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Clergy formed a distinct and privileged group in later medieval society as regarded violent crime. Church law was intended to protect them from it, induce them to avoid it, and exempt them from secular justice following it. But in practice, were the clergy so separate from the violent culture around them and different from the laymen who dominated it? In the first full-length study of this subject in the later medieval period, Peter Clarke shows that clergy accused of violent and other crimes increasingly submitted to secular justice like laymen, seeking clerical immunity only as a last resort. It reveals that church authorities, in providing legal redress for clerical victims of lay violence, sought to heal divisions between laity and clergy, not to deepen them. Additionally, it explores the motives and contexts behind clerical involvement in violent crime, both as perpetrators and victims, revealing that clergy often acted similarly to laymen.
In journalism education, the First Amendment’s guarantee of press freedom is typically taught as a cornerstone of American democracy. Yet this approach too often fails to grapple with the historical and ongoing realities of racial inequality and the experiences of marginalized communities, particularly Black Americans, in relation to press freedom. The traditional emphasis on teaching journalists to be strictly “objective” often leads the press to report in ways that perpetuate the status quo and fail to hold those in power accountable.
In this chapter, I argue for a critical reexamination of how the First Amendment and press freedom are taught in journalism classrooms. I draw on historical analysis, legal case studies, and contemporary examples to advocate for a “reparative journalism” approach. By centering the voices and experiences of those who have been systematically excluded from the full protections of the First Amendment and by interrogating the complex relationship between race, power, and the press, this approach seeks to develop a more inclusive, historically grounded, and forward-looking vision of journalism’s role in society.
Risks and priorities change during the management of public health incidents. Here we describe a new tool, the Incident Management Measurement Tool (IMMT), that can be used to inform midcourse corrections during public health emergencies and realistic exercises.
Methods
We developed the IMMT through a literature review and subject matter expert interviews. We field tested the tool in 23 incidents ranging in size, duration, and complexity, making changes based on user feedback.
Results
The IMMT consists of 2 modular data collection methods, a survey of the incident management team and a protocol for a peer assessor. Pilot testing suggested that the tool is valid, reliable, feasible, and useful.
Conclusions
Measurement of public health incident management is feasible and may be useful for improving response times and outcomes. Moreover, a limited set of standard measures is relevant to a wide range of incident response contexts.
Herbaceous perennials must annually rebuild the aboveground photosynthetic architecture from carbohydrates stored in crowns, rhizomes, and roots. Knowledge of carbohydrate utilization and storage can inform management decisions and improve control outcomes for invasive perennials. We monitored the nonstructural carbohydrates in a population of the hybrid Bohemian knotweed [Polygonum ×bohemicum (J. Chrtek & Chrtková) Zika & Jacobson [cuspidatum × sachalinense]; syn.: Fallopia ×bohemica (Chrtek and Chrtková) J.P. Bailey] and in Japanese knotweed [Polygonum cuspidatum Siebold & Zucc.; syn.: Fallopia japonica (Houtt.) Ronse Decr.]. Carbohydrate storage in crowns followed seasonal patterns typical of perennial herbaceous dicots corresponding to key phenological events. Starch was consistently the highest nonstructural carbohydrate present. Sucrose levels did not show a consistent inverse relationship with starch levels. Lateral distribution of starch in rhizomes and, more broadly, total nonstructural carbohydrates sampled before dormancy break showed higher levels in rhizomes compared with crowns. Total nonstructural carbohydrate levels in crowns reached seasonal lows at an estimated 22.6% of crown dry weight after accumulating 1,453.8 growing degree days (GDD) by the end of June, mainly due to depleted levels of stored starch, with the estimated minimum of 12.3% reached by 1,220.3 GDD accumulated by mid-June. Depletion corresponded to rapid development of vegetative canopy before entering the reproductive phase in August. Maximum starch accumulation in crowns followed complete senescence of aboveground tissues by mid- to late October. Removal of aboveground shoot biomass in late June to early July with removal of vegetation regrowth in early September before senescence would optimize the use of time and labor to deplete carbohydrate reserves. Additionally, foliar-applied systemic herbicide translocation to belowground tissue should be maximized with applications in late August through early fall to optimize downward translocation with assimilate movement to rebuild underground storage reserves. Fall applications should be made before loss of healthy leaf tissue, with the window for control typically ending by late September in Minnesota.
