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Asynchronous online courses are plagued with the challenge of engaging students consistently. Behavioral interventions, such as bottlenecks (enforced deadlines) and nudges (automated reminders), may modulate behaviors that lead to engagement and can now be easily applied and measured in a Learning Management System (LMS).
Methods:
This study included three groups of three asynchronous online courses each over three academic quarters. Two distinct behavioral interventions, bottlenecks and nudges, were implemented to increase engagement with the course compared to non-intervention controls.
Results:
The results showed that behavioral intervention tools increase student engagement with course materials by measures of increased student access to the course and reduced time to quiz completion. However, there was no significant impact in grades across the three groups.
Conclusion:
The use of nudges and bottlenecks as behavioral interventions to increase engagement in asynchronous courses for Clinical and Translational Science Education is recommended as part of best practice in course design with the same or similar structure.
Artificial intelligence (AI) has the potential to help solve global problems and be employed “for good.” One area of immense recent investment and interest is the financial technology (“fintech”) sector. Boasting its ability to provide financial services for the underbanked, various startups are developing apps that collect mobile phone data and use machine learning (ML) to provide credit scores – and subsequently, opportunities to access loans – to groups often left out of traditional banking. Based on 25 semi-structured interviews with corporate leaders, data scientists and investors at fintech companies developing and managing ML-based alternative lending apps in low- and middle-income countries, this study delves into the different ways fintechs conceptualize and define fairness, including from both a process (“fair” algorithmic design) and outcome (“fair” credit assessment) perspective. By engaging insights from industry actors, this research reveals the cultural logics, power dynamics and institutional incentives that underpin fairness narratives, including how these dynamics shape gendered outcomes in access to credit. Rather than challenging systemic exclusion, fintechs prioritize scalability and profit over equity, developing and deploying “gender blind” algorithms that perpetuate and legitimize financial disparities under the guise of neutrality and objectivity. Ultimately, fairness in ML-driven lending is shaped by institutional priorities and economic logics, where fairness narratives inadvertently obscure systemic injustices even as ethical innovation is claimed. This paper contributes to the growing field of empirical AI ethics by examining how fairness is defined, contested and operationalized in fintech-driven algorithmic lending and the ensuing implications, before offering a feminist alternative to fairness in ML that centers community voices and sets equity as a normative horizon.
In his book S/Z, French philosopher and literary theorist Roland Barthes applied his five narrative codes – five analytical tools for scrutinising any literary text – to analysing the intersection of various interpretive divisions and cultural discourses in Honoré de Balzac’s novella Sarrasine. Barthes’s five codes are meant to be used as an investigative methodology, and this article implements this system as a means of analysing symmetrical symbolic structures in the narratives of the two operas of Austrian composer Alban Berg: Wozzeck and Lulu. The aim of this endeavour is to present a new outlook on Berg’s method of dramaturgical construction through interdisciplinary connections that juxtapose musicology with literary analysis. This approach presents Berg as a narrative designer of allegories that closely mirror Barthes’s literary critical technique, as exemplified by their shared use of the five codes.
Illegal wildlife trade is a major driver of biodiversity loss, and online platforms are increasingly used to advertise protected wildlife. In Pakistan, raptor trade is increasingly mediated by online marketplaces, reflecting a wider global transition. As a case study, we assessed the online trade in raptors in Pakistan from January 2021 to December 2023 by monitoring groups on the social media platforms Facebook, Instagram, YouTube, TikTok and WhatsApp, and local e-commerce websites, using keyword-based searches, with cross-checking to reduce duplication and misidentification. We recorded 310 raptors advertised for sale from 92 seller accounts, representing 24 species across four families. Falconidae comprised 61% of individuals and Accipitridae 37%, with peregrine falcon Falco peregrinus and saker falcon Falco cherrug the most frequently advertised species. A substantial proportion of listings involved species protected under provincial wildlife legislation, as well as species listed under CITES and categorized as threatened on the IUCN Red List. Using a generalized linear model, we found that asking prices were higher for threatened and visitor species. Seller activity was concentrated in Punjab and Khyber Pakhtunkhwa, and Facebook accounted for the largest share of records, indicating that improved monitoring and enforcement on this platform is a priority. Our findings provide baseline evidence to support demand-reduction outreach, community reporting and capacity building within wildlife agencies, alongside improved online detection tools and updated assessments of raptor population status in Pakistan, particularly for migratory species using the Central Asian Flyway.
