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Pelvic radiotherapy can be an important management option for people diagnosed with colorectal or anal cancer, who often experience a wide range of adverse effects that can be detrimental to Quality-of-Life (QoL) due to the radiotherapy. Clinical nurse specialists (CNS) are valuable multi-disciplinary members who provide a range of practical and holistic support to these patients, via on-treatment review appointments. A lack of evidence exists relating to colorectal and anal cancer patients’ perceptions of on-treatment CNS review appointments.
Methods:
A service evaluation of the nurse-led on-treatment appointments using a questionnaire was undertaken. Yes/No, Likert Scale and free-text questions were asked, allowing for quantitative and qualitative data collection. Ethical approval was obtained. Standard quantitative data analysis and thematic analysis (TA) methods were used.
Results:
Twelve [12] colorectal and anal cancer patients participated. The data showed that patients had positive experiences with their appointments, but had fears regarding the unknown and the future.
Conclusion:
Patients were satisfied with the on-treatment review service, and the results suggest that the service is efficient and effective. Future research should evaluate this type of colorectal CNS service across a larger colorectal and anal cancer patient population.
Ireland has a long-standing voluntary private health insurance market (PHI) which is regulated to meet the public policy objective of achieving risk solidarity to promote affordability of PHI. Under the regulations underpinning the market, many features are common to those of universal mandatory health insurance markets, that have wider equity objectives of ensuring universal equitable access to care for everyone. The market acts a complete/partial alternative to the public health system, and has been criticised for leading to a two-tier system with consequent implications for equity. To improve equity, these criticisms led to the adoption of a new public health reform plan, called Sláintecare, which seeks to build towards equal access to services based on patient need and not their ability to pay. Given this context, this paper re-examines how might the current voluntary health insurance system be adapted to meet the central Sláintecare objective of increasing health coverage on an equitable basis. It does so by considering to what extent does Ireland meet the preconditions for equity and efficiency under the Enthoven managed competition model. It provides a roadmap for the use of health insurance as a tool for bring this equity.
Archaeogenetics, the study of ancient DNA, can reveal powerful insights into kinship and the movement of individuals in (pre)history. Here, the authors report on the identification of two individuals with genetic profiles consistent with recent sub-Saharan African ancestry, both of whom were buried in early-medieval cemeteries in southern Britain. Focusing primarily on a sub-adult female from Updown in Kent, the authors explore the societal and cultural contexts in which these individuals lived and died, and the widening geographic links indicated by their presence, pointing back to the Byzantine reconquest of North Africa in AD 533–534.
The increasing destruction of cultural heritage in conflict zones has exposed the shortcomings of current crisis response frameworks. Traditional, state-led mechanisms have struggled to address the complexities and rapid developments of modern warfare, leading to the emergence of more flexible, decentralized approaches. In this context, civil society organizations (CSOs) have emerged as key actors, stepping in to address the shortcomings of national governments and international heritage institutions. This article explores the evolving role of CSOs in emergency cultural heritage protection, focusing on Heritage for Peace (H4P) and its interventions in Syria, Sudan, and Gaza. Through case study analysis, this research examines the logistical, ethical, and operational challenges faced by H4P, and presents a model of its strategic interventions in emergency contexts. This model illustrates the opportunities and constraints inherent in crisis environments, including mobility and safety risks, alongside structural challenges in cultural heritage protection, such as limited funding and short-term project cycles that hinder sustainability. The research advocates placing the local population at the center of emergency strategies, strengthening local partnerships, implementing proactive preparedness measures, and strengthening international cooperation mechanisms.
This study examines the impact of a continuing medical education (CME) intervention on smoking cessation among primary-care professionals (PCPs) and explores the relationship between PCP smoking status and patient tobacco-treatment delivery.
Background:
High rates of tobacco use among PCPs have been reported in several European countries. PCPs who smoke are less motivated to provide cessation support to their patients.
Methods:
A before-after study was conducted with 228 PCPs from Greece and Cyprus. The intervention included a one-day CME training, a 2.5-hour seminar three months later, and practice tools. Expert faculty provided informal support to smoking PCPs. Changes in PCP smoking status and 5As (ask, advise, assess, assist, and arrange) tobacco treatment delivery were assessed before and six months after training. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to evaluate the association between the training and PCP smoking status and 5As delivery.
Findings:
At baseline, 18% (n = 47) of PCPs were current smokers, and 39% (n = 66) were ex-smokers. At follow-up, 31.9% of current smokers reported quitting (n = 15/47; p < 0.001). Smoking cessation was higher among female PCPs (p = 0.02) and those in Cyprus and Thessaloniki (p < 0.01). PCPs reported increased 5As delivery at follow-up, with the highest rates among ex-smokers (>6 months) and never smokers. PCPs reported significant quitting rates following a comprehensive evidence-based training intervention. The findings suggest that addressing PCPs’ smoking status can improve both health-care provider and patient smoking outcomes.
