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Depopulation of end-of-lay hens can result in stress and injury for both hens and catchers. A pilot study was assessed to optimise hen and catcher well-being during loading. Two add-on prototypes for attaching to transport container drawers were tested on five commercial aviary farms: prototype 1 (metal tube with vertical flaps); and prototype 2 (frame with horizontal flaps). Per flock, a subset of 800 end-of-lay hens was assigned to one of three treatments: Standard container with 15 drawers; Standard container plus prototype 1; and Standard container plus prototype 2. Parameters (filling duration, number of escapes, number of body part entrapments, restlessness, and loading inefficiency in container) were scored during the catch, supplemented by a post-loading catcher survey, and at the slaughterhouse (loading damage prevalence, number of dead-on-arrivals). The three treatments were compared using a 1–7 Likert scale. Hens were significantly calmer with prototype 1 compared to prototype 2 with no significant difference relative to the standard container. Loading was less efficient for prototype 2 vs the standard container. Catchers preferred prototype 1 and the standard container over prototype 2 for ease of use and hen calmness and prototype 2 showed no advantages for efficiency or animal and catcher well-being. Prototype 1 resulted in fewer breast bruises than the standard container with no difference in loading efficiency and requires larger-scale testing for enhancing effectiveness, animal and catcher well-being.
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.
Natural disasters are becoming more frequent. The crises that follow are becoming more impactful along with diverse emergency-prone hazards and security contexts. EMTs play a crucial role in emergency and disaster response offering timely medical assistance, stabilizing patients, and ensuring safe transport to medical facilities. EMTs must have public health competencies to evaluate, prioritize, and resource all types of medical and public health emergencies.
Objectives:
Define the essential competencies for leading/coordinating actions between public health and disaster medicine to reliably prepare EMTs for lasting success.
Method/Description:
We hosted an international colloquium targeted at EMT capacity building and training.
Results/Outcomes:
EMTs work in environments with limited resources, including medical supplies, equipment, personnel, which impacts their ability to provide care. EMTs provide care to individuals and communities during recovery and provide medical assistance for displaced individuals, addressing acute health concerns and chronic conditions. They empower individuals and communities to take active roles in their recovery fostering empowerment, preparedness, and cohesion. EMTs ensure continuity of care and effectively address emerging health concerns.
Conclusion:
Continued investment is needed in public health training, resources, and support systems to enhance the effectiveness of EMTs in disaster management: 1) training equips EMTs with critical team competencies, 2) adequate resources, including medical supplies, equipment/transportation, are essential for EMTs, 3) investment in mental health support systems to address the psychological impacts of disaster response and recovery, 4) funding research initiatives and embracing technological advancements helps identify best practices and develop evidence-based protocols, 5) establish (international) regulatory framework, registration, and individual competency certification to professionalize EMT cadre.
Increasing daylight exposure might be a simple way to improve mental health. However, little is known about daylight-symptom associations in depressive disorders.
Methods
In a subset of the Australian Genetics of Depression Study (N = 13,480; 75% female), we explored associations between self-reported number of hours spent in daylight on a typical workday and free day and seven symptom dimensions: depressive (overall, somatic, psychological); hypo-manic-like; psychotic-like; insomnia; and daytime sleepiness. Polygenic scores for major depressive disorder (MDD); bipolar disorder (BD); and schizophrenia (SCZ) were calculated. Models were adjusted for age, sex, shift work status, employment status, season, and educational attainment. Exploratory analyses examined age-stratified associations (18–24 years; 25–34 years; 35–64 years; 65 and older). Bonferroni-corrected associations (p < 0.004) are discussed.
Results
Adults with depression reported spending a median of one hour in daylight on workdays and three hours on free days. More daylight exposure on workdays and free days was associated with lower depressive (overall, psychological, somatic) and insomnia symptoms (p’s<0.001), but higher hypo-manic-like symptoms (p’s<0.002). Genetic loading for MDD and SCZ were associated with less daylight exposure in unadjusted correlational analyses (effect sizes were not meaningful). Exploratory analyses revealed age-related heterogeneity. Among 18–24-year-olds, no symptom dimensions were associated with daylight. By contrast, for the older age groups, there was a pattern of more daylight exposure and lower insomnia symptoms (p < 0.003) (except for 25–34-year-olds on free days, p = 0.019); and lower depressive symptoms with more daylight on free days, and to some extent workdays (depending on the age-group).
Conclusions
Exploration of the causal status of daylight in depression is warranted.
