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Naturally occurring retirement communities (NORCs) are geographic areas that have come to house a high proportion (≥30%) of older residents. Implementing onsite social programming in NORCs, or other places where older adults are clustered, can support aging in place. As such it is important to be able to identify sites that could benefit. We describe a data and equity-driven process used to select NORC and social housing sites for a program aimed at empowering older adults and strengthening aging in place in Toronto, Canada. We (1) created a data-driven shortlist of buildings with population-level data, (2) prioritized equity by targeting buildings with high health needs and neighbourhood-level diversity, and (3) facilitated building and resident engagement to assess interest and suitability. This process offers a novel and replicable approach for selecting sites for enhanced, place-based programming that can inform site selection for other community-based programming for older adults across diverse contexts.
It is well known that different types of electoral systems create different incentives to cultivate a personal vote and that there may be variation in intra‐party competition within an electoral system. This article demonstrates that flexible list systems – where voters can choose to cast a vote for the list as ordered by the party or express preference votes for candidates – create another type of variation in personal vote‐seeking incentives within the system. This variation arises because the flexibility of party‐in‐a‐district lists results from voters' actual inclination to use preference votes and the formal weight of preference votes in changing the original list order. Hypotheses are tested which are linked to this logic for the case of Belgium, where party‐in‐a‐district constituencies vary in their use of preference votes and the electoral reform of 2001 adds interesting institutional variation in the formal impact of preference votes on intra‐party seat allocation. Since formal rules grant Belgian MPs considerable leeway in terms of bill initiation, personal vote‐seeking strategies are inferred by examining the use of legislative activity as signalling tool in the period between 1999 and 2007. The results establish that personal vote‐seeking incentives vary with the extent to which voters use preference votes and that this variable interacts with the weight of preference votes as defined by institutional rules. In addition, the article confirms the effect of intra‐party competition on personal vote‐seeking incentives and illustrates that such incentives can underlie the initiation of private members bills in a European parliamentary system.
Non-suicidal self-injury (NSSI) displays an alarmingly high prevalence rate among university students, placing them at high risk for adverse long-term outcomes, including suicide.
Aims
This study aimed to achieve a better understanding of factors contributing to NSSI in university student populations by examining reasons for NSSI and histories of stressful events and coping strategies.
Method
A total of 185 university students with a lifetime history of NSSI were assessed for depressive symptoms and NSSI characteristics. They completed three questionnaires on NSSI reasons, stressful events and coping strategies during childhood and adolescence. Each questionnaire included an ‘others’ option combined with an open-ended response box. After descriptive analysis of the closed questions, these open-ended responses were qualitatively categorised and analysed as predictors of depression severity and NSSI continuation from adolescence into adulthood.
Results
Qualitative analysis identified eight, five and ten categories from the open-ended responses for NSSI reasons, stressful events and coping strategies, respectively, with substantial to almost perfect interrater reliability. Two qualitative reason categories, one stressful event category and two coping strategy categories significantly predicted depression severity (β = 0.21–0.23). Participants reporting events in the stressful events category ‘Traumatisation and experiences of violence’ were three times more likely to continue NSSI into adulthood (f2 = 0.07).
Conclusions
This study demonstrates the value of mixed-methods approaches. Stable qualitative categories highlight the need to capture individual variations in NSSI-related factors. It emphasises trauma-related stressors due to their influence on depression severity and persistence of NSSI into adulthood.
In this paper, we calculate the available energy, an upper bound on the thermal energy released that may in turn drive turbulence, due to an ion-temperature-gradient instability driven by curvature in the presence of adiabatic electrons. This is done by choosing an appropriate set of invariants that neglect parallel dynamics, whilst keeping the density profile fixed. Conditions for vanishing available energy are derived and are found to be qualitatively similar to conditions for stability derived from gyrokinetic theory, including strong stabilisation if the ratio of the temperature and density gradient, $\mathrm{d} \ln T / \mathrm{d} \ln n =\eta$, falls in the range $0 \leqslant \eta \leqslant 2/3$. To assess the utility of the available energy, a database consisting of $6 \times 10^4$ local gyrokinetic simulations in randomly sampled tokamak geometries is constructed. Using this database and a similar one sampling stellarators (Landreman et al. 2025 J. Plasma Phys. vol. 91, E120), the available energy is shown to exhibit correlation with the ion energy flux as long as the parallel dynamics is unimportant. Overall it is found that available energy is good at predicting the energy flux variability due to the gradients in density and temperature, but performs worse when it comes to predicting its variability arising from geometry.
