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The objective of this paper is to devise a set of principles and practices that can break with the temporalities of current pharmaceutical markets, and on this basis sketch a social contract for a new (temporal) political economy of pharmaceuticals. Pharmaceutical futures are, in my analysis, doubly predetermined by standard arguments around pharmaceutical patenting and pricing: they are narrated as a consequence of “past” investments to be recouped, but they are also predetermined on a particular “future perfect,” where past investment successes and promises to maintain the status quo determine the course of action of future investors. This double colonization of the future, in my analysis, eliminates any scope for meaningful change. Making this often implicit temporality of pharmaceutical markets explicit may allow to better take into account multiple temporalities in regulating this space. Chiefly among them are patients’ temporalities, which typically get overridden by the peculiar timelines of patent-based markets. The mRNA vaccine market serves as an illustration of the theoretical arguments raised, and I discuss four strategies that could lead toward a new temporal political economy of pharmaceutical markets: temporally sensitive policymaking; decolonizing the future through narrower patents; delinking patents from their asset condition; and pharmaceutical commons.
The aim of this article is to develop and pilot test a new supportive care intervention, Empower GBM, designed for patients with glioblastoma and their family caregivers to reduce psychological distress and improve quality of life.
Methods
Qualitative interviews were conducted with patients diagnosed with glioblastoma and their caregivers to obtain information about their experiences and needs in coping with glioblastoma. We also gathered their feedback about the supportive care intervention we were proposing (Phase I). Following Phase I, we conducted a single-arm pilot to evaluate the feasibility and acceptability of the 6-session intervention (Phase II).
Results
During interviews (N = 14), patients and caregivers reported having the most difficulty and distress surrounding disease progression and management, maintaining dignity and autonomy, negotiation of roles and responsibilities, and maintaining connection with one another. Participants endorsed that an intervention like Empower GBM with skills focused on managing symptoms to increase independence, increasing caregiving efficacy and support, and coping with dyadic challenges would be of potential benefit. Preliminary results from the pilot study (N = 11) suggested the intervention is both feasible (e.g., 82% completed all 6 sessions and post-treatment surveys) and acceptable (88.9% reported a mean satisfaction score of 3 or higher; mean score of 3.57/4.0). Improvements in psychological outcomes, functional well-being, and caregiving efficacy from pre- to post-treatment survey results suggested the potential benefits of the intervention.
Significance of results
We developed a novel supportive care intervention informed by the dyadic illness model that is designed to meet the individual and interpersonal needs of patients with glioblastoma and their caregivers. Unique features include its flexibility to be delivered to patients and/or their family caregivers individually or jointly, while providing skills and strategies to meet the needs of both individuals and the dyad as the unit of care in coping with glioblastoma.
Submarine glacier melt rates of the Greenland Ice Sheet remain a major uncertainty in climate model projections of future sea level rise. Development of submarine melt parameterizations has to a high degree relied on ocean circulation modelling of glacial fjords, designed to quantify effects such as ocean thermal forcing and fjord–glacier geometry. Greenlandic fjords are relatively narrow, and it is frequently assumed that across-fjord flow variations are small enough to allow marine melt to be quantified with two-dimensional ocean-circulation models. Here, we present three-dimensional model simulations showing that the interplay between fjord–glacier geometry, side wall friction, and Earth’s rotation makes the circulation in ice-shelf cavities three-dimensional even in narrow fjords. Remarkably, we find that Earth’s rotation changes the flow pattern in the cavity below the ice shelf, leading to a decrease in the marine melt on a 10 km wide ice shelf by a factor of five compared to a non-rotating simulation. Our study prompts using three-dimensional model configurations of Greenlandic fjords.
Monitoring wildlife populations in vast, remote landscapes poses significant challenges for conservation and management, particularly when studying elusive species that range across inaccessible terrain. Traditional survey methods often prove impractical or insufficient in such environments, necessitating innovative technological solutions. This study evaluates the effectiveness of deep learning for automated Bactrian camel detection in drone imagery across the complex desert terrain of the Gobi Desert of Mongolia. Using YOLOv8 and a dataset of 1479 high-resolution drone-captured images of Bactrian camels, we developed and validated an automated detection system. Our model demonstrated strong detection performance with high precision and recall values across different environmental conditions. Scale-aware analysis revealed distinct performance patterns between medium- and small-scale detections, informing optimal drone flight parameters. The system maintained consistent processing efficiency across various batch sizes while preserving detection quality. These findings advance conservation monitoring capabilities for Bactrian camels and other wildlife in remote ecosystems, providing wildlife managers with an efficient tool to track population dynamics and inform conservation strategies in expansive, difficult-to-access habitats.
