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Vitamin A deficiency (VAD) poses significant health risks and is prevalent in children and adolescents in India. This study aimed to determine the effect of seasonal variation and availability of vitamin A-rich (VA-rich) foods on serum retinol in adolescents. Data on serum retinol levels from adolescents (n 2297, mean age 14 years) from the Comprehensive National Nutrition Survey (2016–2018) in India were analysed, with VAD defined as serum retinol < 0·7 µmol/L. Five states were selected based on a comparable under-five mortality rate and the seasonal spread of the data collection period. Dietary data from adolescents and children ≤ 4 years old were used to assess VA-rich food consumption. A linear mixed model framework was employed to analyse the relationship between serum retinol, month of the year and VA-rich food consumption, with a priori ranking to control for multiple hypothesis testing. Consumption of VA-rich foods, particularly fruits and vegetables/roots and tubers, showed seasonal patterns, with higher consumption during summer and monsoon months. Significant associations were found between serum retinol concentrations and age, month of sampling, consumption of VA-rich foods and fish. VAD prevalence was lowest in August, coinciding with higher consumption of VA-rich fruits and foods. Findings highlight the importance of considering seasonality in assessing VAD prevalence and careful interpretation of survey findings. Intentional design, analysis and reporting of surveys to capture seasonal variation is crucial for accurate assessment and interpretation of VAD prevalence, including during monitoring and evaluation of programmes, and to ensure that public health strategies are appropriately informed.
This paper examines the aeroelastic stability of uniform flexible wings imperfectly supported at one end and free at the other. Real-world aircraft wings inevitably exhibit imperfections, including non-ideal end supports. This work is motivated by the critical need to fundamentally understand how end-support imperfections influence the aeroelastic behaviour of fixed wings. The equations of motion are obtained via the extended Hamilton’s principle. The bending-torsional dynamics of the wing is approximated using the Euler-Bernoulli beam theory. The aerodynamic lift and pitching moment are modelled using the unsteady aerodynamics for the arbitrary motion of thin aerofoils in the time domain, extended by the strip flow theory. The imperfect support is modelled via rotational springs (with linear stiffness) for both bending and torsional degrees of freedom. The Galerkin method is used for the spatial discretisation. The stability analysis is performed by solving the resulting eigenvalue problem, and the numerical results are presented in Argand diagrams. The numerical results presented in this study are novel and offer great insights. It is demonstrated that support imperfections can substantially influence the critical flow velocity for both flutter and divergence, as well as alter the sequence of instabilities and the unstable mode. The extent of these effects directly depends on the magnitude of the imperfections. Interestingly–and counterintuitively–in certain cases, a reduction in the flutter speed is observed as the imperfections decrease.
Major depressive disorder (MDD) and insulin resistance-related conditions are major contributors to global disability. Their co-occurrence complicates clinical outcomes, increasing mortality and symptom severity.
Aims
In this study, we investigated the association of insulin resistance-related conditions and related polygenic scores (PGSs) with MDD clinical profile and treatment outcomes, using primary care records from UK Biobank.
Method
We identified MDD cases and insulin resistance-related conditions, as well as measures of depression treatment outcomes (e.g. resistance) from the records. Clinical-demographic variables were derived from self-reports, and insulin resistance-related PGSs were calculated using PRS-CS. Univariable analyses were conducted to compare sociodemographic and clinical variables of MDD cases with (IR+) and without (IR−) lifetime insulin resistance-related conditions. Multiple regressions were performed to identify factors, including insulin resistance-related PGSs, potentially associated with treatment outcomes, adjusting for confounders.
Results
Among 30 919 MDD cases, 51.95% were IR+. These had more antidepressant prescriptions and classes utilisation and longer treatment duration than patients without insulin resistance-related conditions (P < 0.001). IR+ participants showed distinctive depressive profiles, characterised by concentration issues, loneliness and inadequacy feelings, which varied according to the timing of MDD diagnosis relative to insulin resistance-related conditions. After adjusting for confounders, insulin resistance-related conditions (i.e. cardiovascular diseases, hypertension, non-alcoholic fatty liver disease, obesity/overweight, prediabetes and type 2 diabetes mellitus) were associated with antidepressant non-response/resistance and longer treatment duration, particularly when MDD preceded insulin resistance-related conditions. No significant PGS associations were found with antidepressant treatment outcomes.
Conclusions
Our findings support an integrated treatment approach, prioritising both psychiatric and metabolic health, and public health strategies aimed at early intervention and prevention of insulin resistance in MDD.
