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This article contributes to the literature on religious soft power by considering how non-Muslim-majority great powers – China, Russia, and the US – use Islam as a foreign policy resource in their soft power strategies. We argue that these states have deployed Islam to present positive self-images on the international stage, at the same time as using negative-other strategies via soft disempowerment to construct competitor states as unfriendly and/or dangerous to Muslims. We conclude by arguing that the use of Islam by non-Muslim great powers is a potentially dangerous game. While instrumentalising Islam may provide immediate benefits, it also opens the possibility for critique, particularly around perceived inconsistencies between domestic religious practices of a state and its internationally promoted narratives. These tensions can invite accusations of illegitimacy and hypocrisy, especially when leveraged by competitors or transnational religious actors.
Heart failure is the most common complication of congenital heart disease (CHD), characterized by high morbidity and mortality. Early recognition and intervention are crucial for improving outcomes in pediatric patients with CHD and heart failure. This study aimed to analyze the clinical value of N-terminal pro-brain natriuretic peptide, adrenomedullin, and cardiac troponin I in pediatric patients with CHD and heart failure.
Methods:
Ninety-eight pediatric patients with CHD complicated by heart failure were included in the Case Group, and 61 pediatric patients with CHD were included in the Control Group. The Case Group was categorized into subgroups based on the cardiac function of patients: grade I (n = 35), grade II (n = 40), and grade III (n = 23). Left ventricular ejection fraction was collected from pediatric patients in the case group. The correlation of the cardiac functional indicators with N-terminal pro-brain natriuretic peptide, adrenomedullin, and cardiac troponin I levels was assessed using Pearson correlation analysis.
Results:
The serum levels of N-terminal pro-brain natriuretic peptide, adrenomedullin, and cardiac troponin I in pediatric patients at grade III of cardiac function were significantly elevated compared to those at grade II, and these levels in patients at grade II were higher than those at grade I (P < 0.05). The left ventricular ejection fraction of pediatric patients in the Case Group were markedly negatively correlated with N-terminal pro-brain natriuretic peptide, adrenomedullin, and cardiac troponin I (r = − 0.6807, r = −0.3013, r = −0.5412, P < 0.0001).
Conclusions:
N-terminal pro-brain natriuretic peptide, adrenomedullin, and cardiac troponin I have a certain diagnostic value in determining concurrent heart failure in pediatric patients with CHD.
The capabilities of large language models (LLMs) have advanced to the point where entire textbooks can be queried using retrieval-augmented generation (RAG), enabling AI to integrate external, up-to-date information into its responses. This study evaluates the ability of two OpenAI models, GPT-3.5 Turbo and GPT-4 Turbo, to create and answer exam questions based on an undergraduate textbook. 14 exams were created with four true-false, four multiple-choice, and two short-answer questions derived from an open-source Pacific Studies textbook. Model performance was evaluated with and without access to the source material using text-similarity metrics such as ROUGE-1, cosine similarity, and word embeddings. Fifty-six exam scores were analyzed, revealing that RAG-assisted models significantly outperformed those relying solely on pre-trained knowledge. GPT-4 Turbo also consistently outperformed GPT-3.5 Turbo in accuracy and coherence, especially in short-answer responses. These findings demonstrate the potential of LLMs in automating exam generation while maintaining assessment quality. However, they also underscore the need for policy frameworks that promote fairness, transparency, and accessibility. Given regulatory considerations outlined in the European Union AI Act and the NIST AI Risk Management Framework, institutions using AI in education must establish governance protocols, bias mitigation strategies, and human oversight measures. The results of this study contribute to ongoing discussions on responsibly integrating AI in education, advocating for institutional policies that support AI-assisted assessment while preserving academic integrity. The empirical results suggest not only performance benefits but also actionable governance mechanisms, such as verifiable retrieval pipelines and oversight protocols, that can guide institutional policies.
This study aimed to compare red meat, white meat and vegetable consumption before, during and after COVID-19 pandemic among older adults in regional China. Data were collected from individuals aged 60+ years in urban areas of Nanjing, China, in 2018, 2021 and 2023. Differences in food intake frequencies between participants and survey years were examined. Multivariate logistic regression models were employed to identify influencing factors of red plus white meat, and vegetable consumption. Totally, 13792 participants were analyzed, with 4355, 4622 and 4815 from 2018, 2021 and 2023 survey, respectively. The mean weekly intake frequency (± standard deviation) among participants in 2018, 2021 and 2023 was, separately, 3.85±2.83, 3.21±2.90 and 4.71±3.94 for red meat, 1.38±1.21, 2.08±1.90 and 2.73±2.55 for white meat, and 10.98±4.84, 10.00±5.04 and 10.34±5.04 for vegetable. Moreover, 23.2%, 32.6% and 52.3% of participants met recommendation for red plus white meat intake, while 53.7%, 46.8% and 49.6% reached recommendation for vegetable consumption before, during and after COVID-19 pandemic, respectively. Red plus white meat intake was positively associated with education, marital status and drinking, but negatively associated with age. Additionally, education and marital status were in negative relation to vegetable consumption, while smoking and drinking were positively associated with vegetable intake. The older residents consumed less red meat and vegetable but more white meat during COVID-19 pandemic, and their consumption levels of red plus white meat and vegetable went up after the pandemic. These findings highlight the need for targeted interventions to support older adults’ dietary habits during emergency events.
