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Do populist governments bend their economic policies to the preferences of bondholders? Populist governments should be a “least likely” case for the market discipline hypothesis. Populist parties typically run on platforms that scapegoat wealthy elites as “enemies of the people” and hence should be more resistant to changing policy positions in the face of market pressure, given their reluctance to alienate their base. Employing most-different case studies of the Five Star Movement/Lega coalition in Italy and Viktor Orbán’s government in Hungary, we find that populists do bend to market pressure but that this “disciplining effect” does not stem primarily from foreign investors. Rather, it was the inaction of domestic investors in bond auctions that caused these governments to reverse course on headline economic policies. Because domestic investors served as both governments’ “buyers of last resort,” they needed to maintain their favor amidst foreign capital flight.
The Hippoboscidae are ectoparasites of birds and mammals, which, as a group, are known to vector multiple diseases. Avipoxvirus (APV) is mechanically vectored by various arthropods and causes seasonal disease in wild birds in the United Kingdom (UK). Signs of APV and the presence of louse flies (Hippoboscidae) on Dunnocks Prunella modularis were recorded over a 16·5-year period in a rural garden in Somerset, UK. Louse flies collected from this site and other sites in England were tested for the presence of APV DNA and RNA sequences. Louse flies on Dunnocks were seen to peak seasonally three weeks prior to the peak of APV lesions, an interval consistent with the previously estimated incubation period of APV in Dunnocks. APV DNA was detected on 13/25 louse flies, Ornithomya avicularia and Ornithomya fringillina, taken from Dunnocks, both with and without lesions consistent with APV, at multiple sites in England. Collectively these data support the premise that louse flies may vector APV. The detection of APV in louse flies, from apparently healthy birds, and from sites where disease has not been observed in any host species, suggests that the Hippoboscidae could provide a non-invasive and relatively cheap method of monitoring avian diseases. This could provide advanced warnings of disease, including zoonoses, before they become clinically apparent.
Medical and surgical advancements have enabled a 95% survival rate for children with CHD. However, these survivors are disproportionately affected by neurodevelopmental disabilities. In particular, they have behavioural problems in toddlerhood. Because there is a known relationship between behavioural problems and early language delay, we hypothesise that children with critical CHD have early detectable language deficits. To test our hypothesis, we performed a retrospective study on a cohort of children with critical CHD to visualise their early language developmental trajectories.
Methods:
We identified a cohort of 27 children with two diagnoses: single ventricle physiology (19) and transposition of the great arteries (8). As part of their routine clinical care, all of these children had serial developmental evaluations with the language subsection of the Capute Scales. We visualised their developmental language trajectories as a function of chronologic age, and we used a univariate linear regression model to calculate diagnosis-specific expected developmental age equivalents.
Results:
In each group, language development is age-appropriate in infancy. Deviation from age-appropriate development is apparent by 18 months. This results in borderline-mild language delay by 30 months.
Discussion:
Using the Capute Scales, our team quantified early language development in infants and toddlers with critical CHD. Our identification of deceleration in skill acquisition reinforces the call for ongoing neurodevelopmental surveillance in these children. Understanding early language development will help clinicians provide informed anticipatory guidance to families of children with critical CHD.
Social Media Synopsis:
Children with single ventricle physiology and transposition of the great arteries have measurable early language delays.
Organizations and managers often implement workplace training programs aimed at fostering collaboration, belonging, and respect among employees. However, the effectiveness of these programs can be undermined when they are framed in ways that only resonate with some participants while alienating others. We propose that moral reframing can enhance the success of such initiatives by aligning messaging with a broader range of moral perspectives. Drawing on moral foundations theory, we identify five key dimensions, care, fairness, loyalty, authority, and purity, that shape how individuals interpret and respond to workplace training efforts. Although many programs emphasize care and fairness, individuals who prioritize loyalty, authority, and purity may perceive them differently, leading to disengagement, skepticism, or resistance. We argue that strategically framing training initiatives across multiple moral frameworks can foster greater engagement, buy-in, and overall effectiveness. Additionally, we offer practical recommendations for organizations to implement moral reframing strategies, ensuring that training efforts resonate with a wider audience and contribute to a more cohesive and productive workplace.
