Functional referral systems are critical to primary health care and universal health coverage. Referral and counter-referral are key relational mechanisms to link communities to the care they need and primary care to secondary and multi-sectoral services. Many referral systems are fragmented, leading to inefficiencies, coverage gaps, and compromised continuity and quality of care. In June 2024, we conducted a scoping review of PubMed, Global Index Medicus and WHO publication databases to identify referral coordination and process initiatives at national, subnational, and local levels.

We classified reports from 181 papers into non-exclusive categories based on referral system design, operational elements, service delivery platform, and/or user group. Initiatives targeting referral system design included modelling, organization and assessment methodologies. Initiatives focusing on operational elements included networks and linkages, pathways and algorithms, e-referral systems and platforms, digital processes and tools, and facility-level processes and tools.

When classified by service delivery platform, community-level initiatives emphasized improved recognition, screening, diagnosis, and communication by community health workers and use of SMS text messaging or mHealth apps. At initiating facilities, reports focused on standardizing referral criteria and protocols and optimizing communication with referral facilities, including for real-time clinical decision-making to improve timely referral and to reduce under- and over-referral. Structured algorithms and pathways were key to minimize the time between referral, diagnosis, and treatment for time-sensitive conditions. At receiving facilities, actions included supporting initiating facility clinical decision-making prior to referral, prioritizing urgent cases, and consistent counter-referral and/or onward referral.

Findings are informing WHO guidance on two-way referral systems.

To reveal the community structuring mechanism of the pebble interstitial macrofauna, we examined the community structure and its relationship with abiotic environmental factors on a pebble beach in Honshu, central Japan (northwest Pacific). Throughout the year-round survey, we found 66 species from 18 classes in 9 phyla, most of which were either endemic or undescribed species. This is a noticeably higher species diversity compared to the common theory (quite low biodiversity) for pebble beaches and also indicates independence from other environments. Moreover, the communities were divided into five groups through clustering, which were significantly explained by sediment particle size and tidal level using RDA (Redundancy Analysis). However, their interpretabilities were moderate, suggesting that the community structure was moderately controlled by environmental factors. This could be owing to the optimization of the benefit of interspecific ecological niche isolation and the cost of recovering from the disturbance. Consequently, the present study reveals the presence of diverse and unique macrobenthic communities that inhabit the pebble beach environment in Japan and are controlled by the abiotic environmental characteristics of microhabitats.

Traditionally, many have imposed higher-order requirements on epistemic justification. That is, many have argued that for a belief to be epistemically justified, it not only needs to satisfy first-order requirements, such as being formed via a reliable process or supported by sufficient evidence, but also some higher-order requirement that bears on the way the belief is formed. For example, BonJour has famously argued that a clairvoyance belief, however reliable, is not justified unless one also has a justified belief that one’s beliefs formed via clairvoyance are reliable. More recently, some have argued for higher-order requirements for inferentially justified beliefs. That is, for example, that inferential beliefs are only justified if we take the reasons for which those beliefs are formed to support the belief. While there is a common underlying theme, these proposals differ with respect to the kind of higher-order state they require. Some proposals require (justified) higher-order beliefs, while others require higher-order evidence or higher-order awareness. This paper sets out to systematically discuss different kinds of higher-order requirements and the objections they face. While I will argue that there are good reasons to think that epistemic justification needs a built-in higher-order requirement, I will argue that only so-called evidential requirements are able to guard off well-known objections. In so doing, I will directly build on my previous work on evidentialist no-defeater clauses. In particular, I will demonstrate that such clauses can be understood as general higher-order requirements of epistemic justification.

This article examines the place of habit in the medical thought and practices of 18th-century Britain. Scholars, including Steven Shapin and Phil Withington, have shown that habit was important to the broadly humoral understandings of health, disease, and regimen that dominated in Europe for much of the early modern period. In this article, I offer the first sustained attempt to understand the role of habit in the medical thought of 18th-century Britain, focusing on the influential Scottish physician William Cullen. For the first time engaging with all of Cullen’s work on habit, including his correspondence, pathological lectures, and clinical lectures, I show that medics of the 18th century developed a new understanding of habit, linked to changing ideas about the nervous system. Increasingly, they emphasised the role that habit could play in causing the periodical return of bodily functions, even when there appeared to be no plausible physical cause. In so doing, medics engaged with one of the key debates of the 18th century – the contested notion that human nature itself might be contingent on social and environmental conditions. For them, habit provided the means by which society could quite literally change the body. These ideas come through clearly in the striking suggestion – hitherto unnoticed – that menstruation was the product of habit, arising not from nature but from culture. Discussions of menstruation reveal the political stakes of habit, with links to highly contested debates about the role that bodies of different genders might play in society.