Compared with other areas of mental health research that are focused on the active and early management of youth presenting in the early stages of major mental disorders, there has been a relative lack of focus on young people with emerging or established bipolar disorders. Recently, this has stimulated both international professional societies (e.g., International Society for Bipolar Disorders [ISBD] Early Intervention Task Force) and funding agencies from Canada, UK, Australia, and the USA – including the Daymark Foundation (Jain et al. 2023), Wellcome Trust (2022), National Health and Medical Research Council, and BD2 – to promote a focus on identifying the major challenges in this field and gathering support for novel research and clinical service programmes.
Functional impairment is a major concern among those presenting to youth mental health services and can have a profound impact on long-term outcomes. Early recognition and prevention for those at risk of functional impairment is essential to guide effective youth mental health care. Yet, identifying those at risk is challenging and impacts the appropriate allocation of indicated prevention and early intervention strategies.
Methods
We developed a prognostic model to predict a young person’s social and occupational functional impairment trajectory over 3 months. The sample included 718 young people (12–25 years) engaged in youth mental health care. A Bayesian random effects model was designed using demographic and clinical factors and model performance was evaluated on held-out test data via 5-fold cross-validation.
Results
Eight factors were identified as the optimal set for prediction: employment, education, or training status; self-harm; psychotic-like experiences; physical health comorbidity; childhood-onset syndrome; illness type; clinical stage; and circadian disturbances. The model had an acceptable area under the curve (AUC) of 0.70 (95% CI, 0.56–0.81) overall, indicating its utility for predicting functional impairment over 3 months. For those with good baseline functioning, it showed excellent performance (AUC = 0.80, 0.67–0.79) for identifying individuals at risk of deterioration.
Conclusions
We developed and validated a prognostic model for youth mental health services to predict functional impairment trajectories over a 3-month period. This model serves as a foundation for further tool development and demonstrates its potential to guide indicated prevention and early intervention for enhancing functional outcomes or preventing functional decline.
When considering the implications of the shareholder-stakeholder debate in defining the purpose of a company, epistemological clarity is vital in this emerging theory of the firm. Such clarity can prevent recurrence based solely on rephrasing key terms. To understand how various stakeholders develop and interpret a shared purpose, I argue for the necessity of a pragmatist approach that is normative and process-oriented. Mental models play a crucial role in interpretive processes that define decision-making, where individual perspectives converge. The figures of Milton Friedman and Ed Freeman serve as “beacons,” as artefacts, in the transmission of knowledge through which we, as individuals, shape a shared understanding. In current societies, profound polarization obstructs solutions to grand challenges. Pragmatism starts by questioning the underlying values of everyone involved. It assumes that sound deliberative processes are the only way to reach real solutions—not only for the mind but, above all, for the heart.
We present a new map of bed topography and ice thickness together with a corresponding ice volume estimate representative of the years ~2010 for all Scandinavian ice caps and glaciers. Starting from surface observations, we invert for ice thickness by iteratively running an innovative ice dynamics model on a distributed grid and updating bed topography until modelled and observed glacier dynamics as represented by their rate of surface elevation change (dh/dt) fields align. The ice flow model used is the instructed glacier model (Jouvet and Cordonnier, 2023, Journal of Glaciology 1–15), a generic physics-informed deep-learning emulator that models higher-order ice flow with high-computational efficiency. We calibrate the modelled thicknesses against >11 000 ice thickness observations, resulting in a final ice volume estimate of 302.7 km3 for Norway, 18.4 km3 for Sweden and 321.1 km3 for the whole of Scandinavia with an error estimate of ~$\pm 11\%$. The validation statistics computed indicate good agreement between modelled and observed thicknesses (RMSE = 55 m, Pearson's r = 0.87, bias = 0.8 m), outperforming all other ice thickness maps available for the region. The modelled bed shapes thus provide unprecedented detail in the subglacial topography, especially for ice caps where we produce the first maps that show ice-dynamically realistic flow features.
The recognised heterogeneity of clinical cohorts of people with depression and other mood disorders has been held to be one of the central reasons why so many studies of causation, neurobiological or psychological correlates, or the effectiveness of treatments have failed to yield significant findings or be easily replicated by independent groups.
A clinical concept that has been taken up with some enthusiasm in mental health services for young people experiencing major mental disorders is that of clinical staging, with the emphasis on identifying and intervening in youth with various ‘at-risk’, ‘sub-threshold’ or ‘attenuated’ syndromes, before the onset of first major episodes (Shah et al 2020). While these concepts were initially developed within the rather focused context of major psychotic disorders, they are now being deployed much more widely and applied to young people presenting with a variety of mental disorders (Hickie et al 2019; Shah 2019).