This study investigates and measures whether the association of childhood stunting with household socio-economic position (SEP) differs in Sri Lanka compared with other South Asian countries.
Design:
Secondary analysis of data of children from the latest available Demographic and Health Surveys data (survey years, 2016–2018). The exposures (SEP) were maternal education and wealth. The outcome was stunting. Binary logistic regression models incorporated SEP, country and SEP-by-country interaction terms.
Setting:
A nationally representative sample of children from Bangladesh, India, Nepal, Pakistan and Sri Lanka.
Participants
Mothers/caregivers of children under 36 months (133 491).
Results:
The prevalence of stunting in Sri Lanka of 19 % was much lower than that observed for all the other low- to low–middle income South Asian countries (37 % in Bangladesh, 36 % in India, 31 % in Nepal and 30 % in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared with other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared with Bangladesh. For example, in Sri Lanka, the poorest group had 2·75 (2·06, 3·67) times higher odds of stunting compared with the richest group, but in Bangladesh, this estimate was 4·20 (3·24, 5·44); the difference between these two estimates being 0·65 (0·44, 0·96) on the OR scale.
Conclusions:
The lower prevalence of stunting in Sri Lanka is unlikely to be due to less inequality. It is more likely that the lower prevalence of stunting in Sri Lanka is related to there being fewer mothers belonging to the lowest SEP groups.
There is a known disparity in clinical trial enrollment of rural-dwelling residents in the United States, largely due to financial constraints and travel burden. A big data study of an Intermountain West rural-serving healthcare system reported strong retention rates of historically underrepresented populations with adapted approaches. This exploratory qualitative descriptive study describes the lived experience and perceptions of eleven rural residents who participated or were interested in clinical trials from this healthcare system. Thematic analysis of interviews identified co-existing dualities between culture and traditional trial models, which suggest adapted designs are necessary to achieve opportunity equity in rural regions.
Field studies were conducted on certified organic land in Lafayette and Vincennes, IN, in 2023 to determine the impact of different between-row weed control methods on weed suppression and sweetpotato yield. Between-row treatments consisted of organic buckwheat (108 kg ha−1) broadcast seeded immediately after sweetpotato transplanting followed by silage tarping from 3 wk after transplanting (WATr) through harvest, organic buckwheat (108 kg ha−1) broadcast seeded 3 WATr and terminated 7 WATr, and cultivation as a grower standard. Weed density at 6 WATr was 0, 184, and 162 plants m−2 for the silage tarping, living mulch buckwheat, and cultivation treatments, respectively. Total yield was 11,048 kg ha−1 for the living mulch buckwheat, 19,792 kg ha−1 for the cultivation, and 17,814 kg ha−1 for the tarping treatments. Tarping effectively suppressed weeds and produced sweetpotato yields comparable to cultivation, indicating the potential for use by organic growers. When buckwheat was grown between rows 3 to 7 WATr, sweetpotato yield was lower than it was with tarping and cultivation. These results suggest that researchers should be evaluating tarps for small-acreage farmers as a weed management strategy.
Conscious but incapacitated patients need protection from both undertreatment and overtreatment, for they are exceptionally vulnerable, and dependent on others to act in their interests. In the United States, the law prioritizes autonomy over best interests in decision making. Yet U.S. courts, using both substituted judgment and best interests decision making standards, frequently prohibit the withdrawal of life-sustaining treatment from conscious but incapacitated patients, such as those in the minimally conscious state, even when ostensibly seeking to determine what patients would have wanted. In the United Kingdom, under the Mental Capacity Act of 2005, courts decide on the best interests of incapacitated patients by, in part, taking into account the past wishes and values of the patient. This paper examines and compares those ethicolegal approaches to decision making on behalf of conscious but incapacitated patients. We argue for a limited interpretation of best interests such that the standard is properly used only when the preferences of a conscious, but incapacitated patient are unknown and unknowable. When patient preferences and values are known or can be reasonably inferred, using a holistic, all-things-considered substituted judgment standard respects patient autonomy.
Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Sentiment and barriers may limit PGx testing. Here we compare confidence in utilizing PGx testing and barriers to implementation by type of provider and treatment condition as identified in a survey.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], 32% of NPs/PAs and 29% of MDs/DOs had used PGx testing for mental health conditions. The major barriers to adopt PGx testing were similar for mental health and primary care conditions yet differed by provider type. NPs/PAs (72-77%) were more concerned with patient cost than MDs/DOs (46-55%), whereas MDs/DOs were more concerned with evidence of clinical utility (54-59%) than NPs/PAs (40-42%). In respondents who use PGx testing, MDs/DOs reported slightly more confidence utilizing PGx than NPs/PAs. For both groups, confidence in using PGx for mental health conditions was somewhat greater than for non-mental health conditions.
Conclusions
These data illuminate the implementation barriers and confidence levels of clinicians utilizing PGx testing. Increasing awareness around patient cost and evidence of clinical utility for PGx testing may improve utilization.
Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Lack of awareness and education may be barriers to implementing routine PGx testing. To characterize current PGx testing utilization and educational needs we conducted a survey of various provider types.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], most indicated that they “don’t use” (44-49%) or “have never heard of” (19-20%) PGx testing for mental health conditions. The most helpful sources to learn about PGx testing were accredited CE/CME activities (55-61%) and peer-reviewed publications (57-59%). Most NPs/PAs preferred webinars (62%) or online learning portal (57%) formats. MDs/DOs had no preference for webinars or learning portals over conferences, written materials, or academic presentations (45-47%). NPs/PAs were more interested in learning about PGx testing than MDs/DOs (4.29/5 vs. 3.96/5 average score).
Conclusions
These data reveal awareness level and desired learning opportunities for PGx testing between types of healthcare providers. Education should be tailored to meet providers’ preferred learning formats and information sources, such as offering CE/CME through an online learning portal.
In hydrodynamic (HD) turbulence, an exact decomposition of the energy flux across scales has been derived that identifies the contributions associated with vortex stretching and strain self-amplification (Johnson, Phys. Rev. Lett., vol. 124, 2020 104501; J. Fluid Mech., vol. 922, 2021, A3) to the energy flux across scales. Here, we extend this methodology to general coupled advection–diffusion equations and, in particular, to homogeneous magnetohydrodynamic (MHD) turbulence. We show that several MHD subfluxes are related to each other by kinematic constraints akin to the Betchov relation in HD. Applied to data from direct numerical simulations, this decomposition allows for an identification of physical processes and for the quantification of their respective contributions to the energy cascade, as well as a quantitative assessment of their multi-scale nature through a further decomposition into single- and multi-scale terms. We find that vortex stretching is strongly depleted in MHD compared with HD, and the kinetic energy is transferred from large to small scales almost exclusively by the generation of regions of small-scale intense strain induced by the Lorentz force. In regions of large strain, current sheets are stretched by large-scale straining motion into regions of magnetic shear. This magnetic shear in turn drives extensional flows at smaller scales. Magnetic energy is transferred from large to small scales predominantly by the aforementioned current-sheet thinning in regions of high strain. The contributions from current-filament stretching – the analogue to vortex stretching – and from bending of magnetic field-lines into current filaments by vortical motion are both almost negligible, although the latter induces strong backscatter of magnetic energy. Consequences of these results for subgrid-scale turbulence modelling are discussed.
