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This Registered Report examines urban-rural tensions in Sweden – a historically egalitarian, multi-party welfare state with strong geographical equalization schemes, making it a least-likely case for place-based resentment theories. Using an online survey experiment (n = 2,051), we measured resentment through perceptions of in-group and out-group, and by experimentally varying whether political statements came from rural or urban politicians. Rural respondents showed stronger in-group identification, greater place-based resentment, and more negative stereotypes of their out-group than urban respondents. However, we find no evidence of place-based bias – that is, that rural respondents are less receptive to urban politicians’ statements, or vice versa. These findings reveal clear urban-rural tensions in a context often considered unlikely for such divides, underscoring the role of regional identities in political discourse and policy in multi-party welfare states beyond Anglo-Saxon settings, while indicating that these tensions do not translate into systematic bias in evaluating political statements.
There is increased interest in self-selected exclusionary diet patterns, specifically vegetarian, vegan, and gluten-free (GF) diets, but there is a lack of research exploring the beliefs and behaviours surrounding these diets in Canadians capable of bearing children (CCBC). The goal of this study was to explore the beliefs and behaviours of CCBC who follow vegetarian, vegan, and/or GF diets using mixed methods. A self-administered online Qualtrics™ survey containing 102 questions was conducted using open text and closed format questions. Continuous variables were summarized using mean and standard deviation while percentages were used to summarize categorical variables. Qualitative data was analysed using thematic analysis. A total of 271 CCBC between 18–45 years of age were analysed, with 27%, 22%, and 3.7% indicating they followed a vegan, vegetarian, and/or GF diet, respectively. Three main themes emerged that influenced CCBC beliefs about their chosen diet. The belief that these diets are healthy or could impart health in some way, was the main reason for following their chosen diet, especially in those who identified as vegetarian. Ethical/moral concerns, primarily around animal welfare and the environment, was the second theme for following their chosen dietary pattern, especially amongst those who identified as vegan. Perception of social judgement in the forms of criticism, guilt, and isolation were noted by some CCBC, with family, friends, and colleagues interacting differently with them because of their dietary choices. These findings serve to enhance our understanding of the beliefs and behaviours of CCBC who choose to follow exclusionary diets.
We evaluated a targeted Candida auris screening program, which revealed a 0.96% positivity rate. The proportion of community-onset cases increased from 8% to 54% following implementation. No significant differences in demographic or clinical characteristics were observed between patients with colonization and those with infection.
The complexity and nuance of how social networks shape dietary behaviours and health dynamics remain underexplored, particularly in collectivist societies where family and peer relationships strongly impact health. This study applies social network analysis to examine these dynamics in Singapore.
Design:
An online household survey of young adults (age 21–35) and family (21+) assessed the consumption of healthy food groups (fruit, vegetable intake), unhealthy food groups (fast food, snack consumption) and social network characteristics (interaction frequency, emotional closeness, shared meals and perceived health influence). Data were analysed using network analysis, mixed regression models and generalised estimating equations.
Setting:
Online Singaporean household survey.
Results:
Among 116 participants from thirty-six households, 345 unique individuals and 1145 dyadic relationships were identified, with networks averaging 9·7 nodes (sd: 4·7) and 33·2 edges (sd: 27·3). Mutual health influence was strongest in spousal (β = 0·89, 95 % CI: 0·42, 1·35) and intergenerational ties (older-to-younger: β = 0·62, 95 % CI: 0·29, 0·94; younger-to-older: β = 0·36, 95 % CI: 0·03, 0·68) and associated with emotional closeness (β = 0·38, 95 % CI: 0·30, 0·46) and shared meals (β = 0·43, 95 % CI: 0·36, 0·49). Greater family health effort correlated with lower snack (Adjusted Odds Ratio [AOR]: 0·50, 95 % CI: 0·29, 0·85) and fast-food consumption (AOR: 0·41, 95 % CI: 0·22, 0·77), while higher perceived family health associated with increased snack intake (AOR: 3·21, 95 % CI: 1·58, 6·52). Frequent meals with friends associated with lower fast-food intake (AOR: 0·50, 95 % CI: 0·30, 0·84), but no associations with fruit or vegetable intake were found.
Conclusion:
Findings highlight intergenerational and spousal ties as key health influencers, particularly through shared meals, and the complex role of social networks in shaping diet. Analyses suggest network-based interventions may be more useful in reducing unhealthy rather than promoting healthy eating behaviours.
Hospital sinks are reservoirs for epidemiologically important pathogens (EIPs), yet practical, effective strategies for sustained decontamination are lacking.
