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As the most populous city in China, Shanghai’s human waste disposal underwent a dramatic transition between 1949 and 2010. While human waste continued to be sold to farmers as fertilizer, the authorities attempted to modernize the methods of manual removal, promoting nightsoil dump stations and vacuum trucks from the early 1970s. These new methods soon became widespread. However, urban human waste gradually lost its value as fertilizer from the late 1970s, chiefly because of the popularization of chemical fertilizers, at which point Shanghai was faced with serious human waste issues. Encountering this unforeseen shift, the municipality had to accept the reality that there were no longer rural markets for urban human waste, and that it would have to start treating human waste as refuse. In contrast to the Western model, Shanghai’s approach to modernizing human waste disposal was distinctive, having been influenced by factors beyond the city.
This article examines the intertwined history of local divination schools and divination instructors during the Yuan–Ming transition through a microhistory of the Zhu family—a diviner family who, as newcomers to Suzhou, carefully navigated the turbulent dynastic transition. Based on broader prosopographical research of Yuan and Ming divination school instructors, this study draws two main conclusions regarding social and institutional history during this crisis period. First, the Zhu family, representing lesser elites whose status depended on state institutions, survived the Yuan–Ming transition by building local networks, transforming their expertise, and manipulating narratives of their family history. Second, despite the Ming founder's order for the re-establishment of local divination schools, it was the diviner families, seeking to recover from the dynastic transition, who played a key role in restoring the local institution. This study extends our understanding of the scope of the fourteenth-century crisis, its diverse manifestations across social groups, and the manipulation of crisis narratives for various purposes. It also proposes a bottom-up approach to engage with the Yuan–Ming social and institutional continuity and rupture.
We evaluated the prevalence and risk factors for child maltreatment in multiples aged 3 years and compared them to singletons in Japanese population-based data. Records on child maltreatment and health check-ups at 3 years of age from 17,125 singletons, 488 twins and 18 triplets were collected from a Public Health Center between April 2007 and March 2011. The associations of child maltreatment with potential risk factors were analyzed using the logistic regression model. Out of all children, 76 (4.31 per 1000) children had documented maltreatment including 69 (4.03 per 1000) singletons and seven (14.31 per 1000) twins. All of the cases in twins were physical abuse (100%) and nearly half of the cases (43%) included emotional abuse. Among twins, 86% of the biological mothers were suspected. The alleged perpetrators of twins showed a significantly higher rate of maternal depression compared to those of singletons. After adjusting the results for a number of potential biological and social risk factors, twins or triplets had a higher risk for maltreatment than singletons (OR 3.39, 95% CI [1.17, 9.83]). Healthcare providers should be aware that a multiple birth can place considerable stress on a family leading to child maltreatment and should provide appropriate support and intervention for mothers with multiples.
Stemming from a canonical commentary of Theodore Balsamon (1130s–1195), this article examines an underexplored Byzantine Christian practice: the consecration of virgins. It focuses on an unusual religious establishment, a parthenon, founded in Thebes by its metropolitan John Kaloktenes (1166–c.1190), which accommodated lay virgins to pursue asceticism without demonstrating monastic commitments. It investigates the practice's origins, development and significance in Byzantine religious heritage, highlighting Kaloktenes's innovative revival of the practice. This study offers a unique case for exploring Byzantine monasticism and ecclesiastical leadership, while also demonstrating the potential for integrating Byzantium into the religious movements of the contemporary Latin West.
Deep brain stimulation (DBS) is an important treatment for Parkinson’s disease, tremor and dystonia in appropriately selected patients. The Canada Health Act emphasizes equity and “reasonable access to medically necessary hospital and physician services.” How to define “reasonable access” has not been well studied. We aimed to assess access to DBS implantation surgery and to determine the time required from initial assessment through to surgery and which step(s) delay the implantation.
Methods:
DBS implants from 2016 to 2023 at the University of Alberta were analyzed. The neurologists’ decision to proceed with DBS marks the start of the workup. The time required to see a neurosurgeon, psychiatrist, neuropsychologist and healthcare allies and to receive DBS surgery was assessed. The impact of COVID-19 was studied.
Results:
The total time from starting the workup to DBS surgery was 387.76 ± 125.19 days prior to COVID-19, and marked delay occurred during and post-COVID-19 (840.15 ± 165.41 days and 839.78 ± 300.66 days, respectively). Most workups were done within 6 months pre-COVID-19, although a big range existed due to variable factors. The longest delay to surgery was from consent to DBS implantation, owing to a lack of operative time. There has not been a recovery post-pandemic.
Conclusions:
Time to DBS implantation surgery from initial decision is lengthy and more than doubled over the course of the COVID-19 pandemic. The biggest delay was in the time from consent to implantation surgery, which has not improved despite the pandemic having ended.
