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The RECOVER Clinical Trials Protocol Working Groups (PWGs) were established to rapidly design trials addressing Long COVID by incorporating the complementary expertise of researchers, clinicians, and patients, caregivers, and community representatives (Representatives). This paper explores the engagement of Representatives in protocol development, highlighting their contributions, challenges faced, and lessons learned. A survey of PWG members revealed that while most Representatives felt their input was valued, gaps in role clarity, communication, and integration of feedback persisted. Representatives emphasized the importance of understanding patient burden and lived experience, while researchers and project leaders noted the value of inclusive perspectives. Findings underscore the need for structured engagement practices, clear expectations, and ongoing support to ensure meaningful participation. These insights offer a roadmap for future clinical trial networks seeking to integrate patient voices in research design.
In this article, we study the pressure at infinity of potentials defined over countable Markov shifts. We establish an upper semi-continuity result concerning the limiting behaviour of the pressure of invariant probability measures, where the escape of mass is controlled by the pressure at infinity. As a consequence, we establish criteria for the existence of equilibrium states and maximizing measures for uniformly continuous potentials. Additionally, we study the pressure at infinity of suspension flows defined over countable Markov shifts and prove an upper semi-continuity result for the pressure map.
Given the high prevalence of mental health challenges, the field of paediatric cardiology has increasingly recognised the need for integrated and embedded psychosocial programming in cardiology care. In response to this, the University of Michigan Congenital Heart Centre Psychosocial and Educational (M-COPE) Program was established in January 2020. This paper aims to describe the development, current structure, preliminary outcomes, and future directions of the M-COPE Program to inform similar programme development efforts.
Methods:
Informed by a comprehensive needs assessment (group/individual interviews, patient surveys), the M-COPE Program mission centres on expanding (1) psychosocial clinical services, (2) psychosocial research, (3) mental health training for all learners, and (4) advocacy for improved psychosocial care for paediatric cardiology patients and families.
Results:
In its first five years, the M-COPE Program has expanded access to mental health care by increasing the number of psychosocial clinicians, embedding psychology/perinatal psychiatry in select cardiology clinics, and developing novel modes of service delivery through collaborative efforts across our multidisciplinary teams. Training initiatives have included the development of cardiac psychology fellowships and a mental health curriculum for cardiology physician fellows. Research is foundational to the programme, ranging from federally funded research to centre-specific quality improvement projects.
Discussion:
The M-COPE Program has become foundational to our heart centre. Future directions include enhancing psychosocial care at home for patients/caregivers, integration of a perinatal psychiatrist, and wider-scale launch of novel patient-focused initiatives. Continued study of programme impact will be ongoing with key metrics including referral patterns and patient/family outcomes.
Malaria, historically a significant health burden in temperate Europe, particularly in the low-lying marshy areas, is often poorly represented in discussions of health in the pre-modern Netherlands. Although malaria does not produce pathognomonic skeletal lesions, the haemolytic anaemia associated with repeated infection is thought to contribute to the development of cribra orbitalia, making population-level patterns in this non-specific skeletal marker informative for exploring past malaria burden. This study applied a spatial epidemiological approach, which investigated (1) the spatial distribution of cribra orbitalia prevalence across 28 archaeological medieval sites in the Netherlands, and (2) whether this distribution can be explained by underlying environmental features consistent with malaria transmission and historical mosquito density. Global Moran’s I revealed a significant positive spatial autocorrelation in prevalence. Local Indicator of Spatial Association (LISA) analysis confirmed this, identifying distinct High–High clusters in the Southwest and Low–Low clusters in the East of the Netherlands. However, linear regression models using broad-scale environmental variables failed to explain these spatial patterns. This likely reflects their inability to capture the specific ecology of the local malaria mosquito, Anopheles atroparvus, which preferentially breeds in brackish environments. Consistent with this interpretation, cribra orbitalia prevalence was significantly positively correlated with historical (1938) estimates of A. atroparvus density. The observed clustering and correlation with mosquito density suggest that malaria contributed to cribra orbitalia prevalence and may have been an important disease in certain regions of the medieval Netherlands; however, interpretation is constrained by small non-adult sample sizes as well as uneven preservation across the Netherlands.
Psychedelic-assisted psychotherapy has shown potential for psychiatric disorders. However, the magnitude of symptom change in control groups remains poorly understood. We aim to evaluate within-group effects in control groups and compare them to treatment groups in psychedelic trials.
Methods
A systematic search was conducted up to 1 July 2025. The study protocol was preregistered in PROSPERO (CRD420251111853).
