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Chapter 3 on Attribution Science delves deeper into the science that establishes causal links between climate change, specific sources of emissions, and its impacts. The authors illustrate how these scientific developments are enhancing our ability to pinpoint the causes of climate impacts, an evolution crucial to a range of procedural and substantive issues that may arise in climate litigation. The authors also delve into specific regional impacts and showcase how attribution science has illuminated the ways in which different parts of the world are experiencing and responding to the unique challenges posed by a changing climate. This includes case studies in Africa, the Americas, Europe, the South Pacific, and Asia. The authors conclude by addressing the limitations and challenges in the field of attribution science before explaining how it is nevertheless poised to play an ever-more critical role in our collective response to climate change.
Penicillin allergies are reported in 10–15% of the US population, but the actual rate is less than 1%. Inappropriate penicillin allergies are associated with adverse patient outcomes, poor antimicrobial stewardship, and increased healthcare costs. Direct oral provocation testing (DOPT) is a safe and cost-effective way to remove false penicillin allergy labels (PAL). However, widespread implementation is currently limited due to inadequate safety data and protocol variations. This systematic review evaluates the safety of single-dose, nongraded DOPT by the nonallergist.
Design:
Systematic review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to May 2025.
Setting:
Inpatient (Intensive care unit (ICU) and general medical ward) and outpatient
Participants:
Adults with self-reported penicillin allergies deemed low risk by a validated scoring system.
Interventions:
DOPT by nonallergists with single-dose oral amoxicillin 250 mg with a 60-minute observation period.
Results:
3 352 studies were identified, 15 were included in the analysis. Of the 1786 patients who completed DOPT, 66 (3.7%) experienced any reaction: 27 (1.5%) immediate rashes, 24 (1.3%) delayed rashes, and 15 (.8%) other reactions. No cases of anaphylaxis, angioedema, or epinephrine use were reported.
Conclusion:
The use of single-dose DOPT in patients deemed low risk, using a validated risk scoring tool, is safe, with low rates of mild reactions and no serious adverse events. A nonallergist can significantly improve penicillin delabeling rates and patient outcomes using this approach.
We prove a Poisson process approximation result for stabilising functionals of a determinantal point process. Our results use concrete couplings of determinantal processes with different Palm measures and exploit their association properties. Second, we focus on the Ginibre process and show in the asymptotic scenario of an increasing observation window that the process of points with a large nearest neighbour distance converges after a suitable scaling to a Poisson point process. As a corollary, we obtain the scaling of the maximum nearest neighbour distance in the Ginibre process, which turns out to be different from its analogue for independent points.
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.
In this paper we derive cumulant bounds for subgraph counts and power-weighted edge lengths in a class of spatial random networks known as weight-dependent random connection models. These bounds give rise to different probabilistic results, from which we mainly focus on moderate deviations of the respective statistics, but also show a concentration inequality and a normal approximation result. This involves dealing with long-range spatial correlations induced by the profile function and the weight distribution. We start by deriving the bounds for the classical case of a Poisson vertex set, and then provide extensions to α-determinantal processes.
Findings from contemporary clinical trials suggest that psychedelics are generally safe and may be effective in the treatment of various psychiatric disorders. However, less is known about the risks associated with psychedelic use outside of medically supervised contexts, particularly in populations that are typically excluded from participation in clinical trials.
Methods
Using a preregistered longitudinal observational research design with a purposive sample of US residents between 18 and 50 years old (N=21,990), we investigated associations between self-reported naturalistic psychedelic use and psychotic and manic symptoms, with emphasis on those with psychiatric histories of schizophrenia or bipolar I disorder.
Results
The follow-up survey was completed by 12,345 participants (56% retention), with 505 participants reporting psychedelic use during the 2-month study period. In covariate-adjusted regression models, psychedelic use during the study period was associated with increases in the severity of psychotic and manic symptoms. However, such increases were only observed for those who reported psychedelic use in an illegal context. While increases in the severity of psychotic symptoms appeared to depend on the frequency of use and the intensity of challenging psychedelic experiences, increases in the severity of manic symptoms appeared to be moderated by a personal history of schizophrenia or bipolar I disorder and the subjective experience of insight during a psychedelic experience.
