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We confirm a conjecture posed by Bergelson, Moreira, and Richter, and in particular show that for every probability-measure-preserving system $(X,\mathscr {B},\mu ,T)$, every $k\in \mathbb {N}$, every set $A\in \mathscr {B}$ with $\mu (A)>0$, and every tempered function f, $ \lim _{N\to \infty }({1}/{N}) \sum _{n=1}^N\mu (A\cap T^{-\lfloor {f(n)\rfloor }}A\cap T^{-\lfloor {f(n+1)\rfloor }}A\cap \cdots \cap T^{-\lfloor {f(n+k)\rfloor }}A)>0. $ This is achieved by establishing conditions on an increasing function $W:\mathbb {N}\rightarrow (0,\infty )$ such that if $(x_n)_{n\in \mathbb {N}}$ is a bounded sequence in a Banach space with $ \lim _{W(N)-W(M)\to \infty }({1}/({W(N)-W(M)})) \sum _{n=M}^N (W(n)-W(n-1))x_n =L $ then the limit of Cesàro averages of $(x_n)_{n\in \mathbb {N}}$, $\lim _{N\to \infty }({1}/{N})\sum _{n=1}^Nx_n$, is also equal to L. Furthermore, the methods we develop can be used to sharpen some of the combinatorial results obtained by Bergelson, Moreira, and Richter. For example, if E is a set of positive upper density, then for any $k\in \mathbb {N}$, any $\varepsilon>0$, and all sufficiently large $N\in \mathbb {N}$ there is an $a\in \mathbb {N}$ and an $n\in [N-N^{1/2+\varepsilon },N]$ such that $\{a,a+\lfloor n^{3/2} \rfloor ,a+\lfloor (n+1)^{3/2}\rfloor ,\ldots ,a +\lfloor (n+k)^{3/2}\rfloor \}\subseteq E.$
Two forms of existential proposition are identified, one favoured by analytical philosophers, one by Thomists. It is argued, against objections, that both forms were recognized and used by Thomas. A useful way of labelling this point is to speak of the distinction between esse ut verum and esse reale: being in the sense of the true, the analytical notion, on the one hand, and the Thomist notion of actual or real existence on the other. The former is best expressed by a second-level predicable, the latter by a first-level predicable. Both express a valid notion which is fittingly called ‘existential’, and both are, indeed, analogically connected in meaning.
This study examines the role of business in tax policymaking through the lens of business power, focusing on the 1950 Tax Revision in the Netherlands as a historical case. The revision policy process unfolded in the context of post-war economic reconstruction and industrialization and became a key site of contention between fiscal and economic policy objectives, in which business interests were strongly represented. Combining historical methodology and process tracing with theoretical perspectives of business power, the study identifies the mechanisms through which business-government interactions operated in the tax policy process. Corporate actors advocated for fiscal relief by exploiting intra-governmental differences and leveraging their structural economic importance and close connections to the government. Crucially, they constructed a narrative framing fiscal relief as a necessity for industrial development, thereby using the reconstruction context to advance their interests.
Most antidepressants do not independently treat impaired cognition associated with major depressive disorder (MDD). Elevated brain cortisol levels are associated with both MDD and cognitive impairment. Emestedastat is a brain-penetrant, intracellular cortisol synthesis inhibitor.
Aims
The XanaCIDD trial aimed to determine whether emestedastat 10 mg could improve both cognitive impairment and depression in a population with persistent MDD and cognitive impairment.
Method
Participants had a diagnosis of MDD, with persistent depression (Hamilton Rating Scale for Depression-17 ≥17) and cognitive impairment (coding test ≤0.5 s.d. of normal). Randomised treatment (1:1) was continued for 6 weeks (week 6), with 4 weeks’ blinded follow-up (week 10). The primary end-point was cognition (composite of attention/working memory) at week 6. Depression end-points included Montgomery–Åsberg Depression Rating Scale (MADRS) and Patient Global Impression of Severity (PGI-S). Analyses used a mixed model for repeated measures (cognitive impairment and MADRS one-sided tests, others two-sided) and Cohen’s d effect size. No adjustments were made for multiple comparisons.