Situated at the intersection of language rights, nation-building processes, and security issues, this article analyzes language policies in Ukraine in the three decades since its independence (1991–2021). It traces the legal evolution and decisions of the Ukrainian Constitutional Court, identifying the specific ideological approaches towards language issues that emerge in such a development. We distinguish four periods in the evolution of Ukrainian laws, highlighting how these stages reflect specific ontological and societal (in)securities and related securitization processes, and their intersection with the process of nation-building and the role assigned to the Ukrainian language in such a process. In this way, the article discusses how, in light of the Soviet legacy and Russian kin-state activism and geopolitical agenda, Ukraine has moved to adopt a more assertive nationalizing approach to language issues that aim at promoting Ukrainian as the state language. Russia’s aggressive actions accelerated the ongoing nation-building process, interplaying with the relevance assigned to the Ukrainian language for the Ukrainian nation-state as well as the country’s ontological and societal (in)securities. In this way, our contribution complements our understanding of language policies, bringing to light the connections of their evolution and variations with how security concerns affect nation-building processes.
In From Survival Cannibalism to Climate Politics (2025) as well as in Law and Politics from the Sea (2024) Mann proposes the ‘commonist lifeboat’ as a political metaphor for the age of climate change. This response to Itamar Mann’s re-reading of Regina vs. Dudley and Stephens proposes a materialist reading of his political theory of the ‘commonist lifeboat’, arguing that the lifeboat may be a metaphorical and practical site from which alternatives to our current ways of doing and thinking about politics in times of climate crisis might emerge. The text brings Mann’s lifeboat into conversation with my own and other scholars’ work on radical vessels – historical and contemporary – in order to demonstrate and expand its analytical capacity as a more-than-metaphorical term. Building on Mann’s use of the lifeboat as a metaphor and a site of maritime custom, I propose to understand the ‘commonist lifeboat’ also as a material container that operates in a specific material environment: the sea. I argue that a focus on the materiality of the sea and of the lifeboat may point to political practice, community and customs yet to be invented, which may help us navigate the turbulent political environment of our time.
We give a simple diagrammatic proof of the Frobenius property for generic fibrations that does not depend on any additional structure on the interval object such as connections.
The global population is ageing rapidly, emphasising the need to understand the decision-making processes of older adults regarding potential care transitions. Gerontological research has focused on healthcare decisions, with less information on living situation choices of older adults. This review explored older adults’ experiences with their involvement in decision-making processes related to transitioning into care facilities in the United Kingdom. From a systematic search of articles, nine were reviewed using thematic narrative synthesis. Four themes with nine subthemes were identified: Involvement in decision-making (Exclusion of older adults, Usefulness of involvement), The necessity of moving (Triggers for moves, The role of family), Timely planning (Helpfulness of planning, Planning avoidance), and Factors for choosing a care home (Non-quality factors, Quality factors, Continuity of life). These themes highlighted the issue of inadequate involvement of older adults in decision-making, often resulting in negative consequences like regret and difficulty settling into new care settings. The necessity of moving arose from sudden events or increased support needs. Some older adults acknowledged the necessity due to declining health or to spare family burden, while relatives grappled emotionally, postponing the choice. Timely planning was found to be beneficial practically and emotionally, facilitating smoother transitions. However, participants would rarely plan and discuss such matters early. Older adults focused on personal experiences and trusted sources rather than publicly available information when considering Factors for choosing a care home. The findings show the need for greater inclusion of older adults in decisions related to their care and the importance of early planning and providing preferred types and formats of information to aid decisions. Future research should focus on a better understanding of older adults’ preferences for successful involvement in care decisions, with support and guidance for others involved in the decisions.
This article provides the general psychiatrist with a pragmatic guide to working confidently and productively in the emergency department (ED). The focus is on effectively navigating the distinctive physical environment, personnel, systems, time pressures, legal boundaries, special challenges and broad scope of practice applicable to this setting to maximally support both patients and staff. It brings to the reader’s attention special considerations at all stages of workflow, including pre-assessment preparations, the assessment process and ongoing planning. It considers common requests and the application of mental health law (in England and Wales) associated with both capacity assessment and involuntary care. Finally, it explores unique challenges associated with risk assessment, physical health advocacy and management of conflict in the ED setting. The specific systems described are those of the UK’s National Health Service, but the principles involved are universal.
To assess what is known about how the labelling of commercial infant food impacts parents’ beliefs about a product’s sugar content and their related purchasing and feeding decisions.
