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This study analyzed standardized excess mortality due to specific causes during the Covid-19 pandemic across 33 European countries, using Eurostat data (2016–2021) and Our World in Data databases. Causes included circulatory and respiratory diseases, neoplasms, transport accidents, and “other” causes (e.g., diabetes, dementia, ill-defined conditions). Additional variables such as vaccination rates, economic and health indicators, demographics, and government stringency measures were also examined. Key findings include: (1) Most European countries (excluding Central and Eastern Europe), recorded lower than expected excess mortality from circulatory and respiratory diseases, neoplasms, and transport accidents. Ireland had the lowest excess respiratory mortality in both 2020 and 2021; (2) Croatia, Cyprus, Malta, and Turkey showed significant positive excess mortality from “other” causes, potentially linked to public health restrictions, with Turkey as an exception; (3) Regression analysis found that higher human development index and vaccination rates were associated with lower excess mortality. Policy Implications are: (1) Statistically significant positive or negative cause-specific excess mortality may indicate future health trends; (2) The pandemic and government stringency measures negatively affected mortality from “other” causes; (3) Strengthening health system resilience, investing in digital medicine, directing aid to countries with weaker systems, and supporting disadvantaged groups are key recommendations.
Following Russia’s invasion of Ukraine in February 2022, Georgia became a key destination for Russian migrants, who significantly influenced the local housing market. This article explores the impact of the influx of Russian migrants into Tbilisi, which caused a surge in rental prices and aroused feelings of social insecurity among Georgian citizens. Using qualitative methods, including social media analysis and semi-structured interviews, the study investigates the emergence of “informal sanctions” imposed by Georgian Airbnb and Booking.com hosts as a means of expressing political dissatisfaction with their own government and protecting national interests. This article identifies four patterns of informal sanctions, such as rejecting, discomforting, avoiding, and exploiting Russian tenants, which reflect a form of patriotism from below. We argue that these spontaneous, everyday practices of resistance lead to the politicization of mundane host-tenant relations and the collective stereotyping of a migrant group in a time of insecurity. The theoretical proposition here is that everyday nationalism is closely related to informality, which opens the possibility of examining grassroots responses to perceived threats and tactics of resistance, with implications for broader social dynamics in times of ongoing geopolitical conflict and wartime migration in Eastern Europe.
In recognition of the impact of current dietary patterns on human and environmental health, dietary shifts towards sustainable diets are considered crucial to adequately feed a growing global population within planetary boundaries. Whilst the composition of sustainable diets varies to account for regional specificity, consensus exists on the need to reduce meat and increase plant protein intakes in sustainable dietary patterns for high-income settings. Due to the high environmental impact resulting from meat production and observational evidence of higher risks of negatives health outcomes associated with excess red and processed meat, a reduction in meat consumption is considered a ‘win-win’ for both people and the planet. However, meat is an important contributor to dietary protein and micronutrient intakes and plays an important sociocultural role, particularly in the UK and Ireland. Whilst a strong evidence-base exists on the environmental and health benefits associated with increased consumption of whole plant foods such as legumes, nuts and seeds, these foods may not address the barriers associated with lower meat diets. Plant-based meat alternatives (PBMAs) are products created to replicate the taste, texture, appearance and functionality of meat and therefore may provide an acceptable means of facilitating the shift to healthy and more sustainable diets. However, less is known about the health and environmental impact of substituting meat with PBMAs. Therefore, this review summarises the literature on the nutritional, health and environmental impact of PBMAs to better understand the role of these products in healthy and sustainable diets for the UK and Ireland.
Meningiomas are benign spinal arachnoid tumours, typically presenting as intradural extramedullary (IDEM) lesions that can compress the spinal cord and require surgical intervention. Minimally invasive surgery (MIS) techniques like mini-open, tubular and endoscopic approaches minimize tissue manipulation, reduce pain and accelerate recovery. This systematic review provides insights into current practices regarding MIS for cervical meningioma and presents a case series of eight patients with cervical meningioma effectively managed by MIS.
