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On November 20, 2021, petroleum fuel contaminated the Red Hill well, which provides water to about 93 000 persons on Oahu, Hawaii. Initial investigations recommended further evaluations of long-term health effects of petroleum exposure in drinking water. We reviewed electronic health records of those potentially exposed to contaminated water to understand prevalence of conditions and symptoms.
Methods
A sample of persons potentially exposed during November 20, 2021-March 18, 2022 who sought care within the military health system through February 24, 2023 was identified. Abstracted records were categorized as worsening preexisting or persistent new for conditions and symptoms.
Results
Of 653 medical charts reviewed, 357 (55%) had worsening preexisting or persistent new conditions or symptoms. Most-documented conditions included worsening preexisting migraine (8%; 50/653) and chronic pain (4%; 26/653), and persistent new migraine (2%; 14/653) and adjustment disorder (2%; 13/653). Most-documented symptoms included worsening preexisting headache (8%; 49/653) and anxiety (6%; 42/653), and persistent new rash (7%; 46/653) and headache (5%; 34/653).
Conclusions
Approximately half of the abstracted medical records demonstrated worsening preexisting or persistent new conditions or symptoms and might benefit from sustained access to physical, mental, and specialized health care support systems. Continued monitoring for long-term health outcomes is recommended.
Two important tasks for theorists of justice are to determine the bounds of justice, which explain why some claims are matters of justice and others are not, and to determine the demands of justice, which settle conflicts that fall within those bounds. In this paper, we clarify the distinction between bounds and demands, revealing two striking things. First, while thresholds have typically been understood to be demands of justice, their use as such is confusing and arguably implausible. Second, thresholds appear to be better understood as demarcating the bounds of justice, if a suitable explanation for their use can be found. We explore three explanations for why thresholds can demarcate bounds and assess the prospects for seeing thresholds in this new and different role. These are satiability of the value of goods, satiability of justice, and conceptual engineering.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
We derive a set of simplified equations that can be used for numerical studies of reduced magnetohydrodynamic turbulence within a small patch of the radially expanding solar wind. We allow the box to be either stationary in the Sun’s frame or to be moving at an arbitrary velocity along the background magnetic-field lines, which we take to be approximately radial. We focus in particular on the case in which the box moves at the same speed as outward-propagating Alfvén waves. To aid in the design and optimization of future numerical simulations, we express the equations in terms of scalar potentials and Clebsch coordinates. The equations we derive will be particularly useful for conducting high-resolution numerical simulations of reflection-driven magnetohydrodynamic turbulence in the solar wind, and may also be useful for studying turbulence within other astrophysical outflows.
We develop a phenomenological model of strong imbalanced magnetohydrodynamic (MHD) turbulence that accounts for intermittency and the reflection of Alfvén waves by spatial variations in the Alfvén speed. Our model predicts the slopes of the inertial-range Elsasser power spectra, the scaling exponents of the higher-order Elsasser structure functions and the way in which the parallel (to the magnetic field) length scale of the fluctuations varies with the perpendicular length scale. These predictions agree reasonably well with measurements of solar-wind turbulence from the Parker Solar Probe (PSP). In contrast to previous models of intermittency in balanced MHD turbulence, we find that intermittency in reflection-driven MHD turbulence increases the parallel wavenumbers of the energetically dominant fluctuations at small perpendicular length scales. This, like the PSP measurements with which our model agrees, suggests that turbulence in the solar wind and solar corona may lead to more ion cyclotron heating than previously realized.
Recommended dietary fibre consumption is rarely met in high-income countries. Detailed analysis of fibre consumption patterns is essential to identify strategies for increasing intake. This study investigated the timing and sources of fibre intake in Switzerland, using data from the Swiss Nutrition Survey, menuCH (n = 2057, 18–75 years). Dietary characteristics were summarised for the adult population and for subgroups stratified by absolute (< 15 g/day, 15-<30 g/day, and >=30 g/day) and relative (< 10 g/1000 kcal/day, 10-<14 g/1000 kcal/day, and >=14 g/1000 kcal/day) fibre intake. Mean fibre intake of both 24 HDRs for each individual and contribution of food groups and timing (before breakfast, breakfast, during the morning, lunch, during the afternoon, dinner, after dinner/at night) was calculated. Fibre was mainly consumed at breakfast (4.1 g/day), lunch (6.0 g/day), and dinner (6.4 g/day). Intake at breakfast differed between the lowest and highest fibre intake groups by 6.4 g/day (absolute) and 4.3 g/day (relative). Breakfast skipping was more frequent among low-fibre intake groups (29% for absolute intake, 19% for relative intake) than in the overall population (15%). The main sources of dietary fibre were grain products (35.6%), followed by vegetables (18.3%) and fruits (18.2%), with whole grains accounting for 17.5% of grain intake. Legumes contributed only to 1% of total fibre intake. Public health efforts encouraging regular breakfast consumption, and intake of whole grains and legumes are recommended to improve fibre intake.
