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This article will argue that Sor Juana develops a revisionary virtue epistemology in her Reply to Sor Filotea in order to counter the oppressive dogmas of her time. Sor Juana’s epistemological reorganization of Catholic Scholasticism helps her epistemically ground and morally justify her lifelong passion for learning. Sor Juana’s virtue responsibilist epistemology posits that properly oriented humility actually motivates studying, even for women; subtly reworks the scope of the supposed vice of curiositas so as to endorse curiosity about the created world as a virtue; and underscores the equal importance of moral and intellectual virtues for persons of any gender. Furthermore, Sor Juana’s system emphasizes grounds for epistemic justification that are accessible third-personally to allow her to move beyond the discriminatory debate about women’s intellectual capacities and demonstrate her epistemic agency through externally observable markers.
The Young Avestan text Wīdēwdād 8.81–96 deals with the contamination of fire as a result of its use in daily activities, arguing that the pristine purity of this sacred element be restored by bringing each of the polluted fires to an appropriate place. While listing non-ritual uses of fire, this text also gives precious details about the material culture of the speakers of Young Avestan in southern Central Asia during the first millennium BCE. This information is relevant for not only better understanding the history of the region in that period but also tracing the composition of these passages back to the Achaemenid period.
The process of new-dialect formation occurs when speakers of mutually intelligible varieties come into contact and create a new dialect. In this paper, I show that the process of new-dialect formation is underway in South Florida, even though the dialects coming into contact are themselves mostly contact varieties spoken by bilinguals, language learners, and the descendants thereof. This paper examines multiple vocalic variables used by 11- to 13-year-olds to explore the high variability and dialect leveling characteristic of stage two new-dialect formation. Imposition and other direct contact effects are evident within the speech of some bilingual participants, but similar patterns within the speech of monolingual English-speaking participants point to high interspeaker variability. Policing of marked features points to the direction in which leveling may shape this emerging dialect.
The introduction fits the religious identities and entanglements of imperial and royal officials into recent work in critical fields of inquiry in the study of late antiquity. It sets the approaches and arguments of the book in the context of previous work on the conversion of the senatorial aristocracy, the religious identities of pagans and Christians, the development of asceticism and episcopal authority, the prevalence (or otherwise) of religious intolerance and violence, patterns of imperial churchgoing, and forms of Christian observance within the household. It also contextualises and justifies the chronology of the book and the specific definition of the ‘state’ and ‘officials’ used within it.
In 795 CE, the Carolingian ruler, Charlemagne, conquered the Central European territories that had been ruled by the Avar steppe people for about two centuries. Carolingian propaganda presented the conquest as a triumph over the ultimate enemies of Christendom and as a triumph that paved the way to Charlemagne’s coronation as the first medieval Western Roman emperor. However, the same ideology made it more difficult to incorporate the newly conquered territories into the new Frankish-Roman empire along the more pragmatic inclusion strategies that Frankish politics had developed over several centuries prior to Charlemagne’s reign for incorporating culturally, legally, and ethnically diverse territories. The conquered Avars, for instance, disappeared as they were unable to maintain their political identity under a Christian Frankish emperor. With the “loss of the Avars,” Carolingian politics lost orientation in the diverse and complex middle grounds of Central Europe, and it became a significant challenge for Charlemagne’s successors to rule the Central European middle grounds throughout the ninth century. The article discusses the complex history of various regime collisions in the ninth century that came to shape the social and political topography of the region along the middle Danube for many centuries to come, even until today.
This article examines whether – and, if so, how – existing international humanitarian law (IHL) protects civilians from cumulative mental harm, understood as harm to mental health caused by the cumulative effect of multiple isolated or interrelated actions undertaken during a military operation. It explores three legal avenues under IHL – (1) the general protection of civilians from the dangers of military operations, (2) the obligation to take constant care to spare civilians in the conduct of military operations, and (3) the prohibition against launching attacks expected to cause excessive incidental civilian harm – to determine the degree to which cumulative mental harm is already addressed by existing law. The article contends that parties to conflict are required to establish a framework for operationalizing these protections and outlines the organizing principles for such a framework.
Indigenous knowledge systems (IKS) contemplate the world through an interconnected lens, reflecting the integrated way life is lived and the symbiotic relationship between humans and their immediate tangible and intangible environment. Through our work at Open Restitution Africa, we have begun to see how the invocation of an IKS lens shifts the means and desired ends of restitutionary work around African artefacts (belongings) and human remains (human ancestors). In this paper we outline and demonstrate the ways in which an IKS lens frames the holistic extent of harm and loss that communities and societies of origin have experienced through the destruction and removal of cultural heritage, from their perspectives. We then bring into focus the holistic restitutionary work that needs to be undertaken to realize meaningful reconciliation, reconnection, repair, and restoration. We conclude with the lesson that communities and societies of origin regain agency by turning toward their own systems and contexts, assessing what needs to be restored there, how and with/through whom, and charting their path to meaningful restitution from that vantage point. We invite further research around how framework developers can leverage IKS to evolve their approaches to restitution to meet them on that path.