Results
A total of 165 participants were enrolled and treated: 134 (81%) were on background antidepressants, 62% were female, mean prior number of MDD episodes was 10 and mean coding z-score was −1.47. There was no benefit on the primary cognitive end-point at week 6 (p = 0.17 favouring placebo), with the cognitive composite improving markedly in both groups without correlation to depressive symptoms or baseline characteristics (R2 ≤ 0.02). The trend towards benefit on the prespecified secondary depression end-point, MADRS, began at week 6 and was maximal at week 10 (2.7 points, Cohen’s d 0.43, p = 0.05). A trend towards potential emestedastat benefit in PGI-S scores was also maximal at week 10 (p = 0.12). Mild–moderate transaminase elevations were seen in 10% of emestedastat participants (≤2 times normal in 7 of 8 cases, 1 discontinuation) versus 1% of the placebo group.
Conclusions
There was no benefit of emestedastat on the primary end-point of cognitive impairment and a large placebo effect, without correlation of cognitive impairment to depression changes or baseline characteristics. Trends towards potential antidepressant activity suggest that emestedastat may be a novel antidepressant worthy of further investigation.
Knowledge of one’s defect is fundamental in optimising outcomes in adults with CHD. We aimed to assess factors associated with defect knowledge and how that knowledge may impact outcomes.
Methods:
We performed a cross-sectional cohort study of adults with CHDs aged 18–82 years with intervention between 1982 and 2003 at one of 11 US centres in the Pediatric Cardiac Care Consortium. Participants completed a survey in 2021–2023 regarding disease knowledge and various health and quality of life outcomes. After comparing participants’ self-identification of their defect to that recorded in the medical record, we identified demographic factors associated with correct identification and assessed the association of correct identification with outcomes.
Results:
Among 2747 respondents with one of the 18 types of CHDs on the survey, 2271 (83%) correctly identified their defect. Those who correctly identified their defect were more likely to be non-Hispanic White (84% correct), were <25 years of age (89%), have a higher level of education (86% for a bachelor’s degree and 87% for a graduate degree), and have higher household income (85% for income ≥$60,000). Those with severe two-ventricle disease were most likely to correctly identify their defect (88% correct); those with moderate disease were least likely (80% correct). Correct identification was associated with seeing a cardiologist in the last 5 years (74% vs. 63%, p < 0.001) but was mixed for other outcomes.
Conclusions:
Improving a person’s knowledge of their CHD may be an effective strategy for maintaining continuity of care.
Clinical decision support (CDS) tools have been demonstrated to improve patient care and outcomes yet remain under-utilized in many clinical domains, including en route care.
Study Objective:
This study evaluated whether a decision-tree CDS tool integrated within the government-created Battlefield Assisted Trauma Distributed Observation Kit (BATDOK; AFRL) clinical care software improves adherence to Joint Trauma System (JTS) guidelines for severe traumatic brain injury (TBI).
Methods:
In a randomized crossover simulation of military clinicians (N = 24), paired participants managed a patient with elevated intracranial pressure (ICP) using either usual care (UC) or BATDOK with TBI CDS in a simulated fixed-wing air transport mission. Outcomes included completion of critical actions by simulation conclusion, time to completion of critical actions, adherence to tiered interventions as outlined in JTS Clinical Practice Guideline (CPG), and user evaluations of the CDS tool using the validated instrument, System Usability Scale (SUS).
Results:
There were no significant differences in the primary outcome, percentage of critical items completed. Teams completed a median 83.3% of the critical items in the UC scenario, compared to 91.7% in the CDS scenario (P = 0.58; median difference 4.2%, 95% CI of the difference -8.1% to 16.4%). The mean SUS score for the CDS platform was 77.6 (SD = 16.0), which is associated with a “good” usability rating. Most participants rated the CDS platform favorably on every item of the SUS.
Conclusion:
The BATDOK with TBI CDS did not statistically increase completion of critical tasks in this initial evaluation of usability. However, these data suggest that BATDOK enhanced with CDS improved tiered guideline-concordant sequencing of ICP interventions outlined by the JTS CPG and was favorably rated by users, suggesting feasibility for operational integration.
This Guest Editorial argues that symptoms, rather than syndromic diagnoses alone, function as the practical units of psychiatric care. To render implicit symptom-oriented reasoning explicit, symptom-oriented clinical psychiatry offers a structured framework for analysing symptom roles, guiding treatment priorities and sequence and reducing reactive polypharmacy while remaining fully compatible with established diagnostic systems.
Missing-model problems are a type of problem that arises when scientists are trying to gain access to initially inaccessible phenomena. This paper describes what missing-model problems are, and examines examples of them from seismology, optics, and the theory of gases. It is argued that the examination of missing-model problems will give us a better understanding of the challenges scientists face when attempting to gain access. Two themes for the further study of missing-model problems are laid out: justification and representation.
