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Scholars and policymakers bemoan an imperial presidency in the war powers context, where the unilateral use of force is frequently interpreted as evidence of an unconstrained executive. Focusing on the strong blame avoidance incentives faced by politicians in the military intervention setting, I develop a model of the war powers focused on “Loss Responsibility Costs.” It suggests that presidents only risk full-scale war when they have the political cover provided by formal authorization, which forces lawmakers to share responsibility. Smaller interventions, in contrast, are frequently undertaken unilaterally because having the president act alone is consistent with congressional preferences for blame avoidance. Novel sentiment data based on tens of thousands of congressional speeches supports the claim that when the president acts unilaterally, they almost always act alongside lawmaker support, who favor intervention but avoid formally endorsing the endeavor. Altogether, it suggests legislators’ influence over war is stronger than commonly appreciated.
Male genital schistosomiasis (MGS), a gender-specific manifestation of urogenital schistosomiasis and neglected tropical disease, typically results from the entrapment of Schistosoma haematobium eggs within the male genital tract. Across the world, there are no current and accurate estimates of the burden of MGS, due to disease underreporting primarily from diagnostic challenges and a lack of general awareness within the health system. Diagnostic methods for MGS are extremely limited. Conventionally, semen microscopy for Schistosoma ova is used though this technique suffers from low sensitivity and lacks protocol standardization. The introduction of molecular diagnostics, such as polymerase chain reaction (PCR), has partly helped overcome this challenge of low sensitivity, though may not be suitable for use in resource-constrained settings. To address these challenges, in this review, we propose a two-step diagnostic algorithm for MGS in accordance with recent WHO guidelines, consisting of a high sensitivity serological test followed by a high specificity test (microscopy or molecular assay, dependent on setting). Further investigation is required into standardization of sample collection, processing, storage, and analysis in order to identify an evidence-based optimal diagnostic pipeline. New diagnostic tools are needed such as isothermal molecular assays, alongside optimization for semen analysis, which may alleviate barriers to diagnosis and present opportunities for integration with other sexual and reproductive health screening. These areas of future investigation underpin the development of a suitable diagnostic pipeline, as the continued neglect of MGS and its underdiagnosis presents a threat to the goal of elimination of schistosomiasis as a public health problem.
Much research has assessed methods of pain control for cattle castration, but there remains a lack of consensus regarding best practice. We conducted a systematic review and meta-analysis of published research including both an untreated control (i.e. castrated without pain mitigation) and at least one unimodal or multimodal analgesia treatment (i.e. castrated with a local anaesthetic alone, or in combination with a non-steroidal anti-inflammatory drug) to summarise findings on castration pain management. Studies were included if they castrated by surgery, elastration or crushing, and reported at least one of the following outcomes: cortisol, change in bodyweight, foot stomping, wound licking, a subjective assessment of pain using a visual analogue scale, or stride length. Our search identified 383 publications, of which 17 were eligible for inclusion. Most publications focused on surgical castration (n = 14), and the most frequently reported outcome was blood cortisol (n = 13). None of the included studies were assessed as having a low risk of bias, mostly due to a lack of reporting blinding procedures and reasons for missing data. Using a three-level random effect model, we concluded that multimodal analgesia reduced blood cortisol concentrations in the first hour following surgical castration in comparison to the control group; this effect was diminished but still evident at 3 and 4 h, but not beyond at 6, 12 and 24 h. Too few data were available to meaningfully assess other outcomes and methods. Variability in methods and outcomes between studies, and risks of bias, hinder our capacity to provide science-based recommendations for best practice.
Squamous cell carcinoma of the external auditory canal is rare, with bilateral cases even rarer. We report the management of a patient with bilateral external auditory canal squamous cell carcinoma related to radiotherapy and immunosuppression.
Case report
A 47-year-old woman with a history of radiotherapy 14 years prior and renal transplantation 6 years prior presented with bilateral external auditory canal squamous cell carcinoma. Squamous cell carcinoma was excised with a purely surgical approach. The two operations included a tympanic membrane graft to preserve hearing on the left side. The patient remains disease-free six months post-op. She uses a bone-conduction hearing aid to good effect on the right side and has mild hearing loss on the left. The operative areas have healed well.
