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The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. This survey assessed which criteria in the EGPRN concept of multimorbidity could detect decompensating patients in residential care within a primary care cohort at a six-month follow-up.
Method:
Family physicians included all multimorbid patients encountered in their residential care homes from July to December 2014. Inclusion criteria were those of the EGPRN definition of multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Decompensation was defined as the occurrence of death or hospitalization for more than seven days. Statistical analysis was undertaken with uni- and multi-variate analysis at a six-month follow-up using a combination of approaches including both automatic classification and expert decision. A multiple correspondence analysis and a hierarchical clustering on principal components confirmed the consistency of the results. Finally, a logistic regression was performed to identify and quantify risk factors for decompensation.
Findings: About 12 family physicians participated in the study. In the study, 64 patients were analyzed. On analyzing the characteristics of the participants, two statistically significant variables between the two groups (decompensation and Nothing To Report): pain (p = 0.004) and the use of psychotropic drugs (p = 0.019) were highlighted. The final model of the logistic regression showed pain as the main decompensation risk factor.
Conclusion:
Action should be taken by the health teams and their physicians to prevent decompensation in patients in residential care who are experiencing pain.
The work presented here revisits the Velikhov-ionisation instability, an instability first discovered in the early 1960s (Velikhov, E. P. 1962 1st International Conference on MHD Electrical Power Generation, Newcastle upon Tyne, England, p. 135). This mode strongly deteriorates the performance of magnetohydrodynamic (MHD) energy convertors in which the seed gas must be at a substantially higher temperature than the high density primary gas, the latter gas carrying almost all the energy. Specifically, a finite temperature difference is necessary for the MHD generator to successfully act as a topping cycle for nuclear (fission and fusion) power plants. The ionisation instability has thus been viewed for many years as a show stopper for MHD nuclear topping cycles. Even so, some experimental observations, never fully exploited, show that nearly full ionisation of the seed gas can stabilise this dangerous instability. One goal of the research presented here is to provide a first-principles theoretical explanation for these experimental observations. The stabilisation can theoretically produce high temperature ratios, of the order of 10, by carefully choosing the density of the unionised seed gas. A second goal of the research is to investigate whether or not the recent development of high-field, high-temperature REBCO (rare-earth barium copper oxide) superconductors can lead to substantially improved power plant efficiency. Here, it is shown that the answer is subtle – no clear conclusions can be drawn, a consequence of the fact that the new stability criterion is a local one. What is needed to assess overall plant efficiency is a global analysis. Additional work has recently been completed on a newly developed global model which answers this question and will be reported on in a future paper.
The use of artificial intelligence (AI) in psychiatry holds promise for diagnosis, therapy, and the categorization of mental disorders. At the same time, it raises significant theoretical and ethical concerns. The debate appears polarized, with proponents and critics seemingly irreconcilably opposed. On the one hand, AI is heralded as a transformative force poised to revolutionize psychiatric research and practice. On the other hand, it is depicted as a harbinger of dehumanization. To better understand this dichotomy, it is essential to identify and critically examine the underlying arguments. To what extent does the use of AI challenge the theoretical assumptions of psychiatric diagnostics? What implications does it have for patient care, and how does it influence the professional self-concept of psychiatrists?
Methods
To explore these questions, we conducted 15 semi-structured interviews with experts from psychiatry, computer science, and philosophy. The findings were analyzed using a structuring qualitative content analysis.
Results
The analysis focuses on the significance of AI for psychiatric diagnosis and care, as well as on its implications for the identity of psychiatry. We identified different lines of argument suggesting that expert views on AI in psychiatry hinge on the types of data considered relevant and on whether core human capacities in diagnosis and treatment are viewed as replicable by AI.
Conclusions
The results provide a mapping of diverse perspectives, offering a basis for more detailed analysis of theoretical and ethical issues of AI in psychiatry, as well as for the adaptation of psychiatric education.
