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Higher-order uncertainty is uncertainty about what one’s evidence supports. In many cases, a rational reaction to such uncertainty is to engage in inquiring activities like double-checking or redeliberating, with the aim of securing a firmer grasp of the evidence. An attractive idea is to account for the epistemic impact of higher-order uncertainty in terms of these inquiring activities. However, I argue that zetetic accounts along these lines are, at best, incomplete, because they cannot deal satisfactorily with cases in which higher-order uncertainty persists even if further inquiry is not required (cases at the end of inquiry). In this paper, I put forward a more general account of the impact of higher-order uncertainty. On this view, higher-order uncertainty may defeat propositional justification by undermining one’s access to the relevant evidence. Losing access to some evidence often calls for further inquiry. However, when this further inquiring is ineffective, inadvisable, or merely optional, one may be justified to adopt instead revised attitudes that fit one’s limited access to the evidence. This proposal accounts for the impact of higher-order uncertainty at the end of inquiry and offers an appealing explanation of the relations between this type of uncertainty and inquiry.
Results are presented of an experimental investigation into the levitation of spheres on thin layers of viscous fluid. In one set of experiments the layer is formed on a planar vertical wall and in a second investigation the sphere sits on a fluid layer on the inside of a rotating horizontal cylinder. The motion takes place at a set of fixed locations in the latter case whereas the sphere generally translates up or down the plane wall of the belt. Lubrication layers formed between the surfaces of the spheres and the walls induce slip. Two distinct states are identified, and excellent accord is found between experimental results and those from a recently developed theory for the single-track state which is only observed in the rotating horizontal cylinder. The two-track state exists in both sets of experiments, but theoretical progress with this remains an outstanding challenge.
Past research suggests that polygenic scores for major depressive disorder (MDD-PGS), family conflict, and parental acceptance may all predict depressive outcomes among adolescents. Few studies have examined the interplay of these factors through gene–environment interaction (GxE) and gene–environment correlation (rGE) in racially/ethnically diverse samples of adolescents. Methods: Utilizing latent curve analysis and growth mixture modeling in a diverse sample of 10,771 adolescents from the Adolescent Brain and Cognitive Development (ABCD) study, the present study examined how MDD-PGS, family conflict, and parental acceptance predicted depressive trajectory class membership through GxE and rGE in independent models for Black, Latinx, and White adolescents. Results: Among all youth, MDD-PGS and family conflict were associated with greater intercept-levels of depressive symptoms. Among Latinx and White youth, parental acceptance was associated with lower intercept levels of depressive symptoms. MDD-PGS (among all youth), lower parental acceptance (among Latinx and White youth), and greater family conflict (among White youth) increased odds of higher-risk trajectories. Evidence of rGE through family conflict was found among White youth. No evidence of GxE was found. Conclusion: Our findings highlight utility of MDD-PGS and the need to expand conceptualizations of environment to identify salient supportive and stressful experiences across racially/ethnically diverse youth.
Many archaeology graduate students pursue advanced degrees in the hope of undertaking an academic career. Job-listing websites often serve as the first port-of-call for students seeking academic positions. We examined tenure-track job advertisements over the past decade to gain insights into the academic job market for archaeologists. Using data from the community-edited Academic Jobs Wiki for Archaeology, we examined changes in the academic job market over time. We investigated the editing dynamics of the Wiki to understand its users and their biases. We then analyzed the text of 431 job ads posted from 2013 to 2023. Our analysis addresses the question of how archaeological topics, methods, and geographic regions specified in archaeological job ads have shifted over time. We also explored whether the labor burden for applicants has changed over time: do institutions request more information and documents from applicants at the initial stages of application, compared to a decade ago? Finally, we assessed the influence of sociopolitical factors on the changing focus of research topics in the field. We conclude with implications for archaeology students, graduates, and advisors seeking to understand the dynamics of the academic job market and the requirements of employers.
La reciente excavación arqueológica efectuada en el centro provincial inka de Tambo Viejo, en el valle de Acarí, Perú, resultó en el hallazgo de una pequeña construcción de forma rectangular y semisubterránea. En su interior encontramos hojas y semillas de coca en asociación con arena limpia. Esta evidencia sugiere que la pequeña construcción sirvió para el almacenamiento de las hojas de coca, las que habían sido cubiertas con arena limpia para garantizar su preservación. La arena tiene propiedades térmicas que crean condiciones relativamente frías y que son óptimas para la preservación de productos orgánicos.
Estimate bacterial pathogen contamination of healthcare workers’ (HCW) long-sleeved attire.