Methods:
We conducted a randomized controlled trial of 30 in-room sinks (15 intervention, 15 control) in a newly renovated hospital unit to evaluate the efficacy of a hydrogen peroxide/peracetic acid foamed disinfectant in reducing sink contamination. Intervention sinks received foamed disinfectant to sink drains three times weekly; control sinks underwent standard daily surface cleaning. Weekly sampling was performed from three sink locations (top surface, tail pipe, P-trap) over 35 weeks. The primary outcome was sink conversion events (SCEs), defined as first detection of ≥1 EIP, defined as Pseudomonas aeruginosa, Stenotrophomonas spp., or Acinetobacter spp., and ESBL-producing or carbapenem-resistant Enterobacterales, in previously negative sinks.
Results:
A total of 2880 samples were collected. All sinks were negative at baseline for study pathogens. Nearly all sinks (29/30) experienced an SCE during the study period. However, only 44 (9%) intervention sink samples were positive for EIPs, compared to 270 (47%) in control sinks (p < 0.00001). EIPs were recovered from 4% versus 24% of P-traps and 4% versus 39% of tail pipes; sink top/handle contamination was rare and similar (3% vs 4%). The most frequent EIPs were Acinetobacter spp. and Stenotrophomonas spp. Intervention sinks experienced a delayed time to SCE (p = 0.0001). Items were stored on/in sinks in 93% of observations.
Conclusion:
Regular application of a foamed disinfectant reduced and delayed EIP contamination in renovated hospital sinks. Foam-based protocols may help mitigate environmental reservoirs of multidrug-resistant organisms.
The association of hypoplastic left heart syndrome with pulmonary valvular abnormalities such as dysplasia, stenosis, or insufficiency is rare and not well defined in the literature. We report a rare case of hypoplastic left heart syndrome with a thickened four-leaflet, four-sinus pulmonary valve. After stage I palliation, this neo-aortic valve developed clinically significant insufficiency in the setting of increased pulmonary blood flow.
This study evaluated the impact of a multimodal antimicrobial stewardship intervention on fluoroquinolone (FQ) use for prophylaxis in outpatient urologic procedures.
Methods:
This single-center retrospective cohort study included patients from the South Texas Veterans Affairs (VA) outpatient urology clinic who underwent procedures between December 1, 2020, and February 29, 2024. Interventions included academic detailing, provider-specific FQ use reports, and prospective urine culture reviews with feedback. One pre-intervention cohort (PRE) and three post-intervention cohorts (POST2021, POST2022, POST2023) were analyzed. The primary outcome was FQ days of therapy (DOT); secondary outcomes included inappropriate prescriptions, post-operative complications, emergence of FQ resistance within 1 year, and Clostridioides difficile infection within 30 days of prophylaxis.
Results:
This analysis included data from 548 patients (150 PRE, 139 POST2021, 168 POST2022, 91 POST2023). Median age was similar across groups (p = 0.20), with over 90% male in each cohort (p = 0.07). Over one-third in each cohort received pre-operative oral antibiotics, 25% of which were FQs. More than 90% received pre-operative IV antibiotics, and over 50% received post-operative oral antibiotics. A significant reduction in FQ DOT/100 procedures was noted from pre- to post-intervention groups (98.6 PRE, 49.6 POST2021, 53.5 POST2022, 45.1 POST2023). No significant differences were observed in the secondary clinical outcomes.
Conclusion:
A multimodal stewardship initiative reduced FQ use before urologic procedures, mainly due to decreased IV use. Further efforts are needed to optimize pre-operative FQ use and address drivers of post-operative antibiotic prescribing.
The main objective of this article is to examine history textbooks as sites of discursive contestation regarding the treatment of the 1986 Jeltoqsan protests, a pivotal moment in post-independence Kazakhstani collective memory. This research analyzes the multilayered and inter-discursive domains of Jeltoqsan across the History of Kazakhstan textbooks published between 1992 and 2024. It focuses on four key contested themes between official narratives and those of protest mourners and sufferers: the portrayal of Dinmukhamed Qonaev, whose dismissal sparked the protests; the role of former President Nursultan Nazarbaev in handling the aftermath; the framing of Jeltoqsan as either an ordinary event or an uprising for significant political change; and ethnic or non-ethnic dimension of the protests. The findings reveal discursive competition and conflict in articulating the official and protestor narratives.
