorithms (logistic regression, linear discriminant analysis, naïve Bayes, k-nearest neighbors, LASSO, ridge regression, elastic net, decision tree, random forest, gradient boosting, and support vector machine (SVM)) to predict dementia conversion based on 54 clinical predictors (e.g., cerebrospinal fluid biomarkers, neuropsychological test scores, comorbidities, and demographics). In a second step, we included delta scores reflecting change in neuropsychological test performance from baseline to follow-up.
Results:
Without delta scores, LASSO, ridge, elastic net, random forest, and SVM performed best, achieving accuracy ≥0.87, kappa = 0.64, and AUC-ROC ≥0.90. These models demonstrated high specificity (0.94) but moderate sensitivity (0.68). Including delta scores improved performance, with ridge and elastic net achieving accuracy = 0.90, kappa = 0.73 and 0.72, AUC-ROC = 0.94, specificity = 0.96, and sensitivity = 0.73. The elastic net model yielded a positive predictive value of 0.85 and a negative predictive value of 0.92.
Conclusions:
ML models incorporating clinical and cognitive change data can accurately predict dementia conversion in MCI, supporting their utility in clinical decision-making.
The aim of this research is to explore the experience of allocating scarce health resources in humanitarian response settings, specifically in relation to decision-making.
Methods
This research utilized an exploratory qualitative design. Participants were identified as clinicians with relevant first-hand experiences with scarce health resource allocation in humanitarian response settings. Participants were purposively recruited to include the broadest perspectives possible. Semi-structured interviews were hosted remotely. Transcripts capturing participant narratives were analyzed using inductive thematic analysis to allow themes to emerge.
Results
Seventeen participants were recruited and interviewed as part of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) project. Inductive thematic analysis related to decision making revealed 5 key themes: devices; priorities; ideals; context-specific decision making; and weight of decision making. These themes informed the development of the SHARE-HRS Decision Making Model.
Conclusions
While health resource allocation decision-making is not unique to humanitarian settings, there are unique situational challenges faced by humanitarian health care workers. The SHARE-HRS Decision Making Model provides a new insight into how these challenges may be addressed or impact decision-making, and thus offers a structure and common nomenclature for future humanitarian health response operations and research.
Case study has been frequently conducted in disaster-related research, yet the trends and patterns of disaster-related case study are unclear. This large-scale analysis aimed at better understanding their thematic focus and reporting practices.
Methods
Based on systematic search strategy, publication metadata from 1901 to 2023 were obtained from Elsevier/Scopus and analyzed. Structural topic modeling was employed to identify the focus areas of the topics. The number of topics was determined based on content and diagnostic metrics such as held-out likelihood and semantic coherence. Hierarchical clustering was used to categorize the identified topics. The contents and reporting styles of the most-cited articles within each topic were further analyzed.
Results
This large-scale analysis included 18,782 publications, showing an increase in number. The number of topics was determined as 12. They grouped into 2 overarching categories: public health and social medicine; and earth science and environmental technology. There were variabilities in reporting.
Conclusions
This study highlighted a growing trend in the publication of disaster-related case studies across diverse thematic areas. As variabilities in reporting exist, there is a need for standardization in reporting to enhance transparency in disaster-related case study.
Data on species’ demography are essential to detect changes in population size, identify drivers of population change, motivate conservation plans, or evaluate the effectiveness of management. The Arctic Skua Stercorarius parasiticus is a seabird with a circumpolar distribution, which is listed as “Endangered” on the International Union for Conservation of Nature (IUCN) European Red List, although listed as “Least Concern” globally. It is both a predator and a kleptoparasite reliant on marine and terrestrial prey, and undertakes migrations from northern breeding habitats to temperate and tropical marine environments. Most studies of breeding populations originate from North Atlantic populations where Arctic Skuas are primarily kleptoparasitic. However, a large proportion of the global breeding population occupies remote coastal and inland tundra of Arctic regions where Arctic Skuas are more generalist in foraging modality and the range of prey taken. Here, we collated and summed national/regional population estimates to provide an updated global estimate of breeding population size and trends. We reviewed drivers of population change and knowledge gaps, and their implications for the conservation of this species. We estimated a minimum breeding population of 185,131–395,315 pairs combining Alaska, Canada, Greenland, and Europe; we extrapolated that at least 40,000 pairs could be found in Asian Russia, where no estimates were available. We noted differential trends, with substantial declines in typically kleptoparasitic populations of the North Atlantic where data quality was higher, whereas for populations in the Nearctic, trend data were scarce and geographically restricted. Various threats were identified as potential drivers of population change, including bottom-up processes, fisheries, heat stress, and interspecific competition/predation. Given the large uncertainty around abundance and population trends for much of the Arctic Skua’s range, the current global conservation status of Least Concern may be better designated as “Data Deficient”, and we encourage the implementation of a range of approaches to improve monitoring of population trends and demography globally.