To accompany the publication of the special issue, ‘Population-Level Data Linkages in Worldwide Twin Registries’, an online, interactive tool titled ‘Twin Registries Worldwide’ has been developed to provide an overview of twin registries across the globe. The tool currently offers a searchable table view that allows users to explore twin registries by country, registry name, recruitment period, sample size, phenotypic domains, availability of biological samples, and linkage to administrative or health-related databases.
Novel tools have allowed researchers to intervene into circuits at the mesoscale. The results of these interventions are often explained by appeal to functions. How are functions ascribed to circuit parts experimentally? I identify two kinds of function ascription practices in circuit interventions. Analysis of these practices shows us that what makes function ascriptions challenging is a lack of interventive control and insufficient constraints on the class of candidate functions to discriminate in practice. One kind of function ascription practice—subtractive analysis—fares better at addressing these challenges.
As China pursues high-quality, innovation-driven growth, it faces rising economic policy uncertainty (EPU) fuelled by information gaps, changing policy priorities and geopolitical tensions. Yet how EPU shapes green technology innovation remains contested. Analysing panel data from A-share listed companies (2009–2019), this study reveals that EPU motivates enterprises to improve green innovation levels. Mechanism analysis shows that EPU increases R&D investment and strengthens environmental, social and governance (ESG) performance, especially among large and state-owned enterprises, while significantly reducing the effectiveness of environmental subsidies. These findings suggest EPU acts as a strategic catalyst, though patent growth may partly reflect strategic filing behaviour rather than substantive technological progress. Consequently, policy frameworks must provide predictable, long-term support. Governments should improve subsidy mechanisms and promote adaptive R&D strategies to utilize uncertainty as a driver for green transformation. While the 2009–2019 scope ensures data reliability, the results’ external validity should be considered alongside post-2020 macroeconomic and geopolitical shifts.
To analyze state healthcare-associated infection (HAI) laws and examine the transition from state-driven surveillance to regulatory frameworks substantially shaped by federal policy.
Methods:
We conducted a systematic public health law review of statutes, administrative regulations, and policies governing HAI surveillance across 50 U.S. states and the District of Columbia as of March 1, 2024. We analyzed the HAI surveillance framework in each jurisdiction to assess the federal influence. To supplement the legal review and clarify state-specific reporting requirements, we administered a survey to state HAI program coordinators.
Results:
As of March 2024, 38 jurisdictions (74.5%) mandate HAI reporting. Early laws were primarily state-driven, while later enactments increasingly incorporated federal standards. Among jurisdictions with HAI reporting laws, 23 (60.5%) reference or incorporate Centers for Medicare & Medicaid Services (CMS) mandates into the state law, enabling sharing of federally reported data. Overall, 41 states (80.4%) modified reporting requirements in response to CMS mandates; nearly all jurisdictions with HAI reporting laws (97.4%) adopt other forms of federal policies.
Conclusions:
The majority of states have adopted HAI legislation, with state-level reporting laws and policies demonstrating continuous development from 2002 to 2024. Early HAI surveillance efforts, while guided by emerging federal government influences, were primarily based on state policy. However, since 2009, new state laws and policies have increasingly adopted federal policies. Over time, state reliance on federal standards has created a policy shift: state HAI reporting frameworks have expanded and adapted to federal policy, creating a legal environment marked by growing federal-state integration.
Annually resolved radiocarbon (14C) records from tree rings provide a high-resolution archive for investigating short-term atmospheric 14C variations driven by solar and cosmic activity, as well as terrestrial processes, including geomagnetic modulation, stratosphere–troposphere exchange, ocean–atmosphere interactions, and tree physiological traits. While extensive data are available for the Northern Hemisphere, comparable high-resolution records from the Southern Hemisphere are scarce, making it difficult to obtain robust 14C calibration for the south and to evaluate 14C distribution models. Here, within the framework of the CHASCA project, we present a new annually resolved 14C record from Fitzroya cupressoides, a long-lived conifer native to southern South America, spanning AD 970–1084 (RAL060), with samples collected in North Patagonia, Argentina. This is the first annually resolved radiocarbon series from South America and among the longest for the Southern Hemisphere.