Ion cyclotron resonance heating is a versatile heating method that has been demonstrated to be able to efficiently couple power directly to the ions via the fast magnetosonic wave. However, at temperatures relevant for reactor grade devices such as DEMO, electron damping becomes increasingly important. To reduce electron damping, it is possible to use an antenna with a power spectrum dominated by low parallel wavenumbers. Moreover, using an antenna with a unidirectional spectrum, such as a travelling wave array antenna, the parallel wavenumber can be downshifted by mounting the antenna in an elevated position relative to the equatorial plane. This downshift can potentially enhance ion heating as well as fast wave current drive efficiency. Thus, such a system could benefit ion heating during the ramp-up phase and be used for current drive during flat-top operation. To test this principle, both ion heating and current drive have been simulated in a DEMO-like plasma for a few different mounting positions of the antenna using the FEMIC code. We find that moving the antenna off the equatorial plane makes ion heating more efficient for all considered plasma temperatures at the expense of on-axis heating. Moreover, although current drive efficiency is enhanced, electron damping is reduced for lower mode numbers, thus reducing the driven current in this part of the spectrum.
Turbulent boundary layers on immersed objects can be significantly altered by the pressure gradients imposed by the flow outside the boundary layer. The interaction of turbulence and pressure gradients can lead to complex phenomena such as relaminarization, history effects and flow separation. The angular momentum integral (AMI) equation (Elnahhas & Johnson, J. Fluid Mech., vol. 940, 2022, A36) is extended and applied to high-fidelity simulation datasets of non-zero pressure gradient turbulent boundary layers. The AMI equation provides an exact mathematical equation for quantifying how turbulence, free-stream pressure gradients and other effects alter the skin friction coefficient relative to a baseline laminar boundary layer solution. The datasets explored include flat-plate boundary layers with nearly constant adverse pressure gradients, a boundary layer over the suction surface of a two-dimensional NACA 4412 airfoil and flow over a two-dimensional Gaussian bump. Application of the AMI equation to these datasets maps out the similarities and differences in how boundary layers interact with favourable and adverse pressure gradients in various scenarios. Further, the fractional contribution of the pressure gradient to skin friction attenuation in adverse-pressure-gradient boundary layers appears in the AMI equation as a new Clauser-like parameter with some advantages for understanding similarities and differences related to upstream history effects. The results highlight the applicability of the integral-based analysis to provide quantitative, interpretable assessments of complex boundary layer physics.
A model for preferential and triadic choice is derived in terms of weighted sums of central F distribution functions. This model is a probabilistic generalization of Coombs' (1964) unfolding model and special cases, such as the model of Zinnes and Griggs (1974), can be derived easily from it. This new form extends previous work by Mullen and Ennis (1991) and provides more insight into the same problem that they discussed.
The global population and status of Snowy Owls Bubo scandiacus are particularly challenging to assess because individuals are irruptive and nomadic, and the breeding range is restricted to the remote circumpolar Arctic tundra. The International Union for Conservation of Nature (IUCN) uplisted the Snowy Owl to “Vulnerable” in 2017 because the suggested population estimates appeared considerably lower than historical estimates, and it recommended actions to clarify the population size, structure, and trends. Here we present a broad review and status assessment, an effort led by the International Snowy Owl Working Group (ISOWG) and researchers from around the world, to estimate population trends and the current global status of the Snowy Owl. We use long-term breeding data, genetic studies, satellite-GPS tracking, and survival estimates to assess current population trends at several monitoring sites in the Arctic and we review the ecology and threats throughout the Snowy Owl range. An assessment of the available data suggests that current estimates of a worldwide population of 14,000–28,000 breeding adults are plausible. Our assessment of population trends at five long-term monitoring sites suggests that breeding populations of Snowy Owls in the Arctic have decreased by more than 30% over the past three generations and the species should continue to be categorised as Vulnerable under the IUCN Red List Criterion A2. We offer research recommendations to improve our understanding of Snowy Owl biology and future population assessments in a changing world.
To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.
Design:
Cross-sectional electronic survey and semi-structured interviews.
Setting:
Academic hospitals in the United States.
Participants:
HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.
Methods:
We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.
Results:
Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.
Conclusions:
HCWs’ understanding of best collection practices and yield of BCx was limited.