Many global norms are currently facing substantial contestation by various actors. While contestation is a regular practice in norm dynamics, it can potentially result in the destabilisation of norms. At the same time, international city networks (ICNs) are increasingly positioning themselves in global governance. While research in International Relations has not analysed how ICNs respond to norm contestation and whether they stabilise existing norms and normative orders, this article demonstrates that ICNs are relevant actors in norm dynamics by focusing on their activities. To examine how ICNs stabilise norms, we employ a theoretical framework based on existing approaches in norm research, which assumes that norms must be as robust, resilient and legitimate as possible to maintain their functions in facilitating individual orientation and collective order. Empirically, we analyse the stabilising activities of three ICNs – Mayors for Peace, Rainbow Cities Network and Fast-Track Cities Initiative – as contributions to preventing norm decay in security, human rights and health. We show that these ICNs stabilise norms by supporting them in discourse and practice, by connecting norms in clusters, and by including affected stakeholders. In sum, we present ICNs as relevant actors in global governance due to their stabilising activities and networked capacities.

Because it is manifest that ‘the world’, traditionally said to be God’s good creation, is shot through with profound ‘wrongs’, the question arises about the sense in which the physical creation is good in and of itself, for its own sake. This essay first briefly argues that theological strategies attempting to ground creation’s goodness in either God’s relating to reconcile sinful humankind or in God’s relating in eschatological blessing are inadequate, and then urges that it can be adequately grounded in a doctrine of creation that shifts focus from offering a causal explanation of the existence of ‘the world’ to description of what it is to be ‘creature’, backed by an exegetical shift in how the text that traditionally warrants doctrines of creation, Genesis 1:1-2:25, is read. That shift entails acknowledgement of two theological aporias, one of which it is important to stress is theologically insoluble, while the other is soluble.

In The Epistemology of Disasters and Social Change (2024)—an energetic dovetail of disaster sociology and feminist epistemology—Pascoe and Stirling claim there is no such thing as a natural disaster, as all disasters are the product/result of human construction. They use Audre Lorde’s poem, “A Litany for Survival” to anchor their project and focus on Lorde’s understanding of the relationship between poetry, knowledge, and survival to critique dominant the disaster imaginaries. I suggest that a more accurate use of “A Litany for Survival” leans toward a phenomenological epistemology of surviving, rather than a focus on the survivor.

Scholars of Kant have long been critical of International Relations’ appropriation of his Toward Perpetual Peace, in particular as it informed democratic peace theory. Now, with democratic backsliding occurring even at the core of the ‘separate peace’ the theory claims developed between democracies, that critique gains newfound salience. This essay demonstrates how the theory is unable to understand democratic backsliding, especially as it is occurring in the United States, but would have been able to if not for misinterpretations of certain substantive elements of Kant’s schema, and, more crucially, a fundamental misunderstanding of the purpose and proper use of it. Grounding a reading of Toward Perpetual Peace more thoroughly in Kant’s philosophical system, I develop the idea of conceiving of and utilizing the essay’s schema in terms of what I call a critical cosmology of peace – a holistic and evolving vision of interrelated practices, conditions, and mechanisms encompassing all of humanity through time and space, and meant mainly to act as a tool of perpetual critique of whatever existing form and degree of democratic peace is currently in existence.

Stone-carved “wheels of Dhamma” (dhammacakkas) symbolizing the Buddha’s enduring teachings constitute an aesthetic corpus of objects once raised on columns set in ornate bases. These dhammacakkas were produced in central Thailand in the second half of the first millennium during the Dvāravatī period. Some carry Pali inscriptions which bear witness to the state of the Pali textual tradition in central Siam in the seventh to ninth centuries. Given that no Pali manuscripts from South or Southeast Asia from this early period survive, these epigraphic witnesses are extremely important. This research article presents inscriptions inscribed on a Dvāravatī-period dhammacakka and an octagonal pillar recovered in Thailand’s Chainat province. A closer examination of the epigraphs has allowed us to give improved readings of the available fragments. This has enabled us to present what may be described as the oldest extant recension of the core passages of the Pali Dhammacakkappavattana, Gotama the Buddha’s first teaching.