In-person networks based on imperial legacies, immigrants, and general trading companies that share a common language and culture can help expand trade in differentiated goods. However, little is known regarding how such networks can facilitate deals for differentiated goods. To investigate the role played by general trading companies in this context, we study how major trading companies navigated a sensitive transaction—the procurement of distillation facilities for oil shale in Manchuria—in imperial Japan during the first age of globalization. Our archival research revealed that trading companies logistically supported Japanese buyer engineers when they met in person with engineers associated with Western suppliers, and visited plants in the West with the aim of acquiring tacit knowledge beyond the scope of written specifications. The role played by Japanese trading companies in this context involved promoting knowledge spillover from the West by providing logistic support for such in-person meetings.
Determining the factors that impact the risk for infection with SARS-CoV-2 is a priority as the virus continues to infect people worldwide. The objective was to determine the effectiveness of vaccines and other factors associated with infection among Canadian healthcare workers (HCWs) followed from 15 June 2020 to 1 December 2023. We also investigate the association between antibodies to SARS-CoV-2 and subsequent infections with SARS-CoV-2. Of the 2474 eligible participants, 2133 (86%) were female, 33% were nurses, the median age was 41 years, and 99.3% had received at least two doses of COVID-19 vaccine by 31 December 2021. The incidence of SARS-CoV-2 was 0.91 per 1000 person-days. Prior to the circulation of the Omicron variants, vaccine effectiveness (VE) was estimated at 85% (95% CI 1, 98) for participants who received the primary series of vaccine. During the Omicron period, relative adjusted VE was 43% (95% CI 29, 54), 56% (95% CI 42, 67), and 46% (95% CI 24, 62) for 3, 4, and ≥ 5 doses compared with those who received primary series after adjusting for previous infection and other covariates. Exposure to infected household members, coworkers, or friends in the previous 14 days were risk factor for infection, while contact with an infected patient was not statistically significant. Participants with higher levels of immunoglobulin G (IgG) anti-receptor binding domain (RBD) antibodies had lower rates of infection than those with the lowest levels. COVID-19 vaccines remained effective throughout the follow-up of this cohort of highly vaccinated HCWs. IgG anti-RBD antibody levels may be useful as correlates of protection for issues such as vaccine development and testing. There remains a need to increase the awareness among HCWs about the risk of contracting SARS-CoV-2 from contacts at a variety of venues.
This paper is a short report considering the role of occupational therapy in providing mental health services in primary care. Primary care is the first point of contact most people have with the healthcare system. Occupational therapists have a role working with people with mental illness but the role of an occupational therapist working in mental health in a primary care setting is not well understood. Common interventions discussed in the literature included lifestyle approaches, assessment and information gathering, and the teaching of skills for daily living. There was a clear divide in the literature regarding the use of generic or specialist (occupation-focused) roles. Physical health was often prioritized over mental health concerns. Limited research examined both the population group of people with mental health concerns and the practice setting of primary care, identifying the need for further research to articulate the role of occupational therapy in working with mental health in primary care settings.
In 1955, André Siegfried wondered whether the planet was entering a new geological age, wrought by industrialism and evident in major geopolitical changes. In this article, I trace his intellectual journey towards this claim and his singular focus on the international politics of agriculture and environmental change. First, I trace Siegfried’s early ideal of French rural democracy and its prudential virtues amid inter-imperial competition and interwar debt crises. Second, after the Dust Bowl, I examine Siegfried’s shifting engagements with environmental arguments against mechanized monoculture, focusing on his fears of erosion, and, after 1945, the loss of soil fertility and ecological resilience associated with small-scale mixed farming. Doubled through a geopolitical lens, I show how Siegfried saw such shifts as existential threats to his idyll of France’s rural democracy and global power. To conclude, I reflect on how Siegfried’s environmental geopolitics can help us rebuild intellectual histories of Anthropocene politics.
Let $G \leqslant \mathrm {Sym}(\Omega )$ be a finite transitive permutation group and recall that an element in G is a derangement if it has no fixed points on $\Omega $. Let $\Delta (G)$ be the set of derangements in G and define $\delta (G) = |\Delta (G)|/|G|$ and $\Delta (G)^2 = \{ xy \,:\, x,y \in \Delta (G)\}$. In recent years, there has been a focus on studying derangements in simple groups, leading to several remarkable results. For example, by combining a theorem of Fulman and Guralnick with recent work by Larsen, Shalev and Tiep, it follows that $\delta (G) \geqslant 0.016$ and $G = \Delta (G)^2$ for all sufficiently large simple transitive groups G. In this paper, we extend these results in several directions. For example, we prove that $\delta (G) \geqslant 89/325$ and $G = \Delta (G)^2$ for all finite simple primitive groups with soluble point stabilisers, without any order assumptions, and we show that the given lower bound on $\delta (G)$ is best possible. We also prove that every finite simple transitive group can be generated by two conjugate derangements, and we present several new results on derangements in arbitrary primitive permutation groups.