Design:
Prospective observational study.
Setting:
Tertiary care hospital.
Participants:
HCWs wearing long-sleeved attire providing direct inpatient care.
Intervention:
Sampling of both sleeves of HCWs wearing long-sleeved attire was performed using a swab and cultured for aerobic bacterial growth classified as potential pathogens or presumptive skin commensals. Potential predictors of sleeve contamination, including participant survey responses related to attire and infection prevention practices, were analyzed using univariate analyses. Whole genome sequencing compared isolates to a genomic surveillance database of patient clinical isolates.
Results:
Among 280 samples, 81.1% (n = 227) demonstrated any bacterial growth and 20.7% (n = 58) grew ≥1 potential pathogen. Speciated organisms included alpha-hemolytic streptococci (n = 28), Bacillus sp. (n = 20), and Pantoea/Mixta sp. (n = 8), gram-negative bacilli (n = 6), and Staphylococcus aureus (n = 2). Univariate analysis demonstrated that sleeves sampled on non-intensive care units (P = .038) were significantly associated with any bacterial growth, and attire type (P = .002) and sleeve material (P = .004) were associated with growth of ≥1 potential pathogen. Fleece attire and material were more likely to be contaminated than other attire and material types. Sequenced isolates from sleeve samples were not genetically related to any patient isolates.
Conclusions:
HCW long sleeve contamination occurs frequently, including with potential pathogens. Changing trends in attire type may have an impact on bacterial transmissibility. While this study could not infer transmission events associated with clinically diagnosed patient infections, the potential benefit of a “bare below the elbows” attire policy warrants further investigation.
Efforts to address overuse of antibiotics for RTIs are important to limit antimicrobial resistance. Leaflets used during GP consultations can empower patients to self-manage respiratory infections (RTIs) and support a reduction in unnecessary antibiotic prescribing.
Objectives:
This study aimed to assess the feasibility and acceptability of a Treat Your RTI (TY-RTI) patient leaflet for GP consultations in Ireland.
Methods:
A single-arm mixed-methods feasibility study was conducted. Six GPs in daytime practice and three GPs in out-of-hours (OOH) services were recruited to use the TY-RTI leaflet during routine RTI consultations where an immediate antibiotic was not deemed necessary. GPs and patients completed questionnaires to assess the feasibility and usefulness of the leaflet during the consultation. Ethical approval was obtained.
Results:
The TY-RTI patient leaflet was used by GPs in 201 RTI consultations (57 in OOH, 28%), and 84 (42%) patients/parents completed the questionnaire (9/84 in OOH, 11%). For over 90% (182/201) of consultations, GPs reported the leaflet was useful, supported communication, safety-netting, and did not increase consultation time. All patients/parents found the leaflet easy to read and useful. They reported the leaflet gave them confidence to self-manage RTIs without antibiotics (88%, 74/84), and it changed their views of the need for antibiotics (81%, 68/84).
Conclusions:
This study demonstrates the feasibility and acceptability of the TY-RTI leaflet for GPs and patients, supporting its wider implementation. The leaflet supports improved communication and safety netting in the consultation and empowers patients in the self-management of RTIs, with potential to reduce patients’ antibiotic-seeking behavior.
An increasing number of children and adolescents are prescribed second-generation antipsychotic medications, which may lead to cardiometabolic or other physical health impairments. It is unknown whether lifestyle interventions can prevent or manage these adverse effects.
Aims
To evaluate the effectiveness of lifestyle interventions for preventing or managing cardiometabolic risks and other adverse physical health outcomes in this population.
Method
Four bibliographic databases were searched up to February 2024. Randomised controlled trials reporting a physical health outcome of children or adolescents (aged 6–17 years) taking antipsychotics and participating in a lifestyle intervention compared with treatment as usual (TAU) were eligible for inclusion. The Cochrane Risk of Bias 2 tool was used to assess risk of bias. Data were synthesised via a random-effects meta-analysis and narrative synthesis.
Results
Four studies with a total of 370 participants were included. Most (75%) had a high risk of bias. Lifestyle interventions resulted in moderate but statistically non-significant reductions in participants’ body mass index (standard mean difference −0.70, 95% CI: −1.70 to 0.31) compared with TAU. Some studies reported improvements in other physical health outcomes favouring the intervention, although findings were inconsistent and varied across different measures. Reporting of secondary indicators of physical health, including participant or family health behaviours, was limited.