The CHASCA series shows strong agreement with Northern Hemisphere datasets and with SHCal20 confirming the expected interhemispheric offset. It also captures the AD 993–994 solar particle event, with a statistically significant level (≈ 7 σ), though with reduced amplitude compared to the shorter decade-long records from New Zealand and Chile. This attenuation may reflect a combination of stratospheric–tropospheric dynamics, regional environmental conditions, and species-specific growth dynamics, although these mechanisms remain speculative and require further investigation, underscoring the complexity of local expression of cosmogenic 14C signals. The CHASCA series thus extends the geographic coverage of annually resolved-14C datasets and establishes South America as a key region for detecting and comparing short-term cosmogenic events.
The extreme warmth of Marine Isotope Stage (MIS) 11 has been extensively studied in the terrestrial realm; however, less is known about its expression in the North Pacific. Here, we present a multiproxy record from Integrated Ocean Drilling Program (IODP) Site U1339 in the southeastern Bering Sea (Umnak Plateau). We use sedimentology, diatoms, and organic geochemistry to reconstruct sea ice and primary productivity from the end of MIS 12 to the beginning of MIS 10 (430–368 ka) at this site. In late MIS 12, the Umnak Plateau experienced extensive seasonal sea ice cover, with spring sea ice concentration near 100%. Based on diatoms and ice-rafted debris, sea ice declined to year-round ice-free conditions during deglaciation but readvanced during the interglacial climatic optimum. In contrast, sea ice has not been present at the Umnak Plateau throughout the Holocene. During MIS 11, sea ice at this site may have persisted due to a more easterly and/or weaker Aleutian Low. Laminated sediments indicate enhanced seasonal productivity during deglaciation. However, productivity does not remain high throughout the interglacial. The decline in productivity during MIS 11 occurs independently of fluctuations in sea ice and upwelling and may be due to increasing nutrient limitation.
We study the geometry of the complex hyperbolic triangle group $\Delta_{4,\infty,\infty;\infty}$ acting on the complex hyperbolic plane $\mathbf{H}^2_{\mathbb C}$ and show that the 3-manifold at infinity of $\Delta_{4,\infty,\infty;\infty}$ is the complement of the chain link $8^4_1$ in the 3-sphere. In particular, the four-cusped hyperbolic 3-manifold $S^3-8^4_1$ admits a spherical CR-uniformisation. Since the ideal boundary of the Ford domain is an infinite-genus handlebody, we introduce a new technique to construct embedded topological disks that cap off the genus, ensuring their boundaries are compatible with the side-pairings. This surgical approach facilitates the determination of the fundamental group of the manifold at infinity and simplifies the computation compared to [14].
Based on this result and previous studies, we conjecture that the chain link $C_p$ serves as an ancestor of the 3-manifold at infinity for the critical complex hyperbolic triangle group $\Delta_{p,q,r;\infty}$, where $3 \leq p \leq 9$.
We construct one of the longest continuous rent series for the pre-modern world, tracing Toledo’s housing market from 1489 to 1810. Using the Cathedral’s portfolio, we merge a hedonic microdataset (1489–1650) with a decadal census of leases (1650–1810), yielding over 34,000 transactions and coverage of up to 35% of dwellings in the city per sampled year. Privileged groups drove a bubble-like surge in rents during the sixteenth-century silver boom, while the working poor saw only modest increases. After 1600, the premiums once paid by artisans and shopkeepers over unskilled laborers steadily disappeared, marking the erosion of Toledo’s middle class. These findings underscore the role of housing markets in both reflecting and reinforcing inequality in early modern Spain.
Current geometric-based path-planning methods for vertical parking in automated parking systems face issues such as stringent initial position requirements, insufficient clearance from garage boundaries, and discontinuous curvature. To address these problems, this paper proposes a parking path-planning method that integrates the Reeds–Shepp curve with an improved particle swarm optimization (PSO) algorithm. The parking process is decomposed into forward and backward segments, each generated using the Reeds–Shepp curve to enhance flexibility. The shift point, defined as the transition between the two segments, serves as the decision variable in the PSO framework. The fitness function jointly considers path length and deviation between the target pose and garage entry. A quadratic Bézier curve and a nonlinear adaptation mechanism are incorporated into the PSO to determine the optimal shift point, mitigating the risk of proximity to garage boundaries. The initial path is then generated using the Reeds–Shepp curve based on the initial pose, shift point, and target pose. After discretization, the path points are optimized via a nonlinear optimization formulation to eliminate curvature discontinuities at segment junctions. Experimental results demonstrate that the proposed method generates feasible, continuous-curvature parking paths across a variety of initial poses, outperforming conventional approaches in terms of flexibility and clearance.