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This Element examines clientelism and its impact on democratic institutions and markets, emphasizing that, alongside electoral competition, politics hosts two additional arenas: one where political actors seek campaign resources and active supporters, and another where socioeconomic actors pursue access to state-distributed resources. Clientelism emerges from reciprocal exchanges between these actors. Political parties use clientelism to incentivize collective action and organize campaigns. Playing this 'clientelist game', no party can reduce clientelistic practices without risking electoral defeat or internal fragmentation. Clientelism weakens the provision of public goods and skews policymaking to benefit clients over general welfare. Eventually, it generates an economic 'tragedy of the commons', as state resources are overexploited and the economy suffers, while formal institutions often fail to constrain it. Even in advanced democracies like the United States, political competition is not only electoral, targeting voters, but structurally clientelist. This title is also available as Open Access on Cambridge Core.
In Relational Justice, Hanoch Dagan and Avihay Dorfman defend a longstanding intuition of bilateral normativity. They argue that private law, for the most part, should structure legal relationships so that parties show reciprocal respect for each other’s self-determination and substantive equality. In this critical notice, I argue against the plausibility of their account. My main claim is that a commitment to individual self-determination and substantive equality should be societal and not bilateral. Rather than reciprocal respect for each other’s self-determination and equality within bilateral relationships, those who care about these values should require that private law help secure them on a societal scale.
The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.
Methods
We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.
Results
Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.
Conclusions
Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.
Rodrigo Duterte's rise and the Marcoses' return to power have captivated Southeast Asia watchers and the rest of the world. That the spectacle of strongman rule has allured most Filipinos is no longer in doubt, with the strong electoral mandate garnered by Ferdinand Marcos Jr in 2022. Whether their capture of state power is in any way connected and what this portends about the country's democratic future is a key theme marking Games, Changes, and Fears. In this volume, Filipino academics and practitioners provide much needed analysis about this political succession and what it means for Asia's oldest republic. Packed with thirteen chapters depicting insightful trends and prognosis on the Philippine economy, domestic politics, foreign policy, and society, this volume offers scholars, students, and policymakers with the analytical repertoire to understand developments in the Philippines. Overall, the chapters suggest that while some policies and practices continue under the Marcos Jr. administration, there have been pivotal changes indicating a break from the past. The chapters offer key policy recommendations critical in recalibrating Philippine political, economic, and social conditions that could address democratic backsliding, economic challenges, and societal polarization.
This chapter overviews the characteristics and circumstances predisposing people to lead or join hate movements with a particular focus on the virulent anti-Semitism that united figures such as Father Charles Coughlin, Charles Lindbergh, and Henry Ford. By analyzing these figures and their followers, we extrapolate practices common among hate groups. After identifying character traits and risk factors (e.g., political and economic insecurity), we discuss their more modern manifestations. First we clarify our definition of hate groups as defined by the Department of Justice, Federal Bureau of Investigation, and Southern Poverty Law Center. We then extrapolate from these definitions to show how they align well with our definition of a cult. Following this, we acknowledge the challenges that accompany hate group designation while concluding that it is still vital for tracking modern-day hate groups and discrimination. We conclude by acknowledging the continued threat of hate groups and the presence of risk factors seen throughout history, such as global public health emergencies. We also discuss challenges unique to the technology age, such as epistemic bubbles and echo chambers. In summary, the chapter provides an outline of how hate groups come to be and provides a discussion of their continuing threat in society.
A ground vortex engendered by the interaction of uniform flow over a plane surface with suction into a cylindrical conduit whose axis is normal to the cross-flow and parallel to the ground plane is investigated in wind tunnel experiments. The formation and evolution of the columnar vortex and its ingestion into the conduit’s inlet are explored using planar/stereo particle image velocimetry over a broad range of formation parameters that include the speeds of the inlet and cross-flows and the cylinder’s elevation above the ground plane with specific emphasis on the role of the surface vorticity layer in the vortex initiation and sustainment. The present investigations show that the appearance of a ground vortex within the inlet face occurs above a threshold boundary of two dimensionless formation parameters, namely the inlet’s momentum flux coefficient and its normalised elevation above the ground surface. Transitory initiations of wall-normal columnar vortices are spawned within a countercurrent shear layer that forms over the ground plane within a streamwise domain on the inlet’s leeward side by the suction flow into the duct. At low suction speeds, these wall-normal vortices are advected downstream with the cross-flow but when their celerity is reversed with increased suction, they are advected towards the cylinder’s inlet, gain circulation and stretch along their centrelines and become ingested into the inlet at a threshold defined by the formation parameters. Finally, the present investigations demonstrated that reduction of the countercurrent shear within the wall vorticity layer by deliberate, partial bypass of the inlet face flow through the periphery of the cylindrical duct can significantly delay the ingestion of the ground vortex to higher level thresholds of the formation parameters.