Primary healthcare units (PHCUs) in Austria play a crucial role in providing regionally tailored, high-quality care through interprofessional teams. Barriers, such as limited training and unclear roles, hinder effective interprofessional collaboration (IPC). Additionally, healthcare and social professionals (HCSPs) in primary healthcare (PHC) face a rise in patients with non-communicable diseases and increasing climate-related challenges, underscoring the need for education addressing IPC and sustainability to build resilient healthcare.
Aim:
This paper presents the protocol of the REALISE study, which aims to evaluate the effectiveness of a didactic concept integrating collaborative, digital, and sustainability skills within multimodal training modules (including simulations).
Methods:
In this prospective trial, HCSPs working in PHC and students in their final year of education in related professions are recruited to participate in interprofessional training modules, which take place on four days within a month in person and with additional e-learning elements between those days. The modules consist of didactic elements on IPC and sustainability, simulation scenarios with acting patients, and immersive virtual reality scenarios. The primary outcomes assess IPC by utilizing the Teamwork Assessment Scale, the Interprofessional Socialization and Valuing Scale (9a/9b), and the Interprofessional Collaborative Competency Attainment Survey. Secondary outcomes focus on sustainability and environmental awareness, as well as the organization and structure of the training modules.
Discussion:
The findings of this study will demonstrate the effect of proprietary training modules on IPC and will inform on the integration of respective modules into standard curricula and continuing educational programmes at the Salzburg University of Applied Sciences.
The 1920s to 1950s was a period of significant transformation and conflict in South and East Asia, marked by the forces of (anti-)imperialism, nationalism, and militarism, eventually escalating into the Second Sino-Japanese War and the Second World War. For a long time, internationalist initiatives hoped that de-escalation and peace could be achieved through diplomacy and exchange. Part of this approach included Asian Christians moving in the milieu of Protestant internationalism, a movement long dominated by American organizations and actors, which after the First World War saw a shift towards Asia—both in terms of representation from and interest in the region.
Between the 1920s and the 1950s, numerous international conferences, organized by missionary associations and organizations such as the World Student Christian Federation or the international Young Men’s Christian Association, debated the political future of Asia in a changing and increasingly belligerent world. The period also witnessed numerous exchanges of Christian delegations between individual countries. By analysing the interrelated histories of three Asian Protestant internationalists—T. Z. Koo of China, Kagawa Toyohiko of Japan, and Augustine Ralla Ram of India—the article offers an examination of the mechanics of Christian diplomacy before, during, and after war. It shows that Protestant internationalist diplomacy, fellowship, and solidarity were often overshadowed by national and political ideologies. However, the article further argues that, despite its shortcomings, which challenged transnational solidarity and fellowship, Christian diplomacy was characterized by a resilience and reach that allowed its Asian protagonists a remarkable international operating space by providing useful networks, opportunities, and resources.
Efforts to drain Lake Maliq, in the Korça Basin of eastern Albania, during the 1940s and 1950s revealed waterlogged wooden structures that were excavated in the 1970s and identified as Neolithic pile-dwellings. Fifty years later, new excavations are exposing the exceptional organic preservation and complex stratigraphy of the Dunavec site. Through a combination of dendrochronological and radiocarbon dating, the authors provide the first secure absolute dates for the structures, placing early activity at the site within the beginning of the fifty-third century BC and creating a chronological anchor for our understanding of Neolithic communities in the western Balkans.