Objectives/Goals: This project aims to inform and develop a clinician-centered educational tool evidence-based and stakeholder-informed that fosters healthcare professionals’ (HCPs) adaptive expertise (AE) in cannabinoid-based therapies (CBT) for chronic pain management (CPM), addressing existing knowledge gaps, improving patient care and clinical decision-making. Methods/Study Population: To achieve this, the project will use a mixed-methods approach divided into three phases to evaluate existing educational resources, identify gaps, and inform the design of a curriculum to transform clinician education in CBT for CPM. It includes stakeholder mapping to engage and consult key experts for real-world insights and an environmental scan to assess and compare current educational resources qualitatively. A rigorous curriculum will be informed to be designed through an adaptive expertise and reflective practice framework, emphasizing case and problem-based learning, clinical simulations, and other pedagogical techniques. The educational tool will be pilot-tested with clinicians, measuring its impact on knowledge and decision-making flexibility through pre- and post-assessments, ensuring it fosters AE on CBT. Results/Anticipated Results: The project is expected to identify key gaps in existing educational resources, particularly AE in HCPs specializing in CPM. Through pilot testing, we anticipate improved knowledge of CBT among clinicians and enhanced ability to apply this knowledge flexibly in clinical practice. We also expect to establish core curriculum components that better support routine and adaptive expertise in chronic pain management. The pilot evaluations will guide further curriculum refinement and inform broader educational implementation. Discussion/Significance of Impact: This project addresses critical gaps in CbT education by informing the development of a curriculum that enhances clinicians’ ability to manage chronic pain with cannabinoid-based therapies. The resulting educational tool could significantly impact clinical practice, empowering patients, and HCPs to make informed decisions and improve patient outcomes.
In this work, we present a detailed assessment of fusion-born alpha-particle confinement, their wall loads and stability of Alfvén eigenmodes driven by these energetic particles in the Infinity Two Fusion Pilot Plant baseline plasma design, a four-field-period quasi-isodynamic stellarator to operate in deuterium–tritium fusion conditions. Using the Monte Carlo codes, SIMPLE, ASCOT5 and KORC-T, we study the collisionless and collisional dynamics of guiding-centre and full-orbit alpha-particles in the core plasma. We find that core energy losses to the wall are less than 4 %. Our simulations shows that peak power loads on the wall of this configuration are approximately 2.5 MW m-$^2$ and are spatially localised, toroidally and poloidaly, in the vicinity of x-points of the magnetic island chain $n/m = 4/5$ outside the plasma volume. Also, an exploratory analysis using various simplified walls shows that shaping and distance of the wall from the plasma volume can help reduce peak power loads. Our stability assessment of Alfvén eigenmodes using the STELLGAP and FAR3d codes shows the absence of unstable modes driven by alpha-particles in Infinity Two due to the relatively low alpha-particle beta at the envisioned 800 MW operating scenario.
The papal penitentiary was the highest office in the later medieval Church concerned with matters of conscience. It granted absolution in cases where this was reserved to the papacy, notably for grave sins such as assaults on clergy, and it issued other graces that were also a papal monopoly, such as dispensations, notably for marriages within the prohibited degrees of kinship, and special licences, especially to appoint a personal confessor. Laity and clergy across later medieval Europe petitioned the office for these favours. The papal penitentiary hence represented a significant point of contact between the papacy and individual Catholics. Its origins were obscure but partly lay in the long tradition of penitential pilgrimage to Rome. Minor penitentiaries heard confessions of penitent pilgrims at Rome’s major basilicas, including Saint Peter’s. By the early thirteenth century, the ‘major penitentiary’ in charge of the office was appointed by the pope from among the cardinals and received growing faculties to concede graces on the pope’s behalf. By the fifteenth century, the office that he headed was a major department of papal government and substantial source of revenue for the papacy.
To improve early intervention and personalise treatment for individuals early on the psychosis continuum, a greater understanding of symptom dynamics is required. We address this by identifying and evaluating the movement between empirically derived attenuated psychotic symptomatic substates—clusters of symptoms that occur within individuals over time.
Methods
Data came from a 90-day daily diary study evaluating attenuated psychotic and affective symptoms. The sample included 96 individuals aged 18–35 on the psychosis continuum, divided into four subgroups of increasing severity based on their psychometric risk of psychosis, with the fourth meeting ultra-high risk (UHR) criteria. A multilevel hidden Markov modelling (HMM) approach was used to characterise and determine the probability of switching between symptomatic substates. Individual substate trajectories and time spent in each substate were subsequently assessed.