Protein fermentation in the human gut is often associated with adverse health effects. Hence, understanding the fermentation characteristics of dietary undigested proteins is important for a comprehensive nutritional value of foods. This study investigated the protein fermentation kinetics of diet-derived proteins from thirty-one different foods using an in vitro model and human faecal inoculum. The undigested diet-derived protein substrate originated from porcine ileal digesta obtained from assessment of the digestible indispensable amino acid score (DIAAS) of the foods. Significant variations in fermentation kinetic parameters, particularly in maximum gas production rate (Rmax) and time to reach cumulative gas production (GP) from the substrate (TGPs), were observed. The Rmax ranged from 15·5 (se 0·7) ml/h for wheat bran-derived to 24·5 (se 0·9) ml/h for oatmeal-derived proteins. Egg-derived proteins had the shortest TGPs (14·7 (se 0·7) h), while mushroom-derived proteins had the longest (27·6 (se 7·1) h). When foods were categorised into five groups (‘animal protein’, ‘grains’, ‘legumes’, ‘fungi, algae and microorganisms’ and ‘others’), no significant differences were found in fermentation kinetics parameters. Samples were additionally incubated with porcine inoculum to assess potential donor-species effects. Human inoculum showed significantly lower Rmax, cumulative GP and microbiota turnover than porcine inoculum, indicating reduced fermentative activity. Linear regression analysis revealed correlations between human and porcine-derived inoculum only for Rmax (R2 = 0·78, P < 0·01) and TGPs (R² = 0·17, P < 0·05). These findings underscore the importance of using human inoculum in in vitro studies to better predict health implications of foods with DIAAS values.
The kinetic stability of collisionless, sloshing beam-ion ($45^\circ$ pitch angle) plasma is studied in a three-dimensional (3-D) simple magnetic mirror, mimicking the Wisconsin high-temperature superconductor axisymmetric mirror experiment. The collisional Fokker–Planck code CQL3D-m provides a slowing-down beam-ion distribution to initialize the kinetic-ion/fluid-electron code Hybrid-VPIC, which then simulates free plasma decay without external heating or fuelling. Over $1$–$10\;\mathrm{\unicode{x03BC} s}$, drift-cyclotron loss-cone (DCLC) modes grow and saturate in amplitude. The DCLC scatters ions to a marginally stable distribution with gas-dynamic rather than classical-mirror confinement. Sloshing ions can trap cool (low-energy) ions in an electrostatic potential well to stabilize DCLC, but DCLC itself does not scatter sloshing beam-ions into the said well. Instead, cool ions must come from external sources such as charge-exchange collisions with a low-density neutral population. Manually adding cool $\mathord {\sim } 1\;\mathrm{keV}$ ions improves beam-ion confinement several-fold in Hybrid-VPIC simulations, which qualitatively corroborates prior measurements from real mirror devices with sloshing ions.
The management of patients with moderate and severe traumatic brain injury (TBI) is centred on the intensive care management to limit the extent of secondary injury to the brain, following the primary trauma. This management aims to optimise the homeostatic environment of the brain after injury and can be guided by multi-modality monitoring, including intracranial pressure (ICP) monitoring. This management often follows a tiered approach to introducing more aggressive interventions to correct physiology, based on evidence for ongoing secondary injury, such as raised ICP. The balance between risk and benefit for these interventions for individual patients is difficult, particularly in the absence of high quality randomised trials for many interventions in this area. In this Element, the authors outline both the approach to intensive care management of moderate and severe TBI, as well as the evidence base available for the interventions discussed.
Fjord ecosystems serve as crucial habitats for elasmobranchs, supporting them across all life stages. Chilean Patagonia provides one of the most complex and extensive networks of fjord ecosystems in the world, displaying high marine biodiversity, including elasmobranchs. However, little is known about this ecologically important group of fishes in these ecosystems. This study investigates the biodiversity of elasmobranchs in the Comau Fjord over a period of 6 months by combining morphological and molecular data. In total, 309 specimens within a radius of 7.5 km were recorded, belonging to six families and nine species: Hexanchus griseus (77.5–178 cm LT), Notorynchus cepedianus (180.6 cm LT), Schroederichthys bivius (35–65.2 cm LT), Scymnodon macracanthus (37.3 cm LT), Centrophorus squamosus (87.4 cm LT), Deania calceus (58.3–98.6 cm LT), Squalus acanthias (25.5–101.1 cm LT), Dipturus chilensis (62.9–152 cm LT), and Dipturus trachyderma (69.8–194 cm LT). This included records of three species previously unknown in the fjord and was equivalent to nearly 20% of the elasmobranch richness found in Southern Chile. The results further suggest that the Comau Fjord could be a primary nursery ground for several species of elasmobranchs. This is the first time that a species inventory of elasmobranchs is conducted in a Chilean fjord system. The outcomes of this research provide an elasmobranch species checklist with biological aspects from the Comau Fjord, which are essential data to inform decision makers, conservation managers, and future research.
