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Implementation represents the most crucial step in the policy process; it is at this stage where the hardest battles for policy success are fought. Implementation is also the most complex of the policy cycle stages, with the largest amount of resources and highest number of actors involved in it. In the realm of social policy, outputs and outcomes determined during the implementation stage have a direct impact on the welfare of the population. However, in both political and academic domains, the analysis of implementation activities commonly receives less attention than the other stages. This article seeks to address this gap by reviewing and comparing relevant issues of social policy implementation in Latin America and Southern Europe, regions that share similar historical and political legacies. Research on these two regions enables the identification of many critical obstacles that social policy implementation faces today in these and other contexts and of opportunities for its improvement.
The extent to which continental acidity during the Early Triassic varied with latitude remains insufficiently constrained, despite its relevance for understanding environmental stress and biotic recovery patterns across the Smithian–Spathian boundary (SSB). We examined the abundance, textures and compositions of strontium-rich hydrated aluminium phosphate–sulphate (APS) minerals in 179 continental samples spanning tropical to high paleolatitudes in both hemispheres. APS minerals display broadly comparable early-diagenetic features across sections, indicating formation shortly after deposition under acidic meteoric conditions. Their distribution suggests a latitudinal trend: APS contents commonly exceed 0.1 vol.% in equatorial western peri-Tethyan basins, where faunal and floral records are sparse during the SSB, whereas concentrations decrease towards higher latitudes and are rare beyond ∼40° in both hemispheres. This pattern does not appear to correlate with lithological or textural variability and may reflect spatial differences in the intensity or duration of acidification linked to Siberian Traps volcanism. Equatorial basins thus likely experienced more prolonged or recurrent acidic episodes, whereas higher-latitude areas may have been subject to comparatively attenuated effects, potentially contributing to earlier ecological recovery. These results provide a useful framework for evaluating continental acidification and its environmental implications during the interval following the end-Permian mass extinction (EPME).
We have been conducting mass-balance monitoring on Aldegondabreen since the early 21st century. Over the most recent five year period (2019/20–2023/24), the glacier has experienced its most negative mass balance, averaging −2.0 m w.e. a−1. This dramatic loss is linked to rising air temperatures, with several of the warmest years on record for the Arctic land occurring during this interval. In 2024, for the first time, the critical threshold of 1.5°C above pre-industrial levels was exceeded globally, and this resulted in the lowest annual balance observed since the beginning of our monitoring program (−2.48 m w.e. a−1). Archival evidence indicates that such intense melting is unprecedented since at least 1911, which marked the end of the Little Ice Age in the region. As of 2025, the glacier’s mean ice thickness has been estimated at 39 m (33 m w.e.) meaning that the loss of 10 m w.e. in just the last five years is an enormous change.
The purpose of this work is to develop a version of Forman’s discrete Morse theory for simplicial complexes, based on internal strong collapses. Classical discrete Morse theory can be viewed as a generalization of Whitehead’s collapses, where each Morse function on a simplicial complex $K$ defines a sequence of elementary internal collapses. This reduction guarantees the existence of a CW-complex that is homotopy equivalent to $K$, with cells corresponding to the critical simplices of the Morse function. However, this approach lacks an explicit combinatorial description of the attaching maps, which limits the reconstruction of the homotopy type of $K$. By restricting discrete Morse functions to those induced by total orders on the vertices, we develop a strong discrete Morse theory, generalizing the strong collapses introduced by Barmak and Minian. We show that, in this setting, the resulting reduced CW-complex is regular, enabling us to recover its homotopy type combinatorially. We also provide an algorithm to compute this reduction and apply it to obtain efficient structures for complexes in the library of triangulations by Benedetti and Lutz.
Research into the Developmental Origins of Health and Disease (DOHaD) has established links between environmental exposures in early life and later-life health outcomes. Emerging interventions typically focus on improving maternal nutrition and neonatal healthcare practices yet often neglect to assess or enhance subject understanding of potential long-term impacts or to communicate the benefits of maximising parental health prior to conception. This study critically evaluates a survey tool developed to measure knowledge of non-communicable diseases (NCDs) and early-life contributors to lifelong health. The rationale behind the wording and format of the questions is examined alongside options for coding and statistical interpretation of the data. Considerations for implementation are discussed, illustrated by key findings arising from tracking of the tool’s application in Aotearoa New Zealand over ten years. We demonstrate that the survey tool can be adapted for use in a variety of contexts, producing both quantitative and qualitative baseline data suitable for informing health promotion interventions and monitoring changes in population knowledge. This research also highlights a key difference between awareness of and understanding of scientific concepts and the importance of distinguishing between these when considering public engagement with science.