Conclusions
The findings suggest that naturalistic psychedelic use specifically in illegal contexts may lead to increases in the severity of psychotic and manic symptoms. Such increases may depend on the frequency of use, the acute subjective psychedelic experience, and psychiatric history.
The extant microeconomic literature on matching markets assumes ordinal preferences for matches, while bargaining within matches is mostly excluded. Central for this paper, however, is bargaining over joint profits from potential matches. We investigate, both theoretically and experimentally, a seemingly simple allocation task in a 2 × 2 market with repeated negotiations. When inefficiency is possible, about 1/3 of the complete matches are inefficient and, overall, more than 3/4 of the experimental allocations are unstable. These results strongly contradict existing bargaining theories requiring efficient matches. Even with regard to efficient matches, the tested theories perform poorly. Standard bargaining and behavioral concepts, such as Selten's (1972) Equal Division Core, are outperformed by the simplistic ɛ-Equal Split, i.e., an equal split of the joint profit plus/minus ɛ.
Data from an RCT of IAPT Norway (“Prompt Mental Health Care” [PMHC]) were linked to several administrative registers up to five years following the intervention. The aims were to (1) examine the effects of PMHC compared to treatment-as-usual (TAU) on work-related outcomes and health care use, (2) estimate the cost–benefit of PMHC, and (3) examine whether clinical outcomes at six-month follow-up explained the effects of PMHC on work−/cost–benefit-related outcomes.
Methods
RCTs with parallel assignment were conducted at two PMHC sites (N = 738) during 2016/2017. Eligible participants were considered for admission due to anxiety and/or depression. We used Bayesian estimation with 90% credibility intervals (CI) and posterior probabilities (PP) of effects in favor of PMHC. Primary outcome years were 2018–2022. The cost–benefit analysis estimated the overall economic gain expressed in terms of a benefit–cost ratio and the differences in overall public sector spending.
Results
The PMHC group was more likely than the TAU group to be in regular work without receiving welfare benefits in 2019–2022 (1.27 ≤ OR ≤ 1.43). Some evidence was found that the PMHC group spent less on health care. The benefit–cost ratio in terms of economic gain relative to intervention costs was estimated at 5.26 (90%CI $ - $1.28, 11.8). The PP of PMHC being cost-beneficial for the economy as a whole was 85.9%. The estimated difference in public sector spending was small. PMHC effects on work participation and cost–benefit were largely explained by PMHC effects on mental health.
Conclusions
The results support the societal economic benefit of investing in IAPT-like services.
The discovery of more than 600 whole and fragmentary engraved stone plaques in the early third millennium BC infill from the ditches of a causewayed enclosure at Vasagård, on the Danish island of Bornholm, represents a unique find in Neolithic miniature art. Termed ‘sun stones’ in reference to the rayed images that characterise many of the plaques, the stones were deposited en masse over a short period. This article offers a fundamental classification of the rich imagery captured in the engravings and examines its potential function at a time of possible climatic crisis that impacted not just Bornholm but the wider northern hemisphere.
We prove Chai's conjecture on the additivity of the base change conductor of semiabelian varieties in the case of Jacobians of proper curves. This includes the first infinite family of non-trivial wildly ramified examples. Along the way, we extend Raynaud's construction of the Néron lft-model of a Jacobian in terms of the Picard functor to arbitrary seminormal curves (beyond which Jacobians admit no Néron lft-models, as shown by our more general structural results). Finally, we investigate the structure of Jacobians of (not necessarily geometrically reduced) proper curves over fields of degree of imperfection at most one and prove two conjectures about the existence of Néron models and Néron lft-models due to Bosch–Lütkebohmert–Raynaud for Jacobians of general proper curves in the case of perfect residue fields, thus strengthening the author's previous results in this situation.