This article analyses the shifting narratives surrounding Polish nude activism during its emergence and eventual decline between the 1980s and early 1990s. Drawing on a wide range of sources – from archival records and media reports to oral histories and private archives – this article reconstructs ways in which nude activists negotiated and reacted to the changing social and economic landscape. It examines how naturism was portrayed in late socialist media as a form of social and erotic escapism and sheds light on how activists navigated the new political reality after the regime change, launching their own adult magazines and even founding the Polish Erotic Party. By focusing on this overlooked aspect of Polish history, the article reveals the paradoxical nature of activist narratives under late socialism and highlights the critical role played by gender and sexuality in the daily experiences of political and economic transformation.
The silver-backed chevrotain Tragulus versicolor, categorized as Data Deficient on the IUCN Red List, is a poorly known and recently rediscovered ungulate endemic to Vietnam. To better understand its distribution and conservation status, we conducted semi-structured interviews and camera-trap surveys during 2018–2025 across 15 forest sites in five provinces of south-central Vietnam. We deployed 522 cameras at 487 stations, totalling 37,592 camera-trap nights. The silver-backed chevrotain was detected at five sites, including four newly confirmed populations beyond the single previously known population in Nui Chua National Park. The species was found in dry and semi-dry forests, with the highest number of detections in Nui Chua National Park and the Hon Heo peninsula. We failed to record the silver-backed chevrotain in several sites within presumed suitable habitat, and interviews indicated possible local extirpations driven by sustained snaring pressure. Our findings highlight the silver-backed chevrotain’s fragmented distribution, as well as its vulnerability to unsustainable hunting pressure and habitat loss and degradation. Given its limited distribution and the ever-increasing anthropogenic threats, urgent conservation actions are needed, including strengthening in situ protection in remaining strongholds and the establishment of an insurance ex situ population. This study provides the most up-to-date assessment of the status and distribution of the silver-backed chevrotain, and provides a foundation for evidence-based conservation planning for the species.
This study compared mental health problems and psychiatric treatment experiences between mothers of twins and mothers of singletons, controlling for assisted reproductive technology (ART), perceived family support (PFS), and demographic covariates. Participants were 1592 South Korean mothers, including 853 mothers of singletons (M = 36.6 years, SD = 3.6) and 739 mothers of twins (M = 38.3 years, SD = 4.9), who completed an online survey assessing the General Health Questionnaire (GHQ), psychiatric treatment experience (PTE), PFS, ART use, and demographic factors. Hierarchical regression, analysis of covariance (ANCOVA), and logistic regression analyses were conducted with GHQ as the outcome variable. PTE was analyzed both as a dependent variable and as an independent variable. ART use significantly predicted GHQ scores beyond PFS, PTE, and demographics in both groups. After adjusting for all covariates, mothers of twins had higher GHQ scores than mothers of singletons, although the effect size was small (Cohen’s d = 0.16). Logistic regression revealed that mothers of twins were more than twice as likely to have received psychiatric treatment compared to mothers of singletons (odds ratio = 2.5, 95% CI [1.8, 3.4]). These results indicate that mothers of twins experience greater mental health challenges than mothers of singletons, indicating the importance of tailored mental health screening, prevention, and intervention programs for this vulnerable group.
It is time for evidence-based medicine to evolve and incorporate a fourth pillar of patient-level data. We describe what this pillar includes, how it integrates with existing pillars and its application to mental health treatment. We highlight key challenges and issue a ‘call to action’ for psychiatry and beyond.
Water is a shared global resource, yet its movement is often invisible. When a country imports products, it also imports ‘virtual water’, the water used to produce those products. While agriculture accounts for 85% of global water transfers, we have lacked a clear understanding of who is actually moving this water: large industrial farms or small-scale farmers? Our study shows that small-scale agriculture plays a disproportionately large role in global virtual water flows, compared to its volume of crop production involved in trade.
