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In this article I argue that the climate crisis may emerge as a new arena for status competition among states, enabled through the grafting of decarbonization and green-energy policies onto the status order’s existing symbolic-materialist logic. Status is often thought of as a destabilizing force in world politics, as its pursuit so often pushes states toward violent and financially wasteful policies of social aggrandizement. But this belief elides two points: that the status order and its rules of membership and esteem are malleable and subject to change; and that the emergence of different and new status symbols can also push status-seeking toward more prosocial outcomes. Rather than see these changes as occurring through explicit normative transformation, however, I argue that the status order is most likely to change surreptitiously when entrepreneurs can graft new status symbols onto an order’s underlying tenets, thus concealing but also producing change. I apply this grafting theory to the climate crisis in arguing that (1) highly visible steps taken to effect the green-energy revolution can be legibly grafted onto the existing status order; (2) this grafting technique was already evident in the Biden administration’s increased framing of the climate as an arena of status competition against China; and (3) in an era of renewed great power rivalry, status competition may at least compel states to make the kinds of costly and needed investments in climate mitigation they eschewed earlier.
This article summarizes how problems in formalizing scientific inference led to the production of social accounts of science, offering Helen Longino’s feminist contextual empiricism as a way forward. Rather than focus on rules of inference that connect knowledge-claims, Longino constructs norms for knowledge-producing communities which, when followed, ensure equitable dialogue and transformative criticism. It is further argued communities engaged in Christian systematic theology would benefit from developing a similar set of norms, given that theological inference is similarly rooted in social cognition and faces many problems analogous to those with which Longino is concerned. Finally, the extent to which Longino’s norms may serve as a starting point for theological communities is explored.
In the United States, about 1 in 100 children are born with a CHD, with complex cases requiring intensive, lifelong care. Despite medical severity, little data exist on economic burden, driving low impact scores in federal research funding applications, a lack of specific funding appropriations, and minimal research investment. Here, the financial and economic impact was quantified by identifying direct, indirect, and mortality costs of six complex CHDs and compared to two common cardiovascular diseases: coronary heart disease and congestive heart failure. Despite lower prevalence, complex CHDs exert disproportionate, often invisible financial burdens on families and the healthcare system. Annually, per patient, direct and indirect costs of complex CHDs are four times higher than coronary heart disease and eight times higher than congestive heart failure. The average lifetime direct and indirect cost for complex CHDs is $2.1 million per patient—nearly 44 times that of congestive heart failure. 31% of lifetime costs for complex CHDs are incurred in the first five years of life with families paying an average of $190,000 out-of-pocket. Many caregivers are forced to reduce employment hours, change jobs, or completely withdraw from the labour force. The annual national cost of complex CHDs is $74 billion, and the total lifetime economic impact exceeds $3.35 trillion. Systemic under-recognition has led to chronic underinvestment in research and stagnant patient outcomes. The biomedical community can catalyse an interdisciplinary response from research institutions, policymakers, and clinical systems to alleviate the economic and human toll of complex CHDs.
Environmental stresses, such as drought and salt, adversely affect plant growth and crop productivity. While many studies have focused on established components of stress signaling pathways, research on unknown elements remains limited. In this study, we collected RNA sequencing (RNA-Seq) data from Oryza sativa registered in public databases and conducted a meta-analysis integrating multiple studies. We analyzed 105 paired RNA-Seq datasets from resistant or susceptible O. sativa cultivars under salt and drought conditions to identify novel stress-responsive genes with common expression changes across these datasets. A meta-analysis identified 10 genes specifically upregulated in resistant cultivars and 12 specifically upregulated in susceptible cultivars under both drought and salt conditions. Furthermore, by comparing previously identified stress-responsive genes in Arabidopsis thaliana, we explored genes potentially involved in stress response mechanisms that are conserved across plant species. The genes identified in this data-driven study may serve as targets for future research and genome editing.
