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This article examines the geographical distribution of tuberculosis mortality in Italy from 1891 to 1951 and its relationship with industrialisation. During this period, industrialisation brought about profound changes, although it affected the north and south of the country unequally. During the same period, the incidence of pulmonary tuberculosis increased, and the disease became a major health problem. Tuberculosis spread mainly among industrial workers and in densely populated urban areas, where living and working conditions were often precarious. Overall, the incidence of pulmonary tuberculosis was significantly higher in the more industrialised provinces of the North than in the backward provinces of the South. This article shows a positive correlation between pulmonary tuberculosis mortality and the levels of provincial industrialisation.
Intrusive re-experiencing of traumatic events is a cornerstone of post-traumatic stress disorder (PTSD). Clinicians notice that clients also experience intrusive mental images of what they think might happen during a traumatic event. As mental imagery has a powerful impact on emotion, imagination-based imagery may be implicated in the peaks of distress (‘hotspots’) during a trauma.
Aims:
A data-only study was undertaken of cognitive therapy for PTSD ‘hotspot’ charts used by Grenfell Health and Wellbeing Service clinicians after the Grenfell fire disaster. The aim was to establish the prevalence and nature of peri-traumatic ‘imagination-based hotspots’ in this sample.
Method:
Hotspots are described as the worst moments within a trauma. Two clinicians independently rated anonymised hotspot charts (N=26) for the presence and content of ‘imagination-based hotspots’, defined as ‘a peak of emotion during a traumatic event that is related to something imagined “in the mind’s eye” as opposed to directly perceived with the senses’.
Results:
81% (N=21) of individuals reported an imagination-based hotspot; 38% of all hotspots (n=159) contained an imagination-based component. The most common was an image in which the person watching the fire imagined themselves in the ‘shoes’ of a tower resident.
Conclusions:
Imagination-based mental imagery appears to be linked to the ‘hotspots’ of a high proportion of people experiencing PTSD in this sample. Results underline the importance of enquiring about the presence of mental imagery during PTSD treatment. The presence of peri-traumatic mental images has implications for effective updating of ‘hotspots’ in PTSD treatment.
Fulton’s matrix Schubert varieties are affine varieties that arise in the study of Schubert calculus in the complete flag variety. Weigandt showed that arbitrary intersections of matrix Schubert varieties, now called ASM varieties, are indexed by alternating sign matrices (ASMs), objects with a long history in enumerative combinatorics. It is very difficult to assess Cohen–Macaulayness of ASM varieties or to compute their codimension, though these properties are well understood for matrix Schubert varieties due to work of Fulton. In this paper, we study these properties of ASM varieties with a focus on the relationship between a pair of ASMs and their direct sum. We also consider ASM pattern avoidance from an algebro-geometric perspective.
We consider spline-based additive models for estimation of conditional treatment effects. To handle the uncertainty due to variable selection, we propose a method of model averaging with weights obtained by minimizing a J-fold cross-validation criterion, in which a nearest neighbor matching is used to approximate the unobserved potential outcomes. We show that the proposed method is asymptotically optimal in the sense of achieving the lowest possible squared loss in some settings and assigning all weight to the correctly specified models if such models exist in the candidate set. Moreover, consistency properties of the optimal weights and model averaging estimators are established. A simulation study and an empirical example demonstrate the superiority of the proposed estimator over other methods.
Research suggests that there may be an association between prescribed opioid use and suicide-related behaviours.
Aims
This 15-year retrospective population-based cohort study examines the relationship between opioid use, self-harm and suicide.
Method
The study was based on the POPPY II study, a population-based cohort of 3 268 282 adults who initiated a prescription opioid between 1 July 2003 and 31 December 2018, in Australia. Prescription dispensing data were linked to hospitalisation, death and other data collections. Opioid use was defined as current opioid exposure, cumulative duration of exposure and estimated daily dose. Outcomes were self-harm hospitalisation and suicide mortality, categorised as overall and according to the method (opioid poisoning, non-opioid substance poisoning and other methods). Time-varying generalised estimating equations were used to assess the relationship with self-harm hospitalisation, and Cox proportional hazard models were used to assess the relationship with suicide mortality, controlling for known suicide-related risk factors.