Results
Four substates of increasing psychopathological severity were identified: (1) low-grade affective symptoms with negligible psychotic symptoms; (2) low levels of nonbizarre ideas with moderate affective symptoms; (3) low levels of nonbizarre ideas and unusual thought content, with moderate affective symptoms; and (4) moderate levels of nonbizarre ideas, unusual thought content, and affective symptoms. Perceptual disturbances predominantly occurred within the third and fourth substates. UHR individuals had a reduced probability of switching out of the two most severe substates.
Conclusions
Findings suggest that individuals reporting unusual thought content, rather than nonbizarre ideas in isolation, may exhibit symptom dynamics with greater psychopathological severity. Individuals at a higher risk of psychosis exhibited persistently severe symptom dynamics, indicating a potential reduction in psychological flexibility.
To quantify the impact of patient- and unit-level risk adjustment on infant hospital-onset bacteremia (HOB) standardized infection ratio (SIR) ranking.
Design:
A retrospective, multicenter cohort study.
Setting and participants:
Infants admitted to 284 neonatal intensive care units (NICUs) in the United States between 2016 and 2021.
Methods:
Expected HOB rates and SIRs were calculated using four adjustment strategies: birthweight (model 1), birthweight and postnatal age (model 2), birthweight and NICU complexity (model 3), and birthweight, postnatal age, and NICU complexity (model 4). Sites were ranked according to the unadjusted HOB rate, and these rankings were compared to rankings based on the four adjusted SIR models.
Results:
Compared to unadjusted HOB rate ranking (smallest to largest), the number and proportion of NICUs that left the fourth quartile (worst-performing) following adjustments were as follows: adjusted for birthweight (16, 22.5%), birthweight and postnatal age (19, 26.8%), birthweight and NICU complexity (22, 31.0%), birthweight, postnatal age and NICU complexity (23, 32.4%). Comparing NICUs that moved into the better-performing quartiles after birthweight adjustment to those that remained in the better-performing quartiles regardless of adjustment, the median percentage of low birthweight infants was 17.1% (Interquartile Range (IQR): 15.8, 19.2) vs 8.7% (IQR: 4.8, 12.6); and the median percentage of infants who died was 2.2% (IQR: 1.8, 3.1) vs 0.5% (IQR: 0.01, 12.0), respectively.
Conclusion:
Adjusting for patient and unit-level complexity moved one-third of NICUs in the worst-performing quartile into a better-performing quartile. Risk adjustment may allow for a more accurate comparison across units with varying levels of patient acuity and complexity.
Disease-modifying therapies (DMTs) for Alzheimer’s disease (AD) are emerging treatment options. This study aimed to estimate the potential health system and associated environmental impacts of DMTs by modeling future bed-days and carbon dioxide equivalent (CO2e) emissions for the UK population under various scenarios for access to and efficacy of DMTs.
Methods
A cohort Markov model was developed to predict the UK population distribution from 2020 to 2040 across five health states—cognitively unimpaired and four stages of AD (mild cognitive impairment, and mild, moderate, severe dementia). These distributions were estimated using national population projections, AD prevalence data, and stage-specific transition rates. Annual bed-days per person for each state and associated CO2e emissions from published literature were applied to estimate total bed-days and emissions. Modeled scenarios combined ranges of DMT efficacy estimates (20 to 30%) and access levels (25 to 58% eligible patients receiving treatment) elicited from expert opinion to explore the extent of potential DMT impacts.
Results
Without DMT access, annual bed-days across the four AD stages were projected to increase from 5.5 million to 8.6 million from 2020 to 2040, with cumulative bed-days totaling 140 million. Associated annual emissions increased from 0.7 Mt to 1.1 Mt CO2e, reaching 17 Mt CO2e cumulatively from 2020 to 2040. Under the various high-access (58% eligible patients treated) DMT efficacy scenarios, relative to no DMT access, annual reductions of 430 thousand to 650 thousand bed-days and 54 kt to 81 kt CO2e were estimated by 2040, and cumulative emissions decreased by 419 kt to 633 kt CO2e. Decreasing DMT access to 25 percent, assuming 25 percent DMT efficacy, reduced annual bed-days by 230 thousand by 2040, and annual emission savings decreased to 29 kt CO2e.
Conclusions
DMTs for AD may contribute to efforts by healthcare systems to reduce the carbon emissions from hospital inpatient care. Environmental sustainability should be considered as part of a holistic value proposition when assessing the benefits of new medicines.