The presence of a basal cingulum, fluting, and overall size have been used to differentiate nodosaurid and ankylosaurid teeth for decades. The taxonomic utility of tooth morphology in ankylosaurs, however, has not been quantitatively tested. In addition, new phylogenetic hypotheses recognize four ankylosaur families (Panoplosauridae, Polacanthidae, Struthiosauridae, and Ankylosauridae), rather than the traditional nodosaurid–ankylosaurid dichotomy. Understanding ankylosaur tooth variation could better help identify taxa with ambiguous phylogenetic affinities or allow isolated teeth to test paleoecological questions such as a potential extirpation of mid-Cretaceous ankylosaurids from Laramidia. We analyzed a large sample of ankylosaur teeth using traditional and geometric morphometrics and investigated the utility of size and the presence of a cingulum and fluting for differentiating ankylosaur teeth. Morphometric analyses show that “nodosaurids” had the greatest variation in tooth shape and size. Panoplosauridae and Struthiosauridae account for a large amount of “nodosaurid” variation, whereas basal ankylosaurs, Polacanthidae, and Ankylosauridae share a similar restricted morphospace. Teeth with a crown base length or height over 10 mm are found only in panoplosaurids, struthiosaurids, and Peloroplites, but smaller sizes are found in all clades. A basal cingulum and fluting are associated with Ankylosauridae and Panoplosauridae. Linear discriminant analyses could accurately identify only between 50% and 75% of the teeth in our sample; thus, they should be used in conjunction with size and discrete traits when identifying isolated teeth. With these findings, caution should be used when attempting to use isolated ankylosaur teeth in broader paleoecological questions, and reclassification of museum collections should be undertaken.
A semi-analytical study of oblique wave interaction with two $\boldsymbol {\sqcap }$-shaped breakwater designs—floating and bottom-fixed structures—incorporating two thin porous plates is presented using linearized theory. Wave potential for both configurations is developed using the eigenfunction expansion method, considering both progressive and evanescent wave modes. The problem of oblique wave scattering by $\boldsymbol {\sqcap }$-shaped breakwaters is reduced to a set of coupled integral equations of first kind, based on horizontal velocity components. These equations are solved using the multi-term Galerkin approximation with appropriate basis functions to handle the square-root singularities at sharp edges of the porous barriers. The performance of the models is evaluated by examining reflection, transmission and energy dissipation coefficients, along with free surface elevation and horizontal drift force. We observe that increasing the plate length of the breakwaters attenuates the incident waves more effectively than increasing the width. Additionally, the floating $\boldsymbol {\sqcap }$-shaped breakwater significantly reduces the free surface elevation in the transmitted region. The results from the developed model can provide valuable insights for the design of wave–structure systems in shallow waters.
Attitudes of mental health professionals toward coercion are a potential tool in reducing the use of coercive measures in psychiatry.
Aims
This study, part of the nationwide Attitudes toward Coercion (AttCo) project, aimed to assess staff attitudes on a nationwide and multiprofessional scale across adult, child and adolescent, and forensic psychiatric departments.
Method
During 9 weeks in 2023, 1702 psychiatric staff members across Germany filled out a survey including gender, age, profession, work experience and setting, and the validated Staff Attitude to Coercion Scale (SACS). Analyses of variance and multivariate regression analysis for SACS mean overall score were computed to assess group differences.
Results
Participants largely supported that coercion could be reduced with more time and personal contact (mean 4.20, range 1–5), and that coercion can harm the therapeutic relationship (mean 4.08); however, they acknowledged that coercion sometimes needs to be used for security reasons (mean 4.10). Regarding group differences, specialisation (P < 0.001) and professional affiliation (P = 0.008) remained significantly associated with SACS mean score (with a higher score in forensic psychiatric staff compared with staff in adult and child and adolescent psychiatry), when controlling for gender, age and work experience.
Conclusions
Differences in attitudes are predominantly linked to professional training and structural surroundings. Professionals in adult psychiatry and child and adolescent psychiatry are more critical than staff in forensic settings, with an emphasis on patients’ rights and individuals’ integrity. Further studies are needed on how mental health professionals view coercion, and how actual use of coercion is influenced by staff attitudes.
In the annual presidential address to the American Society of Church History (ASCH), Esther Chung-Kim discusses the pivotal role of pastors, physicians, and lay healers in responding to poverty and illness in early modern Europe. She offers that their involvement shaped both social welfare and medical care. Reflecting the values of biblical examples, both Catholics and Protestants established institutions to support the sick and poor. Promoting practices of care for the sick, religious leaders, pious physicians, and lay healers promoted charity through medicine, in various efforts to expand access to care. Protestant reformers sought to shift responses to illness away from saintly intercession and instead toward direct appeals to God and natural medicine, seen as a divine gift. In some cities, Reformed ordinances mandated medical support for the poor by institutionalizing care during epidemics. The convergence of religious and medical reform, aided by print culture, resulted in Christian thinkers recognizing medicine as a form of God’s providence in nature (thereby encouraging a positive view of medicine), and physicians promoting religious reform in their medical treatises. In the early modern era, Catholics and Protestants both strengthened the link between Christianity and medicine with theological and practical ways to show care and concern for the sick.