Modern supply chains are vital to global commerce, but they are also major contributors to greenhouse gas (GHG) emissions. As climate change intensifies, achieving carbon neutrality – particularly through supply chain decarbonisation – has become a global imperative. While organisations have made strides in reducing direct emissions, addressing indirect supply chain emissions presents greater complexity and urgency. We invite academic contributions that examine the challenges, enablers, potential risks, strategic approaches and innovative practices related to decarbonisation across a wide range of sectors, including manufacturing, service industries and humanitarian logistics. Emphasis is placed on holistic, multi-stakeholder approaches aligned with the GHG Protocol. The issue welcomes interdisciplinary research employing varied methodologies – ranging from empirical studies to conceptual frameworks – to inform practice, policy and sustainability transitions. By showcasing sector-specific insights and cross-cutting solutions, this issue aims to advance knowledge and action in building low-carbon, resilient supply chains.
Although the social democrats fundamentally opposed the political order of the German Empire, they participated in parliament from the beginning. The party not only sat on the parliamentary benches, but its representatives also proved to be committed parliamentarians. Using a combination of parliamentary, party, and movement sources, this article shows that social democrats’ parliamentary participation followed two lines of reasoning. First, the party admitted that parliamentary participation served publicity purposes. In fact, social democrats took the Reichstag stage to present their political project to the masses. Second, the party was less willing to admit that parliament fitted perfectly into the associational tradition of working-class culture. Orderly and fair debate had been the norm of social democratic activism long before the party was founded. It is precisely this last aspect that provides an important and previously overlooked explanation for the social democrats’ surprising devotion to a political system they so deeply detested.
Humanitarian aid work is an incredibly rewarding experience, but its workers are exposed to specific risks. During the last decades, the Humanitarian Aid Workers are increasingly at risk without being necessarily prepared for work in insecure environments. Moreover, in many instances, despite having been briefed, they had not followed preventive measures for their health and safety.
From an employer’s perspective, International Organizations have a direct duty of care obligations for their workers in matters of safety, security, and well-being. Thus, the employers are required to implement a preventive approach mainly focused on a better risk communication and an integrated occupational health and safety management system.
This review article points to a number of ways in which the study of political participation has followed separate tracks, hence preventing it from deploying its full potential. We argue that the field stands to benefit much from ‘bridging’ different approaches and insights, combining those from different disciplines or subdisciplines. We review works that try to build such bridges, with the aim of encouraging dialogue across the disciplinary boundaries between political science and political sociology, on the one hand, and sociology and social movement studies, on the other. We advocate that students of political participation take such ‘bridges’ seriously in their work and employ them as the basis for new dynamic theorization. We suggest five possible ways in which the study of political participation may combine different perspectives and research traditions. Three of them are theoretical: bridging rationalist, structuralist and culturalist theoretical approaches; bringing together cognitive (attitudes) and affective (emotions) explanations; and combining macro- and micro-level accounts. The fourth is methodological: bridging qualitative and quantitative methodological approaches. The fifth is substantive: bridging a focus on electoral (institutional) participation with one on non-electoral (non-institutional) participation.
The effects of abomasal infusion of corn starch and β-hydroxybutyrate (BHB) on hindgut microbial fermentation characteristics and end-products in early lactation dairy cows were determined via in vitro gas production (GP). Four substrates, either fibre or starch sources differing in expected rate of degradability (slow – cellulose and corn grain; rapid – beet pulp and pregelatinized corn flour), were incubated with faecal inoculum from cows abomasally infused with water only, 1.5 kg corn starch/d + 0.0 mol BHB/d, 3.0 kg corn starch/d + 0.0 mol BHB/d, 0.0 kg corn starch/d + 8.0 mol BHB/d, 1.5 kg corn starch/d + 8.0 mol BHB/d, or 3.0 kg corn starch/d + 8.0 mol BHB/d in a 6 × 6 Latin square design. In vitro GP was measured using an automated GP system with methane (CH4) measured at specific times. After 72 h, volatile fatty acids (VFA), pH, ammonia, and in vitro organic matter digestibility (IVOMD) of incubation fluid were determined. Infusion of BHB had limited effect on hindgut microbial fermentation. Infusion of 3.0 kg corn starch/d increased GP at 3 h of incubation for all substrates but resulted in lower total GP, CH4 production, pH, ammonia concentration, and IVOMD after 72 h, while increasing total VFA concentration and molar proportions of propionate and butyrate vs. 0.0 and 1.5 kg corn starch/d infusions. Among substrates, IVOMD of cellulose was most affected by 3.0 kg corn starch/d infusion. Results suggest that in vitro fermentative activity of hindgut microbes decreases when higher levels of starch enter the hindgut.