Assess the feasibility and effect of Enhanced Barrier Precautions (EBP) on the transmission of Staphylococcus aureus (SA) and carbapenem-resistant organisms (CRO) among residents in nursing home chronic ventilator units (NH-CVU).
Design:
Pre-post interventional study.
Setting:
Two community-based nursing homes with CVUs in Maryland. A total of 56 residents were enrolled in the baseline period and 64 residents were enrolled in the intervention period.
Methods:
During a 3-month baseline and intervention period, residents were swabbed monthly to estimate SA and CRO acquisition. During a 2-month training period, EBP was implemented for residents with chronic wounds, medical devices, or history of multidrug-resistant organism (MDRO) colonization. During the subsequent 3-month intervention period, healthcare personnel (HCP) wore gowns and gloves for high-contact care activities when residents were on EBP. Whole genome sequencing assessed resident-to-resident transmission.
Results:
At baseline, NH-CVU1 used gowns and gloves for all direct contact, while NH-CVU2 used EBP only for residents with a history of MDRO colonization. After training, the proportion of NH-CVU2 residents on EBP increased from 65% in the baseline period to 87% in the intervention period. Glove use was high (93–98%) in both NH-CVUs. Gown use increased from 39% to 77% in NH-CVU1 and from 26% to 72% in NH-CVU2. Resident-to-resident transmission of SA or CRO decreased by 25% in NH-CVU1 (p = 0.60) and by 67% in NH-CVU2 (p = 0.05). CRO transmission decreased by 33% in NH-CVU1 (p = 0.54) and by 83% in NH-CVU2 (p = 0.02).
Conclusions:
EBP is feasible and potentially decreases overall and CRO transmission in nursing home CVUs.
The Stages of Objective Memory Impairment (SOMI) system, based on the Free and Cued Selective Reminding Test (FCSRT), is a potential marker of subtle cognitive impairment in cognitively normal persons defined by a Clinical Dementia Rating (CDR) = 0. We investigated SOMI’s ability to predict incident cognitive impairment (CDR >0) in combination with demographic features and neuroimaging biomarkers.
Methods:
Cognitively unimpaired participants (CDR = 0) from the Harvard Aging Brain Study had baseline FCSRT scores, MRI, FDG-PET, and PiB-PET as well as follow-up CDRs for 5 years. Cox proportional hazards models with correction for multiple testing assessed the predictive validity of SOMI and neuroimaging biomarkers for progression (CDR >0). Comprehensive sensitivity analyses examined alternative outcomes and stricter screening criteria.
Results:
Participants (N = 231) were 73.7 years (SD = 6.0), 60.2% were female, 29.0% were APOE4 positive, and 54 (23.4%) progressed to CDR >0. At baseline, 67% were SOMI-0, 22% were SOMI-1, 4% were SOMI-2, and 7% were SOMI-3/4. After multiple testing correction, hazard ratios (HRs) using SOMI-0 as reference were: SOMI-1 = 2.06 (CI: 1.09 – 3.88), SOMI-2 = 2.85 (CI: 1.08 – 7.54), and SOMI-3/4 = 3.73 (CI: 1.58 – 8.79, p = 0.016). SOMI-3/4 remained significant across most biomarker models. Entorhinal thickness emerged as the most robust biomarker predictor (HR = 0.57 – 0.65, p ≤ 0.015). Sensitivity analyses confirmed robustness across alternative outcomes and stricter screening criteria.
Conclusions:
SOMI stages predict progression to incident cognitive impairment with SOMI-3/4 maintaining significance after rigorous multiple testing correction. Entorhinal thickness provides the strongest biomarker enhancement to prediction models. SOMI demonstrates substantial incremental predictive value beyond standard demographic and biomarker predictors.
