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This study investigates the associations between social determinants of health (SDOH) and hypertension prevalence across Wisconsin communities, with particular attention to food environments, economic factors, and transportation patterns. Using data from the 2019–2020 Wisconsin State Inpatient Database (387,047 patients) and the 2020 AHRQ SDOH database, we employed spatial analysis and logistic regression models to examine relationships between hypertension prevalence and neighbourhood characteristics across 597 ZIP codes. Lower-income areas exhibited significantly higher hypertension prevalence (EE = 1.233, 95% CI: 1.128–1.347 for incomes under $14,999), neighbourhoods with greater food resource density showed protective associations (EE = 0.549, 95% CI: 0.474–0.636 for supermarket access). Active transportation patterns were associated with lower hypertension rates (EE = 0.879, 95% CI: 0.829–0.933 for walking). We observed a ‘Hispanic paradox’ in Milwaukee County, where Hispanic populations demonstrated lower hypertension prevalence despite socioeconomic disadvantages, whereas African American populations with similar disadvantages exhibited higher prevalence. Our proposed ‘Food Environment Synergy Model’ helps frame these findings by conceptualising food environments through three interacting dimensions: physical access, economic accessibility, and cultural dietary patterns. This integrated approach highlights how these dimensions collectively relate to unique risk and resilience profiles within communities, challenging conventional binary classifications of ‘food deserts’ versus ‘food secure’ areas. These findings indicate that addressing food access disparities, promoting walkable neighbourhoods, and preserving beneficial cultural dietary traditions may be related to lower hypertension prevalence and advance health equity in diverse communities. However, the analysis is cross-sectional, causality cannot be inferred; further longitudinal studies are needed to establish causal relationships.
Universities embody a fundamental paradox: they are institutions created to solve civilizational problems that have themselves become primary sites where such problems are generated. This paper develops “crack literacy” – the capacity to read institutional breaking patterns as information rather than failure. Through methodological engagement with kintsugi, the Japanese art of golden repair, we examine how universities operate as recursive systems where attempted solutions intensify original contradictions. Drawing on Byung-Chul Han’s temporal analysis, Isabelle Stengers’ concept of “learning to be affected,” and Bruno Latour’s hybrid networks, the investigation reveals why conventional approaches to institutional reform consistently reproduce the patterns they attempt to address. Following Yoko Tawada’s literary practice, this exploration allows itself to be shaped by the impossible conditions it investigates, developing forms of attention that conventional academic discourse cannot provide. Kintsugi doesn’t eliminate breaking but creates conditions for fragments to hold together differently. Universities practising crack literacy would learn to work with contradiction as structural necessity rather than problem to solve, developing temporal patience adequate to transformation that cannot be rushed.
Nussloch (Germany) is a distinctive site of interest, particularly as a reference sequence for Late Pleistocene European loess, because it provides a comprehensive record of millennial climate variability. A notable feature of this site is its location within an active quarry. Consequently, the stratigraphic profiles documented constitute an ephemeral record, susceptible to rapid disappearance or brief accessibility, contingent on the operational status of the quarry. In order to guarantee the maintenance of a complete record of the sequence, three separate cores were collected and labelled S1, S2, and S3. The results of core S2, which is the most complete and thoroughly examined, are presented here. A comparison is drawn with the most recent P8 profile that is currently available. XRF measurements, conducted after the cores had been opened and described, are also presented. Borehole logging was carried out in the field after core retrieval, and the resulting measurements are also presented. The findings of this study demonstrate that a high degree of correlation can be established between the records from outcrop investigations and core studies, demonstrating the importance of preserving such archives for future research.
How do partisan differences in mass behavior and attitudes vary across contexts? Using new individual-level panel data on the COVID-19 pandemic from 54,216 US adults between March 2020 and September 2021, we consider how partisan differences vary according to the personal costs and benefits of behaviors, their public symbolism, and elite-level policy choices. Employing various panel data estimators, including difference-in-differences, we evaluate how partisan gaps evolve across changes to the political and health contexts, including the national vaccine rollout, individual vaccination status, and within-state policy variation. We find partisan divides are substantial even in (ostensibly) apolitical domains, although they are tempered by higher net personal costs to actions, lower public symbolism, and elite policy choices that counter national party cues.