This research aimed to evaluate health and nutritional practices of mothers during pregnancy and birth outcomes of their newborns in Bukavu, Democratic Republic of the Congo (DRC), comparing semi-urban and rural areas.
Background:
Health and nutrition during pregnancy are crucial for adequate development of the fetus. Health care plays an important role but is often poor in rural areas of developing countries.
Methods:
A baseline survey of a nutritional follow-up study was conducted in two semi-urban and one rural hospital in the vicinity of Bukavu, DRC. In total, 471 mother-child pairs were recruited after delivery. Data collection included socio-demographic parameters, nutrition and health measures during pregnancy, and anthropometric parameters. Semi-urban and rural study locations were compared and predictors of birth weight evaluated.
Findings:
Semi-urban and rural mothers differed significantly in nutrition and health practices during pregnancy, as well as birth outcomes. In the rural area, there was a higher rate of newborns with low birth weight (10.7%) and lower rates of antimalarial medication (80.8%), deworming (24.6%), consumption of nutritional supplements (81.5%), and being informed about nutrition by medical staff (32.8%) during pregnancy as well as practicing family planning (3.1%) than in the semi-urban areas (2.7%, 88.6%, 88.3%; 89.3%, 46.5%, and 17.1%, respectively). Birth weight was positively predicted by increasing maternal MUAC, age, and gestational age and negatively by rural location, being primipara, being a farmer, and female newborn sex.
Conclusion:
The findings highlight the importance of strengthening antenatal care activities especially in rural areas in order to ameliorate both maternal and infantile health and ensure appropriate development.
The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.
Methods
Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) ‘initial network’, that shows the conditional dependencies between factors at first presentation, and a (2) ‘transition network’, how factors are dependent longitudinally.
Results
The ‘initial network’ identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The ‘transition network’ identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59–1.99) and self-harm (RR, 1.32; CI, 1.22–1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69–2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28–5.43) and self-harm (RR, 2.78; CI, 2.55–3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.
Conclusions
This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.
A fan-wide assessment of modern depositional processes on the Río Grande (Guapay) megafan, coupled with the analysis of its Holocene evolution, reveals that most of the 36,000 km2 megafan surface has been subject to sedimentation processes and/or reworking in the last 6–7 ka. Today, depositional dynamics as inferred from multi-date satellite imagery are mostly restricted to a ~ 2,000 km2 depozone on the distal megafan, and are characterised by avulsive fluvial environments. Combining remote sensing with field observations and geochronology at key locations has allowed to capture links between the dynamics of depositional processes and larger-scale landforms, documenting significant changes in the location of the depozone since ~ 4 ka. On shorter time scales, the human impact on these dynamic sedimentary processes is expressed by artificial levees and re-channelisation following crevasse splays. This is likely to have prevented a number of channel avulsions over the last decades and implies that the use of modern avulsion frequencies and depositional rates alone as analogues for understanding Holocene megafan evolution is of limited use. Instead, our observations emphasise the increasing vulnerability to future avulsion events within an intrinsically unstable fluvial environment that has seen rapid deforestation and population growth in recent time.
The world is facing the devastating impact a biological event can have on human health, economies, and political stability. COVID-19 has revealed that national governments and the international community are woefully unprepared to respond to pandemics—underscoring our shared vulnerability to future catastrophic biological threats that could meet or exceed the severe consequences of the current pandemic. This study examines potential threats related to deliberate Russian military use and misuse of the tools of modern biology or an accident caused by a CBRN event evolving rapidly in the highly volatile political environment in and around Ukraine and other conflicts.
Method:
A participatory foresight, co-creative, future and transformation-oriented methodology was used to structure a transformative model for a disciplined exploration of scenarios to confront complex challenges and facilitate improved outcomes. Foresight helps to evaluate current policy priorities and potential new policy directions; see how the impact of possible policy decisions may combine with other developments; inform, support and link policy-making in and across a range of sectors; identify future directions, emerging technologies, new societal demands and challenges; and anticipate future developments, disruptive events, risks and opportunities.
Results:
The study found that the “mitigation scenarios” are based on the “Confront, Regulate, Overcome” metamodel combined with the “Security, Rescue, Care” response modalities. These require the cooperation/coordination of law enforcement forces along with military forces, fire departments and civil security resources, hospital and first-line responder teams, in order to appropriately address populations, assets and territories issues elicited by the identified threat, which drives key decision makers’ tasks at the strategic level.