Are refugee ‘return’ and ‘repatriation’ the same thing? This article investigates the mid-century emergence of these two key concepts in the context of the entangled histories of post-1945 displacement and resettlement in Palestine/Israel, which has long had the dubious distinction of serving as a central site of international experimentation vis-à-vis modern questions surrounding mass expulsion and the possibilities of return. Despite the deeply interwoven nature of Palestinian and Jewish displacement, scholars have generally accepted these histories as distinct and segregated national memories. Such accounts actively ignore a crucial set of actors in the making of these forced migrations and their aftermaths: the ‘international community’, made up mainly of the victorious Allied powers, who constructed the framework within which such nationally bounded interpretations could be perpetuated and sustained. This article therefore aims to bring the international dimension to the forefront and to combine it with the history of concepts (Begriffsgeschichte) to examine how the concepts of ‘return’ and ‘repatriation’ evolved – and diverged – in the aftermath of the Second World War, in the context of an emerging modern international refugee regime designed primarily to serve superpower interests.
Sleep problems are common in psychotic disorders and are associated with worse quality of life and disease prognosis. Genome-wide association studies (GWAS) have revealed genetic influences for schizophrenia and sleep, but polygenic scores (PGSs) for sleep traits have not been evaluated systematically in patients with psychotic disorders.
Methods
This study investigated the associations between PGSs for sleep traits (insomnia, PGSINS; sleep duration, PGSSD; short sleep duration, PGSSS; long sleep duration; PGSLS), diurnal preference (eveningness, PGSME), and schizophrenia (PGSSZ) with clinical features of psychotic disorders in the Finnish SUPER study comprising 8,232 patients with psychotic disorders. The measures included self-reported sleep and well-being, cognitive assessments, clozapine use, and functional outcomes. Using FinnGen data of 356,077 individuals, we analyzed the distributions of PGSs in psychotic and bipolar disorders and the general population.
Results
PGSINS associated with more sleep problems and worse well-being (e.g. worse health-related quality of life [β = −0.07, CI = −0.09, −0.05, p < .001]). High PGSSZ is associated with better sleep quality, worse clinical outcomes, and performance in cognitive tests (e.g. more errors in paired-associated learning [β = 0.07, CI = 0.04, 0.09, p < .001]). PGSINS was higher in affective psychotic and bipolar disorders, while PGSSD and PGSME were higher in schizophrenia as compared with individuals with no psychiatric disorders.
Conclusion
Genetic risks for sleep and diurnal preference vary between non-affective psychosis, affective psychosis, and the general population. The findings in this study emphasize the heterogeneity in genetic etiology of the objective features of disease severity and the more subjective measures related to well-being and self-reported measures of sleep.
To begin with, I wish to thank Editor-in-Chief Xiao-Ping Chen for her initiative to celebrate MOR's twentieth anniversary by inviting a series of essays under the seductive title ‘MOR and Me’, with the overarching subtitle ‘Chinese management research: Looking back, current status, and future prospects’.
Cost-effectiveness models fully informed by real-world epidemiological parameters yield the best results, but they are costly to obtain. Model calibration using real-world data/evidence (RWD/E) on routine health indicators can provide an alternative to improve the validity and acceptability of the results. We calibrated the transition probabilities of the reference chemotherapy treatment using RWE on patient overall survival (OS) to model the survival benefit of adjuvant trastuzumab in Indonesia.
Methods
A Markov model comprising four health states was initially parameterized using the reference-treatment transition probabilities, obtained from published international evidence. We then calibrated these probabilities, targeting a 2-year OS of 86.11 percent from the RWE sourced from hospital registries. We compared projected OS duration and life-years gained (LYG) before and after calibration for the Nelder–Mead, Bound Optimization BY Quadratic Approximation, and generalized reduced gradient (GRG) nonlinear optimization methods.
Results
The pre-calibrated transition probabilities overestimated the 2-year OS (92.25 percent). GRG nonlinear performed best and had the smallest difference with the RWD/E OS. After calibration, the projected OS duration was significantly lower than their pre-calibrated estimates across all optimization methods for both standard chemotherapy (~7.50 vs. 11.00 years) and adjuvant trastuzumab (~9.50 vs. 12.94 years). LYG measures were, however, similar (~2 years) for the pre-calibrated and calibrated models.