Results
There were 49 215 self-harm hospitalisations at a crude rate of 262 per 100 000 person-years and 3087 suicide deaths at a crude rate of 16.5 per 100 000 person-years. Intentional opioid poisoning was the least common method for both self-harm hospitalisation and suicide. Following multivariable adjustment, current opioid exposure, longer cumulative duration and higher doses were significantly associated with a greater risk of opioid-related self-harm or suicide. In adjusted models, associations for other methods of self-harm and suicide were not as strong or consistent.
Conclusions
Opioid poisoning was the least common method of self-harm and suicide. Despite this, for the minority of people prescribed high doses and/or a long duration of prescription opioids, there is an increased risk for opioid-related self-harm and suicide after controlling for known covariates. Suicide-related behaviours should be screened and monitored in people prescribed opioids, particularly among those on long-term and/or high-dose opioids.
Impaired insight is a regularly documented clinical observation in patients undergoing involuntary care, but is easily misunderstood since it refers to different phenomena depending on the context. Within the context of psychotic illness, which comprises the majority of involuntary care, it is more accurately portrayed as unawareness of illness which intersects with the element of capacity related to the ability to appreciate information and weigh it up to make a judgement. Psychotic disorders associated with persistent unawareness of illness are negatively associated with illness outcome and attitudes towards clinical services. There is some evidence that metacognitive therapy can improve insight, but compassionate care which seeks to enhance therapeutic alliance more commonly engages such patients in successful recovery. When insight is substantially impaired, the apparent will and the stated preferences of patients often diverge, in which case involuntary care should not be considered “against the will,” but more accurately “without the consent” of the patient.
Censoring language in medical science enforces ideological conformity and political repression of marginalised groups through self-censorship. This editorial urges the scientific community to resist language control as a grave threat – not only to research freedom, but ultimately to human diversity and life itself.
The rules of international law gently transcend the physical boundaries of our world and extend their influence into the mysterious realm of cyberspace. State practice confirms digital sovereignty, yet rival camps offer divergent approaches. Non-Western states, such as Russia and China, advocate for strict national control, asserting cyber sovereignty to safeguard their digital infrastructures. In contrast, Western countries like the USA and EU Member States support an open, global internet governed by cooperative principles. Further, this article examines the challenges of applying the traditional notion of territorial sovereignty in cyberspace, where clear borders are absent, and evaluates potential solutions. Among these, the competence/function theory and the Functional Equivalent of the Border are explored as means to reconcile competing interests and advance a balanced framework for regulating digital activities while protecting national sovereignty and individual rights.
This scoping review investigates the complex landscape of fake news research, focusing on its link with attitudinal polarization and identifying key themes in the literature. Our objectives included mapping the main themes in fake news literature, analyzing how these themes connect, examining how polarization is conceptualized across studies, and how fake news and attitudinal polarization are related. Through an extensive theme analysis of fake news research sourced from SCOPUS and Web of Science databases, we identified four major thematic areas: (1) the influence of technologies and platforms on fake news, (2) user engagement and behavioral responses to fake news, (3) fake news characteristics and their social consequences, and (4) strategies for fake news detection and countermeasures. In-depth analysis of 20 selected peer-reviewed papers revealed significant inconsistencies in the operationalization of both fake news and polarization and in the definitions of polarization. Regarding evidence on fake news’ influence on polarization, mixed results are found, with some studies indicating attitude reinforcement, while others find negligible effects. This scoping review highlights the need for standardized methodologies to clarify fake news’ role in attitudinal polarization and societal division, calling for a unified framework in fake news and polarization research to advance understanding of fake news’ societal impact.