In the applications of maximum likelihood factor analysis the occurrence of boundary minima instead of proper minima is no exception at all. In the past the causes of such improper solutions could not be detected. This was impossible because the matrices containing the parameters of the factor analysis model were kept positive definite. By dropping these constraints, it becomes possible to distinguish between the different causes of improper solutions. In this paper some of the most important causes are discussed and illustrated by means of artificial and empirical data.
Inquisitive modal logic, InqML, in its epistemic incarnation, extends standard epistemic logic to capture not just the information that agents have, but also the questions that they are interested in. We use the natural notion of bisimulation equivalence in the setting of InqML, as introduced in [7], to characterise the expressiveness of InqML as the bisimulation invariant fragment of first-order logic over natural classes of two-sorted first-order structures that arise as relational encodings of inquisitive epistemic (S5-like) models. The non-elementary nature of these classes crucially requires non-classical model-theoretic methods for the analysis of first-order expressiveness, irrespective of whether we aim for characterisations in the sense of classical or of finite model theory.
An abundance and diverse range of prehistoric fishing practices was revealed during excavations between 2012 and 2022 at the construction site of the Femern Belt Tunnel, linking the islands of Lolland (Denmark) and Femern (Germany). The waterlogged parts of the prehistoric Syltholm Fjord yielded well preserved organic materials, including the remains of wooden fish traps and weirs, and numerous vertical stakes and posts driven into the former seabed – evidence of long term fishing practices using stationary wooden structures from the Mesolithic to the Bronze Age (c. 4700–900 cal BC). Here, we present the results of a detailed study on these stationary wooden fishing structures, making this the most comprehensive and detailed description of prehistoric passive fishing practices in Syltholm Fjord to date. The exceptional scale of the excavated area (57 ha) and abundance of organic materials encountered during excavations provides us with a rare opportunity to identify individual weir systems and information on their construction, maintenance, and use. To contextualise further, we provide an up-to-date compilation of comparable finds in the Danish archaeological record, including a dataset of directly dated specimens, based on both published and unpublished sources. Our results show that stationary wooden fishing structures are an invaluable archaeological resource, and their study, combining landscape reconstruction, ethnographic analogy, and fishing technology, together with artefactual evidence and radiocarbon dating, allows us to reconstruct prehistoric fishing strategies in depth. Due to the long chronology and diversity of the study materials, our results complement previous research on the many nuances and regional specificities of the persistence of fishing practices in the western Baltic Sea over time, despite introductions of new cultures, populations, and livelihoods. Finally, we emphasise that the Neolithisation process in Northern Europe was not as straightforward and uniform in terms of subsistence as commonly assumed.
This project employs a geoarchaeological approach to explore human occupation of the highland wetlands (bofedales) and salt flats of the Dry Puna of northern Chile (>2500m above sea level) during the Holocene. Differences in the archaeological record of each ecosystem are tentatively suggested to relate to settlement patterns and the history of the landscape.
Calicium poculatum and Ramboldia canadensis are described as new species occurring on Larix laricina. Calicium poculatum, currently known from four Canadian provinces and the US state of Minnesota, is characterized by its short-stalked black ascomata, short ascospores and occurrence as a parasite on Lecanora caesiorubella subsp. saximontana. Based on DNA sequence data, its nearest relative is the likewise parasitic Calicium episcalaris. Ramboldia canadensis, currently known only from dead wood of Larix laricina snags in Canada, engages in a fully developed lichen symbiosis with Trebouxia simplex and is characterized in statu symbiotico by having a rimose to verrucose-areolate, greyish creamy sorediate thallus with dark brown to blackish soredia that begin on the margins, and the occurrence of a secondary metabolite similar to barbatolic acid. Phylogenetic analysis recovers it as sibling to a clade of the genus heretofore known only from the Southern Hemisphere and the lower latitudes of the Northern Hemisphere. We also report Lecidella xylophila as new to North America.