Technical Summary
Most global virtual water flows come from agri-food sectors, describing how commodity demand in one country drives water use in others. Despite their significance, virtual water flow assessments have largely overlooked the distinct roles of small-scale versus large-scale agriculture, hindering the development of targeted water and food security policies in both producing and consuming countries. To address this gap, we estimate the contributions of small-scale and large-scale agriculture to crop production and virtual water embedded in trade (export) using detailed hybrid multiregional input–output tables spanning 55 countries. We reveal that, although small-scale agriculture accounts for only 17% of the total crop production involved in trade (in tonnes), its role in virtual water flows is disproportionately large, accounting for 22% of blue and 30% of green virtual water flows. In 13 of the 55 countries, small-scale agriculture accounts for more than 50% of green virtual water exports. Furthermore, virtual water exports from small-scale agriculture exhibit distinct spatial patterns and are driven primarily by demand for labor-intensive crops rather than animal-sourced human food and nonfood products. Our results suggest that explicitly accounting for farmers’ roles in virtual water flows is critical for the design of context-specific, effective, and equitable policy interventions.
Social Media Summary
Check out the unique role of small-scale agriculture in global crop trade and virtual water flows.
Environmental contamination is a significant factor in the transmission of healthcare-associated infections. This study evaluated the effectiveness of gaseous ozone in reducing microbial contamination within hospital settings, focusing on both air and surfaces.
Design:
A cross-sectional study conducted in a single healthcare facility.
Setting:
Two experimental protocols were implemented using the Sany-Plus ozonator: a three-timepoint protocol (3T), which included routine cleaning followed by ozone disinfection, and a two-timepoint protocol (2T), where ozone treatment occurred after patient activity without intermediate cleaning. We conducted active air and surface samplings using RODAC plates. Microbial loads were quantified in terms of colony-forming units (CFU) for both bacteria and molds/yeasts. Data analysis was performed using the Friedman and Wilcoxon tests, applying Bonferroni correction for multiple comparisons.
Results:
In the 3T protocol, bacterial and fungal contamination on surfaces significantly decreased between patient activity and postcleaning, with P-values of .0024 and .0060, respectively. However, no further reduction was observed after ozone disinfection. Airborne microbial loads did not show any statistically significant changes. In the 2T protocol, there was no significant overall decrease in bacterial contamination (P = .0766), although fungal contamination did experience a significant reduction (P = .0058). No changes in air contamination were detected.
Conclusions:
These findings suggest that routine cleaning is the primary determinant of surface decontamination, while ozone treatment may provide a limited complementary antifungal effect. No significant impact on airborne microorganisms was noted. Therefore, ozone should be regarded as an adjunct to, rather than a replacement for, conventional cleaning and disinfection in healthcare environments.
To estimate and compare the vaginal doses in terms of posterior inferior border of symphysis (PIBS) points such as PIBS, PIBS+2, PIBS-2, and vaginal reference length (VRL) for patients of cancer of cervix (CC) treated with intracavitary brachytherapy (ICBT) using Fletcher Williamson applicator (FW) and interstitial brachytherapy (ISBT) using Martinez Universal Perineal Interstitial Template (MUPIT).
Material/methods:
Treatment plans of a total of 36 consecutive CC patients, who underwent ICBT and ISBT with FW and MUPIT respectively, were retrospectively included in the study. The 3D treatment planning for all the patients had been performed on computed tomography (CT) images. The median prescription dose delivered by high dose rate brachytherapy was 6 Gy per fraction. PIBS point doses were estimated for each plan and analysed with OriginPro2024b graphing and analysis software.
Results:
The Mann Whitney test showed statistically significant differences in vaginal doses in terms of percentage of prescription dose (PD) between ICRT and ISBT. Spearman’s rank correlation coefficient (ρ) values indicated that vaginal wall dose and VRL were strongly correlated for FW applicator as compared to MUPIT applicator.
Conclusion:
Vaginal wall doses in terms of percentage of the PD with MUPIT applicator were found higher than with the FW applicator. Our results suggested that estimation of vaginal doses for each patient was necessary during planning phase in order to avoid the late toxicities.