To assess the impact of the COVID-19 pandemic on first-episode psychosis (FEP) presentations across two Early Intervention in Psychosis (EIP) services in Ireland, by comparing pre-pandemic and post-pandemic cohorts.
Methods:
A cross-sectional observational design with retrospective medical record review was employed. The study population comprised 187 FEP patients (77 in pre-pandemic and 110 in post-pandemic cohort). Outcomes measured included duration of untreated psychosis (DUP), FEP presentation numbers, referral sources, global assessment of functioning scores, inpatient admissions, substance misuse and service delivery methods. Statistical analyses utilised chi-square tests to assess categorical variables, Mann–Whitney U tests to compare non-normally distributed continuous variables and Kruskal–Wallis tests to examine interactions between categorical and continuous variables.
Results:
A significant increase in FEP presentations was observed in the post-pandemic cohort (p = 0.003), with an increase in all urban areas and a decrease in the study’s only rural area. The difference in DUP between cohorts was not significant. However, significant interaction between gender, cohort and DUP was shown (p = 0.008), with women in the post-pandemic cohort experiencing longer DUP (p = 0.01). A significant rise in telephone (p = 0.05) and video consultations (p = 0.001) offered was observed, in the post-pandemic cohort. A similar number of in-person appointments were attended across both cohorts.
Conclusions:
This study highlights the impact of the pandemic on FEP presentations, particularly rurally and regarding increased DUP among women. These findings underscore the need for flexible EIP services to respond to public health crises. Despite increased presentations, services adapted, maintaining service continuity through telehealth and modified in-person contact.
Next generation high-power laser facilities are expected to generate hundreds-of-MeV proton beams and operate at multi-Hz repetition rates, presenting opportunities for medical, industrial and scientific applications requiring bright pulses of energetic ions. Characterizing the spectro-spatial profile of these ions at high repetition rates in the harsh radiation environments created by laser–plasma interactions remains challenging but is paramount for further source development. To address this, we present a compact scintillating fiber imaging spectrometer based on the tomographic reconstruction of proton energy deposition in a layered fiber array. Modeling indicates that spatial resolution of approximately 1 mm and energy resolution of less than 10% at proton energies of more than 20 MeV are readily achievable with existing 100 μm diameter fibers. Measurements with a prototype beam-profile monitor using 500 μm fibers demonstrate active readouts with invulnerability to electromagnetic pulses, and less than 100 Gy sensitivity. The performance of the full instrument concept is explored with Monte Carlo simulations, accurately reconstructing a proton beam with a multiple-component spectro-spatial profile.
The ability to manipulate brain function through the communication between the microorganisms in the gastrointestinal tract and the brain along the gut-brain axis has emerged as a potential option to improve cognitive and emotional health. Dietary composition and patterns have demonstrated a robust capacity to modulate the microbiota-gut-brain axis. With their potential to possess pre-, pro-, post-, and synbiotic properties, dietary fibre and fermented foods stand out as potent shapers of the gut microbiota and subsequent signalling to the brain. Despite this potential, few studies have directly examined the mechanisms that might explain the beneficial action of dietary fibre and fermented foods on the microbiota-gut-brain axis, thus limiting insight and treatments for brain dysfunction. Herein, we evaluate the differential effects of dietary fibre and fermented foods from whole food sources on cognitive and emotional functioning. Potential mediating effects of dietary fibre and fermented foods on brain health via the microbiota-gut-brain axis are described. Although more multimodal research that combines psychological assessments and biological sampling to compare each food type is needed, the evidence accumulated to date suggests that dietary fibre, fermented foods, and/or their combination within a psychobiotic diet can be a cost-effective and convenient approach to improve cognitive and emotional functioning across the lifespan.
In LGBTQ+- affirmative counseling, understanding the distinct lifespan development of transgender and gender-diverse people is crucial. Transgender and gender-diverse clients have unique and individual needs that require competent, supportive, and celebratory mental health practitioners. This chapter explores the lifespan of transgender and gender-diverse people from childhood to old age and death, the sociopolitical factors influencing transgender and gender-diverse people’s lives, relevant clinical applications, and the intersectionality of Black, Indigenous, and people of color’s identities and other nondominant identities within this group.