A lifetime history of non-suicidal self-injury (NSSI) is a risk factor for subsequent behavioural and emotional problems, including depression, aggression and heightened emotional reactivity. Traumatic experiences, which are frequently reported by individuals with NSSI, also show predictive links to these mental health problems. However, the exact connections between these areas and their subdomains remain unclear.
Aims
To explore in detail the relationships of specific characteristics of NSSI (e.g. termination in adolescence, duration, frequency, reinforcement mechanisms) and various types of traumatic experience (emotional, physical, sexual) with distinct aspects of emotional reactivity (sensitivity, intensity, persistence), aggression (behavioural, cognitive, affective) and severity of depression in university students.
Method
Via online survey, 150 university students aged 18 to 25 years, who had self-injured at least once, provided information on NSSI, and completed questionnaires including the Childhood Trauma Questionnaire, Patient Health Questionnaire, Emotion Reactivity Scale, and Aggression Questionnaire. Regression analyses were conducted to determine risk factors linked to increased depression scores, aggression and emotional reactivity. The study was pre-registered in the German Clinical Trials Register (DRKS00023731).
Results
Childhood emotional abuse contributed to emotional reactivity, aggression and depressive symptom severity (β = 0.33–0.51). Risk factors for sustained NSSI beyond adolescence included increased automatic positive reinforcement (odds ratio: 2.24).
Conclusions
Childhood emotional abuse significantly contributes to emotional and behavioural problems and needs to be considered in NSSI therapy. NSSI was found to persist into adulthood when used as an emotion regulation strategy.
Maternal depression is associated with difficulties in understanding and adequately responding to children’s emotional signals. Consequently, the interaction between mother and child is often disturbed. However, little is known about the neural correlates of these parenting difficulties. Motivated by increasing evidence of the amygdala’s important role in mediating maternal behavior, we investigated amygdala responses to child sad and happy faces in mothers with remitted major depression disorder (rMDD) relative to healthy controls.
Methods
We used the sensitivity subscale of the emotional availability scales and functional magnetic resonance imaging in 61 rMDD and 27 healthy mothers to examine the effect of maternal sensitivity on mothers’ amygdala responses to their children’s affective facial expressions.
Results
For mothers with rMDD relative to controls, we observed decreased maternal sensitivity when interacting with their child. They also showed reduced amygdala responses to child affective faces that were associated with lower maternal sensitivity. Connectivity analysis revealed that this blunted amygdala response in rMDD mothers was functionally correlated with reduced activation in higher-order medial prefrontal areas.
Conclusions
Our results contribute toward a better understanding of the detrimental effects of lifetime depression on maternal sensitivity and associated brain responses. By targeting region-specific neural activation patterns, these results are a first step toward improving the prediction, prevention, and treatment of depression-related negative effects on mother–child interaction.
The population of adult CHD patients is continuously increasing. The underlying CHD affects performance and prognosis, but also has a significant impact on quality of life, psychosocial behaviour, anxiety and emotional disturbances. This study analyzes these parameters of patients after one or more heart operations and the possible psychological effects of medical and psychosocial complications at the Department of Cardiology of the Kepler University Hospital Linz.
Methods and Results
A total of 81 subjects participated in the questionnaire survey of the Institute of Cardiology and Clinical Psychology during their annual cardiological check-up. Of these, 80 participants were included in the study and three showed a mild CHD, 49 a moderate one, and 28 a severe one. This study has an exploratory design to assess possible stress factors and limitations in quality of life. For this purpose, a self-administered sociodemographic questionnaire and three standardised questionnaires were used. In summary, the quality of life of adult CHD is considered depending on the severity of the symptoms and compared with the healthy population. Differences in this regard are observed in individuals with lower symptom severity, who report higher psychological well-being. Sex differences are observed in physical role function and physical functioning.
Conclusion:
Based on the results, regular repetitions of the study, as well as continuous psychological and psychosocial support, are necessary, since challenges are predictable with the increasing age of adult CHD patients and since the upholding of good quality of life and dealing with difficult life circumstances must be supported.