Conclusions
The effectiveness of lifestyle interventions for preventing or managing the cardiometabolic risk and other adverse physical health outcomes in this population is unclear due to the limited number of available trials, small samples and high risk of bias. Larger trials are needed.
This study investigates the effect of participation in the Global Value Chain (GVC) on Multidimensional Energy Poverty (MEPI), and the role played by the quality of institutions (QI) in the short and long run for 51 African countries over the period 1995–2018. For this purpose, the DCCE-PMG approach is employed, as well as both the GVC and QI indices. MEPI includes electricity, clean fuel, and technology for cooking. The findings show that GVC participation negatively affects MEPI in both the short and long run, meaning that the GVC reduces energy poverty in Africa. Besides, there is mixed evidence regarding the heterogeneity effect according to rural and urban locations. The evidence further shows that GVCs interact with institutions to negatively impact both energy poverty and the rural–urban MEPI gap, implying that the better the institutional quality, the larger the effect of GVC integration on energy poverty reduction. Therefore, a better quality of institution enables local firms, participating in the GVC, to easily capture technology and knowledge diffusion to promote energy development and fulfill the spatial inequality in energy poverty. Additional tests allow us to confirm the evidence and, moving forward, the implications of participation in the GVC.
This study aimed to systematically review the evidence on functional outcomes following dorsal preservation rhinoplasty, with a focus on nasal obstruction.
Methods
A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, Embase, Scopus and Cochrane databases were searched up to March 2025. Studies reporting nasal airway outcomes following dorsal preservation rhinoplasty using subjective or objective measures were included.
Results
Six studies comprising 662 patients were included. Patient-reported outcomes (Nasal Obstruction Symptom Evaluation, Standardized Cosmesis and Health Nasal Outcomes Survey and Visual Analogue Scale) consistently demonstrated significant post-operative improvement. Objective measures (acoustic rhinometry, rhinomanometry and cone-beam computed tomography) showed maintained or improved airway dimensions. dorsal preservation rhinoplasty was functionally equivalent to traditional structural techniques, with low complication (<5 per cent) and revision rates (<2 per cent).
Conclusion
Dorsal preservation rhinoplasty maintains or improves nasal airway function while preserving structural integrity and reducing the need for grafting. It is a safe and effective alternative to traditional dorsal reduction techniques.
This essay on Ernest Weinrib’s Reciprocal Freedom argues that his conceptions of correlativity and systematicity are at odds. Correlativity as he conceives it is inexplicably all-encompassing; it does not track the complexity of interpersonal fairness in either morality or law. Correlativity can be understood as a formal constraint or as a requirement of mutual justification. We do not have reason to treat it as the animating principle that shapes private law. Weinrib’s own concept of systematicity helps us to see why a system of private law that is oriented primarily to vindicating correlativity will always come up short. Systematicity requires that private law work in harmony with the rest of the legal system to promote the principles of justice to which our political community is committed. Systematicity is more demanding than Weinrib allows. The ex post and ad hoc process by which private right is acclimated to public right, in Weinrib’s account, will not suffice to realize systematicity.
Geopolitical tensions escalated between the USSR and the Republic of China over control of the Chinese Eastern Railway during the late 1920s, resulting in a brief war in which several thousand people were killed. Given the violence in Manchuria in the months preceding direct military engagement, it is surprising that Soviet authorities sent an opera tour to the zone of conflict. This article examines the two seasons spent by visiting Soviet opera vocalists at the Railway Assembly Hall (Zhelsob) from September 1927 to February 1929, attending to the staging, reception and political goals of the tour. I argue that the opera stage in the city of Harbin transformed into a temporary zone of informal extraterritoriality, where unpredictable collaborations transpired between ideological enemies on either side of the military clash. The Soviet opera tour to Manchuria prompts us to reconsider the agency and intentionality of musicians in armed conflict.