Mental health policies and plans (MHPPs) are powerful tools developed to facilitate real-world changes in mental-health-related prevention, promotion and treatment. This study examined barriers and facilitators to MHPP implementation across the WHO European region. Key informants from 53 countries were contacted and 25 provided in-depth qualitative interviews on MHPP existence, implementation, and evaluation related barriers and facilitators of implementation. We analyzed data via qualitative framework analysis approach aligned with the WHO Comprehensive Mental Health Action Plan 2013–2030. Reported facilitators included active involvement of key stakeholders, ongoing mental healthcare reform, bottom-up approach to implementation, sufficient funding, favorable political receptivity and strong monitoring. Barriers encompassed insufficient funding, workforce shortages, adequate training in psychiatry, missing or insufficient infrastructure in terms of both physical structures and technology for data collection, low political receptivity, stigma and bureaucratic obstables. While notable progress has been made in the development of mental health plans in the European region, substantial gaps remain in information systems, research capacity, and systematic evaluation frameworks on mental health and development of appropriate evaluation plans. Strengthening these components is essential to ensure the effective and sustainable implementation of MHPPs throughout the region.
Assess clinical outcomes, knowledge, and attitudes about shortage mitigation interventions during a nationwide blood culture bottle shortage. We hypothesized that efforts to target ordering of blood cultures would not change patient-oriented outcomes.
Design:
Retrospective, noninferiority, multicenter study
Setting:
Tertiary, rural healthcare system
Patients:
Eligible patients had any culture ordered before and after mitigation strategies.
Interventions:
Mitigation strategies were rapidly implemented to preserve the availability of blood culture bottles for high-risk patients. Interventions included best practice advisories, algorithms, cascade questions, hard stops, education, and communication.
Results:
The primary composite outcome (death during hospitalization, death within 14 d after discharge, return to the emergency department (ED) or readmission within 14 d after discharge) occurred in 603 of 3,174 patients (19.0%) in the pregroup and 1,496 of 8,232 patients (18.2%) in the postgroup (P = 0.321), meeting noninferiority in inverse probability treatment weight (IPTW) analysis. The groups were similar in secondary outcomes and in the subgroup with severe sepsis or septic shock. 69% of 41 survey respondents answered the case questions correctly. Regulatory pressure and patient status were the strongest drivers of blood culture ordering. Clinicians favored in-person communication, algorithms, and cascade over emails, daily huddles, and hard stops/second signatures.
Conclusions:
Implementation of mitigation strategies during the shortage was not associated with differences in outcomes including mortality, return to the ED, readmission, or length of stay. Preliminary evidence suggests that outcomes may not be affected by the absence of blood cultures in high-risk sepsis patients. If proven in future studies, sepsis recommendations could be rewritten to accommodate pretest probability for bacteremia.
Research indicates that demographic (e.g., age, education) and sociocultural (e.g., acculturation) factors can impact neuropsychological test performance among ethnoculturally diverse adults. Some studies suggest that greater acculturation to the United States (U.S.) is associated with better neurocognitive functioning, though no meta-analysis to date has examined this relationship. This review provides a comprehensive synthesis of the literature and determines the magnitude of the relationship between acculturation and neuropsychological test performance.
Method:
A literature search explored all published articles through January 1, 2024, using three databases (i.e., PubMED/MEDLINE, PsycInfo, PsycNET). Data to calculate study effect sizes (i.e., Fisher’s z) were extracted from in-text results, tables, and figures.
Results:
Findings (k = 18 included in quantitative analyses) revealed a small to medium (r = 0.29, partial r = 0.20, p < .01), statistically significant relationship between higher U.S. acculturation and better neuropsychological test performance. Moderation analyses indicated that language of testing emerged as a significant moderator, testing in English yielded larger effect sizes compared to testing in other languages (B = 0.29, p < .05).
Discussion:
Neuropsychological test performance is significantly associated with U.S. acculturation, and results suggest that the magnitude may vary depending on study methodologies and samples (e.g., ethnocultural group, U.S. born vs. immigrant) examined. The current review also provides recommendations for incorporating acculturation assessment into clinical practice and highlights the need to examine the clinical utility of acculturation tools in conjunction with neuropsychological tests to assist in clinical decision-making with ethnoculturally diverse populations.
