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Mental health disorders such as depression and anxiety are highly prevalent among ophthalmic patients, particularly those with progressive vision impairment. Despite the strong interconnection between mental health and vision-related disabilities, mental health support remains underintegrated into ophthalmic care. The economic burden of untreated mental health conditions in visually impaired patients is understudied, particularly in middle-income countries such as Turkey and Bulgaria.
Aims
This study aims to examine the economic impact of untreated mental health disorders among ophthalmic patients, focusing on financial burden, healthcare access disparities and quality of life outcomes. In addition, the study compares barriers to mental healthcare across ophthalmic conditions and between Turkey and Bulgaria.
Method
A qualitative study was conducted using structured surveys and in-depth interviews with 214 ophthalmic patients (107 in Turkey, 107 in Bulgaria). Mental health symptoms were assessed using the Patient Health Questionnaire-9 (for depression) and Generalized Anxiety Disorder-7 (for anxiety) scales. Thematic analysis was applied to qualitative responses.
Results
Over 50% of participants exhibited moderate-to-severe depression and anxiety, with diabetic retinopathy and retinal disease patients experiencing the highest distress levels. Financial barriers were more pronounced in Bulgaria, whereas long psychiatric wait times disproportionately affected retinal patients. Mental health stigma was higher in Bulgaria, limiting care access.
Conclusions
Findings underscore the urgent need for integrating mental health services into ophthalmic care. Policy interventions should focus on financial support, stigma reduction and improved interdisciplinary care models to enhance mental health outcomes for visually impaired individuals.
According to what I call the Probabilistic View, absence of evidence is evidence of absence when finding evidence is highly expected. However, this view fails to make sense of the practice of using absence of evidence in the paleosciences, where finding evidence is typically not highly expected. Using a case from paleogeology, I offer a novel account of when absence of evidence should be evidence of absence, which I call the Pragmatic View: Appeals to absence of evidence as evidence of absence are warranted because they offer a scaffold to investigate auxiliary hypotheses related to the hypothesis in question.
This paper presents the design and analysis of the Triple band Circular Quarter Mode Substrate Integrated Waveguide (QMSIW) 1 × 2 MIMO antenna for sub-6 GHz 5 G wireless applications. The antenna operates at three distinct frequencies those are 3.57GHz, 4.41GHz and 5.43 GHz respectively. The 3.57 GHz used to operate for WiMAX, 5 G, and Fixed Wireless Access, the 4.41 GHz, is often used for specific satellite uplink/downlink operations, Radar Systems and the third one 5.43 GHz is used for Wi-Fi, DSRC, and WLAN systems. The proposed architectural design underwent simulation utilizing electromagnetic (EM) tools to the extract results, followed by antenna fabrication and measured results, it was observed that there is a close match between the simulation, measured results and validated results. The measured, simulation gain values are 5.092dBi,4.98dBi at 3.57 GHz, 4.51dBi,4.6dBi at 4.41 GHz and 3.075dBi,3.06dBi at 5.43 GHz frequency, while also demonstrating satisfactory isolation between the ports, quantified as being less than −15 dB. The characteristic parameters of the MIMO antenna, including a diversity-gain (DG) surpassing 9.95 dB (>9.95 dB), alongside an envelope-correlation-coefficient (ECC) of less than 0.0001, Mean effective gain (MEG) lies between − 3 dB to − 4 dB, among any two radiating elements at every operational frequency, indicate that the antenna has been meticulously designed.
We develop a weakly nonlinear theory to revisit the water hammer phenomenon resulting from slow valve manoeuvres. The hydraulic head at the valve is known to be nonlinearly coupled with the flow velocity via a relation derived from Bernoulli’s principle, so that solutions have been so far obtained only via numerical models. The governing equations and boundary conditions indeed yield a nonlinear boundary-value problem, which is here solved using a perturbation approach, Laplace transform and complex analysis. We obtain space- and time-dependent analytical solutions in all of the pipe and validate our results by comparison with standard numerical methods (i.e. Allievi’s method) for determining the exact behaviour of the hydraulic head at the valve. Additionally, we derive algebraic practically relevant closed form expressions for predicting the maximum and minimum hydraulic head values during both valve closure and opening manoeuvres.