Methods:
A comprehensive literature search was conducted across Embase, PubMed and Medline Ovid, focusing on MESH terms related to cervical vertebrae, nervous system neoplasms and minimally invasive surgical procedures. Risk of bias in retained studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for case series and case reports. A narrative synthesis of our results is presented.
Results:
Nine studies with 15 patients undergoing MIS for cervical meningioma were included. Most tumours were at the craniospinal junction. Gross total resection (Simpson grade 2) was achieved in 14 cases, with no reported post-operative complications. The length of stay (LOS) ranged from 2 to 6 days, and no tumour recurrence was observed. Our case series of eight patients confirmed MIS benefits, including shorter operative times, comparable surgical outcomes, and the avoidance of spinal deformities requiring instrumentation.
Conclusion:
In well-selected patients, MIS for cervical meningioma is a safe and effective procedure offering direct lateral access, minimal bony resection, limited soft tissue manipulation, and avoidance of cervical fusion, thereby minimizing post-operative complications and LOS.
Human beings are a highly social species, and there are neural systems that have a role in enabling human beings to function as the social animals they are. They connect people into smaller or larger social groups; and at least some of these groups have a unity that lets the united human beings function as one. That this is so has implications for an array of philosophical and theological issues, including the notion of a people, the concomitant notions of a people’s communal guilt and communal shame, the notion of the church as the body of Christ, the understanding of human perfection as a likeness to a triune God, and many other such issues. What is required to elucidate these issues is a metaphysics that can explain the nature of a united something-or-other that includes human persons as constituents. This article explores these issues and outlines the nature of the needed metaphysics.
Macroscopic, modular, morphologically simple skeletons occur in the uppermost Mural Formation (Cambrian, Epoch 2, Bonnia–Olenellus Biozone), west-central Alberta and adjacent east-central British Columbia. They represent organisms that lived almost exclusively in reefal environments dominated by archaeocyaths. Some were attached to archaeocyaths or less commonly other surfaces, and some grew downward, apparently from overhangs or cavities in reefs. Qualitative and quantitative data from a large number of specimens, most of which were serially thin sectioned, indicate that they represent a single, remarkably variable species. The skeletal structure ranges among specimens from entirely cerioid to partially to entirely labyrinthine with irregularly incomplete walls. There is also a wide range of variability in growth form among skeletons, in module size and wall thickness among and within skeletons, in module shape within skeletons, and in number and location of projections extending from the wall into some modules. Module increase occurred by peripheral expansion at the basal surface of the skeleton and longitudinal fission involving projections from the wall as module size increased during vertical growth. Walls of skeletons, now composed of calcite cement, were probably originally aragonite. Modular skeletons from the uppermost Mural Formation are assigned to Rosellatana jamesi Kobluk, 1984a, previously represented only by a few cerioid specimens from correlative strata in the Rosella Formation of north-central British Columbia. The skeletal structure and types of module increase in R.jamesi, and a few similar but less well-known Cambrian taxa from elsewhere in North America, suggest a general biologic affinity with hypercalcified sponges.
‘Positional goods’, a term coined by Fred Hirsch, is an important concept in economics, social sciences and philosophy; however, it is used in different ways. This paper recovers Hirsch’s concept of positional goods as scarce goods that are fixed or near-fixed in supply and argues for the usefulness of this concept. Hirsch’s concept may have explanatory power beyond the concept used by most economists – that of Robert Frank. Moreover, Hirsch’s concept is more explanatorily basic and useful than the concept used by most philosophers – that of Brighouse and Swift.