In the presence of a default option, the optimal search rule for an agent with a reference-dependent utility and a search cost predicts: (i) the default increases the reservation utility due to the reference effect, leading to a better choice, and (ii) those with higher reservation utility will self-select into search and are more likely to find a superior option. Our experiments document the presence of both effects. Those who reject the default are likely to find higher-ranked options in their active search, supporting the self-selection effect. Even when the self-selection channel is shut down, the reference effect remains.
Recent discussions among historians, jurists, and political scientists have increasingly centred on the effectiveness of the Laws of Armed Conflict in safeguarding legally protected groups such as civilians and prisoners of war. Central to this debate is the question of how a state’s public commitment to international law aligns with the actual conduct of its armed forces in combat zones. This article contributes to the discourse by examining the Boxer War in China (1900–1901), during which seven Western powers and Japan opposed an anti-foreign Chinese sect supported by military forces loyal to the Qing court. The analysis focuses on the legal stance of five key members of the anti-Boxer coalition—Germany, the United States, Great Britain, Russia, and Japan—and evaluates the conduct of their troops towards Chinese civilians and prisoners. Particular attention is given to Japan, offering insights into how the application of the international laws of war is shaped not only by the expectations of belligerents and their adversaries, as prominent scholars have suggested, but also by the dynamics among allies, including competition, as well as by each belligerent’s unique history and cultural context. This nuanced perspective highlights the interplay of legal commitments, alliance politics, and national identity in determining the behaviour of military forces during wartime.
In this paper I discuss the fundamental reorganisation of Swedish scientific publication in the 1960s and 1970s in terms of ‘internationalisation’ and, in particular, the elimination of periodicals, which was deemed necessary to achieve visibility in a crowded international landscape of publication. In this context, publication language was not so much a matter of choice on the part of individual scientists as a result of explicit policies implemented by government agencies. Investigating the shift towards English as a dominant publication language in Swedish science requires focusing on research councils and policymakers as crucial actors in this process. I discuss the history of the languages of science in the context of the history of scientific publication and the history of information management, specifically in the context of the ‘information explosion’ of the 1960s.
Despite the recognized importance of older adults ageing in their own homes, the role of public financing in mitigating unmet and under-met home care needs remains under-explored. This study addresses this gap by examining the impact of public financing on home care adequacy among English adults aged over 50, utilizing data from waves 6–9 (2013–2019) of the English Longitudinal Study of Ageing. Longitudinal fixed effects and pooled cross-sectional modelling are used to explore the impact of public financing of home care on the unmet and under-met needs of older people. Findings show that individuals with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), as well as those experiencing cognitive decline, are more likely to receive home care. Importantly, while receipt of publicly financed care is associated with a reduction in unmet needs, it does not necessarily translate to fully met needs, resulting in under-met need and highlighting a crucial distinction between access to and adequacy of care. Comparatively, transitioning from use of publicly financed home care to exclusively informal care is linked with lower odds of reporting under-met needs, suggesting variance in the quality of care provided across funding types. This study not only enriches the existing literature by describing the specific impact of different home care financing mechanisms (publicly financed care versus other types of care) on the unmet and under-met needs of older adults but also underscores the need for policies that ensure care adequacy, not just accessibility.