Between a plasma and a solid target lies a positively charged sheath of several Debye lengths $\lambda _{D}$ width, typically much smaller than the characteristic length scale $L$ of the main plasma. This scale separation implies that the asymptotic limit $\epsilon = \lambda _{D} / L \rightarrow 0$ is useful to solve for the plasma-sheath system. In this limit, the Bohm criterion must be satisfied at the sheath entrance. A new derivation of the kinetic criterion, admitting a general ion velocity distribution, is presented. It is proven that, for $\epsilon \rightarrow 0$, the distribution of the velocity component normal to the target, $v_x$, and its first derivative must vanish for $|v_x| \rightarrow 0$ at the sheath entrance. These two conditions can be subsumed into a third integral one after it is integrated by parts twice. A subsequent interchange of the limits $\epsilon \rightarrow 0$ and $|v_x| \rightarrow 0$ is invalid, leading to a divergence which underlies the misconception that the criterion gives undue importance to slow ions.
Depressive disorders in adolescents affect all aspects of life and impose a very large burden of disease. Sleep is frequently affected by depression and is crucial for facing challenges during development. One of the postulated reasons for depression-induced sleep disruption is dysregulation of the physiological stress system.
Aims
To investigate the links of adolescent depressive disorders with subjective sleep quality, objective sleep quality, and the course of cortisol and alpha-amylase after awakening.
Method
We compared subjective sleep quality (via daily questionnaires) and objective sleep quality (via actigraphy measurement) of 35 adolescents with depressive disorders and 29 healthy controls over 7 consecutive days. In addition, saliva samples were collected on 3 days to examine cortisol and alpha-amylase patterns after awakening.
Results
No significant differences in cortisol or alpha-amylase awakening responses were observed between participants with depressive disorders and healthy controls. We found severe reductions in subjective sleep quality in the depression group (Z = −5.19, P < 0.001, d = 1.80) and a prolonged actigraphy-measured sleep onset latency (Z = −2.42, P = 0.015, d = 0.64) compared with controls. Reductions in subjective sleep quality were partially correlated with objective sleep measures (sleep onset latency: r = −0.270, P = 0.004, sleep efficiency: r = 0.215, P = 0.017).
Conclusions
Sleep onset latency seems to aggravate depressive symptoms and to have an important role in perception of sleep quality. Adolescents with depressive disorders should be supported regarding the establishment of good sleep hygiene and avoiding activities that may impede falling asleep.
In the first half of the twentieth century, Protestant internationalism and missions turned their attention to social and economic matters. The 1920/30s saw an agricultural turn that was paralleled by a global discourse on the “improvement” of the rural. While the transformations in Protestant internationalism have been addressed in view of theological, ecumenical, and geopolitical changes, historians have yet to acknowledge the complex interplay of their local and global effects. By focusing on the work of a particular agent in agricultural missions, the International Missionary Council and its rural expert Kenyon L. Butterfield, and their engagement with rural reconstruction in India, China, and Japan, this article argues that impactful schemes necessitated the cooperation of a wide array of actors, from private to state, from foreign missionaries to local Christian and non-Christian communities and activists. Missionary and Christian rural reconstruction in Asia in the interwar period was shaped by forces of nationalism, (anti-)colonialism, and secularization that could benefit, halt, and transform comprehensive schemes. While the impact of missionary rural reconstruction was eventually hampered by its inherently universalist and invasive nature, its drive for professionalization led to manifold cooperations and careers that transitioned well into and in many ways anticipated and prepared a post-World War II development discourse.
Public service reform in the shape of collaborative governance is consistently promoted by statutory actors in Scotland and other high-income countries to help develop high-quality and efficient public services, responsive to peoples needs, but this notion contains a number of weaknesses. This chapter explores the potential of the capabilities approach (CA), conversion factors in particular, to achieve a more effective model for conceptualizing, driving and evaluating how public services operate, drawing on empirical work conducted by What Works Scotland. It argues that the CA provides an ethical framework for evaluating the role and function of public services in safeguarding peoples well-being and social justice, especially for those with fewest resources. Employing data from two research projects in areas of multiple deprivation, the impact of public service interventions is evaluated in terms of conversion factors, and how these shape outcomes for citizens and communities. The concept of structural conversion factors is an innovative response to criticism of the CA, and the chapter argues that this modification allows it to better confront the drivers of social injustice.