Discussion
The patient’s previous radiotherapy and immunosuppression may have contributed to her bilateral external auditory canal squamous cell carcinoma. Preventative positron emission tomography scans have the potential to identify second malignancies early, allowing more conservative treatment plans.
Oscillations of a heated solid surface in an oncoming fluid flow can increase heat transfer from the solid to the fluid. Previous studies have investigated the resulting heat transfer enhancement for the case of a circular cylinder undergoing translational or rotational motions. Another common geometry, the flat plate, has not been studied as thoroughly. The flat plate sheds larger and stronger vortices that are sensitive to the plate’s direction of oscillation. To study the effect of these vortices on heat transfer enhancement, we conduct two-dimensional numerical simulations to compute the heat transfer from a flat plate with different orientations and oscillation directions in an oncoming flow with Reynolds number 100. We consider plates with fixed temperature and fixed heat flux, and find large heat transfer enhancement in both cases. We investigate the effects of the plate orientation angle and the plate oscillation direction, velocity, amplitude and frequency, and find that the plate oscillation velocity and direction have the strongest effects on global heat transfer. The other parameters mainly affect the local heat transfer distributions through shed vorticity distributions. We also discuss the input power needed for the oscillating-plate system and the resulting Pareto optimal cases.
The cyclicity and Koblitz conjectures ask about the distribution of primes of cyclic and prime-order reduction, respectively, for elliptic curves over $\mathbb {Q}$. In 1976, Serre gave a conditional proof of the cyclicity conjecture, but the Koblitz conjecture (refined by Zywina in 2011) remains open. The conjectures are now known unconditionally “on average” due to work of Banks–Shparlinski and Balog–Cojocaru–David. Recently, there has been a growing interest in the cyclicity conjecture for primes in arithmetic progressions (AP), with relevant work by Akbal–Güloğlu and Wong. In this article, we adapt Zywina’s method to formulate the Koblitz conjecture for AP and refine a theorem of Jones to establish results on the moments of the constants in both the cyclicity and Koblitz conjectures for AP. In doing so, we uncover a somewhat counterintuitive phenomenon: On average, these two constants are oppositely biased over congruence classes. Finally, in an accompanying repository, we give Magma code for computing the constants discussed in this article.
Support for a high-ambition plastics treaty is gaining strength, particularly within global civil society and among lower-income developing countries. Still, opposition to binding measures – such as obligations to regulate petrochemicals or reduce global plastics production – remains intense and widespread. We propose the concept of a “petrochemical historical bloc” to help reveal the depth and extent of the forces opposing strong global governance of plastics. At the bloc’s core are petrostates and industry, especially producers of oil and gas feedstock, petrochemicals and plastics. Extending its influence are broader social forces – including certain political and economic institutions, consultancy firms and nongovernmental organizations – that reinforce and legitimize the discourses and tactics thwarting a high-ambition treaty. This bloc is driving up plastics production, externalizing the costs of pollution, distorting scientific knowledge and lobbying to derail negotiations. Yet the petrochemical historical bloc is neither monolithic nor all-powerful. Investigating differing interests and evolving politics within this bloc, we contend, can expose disingenuous rhetoric, weaken low-ambition alliances and reveal opportunities to overcome resistance to ambitious governance. In light of this, and toward highlighting fractures and potential counter-alliances and strategies, we call for a global research inquiry to map the full scope and nature of the petrochemical historical bloc.
I argue that the epistemic aim of scientific theorizing (EAST) is producing theories with the highest possible number and degree of theoretical virtues (call this “TV-EAST”). I trace TV-EAST’s logical empiricist origins and discuss its close connections to Kuhn’s and Laudan’s problem-solving accounts of the aim of science. Despite TV-EAST’s antirealist roots, I argue that if one adopts the realist view that EAST is finding true theories, one should also endorse TV-EAST. I then defend TV-EAST by showing that it addresses the challenges raised against using “the aim of science” metaphor and offers significant advantages over the realist account.