An understanding of bird movement and habitat use in breeding and non-breeding areas is critical for the conservation of migratory birds. Latham’s Snipe Gallinago hardwickii breeds in Japan and Russia then migrates more than 6,000 km to its non-breeding sites in Australia. It is at risk because it favours areas under pressure from urban development. We investigated the movement patterns of Latham’s Snipe at a key non-breeding site – Jerrabomberra Wetlands, in Canberra, Australia. We tracked 32 Latham’s Snipe using GPS telemetry devices in the 2022/3 and 2023/4 seasons. The tracked birds remained at Jerrabomberra Wetlands for their non-breeding season and formed distinctive and predictable patterns of roosting and foraging. The distance range between roosting and foraging sites was similar across both the 2022/3 and 2023/4 seasons, with 75% of birds travelling less than 2.5 km and the majority of birds travelling <6 km. Approximately one third (31%) of birds travelled up to 30 km overnight before returning to the wetlands, and two birds (6%) travelled up to 140 km for up to three days. Home range sizes averaged 19 ha and did not significantly differ among individuals in either season. The relatively small size of the home ranges and short foraging trip distances suggest that conservation of non-breeding habitat in urbanised areas can be achieved through the protection of small areas, providing the habitat is suitable. However, individuals varied in their use of the broader landscape and therefore their susceptibility to threats may vary. From an urban planning perspective, habitat protection should prioritise roost sites while ensuring a diversity of foraging habitat within 6 km.
Modern monetary theory (MMT) argues that all governments that issue their own currency have the same fiscal and monetary policy space. This paper argues against this position. For MMT’s assumptions to be valid, MMT must abstract from the gravitational force of the US dollar that stems from it being backed by a mass of securities – an influence transmitted through international investment flows. Once the dollar’s gravitational force is recognised, it becomes clear that the huge size disparity separating the US financial market from those of other markets, and most notably those of the emerging market economies (EMEs), translates into an equally huge disparity regarding fiscal and monetary policy capacities. The strategic implications of recognising this disparity are that EME governments should, where possible, join their financial markets into regional blocs of sufficient size to give their regional currencies enough backing mass to allow them to resist the gravitational pull of the dollar. Only by pooling their currency sovereignty can EME governments retain some scope for pursuing macroeconomic policies independently of those pursued by the US government. Without doing so, if EME governments in countries with small financial markets follow MMT’s advice to retain their local currencies, this will condemn these currencies to entrapment in the dollar’s gravitational field and possibly outright dollar colonisation.
To co-design a systems approach aimed at promoting the wide-scale adoption of whole-school approaches to food in UK primary schools to improve school food environments, food provision and dietary intake in children.
Design:
A systems framework (Action Scales Model) was used to guide the co-design of the systems approach. The process involved identifying leverage points within the UK primary school food system that, if influenced, could alter the way in which the system functions. Actions were then agreed upon to influence those leverage points.
Setting:
Co-design workshops were held online between September 2021 and February 2022.
Participants:
Members of the co-design team comprised twelve school stakeholders (headteachers, school food improvement officers, catering leads, representatives of UK school food organisations and a dietician) and a team of researchers with expertise in school food, systems thinking and intervention development. Our partnership board included decision-makers and advocates of the whole-school approach to food in England and Northern Ireland.
Results:
Identified leverage points included the priorities of headteachers, who are instrumental in instigating whole-school approach to food adoption. Direction from local and national policymakers was also identified. Actions to influence these leverage points included providing direct support to schools (through an online resource) and encouraging policymakers to monitor the adoption of the approach.
Conclusion:
The methods described here can be replicated by others to promote the adoption of whole-school approaches to food in other contexts and contribute to the growing literature on developing systems-wide approaches to promote the adoption of public health initiatives.
Traditional diets are culturally accepted and adapted to local environments, but globalisation has shifted towards unhealthy, unsustainable eating habits. This study aims to assess the literature on the effects of traditional, place-based diets on health and sustainability and examines the suitability of common tools used to evaluate them.