Design:
Mixed methods scoping review. Peer-reviewed studies were identified from six electronic databases, and grey literature was identified via Google, relevant websites, government reports and by contacting organisations. Searches were completed in May 2024 using a comprehensive search string incorporating keywords and indexed terms related to ‘parents’, ‘beliefs’, ‘sugar’ and ‘baby food labels’.
Setting:
Northern, Western and Southern Europe, North America, Australia and New Zealand.
Participants:
Parents and primary caregivers of children (≤ 37 months) or those specifically choosing commercial infant food for their children.
Results:
In total, 1123 records were screened, and seventeen were included for review, with all records published since 2015. Records reported on fifteen unique studies, including seven quantitative, seven qualitative and one mixed-methods study. Studies found that simply labelling products as suitable for babies elicited a trust that they were healthy, including not having a high sugar content. Interventions alerting parents to the sugar content of products were associated with less positive opinions or reduced intention to purchase. In eleven studies, parents described being drawn to products displaying labels such as ‘no added sugar’, which some perceived as meaning low sugar. In five studies, parents described sugar labelling as misleading, and/or they explicitly expressed a desire for clearer sugar labelling.
Conclusions:
Parents find the current labelling of commercial infant food misleading and desire clearer labelling to support informed purchasing and feeding decisions.
Anticipating policy instrument preferences can be an important step in policy design to address pressing sustainability problems. But studying preferences for policy instruments is a difficult task because sustainability problems involve a non-negligible degree of trade-offs and uncertainty. We therefore study the role of actors’ underlying ideologies (policy core beliefs) and risk attitudes in forming their preferences for different instruments. Combining the advocacy coalition framework with multi-attribute utility theory, both ideologies and attitudes toward uncertain policy consequences can influence instrument preferences. So far, policy studies literature has paid little attention to trade-offs between policy core beliefs or risk attitudes. Using Bayesian regression models on data from actors in Swiss pesticide risk reduction policy, we found that attitudes toward trade-offs and risk are indeed relevant to explain preferences for different regulatory and market-based instruments addressing agricultural pesticide use. Therefore, when designing policies for sustainability problems, considering the relative importance of policy core beliefs for different actors can help to find effective and broadly supported solutions. In addition, risk attitudes should be considered when policy design involves more coercive and stimulative policy instruments.
Carbon capture technologies are considered essential for addressing global warming issues. To date, various capture technologies have been extensively investigated in the literature, both through experimental studies and simulations. This paper aims to briefly review the most recent advancements in the modeling of various CO2 capture processes. The progress in technologies, including chemical absorption, physical absorption, adsorption, membrane-based separation and chemical looping processes, is discussed. Existing evaluation results obtained from various simulation studies are summarized and compared. In addition to the advancements in each technology, the future research trends and the challenges that need to be addressed in the field of process modeling are identified.
Previous L1 syntactic processing studies have identified the crucial left frontotemporal network, whereas research on L2 syntactic processing has shown that learner factors, such as L2 proficiency and linguistic distance, can modulate the related networks. Here, we developed a function-word-based jabberwocky sentence reading paradigm to investigate the neural correlates underlying Chinese L2 syntactic processing. Twenty Chinese L2 Korean native speakers were recruited in this fMRI study. Chinese proficiency test scores and Chinese-Korean syntactic similarity scores were measured to quantify the learner factors, respectively. The imaging results revealed an effective left frontoparietal network involving superior parietal lobule (SPL), posterior inferior frontal gyrus (pIFG) and precentral gyrus (PreCG). Moreover, the signal intensity of SPL as well as the connectivity strength between SPL and PreCG significantly correlated with the learner factors. These findings shed light on the neurobiological relationships between L1 and L2 syntactic processing and on the modulation of L2 learner factors.
Investigate the factors associated with symptomatic respiratory infection and uptake of seasonal SARS-CoV-2 and influenza vaccine amongst healthcare workers (HCWs).
Design:
Longitudinal prospective multi-center study.
Setting:
Two tertiary healthcare centers in Ireland.
Participants:
N = 893 self-selected HCWs across all disciplines.
Methods:
Monthly self-reported questionnaires from September 2024 to February 2025 completed by all participants, providing infection symptoms, self-testing for COVID-19 and receipt of vaccination against SARS-CoV-2 or influenza in the preceding 30 days. Additional data collected included comorbidities, known diagnosis of Long COVID, demographic data, prior infection and vaccination status, and healthcare role. Multivariable logistic regression models assessed the factors associated with symptom development, self-testing, and vaccine uptake.