Conclusion:
The participatory foresight exercise demonstrated gaps in national and international biosecurity and pandemic preparedness architectures highlighted by the challenges of the Ukraine war—exploring opportunities for better cooperation to improve prevention and response capabilities for high-consequence biological events, and generate actionable recommendations for the international community.
Training in disaster medicine can be partly theoretical but it must include a large practical part. If part of it can be developed through exercises in virtual reality or on a computer, the realization of life-size disaster exercises bringing together all the disciplines is of great help in this learning. Exercises of such magnitude are difficult to carry out in civilian life for reasons of resources and cost. We therefore wanted to develop this disaster medicine course with the three French-speaking civil universities but also with the Royal Military School for the practical part.
Method:
Collaboration agreements were established between three civilian universities (ULB, UCLouvain, ULiège) and the Royal Military School. The army thus provides the infrastructures of the Belgian military units to organize the exercises, personnel, means of make-up, vehicles, and security, all free of cost. Coordination meetings before exercises are also organized during the year by the army.
Results:
The exercises are organized in complete safety conditions on military fields, isolated from the civilian environment without disturbing the daily functioning of civilians. Access is authorized and organized for the various disciplines (firefighters, police, red cross and other participants). Nearly 100 people (victims, firemen, policemen,...) and 50 vehicles per exercise make the scenario completely believable. Different scenarios are repeated six times to complete the training of 80 students.
Conclusion:
The collaboration between civilians and military has made it possible to set up quality training integrating a large part of life-size exercises at no cost and in complete safety. This ends the course by integrating in practice all the knowledge learned during the theoretical part and the virtual exercises.
Aripiprazole 2-month ready-to-use 960 mg (Ari 2MRTU 960) is a new long-acting injectable (LAI) antipsychotic formulation for gluteal administration every 2 months, intended for the treatment of schizophrenia and maintenance monotherapy treatment of bipolar I disorder (BP-I). This 32-week trial evaluated the safety, tolerability, and pharmacokinetic profile of multiple-dose gluteal administration of Ari 2MRTU 960 in clinically stable adult patients with a diagnosis of schizophrenia or BP-I, versus that of aripiprazole once-monthly 400 mg (AOM 400; an LAI indicated for the treatment of schizophrenia and maintenance monotherapy treatment of BP-I).
Methods
This was an open-label, multiple-dose, randomized, parallel-arm trial conducted at 16 sites in the US. Eligible patients (N=266) were randomized to receive Ari 2MRTU 960 every 56±2 days (n=132; 4 injections in total) or AOM 400 every 28±2 days (n=134; 8 injections in total). Safety and tolerability were evaluated throughout the study; assessments included adverse event reporting, patient reporting of injection site pain, and monitoring of extrapyramidal symptoms.
Results
In the Ari 2MRTU group, 102 patients (77.3%) completed the study; in the AOM 400 group, 92 patients (68.7%) completed the study. The overall incidence of treatment-emergent adverse events (TEAEs) was similar between Ari 2MRTU 960 and AOM 400 (71.2% versus 70.9%, respectively). The most frequently reported TEAEs were increased weight (22.7% for Ari 2MRTU 960 versus 20.9% for AOM 400) and injection site pain (18.2% for Ari 2MRTU 960 versus 9.0% for AOM 400), none of which were assessed as serious or severe by the investigators. All injection site pain events in the Ari 2MRTU 960 group were assessed as mild or moderate in severity; most (15.9%) coincided with the first injection and resolved within 5 days. Extrapyramidal symptom scores remained unchanged in both treatment groups.
Conclusions
Multiple-dose administration of Ari 2MRTU 960 was generally well tolerated in patients with schizophrenia or BP-I and did not show any new safety concerns.
Funding
Otsuka Pharmaceutical Development & Commercialization, Inc. (Princeton, NJ, USA) and H. Lundbeck A/S (Valby, Denmark)
In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020–06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.