Actuaries must model mortality to understand, manage and price risk. Continuous-time methods offer considerable practical benefits to actuaries analysing portfolio mortality experience. This paper discusses six categories of advantage: (i) reflecting the reality of data produced by everyday business practices, (ii) modelling rapid changes in risk, (iii) modelling time- and duration-varying risk, (iv) competing risks, (v) data-quality checking and (vi) management information. Specific examples are given where continuous-time models are more useful in practice than discrete-time models.
Competing and complementary risk (CCR) problems are often modelled using a class of distributions of the maximum, or minimum, of a random number of independent and identically distributed random variables, called the CCR class of distributions. While CCR distributions generally do not have an easy-to-calculate density or probability mass function, two special cases, namely the Poisson–exponential and exponential–geometric distributions, can easily be calculated. Hence, it is of interest to approximate CCR distributions with these simpler distributions. In this paper, we develop Stein’s method for the CCR class of distributions to provide a general comparison method for bounding the distance between two CCR distributions, and we contrast this approach with bounds obtained using a Lindeberg argument. We detail the comparisons for Poisson–exponential, and exponential–geometric distributions.
Interfacility patient transfers contribute to the regional spread of multidrug-resistant organisms (MDROs). We evaluated whether transfer patterns of inpatients with similar characteristics to carbapenem-resistant Enterobacterales (CRE) case-patients (CRE surrogates) better reflect hospital-level CRE burden than traditionally used populations.
Design:
We determined the risk factors for subsequent hospital admission using demographic and clinical information from Tennessee Department of Health tracked CRE case-patients from July 2015 to September 2019. Risk factors were used to identify CRE surrogates among inpatients in the 2018 Tennessee Hospital Discharge Data System (HDDS). Transfer networks of CRE surrogates, Medicare/TennCare beneficiaries, and all-inpatients with ≤365 days of intervening community stays were compared with the transfer networks of CRE case-patients in 2019. The associations between hospital-level CRE prevalence and hospitals’ incoming transfer volumes from each network were assessed using negative binomial regression models.
Results:
Eight risk factors for subsequent hospital admission were identified from 2,518 CRE case-patients, which were used to match CRE case-patients with HDDS inpatients, resulting in 10,069 surrogate patients. CRE surrogate network showed more structural similarities with the CRE case-patient network than with the all-inpatient and Medicare/TennCare networks. A 33% increase in hospitals’ CRE prevalence in 2019 was associated with each doubling of incoming transfer of CRE surrogates in 2018 (adjusted Risk Ratio [aRR] 1.33, 95%CI: 1.1, 1.59), higher than all-inpatient (aRR 1.27, 95% CI: 1.08, 1.51) and Medicare/TennCare networks (aRR 1.21, 95% CI: 1.02, 1.44).
Conclusions:
Surrogate transfer patterns were associated with hospital-level CRE prevalence, highlighting their value in MDRO containment and prevention.
We prove a functional transcendence theorem for the integrals of algebraic forms in families of algebraic varieties. This allows us to prove a geometric version of André’s generalization of the Grothendieck period conjecture, which we state using the formalism of Nori motives.
More precisely, we prove a version of the Ax–Schanuel conjecture for the comparison between the flat and algebraic coordinates of an arbitrary admissible graded polarizable variation of integral mixed Hodge structures. This can be seen as a generalization of the recent Ax–Schanuel theorems of [13, 18] for mixed period maps.
This special issue focuses on the many roles that context plays in neural machine translation and the evaluation of machine translation. It includes a survey of the current state of research related to context in machine translation and machine translation evaluation, along with three papers that focus on a variety of topics related to evaluation. Together, these highlight the wide range of topics in this area, and its increasing relevance as high-quality machine translation becomes increasingly common in a variety of settings.
In this paper, frontal variations and surface area changes for each of the years 2017–2023 are assessed for 277 Swedish glaciers, of which the majority is contained within the Randolph Glacier Inventory 7.0. Mapping of all Swedish glaciers became possible by combining Sentinel-2 imagery, semi-automated mapping procedures and the open-source Margin Change Quantification Tool (MaQiT). In addition, manual mapping was performed at a subset of 22 glaciers historically associated with the Swedish Front Variation Program. At four of those, mapping accuracy was assessed by contrasting Sentinel-2 mapped fronts to fronts mapped in situ using Global Navigation Satellite System (GNSS), a total station and an uncrewed aerial vehicle. Results show widespread retreat of all Swedish glaciers, with cumulative frontal variation amounting on average to −55.6 m during 2017–2023 or −9.3 m a−1. Swedish glaciers had a total area of ∼237 km2 in 2017 and of 210 km2 in 2023. The reduction by ∼27 km2 corresponds to a loss of 11% with respect to the areal extent in the year 2017 but varies across regions. It is also almost as large as the combined area loss of Swedish glaciers in the preceding 15 years (∼31 km2, 2002–2017).