Results:
Symptomatic respiratory illness was reported by n = 321 (36%) of participants during the study period, with a preexisting diagnosis of Long COVID associated with developing symptoms. Testing for COVID-19 was performed by 63% (n = 202) of symptomatic individuals, with a shorter duration since prior infection the only significant predictor of self-testing. Vaccine uptake was variable, with 37% receiving influenza and 22% receiving SARS-CoV-2 vaccination for that period. Older age and shorter interval since previous vaccine were associated with increased uptake of both vaccines, while men were more likely to be vaccinated against COVID-19.
Conclusions:
In the postpandemic period, self-reported symptomatic respiratory infections remain common amongst HCWs. The legacy of the pandemic influences this, with a preexisting diagnosis of Long COVID associated with increased symptom burden, while low vaccination rates and understanding the factors associated with this present a challenge to ongoing risk mitigation.
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder leading to vascular malformations in different organ systems. Approximately 10% of patients with HHT have brain vascular malformations (BVMs). Due to the negative health consequences related to BVMs, screening with MRI is recommended. There are no health jurisdictional standards for medical imaging protocols in North America or elsewhere. The objective of this project is to adopt a provincial standardized operating protocol (SOP) to improve diagnostic accuracy and reduce inappropriate imaging in patients with and without HHT in Alberta.
Methods:
Multiple fora were held among the five Alberta Health Services zones with stakeholders from urban, suburban and rural radiology groups, neurology, pulmonology and hematology. The consensus process took five years to complete between 2015 and 2020. The content of the fora was approved by all participants.
Results:
The SOP was implemented in February 2020 and defines that screening for BVMs must include standard unenhanced brain MRI (sagittal T1, axial fluid-attenuated inversion recovery and axial T2) with susceptibility-weighted imaging (SWI), a 3T or 1.5T magnet strength and minimum imaging standards to include 3 mm contiguous slice thickness.
Discussion:
Incorporation of SWI allowed for the elimination of MR contrast to improve access to the local performance of studies within the province, facilitating virtual care.
Conclusion:
A provincial SOP for BVM screening in patients with suspected or confirmed HHT was successfully implemented in Alberta. Gadolinium was avoided, as it was felt to be unnecessary for screening purposes and might complicate imaging at more remote sites.
We theoretically investigate the small-amplitude broadside oscillations of an annular disk within an unbounded fluid domain. Specifically, we formulate a semi-analytical framework to examine the effects of the oscillation frequency and pore radius on the disk’s added mass and damping coefficients. By leveraging the superposition principle, we decompose the complex original problem into two simpler ones. The force exerted on the disk by the fluid is linked to the solutions of these sub-problems through the reciprocal theorem; the first solution is readily available, while the second is derived asymptotically, assuming a small inner radius. Both solutions are evaluated by transforming dual integral equations into systems of algebraic equations, which are then solved numerically. Building on these solutions, we extract asymptotic expressions for the variations of the quantities of interest in the limits of low and high oscillatory Reynolds numbers. Notably, at high frequencies, we uncover a previously overlooked logarithmic term in the force coefficient expansions, absent in prior scaling analyses of oscillating solid (impermeable) disks. Our findings indicate that, when viscosity plays a dominant role, an annular (porous) disk behaves similarly to a solid one, with reductions in the force coefficients scaling with the cube of the pore radius. We also discover, perhaps surprisingly, that, as inertial effects intensify, the damping coefficient initially increases with the pore radius, reaches a maximum and subsequently declines as the disk’s inner hole enlarges further; at its peak, it can exceed the value for an equivalent solid disk by up to approximately 62 % in the asymptotic limit of extremely high oscillatory Reynolds number. Conversely, the added mass coefficient decreases monotonically with increasing porosity. The decay rate of the added mass in the inertial regime initially scales with the cube of the pore radius before transitioning to linear scaling when the pore radius is no longer extremely small. Although our analysis assumes a small pore radius, direct numerical simulations confirm that our asymptotic formulation remains accurate for inner-to-outer radius ratios up to at least $1/2$.
The paper examines the influence of stakes on knowledge attributions, building on the retraction-based experimental design introduced by Dinges and Zakkou. Experiment 1 replicates Dinges and Zakkou’s original findings and extends the research to third-person knowledge ascriptions. The results show that raising the stakes increases the percentage of retraction in both first- and third-person scenarios. Experiment 2 addresses potential concerns about the retraction-based design, specifically whether participants genuinely endorse the initial claim and the worry of scenario sceptics – participants who disagree with a knowledge attribution. Experiment 2 introduces a modification to the initial design by adding a knowledge-ascribing question. This addition makes the act of retraction more realistic. The results confirm that the stakes effect persists even in an improved design. I argue that these findings constitute a serious challenge to classic invariantism and a potential challenge to subject-sensitive invariantism. Their competitors – epistemic contextualism and relativism – seem to be in a better position, even though the retraction-based design at its current stage is unlikely to distinguish between these two.