This book offers new ideas for aligning the American healthcare system to optimize health for everyone. Bridging real-world examples and innovative strategies, it leverages a patient-centric framework to explore healthcare lifecycles and identify primary groups in its ecosystem. Chapters explore critical topics from a comparative global perspective, including the role of government in driving access, the private sector's contribution to quality, and the value of integrating social determinants in policy to achieve health equity. By advocating for public-private collaboration, this work presents actionable solutions to challenges facing the country's modern healthcare system such as resource allocation and long wait times. Designed for healthcare professionals, policymakers, and advocates, it highlights the need for bipartisan approaches, cutting-edge patient care models, and the integration of empathy and culture in healthcare delivery. Addressing affordability, equity, and inclusivity, this book equips readers with a roadmap for reimagining healthcare systems that truly serve everyone.
Carers are critical to support discharge home from hospital at end of life yet remain under-represented in health service initiatives to assist this transition. A carer-focused intervention embedded into practice may facilitate hospital discharge. This open-labeled, single-arm phase 2 study aimed to determine the feasibility of (1) delivering a multi-staged intervention (CARENET) to carers of advanced cancer patients in a hospital setting and (2) the study design to inform a phase 3 trial.
Methods
CARENET, delivered before and after discharge to address carer support needs, was tested in an Australian specialist cancer hospital. Eligible participants included carers of advanced cancer inpatients with planned discharge home. The primary outcome was intervention and trial feasibility (recruitment and adherence). Secondary outcomes were eligibility and effects of intervention on outcomes including carer preparedness.
Results
Of the 382 potential patient–carer dyads, 25 were recruited within required time frames. The intervention adherence outcome feasibility threshold of 80% of carer participants completing all 3 core components of CARENET was not achieved (60% completion). Trends in improvement in overall carer levels of preparedness were observed from baseline to discharge home (n = 12; mean [95% CI]) 0.5 [−0.0007, 1.007]). However, a downward trend in preparedness to provide emotional care after discharge was observed (n = 12; mean [95% CI] 0.25 [−0.30, 0.80]).
Significance of results
Delivering all elements of the CARENET intervention to address carers’ needs in the discharge planning context was not feasible. However, some elements were feasible, including identifying and responding to carer need, whilst completing elements after discharge were less feasible. Findings can be explained by problems with adherence, eligibility, and clinician barriers to fitting a multi-staged carer intervention into an acute healthcare setting. Future research should test a more adaptable intervention and delivery model that is accessible to all carers across and compatible with acute care settings.
These are the WTO's authorized and paginated reports in English. They are an essential addition to the library of all practising trade lawyers and a useful tool for students and academics worldwide working in the field of international economic or trade law. DSR 2023: Volume I contains the panel report on 'United States – Safeguard Measure on Imports of Large Residential Washers' (WT/DS546).
Psychological therapy (PT) along with antipsychotic medication is the recommended first line of treatment for first-episode psychosis (FEP). We investigated whether ethnicity, clinical, pathways to care (PtC) characteristics, and access to early intervention service (EIS) influenced the offer, uptake, and type of PT in an FEP sample.
Methods
We used data from the Clinical Record Interactive Search-First Episode Psychosis study. Inferential statistics determined associations between ethnicity, clinical, PtC, and PT offer/uptake. Multivariable logistic regression estimated the odds of being offered a PT and type of PT by ethnicity, clinical and PtC characteristics adjusting for confounders.
Results
Of the 558 patients included, 195 (34.6%) were offered a PT, and 193 accepted. Cognitive behavioral therapy (CBT) (n = 165 of 195; 84.1%) was commonly offered than group therapy (n = 30 of 195; 13.3%). Patients who presented via an EIS (adj. OR = 2.24; 95%CI 1.39–3.59) were more likely to be offered a PT compared with those in non-EIS. Among the patients eligible for an EIS, Black African (adj. OR = 0.49; 95%CI = 0.25–0.94), Black Caribbean (adj. OR = 0.45; 95%CI = 0.21–0.97) patients were less likely to be offered CBT compared with their White British counterparts. Patients with a moderate onset of psychosis (adj. OR = 0.34; 95%CI = 0.15–0.73) had a reduced likelihood of receiving CBT compared with an acute onset.