Following the recent report of strongyloidiasis caused by Strongyloides fuelleborni within a semi-captive colony of baboons in a UK safari park, we investigated the genetic relationships of this isolate with other Strongyloides isolates across the world. Whole-genome sequencing data were generated with later phylogenetic analysis of mitochondrial (mt) cytochrome oxidase subunit 1 (cox1) and nuclear ribosomal 18S sequences against 300 published Strongyloides reference genotypes. The putative African origin of the UK S. fuelleborni was confirmed and full-length mt genome sequences were assembled to facilitate a more detailed phylogenetic analysis of 14 mt coding regions against all available Strongyloides species. Our analyses demonstrated that the UK isolate represented a novel African lineage not previously described. Additional complete mt genomes were assembled for several individual UK safari park worms to reveal a slightly altered mt genome gene arrangement, allowing clear separation from Asian S. fuelleborni. Furthermore, these UK worms possessed expanded intergenic regions of unknown function that increase their mt genome size to approximately 24 kilobases (kb) as compared with some 16 kb for Asian S. fuelleborni; this may have arisen from unique populational founder and genetic drift effects set within the peculiar mixed species baboon and drill ancestry of this semi-captive primate colony. A maximum likelihood phylogeny constructed from 14 mt coding regions also supported an evolutionary distinction between Asian and African S. fuelleborni.
Cognitive therapy for post-traumatic stress disorder (PTSD) is recommended in a range of national and international guidelines. This clinical guidance paper specifically focuses on cognitive therapy for PTSD (CT-PTSD) where racism has been part of the index trauma event(s). It aims to support CBT therapists to maintain fidelity to the CT-PTSD model but also ensure that racism is integrated into the formulation and interventions in ways that are sensitive and validating. It explores barriers to this occurring ranging from societal factors (e.g. ongoing racism, discouragement from discussing racism), to therapist factors (e.g. lack of understanding of racism, lack of own understanding of racialised identity, anxiety, lack of knowledge, skills and confidence) and patient factors (e.g. shame, fear of therapist response). The paper aims to provide guidance on how these can be addressed alongside case illustrations and practical considerations for therapists and supervisors.
Key learning aims
(1) To understand how Ehlers and Clark’s (2000) cognitive model and related treatment of PTSD can be applied when racism is part of the traumatic event.
(2) To provide guidance, tips and examples on how to identify key personal meanings around the trauma index event involving racism.
(3) The article will encourage therapists to reflect on their own identity and experiences (or lack of) around racism, considering how this might hinder or facilitate the appropriate inclusion of racist experience within CT-PTSD.
(4) To provide suggestions on how to ensure that supervision of CT-PTSD supports the consideration and addressing of relevant experiences of racism and supports therapists where patient experiences may overlap with their own experience of racism.
In this catalogue, we present the results of a systematic study of 199 short gamma-ray bursts (GRBs) detected by Konus-Wind between 1 January 2011 and 31 August 2021. The catalogue extends the Second Catalogue of short GRBs covering the period 1994–2010 by ten years of data. The resulting Konus-Wind short GRB sample includes 494 bursts. From temporal and spectral analyses of the sample, we provide the burst durations, spectral lags, estimates of the minimum variability timescales, rise and decay times, the results of spectral fits with three model functions, the total energy fluences, and the peak energy fluxes of the bursts. We present statistical distributions of these parameters for the complete set of 494 short GRBs detected in 1994–2021. We discuss in detail the properties of the bursts with extended emission in the context of the whole short GRB population. Finally, we consider the results in the context of the Type I (merger-origin)/Type II (collapsar-origin) classification and discuss the extragalactic magnetar giant flare subsample.
This article extends recent insights from new institutional economics to explore the relevance of the concept of meso-institutions. It does so through the exploration of the case of the Brazilian Forest Code, pointing out how and why meso-institutions play a key role in making public policies effective. More specifically, our study shows how crucial is the complete fulfilling of the functions characterising meso-institutions – namely translation, monitoring, and enforcement, to implement regulations and determine their effectiveness. Lessons are drawn regarding the complexities inherent in the creation, implementation, and operationalisation of rules across a multilayered institutional environment.