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People with opioid use disorder (OUD) have substantially higher standardised mortality rates compared with the general population. However, lack of individualised prognostic information presents challenges in personalisation of addiction treatment delivery.
Aims
To develop and validate the first prognostic models to estimate 6-month all-cause and drug-related mortality risk for people diagnosed with OUD using indicators recorded at baseline assessment in addiction services in England.
Method
Thirteen candidate prognostic variables, including sociodemographic, injecting status and health and mental health factors, were identified from nationally linked addiction treatment, hospital admission and death records from 1 April 2013 to 1 April 2022. Multivariable Cox regression models were developed with a fractional polynomial approach for continuous variables, and missing data were addressed using multiple imputation by chained equations. Validation was undertaken using bootstrapping methods. Discrimination was assessed using Harrel’s C and D statistics alongside examination of observed-to-predicted event rates and calibration curve slopes.
Results
Data were available for 236 064 people with OUD, with 2427 deaths due to any cause, including 1289 due to drug-related causes. Both final models demonstrated good optimism-adjusted discrimination and calibration, with all-cause and drug-related models, respectively, demonstrating Harrell’s C statistics of 0.73 (95% CI 0.71–0.75) and 0.74 (95% CI 0.72–0.76), D-statistics of 1.01 (95% CI 0.95–1.08) and 1.07 (95% CI 0.98–1.16) and calibration slopes of 1.01 (95% CI 0.95–1.08) and 1.01 (95% CI 0.94–1.10).
Conclusions
We developed and internally validated Roberts’ OUD mortality risk, with the first models to accurately quantify individualised absolute 6-month mortality risks in people with OUD presenting to addiction services. Independent validation is warranted to ensure these models have the optimal utility to assist wider future policy, commissioning and clinical decision-making.
This article explores the interaction between the Conseil de la Concurrence (Competition Council) and the Autorité de Régulation de la Poste et des Communications Électroniques (Telecommunications and Postal Regulatory Authority) (ARPCE) in the Algerian legal system. Algerian policy-makers have given special consideration to the issue of overlapping jurisdiction between these two authorities. The article discusses the Algerian strategy to resolve regulatory overlaps in the electronic communications market and also highlights the intervention of the ARPCE as a competition authority for the electronic communications market. Furthermore, the article analyses the Optimum Telecom Algeria case as a turning point in restoring the Competition Council’s role and highlights the need for systematizing the intervention of the two authorities. Finally, the article provides a forward-looking perspective through proposing a memorandum of understanding to promote cooperation between the Competition Council and the ARPCE.
Sense of humor is a universal human trait, enjoyed daily across cultures. However, little is known about the factors that shape individual differences in humor, particularly what contributes to developing a great sense of humor. While previous studies have identified a significant genetic component for various humor attributes, such as humor appreciation and humor styles, no study has looked at the heritability of humor production ability. This study is the first to assess the genetic and environmental influences on humor production ability using a twin study design. Participants included 448 pairs of monozygotic twins and 196 pairs of dizygotic twins (median age 66 years, mostly female) from the Twins UK registry. Twins self-assessed their humor ability, rated the funniness of their co-twin, and completed an objective humor production task by composing funny captions for captionless cartoons. Additionally, they completed a short cognitive ability test and reported their overall health. Findings revealed that self-rated humor ability was influenced by both additive genetic and nonshared environmental factors. In contrast, objective humor production showed no evidence of additive genetic effects. Instead, all individual differences were shaped by shared and nonshared environmental influences, though a small genetic effect cannot be ruled out. These results suggest that humor production may be more complex and difficult to assess than other cognitive abilities. The study also presents intriguing implications for the evolutionary basis of humor.
The objective was to evaluate the use of resveratrol conjugated with silica nanoparticles during the in vitro maturation of bovine oocytes. The oocytes were divided into the following treatment groups during the maturation process: control (n = 159), resveratrol 0.5 μM (n = 158), resveratrol 1 μM (n = 155), nanoparticles conjugated with 0.5 μM resveratrol (n = 159), and nanoparticles conjugated with 1 μM resveratrol (n = 158). Several parameters were assessed, including cumulus oophorus size, reactive oxygen species (ROS) production, oocyte nuclear maturation, cell apoptosis, cleavage rates, and blastocyst production rates. Statistical analysis was conducted using Sigma Plot software (version 11) and SAS Studio, with statistical significance defined as P ≤ 0.05 for the main effects and interactions. The results indicated that the cumulus oophorus size was smaller in the resveratrol 1 μM treatment group, and the oocyte size was reduced in the nanoparticle 1 μM treatment group. No significant differences were detected between the treatment groups in terms of ROS production, oocyte maturation, or cell apoptosis. However, the resveratrol 1 μM treatment group exhibited decreased rates of cleavage and blastocyst formation. In contrast, the nanoparticles 0.5 μM and 1.0 μM treatments showed improved cleavage and blastocyst rates compared with the resveratrol 1.0 μM treatment group. In summary, while resveratrol alone at 1 μM concentration had a negative impact on cleavage and blastocyst rates, the use of silica nanoparticles conjugated with resveratrol (both 0.5 μM and 1 μM) enhanced these outcomes, suggesting a potential advantage in using nanoparticle-conjugated resveratrol for the in vitro maturation of bovine oocytes.