This position statement provides guidelines for health professionals who are considering online or direct-to-consumer genetic testing for their patients. It presents the major issues around online and direct-to-consumer (DTC) testing including how it is accessed, motivations for accessing testing and how to return these results. Online or DTC recommendations include: (1) DTC testing should only be done by individuals/consumers who are well informed, aware of the risks, benefits and limitations of testing, and able to consent for their DNA to be collected, analyzed and potentially stored. Where possible, individuals/consumers should also be aware of the alternative option of undertaking testing through healthcare professionals in a clinical context, and the benefits of this. (2) Decisions about having a child tested should be based on peer-reviewed, published evidence. Genomics testing for children should be within a clinical context where parents are informed, have access to clinical support and professional genetic counseling about this decision, as well as support for the range of results received. (3) Parents considering direct-to-consumer testing on their newborn are counselled, or given information, to encourage them to have standard government funded newborn bloodspot screening testing on their newborn. (4) When choosing an online genomic test, preference should be given to tests undertaken in accredited laboratories offering tests accredited with the Therapeutic Goods Administration. (5) Results obtained through methods other than direct analysis from a laboratory accredited to perform genomic testing to inform human health and wellbeing should be interpreted with caution. The HGSA recommends that such results must be confirmed in an accredited diagnostic laboratory prior to relying on them to inform options for treatment, surveillance or risk reduction, or before undertaking cascade testing in family members. (6) When individuals are concerned about their health, they should consult an appropriate healthcare professional to decide whether an online genomic test is appropriate and discuss how useful test results could be to make health-related decisions.
A ceftriaxone safety alert prompted a review of rapid response and cardiac arrest events in relation to the timing of intravenous cephalosporin administrations across a large health system. Despite high utilization, we found a low rate of significant ceftriaxone-related adverse events with a similar incidence as other intravenous cephalosporins.
The accuracy, robustness and affordability of localisation are fundamental to autonomous robotic inspection within aircraft maintenance, repair and overhaul (MRO) hangars. Hangars typically have high ceilings and are predominantly steel-framed structures with metal cladding. Because of this, they are regarded as GPS-denied environments, characterised by significant multipath effects and strict operational constraints, which together form a unique challenging setting. The lack of comparative techno-economic benchmarks for localisation technologies in such environments remains a critical gap. Addressing this, the paper presents the first techno-economic analysis that benchmarks motion capture (MoCap), ultra-wideband (UWB) and a ceiling-mounted camera (CMC) system across three operational scenarios: robot localisation, asset monitoring and surface defect detection within a single-bay hangar. A two-stage optimisation framework for camera selection and placement is introduced, which couples market-based camera-lens selection with an optimisation solver, producing camera layouts that minimise hardware while meeting accuracy and coverage targets. The consolidated blueprints provide quantification of the required equipment and its performance: 15 global-shutter GigE cameras are adequate for drone localisation, 9 cameras meet the requirements for on-bay monitoring and 49 high-resolution cameras facilitate defect mapping of the upper airframe surfaces for midsize defects. Across these scenarios, the study reports indicative performance and cost envelopes: a MoCap installation delivers submillimeter localisation at an estimated £190k per bay, UWB delivers centimetre-level tracking for around £49k and the proposed CMC system layouts achieve task-specific coverage with costs in the £9k–£77k range. The analysis equips MRO planners with an actionable method to balance accuracy, coverage and budget, demonstrating that an optimised CMC system can deliver robust and cost-effective sensing for next-generation smart hangars.
To evaluate physician engagement with an antimicrobial stewardship program (ASP) at a tertiary hospital and identify areas for improvement in the delivery of stewardship interventions.
Design:
Cross-sectional survey study.
Setting:
A 1200-bed tertiary care public hospital in Portugal.
Participants:
Physicians with antibiotic prescribing privileges in inpatient settings. All physicians with active institutional e-mail addresses were invited to participate.
Methods:
An anonymous web-based questionnaire was administered between June and December 2024. The survey addressed six domains: (1) antibiotic knowledge; (2) awareness and use of local prescribing protocols; (3) access to antimicrobial use and resistance reports; (4) awareness of antibiotic restriction policies; (5) use of informal consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions.
Results:
A total of 154 prescribing physicians responded (response rate: 10%), including specialists (75.3%) and residents (24.0%). Most respondents were aware of institutional protocols (78.6%), but 66.9% reported rarely or never consulting them, citing accessibility and reliance on personal knowledge as key barriers. Participation in case discussions was limited (25.3%) but viewed as highly useful. Awareness of restrictive antibiotic policies was low; however, 69.5% indicated that these policies influenced their prescribing behavior. Respondents expressed strong interest in regular feedback on antimicrobial use and resistance trends.
Conclusions:
Key areas for improvement in ASP implementation include enhancing access to protocols, expanding case-based discussions, clarifying communication around restrictions, and establishing regular feedback mechanisms. These findings may inform efforts to align ASP strategies with clinical realities in similar hospital settings.
Despite the high frequency and severity of fatigue among patients with advanced cancer receiving immunotherapy, there are limited treatment options available. The aim of the study was to explore the effects of the methylphenidate (MP) with standardized physical activity (PA) on cancer related fatigue (CRF).