Autistic adolescents are at higher risk of self-harm, suicidal behaviours, and emotion dysregulation compared with their non-autistic peers. Dialectical behaviour therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviour with emerging literature of the application of DBT for autistic populations. Despite this, no qualitative research has investigated the experiences of autistic adolescents of standard DBT. Therefore, this study aimed to explore autistic adolescents’ experiences of non-adapted DBT. Ten adolescents who had or were seeking an autism diagnosis, and were in a DBT programme, completed semi-structured interviews. Qualitative data from the interviews were analysed using reflexive thematic analysis. Themes were generated for each objective. Objective 1 included themes about the lived experience of autistic adolescents accessing DBT, including: ‘The impact of invalidation’, ‘Fostering acceptance and understanding’, ‘What does autism mean to me?’, and ‘Autism and mental health difficulties’. The themes regarding Objective 2 were about the experiences of the various modes of DBT and were organised by each client-facing mode. Objective 3 included themes highlighting the experience of utilising DBT skills in daily life, which included: ‘Barriers to skills use’, ‘Supporting skills use’, and ‘Skills practice or masking?’. Finally, Objective 4 included themes regarding the recommendations participants had for optimising DBT for autistic people: ‘Improving written materials’ and ‘General accessibility advice’. These findings suggest for DBT therapists to embody cultural humility, curiosity, validation, and flexibility when building neuro-affirmative competencies for supporting autistic individuals. Results are discussed in relation to the application and acceptability of DBT for this group.
Key learning aims
(1) Recent publications (e.g. Keenan et al., 2023) have explored the experience of autistic adults accessing DBT and highlighted the need for clinicians to work collaboratively with clients and make reasonable adjustments to improve autistic adults’ understanding and adherence to DBT.
(2) To date, no qualitative studies have explored the experience of autistic adolescents accessing the Rathus and Miller (2015) Adolescent DBT model. The current study explores the views of autistic adolescents on how autism is discussed and considered by clinicians when supporting them to access different components of DBT when describing the strengths and barriers they experience.
(3) Adopting a bottom-up approach, we identify key themes from adolescents’ perspectives on how to support them to access and engage with different DBT components, ranging from making environmental adaptations to meet individual sensory needs to improve accessibility, to providing more opportunities for personalised learning using neuro-affirmative examples that can improve generalisability of skills in everyday life. We provide recommendations for clinicians to consider on ways of adapting the process and content of DBT to increase accessibility and engagement for autistic adolescents in treatment.
Disclosing transition plans to meet future net zero climate targets requires organisations to fundamentally move beyond traditional historical-oriented stewardship reporting towards forward-looking accountability to meet their obligations to their future shareholders and stakeholders. However, despite a range of varying requirements concerning disclosure of climate-related targets to meet the Paris Agreement, confusion remains over the appropriate form, content and standard of transition plan disclosure that are required to implement these targets. The former UK based Transition Plan Taskforce set out globally leading requirements for transition plan reporting in 2023, however the extent to which these recommendations have since been implemented has not yet been comprehensively analysed. This paper summarises the key differences between UK, European and International guidelines for transition plans and then discusses the results of an analysis of variations in transition plan reporting practices by a sample of globally large financial and industrial organisations. It is predicted that a combination of both firm-level climate risk and country-level institutional factors are associated with the propensity to produce public transition plans. The empirical results are largely supportive of these predictions. Firms with greater levels of engagement with climate risk (as proxied by the CDP score), and UK and-or EU based firms, are more likely to produce climate transition plans. The empirical results are corroborated by qualitative analysis, which compares examples of good practice transition plan reporting by a sub-sample of firms within each industry sector. It is concluded that the resulting lack of clarity by regulatory authorities, and diversity in transition plan reporting practices by globally large financial and industrial firms, may potentially result in confusion and a lack of informed decision-making by their stakeholders and policymakers concerning climate-related resilience and risk mitigation actions.
Kidneys are crucial for systemic lactate homeostasis, and a proper lactate balance subsequently supports normal kidney structure and function. The physiological lactate production-clearance axis along the proximal-distal tubular network may represent an important mechanism for maintaining tubulointerstitial microenvironmental balance. In the context of kidney diseases, the dynamic changes in lactate levels reveal the process of renal metabolic remodelling and even participate in the regulation of disease occurrence and progression.
Methods
This review systematically combs the maintenance of renal lactate homeostasis under physiological conditions and integrates current research findings on the roles of lactate in the initiation and progression of various kidney diseases, as well as the underlying core molecular mechanisms.
Results
Existing studies confirm that, in a variety of kidney diseases, abnormal lactate levels are closely associated with the occurrence of renal metabolic remodelling, and lactate itself can further regulate the progression of kidney diseases. Targeted regulation of lactate metabolism or lactate-related mechanisms of action is expected to provide a new perspective for the treatment of kidney diseases.
Conclusion
The exploration of lactate-related mechanisms offers potential insights for developing novel strategies for early diagnosis and therapeutic intervention of kidney diseases; however, more in-depth studies are still required to translate these findings into clinical practice.