Englacial layers are a product of historic accumulation and are reshaped by ice deformation. Hence, radio-echo sounding (RES), which can resolve englacial layering, has been adopted as an observational tool to infer ice age and ice dynamics from ice stratigraphy. However, the commonly applied synthetic aperture radar focusing algorithms, used to improve image resolution, are either i) incoherent or ii) optimized for the ice-bed interface. Dipping specular reflectors, such as englacial layers, are then lost during focusing. Instead, we focus the RES measurements using subapertures, synthetically squinting the radar beam toward orthogonal incidence for every dipping layer. We then either recombine all subapertures or reject those with low signal to generate an image that resolves all englacial targets together. We apply these methods to both along- and across-flow RES images at Academy Glacier, East Antarctica, which has significant englacial layer relief, especially perpendicular to the ice-flow direction. Our method significantly elevates signal power for dipping englacial layers ($ \gt $15 dB), and quantifiably improves layer continuity compared to other processed data products. This squinted focusing approach enables novel studies of ice deformation (as recorded in englacial layering) in the presence of complex basal topography and heterogeneous substrate properties.
Individuals with mild cognitive impairment (MCI) and dementia often engage in self-regulatory driving behaviours, but less is known about individuals with subjective cognitive impairment (SCI), who perceive cognitive decline without objective evidence of it.
Objective and Methods
This study describes the driving status and habits of older Canadians in the COMPASS-ND data set (n = 955) across cognitive groups: cognitively unimpaired (CU), SCI, MCI, and dementia.
Findings
Most participants reported having a driver’s license without restrictions, including over half of the Dementia group, who differed from the other groups by driving less often, shorter distances, and with greater restrictions. Interestingly, on driving frequency and restriction measures, the SCI group showed greater similarity to the MCI than the CU group. Females reported driving less frequently, shorter distances, and with more restrictions than males across cognitive groups.
Discussion
Results suggest that cognitive status and sex influence the driving habits of older adults, with potential implications for autonomy and independent mobility.
Identifying diagnoses from noncoded healthcare visit records presents logistical challenges when large number of records are screened. This study aimed to develop a screening process to identify otitis media (OM) diagnoses in free-text primary care visit records.
Methods:
The free-text primary care records of 200 children aged 0 to 4 years were reviewed independently by three clinicians to determine whether OM was a diagnosis considered during each visit. Terms (abbreviations, words, and phrases) identifying visits where OM was considered or excluded were documented. These terms were used to design a software algorithm subsequently used to detect OM diagnosis within these primary care records. The diagnostic performance of the software algorithm was determined against the gold standard clinicians’ review and described using sensitivity, specificity, predictive values (PVs), and likelihood ratios (LRs) with 95% confidence intervals (CIs).
Results:
The 200 children had 10,034 primary care visits. Clinician review identified 917 (9%) visits where OM was considered, and 9117 (91%) visits where OM was excluded. The software algorithm identified 801/917 visits where OM was considered and 8705/9117 visits where OM was excluded. The algorithm sensitivity was 87% (95% CI 85–89), specificity 96% (95% CI 95–96), positive PV 66% (95% CI 63–69), negative PV 99% (95% CI 98–99), positive LR 19.33 (95% CI 17.54–21.31), and negative LR 0.13 (95% CI 0.11–0.16).
Conclusion:
Software algorithms can assist in screening healthcare visit records. When combined with clinician review, they enable accurate identification of OM visits from non-coded records.
Direct numerical simulation is performed to study the effects of spanwise curvature on transitioning and turbulent boundary layers. Turbulent transition is induced with an array of resolved cuboids. Spanwise curvature is prescribed using a novel approach with a body force that is applied orthogonally to the bulk flow to curve the mean free-stream streamlines at a set radius. The flows are analysed in a streamline-aligned coordinate system. Although the radius of curvature is large compared with the size of the boundary layer, its effects on the development of the boundary layer are appreciable. The results indicate that spanwise curvature induces a non-uniform mean secondary flow and alters the structure of turbulence within the boundary layer. Analytical expressions for the crossflow are derived in the viscous sublayer and log layer. These alterations are visible as changes in the distribution of the turbulent stresses and alignment of the vortical structures with the mean flow. These modifications are responsible for a misalignment between the Reynolds stress tensor and the velocity gradient tensor, which has important consequences for the validity of the widely used Boussinesq turbulent viscosity hypothesis in Reynolds-averaged Navier–Stokes models. Spanwise curvature was observed to decrease turbulent kinetic energy. These results have important implications on the development of turbulence in general applications, such as the flow over a prolate spheroid.