The history of sugar is that of a commodity that has played a central and contested role in the development of global agro-industrial capitalism. In my introduction to this “Suggestions and Debates” collection, the theoretical underpinnings of The World of Sugar will be explained. Reference is made to the agenda of the Commodity Frontiers Initiative, which was published in the Journal of Global History in 2021, and of which I was a co-author. Inspired by the work of Friedmann and McMichael, a key element of this agenda is the notion of successive commodity regimes, separated by systemic frictions and phases of intense innovation to overcome them. Moreover, the argument is made that The World of Sugar can be read as an invitation to explore new directions in global labour history. My introduction concludes with an exhortation to overcome the limitations of single-commodity histories and to give more attention to the agency of workers in shaping the trajectories of global capitalism.
In this perspectives piece we examine the role of dreaming in memory consolidation, the underlying neurobiological mechanisms of nightmares, and the therapeutic potential of lucid dreaming for treating nightmares. Growing evidence suggests that dream content is shaped by both recent and remote memory sources, with non-rapid eye movement (NREM) sleep favoring the incorporation of recent declarative memories and rapid eye movement (REM) sleep reflecting more remote experiences. When these dreams become pathological, we examine nightmares through the lens of the neurocognitive model, and focus on how nightmares affect mental health. We then explore lucid dreaming as a promising intervention to combat nightmares. Our conclusions claim that definitional ambiguity in dream research limits clinical progress, and we propose action to develop standardized definitions for dreaming and nightmares to guide cohesive research designs and enhance interstudy comparability.
We study the moduli stacks of slope-semistable torsion-free coherent sheaves that admit reflexive, respectively, locally free, Seshadri graduations on a smooth projective variety. We show that they are open in the stack of coherent sheaves and that they admit good moduli spaces when the field characteristic is zero. In addition, in the locally free case we prove that the resulting moduli space is a quasi-projective scheme.
This study aims to analyze the effect of internal pay attributions on employees’ perceived organizational support (POS). Furthermore, it examines the pathway through which these pay attributions influence POS by analyzing the mediating effect of pay level satisfaction. Based on survey data from 695 employees, the results show that commitment-focused pay attributions are positively and directly related to POS, and also indirectly related to it through the mediated effect of pay level satisfaction. Regarding control-focused pay attributions, while getting the most out of employees’ pay attribution is only directly and negatively related to POS, the cost-reduction HR strategy pay attribution is only indirectly and negatively related to POS through pay level satisfaction. This study is relevant because it provides a more in-depth understanding of how employees’ perceptions of the intentions behind pay decisions can influence how they assess both the organization and the outcomes they receive.
Flame–flame interactions in continuous combustion systems can induce a range of nonlinear dynamical behaviours, particularly in the thermoacoustic context. This study examines the mutual coupling and synchronisation dynamics of two thermoacoustic oscillators in a model gas-turbine combustor operating within a stochastic environment and subjected to external sinusoidal forcing. Experimental observations from two flames in an annular combustor reveal the emergence of dissimilar limit cycles, indicating localised lock-in of thermoacoustic oscillators. To interpret these dynamics, we introduce a coupled stochastic oscillator model with sinusoidal forcing terms, which highlights the critical role of individual synchronisation in enabling local lock-in. Furthermore, through stochastic system identification using this phenomenological low-order model, we mathematically demonstrate that a transition towards self-sustained oscillations can be driven solely by enhanced mutual coupling under external forcing. This combined experimental and modelling effort offers a novel framework for characterising complex coupled flame dynamics in practical combustion systems.
Brain tumors are associated with negative changes in sense of self and increased distress early in the illness trajectory. Dignity Therapy (DT) is a brief 2-session therapeutic intervention for patients at end-of-life (EOL) that helps conserve a patient’s sense of dignity or self. DT has shown positive results for patients at EOL including increased meaning, improved quality of life (QOL), and reduced distress, with limited research to date on patients early in their illness trajectory (non-EOL). This pre-post design pilot study investigated the benefits and feasibility of DT for 2 groups of patients with incurable brain tumors.
Methods
A total of 51 participants were recruited, of whom 39 participated. Participants were grouped as EOL (prognosis < 1 year, n = 21) and non-EOL (prognosis > 1 year, n = 18). Participants completed self-report measures to determine changes in QOL, psychosocial well-being (i.e., spiritual well-being, connection, and posttraumatic growth), and death anxiety, at baseline, 1 week, and 5 weeks post-intervention.
Results
The intervention had a high completion rate, with 37 of 39 participants (95%) completing DT. Linear regression models fitted with generalized estimating equations (GEEs) showed within- and between-group significant changes in all domains for both groups, but were particularly beneficial for non-EOL participants.
Significance of results
This study demonstrated that DT effectively enhanced psychosocial well-being in patients with brain tumors, including reductions in death anxiety and dignity-related distress. Non-EOL participants benefited most and had higher completion rates, highlighting the intervention’s feasibility and the need for further research in earlier stages of terminal illness.