Results
Fourteen randomized controlled trials (n = 643) were included. Direct between-arm meta-analyses showed greater symptom reductions in treatment compared with control across outcomes, including depressive symptoms (number of study arms [k] = 13; SMD = −0.82; 95% CI = −1.17, −0.47; I2 = 60.1%), posttraumatic stress disorder (PTSD) symptoms (k = 10; SMD = −0.89; 95% CI = −1.14, −0.65; I2 = 0%), and anxiety symptoms (k = 5; SMD = −0.66; 95% CI = −0.94, −0.38; I2 = 0%). Subgroup analyses showed limited evidence that effects differed by placebo type for depressive or PTSD symptoms. Descriptive within-group analyses indicated symptom reductions from baseline in both control and treatment groups, with larger within-group improvements observed in treatment groups across outcomes; notably, larger within-group reductions in PTSD symptoms were observed in inactive placebo groups. Sensitivity analyses showed consistent results.
Conclusions
Control groups in psychedelic trials demonstrated substantial symptom improvement, which may reflect non-specific trial factors (including expectancy and concurrent psychotherapy). These findings emphasize the importance of robust control conditions in psychedelic research and the need for nuanced interpretation of treatment effects.
This meta-analysis investigates the contributions of viewing audiovisual input on second language (L2) learning. We calculated 75 effect sizes from 56 experiments (n = 1954) and assessed the effects of audiovisual input on language learning using a within-group (pre-post) meta-analytic approach. Fifteen moderator variables were included in the analysis. Results showed that a) there was a small effect of audiovisual input on L2 learning (g = .89); b) no differences were found between the effects of viewing audiovisual input on different areas of L2 learning (vocabulary, grammar, pronunciation, speaking, listening proficiency); and c) video category had a significant impact on L2 learning with entertainment-focused videos (e.g., TV series, movies, and mixed videos) yielding lower effects than educational videos (e.g., TED Talks, documentaries, and language-focused).
Within the dynamic realm of historiography and the generation of knowledge, the process of “Becoming Independent” serves as a profound testament to the tenacity and resolve exhibited by a wide array of intellectual communities in their efforts to confront and transform established narratives. This afterword explores the themes in this special issue, which not only offers a critical analysis of historiographical practices from both past and present but also emphasises the imperative for ongoing dedication in the endeavour to cultivate diverse and independent historical narratives. By discussing the different articles of this collection, the afterword explores shared themes, such as the decoloniality of historical scholarship through ethnographic inquiry, prospects of de-emphasising the Eurocentric gaze, fragmentation of history as evidence of varied epistemological sovereignties, and the decolonial agenda through “white expatriates.” By doing so, this Afterword serves as a resounding appeal for the continuous pursuit of intellectual liberation.
To report on a volunteer-led program supporting local healthcare providers (L-HCPs) and disaster responders after the 2024 Noto Peninsula Earthquake, focusing on its implementation and immediate outcomes.
Methods
A volunteer-led initiative established by university alumni deployed medical teams to a local hospital on weekends following the earthquake, providing onsite support to relieve L-HCPs from prolonged strain. The program integrated information and communication technology (ICT) platforms to enable remote support, communication, and structured debriefing sessions for volunteers, facilitating assistance from a wider network.
Results
The project effectively sustained the local health care institution’s capacity by managing diverse patient needs, including a surge in internal medical conditions. It provided essential respite, allowing local physicians crucial personal time, for which they expressed profound gratitude. Volunteer doctors reported effective stress management through the onsite and ICT-based support structure, and the initiative concluded safely without injury.
Conclusions
The project demonstrated that combining onsite medical assistance with strategically implemented ICT effectively mitigates burnout among L-HCPs, providing essential psychological support for deployed volunteers. The findings highlight the significance of sustained recovery-phase support, professional networks, and ICT in disaster response. These experiences highlight the need for comprehensive, system-wide support strategies for all frontline personnel in future disasters.
Despite contemporary relevance in understanding how cities historically overcame demographic, social and economic constraints imposed by the lack of clean, fresh water, the value of estimating aqueduct delivery rates and their potential relationship with population size in the Roman Empire remains uncertain. Here, the authors use settlement scaling theory to examine recent statistics for city size and aqueduct capacity, revealing a systematic but sublinear relationship between these variables, whereby water supply increased at a slower rate than population size. Far from merely ostentatious displays of power, aqueducts were carefully planned to ensure an adequate supply of clean and fresh water.