Edited by
Andrea Fiorillo, University of Campania “L. Vanvitelli”, Naples,Peter Falkai, Ludwig-Maximilians-Universität München,Philip Gorwood, Sainte-Anne Hospital, Paris
Nonsuicidal self-injury (NSSI) is a major mental health problem in youth worldwide. The World Health Organization has recognized it as among the top five major health threats to adolescents. NSSI is defined as deliberate infliction of direct physical harm to one’s own body without suicidal intent. Recently, NSSI was introduced for the first time in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), under section III, “Conditions for Further Study.” In most cases, NSSI occurs for the first time around the age of twelve, with great increase in frequency within each year of adolescence. Injuries range from minor cuts to severe injuries, including biting, hitting, and burning oneself. Most self-harming behavior in adolescents ceases in the long-term, but a substantial proportion of adolescents show a continuity of NSSI into young adulthood accompanied by pronounced psychiatric comorbid disorders. A history of NSSI has also been identified as a strong risk factor for suicide attempts in later life. Emotional dysregulation has been acknowledged as the central clinical feature, both in pathogenesis and treatment of NSSI. Existing neurobiological findings increasingly support this clinical model. The development and implementation of effective intervention programs are of the greatest importance for the future.
Return to driving after moderate-to-severe traumatic brain injury (TBI) is often a key step in recovery to regain independence. Survivors are often eager to resume driving and may do so despite having residual cognitive limitations from their injury. A better understanding is needed of how cognition and self-awareness impact survivors’ driving after injury. This study examined the influence of cognition and self-awareness on driving patterns following moderate-to-severe TBI.
Participants and Methods:
Participants were 350 adults aged 19-87 years (mean age = 46 years; 70% male) with history of moderate-to-severe TBI, who resumed driving and were enrolled in the TBI Model System. Cross-sectional data were obtained ranging 1-30 years post injury, including questions on driving practices, the Brief Test of Adult Cognition by Telephone (BTACT), and the Functional Independence Measure (FIM). Self-awareness of cognitive function was measured via the discrepancy between dichotomized ratings (intact versus impaired) of objective cognitive testing (BTACT) and self-reported cognitive function (FIM Cognition subscale). Driving patterns included frequency (driving 'more than once a week’ versus 'once a week or less') and restricted driving behavior (total number of driving situations the survivor described as restricted, ranging 0-15). Regression analyses were conducted to examine the relationships between cognition, self-awareness, and each driving outcome (frequency and restriction), followed by causal mediation analyses to examine the mediating effect of self-awareness. Demographics (age, sex, education), injury characteristics (time since injury, injury severity, history of seizures in past year), and medical/social factors (family income, motor function, urban-rural classification) were included in the models as covariates.
Results:
Thirty-nine percent of survivors had impaired self-awareness, 88% of survivors drove numerous times per week, and the average survivor reported limited driving in 6 situations (out of 15 total situations). Cognition was inversely related to impaired self-awareness (OR = 0.03, p < 0.001) and inversely related to restricted driving behavior (b = -0.79, p < 0.001). Motor function was positively related to impaired self-awareness (OR = 1.28, p < 0.01). Cognition was not related to driving frequency, and self-awareness did not mediate the relationships between cognition and driving patterns (all p > 0.05).
Conclusions:
Most survivors who drive after their injury are driving frequently, but the situations they drive in differ based on their cognitive ability. Impaired self-awareness of cognitive deficits is common after TBI, and self-awareness of cognitive function does not affect driving patterns. Future research needs to focus on how cognition affects nuanced aspects of driving behavior after injury (i.e., types of situations survivors drive in).
Musculoskeletal disorders have the highest prevalence of work-related health problems. Due to the aging population, the prevalence of shoulder pain in workers in physically demanding occupations is increasing, thereby causing rising costs to society and underlining the need for preventive technologies. Wearable support structures are designed to reduce the physical work load during physically demanding tasks. Here, we evaluate the physiological benefit of the DeltaSuit, a novel passive shoulder exoskeleton, using an assessment framework that conforms to the approach proposed in the literature.