We present an analysis of high-resolution (R ∼ 48000) spectroscopic and photometric data of RS Sgr, a short-period Algol-type binary system. For the first time, precise spectroscopic and absolute parameters of the system have been determined. The primary component is identified as a B3 main-sequence star with an effective temperature of 19000K, while the secondary is classified as an A0-type star with a temperature of 9700 K. The secondary appears to have recently evolved off the main sequence and currently fills its Roche lobe, transferring material through the inner Lagrangian point (L1) to the hotter primary component.
The Hα emission and absorption features observed in the spectra are attributed to a combination of a low-density circumprimary disk, a gas stream originating from the secondary, and a hot spot formed at the impact site on the primary. The combined analysis of spectroscopic and photometric data yields a system distance of approximately 418 pc, which is consistent with the value derived from GAIA DR3 within the uncertainty limits.
Antipsychotic (AP) medication in individuals at clinical high risk for psychosis (CHR-P) is not routinely recommended by clinical guidelines but is commonly prescribed. Since little is known about the predictors of AP inception in CHR-P, we analyzed data from two observational cohorts.
Methods
To avoid baseline predictors being confounded by previous treatment, participants were selected for analysis from the 764 participants at CHR-P enrolled in NAPLS-2 and the 710 enrolled in NAPLS-3 by excluding those with lifetime histories of AP use. Baseline clinical variables available in both studies were employed as predictors of subsequent AP inception over the next 6 months in univariable and multivariable analyses.
Results
Preliminary analyses indicated no important effects of sample. The final combined population included 79 AP inception participants and 580 participants who did not have AP inception. The AP medications most commonly prescribed were risperidone, aripiprazole, and quetiapine. Univariable analyses identified seven significant predictors of AP inception. The final logistic regression model including these variables was highly significant (χ2 = 36.53, df = 7, p = <0.001). Three variables (current major depression, fewer education years, and current benzodiazepine use) emerged as significant independent predictors of AP inception.
Conclusion
This study is the first to determine baseline characteristics that predict subsequent AP initiation in CHR-P. Some AP use in CHR-P appears to be intended as augmentation of antidepressant treatment for comorbid major depression. Some prescribers may not have detected the attenuated positive symptoms characteristic of CHR-P since their severity did not significantly predict AP inception.
This paper presents a detailed technical overview of the femtosecond precision timing and synchronization systems implemented at the Shanghai high repetition rate XFEL and extreme light facility (SHINE). These systems are designed to deliver stabilized optical references to multiple receiver clients, ensuring high-precision synchronization between the optical master oscillator (OMO) and optical/RF subsystems. The core components include an OMO, fiber length stabilizers and laser-to-laser synchronization modules that achieve femtosecond-level accuracy. Our discussion extends to the various subsystems that comprise the synchronization infrastructure, including the OMO, fiber length stabilizer and advanced phase detection techniques. Finally, we highlight ongoing research and development efforts aimed at enhancing the functionality and efficiency of these systems, thereby contributing to the advancement of X-ray free-electron laser technology and its applications in scientific research.
To identify the dietary patterns of ultra-processed food (UPF) consumption in the UK adults, and to explore their nutritional characteristics and associated demographic and socioeconomic factors.
Design:
UPF-based dietary patterns were identified using weighted principal component analysis and k-means cluster analysis on UPFs intakes (identified using Nova classification) from the cross-sectional NDNS data (2008-2019). Weighted multivariable logistic regression models were employed to identify the demographic and socioeconomic factors associated with the patterns.
Setting:
United Kingdom.
Participants:
8,347 adults (≥ 18y).
Results:
UPFs accounted for 54% of total energy intake in the UK adult diet. Three distinct UPF-clusters were identified, labelled as “Sweet Foods,” “Fast Foods,” and “Traditional Foods” based on their predominant food intakes. Older participants (>68 years) were more likely to adhere to the “Sweet Foods” pattern (OR: 2.39; 95% CI: 1.99-2.87) and less likely to be part of the “Fast Foods” pattern (OR: 0.47; 95% CI: 0.40-0.55) compared to younger individuals (< 29). Participants in lower occupations were less likely to adhere to the “Fast Foods” pattern than participants in the higher occupations (OR: 0.82; 95% CI: 0.72-0.94) while being more likely to adhere to the “Traditional Foods” pattern (OR: 1.23; 95% CI: 1.06-1.43).
Conclusions:
The UK diet was dominated by UPF products. Our analysis identified three distinct UPF dietary patterns with varying nutritional quality, influenced by key demographic and social factors. These findings provide valuable insights into the determinants of UPF consumption and highlight which population groups are more likely to consume certain types of UPFs.