Punching shear failure in slab-column connections is a brittle collapse mode that threatens the safety of flat reinforced concrete (RC) slabs. Conventional design provisions are generally conservative but exhibit inconsistencies across geometric and material variations. This study develops an eXtreme Gradient Boosting (XGBoost) model to predict the ultimate punching shear capacity of flat RC slabs, using a database of experimental results categorized by four different geometric domains, including square slab with square column, circular slab with circular column, square slab with circular column, and circular slab with square column, covering the geometric, materials strength, and reinforcement properties of input parameters. The model achieved high predictive accuracy across the domains with coefficient of determination (R2) values > 0.930 in unseen testing datasets with minimal bias (0.994–1.006) and reduced scatter. Model interpretability, addressed through the SHapley Additive exPlanations analysis, confirmed slab thickness and average effective depth as the most critical predictors of shear capacity, followed by concrete strength and reinforcement parameters, while boundary condition parameters showed negligible influence due to the predominance of interior column cases. These findings demonstrate that XGBoost provides accurate, reliable, and interpretable predictions of punching shear capacity, offering a data-driven alternative to code-based methods and supporting safer and more consistent design of flat RC slabs.
Cooperative Extension provides research-based outreach to the public, making it a valuable resource for translation scientists. Herein, we describe a collaboration between Cooperative Extension and the Department of Nutritional Sciences at Pennsylvania State University that resulted in widespread dissemination of novel nutrition education materials. Short videos (3 to 5 minutes each) for the public, healthcare professionals and patients focused on using spices and herbs (S&H) to decrease sodium, saturated fat (SFA), and added sugars, and improve diet quality were developed and evaluated. The videos were effective in improving knowledge about S&H, intent to use them, and making healthy diet changes.
Multiple rounds of European Union (EU) enlargement and the rise of the populist radical right have affected the organisation of political competition in the European Parliament (EP). This study probes how the EU’s efforts to redress democratic backsliding in several EU member states crystallise deepening divides between European lawmakers. Our empirical analysis examines 17 roll-call votes on rule of law issues and well over 900 discursive statements from corresponding parliamentary debates held between 2009 and 2019. Our unique approach enables us to analyse discursive and voting patterns both separately and jointly to understand how they affect each other. We find that behaviour across these different arenas is generally consistent and aligns with an ideological divide that pits Eurosceptic Members of the European Parliament (MEPs) against representatives from pro-EU European party groups. Once we account for ideological orientations and strategic motivations, the often-claimed East–West divide on rule of law issues becomes much less salient, emerging primarily under specific conditions of ongoing democratic erosion and national incumbency in Central and Eastern Europe. Our findings speak to the literature on EU responses to democratic backsliding as well as to the changing dynamics of political competition in the EU more broadly.
A response to the Classical Association’s Write | Speak | Design Competition 2025. A short essay presenting an argument which passionately asserts the centrality of classical education as providing the tools to make sense of the world at a pivotal socio-economic and political juncture, from the perspective of the author, a 16-year-old state school student in a school without classics provision. Emphasising the continued relevance of Classics in modern life through its relation to critical thinking, social mobility, and cultural capital, this essay advocates for the prioritisation of Classics in the modern curriculum. The author argues that the skills developed through the study of Classics, such as linguistic analysis, debate, and source criticism, are essential in providing tools to navigate misinformation and political polarisation. The essay highlights the cultural and intellectual legacy of Ancient Greece and Rome, asserting that lack of access to this education limits students’ cultural capital by decontextualising their understanding of literature, art, and history. Furthermore, the essay addresses the author’s experience of gendered and classist disparities in Classics education, highlighting the urgency for an increased advocacy and resource allocation to make Classical studies more accessible and inclusive in mainstream education.
Hydrilla [Hydrilla verticillata (L.F.) Royle] is a known, persistent aquatic weed in many lakes and reservoirs across the United States. Recently, focus has been placed on the management of invasions of H. verticillata into flowing systems due to increased difficulty in achieving effective control. In flowing environments, increased flow and water exchange rates commonly result in shorter herbicide exposure times using traditional application techniques. This research evaluated the concept of intermittent herbicide exposure as a potential management strategy to overcome operational challenges in high water exchange environments. Monoecious H. verticillata response to intermittent exposure to florpyrauxifen-benzyl, endothall, and fluridone at multiple concentrations and nontreatment intervals was evaluated in greenhouse-scale mesocosm experiments. Decreased efficacy was not observed when nontreatment intervals between exposures were introduced in florpyrauxifen-benzyl treatments. Monoecious H. verticillata treated with 30 µg ai L−1 florpyrauxifen-benzyl and a 6-d nontreatment interval resulted in 89% reduction in aboveground biomass. Nontreatment intervals did not influence endothall efficacy and biomass reduction increased with herbicide concentration (66% to 93%). Fluridone treatments at 5 µg L−1 resulted in 82% biomass reduction, while treatments at 10 and 15 µg L−1 resulted in 89% biomass reduction. Biomass reduction was slightly lower in fluridone applications with a 12-d nontreatment interval (83%) compared with other nontreatment intervals (85% to 91%). The high biomass reduction and similar response between treatments observed suggests the need for additional refinement and operational verification of intermittent herbicide exposures for monoecious H. verticillata control to increase cost-effectiveness and efficiency in public H. verticillata control programs.