This study examined antibiotic stewardship in hospital outpatient departments (HOPDs) and alignment with CDC Core Elements for outpatient settings. It also explored challenges that The Joint Commission accredited hospitals face when implementing hospital-based interventions in outpatient settings.
Design:
Qualitative study using in-depth interviews
Setting:
HOPDs included hospital-affiliated primary care, urgent care, emergency departments, specialty care, surgical centers, wound care, and dental clinics.
Participants:
Respondents included Antibiotic Stewardship Program (ASP) lead pharmacists and physicians with and without infectious disease specialization, clinical pharmacists, and accreditation coordinators.
Methods:
We conducted in-depth interviews with ASP leaders from a cross-section of hospitals of varied size and system membership. We used MAXQDA 2022 (VERBI Software, 2021) and the Framework Method to organize and analyze interview transcripts.
Results:
We interviewed 42 ASP leaders from 28 hospitals. Findings show that ASPs encountered financial constraints in expanding stewardship into HOPDs. Few hospitals had dedicated leaders or extra staffing for outpatient stewardship. Many hospitals did not have outpatient clinics represented on their ASP committee. Although most hospitals had treatment guidelines, tracked antibiotic use, and provided education for HOPDs, these often focused on inpatient priorities. Challenges in implementing hospital-based interventions in HOPDs included staffing limitations, clinical and operational differences between settings, interpreting requirements, and electronic health record and information technology limitations.
Conclusion:
Our research suggests that improving antibiotic stewardship within HOPDs necessitates recognizing the unique attributes of these settings, identification of specific resource requirements, and development of tailored strategies, rather than employing inpatient approaches.
In the COVID-19 pandemic, several phase II and III randomized trials were launched to evaluate the effectiveness of camostat, an orally administered TMPRSS2 inhibitor previously approved for other indications, for treating SARS-CoV-2 infections. Owing to the rapidly changing landscape during the pandemic, many of these trials were unable to reach completion. Further, methods for synthesizing trials that were launched and not completed were critical.
Methods:
This systematic review aimed to consolidate global evidence by identifying placebo controlled, randomized trials of camostat and analyzing their collective clinical and virologic impact on SARS-CoV-2 through an individual patient data meta-analysis (IPDMA). We harmonized data from the studies and utilized Bayesian statistical models to assess virologic outcomes (measured by the rate of change in viral shedding) and clinical outcomes (based on the time to the first of two consecutive symptom-free days), adjusting for age and sex.
Results:
The IPDMA incorporated data from six countries, totaling 431 patients across the studies; 118 patients contributed data for the primary virologic outcome and 240 for the clinical symptom outcome. Camostat did not improve the rate of change in viral load (difference in rate of change = 0.11 Ct value/day higher, 95% credible interval 2.04 lower to 2.23 higher) or time to symptom resolution (hazard ratio = 0.87, 95% credible interval 0.51, 1.55) when compared to placebo.
Conclusions:
Despite its theoretically promising mode of action, camostat did not demonstrate a statistically significant virologic or clinical benefit in treating COVID-19, highlighting the complexity of drug repurposing in emergency health situations.
Diabetes mellitus is a significant health burden, and recent reports indicate an increase in diabetes-related complications in the United States (U.S.). The mission of the National Institute of Diabetes and Digestive and Kidney Diseases Centers for Diabetes Translational Research (CDTR) is to improve the translation of research findings in diabetes prevention and treatment by supporting research across the translational science spectrum. To facilitate this mission, it is imperative to support multidisciplinary translational early-stage investigators (ESIs) to address the societal-, environmental-, and individual-level factors that impact diabetes outcomes. In this special communication article, we characterize the challenges, opportunities, and needs of ESIs transitioning to mid-careers whose goals are to develop a career in diabetes translational research. These challenges and opportunities were collected from 34 ESIs and 19 senior faculty members from 23 institutions across the U.S. who attended the inaugural CDTR National Enrichment Program Conference. Our findings aim to promote the engagement of ESIs in diabetes translational research and provide guidance in strengthening and sustaining their research careers.
To evaluate the impact of the COVID-19 pandemic on physical growth, nutritional intake and immune function in children aged 12–24 months.
Design:
A cross-sectional analysis was conducted utilising data from the National Health and Nutrition Examination Survey (NHANES). Pre-pandemic (2017–2018) and pandemic (2021–2023) cohorts were compared.
Setting:
Nationally representative data from the United States.
Participants:
Children aged 12–24 months (pre-pandemic: n 3 904 863; pandemic: n 3 496 904).