In the mid-fourteenth century, the Jochid ulus went through a phase of extreme political turbulence. Following the death of the last Batuid khan Berdibek (r. 1357–1359), during the next two decades, circa 1360–1380, a high number of power contenders rose at both the central and the local levels of the ulus. This article aims to map and exemplify those attempts as part of the broader theoretical discussion concerning the scope and depth of the khanate's crisis. It does so by combining an overall, bird's-eye perspective on the political history of the ulus by zooming in on the regional history, as well as through the analysis of both written primary and numismatic sources. None of the multiple patterns of reaction to the dying-out of the Batuid lineage clearly contradicted the idea of the khanate's unity and the overarching ‘Chinggisid principle’. At this point in time, the ulus still followed the centrifugal logic of the Chinggisid rule. At the same time, the crisis of the Jochid ulus of the mid-fourteenth century indeed prepared the very ground for the power division between the still-existing branches of the Jochid family and the break-up of the Jochid power domain of the fifteenth century that followed the last unification attempt of the ulus under Toqtamïsh (r. 1380–1406).
This paper compares the views of Hegel and Schelling regarding the problem of individuation, i.e. the question of what makes an individual (a) numerically distinct from others and (b) the very individual it is. My focus is on how Hegel approaches this problem in his metaphysics and how that relates to Schelling’s views as articulated in his ‘negative philosophy’. While Hegelians like Robert Stern and Karen Ng are optimistic that Hegel can solve the problem of individuation, I argue that Schelling puts forward an objection that both challenges Hegel’s account and provides a rationale for taking seriously Schelling’s own insistence on a pre-logical dimension of being.
The Edmonton-based mobile stroke unit (MSU), which transports patients to the University of Alberta Hospital (UAH), enrolled patients in the Intravenous Tenecteplase Compared with Alteplase for Acute Ischemic Stroke (AcT) trial. We examined the feasibility of trial enrollment in MSU, its impact on acute stroke workflow metrics and functional outcomes at 90–120 days.
Methods:
In this post hoc analysis, patients were divided into three groups based on enrollment site: MSU (n = 43), UAH (n = 273) and non-UAH (n = 1261). All patients were enrolled with a deferred consent process. The primary outcome for this analysis was the feasibility of enrollment defined as the proportion of patients receiving intravenous thrombolysis (IVT) during the study period who were enrolled in the trial. Multiple linear and binary logistic regression was used to evaluate the adjusted effect of the study groups on acute stroke workflow metrics and functional outcomes at 90–120 days.
Results:
100% of eligible IVT-treated patients in the MSU during the study period were enrolled in the AcT trial. Covariate-adjusted linear regression showed shorter door-to-needle (17.2 [9.7–24.6] min) and CT-to-needle (10.7 [4.2–17.1] min) times in the MSU compared to UAH and non-UAH sites. There was no difference in the proportion of patients with an excellent functional outcome (mRS 0–1) at 90–120 days or symptomatic intracerebral hemorrhage (ICH) at 24 hours between groups.
Conclusions:
Enrollment in the AcT trial from the MSU was feasible. MSU-enrolled patients demonstrated faster door-to-needle and CT-to-needle times, resulting in earlier IVT administration and similar rates of symptomatic ICH.
This paper explores whether attitudes toward ethnic nationalism among Black and Asian Americans influence attitudes toward the Black Lives Matter Movement. Acceptance of a nationalist ideology typically makes an individual animus towards outgroups. Moreover, ethnic/Black nationalism is known to flare in times of perceived intense oppression. Given current racial tensions in the United States, we are interested in examining factors that may help facilitate alliance-building between Black and Asian Americans—two nonwhite groups that exist on different planks of the U.S. racial hierarchy. We begin by recounting historical and contemporary instances of Afro-Asian solidarity and conflict. This is followed by a review of past theoretical articulation and empirical research on nationalist ideology within each community. We develop a set of group-specific indicators of ethnic nationalism for Black and Asian Americans from the 2020 Collaborative Multiracial Post-Election Survey. Our results show clear evidence that being sympathetic to ethnic nationalism can unite rather than divide the two racialized communities in their attitudes toward present-day projects such as the Black Lives Matter Movement.
In North America, less than 30% of children with complex CHD receive recommended follow-up for neurodevelopmental and psychosocial care. While rates of follow-up care at surgical centres have been described, little is known about similar services outside of surgical centres.
Methods:
This cohort study used Maine Health Data Organization’s All Payer Claims Data from 2015 to 2019 to identify developmental and psychosocial-related encounters received by children 0–18 years of age with complex CHD. Encounters were classified as developmental, psychological, and neuropsychological testing, mental health assessment interventions, and health and behaviour assessments and interventions. We analysed the association of demographic and clinical characteristics of children and the receipt of any encounter.