In high-precision pulsar timing, the accurate recovery of intrinsic pulsar profiles and their associated scattering parameters is of paramount importance. In this paper, we present a comprehensive study focused on the retrieval of intrinsic pulsar profiles through the use of a CLEAN-based algorithm as described in Bhat et al. (2003, ApJ, 584, 782). The primary objective of this study is to elucidate the capabilities of our pipeline in the context of recovering the intrinsic profiles and associated parameters, such as dispersion measure, frequency scaling index, scattering time, pulse broadening function, and time of arrival residuals. We use simulated profiles to rigorously test and validate the efficiency of our recovery pipeline. These simulated profiles encompass single- and multi-component Gaussians, designed to emulate the diverse nature of pulsar profiles. By comparing the recovered profiles and parameters to their injected values, as derived from simulations, we provide a robust evaluation of the pipeline’s performance along with its drawbacks and limitations.
To monitor the influence of international trade and investment agreements (TIA) on the food environment and population nutrition in Canada.
Design:
Implementation of a revised version of the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) trade and investment monitoring protocol to guide descriptive analysis of quantitative trade and investment data over the period 1994 to 2021/22 as well as qualitative review of policy documents related to nutrition regulations and trade concerns.
Setting:
Canada, which has fifteen TIA in force with fifty-one countries as of 2024.
Results:
Extensive tariff reductions occurred in 1995 with the introduction of the World Trade Organization (WTO), with minimal tariff reductions since that time. Tariff rates were generally highest on ultra-processed focus foods, though many countries gained tariff-free access over the study period. There were large surges in imports of dairy products, meats, sugars and soft drinks after joining the WTO, while exports of grains, dairy products, sugars, processed meats, ready-to-eat meals and sauces saw substantial growth. Foreign direct investment into Canada’s food manufacturing sector increased consistently, reaching $32·6 billion in 2020–2022. Canada has raised several specific trade concerns at the WTO over other countries’ nutrition labelling policies, and some of the challenged policies have subsequently been abandoned, modified or delayed.
Conclusions:
Increased trade and investment openness in Canada appears linked to changes in food imports, exports and foreign investment that may impact the nutritional quality of food environments. Monitoring how trade agreements shape national food supplies is critical to developing trade policies that improve nutrition in alignment with public health goals at home and abroad.
A computable topological presentation of a space is given by an effective list of a countable basis of non-empty open sets so that the intersection of the basic sets is uniformly effectively enumerable. We show that every countably-based $T_0$-space has a computable topological presentation, and that, conversely, every (formal) computable topological presentation represents some Polish space. In the compact case, we give a computable uniform list of computable topological presentations such that every compact Polish space is represented by exactly one presentation from the list. Note that none of these results assume that the Polish (or $T_0$) spaces are effective. Quite surprisingly, the effectively compact topological presentations turn out to be rather well behaved. Not only do such presentations allow one to construct a $\Delta ^0_2$ (complete) metric compatible with the topology, but also, under a mild extra condition, they can be turned into a computably compact Polish presentation of the space.
The intersection between the Assisted Decision-making (Capacity) Act 2022 (ADMCA) and the Mental Health Act, 2001 (MHA) has prompted considerable debate. Although not alone in its differential treatment of mental health and physical health advance healthcare directives (AHDs), Ireland is unique in affording legally binding status to mental health AHDs for some but not all inpatient service users detained under mental health legislation. As such, in this study we aim to compare groups of service users for which AHDs would be binding or not at point of detention and to track changes in binding status over the course of admission.
Methods:
This is a retrospective observational study examining involuntary admissions to a 36 bedded acute psychiatric unit in Dublin from 2021 to 2023. Admissions were grouped into those initially detained on grounds of risk or on the treatment criterion alone, as this would determine binding status of a mental health AHD. We also examined changes to binding status over the course of admission to calculate median bed days when a service user would be entitled to a binding AHD. Descriptive statistics and inferential testing (Chi-squared and Mann–Whitney U) were used to analyse the data.
Results:
Of 287 admissions of 212 service users, 73.9% admissions were under the treatment criterion alone and would therefore qualify for a binding AHD. We found that diagnosis, mode of detention, and service division were significantly associated with AHD binding status. Service users would qualify for binding AHDs on 83.6% of involuntary bed days and, of those admissions affirmed by the first tribunal, 89.9% would qualify for binding AHDs in the days afterward.
Conclusion:
Most involuntary service users would qualify for a legally binding AHD under the ADMCA for at least part of their admission. Should AHDs become common practice, binding AHDs will play a significant role in inpatient psychiatric care.