Cover crops (CCs) are widely promoted for their multifunctional roles in sustainable agriculture, including improving soil health, enhancing crop productivity, and suppressing weeds. This meta-analysis quantitatively assessed the effects of CCs on three key outcomes: soil organic carbon (SOC), successor crop yield, and weed biomass, based on data from multiple independent studies. Weighted random-effects models and log response ratios (lnRR) were used to synthesize results. CCs significantly increased SOC (mean lnRR = 0.390), corresponding to an estimated 47.7% gain compared with controls, although substantial heterogeneity was observed (I2 = 97%), indicating context-dependent responses across systems. Successor crop yields showed an overall neutral response (mean lnRR = 0.052), with high between-study variability (I² = 90.5%), suggesting that positive or negative outcomes depend on site-specific factors. Weed biomass was consistently reduced across all studies (mean lnRR = −1.759), corresponding to an average 82.8% suppression, although variability remained high (I² = 99.2%). Complementary economic analysis indicated that while CCs involve initial establishment costs (∼US$150 ha−1), these are often offset by savings in agrochemical use, improved weed and fertility management, and long-term gains in land value. Altogether, the results highlight the potential of CCs as a sustainable agronomic practice, offering multiple ecosystem services and economic co-benefits. Optimizing species selection, management timing, and system integration will be key to maximizing outcomes under diverse agronomic conditions.
This study aims to adapt and validate a Spanish (Argentina) version of the Caregiver Indirect and Informal Care Cost Assessment Questionnaire (CIIQ) to enable the measurement of informal care-related costs in the Argentine context, addressing the current lack of Spanish-language tools for assessing indirect costs.
Method
The CIIQ was translated, cross-culturally adapted, and validated for the Spanish–Argentine language and culture. Psychometric properties were evaluated in a purposive sample of relatives of patients with advanced chronic disease and limited life expectancy in Argentina. Missing data and internal consistency (Cronbach’s α) were assessed, along with discriminant capacity, content, and construct validity. Construct validity was examined through principal component analysis (PCA) and confirmatory factor analysis (CFA).
Results
The translation and cultural adaptation process was completed without major difficulties. A total of 154 caregivers completed the baseline questionnaire and 90 completed the follow-up assessment, with missing data remaining below 10% across items. Internal consistency was high for the overall instrument (α = 0.802) and for the unpaid care cost domain (α = 0.866). The productivity loss domain showed moderate reliability (α = 0.362). Low correlations with unrelated domains (ρ < 0.2) supported adequate discriminant validity. PCA identified 2 components – informal care costs (51.5% of explained variance) and productivity loss costs (20.3%) – which were further supported by CFA.
Significance of results
The Spanish–Argentine version of the CIIQ is a reliable and culturally appropriate instrument for assessing the economic burden of informal care in Argentina. While the unpaid care items demonstrated strong psychometric performance, productivity-related items may require refinement to improve reliability in future applications.
The COVID-19 pandemic presented significant challenges to infectious disease management and mental health services (MHS). Service demand and delivery changed due to fear of infection, economic hardships, and the psychological effects of protective measures. This systematic review with meta-analysis aims to quantify these impacts on different mental health service settings.
Methods
Comprehensive searches were conducted in PubMed, Embase, and PsycINFO, focusing on studies published from the initial outbreak of COVID-19, starting in November 2019. Studies were included comparing the utilization of mental health inpatient, emergency department (ED), and outpatient services (including telemedicine and medication prescriptions) before and during the COVID-19 pandemic. A random-effects model was employed to estimate pooled effects, with study quality assessed using a modified Newcastle-Ottawa Scale.
Results
Among 128 studies, significant decreases in utilization were observed during the initial phase of the pandemic for inpatient services (RR: 0.75, 95% CI: 0.67 to 0.85) and ED visits (RR: 0.87, 95% CI: 0.69 to 1.10). Outpatient services showed a similar decline (RR: 0.78, 95% CI: 0.66 to 0.92), while no significant change was found in psychotropic medication prescriptions (RR: 0.90, CI: 0.77 to 1.05). In contrast, telemedicine utilization increased significantly (RR: 7.57, 95% CI: 3.63 to 15.77).