In the present work, we experimentally investigate the transverse injection of elliptic liquid jets into a supersonic cross-flow ($M_\infty$ = 2.5). The primary focus is to understand the effect of injection orifice aspect ratio ($\textit{AR}$ = spanwise/streamwise dimension), on the liquid jet breakup mechanism, the flow field around the liquid jet and the resulting droplet sizes formed downstream, for three $\textit{AR}$ cases ($\textit{AR}$ = 0.3, 1, 3.3). We find that the $\textit{AR}$ = 0.3 case has large unsteadiness in the spray core due to relatively large wavelength Rayleigh–Taylor (RT) waves formed on the liquid jet surface. However, the primary jet breakup occurs through Kelvin–Helmholtz (KH) instabilities formed on the large lateral surfaces, as in coaxial liquid jet breakup. This leads to a higher Sauter mean diameter (SMD) of the droplets in the spray core with a wider range of droplet sizes compared with the circular case ($\textit{AR}$ = 1.0). However, in the case of $\textit{AR}$ = 3.3, the RT waves are more intense and of smaller wavelength due to the large drag on the liquid jet, which results in a direct catastrophic breakup of the liquid jet by the RT waves. This results in a relatively steady liquid jet and shock structure with the formation of a fine spray and smaller droplets in the spray core than for the $\textit{AR}=1.0$ case. The study shows the importance of the orifice $\textit{AR}$ on the flow around, and the spray downstream of, the liquid jet injection into supersonic cross-flow.
Forced labour in the Middle Congo was characterized in the interwar period by, on the one hand, a declining role of the notorious French concession companies, and, on the other hand, the growing importance of forced recruitment and forced labour orchestrated by the colonial state. The article attempts to analyse and understand the overall setup of overburdening created by these conditions. Based on new French and Congolese archival resources, it discusses the effects of this overburdening, linking it to the responses shown by local populations, notably through flight and evasion. In a last step, the discussion focuses on the role of intermediaries and their impact on the violence that was locally experienced. The analysis includes a wider perspective into the changes and continuities during the years of World War II, and on the challenges for the forced labour system due to its official abolition in 1946 and the decline of clandestine practices of continuity until 1948.
Hot tap water is the most common source of scald injuries, representing a quarter of all scald injuries requiring hospitalization in the United States. Children and older adults are at increased risk of scald burns. Evidence suggests that poor knowledge of burn risks and treatment among parents and the public may contribute to the burden of scald injuries in children. Medical and injury surveillance categorizes most scald burns as unintentional injuries. However, scald burns can also lead to investigation by the justice system if the injury is suspected to result from abuse or neglect. The Department of Justice recommends assessing criminal intent in childhood scald burns based on traditional indicators derived from medical research: burn uniformity, areas of sparing, burn locations, family history, and speed of medical care. In this study, we present an overview of the existing literature on intentional scald burns in children caused by hot tap water in order to improve their identification and prevention. This systematic review aims to answer two questions: (1) What are the indicators of intentional scald burns in children according to the literature and (2) Is the body of evidence for common indicators of intentional scald burns subject to bias?
In this article, we show that the Russian invasion of Ukraine triggered a pro-democratic reaction from citizens in liberal democracies, which we term the “rally for democracy.” Unlike the conventional “rally ‘round the flag” effect that boosts government popularity, this involves citizens rallying behind democracy as an international ideal. It includes expressing stronger proximity to democratic powers, stronger approval for democratic leaders abroad, and greater aversion to authoritarian regimes. Through a survey quasi-experiment conducted in six countries between February and May of 2022, we provide evidence that the “rally for democracy” emerged immediately following Russia’s invasion. Exploring this observation further via analysis of data from 55 countries between 2014 and 2023, we find this to be the intensification of a longer-term trend in response to the rise of authoritarian great powers. A new cleavage exists in geopolitical loyalties, based on the degree to which citizens feel attachment to democracy, and this divide runs both between and within countries.
In this paper, we first prove that the totally real discs lying in certain Levi-flat hypersurfaces are polynomially convex. We also studied the polynomial convexity of totally real discs lying in the regular part of certain singular Levi-flat hypersurfaces. In particular, a necessary and sufficient condition for polynomial convexity of totally real discs lying in the non-singular part of the boundary of the Hartogs triangle is achieved. Sufficient conditions on general compact subsets lying on those hypersurfaces for polynomial convexity are also reported here.
Public health emergencies make an impact on policing in many ways, create unique challenges for police departments and affect the quality of life of police officers. These impacts include response, enforcement, preparedness, and inter- and intra-organizational dynamics. While there is much research on policing the pandemic in the Global North, similar scholarship emanating from the Caribbean is limited. With this lacuna in mind, the views of 32 members of the Trinidad and Tobago Police Service were collected via semi-structured interviews at the back end of the COVID-19 pandemic and used to answer four research questions. The results indicate a host of impacts on policing, police leadership and police officer quality of life as a result of the COVID-19-facilitated pandemic. The current study adds to the limited scholarship on policing during the pandemic and offers guidance on policing practice to ensure police officer safety and preparation for future health pandemics.