This article traces the development of the state politics subfield within political science. Using three sources of evidence – the publication of state politics articles in the American Political Science Review, American Journal of Political Science, and Journal of Politics; the corpus of articles in State Politics & Policy Quarterly (SPPQ); and the programs of the State Politics and Policy Conference (SPPC) – we examine how the field has developed over the past six decades. We argue that the founding of SPPQ and SPPC helped formalize the subfield. But, as these subfield outlets entered the scene, the proportion of state politics research in leading generalist outlets began to decline even as the number of articles remains relatively constant. Additionally, the substantive focus of the subfield has endured, anchored in topics such as elections, legislatures, and public opinion, even as areas like judicial politics and gender have gained prominence and studies of political parties have declined. Finally, we document the rise of coauthorship in state politics research, reflecting the collaborative nature of the subfield.
Cullen Maiden was a bass opera singer, poet, actor, composer, and teacher born in Cleveland, Ohio, in 1932. After serving with the US military in Korea and postgraduate study at the Juilliard School, he toured with the Katherine Dunham Dance Company and the Belafonte Folk Singers before travelling to Europe — Stockholm, Rome, London, Munich — for further study and professional engagements in the early and mid-1960s. His move to Europe was motivated by racist barriers in the music industry which, while still inescapably present in Europe, seemed more navigable than those in the United States at the time.1 Maiden therefore belongs to a multi-generational cohort of African American musicians who made similar moves to German-speaking Europe, as outlined in Kira Thurman’s landmark study Singing like Germans.2 A successful audition for the Komische Oper in East Berlin led to stable employment in the house’s ensemble, and Maiden later rose to prominence as a popular Porgy in productions of Gershwin’s Porgy and Bess. Maiden lived in West Berlin for over thirty years, regularly crossing the border for work, and he pursued many independent artistic projects there, some in collaboration with political and aid organizations. In the later 1970s and early 1980s, while still living in Berlin, he made a professional return to the United States to give a series of recitals and to perform with the Black-led company Opera/South. By the early 1990s, Maiden was experiencing difficulties singing due to a medical condition, so took on increasing teaching work during his final decade in then-reunified Germany. Maiden and his British wife, Chris Hall-Maiden, moved to London in 2000, from which point he focused his multifaceted creativity on composition. He died in 2011.
Following Heath White, let ‘divine determinism’ denote the pairing of the following theses: ‘(1) the facts about God’s will entail every other contingent fact, and (2) the facts about God’s will are explanatorily prior to every other fact’. In the article, we develop a theological version of Peter van Inwagen’s so-called Direct Argument and show that, if sound, the Theological Direct Argument leads to the conclusion that divine determinism is incompatible with human moral responsibility. But, the soundness of the argument depends upon two inference rules, one of which, called Rule B, is controversial. So, in the third section of the article, we offer a novel, two-part defence of Rule B. This defence, in the first part, has to do with how truth, in a fairly trivial way, depends on the world. The second part of the defence has to do with the way that the logic of conditionals works. The upshot of this defence is that counter-examples to Rule B are impossible. Even so, should that defence fail, we also consider, in section four, a way of reformulating Rule B that, if successful, circumvents alleged counter-examples to the original statement of Rule B.