A 13,500-year-old record from Langohr Wetland in the Gallatin Range of southwestern Montana offers new insights into the vegetation and fire history at middle elevations within the Greater Yellowstone Ecosystem. Pollen data suggest that following deglaciation, a tundra–steppe established until warmer and wetter conditions than before could support Picea parkland. The development of an open, predominantly Pinus mixed-conifer forest from ca. 9300–7000 cal yr BP suggests warming summer temperatures led to an increase in forest cover and fire activity; the increase in tree abundance supported infrequent, stand-replacing fires approximately every 600 years. Picea and Pseudotsuga increased their presence at ca. 7000 cal yr BP, and the mixed-conifer forest became denser during the Mid- and Late Holocene, suggesting summers became cooler and wetter. The additional fuel load led to increased fire activity, with stand-replacing fires occurring approximately every 350 years in the Late Holocene. The forest surrounding Langohr Wetland experienced less change in vegetation composition and structure and fewer fire episodes than other low- and high-elevation sites in the Greater Yellowstone Ecosystem. The stability of this forested ecosystem over thousands of years is likely a result of its cool mesic mid-elevation setting, limiting the frequency of intense fire episodes.
In March 2024, the East Midlands Health Protection Team was notified of a case of invasive Group A Streptococcus (iGAS) infection in an elderly care home resident. Twenty-two days later, another case in a resident from the same floor of the care home was notified. In accordance with national guidelines, an outbreak was declared, and a multidisciplinary outbreak control team (OCT) was urgently convened. Screening for GAS throat carriage was undertaken for staff and residents, excluding those receiving end-of-life care. All isolates were strain typed and characterised. Infection prevention and control (IPC) visits were undertaken to provide ongoing support. Screening identified five residents and five staff members positive for GAS. Antibiotic prophylaxis was provided to all staff throughout the setting (n = 74) and all residents on the affected floor (n = 35). Three individuals were positive on repeat screening. All staff and residents screened negative after 4 months and the two clinical cases recovered. Eleven of the 12 GAS isolates were identified as emm 3.93. This outbreak highlighted the importance of rapid screening, possible only through the deployment of a dedicated team, and rescreening post-decolonising treatment, as a means to contain such outbreaks.
In this article, we consider the relationship between conceptual blending, creativity and morphological change, within the framework of Diachronic Construction Morphology (DCxM; Norde & Trousdale 2023). In particular, we suggest that a refinement to models of creativity in the literature might help to account better for different types of morphological change (Norde & Trousdale 2024). This is achieved via a contrastive analysis of two different sets of changes: (a) the creation of English libfixes (Zwicky 2010; Norde & Sippach 2019), e.g. snowmaggedon and spooktacular, and (b) the development of Dutch pseudoparticiples (Norde & Trousdale 2024), e.g. bebrild ‘bespectacled’ and ontstekkerd ‘with all plugs removed’.
This study aimed to describe changes over time in the prevalence and associated factors of suicidal behaviours among 13– to 15–year–olds in Southeast Asian countries. It is a secondary analysis of cross-sectional data from the Global School-based Student Health Surveys conducted in Indonesia, Myanmar, the Philippines and Thailand in 2007/2008 and 2015/2016. Each survey included a nationally representative sample of students aged 13–15 years. Data on suicidal thoughts, plans, attempts, and associated factors—including health risk behaviours, experiences of physical violence and bullying, social difficulties, and parental supervision—were collected using self-report questionnaires. The population attributable fraction for each risk factor was calculated using multiple logistic regression. The prevalence of suicidal behaviours ranged from 0.7% (Myanmar) to 17.3% (Philippines) in 2007/2008, and from 8.6% (Indonesia) to 20.9% (Thailand) in 2015/2016. Being physically attacked or bullied and experiencing social difficulties were the most consistent and significant risk factors across countries and time points. Female gender, poverty, alcohol consumption, and drug use also contributed to risk at varying levels. Suicidal behaviours have risen alarmingly in several Southeast Asian countries. These findings suggest the urgent need for coordinated action by policymakers, health professionals, educators, and families to prevent adolescent suicidal behaviours.