The future contributions of the Antarctic Ice Sheet to sea level rise will depend on the evolution of its surface mass balance (SMB), which could amplify/dampen mass losses increasingly observed at the ice sheet's edge. In situ constraints of SMB over annual-to-decadal timescales consist mostly of firn/ice cores that have a surface footprint $\sim$cm$^{2}$. SMB constraints also come from climate models, which have a higher temporal resolution but a larger surface footprint of several km$^{2}$. We use ice-penetrating radar data to obtain an intermediate spatial and temporal resolution SMB record over three ice rises along the Princess Ragnhild Coast. The co-located ice cores allow us to obtain absolute radar-derived SMB rates at a multi-annual-to-decadal temporal resolution. By comparing the ice core SMB measurements and the radar-derived SMB records, we determine that pointwise measurements of SMB are representative of a small surface area, $\sim 200-500$ m radius extending from the ice core drill site for the ice rises studied here, and that the pointwise measurements are systematically 7–15 cm w.e. a$^{-1}$ lower than the mean SMB value calculated for the whole ice rises. However, ice core records are representative of an entire ice rise's temporal variability at the temporal resolution examined.
Uvite, CaMg3(Al5Mg)(Si6O18)(BO3)3(OH)3(OH), is a new mineral of the tourmaline supergroup. It occurs in the Facciatoia quarry, San Piero in Campo, Elba Island, Italy (42°45′04.55″N, 10°12′50.89″E) at the centre of a narrow (2–3 cm wide) vein composed of aggregates of dark brown to black tourmaline, penetrating (magnesite + dolomite)-rich hydrothermally altered metaserpentinite. Crystals are euhedral and up to 1 cm in size, brown with a vitreous lustre, conchoidal fracture and grey streak. Uvite has a Mohs hardness of ~7½, a calculated density of 3.115 g/cm3 and is uniaxial (–). Uvite has trigonal symmetry, space group R3m, a = 15.9519(10) Å, c = 7.2222(5) Å, V = 1597.3(1) Å3 and Z = 3. The crystal structure was refined to R1 = 1.77% using 1666 unique reflections collected with MoKα X-rays. Crystal-chemical analysis resulted in the empirical crystal-chemical formula $^X ({\rm Ca}_{0.61}{\rm Na}_{{0.35}} \square_{{0.04}})_{\Sigma 1.00}{}^{Y} \left( {{\rm Mg}_{1.50}{\rm Fe}^{2 + }_{0.47} {\rm Al}_{0.71}{\rm Fe}^{3 + }_{0.14} {\rm Ti}_{0.18}} \right)_{\Sigma 3.00}$${}^{Z} \left( {{\rm Al}_{4.54}{\rm Fe}^{3 + }_{0.18} {\rm V}^{3 + }_{0.02} {\rm Mg}_{1.27}} \right)_{\Sigma 6.00}{}^{T}\left[ {{\left( {{\rm Si}_{5.90}{\rm Al}_{0.10}} \right)}_{\Sigma 6.00}{\rm O}_{18}} \right]{\rm } \left( {\rm BO_3} \right)_3^{} {^{\rm O(3)}}\left( {\rm OH} \right)_3{}^{{\rm O}\left( 1 \right)} [\left( {\rm OH} \right)_{0.55}{\rm F}_{0.05}{\rm O}_{0.40}]_{\Sigma 1.00}$
which recast in its ordered form for classification purposes is:
Uvite is a hydroxy-species belonging to the calcic-group of the tourmaline supergroup. The closest end-member compositions of valid tourmaline species are fluor-uvite and feruvite, to which uvite is related by the substitutions W(OH)– ↔ WF– and YMg2+ ↔ YFe2+, respectively. The occurrence of a solid-solution between uvite and magnesio-lucchesiite, according to the substitution ZMg2+ + W(OH)– ↔ ZAl3+ + WO2–, is supported by experimental data. The new mineral was approved by the IMA–CNMNC (IMA 2019-113). Uvite from Facciatoia formed by the reaction between B-rich fluids, released during the crystallisation process of LCT pegmatites, and the surrounding metaserpentinites, altered by contact metamorphism in the aureole of the Miocene Mt. Capanne monzogranitic pluton.
For a Galois extension $K/F$ with $\text {char}(K)\neq 2$ and $\mathrm {Gal}(K/F) \simeq \mathbb {Z}/2\mathbb {Z}\oplus \mathbb {Z}/2\mathbb {Z}$, we determine the $\mathbb {F}_{2}[\mathrm {Gal}(K/F)]$-module structure of $K^{\times }/K^{\times 2}$. Although there are an infinite number of (pairwise nonisomorphic) indecomposable $\mathbb {F}_{2}[\mathbb {Z}/2\mathbb {Z}\oplus \mathbb {Z}/2\mathbb {Z}]$-modules, our decomposition includes at most nine indecomposable types. This paper marks the first time that the Galois module structure of power classes of a field has been fully determined when the modular representation theory allows for an infinite number of indecomposable types.