We studied the reconstruction of turbulent flow fields from trajectory data recorded by actively migrating Lagrangian agents. We propose a deep-learning model, track-to-flow (T2F), which employs a vision transformer as the encoder to capture the spatiotemporal features of a single agent trajectory, and a convolutional neural network as the decoder to reconstruct the flow field. To enhance the physical consistency of the T2F model, we further incorporate a physics-informed loss function inspired by the framework of physics-informed neural network (PINN), yielding a variant model referred to as T2F+PINN. We first evaluate both models in a laminar cylinder wake flow at a Reynolds number of $\textit{Re} = 800$ as a proof of concept. The results show that the T2F model achieves velocity reconstruction accuracy comparable to that of existing flow reconstruction methods, while the T2F+PINN model reduces the normalised error in vorticity reconstruction relative to the T2F model. We then apply the models in turbulent Rayleigh–Bénard convection at a Rayleigh number of $Ra = 10^{8}$ and a Prandtl number of $\textit{Pr} = 0.71$. The results show that the T2F model accurately reconstructs both the velocity and temperature fields, whereas the T2F+PINN model further improves the reconstruction accuracy of gradient-related physical quantities, such as temperature gradients, vorticity and the $Q$ value, with a maximum improvement of approximately 60 % compared to the T2F model. Overall, the T2F model is better suited for reconstructing primitive flow variables, while the T2F+PINN model provides advantages in reconstructing gradient-related quantities. Our models open a promising avenue for accurate flow reconstruction from a single Lagrangian trajectory.
This study aimed to evaluate the clinical efficacy and potential immunomodulatory effects of autologous platelet concentrates in promoting tissue regeneration and enhancing post-operative recovery in otorhinolaryngology.
Methods
A systematic search of PubMed, Scopus and the Cochrane Library was conducted through November 2025, focusing on randomised controlled trials and prospective studies using autologous platelet concentrates in otological, rhinological and laryngological surgery.
Results
Twelve studies met the inclusion criteria. Autologous platelet concentrates improved tissue healing, most notably by increasing graft uptake rates in myringoplasty. Recent trials (2024–2025) also reported reduced post-operative pain and mucosal oedema following tonsillectomy and tympanoplasty.
Conclusion
Autologous platelet concentrates appear to be effective adjuncts for enhancing regeneration and reducing post-operative morbidity in ear, nose, and throat procedures. These benefits likely involve downregulation of pro-inflammatory cytokines (e.g., interleukin-6) and modulation of matrix metalloproteinases (e.g., matrix metalloproteinase-9). Standardised biomarker-based studies are needed to confirm these mechanisms.
Given a group G and an automorphism $\varphi $ of G, two elements $x,y\in G$ are said to be $\varphi $-conjugate if $x=gy\varphi (g)^{-1}$ for some $g\in G$. The number $R(\varphi )$ of equivalence classes with respect to this relation is called the Reidemeister number of $\varphi $ and the set $\{R(\varphi ) \mid \varphi \in \text {Aut}(G)\}$ is called the Reidemeister spectrum of G. We determine the Reidemeister spectrum of ZM-groups, extending some results of Senden [‘The Reidemeister spectrum of split metacyclic groups’, Preprint, 2022, arXiv:2109.12892].
We present a linear stability analysis of two-dimensional magnetoconvection considering the effects of spatial confinement (characterised by the aspect ratio $\varGamma$) and magnetic field (characterised by the Hartmann number $\textit{Ha}_{i=x,y,z}$ with subscript representing its direction). It is found that when the magnetic field is perpendicular to the convection domain ($y$-direction), it does not affect the onset of convection due to zero Lorentz force. With a magnetic field in the $z$ (vertical) or $x$ (horizontal) directions, the onset of convection is delayed, resulting in a larger critical Rayleigh number $Ra_c$ for the onset of convection. We outline phase diagrams showing the dominating factors determining $Ra_c$. When $\varGamma \leqslant 0.83\textit{Ha}_z^{-0.5}$ for vertical and $\varGamma \leqslant 0.66\textit{Ha}_x^{-1.01}$ for horizontal magnetic field, $Ra_c$ is mainly determined by the geometrical confinement with $Ra_c=502\varGamma ^{-4.0}$. When $\varGamma \geqslant 2^{1/6}\pi ^{1/3}\textit{Ha}_z^{-1/3}$ for vertical and $\varGamma \geqslant 5$ for the horizontal magnetic field, $Ra_c$ is mainly determined by the magnetic field with $Ra_c=\pi ^2\textit{Ha}^2$. In the intermediate regime, both the magnetic field and spatial confinement determine $Ra_c$, and a horizontal magnetic field is found to suppress convection more than a vertical magnetic field. In addition, under a horizontal magnetic field, there exists a subregime characterised by $Ra_c = 9.9\,\varGamma ^{-2.0} \textit{Ha}_x^2$, which is explained by a theoretical model. The magnetic field also modifies the length scale $\ell$. For a vertical magnetic field, $\ell$ decreases with increasing $\textit{Ha}_z$, following $\ell =2^{1/6}\pi ^{1/3}\textit{Ha}^{-1/3}$. For a horizontal magnetic field, when $\varGamma \lt 0.62\textit{Ha}_x^{0.47}$, the flow is a single-roll structure with $\ell$ being the width of the domain. The study thus shed new light on the interplay between magnetic field and spatial confinement.