This paper examines the effect of post-Brexit UK trade agreements on devolved regulatory autonomy. It does so by: (i) carrying out a comprehensive mapping exercise of the overlaps between such agreements and devolved matters; (ii) analysing the domestic legal framework for the implementation of international trade commitments in devolved law; and (iii) identifying the extent to which trade agreements have affected devolved competences and/or caused substantive changes to devolved legislation. The paper demonstrates that UK trade agreements have rarely resulted in significant changes to devolved legislation. This outcome is attributable not only to the limited regulatory ambition of the agreements concluded so far, but also to the distinctive role played by UK domestic implementing legislation in shaping the scope of devolved autonomy. In particular, it shows how the interaction between international trade commitments and the UK’s implementation framework operates as a ‘double bind’ on devolved autonomy.
This article explores the potential of supported decision-making for helping individuals with intellectual or cognitive disabilities to make value-aligned or authentic decisions with respect to participation in clinical research. We argue that supported decision-making is valuable in this context not merely because it promotes self-determination, but also because it increases the likelihood that individuals’ decisions align with what matters to them. To realize this potential, it is important to recognize and address situations in which individuals with intellectual or cognitive disabilities are at increased risk of making decisions that are contrary to their values. We focus on two such situations in particular: when the individual must integrate multiple, potentially competing values, and when the relevant values are insufficiently specified and require unpacking. These challenges can be met, we propose, by integrating dialectical support — a form of structured, dialogue-based assistance designed to help individuals explore and apply their values — into supported decision-making practices.
We prove the existence of a stationary IARCH (integrated autoregressive conditionally heteroskedastic) process for a class of models with polynomially decaying coefficients.
The reliable assessment of formal thought disorder (FTD), a collection of observable signs of suspected problems in generating organised thoughts, is the cornerstone of interviewing a person with psychosis. A significant gap persists between the success of assessments reported in published FTD rating scales and the practical constraints of a clinical interview. Validated rating scales largely focus on operationalised criteria for describing items; the procedural aspects of how to elicit these signs often remain implicit. We synthesise the principles and procedures of FTD assessment embedded in rating scales, translating their design into a framework for routine clinical use. Systematic employment of several manoeuvres can help elicit FTD signs: conversational stimulation, cognitive loading, social modulation and pointed clarifications to stress-test thought, language and communication processes. By making these procedures explicit, we aim to equip clinicians and trainees with a strategic, measurement theory-informed approach to the psychiatric interview when assessing for FTD.
Pesticide self-poisoning accounts for 14–20% of global suicides, predominantly in agricultural regions where highly hazardous pesticides (HHPs) remain accessible. This poses a critical challenge in South Korea despite its advanced healthcare system. In response, South Korea implemented a phased ban on HHPs, including paraquat, beginning in November 2011. This study aimed to evaluate the long-term effect of this ban on pesticide suicide mortality.
Methods
We conducted an interrupted time series study using national mortality data from 2004 to 2023, with autoregressive integrated moving average errors to account for autocorrelation. Sensitivity analyses included alternative intervention timings, period definitions and outcome measures. The primary outcome was the monthly count of pesticide-related suicides.
Results
Among 268,869 suicide deaths recorded during the study period, 34,962 (13.0%) involved pesticide poisoning. The monthly pesticide suicide counts declined from a mean of 244 before the ban to 81 afterwards. The interrupted time series analysis revealed no immediate level change following the ban (−0.204; 95% confidence interval [CI]: −0.989 to 0.581; P = 0.61) but showed a significant acceleration in the decline during the first 36 months (initial slope change: −0.122; 95% CI: −0.163 to −0.082; P < 0.001). Counterfactual projections estimated 10,846 deaths averted (95% CI: −567 to 29,715), representing a 48% model-based reduction. These effects were robust across all sensitivity analyses. Structural breakpoint analysis identified an increase in gas poisoning suicides in August 2008, more than three years before the ban, indicating no evidence of method substitution. The demographic profiles of pesticide and gas poisoning suicides differed substantially.
Conclusions
The ban on HHPs in South Korea was associated with a sustained decline in pesticide suicide mortality over 12 years, with no evidence of method substitution. These findings support the means restriction through pesticide regulation as an effective suicide prevention strategy.