Design:
A systematic search was conducted using the PRISMA 2020 guidelines across seven databases (CINAHL, Cochrane Library, MEDLINE, Scopus, Web of Science, PubMed and Google Scholar), and the protocol was registered with PROSPERO (CRD42023445750). The inclusion criteria were traditional place-based diets, studies examining the nutritional, health benefits and sustainability impacts of traditional food consumption, published in English, with no date restriction.
Results:
Eleven studies from Spain, Romania, Portugal, Mexico, Chile, Japan, Uganda and India met the criteria. Assessment tools included carbon footprints (via LCA), nitrogen footprints, NRF9.3, Nutri-Score and EAT-Lancet; some incorporated qualitative methods. Mediterranean, Atlantic and Japanese diets aligned well with health and sustainability, whereas meat-heavy or nutrient-deficient patterns raised concerns. Most studies relied on standardised tools and secondary datasets, with limited use of region-specific environmental data or qualitative insights. Only one intervention study was identified.
Conclusions:
Traditional diets show promise as culturally appropriate models for sustainable and healthy eating. Current tools designed around standardised, reductionist frameworks often fail to capture the complexity of traditional food systems, including local practices, preparation methods and cultural meaning. To better assess traditional diets, future research should develop regionally adapted indicators and integrate quantitative measures with qualitative insights from local communities.
Research on the effects of textually enhanced (TE) subtitles on vocabulary acquisition through audiovisual input has yielded mixed results, primarily focusing on short viewing interventions. This study investigates the impact of TE on vocabulary meaning recall among 22 international students with limited knowledge of L3 Dutch. Participants watched an entire season of a comedy TV series in L2 English, accompanied by L3 Dutch subtitles as it would be broadcast on television. Using a within-subjects design, we assessed learning outcomes for 16 enhanced target words, 16 unenhanced target words, and 16 filler words absent from the subtitles. Two eye-tracking sessions were employed to measure participants’ attention to both enhanced and unenhanced target words during the first and last episodes, addressing the limitations of previous studies that only included a single eye-tracking session and could not capture shifts in processing at pre- and posttest. The findings reveal that TE significantly increases fixations on enhanced words compared to unenhanced ones, with this difference remaining significant over the duration of the intervention, resulting in greater learning gains. Overall, the results highlight the potential of TE to facilitate vocabulary acquisition through subtitled audiovisual input.
The crucifer flea beetle, Phyllotreta cruciferae (Goeze), and the striped flea beetle, P. striolata (Fabricius) (Coleoptera: Chrysomelidae), are invasive pests to canola, Brassica napus (Linnaeus) (Brassicaceae), in North America. Understanding how temperature and predators influence flea beetle damage in canola is critical for improving current management strategies, yet these factors are rarely studied. We examined the prevalence (proportion of plants damaged), intensity (defoliation of damaged plants), and overall damage (mean defoliation = prevalence × intensity) caused by flea beetles on canola seedlings at different temperatures, plant densities, and with or without generalist predators. Flea beetles preferred to feed on the abaxial (undersides) of cotyledons rather than the typically assessed adaxial (top) side, regardless of temperature, and produced more stem and cotyledon damage at higher temperatures, regardless of the species. Predators Pardosa spp. (Araneae: Lycosidae) and Pterostichus melanarius (Illiger) (Coleoptera: Carabidae) reduced flea beetle abundance and the intensity of cotyledon defoliation. Pterostichus melanarius also reduced overall stem damage, whereas Pardosa spp. reduced stem damage intensity. Under constant flea beetle densities, canola sustained less damage at a higher plant density. These results suggest that reducing the number of flea beetles per seedling, through predation or higher plant density, may help reduce Phyllotreta damage to canola.
This study quantitatively investigates the two-dimensional pseudosteady shock refraction at an inclined air–water interface, referred to as the water wedge, in the weak and strong incident shock strength groups. Numerical simulations are employed to validate the predicted refraction sequences from a previous study (Anbu Serene Raj et al. 2024 J. Fluid Mech.998, A49). A distinctive irregular refraction pattern, referred to as the bound precursor refraction with a Mach reflection, is numerically validated in the weak shock group. Based on the numerical simulations, an enhanced formulation is proposed to determine the sonic line of the incident flow Mach number ($M_b$) in water, thereby providing an appropriate transition condition for an irregular refraction with a Mach reflection to a free precursor refraction with a Mach reflection transition. Furthermore, comparative studies on solid and water wedges of wedge angle $20^\circ$ reveal discernible differences in the shock reflection patterns. The interplay of the energy dissipation due to the transmitted shock wave and the Richtmyer–Meshkov instability at the air–water interface results in the variation of the triple-point trajectory and transition angles between single Mach reflection (SMR) to transitional Mach reflection (TMR) occurring in air.
