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The LGBTQIA+ community faces pervasive discrimination, including in healthcare settings. This discrimination can be particularly detrimental during hospice and palliative care, where patients are especially vulnerable and may have distinct needs related to their sexual orientation or gender identity.
Objectives
This study aimed to identify the barriers and enablers to accessing equitable and inclusive palliative care for LGBTQIA+ individuals.
Methods
A self-administered online survey was conducted in November 2023 among LGBTQIA+ adults residing in Portugal. Thematic analysis was applied to identify barriers and enablers, mapped using an adapted socioecological framework.
Results
Fifty-five respondents participated, primarily cisgender women (49.1%) identifying as homosexual (50.9%), with most aged 18–34 (76.4%). Barriers included caregiver homophobia, lack of LGBTQIA+-specific knowledge among professionals, fear among patients, misaligned care priorities, exclusion of partners from decision-making, and limited access to care. Enablers involved professional LGBTQIA+-specific training, psychological support, integration of partners or chosen families in care, workforce diversity, dissemination of palliative care information, community engagement, and inclusive societal values.
Significance of results
Inclusive and responsive palliative care is essential to addressing the unique needs of LGBTQIA+ individuals. The findings highlight the need for systemic reforms to advance equity in care. The study calls for mandatory LGBTQIA+-focused training for healthcare providers, recognition of chosen families in care decisions, and public health campaigns that promote inclusivity. Collaboration with LGBTQIA+ organizations to improve outreach and access is vital, along with legislative measures to ensure equitable and inclusive care.
We establish large deviation estimates related to the Darling–Kac theorem and generalized arcsine laws for occupation and waiting times of ergodic transformations preserving an infinite measure, such as non-uniformly expanding interval maps with indifferent fixed points. For the proof, we imitate the study of generalized arcsine laws for occupation times of one-dimensional diffusion processes and adopt a method of double Laplace transform.
Between the late Middle Ages and the early modern period, large quantities of wax were exported from the Maghrib to Europe. In the Maghrib, both raw wax and wax candles were involved in various social interactions that transcended mere environmental and economic considerations. For some Muslims, wax came to index Christianity, and its significance during the celebration of the Prophet’s birthday was critiqued as a corrupt innovation. At the same time, to prevent the facilitation of Catholic devotion—and because wax was deemed war material—the sale of wax to Christians was forbidden. Nevertheless, wax remained a profitable product sold to Christians in significant quantities. The anxiety surrounding the movement of wax and the attempts to regulate it indicate that for Muslims, wax served as a religious boundary marker. Christians too utilized the substance to reinforce communal boundaries. Catholics in the Maghrib—captives, clergy, and merchants—used wax to establish and express confessional divides, aiming to deter Catholic captives from converting to Islam. Priests distributed blessed candles to captives, who in turn donated wax to the clergy. Moreover, priests gifted candles to Algerian dignitaries, a practice opposed by the papacy. Wax formed invisible, often unintended connections between Muslim theologians and rulers, Catholic and Muslim captives, slaves, wax makers, merchants, and redeemers. These entanglements sparked anxiety, a sense of impurity, and a drive to reinforce religious boundaries. This article explores a fragmented history of these connections and relationships and argues that the failed attempts to regulate this circulation fostered new entanglements.
Many authors have studied the biogeography of the Southern Ocean (SO), defined its limits and proposed their division into biogeographical zones and provinces. In this work we analyse the biogeography of sea slugs in a broad sense (Mollusca, Gastropoda, Heterobranchia) in the different areas and zones of the SO below 41°S. Most of the published scientific publications, databases and technical reports where records of benthic sea slugs appear in the SO have been analysed in addition to our own records, cataloguing a total of 355 different benthic species. The following areas and zones of the SO have been considered: Antarctica (Weddell Sea, West Antarctica, Ross Sea, East Antarctica), the sub-Antarctic zone (Falkland Islands, South Georgia Island, South Orkney Islands, South Sandwich Islands, Bouvet Island, Crozet and Prince Edward islands, Kerguelen Islands, Macquarie Island), southern South America (Patagonia/Magellan), Tasmania and New Zealand (South Island). A presence/absence table for all recorded species in the different zones has been compiled, and the differences and similarities between them have been calculated using the Sorensen index. The best representation has been obtained by classifying the zones into five groups: G1 (the four Antarctic zones, South Georgia Island, South Sandwich Islands, South Orkney Islands), G2 (Kerguelen Islands, Crozet and Prince Edward islands and Macquarie Island), G3 (Falkland Islands and Patagonia/Magellan), G4 (Tasmania and New Zealand’s South Island) and G5 (Bouvet Island). In addition, the concordance between the non-hierarchical classification (K-mean) and the hierarchical classification obtained using the WARD and UPGMA cluster analysis methods has been verified. The representative and distinctive species of each of these groups are indicated. In this work, as regards benthic sea slugs, the biogeographical affinities between the Antarctic zones and some of the sub-Antarctic zones are confirmed, as well as between the fauna of these molluscs in the Patagonian/Magallan zone and the Falkland Islands, while the affinities between the other zones need further confirmation when more species records become available.
