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Do societies with more extensive welfare states also perform better environmentally? Surprisingly, the empirical evidence for this relationship remains inconclusive. We focus on CO2 emissions in lower-income countries and argue that considering state capacity as a moderator helps achieving greater theoretical and empirical clarity in understanding when the welfare state – climate change mitigation relationship. We hypothesize that lower-income societies with more developed welfare states exhibit lower carbon emissions when they also have more state capacity. The underlying mechanism centers on the ability of the state to compensate losers from policy change and its enforcement power required for policy implementation. Using data on CO2 emissions, social protection, and labor market regulations, as well as state capacity in 66 lower-income countries since 2005, we find that carbon emissions tend to be lower in countries characterized both by a welfare state focused on reducing socio-economic inequality and high state capacity.
We conducted a scoping review of peer-reviewed literature to describe the nature and extent of reporting on the involvement of stakeholders in early-stage translational research.
Methods and results:
We conducted two literature searches in six databases, screened records and full-text articles, and abstracted and analyzed data from included publications. The literature searches yielded unduplicated 2,894 records. After screening, 13 articles were included.
Findings:
Our review of the literature yielded rare reports of engagement in early-stage translational research. Half of included articles reported on engagement with patients, clinicians, and researchers while fewer that one in three reported on engagement with policymakers, industry, and insurers. One in four reported engagement in the publication’s acknowledgments but not in the main text. More than half drew unmeasured conclusions about the outcomes of engagement.
Interpretation:
Our definition of early-stage translation pointed to a specific set of peer-reviewed research; our findings indicate a reporting gap and not necessarily a gap in practice. By addressing four themes–developing a shared language, identifying frameworks and principles, creating a repository of resources, and establishing a research agenda, research leaders can develop new insights about how to engage communities in early-stage translational research.
The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Cross-Trial Statistics Group gathered lessons learned from statisticians responsible for the design and analysis of the 11 ACTIV therapeutic master protocols to inform contemporary trial design as well as preparation for a future pandemic. The ACTIV master protocols were designed to rapidly assess what treatments might save lives, keep people out of the hospital, and help them feel better faster. Study teams initially worked without knowledge of the natural history of disease and thus without key information for design decisions. Moreover, the science of platform trial design was in its infancy. Here, we discuss the statistical design choices made and the adaptations forced by the changing pandemic context. Lessons around critical aspects of trial design are summarized, and recommendations are made for the organization of master protocols in the future.
Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT.
Methods:
This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life.
Results:
24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65). Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups.
Conclusion:
A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.
Bromide-containing impurities were found to decrease the thermal stability of quaternary alkyl ammonium-modified layered silicates. Improved purification procedures completely removed bromide and led to a 20°C to >100°C increase in organic modified layered silicate thermal stability. Using mass spectrometry and thermal and electrochemical analysis, N,N-dimethyl-N,N-dioctadecyl quaternary ammonium-modified montmorillonite and fluorinated synthetic mica were found to degrade primarily through elimination and nucleophilic attack by these anions. The nature of residual bromides was identified and quantified, and the efficiency of removing these anions was found to be solvent dependent; sequential extraction, first ethanol then tetrahydrofuran, gave the best results. This exhaustive extraction method represents a viable alternative to the use of expensive, more thermally stable oniumion treatments for layered silicates.
In July 2021, Public Health Wales received two notifications of salmonella gastroenteritis. Both cases has attended the same barbecue to celebrate Eid al–Adha, two days earlier. Additional cases attending the same barbecue were found and an outbreak investigation was initiated. The barbecue was attended by a North African community’s social network. On same day, smaller lunches were held in three homes in the social network. Many people attended both a lunch and the barbecue. Cases were defined as someone with an epidemiological link to the barbecue and/or lunches with diarrhoea and/or vomiting with date of onset following these events. We undertook a cohort study of 36 people attending the barbecue and/or lunch, and a nested case-control study using Firth logistic regression. A communication campaign, sensitive towards different cultural practices, was developed in collaboration with the affected community. Consumption of a traditional raw liver dish, ‘marrara’, at the barbecue was the likely vehicle for infection (Firth logistic regression, aOR: 49.99, 95%CI 1.71–1461.54, p = 0.02). Meat and offal came from two local butchers (same supplier) and samples yielded identical whole genome sequences as cases. Future outbreak investigations should be relevant to the community affected by considering dishes beyond those found in routine questionnaires.