This article develops the problem of divine domination. Classical theism describes God as essentially all-powerful, sovereign, personal, omnipresent, and a se. If such a being exists, then he dominates humans in virtue of his essential properties. Since dominative relationships are unjust, the divine-human relationship is unjust. I reject solutions to this problem that appeal to humanity’s childlikeness or divine goodness, justice, or greatness. I conclude by gesturing towards what a solution to the problem might require.
Selenodantopaite is a new mineral species discovered in a sample collected from the mine dumps of the abandoned Princ Evžen deposit near Potůčky, the Krušné hory Mts., Czech Republic. Selenodantopaite occurs as anhedral grains, up to 100 μm in size, in a quartz gangue with abundant coffinitized uraninite, chalcopyrite and pyrite; it is also associated with bohdanowiczite, unnamed selenide (Bi,Ag)3(Se,S,Te)4, minerals of the galena–clausthalite solid solution, sphalerite and tennantite-(Fe). Selenodantopaite is dark grey, with metallic lustre. Mohs hardness is ca. ∼3½, calculated density is 7.403 g.cm–3. In reflected light, selenodantopaite is white to light grey; bireflectance and pleochroism are weak, anisotropy is distinct with light bluish white – light purplish brown rotation tints. Internal reflections were not observed. Reflectance values for the four COM wavelengths of selenodantopaite in air [Rmax, Rmin (%) (λ in nm)] are: 48.3, 44.9 (470); 48.8, 45.3 (546); 48.4, 45.1 (589); and 47.7, 44.6 (650). The empirical formulae, based on electron-microprobe analyses, are Cu0.24(4)Ag5.09(7)Fe0.17(5)Pb0.51(4)Bi12.32(21)Se15.11(21)S6.89(21) and Cu0.05(3)Ag5.23(11)Fe0.06(4)Pb0.62(12)Bi12.38(13)Se14.77(16)S7.23(16) for Cu-bearing and Cu-poor variety, respectively. The ideal formula is Ag5Bi13Se22 (Z = 1), which requires (in wt.%) Ag 10.80, Bi 54.41, and Se 34.79, total 100.00. Selenodantopaite is monoclinic, C2/m, with unit-cell parameters a = 13.670(4), b = 4.1400(11), c = 19.282(6) Å, β = 106.385(11)° and V = 1046.9(5) Å3. According to the single-crystal X-ray diffraction data (R1 = 0.0625), the crystal structure of selenodantopaite is isotypic with that of dantopaite and it is composed by two kinds of slabs, parallel to (001), i.e. a PbS-like thick slab and a thin slab, following the classical structural scheme of pavonite homologues. Selenodantopaite is named in accord with its composition and its relationship with dantopaite. The mineral and its name have been approved by the Commission on New Minerals, Nomenclature and Classification of the International Mineralogical Association (2023-092)
The perinatal period has gained increasing attention from developmental psychopathologists; however, experiences during birth have been minimally examined using this framework. The current study aimed to evaluate longitudinal associations between childhood maltreatment, negative birth experiences, and postpartum mental health across levels of self-reported emotion dysregulation and respiratory sinus arrhythmia (RSA). Expectant mothers (N = 223) participated in a longitudinal study from the third trimester of pregnancy to 7 months postpartum. Participants contributed prenatal resting RSA and completed questionnaires prenatally, 24 hours after birth, and 7 months postpartum. Results indicated that more childhood maltreatment was associated with higher birth fear and postpartum anxiety and depressive symptoms. Resting RSA moderated the association between childhood maltreatment and birth fear, such that more childhood maltreatment and higher resting RSA were associated with increased birth fear. Additionally, self-reported prenatal emotion dysregulation moderated the association between childhood maltreatment and postpartum depressive symptoms, such that more childhood maltreatment and higher emotion dysregulation were associated with increased depressive symptoms. Emotion dysregulation across multiple levels may amplify vulnerability to negative birth experiences and postpartum psychopathology among individuals with childhood maltreatment histories. Thus, emotion dysregulation in the context of trauma-informed care may be worthwhile intervention targets during the perinatal period.