Thirty-five years have passed since the killing of the South African refugee Jerry Masslo in Villa Literno in 1989 to the death of the Indian labourer Satnam Singh in Latina in 2024, marked by exploitation, violence, and abuses in the Southern Italian countryside. Only a few journalistic reports have documented this situation, and the article aims to fill this historiographical gap with a timely investigation, calling for the start of an international debate on the inhuman working conditions of foreigners in the countryside of developed countries. The article highlights some variables that have remained steady over time: the absence of public policies to regularise agricultural labour, the widespread presence of informal settlements in the countryside with risks to the safety of farm labourers, the low wage levels that violate people’s dignity, the persistent illegality in recruiting labour through ‘caporalato’ (forced labour), deaths at work due to exploitation and climate change. These are elements of critical analysis that call for an in-depth reflection on how to improve the working conditions of labourers in the rural economy today. The contribution of foreigners, as emerges from the quantitative analysis in the article, is irreplaceable for the well-being of developed societies. This is why history has an essential ethical and civic mission in highlighting the conditions of severe exploitation in which they are forced to work.
Comparative histopathological and ultrastructural investigations were performed on the livers of 2 fish species, namely, flounder (Platichthys flesus (L.)) naturally infected with the nematode Anisakis simplex (s.l.) (Rudolphi, 1809) larvae (L3) and tuvira (Gymnotus inaequilabiatus) (Valenciennes, 1839) harbouring the nematode Brevimulticaecum sp. (L3) (Shikhobalova and Mozgovoi, 1952). The intensity of infection by A. simplex (s.l.) larvae (L3) in flounders ranged from 3 to 10 parasites per organ. The worms were encapsulated by the peritoneal visceral serosa on the external surface of the liver. Infected P. flesus livers showed hepatocyte cytoplasmic rarefaction and cell swelling. A few immune cell types, such as macrophages, limited numbers of mast cells (MCs), lymphocytes and some epithelioid cells, were observed within the granuloma. The intensity of infection by Brevimulticaecum sp. (L3) in G. inaequilabiatus ranged from 4 to over 340 larvae per organ, and the nematode larvae were encircled by round-to-oval granulomas. Each granuloma possessed 3 concentric layers of cells and tissue: an inner layer in close proximity to the Brevimulticaecum sp. (L3) cuticle, formed by densely packed layers of epithelioid cells showing several desmosomes between each other; a middle layer of numerous MCs entrapped in a thin fibroblast-connective mesh; and an outer layer of fibrous connective tissue with thin, elongated fibroblasts. High numbers of macrophages and macrophage aggregates were scattered within the granuloma. This is the first study to compare the cellular nature of granulomas and the immune responses in the livers of paratenic fish hosts of 2 nematode species.
The medical workforce in psychiatry is increasingly diverse, but not necessarily in its senior leadership in the UK’s National Health Service (NHS). We aimed to describe the characteristics of psychiatrists with board-level responsibility in mental health trusts in England in 2024, comparing the current picture with that of 2016 and 2020, using publicly available data.
Results
The proportion of medical directors who are female has not changed, so women remain underrepresented, while the proportion who are international medical graduates has increased substantially, so they are no longer underrepresented. Although fewer in number, intellectual disability psychiatrists are underrepresented.
Clinical implications
Greater attention will need to be paid to developing female medical leaders if representative leadership is to be achieved.
This study investigated the factors influencing the mental health of rural doctors in Hebei Province, to provide a basis for improving the mental health of rural doctors and enhancing the level of primary health care.
Background:
The aim of this study was to understand the mental health of rural doctors in Hebei Province, identify the factors that influence it, and propose ways to improve their psychological status and the level of medical service of rural doctors.
Methods:
Rural doctors from 11 cities in Hebei Province were randomly selected, and their basic characteristics and mental health status were surveyed via a structured questionnaire and the Symptom Checklist-90 (SCL-90). The differences between the SCL-90 scores of rural doctors in Hebei Province and the Chinese population norm, as well as the proportion of doctors with mental health problems, were compared. Logistic regression was used to analyse the factors that affect the mental health of rural doctors.
Results:
A total of 2593 valid questionnaires were received. The results of the study revealed several findings: the younger the rural doctors, the greater the incidence of mental health problems (OR = 0.792); female rural doctors were more likely to experience mental health issues than their male counterparts (OR = 0.789); rural doctors with disabilities and chronic diseases faced a significantly greater risk of mental health problems compared to healthy rural doctors (OR = 2.268); rural doctors with longer working hours have a greater incidence of mental health problems; and rural doctors with higher education backgrounds have a higher prevalence of somatization (OR = 1.203).