Displacement ventilation, where cool external air enters a room through low-level vents and warmer air leaves through high-level vents, is characterised by vertical gradients in pressure arising from the warmer indoor temperatures. Models usually assume that horizontal variations of temperature difference are small in comparison and are, therefore, unimportant. Small-scale laboratory experiments and computational fluid dynamics were used to examine these flows, driven by a uniformly heated floor. These experiments and simulations show that the horizontal variations of temperature difference can be neglected for predictions of the bulk ventilation rate; however, they also evidence that these horizontal variations can be significant and play a critical role in establishing the pattern of flow within the room – this renders the horizontal position of the low- and high-level vents (relative to one another) important. We consider two cases: single-ended (where inlet and outlet are at the same end of the room) and opposite-ended. In both cases the ventilation flow rate is the same. However, in the opposite-ended case a dead zone is established in the upper part of the room which results in significant horizontal variations. We consider the formation of this dead zone by examining the streamline patterns and the age of air within the room. We discuss the implications for occupant exposure to pollutants and airborne disease.
Medically assisted alcohol withdrawal (MAAW) is increasingly undertaken on acute adult psychiatric wards.
Aims
Comparison of the quality of MAAW between acute adult wards and specialist addictions units in mental health services.
Method
Clinical audit conducted by the Prescribing Observatory for Mental Health (POMH). Information on MAAW was collected from clinical records using a bespoke data collection tool.
Results
Forty-five National Health Service (NHS) mental health trusts/healthcare organisations submitted data relating to the treatment of 908 patients undergoing MAAW on an acute adult ward or psychiatric intensive care unit (PICU) and 347 admitted to a specialist NHS addictions unit. MAAW had been overseen by an addiction specialist in 33 (4%) of the patients on an acute adult ward/PICU. A comprehensive alcohol history, measurement of breath alcohol, full screening for Wernicke's encephalopathy, use of parenteral thiamine, prescription of medications for relapse prevention (such as acamprosate) and referral for specialist continuing care of alcohol-related problems following discharge were all more commonly documented when care was provided on a specialist unit or when there was specialist addictions management on an acute ward.
Conclusions
The findings suggest that the quality of care provided for medically assisted withdrawal from alcohol, including the use of evidence-based interventions, is better when clinicians with specialist addictions training are involved. This has implications for future quality improvement in the provision of MAAW in acute adult mental health settings.
Experiential learning, such as simulation-based training, is widely used in health education. Dramatic self-expression adds another layer through enacted perspective taking, and embodied self-exploration of interaction with others, to foster situated learning. We describe the evaluation of an innovative drama-based experiential learning project involving collaboration between multidisciplinary mental healthcare staff and people with lived experience of mental illness. The programme was facilitated at East London NHS Foundation Trust by a theatre company experienced in delivering workshops with service users. A weekly group programme took place online over 8 weeks during the COVID-19 pandemic and included activities of improvisation, embodied enactments and debriefing. The programme led to co-production of a drama piece that was filmed and distributed online. It was hypothesised that the experiential learning might result in individual benefits for all participants, such as improved well-being and increased mutual understanding of each other's experience of mental health care. The project aimed to improve relationships between healthcare disciplines, and between staff and service users. Additionally, aims were to empower service users, and support staff to practice core interpersonal skills. Objectives of the evaluation were to study the impact of the experiential learning, understand participants’ experience, and explore challenges and benefits.
Methods
A mixed methods approach was taken to evaluate the programme. Following completion of the project, participants were invited to complete a questionnaire utilising a Likert scale rating of overall satisfaction with the project, perceived benefit and impact on specific domains such as working with others. One-to-one semi-structured interviews were conducted according to a topic-guide, and qualitative data were analysed using open & axial coding for thematic analysis.
Results
11 participants, including Psychiatrists, Occupational Therapists and current service users, completed the experiential learning and filming. Questionnaire data suggested participants were highly satisfied with the learning and felt it would be valuable to others. Themes include the positive experience of creativity, dismantling of hierarchy, improved empathy, confidence and connection. Potential challenges were digital inequality and lack of dedicated time for professional development.
Conclusion
A drama-based experiential learning group programme for healthcare staff and service users is a highly beneficial learning experience. Participants describe changes on a personal level as well as improved understanding of others’ perspectives. This form of experiential learning features collaborative working that aligns with principles of co-production and supports the development of interpersonal skills; the findings suggest that drama-based experiential learning is a useful method in health education to complement knowledge acquisition.