We offer a novel analysis of conspiracy theorizing, according to which conspiracy theory communities are engaged in collective projects of storytelling. Other recent accounts start by analyzing individual conspiracy theorists’ psychologies. We argue that a more explanatorily unifying account emerges when we start by analyzing conspiracy theorizing as a social practice. This helps us better account for conspiracy theorists’ psychological heterogeneity. Some individual theorists care about uncovering the truth, while others incorporate truth into their theorizing in subtler ways; viewed as a social phenomenon, though, the function of conspiracy theorizing is not to discover the truth, but to tell good stories.
Few village-born social movements have influenced international relations as much as the campaign against Myitsone Dam in Burma (Myanmar). This village-born resistance led in 2011 to the suspension of a major Burmese and Chinese infrastructure project. This suspension became a symbol of democratization in Burma and a much-discussed setback of Chinese development-investment abroad. However, research literature on the Myitsone Dam has tended to conflate the local rural resistance with the broader ethnic Kachin and Burmese anti-dam movements. In contrast, this study focuses specifically on the local villages directly affected by the project, exploring their diverse stories and responses to the mega-project. Combining diverse published sources with ethnographic fieldwork and interviews done since 2010, it tells a story of displacement, resistance, social divisions, and complex relations with outsiders. This is a two-part article series. Another article – Part 1 – explores the Myitsone Dam’s rural story from its earliest days until the mega-project’s fall. This article – Part 2 – examines what has occurred after the mega-project’s suspension. It explores local village experiences after most residents had been resettled into relocation villages, from 2010 until now. This story begins with a bomb attack against the project and traces the village struggles until a post-coup gold mining boom.
Computational archaeology and theoretical archaeology often appear as separate domains within the field, each driven by distinct methodologies and objectives. Through the lens of discussions held at the 2021 Central European Theoretical Archaeology Group (CE-TAG) conference and analysis of a follow-up questionnaire, this study explores the current trends and intersections between these areas to identify opportunities for meaningful integration. We highlight key challenges, such as the theoretical underpinnings of computer-assisted methods, the epistemological implications of data-driven approaches, and the need for open-science practices. Our findings emphasize the importance of mutual understanding and collaboration, particularly in research and education, in bridging divides and enhancing the synergy between these domains. By addressing shared concerns such as bias, scalability, and methodological transparency, we propose a framework for fostering innovation in both computational and theoretical archaeology while maintaining their shared goal of interpreting the human past.
A vast body of literature studies how national identities explain immigration attitudes. In Europe, however, migration policy is largely Europeanised, requiring a European perspective. This article distinguishes between civic and cultural European identities and theorises how the two identity types relate to characteristics of immigrants with respect to admission decisions. Among others, we introduce the novel hypothesis that value congruence among Europeans and immigrants matters. The analyses of observational data and conjoint experiments show that Europeans with a cultural identity hold more restrictive attitudes; civics particularly prioritise immigrants who share their own values, while culturals more strongly reject immigrants who are culturally distant (ie Afghans and Muslims). Despite these differences, the following finding stands out: The more distant immigrants are perceived, the less likely they are to be admitted by Europeans from both identity types, raising serious questions about the role of humanitarian reasons in immigration decisions.
Umbrella reviews (URs) synthesize findings from multiple systematic reviews on a specific topic. Methodological approaches for analyzing and presenting UR results vary, and reviewers often adapt methods to align with research objectives. This study examined the characteristics of analysis and presentation methods used in healthcare-related URs. A systematic PubMed search identified URs published between 2023 and 2024. Inclusion criteria focused on healthcare URs using systematic reviews as the unit of analysis. A random sample of 100 eligible URs was included. A customized, piloted data extraction form was used to collect bibliographic, conduct, and reporting data independently. Descriptive analysis and narrative synthesis summarized findings. The most common terminology for eligible studies was “umbrella reviews” (65%) or “overviews” (30%). Question frameworks included PICO (43%) and PICOS (14%), with quantitative systematic reviews included in most URs (98%), and 68% including randomized controlled trials. The most frequent methodological guidance source was Cochrane (32%). Data analysis commonly used narrative synthesis and meta-analysis, with Stata, RevMan, and GRADEPro GDT employed for presentation. Information about study overlap and certainty assessment was rarely reported.Variation exists in how data are analyzed and presented in URs, with key elements often omitted. These findings highlight the need for clearer methodological guidance to enhance consistency and reporting in future URs.
We explored the impact of infectious disease (ID) consultations on hospitalists’ prescribing of broad-spectrum, hospital-onset (BSHO) antibiotics. Periods with more ID consults had increased BSHO-DOT; however, this relationship was nonlinear, and ID consult frequency did not explain variability in prescribing. ID consultation should be considered when creating prescriber performance metrics.