Conclusions
RWD/E calibration resulted in realistically lower survival estimates. Despite the little difference in LYG, calibration is useful to adapt external evidence commonly used to derive transition probabilities to the policy context, thereby enhancing the validity and acceptability of the modeling results.
Non-adherence and negative attitudes towards medication are major problems in treating psychotic disorders. Cytochrome P450 2D6 (CYP2D6) contributes to the metabolism of aripiprazole and risperidone, and variations in CYP2D6 activity may affect treatment response or adverse effects. However, the impact of these variations on adherence and medication attitudes is unclear. This study investigates the relationships between CYP2D6 phenotype, self-reported adherence, adverse effects, and attitudes among aripiprazole and risperidone users. The study analysed data from the SUPER-Finland cohort of 10,474 adults with psychotic episodes, including 1,429 aripiprazole and 828 risperidone users. The Attitudes towards Neuroleptic Treatment (ANT) questionnaire assessed adherence and adverse effects in all patients, while medication-related attitudes were examined in a subgroup of 1,000 participants. Associations between CYP2D6 phenotypes and outcomes were analysed using logistic regression and beta regression in aripiprazole and risperidone groups separately. Among risperidone users, we observed no association between CYP2D6 phenotypes and adherence, adverse effects, or attitudes. Similarly, we found no link between adherence and CYP2D6 phenotypes among aripiprazole users. However, aripiprazole users with the ultrarapid CYP2D6 phenotype had more adverse effects (OR = 1.71, 95 % CI 1.03–2.90, p = 0.041). Among aripiprazole users, CYP2D6 ultrarapid phenotype was associated with less favourable attitudes towards antipsychotic treatment (β = −0.48, p = 0.023). These findings provide preliminary evidence that the ultrarapid CYP2D6 phenotype is associated with increased adverse effects and negative attitudes towards antipsychotic medication among aripiprazole users. CYP2D6 phenotype did not influence adherence, adverse effects, or attitudes among risperidone users.
In this article, we study the behavior of complete two-sided hypersurfaces immersed in the hyperbolic space $\mathbb H^{n+1}$. Initially, we introduce the concept of the linearized curvature function $\mathcal {F}_{r,s}$ of a two-sided hypersurface, its associated modified Newton transformation $\mathcal {P}_{r,s}$ and its naturally attached differential operator $\mathcal {L}_{r,s}$. Then, we obtain two formulas for differential operator $\mathcal {L}_{r,s}$ acting on the height function of a two-sided hypersurface and, for the case where their support functions are related by a negative constant, we derive two new formulas for the Newton transformation $P_{r}$ and the modified Newton transformation $\mathcal {P}_{r,s}$ acting on a gradient of the height function. Finally, these formulas, jointly with suitable maximum principles, enable us to establish our rigidity and nonexistence results concerning complete two-sided hypersurfaces in $\mathbb H^{n+1}$.
Central line-associated bloodstream infections (CLABSIs) result in morbidity and mortality among hospitalized patients. Hospital interventions to reduce the incidence of CLABSI are often broadly applied to all patients with central venous access. Identifying central lines at high risk for CLABSI at time of insertion will allow for a more focused delivery of preventative interventions.
Design:
This was an observational cohort study conducted at three hospitals including all patients who received central venous access. CLABSIs were identified using an institutional CLABSI database maintained by the hospital epidemiology team. Logistic regression (LASSO) and machine learning (random forest, XGboost) techniques were applied for the prediction of CLABSI occurrence, adjusting for selected patent and insertion-level characteristics.
Results:
A total of 40,008 central venous catheters were included, of which 409 (1.02%) were associated with CLABSI. The random forest and the XGBoost models had the highest discrimination (Area Under the Received Operating Curve [AUC] 0.79) followed by LASSO (0.73). High illness severity, receipt of total parenteral nutrition, receipt of hemodialysis, pre-insertion hospital length-of-stay, and low albumin levels were all predictive of CLABSI occurrence. Precision for all models was poor owing to a high false-positive rate.
Discussion:
CLABSI can be predicted based upon patient and insertion level factors in the electronic health record. In this study, random forest and gradient-boosted models had the highest AUC. Prediction cut-offs for the identification of CLABSI can be adjusted based upon the acceptable rate of false-positives for a given CLABSI preventative intervention.
The Dutch city of Leiden experienced economic and demographic growth from the last quarter of the sixteenth century onwards. This article analyses its effects on the urban private housing market by charting both the ratio of owners to tenants and the spatial patterns of housing wealth. Housing inequality increased in Leiden, reinforcing existing economic disparities and patterns of residential segregation. These dynamics were mainly caused by migration, which created great demand for housing. Gaining an insight into the pre-modern housing market also helps us to understand how inequalities were (re)produced and how they affected the daily lives of urbanites differently.