Conclusions
Accessing EIS during FEP increased the likelihood of being offered a PT. However, treatment inequalities remain by ethnicity and clinical characteristics.
Capillary leak syndrome is a serious postoperative complication in neonates and infants after open-heart surgery for CHD. The aim of this study was to investigate the relationship between sternal opening width and the occurrence of capillary leak syndrome in patients undergoing cardiac surgery with delayed sternal closure.
We retrospectively analysed the clinical data of neonates and infants (aged < 12 months) who underwent open-heart surgery with delayed sternal closure at our institution between January 2016 and December 2021. Patients were categorised into groups based on postoperative diagnosis of capillary leak syndrome, defined as delayed sternal closure exceeding 3 days in combination with established clinical criteria. Stent length per kilogram (SL/kg) was calculated as the ratio of the sternal stent length to the patient”s body weight (mm/kg).
Of the 164 patients, 12 (7.3%) met capillary leak syndrome criteria. Capillary leak syndrome patients had higher median SL/kg (19.7%, p = 0.02), higher prenatal diagnosis rate (31.3%, p = 0.03), longer cardiopulmonary bypass time (24 min, p = 0.01), inotrope use (155 hours, p < 0.001), drainage time (99 hours, p < 0.001), duration of invasive ventilation (168 hours, p < 0.001), delayed sternal closure (3.8 days, p < 0.001), postoperative paediatric ICU length of stay (8.0 days, p < 0.001), and total hospital length of stay (8.5 days, p = 0.002). Nine deaths occurred, three of which were in the capillary leak syndrome group.
Univariate analysis identified higher SL/kg (OR:1.17, 95% CI:1.00–1.38) as a risk factor for postoperative mortality. Multivariate analysis identified SL/kg (OR:1.28, 95% CI:1.05–1.58) and prolonged paediatric ICU length of stay (OR:1.11, 95% CI:1.03–1.21) as significant risk factors for mortality.
In conclusion, capillary leak syndrome after open-heart surgery in neonates and infants with delayed sternal closure is associated with postoperative morbidity. Increased SL/kg and prolonged paediatric ICU length of stay are associated with mortality. Importantly, patients requiring wider sternal separation often present with greater haemodynamic instability and require more extensive postoperative support and prolonged intensive care. Thus, SL/kg may function as a surrogate marker of overall illness severity, rather than as an independent risk factor for capillary leak syndrome or mortality.
Human babesiosis is a disease transmitted by the bite of an infected tick or via blood transfusions involving contaminated blood products; in humans, it can lead to severe complications and even death, depending on the clinical history, age and health status of the affected patient. Babesiosis is caused by members of the Babesia spp., protozoan parasites whose life cycle includes sexual reproduction in the arthropod vector and asexual reproduction in the mainly mammalian host. Cases of human babesiosis have been rare, but there are increasing reports of human babesiosis associated with climatic changes affecting the geographical distribution of the parasite and tick vector, enhanced vector–human interactions and improved awareness of the disease in humans. Diagnostics and treatment options for humans are based around discoveries in veterinary research, such as point-of-care testing in cases of bovine babesiosis, and include direct diagnosis by blood smears, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) technologies, and indirect diagnosis by ELISA, immunofluorescence tests (IFAT) and fluorescent in situ hybridisation. Treatment involves a combination of drugs such as azithromycin and atovaquone, or clindamycin and quinine, but more effective options are being investigated, including, but not limited to, trans-chalcones and tafenoquine. Improved surveillance, awareness and diagnosis, as well as advanced technologies to interrupt vector–host interactions, are crucial in managing the increased threat posed by this once-neglected disease in humans.
Family caregivers (FCGs) may experience numerous psychosocial and practical challenges with interpersonal relationships, mental health, and finances both before and after their care recipient (CR) dies. The specific challenges affecting rural FCGs who often have limited access to palliative care services, transitional care, and other community resources are not well understood. The purpose of this paper is to quantify the challenges rural FCGs experienced immediately before the death of a CR and continuing into the bereavement period.
Methods
A secondary analysis of data from a randomized controlled trial was conducted. The 8-week intervention included video visits between a palliative care research nurse and FCGs caring for someone with a life-limiting illness. Data were from structured interviews during nurse visits with FCGs in the intervention arm whose CR died during the intervention period.