The impact of the coronavirus disease 2019 (COVID-19) on hepatocellular carcinoma (HCC) care is unclear. This study reports on HCC patterns during the COVID-19 pandemic in the Netherlands.
Methods
Patients diagnosed with HCC between 2017 and 2020 were identified from the Netherlands Cancer Registration. Monthly incidence rates were compared between 2020 and 2017–2019. Patient, tumor, process, and treatment characteristics and survival were compared between 2020 and 2017–2019, and between COVID-high (April and May 2020) and COVID-low (June and July 2020) months.
Results
The incidence of HCC was lower in May 2020 (IRR 0.56, P = 0.001) and higher in June 2020 (IRR 1.32, P = 0.05) compared to the same months in 2017–2019. In 2017–2019, 2134 patients presented with HCC, compared to 660 in 2020. Time-to-treatment was shorter in 2020 (median 60 vs. 70 days, P < 0.001). The percentage of patients undergoing any treatment did not differ, yet if treatment was not performed this was more commonly due to comorbidity in 2020 (52 vs. 39%, P < 0.001). No other differences were found in patient, tumor, process and treatment characteristics and survival between COVID-high and COVID-low months.
Conclusions
This study demonstrated no impact of the COVID-19 pandemic on HCC patients, despite a decrease in HCC diagnoses.
Little is known about the Chondrichthyes fauna of the state of Espírito Santo, southeastern Brazil, notably on the species composition, distribution, and biology. Historically, only a few studies have focused on these issues. Basic taxonomy is one of the main tools employed in cataloguing, organizing, and initiating other, more specific, assessments regarding regional diversity. In this context, this study presents the most comprehensive list of shark and ray species occurring in the state of Espírito Santo to date. The compiled data were obtained from specimens deposited in ichthyological collections, literature reviews, and samplings conducted at fisheries landings and onboard commercial fleet vessels. The findings indicate 79 species, comprising 51 sharks and 28 rays. A total of 53.2% of threatened Brazilian marine elasmobranch species occur in the area, indicating the importance of carrying out local studies focusing on this group. A first record for the Brazilian large-eyed stingray, Hypanus marianae, was also observed for the state, increasing the southern limit of the species known distribution, previously considered restricted to the North and Northeast coasts.
To capture the distortion of exploratory activity typical of patients with spatial neglect, traditional diagnostic methods and new virtual reality applications use confined workspaces that limit patients’ exploration behavior to a predefined area. Our aim was to overcome these limitations and enable the recording of patients’ biased activity in real, unconfined space.
Methods:
We developed the Free Exploration Test (FET) based on augmented reality technology. Using a live stream via the back camera on a tablet, patients search for a (non-existent) virtual target in their environment, while their exploration movements are recorded for 30 s. We tested 20 neglect patients and 20 healthy participants and compared the performance of the FET with traditional neglect tests.
Results:
In contrast to controls, neglect patients exhibited a significant rightward bias in exploratory movements. The FET had a high discriminative power (area under the curve = 0.89) and correlated positively with traditional tests of spatial neglect (Letter Cancellation, Bells Test, Copying Task, Line Bisection). An optimal cut-off point of the averaged bias of exploratory activity was at 9.0° on the right; it distinguished neglect patients from controls with 85% sensitivity.
Discussion:
FET offers time-efficient (execution time: ∼3 min), easy-to-apply, and gamified assessment of free exploratory activity. It supplements traditional neglect tests, providing unrestricted recording of exploration in the real, unconfined space surrounding the patient.
The design of gear boxes is a complex challenge characterized by conflicting requirements and seemingly circular dependencies. Existing tools support engineers but focus on a single predefined design, often leading to costly iterative processes and non-optimal solutions. Solution Space Engineering (SSE) alleviates this by generating multiple designs represented by solution spaces. For this, a particular model structure is needed, and thus restructuring existing models, e.g., from industry standards. The application of solution spaces to a two-stage gear box is presented.