This research aimed to explore the perspectives of primary and community care providers on the challenges that hinder the delivery and uptake of personalized type 2 diabetes (T2D) care, with a focus on the integration of mental health support and care.
Background:
The day-to-day burden and demand of self-managing T2D can negatively impact quality of life and take a toll on mental health and psychological well-being. As a result, there is a need for personalized T2D self-management education and support that integrates mental health care. Despite the need for this personalized care, existing systems remain siloed, hindering access and uptake. In response, innovative, comprehensive, and collaborative models of care have been developed to address fragmentations in care. As individuals living with T2D often receive their care in primary care settings, linking mental health care to existing teams and networks in primary care settings is required. However, there is a need to understand how best to support access, adoption, and engagement with these models in these unique contexts.
Methods:
A cross-sectional survey was distributed to primary and community providers of an Ontario-based smoking cessation network. Survey data were analyzed descriptively with free text responses thematically reported.
Findings:
Survey respondents (n = 85) represented a broad mix of health professions across primary and community care settings. Addressing challenges to the delivery and uptake of personalized T2D care requires comprehensive strategies to address patient-, practice-, and system-level challenges. Findings from this survey identify the need to tailor these models of care to individual needs, clearly addressing mental health needs, and building strong partnership as means of enhancing accessibility and sustainability of integrated care delivery in primary care settings.
Sugar beet root damage at harvest promotes sucrose losses of circa 0.1 – 0.4 % day–1 in storage. However, root response to environmental stresses at harvest and their consequential rates of damage are not known. We investigated the effects of temperature and water stress at harvest on root resilience to damage and tissue strength. Water (irrigated to field capacity and non-irrigated) and temperature (cold and mild) treatments were imposed on physiologically mature sugar beet plants for seven weeks prior to and for three days after harvesting, respectively. Water status at harvest significantly affected relative water content (RWC) (p < 0.001), root weight (p < 0.001) and root width (p < 0.001). RWC was positively correlated to surface damage (R2 = 0.43, p = 0.02), root tip damage (R2 = 0.42, p = 0.03), tissue compression (R2 = 0.41, p = 0.05) and tissue puncture (R2 = 0.46, p = 0.01). Tissue damage was not affected by root tissue temperature of 4 °C compared to 12 °C. We conclude that sugar beet damage at harvest is not influenced by root temperatures over the range commonly observed in the UK and temperate production areas. However, higher water status at harvest, such as would be observed in a wet season, increases root tip and surface damage. These findings will help to inform optimum harvesting conditions to minimize sugar loss from the sugar beet crop.
Zoroastrianism is a religion with a long history, but it has been comparatively neglected by contemporary philosophers. This Element aims to bring aspects of its long intellectual history into conversation with contemporary Anglo-American philosophy. Section 1 provides an introduction to Zoroastrianism and its history, some of the important texts, and some contemporary philosophy engaged with Zoroastrian themes. Section 2 discusses distinctive contributions Zoroastrian thought can make to the problems of evil and suffering. And Section 3 discusses a 'quasi-universalist' approach to puzzles about heaven and salvation, inspired by Zoroastrian theological texts. This title is also available as Open Access on Cambridge Core.
We prove two compactness theorems for HOD. First, if $\kappa $ is a strong limit singular cardinal with uncountable cofinality and for stationarily many $\delta <\kappa $, $(\delta ^+)^{\mathrm {HOD}}=\delta ^+$, then $(\kappa ^+)^{\mathrm {HOD}}=\kappa ^+$. Second, if $\kappa $ is a singular cardinal with uncountable cofinality and stationarily many $\delta <\kappa $ are singular in $\operatorname {\mathrm {HOD}}$, then $\kappa $ is singular in $\operatorname {\mathrm {HOD}}$. We also discuss the optimality of these results and show that the first theorem does not extend from $\operatorname {\mathrm {HOD}}$ to other $\omega $-club amenable inner models.