In this study, 32 healthy volunteers performed isometric, quasi-isometric, and dynamic tasks that represent typical overhead work to evaluate the DeltaSuit performance. Muscle activity of the arm, neck, shoulder, and back muscles, as well as cardiac cost, perceived exertion, and task-related discomfort during task execution with and without the exoskeleton were compared.
When working with the DeltaSuit, muscle activity was reduced up to 56% (p < 0.001) in the Trapezius Descendens and up to 64% (p < 0.001) in the Deltoideusmedius. Furthermore, we observed no additional loading on the abdomen and back muscles. The use of the exoskeleton resulted in statistically significant reductions in cardiac cost (15%, p < 0.05), perceived exertion (21.5%, p < 0.001), and task-related discomfort in the shoulder (57%, p < 0.001).
These results suggest that passive exoskeletons, such as the DeltaSuit, have the potential to meaningfully support users when performing tasks in overhead postures and offer a valuable solution to relieve the critical body parts of biomechanical strains for workers at high risk of musculoskeletal disorders.
This work reports on the development and numerical implementation of the linear electromagnetic gyrokinetic (GK) model in a tokamak flux-tube geometry using a moment approach based on the expansion of the perturbed distribution function on a velocity-space Hermite–Laguerre polynomials basis. A hierarchy of equations of the expansion coefficients, referred to as the gyro-moments (GMs), is derived. We verify the numerical implementation of the GM hierarchy in the collisionless limit by performing a comparison with the continuum GK code GENE, recovering the linear properties of the ion temperature gradient, trapped electron, kinetic ballooning and microtearing modes, as well as the collisionless damping of zonal flows. An analysis of the distribution functions and ballooning eigenmode structures is performed. The present investigation reveals the ability of the GM approach to describe fine velocity-space-scale structures appearing near the trapped and passing boundary and kinetic effects associated with parallel and perpendicular particle drifts. In addition, the effects of collisions are studied using advanced collision operators, including the GK Coulomb collision operator. The main findings are that the number of GMs necessary for convergence decreases with plasma collisionality and is lower for pressure gradient-driven modes, such as in H-mode pedestal regions, compared with instabilities driven by trapped particles and magnetic gradient drifts often found in the core. The accuracy of approximations often used to model collisions (relative to the GK Coulomb operator) is studied in the case of trapped electron modes, showing differences between collision operator models that increase with collisionality and electron temperature gradient, consistent with the results of Pan et al. (Phys. Rev. E, vol. 103, 2021, L051202). Such differences are not observed in other edge microinstabilities, such as microtearing modes. The importance of a proper collision operator model is also confirmed by analysing the collisional damping of geodesic acoustic modes and zonal flows.
Climate models are primary tools for investigating processes in the climate system, projecting future changes, and informing decision makers. The latest generation of models provides increasingly complex and realistic representations of the real climate system, while there is also growing awareness that not all models produce equally plausible or independent simulations. Therefore, many recent studies have investigated how models differ from observed climate and how model dependence affects model output similarity, typically drawing on climatological averages over several decades. Here, we show that temperature maps of individual days drawn from datasets never used in training can be robustly identified as “model” or “observation” using the CMIP6 model archive and four observational products. An important exception is a prototype storm-resolving simulation from ICON-Sapphire which cannot be unambiguously assigned to either category. These results highlight that persistent differences between simulated and observed climate emerge at short timescales already, but very high-resolution modeling efforts may be able to overcome some of these shortcomings. Moreover, temporally out-of-sample test days can be assigned their dataset name with up to 83% accuracy. Misclassifications occur mostly between models developed at the same institution, suggesting that effects of shared code, previously documented only for climatological timescales, already emerge at the level of individual days. Our results thus demonstrate that the use of machine learning classifiers, once trained, can overcome the need for several decades of data to evaluate a given model. This opens up new avenues to test model performance and independence on much shorter timescales.