Lower COVID-19 vaccination coverage was observed among some populations with a migration background in the Netherlands. This study examined determinants of being unvaccinated against COVID-19 in the primary vaccination round in adults and in the 2022 autumn booster round in persons aged ≥60 years, among four populations of non-Dutch origin with below average vaccination coverage: Moroccan, Turkish, Surinamese and Dutch-Caribbean, and persons of Dutch origin. We performed a population-wide register-based study, examining associations between potential determinants and being unvaccinated using multivariable logistic regression and computing population attributable fractions. Being a migrant with two foreign-born parents, younger age, living in highly/extremely urban areas and having a lower income, lower education level and low medical risk for severe COVID-19 were risk factors for being unvaccinated in all populations. Substantial differences in the (strength of) determinants and population attributable fractions between populations were also observed. Socioeconomic status only partially mediated the association with being a migrant with two foreign-born parents. These findings illustrate that interventions targeting specific ethnic minority and migrant populations need further study with the aim to optimize the impact of vaccination programmes and improve health equity. To understand reasons behind non-uptake and design (community-based) interventions, qualitative and survey-based research is needed.
Life-cycle health technology assessment (HTA) requires an index economic model to establish how estimated cost-effectiveness evolves with emerging evidence. We developed an open-source index economic evaluation of entrectinib, a tumor-agnostic therapy with conditional market authorization. Our objective was to replicate the initial HTA report from publicly available information, aiming to identify key operational and methodological aspects for operationalizing life-cycle decision-making.
Methods
We used partitioned survival analysis to determine tumor-agnostic and tumor-specific cost-effectiveness, using publicly available HTA reviews for parameterization. We estimated incremental costs in 2021 Canadian and US dollars (CAD and USD) from a public-payer healthcare perspective, quality-adjusted life years (QALYs), and incremental net monetary benefit (INMB). We assessed the impact of treatment effectiveness, extrapolation assumptions, and next-generation sequencing (NGS) costs.
Results
One-third of the parameters (n = 30) were unavailable in the Canadian reimbursement review and were sourced from international reviews. Tumor-agnostic incremental costs were CAD 68,451 (95 percent confidence interval: 35,466, 92,155) and USD 54,608 (28,294, 73,518), and QALYs were 0.13 (−0.42, 0.42), yielding INMB CAD −55,803 at 100,000/QALY (USD −44,518). Full extrapolation of treatment effectiveness also yielded negative INMB (CAD −66,664). Inclusion of NGS costs diminished the expected value. Heterogeneity was considerable across tumor indications.
Conclusions
We developed an open-source index economic evaluation to operationalize life-cycle HTA for a conditionally authorized tumor-agnostic therapy. Our findings outline key operational and methodological considerations necessary for the development of index economic models that support life-cycle HTA, offering insights into their potential integration into regular HTA and policy decision-making processes.
Interventions at frequently used suicide locations that restrict access to means, encourage help-seeking, and increase the likelihood of intervention by a third party are effective in preventing suicide at such sites. However, there have been concerns that such efforts may displace suicides to other sites. It is important to synthesize the evidence on suicide displacement effects.
Methods
We conducted a systematic search of Medline, PsycINFO, Scopus, and Google for eligible studies from their inception to February 20, 2025. Meta-analyses were conducted to assess the pooled effects of interventions on suicides at frequently used locations and other sites, and on overall suicides involving the same method.
Results
Our search identified 17 studies. Meta-analyses showed a reduction in suicides at the intervention sites (pooled incidence rate ratio [IRR] 0.09, 95% confidence interval [95% CI] 0.04–0.21) and no evidence of changes in suicides at other sites after restricting access to means was deployed alone. The pooled IRR for nearby sites (same type) was 0.99 (95% CI 0.72–1.38); for other sites (same type), it was 0.99 (95% CI 0.76–1.29); and for other sites (different/unspecified type), it was 1.19 (95% CI 0.90–1.58). There was an overall reduction in suicides involving the same method during the post-intervention period (IRR 0.77, 95% CI 0.65–0.92). Similar patterns were observed when restricting access to means was assessed alone or with other interventions.
Conclusions
Suicide numbers at other sites did not change after interventions such as restricting access to means were deployed at frequently used locations.