Background: We evaluated vorasidenib (VOR), a dual inhibitor of mIDH1/2, in patients with mIDH1/2 glioma (Phase 3; NCT04164901). Methods: Patients with residual/recurrent grade 2 mIDH1/2 oligodendroglioma or astrocytoma were enrolled (age ≥12; Karnofsky Performance Score ≥80; measurable non-enhancing disease; surgery as only prior treatment; not in immediate need of chemoradiotherapy). Patients were stratified by 1p19q status and baseline tumor size and randomized 1:1 to VOR 40 mg or placebo (PBO) daily in 28-day cycles. Endpoints included imaging-based progression-free survival (PFS), time to next intervention (TTNI), tumor growth rate (TGR), health-related quality of life (HRQoL), neurocognition and seizure activity. Results: 331 patients were randomized (VOR, 168; PBO, 163). The median age was 40.0 years. 172 and 159 patients had histologically confirmed oligodendroglioma and astrocytoma, respectively. Treatment with VOR significantly improved PFS and TTNI. Median PFS: VOR, 27.7 mos; PBO, 11.1 mos (P=0.000000067). Median TTNI: VOR, not reached; PBO, 17.8 mos (P=0.000000019). Treatment with VOR resulted in shrinkage of tumor volume. Post-treatment TGR: VOR, -2.5% (95% CI: -4.7, -0.2); PBO, 13.9% (95% CI: 11.1, 16.8). HRQoL and neurocognition were preserved and seizure control was maintained. VOR had a manageable safety profile. Conclusions: VOR was effective in mIDH1/2 diffuse glioma not in immediate need of chemoradiotherapy.
Background: Reporting extent of resection (EOR) in pituitary adenoma (PA) surgery via endoscopic endonasal approaches (EEA) is not standardized. The use of 3-dimensional volumetric analysis is proposed for measurement of tumor volumes and EOR. Their relationship with visual outcomes is explored. Methods: A retrospective analysis of PA patients presenting with visual disturbances and treated surgically via EEA by a single surgeon between 2006 and 2021. The main outcome was visual function at 12 months post-operatively. Results: 142 patients were included. Majority were male, with mean age of 57.1 years. Most (58.2%) presented with bitemporal hemianopsia. The mean tumor size was 11.3 cm3. The mean EOR was 84.5% (range 21.5-99.8%), with a mean post-operative tumor volume of 1.9 cm3. Visual function improved in 92.2%. Re-resection for visual deterioration was performed in 5.7% of patients, (mean time 2.4 years). No clinical, pathologic, or imaging factors were significantly associated with visual outcome. A significant association was found between EOR and re-resection (mean EOR 66.7% vs 85.6%, p=0.002). Conclusions: For patients with PA presenting with visual deficits, treatment with EEA led to improvement in visual function in the majority of patients, without the need for gross total resection. EOR was significantly associated with the need for re-resection.
NASA’s all-sky survey mission, the Transiting Exoplanet Survey Satellite (TESS), is specifically engineered to detect exoplanets that transit bright stars. Thus far, TESS has successfully identified approximately 400 transiting exoplanets, in addition to roughly 6 000 candidate exoplanets pending confirmation. In this study, we present the results of our ongoing project, the Validation of Transiting Exoplanets using Statistical Tools (VaTEST). Our dedicated effort is focused on the confirmation and characterisation of new exoplanets through the application of statistical validation tools. Through a combination of ground-based telescope data, high-resolution imaging, and the utilisation of the statistical validation tool known as TRICERATOPS, we have successfully discovered eight potential super-Earths. These planets bear the designations: TOI-238b (1.61$^{+0.09} _{-0.10}$ R$_\oplus$), TOI-771b (1.42$^{+0.11} _{-0.09}$ R$_\oplus$), TOI-871b (1.66$^{+0.11} _{-0.11}$ R$_\oplus$), TOI-1467b (1.83$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-1739b (1.69$^{+0.10} _{-0.08}$ R$_\oplus$), TOI-2068b (1.82$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-4559b (1.42$^{+0.13} _{-0.11}$ R$_\oplus$), and TOI-5799b (1.62$^{+0.19} _{-0.13}$ R$_\oplus$). Among all these planets, six of them fall within the region known as ‘keystone planets’, which makes them particularly interesting for study. Based on the location of TOI-771b and TOI-4559b below the radius valley we characterised them as likely super-Earths, though radial velocity mass measurements for these planets will provide more details about their characterisation. It is noteworthy that planets within the size range investigated herein are absent from our own solar system, making their study crucial for gaining insights into the evolutionary stages between Earth and Neptune.