The Cambrian Explosion saw the widespread development of mineralized skeletons. At this time, nearly every major animal phylum independently evolved strategies to build skeletons through either agglutination or biomineralization. Although most organisms settled on a single strategy, Salterella Billings, 1865 employed both strategies by secreting a biocalcitic exterior shell that is lined with layers of agglutinated sediments surrounding a central hollow tube. The slightly older fossil, Volborthella Schmidt, 1888, shares a similar construction with agglutinated grains encompassing a central tube but lacks a biomineralized exterior shell. Together these fossils have been grouped in the phylum Agmata Yochelson, 1977, although no phylogenetic relationship has been suggested to link them with the broader metazoan tree, which limits their contribution to our understanding of the evolution of shells in early animals.
To understand their ecology and place them in a phylogenetic context, we investigated Salterella and Volborthella fossils from the Wood Canyon and Harkless formations of Nevada, USA, the Illtyd Formation of Yukon, Canada, and the Shady Formation of Virginia, USA. Thin-section petrography, acid maceration, scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction, and X-ray tomographic microscopy were used to provide new insights into these enigmatic faunas. First, morphological similarities in the aperture divergence angle and ratio of central tube diameter to agglutinated layer thickness suggest Salterella and Volborthella are related. Second, both fossils exhibit agglutinated grain compositions that are distinctive from their surrounding environments and demonstrate selectivity on the part of their producers. Finally, the calcitic shell composition and simple layers of blocky prismatic shell microstructure in Salterella suggest a possible cnidarian affinity. Together these data point to these organisms being sessile, semi-infaunal filter or deposit feeders and an early experimentation in cnidarian biomineralization chronicling a hypothesized transition from an organic sheath in Volborthella to a biomineralized shell in Salterella.
This article investigates the transformation of the official historical narrative of the Golden Horde in Kazakhstan, tracing a significant shift from Nazarbayev to Tokayev’s presidencies. The narrative of the Golden Horde became a strategic component of the second president, Tokayev, who announced the commemoration of 750 years of the Horde foundation in Kazakhstan and proclaimed that it laid the foundations for Kazakh statehood. The research explores the abrupt transformation of the official historical narrative and underscores the pivotal role of historians as memory actors. The study investigates the “memory game” between two schools of historians in independent Kazakhstan, revealing the agency of a new generation of historians in reshaping the national historical narrative through historicizing strategies, thus engaging in memory politics. This contribution extends the literature on the mnemonic context in Kazakhstan and non-state memory actors in authoritarian settings, shedding light on the dynamics of historical representation and memory politics in evolving mnemonic landscapes.
This study aimed to evaluate an artificial intelligence-assisted tool for psychiatric case formulation compared with human trainees. Twenty trainees and an artificial intelligence system produced formulations for three simulated psychiatric cases. Formulations were scored using the integrated case formulation scale (ICFS), assessing content, integration and total quality. Time taken was recorded, and assessor predictions of formulation origin were analysed.
Results
Artificial intelligence produced formulations significantly faster (<10 s) than trainees (mean 52.1 min). Trainees achieved higher ICFS total scores (mean difference 8.3, P < 0.001), driven by superior content scores, while integration scores were comparable. The assessor identified artificial intelligence-generated formulations with 71.4% sensitivity, but overall accuracy of who produced the formulations was only 58.3%.
Clinical implications
Artificial intelligence shows promise as a time-saving adjunct in psychiatric training and practice, but requires improvements in generating detailed content. Optimising teaching methods for trainees and refining artificial intelligence systems can enhance the integration of artificial intelligence into clinical workflows.
Environmental DNA (eDNA) metabarcoding has lagged in parasite biodiversity assessments. We implemented this method to examine parasite diversity in sediment and water from 4 physically connected aquatic habitats in coastal South Carolina, USA, as part of a ParasiteBlitz in April 2023. Sediment was collected using a syringe corer, and water was sampled using active filtration and passive collection. Five amplicon libraries, using primers targeting portions of the mitochondrial COI of platyhelminths and 18S ribosomal RNA genes of nematodes, myxozoans, microsporidians, and protists, successfully yielded parasite sequences. Out of >5.8 million sequences, we identified >1,000 parasite amplicon sequence variants (ASVs) corresponding to ~600 parasite operational taxonomic units, from 6 parasite groups. Most diversity was observed among the microsporidians, whose assay demonstrated the highest fidelity. Actively-filtered water samples captured ASVs of all 6 groups, whereas sediment captured only 4, despite yielding 3× as many ASVs. Low DNA yields from passive water samples resulted in fewer, but some unique, ASVs representing 3 parasite groups. The most efficient sampling method varied with respect to parasite group across habitats, and the parasite communities from each habitat were distinct regardless of sampling method. We detected ASVs of 9 named species, 4 of which may represent introductions to the US. The abundance of our results demonstrates the effectiveness and efficiency of eDNA metabarcoding for assessing parasite diversity during short, intensive surveys, and highlights the critical need for more comprehensive sequence databases and the development of primers for those parasite taxa that elude detection using eDNA methods.