Conclusion:
Rural doctors who are younger, male, have been in medical service longer, have a chronic illness or disability, and have a high degree of education are at greater risk of developing mental health problems. Attention should be given to the mental health of the rural doctor population to improve primary health care services.
Routine immunization programs may reduce antibiotic use, but few studies have comprehensively examined their impact on antibiotic utilization. We aimed to explore temporal trends in vaccination and antibiotic use among young children in the United States.
Design:
Ecological study using the Merative® MarketScan Commercial Claims and Encounters database.
Methods:
We analyzed claims data on pediatric vaccine uptake (pneumococcal conjugate, Haemophilus influenzae type b, diphtheria-tetanus-pertussis, and influenza) and antibiotic prescriptions and antibiotic-treated respiratory tract infections among US children <5 years during 2000–2019. Vaccination status was assessed annually, and children were categorized based on receipt of all four vaccines, 1–3 vaccines, or no vaccines. Antibiotic prescriptions were classified by spectrum and drug class. Respiratory infections included otitis media, pharyngitis, pneumonia, sinusitis, and viral infections.
Results:
Among 6.7 million children, vaccine uptake increased from 32.5% receiving all four vaccines in 2004 to 66.8% in 2019. During this period, overall antibiotic prescriptions decreased from 1.89 to 1.01 per person-year, with the greatest reductions in macrolides (73.3%) and broad-spectrum antibiotics (57.0%). Antibiotic-treated respiratory tract infections declined from 2.43 to 1.61 episodes per person-year, with the largest decreases in sinusitis (64.7%) and pharyngitis (39.8%).
Conclusions:
The findings suggest a temporal association between routine childhood immunization uptake and reduced antibiotic utilization. Although immunization programs are primarily aimed at protecting children from vaccine-preventable diseases, their potential role in complementing antimicrobial stewardship efforts and other factors influencing antibiotic reduction warrants further investigation through more rigorous study designs.
During nematode surveys conducted to investigate the biodiversity of plant-parasitic nematodes in Mediterranean olive groves with different management strategies (organic and conventional), a nematode population of the genus Neothada was detected in southern Spain. Application of integrative taxonomical approaches clearly demonstrated that it is a new species described herein as Neothada olearum sp. nov., also representing the first report of the genus in Spain. The new species is amphimictic, characterised by a short body (563–774 μm); cuticle widely annulated (2.5–3.0 μm); total number of body annuli 214–226; 16 longitudinal ridges giving a tessellate body surface; stylet without distinct basal knobs (9.0–11.0 μm); and tail elongate-conoid, with tip bluntly rounded. The results of molecular analysis of D2-D3 28S rRNA, ITS rRNA, partial 18S rRNA, and cytochrome oxidase c subunit 1 (COI) gene sequences support for the new species status and clearly separated from N. major and other species within Neothada. Phylogenetic analyses of ribosomal and mitochondrial markers of this study suggested that Neothada is a monophyletic genus, clearly separated from Thada.
This paper studies voter turnout and selective abstention on voting days with more than one election or referendum. We extend the rational choice model to a setting with multiple concurrent votes. The model is based on a voter’s net benefit, which includes a vote’s salience and information costs. It explains how the net benefit of different concurrent votes enters a voter’s utility function and thereby affects turnout and selective abstention, the tendency to vote in one but not all votes held on the same day. We test our theoretical predictions using data on concurrent propositions in Switzerland from 1988 to 2016. Our results suggest that the proposition with the highest net benefit and the sum of the net benefits of all concurrent propositions are relevant determinants of the individual turnout decision. We also find that a proposition’s net benefit explains variation in selective abstention.