This chapter focuses on systemic factors in healthcare systems and how these can promote qualities such as mindfulness, awareness, resilience, and compassion. Too often, health systems do not promote these values at the organisational level despite the best efforts of individual healthcare workers. With attention and awareness, however, this can be remedied. This chapter examines the themes of compassionate leadership in healthcare organisations, resilience in these settings, and specific approaches that healthcare professionals can take to increase compassion across the healthcare systems in which we work. These steps include: (a) leading by example to promote compassionate behaviour for better care; (b) supporting the well-being of colleagues and staff we manage; (c) fostering open communication across clinical and managerial teams; (d) including patients and families in decision-making and valuing their perspectives; (e) promoting teamwork and collaboration that are inclusive, adaptive, and resilient; (f) recognising and rewarding compassionate care, both formally and informally; and (g) making self-compassion a key organisational value: health care is challenging, we are all human, and self-compassion is the basis of compassion for others.
This chapter argues that there was significant competition for junior senatorial positions during the early-imperial period. The number of eligible candidates in Italy alone exceeded the available positions with a wide margin. Moreover, the inclusion of increasing numbers of provincials further intensified the competition. Selection occurred across several stages—the latus clavus, vigintivirates, and quaestorship—mitigating potential friction that could arise among competing candidates and their supporters.
This chapter investigates the variation in the governing bodies (the curial councils) of the Italian civitates. It focuses on two aspects: the number of decurions and the census qualification for council entry. The evidence reveals a similar pattern for both of these aspects: medium-sized and larger civitates adhered to ‘canonical’ values (a hundred decurions with at least HS 100,000, likely inspired by Roman tradition), while smaller civitates deviated from this canon, probably due to local economic constraints.
Depression is closely associated with abnormalities in brain function. Traditional static functional connectivity analyses offer limited insight into the temporal variability of brain activity. Recent advances in dynamic analyses enable a deeper understanding of how depression relates to temporal fluctuations in brain activity.
Methods
This study utilized a large resting-state functional magnetic resonance imaging dataset (N = 696) to examine the association between brain dynamics and depression. Two complementary approaches were employed. Hidden Markov modeling (HMM) was used to identify discrete brain states and quantify their temporal switching patterns; temporal variability was computed within and between large-scale functional networks to capture time-varying fluctuations in functional connectivity.
Results
Depression scores were positively associated with switching rate and negatively associated with maximum fractional occupancy. Furthermore, depression scores were significantly associated with greater temporal variability both within and between networks, with particularly strong effects observed in the default mode network, ventral attention network, and frontoparietal network. Together, these findings suggest that individuals with higher depression scores exhibit more unstable brain dynamics.
Conclusion
Our findings reveal that individuals with higher depression levels exhibit greater instability in brain state transitions and increased temporal variability in functional connectivity across large-scale networks. This instability in brain dynamics may contribute to difficulties in emotion regulation and cognitive control. By capturing whole-brain temporal patterns, this study offers a novel perspective on the neural basis of depression.
Phase change materials (PCMs) hold considerable promise for thermal energy storage applications. However, designing a PCM system to meet a specific performance presents a formidable challenge, given the intricate influence of multiple factors on the performance. To address this challenge, we hereby develop a theoretical framework that elucidates the melting process of PCMs. By integrating stability analysis with theoretical modelling, we derive a transition criterion to demarcate different melting regimes, and subsequently formulate the melting curve that uniquely characterises the performance of an exemplary PCM system. This theoretical melting curve captures the key trends observed in experimental and numerical data across a broad parameter space, establishing a convenient and quantitative relationship between design parameters and system performance. Furthermore, we demonstrate the versatility of the theoretical framework across diverse configurations. Overall, our findings deepen the understanding of thermo-hydrodynamics in melting PCMs, thereby facilitating the evaluation, design and enhancement of PCM systems.
The American public is increasingly affectively polarized. A growing body of research has associated affective polarization with two key phenomena: ideological polarization and social group sorting. Although there is ample evidence that social group sorting, particularly along racial and ethnic lines, is driving Republicans’ affect toward the Democratic Party, it is not clear how it shapes Democrats’, particularly White Democrats’, feelings toward the predominantly White Republican Party. We propose a third model that bridges these two theoretical approaches, a racial ideology model that helps explain Democrats’ feelings toward the Republican Party. Specifically, we argue that Democrats increasingly dislike Republicans because Republicans are seen as standing in opposition to racially progressive policies. Using a preregistered conjoint experiment, we find that Americans across party lines see Republicans as opposing efforts to reduce racial inequality and that this perception is associated with negative affect toward the Republican Party among both White and non-White Democrats.