Conclusions
The findings reveal substantial shifts in mental health service utilization during the pandemic, with the largest reductions in inpatient services and significant increases in telemedicine use. These results emphasize the need for flexible healthcare models. Further research is essential to evaluate the consequences of reduced MHS utilization.
We prove an André–Oort-type result for a family of hypersurfaces in ${\mathbb{C}}^n$ that is both uniform and effective. Let $K_*$ denote the single exceptional imaginary quadratic field which occurs in the Siegel–Tatuzawa lower bound for the class number. We prove that, for $m, n \in {\mathbb{Z}}_{\gt0}$, there exists an effective constant $c(m, n)\gt0$ with the following property: if pairwise distinct singular moduli $x_1, \ldots, x_n$ with respective discriminants $\Delta_1, \ldots, \Delta_n$ are such that $a_1 x_1^m + \cdots + a_n x_n^m \in {\mathbb{Q}}$ for some $a_1, \ldots, a_n \in {\mathbb{Q}} \setminus \{0\}$ and $\# \{ \Delta_i \;:\; {\mathbb{Q}}(\sqrt{\Delta_i}) = K_*\} \leq 1$, then $\max_i \lvert \Delta_i \rvert \leq c(m, n)$. In addition, we prove an unconditional and completely explicit version of this result when $(m, n) = (1, 3)$ and thereby determine all the triples $(x_1, x_2, x_3)$ of singular moduli such that $a_1 x_1 + a_2 x_2 + a_3 x_3 \in {\mathbb{Q}}$ for some $a_1, a_2, a_3 \in {\mathbb{Q}} \setminus \{0\}$.
Extreme weather events, combined with human-induced factors, such as expanding impervious surfaces and inadequate drainage infrastructure, are driving escalating urban flood risks worldwide. In this study, we present a novel spatiotemporal Long Short-Term Memory (LSTM)-based surrogate of the U.S. Environmental Protection Agency (EPA)’s Storm Water Management Model (SWMM) to predict maximum water depth and inflow at the asset level within urban drainage networks. The high-resolution SWMM model, encompassing the full network of conduits and manholes, was first calibrated and validated using U.S. Geological Survey (USGS) observations. The LSTM surrogate was then trained on data from 5,000 rainfall events across seven Annual Recurrence Intervals (ARIs) ranging from 1 to 100 years. The SWMM-LSTM surrogate model consistently achieves high predictive performance for both water depth and inflow, highlighting its robustness across diverse storm scenarios and ARI conditions. Hyperparameter optimization via grid search revealed task-specific configurations: larger hidden layers with moderate dropout improved water depth predictions, while deeper network architectures with minimal dropout optimized inflow forecasts. By providing rapid, computationally efficient predictions without compromising accuracy, the SWMM-LSTM surrogate offers a practical tool for real-time flood risk assessment, scenario evaluation and actionable decision-making in complex urban drainage systems.
During World War II, condom consumption increased in both belligerent and non-belligerent countries, including Sweden. Yet the relationship between state-led initiatives and commercial marketing in driving this trend has received little scholarly attention. The main sources in this article consist of wartime public health campaigns and condom advertisements. Applying the concepts of social and consumer engineering, the article examines how government interventions, specifically through public health measures, influenced condom marketing practices. The findings show that wartime campaigns sought to engineer citizens’ sexual behavior and that businesses strategically aligned their messaging with government propaganda. This convergence was instrumental in positioning condoms as essential tools for public health and facilitated a more permissive attitude toward condoms as prophylactics, bridging state-led public health efforts with commercial objectives. By examining this dynamic, the article contributes to understanding how wartime policies shaped consumer behavior and forged enduring connections between public health and market strategies.
This series of comments brings together four historians of neoliberalism, each of whom focuses on a different part of the world but whose work has implications that are transnational if not global. Quinn Slobodian reconstructs the rise of the category of neoliberalism among historians and identifies the different paths of inquiry it is generating. Priya Lal, offering an Africanist’s perspective, moves beyond the reduction of the neoliberal narrative of the continent to one of linear declension and abjection by way of structural adjustment to show continuities from the colonial era to early independence. Gary Gerstle, an Americanist by training, offers a macro take on the move from a Keynesian and social democratic order to a neoliberal one while insisting we attend to the diverse ways policies and elite neoliberal ideas are taken up by populations for whom promises of freedom may mean something different from what intellectuals intended. Finally, Tehila Sasson, a historian of modern Britain and the world, explores the left-wing features of what has come to be called neoliberalism, insisting we keep a keen eye out for unintended consequences and unlikely origins. Together, the comment offers a satellite’s eye view of a subfield reaching maturity.