Achieving sustainability on the ground poses a challenge in decoding globally defined goals, such as sustainable development goals, and aligning them with local perspectives and realities. This decoding necessitates the understanding of the multifaceted dimensions of the sustainability challenges in a given context, including their underlying causes. In case studies from Brazilian drylands, we illustrate how an enhanced multiscale participatory method, combined with systems thinking tools, can shed light on systemic structures that currently entrench unsustainable development trajectories. This method offers insights into co-designing potential pathways toward sustainable futures and unlocking transformative capacities of the local population.
Technical summary
Translating United Nations global sustainable development goals (SDGs) into actions that address local realities and aspirations is an urgent challenge. It requires new thinking and approaches that foster the discussion about the main challenges to implementing the SDGs at multiple levels. This paper presents a novel multiscale participatory approach that combines the popular Three Horizons diagram with the formalism of causal loop diagrams in systems thinking. We present results from six multi-stakeholder dialogues held across drylands in Brazil with a focus on desired futures aligned with SDGs. Focusing on identifying the root causes and systemic structures of unsustainability, participants identified lock-ins, leverage points, and interventions for how these could be changed. The core lock-ins are the discontinuity of public policies, and the historical land and power concentration reinforced by the current expansion of large-scale agricultural, mining, and energy projects. The proposed interventions are structural and – if implemented – would contribute to achieving SDGs in an integrated manner. The unique approach developed in this study can provide leverage as it bridges the inclusivity of participatory visioning with the change potential of systems thinking tools to tackle root causes and unleash societal transformations.
Social media summary
We are not achieving SDGs. Understanding root causes of unsustainability is critical to move toward sustainable and just futures.
Microgeographic units of analysis have moved to the center of criminological inquiry. This Element brings together leading crime-and-place scholars to identify promising areas for future study. Section 1 introduces the Element and the importance of focusing on the future of studies of crime and place. Section 2 examines the development of hot-spots policing and the importance of focusing on its impact on communities. It also looks at how 'pracademics' can advance the science and practice of place-based policing. Section 3 focuses on place managers as prevention agents and examines how city government can influence crime at place. It further contends that rural communities need to become a key focus of crime-and-place scholarship. Section 4 emphasizes the importance of the connection of health, crime, and place. It also argues for the importance of expanding the methodological tools of crime and place to include careful ethnographic and qualitative research.
We derive an analytic model of the inter-judge correlation as a function of five underlying parameters. Inter-cue correlation and the number of cues capture our assumptions about the environment, while differentiations between cues, the weights attached to the cues, and (un)reliability describe assumptions about the judges. We study the relative importance of, and interrelations between these five factors with respect to inter-judge correlation. Results highlight the centrality of the inter-cue correlation. We test the model’s predictions with empirical data and illustrate its relevance. For example, we show that, typically, additional judges increase efficacy at a greater rate than additional cues.
We investigate the implications of penalizing incorrect answers to multiple-choice tests, from the perspective of both test-takers and test-makers. To do so, we use a model that combines a well-known item response theory model with prospect theory (Kahneman and Tversky, Prospect theory: An analysis of decision under risk, Econometrica 47:263–91, 1979). Our results reveal that when test-takers are fully informed of the scoring rule, the use of any penalty has detrimental effects for both test-takers (they are always penalized in excess, particularly those who are risk averse and loss averse) and test-makers (the bias of the estimated scores, as well as the variance and skewness of their distribution, increase as a function of the severity of the penalty).
“Improper linear models” (see Dawes, Am. Psychol. 34:571–582, 1979), such as equal weighting, have garnered interest as alternatives to standard regression models. We analyze the general circumstances under which these models perform well by recasting a class of “improper” linear models as “proper” statistical models with a single predictor. We derive the upper bound on the mean squared error of this estimator and demonstrate that it has less variance than ordinary least squares estimates. We examine common choices of the weighting vector used in the literature, e.g., single variable heuristics and equal weighting, and illustrate their performance in various test cases.
A recent paper by Wainer and Thissen has renewed the interest in Gini’s mean difference, G, by pointing out its robust characteristics. This note presents distribution-free asymptotic confidence intervals for its population value, γ, in the one sample case and for the difference Δ = (γ1 − γ2) in the two sample situations. Both procedures are based on a technique of jackknifing U-statistics developed by Arvesen.
Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.
Results:
Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 – 21, P = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, P = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase (P = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, P = 0.018).
Conclusions:
Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.
In many regions of Canada, knowledge of the distribution of insect species is far from complete. This knowledge gap, known as the Wallacean Shortfall, is often manifest by species records separated by large, often remote areas with no records. Paradoxically, these difficult-to-access areas offer the best opportunity to study unaltered native community assemblages. Such gaps in knowledge are exemplified by ground beetles, a well-known group, yet with record gaps in many unstudied areas of Canada, including Akimiski Island, Nunavut. This postglacial rebound island, located in James Bay, has no permanently occupied human dwellings and almost no human-altered habitat. Using a combination of pitfall-malaise traps, pitfall traps, and hand captures during 2008–2014, we collected 1368 ground beetles (Coleoptera: Carabidae) as part of a larger biodiversity survey. We identified 31 species, 29 of which were first territorial records for Nunavut. Our results almost double the number of Carabidae known from Nunavut and extend the known range of eight other species. Seventeen of the species that we caught cannot fly, evidence for colonists arriving on Akimiski on floating debris. Our study fills substantial range gaps and serves as baseline information to detect future change.