This study compared endoscopic butterfly inlay and microscopic over-underlay cartilage tympanoplasty regarding graft success and hearing outcomes.
Methods
A retrospective analysis was performed on patients who underwent tympanoplasty between January 2022 and December 2024. Patients with additional otologic procedures, cholesteatoma or revision surgery were excluded. Patients were assigned to Group 1 (endoscopic butterfly inlay) or Group 2 (microscopic over-underlay). Demographic characteristics, perforation size, operative time, graft success and audiometric outcomes were evaluated using air–bone gap (ABG).
Results
Sixty-four patients were included (33 in Group 1, 31 in Group 2). Operative time was significantly longer in the microscopic group, while perforation size and graft success rates were similar. Both techniques resulted in significant post-operative hearing improvement without inter-group differences.
Conclusion
Both techniques provided comparable graft success and hearing outcomes. The endoscopic butterfly inlay technique achieved similar results with shorter operative time, supporting its use as a minimally invasive alternative.
In a recent paper, Juodis and Reese (2022, Journal of Business & Economic Statistics, 40, 1191–1203) (JR) show that the application of the CD test proposed by Pesaran (2004, General diagnostic tests for cross-sectional dependence in panels, CWPE 0435, Cambridge) to residuals from panels with latent factors results in over-rejection. They propose a randomized test statistic to correct for over-rejection, and add a screening component to achieve power. This article considers the same problem but from a different perspective and shows that the standard CD test remains valid if the latent factors are weak. A bias-corrected version, CD$^{\ast}$, is proposed which is shown to be asymptotically standard normal under the null of error cross-sectional independence which has power against network-type alternatives. This result is shown to hold for pure latent factor models as well as for panel regression models with latent factors. The case where the errors are serially correlated is also considered. Small sample properties of the CD$^{\ast}$ test are investigated by Monte Carlo experiments and are shown to have satisfactory small sample properties. In an empirical application, using the CD$^{\ast}$ test, it is shown that there remains spatial error dependence in a panel data model for real house price changes across 377 Metropolitan Statistical Areas in the United States, even after the effects of latent factors are filtered out.
We present a study on the melting dynamics of neighbouring ice bodies by means of idealised simulations, focusing on collective effects, with the goal of obtaining fundamental insight into how collective interactions influence the melting of ice. Two neighbouring (vertically or horizontally aligned), square-shaped and equally sized ice objects (size of the order of centimetres) are immersed in quiescent fresh water at a temperature of ${20}\,^\circ \textrm {C}$. By performing two-dimensional direct numerical simulations, and using the phase-field method to model the phase change, the collective melting of these objects is studied. When the objects are horizontally aligned, no significant influence of the neighbouring object on the melting time is observed. On the other hand, when vertically aligned, although the melting of the upper object is mostly unaffected, the melting time and the morphology of the lower ice body strongly depends on the initial inter-object distance. We report that the melting of the bottom object can be enhanced by more than 10 %, or delayed more than 20 %, displaying a non-monotonic dependence on the initial object size. We show that this behaviour results from a non-trivial competition between layering of cold fluid, which lowers the heat transfer, and convective flows, which favour mixing and heat transfer. For this melting in mixed convection, we were able to collapse our data onto a single curve.