Results
Ninety (41.8%) of the 215 FCGs experienced the death of their CR. The majority of FCGs were female (58.9%), White (97.5%), spouses or partners (55.6%) and lived with the CR (66.7%). Most FCGs (84%) continued with intervention visits by the study nurse after the CR’s death. Visits resumed on average 7.2 days post-death. The majority of FCGs experienced challenges with grief/coping skills (56%) and interpersonal relationships/support systems (52%) both pre- and post-death of the CR. FCGs also experienced practical challenges with income/finance, housing, and communication with community resources both pre-and post-death.
Significance of results
Bereavement support should extend beyond a focus on grief to include practical challenges experienced by FCGs. Because challenges experienced in the bereavement period often begin before a CR’s death, there is benefit in continuity of FCG support provided by a known clinician from pre- to post-death. When given an option, many rural FCGs are open to bereavement support as early as a week after the death of a CR.
Accurate prediction of the hydrodynamic forces on particles is central to the fidelity of Euler–Lagrange (EL) simulations of particle-laden flows. Traditional EL methods typically rely on determining the hydrodynamic forces at the positions of the individual particles from the interpolated fluid velocity field, and feed these hydrodynamic forces back to the location of the particles. This approach can introduce significant errors in two-way coupled simulations, especially when the particle diameter is not much smaller than the computational grid spacing. In this study, we propose a novel force correlation framework that circumvents the need for undisturbed velocity estimation by leveraging volume-filtered quantities available directly from EL simulations. Through a rigorous analytical derivation in the Stokes regime and extensive particle-resolved direct numerical simulations (PR-DNS) at finite Reynolds numbers, we formulate force correlations that depend solely on the volume-filtered fluid velocity and local volume fraction, parametrised by the filter width. These correlations are shown to recover known drag laws in the appropriate asymptotic limits and exhibit a good agreement with analytical and high-fidelity numerical benchmarks for single-particle cases, and, compared with existing correlations, an improved agreement for the drag force on particles in particle assemblies. The proposed framework significantly enhances the accuracy of hydrodynamic force predictions for both isolated particles and dense suspensions, without incurring the prohibitive computational costs associated with reconstructing undisturbed flow fields. This advancement lays the foundation for robust, scalable and high-fidelity EL simulations of complex particulate flows across a wide range of industrial and environmental applications.
This paper investigates the flow and density field around a spinning solid spheroid with a given aspect ratio, immersed in a rotating stratified fluid. First, we derive the general system of equations governing such flows around any solid of revolution in the limit of infinite Schmidt number. We then present an exact analytical solution for a spinning spheroid of arbitrary aspect ratio. For the specific case of a sphere, we provide the diffusive spin-up solution obtained via an inverse Laplace integral. To validate the theoretical results, we experimentally reproduce these flows by spinning spheroids in a rotating tank filled with stratified salt water. By varying the stratification intensity, the angular velocities of the spheroid and the rotating table, and the spheroid’s shape, we explore a broad parameter space defined by Froude, Reynolds and Rossby numbers and aspect ratio. Using particle image velocimetry to measure the velocity field, we demonstrate excellent agreement between theory and experiments across all tested regimes.
The problem of a uniform current interacting with bodies submerged beneath a homogeneous ice sheet is considered, based on linearised velocity potential theory for fluid and elastic thin plate theory for ice sheet. This problem is commonly solved by the boundary element method (BEM) with the Green function, which is highly effective except when the Green function becomes singular, and the direct solution of the BEM is no longer possible. However, flow behaviour, body force and ice sheet deflection near the critical Froude numbers are of major practical interest, such as in ice breaking. The present work successfully resolves this challenge. A modified boundary integral equation (BIE) is derived, which converts the singular Green function term to a far-field one and removes the singularity. The BIE is then imposed at infinity for additional unknowns in the far field. It is proved that the solution is finite and continuous at the critical Froude number $F = F_c$, where the body starts generating travelling waves, and finite but discontinuous at depth-based Froude number $F = 1^\pm$. Case studies are conducted for single and double circular cylinders and an elliptical cylinder with various angles of attack. A comprehensive analysis is made on the hydrodynamic forces and the generated flexural gravity wave profiles, and their physical implications are discussed. It is also concluded that the method developed in this paper is not confined to the present case but is also applicable to a variety of related problems when the BEM fails at the critical points.