We investigated risk factors associated with COVID-19 by conducting a retrospective, frequency-matched case-control study, with three sampling periods (August–October 2020). We compared cases completing routine contact tracing to asymptomatic population controls. Multivariable analyses estimated adjusted odds ratios (aORs) for non-household community settings. Meta-analyses using random effects provided pooled odds ratios (pORs). Working in healthcare (pOR 2.87; aORs 2.72, 2.81, 3.08, for study periods 1–3 respectively), social care (pOR 4.15; aORs 2.46, 5.06, 5.41, for study periods 1–3 respectively) or hospitality (pOR 2.36; aORs 2.01, 2.54, 2.63, for study periods 1–3 respectively) were associated with increased odds of being a COVID-19 case. Additionally, working in bars, pubs and restaurants, warehouse settings, construction, educational settings were significantly associated. While definitively determining where transmission occurs is impossible, we provide evidence that in certain sectors, the impact of mitigation measures may only be partial and reinforcement of measures should be considered in these settings.
The Bosnian War (1992–95), fueled by complex alliances and deeply held animosity among the belligerents, bedeviled diplomatic resolution despite years of effort. In fall 1995, Operation Deliberate Force became the preeminent ingredient forcing warring factions to negotiate a settlement at the Dayton Peace Conference. Despite this success, airmen remain reluctant to claim Deliberate Force’s effectiveness because of its graduated, incremental, and restrained character. This ambivalence would have astonished earlier generations of airmen, who could only dream of such success.
Sleep is essential for optimal physiological functioning, but often interrupted in hospital settings. Disturbed sleep is associated with relapse of mood disorders and multiple comorbidities including impaired immunological function and increased cardiovascular risk. There are unique environmental challenges on psychiatry wards, such as overnight monitoring. Recent studies highlight the importance of evaluating and managing inpatient sleep disturbance. Aims include exploring the extent to which patients’ sleep is impacted by inpatient admission, elucidating causes of sleep disturbance and determining ways to improve sleep during admission.
Method
Patients aged 18–65 years, who consented and were expected to be inpatients for a week, were approached after 72 hours of admission (n = 35). Quantitative and qualitative data, including on pre-hospital and hospital sleep quantity and quality, were gathered, as part of a cohort characterisation. Questionnaires using Pittsburgh Sleep Quality Index elements were used to gather data. Offering earplugs as a sleep-aid intervention was implemented, with sleep quantity and quality reassessed 72 hours post-intervention. In response to feedback, sound monitoring at regular intervals overnight was undertaken using a decibel-metre to determine noise baseline and variation.
Result
All patients approached agreed to participate. Pre-hospital average sleep quantity was 5.2 hours, with restedness score of 4.3, and 71% patients rating their sleep as ‘bad’. After 72 hours post-admission, average sleep length was 6.5 hours and restedness 5.3. Of patients who accepted earplugs (59%), there were improvements to mean sleep quality and quantity (7.6 hours), with 86% patients rating earplugs helpful. All patients surveyed thought that earplugs should be offered routinely on admission. 70% of patients were prescribed benzodiazepines or z-drugs as required. Self-reported factors affecting sleep included noise, psychiatric symptoms and medication side effects, with 13 patients mentioning the former. Sound monitoring recorded an average decibel level with a range of 35–75 dB, with peaks reaching 95 dB.
Conclusion
Poor sleep in hospital is widespread. There is a need to understand and address modifiable environmental and ward factors implicated in sleep disturbance within inpatient settings. Pharmacological options for sedation are common, but it is important to focus on alternative options of low-cost, non-pharmacological interventions which promote sleep optimisation and enhance inpatient care.
This study documents the contexts of platform pipe creation, distribution, and disposition at Illinois Havana Hopewell Tradition (50 BC to AD 200–250) sites to identify regional variation in Hopewell ceremonialism and exchange. We observe that the large deposits of stone pipes buried during communal rituals in the Scioto Valley and the continued influence of the Hopewell Sphere of Interaction have skewed archaeological interpretation. Aside from the several large deposits, pipes are limited in the Scioto Tradition and seldom found in habitation areas. In Illinois, pipe fabrication debris commonly occurs in habitation areas along with numerous examples of pipe repair and maintenance. Local pipestones—often from northern Illinois Sterling deposits—predominate, and exotic imported pipestones are unusual. Pipes are rare inclusions with individual burials as indicators of status, spiritual prowess, achievement, or group membership. The high value placed on pipes as communal sacra in Ohio and their value in Illinois as items of personal influence parallels their common occurrence in Illinois and their unique context in Ohio Hopewell. This study of the contexts of pipe manufacture and deposition reinforces current discussions of such artifact assemblages as important in documenting local variations in political, social, and religious mortuary ceremonialism across the “Hopewellian sphere.”