Methods
In this pilot study, patients with advanced cancer with clinically significant CRF (<34 on Functional Assessment of Cancer Illness Therapy – fatigue scale, FACIT-F), on anti-PD1 immunotherapy were eligible. Patients were randomized to standardized PA with either patient-controlled MP 5 mg (MP + PA arm) or matching Placebo (Pl + PA arm) twice daily for 14 days. The primary outcome was the change in the FACIT-F score. Secondary outcomes included changes in fatigue dimensions (Multidimensional Fatigue Symptom Inventory-Short Form (MSFI-SF), Functional Assessment of Cancer Therapy – General (FACT-G), Patient-Reported Outcome Measurement Information System-Fatigue (PROMIS-F), and hospital anxiety and Depression Scale (HADS).
Results
Of the 40 randomized patients, 34 were evaluable. The FACIT-F scores significantly improved in both the arms with mean (SD) change, effect size (ES) of 11(14), 0.87(P < .001); and 9(12), 0.74(P = .04) in MP + PA, and Pl + PA arms respectively. We also found significant improvements in PROMIS-F, ES − 1.05(P = .003), MFSI-SF(global), ES − 1.32(P < .001), and HADS-depression, ES − 0.92(P = .004) in the MP + PA arm; There were no significant differences in adverse events between groups.
Significance of results
Our preliminary study found MP + PA was associated with significant improvement in CRF scores. The fatigue dimensions and depression scores significantly improved in the MP + PA arm. Further comparative studies using MP + PA for CRF are justified.
This symposium firmly covers the impacts of human rights law on penal, prison, (police) custodial, immigration, and psychiatric policies in diverse jurisdictions, including Russia, Australia, Japan, Israel, the United States, and Europe, that have been understudied and neglected in comparison with the United States and Europe. It also raises socio-legal debates about accountability, operational complexities, transparency, the ability to either limit or increase the state’s right to punish, the efficacy of oversight bodies, the limits of human rights “law” in this context, access to justice and legal aid for detainees and prisoners, and the persistence of violations in the face of reform. In particular, this symposium offers an opportunity to analyze the way in which the United Nations, the European Court of Human Rights, national courts, the monitoring bodies, and detainees are able to challenge penal and detention policies as well as to soften them through the lens of human rights. This symposium intends therefore to demonstrate an engagement with existing scholarship in human rights, penal, detention, immigration and prison policies, and punishment. It relies on theoretical and empirical socio-legal work that addresses these issues from a local, national, and global perspective. It also challenges traditional socio-legal boundaries by taking into account and integrating the intersection of policy and subdiscipline spheres that cover criminal and penal justice, immigration, psychiatric institutions, and human rights. In this way, this symposium combines the study of these socio-legal fields and all places of detention in very contrasting jurisdictions with a view to analyzing the nature of relations between human rights and detention.
We show that a very general hypersurface of degree $d \geq 4$ and dimension $N \leq (d+1)2^{d-4}$ over a field of characteristic $\neq 2$ does not admit a decomposition of the diagonal; hence, it is neither stably nor retract rational, nor $\mathbb {A}^1$-connected. Similar results hold in characteristic $2$ under a slightly weaker degree bound. This improves earlier results in [44] and [33].
Although many online-based dietary surveys have been developed in recent years, systems that easily survey the dietary balance based on the Japanese diet are insufficient. This study aimed to evaluate the relationship between dietary balance scores from an online survey system based on the Japanese Food Guide Spinning Top, and nutrient/food intake calculated using the weighing method from dietary records (DRs), as well as to assess the system’s utility and applicability. An online dietary balance survey and semi-weighted DR assessment with food photographs were conducted in Japanese participants (n = 34). Registered dietitians entered the balance scores into the system based on the participants’ food photographs, and the scores were calculated using the system. Significant positive correlations (p < 0.001) were found between the online dietary balance scores and nutrient/food intake from DRs; especially for ‘grain dishes’ and carbohydrates (r = 0.704); ‘vegetable dishes’ and the vegetable dish group (sum of potatoes, vegetables, mushrooms, and algae) (r = 0.774); ‘main dishes’ and protein (r = 0.661); ‘milk’ and the milk and milk products group (r = 0.744); and ‘fruits’ and the fruits group (r = 0.748). Bland–Altman analysis showed that the dietary balance scores obtained by this system tended to underestimate the intake compared with the weighing method. Although there are limitations to the accurate estimation of nutrient and food intake, the online dietary balance scores obtained from the online dietary balance survey system were useful for understanding the dietary balance in the Japanese diet.