In this randomized experimental study, Tru-D iQ and Legacy UV-C systems both reduced environmental contamination in hospital rooms. Both systems significantly reduced contamination, with the Tru-D iQ achieving comparable efficacy overall and significantly shorter cycle times.

Overlap of primary studies among multiple systematic reviews (SRs) is a major challenge when conducting overviews. The corrected covered area (CCA) is a metric computed from a matrix of evidence that quantifies overlap. Therefore, the assumptions used to generate the matrix may significantly affect the CCA. We aim to explore how these varying assumptions influence CCA calculations. We searched two databases for intervention-focused overviews published during 2023. Two reviewers conducted study selection and data extraction. We extracted overview characteristics and methods to handle overlap. For seven sampled overviews, we calculated overall and pairwise CCA across 16 scenarios, representing four matrix-construction assumptions. Of 193 included overviews, only 23 (11.9%) adhered to an overview-specific reporting guideline (e.g. PRIOR). Eighty-five (44.0%) did not address overlap; 14 (7.3%) only mentioned it in the discussion; and 94 (48.7%) incorporated it into methods or results (38 using CCA). Among the seven sampled overviews, CCA values varied depending on matrix-construction assumptions, ranging from 1.2% to 13.5% with the overall method and 0.0% to 15.7% with the pairwise method. CCA values may vary depending on the assumptions made during matrix construction, including scope, treatment of structural missingness, and handling of publication threads. This variability calls into question the uncritical use of current CCA thresholds and underscores the need for overview authors to report both overall and pairwise CCA calculations. Our preliminary guidance for transparently reporting matrix-construction assumptions may improve the accuracy and reproducibility of CCA assessments.

The high incidence of new cases of anxiety disorders highlights the need for scalable preventive interventions, which can be achieved through information and communication technologies. To our knowledge, no meta-analysis has been conducted to evaluate purely digital preventive interventions for anxiety in all types of populations. The aim of this study was to assess the effectiveness of digital interventions for the prevention of anxiety disorders. Systematic searches were conducted in six electronic databases (PubMed, PsycINFO, EMBASE, Web of Science, OpenGrey, and CENTRAL) from inception to December 12, 2024. Inclusion criteria for the studies were as follows: (1) randomized controlled trials (RCTs), (2) psychological or psychoeducational digital interventions to prevent anxiety, and (3) all types of populations without anxiety at baseline of the study. A total of 15 studies (19 comparisons; 6093 participants) were included in the systematic review. One study was identified as an outlier and was therefore excluded from the meta-analysis. The pooled analysis showed a small effect in favor of preventive interventions among non-anxious and varied populations (standardized mean difference = −0.32, 95% confidence interval: −0.44 to −0.20; p < 0.001). Sensitivity analyses supported the robustness of this finding. We found no evidence of publication bias. Heterogeneity was high, however, a meta-regression that included one variable (country, the Netherlands) explained 100% of the variance. All RCTs, except two, had a high risk of bias, and the quality of the evidence, according to Grading of Recommendations Assessment, Development, and Evaluation, was very low. There is a need to develop and evaluate new digital preventive interventions with a rigorous methodology.

This Perspective article addresses the issue of recovery in mental health research, policy and practice from a service user/survivor perspective. In doing so, it brings to bear a fundamentally different viewpoint to that which has dominated psychiatric history, one based on lived experience rather than the ideological allegiances of its founders. The article addresses the modern history of Western mental health provision, its over dependence on medicalised individual understandings of wellbeing, the limitations this has imposed and the challenges it has been subjected to. The issue of recovery is examined in its historical context, exploring its strengths and weaknesses. The latter weaknesses have been magnified by the association of recovery by different governments, nationally and internationally, with pressing mental health service users and others experiencing distress into employment; this is often poor quality and unsupported employment. The article puts this in the broader context of a number of values and principles underpinning both the developing psychiatric system survivor movement and the emerging international interest in Mad Studies. In doing so, the article offers a basis for the radical reform of both understandings of madness and mental distress, recognition of their holistic relations and more helpful routes to offering support and engaging with the lived experience and experiential knowledge of mental health service users.