North-western Arabia is marked by thousands of prehistoric stone structures. Of these, the monumental, rectilinear type known as mustatils has received only limited attention. Recent fieldwork in AlUla and Khaybar Counties, Saudi Arabia, demonstrates that these monuments are architecturally more complex than previously supposed, featuring chambers, entranceways and orthostats. These structures can now be interpreted as ritual installations dating back to the late sixth millennium BC, with recent excavations revealing the earliest evidence for a cattle cult in the Arabian Peninsula. As such, mustatils are amongst the earliest stone monuments in Arabia and globally one of the oldest monumental building traditions yet identified.
Since the commercialization of herbicide-resistant (HR) crops, primarily glyphosate-resistant crops, their adoption has increased rapidly. Multiple herbicide resistance traits in crops such as canola (Brassica napus L.), corn (Zea mays L.), cotton (Gossypium hirsutum L.), and soybean [Glycine max (L.) Merr.] have become available in recent years, and management of their volunteers needs attention to prevent interference and yield loss in rotational crops. The objectives of this review were to summarize HR crop traits in barley (Hordeum vulgare L.), canola, corn, cotton, rice (Oryza sativa L.), soybean, sugarbeet (Beta vulgaris L.), and wheat (Triticum aestivum L.); assess their potential for volunteerism; and review existing literature on the interference of HR crop volunteers, yield loss, and their management in rotational crops. HR crop volunteers are problem weeds in agronomic cropping systems, and the impact of volunteerism depends on several factors, such as crop grown in rotation, the density of volunteers, management practices, and microclimate. Interference of imidazolinone-resistant (IR) barley or wheat volunteers can be a problem in rotational crops, particularly when IR crops such as canola or wheat are grown. HR canola volunteers are abundant in the Northern Great Plains due to high fecundity, seed loss before or during harvest, and secondary seed dormancy, and they can interfere in crops grown in rotation such as flax (Linum usitatissimum L.), field peas (Pisum sativum L.), and soybean. HR corn volunteers are competitive in crops grown in rotation such as corn, cotton, soybean, and sugarbeet, with yield loss depending on the density of HR corn volunteers. Volunteers of HR cotton, rice, soybean, and sugarbeet are not major concerns and can be controlled with existing herbicides. Herbicide options would be limited if the crop volunteers are multiple HR; therefore, recording the cultivar planted the previous year and selecting the appropriate herbicide are important. The increasing use of 2,4-D, dicamba, glufosinate, and glyphosate in North American cropping systems requires research on herbicide interactions and alternative herbicides or methods for controlling multiple HR crop volunteers.
The finite-amplitude space–time mean flows that are precessionally forced in rotating finite circular cylinders are examined. The findings show that, in addition to conventional Reynolds-stress-type source terms for streaming in oscillatory forced flows, a set of Coriolis-type source terms due the background rotation also contribute. These terms result from the interaction between the equatorial component of the total rotation vector and the overturning flow that is forced by the precession, both of which have azimuthal wavenumbers $m={\pm }1$. The interaction is particular to precessing flows and does not exist in rotating flows driven by libration ($m=0$ forcing) or tides ($m={\pm }2$ forcing). By examining typical example flows in the quasi-linear weakly forced streaming regime, we are able to consider the contributions from the Reynolds-stress terms and the equatorial-Coriolis terms separately, and find that they are of similar magnitude. In the cases examined, the azimuthal component of streaming flow driven by the equatorial-Coriolis terms is everywhere retrograde, whereas that driven by Reynolds stresses may have both retrograde and prograde regions, but the total streaming flows are everywhere retrograde. Even when the forcing frequency is larger than twice the background rotation rate, we find that there is a streaming flow driven by both the Reynolds-stress and the equatorial-Coriolis terms. For cases forced at precession frequencies in near resonance with the eigenfrequencies of the intrinsic inertial modes of the linear inviscid unforced rotating cylinder flow, we quantify theoretically how the amplitude of streaming flow scales with respect to variations in Reynolds number, cylinder tilt angle and aspect ratio, and compare these with numerical simulations.
Breast cancer treatment and prognosis is informed by biomarker expression. Expression of Oestrogen Receptor-alpha (ERα) for example influences whether the patient receives endocrine- or chemo-therapy. Nutritional status is a modifier of disease free survival and elevated circulating cholesterol associates with increased risk of relapse. Cholesterol hydroxylation produces ‘oxysterols’ which are selective Liver X Receptor alpha (LXRα) modulators and ERα agonists. In ER-positive breast cancer, oxysterols induce proliferation and resistance to endocrine therapy, whilst in ER-negative disease oxysterols are anti-proliferative and pro-metastatic suggesting that there are breast cancer subtype specific differences in the genomic targets of the oxysterol-LXR pathway. This study explored the regulation of LXRα signalling in ER-positive and ER-negative breast cancer, and how ligand, receptor and co-factors combine to regulate LXRα target gene expression in different breast cancer types.