Results:
No significant differences were observed in physical growth (weight, length and BMI) or macronutrient intake between cohorts. Pandemic-born children had lower vitamin A (437·0 v. 540·0 mcg/d, P = 0·006) and B12 (2·7 v. 3·4 mcg/d, P = 0·009) intake but higher vitamin C intake (87·0 v. 62·8 mg/d, P < 0·001). Inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index) showed minor age- and sex-specific variations but remained within normal ranges. Environmental toxin exposure (cadmium and mercury) was significantly reduced during the pandemic.
Conclusions:
The COVID-19 pandemic did not substantially alter growth, nutrition or immune function in infants and toddlers, though micronutrient intakes and toxin exposure shifted. Long-term monitoring is warranted.
The articles in this special issue makes three important contributions to New Cold War History. First, they strengthen the interpretations highlighting the multiplicity and fluidity of the Cold War, which extended well beyond the interactions between superpower and formal bloc-to-bloc divisions to include a diverse array of national actors, including non-European ones such as Japan. Second, they underscore the significance of international organisations as fora for debate, exchange and expertise, as well as active agents – through their secretariats and staff – of pan-European economic cooperation. Moreover, the special issue places particular emphasis on the agency of non-state actors on the ground, including industrial and financial enterprises, business associations, experts and academics. Collectively, the contributions offer new empirical evidence on how these actors and sites structured and sustained pan-European economic spaces throughout the Cold War. Third, while the focus remains on the Cold War, some contributions emphasise the temporal dimension of pan-European economic spaces, tracking continuities from the inter-war period alongside discontinuities that reflect their reinvention during the Cold War decades. Some cases also suggest divergent post–Cold War trajectories, which point to avenues for further research on how pan-European spaces were reconfigured through the persistence, adaptation or transformation of collaborative structures and modes of engagement.
Federally Qualified Health Centers (FQHCs) serve diverse populations and may enhance participant diversity in clinical trials; however, their engagement in trials remains understudied. The objective of the current study was to examine participant diversity in hypertension (HTN) and type-2 diabetes (T2D) clinical trials.
Methods:
We searched PubMed, Cochrane, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, Embase, and Scopus for clinical trials of medical interventions addressing HTN or T2D among adults (≥18), engaging one or multiple FQHCs, and published between 2013 and 2023. We reported pooled proportions of representation of underserved populations in clinical trials.
Results:
Of 4552 articles identified, 26 clinical trials were included. The pooled proportion was 0.35 (95% CI: 0.26, 0.45) for Hispanic, 0.36 (95% CI: 0.23, 0.48) for Black/African American, 0.03 (95% CI: 0.02, 0.05) for Asian, 0.58 (95% CI: 0.54, 0.63) for female, and 0.25 (95% CI: 0.07, 0.43) for uninsured participants, and 0.54 (95% CI: 0.36, 0.72) for people with limited education (≤high school).
Conclusion:
Trials involving FQHCs demonstrated high inclusion of historically underrepresented than typical trial populations. This underscores the potential of FQHCs to improve clinical trial representativeness and to enhance the generalizability of research findings.
To examine parents’ lived experiences of implementing cot-only advice in a contemporary Australian cohort, assess alignment with the international literature on infant sleep and shared sleep practices, and determine whether explicit risk minimization guidelines address information needs identified by parents.
Background:
The risk elimination approach to shared sleeping has dominated public health messaging for decades but has been unsuccessful in reducing Sudden Unexpected Deaths in Infancy (SUDI) rates, while bedsharing rates have remained stable. The risk minimization approach offers an alternative, pragmatic framework for reducing controllable risks.
Methods:
A retrospective, secondary, qualitative directed content analysis of free-text responses related to bed-sharing drawn from the 2017 Infant Care Awareness and Routines Evaluation among Queenslanders (I-CARE Qld Study) cross-sectional survey dataset. 3,341 primary caregivers (97% mothers) of infants aged approximately three months, born in Queensland between April and May 2017. For this secondary analysis, free-text responses related to co-sleeping/bedsharing were extracted and analysed qualitatively in line with study objectives.
Findings:
Queensland parents expressed a desire for more information and non-judgemental education on improving safety while sharing sleep with their baby. Nearly a third of this cohort reported difficulty following advice to sleep their baby separately citing infant temperament/ needs, breastfeeding and caregiver fatigue or exhaustion as top rationales for this difficulty, aligning with earlier international findings. Some awareness by parents of risk minimization strategies to improve shared sleep safety was evident and in alignment with current Queensland Clinical Guidelines. There is an urgent need for public health messaging on safer infant sleep to better align with the lived experiences of parents and families through the adoption of a universal, proactive risk minimization approach to shared sleep. Co-designing guidance with parents may serve to bridge the gap between idealized and real-world implementation of safer infant sleep strategies.