Time series of counts often display complex dynamic and distributional characteristics. For this reason, we develop a flexible framework combining the integer-valued autoregressive (INAR) model with a latent Markov structure, leading to the hidden Markov model-INAR (HMM-INAR). First, we illustrate conditions for the existence of an ergodic and stationary solution and derive closed-form expressions for the autocorrelation function and its components. Second, we show consistency and asymptotic normality of the conditional maximum likelihood estimator. Third, we derive an efficient expectation–maximization algorithm with steps available in closed form which allows for fast computation of the estimator. Fourth, we provide an empirical illustration and estimate the HMM-INAR on the number of trades of the Standard & Poor’s Depositary Receipts S&P 500 Exchange-Traded Fund Trust. The combination of the latent HMM structure with a simple INAR$(1)$ formulation not only provides better fit compared to alternative specifications for count data, but it also preserves the economic interpretation of the results.
This study presents an innovative system for upper limb rehabilitation, combining a variable stiffness device, the ReHArm prototype, with a dynamic and engaging user interface, known as Arms Rehabilitation Management System. The proposed system offers a highly customisable approach to rehabilitation, ensuring real-time adaptability to patients’ specific needs while maintaining compactness and ease of use. Key features include a modular design allowing precise stiffness adjustments, a robust control architecture, and interactive rehabilitation phases designed to enhance user engagement. Extensive multidisciplinary analyses, including kinematic, dynamic, and structural evaluations, demonstrate the system’s ability to improve therapy effectiveness through tailored interaction and feedback. Validation tests demonstrated the prototype’s reliability and robustness, and initial usability assessments suggest its potential to improve rehabilitation outcomes. Further clinical studies involving patients will be necessary to fully evaluate its therapeutic effectiveness.
The spatio-temporal evolution of very large-scale coherent structures, also known as superstructures, is investigated in both smooth- and rough-wall boundary layers by means of direct numerical simulations up to a frictional Reynolds number of ${\textit{Re}}_\tau = 3\,150$. One smooth-wall and four rough-wall cases are considered, all developing over a region as long as $\sim$60 times the incoming boundary-layer thickness in the streamwise direction. Bio-inspired, biofouling-type topographies are employed for the rough-wall cases, following the previous work of Womack et al. (2022 J. Fluid Mech. vol. 933, p. A38) and Kaminaris et al. (2023 J. Fluid Mech. vol. 961, p. A23). We utilise three-dimensional time series, as well as multiple two-point correlation functions along the boundary layer to capture the detailed length- and time-scale evolution of the superstructures. The results suggest that the presence of roughness significantly amplifies both the strength and the streamwise growth rate of superstructures. Interestingly, however, their ratios relative to the local boundary-layer thickness, $\mathscr{L}_{\!x}/\delta$ and $\mathscr{L}_z/\delta$, remain constant and independent of the streamwise coordinate, indicating that such scaled length scales might constitute a possible flow invariant. Volumetric correlations revealed that all cases induce structures inclined with respect to the mean-flow direction, with those over the rough-wall topographies exhibiting steeper inclination angles. Finally, via proper orthogonal decomposition, pairs of counter-rotating roll modes were detected and found to flank the high- and low-speed superstructures, supporting the conjecture in the literature regarding the mechanisms responsible for the lateral momentum redistribution. The latter also suggests that the way momentum organises itself in high Reynolds number wall-bounded flows might be independent of the roughness terrain underneath.