Previous studies show that at the small scales of stably stratified turbulence, the scale-dependent buoyancy flux reverses sign, corresponding to a conversion of turbulent potential energy (TPE) back into turbulent kinetic energy (TKE). Moreover, the magnitude of the reverse flux becomes stronger with increasing Prandtl number $\textit{Pr}$. Using a filtering analysis we demonstrate analytically how this flux reversal is connected to the mechanism identified in Bragg & de Bruyn Kops (2024 J. Fluid Mech. vol. 991, A10) that is responsible for the surprising observation that the TKE dissipation rate increases while the TPE dissipation rate decreases with increasing $\textit{Pr}$ in stratified turbulence. The mechanism identified by Bragg & de Bruyn Kops, which is connected to the formation of ramp–cliff structures in the density field, is shown to give the scale-local contribution to the buoyancy flux. At the smallest scales this local contribution dominates and explains the flux reversal, while at larger scales a non-local contribution is important. Direct numerical simulations of three-dimensional statistically stationary, strongly stably stratified turbulence confirm the theoretical analysis, and indicate that, while on average the local contribution only dominates the buoyancy flux at the smallest scales, it remains strongly correlated with the buoyancy flux at all scales. The results show that ramp cliffs are not only connected to the reversal of the local buoyancy flux but also the non-local part. At the small scales (approximately below the Ozmidov scale), ramp structures contribute exclusively to reverse buoyancy flux events, whereas cliff structures contribute to both forward and reverse buoyancy flux events.
Relying on a variety of archival sources, including the recently discovered private correspondence of the Uruguayan diplomat Enrique Buero, this article demonstrates that a Latin American bloc with a common agenda emerged in Geneva during the 1920s and transformed the codification of international law in both the League of Nations and the Pan-American Union. Key pressure groups previously thought to have operated exclusively in the Americas were created in the League by Latin American diplomats who wanted to reform international law to protect small states but had lost faith in Pan-Americanism. The article examines the ideological origins of this bloc and the obstacles that it encountered, including an initial tendency among some diplomats to prioritize status-seeking. It charts the Latin American bloc’s success in dismantling obstacles to the League’s involvement in the Americas. Finally, the article demonstrates that the bloc was able to leverage its influence beyond the League, including during the run-up to the 1933 Montevideo Conference.
As an essential trace element, iron is indispensable for oxygen transport, energy metabolism, and other physiological processes. During the physiological stage of gestation, the iron demand of sows increases substantially. Iron deficiency anemia is highly prevalent in pregnant sows, adversely affecting their reproductive performance and potentially inducing growth retardation, weakened immunity, and compromised health in piglets. Consequently, these adverse outcomes can ultimately compromise the sustainable production of sows. To address this issue, dietary iron supplements have evolved from inorganic forms like ferrous sulfate through organic salts such as ferrous fumarate to the current chelated iron, which is currently known for its high bioavailability. This paper reviews the relationship between iron metabolism and anemia in pregnant sows, analyzes the negative impacts of anemia on sow reproductive performance and piglet health, and discusses nutritional strategies for iron regulation within the context of sustainable swine production. This review aims to provide a theoretical basis for improving sow productivity and promoting sustainable development in the swine industry.
Cumulative stress exposure is extensively involved in carcinogenesis. However, cancer risk associated with allostatic load (AL), a valid measure of chronic stress, has not been comprehensively evaluated in large cohorts, and the combined effect of AL and personality trait on cancer risk remains unknown.
Methods
This prospective cohort study was conducted based on 245,683 participants from the UK Biobank, with a median follow-up of 13.5 years. The AL score was calculated based on 11 biomarkers. Personality traits were constructed and categorized into two clusters. Multivariable Cox regression model was used to assess the risk of incident cancer according to AL and personality clusters, and multiplicative and additive interactions were evaluated.
Results
High AL was associated with an increased cancer risk compared to low AL (hazard ratio [HR] = 1.06, 95% confidence interval [CI]: 1.04–1.09), particularly for cancers of stomach, liver, kidney, esophageal, lung, colorectal, breast, and leukemia (HR ranged from 1.08 to 1.43). Personality clusters was associated with risk of lung cancer (HR = 1.14, 95% CI: 1.05–1.23), but not overall cancer. Significant synergistic interaction was observed between high AL and ‘nervous-dominant’ personality for overall cancer risk, with the strongest association observed for liver cancer (HR = 1.58, 95% CI: 1.24–2.02).
Conclusions
High AL was related to higher risks of overall cancer and site-specific cancers, particularly when combined with nervous-dominant personality, highlighting the interplay between chronic physiological stress and psychological factors in cancer development.