In this radical reinterpretation of the Financial Revolution, Craig Muldrew redefines our understanding of capitalism as a socially constructed set of institutions and beliefs. Financial institutions, including the Bank of England and the stock market, were just one piece of the puzzle. Alongside institutional developments, changes in local credit networks involving better accounting, paper notes and increased mortgaging were even more important. Muldrew argues that, before a society can become capitalist, most of its members have to have some engagement with 'capital' as a thing – a form of stored intangible financial value. He shows how previous oral interpersonal credit was transformed into capital through the use of accounting and circulating paper currency, socially supported by changing ideas about the self which stressed individual savings and responsibility. It was only through changes throughout society that the framework for a concept like capitalism could exist and make sense.
Contemporary India provides a giant and complex panorama that deserves to be understood. Through in-depth analysis of democracy, economic growth and distribution, caste, labour, gender, and foreign policy, Atul Kohli and Kanta Murali provide a framework for understanding recent political and economic developments. They make three key arguments. Firstly, that India's well-established democracy is currently under considerable strain. Secondly, that the roots of this decline can be attributed to the growing inequalities accompanying growth since the 1990s. Growing inequalities led to the decline of the Congress party and the rise of the BJP under Narendra Modi. In turn, the BJP and its Hindu-nationalist affiliates have used state power to undermine democracy and to target Indian Muslims. Finally, they highlight how various social groups reacted to macro-level changes, although the results of their activism have not always been substantial. Essential reading for anyone wishing to understand democracy in India today.
When do citizens voluntarily comply with regulations rather than act out of fear of sanctions? Can the Public be Trusted? challenges prevailing regulatory paradigms by examining when democratic states can rely on voluntary compliance. Drawing on behavioral science, law, and public policy research, Yuval Feldman explores why voluntary compliance, despite often yielding superior and more sustainable outcomes, remains underutilized by policymakers. Through empirical analysis of policy implementation in COVID-19 response, tax compliance, and environmental regulation, Feldman examines trust-based governance's potential and limitations. The book presents a comprehensive framework for understanding how cultural diversity, technological change, and institutional trust shape voluntary cooperation. By offering evidence-based insights, Feldman provides practical recommendations for balancing trust, accountability, and enforcement in regulatory design. This book is essential reading for scholars, policymakers, and practitioners seeking to optimize regulatory outcomes through enhanced voluntary compliance. This title is also available as open access on Cambridge Core.
International security is an ambiguous concept – it has many meanings to many people. Without an idea of how the world works, or how security is defined and achieved, it is impossible to create effective policies to provide security. This textbook clarifies the concept of security, the debates around it, how it is defined, and how it is pursued. Tracking scholarly approaches within security studies against empirical developments in international affairs, historical and contemporary security issues are examined through various theoretical and conceptual models. Chapters cover a wide range of topics, including war and warfare, political violence and terrorism, cyber security, environmental security, energy security, economic security, and global public health. Students are supported by illustrative vignettes, bolded key terms and an end-of-book glossary, maps, box features, discussion questions, and further reading suggestions, and instructors have access to adaptable lecture slides.
Venal Origins is a comparative and historical study of the roots of spatial inequalities in Spanish America. The book focuses on the Spanish colonial administration and the 18th-century practice of office-selling-where colonial positions were exchanged for money-to analyze its lasting impact on local governance, regional disparities, and economic development. Drawing on three centuries of rich archival and administrative data, it demonstrates how office-selling exacerbated venality and profit-seeking behaviors among colonial officials, fostering indigenous segregation, violent uprisings, and the institutionalization of exploitative fiscal and labor systems. The enduring legacies from their rule remain visible today, in the form of subnational authoritarian enclaves, localized cycles of violence, and marginalized indigenous communities, which have reinforced and deepened regional inequalities. By integrating perspectives from history, political science, and economics, Venal Origins provides a nuanced and empirically grounded analysis of how colonial officials shaped-and still influence-subnational development in Spanish America.
This book presents readers with a new theory and practice of international human rights law that is designed to improve its protection of the environmental rights of future generations. Arguing that international law is currently unable to safeguard future generations from foreseeable environmental harm, Bridget Lewis proposes that the law needs to be reformed in the interests of achieving intergenerational justice. The book draws on different theories of intergenerational responsibility to articulate a fresh approach, revising both substantive principles of environmental rights and procedural rules of admissibility and standing. It looks at several case studies to explore how the proposed new approach would apply in relation to contemporary environmental challenges like fracking, deep seabed mining, nuclear energy, decarbonisation and geoengineering.