This study tests for sample selection using data from a feedlot in Oklahoma by analyzing the distribution of cattle quality between alternative marketing arrangements and cash markets. Unlike previous studies employing Heckman and Roy models to detect sample selection, we directly examine the empirical distributions of cattle quality variables derived from heteroskedastic probit, residual, truncated, and generalized least squares regressions. Nonparametric procedures are used to identify differences in the empirical distribution functions of quality variables between the two markets. The results find strong evidence of sample selection in cattle procurement for the analyzed dataset. Initiatives promoting greater disclosure of quality-related information for cattle sold in the cash market are recommended to mitigate this issue.
European Union (EU) public opinion research is a rich field of study. However, as citizens often have little knowledge of the EU it remains the question to what extent their attitudes are grounded in coherent, ideologically informed belief systems. As survey research is not well equipped to study this question, this paper explores the value of the method of cognitive mapping (CM) for public opinion research by studying the cognitive maps of 504 Dutch citizens regarding the Eurozone crisis. The paper shows that respondents perceive the Eurozone crisis predominantly as a governmental debt crisis. Moreover, the concept bureaucracy unexpectedly plays a key role in their belief systems exerting an ambiguous but overall negative effect on the Eurozone and trust in the EU. In contrast to expectation, the attitudes of the respondents are more solidly grounded in (ordoliberal) ideology than that of the Dutch elite. Finally, the paper introduces new ways to measure ambivalence prompting a reevaluation of the significance of different forms of ambivalence and their impact on political behavior. Overall, the results of this study suggest that CM forms a promising addition to the toolbox of public opinion research.
Remote videoconference neuropsychological assessments offer opportunities that remain under-exploited. We aimed to evaluate teleneuropsychology (TeleNP)-suitable oral and digital versions of the Symbol Digit Modalities Task (SDMT) and Trail Making Test (TMT) – widely used measures of speed and attention – by comparing them to their written counterparts.
Methods:
Three-hundred and twenty-one Australian Epilepsy Project (AEP) adult participants with seizure disorders completed the written SDMT and TMT in-person. One-hundred and forty-four of these participants also completed the oral SDMT and TMT during a remote videoconference-based assessment while 177 completed a novel, examiner-administered digital SDMT analogous measure named Symbol Decoding and a novel digital TMT remotely via custom videoconference-based software.
Results:
Oral SDMT and digital Symbol Decoding strongly correlated with in-person written SDMT (r (133) = .77, p < .001 and r (126) = .76, p < .001, respectively). Oral TMT-B was only moderately associated (r (126) = .52, p < .001) with written TMT-B and, less strongly related to measures of sustained attention and spatial working memory than its written counterpart. Digital TMT better reproduced the written test’s properties with improved association with written TMT-B (r (154) = .71, p < .001).
Conclusions:
Oral SDMT and digital Symbol Decoding are strongly correlated with in-person written SDMT. The digital TMT better captures the cognitive demands and performance characteristics of the in-person written form than does oral TMT. Videoconference-integrated digital tasks offer increased standardization and automation in administration and scoring and the potential for rich metadata, making them an attractive area for further development.
This research note challenges the utility of the “far right” label, which groups together the extreme right and the (populist) radical right, for the study of contemporary European party systems. It argues that while extreme right parties are typically consistent with the traditional conceptualization of anti-system parties, those belonging to the (populist) radical right increasingly experience a pattern of integration without substantive ideological moderation – i.e. negative integration – which challenges the Sartorian conceptualization. Nevertheless, Sartori's idea of disjointed space, which separates via “no coalition” points the parties that are perceived to be illegitimate players in the party system from the others, remains essential to understanding the diverging trends that characterize the extreme right and the (populist) radical right today as well as the cases that deviate from the typical pattern. The notion of disjointed space accounts for the qualitative difference between the actors that are perceived to be suitable for coalitions by the more traditional mainstream parties and, ultimately, allows us to understand why (populist) radical right parties are often integrated in party systems, while those of the extreme right are not. The analysis invites scholars to use the most precise term whenever possible rather than vaguely referring to the “far right,” as it overlooks key differences from a party system perspective. Notably, although nativist and authoritarian ideas increasingly permeate public debate, when it comes to political parties, it is more accurate to speak of the mainstreaming of the (populist) radical right rather than of the “far right” as a whole.