In vitro, MDA.MB.468 (ER-negative) cells were more responsive than MCF-7 (ER-positive) cells to synthetic LXRα agonists (T0901317, GW3965) and six oxysterols (22-hydroxycholesterol [22-OHC], 24-OHC, 25-OHC, 27-OHC, 7-ketocholesterol and 24,25-epoxycholesterol), as measured by MTT, LXR-luciferase reporter, and qPCR of canonical targets ABCA1 and APOE (Students t-tests: p < 0.01). Responses to the antagonist GSK2033 was comparable across cell lines. In vivo, LXRa expression correlated with 48/146 target genes in ER-negative (n = 81), but with just 9/146 in ER-positive tumours (n = 234) (Fischer exact test: p < 0.0001) indicating greater LXRa-mediated transcription of target genes in the aggressive subtype. This was not explained by ligand concentration, as we developed a novel fast oxysterol detection system and found no difference in concentration of 22-OHC, 24-OHC, 25-OHC or 27-OHC between ER-negative (n = 11) and ER-positive (n = 11) primary tumours obtained from the Leeds Breast Tissue Bank. However, we did observe that expression of LXRa and 2/7 of its co-activators (SRC, TRRAP) were higher in ER-negative relative to ER-positive disease (using TCGA data from cBioPortal) (Mann-Whitney U test: p < 0.001), and that expression of all LXRa co-repressors were lowest in ER-negative disease (NCOR1, NCOR2, LCOR: Mann-Whitney U test: p < 0.001 for all). siRNA knock-down of NCOR1 and NCOR2 resulted in MCF-7 cells that mimicked the response of MDA.MB.468 cells to oxysterols (as measured by LXR-luciferase and qPCR assay).
These data indicate that despite the anti-proliferative actions of oxysterol-LXRa signalling, there is a, yet to be identified, selective advantage for retention and enhancement of this pathway in ER-negative breast cancer. Dietary routes to selective LXRa modulation (such as plant sterols) may provide patient-led routes to improving ER-negative survival rates.
Background: community researchers in the Productive Margins programme
The role of community researchers within the projects of Productive Margins was envisaged at the earliest stages of programme development. This vision was driven, in part, by the expert experience of one of the partner organisations who had previously led a longitudinal qualitative research project in which the fieldwork was primarily conducted by community researchers. It was also informed by the programme's founding understanding: that people and communities have expertise, experience and creativity that can catalyse new spaces for engagement in and the redesign of regulatory regimes. This echoed a wider trend towards the inclusion of community or ‘peer’ researchers within coproduced research processes, recognising that community researchers are, in many ways, a practical example of co-production's attempt to radically redistribute power within the research process.
Who are community researchers?
Community researchers are typically people without any prior recognised research training, with minimal knowledge or experience of research, and who are also ‘peers’ to a project's research participants, sharing at least one ‘lived experience’. Community researchers tend to be community members, and they are distinct from the community partner organisations that are co-producing a project. The roles and responsibilities of community researchers within research projects shift substantially across contexts. Community researchers can be paid employees of an organisation or university, but most are community members who work on a voluntary basis, receiving some alternative form of remuneration for contributed time. In some cases, community researchers are partners in all facets of a research project and are members of the core research team. In the majority, however, they are instrumental in one or more specific aspects of fieldwork or recruitment, or in consulting/reviewing project design, data and findings in a more advisory capacity.
Community researchers’ status as community members locates them in close personal proximity to people whom policymakers often characterise as ‘hard to reach’. In the literature (see the ‘Further reading’ section), community researchers are said to: minimise power differentials between academic researchers and communities who have been marginalised or stigmatised by previous research; reduce ‘blind spots’ experienced by researchers who are at a distance from the realities that they are studying; and produce findings that are more applicable to community contexts.
Toeplitz conjectured that any simple planar loop inscribes a square. Here we prove variants of Toeplitz’s square peg problem. We prove Hadwiger’s 1971 conjecture that any simple loop in $3$-space inscribes a parallelogram. We show that any simple planar loop inscribes sufficiently many rectangles that their vertices are dense in the loop. If the loop is rectifiable, there is a rectangle that cuts the loop into four pieces which can be rearranged to form two loops of equal length. (The previous two results are independently due to Schwartz.) A rectifiable loop in $d$-space can be cut into $(r-1)(d+1)+1$ pieces that can be rearranged by translations to form $r$ loops of equal length. We relate our results to fair divisions of necklaces in the sense of Alon and to Tverberg-type results. This provides a new approach and a common framework to obtain inscribability results for the class of all continuous curves.