How do authoritarian actors navigate the liberal international order, adopting democratic facades without committing to democratic principles? And why is it so difficult for the international normative system to debunk their pretence when it comes to the use of democratic values? This paper explores this question by introducing ‘profilicity’ and ‘performativity’ as key concepts to understand how autocratic regimes build powerful profiles within a liberal system that values authenticity. Unlike conventional theories, which assume that engagement with liberal norms requires genuine commitment, profilicity reveals that strategic image-building can be just as effective. Through this lens, we see how autocracies exploit liberalism’s own ideals, using performative adaptation to secure status and reshape norms. This paper suggests that the liberal order’s emphasis on sincerity may itself be a strategic weakness, one that autocratic actors skilfully navigate in a world increasingly driven by profiles over principles.
Medieval elite culture is often difficult to grasp among archaeological records from settlement sites. A silver-gilt amethyst setting, probably part of a brooch, from the moat of Castle Kolno in Poland represents an unusual high-status find from a context related to everyday activity.
A growing demand for wheat as a staple crop leads to an expansion of its production. The consequence is land use change and short rotations for wheat. But wheat grown in short rotations causes yield decline. To secure future food supplies, a deeper understanding of the physiological processes contributing to this yield reduction is needed. Therefore, a three-year data set from a long-term field trial in Northern Germany was analysed to investigate the impact of crop rotational position (CRP) (wheat grown in the first [W1] and in the third [W3] year in self sequence after break crop) in combination with three genotypes and four rates of nitrogen (N) fertilizer on intercepted radiation by the canopy (Q), radiation use efficiency (RUE), grain yield and yield components. All genotypes showed a reduction of Q, RUE and yields in W3. The focus was further set on differences in yield formation pre- and post-anthesis. This revealed a significant interaction between CRP and genotype. An overall reduction in intercepted radiation pre-anthesis as well as in kernels/m2 in W3 suggested, that yield formation under adverse pre-crop conditions was rather ‘source limited’. A possibility to compensate this limitation might be a prolonged phase of radiation interception post-anthesis.
The International Commission on Radiological Protection (ICRP) Task Group 120 (TG120) is developing ICRP recommendations for radiological protection for a wide range of radiation accidents and malicious events, complementing those given in ICRP Publication 146 (2020) for large nuclear accidents. The scope includes accidents involving criticalities, operating faults, and fires and explosions in nuclear facilities, inadvertent damage to sealed radiation sources, as well as malicious events, such as sabotage of nuclear facilities or materials, use of radiological dispersal devices, the contamination of food and drinking water supplies, and the deployment of nuclear weapons. A template has been designed to collate relevant information on a wide range of case studies and hypothetical malicious scenarios to ensure that the recommendations developed are broadly applicable and comprehensive. For all scenarios, a graded approach to protection is being taken, accepting that specific guidance may be required for some distinctive aspects, for example, protection during times of armed conflict. This paper provides an overview of the scenarios and scope of the work of TG120, including some of the radiological and non-radiological impacts of radiation emergencies, along the response and recovery timeline.
Pharmacological treatment of attention-deficit hyperactivity disorder (ADHD) involves central stimulants and non-stimulant drugs. Because treatment preferences may vary geographically, we hypothesize that prescription data can be estimated from publicly available sources. First, we explore the relevance of internet search trends as proxies for real-life drug prescription patterns. Second, we identify geographical variations in ADHD drug trends over time. Publicly available Google Trends data for five ADHD drugs were analysed for the years 2010–2023. Temporal and spatial patterns were compared within Scandinavia, and the preference for central stimulants over non-stimulant drugs was compared across 17 countries. We find that internet search trends correlate with ADHD drug prescriptions. In the Scandinavian countries, a dominance of methylphenidate is observed, with rising internet search trends over time in Norway and Denmark. Furthermore, interest in lisdexamphetamine, relative to dextroamphetamine and atomoxetine, has increased sharply in recent years in the Scandinavian countries. The search proportion of central stimulants to non-stimulant drugs in Scandinavia ranges from 81% (Denmark) to 93% (Norway). Overall, internet search trends for ADHD drugs mirror reported prescription patterns and identify a dominance of methylphenidate, with an increasing interest in lisdexamphetamine. As such, search trends may serve as a feasible source for identifying geographical drug preferences.