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Clozapine remains the only evidence-based treatment for treatment-resistant schizophrenia, supported by guidelines from the National Institute for Health and Care Excellence (NICE) and other authorities. However, clozapine is still underutilised for treatment-resistant schizophrenia, despite its proven benefits, including reduced all-cause mortality. This is attributed mainly to its association with adverse effects, including cardiac adverse effects. This review focuses on the latter, with a detailed exploration of clozapine-induced myocarditis – a potentially fatal acute hypersensitivity reaction – and cardiomyopathy, tachycardia and conduction deficits. Among other things, we discuss their pathophysiology, diagnosis and management, with signposting to international diagnostic criteria and monitoring protocols.
In this article, I explain how peasant communities were affected by fire disasters in North Ostrobothnia in northern Finland during the seventeenth century. Unlike previous research mainly based on dendrochronological data aimed at dating these fire disasters’ scope and occurrence, I focus on the socio-economic consequences of wildfires from both a bottom-up and a top-down perspective in order to establish different factors of resilience and vulnerability. Through the analysis of local district court protocols, tax records and Swedish legislation, the article explains how and why fires occurred and what role peasant common-pool institutions and the early modern Swedish state played in this development. The results show how peasant communities were able to bounce back from recurrent events of fire disasters thanks to close cooperation between them and Swedish officials, the reinvigorated medieval relief institution of fire support (Swe. brandstod), and owing to the robustness of the peasants’ common-pool institutions.
Small-leaf spiderwort (Tradescantia fluminensis Vell.) is a low-growing perennial ground cover that has become increasingly problematic in Florida due to its ability to quickly spread vegetatively over large areas and outcompete native vegetation. Prior research has identified several herbicides that can be used to manage T. fluminensis, but the effect of application timing on herbicidal efficacy is unknown. Therefore, the objective of this study was to evaluate the efficacy of selected postemergence herbicide applications and to understand differences in the efficacy of these timings (i.e., spring and fall), including on the rate of regrowth of target plants. Specific herbicides evaluated in this study included 2,4-D, 2,4-D + triclopyr amine, aminopyralid, glyphosate, and triclopyr (as acid and amine). An additional aspect of this study was to reapply treatments when coverage ratings exceeded 25% to assess the impact of sequential applications when using less efficacious herbicides that might provide greater selectivity to non-target plants. Overall, the data showed that initial treatment timing had little to no impact on efficacy for most of the herbicides evaluated. Triclopyr (acid or amine) tended to provide the highest level of control and required no retreatment over a 12-mo evaluation period. Other effective options included glyphosate and 2,4-D + triclopyr amine, which provided results similar to triclopyr on most evaluation dates. The 2,4-D and aminopyralid treatments were in general the least efficacious options, requiring retreatment at either 3, 6, or 9 mo following the initial application to achieve less than 25% T. fluminensis coverage. Results indicate that practitioners would likely achieve similar levels of T. fluminensis control regardless of application timing. Data also suggest triclopyr would be the most effective option, while a low level of control would be expected with 2,4-D, even following multiple applications.
A wall-modelled large eddy simulation approach is proposed in a discontinuous Galerkin (DG) setting, building on the slip-wall concept of Bae et al. (J. Fluid Mech., vol. 859, 2019, pp. 400–432) and the universal scaling relationship by Pradhan and Duraisamy (J. Fluid Mech., vol. 955, 2023, A6). The effect of the order of the DG approximation is introduced via the length scales in the formulation. The level of under-resolution is represented by a slip Reynolds number and the model attempts to incorporate the effects of the numerical discretization and the subgrid-scale model. The dynamic part of the new model is based on a modified form of the Germano identity -- performed on the universal scaling parameter -- and is coupled with the dynamic Smagorinsky model. A sharp modal cutoff filter is used as the test filter for the dynamic procedure, and the dynamic model can be easily integrated into any DG solver. Numerical experiments on channel flows show that grid independence of the statistics is achievable and predictions for the mean velocity and Reynolds stress profiles agree well with the direct numerical simulation, even with significant under-resolution. When applied to flows with separation and reattachment, the model also consistently predicts one-point statistics in the reverse flow and post-reattachment regions in good agreement with experiments. The performance of the model in accurately predicting equilibrium and separated flows using significantly under-resolved meshes can be attributed to several aspects that work synergistically: the optimal finite-element projection framework, the interplay of the scale separation and numerical discretization within the DG framework, and the consistent dynamic procedures for subgrid and wall modelling.