Commonwealth Fusion Systems (CFS) plans to operate a tokamak power plant called ARC in the early 2030s. Tokamak plasmas have stability limits that, if crossed, lead to a rapid termination of the plasma, referred to as a disruption. Disruptions pose a melt risk to the first wall resulting from thermal and non-thermal particle heat fluxes, and an electromagnetic loading risk on all metal components within the equilibrium coils. A comprehensive set of models is used herein to provide an assessment of both mitigated and unmitigated ARC disruption loads. A preliminary massive gas injection system is baselined and a runaway electron mitigation coil option is proposed to close possible gaps in the baseline. It is predicted that all ARC disruption loads are within a factor of 2 of the disruption loads in SPARC, a tokamak presently under construction by CFS, and therefore SPARC provides an opportunity to calibrate models, test solutions and inform the design of ARC. The goal for ARC is disruption-free operation, however, the pragmatic design target is to withstand one mitigated disruption per day, and to restart the plasma following mitigation in tens of seconds without interrupting the power output. Unmitigated disruptions must be rare, and experience with unmitigated disruption impacts in SPARC will better define what rare means. The implications of this strategy for plasma disruptivity and disruption prediction are discussed, and operating the ARC scenario on SPARC is expected to refine the ARC final design and operational plan.
Growing concerns about affective polarization have led scholars to develop depolarizing interventions (i.e., experimental manipulations designed to reduce partisan animosity) with promising results in the United States. However, these interventions remain untested in Europe’s multi-party systems. This study adapts depolarization interventions highlighting commonalities among political parties and voters to the European context. We test these interventions in a 16-country experiment, featuring approximately 27,000 participants, conducted right before the 2024 European Parliament elections. Our results present three key findings. First, our interventions effectively increased perceptions of parties’ shared European and democratic ground. Second, their effects are conditional, influencing only non-far-right party supporters with pro-European and pro-democratic views. Third, despite successfully shifting perceptions, the interventions fail to reduce affective polarization. These findings contribute to the growing consensus that depolarization is difficult to achieve and extend it to the European context. In particular, they highlight the limitations of commonality-based interventions in multi-party systems, where heterogeneous partisan alignments make it harder to identify shared ground that resonates across political groups. More broadly, this paper challenges the generalizability of depolarization strategies tested in the United States and urges us to define the scope and conditions for interventions to depolarize effectively across diverse political contexts.
Commonwealth Fusion Systems plans to build ARC as the first fusion power plant at a site in Chesterfield County, Virginia, USA by the early 2030s. We present an overview of analysis comprising the physics basis of the ARC V3A design, a high-magnetic-field tokamak with $B_0=11.4 \ \text{T}$, $I_p=12.0 \ \text{MA}$, $R_0=4.62 \, \text{m}$, $a=1.18 \, \text{m}$. ARC V3A is designed to produce $P_{fus} \approx 1.13$ GW DT fusion power and deliver $\geqslant$400 MW net electric power to the grid. This overview includes quantitative analysis of fundamental issues for design of and operational plasma scenarios for a tokamak power plant, and lays out the design targets and strategic choices for ARC, including empirical fusion performance projections, assessment of H-mode access, ion cyclotron resonance heating simulations, alpha particle physics and time-dependent full-pulse simulations. This is complemented by topical papers on fusion performance and transport, disruption physics, boundary physics and magnetohydrodynamic stability. Critically, these studies identify key model uncertainties and physics risks to be retired through SPARC operation. Due to the modular nature of ARC, early results from SPARC can be incorporated into the design of the first ARC as well as subsequent replacements of the ARC vacuum vessel.
Syphilis remains a significant transfusion-transmitted infection. In Colombia, routine epidemiological surveillance primarily targets pregnant women, leaving the burden of infection among the apparently healthy population. This study determined the incidence of Treponema pallidum and its associated factors in donors at a blood centre in Colombia between 2012 and 2024. A retrospective cohort study was conducted, analyzing 64,166 repeat blood donors. Incidence was calculated using 95% confidence intervals. Associations with demographic and donation-related variables were assessed using Chi-square test and potential confounders were adjusted using a multivariable regression model. The overall incidence of syphilis was 5.1 per 1,000 donors. The associated factors included age, sex, occupation, collection site, and donor type. Higher incidence proportions were observed in male donors (RR = 1.76), individuals aged between 60 and 65 years (RR = 2.43), unemployed individuals (RR = 3), donors collected at the centre (RR = 1.45), and replacement donors (RR = 3.51). These incidences indicate ongoing transmission within a low-risk population. The highest incidence in some groups enabled the generation of hypotheses about differential exposure patterns, guiding subsequent aetiological studies, and optimizing donor selection. Understanding local epidemiology is essential for designing public health interventions tailored to the specific epidemiological profile.