Results:
Of 799 unique children with complex CHD (57% male, 56% Medicaid, and 64% rural), 185 (23%) had at least one developmental or psychosocial encounter. Only 13 children (1.6%) received such care at a surgical centre. Developmental testing took place at a mix of community clinics/private practices (39%), state-based programmes (31%), and hospital-affiliated clinics (28%) with most encounters billing Medicaid (86%). Health and behavioural assessments occurred exclusively at hospital-affiliated clinics, predominately with Medicaid claims (82%). Encounters for mental health interventions, however, occurred in mostly community clinics/private practices (80%) with the majority of encounters billing commercial insurance (64%).
Conclusion:
Children with complex CHD in Maine access developmental and psychosocial services in locations beyond surgical centres. To better support the neurodevelopmental outcomes of their patients, CHD centres should build partnerships with these external providers.
This article presents a description of German schon and noch as nontemporal scalar focus operators. Both items operate in a scalar model of sufficiency and signal that the focus value yields a more informative proposition than all alternatives under consideration; that is, they are special cases of scalar additives. Where the two expressions differ is in the complementary perspectives they evoke. Schon relates to higher alternatives. Noch relates to lower alternatives, but brings about an inverse (i.e., antonymically ordered) scalar model. The use of schon and noch as scalar sufficiency operators is traced back to an amalgamation of two other uses of the same items. The descriptive findings contribute to the advancement of our cross-linguistic understanding of scalar focus operators and raise fundamental questions pertaining to the typological and theoretical status of scale reversal phenomena.*
Randomised controlled trials are the ‘gold standard’ approach in nutrition research to show a causal relationship between a dietary intervention and clinically relevant outcomes at the population level. Here we review why different study designs are needed to establish the efficacy of dietary interventions at the individual level and to better account for relevant factors that can also influence the outcomes. Over the past decade, precision nutrition approaches have been developed as a new way to measure the effectiveness of dietary interventions at the individual and population level. Precision nutrition aims to determine the individual factors that are associated with differences in responses to dietary interventions. This is complex, typically needing studies with a large number of participants and using advanced statistical approaches and machine-learning algorithms to identify predictors that can explain why individuals do or do not respond to consuming specific foods, meals or diets, for a given outcome. N-of-1 study designs, which are new to nutrition science, offer a robust alternative approach to assess how an intervention and everyday behaviours affect individual health outcomes. They utilise repeated measures within individuals, rather than baseline and end measures in a larger number of participants, to provide the statistical power required to determine an individual’s responsiveness to an intervention. The adoption of new study designs and modelling approaches, particularly the N-of-1 approach, to examine responses to interventions within individuals, will help to further the understanding of the relationships between diet and health within individuals more effectively and accurately.
Natural disasters are frequent occurrences worldwide and can influence fertility preferences. This study aimed to assess the impact of disaster preparedness training on the disaster readiness levels of women of reproductive age and their fertility and childbearing attitudes.
Methods
The study employed a classic experimental design with a pre-test and post-test control group. The sample consisted of women of reproductive age in Turkey, determined through the G-Power 3.1.9.7 program, with intervention (n = 88) and control (n = 88) groups totaling 176 participants. Data were collected using a “Preliminary Evaluation Form,” “Descriptive Information Form,” “Disaster Preparedness Scale (DPS),” and “Attitudes Toward Fertility and Childbearing Scale (AFCS).”
Results
In the intervention group, the post-test scores significantly increased for the DPS and the AFCS sub-scale on the importance of fertility for the future (P<0.05).
Conclusions
The study found that disaster preparedness training provided to women of reproductive age improved their disaster readiness levels. Following the training, the women’s knowledge about physical protection during disasters, assistance in disasters, and disaster warnings and systems also increased. Additionally, the training enhanced the positive attitudes of these women toward childbearing.
While previous research has highlighted the significant role of language in conditioning migrants’ access to key institutions of the welfare state, the question of how individual migrants experience linguistic disadvantage has been less in focus. Drawing on a relational approach, the article moves beyond the idea of language barriers as a static structure of (in)equality or a matter of individual shortcomings. It demonstrates how language policies and language ideologies, and their entanglements with more general trends in welfare policies and ideologies, shape migrants’ relational experiences with the welfare states and their representatives, and what are the implications of such interactions – or the lack of interaction. Empirically, it builds on qualitative data collected in Belgium and Finland, showing how language barriers and discrimination can result in Kafkaesque administrative processes that produce both material and affective hardship for migrants in these national contexts.