The European Green Deal (EGD) provides a strategic framework for the European Union’s (EU) transition to climate neutrality by 2050. Yet, limited integration of socio-economic dimensions may hinder its long-term success and fairness. This study investigates the indirect impacts of socio-economic factors on EGD performance by constructing a Green Deal Performance Index (GDPI) using a multi-criteria decision-making approach for 22 EU countries over 2010–2020. We then apply an instrumental variable regression approach to estimate how emissions, shaped by structural socio-economic conditions, affect the GDPI. Our results show that the negative impact of emissions is nearly 47 times larger when socio-economic dynamics are ignored. These findings underscore the necessity of inclusive policymaking for achieving carbon neutrality, contributing to discussions on ensuring a just transition by highlighting the critical role of socio-economic dynamics. We also present implications for policymakers developing fair and equitable strategies promoting sustainability and social justice in this context.
This article offers a view of the prospects of nuclear fusion as a sustainable energy source, with a focus on magnetic confinement fusion and tokamaks. It highlights the key theme of integration and presents the EUROfusion programme as a model for coordinated fusion R&D in Europe while stressing the need for public–private partnerships to bridge the gap between laboratory innovation and industrial implementation. A crucial element is human capital development, i.e. the training of a new, diverse generation of scientists, engineers, and technicians. A broader educational effort is called for, with industry–academia collaboration, hands-on training, and mechanisms to retain and transfer knowledge from legacy projects such as JET.
Autologous hematopoietic stem cell transplant (HCT) cancer caregivers experience significant burden and stress with limited tailored resources. Mindfulness interventions hold promise in alleviating caregiver distress. Predicated on our previous work with allogeneic HCT caregivers, this single-arm trial tested the feasibility and acceptability of a modified mindfulness-based intervention, AutoFOCUS, among autologous HCT caregivers.
Methods
Participants received the 6-session AutoFOCUS face-to-face via telehealth, with assessments at baseline, end of treatment, and 1-month post-treatment. Feasibility was assessed through recruitment, retention, and session attendance, and acceptability was measured via satisfaction and intent to continue using skills learned. Exploratory outcome measures included distress, anxiety, perceived stress, affect, and post-traumatic growth. Data from the smartphone app that supplemented the face-to-face component of the intervention were collected. In-depth interviews gathered participant feedback.
Results
Twenty-six caregivers (mean age = 57.7 years, 89% female) were enrolled and 19 completed at least 4 sessions, 14 completed all 6 sessions, and 22 completed the 1-month follow-up. High satisfaction (M = 3.56/4; SD = 0.43) and intent to utilize the skills learned in the future (M = 8.58/10; SD = 1.81/4) were reported. Significant reductions in distress (p < .001, (effect sizes [ES]) = 0.99), anxiety (p = .032, [ES] = 0.53), perceived stress (p = .035, [ES] = 0.52), and negative affect (p = .008, [ES] = 0.69) were reported, along with a significant increase in post-traumatic growth (p = .009, [ES] = 0.67) from baseline to end of treatment. App use was moderate. Interview results highlighted positive perceptions and supported quantitative results.
Significance of results
AutoFOCUS was feasible and acceptable. Future studies should explore the efficacy of this treatment on a larger scale with a comparison condition.
Carbon credits have become increasingly important for supporting sustainable forest management and mitigating climate change. However, carbon projects can be challenging for local communities and smallholders to implement due to high expenses and complicated protocols. Forest projects often suffer from inefficiency, lack of transparency, and uneven benefit distribution. This study suggests a blockchain-based framework for aggregating forest carbon projects. This framework is the first in the forest sector to provide a reward mechanism for local communities or smallholders with a direct integration into an accredited registry protocol of Monitoring, Reporting, and Verification. The system combines digital identities, smart contracts, and automated incentives to improve transparency, responsibility, and trust among stakeholders. Two types of tokens are introduced: (i) Carbon Coin represents verified carbon credits within the system; and (ii) Forest Coin functions as a security token used to proportionally distribute project revenue among stakeholders. The revenue distribution was demonstrated in scenarios of afforestation, reforestation, and conservation. In addition, a web application was developed so that users can monitor project details. Unlike most blockchain carbon platforms that focus on investment and trading, this framework addresses upstream challenges, prioritising equitable benefit-sharing. The framework supports project aggregation and prioritises community ownership, advancing inclusive access to the carbon market. This study demonstrates how technological advantages can be transferred to community-driven ecological conservation.