This study aims to compare the dosimetric accuracy between the enhanced leaf model (ELM) in Eclipse V18.0 and the traditional multileaf collimators (MLCs) modelling in Eclipse V16.1 for volumetric modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT) treatments. The objective is to evaluate whether the ELM improves dose calculation accuracy and agreement with measurements in clinical practice.
Methods:
A retrospective analysis of 30 patients was conducted, categorized into Head-and-Neck (H&N), pelvic and lung SBRT groups. Treatment plans were created using the Acuros XB algorithm in both Eclipse versions. Gamma index pass rates for 1%/1 mm, 2%/2 mm and 3%/3 mm criteria were calculated using portal dosimetry for patient-specific quality assurance. Validation of MLC modelling was performed using closed leaf fields, sweeping gap fields, and the Picket Fence (PF) test across 6MV, 10MV, 6FFF and 10FFF photon energies.
Results:
Eclipse V18.0 demonstrated statistically significant improvements (p < 0·05) in dosimetric accuracy and gamma index pass rates across all photon energies and test conditions. In fully blocked fields, dose discrepancies reduced from 1.1% in V16.1 to 0.49% in V18 for 6MV. For the 6 mm sweeping gap test, discrepancies reduced from 1.19% to 0.31% for 6MV. The 1%/1mm gamma pass rates improved from 70% to 91.8% for H&N cases and from 82.4% to 87.3% for SBRT cases.
Conclusion:
The ELM in Eclipse V18.0 significantly improves dose calculation accuracy and treatment deliverability, supporting its adoption in clinical practice for VMAT and SBRT to achieve better treatment accuracy and outcome.
Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders.
Methods
We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years.
Results
In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15–1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99–1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15–2.09, fully adjusted model). The results further demonstrated an exposure–response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants.
Conclusions
Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.
This paper argues that recategorizing Lewis Carroll’s Alice’s Adventures in Wonderland (1865) and Through the Looking-Glass (1872) as humane children’s literature exposes a nineteenth-century humane education that was based in human exceptionalism, while the narratives also push for a conception of subjectivity that would include the child and nonhuman-animal. The Alice books overturn the popular nineteenth-century views that children were inferior British subjects and that nonhumans lacked subjectivity altogether (even as this era saw an upsurge in legal protections for children and animals alike). I argue that Carroll’s work satirizes, not just children’s literature, but humane children’s literature, imagining a revised form of humane education that resisted a speciesist indoctrination of the Victorian child. In the Alice books, humane education leads to positive interspecies relationships and provides children and animals with opportunities to model a robust humane framework for Victorian adult society, ultimately pushing for a view of children and animals not as subordinate to their adult (human) counterparts but as autonomous beings not lacking in subjectivity.
A stakeholder structured engagement process at the Sustainable Water Infrastructure Management (SWIM) conference and workshop was held in December 2024. The participants identified critical current and future issues facing the water sector that are synthesized in this paper. In particular, they highlighted issues of water systems’ vulnerability and lack of resilience to hazards and stressors; inequities associated with water scarcity; and water quality problems – all affected by natural or man-made influences. The Smart One Water (S1W) vision was the baseline for the SWIM 2024 conference. This paper expands the S1W vision with a synthesis of the conference discussions about S1W-related fundamental concepts, practices and implementation barriers. It includes initial recommendations – based on a digital, data-focused, stakeholder-driven approach – with expert representatives of the public and private water supply sectors, academia, government and policymakers tasked to generate real-world adaptable ideas and practical solutions. Specifically, S1W envisions a future where water management and governance silos are eliminated to provide the necessary collaboration to enable efficient, resilient, affordable and equitable water access capable of adapting to a changing environment. This would be a future where communities govern collaboratively through integrated decision-making on policy, management and funding of natural and engineered water systems at the river basin scale.
The specialties of ENT and anaesthesia have always had a unique relationship because of their longstanding history of co-operation over the shared airway.
Methods
This historical review narrates how the modern practice of ENT surgery has developed following advances in anaesthetic techniques, as well as inspiring them.
Results
From the earliest use of anaesthetic gases by Long, Wells and Morton, to their rapid adoption for use in tonsil and cleft palate surgical procedures, ENT surgeons were early beneficiaries of this new technology. The demands of surgery for facial injuries in World War II was a driver for anaesthetic advances, and Ivan Magill reinvented the specialty in response.
Conclusion
Further developments in managing the shared airway, including jet ventilation, total intravenous anaesthesia and awake fibre-optic intubation, have shaped the modern ENT operating theatre, and highlight the vital collaboration between ENT and anaesthesia over the past 150 years.