The effects of wall temperature on hypersonic boundary layer transition are investigated by analysing the kinematics (acoustic ray trajectories) and mechanics (fluctuation energy production and transport) of second-mode instabilities. The disturbance energy formulation is taken from Roy & Scalo (J. Fluid Mech. 2025, vol. 1007, A49). Flow conditions are taken from a Mach 6 boundary layer over a $3^\circ$ cone, with varying degrees of wall-to-adiabatic temperature ratios, $\varTheta =T_w/T_{\textit{ad}}=0.25{-}1.75$. Boundary layer-resolved axisymmetric direct numerical simulations with companion Laguerre polynomials-based linear stability theory provide the supporting numerical datasets. It was found that second-mode instabilities comprise two decks, separated by the pressure node location $(y=y_\pi )$. The upper deck ($y\gt y_\pi$) is characterised by temperature ($T^{\prime}$) and density ($\rho'$) fluctuations working with in-phase wall-normal velocity fluctuations ($v'$) to sustain the total disturbance energy production term, $-(\rho _0 v'T'\partial T_0/\partial y+\rho ' u_0 v' \partial u_0/\partial y$), which peaks at the generalised inflection point $y=y_i$. The downward-oriented energy flux peaks below the critical layer, $y\lt y_c$, and sustains acoustic energy accumulation in the lower deck. Effective energy transfer requires the streamwise and wall-normal fluxes to maintain a $90^\circ$ phase difference. This is satisfied especially for colder walls, whereas heated walls yield out-of-phase $v'$–$T'$ and in-phase pressure ($p'$) – streamwise velocity ($u'$) fluctuations, reducing the disturbance energy production and discouraging the coupling between the two decks. Ray tracing reveals the trajectory of purely acoustic wave paths emanating from the wall, as trapping occurs below the generalised inflection line $(y_i)$, governed by the mean flow velocity gradients $(\partial u_0/\partial y)$.
In this article, I explore how the mental health and mental capacity laws in England and Wales can be used for suicide prevention. I criticise the use of compulsion for persons diagnosed with a mental disorder who nonetheless retain decision-making capacity and argue for a greater reliance upon capacity as a distinguisher between autonomous decision-making about the end of life and the risk to life posed by symptoms of mental illness. The label of ‘suicide’ is also criticised as an outdated legal notion carrying pejorative meaning. Although focused on the law in England and Wales, the arguments apply much more broadly to all jurisdictions seeking to reconcile the demands of respect for life and respect for autonomy.
Clinical pharmacists are increasingly recognized as essential members of multidisciplinary palliative care teams, yet their specific roles and impact have not been comprehensively summarized. This scoping review aimed to systematically map and synthesize published evidence on the clinical roles, interventions, and professional contributions of pharmacists within multidisciplinary palliative care services for patients with non-communicable diseases.
Methods
A scoping review was conducted by searching PubMed, Embase, Web of Science, and Scopus from January 2000 to May 2024. Eligible studies reported clinical pharmacist interventions in palliative care. Data were extracted on study characteristics, pharmacist activities, and clinical outcomes.
Results
Twelve studies were included, predominantly from the United States. Pharmacist-led interventions encompassed medication reconciliation (91.7%), symptom management (83.3%), adverse drug event prevention (75.0%), patient and caregiver education (58.3%), and policy-level contributions (33.3%). High physician acceptance rates (≥90%) were consistently reported. Outcomes included improved symptom control, reduced drug-related problems, and enhanced patient-reported quality of life.
Significance of results
This scoping review synthesizes current evidence on the roles of clinical pharmacists in palliative care teams. The findings highlight their essential contributions to medication safety, symptom management, deprescribing, and opioid stewardship, reinforcing the need for pharmacist integration into multidisciplinary palliative care models to improve patient-centered outcomes. Future research should focus on implementation models, cost-effectiveness analyses, and service expansion in community-based settings.