This article sheds light on a series of Xinjiang maps created by order of imperial Japan’s General Staff Headquarters in 1943. These maps, seventeen in all, offered panoramic views on Xinjiang’s topography, geological and meteorological conditions, ethnic composition, major cities, riverine systems, aviation ports, roads for motorized vehicles, wireless and postal systems, and various resources. Those maps invite the heretofore little-studied question of how Xinjiang figured in imperial Japan’s geostrategy. This article contextualizes imperial Japan’s heightened strategic interest in Xinjiang during World War II, particularly after the closure of the Burma Road, which paradoxically revitalized Chongqing’s Republican regime. These sources inform the argument that the place of Xinjiang in imperial Japan’s geostrategic thinking must be understood beyond the narrow lens of Sino-Japanese enmity. It warrants a world historical perspective. The article examines said maps and uncovers the multiplicity of Xinjiang’s toponyms and ethnonyms that encapsulated parallel and oftentimes contested temporalities. Tokyo’s attentiveness to ethnological understandings of the region’s indigenous populations reflects an aspiration to construct a political demography that tethered indigenous sovereignty to the authority of the colonial state, bypassing the domination of the Chinese Republic in Chongqing.
Ce texte explore le rôle du sujet dans la théorie des savoirs situés de Donna J.Haraway et de Lorraine Code. Il examine la tension entre l’approche individualiste et l’approche collective dans les épistémologies féministes. Nous y soutenons que les savoirs situés permettent de concilier la dimension individuelle du sujet avec une perspective politique et collective, tout en évitant une critique anti-individualiste qui nierait l’agentivité personnelle. Cette approche offre des critères de responsabilité épistémique individuelle et s’intéresse plus aux actions du sujet qu’à son essence.
We present a new Eulerian framework for the computation of turbulent compressible multiphase channel flows, specifically to assess turbulence modulation by dispersed particulate matter in dilute concentrations but with significant mass loadings. By combining a modified low-dissipation numerical scheme for the carrier gas phase and a quadrature-based moment method for the solid particle phase, turbulent statistics of the fluid phase and fluctuations of the particle phase may be obtained as both are resolved as coupled fields. Using direct numerical simulations, we demonstrate how this method effectively resolves the turbulent statistics, kinetic energy, skin friction drag, particle mass flow rate and interphase drag for moderate-Reynolds-number channel flows for the first time. Validation of our approach to the turbulent particle-free flow and the turbulent particle-laden flow proves the applicability of the carrier flow low-dissipation scheme to simulate relatively low-Mach-number compressible flows and of the quadrature-based moment method to simulate the particle phase as an Eulerian field. This study also rationalises the computed interphase drag modulation and total Reynolds shear stress results using a simplified analytical approach, revealing how the particle migration towards the wall can affect the drag between the two phases at different Stokes numbers and particle loadings. Furthermore, we show the effect of near-wall particle accumulation on the particle mass flow rate. Using our Eulerian approach, we also explore the complex interplay between the particles and turbulent fluctuations by capturing the preferential clustering of particles in turbulence streaks. This interplay leads to turbulence modulations similar to recent observations reported in prior computational works using Lagrangian simulations. Our study extends the applicability of the Eulerian approach to accurately study particle–fluid interactions in compressible turbulent flows by explicitly calculating the energy equations for both the particle phase and the carrier fluid motion. Since the formulation is compressible and includes energy equations for both the particle and carrier flow fields, future studies for compressible flows involving heat and mass transfer may be simulated using this methodology.
On February 6, 2023, 7.7 and 7.6 magnitude earthquakes struck southeastern Türkiye, affecting 11 provinces and causing significant losses. This study aims to assess the mental health status of survivors in the twelfth month after the earthquake.
Methods
A cross-sectional study was conducted using an online survey with the virtual snowball sampling method. The survey included sociodemographic data, previous traumas, earthquake-related experiences, and the Post-Earthquake Trauma Level Determining Scale (PETLDS) and Hospital Anxiety and Depression Scale.
Results
The study included 2544 participants. The mean PETLDS score was 58.14±18.18, indicating that the participants were highly traumatized. Among them, 59.5% had high levels of post-traumatic symptoms, 44.2% had high anxiety, and 61% had high depression symptoms. 35.77% of participants displayed a co-occurrence of post-traumatic stress along with anxiety and depression. Female gender was the strongest predictor of high-level trauma and anxiety, while a history of psychiatric disorder was the strongest predictor of depression. Multiple logistic regression analysis indicated that symptoms were predicted by low income, low education level, smoking, comorbid chronic diseases, past traumatic experiences, the loss or injury of a loved one due to the earthquake, personal injury, temporary displacement, and damage to homes and workplaces.
Conclusions
The findings suggest that one year after the earthquake, mental health problems are prevalent among survivors, highlighting the need for urgent psychiatric interventions.