This chapter focuses on resilience and compassion, starting by examining the relevance of resilience in healthcare, especially during the Covid-19 pandemic. The chapter notes that while a certain amount of resilience is helpful and even essential, resilience depends on not only the personal characteristics of each healthcare worker, but also the conditions in which they work. Relevant factors include the structure and function of teams, models of organisation, quality of leadership, and resources. These matters have an enormous influence on individual experiences, attitudes, and behaviour, and on the levels of resilience that are required and accessible in the workplace, as well as compassion. This chapter considers the concepts of ‘compassion fatigue’ and ‘burnout’, and outlines barriers to, and facilitators of, compassionate care. Systemic challenges include competing system demands, time constraints, inadequate resources, communication issues, poor emotional connections with the broader healthcare system, and the perception and/or reality of staff not being valued for the care they provide. These are themes that resonate with many people who work in large healthcare systems where organisational challenges loom large, often distracting focus from day-to-day patient care. This chapter also examines the roles of mindfulness and meditation in navigating these challenges.
Certain skills support compassion and help us to develop and sustain compassion even in circumstances that are far from ideal. Against this background, recent decades have seen a remarkable growth of research in this field. There is, in particular, a welcome flourishing in the area of compassion studies and compassion-based therapies, which form the focus of this chapter. Paul Gilbert, in particular, has developed compassion-focused therapy (CFT) which is outlined further by the Compassionate Mind Foundation and available in many countries around the world, as well as online. The Compassionate Mind Foundation advances an evolutionary and bio-psycho-social informed approach to compassion, and this forms the basis of CFT and ‘Compassionate Mind Training’. This chapter starts by exploring the origins of CFT and key attributes for the cultivation of compassion, before considering compassion and shame in clinical contexts. Shame can be an especially powerful emotion with a profound effect on health-related behaviour. Compassion can be a valuable way to address this issue. This chapter examines CFT in practice and notes the growing evidence base to support its use. The chapter concludes with further reflections on compassion and self-compassion as key skills and vital resources in healthcare.
In theory, compassion lies at the heart of all healthcare. There are, however, many reasons for the erosion of compassion in day-to-day clinical practice: increased demand on services, limited resources, large caseloads, insufficient time to spend with each patient, and a consequent transactional rather than relational approach to each person. Systemic focus on efficiency and throughput can also impede the cultivation of compassion, empathy, understanding, and addressing the individual needs and concerns of each patient and their family. Growing reliance on technology and electronic health records can further depersonalise patient interactions and reduce compassion, despite the many benefits of such technologies. This chapter outlines these and other factors which tend to diminish compassion, reflects on the relevance of overarching values in medical education, focuses especially on the meaning of ‘equanimity’ in this context, and overviews the place accorded to compassion in guides to professional ethics and codes of practice. The role of health systems in limiting compassion and empathy is balanced by evidence supporting the importance and possibilities of compassionate care, especially during times of emergency such as the Covid-19 pandemic in the early 2020s.
While evidence-based clinical practice guidelines promote high-quality care, their absence may create unwarranted variation in disease management, leading to suboptimal outcomes. This study aimed to identify existing clinical practice guidelines for tardive dyskinesia (TD) in France, Germany, Italy, Spain, and the United Kingdom (EU4+UK), assessing the evidence for recommended TD treatments.
Methods
MEDLINE, PubMed, and other sources (e.g., government/public agencies, associations, patient/research organizations) were searched to identify clinical practice guidelines for TD published between January 2000 and February 2025 in EU4+UK. Mentions of TD treatments in identified documents were classified as “recommendations” or “descriptions.” Recommendations were ranked according to the Scottish Intercollegiate Guidelines Network grading system or received a “no-rank” label. Subanalyses on tetrabenazine and tiapride, were performed.
Results
Of the 31 documents identified, only two were TD-specific, with the remainder primarily developed for schizophrenia, major depressive disorder, and bipolar disorder. Data extraction led to 112 mentions of TD treatments (40 recommendations, 72 descriptions). Most recommendations focused on antipsychotic regimen modification (75%) and had no rank (88%). Only five recommendations (no rank) proposed a pharmaceutical (add-on) treatment: three for tetrabenazine and one each for amantadine and buspirone. Neither of the TD-specific guidelines contained TD treatment recommendations.
Conclusions
No specific clinical practice guidelines for TD in EU4 + UK were found, although TD management was mentioned in guidelines for other disorders. Most recommendations were not supported by high-quality evidence. To improve quality of care for patients with TD in Europe, updated treatment recommendations are needed based on high-quality studies.