La espelunca La Espiral, en la provincia Artemisa, presenta varias pinturas de las que sobresalen círculos concéntricos y una espiral. Para conocer la composición química de sus pinturas y obtener la fracción orgánica, que resulta la más difícil de estudiar a causa del comprensible proceso de degradación en el tiempo, se emplearon la microscopía electrónica de barrido y microanálisis de energía dispersiva por rayos-X, la microespectroscopía Raman y la cromatografía de gases acoplada a espectrometría de masas. El estudio nos muestra una comunidad de bajos niveles productivos con la capacidad técnica de crear una mezcla compleja con huevo, leche, ácido elágico y, como colorante principal, guano de murciélago. El hallazgo de residuos de aminoácidos de triptófano de huevo y leche en la mezcla pictórica resulta la primera evidencia arqueológica concreta del empleo de ambos productos en Cuba y las Antillas. Se propone la propuesta de la posible cadena operativa vinculada a la preparación de la pintura, a una aproximación a la inversión laboral y al número de miembros implicados en la ejecución de los gestos técnicos. Se teoriza sobre la relevante presencia femenina en su manufactura.
Malnutrition is highly prevalent among oncology patients, with large-scale studies reporting involuntary weight loss in 31–87%, depending on tumour site and disease stage. A combination of nutrition-impact symptoms, reduced oral intake and systemic inflammation lead to poor tolerance to treatment, diminished quality of life and reduced survival. Systemic inflammation is a hallmark of cancer-associated malnutrition and contributes to loss of lean mass and abnormal body composition phenotypes (sarcopenia, cachexia and low muscle density) which may coexist with overweight and obesity. Malnutrition screening tools are widely used to identify patients at risk; however, traditional weight and BMI-based instruments such as the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) frequently misclassify patients with cancer as well-nourished. These tools fail to account for nutrition-impact symptoms, inflammation and muscle wasting. Although obesity is an established cancer risk factor, 40–60% of patients with metastatic disease remain overweight or obese during treatment. When screening tools are BMI-based, high fat stores mask muscle wasting, leading to misclassification of nutritional risk and delayed dietetic referrals. To improve detection, screening tools should incorporate patient-reported symptoms, inflammatory markers and body composition assessment, enabling earlier, proactive nutritional care. Alternatively, it may be time to acknowledge that all cancer patients are inherently ‘at-risk’ of malnutrition and to prioritise universal access to dietetic support from diagnosis through treatment. This review summarises current malnutrition screening and assessment practices in oncology and outlines key considerations for future research and clinical practice.
What does decolonial justice require in response to the epistemic devastation of colonisation? Recent work proposes restoring lost epistemic status or compensating victims with epistemic goods. I argue that neither restitution nor compensation is a viable response to the destruction of Indigenous knowledge systems. Drawing on international law and reparations theory, I show that these frameworks neglect the role of proportionality as a normative constraint on adequate redress. Once this constraint is taken seriously, it becomes clear that the logic of repair is incompatible with the aims of decolonisation.
In 2024, US hospitals were affected by the Becton Dickinson (BD) BACTEC blood culture bottle shortage with little time to respond and conserve supply. The extent of the impact of this shortage on clinical practice has not been explored.
Methods:
We developed a 7-question online poll with the Emerging Infections Network (EIN) exploring the extent to which facilities were impacted by the shortage, the geographic location and facility type of institutions affected, the actions taken to mitigate the shortage, and the impact on clinical management of fever and Staphylococcus aureus bacteremia. The link was sent to >3,100 EIN listserv members 3 times during September 2024. Descriptive and thematic analyses were performed on quantitative and qualitative responses.
Results:
Of 202 respondents from 39 states, 129 said their hospital had limited blood cultures available, 8 were unsure how their hospitals were affected, and 65 indicated their hospitals were not affected. Top mitigation strategies included publishing algorithms for best practice use, restricting follow-up blood cultures, using single blood culture sets, and implementing EMR-based alerts on blood culture orders. Important clinical themes identified by affected respondents included limitations on blood culture use, concerns with overall treatment and care, concerns with bacteremia management, and increased diagnostic stewardship opportunities.
Conclusion:
The BD BACTEC blood culture bottle shortage caused widespread clinical impact. The themes identified highlight the challenges placed on healthcare systems during times of shortage as well as the effects on patient care. Mitigation strategies implemented during the shortage may create future opportunities for diagnostic stewardship.