Atrial septal defect is the second most common CHD in adults. This study aimed to evaluate the relationship between age and early postoperative changes in cardiac function—including right ventricular function, tricuspid regurgitation, pulmonary artery pressure, mitral regurgitation, and left ventricular ejection fraction—in adult patients undergoing surgical atrial septal defect repair.
Methods:
This retrospective study included 214 patients aged 16–65 years who underwent isolated atrial septal defect repair between 2014 and 2024. Patients were divided into five age groups. Echocardiographic parameters were compared at three time points: preoperative, 1-month, and 6-month postoperative.
Results:
Of the patients, 60.7% were female. A significant postoperative left ventricular ejection fraction decrease was observed only in the 56–65 age group. Preoperative tricuspid regurgitation severity and pulmonary artery pressure values increased with age, but both showed significant postoperative improvement across all age groups. Postoperative pulmonary artery pressure reduction was most prominent in the youngest and oldest groups. Mitral regurgitation was mildly increased in all groups, without progression to moderate severity. Tricuspid annular plane systolic excursion values, inversely correlated with age, decreased in younger patients postoperatively but improved in older patients, indicating enhanced right ventricular function after volume unloading.
Conclusion:
Surgical atrial septal defect repair leads to early improvement in several cardiac parameters. However, the benefit is more pronounced in younger patients. These findings support early surgical intervention to preserve right ventricular function and prevent long-term complications, particularly in asymptomatic adults.
Stand-up comedy is one of the simplest theatre forms in existence. The comedian stands on a (usually) bare stage, talking straight to the audience in the hope of getting laughs. Yet it has never been more popular, with national scenes developing across every continent except Antarctica. In this insightful and accessibly written volume, diverse chapters explore the subject from many angles, ranging from national scenes, live venues, and recordings to politics, race, sexuality, and the question of offensiveness. Chapters also consider the performance dynamics of stand-up in detail, examining audience, persona, and trauma. Interspersed throughout the chapters are a series of originally commissioned interviews with comedians from nine different countries, including Maria Bamford, Jo Brand, Aditi Mittal, and Rod Quantock, providing rare insights into their craft.
Anton Webern is recognised as one of the pivotal figures of atonality and precursors to post-war serialism. However, his earlier, tonal works have been largely neglected and shrouded in clichés. A study of both the generative elements of Webern's aesthetic imagination, and the philosophical signatures of musical modernity, this first book-length account of Webern's tonal music explores the complex and variegated ways in which the young composer engaged with, and sought to contribute to, the cultural discourses of fin-de-siècle modernism, well before he self-consciously embarked upon his famous 'path' to the New Music. While acknowledging the rapid stylistic transformation that Webern's musical language underwent, the author suggests that earliness in Webern is not simply a chronological term but is rather best understood in terms of a constitutive tension between phenomenological and dialectical modes of musical thought.
As Yemenis start planning the reconstruction and rebuilding of their country after recent turmoil they face huge challenges in every major sphere. This book discusses the political and economic background and analyses the most important issues: (i) the option of improved governance through a federal government; (ii) addressing the powerful and patronage networks of the previous regime; (iii) investing in Yemen's human and natural resources to compensate for falling revenues from oil and gas; (iv) maintaining rural life through reduced dependence on irrigated agriculture and investing in enhancing rain fed agriculture; (v) addressing the issue of urban water shortage through desalination; and (vi) involving women in enhancing security.
Modern accounts of the great war between the Athenians and the Spartans in the late fifth century BC have simply reanalysed the gripping analysis of military and political events given by Thucydides. But a great deal of other evidence survives from this best-known of all periods of Athenian history. This book exploits that evidence and our rich knowledge of ancient Greek society to reveal the Peloponnesian War as not just an event but an experience that reshaped Athenian society as it was happening. It looks again not merely at the causes of the war and its military and political narratives, but at how the war reshaped the world, for men, for women, and even for the gods. This book not only re-illuminates the most dramatic years of classical Athenian history, it reshapes what it is to write history.