This article connects infrastructural violence to environmental injustice in the South Durban Basin, the industrial hub of the Durban metropolis in South Africa, where escalating ecological difficulties have negatively impacted living standards. The combination of the racially insensitive apartheid regime in South Africa and the harmful effects of toxicity requires a decolonial repair perspective founded on egalitarian dialogue and the inclusion of affected viewpoints and participation. In advocating for this repair framework, this article calls for horizontal discussions that thoroughly examine these issues, which can subsequently facilitate equitable environmental policies, regulations, and laws.
This article argues that, as they are currently designed, UN climate talks fail to address the environmental catastrophe they aim to address. While dialogue is the primary means through which the world’s population can get together, discuss the scope and nature of the problem, and put appropriate measures into action, these talks are, year after year, employed as a way to create the illusion that democratic decision-making occurs. As a result, these kinds of events can only succeed in entrenching positions, exacerbating the impasse at which we currently find ourselves. This, in turn, solidifies the notion that we indeed need to engage in a dialogue about climate change, thus perpetuating a never-ending cycle that protects, under the veneer of planetary engagement, the continuation of capitalist business as usual. The article, therefore, proposes that a dialogic path to finding a solution to the climate catastrophe can only be successful if climate talks are rethought, placing at the helm voices from the most affected populations in the Global South. Otherwise, these talks will continue to fail in making a significant change that ensures the possibility of an environmentally just and viable future for the planet.
The Alpha, Delta, and Omicron variants of the SARS-CoV-2 virus have been deemed as variants of concern (VOCs) by the WHO due to their increased transmissibility, severity of illness, and resilience against treatments. Geographically tracking the spread of these variants can help us implement effective control measures. RNA from 8,154 SARS-CoV-2 positive nasal swab samples from a Central Texas hospital collected between March 2020 and April 2023 were sequenced in Temple, TX. Global and U.S. sequencing metadata was obtained from the GISAID database on 3 April 2023. Using sequencing metadata, the growth rate of Alpha, Delta, and the first subvariant of Omicron (BA.1) were obtained as 0.27, 0.3, and 1.08 each. The average time in days to penetrate the US for Alpha, Delta, and Omicron were 269.2, 326.2, and 27.3 days, respectively. Viral sequencing data can be a useful tool to examine the spread of viruses. Each emerging SARS-CoV-2 variant penetrated cities more rapidly as the pandemic progressed. With a high logarithmic growth rate, the Omicron variant penetrated the US more rapidly as the pandemic progressed.
We use a graph to define a new stability condition for algebraic moduli spaces of rational curves. We characterise when the tropical compactification of the moduli space agrees with the theory of geometric tropicalisation. The characterisation statement occurs only when the graph is complete multipartite.
The article highlights the role of partisan ethnography in studying the chains of co-optation of grassroots environmental activism in ecologically and politically sensitive contexts. In Thailand, such chains are often undergoing the process of institutionalization of eco-Buddhist approaches to nature conservation, also concurring with the detachment of grassroots socio-environmental activism from the recent, urban based pro-democracy uprisings. The discussion will focus on the recent history of the eco-politics related to natural resources conservation in the Nan River Basin (Northern Thailand). It will describe how, since the 1980s, eco-Buddhist NGOs, Royal think tanks, international cooperation organizations, and corporate C.S.E.R. programs, which comply with the latter agencies, have systematically tended to manipulate pioneer, grassroots eco-political imagination and the organisational know-how of local environmental activists. These powerful institutional actors demonstrated interest in the Buddhist moralization of local ecological beliefs and praxis as a strategy to afford privileges of access to land, water, and forest resources through forms of internal “green grabbing”. At stake here is the fact that, beyond the grabbing of Thai river basins’ contested landscapes, activists’ radical imaginations and alter-political practices – an intangible component of such landscapes - are subject to a form of intellectual and political grabbing. The anthropological enterprise and the ethnographic encounter, conceived as partisan collaboration, nevertheless show that forms of patient resistance to such structural dynamics of co-optation might also express an unexpected source for the creative rearticulation of dissent and alter-political imaginations.