Obesity is characterised by chronic low-grade inflammation, which is a key factor in the development of obesity-related co-morbidities. Intake of n-3 long-chain PUFAs is associated with anti-inflammatory effects. Recent studies suggest that also n-11 long-chain MUFAs may reduce the concentrations of inflammatory markers, possibly by increasing the biosynthesis of EPA. The primary aim was to investigate if diets added herring oil containing cetoleic acid (CA, C22:1n-11) or a CA concentrate (CECO) affected the fatty acid composition in tissues from obese rats with chronic inflammation. Secondary aims included investigating the effects on inflammatory markers. Thirty male obese Zucker fa/fa rats were fed diets containing herring oil (HERO) or a CECO, containing 0·70 or 1·40 wt% CA, respectively, with a comparable content of EPA (0·17 and 0·20 wt%, respectively), or a control diet with soyabean oil for 5 weeks. Data were analysed using one-way ANOVA. CA from HERO and CECO diets were recovered in liver, adipose tissue, muscle and blood cells. The EPA concentration was similar between HERO and CECO groups in tissues, whereas the hepatic concentrations of fatty acid desaturases were lower or similar to Controls. The concentrations of TNFα, matrix metalloproteinase-3, IL6, monocyte chemotactic protein 1 and integrin α M in adipose tissue, and the hepatic concentration of CD68 were lower after CECO intake but were not affected by the HERO diet. To conclude, rats fed the CECO diet had lower concentrations of inflammatory and macrophage infiltration markers, but this effect was probably not mediated through increased EPA biosynthesis.
There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors; however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster-randomised Mediterranean diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Programme costs ($AUD2024) covered staff to deliver the MedWalk programme and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained or improved) was determined using a cross-tabulation test. MedWalk programme costs were estimated at $2695 AUD per participant and control group cost at $165 per person – a differential cost of $2530. Mean change in utility scores from baseline to 12 months was not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20·3 % MedWalk v. 42·6 % control group) (P = 0·020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians; however, longer-term follow-up would be beneficial to see if this is maintained.
The study was conducted to determine the relationship between spirituality and the quality of life among women with breast cancer.
Methods
This study utilized descriptive correlational research and a purposive sampling technique that involved women with breast cancer. Patients with breast cancer from particular breast cancer societies and organizations in Manila made up the sample. A total of 123 participants were included in the study. The Spiritual Index of Well-Being (SIWB) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire were used to collect the needed data. Descriptive and inferential statistics were used to determine the relationship between spirituality and quality of life among women with breast cancer.
Results
A high level of spirituality and quality of life were found among the participants. Overall, the mean score of the SIWB among the participants was 4.48 (±0.670), while the quality of life score was 62.6 (±10.9). A significant negative correlation was found between spirituality and quality of life (r = -0.127, p = 0.031), while significant positive correlations were noted between quality of life and self-efficacy (r = 0.683, p < 0.001) and life schemes or meaning in life (r = 0.704, p < 0.001).
Significance of results
Although spirituality and quality of life had a negative correlation, the subscales of self-efficacy and life scheme had high positive correlations, indicating the complex dimensions of spirituality. In addition to providing coping strategies, spirituality offers patients the emotional, social, and existential support they need to deal with the unknowns of illness.
As part of healthcare-associated infections prevalence survey, we examined the prevalence of antibiotic allergies among inpatients and the possibility to de-label reported penicillin and sulfa allergies. Results show that most of the patients with a penicillin or sulfa allergy label are eligible for either direct de-labeling or oral antibiotic challenge.
In this paper we study the class of optimal entropy-transport problems introduced by Liero, Mielke and Savaré in Inventiones Mathematicae 211 in 2018. This class of unbalanced transport metrics allows for transport between measures of different total mass, unlike classical optimal transport where both measures must have the same total mass. In particular, we develop the theory for the important subclass of semi-discrete unbalanced transport problems, where one of the measures is diffuse (absolutely continuous with respect to the Lebesgue measure) and the other is discrete (a sum of Dirac masses). We characterize the optimal solutions and show they can be written in terms of generalized Laguerre diagrams. We use this to develop an efficient method for solving the semi-discrete unbalanced transport problem numerically. As an application, we study the unbalanced quantization problem, where one looks for the best approximation of a diffuse measure by a discrete measure with respect to an unbalanced transport metric. We prove a type of crystallization result in two dimensions – optimality of a locally triangular lattice with spatially varying density – and compute the asymptotic quantization error as the number of Dirac masses tends to infinity.